Leucoderma (psoriasis)
Psoriasis is a skin disease characterized by erythematous, scaly lesions, punctate bleeding and thin film phenomenon, which can be cured clinically but is prone to recurrence.
I. Diagnosis
Chinese medicine diagnosis refer to the Clinical Treatment Guide for Common Diseases in Chinese Medicine Dermatology.
Western medicine diagnosis refers to the Clinical Diagnosis and Treatment Guide-Dermatology and Venereal Diseases (edited by the Chinese Medical Association, People’s Health Publishing House), and the Clinical Technical Practice Specification-Dermatology and Venereal Diseases (edited by the Chinese Medical Association, People’s Military Medical Publishing House).
II. Chinese medicine treatment
(A) Internal treatment of common psoriasis
1.Blood-heat and wind-shedding evidence: When psoriasis starts, red papules, as small as corn and as large as broad beans, are distributed. It can be expanded into patches over time, and some of them can be fused with each other, with bright red or flesh-red color, little surface scales, “isomorphic reaction”, itchy but not very. Systemic symptoms include dry throat and thirst, sore throat, dry stool, yellow urine, red tongue with yellow or yellowish coating, and slippery pulse. Treatment should be to clear heat and cool the blood, dispel wind and detoxify. The late famous veteran Chinese medicine doctor Zhu Renkang researcher has developed a side, the name “gram silver side”, the taste of medicine: Fu Ling 30 grams, Lonicera japonica 15 grams, the northern bean curd 10 grams, the root of the 15 grams, the grass river car 15 grams, white fresh skin 15 grams, Wei Ling Xian 6 grams, licorice 6 grams (“Zhu Renkang clinical experience collection”). Add 10-15 grams of Da Qing Ye for dry stools. Red rash with hot and dry mouth add 15-30 g of raw earth and 15 g of dandan bark. Add 15 grams of white foxglove root for yellow urine.
2. Wind-heat and dampness evidence: the rash of psoriasis vulgaris in the progressive stage and the initial stable stage is red or light red, with scales on the rash surface and a 0.2-0.5-cm-wide light red halo (Woronoff) or swelling around it.
ring) or swelling, with a fat and light red tongue and white greasy coating, the treatment is to clear heat and detoxify the toxin. The formula is based on Cool Blood Detoxification Tang (Zhao Bingnan’s Clinical Experience Collection) or Gentian Diarrhea Liver Tang (He Ji Bureau Formula) plus or minus. Radical Blood Detoxification Tang: Rhinoceros horn (where rhinoceros horn is used clinically, rhinoceros horn is replaced by water buffalo horn, antelope horn or antelope horn powder), raw earth, silver flower, lotus seed heart, white foxglove root, smallpox powder, dingding, gardenia, fleabane, licorice, Huanglian, raw gypsum. If the rash is red and swollen (infiltrated), add Dioscorea Z and Bupleurum; if the tongue is greasy and yellow, add Patchouli, Perilla, Sharen, Coix, etc.; if the rash is windy and itchy, add Bai Xian Pi, Dioscorea, Bitter Ginseng; if the rash is red, add Comfrey, Sophora, Sheng Di Yu; if the rash is also tonsillitis, add Pan Lan Gen, Radix et Rhizoma, Burdock; if the stool is constipated and unpleasant, add Da Qing Ye, Atractylodes, etc.
3, blood deficiency and wind dryness evidence: lesions to the stable stage, the rash flat flat light red, the surface is dry and flaky, sometimes itchy. The treatment is to clear heat and detoxify, nourish blood and moisten dryness, with Zhu Renkang’s “Ke-Yin Er Fang”. Medicinal flavor: 30 grams of raw earth, 15 grams of ginseng, 15 grams of danshen, 10 grams of sesame, 15 grams of dacquoise leaf, 10 grams of northern bean root, 15 grams of white fresh peel, 15 grams of caohe che, 15 grams of forsythia (Zhu Renkang Clinical Experience Collection). Add Dendrobium and Yuzhu if the skin is flaky and itchy; add Yujin, Sanliao and Curcuma if there is blood deficiency and stasis (dark red and dry skin lesions, dark red or dark purple tongue).
4.Blood stasis and wind power evidence: the chronic state of psoriasis, plaque-like damage of varying sizes on the trunk and extremities, with clear boundaries, dark red, with flaky or fragmented scales on the surface, and lesions that remain motionless for a long time, often due to recurrent attacks of the disease or the long-term use of blood cooling and detoxifying drugs that cause blood cooling and stagnation, with lesions of plaque type. The treatment is to activate blood circulation and eliminate blood stasis and to clear heat and detoxification. The formula is Blood Mansions and Stasis Removal Tang.
These are the four common types of common psoriasis. The stages are progressive: blood-heat, stable: blood-heat, blood-heat with dampness, receding: blood deficiency, blood stasis, and all stages are accompanied by wind evidence: scaling and itching. Clinical use of medicine should be divided into stages to identify the evidence with different prescriptions and add and subtract to treat the evidence to achieve the therapeutic effect.
(2) Internal treatment of pustular psoriasis
Pustular psoriasis can be primary, or it can be the result of the transformation of common psoriasis over a long period of time or improper treatment. For pustular psoriasis, the etiology of Chinese medicine is damp-heat and toxicity. In addition to the rash, the symptoms include heat and thirst, red face, dry lips, irritability, constipation, red urine, red and vivid tongue, yellow and greasy coating, and slippery pulse. Treatment is to cool the blood and clear the heat and detoxify the toxin, using Puji Disinfection Drink and Wu Wei Disinfection Drink plus or minus. If the heat is very pustular, add three needles; if it is itchy, add Bai Xian Pi and Bitter Ginseng; if it is dry and itchy, add Sheng Di and Dan Pi; if the heat is very dry, add Xuan Shen, Mai Dong, Da Qing Ye and Zi Cao.
(C) Internal treatment of arthritic psoriasis
The appearance of arthritic psoriasis is often due to wind, cold and dampness invading the skin, paralyzing the meridians, wind-dryness hurting the blood, stagnant qi and blood stasis and unfavorable joints, and mostly plaque-like psoriasis on the skin. Treatment should be early rather than late. Chinese medicine is to search wind and remove dampness, detoxify and dispel paralysis, and the formula is to use Gui Zhi Shao Yao Zhi Mu Tang or Dou Shuo Xie Sheng Tang plus or minus. If the upper extremity is bad, add turmeric, sea breeze vine; if the lower extremity is bad, add antibiotics; if the joints are deformed, add transverse bone grass, whole scorpion, centipede, cicada, etc. In case of heavy psoriasis lesions, add Dan Shen, Dioscorea Z, Wu Snake, etc. For those whose symptoms do not subside for a long time, frankincense, myrrh, trigonella and curcuma can be tried under close observation.
(D) Internal treatment of erythrodermic psoriasis
In the treatment of this disease, Chinese medicine attaches importance to the examination of the evidence to seek the cause, the evidence belongs to heat and poison injury to yin, the treatment is appropriate to cool the blood and clear the camp, nourish yin and detoxify. The formula uses Qing Ying Tang and Rhizoma Dihuang Tang plus or minus. When clearing heat and detoxifying the blood, it should be given to nourish Yin and nourish the blood. Commonly used heat-clearing and detoxifying drugs include dandelion, ditin, white flowered snake’s tongue, three needles, lobelia, etc. Commonly used products to nourish Yin and nourish Blood include raw earth, chasteberry, dry lotus herb, danpi, salvia, red and white peony, etc.
When using the above prescriptions, there are several principles as follows: identify the evidence accurately: the diagnosis of psoriasis is not difficult, based on the characteristics of the skin lesions and light tongue and pulse evidence, identify the evidence and treat; keep the prescription and do not move: as long as the evidence is accurate, take the medicine 1~3 weeks to see the effect, generally adhere to the average of 7~10 weeks; change the amount of medicine: take the medicine 1~3 weeks to see no effect, you can appropriately increase the amount; change the prescription: after a period of effective treatment, and then take the skin lesions After a period of effective treatment, the skin lesions do not change much, so the prescription can be changed to continue treatment.
C. Effect of Chinese medicine treatment
(a) The curative effect is obvious and the recurrence rate is low.
(2) Reduce the dosage of western medicine, reduce the side effects of western medicine.
IV. Difficulties of TCM treatment
Slow curative effect, long course of disease, poor patient compliance.
V. Responses to the difficulties of Chinese medicine treatment ideas
Strengthen the diagnosis and treatment of Chinese medicine.
Chinese medicine characteristic therapy
(1) Chinese medicine bath
The medicinal bath method is one of the external treatment methods, which can unblock the meridians, invigorate blood circulation, dispel wind and cold, clear heat and detoxify, reduce swelling and pain, adjust yin and yang, coordinate the internal organs, pass qi and blood, moisten the whole body and other health effects.
(2) Psychotherapy
Psychotherapy is the use of medical psychological principles and methods, through the medical staff’s words, expressions, posture, attitude and behavior, or through the corresponding instruments and the environment to change the patient’s feelings, awareness, emotions, personality, attitude and behavior, so that patients enhance confidence, eliminate tension, to promote the patient’s compensation, the recovery of regulatory functions, so as to achieve the purpose of treating disease.
(3) Acupuncture cupping
After routine sterilization of selected acupuncture points, first puncture with a trigeminal needle, requiring light and shallow and fast, to pull out 0.3 to 0.4 ml of blood is appropriate, leaving the can about 10 to 15 minutes, the top of the head acupuncture points can be punctured without cupping. A few residual lesions can be punctured several times along the perimeter of the lesion and in the middle, and then cupped.