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Psoriasis (in English and Chinese 中英文) Click here if you are using Internet Explorer Edited by: Joe Hing Kwok Chu Click on the links: Causes of psoriasis have not been completely understood. The following facts have been observed: I. Auto-immune system dysfunction: (1). the ratio of T-helper to T-suppressor lymphocytes (TH/TS) is abnormal. (2). Immune function of the body fluid overactive: IGE and IGA are high and IGM is low. II. Streptococcus infection: Clearing streptococcus infection has helped to relieve psoriasis because the toxin of the bacteria causes the diseased cells to speed up division. III. Metabolism dysfunction: ration of cAMP and cGMP is abnormal. The diseased skin of psoriasis patients is low in cAMP, which is an epidermal chalone which inhibits the cells of the skin division. Traditional Chinese herb medicine and certain qigong can balance the ratio of cAMP and cGMP. Currently Western drugs lack the satisfactory therapy to solve this issue. There are hundreds of treatment methods for psoriasis. There is no satisfactory Western medicine for treatment of psoriasis. Individually prescribed Chinese herbal medicines are more effective. (Acupuncture is not commonly used in China for psoriasis.) Since Traditional Chinese herb medicine is more effective for skin problems, many Westerners seek Chinese herb therapy for psoriasis; but it is difficult to locate knowledgeable Traditional Chinese herb practitioners, especially in the West. Some cases of psoriasis can be caused by systemic fungus infection. At present true psoriasis has no effective complete cure. Some claim certain therapies are effective cures. This can be a misconception and some skeptics even think the claims can be fraudulent. The truth is that the cycle of psoriasis comes in stages:
If a person uses a certain therapy and it happens that it is immediately prior to the remission and subsiding stage, the patient or the practitioner may think the therapy is working. In fact the disease is running its course. Usually Chinese herb medicine (not the manufactured "herb" which might have been mixed with Western drugs) is much safer than modern drugs, although there were cases of fatalities reported in Britain and Hong Kong, after using herbal medicine. Under normal correct usage, not the concentrated chemical extracts, the toxicity of those herbs used in those prescriptions is mild and should not have caused death. The death incidence could be caused by extreme allergic reactions of the individuals. There are controversies of those research studies done on toxicity of Chinese herbs using the concentrated chemical extracts from Chinese herbs beyond the amounts of normal usage. In many instances the concentrated chemical extracts showed toxicity in lab animals. Many argue that the chemical concentrates from herbs should be considered as drugs and not herbs. Since 1966 psoriasis has been officially called "yin xiao bing" 銀 痟 病 in China. "Yin xiao bing" literally means "silver particles sickness". Most Chinese people call it "niu pi xian"牛 皮 癬, which literally means "cowhide fungus." But, niu pi xian mentioned in traditional Chinese medicine classics is not yin xiao bing which is psoriasis. There are many highly respectable publications in Chinese are still using the term niu pi xian for psoriasis. This can be confusing for the general public, even for medical people who read Chinese. The Chinese herb therapy can be classified into three categories: 1. clearing heat (re), 2. blood invigorating method 3. tonifying blood method
xue yu (blood stasis) 血淤, and dry 1. rid of heat and cool the blood method This method is for the progressing stage. Symptoms : New bright red particle- like or blotches of rashes. The surface is covered with white flakes, and under them there are bleeding small particles. Itchiness, restlessness, dislike of heat, yellow urine, constipation, red tongue with thin moss, strong tight (stringy) pulse.
Prescription: tu fu ling 30 g, huai hua 30 g, sheng di huang 30 g, mao gen 30 g, zi cao 15 g, gan cao 6 g. Adjustment of formula: (1) If constipation is serious, add : da huang 10 g. (2) If there are new rashes, particle- like, bright red, not many particles (flakes), dry tongue and mouth, swollen tonsils, add :jin yin hua, da qing ye, ban lan gen 15 g each. (3) When rashes become larger with more flakes, especially on the upper limbs and upper torso and on the scalp , add wind -ridding (pain) herbs like jing jie, fang feng, niu bang zi 10 g each， can tui 6 g.. If the problem is mainly on the scalp and when the usual herbs for ridding of wind are not effective, try to use insects or snake type of herbs like wu gong or wu she. (4) If rashes are more on the lower limbs with heaviness at the chest, tongue is white, limbs feel heavy, showing dampness, add： fu ling, yi yi ren 15 g each, fang ji 10 g. (5) If rash is gradually turning from bright red into dark red patches, and tongue is showing purpura, add moving blood herbs like： chi shao, dang gui wei 15 g each, hong hua 10 g. (6) If thirsty, restless, yellow tongue coating, pulse is hong (洪 大 ), indicates that the lung and stomach evil heat is not solved. Add： sheng shi gao 30 g, zhi mu 10 g.
銀 痟 病 1. 清 熱 涼 血 法 ﹕ 銀 痟 病 進 行 期 ， 新 疹 出 現 ， 色 鮮 紅 ， 點 滴 或 班狀 ， 表 面 覆 蓋 白 色 鱗 痟 ， 基 底 有 出 血 小 點 ， 痒， 心 煩 ， 怕 熱 ，尿 黃 赤 ， 便 秘 ， 舌 紅 苔 薄 ， 脈 弦有 力 。 處 方 ﹕ 土伏苓 30 克 ， 槐花 30克 ， 生地黃 30克 ， 茅根 30克 ， 紫草 15克 ， 甘 草 6克 。加 減 ﹕ (1) 便 秘 甚 者 加 大黃 10克 。 (2) 皮 疹 初 起 ， 呈 點 滴 狀 ， 疹 色 鮮 紅 ， 鱗 痟 少 ， 口 乾 舌 燥 ， 扁 桃 腺 腫 大 者 ， 加: 銀 花， 大 青 葉 ， 板 藍 根 各 15克 。 (3)皮 疹 由 點 滴 狀 丘 疹 散 大 ， 變 為 斑 塊 ， 表 面 鱗 痟 較 多 ， 以 上 肢 或 軀 幹 上 部 為 甚 ， 尤 有 分 布 頭 皮者 ， 加 却 風 藥 如： 荊芥 ， 防風 ， 牛蒡子 各 10克， 蟬退 6克。 (4)如 頭 皮 為 銀 痟 病 好 發 部 位 ， 用 一 般 驅 風 藥 無 效 時 ， 試 加 蟲 類 驅 2. 清 肝 膽 濕 熱 法 來 源 ﹕ 俞 熄 純 。
外用药方：
羊蹄根散《 醫宗金鑒 》
必效散組成：川槿皮四兩，海桐皮大黃各二兩，百藥煎一兩四錢，巴豆去油一錢五分，斑蝥全用一個，雄黃輕粉各四錢。共研極細末，用陰陽水調藥，將癬抓損，薄敷。藥乾必待自落。
註：百藥煎為五倍子同茶葉等經發酵制成的塊狀物。《本草蒙筌》 2. Clearing damp heat of liver and gall method Using water decoction of lei gong teng and alcohol extract of lei gong teng: They both contain 50 lei gong ten 50 g, and ji xue tang 50 g each. Take orally 50 ml, twice a day after meals. 30 days is one therapy period Result: Total patients: 193 Patients taking alcohol extract: 116 Effective rate: 86.2% Patients taking water decoction: 77 Effective rate: 72.72% It showed that the alcohol extract was more effective than the water decoction. [21]
Note: Chinese herbal medicine is a completely different branch of Traditional Chinese medicine by itself. Traditionally it is practised by specially trained Chinese herb doctors and not by acupuncturists. An herb doctor is not necessarily a trained acupuncturist. In America, Chinese herbal medicine and acupuncture were grouped together by some of the law making bodies to save administrative expenses. A licensed acupuncturist in America is not necessarily a trained herbalist. Modern Drug Therapy and its Toxicity Click here to go back to Table of Contents methotrexate (Aminopterin) and ethylenediamine tetraaccetylimide Some of the brands of methotrexate: Folex , Folex PFS , Methotrexate LPF , Rheumatrex Toxicity: methotrexate (formally, aminopterin) can cause cirrhosis of the liver, decrease of white cell count, thus lowering the immune system, and even cause leukemia. During the sixties, aminopterin caused many cases of death in China. Ethylenediamine tetraaccetylimide is toxic to the CNS. It should not be used by chronic leukemia patients, kidney impaired patients and pregnant women. Methotrexate similar to folic acid, an antimetabolite, is being used in the treatment of severe psoriasis. Ethylenediamine tetraaccetylimide: main usage is for the regular type, special type and mixed type of psoriasis during progression and remission stages. It is mostly used for flare ups and failure of other drugs like methotrexate, formylmerphalan (Formylsarclysin), hydroxycarbamide, etc. It is effective for the short term. Usually after using the drug after 3 to 4 weeks, it shows the marked improvement. Dosage: oral application. For adult: 300 to 400 mg daily divided into 2 ~ 3 doses after meals. Use daily or every other day. Thirty days is one therapy cycle. bimolane (AT-1727) Toxicity: During the seventies, bimolane (AT-1727) was used. Reports in China mentioned that it caused more than 200 deaths. Bimolane is more effective than ethylenediamine tetraccetylimide in psoriasis therapy and it causes fewer side effects. It can be used in cases where steroids are ineffective and when combined with steroids it can improve their effectiveness. Dosage: for psoriasis therapy, take orally 200 mg each time, 3 times a day. if no side effects are observed, continue until symptoms subside.
dithranol
Some commonly used brand names are: Drithocreme , Drithocreme HP , Dritho-Scalp , ,Micanol , Anthraforte 1 , Anthraforte 2 , Anthranol 0.1 , Anthranol 0.2 , Anthranol 0.4 , Anthrascalp
For psoriasis, dithranol is usually made into ointment for topical application. It is used for mild to moderate cases of psoriasis and is usually more effective when combined with ultraviole ttherapy. Toxicity: Dithranol can cause tumors. Psoralen (補 骨 脂 素) is an extract of the medicinal part of a Chinese herb, bu gu zhi (補 骨 脂) which is also known as po gu zi (破 故 子). It is used for treatment of psoriasis, eczema and vitiligo. It is a modern version of an old Chinese herb. Click here to go to ultraviolet therapy with psoralen. Methoxypsoralen (甲 氧 補 骨 脂 素) is another extract of the medicinal part of a Chinese herb, bu gu zhi. It is being used for treatment of psoriasis, eczema and vitiligo. Its use is similar to that of psoralen, and it is considered more effective than psoralen in psoriasis therapy.Click here to go to ultraviolet therapy with methoxypsoralen.
Retinoic acid (Retin-A, Vitamin A Acid) Toxicity: Retinoic acid (Retin-A,Vitamin A Acid) has caused many cases of deformed fetuses. Tretinoin - topical Some commonly used brand names are: Renova, Retin-A , Retin-A MICRO, Avita, Renova , Retin-A , Retisol-A , Stieva-A, Stieva-A Forte, Vitamin A Acid, Vitinoin Usually it is used for mild to moderate cases of psoriasis as topical application. Because of skin irritation caused by this drug, steroids for topical application are also used along with it. Toxicity: Steroids: When given in oral applications or injections even through inhalers, steroids may cause full moon face, whole body water retention, osteoporosis, weight gain, bleeding ulcers, memory loss, diabetes, cataracts and worsening of lung TB. Usually topical application is used to stop itching.
Ultraviolet Therapy (sunlight or artificial light/phototherapy), a Complementary Method Click here to go back to Table of Contents (1) Ultraviolet with Psoralen (補 骨 脂 素) Take 40 to 80 mg of psoralen orally (patients with lighter body weight should take less). Two hours after taking the medicine, use ultraviolet light for the whole body for about 15 to 30 minutes at a distance of 7 to 17 cm and at a shorter distance for areas that are more serious. Treatment should be applied daily or every other day, three to six times per week. After symptoms are gone, continue the treatments, gradually spacing them further apart.
(2) Ultraviolet with methoxypsoralen (甲 氧 補 骨 脂 素)
The method of light therapy of using methoxypsoralen is the same as that of using psoralen.
Oral dosage is 30 to 50 mg to be taken after a meal. One hour later, soak the whole body in water from a mineral hot springs for 20 to 30 minutes. After two hours, apply long wave ultra - violet light, starting from a small dosage of light, and gradually increasing the amount. External application of 0.5% of methoxypsoralen tincture can also be used.
Treatment record: Under this method, therapy was applied once a day (except Sunday). It was continued until symptoms gradually subsided, then the frequency of therapy was decreased to once a week, then down to once a month, then long- term treatments were continued to secure long -term remission. Total patients: 46. Healed: 45. Obviously improved: 1. The effectiveness of therapy showed after 9 treatments, and patients were totally healed after 60 treatments.
Warning: Methoxypsoralen can affect the blood- producing function of the bone marrow. It may decrease the total white cells.
Inject 2 ml (1 mg of psoralen), and apply externally 30% bai zhi tincture. After 2 hours, use light therapy as above, once a day.
Treatment record: 20 patients. Healed: 15. Obviously improved: 5. Follow -up investigation: 3 months to 1 year with no relapses.
Side effects: minor headaches, nausea, decreased appetite and itchiness.
Available dosage forms and strengths:
Injection liquid (oil base): 2 ml per tube, with mg of psoralen.
Solution for external use: 50 ml per bottle with 25 mg of psoralen.
Capsules: 40 mg of psoralen each. Caution when using ultraviolet therapy (phototherapy): (1) Do not apply to patients who are allergic to sunlight. (2) Discontinue the treatments if after sunbathing or receiving ultraviolet therapy, local areas become swollen and inflamed. After the inflammation has subsided, continue with the treatments but shorten the sunbathing or the ultraviolet therapy time. (3) If the injection liquid of psoralen shows crystallization, place the tube in boiling water until the crystals have dissolved. Cool the liquid before using. If the liquid becomes cloudy during heating, it is because of the increased density of the solution. After cooling off, it should become clear again. (4) Store the medicine in a dark place and avoid freezing. (5) Long -term exposure to sunlight (or ultra- violet lamps) may cause damage to the DNA and may cause skin cancer.
Folk therapy includes using: evening primrose oil, witch hazel, tea tree oil, mahonia aquifolium, capsaicin, and oat meal bath.
Lei gong teng therapy
Using water decoction of lei gong teng and alcohol extract of lei gong teng: They both contain lei gong teng 50 g, and ji xue teng 50 g each. Take orally 50 ml, twice a day after meals. 30 days is one therapy period.
Result: Total patients: 193 Patients taking alcohol extract: 116 Effective rate: 86.2% Patients taking water decoction: 77 Effective rate: 72.72% It showed that the alcohol extract was more effective than the water decoction.
See this study: http://www.sciencedirect.com/science/article/pii/S037887410600225X 註：青龍衣是胡桃楸(Jugland mandshurica Maxim)和胡桃(Juglans regial)的未成熟外果皮 Sponsors' Ads by Google 以下為谷歌所提供贊助者之廣告
Last update: Feb 2, 2013; 5:46 p.m. LAH |
Last update: July 24 2012; 3 p.m. LAH