(203) Behcet syndrome

[HB KIM]

Behcet syndrome & Herbal Formulas

DEFINITION AND SYMPTOMS
Behcet syndrome is an inflammatory disorder producing recurrent mouth and genital ulcers.
AGE: most common between the age of 20 and 40
GENDER: more common in males
GENETICS: sometimes runs in families; more common in some ethnic groups
LIFESTYLE: not a significant factor

Behcet syndrome is a rare disorders that varies in severity.  The effects of the disorder range from difficulty eating to significant disability. Painful ulcers usually recur in the mouth and on the genitals.  Other symptoms include eye inflammation (uveitis), an acnelike rash, and/or small, tender lumps on the shins.  The brain, spinal cord, and joints (arthritis) may be affected, and there is an increased tendency for the blood to clot.

Behcet syndrome is an autoimmune disorder.  The cause of the abnormal immune reaction is unknown, but is may be triggered by viral infection.  The syndrome can develop in members of the same family and occurs more often in people of Japanese or Mediterranean origin, suggesting that genetic factors may be involved.  Behcet syndrome is twice as common in men and occurs most frequently in adults under age 40. 

Treatment in Western medicine:  Topical corticosteroid for the ulcers, eyedrops for eye inflammation, oral corticosteroids, immunosuppressant

Behcet syndrome is a chronic condition with symptom-free periods that may last weeks, months, or even years.  It rarely affects life expectancy.


DIFFERENTIAL DIAGNOSIS
1. Yin Deficiency with Toxic Heat : Si Miao Yong An Tang (Xuan Shen 16g, Jin Yin Hua 16g, Dang Gui 8g, Gan Cao 8g) + Qing Dai, Huang Lian, Zi Cao, Da Huang

2. Damp-Heat pouring downward : Long Dan Xie Gan Tang (Gan Cao 3g, Ze Xie 3g, Che Qian Zi 1.5g, Mu Tong 1.5g, Sheng Di 9g, Dang Gui 9g, Long Dan Cao 9g) / Er Miao San (Huang Bai 9g, Cang Zhu 9g)

3. Cold and Blood accumulation : Li Zhong Wan (Ren Shen 9g, Gan Jiang 9g, Zhi Gan Cao 9g, Bai Zhu 9g) / Tao Hong Si Wu Tang (Shu Di, Bai Shao, Dang Gui, Chuan Xiong, Tao Ren, Hong Hua)

4. LV and KD Yin deficiency : Qi Ju Di Huang Wan (Sheng Di, Shan Zhu Yu, Fu Ling, Shan Yao, Mu Dan Pi, Ze Xie, Gou Qi Zi, Ju Hua)


Empirical Herbal Formula
(1) Empirical formula 1: Nourish Yin, Strengthen SP, Transform Damp
Shi Hu 5g, Xuan Shen 15g, Tian Men Dong 15g, Mai Men Dong 15g, Fu Ling 12g, Che Qian Zi 12g, Hou Po 6g, Huang Lian 5g, Lian Zi Xin 6g, Gan Cao 6g, Yu Zhu 9g, Bai Zhu 6g

(2) Empirical formula 2:  Warm Yang, Benefit Qi, Clear Toxic-Heat
Dang Shen 12g, Huang Qi 30g, Fu Zi 9g, Gan Jiang 3g, Xian Mao 9g, Huang Lian 9g, Huang Bai 6g, Bai Hua She She Cao 15g, Ku Shen 9g, Mu Dan Pi 9g, Jin Yin Hua 15g, Gan Cao 9g

(3) Empirical formula 3:  Clear HT and Toxic-Heat, Clood Blood, Nourish Yin
Mu Tong 5g, Huang Lian 10g, Sheng Di 10g, Huang Qin 15g, Jiu Da Huang 5g, Deng Xin Cao 3g, Zhu Ye 5g

(4) HB's choice for Behcet syndrome: Wen Qing Yin (Huang Lian Jie Du Tang + Si Wu Tang)
Huang Lian Jie Du Tang calms down the sympathetic nerve system, and Si Wu Tang regulates luekocytosis for inflammation.  This is the first formula I would consider for Behcet syndrome in my practice.