Psoriasis

Psoriasis is a chronic, recurrent inflammatory skin disease characterized by well-defined erythematous plaques topped by large, adherent silvery scales. It has a prevalence worldwide of 1 to 3 percent, although it is commoner in Europe and North America than in Africa and Asia.
In China, TCM doctors have been dealing with Psoriasis for thousands of years, there are lots of successful cases recorded in the history and a comprehensive understanding about it.

TCM Aetiology:
1.External pathogenic factors ( principally wind-heat or wind-cold ), which settle in the skin and flesh, disturb the normal diffusion of qi by the lungs and spleen. These pathogenic factors then obstruct the channels and network vessels and stagnate in the skin and interstices ( cou li ), depriving the skin and flesh of nourishment.
2.Dietary irregularities or internal damage due to the emotions can lead to blood-heat accumulation internally. Where this occurs over a period of time, blood-heat becomes exuberant, leading to generation of wind. Prevalence of wind gives rise to dryness, preventing adequate nourishment of the skin and flesh.
3.Qi stagnation and blood stasis caused by wind, damp and heat pathogenic factors being retained over a long period or by internal damage due to the emotions deprive the dkin and flesh of nourishment.
4. An improper diet can impair the normal functions of spleen and stomach and generate internal damp-heat. If the body is attacked by external wind, then damp, heat and wind will combine to obstruct skin and flesh and stagnate in the cannels and network vessels to deprive the skin and flish of nourishment.
5.Exuberant heart-fire complicated by an invasion of wind-heat leads to transformation into Toxins. Heat toxins gradually enter the ying and xue levels to consume body fluids, thus impeding correct nourishment of the skin and flesh. Insufficiency of lung yin and impairment of the transformation of qi also results in body fluids not being disseminated correctly to nourish the skin and flesh.
6. In deficiency of the liver and kidney leads to insufficiency of the essence and blood with the skin being deprived of moisture and nourishment and consequently becoming dry with desquamation.

Pathogenesis:
1. Blood heat.
2. Blockage in channels, Qi and Blood deficiency that fails to nourish skin

TCM patterns and their treaments
1.Wind-heat
Main symptoms and signs:
This pattern occurs in the early stages of an initial attack or subsequent episode of plaque psoriasis. Red or dark red maculopapules, papules or small erythematous patches develop quickly on the trunk and limbs, sometimes also spreading to the scalp or scalp margin. The surface of the lesions is covered by silvery-white scales that can be peeled off easily to reveal small bleeding points. Accompanying symptoms and signs include itching, fever, thirst, and a sore and dry throat. The tongue body is red with a thin yellow coating, the pulse is floating and rapid.
Treatment principle
Dredge wind and release the exterior, clear heat and cool the blood
Formula:
Modified Xiaofeng san
Kushen 6g, zhimu 6g, Jing jie 6g, chan tui 6g, mudanpi 10g, fangfeng 10g, sheng di huang 12g, huangqin 10g, hong hua 4.5g, ling xiao hua 4.5g, chao niu bang zi 10g

2.Wind-cold
This pattern occurs in an initial episode of plaque or guttate psoriasis. Lesions appear as dots or coin-shaped discs or coalesce into red patches covered by scales that are easy to peel off. The pattern may occur in any season but is relatively severe in winter, usually moderating or subsiding in summer. The tongue body is pale red with a thin white coating, the pulse is floating and tight.
Treatment principle
Dredge wind and dissipate cold, invigor.ate blood and regulate the ying lever
Formula:
Modified si wu mahuang tang
Ma huang 6g, guizhi 6g, xing ren 6g, chuan xiong 6g, dang gui 12g, bai shao 12g, sheng di huang 12g, bei sha shen 12g, sheng jiang 10g, da zao 15g.

3.Blood-heat
main symptoms and signs:
This pattern occurs in the early stages of an initial attack or subsequent episode of guttate or plaque psoriasis. Lesions manifests as bright red or dark red papules, maculopapules or macular patched of varying sizes scattered throughout the body or distributed mostly on the trunk and lumbs. Sometimes lesions start on the scalp before spreading gradually to other parts of the body.new lesions appear continuously, covered by silvery-white scales that shed easily when dry and elicit the characteristic Auspitz’s sign on removal of the underlying moist layer. Accompanying symtoms and signs include itching, irritability, thirst, constipation, and short voiding of yellow urine. The tongue body is red with a thin yellow coating, the pulse is wiry and rapid, or slippery and rapid.
Treatment principle
cool blood and relieve toxicity, invigorate the blood and reduce erythema
formula:
modified yin hua hu zhang tang
jinyin hua 15g, hu zhang 15g, dan shen 15g, ji xue teng 15 sheng di huang 15g, dang gui wei 12g, chi shao 12g, huai hua 12g, da qing ye 10g, mu dan pi 10g, zi cao 10g, bei dou gen 10g, nan sha shen 10g

4. Blood stasis
main symptoms and signs:
in this plaque psoriasis pattern, the disease is of relatively long duration. Lesions are dull red, hard and thick, mostly forming coin-shaped plaques, but with some resembling oyster shells. They are covered by thick, dry, relatively adherent silvery-white scales. Old lesions tend to remain fixed in size and position and new lesions seldom appear. Accompanying symptoms and signs include itching of varying intensity or absence of itching, and a dry mouth with no desire for drinks. The tongue body is dull purple or dark red with stasis marks and a thin white or thin yellow coating, the pulse is wiry and chppy, or deep and choppy
treatment principle
invigorate the blood and transform blood stasis, free the netword vessels and dissipate lumps
formula:
modified huang qi dan shen tang
dan shen 15g, ze lan 15g, huo xue teng 15g, huang qi 10g, xiang fu 10g, qing pi 10g, chen pi 10g, chi shao 6g, san leng 6g, e zhu 6g, ling xiao hua 6g, si gua luo 6g, jiang can 6g

5.Wind-dryness due to blood deficiency
main symptoms and signs
This pattern occurs in the chronic phase of all types of psoriasis and in patients with a weak constitution. It is characterized by thin, pale red or dark red lesions distributed in numerous patches throughout the body. Lesions are covered by large quantities of dry silvery-white scales that peel off in layers. Old lesions tend to dom appear. Accompanying symptoms and signs include itching of varying intensity , a lustreless facial complexion and lassitude, or dizziness, insomnia and poor appetite. The tongue body is pale with a scant coating or no coating, pulse is wiry and thread, or deep and thread.
treatment principle
nourish blood and harmonize the ying level, augment qi and dispel wind
formula:
modified yang xue qu feng tang
huang qi 10g, dang shen 10g, huo ma ren 10g, xuan shen 12g, bai shao 12g, shu di huang 12g, ji xue teng 12g, mai men dong 12g, bai xian pi 15g, bai zhi 6g, bai ji lz 6g

6.Blood-dryness due to damage to yin
main symptoms and signs:
this pattern, the disease tends t linger with persistent lesions distributed over the trunk and limbs. The lesions are dark red, brownish-red or pale red and appear in various shapes, but mostly present as patches thick or thin layer of dry silvery-white scale that is difficult to peel off. Itching may be slight or severe. Accompanying symptoms and signs include dry throat and lips, a feverish sensation in the chest, palms and soles or in the palms alone, a dry mouth, thirst without a desire for drinks, and constipation. The tongue body is dry and red with a thin, dry, yellow coating, the pulse is wiry and thread, or thread and rapid.
treatment principlep
enrich yin and moisten dryness, clear heat and expel wind
formula:
yang xue run fu tang
dang fui 10g, dan shen 10g, mu dan pi 10g, chi shao 10g, he shou wu 12g, sheng di huang 12g, shu di huang 12g, bei dou gen 12g, tian men dong 12g, mai men dong 12g, chong lou 15g, bai xian pi 15g, bai ji li 15g

Acupuncture and other treatments
Blood-Heat: ganshu, shenshu, fengmen
Wind-Dryness due to blood deficiency: feishu, danshu and pishu
Pricking to bleed treatment
Lesions on back: dazhui
Lesions on head: baihui , sishengcong

From:
Xu.Y, 2004.Dermatoloty in Traditional Chinese Medicine. Donica Publishing