Acupuncture and Chinese Herbal Medicine for Psoriasis

Sep 28, 2016

This article was written by Peter Chen and used for his lecture in the TCM (traditional Chinese medicine) Master’s degree program for University of Western Sydney. It discussed the TCM diagnosis, differential treatment, dietary and life style advice, case study, research, other famous TCM doctors experience etc.

Summary

Psoriasis is a persistent, chronic and recurrent skin disease occurring in about 2% of the population. It seems to show a strong hereditary factor and has some relationship with arthritis (inflammation of the joints) and nail changes (thickening of nail beds etc.). These clearly defined plaques appear more on the elbows, knees, torso, or scalp, although underarm and genital areas may also be involved.

It is characterized by reddened, raised patches on the skin with silvery scales called plaques. The lesions may be small and discrete and confined to a small area or they may cover most of the body surface. It begins with papules that covered with scales that coalesce to form plagues with distinct borders. These become covered with layers of silver-white scales. When these scales are removed the lesions exhibit the typical cribriform bleeding. In the active stage there is itching, which maybe very severe, and the lesions proliferate. Following this there is a resting stage in which the lesions stop extending and the itching becomes reduced. This is followed by the regressive stage, where the scales recede, leaving pigmentation. The whole process usually takes two to three months.

Psoriatic arthritis is a specific type of arthritis that has been diagnosed in approximately 23 percent of people who have psoriasis, according to the Psoriasis Foundation’s 2001 Benchmark Survey. Psoriatic arthritis is similar to rheumatoid arthritis but generally milder. In psoriatic arthritis, the joints and the soft tissue around them become inflamed and stiff. Psoriatic arthritis can affect the fingers and toes and may involve the neck, lower back, knees and ankles. In severe cases, psoriatic arthritis can be disabling and cause irreversible damage to joints.

No one knows exactly what causes psoriasis, but it is believed to have a genetic component. Most researchers agree that the immune system is somehow mistakenly triggered, which speeds up the growth cycle of skin cells. A normal skin cell matures and falls off the body’s surface in 28 to 30 days. But a psoriatic skin cell takes only three to four days to mature and move to the surface. Instead of falling off (shedding), the cells pile up and form the lesions. Lots of researchers also think the occurrence of psoriasis maybe related to metabolism disorder, endocrine disorder, stress etc.

Conventional medical treatment relies on a combination of controlled ultraviolet light exposure (sometimes after ingestion of sensitizing chemicals called psoralens), lotions containing tar derivatives, and steroid creams to alleviate the condition. Oral steroids and even cytotoxic drugs are also sometimes used in severe cases. While these treatments may help in a certain stage, they can cause rebound reactions which could be more severe than the initial attack, or in the case of topical steroids, cause immediate worsening if the psoriasis is currently very active. Long-term use of these treatments can produce side effects ranging from advanced osteoporosis, high blood pressure (from corticosteroids) to liver and kidney abnormalities (methotrexate) and hair loss, severe gingivitis necessitating tooth extraction and fetal malformation (retinoids).

Acupuncture is seldom used alone for psoriasis; it is often used in conjunction with the herbal remedies

Clinical manifestations, TCM diagnosis and differential treatment:

 

1. Wind in the skin with heat in blood

Acute or initial active stage, severe itching, red papules with severe scaling, red tongue with a thin yellow coat, wiry and rapid or slippery pulse. There may also be: aversion to heat, restlessness, irritability, dry mouth and throat, bitter taster in the mouth, dry stool or constipation, yellow urine.

Principle of treatment:

Herbal medicine

Clear heat and resolve toxicity, cool the blood and dispel wind to alleviate itching.

Herbal medicine:

Modified Xiao Feng San

Variations:

With constipation: combined with Ma Zi Ren Wan.

If the stools are very hard, wind and heat are both severe, can use modified Fang Feng Tong Sheng San

Acupuncture:

Clear heat and resolve toxicity, cool the blood: Qu Chi LI 11, Ge Shu BL.17, Xue Hai SP10, Wei Zhong BL40, Xi Men P4, Da Zhui Du14.

Dispel wind to alleviate itching

He Gu LI4, Qu Chi LI11, Feng Chi GB20, Xue Hai SP10.

 

2. Blood Dryness

Prolonged courses, static or regressive stage, dry lesions, color has faded, reduced scaling, there may also be some pigmentation, normal or pale tongue with little or thin and dry coat, weak, thready or deep pulse.

Principle of treatment:

Herbal medicine

Nourish the Yin and generate body fluids to dispel wind and alleviate itching.

Xiao Feng San plus Qi Ju Di Huang Wan.

Acupuncture:

Nourish the Yin and generate body fluids

Tai Xi K3, Zhao Hai K6, San Yin Jiao SP6, Guan Yuan Ren 4.

Dispel wind and alleviate itching

He Gu LI4, Qu Chi LI11, Feng Chi GB20, Xue Hai SP10.

 

3. Blood Stagnation

Persistent dark red or pigmented lesions, thick scales, mild itching, or in resting stage. There may also be dark or purple-hued tongue or with dark spots, weak and uneven pulse.

Principle of treatment:

Herbal medicine

Quicken the blood and dispel blood stasis, nourish the blood and dispel wind to alleviate itching.

Xiao Feng San plus Tao Hong Si Wu Wan

Acupuncture:

Quicken the blood and dispel blood stasis

Ge Shu BL17, Xue Hai SP.10

Nourish the blood and dispel wind to alleviate itching.

San Yin Jiao SP.6, Zu San Li ST 36., Pi Shu BL.20, Wei Zhong BL.40, Yin Ling Quan SP9, Da Zhui DU14, He Gu LI4, Qu Chi LI11, Feng Chi GB 20, Xue Hai SP10.

 

4. The Channel-blocked by Wind-dampness

The symptoms and signs of the channel-blockage of wind-dampness type are those of the type of psoriasis that affects the joints. This may be arthralgia (pain in joints), joint swelling or even stiffness, a deformation of joints, and a hindrance to movement at the joints as well.

Principle of treatment:

Herbal medicine

Expel wind and dampness, promote blood circulation and regulate channels.

Xiao Feng San combined with Du Huo Ji Sheng Tang.

Acupuncture  

Expels wind and dampness, promotes blood circulation and regulates channels.

Yang Ling Quan (GB 34), Feng Chi (GB 20), Yin Ling Quang (SP 9), Ge Shu (BL 17).

 

5. The Toxic Heat and Dampness Type

When dealing with the toxic heat and dampness type, most of the symptoms are similar to those of the pus-pocket type of psoriasis. There may also be erosion, exudation, thirst, fever, constipation and other general symptoms. The tongue is reddened with a yellow, greasy fur. The pulse is taut or slippery.

Principle of treatment:

Herbal medicine

Clear away heat and toxic material and remove dampness.

Modified Long Dan Xie Gan Tang plus Wu Wei Xiao Du Yin.

Acupuncture 

Clears away heat and toxic material and removes dampness by using points mainly from the Large Intestine meridian of Hand Yangming.
He Gu (LI 4), Qu Chi (LI 11), Da Zhui (DU 14), Yin Ling Quan (SP 9), Xing Jian (LR 2).

 

6. The Excessive Fire-Toxin Type

The symptoms of this type of psoriasis are those of the erythroderma (red skin) type. The skin all over the body is diffuse, flushed or dark red, with vast amounts of desquamation (coming off in scales) and a burning-heat sensation. Protracted cases have moist and thick skin lesions, often accompanied by fever, aversion to cold, restlessness, thirst, constipation, frequent urination and yellow urine. The tongue would be dark red, with little or no coating, while the pulse is slippery and quick.

Herbal medicine
Clear away heat toxin from the blood.

Modified Qing Ying Tang.

Acupuncture Clear away heat toxin from the blood by using points mainly from the Large Intestine meridian of Hand Yangming and Du channel.

Qu Chi (LI 11), Da Zhui (DU14), He Gu (LI 4), Tai Chong (LR 3), Nei Ting (ST44).

Dietary and lifestyle advice

1) Refrain from drinking alcoholic beverages and soft drinks or eating irritating food with a pungent hot taste. Eat more fruits and vegetables and try to keep the digestive canal free of disturbance.

2) Don’t scratch by hand, it is better to pat itching area by soft cotton tower.

3) Suck sweat or water of the body with dry and clean tower.

4) Don’t use soap or shampoo to wash affected area. There is a kind of membrane formed by lipid which can protect the skin. We should try to protect it instead of destroy it.

5) Don’t put essential balm, toilet water or salt on the affected area. It maybe relieves the itching for a while, but the itching will become more severe after a while.

6) It’s better to wear cotton clothes which should be loose, soft and ventilate.

7) Keep the air of the room fresh.

8) Regular life and peaceful attitude. Try to reduce emotional stress. Keep easy and smooth stools. Try to have enough sleep.

9) Infections, such as upper respiratory infections, may aggravate psoriasis. Try to avoid catching a cold or the flu.

 

Some clinical cases study

Case 1

A 38 year old woman with psoriasis for the past 3 years.

S/S: Generalised erythematous plaques with silver-white scales, severe itching, cribriform bleeding after peeling off the scales, soreness of the knees, dry mouth, floating and slippery pulse, slightly red tongue with a thin and yellow coat.

Analysis:

Generalised erythematous plaques with silver-white scales

= Wind and Dampness attacking the skin, resulting in malnourishment of the skin

Severe itching, cribriform bleeding after peeling the scales

= accumulation of Dampness transforming into Heat, the Blood Heat accumulating in the collaterals

Soreness of the knees

= Wind and Dampness accumulating in the knees

Dry mouth, floating and slippery pulse, slightly red tongue with a thin and yellow coat

= accumulation of Wind, Dampness and Heat

TCM diagnosis:

Wind and Dampness attacking the skin, Blood Heat accumulating in the collaterals.

Principle of treatment:

Dispel Wind and eliminate Dampness, cool the Blood and clear Heat

Basic formula:

Modified XIAO FENG SAN

JING JIE 9g, FANG FENG 9g, NIU BANG ZI 9g, BO HE 5g, DANG GUI 9g, SHENG DI HUANG 15g, CHI SHAO 9g, HU MA REN 9g, MU TONG 9g, ZHI MU 9g, GAN CAO 3g, DI FU ZI 9g, FU LING 15g

Equivalent patent formula:

XIAO FENG SAN

plus DI FU ZI Kochia, FU LING Poria

 

Case 2

A 43 year old man with psoriasis in the past 10 years. The erythematous plaques appeared on the legs at the beginning, then spread to the hip, ankles and trunk.

S/S: Erythematous plaques on the trunk and the lower limbs, with silver-white scales, severe itching, cribriform bleeding after peeling off the scales, dry mouth, yellow urine, constipation, red tongue with a yellow and greasy coat, deep and full pulse.

Analysis:

Erythematous plaques on the trunk and the lower limbs, with silver-white scales

= Wind and Heat attacking the skin, Dryness of the Blood leading to malnourishment of the skin

Severe itching, cribriform bleeding

= accumulation of Wind and Heat, Dryness of the Blood and hyperactive Fire doing harm to the collaterals

Dry mouth, yellow urine, constipation, red tongue with a yellow and greasy coat, deep and full pulse

= accumulation of Heat in the bowels, excess of the Fire and Dryness of the Blood

TCM diagnosis:

Accumulation of Wind and Heat, Dryness of the Blood and hyperactivity of Fire.

Principle of treatment:

Dispel Wind to release the exterior, purge the bowels to clear Heat

Basic formula:

Modified FANG FENG TONG SHENG WAN

JING JIE 9g, FANG FENG 9g, HUANG QIN 9g, BO HE 9g, LIAN QIAO 9g, JIE GENG 9g, SHAN ZHI ZI 9g, DANG GUI 9g, CHI SHAO 9g, CHUAN XIONG 9g, DA HUANG 9g, MANG XIAO(decocted it later) 9g, BAI ZHU 9g, GAN CAO 3g, JIN YIN HUA 9g

Equivalent patent formula:

FANG FENG TONG SHENG WAN

Introduction of the experience of a famous TCM doctor

A famous TCM doctor Mingqi Zhou use his own experience formula Yin Xue Tang: Bai Xian Pi 30g, Jin Yin Hua 40g, Lian Qiao 15g, Tu Fu Ling 30g, Sheng Di Huang30g, Bai Mao Gen 50g, Ku Shen15g, Fang Feng10g, Di Fu Zi 15g, Dan Shen 15g, Ji Xue Teng 25g, Dan Gui 15g. Decoct Jin Yin Hua separately and no more than 10min after boiled. One course of treatment is 3 month. It is important to persuade patient take the treatment without stop for 3 months. When using this formula,if the heat in blood is severe, please add Zi Cao15g, Sheng Huai Hua30g, Huang Qin10g. If the blood stasis is severe, please add Chi Shao 15g, Hong Hua 10g, E Zhu 10g. If the wind is obvious and very itching, please add Bai Ji Li 30g, Niu Bang Zi 15g. If the lesion is more obvious on head, please add Chuan Xiong 10g, Gao Ben10g. If Yin and Blood is deficient, please add Xuan Shen 20g, Sheng Shou Wu 20g, Shu Di Huang20g, Sheng Huang Qi 15g. He pointed out, the patient must abstain from the liquor and be careful to avoid taking pungent foods so as to consolidate the therapeutic effect and prevent relapse.

Some Influential Doctrines and Recent research:

The most influential TCM doctrines about psoriasis are as follows: blood heat doctrine, blood stasis doctrine and blood deficiency doctrine.

The representative of blood heat doctrine is Renkang Zhu and Bingnan Zhao, they believe that heat in the blood is the main pathogenesis of psoriasis. If being attacked by external pathogens, taking spicy food, drinking alcohol, being upset or stress, the patient can be suffering from accumulation of blood heat; the accumulation can produce more heat and toxicity and cause the occurrence of psoriasis. (Bingnan Zhao’s Clinical Experince Collection, Beijing, People’s Sanitation Publishing Company, 1975,221)

The representative of blood stasis doctrine is Wanzhang Qin and Shaoxi Wu. Wanzhang Qin thinks that the patients who are suffering from psoriasis has 7 items of sign according to the modern medical research. 1) Squamous and dry skin, unsmooth movement of joints; 2) Bleeding spot after peeled the lesion and plaques.3) more than 35% client’s tongue is purple or with blood stasis spot. 4) the capillary check with angioscope can find the twist of capillaries. 5) Increasing of blood viscosity. 6) Extensive eruptions, increasing of vascular permeability; 7) Expanding capillary of dermal papilla. Shaoxi Wu discoved that the metamorphotic function of red cells decreased. The activity membrane ATP enzyme is abnormal. It indicates that there are abnormal changes of membrane electric charge, membrane function and even membrane structure. It shows that blood stasis is the essence of psoriasis.(Wanzhang Qin, Dermatology Research, Shanghai: Shanghai Science and Technology Publishing Company, 1990,326) (Shaoxi Wu, The Research into Psoriasis Patient’s Blood Stasis Essence. Dissertation Collection of The First Chinese Psoriasis Academic Conference, 1997,238)

The representative of blood deficiency doctrine is Bohua Gu. He thinks that psoriasis is caused by blood deficiency which leads to internal wind and dryness, and then the skin will lack of nourishment. (Bohua Gu, Clinical Brochure of TCM External Diseases, Shanghai: Shanghai Science and Technology Publishing Company, 1986,364)

Besides, there are other doctrines such as abundant toxicity doctrine, Yin deficiency with stasis and heat doctrine, etc.

It is necessary to point out, Qinglin Xiao who suggests Yang deficiency of the body constitution is the main cause of psoriasis supplied a new way for treating this disease. The occurrence of psoriasis is due to Yang deficiency and Yin invading according to the evidence that psoriasis is often occur in the winter, external side of body and limbs tend to be affected. Yang deficiency will lead to cold and cause blood stasis. Qinglin Zhao thinks the principle of treatment should be warm and tonify the kidney Yang. (Qinglin Xiao, Clinical Research into Treating Psoriasis with Yinfuxin Series, Tianjing Journal of Traditional Chinese Medicine,2000,17(2):20)

Acupuncture is very seldom used alone in the treatment of psoriasis. Yuanhong Wang, Guirong Dong and Deyou Jiang treated 52 cases of psoriasis with blood letting puncturing and cupping. The main acupoints are Fei Shu(BL13), Xin Shu(BL15), Gan Shu(BL18), Pi Shu (BL20), Shen Shu (BL23), auxiliary acupoints are Da Zhui(CV14), Wei Zhong(BL40), Zi Yang(CV9), Shen Dao(CV11), Shen ZhuCV12), Tao Dao(CV13). Puncture the acupoint for 4 times and cause bleeding. Then use flash fire cupping for several times. After that remain the cup on the acupoint for 25 min. To help the bruise which caused by cupping, we can use Vaseline externally. One course of treatment is 15 times. Do one treatment in every other day. Use 12 cups every time. Use the main acupoints every time and use the auxiliary acupoint alternatively. (Yuanhong Wang, Guirong Dong and Deyou Jiang , ITCM.Jan.2005,Vol.22,No.1:18)

Xiaoyan Zhang and Shushen Zhang thinks that the psoriasis usually caused by dryness of blood which lead to wind. So the principle of treatment should be nourish the blood and dispel the wind. From 1994, they’ve treated 240 cases of psoriasis with modified Run Xue Xiao Yin Tang. The ingredients of Run Xue Xiao Yin Tang are as follows:Tai Zi Shen10g, Bai Zhu 10g, Fu Ling15g, Dan Gui 10g, Xuan Shen10g, Fang Feng10g, Chan Tui10g, Zhi Mu10g, Hu Ma Ren 10g, Ku Shen10g, Dan Pi10g, Mai Dong10g, Gan Cao10g. Two decoction per day. Abstain from fish, crab, shrimp, mutton and spicy food. (Xiaoyan Zhang, Shushen Zhang, Modern Journal of Integrated Traditional Chinese and Western Medicine 2004 Jan, 13(1):140)

Some TCM doctors did some practice or research for external treatment. For example, a Japanese doctor did some research related to treating psoriasis with Huang Lian or Huang Bai and discovered that they can restrain the composing and rebirth of the lipid of psoriasis cuticle cells. The external use of Huang Lian ointment can be better than the external use of Vaseline ointment. (Overseas Medical Research-Fascicle of Traditional Chinese medicine, 1995,17(1):38) On the other hand, Xinliang Cai and Yuhua Zhang treated 43 cases with external use of Ru Mo Dan Qing Gao and internal use of Chu Xian Tang. The ingredients of Ru Mo Dan Qing Gao are Ru Xiang, Mo Yao, Bai Ji, Huang Bai (even quantity of each herb, grind them into powder, add some water into the powder, boil it with lower fire, apply it onto affected area, massage it gentlely and then put fresh egg white onto it, after that, please massage that area for 15 min. Clean it with warm water after 2-4 hours. Do the external treatment once per day. The ingredients of internal used herbs are Sheng Di Huang, Xuan Shen, Dan Pi, Chi Shao, Shan Yao, Bai Shao, Bai Zhu, Fa Ban Xia, Dan Gui, Jin Yin Hua, Pu Gong Ying, Bai Xian Pi, Bai Ji Li, Jiang Can. If the heat is obvious, add Huang Qin and Zi Cao; if belongs to cold and deficient style, add Tai Zi Shen and Rou Gui; if relapsed on and off for a long time add Huang Qi and Wei Ling Xian. ( Xinliang Cai and Yuhua Zhang, Hunan Journal of Traditional Chinese Medicine, 2002, Vol.18, No.5: 38)

Some TCM doctors try to point out the future direction about psoriasis TCM research. For example, according to the cause and pathogenesis of psoriasis, Haixing Ye points out that we can use some kinds of herbal medicine in the treatment of psoriasis such as Anticancer Herbs or herbs which can regulate immunity system. (Haixing Ye, Shaojian Ling. TCM Research into Psoriasis, Forum of TCM Doctors, 2003,18(3):53)

Guide to further readings

http://www.psoriasis-help.org.uk/html/faqs.htm

http://www.psoriasis.org/treatment/

http://www.healthy.net/scr/article.asp?ID=1614

http://www.vitalitymagazine.com/node/view/358