bubble_chart Concept

This disease is not clearly documented in Chinese medicine literature, but based on its clinical manifestations, it is generally considered to fall under the categories of "atrophy-flaccidity disease" and "Bi disease" in Chinese medicine. For example, the "Su Wen‧Wei Lun" chapter provides a detailed discussion on atrophy-flaccidity disease, stating that the five zang-organs can all lead to atrophy, with the lungs, spleen, and kidneys being particularly closely related to this disease. In summary, the disease cause and mechanism of disease are as follows: the nutrient-defense system is not firm, wind-cold and dampness evils invade externally, lodging in the lungs and spleen, stagnating and transforming into heat, accumulating in the skin and muscles; leading to red skin and muscle pain, which over time consumes qi and damages blood, resulting in qi deficiency and blood deficiency; or due to liver and kidney yin deficiency, dampness-heat invades, stagnating in the collaterals, causing qi and blood stagnation, and the muscles and skin losing nourishment, which can lead to the inability to use the hands and feet.

bubble_chart Modern Research

Dermatomyositis is an autoimmune connective tissue disease characterized by inflammation of the skin, muscles, and small blood vessels. This disease can also affect only the muscles without skin symptoms, known as polymyositis. This connective tissue disease can also involve visceral damage, becoming a systemic disease. Clinically, it commonly presents with purplish-red patches on the face and neck, edema of the upper eyelids, pale purplish-red patches around the eyes, erythema on the extensor side of the metacarpophalangeal or interphalangeal joints (which may be accompanied by atrophy), muscle weakness, muscle pain, and muscle swelling, most notably in the proximal muscles of the limbs. The incidence of this disease is 0.001% to 0.006%. It is more common in women than in men, with a female-to-male ratio of 2:1. The peak age of onset in children is between 5 and 15 years, and in adults, it is between 30 and 50 years. About 9% to 52% of cases are complicated by cancer.

The pathogenesis of this disease is generally believed to be related to tumors, infections, viruses, drugs, endocrine dysfunction, and muscle metabolic disorders. In recent years, it is widely considered to be an autoimmune disease. This disease shares many clinical manifestations and immunological abnormalities with systemic lupus erythematosus and scleroderma, such as the presence of lupus cells in the blood in some cases, positive antinuclear antibodies and rheumatoid factors, positive antibodies against myosin, and the presence of anti-tumor antibodies in the patient's serum. Tumor tissue can act as an autoantigen, and the cross-antigenicity between tumor tissue and muscle fibers, blood vessels, and connective tissue in the body, along with the resulting cross-antigen-antibody reactions, can cause lesions. It has also been found that the lymphocyte transformation rate is increased and serum immunoglobulins are decreased in patients. All of the above support the notion that the basis of this disease is immune dysfunction.

[Diagnosis]

Based on the symmetric lack of strength, pain, and tenderness in the proximal muscles of the limbs, accompanied by characteristic skin lesions such as purplish-red edematous changes around the eyelids (this erythema has high diagnostic value), Gottron's sign, and mid-furrow rigid capillary dilatation erythema, a diagnosis can be made. Further supported by elevated serum levels of creatine phosphokinase (CPK), aldolase, lactate dehydrogenase (LDH), transaminases, increased 24-hour urinary creatine excretion, and, if necessary, combined with electromyographic changes and biopsy of the affected muscles, the disease can be confirmed.

bubble_chart Pattern Analysis

1. Lung Heat Damaging Body Fluids︰After the onset of fever, or following the subsidence of fever, sudden weakness or numbness in the limbs may occur, accompanied by restlessness, thirst, dry throat, scanty yellow urine, and dry stools. The tongue is red with a yellow coating, and the pulse is rapid. The treatment involves clearing heat and moistening dryness, as well as nourishing the lungs and promoting fluid production. Modified Dryness-Clearing Lung-Rescuing Decoction is used, consisting of 15g Tangshen, 15g Ophiopogon Tuber, 30g Gypsum (to be decocted first), and 10g each of Mulberry Leaf, Bitter Apricot Seed, Hemp Seed, Mulberry Twig, Pubescent Angelica, and Achyranthes Root. For cases with high fever, thirst, and sweating, increase the dosage of Gypsum to 60g and add 10g each of Anemarrhena, Lonicera, and Forsythia. For coughing with scant phlegm, consider adding 15g of whole Trichosanthis Fruit and 10g each of White Mulberry Root-Bark and Loquat Leaf. For limb numbness, add 10g each of Atractylodes Rhizome and Chinese Clematis Root, and 30g of Suberect Spatholobus Stem. If the fever has completely subsided but there is reduced appetite, dry mouth and throat, and muscle weakness, with a red tongue and scant coating, Stomach-Tonifying Decoction should be used with the addition of Coix Seed, Chinese Yam, and Millet Sprout.
2. Dampness-heat︰Heaviness and weakness of the limbs, or accompanied by slight swelling, numbness, especially in the lower limbs, or fever, chest and gastric stuffiness, scanty and dark urine. Red tongue with yellow greasy coating or mixed yellow-white greasy coating, soggy and rapid or slippery and rapid pulse. Clearing heat and draining dampness, relaxing sinew and activating collaterals. Modified Two Wonderful Herbs Powder: Phellodendron Bark, Atractylodes Rhizome, Stephania Tetrandra, Akebia Stem, Silkworm Droppings, each 10g; Smilax Glabra, Flowering Quince Fruit, each 6g; Coix Seed 30g. For predominant dampness with chest and gastric stuffiness, heavy and swollen limbs, slippery and greasy tongue coating, soggy pulse, consider adding Magnolia Bark, Poria, Alisma, Patchouli, Fortune Eupatorium. For dampness-heat damaging yin with emaciation, low-grade fever, red tongue with scant coating, thin and rapid pulse, remove Atractylodes Rhizome and add Unprocessed Rehmannia Root 15g, Ophiopogon Tuber 10g, Tortoise Carapace 20g. For numbness and inflexibility of limbs, purple tongue or spots, add Peach Kernel, Carthamus, Red Peony Root, Salvia, each 10g. For numbness with cold sensation in limbs, remove Phellodendron Bark and add Cinnamon Twig 10g.
3. Spleen-stomach Weakness︰Limp and weak limbs gradually worsening, accompanied by poor appetite, loose stools, facial puffiness without luster, mental fatigue, and lack of strength. Pale tongue with thin white coating, and a thready weak pulse. Tonify the spleen and replenish qi, nourish blood, and strengthen tendons. Modified Ginseng, Poria, and White Atractylodes Powder. Codonopsis Root 15g, White Atractylodes Rhizome, Hyacinth Bean, Poria, Villous Amomum Fruit (to be decocted later), and Dried Tangerine Peel 10g each, Chinese Yam and Coix Seed 30g each, Lotus Seed, Chinese Taxillus Herb, and Achyranthes Root 15g each. For fear of cold and cold limbs, add Aconite Lateral Root 6–10g and Dried Ginger 10g. For prolonged illness with weak constitution and deficiency of both qi and blood, increase the dosage of Codonopsis Root, White Atractylodes Rhizome, and Chinese Yam, and add Astragalus Root 15g, Prepared Rehmannia Root 15g, and Chinese Angelica 10g.
4. Liver and Kidney Deficiency︰The disease course is prolonged, with weakness and flaccidity of the limbs, especially the lower limbs, or accompanied by muscle spasms, numbness, soreness and weakness of the lower back, vertigo, tinnitus, seminal emission, or menstrual irregularities. The tongue is red with scant coating, and the pulse is thready and rapid. The treatment involves tonifying the liver and kidneys, enriching yin and clearing heat, using Hidden Tiger Pill with modifications: Prepared Rehmannia Root and Tortoise Carapace, 15g each; tiger bone, Achyranthes Root, Songaria Cynomorium Herb, Chinese Angelica, Peony Root, Sichuan Teasel Root, Chinese Taxillus Herb, Phellodendron Bark, and Anemarrhena, 10g each. Clinically, tiger bone is replaced with 30g of dog bone. If heat is severe, remove Songaria Cynomorium Herb. For cases complicated by blood deficiency, presenting with a sallow complexion, palpitations, severe palpitations, or insomnia, add Astragalus Root, 15g; Tangshen and Chinese Angelica, 10g each; and Suberect Spatholobus Stem, 30g. For prolonged illness where yin impairment affects yang, manifesting as fear of cold, cold limbs, impotence, a pale tongue, and a deep pulse, remove Anemarrhena and Phellodendron Bark, and consider adding Deer Horn Slices, Psoralea, Epimedium Herb, Morinda, Aconite Lateral Root, Cassia Bark, etc.