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Lei Gong Teng and Lupus
September 24, 2007
Lei Gong Teng, the Thunder god vine, is a perennial vine-like plant that grows in the mountainous regions of southeast and southern China. According to ancient Chinese medical texts, such as the Materia Medica, crude preparations and decoctions of Lei Gong Teng were routinely applied in the clinical setting for a variety of ailments; accordingly, Chinese pharmaceutical encyclopedias have substantiated the herb’s clinical value by itemizing the plant’s effects: “stimulates blood circulation, relieves stasis, is an anti-inflammatory, relieves edema, purges excess internal warmth, and eliminates toxicity…” (Lipsky & Tao, 1997, p. 713).
While health-related websites have asserted that Lei Gong Teng has been used in medical practice for “centuries” (http://www.yourhealthbase.com/chinese_medicine.html), Lipsky and Tao (1997, p.713) point out that pharmaceutical catalogs, as recent as 1985, did not mention Lei Gong Teng in their exhaustive indices. In fact, historical studies show that Lei Gong Teng was primarily used as an agricultural pesticide, and was not considered a medicinal herb, until the aftermath of China’s Cultural Revolution in the 1960s. The revolution, led by China’s figurehead Mao Zedong, ushered in western-style, evidence based medicine; concomitant with the implementation of biomedical practice and education, was the development and exponential growth of research, in particular clinical trials, which assessed the efficacy and reliability of drugs’ therapeutic value.
While it can be said that Mao clearly aimed to “scientize” Chinese medicine, he also sought to preserve China’s cultural solidity and nationalistic unity; case in point, Mao reintroduced several “traditional” herbs – those considered outdated and antiquated – and reinterpreted them into a modern context, by submitting them to scientific rigor and objective analysis (Sheid, 2002, p. 72; Lipsky & Tao, 1997, p. 713-714). As a result of Chinese medicine’s modernization, Lei Gong Teng is considered a colloquial term, and the herb is now identified by its scientific name, Tripterygium wilfordii Hook F (TwHf); most significantly though, by the 1980s considerable data and clinical experience regarding the use of Tripterygium for autoimmune and inflammatory conditions materialized (Lipsky & Tao, 1997, p. 714).
The research that emerged during this time was promising and has continued. The evidence accrued from cellular and immunological assays, in vivo and in vitro analyses, as well as experiments with animal models supported the general scientific consensus that TwHf possesses immunosuppressant and anti-inflammatory properties; as a result, researchers conducted clinical trials to evaluate TwHf as a treatment for Rheumatoid Arthritis (RA), most of which indicated that TwHf improved clinical symptoms and normalized lab results for the RA patients (Lipsky & Tao, 1997, p. 714; http://www.yourhealthbase.com/chinese_medicine.html). In sum, these research findings have spawned a new area of research that investigates TwHf’s therapeutic value for other disorders that require immunosuppressants and anti-inflammatories. The following report examines the popular and scientific literature regarding Tripterygium wilfordii Hook F (TwHf) as a potential treatment for Systemic Lupus Erythermatosus.
Systemic Lupus Erythermatosus (SLE) is an autoimmune connective tissue disorder, with various clinical presentations and levels of severity. Like other autoimmune disorders, SLE results from a dysregulated immune system, in which autoantibodies are directed towards “normal” host antigens, causing inflammation, and damaging the tissues of the body (Lee & Kavanaugh, 2006). SLE is often referred to as a “multisystem” syndrome, in that the disorder targets a large range of organs, including the joints, skin, lungs, heart and circulatory system, nervous system, kidneys, GI system, and eyes (D’Cruz, 2007). Due to the ambiguity of the cause and the mechanisms that underlie autoimmune dysregulation, diagnosis and treatment are both extremely challenging for medical practitioners (Patavino & Brady, 2001).
Current research on SLE involves unraveling the signal pathways and molecular mechanisms that can account for the immune system’s dysregulation; by sophisticating our knowledge regarding these mechanisms, researchers hope to develop better treatments for SLE patients, alleviating the inflammation, organ damage, and destruction that occur as a result of the dysregulation. Current treatments vary depending on the severity of the inflammation or the degree to which organs are affected by the immune system’s aberrant behavior; generally speaking, treatment tends to involve a combination of corticosteroids and immunosuppressants that aim to reduce and suppress the inflammatory response. Both drugs are believed to inhibit the production of cytokines, most notably interleukin-1 and interleukin-2, which serve as messengers within the immune system, allowing for the inflammatory response to occur. For the most part these treatments are effective, and can put the disorder into remission, without clinical manifestations. Other cases are not as fortunate, especially those that involve multiple organ systems, as the majority of SLE-related fatalities are due to the organ dysfunction and failure that occurs as a result of the autoimmune response (Patavino & Brady, 2001),
The treatment of interest involves the use of the Chinese herb Tripterygium wilfordii Hook F (TwHf) for Systemic Lupus Erythermatosus (SLE); accordingly, TwHf treatment chiefly aims to alleviate the clinical manifestations associated with SLE. Secondary aims include decreasing SLE patients’ necessity for biomedical drug therapy, in particular for synthetic corticosteroids, and last to normalize the pathological indications of SLE, derived from hematological laboratory assays (http://www.vitacost.com/Healthnotes/Concern/Lupus.aspx; http://www.yourhealthbase.com/chinese_medicine.html; Patavino & Brady, 2001).
Medical research has verified that TwHf extracts, particularly Triptolide (TPT), have anti-inflammatory and immunosuppressant effects on humans, by suppressing T-lymptocyte activation and proliferation, and inhibiting cytokine production, most notably TNF (tumor necrosis factor) and IL-2 (interleukin-2). Molecular and genetic research suggests that TPT suppresses cytokine production by blocking the upregulation of the cytokines, or “inflammatory genes”, such that their receptor expression and mRNA transcription is blocked (Brinker, Ma, Lipsky, & Raskin, 2006; Chen, Murakami, Oppenheim, Howard, 2005).
Given that reducing inflammation and suppressing the immune system are the fundamental principles of Lupus management, TwHf extracts are compared to established biomedical therapeutics, particularly corticosteroids and immunosuppressants; as a result, some Internet sources have suggested that TWHF be considered and evaluated as a potential and alternate means to regulate, manage, and treat SLE (http://www.yourhealthbase.com/chinese_medicine.html). Most articles and informational sites do not explain in further detail the mechanisms by which TWHF acts as an immunosuppressant or the scientific rationale that substantiates the use of immunosuppression to manage autoimmune disorders, as these are typically extremely complex theories, which employ technical, esoteric language; however, I found that occasionally journal reviews were found on informational sites (e.g the article written by Pattavino and Brady), and in such cases more technical language and mechanisms were used to explain and rationalize SLE therapies .
Furthermore, proponents of TwHf treatment, state the obvious: biomedicine’s standard treatment for SLE (corticosteroids and immunosuppressants), has deleterious and often irreversible side effects.
But the question still remains: Does TwHf hold practicable promise for SLE patients? While the rationale for its employment is validated by sound research, its therapeutic value, has yet to be determined.
Patients need to proceed with caution when reviewing on-line sources regarding alternative treatments, as evidence regarding their therapeutic value has not met biomedical standards, hence their absence from biomedical practice. Well-designed clinical trials of TwHf treatment for SLE are scant in the medical literature, and several are still in process; accordingly, informational web sites that discuss or promote TwHf treatment often cite successful clinical trials with Rheumatoid Arthritis patients, studies that show TwHf’s immunosuppressant and anti-inflammatory effects, or SLE clinical studies that are either flawed (study is not randomized, double-blind, or controlled) or preliminary (study lasts a limited amount of time, conducted more than 10 years ago, and or has not yet been replicated) (http://www.yourhealthbase.com/chinese_medicine.html, http://www.vitacost.com/Healthnotes/Concern/Lupus.aspx). Preliminary studies show promise in that SLE patients’ symptoms were improved or blood work indicated less inflammation, both of which need to be taken solely as preliminary data, which needs further replication to be considered legitimate cause to integrate TwHf into our healthcare system.
On the other hand, studies that document TwHf’s potential side effects, are more recent and designed better; for example, Vitacost.com cites a 2000 retrospective study which found that after five years of TwHf treatment, women with SLE experienced a significant loss in bone mass density, but less so than the women treated with prednisone (http://www.vitacost.com/Healthnotes/Concern/Lupus.aspx). Another claim is that while TwHf has side effects, such as nausea, stomach pain, dizziness, and amenorrhea, these are controllable as long as the dosage of TwHf is adjusted correctly (Pattavino & Brady, 2001).
Given the fact that biomedicine has yet to clearly delineate the pathology or find a cure for SLE, researchers and patients continue to search for possibilities, as evidenced by the preponderance of self-help and patient-oriented articles, found in health magazines and websites, as well as the research activity dedicated to determining TwHf’s therapeutic value. Moore, Petri, Manzi, Isenberg, and Gordon (2001) studied the prevalence of alternative treatment among patients diagnosed with SLE, and found that approximately half used some form of alternative therapy.
Traditional Chinese Medicine, is a popular alternative for such patients, as these
Chinese herbal treatments are often advertised and perceived by patients as having stood the test of time, all “natural”, and because potential side effects may be overlooked, only briefly touched upon, or not included by these alternative medicine web portals.
To validate the clinical use of herbal treatments, they are portrayed as less “harmful” than their biomedical counterparts, synthetic corticosteroids and immunosuppressants, who in contrast have accumulated decades of evidence showing the risks involved.
Disconcerting as it is, the fact that the information provided by these websites often contradict one another, is merely a reflection of the preliminary stage in whichTwHf is being assessed, and the lack of knowledge with regards to the ethiopathology of autoimmune responses. Patients have the right to know about experimental treatments and the latest research, but they need to learn how to evaluate the claims made by studies and websites, so that they can in fact make the best decision for their health.
Brinker, A., Ma, J., Lipsky, P., & Raskin, I. Medicinal chemistry and pharmacology of genus Tripterygium (Celastraceae). Phytochemistry, 68, 732-66.
Chen, X., Murakami, T., Oppenheim, J., & Howard, Z. (2005). Triptolide, a constituent of immunosuppressive Chinese herbal medicine, is a potent suppressor of dendritic-cell maturation and trafficking. Blood, 106, 2409-16.
D’Cruz, D. P. (2006). Systemic lupus erythematosus. British Medical Journal, 332, 890-4.
Lee, S. J. & Kavanaugh, A. (2006). Autoimmunity, vasculitis, and autoantibodies. Journal of Allergy and Clinical Immunology, 117, S445-50.
Lipsky, P.E., & Tao, X. A potential new treatment for rheumatoid arthritis: thunder god vine. (1997). Seminars in Arthritis and Rheumatism, 26, 713-723.
Moore, A.D., Petri, M. A., Manzi, S., Isenberg, D. A., Gordon, C., et al. (2000).The use of alternative medical therapies in patients with systemic lupus erythematosus. Arthritis and Rheumatism, 43, 1410-18.
Patavino, T., & Brady, D. M. (2001) Natural medicine and nutritional therapy as an alternative treatment in systemic lupus erythematosus. Alternative Medicine Review, 6, 460-71.
Scheid, Volker. (2002). Chinese Medicine in Contemporary China: Plurality and Synthesis. Durham & London
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