Sjogren Syndrome Treatment

Treatment of Sjogren's syndrome Specialized Department, as one of the key departments of Rheumatism and Immunological Disease Treatment Center of Hebei Yiling Hospital, has achieved distinct clinical therapeutic effects in the treatment of Sjogren syndrome on the basis of propagating the essence of traditional medicine and sufficiently integrating the advancing frontline achievements of modern medicine science as well as renovating concepts and innovating therapy on aspect of theory, experiment and clinical research. Now, the treatment research of Sjogren syndrome undertaken by the specialized department has been listed as a key science and technology project to be tackled by Hebei Provincial Science and Technology Department. 
Moreover, our center has introduced “plasmapheresis" equipment from Japan, which can effectually remove the immune complex from the body of Sjogren syndrome patient, and rapidly rectify patient's clinical symptoms. At present, the equipment is one of the most advanced therapeutic means in the treatment of autoimmune disease at home and abroad. 
We sincerely hope that the establishment of the website will strengthen our communication and provide fundamental knowledge of prevention and treatment of Sjogren syndrome; meanwhile, we wholeheartedly introduce our characteristic therapies against Sjogren syndrome, and provide consulting services on line at the same time so that you can get guidance from the experts of our center while sitting at home. 

Experts Introduction
Mr. Zhong Qicheng, Chief Physician and Professor
Assistant Director of the Treatment Center of Rheumatism and Immune Diseases and member of Chinese Communist Party. After graduated from Jiangxi College of Traditional Chinese Medicine with a bachelor's degree, he received further education of rheumatism and immunity diseases exclusively. With more than 20 years' clinical practice against rheumatism and immunity related diseases with combined TCM and western medicine, he has very solid theoretical basis, abundant clinical experience and profound scientific attainments. Mr. Zhong has been involved in the compiling of two academic books up to 800,000 Chinese characters in total. He published more than 30 technical papers on professional journals of the national or the provincial level, and his papers published on international journals ever won him the International Prize of Excellent Papers. He has taken part in the research work in numerous research projects of the national or the provincial level and two of his achievements have been promoted in such areas like the Central China. His name has been listed into the national talent bank officially by the publishing house of the People's Daily-- the "Chinese Scientists and Remarkable Experts Collection" and the "Dictionary of Famous Chinese Doctors". Moreover, he is invited as the director of the China Association of Famous Doctors and the Hong Kong International Association of Traditional Medicine. He enjoys certain popularity both in and outside China. 

Mr. Zhong conducted in-depth research in the treatment of lupus erythematosus, Behcet's disease, Sjogren syndrome as well as scleroderma, dermatomyositis, polymyositis, rheumatism, rheumatoid arthritis and other kinds of rheumatism and immunological diseases. Especially in treatment of lupus erythematosus, Behcet's disease and Sjogren syndrome, he has diagnosed and treated thousands of patients and accumulated abundant experience. He is ready at not only summarizing experience but also continuing to bring new ideas and to develop new technology and new therapies. Taking the advantages of TCM, he gained great therapeutic efficacy with the method combining comprehensive treatment with partial treatment against Sjogren syndrome. The dredging therapy through injections to the parotid gland for the treatment of Sjogren syndrome is his original creation around the world. The therapy is very unique and remarkable in therapeutic effects. In the treatment of lupus erythematosus, he adopts the method combining TCM with western medicine and has gained satisfactory efficacy in many serious cases. As for Behcet's disease, he also worked out an efficacious TCM therapeutic method through long-term practice. Generally speaking, for any of the above-mentioned disease, Mr. Zhong has mastered two sets of therapies, the TCM series and the Western series. He is very accomplished in taking the advantages of TCM to reduce and avoid the toxic and adverse reactions of Western medicines and reduce the risks of using Western medicines. Following the principle of diagnosing and treating diseases on the basis of an overall analysis of the illness and the patients' conditions, he developed individualized therapies specific to different patients and different stages of the illness. He takes good care of patients, diagnoses and treats them with cares and patience, which won him the hearty trust from the patients. At present, his main diagnosis field and major research direction are diagnosis and treatment of such rheumatism and immunity diseases as lupus erythematosus, Behcet's disease and Sjogren syndrome with both western medicine and TCM therapies. 

Mr.Li Zhenguo,  Chief Physician
Mr. Li, chief physician, born in June, 1953, graduated from North China Coal Medical College (former Tangshan Coal Medical College) and awarded the bachelor's degree in 1979. He has been engaged in internal medicine clinic and scientific research for 30 years and accumulated abundant experience in the treatment of diabetes, chronic gastritis, peptic ulcer, rheumatoid arthritis, Sjogren syndrome, Behcet's disease, lupus erythematosus and other diseases with the therapies combining TCM with western medicine; especially, he is expert at the treatment of stubborn rheumatic and immunological diseases. He has been devoting himself to the treatment research of polymyositis, dermatomyositis and scleroderma for long and contributed a lot to the theory. In years' clinical practice and research of the treatment of scleroderma, considering the' clinical characteristics of scleroderma like chronic progression and complicated conglutination, he hold the view that its main pathological mechanism is "phlegm-stasis blocking collaterals". Upon this principle, he originated the innovative viewpoint of dispelling phlegm, dissolving the stagnant and activating the channels for treatment of scleroderma, which is proven efficacious clinically in treatment of polymyositis/dermatomyositis for it emphasizes in differentiation of symptoms and signs as well as individual characteristics of different patients.And it won widespread recognation from patients. He had over 30 medical papers published on national medical publications including "A Study on Treatment of Scleroderma from the Viewpoint of Phlegm-stasis Blocking Collaterals", "Lung Deficiency and Phlegm-stasis Blocking Collaterals is the Fundamental Pathogenesis of Pulmonary Fibrosis due to Systemic Scleroderma",  "The Research Progress of TCM in the Treatment of Polymyositis and Dermatomyositis". In addition, he participated in compiling of 2 medical exclusive books and 4 academic exclusive books, which won him two provincial and municipal Scientific and Technological Progress Prizes respectively. And his name was enrolled into the "Blue Book of Chinese Experts" by Chinese Bank of Talents in 1992 as a successful medical expert. 

Typical Case 1
Ms. Zhang, a 41-year-old patient, paid her first visit on August 20, 1999. She had suffered from dryness of eyes and mouth for more than five years. Her conditions were aggravated in the last year. Observations at Admission: dryness of eyes and mouth, leanness, fatigue, dizziness and tinnitus, upset and hectic fever, xerosis cutis and itching, eating little and constipation, hypermenorrhea, swelling parotid glands, red tongue without coat, deep and faint pulse. Laboratory Examination: HBcAb (+), anti SSA(+), anti SSB(-), RF(+) and ESR (45mm/h);  quantitative determination of immune globulin were as follows: IgG 31.7g/L, IgA 5.4g/L, IgA 2.2g/L; tear flow rate determination: 2mm(left eye ), 6mm (right eye);  fluorescent staining of cornea: positive, glandulae labiales biopsy: a great quantity of lymphocytes were infiltrated, a part of glandular organs were atrophic;  parotid sialography:  bilateral parotid's duct showed  sausage-like lesion with uneven diameters and the examination results were in line with the diagnosis standard of Sjogren syndrome. TCM Diagnosis:  syndrome caused by dryness-evil (deficiency of kidney Yin and liver Yin); Diagnosisat of Western Medicine: Sjogren syndrome. The patient was administered with Runzaoling Capsule, 5 capsules/times and 3 times/day, and Runzaoling No.2, 1 pouch/time and 3 times/day. After treated for three months, the symptoms of dryness of mouth and eyes were improved evidently, and general symptoms disappeared. Tear flow rate determination showed 6mm (left eye), 8mm(right eye); cornea fluorescence staining was positive. Laboratory Examination: Anti SSA (-), Anti SSB(-), RF(+), ESR 17mm/h, IgG17.7g/L, IgA3.2g/L, IgM1.7g/L. The patient was told to continue taking the prescribed drugs for one treatment course to consolidate the therapeutic effects, and no signs of recurrence of the disease were observed during the half-a-year follow-up period. 

Typical Case 2
Ms. Zhao, 43, paid her first visit in April 1999 for suffering from dryness of eyes and mouth for more than eight years. Observations at Admission: dry mouth and throat, extremely thirsty, hoarseness, little cough, disinclination to talk, general lassitude, anorexia, leanness, red and dry tongue, thready and rapid pulse. Laboratory Examination: anti SSA(+), anti SSB(+) and RF(+), ESR（51mm/h); the quantitative determination of immunoglobulin was as follows, IgG27.4g/L, IgA3.8g/L and IgA2.5g/L; the tear flow rate determination were 3mm(left eye) , 4mm (right eye); cornea fluorescence staining was positive; gastroscopy showed chronic gastritis; pathological biopsy of labial gland showed a great quantity of lymphocytes were infiltrated;  parotid sialography showed expanded parotid ducts on both sides and spherular expansion of branch ducts. TCM Diagnosis:  syndrome caused by dryness-evil (deficiency of lung Yin and stomach Yin); Diagnosis of Western Medicine: Sjogren syndrome. The patient was administered with Runzaoling Capsule, 5 capsules/times and 3 times/day, and Runzaoling No.1, 1 pouch/time and 3 times/day. After a course of treatment, the symptoms of dryness of mouth and eyes were improved evidently, and general symptoms disappeared. Tear flow rate determination showed 8mm (left eye), 10mm(right eye ); cornea fluorescence staining was negative. Laboratory Examination: Anti SSA (-), Anti SSB(-), RF(+), ESR 18mm/h, IgG15.2g/L, IgA2.7g/L, IgM1.9g/L. The patient was told to continue taking the prescribed drugs for two more months to consolidate the therapeutic effects, and no signs of recurrence of the disease were observed during the half-a-year follow-up period. 

Typical Case 3
Ms. Ouyang, a 37-year-old patient, paid her visit in October 1999. She complained of dry mouth and eyes for more than eight years. Observations at Admission: dryness of mouth and tongue, and absence of saliva, unable to swallow dry food, dry eyes and absence of tears, hazy vision, vertigo and tinnitus, costal regions pain, poor nourished skin, fragile nail, soreness of the waist and knees, limb arthralgia, dryness of vagina, little secretion, crimson tongue and lack of saliva, absence of tongue fur, thready and rapid pulse. Laboratory Examination: anti SSA (+), anti SSB (+), RF (+), ESR (80mm/h); tear flow rate determination showed left eye 0 mm and right eye 2mm; cornea fluorescence staining was positive; gastroscopy showed atrophic gastritis; parotid sialography showed thin parotid duct of uneven diameters.  TCM Diagnosis:  syndrome caused by dryness-evil (toxins due to excessive dryness); Diagnosis of Western Medicine: Sjogren syndrome. The patient was administered with Runzaoling Capsule, 5 capsules/times and 3 times/day, and Runzaoling No.5, 1 pouch/time and 3 times/day. After two courses of treatment, the symptoms of dryness of mouth and eyes were improved evidently, and general symptoms disappeared. Tear flow rate determination showed 5mm (left eye), 6mm(right eye ); cornea fluorescence staining was positive. Laboratory Examination: Anti SSA (-), Anti SSB(-), RF(+) and ESR 28mm/h. The patient was told to continue taking the prescribed drugs for three more months to consolidate the therapeutic effects, and no unstable signs of the disease were observed during the half-a-year follow-up period. 

Typical Case 4
Ms. Wan, a 55-year-old patient from Hebei province, had suffered from dryness of eyes and mouth for five years along with systemic arthralgia for three years. She was hospitalized in July, 2003. About 5 years ago, she began to suffer from dryness of mouth and eyes, mycteroxerosis symptom without definite cause. At first the symptoms were only oligoptyalism and dry eyes, then aggravated progressively. She could not eat dry foods, and needed to drink water frequently, secreta of both eyes increased, both hands turned to white when caught a cold. She visited the local hospital, but the doctor could not identify the causes and the treatment suggested was effectless.  The patient began to have the symptom of systemic arthralgia three years ago, and the region mainly involved the major joints, and was most common in knee joints, ankle joints, shoulder joints, etc., which was accompanied by arthrocele, sense of sourness and weakness occasionally while walking, sense of teeth loosening with flaking phenomenon, and even fracture some of them. The patient had no fever, systemic skin rash, alopecia, erythema or swollen parotid gland, and no obvious fatigue, leanness or other manifestations. He visited Beijing Xiehe Hospital in May 2001; the examination results were as follows, RF+, ANA+, ESR 34mm/h, parotid ECT examination showed loss function of parotid gland. She was diagnosed as "Sjogren syndrome", and administrated to take prednisone (initial dosage was 15mg a day) and other treatments. After treatment, dry mouth was slightly improved, but her systemic arthralgia was not relived. The symptom was worse in overcast weather, aggravated in the morning, slightly eased in the afternoon so that she is difficult to walk, unable to crouch or take daily activities and work, her visual acuity descended. Her tongue was normal in size, red in color, coated with yellow and thick fur.  After being hospitalized to our center, and the results from routine blood, urine and stool examinations were all normal, the functions of liver and kidney were normal too; blood sedimentation (41.9mm/h, IgG27.07g/L, C3, C4) were normal, anti SSA antibody (+), anti SSB antibody (+), the results from B ultrasonoscope of spleen and liver were all norma; tear flow rates of both eyes were 2.5mm/min, then she was diagnosed as "primary Sjogren syndrome" in our hospital. According to the symptoms, she was administrated orally with 1 dosage of Chinese herbal medicine a day, Runzaoling No.2 medicinal granules by 5g/times and 3 times/day, Runzaoling No.4 capsule by 4 caps./time and 3 times/day, 25mg of Anethol Trithione by 3 times/day. Then prednisone in a maintaining dosage of 10mg a day was used, 20mg of Glucosidorum Tripterygll Totorum by 3 times a day; Mailuoning injection 20ml a day through intravenous transfusion plus injection therapy at the parotid gland by 1 time a week, treated at hospital for one month, then dryness of mouth and eyes obviously relieved, arthralgiat was eased. She could freely do any exercise again. Tests found her pale tongue with very little fur, coated thin fur, tear flow rate of both eyes approached normal level when rechecked, blood sedimentation was 24mm/h, liver and kidney function was normal, so the dosage of prednisone was reduced to 5mg a day, the other drugs were used following the same method above. The patient was instructed to eat bland diet after leaving the hospital, and continue to consolidate the therapeutic effects following the above proposal, her conditions are stable for several months according to the feedback. 

Typical Case 5
Ms. Fang, a 51-year-old patient from Henan province. She had suffered from dry mouth and systemic arthralgia for twenty years along with iterative intumescence of parotid gland for two years. She was hospitalized in September 2002. The patient began to appear the symptom of dry mouth and systemic arthralgia after a Caesarean operation in 1990. At first, the symptoms were not obvious, so she paid no attention to them. However, the illness was gradually aggravated accompanied with slight alopecia, and her both hands would turn to white and feel pain when she caught a cold, along with ulcerative stomatitis occasionally. Arthralgia mainly involved in major joints, especially both knee joints. She felt sour and weak while walking. Facial butterfly erythemata occurred on her face, which easily occurred in spring and aggravated under the sun. Since she had no pruritus or ecdysis, and the blood sugar examination showed normal, she did not see a doctor at that time. The symptom of dry mouth was gradually aggravated so much since 1999 that she could hardly swallow dry foods without the help of drinking some soup. She had to drink water frequently every day; meanwhile, she underwent dryness of both eyes, tears diminution, swelling and pain of left parotid gland iteratively, sense of loose teeth along with flaking. At admission, she had red tongue with little coating, no fever, systemic skin rash, obvious lassitude or leanness. Then she was hospitalized, and the test results of routine blood and urine examination, liver, kidney function, blood sedimentation rate and immunity were all normal. B ultrasonoscope of the liver, gallbladder, spleen, and both kidneys showed all normal.  Parotid Sialography: chronic inflammation of both parotid glands. Admitting diagnosis suggested "Sjogren syndrome". According to her symptoms and signs, she was instructed to take Chinese herbal medicine  orally by 1 dose a day; 5% glucose + Mailuoning injection 20ml, 5% glucose + Shuanghuanglian injection 40ml, IVT 1 time a day; 6g Runzaoling No.1 and 6g  Runzaoling No.5 by 3 times a day; 5mg thymulin by 2 times a day plus local injection into parotid glands  1 times a day. She was treated at hospital for 17 days, and discharged after all the symptoms were obviously improved. At home, she continued taking the medicines prescribed to consolidate the therapeutic effects. 

Sjogren syndrome involves various nervous system symptoms, but it is less common than systemic lupus erythematosus, and its prognosis will also be better than systemic lupus erythematosus. The process of nervous lesion due to Sjogren syndrome is indolent, and is mainly caused by vasculitis. The disease can be divided into two categories:  pathological changes of central nervous system and pathological changes of peripheral nervous system. The attack rate of pathological changes of central nervous system is low, and the majority of them are usually temporary function disturbance. However, in case of iterative occurrence, it also can develop to accumulative nervous lesion, such as hysteria, somatopsychosis, dysphoria-depression syndrome, epilepsy, ataxia, lesion of cranial nerves, hemiablepsia, hallucination, suspiciousness, delusion of persecution, stupor and coma, cerebral infarction, cerebral hemorrhage, and even death. Only 5% of patients undergo severe pathological changes of central nervous system. Pathological changes of peripheral nervous system are more common than those of central nervous system, but is more easily missed in diagnosis. It usually involves trigeminal nerve as well as other sensory nerve and motor nerve, which might lead to acroaesthesia, anesthesia or dyskinesia with the manifestations like facioplegia, numb limbs and tense tendons, carpal tunnel syndrome, etc. Pathological changes of nervous system are mainly caused by cryoglobulinemia and (or) hyaglobulinemia and vasculitis induced by deposition of immune complex, therefore, once nervous system symptoms occurs with Sjogren syndrome patient, they should be given with brain CT, magnetic resonance and other examinations at early stage for early diagnosis and treatment. To delay diagnosis and treatment usually makes the pathological changes of central nervous system nonreversible. 

[Clinical Manifestations] The patient falls ill slowly, usually undergoes hypodynamia and even fever. 
1. Dry Mouth.  The patient always feels dry mouth and desires to drink water, and even can not eat dry foods for serious cases. Dental caries easily occurs with patient, because the flushing action is reduced due to lack of saliva. 63% of primary SS patients suffer from dental caries while 40% of them suffer from sialosis, which occurs symmetrically with smooth and not hard. Sialosis may last persistently or attack iteratively, and seldom induces secondary infection. If the glandular organ is stiff and appears nodosity, care must be taken for possible malignant change. 
2. Dryness of eyes. There are scraping or foreign body sensations on eyes or absence of tears; lacrimal gland is usually not swollen, or slight enlargement. 
3. Skin Mucous Membrane. The patient suffers from xerosis cutis and pruritus, and purpura is the most common skin rash. Patient may also undergo hives-like skin rash, which appears polymorphy and nodule erythema. The other symptoms include dry oral lips, ulcerative stomatitis, dryness of nasal cavity and vagina mucous membrane. 
4. Joints and Muscles.  70% to 80% of the patients appear arthralgia, and even arthritis, but malignant arthritis is not common. The patient may undergo myasthenia, and 5% of them may undergo myositis. 
5. Kidney. About half of the patients may have renal damage, and the most common region involved is the distal uriniferous tube. The clinical manifestations include symptomatic or subclinical renal tubular acidosis. The former appears low pH in blood and its urine can not be acidized (pH＞6). Subclinical type can be measured by ammonia chloride loading test. The complications of renal tubular acidosis include: ①periodical hypokalemic paralysis; ②renal chondropathia; ③renal diabetes insipidus, and the involved proximal end renal tubule shows acidaminuria, phosphoric aciduria, glycosuria or β2- micro globulinuria. Affection of acinus renis is not common, but its prognosis is much worse. 　
6. Lung. 17% of patients undergo dry cough, but no iterative pulmonary infection. Excessive inflammatory cells may be found in the bronchus air sac rinse solution of 50% patients, which indicates the existence of air sac inflammation. Only few patients undergo diffuse pulmonary fibrosis. Pulmonary function test usually shows that the function is reduced, but usually no clinical symptoms. 
7. Alimentary System.  ① atrophic gastritis,  hypofunction of gastric acid secretion, deficiency of gastric acid; ② intestinal malabsorption; ③  hypofunction of pancreas exocrine ; ④ hepatauxe, raisen serum transaminase. Liver pathology biopsy of jaundice patient usually shows changes of chronic active hepatitis, these patients are suitable for the use of ACH. 
8. Nervous System. Different level of damages in central nervous system can be induced by different region of vasculitis, and the symptoms include epilepsy, hemiplegia, hemianopsia, myelitis, cranial neuritis and peripheral neuritis. The later mainly involves sensory fiber. 
9. Hemogram.  1/4 to1/5 of patients undergo the reduction of leucocyte and thrombocytopenia, and only few patients undergo bleeding. 
10. Lymphoplasia. 5% to 10% of patients undergo lymphadenectasis. At least 50% of patients undergo infiltration of a great quantity of lymphocyte in internal organs in the course of disease. And what's more, the leucoma attack rate of patients suffering from this disease is 44 times more than health people. During the follow-up period, 2 of 150 SS patients in China undergo leucoma. Macroglobulinemia or monoclone hyaglobulinemia may occur before the manifestation of leucoma with SS patients. After the manifestation of leucoma, immune globulin level may be reduced, and autoantibody may disappear. 

Is the manifestations of respiratory system and kidney of Sjogren syndrome patient significant？
1. Respiratory System. Air tube impairment is induced by infiltration of upper and lower respiratory tract mucomembranous achroacyte and atrophy of its exocrine glandular organ. About 25% of patients, trachea and bronchus appear dry cough due to dryness, iterative bronchitis and pulmonary atelectasis, and the most frequent manifestation is chromic fibrous pneumonia and pulmonary interstitial fibrosis. The patients undergo cough and respiratory distress, reticulate and nodosity shadow upon x-ray. Lung function mainly involves disorder of small airway, the next is diffusion function and restricted disfunction, and lung disfunction is usually prior to x-ray manifestation of lung. 
2. Kidney. About 50% of patients undergo kidney damage, and it is most common in the distal end of renal tubules with the manifestation such as renal tubular acidosis, the pH in urine is increased, urinary concentration functional is impaired, nephrogenic diabetes insipidus, renal osteomalacia, uropoiesis calculus and nephridial tissue calcification, hypokalemic paralysis and calcium and phosphorus metabolism disorder. For a considerable number of patients who has no symptoms, ammonia chloride test is the only way to detect subclinical renal tubular acidosis. 

1. Respiratory System. Air tube impairment is induced by infiltration of upper and lower respiratory tract mucomembranous achroacyte and atrophy of its exocrine glandular organ. About 25% of patients, trachea and bronchus appear dry cough due to dryness, iterative bronchitis and pulmonary atelectasis, and the most frequent manifestation is chromic fibrous pneumonia and pulmonary interstitial fibrosis. The patients undergo cough and respiratory distress, reticulate and nodosity shadow upon x-ray. Lung function mainly involves disorder of small airway, the next is diffusion function and restricted disfunction, and lung disfunction is usually prior to x-ray manifestation of lung. 
2. Kidney. About 50% of patients undergo kidney damage, and it is most common in the distal end of renal tubules with the manifestation such as renal tubular acidosis, the pH in urine is increased, urinary concentration functional is impaired, nephrogenic diabetes insipidus, renal osteomalacia, uropoiesis calculus and nephridial tissue calcification, hypokalemic paralysis and calcium and phosphorus metabolism disorder. For a considerable number of patients who has no symptoms, ammonia chloride test is the only way to detect subclinical renal tubular acidosis. 
3. Nervous System: Different regions of vasculitis can induce nervous lesion of different regions and corresponding clinical symptoms. (1) pathological changes of peripheral neuropathy: about 8.3% to 32% of patients have such manifestations as lower limb pain,  peripheral sensory disturbance, carpal tunnel syndrome, low tendon reflex, etc. Electromyogram shows nervous impairment and peripheral nerve conduction velocity slows down. (2) pathological changes of central nerve: about 5% of patients are manifested by epilepsy-like attack, various mental symptoms, disturbance of consciousness, focal symptom, etc, but these symptoms usually appear moderate. 
4. Alimentary System. About 63% to 70% of patients suffer from atrophic gastritis, whose manifestations are epigastric discomfort, nausea, abdominal distention, etc. About 25% of patients undergo hepatomegaly and increased aminopherase. A great number of patients who have chronic hepatitis or biliary cirrhosis are also accompanied with Sjogren syndrome. 　
5. Joints and Muscle: About 70% of patients may suffer from arthralgia, but only few patients would develop to arthritis, and also few patients are accompanied with myositis and myasthenia gravis. 
6. Lymph porliferation and Leucoma: Basic pathology manifestations of Sjogren syndrome are lymphadenia and infiltration of different regions, which can be divided into three stages: 

The first stage: autoimmunity exocrine diseases, of which the clinical manifestations are dryness of mouth and eyes; pathology characteristic is infiltration of a great quantity of lymphocytes in glandular organ and the orrhology characteristics of the disease are hyaglobulinemia, anti SSA and anti SSB are positive. The second stage:  pseudolymphoma, of which the clinical manifestations are intumescence of liver and splenic lymph nodes, affection of kidney and central nervous system; pathology characteristics of the disease are infiltration of lymphocytes in the external tissue of glandular organ; orrhology characteristics of the disease are hyaglobulinemia, monoclonal immunoglobulin peak, anti SSA and anti SSB are positive. The third stage: leucoma.about 0.01% to 0.06% of Sjogren syndrome patients undergo malignant pathological changes and turn to malignant leucoma, of which the clinical manifestations include obviously swollen lymph nodes, salivary gland and parotid gland as well as evident progressive emaciation. 

The Symptoms of Ocular Region and Pancreas Occurs with Sjogren Syndrome Patients
 Manifestations of Ocular Region: Secretion function of lacrimal gland is descended, and patients appear self-conscious dryness of both eyes, little tears or alacrimia, weeping without tears when agitation, ocular region has scraping sensation of foreign body or burning sensation, heavy eyelid, self-conscious tentiform shielding ahead of eyes, photophobia, ophthalmalgia, recurrent attacks of keratitis, conjunctivitis, and even nebula,  corneal perforation or uveitis. 
Manifestation of Pancreas: Exocrine function of pancreas is descended, patients appear chronic diarrhea, but most patients occur slightly clinical symptom or subclinical pancreatitis without symptom at all. 
Manifestations with other glandular organ include serious achroacyte infiltration occurs with glandular organ tissue and cause reduced secretion of the excrine glandular organs such as nose, trachea, lower respiratory tract, alimentary canal and vagina, and dryness symptom, for example, xerosis cutis, dryness in the nasal cavity and absence of nasal discharge, expectorate phlegm, dry stool, dryness of vagina, dyspareunia etc. 

Our center makes use of TCM as the major therapeutic measure, renovates the idea, innovates the therapies, and puts special emphasis on our advantages. After many years' research, we have gained the following discoveries: the major pathomechanism of Sjogren syndrome is deficiency of kidney-yin and kidney yin fluid dried up. According to TCM theories, the kidney masters body fluid, so dryness of eyes and mouth, absence of tears and saliva are all closely related to deficiency of kidney-yin. Deficiency of kidney-yin can directly result in functional disorder of salivary gland and lacrimal gland, so the patients will undergo a series of symptoms like dryness of mouth and eyes. The key to treatment of this disease is to nourish kidney and moisturize dryness-syndrome, activate gland and enhance secretion of body fluid, namely "the therapy of nourishing kidney and activating gland". We have developed Runzaoling series of TCM preparations, and formed an unique theoretical system on treatment of Sjogren syndrome and medication regularity. Clinical application indicates that the therapy of nourishing kidney and activating gland can effectually restore the function of glands, promote secretion of glands, and release such symptoms as dryness of mouth or eyes. 
Local application combined with systemic administration can enhance therapeutic effect. Sjogren syndrome is a type of systemic disease of which the major manifestation is local pathological changes. To effectively and rapidly release patients from self-conscious symptoms and physical signs is what they expect. This purpose is achievable by applying such medicines as eye drip liquid, gargarism and other preparations developed by our hospital, which can effectively release clinical symptoms in a short period. However, Sjogren syndrome is also a systemic disease accompanied with systemic immunological function disorder, so we must adjust the general immunity function as a whole, therefore both local and systemic application of medicine is actually a treatment method concerning both secondary aspect and primary aspect of the disease. Meanwhile, our center adopts the therapy of "Local Injection of Parotid Gland” as the only hospital in China that use this therapy against the disease, which, as a proven therapy, combining with other comprehensive treatment methods, can definitely relieve Sjogren syndrome patients from suffering and prevent the disease from affecting other organs further. 
Emphasis should be set on early treatment to prevent further development of the disease and affecting multiple organs and systems. More than half of the Sjogren syndrome patients would undergo recurrent attacks of parotid gland intumescence during their adolescent period. These early manifestations are very easy to be neglected during diagnosis and misdiagnosed consequently. If these manifestations are not paid enough attention, the treatment may be postponed and the disease may be exacerbated and worsened. If the disease affects multiple organs and systems, the sufferings of the patients would be exacerbated, leading to cases that are relatively difficult to treat and poor prognoses. So the aim of the clinical treatment should include the following two aspects, one is to actively treat the present disease and alleviate the clinical symptoms while the other is to prevent the exacerbation of the disease, the possible development to multiple organs and multiple systems as well as any undesirable results. 

International Classification and Final Diagnosis Standard of Sjogren Syndrome (in 2002)
Ⅰ.Buccal Cavity Symptom: one or more of the following three items:
   1. The patient feels dry mouth every day for more than three months, 
   2. There are iterative or successive intumescence of parotid gland for adult patient, 
   3. The patient needs the help of water to swallow dry foods.
Ⅱ.Eye Symptom: one or more in the following three items:
   1. The patient feels unbearable dryness of eye every day for successively three months, 
   2. The patient feels the existence of sand in eyes frequently, 
   3. The patient needs artificial tears three times or more a day. 
Ⅲ. Physical Sign of Ocular Region: one or more in the following examinations is positive:
   1. Schirmrl Test (+) (≤5mm/5min)
   2. Cornea Staining (+) (4 van Bijsterveld count method) 
Ⅳ. Histological examination: number of small glandulae labiales lymphocyte focus ≥1 
Ⅴ. Salivary Gland Damage: one or more in the following examinations is positive:
   1. Saliva Flow Rate (+)(≤1.5ml/15min)
   2. Parotid gland Visualization (+)
   3. Salivary Gland nuclide Examination (+) 
Ⅵ. Autoantibody: anti SSA or anti SSB (+) (both diffusion method) 
   
Specific Rules of Diagnosis
1 Primarily Sjogren Syndrome: in the case of no other potential diseases, it is suggested to make the diagnosis based on the following two rules: a. conform to four or more of the above standard articles, and at least either Article Ⅳ (histological examination) or Article Ⅵ(auto antibody) is positive in test. b. Any three of Article Ⅲ, Ⅳ, Ⅴor Ⅵ are positive.
2. Secondary Sjogren Syndrome: patient who is suffering from potential disease(s) (any kind of connective tissue diseases) , and is consistent with either ArticleⅠ or Ⅱ, and two of Article Ⅲ, Ⅳor Ⅴ at the same time.
3. Exception from above 1 or 2: radiotherapeutic history with neck, head or face, HCV infection, AIDS, leucoma, sarcoidosis, transplant anti host disease, use of anti acetylcholine (such as, atropine, cytospaz, propantheline bromide, atropa belladonna etc.)

How to definitely diagnose Sjogren syndrome?
Clinical examinations that Sjogren syndrome patient should take include parotid gland visualization, lipmucous membrane biopsy, tear flow rate determination, tear-film rupture test, cornea fluorescence staining, saliva flow rate determination, anti SSA antibody, anti SSB antibody determination, blood sedimentation, rheumatoid factor etc. If the results from above examinations show abnormal or positive plus typical clinical manifestations, it can be diagnosed definitely as Sjogren syndrome.
Some Sjogren syndrome patients may suffer from adenalgia and adenoncus of both parotid glands instead of self-conscious symptoms like dryness of mouth or eyes, or slight symptoms of dryness of mouth and eyes, which should be paid enough attention by patients themselves and doctors. 
Sjogren syndrome patient should never neglect that the disease can damage respiration, kidney, nerve, digestion and other multitude systems, and never hold the view that drinking more water can release the symptoms instead of going to hospital for medical care. Sjogren syndrome patients tend to undergo debilitation, skin erythema, arthralgia, and hyaglobulinemia etc, which might mislead to other diseases such as hypokalemic paralysis, purpura haemorrhagica, dermatitis glandularis erythematosa, arthritis deformans, chronicity hepatitis etc. 　
The disease can generate various autoantibodies such as antinuclear antibody, RF, anti RNP antibody, anti SSA antibody, anti SSB antibody, etc, so attention should be paid to distinguish this disease from arthritis deformans, systemic dermatitis glandularis erythematos and other connective tissue diseases. 
For Sjogren syndrome patient whose systemic manifestations obviously occur with one system such as renal tubule acidosis, chronic pancreatitis etc, and clinicians should pay more attention to finding out the real causes to the disease in the process of diagnosis.