Medical Advisor Journals

Friday, April 27, 2012

Meningitis

Meningitis is defined as a condition of inflammation of the protective membranes, covering the brain and spinal cord (meninges). Meningitis, a life threaten disease, can kill and immediate action can and does save lives.(1) Although bacterial meningitis has become an uncommon disease in the developed world. Unfortunately, because of limited economic resources and poor living conditions, many developing countries are still affected by the devastating consequences of this life-threatening systemic infection(2)

Signs and Symptoms
In the research posted in European Journal of Pediatrics, scientists showed that
1. The most common symptoms according to age were as follows: 1–5 months: irritability (85%), 6–11 months and 12 months or more: vomiting (82%) and neck rigidity (78%).
2. Meningitis should be suspected in irritable or lethargic febrile children despite absence of neck rigidity. Fever and vomiting were the most frequent reasons for consulting a physician (60% and 31%, respectively). Despite the frequency and alarming character of irritability, impaired consciousness and neck rigidity, their presence led infrequently to a consultation (6%, 22% and 3%, respectively).(8)

2. In other study to identify 433 patients with viral meningitis and 101 TBM patients and compared their clinical and laboratory features. Multivariable analysis showed a statistically significant association between TBM and the following variables: duration of symptoms before admission of ≥5 days, presence of neurological impairment (altered consciousness, seizures, mild focal signs, multiple cranial nerve palsies, dense hemiplegia or paraparesis), cerebrospinal fluid/blood glucose ratio < 0.5 and cerebrospinal fluid protein level > 100 mg/dl(10)

3. Confusion
Confusion is also associated with symptoms of meningitis. in study of a seventy-five-year-old patient was hospitalized because of relapsing feverish confusion episodes with meningitis. During the year before his admission he had experienced four spontaneously regressive episodes of feverish confusion(9)

4. Other symptoms include sleepiness, discomfort looking into bright lights and In some cases, rash may be presented as a result of meningococcal bacteria.

5. Etc.

Causes and risk factors
A. Causes
1. Bacterial
Bacterial causes of meningitis can be classified according to age group
a. In Infants and children In the report of "Acute bacterial meningitis in infants and children" conducted by Johns Hopkins University School of Medicine, scientists showed that bacterial meningitis continues to be an important cause of mortality and morbidity in neonates and children throughout the world. The introduction of the protein conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has changed the epidemiology of bacterial meningitis(12). Another study of "Meningitis in children in Fiji" showed that Over a 3-year period, all eligible children with suspected meningitis admitted to CWMH had blood drawn for culture. Of these children, those for whom is was possible were tested for a four-fold rise in antibody titers to Haemophilus influenzae type b (Hib) and pneumococcal surface adhesin A (PsaA). Cerebrospinal fluid (CSF) was taken for bacteriological culture and antigen testing. CSF was also tested by PCR for Streptococcus species, Neisseria meningitidis, Hib, Mycobacterium tuberculosis, and enterovirus.(13)
Some researchers suggested bacterial meningitis in young children can impair vestibular function completely, leading to delayed posturomotor development if meningitis occurs before independent walking, even in absence of neurologic impairment(11)

b. In adult
In adults, according to Community-Acquired Bacterial Meningitis in Adults, bacterial meningitis has an annual incidence of 4 to 6 cases per 100,000 adults (defined as patients older than 16 years of age), and Streptococcus pneumoniae and Neisseria meningitidis are responsible for 80 percent of all cases.(14). In a report conducted by National Institute of Infectious and Tropical Diseases, S. suis was commonly diagnosed as a cause of bacterial meningitis in adults in northern Viet Nam. In countries where there is intense and widespread exposure of humans to pigs, S. suis can be an important human pathogen.(15)

2. Viral
Certain virus can cause meningitis. Enteroviruses is defined as condition in which a virus that enters the body through the gastrointestinal tract and thrives there, often moving on to attack the nervous system. are the most common cause at all ages, including 29 Coxsackieviruses (23 Coxsackie A viruses and 6 Coxsackie B viruses), 28 echoviruses, and 4 other enteroviruses.(16)
a. Varicella zoster virus
Varicella zoster virus is defined as a condition of infection and results from exposure of a person susceptible to the virus. The virus remains latent in cranial nerve ganglia and reactivates and can cause a wide range of neurologic disease if a infected patient is association with a decline in cell-mediated immunity in the elderly and immuno-compromised. there are report of a 46-year-old female who initially presented with worsening headache, nuchal rigidity, fever, and a skin rash, who was subsequently found to have varicella zoster meningitis.(3)

b. Immunodeficiency virus and tuberculosis
In the study of 642 individuals conducted by University of KwaZulu-Natal, 14 episodes of meningitis in 10 patients were identified. For 8 patients, this episode of meningitis was the AIDS defining illness, with cryptococcus (9/14 episodes) and tuberculosis (3/14 episodes) as the commonest aetiological agents. The combination of headache and neck stiffness (78.6%) was the most frequent clinical presentation. Relapsing cryptococcal meningitis occurred in 3/7 patients. Mortality was 70% (7/10), with 4 deaths directly due to meningitis(4)

3. Aseptic meningitis
Aseptic meningitis is defined as a condition of all cases of meningitis in which no bacterial infection can be found. In the study of DIFFICULT AND RECURRENT MENINGITIS by L Ginsberg showed that examination yields a typical ‘‘aseptic meningitis’’ picture (elevated white cell count, predominantly lymphocytic, no organisms on Gram stain, normal or elevated protein concentration, normal or reduced glucose concentration) because of the breadth of the differential diagnosis, both infective and non-infective (table 1). In these circumstances, it is particularly important to exclude or diagnose tuberculosis, cryptococcosis, and other fungal infections, partially treated pyogenic meningitis, neurosyphilis, and Lyme disease, because of the need for urgent treatment and the consequences of failure to treat.(17)

4. Parasitic
It is a very common in underdeveloped countries as result of parasites found in contaminated water, food, and soil, including Angiostrongylus cantonensis, Gnathostoma spinigerum, Schistosoma etc.

5. Non-infectious
5. 1. Medication
Meningitis is either caused by infection of bacteria or viral, but certain medication, including nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, intravenous immunoglobulins, and OKT3 antibodies (monoclonal antibodies against the T3 receptor) are the most frequent cause of Drug-induced aseptic meningitis (DIAM), as resolution occurs several days after drug discontinuation and the clinical and cerebrospinal fluid profile (neutrophilic pleocytosis) do not allow DIAM to be distinguished from infectious meningitis(7)

a. Infliximab
There are report of a 51-year-old female, was being treated for Crohn's disease. After an infliximab infusion, she had headache, fever, arthralgia, myalgia, and meningismus. Infliximab commonly causes headache and is very immunogenic, we infer that infliximab-induced meningitis is immune-mediated and underrecognized. Potential risk factors and means for minimizing its occurrence are offered(4)

b. Spinal analgesia and anaesthesia
Even though spinal analgesia and anaesthesia (SA) is a rare predisposing condition to bacterial meningitis but, due to the seriousness of the infection, it should be considered in the differential diagnosis for any patient who develops fever or headache in this setting(5). Also there are report of two cases of meningitis which developed after combined spinal-extradural procedures for obstetric analgesia. The first case was thought to be caused by aseptic or chemical meningitis and the second was a case of bacterial meningitis in a patient who also received an extradural blood patch.(6)

5.2. Inflammatory conditions
a. Systemic lupus erythematosus
is defined as a condition of autoimmune diseases, as the immune system attacks the body's cells and tissue,of that lead to inflammation and tissue damage. There is report that Aseptic meningitis appears to be an early manifestation of SLE and may herald more serious brain damage. No new cases of aseptic meningitis occurred in this series after initiation of therapy for SLE. In contrast, bacterial meningitis did occur as a late complication of the disease(18)

b. Vasculitis
Vasculitis is defined as a inflammatory condition of the blood vessels as a result of group of diseases. In a study of a 53-year-old man with pneumococcal meningitis who developed numerous ischemic lesions in the brainstem and basal ganglia caused by parainfectious vasculitis, researchers suggested that parainfectious vasculitis may respond to late corticosteroid treatment. MMP-9 level in CSF may be a marker of vasculitic complication in bacterial meningitis.(19)

c. Migraine
Dr. Bruce H. Dobkin at the Daniel Freeman Hospital Medical Center Stroke/Neurological Rehabilitation Unit, wrote" Schraeder and Burns (ARCHIVES 1980;37:377-379) suggested that the rare CSF lymphocytosis found in patients with hemiplegic migraine results from a secondary meningeal reaction. Another report concluded that the complicated migraines of seven patients resulted from an inflammatory disturbance.....(20)

d. Etc.

5.3. Immunodeficiency virus and tuberculosis
In the study of 642 individuals conducted by University of KwaZulu-Natal, 14 episodes of meningitis in 10 patients were identified. For 8 patients, this episode of meningitis was the AIDS defining illness, with cryptococcus (9/14 episodes) and tuberculosis (3/14 episodes) as the commonest aetiological agents. The combination of headache and neck stiffness (78.6%) was the most frequent clinical presentation. Relapsing cryptococcal meningitis occurred in 3/7 patients. Mortality was 70% (7/10), with 4 deaths directly due to meningitis(4)

5.4. Etc.

B. Risk factors
Some people are more susceptible to meningitis than others

1. People with weakened immune systems
In a study conducted by Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Dr. Koppe U and the research team indicated "The innate immune system is critical for the control of colonization and for defence during invasive disease. Initially, pneumococci are recognized by different sensors of the innate immune system called pattern recognition receptors (PRRs), which control most subsequent host defence pathways. These PRRs include the transmembrane Toll-like receptors (TLRs) as well as the cytosolic NOD-like receptors (NLRs) and DNA sensors". Streptococcus pneumoniae is both a frequent colonizer of the upper respiratory tract and a leading cause of life-threatening infections such as pneumonia, meningitis and sepsis.(21)

2. Pregnant women
In the examine listeriosis cases reported through the U.S. Listeria Initiative during 2004-2007. Cases were classified as pregnancy-associated if illness occurred in a pregnant woman or an infant aged <28 days. Of 758 reported Listeria cases, 128 (16.9%) were pregnancy-associated. Maternal infection resulted in four neonatal deaths and 26 (20.3%) fetal losses. Invasive illnesses in newborns (n=85) were meningitis (32.9%) and sepsis (36.5%)(21). There is a case report of TBM in a previously healthy woman whose signs and symptoms developed immediately after delivery and were initially attributed to postpartum depression and a puerperal-acquired bacterial infection. Although tuberculous meningitis (TBM) rarely complicates pregnancy and seldom occurs in puerperal women,(22)

3. Chronic Diseases
a. AIDS
People with AIDS are more susceptible to develop Meningitis. In a retrospective review of confirmed HIV-TB coinfected patients previously enrolled as part of the SAPiT study in Durban, South Africa. Patients with suspected meningitis were included in this case series. From 642 individuals, 14 episodes of meningitis in 10 patients were identified. For 8 patients, this episode of meningitis was the AIDS defining illness, with cryptococcus (9/14 episodes) and tuberculosis (3/14 episodes) as the commonest aetiological agents.(23)

b. Diabetes
In a study conducted by , Far Eastern Memorial Hospital, Dr. Ho MP and the research team showed that advanced age, newly recognized DM, K. pneumoniae bacteremia, and DIC may be the cause of a fatal Klebsiella pneumoniae meningitis and concomitant disseminated intravascular coagulation (DIC) in a 72-year-old woman(24)

c. Rheumatoid arthritis
People with Rheumatoid arthritis may have an increased risk of Meningitis. Even though most common complications of RA occur in the severe and chronic stages of the disease, but Meningoencephalitis is a rare but aggressive complication of rheumatoid arthritis (RA).(25)

d. Others chronic diseases such as heart diseases, liver disease may also risk factors of meningitis

4. Removal of your spleen puts you at risk for meningitis, as spleen is essential part of the immune system

5. In the study to overview outcome of meningococcal meningitis in Slovakia, researcher(s) indicated that risk factors such as underlying disease, cancer, diabetes, alcoholism, surgery (brain surgery), age (children under 5, teens and young adults ages 16 to 25 (especially college freshman living in dorms), and adults over 55), previous infections, trauma, sepsis were recorded and mortality, survival with sequellae, therapy failure were compared between meningococcal and non-meningococcal cases of bacterial meningitis(26)

f. Etc.

Complications and diseases associated
A. Complications
1. In the study to raise awareness of meningitis and its symptoms and describes some of the practical support that can be offered to sufferers, their families and friends. Doctors at the University of Hertfordshire. indicated that he prognosis and possible complications are described. These include potential problems such as sensorineural deafness, raised intracranial pressure, the need for skin grafting and the amputation of limbs and/or digits.(1)

2. Spectrum of complications
Systematically central nervous system and systemic complications during the acute phase of adult bacterial meningitis
a. Central nervous system complications
Include brain swelling, hydrocephalus, brain abscess, subdural empyema, or subdural effusion (using computed tomography) and cerebrovascular involvement (using cerebral angiography),
b. Systemic complications
Include septic shock, disseminated intravascular coagulation, adult respiratory distress syndrome, or septic or reactive arthritis(30). Cerebrovascular complications are the most frequent intracranial complications in bacterial meningitis of the adult (37.1%) and are major determinants in the prognosis of this disease(31)

3. Others spectrum of complications

In the analysing 87 consecutive cases between 1984 and 2002. Meningitis-associated intracranial complications developed in 74.7% and systemic complications in 37.9% of cases. Diffuse brain oedema (28.7%) and hydrocephalus (16.1%) developed more frequently than previously reported. The incidences of arterial (21.8%) and venous (9.2%) cerebrovascular complications were also very high. Furthermore, 9.2% of cases developed spontaneous intracranial haemorrhages (two patients with subarachnoid and two with subarachnoid and intracerebral bleedings, all in association with vasculitis; one subject with intracerebral haemorrhage due to sinus thrombosis; and three cases with intracerebral bleedings of unknown aetiology). Other new findings were the incidence of acute spinal cord dysfunction due to myelitis (2.3%) and that of hearing loss (19.5% of all patients and 25.8% of survivors). The in-hospital mortality was 24.1%. Only 48.3% of the patients had a good outcome at discharge (32)

4. Etc.

B. Diseases associated
1. Hodgkin's disease
In a report of a seventy-five-year-old patient was hospitalized because of relapsing feverish confusion episodes with meningitis. and exploration of these episodes disclosed a paraneoplastic limbic encephalitis due to an underlying Hodgkin's disease. The treatment of Hodgkin's disease led to perfect recovery of cognitive function.(9)

2. AIDS
Patient with AIDS are susceptible to
a. Cryptococcal
b. Tuberculous
c. Syphilitic
d. Listeria species
e. Lymphomatous
f. Aseptic
as a result of infections and very low CD4+ lymphocyte counts.(27)

3. Kikuchi's Disease
Kikuchi's disease is an idiopathic illness, typically causing cervical lymphadenopath. Dr. Dr. Mahdad Noursadeghi, Dept. of Infection & Tropical Medicine, Northwick Park Hospital in the study of "Kikuchi's Disease: A Rare Cause of Meningitis?" said that many patients with Kikuchi's disease who present with fever and meningitis will be assessed by infectious disease physicians who will not be aware of the association of Kikuchi's disease with meningitis.(28)

4. Other diseases
In the data collected from medical records of all adult patients with bacterial meningitis admitted to Chang Gung Memorial Hospital-Kaohsiung from January 1986 to December 2000, three of the 14 patients with ALD had liver cirrhosis (2 with Child's class B and 1 with Child's class C). The causative pathogens of these 14 cases were Klebsiella pneumoniae in 11, Staphylococcus aureus in 2 and Enterococcus in 1. Diabetes mellitus (DM) was the most common underlying disease and was present in 64% of patients (9/14). All patients with DM had K. pneumoniae as the causative pathogen. Bacteremia and thrombocytopenia were found in 64% (9/14) and 50% (7/14) of the patients, respectively. Focal suppurations including brain abscess, intracranial subdural empyema, and cervical epidural abscess were found in 4 patients. The overall mortality rate was 14% (2/14). ALD accounted for 11.5% (14/122) of the underlying conditions of all adult cases of community-acquired spontaneous bacterial meningitis treated during the study period.(29)

Diagnosis
1. Spinal tap
After assessing the symptoms and taking the physical exam, the diagnosis is to obtain a sample of spinal fluid to identify type of bacteria responsible by performing a lumbar puncture with local anesthetic and a needle inserted into an area in the lower back where fluid in the spinal canal, but the risk of lumbar puncture can lead to brain herniationis if there is an elevation of a mass in the brain (tumor or abscess) or the intracranial pressure (ICP)(33).

2. The Xpert EV test
Approved by the Food and Drug Administration (FDA) in 2007, when used in combination with other laboratory tests, will help physicians distinguish between viral meningitis and the less-common, but more severe, version of meningitis caused by detecting the RNA of the enterovirus that causes meningitis, but results from the Xpert EV test are available in two and one-half hours(34)

3. Meningococcal rash pressure test
Patient with rash and a cold or flu with fever, headache, aches and pains in joints and muscles and suspected to have menigitis, meningococcal rash pressure test may be the best choice. By using medical instruments to apply pressure to the skin around, bacterial meningitis will not whiten under pressure. As Meningococcus bacteria cause several different infections besides meningitis. They can cause different forms of blood poisoning: septicemia, which is severe; and meningococcemia, a milder form; also pneumonia, arthritis, and infections of the heart, eye, or other parts of the body(35)

4. Blood Culture Tests
Blood Culture Tests is to is a microbiological culture of blood to detect for the presence of of meningococcal bacteria.

5. Etc.

Preventions
A. Do's and Do not's list
1. Behavioral
Neisseria meningitidis bacteria are spread through the exchange of respiratory and throat secretions like spit (e.g., living in close quarters, kissing). Fortunately, these bacteria are not as contagious as what causes the common cold or the flu. Also, the bacteria are not spread by casual contact or by simply breathing the air where a person with meningococcal disease has been(36). Especially when you are pregnant to avoid listeriosis

2. Eat your vegetable and fruits
Vegetable and fruit contain high amount of antioxidant, not only enhances the immune system but also fight against foreign virus and bacteria infection and inflammatory causes of meningitis(37)

3. Avoid excessive drinking
Excessive drinking can increase the risk of liver diseases that can lead to weaken immune function causes of meningitis

4. Moderate exercise
Moderate exercise can enhance the circulatory system and increase the function of immune system in fighting against bacterial and viral invasion.

5. Smoking
The odds ratio of purulent meningitis for children receiving passive smoking was 3.0, and the 95% confident limit was greater than 1 (P < 0.05). There was significant dose-effect relationship between the daily dosage of cigarette smoked by family members and the odds ratio of purulent meningitis (P < 0.005)(38)

6. Etc.

B. Diet against meningitis
1. Flaxseed oil is extracted from the seeds of the flax plant (Linum usitatissimum) contained both omega-3 and omega-6 fatty acids. Flaxseed oil generally contains 50% of the omega-3 fatty acid - alpha-linolenic acid and 25 % of the omega-6 fatty acid linolenic acid, 15 % of mainly monounsaturated oleic acid and trace amounts of palmitoleic acid and eicosenoic acid.
In the investigation of Omega 3 fatty acids and theirs effect on inflammation, a physiological response to tissue trauma or infection found that dietary n-3-PUFA, EPA, to inhibit this process not only revealed an unsuspected level of regulation in the migration of inflammatory leukocytes, it also contributes to our understanding of the interactions of this bioactive lipid with the inflammatory system. Moreover, it indicates the potential for novel therapeutics that target the inflammatory system with greater affinity and/or specificity than supplementing the diet with n-3-PUFAs, according to "Omega-3 Fatty acids and inflammation: novel interactions reveal a new step in neutrophil recruitment" by Tull SP, Yates CM, Maskrey BH, O'Donnell VB, Madden J, Grimble RF, Calder PC, Nash GB, Rainger GE.(46)

2. Green Tea
a. Antimicrobial activities
In the investigation of Antimicrobial activities of green of the study of "Antimicrobial activities of tea catechins and theaflavins and tea extracts against Bacillus cereus" by Friedman M, Henika PR, Levin CE, Mandrell RE, Kozukue N., researchers found that flavonoids in green tea has exerted its ability in protective effects against Bacillus cereus.(47)

b. Immune system
a. In the investigation of the immunomodulatory effects of decaffeinated green tea extract in rain bow of the study of "Immunomodulatory effects of decaffeinated green tea (Camellia sinensis) on the immune system of rainbow trout (Oncorhynchus mykiss)" by Sheikhzadeh N, Nofouzi K, Delazar A, Oushani AK., researchers found that showed that decaffeinated green tea in lower doses of administration could be optimum to enhance the immunity of rainbow trout(48)

3. Garlic
Garlic is the natural superfood healer for its natural antibiotic with antiviral, antifungal, anticoagulant and antiseptic properties. Garlic cooked is fine but it loses many of its health-giving powers. Raw garlic does most of its antibiotic and preventive medicines. Here are some of effective use of garlics for PROVEN DISEASE CURED.

4. Blueberry
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.(49)

5. Shiitake mushroom
a. Immune system
Shiitake mushroom enhances the immune system in fighting against infection and disease. influenza, viruses and irregular cells growth due to it anti-tumor polysaccharide lentinan, according to "Immunoregulatory effects of the antitumor polysaccharide lentinan on Th1/Th2 balance in patients with digestive cancers" by Yoshino S, Tabata T, Hazama S, Iizuka N, Yamamoto K, Hirayama M, Tangoku A, Oka M.(50)

b. Free radicals
Shiitake mushroom contains high levels of antioxidants such as L-ergothioneine, that helps to
reduce the risk of oxidative cause of mutation in cell division and alternation, according to"Ergothioneine; antioxidant potential, physiological function and role in disease" by Cheah IK, Halliwell B.(51)

6. Etc.

C. Nutritional supplement against meningitis
1. Vitamin A, C, E. D.
a. 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.(39)

2. Antioxidants
a. Catechin
a.1. Anti-inflammatory effect
In the preparation of the gel of Chinese medicine catechu, and to observe the release mechanism in vitro and anti-inflammatory activity in rats, found that the optimum condition of extraction from catechu was as follows, the concentration of ethanol, ratio of raw material to solvent, ultrasonic time, and extraction temperature were 50% , 1: 12, 35 min and 60 degrees C, respectively. The formulation of catechu gel was carbomer-9 400.5 g, glycerol 5.0 g, the extracts of catechu 50.0 mL, and triethanomine 0.5 mL The gel was semitransparent and stable. The drugs released quickly. The catechu gel reduced the paw edema considerably in dose-dependent manner compared to carrageenan-induced rat, according to "[Preparation and pharmacodynamics studies on anti-inflammatory effect of catechu gel].[Article in Chinese]" by Zheng X, Zheng C.(41)

a.2. Anti-influenza virus activity
In the study of Polyphenolic compounds present in green tea, particularly catechins, and its effect on strong anti-influenza activity, found that therapeutic administration of green tea by-products via feed or water supplement resulted in a dose-dependent significant antiviral effect in chickens, with a dose of 10 g/kg of feed being the most effective (P < 0.001), according to "Anti-influenza virus activity of green tea by-products in vitro and efficacy against influenza virus infection in chickens" by Lee HJ, Lee YN, Youn HN, Lee DH, Kwak JH, Seong BL, Lee JB, Park SY, Choi IS, Song CS.(42)

b. Quercetin
b.1. Anti-Inflammatory effects
According to the study of `Antioxidant and Anti-Inflammatory Activities of Quercetin 7-O-β-D-Glucopyranoside from the Leaves of Brasenia schreberi.`by Legault J, Perron T, Mshvildadze V, Girard-Lalancette K, Perron S, Laprise C, Sirois P, Pichette A. (Source from Laboratory for Analysis and Separation of Plant Species (LASEVE), Université du Québec à Chicoutimi , Chicoutimi, Québec, Canada.), posted in PubMed, researchers found that some flavonoids have been reported to possess beneficial effects in cardiovascular and chronic inflammatory diseases associated with overproduction of nitric oxide. Quercetin-7-O-β-D-glucopyranoside possesses anti-inflammatory activity, inhibiting expression of inducible nitric oxide synthase and release of nitric oxide by lipopolysaccharide-stimulated RAW 264.7 macrophages in a dose-dependent manner. Quercetin-7-O-β-D-glucopyranoside also inhibited overexpression of cyclooxygenase-2 and granulocyte macrophage-colony-stimulating factor.

b.2. Antimicrobial and cytotoxic activities
According to the study of `Antimicrobial and cytotoxic activities of leaves, twigs and stem bark of Scutia buxifolia Reissek.`by Boligon AA, Janovik V, Frohlich JK, Spader TB, Forbrig Froeder AL, Alves SH, Athayde ML. (Source from a Phytochemical Research Laboratory, Department of Industrial Pharmacy , Federal University of Santa Maria , Build 26, room 1115 , Santa Maria , CEP 97105-900 , Brazil.), posted in PubMed, researchers found that quercitrin, isoquercitrin and rutin were identified by HPLC and may be partially responsible for the antimicrobial activities observed. This study reports for the first time the antimicrobial and cytotoxic activities of S. buxifolia leaves, twigs and stem bark.

c. Lycopene
c.1. Anti Inflammation
According to the study of `Inhibitory mechanism of lycopene on cytokine expression in experimental pancreatitis.`by Kim H. (Source from Department of Food and Nutrition, Brain Korea 21 Project, College of Human Ecology, Yonsei University, Seoul, South Korea. kim626@yonsei.ac.kr), posted in PubMed, researchers found that in pancreatic acinar cells, which is mediated by the activation of NADPH oxidase. Lycopene functions as a very potent antioxidant to suppress the induction of inflammatory cytokines, in pancreatic acinar cells stimulated with cerulein. In this review, the possible beneficial effect of lycopene on experimental pancreatitis shall be discussed based on its antioxidant activity.

c.2. Antioxidants
In the study of `Comparison of lycopene and tomato effects on biomarkers of oxidative stress in vitamin E deficient rats` by Delphine Gitenay, Bernard Lyan, Mathieu Rambeau, Andrzej Mazur and Edmond Rock. (Source from European Journal of Nutrition Volume 46, Number 8, 468-475, DOI: 10.1007/s00394-007-0687-2), posted in springerprotocols.com, researchers found that Our study showed for the first time that tomatoes, containing or not containing lycopene, have a higher potential than lycopene to attenuate and or to reverse oxidative stress-related parameters in a mild oxidative stress context.

d. Theaflavin
d.1. Antioxidant effects
In the investigation of four main TF derivatives (theaflavin (TF(1)), theaflavin-3-gallate (TF(2)A), theaflavin-3'-gallate (TF(2)B), and theaflavin-3,3'-digallate (TF(3))) in scavenging reactive oxygen species (ROS) in vitro, their properties of inhibiting superoxide, singlet oxygen, hydrogen peroxide, and the hydroxyl radical, and their effects on hydroxyl radical-induced DNA oxidative damage, found that compared with (-)-epigallocatechin gallate (EGCG), TF derivatives were good antioxidants for scavenging ROS and preventing the hydroxyl radical-induced DNA damage in vitro. TF(3) was the most positive in scavenging hydrogen peroxide and hydroxyl radical, and TF(1) suppressed superoxide. Positive antioxidant capacities of TF(2)B on singlet oxygen, hydrogen peroxide, hydroxyl radical, and the hydroxyl radical-induced DNA damage in vitro were found, according to "Evaluation of the antioxidant effects of four main theaflavin derivatives through chemiluminescence and DNA damage analyses" by Wu YY, Li W, Xu Y, Jin EH, Tu YY.(43)

d.2. Antibacterial effects
in the evaluation of the antibacterial effects of various concentrations of theaflavin as well as combinations of theaflavin and epicatechin, using the disk diffusion assay, found that strong antibacterial activity of theaflavin against eight clinical isolates of S. maltophilia and A. baumannii. Significant synergy (P≤0.05) was also observed between theaflavin and epicatechin against all isolates, according to "Antibacterial effects of theaflavin and synergy with epicatechin against clinical isolates of Acinetobacter baumannii and Stenotrophomonas maltophilia" by Betts JW, Kelly SM, Haswell SJ.(44)

3. Minerals(40)
a. Manganese
Manganese is an essential trace nutrient in all forms of life. It is well known for its role in helping the body to maintain healthy skin and bone structure, but also acts as cofactors for a number of enzymes in higher organisms, where they are essential in detoxification of superoxide (O2−, with one unpaired electron) free radicals. Although superoxide is biologically quite toxic and is deployed by the immune system to kill invading microorganisms by utilizing the enzyme NADPH oxidase. Any Mutations in the gene coding for the NADPH oxidase cause an immunodeficiency syndrome.

b. Zinc
Zinc is an essential mineral that is naturally present in some foods. The ability of zinc in inhibiting oxidative processes has been recognized for many years. Chronic effects, zinc enhances the introduction of metallothioneins, which help to capture the superoxide and hydroxyl radicals due to cysteine residues, resulting in lessening the risk of oxidative stress. Over acute effects, zinc may reduce the postischemic injury to a variety of tissues and organs by involving the antagonism of copper reactivity as a result from its antioxidant functions.

c. Copper
Copper, an essential trace element is essential for the absorption and utilization of iron and distributed widely in the body and occurs in liver. Antimicrobial and viral Copper enhances the immune function in fighting against foreign invasion, such as bacteria and virus, thus reducing the risk of infection and inflammation by utilizing the absorption of oxygen and production of energy within cells.

4. Etc.

Treatments
A. In conventional Medicine
A.1. Vaccines
Vaccine is defined as is a biological preparation to enhance immune function against a particular disease.
1. Monovalent meningococcal C conjugate vaccine (MCV-C)
One dose of serogroup C meningococcal conjugate vaccine (MCV-C) at 12 months of age is the most common immunization schedule in Canada, but immunity may wane over time.(52)

2. Tetravalent meningococcal polysaccharide vaccine (MPV-ACWY)
Serum bactericidal activity and antibodies against serogroups A and C were determined before and after they received MCV-C, and 4 weeks after they received MPV-ACWY. Near-total splenectomy provides a favourable immunological basis for natural and vaccine-induced protection against meningococcal serogroup A and C infections. Sequential meningococcal vaccination is immunogenic in patients splenectomized for hereditary spherocytosis.(53)

3. Meningococcal conjugate vaccine(MCV-4)
A newly licensed vaccine (pneumococcal conjugate vaccine) that appears to be effective in infants for the prevention of pneumococcal infections and is routinely recommended for all children greater than 2 years of age.(54)

4. The pneumococcal polysaccharide vaccine
College freshman, especially those who live in dormitories are at higher risk for meningococcal disease and should be educated about the availability of a safe and effective vaccine which can decrease their risk. Although large epidemics of meningococcal meningitis do not occur in the United States, some countries experience large, periodic epidemics. Overseas travelers should check to see if meningococcal vaccine is recommended for their destination. Travelers should receive the vaccine at least 1 week before departure, if possible. Information on areas for which meningococcal vaccine is recommended can be obtained by calling the Centers for Disease Control and Prevention at (404)-332-4565. There are vaccines to prevent meningitis due to S. pneumoniae (also called pneumococcal meningitis) which can also prevent other forms of infection due to S. pneumoniae . The pneumococcal polysaccharide vaccine is recommended for all persons over 65 years of age and younger persons at least 2 years old with certain chronic medical problems(54)

5. Etc.

A. 2. Medication
1. Antibiotics
a. Bacterial meningitis can be treated with a number of effective antibiotics, depending to the bacteria causing the infection, In the study of moxifloxacin and ampicillin + gentamicin in the treatment of Listeria monocytogenes meningitis in a rabbit meningitis model, scientists at Ege University showed that moxifloxacin (M), ampicillin + gentamicin (A), ampicillin + gentamicin 2 (A2) and control (C). Group M received 20 mg/kg moxifloxacin at the end of the incubation time and 5 h later by intravenous (i.v.) route. Group A received ampicillin (30 mg/kg/h) and gentamicin (2.5 mg/kg/h) by i.v. route with continuous infusion for 8 h in 36 mL of 0.9% NaCl, group A2 received the same dosage of gentamicin and ampicillin in two different 36 mL 0.9% NaCl solutions and group C did not receive any treatment. Cerebrospinal fluid (CSF) samples (0.1-0.25 mL) were obtained 16 and 24 h after induction of meningitis. When the three treatment groups were compared, bacterial counts were found to be similar (P > 0.05)(55)

b. Side effects are not limit to diarrhea and gastrointestinal discomfort. In some cases, antibiotics can cause
b.1. Vomiting Severe watery diarrhea and
b.2. Abdominal cramps
b.3. Allergic reaction, such as shortness of breath, hives, swelling, etc.
b.4. Skin Rash
b.5. Etc.

2. Corticosteroids
a. Dexamethasone treatment may be associated with a lower mortality in adults and fewer neurological and auditory sequelae in adults and children from high-income countries, in particular in adults suffering from pneumococcal meningitis. In contrast, studies conducted in developing countries have yielded less favourable results.(56). Others suggested that the adjunctive administration of corticosteroids is beneficial in the treatment of adolescents and adults with bacterial meningitis in patient populations similar to those seen in high-income countries and in areas with a low prevalence of HIV infection.(57)

b. Side effects are not limit to
b.1. stomach irritation
b.2. rapid heartbeat (tachycardia)
b.3. nausea
b.4. insomnia
b.5. Etc.
Other severe side effects include hyperglycemia, insulin resistance, diabetes mellitus,osteoporosis, cataract, anxiety, depression, colitis, hypertension, ictus, erectile dysfunction, hypogonadism, hypothyroidism, amenorrhoea, and retinopathy.(58)

A.2. Viral Meningitis
1. According to the statistic
Enteroviruses account for more than 85% of all cases of viral meningitis, Arboviruses account for about 5% of cases in North America, Herpes family viruses (Herpes simplex virus (HSV)-1, HSV-2, varicella-zoster virus (VZV), Ebstein-Barr virus (EBV), cytomegalovirus (CMV), and human herpesvirus-6 collectively) cause approximately 4% of cases of viral meningitis(58)

2. There is no treatment for viral meningitis, as the immune system, however, will produce antibodies to destroy the virus. Care must be taken during the Leighton for the body to run its course.

A.3. Aseptic meningitis
Clinicians must consider partially-treated bacterial meningitis as a possible etiology for the aseptic nature of their patient's disease; for example, patients with bacterial otitis and sinusitis who have been taking antibiotics may present with meningitis and CSF findings identical to those of viral meningitis.(58)

A.4. Parasitic meningitis
Parasitic meningitis usually is treat with a benzimidazole derivative or corticosteroid
1. Benzimidazole derivative
a. Albendazole
Researchers at the Chung Shan Medical University, in the study of the efficacy of Albendazole in parasitic meningitis, showed that examination of brain tissue revealed a similar pattern of decrease (48.6% by day 7, and 53.9% by day 14). Albendazole may thus be an effective compound for the treatment of angiostrongyliasis through its larvicidal activity and facilitation of an improved inflammatory response via the reduction of MMP-9 activity(59)

b. Albendazole-GM6001 co therapy
The combination treatment reduced MMP-9 activity by 89.2% in cerebrospinal fluid. The numbers of inflammatory cells increased significantly upon establishment of infection, but subsided upon co-treatment. Significantly fewer larvae were recovered from treated mice than from untreated, infected mice. The present results strongly suggest that co-therapy with albendazole and GM6001 may be an useful approach for the treatment of human angiostrongyliasis.(60)

c. Etc.

2. Corticosteroid
Dr. Sawanyawisuth K, at the Khon Kaen University, in the study of Drug target in eosinophilic meningitis caused by Angiostrongylus cantonensis showed that eosinophilic meningitis caused by Angiostrongylus cantonensis is an emerging infectious disease. It is the most common form of human angiostrongyliasis. The diagnosis is made by clinical criteria including the presence of cerebrospinal fluid eosinophils and a history of exposure to A. cantonensis larvae, e.g., from raw freshwater snails or contaminated vegetables. Among various treatment options, corticosteroid is the only effective treatment.(61)

3. Others suggested treatment options consist of symptomatic interventions, steroid therapy, antihelminthic therapy, or a combination of these strategies(62). Others showed that interleukin-12 and mebendazole lower levels of worm recovery and dramatic lessening of the eosinophilic meningitis. A reverse transcriptase PCR assay of mRNA expression in the brain also revealed that the use of IL-12 had shifted the immune response of the mouse from Th2 type to Th1 type.(63)

4. Etc.

A.5. Non medication causes of meningitis
There is report of 39-year-old woman with systemic lupus who presented with recurrent aseptic meningitis secondary to treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), clinical manifestation resolved rapidly with ibuprofen discontinuation, and corticosteroids therapy was unnecessary. Aseptic meningitis related to NSAIDs reported in lupus patients should be considered because of their specific modality of care and their favourable outcome.(64).

B. Treatment in herbal medicine(71)
The aim of herbal remedies are to aid the recovery process during recover phase from meningitis by strengthening the body immune system.
1. Garlic
a. Antifungal antitumor cytotoxicity and blood coagulability effects
In the identification of organosulfur compounds and theirs effects on cardiovascular diseases found that in vitro antifungal antitumor cytotoxicity and blood coagulability effects of steroid saponins from garlic and related Allium species are provided. Animal studies on the cholesterol-lowering effects of the saponin fractions from garlic are also summarized, according to "Saponins in garlic as modifiers of the risk of cardiovascular disease" by .Matsuura H(67)

b. Antioxidant effects
In the study of the Extracts of aged fresh garlic that are aged over a prolonged period and its antioxidant effects found that the ability of AGE to protect against oxidant-induced disease, acute damage from aging, radiation and chemical exposure, and long-term toxic damage. Although additional observations are warranted in humans, compelling evidence supports the beneficial health effects attributed to AGE, i.e., reducing the risk of cardiovascular disease, stroke, cancer and aging, including the oxidant-mediated brain cell damage that is implicated in Alzheimer's disease, according to "Antioxidant health effects of aged garlic extract" by

Borek C.(68)

2. Ginseng
a. Antioxidant activity
In the evaluation of the extraction conditions of polysaccharides from the rhizomes of Panax japonicus C.A. Meyer and its antioxidant effect found that antioxidant activity exhibited Panax japonicus polysaccharides (PJP) had a good potential for antioxidant, according to "Optimization of polysaccharides from Panax japonicus C.A. Meyer by RSM and its anti-oxidant activity" by Wang R, Chen P, Jia F, Tang J, Ma F.(69)

b. Immunological activities
In the study of Water-soluble ginseng oligosaccharides (designated as WGOS) with a degree of polymerization ranging from 2 to 10 were obtained from warm-water extract of Panax ginseng roots, found that WGOS were potent B and T-cell stimulators and WGOS-1 has the highest immunostimulating effect on lymphocyte proliferation among those purified fractions. It is hoped that the WGOS will be developed into functional food or medicine, according to "Structural characterization and immunological activities of the water-soluble oligosaccharides isolated from the Panax ginseng roots" by Wan D, Jiao L, Yang H, Liu S.(70)

3. Astralgus
a. Immune system
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(65)
C. Treatment in Traditional Chinese medicine

b. Anti-inflammation
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(66)

C. In Chinese medicine(72)
C.1. Meningitis is defined as a condition caused by
1. Heat excess in the Liver channel stirring up internal movement of Wind. Liver-Yang rising
a. Symptoms
a.1. High fever;
a.2.Irritability
a.3. Persistent fever
a.4. Restlessness
a.5. Loss of consciousness
a.6. Restless legs
a.7. Dry tongue with red-tipped spots;
a.8. Rapid-Wiry pulse
a.9. Etc.

b. Formula Ling Jiao Gou Teng Tang(72)
* Ling Yang Jiao (Cornu Antelopis, Antelope Horn) - 4.5g. -soothes liver, eliminates wind, clear heat *Gou Teng (Ramulus cum Uncis Uncariae, Gambir Vine Stem, Gambir) - 9g. -restores relationship between fire and wood (pericardium and liver)
*Sang Ye (Folium Mori Albae, White Mulberry Leaf) - 6g. -expel wind, clear lung and liver heat
*Ju Hua (Flos Chrysanthemi Morifolii, Chrysanthemum Flower) - 9g. -expel wind, clear lung and liver heat
*Bai ShaoYao (Radix Paeoniae Lactiflorae, White Peony Root, Peony) - 9g. -nourish yin and fluids, soothe liver, relax sinews
*Sheng Di Huang (Radix Rehmanniae Glutinosae, Chinese Foxglove Root, Rehmannia) - 15g. -nourish yin and fluids, soothe liver, relax sinews
*Chuan Bei Mu (Bulbus Fritillariae Cirrhosae, Tendrilled Fritillaria Bulb, Fritillaria) - 12g. -clear heat, transform phlegm
* Zhu Ru (Caulis Bambusae in Taeniis, Bamboo Shavings) - 15g. -clear heat, transform phlegm
*Fu Shen (Sclerotium Poriae Cocos Pararadicis, Poria Spirit) - 9g. -clears heat, relieves irritability, calms restlessness
*Gan Cao (Radix Glycyrrhizae Uralensis, Licorice Root) - 2.4g. -harmonize other herbs within formula, nourish yin, relax sinews, relieve spasms

2. Heat entering the terminal Yin channel. Vigorous Heat generates Wind, which leads to internal movement of Liver Wind
a. Symptoms
a.1. Migraine
a.2. Muscle spasms in the extremities
a.3. Opisthotonos
a.4. Tetanus
a.5.Trismus
a.6. Scarlet red,
a.7. Stiff tongue
a.8. Rapid-Wiry pulse
a.9. Etc.

b. Formula Zhi Jing San
*Quan Xie (Buthus Martensi, Scorpion, Buthus) -extinguish wind, relieve spasms, stop pain, relieve toxicity
*Wu Gong (Scolopendra Subspinipes, Centipede, Scolopendra) -extinguish wind, relieve spasms, stop pain, relieve toxicity

3. Heat excess which leads to internal movement of Liver Wind (in children). Phlegm-Heat in the Lungs
a. Symptoms
a.1. High fever
a.2. Pneumonia
a.3. Tetanus
a.4. Body rigidity
a.5. Opisthotonos
a.6. Restlessness
a.7. Spasms
a.8. Stiff jaw
a.9. Etc.

b. Hu Po Bao Long Wan(74)
*Niu Huang (calculus bovis) 7.8%
*Tian Zhu Huang (Concretio Siliceae Bamusae) 7.8%
*Dan Nan Xing (Pulvus Ariseamatis Cum Felle Bolvis) 3.1%
*She Xiang (Secretio Moschus)0.6%
*Quan Xie (Buthus Martensi) 4.7%
*Jiang Can (Bombyx Batryticatus) 15.3%
*Zhu Sha (Cinnabaris) 4.7%
*Hu Po (Succinun) 3.8%
*Xiong Huang (Realgar)1.6%
*Chi Fu Ling (Sclerotium Poriea Cocus) 15.5%

Healthy Happy Herbs
A Beginner's Guide To Herbs And
Herb Gardening, Step by step

Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer

For the world most popular herbs list, visit http://theworldmostpopularherbs.blogspot.com/2011/10/world-most-popular-herbs-health.htmlother health articles, please visit http://medicaladvisorjournals.blogspot.com/

Wednesday, April 18, 2012

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.
Natural Remedies for Dementia Memory Loss Reversal
Guarantee to Stop Progression and Reverse Memory Loss in Alzheimer and Dementia with step by step instructions through Scientific Studies within 2 Months or your Money back

Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer

For over 100 healthy recipes, http://diseases-researches.blogspot.ca/p/blog-page_17.html

Medical Advisor Journals

Pages

Natural Medicine for Fatty Liver And Obesity Reversal

Friday, April 27, 2012

Meningitis

Wednesday, April 18, 2012

Cerebritis, Lupus, and Lupus Cerebritis