
Bettina Brill is a Melbourne based TCM practitioner and translated this article
This journal article first appeared in the Journal of the Australian Chinese Medicine Education and Research Council in volume 4, edition # 2.
It has been translated into English by Bettina Brill, a Melbourne based TCM practitioner and co-editor of the Lantern, a leading internationally recognized TCM journal.
Bettina Brill also has a special interest and experience in treating all gynecology and dermatology disorders.
Steve Clavey, the past editor of the Journal of ACMERC has given kind permission to reproduce this article here.
Psoriasis (Yin Xie Bing) is commonly called “Pi Xian”. In the last few centuries other names appeared, such as “Niu Pi Xian” (Cow skin eczema), “Bai Dian Feng” (White spots wind) and “She Shi Bing” (Snake lice illness).
This disease occurs more frequently during winter and spring, being worse in winter and better in summer. In bad cases it might not change during the whole year. It can affect the old and the young, men and women, but more often seems to affect people between the age of 30-40 years.
It can be partly hereditary and in such cases the outbreak tends to occur frequent and is difficult to treat.
Treatment Principle
Clear heat, cool blood, eliminate poisons, transform plaques, nourish blood and moisten dryness. In chronic cases there is often stagnation of qi and blood and blockage of the jing-luo. In that case one should move blood and qi.
Pathogenesis
The causes of the disease are latent heat in the blood and external pathogenic factors such as wind, cold, dampness, dryness and toxins that attack the skin and cause local stagnation.
Among the classic literature the “Zhu Bing Yuan Huo Lun” (Generalised Treatise on the Etiology and Symptomatology of Disease, Chao Yuan-Fang, 610AD) describes the cause of psoriasis: “Wind, cold and dampness penetrate the skin tissue and block qi and blood. This leads to psoriasis” … “When wind and toxins penetrate deeply into the skin, this causes dry psoriasis. In this case there is no sweating.”
This corresponds to internal and external cause of disease. The internal causes are qi and blood disharmonies, the external causes are wind, cold and dampness. The external causes trigger off the disease.
This theory had a great influence on later generations: During the Tang dynasty it influenced the “Tai Ping Sheng Hui Fang” (Sacred, Benevolent Formulas, 992); during the Song dynasty the “Sheng Ji Zong Lu” (Comprehensive Recording of Sage-Like Benefit, Shen Fu, 1122) during the Ming dynasty on the “Zheng Zhi Zhun Sheng” (Standards of Patterns and Treatment, 1602).
All these texts have their own theories regarding psoriasis. During the Ming and Qing dynasties a new theory surfaced with the development of surgery. More emphasis was put on internal pathological changes.
Changes within the Blood
The most common external cause for psoriasis is wind combined with cold, dampness, dryness and toxins. The internal causes have their origin in changes within the blood: blood dryness, blood heat and blood deficiency.
If one combines this theory with clinical symptoms the pathogenesis appears as follows. Blood Heat
This is the major cause of the disease. The Heart rules the blood vessels and the element fire. Intense Heart fire leads to latent heat within ying-blood. This, in combination with external pathogens such as wind, cold, heat, dampness, dryness or dry heat can cause the outbreak of psoriasis.
Wind-cold attacks the exterior and blocks the tissues and the yang-qi. After a certain period of time it will turn into heat. When wind-heat penetrates the skin or when wind-dampness blocks the skin and pores, there will be qi and blood stagnation. External dryness moves the qi and this consumes blood and damages yin. All these factors can lead to blood heat.
Blood Deficiency
Constitutional blood deficiency and the influence of external wind or wind-damp blockages can lead to qi and blood stagnation and yin-blood deficiency. In this way the skin lacks nourishment. In chronic cases and in cases where pathogenic wind has been locked internally over a prolonged period of time, the excess wind will change to excess dryness. In this way blood dryness and exhaustion of fluids will develop. The skin will not be nourished. All these factors can lead to blood deficiency.
Blood Stagnation
This occurs in chronic cases that have been caused by pathogenic wind-heat. The wind and heat get trapped within the skin tissue and lead to qi and blood stagnation. Over a long period of time the skin lacks nourishment and blood and yin get consumed and damaged. Wind and dryness lead to a blockage of the jing-luo, qi and blood stagnation. This also leads to undernourishment of the skin. All these factors can lead to blood stagnation.
Blood Dryness
Blood heat or chronic toxic heat accumulation is smoldering in the interior. Internally qi does not move, and at the exterior the skin cannot be released. This consumes the blood, damages yin and in the long term leads to yin deficiency and blood dryness. This prevents proper nourishment of the skin. All these factors lead to blood dryness.
Damage to Chong and Ren Mai
Internal heat and external pathogenic factors lead to damage of Chong and Ren Mai, essence and to blood deficiency. This causes undernourishment of the skin. All these factors lead to Chong and Ren Mai disharmony.
Wind-Damp Blockage
Damp-heat smolders internally and wind-dampness enters the skin externally. Internal and external damp-heat combine and block the jing-luo. This leads to blockage within the skin layer. These factors lead to wind-damp blockages.
Toxic Damp-Heat Accumulation
Internal smoldering of damp-heat leads to formation of toxins and toxic heat that stagnates within the skin layer. This leads to accumulation of toxic damp-heat.
Toxic Heat damages Ying
When excess heat enters the blood this will lead to accumulation of toxic blood heat within the skin tissues. This may occur as a result of the use of strongly irritating pharmaceutics or as a result of the wrong treatment. This will lead to damage of ying by toxic heat.
Differential Diagnosis
At the start erythema, pustules and silvery scales will appear. If the scales are scraped off, tiny spots of blood may show. With the progression of the disease the lesions increase in size and are circular and coin shaped. The skin surface looks like the shell of an oyster. Many layers of scales develop and these reappear after they have been scraped off.
In mild cases of psoriasis the lesions only develop locally or are diffused, but in serious cases the whole body surface can be affected. If the lesions appear on the head, they will be thick and hard. Some patients develop greyish, rough, watch glass-like nails. On the hands and feet pustules or painful skin depressions may form, and in serious cases there can be a burning redness over the entire body with strong scaling.
Principle of Treatment
Clear heat, cool blood, nourish blood and moisten dryness. Heat in the Blood
Symptoms: Acute disease, e.g. acute onset or beginning stage of the disease. Typical appearance of dotted, round, reddish pustules that show a fresh to dark red colour and are covered by silvery-white scales. If the scales are scraped off, tiny spots of blood appear. If the skin is damaged the lesions will appear in this area.
The skin rash is more pronounced on the body trunk and the extremities. It spreads continuously and forms new lesions. Itching may be mild to moderate and there will be thirst present. The tongue colour is red with a yellow coat, and the pulse is tight and slippery, or slippery and rapid.
Disease mechanism:
Blood heat smolders internally
Wind damages the exterior .
Excess wind turns into dryness
Emotional stress, tension and flaring of Heart fire
Wrong diet with strongly stimulating foods that accumulate in the Spleen and
Stomach and turn into heat Heat accumulation within the blood vessels causes the reddish skin colour. Excess wind, heat and dryness cause the development of lesions and scaling, because the skin is lacking proper nourishment. If the scales are removed there is itching. This syndrome corresponds to the more advanced stage of psoriasis.
Treatment principle: Clear heat, cool blood, resolve toxins and clear plaques.
Formula: Modified ‘Tu Huai Yin’
Tu Fu Ling (Smilacis Glabrae, Rhizoma)
Sheng Huai Hua (Sophorae Japonicae, Flos)
Sheng Di (Rhemannia Glutinosae, Radix)
Bai Xian Pi (Dictamni Dasycarpi Radicis, Cortex)
Zi Cao (Lithospermi seu Arnebiae, Radix)
Da Qing Ye (Daqingye, Folium)
Chi Shao (Paeonia Rubra, Radix)
Mu Dan Pi (Mutan Radicis, Cortex)
Jiang Can (Bombyx Bartryticatus)
Jin Yin Hua (Lonicerae Japonicae, Flos)
Gan Cao (Glycyrrhizae Uralensis, Radix)
Cao He Che (Polygonum Bistorta, Radix)
Gui Jian Yu (Euonymus Alatus, Herba)
One bag per day to be taken internally This syndrome is caused primarily by heat accumulation in the blood, which causes erythema. External wind, heat and dryness lead to undernourishment of the skin. If the scales are removed there will be itching. Therefore it is essential to clear the heat and cool the blood.
Sheng Di Huang, Mu Dan Pi, Sheng Huai Hua are used to clear heat and cool the blood. Tu Fu Ling and Bai Xian Pi clear heat, eliminate dampness, resolve toxins, disperse wind and stop itching. Cao He Che and Jin Yin Hua clear heat, toxins and transform plaques. Gui Jian Yu moves the blood and disperses wind. Jiang Can disperses Wind and clears heat, and Gan Cao clears heat and resolves toxins. Modifications:
- For sore throat add Xuan Shen and Tian Hua Fen
- For intense itching use Ku Shen, Xi Xian Cao and Wu She Rou
- For Liver qi stagnation use Yu Jin and Zhen Zhu Mu External application:
From experience of “Zhao Bing Nan”:
Dang Gui 30 g (Angelica Polymorpha, Radix)
Zi Cao 6 g (Lithospermi seu Arnebiae, Radix)
Da Huang 4.5 g (Rhei, Rhizoma)
Xiang You 500 g (Sesame oil)
Huang Tan 180 g (Yellow wax)
Fry the herbs in the sesame ojj and mix with the wax. It has the function of clearing he&, resolving toxins, cooling blood and stopping pain. Apply to the affected parts.
Blood Deficiency
Symptoms: Lesions are only in form of thin, rounded spots that are pink or dark brown in colour. The scales are silvery and dry and can be picked off easily. Itching is present and may be moderate to severe. Other symptoms are weakness, dizziness, sleeping disorders, low appetite, dry stool and a pale red tongue with thin white or no coating, and a thin, tight or thin and deep pulse.
Disease mechanism: Chronic disease with a weak constitution, deficiency of qi and blood or yin and blood. Blood deficiency leads to wind which transforms into dryness. The skin tissues are not nourished and the skin becomes dry, rough and scaly. Because of the blood deficiency there is wind. Excess wind causes itching. This syndrome corresponds to the inactive stage of psoriasis.
Formula: Modified ‘Ke Yin Fang7
Sheng Di (Rhemannia Glutinosae, Radix)
Dan Shen (Salviae Milthorrhizae, Radix)
Da Qing Ye (Daqingye, Folium)
Jin Yin Hua (Lonicerae Japonicae, Flos)
Mai Men Dong (Ophiopogonis Japonicae, Tuber)
Bai Xian Pi (Dictamni Dasycarpi Radicis, Cortex)
Cao He Che_ (Polygonum Bistorta, Radix)
‘ Tu Fu Ling “(SmilacisGTabrae, Rhizoma)
Lion Qiao (Forsythiae Suspensae, Fructus)
Dang Gui (Angelica Polymorpha, Radix)
Jiang Can (Bombyx Bartryticatus)
Xuan Shen (Scrophulariae Ningpoensis, Radix)
Gan Cao (Glycyrrhizae Uralensis, Radix)
One bag per day to be taken internally This chronic disease damages blood and yin. Blood deficiency leads to dryness and scaling. Therefore the main principle of treatment is to nourish blood and moisten dryness.
Dang Gui, Xuan Shen, Mai Men Dong and Sheng Di nourish blood and moisten. Jin Yin Hua, Lian Qiao, Cao He Che and Da Qing Ye clear heat and resolve toxins. Dan Shen clears heat and calms the spirit. Tu Fu Ling and Bai Xian Pi clear heat, eliminate dampness and disperse wind. Jiang Can disperses wind and clears heat. Gan Cao harmonises the effect of the other herbs. External application: As for blood heat type
Blood Stagnation
Symptoms: This type is chronic in nature. The skin is thick and hard and shows coin shaped lesions. Occasionally they have the appearance of oyster shells. The lesions are dark purple in colour and covered by thick, silvery scales that are difficult to remove. New lesions rarely develop. Itching can be present or absent. Other symptoms are dry mouth without thirst, dark red tongue colour with purple spots and a thin white or thin yellow coat, and a tight, choppy or deep and choppy pulse.
Disease mechanism: This is a disease of long duration. Qi and blood are not moving and the jing-luo are blocked. The stagnation of qi and blood prevents proper nourishment of the skin. This leads to formation of thick, hard and dark purple lesions. This syndrome corresponds to the remission phase of psoriasis.
Treatment principle: Move blood, transform blood stagnation, move qi and clear through the jing-luo.
Formula: Modified ‘Huo Xue San Yu Tang’
Hong Hua (Carthami Tinctorii, Flos)
San Leng (Sparganii, Rhizoma)
E Zhu (Curcumae Zeodariae, Rhizoma)
Ji Xue Teng (Jixueteng, Radix et Caulis)
Gui Jian Yu (Euonymus Alatus, Herba)
Bai Hua She She Cao (Oldenlandiae Diffusae, Herba)
Chen Pi (Citri Reticulatae, Pericarpium)
Tao Ren (Persicae, Semen)
This syndrome is caused by the blockage of the jing-luo and qi and blood stagnation. This way the skin is not nourished and turns hard and thick. Tao Ren, Hong Hua, Gui Jian Yu and Ji Xue Teng move blood and clear blood stagnation. San Leng moves blood and qi. Bai Hua She She Cao resolves blood stagnation and toxins. Chen Pi moves qi and regulates the middle jiao. Modifications:
- For periods with small amounts of blood or blood clots use Yi Mu Cao and Dan Shen
- For intense itching use Zi Cao and Wang Bu Liu Xing External treatment: As for blood heat type.
Blood Dryness
Symptoms: The skin hardly changes during the disease. Typical are large, round spots that are dark or pale red in colour and covered by scales. The skin is dry and cracked with thick or thin scales that are difficult to remove. New lesions rarely form. Itching may be present or absent. Other symptoms are dry throat, dry lips, heat sensations in the five centres, dry mouth but no thirst, dry stool. The tongue is red with a thin, yellow, dry coat. The pulse is tight, thin or thin and rapid.
Disease mechanism: The disease is chronic. Heat is smoldering within the blood and damages the fluids, yin and blood. Because of yin deficiency and dryness of the blood the skin cannot be nourished and becomes cracked and dry. The lesions are dark red or pale in colour and covered with silvery scales.
Treatment principle: Nourish the blood, moisten dryness, disperse wind and stop itching. Formula: ‘Yang Xue Run Fu Yin’ (“Nourish the blood and moisten the skin decoction”)
Dang Gui (Angelica Polymorpha, Radix)
Dan Shen (Salviae Milthorrhizae, Radix)
Sheng Di (Rhemannia Glutinosae, Radix)
Bai Xian Pi (Dictamni Dasycarpi Radicis, Cortex)
Tao Ren (Persicae, Semen)
Bai Shao (Paeoniae Lactiflora, Radix)
Chan Tui (Cicadae, Periostracum)
He Shou Wu (Polygoni Multiflori, Radix)
Xuan Shen (Scrophulariae Ningpoensis, Radix)
Mai Men Dong (Ophiopogonis Japonicae, Tuber)
One bag per day to be taken internally. This syndrome develops from yin deficiency and dry blood failing to nourish the skin. The skin becomes dry and scaly. Dang Gui, Dan Shen, Bai Shao and Tao Ren tonify and move blood. Sheng Di, Xuan Shen, Mai Men Dong and He Shou Wu tonify yin and moisten dryness. Chan Tui is dispersing and stops itching. Bai Xian Pi clears heat and disperses wind. Modifications:
- For intense itching use Zi Cao
- For thirst use Tian Hua Fen
- For blood deficiency and dry stool use Rou Cong Rong External treatment: As for blood heat type.
Chong and Ren Mai Disharmony
Symptoms: Outbreaks occur during menstruation or pregnancy. Many diseases and skin problems worsen during those periods. Some may develop following menstruation or birth. The entire body can be affected by formation of pustules and scaling. The lesions are bright red or pale red with silvery scales and slight itching.
Other symptoms are dry mouth, tension, dizziness, lumbar pain, red or pale red tongue with a thin coating, and a rapid-slippery or deep and thin pulse.
Disease mechanism: Damage to Chong and Ren Mai as well as to jing/essence and blood deficiency lead to undernourishment of the skin. As a result red or pale red papules and silvery scales develop.
Treatment principle: Regulate Chong and Ren
Formula: ‘Er Xian Tang‘
Xian Mao (Curculiginue Orchioidis, Radix)
Xian Ling Pi (Epimedii, Herba)
Chi Shao (Paeonia Rubra, Radix)
Dang Gui (Angelica Polymorpha, Radix)
Shou Di (Rhemanniae Glutinosae Conquitae, Radix)
Ba Ji Tian (Morindae Officinalis, Radix)
Nu Zhen Zi (Ligustri Lucidi, Fructus)
Han Lian Cao (Ecliptae Prostratae, Herba)
Huang Bai (Phellodendri, Cortex)
Zhi Mu (Anemarrhenae Asphodeloidis, Radix)
One bag per day.
This syndrome is the result of damage to Chong and Ren Mai. Therefore one needs to tonify blood and regulate menstruation.
Xian Mao, Xian Ling Pi and Ba Ji Tian tonify and warm Kidney Yang. Huang Bai and Zhi Mu tonify Yin and constrain Yang. Chi Shao is cooling and moves blood and dissolves blood stagnation. Shou Di tonifies blood. External treatment: As for blood heat type.
Wind-Damp Bi
Symptoms: The skin has a red appearance and is covered with papules and silvery scales. When the scales are scraped off small spots of blood will appear. Occasionally pustules and pain occurs at the joints of the hands and feet. The tongue is red with a yellow, slippery coating, and the pulse is tight or slippery and rapid.
Disease mechanism: Damp-heat smolders in the interior. External Wind-dampness combine with the internal heat, block the jing-luo and accumulate in the skin. This causes erythema, papules, silvery scaling and pain. This syndrome corresponds to arthritic psoriasis.
Treatment principle: Drain dampness, free up jing-luo, resolve toxins and clear the heat.
Formula: Modified “Du Huo Ji Sheng Tang”
Du Huo (Duhuo, Radix)
Fang Feng (Zede6ouriellae Sesloidis, Radix)
Sang Zhi (Mori Albae, Ramulus)
Wei Ling Xian (Clemetidis Chinensis, Radix)
Bai Xian Pi (Dictamni Dasycarpi Radicis, Cortex)
Tu Fu Ling (Smilacis Glabrae, Rhizoma)
Sang Ji Sheng (Loranthi seu Visci, Ramus)
Chi Shao (Paeonia Rubra, Radix)
Dang Gui (Angelica Polymorpha, Radix)
Ji Xue Teng (Jixueteng, Radix et Caulis)
Niu Xi (Achyranthis Bidentatae, Radix)
Qin Jiao (Gentianae Macrophyllae, Radix)
One bag per day
This syndrome is caused by dampness, heat and toxins blocking the jing-luo. This leads to erythema, papules, scales and joint pain.
Du Huo, Fang Feng, Sang Ji Sheng, Qin Jiao and Wei Ling Xian disperse Wind and drain dampness. Tu Fu Ling and Bai Xian Pi clear heat and drain dampness. Dang Gui, Chi Shao and JiXue Teng nourish and move blood (in order to treat wind move blood; once the blood is moving the wind will be dispersed). Sang Zhi and Niu Xi drain wind-dampness and clear through the jing-luo in the extremities.
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External treatment: ‘Huang Lian Gar/ (from the “Yi Zong Jin Jian” – The golden mirror of medicine) |
Fry all the herbs (but not the wax) in sesame oil until they dry out, eliminate the dregs. Mix the liquid evenly into the wax. Apply onto gauze and put on affected parts. Indicated for rheumatic psoriasis (and, in the original text, for boils within the nose, eczema, burns, cracked nipples and red swollen sores).
Toxic Damp-Heat
Symptoms: The disease is acute with sudden appearance of erythema and chickpea size yellow pustules over the entire body. The pustules break easily and turn into plaques. The skin is covered with scars and overlapping scales, and the skin surface is thick and appears unclean. Other symptoms are fever, thirst, red face, swollen, painful joints, constipation and yellow urine. The tongue is red with a yellow, thick coating, and the pulse is either tight and slippery or slippery and rapid.
Disease mechanism: Chronic retention of dampness turns into heat and toxins. Toxic damp-heat accumulates under the skin and causes erythema and pustules. This syndrome corresponds to pustular psoriasis. Treatment principle: Clear heat and resolve toxins.
Formula: “Wu Wei Xiao Du Yin”
Jin Yin Hua (Lonicerae Japonicae, Flos)
Ye Ju Hua (Chrysanthemi Indici, Flos)
Pu Gong Ying (Taraxaci Mongolici cum Radice, Herba)
Zi Hua Di Ding (Violae cum Radice, Herba)
Tian Kui Zi (Begonia, Herba)
Zi Hua Di Ding and Tian Kui Zi are used for swellings and toxins, abscesses and tumors. Jin Yin Hua and Ye Ju Hua cool heat, resolve toxins, reduce swellings and clear abscesses. These four herbs in combination have a strong effect in clearing heat and resolving toxins. Modifications:
- For intense heat use Lian Qiao and Huang Lian to clear heat and resolve toxins.
- For toxins in the blood use Chi Shao, Mu Dan Pi and Sheng Di to clear heat and cool blood
External treatment: As for wind-damp Bi syndrome. Toxic Heat damages Ying Blood
Symptoms: The onset is acute and starts with diffuse erythema over the entire body, including the face, and a burning sensation of the skin. If the skin is pressed with the finger the red colouration disappears. The scales can easily picked off. Other symptoms are high fever, thirst, sensitivity to coldA restlessness, weakness, constipation and reddish urine. The tongue is dark red with or without a thin coating. The pulse is rapid, tight or slippery and rapid.
Disease mechanism: Intense heat in the blood combines with external toxic heat that may have been caused by external application of strongly irritating medicines or by the wrong treatment. The blood heat accumulates and smolders together with the toxins in the skin. This leads to erythema that spreads over the entire body. When toxic heat remains within the body for a prolonged period of time, it will damage Yin and the fluids. This causes extensive scaling. This syndrome is similar to exfoliative psoriasis. Treatment Principle: Clear heat and cool blood, resolve toxins and transform plaques.
Formula: ‘Qing Wen Bai Du Yin‘
Sheng Di | (Rehmanniae Glutinosae, Radix) |
Chi Shao | (Paeonia Rubra, Radix) |
Mu Dan Pi | (Moutan Radicis, Cortex) |
Huang Lian | (Coptidis, Rhizoma) |
Zhi Mu | (Anemarrhenae Aspodeloidis, Radix) |
Dan Zhu Ye | (Lopatheri Gracilis, Herba) |
Jin Yin Hua | (Lonicerae Japonicae, Flos) |
Lian Qiao | (Forsythiae Suspensae, Fructus) |
Shan Zhi Zi | (Gardeniae Jasminoidis, Fructus) |
Jie Geng | (Platycodi Grandiflori, Radix) |
Sheng Shi Gao | (Gypsum) |
Xuan Shen | (Scrophulariae Ningpoensis, Radix) |
Sheng Gan Cao | (Glycyrrhizae Uralensis, Radix) |
This formula is a combination ‘Bai Hu Tang’, ‘Xi Jiao Di Huang Tang’ and ‘Huang Lian Jie Du Tang’. ‘Bai Hu Tang’ clears Yang Ming heat. ‘Huang Lian Jie Du Tang’ clears fire from the San Jiao. These two formulas in combination clear heat, especially from the qi level, and resolve toxins.
‘Xi Jiao Di Huang Tang’ cools blood, resolves toxins and has the special effect of
clearing heat in the blood. All three formulas can clear heat at the qi and blood level.
Xuan Shen, Lian Qiao, Sheng Gan Cao and Jie Geng treat the inflamed and sore throat.
Zhu Ye clears Heart heat through the urine and leads the heat downwards. Thus, Zhu Ye
can treat toxic heat that has attacked Ying.
External treatment: ‘Pu Lian Gao’
Huang Bai 30 g (Phellodendri, Cortex)
Huang Qin 30 g (Scutellariae Baicalensis, Radix)
Vaseline 240 g
Grind herbs into powder and mix with the vaseline. Apply to the affected parts.
Clears heat, drains dampness, reduces swelling and stops pain. Indicated for exfoliative
psoriasis.
Syndrome Differentiation
- Seborrheic Dermatitis (“Bai Xie Feng” – White Scale Wind): Clearly defined differentiation, thinner and less scaling, oily, greasy skin spots of yellow colour, no bleeding when scales are scraped off. The affected body parts are the head, chest, neck and back. If scaling occurs on the head it appears white and loose (dandruff), accompanied by hair loss.
- Pityriasis Rosacea (Wind-Heat Rash): Stronger developed on the body trunk and the sides of the extremities. Round or elliptical shaped macules.
- Neurodermatitis, Lichen Simplex Chronicus: At the onset there is itching, and after scratching a few, chickpea size to bean size papules develop. They join after a while and lichenification with some scaling occurs. Most frequently seen on back, neck, elbows and knees.
Prevention
- After the skin condition has improved herbs should be continued for another two to three months.
- Avoid dampness and cold and adjust to weather conditions. Infections like tonsillitis or pharyngitis should be promptly treated.
- Avoid consumption of spicy foods, fish and seafood
- Do not bathe in hot water. External applications of creams and medicines could exacerbate the disease.
Case Study
Cheung, male, gardener, 33 years old First visit: 25/5/86
Erythema over the entire body, itching for five years, worse for the last six months
Medical history: Five years ago appearance of rashes on the body trunk and extremities that did not clear up for a long period of time. Especially in the last six months the rashe recurred frequently. The diagnosis was psoriasis and western medical treatment was given. This did not lead to any improvement and the patient decided to visit our hospital Examination: Head, trunk and extremities had diffuse, round exfoliative spots that were covered with thick, white, large scales. When the scales were scraped off small spots of blood did appear. Around existing lesions many new ones had developed. The tongue was red with a yellow coating and the pulse was tight.
Diagnosis: Blood heat and pathogenic wind. Wind and heat accumulate in the skin and cause psoriasis.
TCM diagnosis: Psoriasis of blood heat type. Western medical diagnosis: Advanced stage of psoriasis.
Principle of treatment: Clear heat, cool blood, resolve toxins and transform plaques.
Formula: Modified ‘Tu Huai Yin’
Tu Fu Ling | 30 g | (Smilacis Glabrae, Rhizoma) |
Sheng Huai Hua | 30 g | (Sophorae Japonicae, Flos) |
ShengDi | 30 g | (Rhemannia Glutinosae, Radix) |
Bai Xian Pi | 15g | (Dictamni Dasycarpi Radicis, Cortex) |
Zi Cao | 15g | (Lithospermi seu Arnebiae, Radix) |
Jiang Can | 10g | (Bombyx Bartryticatus) |
Jin Yin Hua | 20 g | (Lonicerae Japonicae, Flos) |
Gan Cao | 6g | (Glycyrrhizae Uralensis, Radix) |
Chi Shao | 12 g | (Paeonia Rubra, Radix) |
Mu Dan Pi | 12g | (Mutan Radicis, Cortex) |
Bai Ji Li | 12 g | (Tribuli Terrestris, Fructus) |
Cao He Che | 15 g | (Polygonum Bistorta, Radix) |
Gui Jian Yu | 10g | (Euonymus Alatus, Herba) |
One bag per day. |
This formula and modifications of it were taken for three months. After that time the lesions had nearly all cleared up. To stabilise the treatment herbs and pills were continued for another three months. There were no side effects. After one year there had only been rare recurrences of the disease.
Wash the skin twice daily with the decoction. In 93% of cases this will lead to improvement (Shan Dong TCM Journal (4), 47, 1980). |
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Use She Chuang Zi Tang as an external wash. |