I. Diagnosis
(A) Disease diagnosis
1. Diagnostic criteria in Chinese medicine.
(1) The skin lesion is initially a pinpoint to lentil-sized inflammatory red papule, often in a dotted distribution, rapidly increasing in size, covered with silvery-white multilayered scales, resembling mica. After the scales are peeled off, thin film phenomenon and sieve hemorrhage can be seen, basal infiltration, there may be isomorphic reaction.
(2) It usually occurs on the scalp and extensor side of the limbs, and is more common on the elbow joint surface, and often generalizes to the whole body.
(3) In some patients, nail lesions are seen, ranging from punctate depression in mild cases to thickening of the nail plate and loss of luster in severe cases. It may be seen in the mucous membrane of the mouth and pubic area. If it occurs in the scalp, bundles of hair can be seen.
(4) Slow onset, easy to recur. There are obvious seasonality, generally heavy in winter and light in summer.
(5) There may be a family history.
(6) Histopathological examination shows hyperkeratosis and hyperkeratosis of the epidermis. There is an accumulation of neutrophilic polymorphonuclear leukocytes in the stratum corneum and thickening of the spinous layer. The epidermal protrusions extend downward in a regular manner, the dermal papillae are edematous and rod-shaped, the blood vessels within the papillae are dilated, and there is inflammatory cell infiltration around the blood vessels.
2.Western medical diagnosis criteria.
(1) More young and strong age onset. Partial onset or exacerbation is often triggered by tonsillitis or upper respiratory tract infection.
(2) It is usually found on the scalp, trunk and extremities, often symmetrically distributed, but also confined to a certain area.
(3) The typical rash is a red papule, macular rash or plaque of corn to green bean size, which may fuse into patches, with clear borders, surrounded by an inflammatory red halo, with significant infiltration, and covered with thick silvery white scales. When the scales are gently scraped away, a light red translucent film is visible (film phenomenon); after scraping away the film, punctate hemorrhage appears (Auspitz sign). White scales, film phenomenon and punctate hemorrhage are the clinical features of this disease. The rash can be in various forms, such as drip-like, coin-like, map-like, oyster shell-like, etc.
(4) If the rash occurs on the scalp, the hair is in bundles. There may be finger (toe) nail involvement and mucosal damage.
(5) There are three clinical phases: progressive phase, resting phase, and receding phase.
(6) Chronic course, even lifelong persistent. It often relapses or worsens in winter and decreases or disappears in spring and summer, or the opposite.
(7) Histopathology: The epidermal reshaping appears early, mainly as incomplete keratinization, and sometimes Munro microabscesses can be seen in or under the stratum corneum. The granular layer is thinned or disappeared. The spinous layer is hypertrophied and the epidermal crest is prolonged. The dermal papillae are distorted and dilated with mild thickening of blood vessels. The epidermis above the papillae is thinned. Mild to moderate inflammatory cell infiltration in the upper part of the dermis.
(B) Evidence diagnosis
1, blood heat evidence: new rash increasing, rapidly expanding; lesions flushed, silvery white scales, sieve-like bleeding, itching, may be accompanied by yellow urine, dry stool. The tongue is red, with thin yellow or white coating; the pulse is smooth or counted.
2. Blood dryness: light red lesions, dry and flaky, may be accompanied by chapped, dry mouth and throat. The tongue is light, with little or thin white coating, and slow or sunken pulse.
3, blood stasis evidence: the lesions are thick and infiltrated, do not subside after a long time, dark red color, scales attached closely, women may have dysmenorrhea. The tongue is purple and dark or with petechiae and petechiae; the pulse is astringent or slow.
II. Treatment plan
(A) Select oral Chinese medicine soup or Chinese patent medicine according to the evidence
1. Blood-heat evidence
Treatment: cool the blood and detoxify the toxin.
Recommended formula: Rhizoma Dihuang Tang plus or minus. Water hyacinth, Dan Pi, Tu Fu Ling, raw Sophora, Comfrey, Cao He Che, Sheng Di, Bai Xian Pi, Red Peony.
Add and subtract: for wind, add thornbush, bongfeng, qiangwu, doklam, wei lingxian, whole scorpion, centipede, wuxia, etc.; for blood stasis, add danshen, chicken blood vine, etc.; for heat, add white foxglove root, big green leaf; for dampness, add bitter ginseng; for toxicity, add lonicera, silver flower, dingding, panax quinquefolium, raw licorice, etc.; for sore throat, add northern sansho root.
Chinese patent medicine: can be used to eliminate silver granules, compound Qing Dai capsule, Qing Kai Ling oral liquid (granules), etc.
2.Blood dryness evidence
Treatment: Nourish blood and detoxify it.
Recommended formula: Angelica Drinking Plus or Minus. Radix Salviae Miltiorrhiza, Radix Angelicae Sinensis, Radix Rehmanniae Praeparata, Radix et Rhizoma Macrocephala, Radix et Rhizoma Ginseng, Radix Rehmanniae Sinensis.
Add and subtract: for heavy heat, add Yinhua, Red Peony, Comfrey, Smallpox; for poison, add Caohe Che, Tu Fu Ling, Beehive, Da Qing Ye, White Flowering Snake Tongue Herb, Licorice; for stasis, add Peach kernel, Safflower, Chuanxiong; for dryness, add Ma Ren, Tian Dong; for wind, add Thornbush, Fang Feng, Bai Xian Pi, Wu Snake, Wei Ling Xian, Scorpion, Centipede, etc.; for Yang deficiency, add Hsiang Xin, Radix et Rhizoma; for spleen deficiency, add Huang Qi For spleen deficiency, add Astragalus, Atractylodes, Poria, Atractylodes, etc.
Chinese herbal medicines: Siwu Hodong, Liu Wei Di Huang Wan, etc. can be used.
3.Blood stasis evidence
Treatment: Invigorate blood circulation and detoxify.
Recommended formula: Peach and red four substances soup with reduction. White flower and snake tongue grass, curcuma longa, ghost arrow, safflower, chicken blood vine, peach kernel, salvia, angelica, chuanxiong
Add and subtract: for heavy heat, add Daxing leaf and Zi Cao; for stasis, add Radix Paeoniae and Trigonella; for dryness, add Radix Rehmanniae, Ma Ren and Yuan Shen; for sore throat, add Radix et Rhizoma Polygonati; for dampness, add Radix et Rhizoma Bitter, Radix et Rhizoma Tigrinum and Chen Pi. In case of wind, choose to add thornbush, windproof, white fresh skin, wuzhang, wei ling xian, whole scorpion, centipede, etc.; in case of qi deficiency, add huang qi, etc.; in case of yang deficiency, choose to add hosin, sophora, etc.; in case of spleen deficiency, choose to add huang qi, atractylodes, poria, atractylodes, etc.
Chinese patent medicines: rhubarb sting worm pill (capsule), blood province and blood stasis pill (capsule), etc..
(II) External treatment method
1.Wet application of Chinese medicine: applicable to blood heat evidence, red skin lesions. Select heat-clearing and blood-cooling, dampness-drying and detoxifying herbs in the proportion of 3% to 10%, add water to the decoction and leave it to cool, then apply to the affected area with 8 layers of gauze soaked in moisture for 20 to 40 minutes each time, 1 to 2 times a day.
2.Chinese herbal medicine bath: applicable to blood dryness and blood stasis, with dark or light skin lesions, stationary or tending to fade.
According to the condition, choose to nourish the blood, activate the blood, moisten the dryness and relieve itching, decoction bath or fumigation, 20 minutes each time, once a day or every other day.
Or mineral bath can be used according to the condition.
According to the condition, we can choose leg bath treatment device, intelligent Chinese medicine fumigation steam self-control treatment instrument, fumigation bed (sitting) medical intelligent steam therapy instrument and other Chinese medicine treatment equipment.
3.Chinese medicine ointment: according to the condition, choose Chinese medicine ointment such as clearing heat and detoxifying, emollient and anti-itch to apply externally to the affected area, mainly to soothe and avoid stimulation, twice a day. Hypertrophic lesions can use sealing method.
(iii) Acupuncture therapy
1.Body acupuncture: take the acupuncture points of Dazhi, Quchi, Hegu, Blood Sea, Sanyinjiao, Tao Dao, Scapular Wind, Liver Yu, Spleen Yu, etc. and use the diarrhea method. Keep the needle for 20-30 minutes, once a day or every other day. Or acupuncture point injection, once a day or every other day. Progressive phase is prohibited, pay attention to any isomorphic reaction when using.
2, cupping: prohibited during the progressive phase. Suitable for thick skin, thick lesions, stubborn and long-standing. Can be used for walking can therapy, cupping first in the skin of the cupped area or the mouth of the can, coated with a layer of Vaseline and other lubricants, then the can cupped. Then the doctor holds the jar with the right hand and pushes it up, down, or left, or right to the area to be cupped, back and forth, until the skin of the area cupped is red, flushed with blood, or even stasis, the jar is removed. This is done once daily or every other day.
(iv) Other therapies.
Choose ultraviolet light therapy, photochemotherapy, 308 excimer laser, etc. for treatment according to the condition.
(V) Care
1, diet: generally give a general diet, less oily food, avoid alcohol, spicy and stimulating products that start the wind.
2, emotional conditioning: communicate with the patient diligently, can be used to listen, comfort the patient, avoid impatience and restlessness, avoid anger, moody, maintain a good mood.
3, health guidance: explain to the patient the characteristics of the disease, the treatment process, general knowledge of medication, relapse prevention measures and precautions. Guide the patient to live a regular life, regular living, reasonable diet, quit smoking and alcohol, avoid trauma and drug abuse to prevent the recurrence of the disease.