The Study Of TCM Syndrome Differentiation Of Phlegm And Blood-statis And Disharmony Between Yingfen And Weifen Of Chronic Plaque-type Psoriasis

ObjectiveTo verify scientificity and practicability of the theory of TCM Syndrome Differentiation of Phlegm and Blood-stasis and Disharmony between Yingfen and Weifen of Chronic Plaque-type Psoriasis, and provide an effective and safe TCM therapy for chronic plaque-type psoriasis.MethodsClinical study I:173cases of chronic plaque-type psoriasis patients were divided into two syndrome differentiation groups according to the diagnostic criteria based on the theory of "Phlegm and Blood-stasis and Disharmony between Yingfen and Weifen "; observations taken on difference of symptoms and signs, and therapeutic effects with the same accepted therapy between the two groups, the impact of the disease with different serum lipid levels was also observed. Then different symptoms and signs were analysed by single-variate and multi-variates logistic regression method, to identify the meaningful symptoms and signs for TCM differentiation and the risk factor for refractory psoriasis.Clinical study Ⅱ:44selected cases of psoriasis patients of "Phlegm and Blood-stasis and Disharmony between Yingfen and Weifen" TCM differentiation were randomly and averagely separated into treatment group and control group, respectively recieving8weeks of treatment of warming yang, regulating yingfen and weifen, cooling blood and dispersing blood stasis method, and cooling blood and dispersing blood stasis method, and then allowing a16weeks’follow-up. PASI, BSA and adverse events recorded every8weeks.Results:Clinical study I:1.73cases were classified as the syndrome of phlegm and blood-stasis and disharmony between Yingfen and Weifen, and100cases were not. Differenences of age, gender, individual history, previous medical history, PASI and BSA score, previous systematic usage of drugs between the two groups had no statistically difference, and the BMI, serum TC and TG level in the new syndrome group was statistical higher than the other (P<0.05). The course of the disease and duration of skin lesions had a longer trend in the new syndrome group than the other, but had no statistical difference(P>0.05). Taking the same agreement therapy of cooling blood and dispersing blood stasis for12weeks, and then followed-up for9months, the total effective rate of the new syndrome group was lower, and the PASI score and the ineffective rate was higher, both to a level of statistical significance(P<0.001).2. According to the single-variate analysis, symptoms and signs such as heavy head and limbs, lethargy, anhidrosis and feeling depressed in skin lesions, enlarged tongue, dark-purple tongue, and greasy coating and wiry pulse showed statistical significance between the two groups(P<0.05), concerned the statistical higher level of serum lipid, by multi-variates logistic regression, the meaningful symptoms and signs for Phlegm and Blood-stasis and Disharmony between Yingfen and Weifen are anhidrosis and feel depressed in skin lesions, enlarged tongue, greasy coating and high level of serum TC; feel depressed in skin lesions and sublingual varices are the risk factor for refractory psoriasis.3.116of173cases had dyslipidemia, with24cases of hypercholesteremia,43cases of hypertriglyceridemia, and49cases of mixed hyperlipidemia. Compared with the normal group, the dyslipidemia group had statistical significance of age and BMI, and no statistical significance of greasy diet habits, tobacco and alcohol habits, lack of exercise. According to psoriasis, there were no difference in course of disease, age of onset, PASI and BSA score, previous systematic usage of drugs and curative efficacy between in two groups; while the dysl ipidemia group’s duration of skin lesions, the rate of not improved in recent5years and PASI score at the end of follow-up were higher, to a degree of statistical significance.Clinical study Ⅱ:1. The comparisons of age, gender, course of disease, individual history, PASI score and BSA score between the two groups before treatment have no statistical significance, and the two groups are comparable. 2. PASI and BSA score:the compared with the score before treatment, the score after treatment all have statistical significance in two groups (P<0.05), and have statistical significance with the score after the follow-up as well, and for the treatment group, the long-term efficacy has statistical significance compared with short-term efficacy (P<0.05), while the control group has not; both the short-term and long-term efficacy have statistical significance compared with the control group (P<0.001).3.The total effective rate of the treatment group has statistical significance compared with the control group [according to the PASI score, the treatment group’s short-term rate was63.64%and long-term rate was86.4%, while the control group’s short-term rate was9.09%and long-term rate was31.8%(P<0.001); according to the BSA score, the treatment group’s short-term rate was63.64%and long-term rate was90.9%, while the control group’s short-term rate was18.2%and long-term rate was45.5%(P<0.001)]. The long-term recurrent rate of treatment group has statistical significance compared with control group (according to the PASI score, the treatment group have no recurrent case, and the control group’s rate wasl8.2%; according to the BSA score, the treatment group’s rate was4.6%, while the control group was31.81%).4.One case in treatment group reported a mild bellyache, which was alleviated itself after a short time. The treatment is safe.Conclusion1. Phlegm and Blood-stasis and Disharmony between Yingfen and Weifen is a subtype of TCM syndrome differentiation of blood stasis in chronic plaque-type psoriasis, which has particular symptoms and signs such as anhidrosis and feel depressed in skin lesions, feeling heaviness of head and limbs, lethargy, enlarged tongue, dark-purple tongue, and greasy coating and wiry pulse, higher level of TC and TG. The agreement therapy for blood stasis syndrome of cooling blood and dispersing blood stasis is not effective for this type.2. The meaningful symptoms and signs for Phlegm and Blood-stasis and Disharmony between Yingfen and Weifen are anhidrosis and feeling depressed in skin lesions, enlarged tongue, greasy coating and high level of serum TC; feel depressed in skin lesions and sublingual varices are the risk factors for refractory psoriasis3.Patients with chronic plaque-type psoriasis are more likely to suffer dyslipidemia, while greasy diet habits, tobacco and alcohol habits, lack of exercise are unrelated, and serum lipid levels are unrelated directly with severity of disease.4.For the new TCM differentiation, the treatment of warming yang, regulating yingfen and weifen, cooling blood and dispersing blood stasis method is effective and safety, and the effect is significant compared with the control group.