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Saturday, 2 November 2013

Cerebritis, Lupus, and Lupus Cerebritis

Cerebritis is defined as an inflammation of the cerebrum, a structure associated with memory, speech, etc., as a result of the formation of an abscess within the brain itself, found commonly in patients with lupus.

Systemic lupus erythematosus (SLE) or Lupus is a chronic, autoimmune disease as as a result of the development of autoantibodies that attack the systems and organs in the body.researchers at the indicated that saturated fatty acid palmitate, but not unsaturated oleate, induces the activation of the NLRP3-ASC inflammasome, causing caspase-1, IL-1β and IL-18 production.

Lupus cerebritis is a disorder of nervous system problems (an autoimmune inflammatory disorder) caused by lupus as as a result of the development of autoantibodies that attack the systems and organs in the body. It causes migraine headache, if the duration of the central nervous system involvement last for a few minutes, or causes dementia that can lead to neurological deficits as a transient attacks or permanently.

A. Symptoms
Common symptoms include
1. Slurred speech
2. Confusion
3. Nausea and dizziness
4. Visual disturbances
5. Mood changes
6. Memory loss
7. Swelling
8.  Headaches, depression, anxiety
9.  Seizures
10. However, symptoms of cerebritis in some cases can evolve and worsen quickly as patients may develop severe and life-threatening conditions including stroke and heart-related death-causing diseases.
11. Etc.

B. Causes
Cerebritis can be caused by an infection due to bacteria, viruses invasion and pathogens invasion into
the brain through the sinuses or as a result of trauma
1. Gene
Research at the Oklahoma Medical Research Foundation, published in the April 6 issue of the American Journal of Human Genetics describes three lupus genes discovered by OMRF researchers as part of a massive international collaboration, by Using samples from a wide range of ethnic backgrounds, scientists found the genes IRF8 and TMEM39a were associated with lupus in European-American, African-American, Gullah and Asian patients. A third gene named IKZF3 was only significant in African-American and European-American samples."Identifying and characterizing these genetic risk factors in lupus will undoubtedly lead to improved diagnostics and therapeutics for this complex disease," said senior author and OMRF scientist Kathy Moser, Ph.D.(18)

2. Klebsiella pneumoniae
Klebsiella pneumoniae is defined as a form of bacterial pneumonia associated with Klebsiella pneumoniae. In a report of a case of Klebsiella cerebritis in an adult patient with a proven extracranial focus of infection, researchers suggested considering cerebritis as a differential diagnosis for altered level of consciousness in patients of severe sepsis, even if an extracranial source of infection is proven.(2)

3. Autoimmune system dysfunction
Some researchers found that the interactions between elevations of serum prolactin (PRL)[1], cytoquines[2], autoantibodies[3] and organ involvement[4] suggest that PRL participates in local and generalized immune and inflammatory processes and acts as a bridge between the neuroendocrine and immune systems in SLE. Understanding the interactions between these systems in systemic lupus erythematosus (SLE), will help us to understand and treat this important autoimmune disease(3)

[1]. Elevations of serum prolactin (PRL)
In a study of conducted by Centro Medico Nacional La Raza, showed that elevated PRL and interleukin (IL)-6[5] have been found in the urine of patients with active lupus nephritis and in cerebrospinal fluid (CSF) of patients with active central nervous system (CNS) SLE. PRL may therefore participate in the pathogenesis of lupus nephritis and cerebritis, and the presence of PRL may reflect an abnormal communication between the immune system and the neuroendocrine system in active SLE. Lymphocytes from patients with active SLE produce increased amounts of PRL, and this extrapituitary PRL may participate in aberrant immune processes in SLE.(3)

[2]. Cytoquines
Cytoquines is a small protein released by cells that has a specific effect on the interactions between cells, on communications between cell, or on the behavior of cells. There a report that the final mechanism of lupus cerebritis involves the cytokines. The cytokines trigger edema, endothelial thickening, and infiltration of neutrophils in brain tissue. Two cytokines, interferon alpha and interleukin-6, have been found in the CSF of SLE patients with psychosis(4)

[3}. Antibodies
In the study to investigate the possibility that idiotypes (Ids) defined on anti-double stranded DNA (dsDNA) antibodies during active and inactive stages of lupus (1/84 Id and 4/90 Id, respectively) were expressed on anti-DNA antibodies during a subsequent active period (9/90) of the disease, researchers at the St. Luke's Hospital showed that they are of related clonal origin. The present study suggests the idiotypic heterogeneity of anti-DNA antibodies and the shift of antigen specificity within an idiotypically related anti-DNA population during exacerbation of the disease.(7)

[4] Organ involvement
In the report there are few data on the relationship between the onset of new organ involvement and lupus serologies, especially in children, found that in managing two children with lupus nephritis, both developed life-threatening extrarenal complications (cerebritis and carditis) soon after receiving high-dose immunosuppressive therapy and despite normalizing serologies. This lack of concordance between serologies and the development of carditis and cerebritis needs to be recognized so that health care professionals treating children with SLE can promptly intensify immunosuppressive medications and avoid life-threatening delays from seeking alternative explanations for symptomatology.(5)

[5]. Interleukin (IL)-6
Interleukin (IL)-6 secreted by T cells and macrophages to stimulate immune response has the function to act  both a pro-inflammatory and anti-inflammatory cytokine.[see Cytoquines]

[6]. DNA and anti-DNA complexes
Circulating immune complexes, consist of DNA and anti-DNA, cause an inflammatory response as well as a disruption of the blood-brain barrier. There is a report that the number of patients with the SLE manifestations was not higher in the group with the high amount of DNA in immune complexes. Elevated levels of DNA in immune complexes was found only in sera of SLE patients with the active, as well as quiescent form, of the disease and not in sera of healthy donors. The presence of increased amounts of DNA antigen in circulating immune complexes could indicate the presence of SLE pathology even if no manifestations of SLE are found.(6)

[7]. Etc.

C. risk factors
1.  Ultraviolet light 
exposure to ultraviolet light increases the risk of as it can exacerbate lupus by modulation of the immune system at the level of the skin. It has also been found that ultraviolet light can lead to the formation of antinuclear antibodies.(8)

2. Pegylated interferon therapy
People who are in treatment with  receiving pegylated interferon monotherapy may increase the risk of Lupus activation with cerebritis(9)

3. Gene mutation 
An international team of researchers led by Chaim O. Jacob, associate professor of medicine and microbiology & immunology at the Keck School of Medicine of USC, has identified a gene mutation involved in causing lupus, a chronic inflammatory disease that affects the skin, joints and organs, posted in the Dec. 26 online edition of the Proceedings of the National Academy of Sciences.(19)

4. Other risk factors
Risk factors were more present in bacterial infections of the nervous system and cerebrit than in virus infection of CNS. In virus infections of the CNS, 28% of patients had some risk factor, most often-chronic ethylism[1], diabetes mellitus[2] and acquired heart diseases[3]. In bacterial infections of the CNS, 64% of patients had some predisposed factor. The most frequent factor of risk in these patients were chronic otitis[4] (21.6%) and cranio-trauma[5] (14.4%). In cerebritis, risk factors were present in 76% of patients and they were: sepsis[6] (20%), chronic otitis[7] (12%) and systemic lupus erythematosus[8] (8%).(10)

Diagnosis
There is no specific standard for the diagnosis, bur some researchers suggested
the following
1. Serologic tests
Is the test to measure the levels of specific antibodies in a patient's blood, the test is essential as the antinuclear antibody (ANA) titer is positive in virtually all patients with this disorder, but some researchers showed that serologic tests are helpful in establishing the diagnosis of SLE and predicting disease flares. However, there are few data on the relationship between the onset of new organ involvement and lupus serologies, especially in children.(11)

2. Electroencephalography (EEG) 
Electroencephalography (EEG) is to record the measurement of voltage fluctuations resulting from ionic current flows within the neurons of the brain. In a report of a 13-year-old girl with a known diagnosis of systemic lupus erythematosus presented with seizures and psychosis. An electroencephalogram (EEG) revealed continuous, non-evolving periodic lateralized epileptiform discharges (PLEDs) in the left temporal region, which did not resolve with benzodiazepine. A magnetic resonance imaging (MRI) brain scan demonstrated a focal hyperintensity in the left medial temporal and left occipital lobes, left thalamus and bilateral cerebellar white matter, with evidence of vasculitis in the magnetic resonance angiography. Intravenous immunoglobulin was given because of failed steroid therapy, which resulted in a full resolution of clinical, EEG and MRI abnormalities. Lupus cerebritis should be considered as a possible aetiology in (Focal (Nonepileptic) Abnormalities on EEG) PLEDs, and immunoglobulin can be effective in neuropsychiatric lupus.(14)

3. Computed tomography (CT scans)
In the study of thirty-four patients from the Jackson Memorial Hospital and Miami Veterans Administration Medical Center complex with 4 or more ARA criteria for SLE had CT of the brain. Of these patients with SLE, 14 had clinical features of cerebritis and 20 without cerebritis on longterm steroid therapy served as controls. Clinical examinations were performed by 1 of our group (NG). The CT of the brain was independently read by 2 neuroradiologists (SO and RQ), whose only knowledge of the patients was their age, sex and the diagnosis of SLE, showed that some abnormality of the brain by CT was present in 11/14 patients during their 1st attack of SLE cerebritis. At the initial presentation with SLE cerebritis, 9 of 14 patients had marked cortical atrophy by CT and 2 had minimal cortical atrophy. At that time, a normal CT was found on 3 patients with SLE cerebritis. Two of these patients were on 30 and 40 mg prednisone at the time of the normal CT. The 3rd had been on corticosteroids previously but not in 4 months prior to the normal CT. Corticosteroids were administered in all 3 patients and after remission and reexacerbation of SLE cerebritis, repeat CT demonstrated development of marked cortical atrophy in 2 of these patients and minimal cortical atrophy in the other. The role of corticosteroids in their cortical atrophy is unclear.(12)


4. A magnetic resonance imaging (MRI)
Most systemic lupus erythematosus patients having central nervous system involvement tend to have abnormal MRI scans, as cerebral edema that can occur due to cerebritis can be effectively identified by MRI scan(13) 

5. Etc. 

Prevention
A. What to avoid
Any thing which cause inflammation must be avoid. thyere is a report found that SLE patients and lupus-prone mice induces skin inflammation following intradermal injection into normal mice. Lupus serum depleted of IgG failed to cause skin inflammation(36). including
1. Sugar
Refined sugar with high glycemic values cause fluctuation of insulin levels and put the immune system on high alert. In the evaluation of one hundred and eleven serum samples were assayed from patients with Graves' disease, primary hypothyroidism, chronic autoimmune thyroiditis, Addison's disease, chronic autoimmune hepatitis, pernicious anemia, lupus erythematosus, and rheumatoid arthritis, together with 45 serum samples from normal subjects, conducted by Clinic of Endocrinology, University La Sapienza, showed that contrary to expectation anti-immunoglobulin antibodies are not associated with non-diabetes-related autoimmune diseases, increased humoral immunoresponsiveness to endogenous insulin appears to be related to autoimmunity in general rather than restricted to Type I diabetes.(33)

2. Saturated and trans fat
Saturated fat and trans fat  trigger and stimulate the immune system's inflammatory response. In the study of Fatty acid–induced NLRP3-ASC inflammasome activation interferes with insulin signaling, Dr. Haitao Wen, and the team indicated that High-fat diet (HFD) and inflammation are key contributors to insulin resistance and type 2 diabetes (T2D). Interleukin (IL)-1β plays a role in insulin resistance, yet how IL-1β is induced by the fatty acids in an HFD, and how this alters insulin signaling, is unclear. We show that the saturated fatty acid palmitate, but not unsaturated oleate, induces the activation of the NLRP3-ASC inflammasome(34)
3. Diary products
Diary products can cause allerdic effect that lead to the production immunoglobulin E antibodies, histamine, etc., causing immune system malfunction.

4. Process foods
In an article of Inflammatory Foods, Consider avoiding to achieve Natural remission in RA, the author wrote "often times people reduce the intake of inflammatory foods but fail to recognize all the hidden places, generally in processed foods, that these foods are being consumed. Many arthritic symptoms are triggered by allergies" (35) that can lead to inflammation.

5. Smoking and alcohol
In the assessment of whether smoking or alcohol consumption is associated with lupus erythematosus (LE), conducted by Place de l'hôpital, Dr. Boeckler P and the team showed that cigarette smoking is associated with LE, but alcohol consumption is not. The risk conferred by cigarette smoking seems highest in patients who meet fewer than 4 ACR criteria and/or who do not have antinuclear DNA antibodies(37)

6. Refined products
Refined grains pattern was positively related to sICAM-1 (P for trend = 0.007)(38)

7. Artificial ingredients
There is a report that scientists disagree about the relationships between sweeteners and lymphomas, leukemias, cancers of the bladder and brain, chronic fatigue syndrome, Parkinson's disease, Alzheimer's disease, multiple sclerosis, autism, and systemic lupus.(39)


8. Allergic effects
Allergic effect can increase the risk of the development of lupus as a result of inflammation caused by  immune system malfunction.


9. Etc.


B. Diet against Lupus
1. Deep see fish (such as Salmon)(24)
a. Antioxidants
In the research of the antioxidant effect of vitamin E after ingestion of salmon found that that megadoses of vitamin E, far from having pro-oxidative activity, actually increase the anti-oxidative capacity of the liver, especially after ingestion of salmon oil, according to "Effects of megadoses of dietary vitamin E on the antioxidant status of rats fed lard or salmon oil" by Flader D, Brandsch C, Hirche F, Eder K.(e)

b. Vitamin D
Vitamin D not only is important to the heart health with calcium supplementation, according to "Systematic review: Vitamin D and calcium supplementation in prevention of cardiovascular event` by Wang L, Manson JE, Song Y, Sesso HD.(Ia) but also plays an vital role in epidemiological associations between vitamin D status and a large number of autoimmune and inflammatory diseases, according to "Vitamin D and inflammation" by Guillot X, Semerano L, Saidenberg-Kermanac'h N, Falgarone G, Boissier MC.(I)

c. Omega 3 fatty acids
Omega 3 fatty acids is necessary to maintain the ratio of good and bad cholesterol, thus reducing the risk of cholesterol inflammation according to the study of "In vitro fatty acid enrichment of macrophages alters inflammatory response and net cholesterol accumulation" by Wang S, Wu D, Lamon-Fava S, Matthan NR, Honda KL, Lichtenstein AH., posted in PubMed (IV) and forming of free radical in the heart cells, leading to heart diseases. It also reduces the risk of plaque forming in the arterial wall, thus also decreasing the risk of stoke, according to the study of "N-3 vs. saturated fatty acids: effects on the arterial wall" by by Sudheendran S, Chang CC, Deckelbaum RJ.

d. Anti inflammationIt is said the Omega 3 fatty acids beside reduced the risk of inflammatory effects on our joints and improved blood flow, by regulating the migration of inflammatory cells that cause inflammation, but also autoimmune diseases as a result of the elevation of IL-1 and the proinflammatory leukotriene LTB(4) produced by omega-6 fatty acids, according to the study of "Omega-3 fatty acids in inflammation and autoimmune diseases" by Simopoulos AP.

e. Etc.


2. Olive oil(25)
a.  Antioxidants and weight loss
In the
analyzing the influence of a Mediterranean dietary pattern on plasma total antioxidant capacity (TAC) found that Mediterranean diet, especially rich in virgin olive oil, is associated with higher levels of plasma antioxidant capacity. Plasma TAC is related to a reduction in body weight after 3 years of intervention in a high cardiovascular risk population with a Mediterranean-style diet rich in virgin olive oil, according to "A 3 years follow-up of a Mediterranean diet rich in virgin olive oil is associated with high plasma antioxidant capacity and reduced body weight gain" by Razquin C, Martinez JA, Martinez-Gonzalez MA, Mitjavila MT, Estruch R, Marti A.(c)

b. Free radical
Oleic acid contains high amount of andioxidant that helps to improve the immune system in fighting against the forming of free radicals cause of lipid peroxidation , according to "Effect of dietary high-oleic-acid oils that are rich in antioxidants on microsomal lipid peroxidation in rats" by Perona JS, Arcemis C, Ruiz-Gutierrez V, Catalá A.

3. Romaine Lettuce(26)
a. Antineurodegenerative effect
In the investigation of Phenolics extracted in fresh romaine lettuce and its effect on on biological protection for neuron-like PC-12 cells found that total phenolics and total antioxidant capacity of 100 g of fresh romaine lettuce averaged 22.7 mg of gallic acid equivalents and 31.0 mg of vitamin C equivalents, respectively. The phenolic extract of romaine lettuce protected PC-12 cells against oxidative stress caused by H(2)O(2) in a dose-dependent manner. Isochlorogenic acid, one of the phenolics in romaine lettuce, showed stronger neuroprotection than the other three caffeic acid derivatives also found in the lettuce, according to "Antineurodegenerative effect of phenolic extracts and caffeic acid derivatives in romaine lettuce on neuron-like PC-12 cells" by Im SE, Yoon H, Nam TG, Heo HJ, Lee CY, Kim DO.

b. Antioxidants
In the evaluation of phenolic extracts from lettuce (baby, romaine, and iceberg cultivars) and their antioxidants effect found that the antioxidant capacity was linearly correlated with the phenolic content. The results obtained indicate that lettuce byproducts could be, from the industrial point of view, an interesting and cheap source of antioxidant phenolic extracts to funcionalize foodstuffs, according to "Lettuce and chicory byproducts as a source of antioxidant phenolic extracts" by Llorach R, Tomás-Barberán FA, Ferreres F.

c. Chlorophyll
Chlorophyll is a green pigment found in almost all plants, algae, and cyanobacteria, including romaine lettuce. It has anti-oxidant, anti-inflammatory, body cleansing and wound-healing properties, according to the study of "Effects of chlorophyll and chlorophyllin on low-dose aflatoxin B(1) pharmacokinetics in human volunteers" Jubert C, Mata J, Bench G, Dashwood R, Pereira C, Tracewell W, Turteltaub K, Williams D, Bailey G., posted in PubMed (40) researchers wrote that Chlorophyll (Chla) and chlorophyllin (CHL) were shown previously to reduce carcinogen bioavailability, biomarker damage, and tumorigenicity in trout and rats.
 
4. Tomato(27)
a. Antioxidative and Cancer Cell-Inhibiting Activities
In the research of Tomato ( Solanum lycopersicum ) plants synthesize nutrients, pigments, and bioactive compounds and their benefit in nutrition and human health found that Tomato extracts promoted growth in normal liver (Chang) cells, had little effect in normal lung (Hel299) cells, mildly inhibited growth of lung cancer (A549) cells, and first promoted and then, at higher concentrations, inhibited growth in lymphoma (U937) cells. The relationship of cell growth to measured constituents was not apparent, according to "Free Amino Acid and Phenolic Contents and Antioxidative and Cancer Cell-Inhibiting Activities of Extracts of 11 Greenhouse-Grown Tomato Varieties and 13 Tomato-Based Foods" by Choi SH, Kim HR, Kim HJ, Lee IS, Kozukue N, Levin CE, Friedman M.

b. Lycopene
Lycopene, one of the powerful antioxidant in tomatoes, not only helps the immune system in neutralizing the forming of free radicals in the body and according to Harvard investigation as it found that men who ate more than 10 servings tomato-based foods daily (like cooked tomatoes and tomato sauce,) had a 35 percent lower risk of developing prostate cancer than those who ate the least amount of these foods. The benefits of lycopene was more pronounced with advanced stages of prostate cancer. Also according to the study of "Chemoprevention of prostate cancer with lycopene in the TRAMP model" by Konijeti R, Henning S, Moro A, Sheikh A, Elashoff D, Shapiro A, Ku M, Said JW, Heber D, Cohen P, Aronson WJ., posted in PubMed (41)

c. Antiseptic
Tomato is considered as antiseptic natural foods including natural antiseptic agent ascorbic acid that helps to enhance the immune system in guarding our body against the possibility of infection, sepsis, or putrefaction, according to the article of "The 7 Benefits Of Drinking Lemon Water" posted in Simple Health Cures.(42)

5. Calciferous vegetable (such as Cabbage)(28)
a. DNA Damage
Ascorbic acid (AA), known as vitamin C, has important antioxidant vitamin has exerted the activity in preventing (imazalil)IMA-induced cause of DNA damage, according to the stuyd of "The protective role of ascorbic acid on imazalil-induced genetic damage assessed by the cytogenetic tests' by Türkez H, Aydin E.


b.  Omega 3 fatty acid
Cabbage reduces the risk of cardiovascular diseases by controlling the secretion of bad cholesterol, due to high amount of Omega 3 fatty acid, according to the study of "The Omega-3 Index as a risk factor for cardiovascular diseases' by von Schacky C.(9)

6. Blueberries(29)
a.  Antioxidant Capacity
In the investigation of
Blueberry and blackberry wines commercially available in Illinois and theirs potential health benefits, found that fruit wines made from blueberries and blackberries may have potential health applications and therefore could contribute to the economy of the wine industry. Practical Application: The majority of wines are produced from grapes, but wine can also be produced from other fruits including blueberries and blackberries, which contain phenolic compounds that may contribute to human health, according to "Comparison of Chemical Composition and Antioxidant Capacity of Commercially Available Blueberry and Blackberry Wines in Illinois" by Johnson MH, Gonzalez de Mejia E.

b. DNA Damage
Ascorbic acid (AA), known as vitamin C, has important antioxidant vitamin has exerted the activity in preventing (imazalil)IMA-induced cause of DNA damage, according to the stuyd of "The protective role of ascorbic acid on imazalil-induced genetic damage assessed by the cytogenetic tests' by Türkez H, Aydin E.(2)



7. Tumeric(30)
c. Anti inflammatory effects
In a systematic review of the literature was to summarize the literature on the safety and anti-inflammatory activity of curcumin, found that curcumin has been demonstrated to be safe in six human trials and has demonstrated anti-inflammatory activity. It may exert its anti-inflammatory activity by inhibition of a number of different molecules that play a role in inflammation, according to "Safety and anti-inflammatory activity of curcumin: a component of tumeric (Curcuma longa)" by Chainani-Wu N.

b. Antioxidants
In the research of a literature search (PubMed) of almost 1500 papers dealing with curcumin, most from recent years, with ll available abstracts were read and pproximately 300 full papers were reviewed, found that curcumin, a component of turmeric, has been shown to be non-toxic, to have antioxidant activity, and to inhibit such mediators of inflammation as NFkappaB, cyclooxygenase-2 (COX-2), lipooxygenase (LOX), and inducible nitric oxide synthase (iNOS). Significant preventive and/or curative effects have been observed in experimental animal models of a number of diseases, including arteriosclerosis, cancer, diabetes, respiratory, hepatic, pancreatic, intestinal and gastric diseases, neurodegenerative and eye diseases, "Curcumin, an atoxic antioxidant and natural NFkappaB, cyclooxygenase-2, lipooxygenase, and inducible nitric oxide synthase inhibitor: a shield against acute and chronic diseases" by Bengmark S.

c. Neuroprotective effect
In the finding of the A Potential Neuroprotective Agent in treating Parkinson's Disease, found that curcumin exhibits antioxidant, anti-inflammatory and anti-cancer properties, crosses the blood-brain barrier and is neuroprotective in neurological disorders. Several studies in different experimental models of PD strongly support the clinical application of curcumin in PD. The current review explores the therapeutic potential of curcumin in PD, according to "Curcumin: A Potential Neuroprotective Agent in Parkinson's Disease" by Mythri RB, Bharath MS.

8. Ginger (31)
GINGER for OSTEOARTHRITIS:Ginger has a thytochemical called curcumin that helps reduce inflammation. It helps to protect your joints.Before we go further, we would like to remind you of cautions of using Superfood GINGER. While GINGER can help to strengthen anticoagulants such as heparin, warfarin and ticlopidine by helping your blood get less sticky but ginger raises the odd of bleeding.

9. Garlic(32)
Garlic to fight COLD and FLU. The natural compoud Allicin is released when garlic is crushed. Allicin works to fight cold, flu and other infections by breaking down into smaller chemicals called Sulfur compounds. They wake up your inmuune system, helping your body to get rid of toxins and microorganisms naturally.

10. Etc.



C. Nutritional supplement against lupus
C.1. Free radical scavengers(20)
1. Bilirubin
Bilirubin is a prosthetic group which helps to break down molecules into smaller units in releasing energy, excreted in bile and urine. It is a cellular antioxidant, by reverting to biliverdin, a green tetrapyrrolic bile pigment, once again when oxidized that inhibits the effects of mutagens.

2. Carotenoids
Carotenoids are organic pigments, occurring in the chloroplasts and chromoplasts of plants and some other photosynthetic organisms like algae, some bacteria.
a. Beta-carotene
Beta-Carotene, an organic compound and classified as a terpenoid, a strongly-coloured red-orange pigment in plants and fruits.
a.1. It is not toxic and stored in liver for the production of vitamin A that inhibits cancer cell in experiment. Beta-carotene also neutralize singlet oxygen before giving rise of free radicals which can damage of DNA, leading to improper cell DNA replication, causing cancers.
a.2. Cell communication
Researcher found that beta-carotene enhances the communication between cell can reduce the risk of cancer by making cells division more reliable.
a.3. Immune system
Beta-carotene promotes the immune system in identifying the foreign invasion such as virus and bacteria by increasing the quality of MHC2 protein in maintaining optimal function of white cells.
a.4. Polyunsaturated fat
Researchers found that beta-carotene also inhibits the oxidation of polyunsaturated fat and lipoprotein in the blood that reduce the risk of plaques build up onto the arterial walls, causing heart diseases and stroke.
a.5. There are more benefits of beta-carotene.

b. Alpha-carotene
Alpha-carotene, one of the most abundant carotenoids in the North American diet, is a form of carotene with a β-ring at one end and an ε-ring at the other. It is the second most common form of carotene which not only protects cells from the damaging effects of free radicals and enhances the immune system in fighting against bacteria and virus invasion, but also stimulates the communication between cells thus preventing irregular cell growth cause of cancers.

c. Beta-cryptoxanthin
Beta cryptoxanthin is an antioxidant, beside helping to prevent free radical damage to cells and DNA but also stimulates the repair of oxidative damage to DNA. it enhances the immune function infighting against inflammatory cause of polyarthritis, and irregular cell growth cause of cancer due to oxidation.

d. Lutein
Lutein is one of the most popular North American carotenoids. It is found in greens like kale and spinach as well as the yolk of eggs. Lutein is also found in the human eye. Getting enough lutein in your diet may help to fight off age related macular degeneration, an eye condition.
Researcher has shown that people who do not have enough lutein in their diet will not have enough lutein present in the muscular part of the eye. This is what likely leads to age related macular degeneration that can result in blindness.

e. Zeaxanthin
Zeaxanthin, a most common carotenoid alcohols found in nature, is one of the two primary xanthophyll carotenoids contained within the retina of the eye. Intake of foods providing zeaxanthin with lower incidence of age-related macular degeneration as a result of its function of reducing the risk oxidative stress.

f. Lycopene
Lycopene is a red carotene of the carotenoid group that can be found in tomatoes, watermelons, and grapefruits. This powerful antioxidant is believed to be a powerful fighter of prostate cancer. Lycopene has many anti-aging capabilities as well as one of the most powerful antioxidants in the carotenoid group.

3. Flavonoids
Flavonoids also known as Vitamin P and citrin are a yellow pigments having a structure similar to that of flavones occurred in varies plants. it has been in human history for over thousands of years and discovered by A. S. Szent-Gyorgi in 1930. As he used vitamin C and flavonoids to heal the breakage of capillaries, which caused swelling and obstruction of blood flow. Most plants have more than one group or type act as predominate.
Flavonoids process a property as antioxidants. it helps to neutralize many of reactive oxygen species (ROS), including singlet oxygen, hydroxyl and superoxide radicals.
Although nitric oxide is considered a free radical produced by immune system to destroy bacteria and cancerous cells, but when it is over produced, it causes the production peroxynitrite which may attack protein, lipid and DNA, Flavonoids inhibit NO production of peroxynitrite due to reduction of enzyme expression.
a. Quercetin
Quercetin is a plant-derived flavonoid found in fruits, vegetables, leaves and grains and studies show that quercetin may have anti-inflammatory and antioxidant properties as a antioxidant, quercetin scavenges free radicals, which damage cell membranes, cause mutation of cells with tampering DNA.

b. Rutin
Rutin is a citrus flavonoid glycoside found in buckwheat and glycoside of the flavonoid quercetin. It inhibits platelet aggregation, decreases the capillary permeability, makes blood thinner and improves circulation. As an antioxidant, it can reduce the cytotoxicity of oxidized LDL cholesterol caused by free radical that lowers the risk of heart diseases.

c. Catechin
Catechin is a natural phenol antioxidant plant and natural anti-bacterial substance. Study showed catechin as good free radical scavenging power inhibits ROS production, thus it can be useful to the development of alimentary strategies to prevent OTA-induced cytotoxicity in human.

d. Etc.

4. Uric acids
Uric acids may have a potential therapeutic role as an antioxidant becuase of its function of inducing oxidative stress, either through creating reactive oxygen species or inhibiting antioxidant systems.
High uric acid can cause arthritis, cardiovascular disease, diabetes, Metabolic syndrome, kidney stones, etc.

5. Thiols (R-SH)
Chemically, thiol, a organosulfur compound has strong odours resembling that of garlic. They are used as odourants to assist in the detection of natural gas. It presents in the amino acid cysseine which helps to the functioning of enzyme regulation, cell signaling, protein trafficking and control of gene expression. As a sulfide residue, thiol plays an important role in cell function of reversal oxidation by interacting with GSSG resulting in formation of intramucolar protein disulfide and GSG.

6. Coenzyme Q10
Coenzyme Q10 is discovered by Dr. Karl Folfers in 1957, beside promotes the chemical reaction, often by speeding it up or allowing it to proceed under less stringent conditions, it also enhances energy production by promoting the process of the production of ATP then serving as fuel for the cells and acts an antioxidant to prevent the generation of free radicals during this process.

7. Vitamin A, C, E. D.
a. Vitamin A
Vitamin A occurs in the form retinol and is best known for its function in maintaining the health of cell membrane, hair, skin, bone, teeth and eyes. It also plays an important role as an antioxidant as it scavenges free radicals in the lining of the mouth and lungs; prevents its depletion in fighting the increased free radicals activity by radiation; boosts immune system in controlling of free radicals; prevents oxidation of LDL and enhances the productions of insulin pancreas.

b. Vitamin C
Vitamin C beside plays an important role in formation and maintenance of body tissues, it as an antioxidant and water soluble vitamin, vitamin C can be easily carry in blood, operate in much of the part of body. By restoring vitamin E, it helps to fight against forming of free radicals. By enhancing the immune system, it promotes against the microbial and viral and irregular cell growth causes of infection and inflammation.
Vitamin C also is a scavenger in inhibiting pollution cause of oxidation.

c. Vitamin E
Vitamin E is used to refer to a group of fat-soluble compounds that include both tocopherols and tocotrienols discovered by researchers Herbert Evans and Katherine Bishop. It beside is important in protecting muscle weakness, repair damage tissues, lower blood pressure and inducing blood clotting in healing wound, etc, it also is one of powerful antioxidant, by moving into the fatty medium to prevent lipid peroxidation, resulting in lessening the risk of chain reactions by curtailing them before they can starts.

d. Vitamin D
Reseacher found that vitamin D, a group of fat-soluble secosteroids is also a membrane antioxidant, with the ability to inhibit iron-dependent lipid peroxidation in liposomes compared to cholesterol.


8. Etc.
C.2. Omega 3 fatty acid
1. Antioxidative, anti-inflammatory, and anticarcinogenic activities
In the examination of the inhibition of inflammation as well as of cancer formation and growth in the lung and colon in animal models., using a tocopherol mixture that is rich in gamma-T (gamma-TmT, which contains 57%gamma-T), found that when given in the diet at 0.3%, gamma-TmT inhibited chemically induced lung tumorigenesis in the A/J mice as well as the growth of human lung cancer cell H1299 xenograft tumors. gamma-TmT also decreased the levels of 8-hydroxydeoxyguanosine, gamma-H2AX, and nitrotyrosine in tumors. More evident anti-inflammatory and cancer preventive activities of dietary gamma-TmT were demonstrated in mice treated with azoxymethane and dextran sulfate sodium. These results demonstrate the antioxidative, anti-inflammatory, and anticarcinogenic activities of tocopherols, according to "Inhibition of inflammation and carcinogenesis in the lung and colon by tocopherols" by Yang CS, Lu G, Ju J, Li GX.

2. Antioxidant and Antidiabetic Activities
In the determination of the antioxidant and antidiabetic activities of proximate composition, amino acids, fatty acids, tocopherols, sterols, glucosinolate and phenolic content in extracts, found that all examined extracts were prominently rich in phenolics and glucosinates, and they showed potent antidiabetic and antihemolytic activity. The present study could be helpful in developing medicinal preparations for the treatment of diabetes and related symptoms, according to "Compositional Studies: Antioxidant and Antidiabetic Activities of Capparis decidua (Forsk.) Edgew" by Zia-Ul-Haq M, Cavar S, Qayum M, Imran I, de Feo V.

3. The antioxidant and anti-inflammatory activities
In the investigation of the antioxidant and anti-inflammatory actions of tocopherols in mice and determination of whether the nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is involved in these activities, indicated that the antioxidant and anti-inflammatory activities of γ-TmT in the colon are mostly due to the direct action of tocopherols in trapping reactive oxygen and nitrogen species, independent of the antioxidant enzymes and anti-inflammatory proteins that are regulated by Nrf2; however, Nrf2 knockout appears to affect the serum levels of tocopherol metabolites, according to "The antioxidant and anti-inflammatory activities of tocopherols are independent of Nrf2 in mice" by Li G, Lee MJ, Liu AB, Yang Z, Lin Y, Shih WJ, Yang CS.

4. Cognitive effects
In the examination of the relation of all plasma vitamin E forms and markers of vitamin E damage (α-tocopherylquinone, 5-nitro-γ-tocopherol) to mild cognitive impairment (MCI) and Alzheimer's disease (AD). Within the AddNeuroMed-Project, plasma tocopherols, tocotrienols, α-tocopherylquinone, and 5-nitro-γ-tocopherol were assessed in 168 AD cases, 166 MCI, and 187 cognitively normal (CN) people, found that compared with cognitively normal subjects, AD and MCI had lower levels of total tocopherols, total tocotrienols, and total vitamin E. In multivariable-polytomous-logistic regression analysis, both MCI and AD cases had 85% lower odds to be in the highest tertile of total tocopherols and total vitamin E, and they were, respectively, 92% and 94% less likely to be in the highest tertile of total tocotrienols than the lowest tertile. Further, both disorders were associated with increased vitamin E damage. Low plasma tocopherols and tocotrienols levels are associated with increased odds of MCI and AD, according to "Tocopherols and tocotrienols plasma levels are associated with cognitive impairment" by Mangialasche F, Xu W, Kivipelto M, Costanzi E, Ercolani S, Pigliautile M, Cecchetti R, Baglioni M, Simmons A, Soininen H, Tsolaki M, Kloszewska I, Vellas B, Lovestone S, Mecocci P; AddNeuroMed Consortium.

5. Etc. 

C. 3. Phytochemicals
1. Allyl Sulfides(21)
a.  Immune system
According to the article of "GARLICTHE BOUNTIFUL BULB" by Carmia Borek, Ph.D. posted in Life extension magazine, the author indicated that human studies confirm immune stimulation by garlic. Subjects receiving aged garlic extract at 1800 mg a day for three weeks showed a 155.5% increase in natural killer immune cell activity that kills invaders and cancer cells. Other subjects receiving large amounts of fresh garlic of 35g a day, equivalent to 10 cloves, showed an increase of 139.9%. In six weeks, patients with AIDS receiving aged garlic extract showed an enhancement of natural killer cells from a seriously low level to a normal level.

b. Neurological disease
According to the study of " Antioxidant Health Effects of Aged Garlic Extract" by Carmia Borek, posted in (Journal of Nutrition. 2001;131:1010S-1015S.)© 2001 The American Society for Nutritional Sciences, researcher indicated that the studies suggest that AGE may have antiaging effects and help in preventing age-related deterioration of brain function that are linked to dementia and Alzheimer’s disease.

c. Antioxidant against oxidation
According to the study of " Antioxidant Health Effects of Aged Garlic Extract" by Carmia Borek, posted in (Journal of Nutrition. 2001;131:1010S-1015S.)© 2001 The American Society for Nutritional Sciences, researcher found that AGE contains a wide range of antioxidants that can act in synergistic or additive fashion and protect cells against oxidative damage, thus helping to lower the risk of heart disease, stroke, cancer and Alzheimer’s disease and protect against toxic, tissue-damaging effects of ROS-producing radiation, including UV light, drugs used in therapy and chemicals in the environment and industry.

d. Detoxification
Looking for a natural detox? Allyl Sulfides declare war against toxins. They do this by stimulating the enzymes that eliminate toxins from the body. These enzymes are located in the digestive system. They are part of the normal digestive process. The Allyl Sulfides in onions and garlic simply encourage them to work harder and faster to eliminate toxins.

2. Allyl isothiocyanate(22)
a.  Antimicrobial effects
In the investigation of the antimicrobial effect of a chitosan coating+allyl isothiocyanate (AIT) and nisin against Salmonella on whole fresh cantaloupes, showed that The same coating treatment completely inactivated mold and yeast on cantaloupe at day 1 and no regrowth occurred even up to 14days of storage. Scanning electron microscopy revealed that cell membrane damage and leakage of intercellular components occurred as a result of the chitosan-AIT coating treatments. No visual changes in overall appearance and color of cantaloupe rind and flesh due to coating treatments were observed. These results indicate that the application of an antimicrobial coating may be an effective method for decontamination of cantaloupes, according to "Inactivation of Salmonella on whole cantaloupe by application of an antimicrobial coating containing chitosan and allyl isothiocyanate" by Chen W, Jin TZ, Gurtler JB, Geveke DJ, Fan X.

b.  Anti-inflammatory effects
In the evaluation of the underlying mechanisms of the potential anti-inflammatory properties of allyl-isothiocyanate (AITC) were analysed in vitro and in vivo, showed that 1. AITC was slightly less potent than sulforaphane (used as a positive control) in down-regulating inflammation in LPS stimulated macrophages. A significant increase in nuclear Nrf2 and heme oxygenase 1 gene expression and only a moderate down-regulation of interleukin 1β and microRNA-155 levels due to AITC was found in mouse liver. Present data suggest that AITC exhibits potent anti-inflammatory activity in cultured macrophages in vitro but has only relatively little anti-inflammatory activity in mice in vivo, according to "Anti-inflammatory potential of allyl-isothiocyanate-role of Nrf2, NFκB and microRNA-155" by Wagner AE, Boesch-Saadatmandi C, Dose J, Schultheiss G, Rimbach G.

c. White Blood Cells (WBCs)
In the investigation of the effects of AITC (dose=20 mg/kg body weight/day for 10 days, subcutaneous: s.c.) on the number of WBCs (total WBCs, lymphocytes, monocyte, neutrophil, basophil and eosinophil) and plasma corticosterone concentrations in adult male rats, showed that administration of AITC decreased significantly the number of total WBCs on days 1-4 post s.c. injection by 25-27%. AITC also decreased the number of lymphocytes on days 1-10 by 21-36% and monocyte on days 1-8 by 28-78%. However, administration of AITC increased the number of neutrophil on days 8-10 by 61-112%. AITC did not change the number of eosinophil and basophil. Plasma corticosterone concentrations during the experimental period were 4.7-8.4 times significantly higher in the AITC group than in the control group, indicating that AITC induced stress-responses, according to "Allyl isothiocyanate-induced changes in the distribution of white blood cells in rats" by Imaizumi K, Sato S, Sakakibara Y, Mori S, Ohkuma M, Kawashima Y, Ban T, Sasaki H, Tachiyashiki K.

3. Etc.
 
Treatments and management
A. In conventional medicine perspective
 Management of central nervous system (CNS) involvement still remains one of the most challenging problems in systemic lupus erythematosus (SLE). In the assessment of the diseases, some researchers suggested that the choice of treatment depends on the most probable underlying pathogenic mechanism and the severity of the presenting neuropsychiatric symptoms. Patients with mild manifestations may need symptomatic treatment only, whereas more severe acute nonthrombotic CNS manifestations may require pulse intravenous cyclophosphamide. Plasmapheresis may also be added in patients with more severe illness refractory to conventional treatment. Recently, the use of intrathecal methotrexate and dexamethasone has been reported in a small series of patients, with a good outcome in patients with severe CNS manifestations. Anticoagulation is warranted in patients with thrombotic disease, particularly in those with the antiphospholipid syndrome (APS). This article reviews the clinical approach to therapy in patients with CNS lupus(15)
Other suggested that the therapeutic choice depends on accurate diagnosis, identification of underlying pathogenic mechanism, severity of the presenting neuropsychiatric symptoms, and on prompt identification and management of contributing causes of CNS disease. Mild neuropsychiatric manifestations may need symptomatic treatment only. In more severe CNS disease it is important to distinguish between thrombotic and non-thrombotic mechanisms. Focal CNS manifestations, particularly TIA and stroke, are associated with the presence of antiphospholipid antibodies (aPL). Anticoagulation is warranted in patients with thrombotic disease, particularly in those with the antiphospholipid (Hughes) syndrome (APS). Other CNS manifestations, such as demyelinating syndrome, transverse myelitis, chorea, seizures, migraine and/or cognitive dysfunction, when associated with persistent positivity for aPL, may also benefit from anticoagulation in selected patients. Severe diffuse CNS manifestations, such as acute confusional state, generalised seizures, mood disorders and psychosis, generally require corticosteroids in the first instance. Pulse intravenous cyclophosphamide therapy may help when more severe manifestations are refractory to corticosteroids and other immunosuppressive agents, generally when response is not seen in 3-5 days. Plasmapheresis may also be added in severe cases of symptoms refractory to conventional treatment. Intravenous immunoglobulins, mycophenolate mofetil, rituximab, intratecal methotrexate and dexametasone deserve further studies to confirm their usefulness in the treatment of neuropsychiatric SLE(16) 
1. Symptomatic therapy
1.1. Symptomatic therapy is defined as a medical therapy used to treat the symptoms of the disease but not its causes, such as Anti-inflammatory, Analgesic, Antitussives agents, etc.

b. Side effects are not limit to
b.1. Anti-Inflammatory agent (hypertension, skin rash and itching, gastrointestinal discomforts, ulcers and bleeding, kidney damage, etc.
b.2.  Analgesics (long-term use of pain relievers can be addictive, stomach irritation, Over doses (2000 mg/day or more) can cause liver damage, etc.
b.3. Antitussives agents (Nausea, vomitin, skin rash and itching, welling,  dizziness, etc.

2. Intravenous cyclophosphamide, methotrexate or dexamethasone or immunoglobulin
a. Depending to the severity of the diseases, medical condition, weight, response to therapy cyclophosphamide or methotrexate or dexamethasone or immunoglobulin is injection into a vein by your doctor or a healthcare professional.

b. Side effects sre not limit to
b.1. Cyclophosphamide (Nausea, vomiting, loss of appetite, stomach ache, diarrhea, s, temporary hair loss,  unusual tiredness or weakness, joint pain, easy bruising/bleeding, etc.)
b.2. Methotrexate (Dizziness, general body discomfort, headache, loss of appetite, mild sore throat, mild stomach pain, nausea, vomiting, tiredness, etc.)
b.3. Dexamethasone (Difficulty sleeping, feeling of a whirling motion, increased appetite and sweating, indigestion; mood swing, nervousness, etc.)
b.4. Immunoglobulin(headache, dermatitis, chills, migraine, dizziness, fever, nausea, vomiting, fatigue , itching, increased Blood Pressure etc.)

3. Immunosuppressive Therapy
a. Immunosuppressive Therapy is defined as the treatment to suppress the immune response to antigen(s), on most cases it is used in conditions such as organ transplantation, autoimmune disease, allergy, etc.

b. Side effects are not limit to
b.1. Fever
b.2. High blood pressure
b.3. Kidney function.
b.4. Researchers found that Remissions were cyclosporine dependent in 26% of the patients responding to a regimen that included cyclosporine. Clonal or malignant diseases developed in 25% of the patients.(17)
b.5. Etc.

4.  Anticoagulant therapy
a. Anticoagulants is also well as blood thinners, used to slow the rate of blood clots of diseases such as thrombosis to atrial fibrillation.
b. Side effects are not limit to
b.1. Itching,
b.2. Rashes
b.3. Easy bruising,
b.4. Increased the risk of bleeding from injuries
b.5. Purplish spots on the skin
b.6. Etc.

5. Etc. 

B. In herbal medicine perspective
Herbs used to treat and manage lupus are associated to anti inflammation and enhanced immune system as the diseases are characterized as lupus is mainly thought of as an autoimmune disorder also considered a rheumatic condition
B.1. Immune system enhancing herbs
1. Andrographis 
Andrographis paniculata (Burma) Wall. ex Ness (AP) beside have been used to treat upper respiratory tract infection (URI) as well as acute diarrhea, but its leaves also have exerted the activity of anti-bacteria against infection, according to the study of "Undetectable anti-bacterial activity of Andrographis paniculata (Burma) wall. ex ness" by Leelarasamee A, Trakulsomboon S, Sittisomwong N.(43)

2. Astragalus
Astragalus polysaccharides (APS) isolated from astragalus enhances the immune system by enhancing and regulating the function of T cells, by suppressing the CD4(+)CD25(+)Treg activity, at least in part, via binding TLR4 on Tregs and trigger a shift of Th2 to Th1, according to the study of "Astragalus polysaccharides attenuate postburn sepsis via inhibiting negative immunoregulation of CD4+ CD25(high) T cells" by Liu QY, Yao YM, Yu Y, Dong N, Sheng ZY., posted in PubMed(44)

3. Echinacea 
In the observation of ethanolic extract of fresh Echinacea purpurea and the changes in cytokine production in blood samples from 30 volunteers before and during 8-day oral administration found that Echinaforce regulates the production of chemokines and cytokines according to current immune status, such as responsiveness to exogenous stimuli, susceptibility to viral infection and exposure to stress, according to the study of "Effects of Echinaforce® treatment on ex vivo-stimulated blood cells" by Ritchie MR, Gertsch J, Klein P, Schoop R.(46)

4. Goldenseal 
In the investigation of new potential sources of antimicrobial agents to Neisseria gonorrhoeae (Ng) resistance found that Extracts of Arctostaphylos uva ursi (kinnikinnick or bearberry), Hydrastis canadensis (goldenseal), Prunus serotina (black cherry), and Rhodiola rosea (roseroot) inhibited the growth of all Ng isolates with minimum inhibitory concentrations of 32 μg/mL, 4 to 32 μg/mL, 16 to >32 μg/mL, and 32 to 64 μg/mL, respectively. Extracts of Acorus americanus (sweet flag), Berberis vulgaris (barberry), Cimicifuga racemosa (black cohosh), Equisetum arvense (field horsetail), Gaultheria procumbens (wintergreen), Ledum groenlandicum (Labrador tea), Ledum palustre (marsh Labrador tea), Oenothera biennis (common evening primrose), Sambucus nigra (elderberry), and Zanthoxylum americanum (prickly ash) had weak or no antimicrobial activity against the Ng isolates with minimum inhibitory concentrations ≥256 μg/mL, according to "Extracts of Canadian first nations medicinal plants, used as natural products, inhibit neisseria gonorrhoeae isolates with different antibiotic resistance profiles" by Cybulska P, Thakur SD, Foster BC, Scott IM, Leduc RI, Arnason JT, Dillon JA.(47)

5. Cat's Claw 
a. Oral extract of Cat's claw has demonstrated the activity of protection against indomethacin-induced gastritis, and prevention of TNFalpha mRNA expression and apoptosis, according to the study of `Anti-inflammatory and antioxidant activities of cat's claw (Uncaria tomentosa and Uncaria guianensis) are independent of their alkaloid content`by Sandoval M, Okuhama NN, Zhang XJ, Condezo LA, Lao J, Angeles' FM, Musah RA, Bobrowski P, Miller MJ.(48)

b. Extract of U. tomentosa ingested daily for 15 days by a smoker has decreased the mutagenicity induced in S. typhimurium TA98 and TA100 by the subject's urine, according to the study of `Mutagenic and antimutagenic activities of Uncaria tomentosa and its extracts`by Rizzi R, Re F, Bianchi A, De Feo V, de Simone F, Bianchi L, Stivala LA.(49)

6. Etc.



B.2. Anti inflammatory herbs
1. Aloe Vera
Aloe Vera also is popular used in treating infection and inflamation as a result of its antioxidant property. according to the study of " In Vitro Antimicrobial and Antioxidant Activities of Anthrone and Chromone from the Latex of Aloe harlana Reynolds" by Asamenew G, Bisrat D, Mazumder A, Asres K., (50)

2. Ginger
In the classification of the effect of ginger extract on the expression of NFκB and TNF-α in liver cancer-induced rats found that ginger extract significantly reduced the elevated expression of NFκB and TNF-α in rats with liver cancer. Ginger may act as an anti-cancer and anti-inflammatory agent by inactivating NFκB through the suppression of the pro-inflammatory TNF-α, according to "Ginger Extract (Zingiber Officinale) has Anti-Cancer and Anti-Inflammatory Effects on Ethionine-Induced Hepatoma Rats" by Shafina Hanim Mohd Habib,I Suzana Makpol, Noor Aini Abdul Hamid, Srijit Das, Wan Zurinah Wan Ngah, and Yasmin Anum Mohd Yusof (51)

3. Saw Palmetto
In the Investigate the antiinflammatory activity of Serenoa repens (SeR), LY, and) on proinflammatory phenotype in rat peritoneal macrophages (Ms) found that the Ly-Se-SeR association caused a greater inhibitory effect on the expression of COX-2, 5-LOX, and iNOS. The Ly-Se-SeR association showed a higher efficacy in reducing the loss of IκB-α, the increased NF-κB binding activity, the enhanced mRNA levels of TNF-α, the elevated MDA, and nitrite content, according to "Effect of Serenoa repens, lycopene, and selenium on proinflammatory phenotype activation: an in vitro and in vivo comparison study" by Bonvissuto G, Minutoli L, Morgia G, Bitto A, Polito F, Irrera N, Marini H, Squadrito F, Altavilla D.(52)

4. Astragalus
Astragalus has exerted an anti-inflammatory effect as a result of inactivation the p38 and Erk1/2 and inhibition NFkappaB-mediated transcription, according to the study of "Astragali Radix elicits anti-inflammation via activation of MKP-1, concomitant with attenuation of p38 and Erk" by Ryu M, Kim EH, Chun M, Kang S, Shim B, Yu YB, Jeong G, Lee JS., posted in PubMed(45)

5. Green tea
In the investigation of l-Theanine is a unique amino acid in green tea effects on ethanol-induced liver injury of the study of "l-Theanine prevents alcoholic liver injury through enhancing the antioxidant capability of hepatocytes" by Li G, Ye Y, Kang J, Yao X, Zhang Y, Jiang W, Gao M, Dai Y, Xin Y, Wang Q, Yin Z, Luo L[5a], researchers found that l-theanine significantly inhibited ethanol-induced reduction of mouse antioxidant capability which included the activities of SOD, CAT and GR, and level of GSH. These results indicated that l-theanine prevented ethanol-induced liver injury through enhancing hepatocyte antioxidant abilities(53)

6.  Etc.

C. In Chinese medicine perspective 
Depending to the  symptoms and differentiation together with the physical exam and appearance, etc. Systemic lupus erythematosus (SLE) can be classified as(54)
C. 1. Toxin heat invasion
1. Symptoms
Acute stage - red eruptions with a high fever, irritability
2. Formula used to treat used for all types of bleeding due to Heat and Blood Stasis. (Do not use for bleeding due to Spleen deficiency)
2.1. Xi Jiao Di Huang Tang
a. Xi Jiao (cornu rhinoceri) 3g
b. Sheng Di Huang (radix rehmanniae glutinosae) 24g
c. Shao Yao (radix paeoniae) 9g
d. Mu Dan Pi (cortex moutan radicis) 6g

2.2. Wu Wei Xiao Du Yin
a. Jin Yin Hua (honeysuckle flower) 9g
b. Pu Gong Ying (dandelion) 3.6g
c. Zi Hua Di Ding (viole) 3.6g
d. Ye Ju Hua (wild chrysanthemum flower) 3.6
e. Zi Bei Tian Kui (Begonia) 3.6g


C.2. Internal Heat due to Yin-Deficiency
1. Symptoms
Slight fever, fatigue, dry mouth, flushed face, red cheeks, nocturnal emissions, chronic sore throat, frequent urination of dark

2. Formula
Zhi Bai Di Huang Tang used to treat insufficient liver and kidney yin plus heat signs.  
2.1. Zhi Bai Di Huang Tang
a, Shu Di (Rehmannia prepared root)  (21.7%)
b. Zhi Mu (Anemarrhena root)(16.2%)
c. Huang Bai (Phellodendron bark)(16.2%) 
d. Shan Zhu Yu (Cornus fruit)(10.8%)
e. Shan Yao (Dioscoria root)(10.8%) 
f. Fu Ling (Poria cocos fungus) (8.1%) 
g. Mu Dan Pi (Moutan bark)(8.1%)
h. Ze Xie (Alisma rhizome) (8.1%)

C.3. Spleen-Yang and Kidney-Yang Deficiency  
Fatigue, edema, puffy, brittle hair, menstrual disorder, digestive disorder 2. Formula
Ling Gui Zhu Gan Tang used to transforms Phlegm-fluids, strengthen Spleen, clear Damp
a. Fu Ling (sclerotium poriae cocos) 12g
b. Gui Zhi (ramulus cinnamomi cassiae) 9g
c. Bai Zhu (rhizoma atracylodis macrocephalae) 6g
d. Zhi Gan Cao (honey fried radix glycyrrhizae uralensis) 6g

+ Shen Ling Bai Zhu San used to nourish Spleen, enhance the digestive function and removes Dampness
e. Ren Shen (Radix Ginseng)
f. Fu Ling (Sclerotium Poriae Cocos)
g. Bai Zhu (Rhizoma Atractylodis Macrocephalae)
h. Shan Yao (Rhizoma Dioscoreae Opposita)
i. Lian Zi (Semen Nelumbinis Nuciferae)
j. Bai Bian Dou (Semen Dolichoris Lablab)
k. Yi Yi Ren (Semen Coicis Lachryma-Jobi)
l. Sha Ren (Fructus Amomi)
m. Jie Geng (Radix Platycodi Grandiflori)
n. Gan Cao (Radix Glycyrrhizae Uralensis)


Author note: the article is for information and education only, please consult with your doctor or related field specialist before applying.

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