The Chinese medical treatment of psoriasis - Chinese Medicine Update

Townsend Letter for Doctors and Patients, May, 2003 by Bob Flaws

Keywords: Psoriasis, dermatology; Chinese medicine, Chinese medical dermatology

Psoriasis is a common chronic, recurring disease characterized by dry, well circumscribed, silvery, scaling papules and plaques of various sizes. It may vary in severity from one or two lesions to widespread dermatosis, sometimes associated with disabling arthritis or exfoliation. According to Western medicine, its cause is unknown. The response of psoriasis to the immunosuppressive drug cyclosporine suggests that its primary pathogenic factor may be immunologic (as in an autoimmune disease). The prognosis of this condition depends on the extent and severity of the initial involvement. Usually, the earlier the age of onset, the greater the severity. Because this disease is a recalcitrant, difficult to treat condition, I am always on the lookout for articles discussing its Chinese medical treatment. Below are abstracts of three recently published articles in Chinese medical journals.

I find the following clinical audit very interesting since it was written by a Chinese doctor who worked in America for several years. In this article, the author, Li Ya-qin, describes his treatment of 68 cases of psoriasis among Americans. Dr. Li attributes the relatively large incidence of psoriasis among Americans to our peculiar diet and lifestyle. The full article from which the following has been abstracted was titled, "The Treatment of 68 Cases of Psoriasis with Xiao Ying Fang (Disperse Silver Formula)." It appeared in Xin Zhong Yi (New Chinese Medicine), #5, 2001, on page 62.

Cohort description

Of the 68 patients described in this clinical audit, 42 were male and 26 were female. They ranged in age from 19-65 years old, and their disease had lasted from six months to 25 years. Forty-nine of these patients had been treated with corticosteroids or immune-suppressing medications. One month before beginning Chinese medicinals, they stopped taking any corticosteroids or immune suppressants and also stopped any light therapy. In addition, the patients were divided into four Chinese medical patterns: 1) heat toxins blazing and exuberant, 2) blood vacuity wind dryness, 3) qi stagnation and blood stasis, and 4) damp heat brewing toxins.

Treatment method

All the patients in this study were administered the following basic Chinese medicinal formula: Herba Oldenlandiae Diffusae Cum Radice (Bai Hua She She Cao) and Radix Scutellariae Barbatae (Ban Zhi Lian), 10-20g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 10-15g, Herba Sargassii (Hai Zao), Thallus Algae (Kim Bu), and Rhizoma Curcumae Zedoariae (E Zhu), 10g. If there was heat toxins blazing and exuberant, uncooked Radix Rehmanniae (Sheng Di), Cortex Radicis Moutan (Dan Pi), Radix Et Rhizoma Rhei (Da Huang) , Rhizoma Smilacis Glabrae (Tu Fu Ling), and Flos Immaturus Sophorae Japonicae (Huai Hua Mi) were added. If there was blood vacuity wind dryness, Radix Angelicae Sinensis (Dang Gui), Radix Polygoni Multiflori (He Shou Wu), Radix Astragali Membranacei (Huang Qi), and Radix Ledebouriellae Divaricatae (Fang Feng) were added. If there was qi stagnation and blood stasis, Semen Pruni Persicae (Tao Ren), Flos Carthami Tinctorii (Hong Hua), Radix Rubiae Cordifoliae (Qian Cao Gen), and Rhizoma Sparganii (San Leng) were added. If there was damp heat brewing toxins, Radix Gentianae Scabrae (Long Dan Cao), Fructus Gardeniae Jasminoidis (Zhi Zi), Rhizoma Dioscoreae Hypoglaucae (Bie Xie), and Radix Stephaniae Tetrandrae (Fang Ji) were added. Further, if itching was severe, Cortex Radicis Dictamni Dasycarpi (Bai Xian Pi) and Radix Lithospermi Seu Arnebiae (Zi Cao) were added, while if there was insomnia, Caulis Polygoni Multiflori (Ye Jiao Teng) was added. One ji of these medicinals was decocted in water and administered per day in two divided doses, with 10 days equaling one course of treatment. During this time, patients were forbidden to eat red meat or oily, fatty foods, and they were asked to limit stimulating foods, sweets, or seafood.

Treatment outcomes

Basic cure meant that all the patient's symptoms completely disappeared or receded by 80% or more. Improvement meant that the skin lesions receded by 30% or more and their symptoms were markedly decreased. No effect meant that the lesions did not decrease in size by 30% and there was no marked change in symptoms. Based on these criteria, 20 cases were judged cured, 35 cases improved, and 13 cases got no effect.

Representative case history

The patient was a 67 year old American homemaker who was first examined on July 11, 1998. This patient had had recurrent psoriasis for four years, with lesions on her chest, abdomen, upper back, both elbows, and both lower limbs, these lesions were red, dry, and itchy with silvery scales. Initially, they were caused by emotional tension and habitually eating beef, lamb, and oily, fried foods. In addition, she drank a small amount of red wine. The patient's stools were dry, moving only once every 2-4 days. Her sleep at night was not good, and her affect was depressed. She spoke little, her mouth was dry, her tongue was red with thin fur, and her pulse was bowstring.