bubble_chart Concept

According to the clinical characteristics of skin lesions, fever, lack of strength, and arthralgia in this disease, it is described as "lupus erythematosus," "Zhuyu Dan," "common lantana leaf," "sunburn sores," "yin and yang toxin," "pruritic dermatosis," "cheek ulcers," "buccal cellulitis," "facial toxic eruptions," and "facial seborrheic dermatitis." The visceral lesions are seen in syndromes such as "edema," "swelling damage," "wheezing," "hemorrhagic syndrome," and "anuria and vomiting." Zhang Zhong-jing discussed the manifestations and treatment of yin and yang toxin in Jingui Yaolue: "Yang toxin manifests as a face with red patches like brocade, sore throat, and spitting of pus and blood... Cimicifuga and Turtle Carapace Decoction is the main treatment." "Yin toxin manifests as red eyes, body pain as if beaten, sore throat... Cimicifuga and Turtle Carapace Decoction without Realgar Pricklyash Peel is the main treatment." This yin and yang toxin is essentially a type of yin-yang imbalance in this disease.

The disease cause and mechanism can be summarized as congenital insufficiency, or external contraction of the six excesses, or emotional and lifestyle irregularities, or overexertion and excessive sexual activity, leading to yin-yang disharmony, qi and blood deficiency, poor circulation, qi stagnation and blood stasis, and meridian obstruction, thereby affecting the five zang and six fu organs, limbs, skeleton, skin, and muscles. The symptoms are numerous, complex, and variable, with a prolonged and difficult course. The disease often occurs or worsens after sun exposure, so the external cause is often the invasion of heat toxin. Heat toxin enters and scorches yin blood, obstructs Jingmai, damages zang-fu organs, and erodes the bones, muscles, and skin. Additionally, drug allergies, viral and bacterial infections, unclean substances, food allergies, indulgence in rich flavors, living in damp environments, or exposure to the six excesses can all generate heat toxin. Combined with congenital insufficiency and deficiency of primordial yin and yang, various syndromes can arise. If the disease persists for a long time and hormones or other Western medicines are frequently used, it is more likely to lead to yin deficiency with yang hyperactivity or dual deficiency of qi and yin, yin impairment affecting yang, deficiency of dual yin and yang, mutual disharmony, and further qi and blood deficiency and disharmony, leading to chaotic circulation and stagnation, ultimately resulting in the separation of yin and yang, and critical conditions.

This disease has a wide range of invasions, affecting the entire body internally and externally, yin-yang, qi, and blood, so the clinical manifestations are complex and variable. If heat toxin transforms into cold, causing cold coagulation, blood stagnation, and qi obstruction, symptoms such as purplish macules (or Raynaud's phenomenon), fixed discoid purplish-red patches, reticulated cyanotic macules, pigmentation or dyschromia changes, scaly skin, and joint pain may be seen. Young female patients often experience emotional depression, menstrual irregularities, and a purplish-red, cyanotic, or ecchymotic tongue texture. Additionally, depending on the stage and phase of the disease, manifestations such as upper excess and lower deficiency, upper heat and lower cold, internal heat and external cold, internal dryness and external swelling, non-interaction between water and fire, and non-interaction between the heart and kidney may be seen, reflecting the complex mechanisms of deficiency and excess. In summary, Western medicine focuses on genetic factors combined with external triggers and immune disorders as the cause of the disease, which aligns with Chinese medicine's view of congenital insufficiency, pathogenic invasion due to deficiency, and disharmony of qi, blood, yin, and yang as the disease cause and mechanism.

bubble_chart Modern Research

Lupus erythematosus is a relatively common and typical systemic autoimmune disease, with an incidence rate of 0.01% to 0.08%. The incidence is higher in women, with a male-to-female ratio of 1:9, and it almost always occurs in the childbearing age group of 20 to 40 years. With the improvement of medical standards, the 10-year survival rate has now reached over 85%. Clinically, this disease is divided into two major types: discoid and systemic (also known as systemic). The former mainly causes facial skin damage, which can lead to facial disfigurement, while the latter can be life-threatening due to lesions in various organs and systems throughout the body.

The early symptoms of this disease are often atypical and can easily be misdiagnosed as other diseases, delaying treatment. The exact cause of this disease is still not fully understood. In recent years, some scholars believe that genetic factors—specifically, polygenic abnormalities—are the basis of the disease, and the triggers that promote the onset mainly include the following four aspects:

• Viral infections.
• Ultraviolet radiation.
• Drug allergies.
• Endocrine influences.

In addition, factors such as childbirth, trauma, major surgery, psychological trauma, and fatigue often induce or exacerbate the disease. Regardless of the trigger, it can cause the body to produce various autoantibodies and cellular immunity, thereby causing damage to the body.

The various autoimmune antibodies produced by this disease can be roughly divided into two categories:

• One is non-organ-specific autoantibodies, which can directly attach or deposit through immune complexes, injuring various systems and organs of the body without a specific target. Among these, antinuclear antibodies are a key factor in the disease mechanism and pathological damage.
• The other is organ-specific autoantibodies, among which the allergic reactions caused by anti-leukocyte antibodies are particularly severe in damaging the body.

In summary, various autoantibodies may appear during the course of this disease, but not every patient will exhibit all of them. The types and titers of antibodies that appear may vary among different patients or at different stages. The appearance of these antibodies, on one hand, indicates the patient's immune mechanism disorder, which is a result; on the other hand, they cause damage to the body, becoming a cause of the disease. In terms of cellular immunity, patients generally have reduced T cells and decreased function, leading to immune deficiency, but the mechanism is not yet fully understood. The disease cause and mechanism of disease described above are currently only fragments of knowledge obtained from research on the disease process, and the intrinsic relationships between them are still unclear. Many aspects remain at the stage of theoretical speculation or hypothesis, making it difficult to comprehensively explain the disease mechanism.

[Diagnosis]

Clinical manifestations:

1. Butterfly or discoid rash.
2. Non-deforming arthritis or arthralgia.
3. Alopecia areata.
4. Raynaud's phenomenon and/or vasculitis.
5. Oral mucosal ulcers.
6. Serositis.
7. Photosensitivity.
8. Neuropsychiatric symptoms.

Laboratory tests:

1. Increased erythrocyte sedimentation rate (Westergren method >20/1 hour).
2. Decreased white blood cell count (<4000/mm³) and/or decreased platelet count (<80000/mm³) and/or hemolytic anemia.
3. Proteinuria (persistent + or more) and/or cast urine.
4. Hypergammaglobulinemia.
5. Positive lupus cells (at least 2 per slide or at least two positive results).
6. Positive antinuclear antibodies.

A diagnosis can be confirmed if 6 of the above clinical and laboratory criteria are met. Before diagnosis, other connective tissue diseases, drug-induced lupus syndrome, subcutaneous nodule disease, and chronic active hepatitis should be ruled out. Cases that do not meet the above criteria are considered suspected and should undergo further laboratory tests. A diagnosis can be confirmed if 4 of the following criteria are met:

1. Anti-DNA antibody positive (radioimmunoassay with isotopically labeled DNA, immunofluorescence assay with Trypanosoma equiperdum smear or short membrane smear, and other physical, immunochemical, and biological methods).
2. Lupus band test positive.
3. Renal biopsy positive.
4. Sm antibody positive.

If clinical manifestations are not obvious but laboratory tests are sufficient to diagnose systemic lupus, it may be temporarily referred to as subclinical systemic lupus erythematosus.

bubble_chart Pattern Analysis

1. Exuberant Heat Toxin︰Sudden high fever or persistent fever, erythema or edematous erythema on the face and other parts of the skin, even large blisters or blood blisters. The condition worsens or suddenly occurs after sun exposure, accompanied by general weakness, muscle and joint pain, dysphoria and insomnia, mental confusion or unconsciousness with delirious speech, convulsions, dry stools, scanty dark urine, thirst with a preference for cold drinks, red eyes, red lips, or possible bleeding such as hematemesis, epistaxis, bloody stool, or mouth and tongue sores, swollen and sore throat. The tongue is red or purplish-dark or crimson, with a yellow greasy or yellow dry coating, or a mixed yellow-white greasy coating, or a mirror-like tongue. The pulse is wiry and rapid. This pattern is commonly seen in acute episodes of the disease or cases with secondary infections. Treatment involves clearing heat and removing toxins, cooling blood and nourishing yin, and resolving phlegm to eliminate spots. Modified Plague-Clear Toxin-Vanquishing Decoction is used: raw gypsum 60g (to be decocted first), buffalo horn 30g (to be decocted first), Anemarrhena, Coptis Rhizome, Skullcap Root, Gardenia, Forsythia, Scrophularia Root, each 15g; Unprocessed Rehmannia Root, Moutan Bark, Red Peony Root, Chinese Angelica, each 20g; Bamboo Leaf, Platycodon Root, Liquorice Root, each 10g. For dry stools, add Rhubarb Rhizoma 10g (to be decocted later). For persistent high fever or mental symptoms, add antelope horn 0.3–0.5g (take infused). For lingering low fever, add Starwort Root and Chinese Wolfberry Root-bark, each 15g. For severe bleeding spots, add lotus rhizome node, lalang grass rhizome, and Arnebia, each 20g. For pronounced dampness-heat with thick greasy tongue coating, add Atractylodes Rhizome and Acorus, each 10g, and remove Unprocessed Rehmannia Root, Scrophularia Root, and Anemarrhena.
2. Heat Damaging Qi and Yin︰Feverishness, spontaneous sweating, palpitation, chest tightness and shortness of breath, cough, restlessness and insomnia. Or severe dysphoria, or cyanosis of the lips, or pale complexion, reversal cold of limbs. Weakness in the limbs, mental fatigue. Thready and weak or knotted and intermittent pulse, pale tongue with thin white coating. This pattern is commonly seen in cases with heart and lung damage or central nervous system damage. Clear heat and nourish yin, tonify qi and calm the spirit. Modified Prepared Liquorice Decoction combined with Heart-Draining Decoction. Ginseng 15g, Chinese Date 20 pieces, Unprocessed Rehmannia Root 50g, Prepared Liquorice Root 15g, Donkey-hide Gelatin (melted), Ophiopogon Tuber, Fresh Ginger Rhizome, Cinnamon Twig, Hemp Seed, Coptis Rhizome, Skullcap Root, Rhubarb Rhizoma (to be decocted later) 10g each. Severe qi deficiency: add Astragalus Root 30-100g (gradually increase); obvious spleen deficiency leading to loose stool and poor appetite: add Poria, White Atractylodes Rhizome, and scorched Three Immortals 10g each; obvious yin deficiency leading to dry mouth and throat, dry cough: add Glehnia 20g, Ophiopogon Tuber 10g each; severe restlessness and insomnia: add Silktree Albizia Bark, Tuber Fleeceflower Stem, and Sour Jujube 10g each; severe dysphoria: add Bamboo Leaf 5g, Forsythia and Chinese Wolfberry Root-bark 10g each; rapid breathing and cough with difficulty expectorating phlegm: add White Mulberry Root-Bark, Heartleaf Houttuynia Herb, Aster, and Coltsfoot Flower 10g each, Hedyotis 15g. Pale complexion and pronounced cold limbs: add Aconite Lateral Root, Cassia Bark, and Epimedium Herb 10g each.
3. Liver Channel Stagnation-Heat︰Pain in the liver region, or stuffiness, fullness, and distending pain in the chest, ribs, epigastrium, and abdomen; irritability or depression; red or purplish-dark skin lesions; women often experience dysmenorrhea or amenorrhea with irregular menstruation. Other symptoms may include fear of cold, fever, anorexia, lack of strength, dizziness, insomnia; a deep red tongue or tongue with ecchymosis, thin white or yellow and rough coating; tight and thin or wiry and rapid pulse. This pattern is often due to prolonged use of steroid hormones, with generally elevated blood pressure and frequent complications such as hepatosplenomegaly and functional impairment. Treatment involves soothing the liver and clearing heat, invigorating blood and resolving stasis. Modified All-Along Decoction combined with Four Wonderful Herbs Resting Hero Decoction is used. Ingredients include Chinese Angelica and Unprocessed Rehmannia Root, 30g each; Scrophularia Root and Barbary Wolfberry Fruit, 20g each; Lonicera, 15g; Chinese Angelica, 30g; Glehnia, Ophiopogon Tuber, Chinaberry Fruit, and raw Liquorice Root, 10g each. For hepatosplenomegaly and liver region pain, add Tortoise Carapace and turtle carapace, 30g each; Cyperus and Curcuma Root, 15g each. For severe blood stasis, add Sparganium Rhizome and Zedoary Rhizome, 15g each; Red Peony Root and Moutan Bark, 10g each. For pronounced spleen deficiency, add Ginseng, 10g; Poria, 20g; White Atractylodes Rhizome, 10g. For excessive heat toxin, add Rhubarb Rhizoma, Gentian, Bupleurum, and Gardenia, 10g each.
4. Yin Deficiency︰Chronic low-grade fever, vexing heat in the chest, palms, and soles, facial flushing, malar redness, night sweats, spontaneous sweating, lack of strength, red or pale red rashes with few new eruptions, joint pain, dizziness, blurred vision, tinnitus, alopecia areata, dry throat and mouth, dark urine, dry stools, and in women, menstrual irregularities may be observed. The tongue is red with scant coating, and the pulse is wiry, thin, and rapid. This pattern is commonly seen in the acute or subacute stages of the disease. The treatment principle is to nourish yin and clear heat. Modified Major Yin-Tonifying Pill combined with Four Ingredients Decoction is used. Ingredients: Tortoise Carapace and turtle carapace, 30g each; Unprocessed Rehmannia Root, Prepared Rehmannia Root, Phellodendron Bark, Anemarrhena, and Chinese Angelica, 20g each; Peony Root and Sichuan Lovage Rhizome, 10g each. For severe qi deficiency, add Astragalus Root 20g and American Ginseng 10g. For pronounced night sweats and spontaneous sweating, add Fossil Bone and oyster shell, 10g each. For spleen deficiency with poor appetite, add Chinese Yam and Poria, 20g each, and White Atractylodes Rhizome 10g. For marked tidal fever and vexing heat in the chest, palms, and soles, add Chinese Yam and Poria, 20g each, and Moutan Bark, Cornus, and Alisma, 10g each. Additionally, consider adding Chinese Wolfberry Root-bark, Scrophularia Root, Mongolian Snakegourd Root, and Qinghao, 10–15g each. For prominent blood stasis and rashes, add Peach Kernel and Carthamus, 10g each, and Salvia and Red Peony Root, 15g each, along with Lalang Grass Rhizome and Lotus Rhizome Node, 20g each. For significant kidney deficiency presenting with soreness and weakness in the lower back and knees, dizziness, and tinnitus, add Barbary Wolfberry Fruit, Dodder Seed, Palmleaf Raspberry Fruit, Desertliving Cistanche, Achyranthes Root, and Fleeceflower, 10g each.
5. Qi Stagnation and Blood Stasis︰Acrocyanosis or alternating pallor and cyanosis, skin purpura or discoid pigmentation or dyschromia, scaly skin, joint and muscle pain. In females, emotional depression, menstrual irregularities, amenorrhea, or dysmenorrhea may be observed. The tongue appears purplish-red with dark, thickened sublingual veins. This pattern is commonly seen in cases with severe Raynaud's phenomenon and obvious vasculitis. The treatment principle is to activate blood circulation, resolve phlegm, regulate qi, and unblock collaterals. Modified Blood House Stasis-Expelling Decoction is used, consisting of Unprocessed Rehmannia Root, Peach Kernel, Carthamus, Red Peony Root, and Achyranthes Root, 20g each; Bupleurum and Sichuan Lovage Rhizome, 15g each; Immature Orange Fruit, 10g. For emotional depression and chest or hypochondriac distending pain, consider adding Curcuma Root, Cyperus, Green Tangerine Peel, and Finger Citron, 10g each. For extremity or joint pain, add Mulberry Twig, Cinnamon Twig, Gentian, Suberect Spatholobus Stem, and Honeysuckle Stem, 10–15g each. For predominant blood stasis, manifested as prolonged cyanosis of the extremities or skin, increase Sichuan Lovage Rhizome to 20g and add Sparganium Rhizome, Zedoary Rhizome, 10g each; Sanqi and whole Chinese Angelica, 15g each; Frankincense and Myrrh, 10g each. For predominant qi stagnation with yang qi failing to reach the extremities, leading to prolonged pallor and cold limbs, add Cassia Bark and Aconite Lateral Root, 10g each; Asarum, 3g; Akebia Stem, 10g; Kusnezoff Monkshood Root and Aconite Mother Root, 10g each. For severe joint or extremity pain, add Little Multibanded Krait, Scorpion, and Centipede, 10g each.
6. Deficiency of Both Spleen and Kidney︰Cold limbs, low-grade fever or tidal fever, mental fatigue and lack of strength, shortness of breath and reluctance to speak, worsening with exertion, anorexia, abdominal distension and fullness, or even vomiting and diarrhea, pale or sallow complexion, soreness and weakness in the lower back and knees, joint swelling and pain, limb edema, dysuria, absent or dull purple rashes. The tongue is pale, swollen, or dull with tooth marks and thin white coating; the pulse is soggy and thin or deep and thin. This pattern is commonly seen in nephrotic syndrome accompanied by Raynaud's phenomenon and long-term steroid use. Tonify the kidneys and strengthen the spleen, warm yang and promote water excretion. Modified Kidney Qi Pill combined with Four Gentlemen Decoction. Cassia Bark and Aconite Lateral Root (15g each), Chinese Yam (20g), Poria (30g), Ginseng, White Atractylodes Rhizome, and Cornus (10g each), Moutan Bark (12g), Prepared Liquorice Root (6g), Alisma (12g). For severe nausea and vomiting, add Fresh Ginger Rhizome (20g), Dried Tangerine Peel, Pinellia, Magnolia Bark, and Acorus (10g each). For predominant kidney deficiency, add Dodder Seed, Common Curculigo Rhizome, Epimedium Herb, Chinese Taxillus Herb, Dipsacus, Barbary Wolfberry Fruit, Eucommia Bark, Fleeceflower, and Desertliving Cistanche (10–15g each). For severe dysuria and edema, add Polyporus, Areca Peel, Lalang Grass Rhizome, and Rice Bean (10–15g each). For diarrhea, increase Chinese Yam to 30g, replace White Atractylodes Rhizome with stir-fried White Atractylodes Rhizome (20g), and add Nutmeg and Villous Amomum Fruit (10g each).

Since the disease can involve various parts and systems of the body, the clinical manifestations are complex and variable, the course of the disease is long, there are many complications, and the associated symptoms are complicated. The clinical syndromes often overlap with each other. Therefore, in addition to the above classifications, the following pattern identification and disease-specific modifications should be applied:

1. For symptoms such as soreness and weakness in the waist and knees, dizziness, tinnitus, and kidney deficiency, the following can be selected: Barbary Wolfberry Fruit, Eucommia Bark, Desertliving Cistanche, Dodder Seed, Cibot Rhizome, Giant Knotweed, Sichuan Lovage Rhizome, Chinese Taxillus Herb, Cinnamon Twig, Cassia Bark, Common Curculigo Rhizome, Epimedium Herb, Songaria Cynomorium Herb, Sharpleaf Galangal Fruit, etc.
2. For edema, the following can be added: Plantain Seed, Plantain Herb, Alisma, Rice Bean, Areca Peel, Coix Seed, Poria, Polyporus, Lalang Grass Rhizome, Corn Stigma, Pyrrosia Leaf, etc.
3. For joint pain, the following can be added: Gentian, Mulberry Twig, Chinese Taxillus Herb, Chinese Clematis Root, Paniculate Swallowwort Root, Fourstamen Stephania Root, Saposhnikovia Root, Corydalis Rhizome, Giant Knotweed, Suberect Spatholobus Stem, Orientvine Vine, Honeysuckle Stem, Sichuan Lovage Rhizome, Cinnamon Twig.
4. For hypochondriac region distending pain and emotional depression, the following can be added: Curcuma Root, Cyperus, Green Tangerine Peel, Corydalis Tuber, Submature Bitter Orange, Finger Citron, Bupleurum.
5. For palpitation, the following can be added: Schisandra Fruit, Acorus, Milkwort Root, Poria, Poria with Pine Wood, Eucommia Bark, Scrophularia Root, Platycladi Seed.
6. For insomnia, the following can be added: Tuber Fleeceflower Stem, Albizia Flower, Silktree Albizia Bark, Sharpleaf Galangal Fruit, Orientvine Vine, Acorus, Sour Jujube, etc.
7. For dry cough or yin deficiency cough, the following can be added: Asparagus Root, Ophiopogon Tuber, Lily Bulb, Glehnia, Remote Lemongrass Herb, India Madder Root, Platycodon Root, Tendrilleaf Fritillary Bulb, Loquat Leaf, etc.
8. For precordial pain, coronary stirred pulse, and insufficient blood supply, with heart damage, the following can be added: Sanqi, Sichuan Lovage Rhizome, Chinese Angelica, Hawthorn Fruit, Pubescent Holly Root and Stem, Corydalis Rhizome, Trichosanthis Fruit, Motherwort Herb, Salvia, Cinnamon Twig, Peony Root, etc.
9. For arrhythmia with regularly intermittent pulse, the following can be added: Epimedium Herb, Sophora, Chinese Angelica, Sweet Wormwood, Longan Aril.
10. For liver pain, hepatosplenomegaly, and liver damage, the following can be added: Curcuma Root, Bupleurum, Stringy Stonecrop Herb, White Atractylodes Rhizome, Virgate Wormwood, Dandelion, Tortoise Carapace, Turtle Carapace, Salvia, Sichuan Lovage Rhizome, Chinese Angelica, Sparganium Rhizome, Zedoary Rhizome.
11. For kidney damage: for proteinuria, the following can be added: Tangshen, Astragalus Root, Cherokee Rose Fruit, Schisandra Fruit, Hawthorn Fruit, Gordon Euryale Seed, Germinated Barley, Lalang Grass Rhizome, Lonicera, etc.; for granular casts, the following can be added: Hawthorn Fruit, Chinese Yam, Songaria Cynomorium Herb, Morinda; for pus cells, the following can be added: Cluster Mallow Fruit, Plantain Seed, Lonicera, Heartleaf Houttuynia Herb; for uremia, the following can be added: Ginseng and Aconite Decoction, Korean Ginseng, Anemarrhena, Phellodendron Bark, Cassia Bark, Rhubarb Rhizoma (to be decocted later).
12. For bleeding or coagulation abnormalities, the following can be added: Platycladus, India Madder Root, Typha, Taiwan Beautyberry Leaf, Buffalo Horn, Hairyvein Agrimonia Herb, Lalang Grass Rhizome, Donkey-hide Gelatin, Sanguisorba Charcoal, Lotus Rhizome Node, etc.
13. For leukopenia, the following can be added: Glossy Privet Fruit, White Atractylodes Rhizome, Cassia Bark, Sophora, Black Nightshade, etc.
14. For loss of appetite and poor digestion, the following can be added: Chicken's Gizzard-Skin, Lindera, Fresh Ginger Rhizome, Dried Tangerine Peel, Gentian, etc.
15. For hypertension, the following can be added: Hawthorn Fruit, Schisandra Fruit, Pubescent Holly Root and Stem, Salvia, White Atractylodes Rhizome, Scrophularia Root, Chinese Wolfberry Root-bark, Eucommia Bark, Moutan Bark, Pueraria Root, Orientvine Vine, etc.
16. For central nervous system damage and neuropsychiatric symptoms, the following can be added: Gastrodia Tuber, Uncaria, Stephania Tetrandra, Arisaema, Acorus, Milkwort Root, Stiff Silkworm, Poria, Areca Seed Powder (to be swallowed), Pearl Powder, Antelope Horn Powder, etc. Fever in lupus erythematosus is very common and difficult to eliminate. Sometimes it is difficult to determine the cause of the fever. During clinical practice, careful observation and detailed analysis should be conducted. If there is a clear cause, disease-specific modifications should be applied; if the cause is unknown, pattern identification modifications should be applied.
17. For qi-deficiency fever, the following can be added: Astragalus Root, White Atractylodes Rhizome, Tangshen, Maltose, Chinese Date, Longan Aril, etc.
18. For blood-deficiency fever, the following can be added: Chinese Angelica, Prepared Rehmannia Root, Donkey-hide Gelatin, Solomonseal Rhizome, Polyghace Seche, etc.
19. For yin-deficiency fever, the following can be added: Sweet Wormwood, Chinese Wolfberry Root-bark, Starwort Root, Neopicrorhiza, Donkey-hide Gelatin, Egg Yolk, Scrophularia Root, etc.
20. For allergic fever, the following can be added: Skullcap Root, Stephania Tetrandra, Dried Tangerine Peel, Ephedra, Liquorice Root, etc.
21. For bacterial infection fever, the following can be added: Forsythia, Heartleaf Houttuynia Herb, Coptis Rhizome, Ginkgo Leaf, Chrysanthemum Flower, Lonicera, Dandelion, Bupleurum, Dyers Woad, Chinese Pulsatilla Root, Chinese Wolfberry Root-bark, etc.
22. Viral infection fever, optionally add Dyers Woad, Isatis Root, Chinese Pulsatilla Root, Hedyotis, Barbated Skullcup Herb, Chinese Lobelia Herb, Lilac Pink Herb root, fig, Lonicera, Dandelion, Tokyo Violet Herb, Peony Root, Chinese Wolfberry Root-bark, Bupleurum, Snakehead Yicao, Shidanian, loquat leaf, Cherokee Rose Fruit, Virgate Wormwood, Sweet Wormwood, etc.

Since potential or apparent persistent viral infections are one of the disease causes or exacerbating factors for lupus erythematosus, antiviral Chinese herbal medicine can be considered in each prescription.