Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of large amounts of autoantibodies and the formation of immune complexes, which can easily lead to multisystem damage in the nervous system, respiratory system, digestive system, and hematological system, with a poor prognosis [1]. According to its clinical characteristics, it is roughly equivalent to warm toxin hair spots in Chinese medicine, and has the names of “yin and yang toxin”, “butterfly sore”, “sun sore”, and “ghost face sore It is known as “Yin Yang Poison”, “Butterfly Dan”, “Sun Sore” and “Ghost Face Sore”. As early as in the “Jin Kui Yao Yao”, there is a description of the disease: “Yang poison for the disease, the face red spots like brocade, sore throat, spit pus and blood; Yin poison for the disease, the face green, body pain like being staff, sore throat.” The author used Chinese medicine to treat the disease to achieve better results, is introduced as follows. Li Songwei, Department of Rheumatology, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine, China1 The pathogenesis of the disease is discussed in Chinese medicine, which believes that the kidney is the origin of the congenital, the main yin and yang, the kidney collects essence, while the liver collects blood, and the essence and blood of the liver and kidney are homologous. There is an obvious genetic predisposition for the disease, with the risk of developing SLE among first-degree relatives of SLE patients being about 20 times higher than that of the general normal population [2], and the concordance rate for the onset of the disease in identical twins being as high as 24%, compared with only 2% in dizygotic twins [3]. This suggests that the disease is closely related to congenital endowment deficiency and that deficiency of kidney essence is the basis for the pathogenesis of SLE. Also, the study confirmed that there is a significant gender difference in the onset of the disease, with a male to female ratio of 1:9, and it mainly occurs in women of childbearing age. “The liver is the precursor of women, and women lose yin blood month by month during menstruation, so women have a deficiency of liver blood, and “liver and kidney essence and blood are of the same origin”, which leads to liver and kidney yin deficiency over time. It is presumed that deficiency of liver and kidney yin and blood is the main basis of SLE, and the deficiency of liver and kidney yin and blood makes water deficiency and fire easy to generate internal heat. On this basis, due to exposure to sunlight or cold, the two yangs will combine and heat toxins will be rampant, injuring the blood channels and forcing the blood to move deliriously, resulting in strong heat and thirst, sores on the mouth and tongue, skin rashes, blood in urine or stool, and even delirium. Due to the deficiency of liver and kidney yin, deficiency of heat, or heat toxicity consumes qi and injures yin, the patient may suffer from erythema on the face, loss of body weight, fatigue, irritable heat, dry eyes and mouth, insomnia and dreaminess, hair loss, etc. Liver and kidney yin deficiency, yin deficiency and yang hyperactivity, internal movement of liver wind, easily appearing dizziness, bitterness in the mouth, dizziness, headache, twitching of hands and feet, irritability, mental abnormality, etc. Due to the lack of emotion, the liver loses its control, the qi stagnates and blood stagnates, the tendons and veins are paralyzed and obstructed, and the limbs, joints and muscles are sore and painful, the mouth is bitter, and the ribs are painful. Liver stagnation and qi stagnation, liver wood multiplied by spleen, spleen mastering the limbs, spleen loss of health, stagnation of water and dampness, body sleepiness and weakness. Due to overwork, depletion of liver and kidney, Yin deficiency and fire, Qi and blood rebellion, the condition is repeated or aggravated. Insufficient kidney yin, yin loss and yang over time, yin and yang deficiency, or spleen and kidney deficiency, lung and kidney deficiency, kidney qi deficiency, kidney deficiency, spleen deficiency, lung deficiency, water-damp stagnation, palpitations, shortness of breath, cough, asthma, chest tightness, nausea and vomiting, poor circulation, swelling of limbs, ascites, proteinuria, tubular urine, hematuria and other manifestations. In addition, sun exposure, cold weather, depression, overexertion and excessive spicy food are important factors leading to the triggering or aggravation of the disease. In addition, stasis of blood is also involved in the pathogenesis of SLE, which is vasculitis in nature, with a large number of immune complexes deposited in the blood vessels, and these patients tend to have high fibrinogen and increased blood viscosity, suggesting the presence of microcirculatory disorders, i.e., stasis of blood [4,5]. The causes of stasis may vary from heat toxicity burning the yin and fluid to stasis, or yin loss and yang to stasis due to cold, or qi deficiency and weakness to stasis. Clinical manifestations are: frostbite like skin lesions, Raynaud’s phenomenon, gangrene of the extremities, numbness of the extremities, skin petechiae, enlarged liver and spleen lymph nodes, irregular menstruation or amenorrhea, and even pulmonary hypertension in some cases. The tongue is dark or with petechiae, the veins at the base of the tongue are tortuous, and the pulse is astringent. 2 Evolution of symptoms and treatment 2.1 Initial main manifestations: joint and muscle pain, body sleepiness, dry mouth, facial erythema, skin itching, nodular erythema, frostbite like lesions, Raynaud’s phenomenon, etc. The tongue is light red, with thin white coating or yellowish greasy coating and smooth pulse. This stage is easily overlooked. Laboratory tests mostly show anti-nuclear antibodies (+), anti-Sm (+), anti-SSA (+), anti-U1RNP (+), and mild hypocomplementation. This period is mostly due to the feeling of wind-damp-heat poison, paralyzing the joints and muscles, resulting in the poor flow of Qi and blood. Treatment should be to dispel wind and clear heat and detoxify dampness. Commonly used is Fangqi Dihuang Tang. Main drugs: Radix Rehmanniae, Radix Paniculatae, Radix Bupleuri, Radix Cinnamomi, Radix Paeoniae Alba, Radix Paeoniae Alba, Radix Wei Lingxian, Radix Haifengtang, Radix Lonicerae, Radix Dilaemon, Radix Ouzhoki. If the pain in the joints of the limbs is obvious, add Bonesetter and Scorpion to activate blood circulation and relieve pain; if the erythema itch is obvious, add Cicadelle, Bitter Ginseng, White Fresh Peony and Ling Xiao Hua to cool the blood and dispel wind and relieve itch; if the nodular erythema is obvious, add Mudanpi, Bile South Star, White Mustard Seed, Saponaria, Zhe Bei Mu and Wang Bu Li Xing to clear heat and dissolve phlegm and disperse knots; if the frostbite like skin lesion and both hands are Raynaud, add Ghost Arrow Feather, Dan Shen, Chicken Blood Vine, Shu Di and Ma Huang to nourish blood and promote circulation. 2.2 The main manifestations of the acute active stage are: high fever that does not subside, vague facial or generalized rash, even bleeding tendency, oral ulcers, thirst and drinking, chest tightness and chest pain, weakness, swelling of limbs, irritability and insomnia, or even delirium, twitching of limbs, red or reddish-red tongue, yellowish greasy and dry coating, and slippery pulse. This stage is mostly severe lupus, often combined with damage to multiple organs, such as the kidneys, hematological system, nervous system, digestive system and circulatory system. Laboratory tests mostly show anti-nuclear antibodies (+), anti-Sm (+), anti-dsDNA (+), markedly low complement, markedly elevated blood sedimentation, C-reactive protein, immunoglobulin and other inflammatory indicators, and large amounts of urinary protein. This period is mostly characterized by incandescent heat toxicity and burnt Qi and Ying. This is due to heat and toxicity in the Qi and Ying divisions, forcing the blood to move, decocting the fluid and blood, and causing Qi and blood rebellion. Treatment is to clear the heat and detoxify the toxin, clear the camp and cool the blood. Rhizoma Rhizoma Dihuang Tang combined with Qing Ying Tang is used. For those who have fever, dense rash, we can strengthen the function of clearing heat and detoxifying; for high fever that does not subside, add antelope horn powder, Artemisia annua, gypsum and Zhi Mu; for those who have faint rash on face or whole body, add Zi Cao, Xian He Cao, Bai Mao Root, etc. to cool the blood and stop bleeding; for delirium, add Angong Niu Huang Wan, for convulsions, add Zi Xue Dan; for combined plasma membrane inflammation, add Draba Draba, White Mustard Seed, Zhe Bei Mu, Xiang Xiang Shen, Whirlpool Flower, etc. In cases of combined liver function abnormalities and liver and spleen enlargement, add Yin Chen, Wu Wei Zi, vinegar turtle nail and Yu Jin to remove liver stasis and soften the firmness. 2.3 The main manifestations of the remission period are: swelling of the face, dry throat, irritability and insomnia, heat in the hands and feet, shortness of breath, weakness, swelling of the limbs, red tongue with little moss and fine pulse. In this stage, the disease is in remission and the degree of organ damage is mild. Laboratory tests mostly show anti-nuclear antibody (+), anti-Sm (+), mildly elevated or normal anti-dsDNA titers, mildly low complement, often mildly abnormal blood sedimentation, C-reactive protein, immunoglobulin and other inflammatory indicators, often combined with urine protein (+ to +++), anemia, low platelets or white blood cells, etc. This period is mostly seen in the late stage of febrile illness, where heat toxicity depletion causes internal heat due to yin deficiency. The treatment should be to nourish Yin and clear heat. The main drugs are: Zhi Mu, Huang Bai, Sheng Di, Cornus officinalis, Shan Yao, Ze Di, Mudan Pi, Fu Ling, etc. For dry mouth and eyes, add sage, asparagus, dendrobium, smallpox, Erzhiwan, etc. to nourish yin and promote fluid; for swollen limbs, add kozozi, poria soup, zelen, etc. to nourish yin and dispel dampness; for proteinuria, add mulberry, atractylodes, gorgonian, motherwort, etc. to nourish the kidneys, strengthen the spleen and remove stasis; for recalcitrant thrombocytopenia, add forsythia, senghuang, pu huang, etc. to detoxify and activate blood and stop bleeding. 2.4 Main manifestations in the stable phase: lumbar Sore knees, fatigue, dry mouth, hair loss, fear of cold, light red tongue, thin white fur or less fur, sunken or weak pulse. The disease is relatively stable in this stage and there is no obvious organ damage. Laboratory tests mostly show anti-nuclear antibody (+), anti-Sm (+), mildly elevated or normal anti-dsDNA titers, mildly low or normal complement, often mildly elevated or normal blood sedimentation, C-reactive protein, immunoglobulin and other inflammatory indicators, some with a small amount of urine protein, mild anemia or low white blood cells. Some patients develop osteoporosis and even femoral head necrosis, etc. This period is often characterized by weakness of positive energy, mainly deficiency of both qi and yin, or yin and yang. Treatment is to benefit qi and nourish yin, and to nourish the spleen and kidney. The main drugs are: Radix Rehmanniae, Cornu Cervi Pantotrichum, Yam, Poria, Radix Codonopsis, Rhizoma Atractylodis Macrocephalae, Radix Angelicae Sinensis, Radix Paeoniae Alba, Radix et Rhizoma Glycyrrhizae. For those with fatigue, coldness and fear of cold, add Astragalus, Xian Ling Spleen, Bacopa monniera, etc. to benefit Qi and warm Yang; for those with soreness and pain in the waist and knees, add Mulberry, Eucommia, Radix et Rhizoma, Boneset, Boneset, etc. to tonify the kidney and strengthen the waist; for those with combined femoral head necrosis, add turtle worms, natural copper, Di Long, Angelica, Salvia, Boswellia, Myrrh, etc. to invigorate the blood and open the channels on the basis of tonifying the kidney and strengthening the waist. The above staging is relative, and should be applied flexibly in clinical practice based on the principle of evidence-based treatment. Since blood stasis is involved in the pathogenesis of the disease, blood activating and energizing products should be added regardless of the stage, commonly used are red peony, peony skin, angelica, ghost arrow feather, danshen, panax notoginseng, chicken blood vine, dilong, and purple grass [6].3 The importance of combining Chinese and Western medicine in the treatment of SLE is particularly evident, especially in the acute active stage of SLE, combined with the injury of important organs In particular, in the acute active stage of SLE, combined with the damage of important organs, high dose hormone or even hormone shock and immunosuppressive therapy should be given, and in the case of combined infection, gammaglobulin shock therapy should be used, and even plasma exchange or immunosorbent therapy should be performed if necessary, in order to reverse the disease and avoid the damage of important organs. At this stage, it is difficult to control the disease with Chinese medicine alone, and the combination of the two is beneficial to the remission of the disease as soon as possible. Chinese medicine has significant efficacy in controlling the progression and recurrence of the disease, and also has certain advantages in improving the toxic side effects of western medicine. Patients taking glucocorticosteroids for a long time often show signs of Yang Qi deficiency, such as weakness, coldness, weakness of the waist and knees, swelling of the limbs, etc. This is related to the decrease in adrenal cortical function caused by long-term use of glucocorticosteroids. Right Guei Pill can be given in chemotherapy to tonify the kidneys and warm yang, using: Fructus Lycii, Xian Ling Spleen, Xian Mao, Sang Sang Sang, Astragalus, Cuscuta, Cornu Cervi Pantotrichum, Yam, Shu Di, and Turtle Board, which facilitates the withdrawal of hormones [7]. It also has a good effect on the prevention and treatment of glucocorticoid-induced osteoporosis and femoral head necrosis.4 Typical case Patient, female, 27 years old, first diagnosed on March 11, 2014. The patient was diagnosed with SLE in a provincial hospital in June 2011 due to facial butterfly erythema, arthritis, and pleural effusion, etc. She was given prednisone 50 mg/day and hydroxychloroquine sulfate 0.2/day, and the hormone was reduced after the symptoms subsided. markedly, with fever, insomnia, dry mouth, five heartburn, pain in both hips, red tongue, yellowish coating, and slippery pulse. Blood: platelets 65×109/L. Urine: urine protein (++). 24-hour urine protein quantification 2.8 g. Anti-nuclear antibody 1:3200 (granular), anti-U1RNP (+), anti-Sm (+), anti-dsDNA (+). 25 g/L IgG (7-16 g/L), 3 g/L IgA (0.7-4 g/L), 4.7 g/L IgM (0.4-2.6 g/L). 0.4-2.6 g/L), complement C3 0.4 g/L (0.9-1.8 g/L), C4 0.05 g/L (0.1-0.4 g/L); hematocrit 90 mm/h; C-reactive protein 110 mg/L (0-5 mg/L). Chest CT suggested pericardial effusion (moderate amount), enlarged mediastinal lymph nodes, and splenomegaly. Combined with the clinical manifestations, the diagnosis of SLE was made in the acute active stage with combined hematologic and renal damage, and the hormone dosage should be increased to control the progression of the disease. However, the patient refused to increase the dosage of hormone in consideration of femoral head necrosis, and requested to use Chinese herbal medicine as the main treatment based on the existing western medicine. Combining his symptoms with his tongue and pulse, he was identified as having heat toxicity with liver and kidney yin deficiency. The treatment is to clear heat and detoxify the toxin, cool the blood and nourish Yin. The medicine used: 15g of Artemisia annua, 30g of honeysuckle, 15g of forsythia, 15g of shouluo, 30g of raw groundnut, 15g of red peony, 15g of white peony, 15g of peony peony, 15g of peony bark, 15g of xuan shen, 10g of maitong, 20g of comfrey, 15g of cicada molasses, 30g of groundnut, 15g of white fresh peel, decoction in water, 1 dose daily. He had a good spirit and reduced thirst, but still had pain in both hips and soreness in the waist and knees, with a red tongue, yellow tongue coating and a slightly thin pulse. He was rechecked with platelets of 90×109/L, 24-hour urine protein of 2.0g, blood sedimentation of 40mm/h, C-reactive protein of 65mg/L. The treatment was adjusted to clear heat and cool blood, nourish Yin and tonify kidney. On April 3, 2014, the patient’s erythema on the face and trunk did not reappear, and the pain in the lumbosacral region was significantly reduced. On the fourth consultation on April 17, 2014, the patient’s hip pain disappeared and the routine blood test was repeated: platelets 150×109/L, urine protein (-), 24-hour urine protein 0.3g, immunoglobulin and complement were normal, blood sedimentation 25mm/h, C-reactive protein 17mg/L. No significant adverse reactions were complained during the course of drug administration. Prednisone 20mg/day was recommended to be reduced regularly, hydroxychloroquine 0.2/day and Chinese herbal medicine was slightly used for consolidation. 3 months later, the patient was followed up and the prednisone had been reduced to 10mg/every other day and the condition had been stable.