LYCOS RETRIEVER 
Sarcoidosis: Patients
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Sarcoidosis is a medical mystery. For the physician who is working on the scientific frontier, the disease can be a fascinating challenge. For the patient it can be a very seroius illness, rarely fatal, sometimes of little consequence.
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Sarcoidosis can involve all of the organ systems of the body, but thoracic lymph nodes and the lung parenchyma are most often and most visibly involved. In the U.S. the chest radiograph is abnormal in more than 90% of patients of patients with sarcoidosis. The reported percentage is less in some other countries. Findings on the chest radiograph are a most important feature of sarcoidosis and these findings are often the initial signpost leading to the diagnosis, frequently in an asymptomatic patient.
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Sarcoidosis may not result in symptoms and the disease may come and go without the patient or doctor ever being aware of it. Symptoms can appear suddenly and then just as quickly resolve spontaneously. Sometimes... they can continue over a lifetime.
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In 1916, Boeck first described cutaneous anergy to tuberculin in patients with sarcoidosis. It was later on realized that this phenomenon was not limited to tuberculin alone, but that anergy to a variety of other skin tests-antigens such was ... typical. In 1994, Kataria and Holter proposed a mechanism for the cutaneous anergy seen in sarcoidosis. At sites of granulomatous inflammation, there is a predominance of helper T lymphocytes, which proliferate and secrete large amounts of lymphokines, including interleukin (IL)-2, monocyte chemotactic factor (MCF) and migration inhibition factor (MIF). These lymphokines induce and amplify the immune response by enhancing T-lymphocyte proliferation as well as recruiting and retaining monocytes from the circulation. The lymphokines and monokines produced at sites of granulomatous inflammation have their highest concentration locally.
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When considering treatment options for sarcoidosis, it should be remembered that many patients will show spontaneous resolution without intervention. When pulmonary manifestations are present, treatment is generally required. Extrapulmonary manifestations require treatment when major organs, neurologic, ocular, deforming skin lesions, or aerodigestive tract involvement are present. Oral steroids remain the cornerstone of treatment, but there is no set protocol. Patients are usually treated for at least six months initially. ACE or the ESR levels can be used to monitor response to the medical regimen.
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Dietarily, one would expect that an excess type diet, which allows phlegm to accumulate, should be avoided in an effort to resolve sarcoidosis. Fruits and non-fatty vegetables (e.g., broccoli but not avocado) would be an important therapeutic dietary component, while fatty meats, especially pork, and all kinds of heavy deserts would be contraindicated. Fish, which is used in Chinese dietetics to drain excess dampness, would be appropriate. Alcohol, which contributes to dampness and heat, on the other hand, would be contraindicated; green tea might be the ideal beverage, as it is considered cooling and phlegm-resolving (see: Beverage teas for health). A small study (8) carried out in the Balkans suggested some therapeutic benefit could be attained for patients with sarcoidosis by therapeutic fasting for those with the early stage of the disease (duration less than one year). In organizing an appropriate diet, it is important to make sure that there is adequate nutrition; from the traditional viewpoint, liver blood deficiency can contribute to liver qi stagnation and lump formation.
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