Study On Clinical Efficacy In The Treatment Of Chronic Plaque Psoriasis According To Syndrome Differentiation Based On Spleen And Kidney Pathology

ObjectivePsoriasis vulgaris is a non-infectious,immune-mediated,recurrent,inflammatory skin disease.It appears as reddish plaques of varying sizes on the skin,covered with flaky silvery white scales.Itchy skin may occur.When being scraped,these plaques will crack and bleed.The disease can easily recur and is not uncommon to develop into a chronic one.The unfavorable appearance of the skin lesion often leads to misunderstanding from others and even labeling effect,making patients feel very frustrated.With negative and low self-image that may arise,not only do patients suffer physiologically,their social life is affected as well.This may trigger psychological problems and even mental illness among some patients.For severe cases,self-mutilation or suicidal tendencies may occur.As such,patients can suffer greatly with this kind of skin problem.Both Chinese and Western medicine can relieve symptoms and reduce dermatitis on acute attack.However,it is difficult to achieve satisfactory result in the treatment of chronic recurrent conditions.As the exact aetiologies of psoriasis are still unclear,the disease is recognized as one of the skin diseases refractory to treatment.The purpose of this thesis is to investigate the clinical effectiveness of the TCM therapeutic treatment method for chronic stage of psoriasis vulgaris.This investigation is based upon the holistic view of TCM,and is under the guidance of the principle of treating external illness through internal means,as well as treating disease through eradicating the cause.The disease psoriasis vulgaris is viewed at the perspective of syndrome differentiation in TCM internal medicine.There is no conflict with TCM external medicine(dermatology)in the treatment of psoriasis vulgaris from the TCM internal medicine point of view.Basically,one focuses on the internal syndrome and the other focuses on the external manifestation.In fact,both internal and external components are different parts of the disease unity.During the treatment process,syndrome differentiation of local skin lesion and internal organ pathological changes have to be taken into account simultaneously.When the condition is urgent,the skin manifestations will be treated first.In other words,the priority of treatment is on skin lesion rather than internal organ disorders.When the condition becomes stable and chronic,the internal organs become the focus of treatment in order to eradicate the etiological factors.In TCM internal medicine,syndrome differentiation is summarized upon various syndrome differentiation methods for the set of manifestations.The syndrome identifies the disorder of specific internal organs,measures the condition of the body during the conflict between healthy qi and evil qi,and determines the treatment protocol.Under the guidance of the holistic view in TCM,Zang Fu syndrome differentiation method is the center of syndrome differentiation in various disciplines.Dermatology is no exception.External skin lesion,other than relating to qi and blood,is closely related to Zang Fu disorders.During the acute stage when the external pathogen is attacking the surface of the skin,Lung is the first organ coming up to defend,as it is the organ that governs the skin.There will be some manifestations of the Lung being disturbed at the time of appearance of skin lesions.Internal heat,generated when the pathogen enters interior,damages qi and stirs blood.Liver is also affected.As Liver is the pivot of qi mechanism,the body will respond with liver depression manifestations.When Heart is affected,there will be spirit disturbance.At this moment,both healthy qi and evil qi are in excess,skin lesion develops quickly as skin is the location of confrontation.External manifestations are mainly due to the underlying Blood heat.If the treatment result in the acute stage is not satisfactory,or if there is error in self-treatment of the patient,the disease will turn chronic insidiously.Spleen,and other internal organs as well,will be involved and the whole situation will become complicated.During the chronic stage,there will be wax and wane of the healthy qi and pathogens,resulting in on and off of the disease condition.This is the dormant period of Blood deficiency,Blood dryness,and Blood stagnation that TCM External Medicine refers to.Blood deficiency is the result of insufficient transformation of blood from kidney essence and insufficient generation of blood from a weaken Spleen.Blood dryness is the result of poor perfusion of blood and body fluid to the skin because of Spleen qi deficiency.Spleen qi deficiency can also lead to dampness and phlegm generation as the result of impaired fluid circulation.The outcome is thus simultaneous external dryness and internal dampness.Blood dryness can also be the result of Kidney yin deficiency and body fluid depletion.Blood stagnation can be resulted from leakage of blood from blood vessels,as the Spleen function of governing Blood is impaired.Weak Spleen qi unable to push blood can also cause blood stagnation.Blood stagnation can also be the result of Kidney yang deficiency with the deficiency cold congealing blood.If both Spleen and Kidney are in deficient,resulting into insufficient transportation and transformation,the skin lesions will be more difficult to treat.Therefore,this thesis audaciously put forward the idea of treating chronic stage of psoriasis vulgaris according to Spleen and Kidney syndrome differentiation,and integrating internal treatment of external disease to the external treatment of external disease,as well as to explore the clinical effectiveness of such treatment method.MethodologyIn this clinical study,samples were selected from existing patients with symptoms of psoriasis vulgaris.The selection criteria were based on biomedicine clinical diagnostic standard set in the book "Clinical Dermatology" written by Zhao Bian(??).Patients were then divided into three groups,namely,Blood Heat,Blood Dryness,and Blood Stagnation,according to the TCM syndrome differentiation diagnostic standard set in the"Criteria of diagnosis and therapeutic effect of diseases and syndromes in traditional Chinese medicine".Patients with disease for over one year and refractory to treatment were selected,regardless of age,gender,lesion size,location,and distribution.Qualified patients had to consent to be treated according to the treatment guideline.The treatment includes both external and internal treatment methods.Acupuncture needling and herbal formula were prescribed in order to treat the manifestation and cause simultaneously.Patients had to be treated continuously for a period of at least 12 weeks(or 12 times)to a maximum of 52 weeks.Internal treatment was administered according to TCM syndrome differentiation.Spleen deficiency patients were given Shen Ling Bai Zhu Sa modified and needling of two main points,ST36 and ST37 with even method.Ren6,BL20 were added for qi deficient patients.Liv3 was added for Liver qi stagnated patients.All needles were retained for 30 minutes.Patients with Kidney deficiency were given Liu Wei Di Huang Wan modified and needling of two main points,Kid3 and Kid6 with even method.Additional points would be added according to the syndromes.All needles were retained for 30 minutes.For external syndromes,no matter Blood Heat,Blood Dryness or Blood Stagnation,circumferential needling plus assistant points would be applied.For example,ST8 for lesions over the head,LI4,LI11 for upper limbs,and SP6,GB34 for lower limbs.Scores were given to the skin lesion and syndrome before and after clinical performance.Therapeutic effect judging standard depended both on alleviation or disappearance of key manifestation of internal syndromes,and alleviation or disappearance of skin lesion.Complete healing of skin lesions and disappearance of manifestations of syndromes are the final evaluation criteria.ResultsAfter treatment,the therapeutic effect of external manifestation is as follow:clinically completely healed in 2 patients,obvious improvement in 3 patients,no effect in 1 patient.The therapeutic effect of internal syndrome is similar.ConclusionIn the past,healing or disappearance of skin lesion is the main objective of clinical treatment for external diseases.With this kind of treatment,even there is recovery of the skin lesion,internal organ dysfunction is not regulated.It is easy to relapse.Repeatedly treating the skin lesion leads to repeated recurrence.The disease then becomes more difficult to treat.This research focuses more on internal treatment,using both internal and external manifestation results as indicators of treatment efficacy.External manifestation is treated with acupuncture needling.Internal syndrome is treated with needling and herbal formula.Excellent result is obtained.Seven out of eight cases are effectively treated and there is no relapse case until now.The conclusion is that the treatment of chronic stage of psoriasis vulgaris according to Spleen and Kidney syndrome differentiation is effective.Among the cases under treatment,there is no recurrence for a period of 19 months for 2 patients.In order to have further understanding and clarifications of the recurrence issue,it may need more case studies and long-term follow-up.Undoubtedly,the major contributing factors of the success in this study are confidence,patience and compliance of the patients.It is of course not easy for them to undergo a treatment course lasting for at least 12 weeks.Though the successful result of this study is merely at an initial stage,it is very encouraging to have a breakthrough in the direction and method of treatment of chronic psoriasis vulgaris.However,due to research constraint,cases for the study are limited.If condition allows having sufficient cases and the set up of control study,better data and evidence could then be obtained for further analysis and research study.