88 97 6 24 SLE 8 (prednisolone, 1 mg/kg) 8 7 ( ) Systemic lupus erythematosus 13 97 5~6 14 6 9 C3 (mg/dl) C4 (mg/dl) A-dsDNA (IU/mL) ESR (mm/hr) WBC (

J Chin Med 20(1,2): 87-96, 2009 87 1,2 1 1 1 1 2 98 03 05 98 06 26 16 hydroxychloroquine sulfate prednisolone DNA 1018.7 IU/mL ESR 46 mm/hr 125.1 IU/mL 23 mm/hr C3 C4 31.2 2.3 mg/dl 87.5 9.09 mg/dl DNA 88.3 IU/mL 16 mm/hr C3 C4 87.7 8.57 mg/dl ( ) DNA ( S y s t e m i c L u p u s Erythematosus SLE) 1 SLE 1994 6 SLE 2 16 hydroxychloroquine sulfate prednisolone SLE SLE SLE 16 152 40 83342 123 07-7317123 2333 2334 07-7317123 2335 e120845@adm.cgmh.org.tw

88 97 6 24 SLE 8 (prednisolone, 1 mg/kg) 8 7 ( ) Systemic lupus erythematosus 13 97 5~6 14 6 9 C3 (mg/dl) C4 (mg/dl) A-dsDNA (IU/mL) ESR (mm/hr) WBC (10 3 /cm 2 ) RBC (10 6 /cm 2 ) HGB (g/dl) HCT (%) Platelet (10 3 /cm 2 ) 2008/07/04 21.00 2.99 2511.2 106 2.5 3.53 9.7 28.5 83 2008/07/21 31.20 2.30 1018.7 46 9.2 3.55 9.8 29.0 270 2008/08/14 62.80 5.44 226.7 32 10.2 4.21 12.2 36.5 308 2008/09/10 74.10 7.23 151.3 25 8.8 4.18 12.5 36.7 313 2008/10/02 79.60 7.38 198.9 19 11.2 4.32 13.2 38.3 314 2008/10/29 87.50 9.09 125.1 23 8.5 4.14 12.9 36.9 288 2008/11/26 87.70 8.33 91.1 19 7.0 3.96 12.3 36.5 361 2008/12/18 83.50 8.53 102.1 17 8.2 4.00 13.0 36.8 325 2009/01/07 87.70 8.57 88.3 16 7.0 3.76 12.5 35.3 336 2008/08/07

89 Hydroxychloroquine sulfate 200mg/tab Prednisolone 5mg/tab 97/07/11 ~ 97/07/31 1 PC/BID 2 PC/BID 97/08/01 ~ 97/08/27 1 PC/BID 4 PC/QD 97/08/28 ~ 97/09/17 1 PC/BID 3.5 PC/QD 97/09/18 ~ 97/10/08 1 PC/BID 3 PC/QD 97/10/09 ~ 97/11/05 1 PC/BID 3 PC/QD 97/11/06 ~ 97/12/03 1 PC/BID 2.5 PC/QD 97/12/04 ~ 97/12/24 1 PC/BID 2.25 PC/QD 97/12/25 ~ 98/01/15 1 PC/BID 2 PC/QD 2008/08/07 hydroxychloroquine sulfate prednisolone ( ) 3.5 g 0.5 g 0.5 g 0.5 g 8 14 8 21 8 28 3.5g 0.5 g 0.5 g 0.5 g 0.5 g 9 18 9 3 8 28 10 9 2.5 g 1.0 g 0.4 g 0.4g 0.4 g 0.4 g 0.4 g 11 6 10 13 12 4 11 1712 25 2.5 g 1.0 g 0.5 g 0.4 g 0.5 g 0.4 g 98 1 15 3.0 g 0.5 g 0.5 g 0.4 g 0.5 g 0.4 g C3 C4 C SLE 3 益

90 C3( 90-180 mg/dl) C4( 10-40 C3 C4 C3 C4 SLE C3 C4 Anti-dsDNA Anti-dsDNA SLE Anti-dsDNA

91 ESR ESR SLE mg/dl) ESR( <30 mm/hr) antidsdna( <35 IU/mL) 4 2 SLE SLEDAI SLE daily activity index 28 ( ) 2 ( ) VAS (vision analysis score) 8.9 2.1 SLE (SLE) ( ) ( ) ( Raynaud s phenomenon) 1997 年 SLE ( ) ( ) 狀 ( ) ( ) ( ) ( 六 ) ( ) 尿 (>0.5g/ ) ( ) 精 神 ( ) 淋 ( ) DNA Sm ( ) 若 列 SLE 98% (ANA)

92 SLE anti-dsdna SLE anti-dsdna ESR C3 C4 4 ( N S A I D ) hydroxychloroquine ( plaquenil) ( ) azathioprine ( Imuran) cyclophosphamide ( Endoxan) chlorambucil ( Leukeran) cyclosporine methotrexate 5 1 mg/kg (Cushing's syndrome) SLE SLE SLE SLE ( ) 6 SLE SLE SLE SLE 7 1994 6 SLE 2 SLE 1,8 SLE 1994 SLE 2002 SLE 9 SLE SLE

93 10 8 SLE 10 ( ) SLE 11,12,13,14 SLE 15 10 SLE SLE ( ) Anti-dsDNA SLE SLE C3 C4 C3 C4 SLE

94 C3 C4 SLE 16,17 11 2~3 SLE SLE SLE 1. Peter HS, Daniel JW. Diagnosis and differential diagnosis of systemic lupus erythematosus in adults. UpToDate, 2008. 2. 1994 3. 24 153-154 2002 4. Peter HS, Daniel JW. Diagnosis and differential diagnosis of systemic lupus erythematosus in adults. UpToDate, 2008. 5. Thomas JAL. Systemic lupus erythematosus in children. UpToDate, 2008. 6. 2 14-15 2008 7. 24 66-67 2002 8. 28 105-106 2008 9. 111-115 2002 10. 15 162-164 2006 11.

95 26 743-745 2006 12. 20 62-64 2007 13. 33 14-15 2001 14. SLE 22 6-7 2001 15. 34 536-538 2007 16. 24 1701-1702 2006 17. 41 48-49 2007 18. 6 201-203 2007 19. 35 389-392 2002 20. 26 46-47 2006 21. 14 44-45 2007

96 J Chin Med 20(1,2): 87-96, 2009 A CASE REPORT OF TREATING SYSTEMIC LUPUS ERYTHEMATOSUS WITH INTEGRATION OF TRADITIONAL CHINESE AND WESTERN MEDICINE Yu-Chiang Hung 1,2, Chao-Hsien Chen 1, Yu-Chi Liu 1, Chun-Hung Hsu 1 1 Department of Chinese Medicine of Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan 2 School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan ( Received 5 th March 2009, accepted 26 th June 2009 ) This case is a 16-year-old girl, who visited our hospital because of poor appetite, proteinuria, loss of weight and hair. The medical diagnosis by the Rheumatology/ Immunology Division of Western Medicine was systemic lupus erythematosus. She was transferred to the Chinese Medicine and Rheumatology/ Immunology union outpatient service and took the treatment of both Chinese medicine and Western medicine (hydroxychloroquine sulfate, prednisolone and Jhih Bo Di Huang Wan). After three-month treatment, the levels of anti-double-strand DNA antibody (anti-ds DNA antibody, 1018.7 IU/mL) and erythrocyte sedimentation rate (ESR, 46 mm/hr) were significantly decreased to 125.1 IU/mL and 23 mm/hr, respectively. And the levels of C3 and C4 complements (31.2 and 2.3 mg/dl) were significantly increased to 87.5 and 9.09 mg/dl, respectively. The data of antids DNA antibody, ESR and complements C3 and C4 kept improving later (88.3 IU/L, 16mm/hr, 87.7 and 8.57 mg/dl, respectively). The hair loss and proteinuria also subsided. Therefore, the integrated treatment of traditional Chinese medicine and modern Western medicine was efficacious in this case. In addition, we found this patient's syndrome of yi-deficiency and yang-hyperactivity corresponded to the deficiency of the complements and hyperactivity of anti-ds DNA antibody. Key words: systemic lupus erythematosus, Jhih Bo Di Huang Wan, integration of Chinese and western medicine Correspondence to: Hung Yu-Chiang, Department of Chinese Medicine of Chang Gung Memorial Hospital, Kaohsiung, No.123, Dapi Rd., Niaosong Township, Kaohsiung County 833, Taiwan, Tel: +886-7-7317123 ext. 2333 2334, Fax: +886-7-7317123 ext. 2335, E-mail: e120845@adm.cgmh.org.tw