A Case Study in the Treatment of Psoriasis
by Jane Bean, Lic. Ac
According to Chinese medical theory, most cases of psoriasis involve a vacuity of the constructive and blood which leads to dryness, wind, and loss of nourishment of the skin and flesh. One cause of psoriasis is systemic qi and blood vacuity. Other causes are attack of wind heat or wind cold or pre-existing damp heat, all of which may disrupt the flow of qi and blood in the skin, leading to a local qi and blood vacuity. Once lodged in the skin, these evils may then transform into heat which further damages the constructive and blood. Long-term vacuity of qi and blood in the skin may also lead to blood stasis1. Thus one may see many complicated patterns when treating psoriasis. It is important to look at both the characteristics of the skin lesions and the overall patterns of disharmony when developing a treatment plan. The following case, functionally translated from the Chinese journal literature2, is a good example of this as well as an interesting use of a formula which is usually considered more for the treatment of headache or hypertension than psoriasis.
The patient was a 71 year-old female who had suffered from psoriasis for more than four years. Her skin was scaly and flaked off from time to time. She had unusually severe itching which was difficult to bear, especially at night. Examination showed that her skin had long-standing damage. The lesions were dark and purple around their bases and had mica-like scales on top. In between, there were long, fingernail scratch marks. The patient's body was emaciated and she had dizziness and tinnitus. Her tongue body was dark with dry fur. The left inch and bar pulses were congested and large. The foot pulse was weak. The right inch pulse was fine and weak, while the bar and cubit were deep. Thus her pattern was categorized as liver-kidney yin depletion, wind yang harassing the upper body, fluid damage, and blood stasis with consequent malnourishment of the skin and flesh.
Apppropriate treatment was to subdue the yang and boost the kidneys, calm the liver and extinguish wind. The formula was composed of: Rhizoma Gastrodiae Elatae (Tian Ma), 6g, Ramulus Uncariae Cum Uncis (Gou Teng), 12g, Concha Haliotidis (Shi Jue Ming), 15g, Fructus Gardeniae Jasminoidis (Zhi Zi), 6g, Cortex Eucommiae Ulmoidis (Du Zhong), 9g, Radix Achyranthes Bidentatae (Niu Xi), 15g, Herba Leonuri Heterophylli (Yi Mu Cao), 12g, Radix Salviae Miltiorrhizae (Dan Shen), 15g, Radix Gentianae Macrophyllae (Qin Jiao), 9g, Radix Astragali Membranacei (Huang Qi), 15g, Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), 9g, and Radix Platycodi Grandiflori (Jie Geng), 10g. These were decocted in water and administered internally one ji per day.
Second Examination: After taking six ji of the above medicinals, the dizziness and tinnitus had decreased, while the bases of the skin lesions on the upper limbs had become lighter. The unusually extreme itching had also decreased. After continuing the original formula for 12 more ji, the dizziness and tinnitus were eliminated, scratching was reduced by half, the complexion of the damaged areas of the skin on the whole body became lighter, and the area of damaged skin on the arms was markedly reduced. Because the tendency to hyperactivity of yang was already subdued, the amount of Concha Haliotidis was reduced to 9 grams, and 24 more ji were prescribed. After three months of treatment, there was very little damaged skin on the whole body, and the itching had stopped. The color of the skin and its luster were basically normal. On follow-up after half a year, there was no sign of recurrence. Thus, short-term, the treatment was considered a cure.
Note: The Su Wen (Simple Questions) says: "All counterflow upsurging is ascribed to fire." In this patient's case, the root of the disease pertained to liver-kidney yin depletion resulting in a tendency to hyperactivity of liver yang, blood dryness engendering wind, and improper nourishment of the skin and flesh. Because the right inch pulse was weak, Tian Ma Gou Teng Yin (Gastrodia & Uncaria Drink) plus Astragalus, Anemarrhena, and Platycodon was used in order to boost the qi and engender fluids, moisten the skin and scatter wind. Gentiana Macrophylla and Salvia were added to dispel wind and quicken the blood based on the idea of "To treat wind, first treat the blood; when the blood moves wind, naturally disappears." Leonurus and Uncaria were combined with the previous five ingredients in order to repair the skin damage, improve the microcirculation, and nourish the skin and flesh to promote recovery of the damaged skin.
Endnotes:
1 Manual of Dermatology in Chinese Medicine, Shen De-Hui, Wu Xiu-Fen, & Nissi Wang, Eastland Press, Seattle, WA, 1995, p.216-217
2 From "Effective Treatment with Tian Ma Gou Teng Yin (Gastrodia & Uncaria Drink)" by Mao Shi-you, Hu Nan Zhong Yi Za Zhi (The Hunan Journal of Chinese Medicine), #2, 1991, p. 24 as quoted in Gu Fang Xin Yong Jing Xuan (Carefully Chosen New Uses for Ancient Formulas), Vol. 1, compiled by Guo Tao-mei, Guangdong Science & Technology Press, Guangzhou, 1997, p.277
