Psoriasis is a common disease in dermatology that is easy to diagnose but difficult to treat. Every year, hundreds of research papers on psoriasis are published in various medical journals, and both basic and clinical research are in progress, but the eradication of psoriasis is still an elusive task in terms of results. Reflecting on the current psoriasis treatment profile, perhaps we should make changes in the purpose of treatment and treatment mode. Wang Lijun, Department of Dermatology, Wuxi Hospital of Traditional Chinese Medicine 1. Differences in the purpose of treatment between doctors and patients The skin is the largest organ of the human body, and in addition to its many important physiological functions, it also plays an important aesthetic function because it is directly exposed on the surface of the human body. Healthy skin plays an important role in building an individual’s self-confidence and self-esteem. Therefore, most psoriasis patients are eager to get rid of their psoriasis lesions completely, and after many repeated attacks, they may experience anxiety, depression, low self-esteem and other adverse psychological states due to cosmetic defects and social frustration. Although both doctors and patients are concerned about how to restore the normal appearance of the patient’s skin lesions, the difference in their knowledge backgrounds makes them different in terms of the ultimate goal of treatment and therefore affects the communication and trust between doctors and patients. Most psoriasis patients are eager to be completely cured, and many of them have moved around to try various treatment methods. The lack of knowledge about psoriasis and the eagerness of patients and their families to seek a cure are easily attracted by the proliferation of medical advertisements. The promise of “complete cure and refund” and the self-appointed titles of so-called “experts” and “professors” are irresistibly tempting. Although the state has increased its efforts to review medical advertisements, it is foreseeable that the lure of bad advertisements will be difficult to eliminate in the short term. As a result, patients not only pay money, but also do not get the expected results, and some patients are even aggravated by this. In addition, the patients’ eagerness to seek a cure makes the treatment process impatient, and they lose trust in the doctors when the results are slow or the disease recurs. After years of clinical experience, as well as exchanges and continuing education at various levels of annual dermatology meetings, it is now recognized by dermatologists that the onset of psoriasis is closely related to genetic factors and may be a polygenic genetic disease, but the expression of genes is affected by the internal and external environment; the occurrence, aggravation, remission and cure of psoriasis are closely related to mental tension and psychological stress, and belong to the category of psychosomatic diseases; the existing internal and external treatments can only be used temporarily. The existing internal and external therapies can only temporarily eliminate symptoms and cannot prevent recurrence. Therefore, in clinical practice, we have abandoned the use of immunosuppressive drugs, antitumor drugs and corticosteroids with high toxic side effects in pursuit of short-term efficacy, and have instead adopted relatively “mild” methods to control the disease according to the patient’s condition, and helped patients improve their understanding of psoriasis through health education and choose a reasonable lifestyle to reduce recurrence. This shows that dermatologists are not very aggressive in removing psoriasis vulgaris lesions compared to patients. When the patient’s condition relapses or worsens, he or she will naturally feel that the doctor has not done his or her best to treat the condition, thus increasing the confrontation between the doctor and the patient. In fact, although psoriasis has a high recurrence rate, it is possible to remit with appropriate treatment and care after each recurrence; with methods that promote remission, although it cannot be cured, patients can work and live normally. In China, Peng Yongnian et al. followed up 730 patients with psoriasis for 20-30 years and found that 21.12% of the patients had only one attack and only 9.17% of the relapsed cases were severe cases with extensive lesions, while most of the patients had different degrees of remission after one or several relapses, and only 1.11% of the patients failed to remit during the course of the disease. This shows that the prognosis of most psoriasis patients is still very good, and “over-aggressive” treatment methods are not necessary. In the earliest research, doctors observed clinically that psoriasis was characterized by hypertrophy of the skin and a significant increase in epidermal thickness in histopathology, so it was believed that psoriasis was a disease with epidermal hyperplasia as the main cause, and drugs to inhibit epidermal hyperplasia such as coal tar, retinoic acid preparations and anti-tumor drugs were widely used. With the major breakthrough in the study of acquired immune system in the field of immunology, researchers noticed that psoriasis is usually accompanied by a large infiltration of T lymphocytes in the skin lesions and abnormal blood T cell function, and therefore proposed that psoriasis is a chronic T cell-mediated inflammatory and proliferative skin disease, thus shifting the center of psoriasis research to T cell immunity, and therapies that induce apoptosis of lymphocytes such as immunosuppressants, PUVA, NB The use of immunosuppressive agents, PUVA, NB-UVB, etc. has been widely used. Recent studies have revealed that the interaction between T cells and antigen-presenting cells plays an important role in the development and progression of psoriasis through immunohistochemical techniques. Antigen-presenting cells such as Langerhans cells and dendritic cells capture antigens, process them, present them to T cells, and activate them with the action of co-stimulatory molecules. With the development of genetic engineering, some new bioengineered agents including fusion proteins, monoclonal antibodies, and recombinant cytokines can selectively block one step of T/APC action, thus inhibiting T cell activation, co-stimulatory effect and T cell proliferation, regulating immune differentiation, blocking the action of a specific cytokine, and thus treating psoriasis. Based on the understanding of this immune mechanism, a series of biological agents targeting T lymphocytes and regulating cytokines have been developed and applied in clinical practice. Although no less than hundreds of drugs have been developed for the treatment of psoriasis under the guidance of the traditional biomedical model and methods, and more sophisticated and expensive methods are being used as medical technology advances, there is still no hope for the eradication of psoriasis. As the medical model changes from a purely biological model to a bio-social-psychological model, doctors gradually begin to focus on the impact of environmental and psychological factors on the onset and recurrence of psoriasis, and psychotherapy and biofeedback therapy begin to participate in the treatment of psoriasis. 3, how to treat psoriasis in Chinese medicine In China, treating psoriasis with Chinese medicine or a combination of Chinese and Western medicine is one of the many common treatment methods, and the exact efficacy and the deeply rooted culture of Chinese medicine also make patients willing to make this choice. With the Yellow Emperor’s Classic of Internal Medicine as a symbol, Chinese medicine has formed a complete theoretical system, featuring the ideas of “holistic concept, examination of evidence and cause, and discriminatory treatment”, “the correspondence between heaven and man” and “the doctrine of the five elements of yin and yang “It is a holistic view of Chinese medicine, which is based on the “theory of internal organs and meridians” and the “seven emotions causing disease”. It can be said that Chinese medicine has the germ of modern medical model. In terms of specific clinical practice, the ancients believed that the external causes of psoriasis were mainly wind evil, with cold, dampness and toxicity causing the disease; the internal causes were blood dryness. Contemporary medical practitioners have developed on this basis, such as recognizing that the disease is caused by internal injury of emotion and will, stagnation of qi qi, long depression and fire, hyperactivity of heart fire, poisonous heat in the blood; or due to diet disorder, excessive consumption of fishy and windy food, disharmony of spleen and stomach, poor qi qi qi, long depression and heat, and the onset of the disease by wind-heat and poisonous evil. The clinical classification of psoriasis is increasing, and there are various ways of classification, such as qi-blood classification (blood stasis, blood stasis and wind dryness, blood dryness, blood deficiency, blood deficiency and wind dryness, blood heat, blood heat and wind dryness), internal organs classification (liver and kidney deficiency, spleen deficiency and toxicity), six molestations classification (rheumatism, dampness and heat, dampness and toxicity, dampness and heat and toxicity, wind heat, toxicity and heat, fire and toxicity), meridian classification (dysregulation of the flushes and the capitals), and guard qi and blood classification (toxicity and heat injure the camp). etc. Although physicians around the world have their own focus on the differentiation of symptoms, they all regard blood abnormalities as the main object of differentiation and are generally aware of the importance of “blood”. Although recognizing the influence of emotion and lifestyle habits on the disease, Chinese medicine practitioners still adopt a treatment model similar to that of pure biomedicine, that is, they try to clear psoriasis lesions with drugs alone, sometimes even using the method of “attacking poison with poison”. As a result, some patients suffer from serious adverse effects. It should be the direction of future work to re-examine the ideas in Chinese medical theory that are in line with the modern medical model, and to use Chinese medical theory to guide the treatment, care and health practice of patients. 4.Psoriasis treatment under the modern medical model Combining biological, psychological and social factors for the prevention and treatment of psoriasis and focusing on the role of psychological and environmental factors on the occurrence and development of psoriasis is the new modern medical model that has been explored in recent years. Under the guidance of this mode of thought, treatment and care are put on the same level of importance. Through health education, patients are relieved of all misunderstandings and concerns about psoriasis, and their confidence in controlling the disease is enhanced; they understand the disease in detail, analyze its triggering and aggravating factors, and implement a reasonable lifestyle to facilitate prevention; according to the patient’s typing, staging, estimated lesion area and severity, different treatment plans are designed and continuously adjusted according to the treatment effect, taking into account the patient’s specific conditions and economic conditions. In short, we should attach importance to psychological treatment and try to eliminate harmful psychology that is not conducive to disease recovery, so that patients can correctly treat the chronic process of psoriasis and the reality of recurrence as early as possible, remove blindness, and enhance scientific and consciousness. In front of the disease, the doctor and the patient are collaborators. By discussing and understanding psoriasis knowledge, analyzing its triggering and aggravating factors, and sharing successful psoriasis prevention and treatment experiences between doctors and patients on an equal footing, the effectiveness of psoriasis psychotherapy and drug treatment can be improved.