Sarcoidosis is an immune-system-based disease in which an excess production of cytokines (immune system messengers) leads to a type of inflammatory process. The cause of the disease is unknown, but is assumed to involve one or more of a viral infection, bacterial infection, or environmental antigen; it can also occur with immune-based drug therapies, such as interferon administration. There is a genetic component that contributes to a higher incidence of sarcoidosis among northern Europeans (especially Swedes) and among American blacks. Sarcoidosis rarely occurs in the Orient, making it difficult
to obtain direct information about traditional Chinese medical treatment of the disease.
The defining characteristic of the disease is formation of granulomas, accumulations of immune cells that are normally intended to surround and neutralize bacteria or other foreign bodies. In sarcoidosis, the granulomas don’t form an encasement. The most common site for granuloma formation is in the lymphatic system, but they also appear in the lungs, liver, eyes, skin, and joints. The site of the main disease manifestation is related to the extent of cytokine deposition by activated immune cells in different parts of the body.
Each of the granulomas may completely resolve (as usually occurs with infection-induced granulomas) or they may proceed to a fibrotic stage. Over time, increasing numbers of granulomas and accumulation of fibrotic tissue can disrupt normal body functions; the specific symptoms will depend on the sites of accumulation. On the other hand, many patients remain largely asymptomatic with limited levels of granuloma formation.
Sarcoidosis often remits spontaneously and may have a course of several months or years before clearing up. Remission rates are as high as 85% after 9 years, and the remission rate for groups of patients appears to depend on both the disease site and genetic background. About 10% of patients develop serious disability, such as ocular damage, respiratory impairment, or liver damage, but the mortality is low (rated as less than 3%), and is primarily associated with the pulmonary development of the disease.
The main treatment, when anything is offered, is to administer corticosteroids, as these drugs will inhibit the granuloma formation and, thereby, relieve symptoms. However, such treatment is not expected to alter the overall disease process. Due to the adverse effects of long-term administration of steroids, the treatment is usually administered only temporarily (up to a year)
CHINESE HERBS
In the absence of direct reports of sarcoidosis treatment from the Orient, the approach of using Chinese herbs must be pursued by utilizing a traditional Chinese medicine interpretation of all available data.
Characteristics of the disease during its early stages involve accumulation of material (granulomas), representing a type of excess pattern. The granulomas initially are soft and resolvable small masses, having a tendency to swell the lymph nodes (they can also swell the liver, spleen, or other organs), implying formation of a “phlegm-mass.” Fever is present in many patients, but is not universal. The tendency to have fever may imply the role of damp-heat rather than cold-damp in terms of the excess syndrome. Herb formulas that are traditionally aimed at resolving phlegm masses and, especially those that treat lymph node swellings, are appropriate to consider. The persistence of a progressive disease also suggests the presence of a “toxin” in accordance with the use of the term in Chinese medical texts; therefore, herbs for removing toxin would be a reasonable component of the therapy. Antitoxin herbs may inhibit viruses and bacteria that can contribute to the disease.
From the traditional perspective, because this disease develops gradually-with the internal organs being affected and no obvious external causative factor-it would likely be deemed to arise primarily as the result of emotional disturbance. Accumulative disorders are often ascribed to liver/spleen type syndromes, in which anger, anxiety, and worry contribute to the organ system problems. The splenic disorder leads to the phlegm-accumulation (the spleen fails to transform and transport the food-based fluids) and the liver disorder leads to stagnation and formation of localized accumulations. Of course, other emotions can contribute the syndrome, such as grief affecting the lungs, causing the phlegm to accumulate and impeding proper circulation of fluids downward (with the lungs being a primary site of attack in sarcoidosis). Therefore, addressing emotional conditions is potentially important to the therapy. The “toxin” component of the disease would be an outside influence, such as a virus or a drug, affecting a person with the predisposing factors that include emotional effects on the internal organs and genetic background.
Dietarily, one would expect that an excess type diet, which allows phlegm to accumulate, should be avoided in an effort to resolve sarcoidosis. Fruits and non-fatty vegetables (e.g., broccoli but not avocado) would be an important therapeutic dietary component, while fatty meats, especially pork, and all kinds of heavy deserts would be contraindicated. Fish, which is used in Chinese dietetics to drain excess dampness, would be appropriate. Alcohol, which contributes to dampness and heat, on the other hand, would be contraindicated; green tea might be the ideal beverage, as it is considered cooling and phlegm-resolving. Acupuncture therapy for sarcoidosis would be aimed at draining excess, and especially resolving phlegm accumulation, while herbal therapies can be used to address the more general characteristics of the disease.
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