中藥治療系統性紅斑性狼瘡合併狼瘡腎炎病例報告

Chinese Herbal Medicine for Treating the Patient with Systemic Lupus Erythematosus Combined with Lupus Nephritis: A Case Report

26歲男性患有系統性紅斑狼瘡（Systemic lupus erythematosus）合併狼瘡腎炎（Lupus nephritis），患者於2019年5月至臺北榮民總醫院傳統醫學部門診就診，主訴近兩月來感到倦怠、下肢水腫及嚴重蛋白尿（836.4 mg／dL），且接受脈衝類固醇合併Cyclophosphamide治療後噁心嘔吐加重。中醫辨證為肝腎陰虛、下焦溼熱、氣滯血瘀，採用祛風除溼、清熱育陰、活血化瘀治法。於中藥治療一個月後，患者自述疲倦、下肢水腫及身體瘀斑減輕，且觀察到尿蛋白減少至342.9mg／dl；中藥治療兩個月後疲憊持續改善，下肢水腫、身體瘀斑、噁心嘔吐感顯著改善至幾近無症狀，且尿蛋白、膽固醇及三酸甘油酯也顯著改善趨於穩定正常範圍。本病例報告發表整合中西醫療法治療系統性紅斑狼瘡合併狼瘡腎炎之經驗，可望提供替代之整合治療與中醫實證醫學指引。

A 26-year-old male patient who had systemic lupus erythematosus combined with lupus nephritis came to Center for Traditional Medicine, Taipei Veterans General Hospital for first visit in May, 2019. The patient suffered from feeling tiredness, bilateral lower limb pitting edema and severe proteinuria (836.4 mg/dl) in recent 2 month, and he also felt nausea and vomiting worse after receiving pulse steroid therapy plus cyclophosphamide. After taking his history and making a Traditional Chinese Medicine (TCM) diagnosis, TCM patterns were identified as “Liver and kidney yin deficiency”, “Dampness-heat in lower Jiao”, and “Qi stagnation and blood stasis”. Hence, we prescribed Chinese herbal medicine (CHM) with the principle of “Expelling wind and dampness”, “Clearing heat and nourishing yin”, and “Promoting blood and resolving stasis” for him. After taking CHM for 1 month, the patient told about that his symptoms about fatigue, edema improved and proteinuria decreased to 342.9 mg/dl. After 2 months of treatment, the subjective symptoms including fatigue, edema, bruise, nausea and vomiting relieved, while the objective sign about the urine protein, total cholesterol and total triglyceride all significantly decreased to nearly normal range. Through the integrated TCM and Western medicine therapy in treating with this case, we could provide the evidence-base concept for Systemic lupus erythematosus combined with lupus nephritis case.