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The diagnosis of systemic lupus erythematosus can be difficult. The disease may present in many different ways and most of the laboratory tests carried out on patients with SLE are not specific. For these reasons, other diseases have to be carefully considered before a diagnosis of SLE can be made. Physicians should always consider the possibility of SLE in a disease which is affecting many systems of the body, especially those involving the skin and joints of young women.
In 1982, the American College of Rheumatology compiled a list of 11 criteria, at least four of which should be present, not necessarily at the same time, to make a diagnosis of SLE. In some patients, only one or two criteria may be present initially and after several weeks, months or even years do the others appear. These criteria are:
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Characteristic "butterfly" rash on the face |
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Generalized skin rash |
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Mouth ulcers |
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Arthritis |
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Sensitivity to ultraviolet light |
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Inflammation of the lining of the chest wall or the membrane surrounding the heart |
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Renal (kidney) disorder |
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Nervous system disorder |
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Low red or white blood cell count |
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Positive antinuclear antibodies |
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Positive lupus anticoagulant |
These last two are immunologic laboratory tests.
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Diagnosis in TCM places importance on determining the circumstances and manifestations of a disease through inquiry and symptom observation. Diagnosis is based on the traditional four examination techniques:
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Questioning: The TCM practitioner will establish the medical history of both the patient and his family. |
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Observation: Examination of the physical features of the body, such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and location of pain, all offer clues to the problem. The tongue is a particularly useful indicator of the functioning of the internal organs. |
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Listening and swelling: The smelling of sputum and breath and listening to the sounds produced by the chest offer additional clues to the patient's health. |
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Touching: Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance. |
In SLE, the disharmony patterns present at different stages during the course of the disease and can be described as follows: :
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Excessive toxic heat accumulation |
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In TCM, it is held that the occurrence of SLE is closely related to over-heating of the heart meridian. The heart controls the blood and blood vessels. When the heart pumps, blood is transported within the vessels around the entire body. The heart, blood and blood vessels are thus united by their common activities. When heat pathogens are congested in the heart meridian, it means a serious invasion of the internal organs has occurred. The qi and blood bring these pathogens to every part of the body, damaging internal organs, muscles and skin along the way.
On examination, the tongue appears red or dark red and ulcerated, or sores may be present on the inside of the mouth. The tongue may be coated with a fur that is greasy and yellow, dry and yellow, greasy and white, or the fur may be absent altogether. The pulse feels taut and rapid.
Example of greasy and yellow tongue fur |
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Blood yin deficiency |
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When the body accumulates too many heat pathogens over a period of time, the body fluids dry up and organs will not function properly. This decreases the production of blood and kidney essence and leads to a morbid condition of general weakness with sweating, low-grade fevers and hot sensations in the palms and soles of the feet.
On examination, the tongue appears red with a white fur coating or with no coating. The pulse sign feels thready, rapid and weak. |
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Toxic factor attacking the heart |
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Impairment of the functioning of several internal organs signals involvement of the heart and a serious effect to the blood flow. Individuals present with pallor, palpitations and cold extremities.
On examination, the tongue is pale and coated with thin white fur. The pulse feels thready, weak, or choppy. |
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Kidney yin deficiency |
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This occurs usually in a late stage of the disease when the pathogens finally invade the kidney. Kidney-yin refers to the fluid and essence stored in the kidneys. The invading pathogens cause a deficiency in the amount of this fluid and essence and the kidneys begin to over-function. This is the yang part of the kidney compensating for the loss of yin and creates a virtual fire in the kidneys. This produces back pain, limb weakness and heat symptoms such as fever or tongue sores.
On examination, the tongue appears bulky, moist and pale. The tip of the tongue may also be red. The pulse feels deep, thready and weak. |
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Impairment of the liver due to heat |
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Heat pathogens dry up body fluid and this leads to inadequate nourishment for the liver. In TCM thinking, the liver helps regulate qi and blood movement, and the digestive function of the spleen. Individuals with this disharmony pattern present with pain in the liver region, bleeding problems or loss of appetite.
On examination, an enlarged liver and spleen may be palpable. |
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