The Chinese medical treatment of psoriasis – Chinese Medicine Update
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.
Based on the above signs and symptoms, Dr. Li decided that the requisite treatment principles were to clear heat and resolve toxins, nourish the blood and dispel wind. Therefore, he prescribed: Herba Oldenlandiae Diffusae Cum Radice (Bai Hua She She Cao) and Radix Scutellariae Barbatae (Ban Zhi Lian), 15g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), Radix Angelicae Sinensis (Dang Gui), Caulis Polygoni Multiflori (Ye jiao Teng), and Radix Scrophulariae Ningpoensis (Xuan Shen), 12g each, Herba Sargassii (Hai Zao), Thallus Algae (Kun Eu), Cortex Radicis Moutan (Dan Pi), Cortex Radicis Dictamni Dasycarpi (Bai Xian Pi), Fructus Kochiae Scopariae (Di Fu Zi), Fructus Cnidii Monnieri (She Chuang Zi), Radix Polygoni Multiflori (He Shou Wu), and Cortex Albizziae Julibrissinis (He Huan Pi), 10g each, and Radix Ledebouriellae Divaricatae (Fang Feng), 5g.
After one month of taking these medicinals, all the patient’s symptoms were markedly improved. After another half month, the lesions had basically receded from the upper half of the woman’s body. After two more months, the lesions on both lower limbs also gradually receded. During the time the patient took these medicinals, the frequency and number of her movements increased to 2-3 times per day. In addition, they were soft. When the patient stopped taking these medicinals, her stools remained normal.
Discussion
Although it is embarrassing that this study was conducted by a Chinese in the U.S. and then published in the People’s Republic of China, I do believe it is an example of the kind of outcomes research we Western practitioners of Chinese medicine must do within our own patient populations. This protocol shows that a standard contemporary Chinese medical approach to the treatment of psoriasis can work with American patients in America.
The following is a report of a Chinese medical treatment protocol recently researched in the People’s Republic of China. The original report on this research was titled, “A Clinical Audit on the Treatment of 303 Cases of Psoriasis with Liang Xue Xiao Yin Tang Jia Jian (Cool the Blood & Disperse Silver [Scales] Decoction with Additions & Subtractions).” It was written by Mai He Mu Di [sic] et al. and appeared in Shan Xi Zhong Yi (Shanxi Chinese Medicine), #3, 2001, on page 21.
Cohort description
All 303 patients were seen as out-patients. One hundred seventy-two were male and 131 were female. Their ages ranged from 9-82 years. Fifteen cases were under 20, 155 were 20-40, and 133 were over 40. These patients’ course of disease had lasted from seven days to 30 years. It had lasted less than five years in 105 cases, 5-10 years in 115 cases, and over 10 years in 83 cases. The lesions covered less than 10% of the surface of the body in 110 cases and more than 30% in 70 cases. In 200 cases there was eruptions over the whole body. In the remaining 103 cases, the lesions only occurred in limited areas. One hundred ten cases had a familial history. In 193 cases, there were various sorts of definite precipitating factors.
In addition, all these patients were divided into three Chinese medical patterns. One hundred thirty-seven displayed a pattern of blood heat, 109 displayed blood dryness, and 57 displayed blood stasis. Blood heat was characterized by red macular lesions which bled after cracking, gradually increasing lesions, tension and agitation, easy anger, a dry mouth, and a bowstring, slippery, possibly rapid pulse. Blood dryness was characterized by pale red, scaly lesions with an enduring history and stable location. These lesions sometimes itched. In addition, there was anxiety, depression, vexation and agitation, a pale red tongue with scanty fur, and a deep, fine pulse. Blood stasis was characterized by geographic, macular plaques, thick lesions which were dark red in color, and a purple, dark tongue or possible static spots.
Treatment method
All the patients in this study were orally administered the following Chinese medicinals: Ramulus Mori Albi (Sang Zhi), 15g, Radix Ledebouriellae Divaricatae (Fang Feng), 10g, Radix Angelicae Dahuricae (Bai Zhi), 20g, Radix Rubiae Cordifoliae (Qian Cao Gen), 15g, Rhizoma Imperatae Cyclindricae (Bai Mao Gen), 15g, Radix Sophorae Subprostratae (Shan Dou Gen), 15g, uncooked Radix Rehmannine (Sheng Di), 30g, Cortex Radicis Moutan (Dan Pi), 30g, Sclerotium Poriae Cocos (Fit Ling), 30g, Caulis Milletiae Seu Spatholobi (Ji Xue Teng), 30g, Sanguis Draconis (Xue Jie), 6g, washed down with the decocted liquid, Buthus Martensis (Quan Xie), 10g, washed down with the decocted liquid, Zaocys Dhumandes (Wit Shao She), 20g, Rhizoma Polygoni Bistortae (Zao Xiu), 30g, and scorched San Xian (Three Immortals, i.e., Fructus Crataegi, Shan Zha, Massa Medica Fermentata, Shen Qu, and Fructus Germinatus Hordei Vulgaris, Mai Ya), 15g. If there was blood heat, Radix Gentianae Scabrae (Long Dan Cao), Rhizoma Anemarrhenae Aspheloidis (Zh i Mu), and Fructus Forsythiae Suspensae (Lian Qiao) were added. If there was blood dryness, Radix Astragali Membranacei (Huang Qi), Radix Angelicae Sinensis (Dang Gui), and Rhizoma Atractylodis Macrocephalae (Bai Zhu) were added. If there was blood stasis, Radix Clematidis Chinensis (Wei Ling Xian), Rhizoma Sparganii (San Leng), Hirudo Seu Whitmania (Shiti Zhi), Tabanus (Meng Chong), and Semen Pruni Persicae (Tao Ren) were added. Oneji of these medicinals was decocted in water and administered per day. At the same time, camp to the cine ointment and vitamin B6 were applied externally. Seven to 15 days equaled one course of treatment, and 5-8 courses were given.
Treatment outcomes
Cure was defined as complete disappearance or receding of 95% or more of the psoriasis lesions. Marked effect was defined as receding of 75% or more of the psoriasis lesions. Improvement was defined as receding of 50% or more of the psoriasis lesions. No effect meant that the lesions receded less than 50%. Based on these criteria, 175 patients (57.76%) were judged cured, 82 patients (27.06%) got a marked effect, 30 patients (9.9%) improved, and 16 (5.2%) got no result. Thus, the total amelioration rate was 94.72%. Of the 287 patients who got an effect, 50 were followed up afterwards. Among these, there were 13 relapses (26%). Among these relapses, five were due to common cold, one was due to purulent tonsillitis, two were due to eating acrid, peppery foods and drinking alcohol, and five were provoked by no clear cause. Of those that were cured, healing of the lesions typically occurred in 3-5 courses.
Discussion
According to the Chinese authors of the original article, this disease is mostly caused by externally invading wind evils which then lie hidden or deeply in the constructive and blood. Thus the blood becomes hot and toxins become exuberant. It may also be due to internal damage by the emotions which cause qi and blood depression and stagnation. Depression may then transform heat, and wind and heat may mutually struggle. In addition, it may also be due to unregulated eating and drinking with loss of harmony of the spleen and stomach. Any of these causes may result in the contraction of wind heat evil toxins and the occurrence of this disease. If this disease endures for a long time, yin will be consumed and blood is damaged. Yin vacuity and blood dryness then fail to nourish the skin. Further, blood dryness engenders wind, thus causing silvery scaling and itching. Qi and blood depression and stagnation cause thickening of the skin and the occurrence of geographic plaque-like lesions. To make matters worse, if there is liver-kidney depletion and detriment with chong and ren loss of regulation, the organic function of the viscera and bowels may lose its regulation. Hence the constructive and blood are not harmonious and the function of the defensive exterior is lowered. Thus the Chinese authors are of the opinion that the treatment principles for this condition should be to clear heat and cool the blood, dispel wind and free the flow of the network vessels, supplement the qi, nourish the blood, and enrich yin, and quicken the blood and transform stasis.
Within this formula, Qian Cao Gen, Shan Dou Gen, Bai Mao Gen, Sheng Di, Dan Pi, and Zao Xiu are the sovereigns which clear heat, cool the blood, and resolve toxins. Sang Zhi, Bai Zhi, Fang Feng, Quan Xie, and Wu Shao She are the ministers which dispel wind, eliminate dampness, and free the flow of the network vessels. Xue Jie and Ji Xue Teng move stasis and quicken the network vessels. Fu Ling and scorched San Xian transform dampness, fortify the spleen, and open the stomach. When this formula is modified based on each patient’s personal pattern discrimination, it achieves relatively satisfactory results. During treatment with this protocol, eating acrid, peppery, stimulating foods is prohibited.
The third report is from an article titled, “The Treatment of 86 Cases of Wind Heat Blood Dryness Pattern Common Psoriasis with Liang Xue Jie Du Fang (Cool the Blood & Resolve Toxins Formula)” written by Cao Xue-hui and Liao Lie-hui and appearing in Xin Zhong Yi (New Chinese Medicine), #7, 2001, on page 58.
Cohort description
Among the 86 patients in this study, there were 55 men and 31 women ranging in age from 16-63 years old and who had been ill from two months to 24 years. Thirty-four patients had papular lesions, 33 had plaque-like lesions, and nine had geographic lesions. Ten patients had mixtures of these types. Eighteen patients had initial onset of psoriasis, while 68 had recurrent cases. All were diagnosed by criteria published in China in 1994.
Treatment method
The basic internally administered Chinese medicinal formula consisted of: Cornu Bubali (Shui Niu Jiao), 40g, uncooked Radix Rehmanniae (Sheng Di), Radix Salviae Miltiorrhizae (Dan Shen), Rhizoma Smilacis Glabrae (Tu Fu Ling), and Herba Oldenlandiae Diffusae Cum Radice (Bai Hua She She Cao), 30g each, Fructus Tribuli Terrestris (Bai Ji Li) and Rhizoma Polygoni Bistortae (Chong Lou), 20g each, Cortex Radicis Moutan (Dan Pi) and Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 12g, Radix Angelicae Sinensis (Dang Gui), 10g, Rhizoma Curcumae Zedoariae (E Zhu) and Radix Glycyrrhizae (Gan Cao), 6g, and Pulvis Indigonis (Qing Dai), 3g. One ji of these medicinals was decocted in water and administered per day. If blood heat was exuberant, 15 grams of Os Antelopis Saiga-tatarici (Ling Yang Gu) were added and Dang Gui was removed. If, after administration, there was diarrhea, 15 grams of Rhizoma Atractylodis Macrocephalae (Bai Zhu) were added. Results were assessed after two months of administration.
Treatment outcomes
Cure was defined as complete disappearance of the lesions or their receding by 95% or more. Improvement meant the lesions receded 50% or more, and no cure meant that the lesions receded less than 50%. Based on these criteria, there were 53 cases which were judged cured, 28 cases which were judged improved, and five cases which were not cured. Thus the total amelioration rate was 94.2%. On follow-up after six months to one year, there were 38 cases of recurrence among the 53 cases initially cured. After a second course of treatment with this protocol, 34 of these were cured and four improved. In terms of side effects, 12 cases experienced diarrhea with bowel movements 2-3 times per day after taking these medicinals for 1-3 days. If diarrhea persisted after four days, which it did in four cases, Bai Hua She She Cao was reduced to 15 grams and 15 grams of Bai Zhu were added, at which point the stools returned to normal.
Discussion
According to Cao and Liao, this disease is mainly caused by blood aspect or division heat. This heat may be due to recurrent external contraction of the six environmental excess evil qi, unregulated eating and drinking, or internal damage by the seven affects, any of which may cause depression and stagnation of the qi mechanism with enduring depression transforming fire. Then fire, heat, toxins, and evils brew internally in the blood division. When this heat is effused or emitted to the skin, it results in this condition. In addition, heat toxins brewing in the blood division may consume and damage yin and blood, while deep-lying heat depressed and steaming in the blood and fluids may stew the juices and produce stasis. Hence the channels and vessels become obstructed and stagnant. For any and all these reasons, the skin may lose its nourishment. Thus dryness is transformed and wind is engendered locally resulting in dry, silvery scaling.
Within this formula, Shui Niu Jiao, sheng Di, Tu Fu Ling, Bai Hua She She Cao, Chong Lou, Dan Pi, and Qing Dai clear heat, cool the blood, and resolve toxins. Sheng Di also enriches yin and moistens dryness. Dan Shen, Chi Shao, Dang Gui, and E Zhu quicken the blood and transform stasis. Bai Ji Li dispels wind and stops itching, and Gan Cao regulates and harmonizes all the other medicinals in the formula.
For more information on the Chinese medical treatment of psoriasis, see Liang Jian-hui’s A Handbook of Traditional Chinese Dermatology available from Blue Poppy Press.
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