Healing Psoriasis with Traditional Chinese MedicineAdina Stanescu, R.TCMP February 1, 2013
Psoriasis has been with us since ancient times. In old medical texts, Traditional Chinese Medicine (TCM) described psoriasis as “pine skin dermatosis,” a term descriptive of its clinical features. Around 400 BC, Hippocrates named it psora in his medical collection, Corpus Hippocraticum.
Psoriasis is a chronic, inflammatory disease, which causes red plaques covered in thick, whitish scales to form on the skin. It reflects a defect of skin regeneration: the skin cells in psoriasis reproduce up to 10 times faster than normal, and it is this hyperactivity in skin shedding and turnover that causes the plaques to build. This condition has a genetic component, with patients often reporting a family history, but it can also be triggered by bacterial infections (strep throat), gingivitis, and exposure to toxins, as well as pharmaceutical or recreational drugs. Its worldwide incidence is approximately two to three percent.
While conventional Western medicine considers it an intractable and incurable condition, Chinese herbal medicine offers a very solid hope of drastic improvement, and even complete remission, by treating it internally. Up to 70 percent of cases can be completely cleared of lesions, and most of these will not relapse. This is achieved by treating the skin internally, at the root: most chronic skin disease sufferers have a hunch that their conditions stem “from inside,” and psoriasis is no exception.
Careful Clinical Observation
The assessment and treatment of psoriasis using Traditional Chinese Medicine hinges on very detailed observation of each individual’s clinical presentation. This is crucial to the success of treatment, because each person will manifest slight variations in symptoms, and these variations give us invaluable clues as to the internal root of the problem.
For instance, patients may present with plaques that are fire-engine red, pale pink, or purplish. While these will all fall under the Western bio-medical diagnosis of “psoriasis,” this colour variation points a TCM dermatologist toward a different internal cause for each patient, calling for a different herbal combination to address it. Next, we look at the size and shape of the lesions: are they the typical large plaques or smallish round patches no bigger than a dime? Are they all over the body or limited to a certain area? Are the scales very thick and rooted in the skin, or are they thin and do they flake off easily with the slightest friction? Again, the answers will point to different herbal ingredients for each case.
And finally, what is the fundamental state of health and vitality of the patient? Psoriasis in an older, weaker patient will require a much more tonifying, strengthening approach than psoriasis in a vigorous, healthy individual. This type of “big picture” holistic approach is key to TCM’s success with this disease.
Armed with these details, the practitioner is now ready to prescribe the customized herbal formula, which often consists of up to 16 ingredients. Compound formulas such as these can attack the problem from many sides, surrounding the enemy as it were, and prevent the well-known tendency of psoriasis to develop resistance to various treatments.
Let’s take a closer look at the TCM sub-types:
HOT BLOOD and FIRE TOXINS
These patients present with large red plaques, which grow steadily or new spots frequently appear. Both of these characteristics show that the blood is “boiling” as it were, causing pronounced disease activity and aggravation. Recent onset cases are always the Hot Blood type, and TCM employs strongly cooling, detoxifying herbs such as Lonicera flower, Dictamnus bark, Lithospermum, and Rehmannia roots to cool down the blood and begin breaking down the plaques.
HOT BLOOD WITH WIND
This is the primary presentation of guttate psoriasis. Also called “teardrop” psoriasis, it presents with small round spots, often profusely scattered all over the body, similar to a rash. This can be the very first manifestation of the disease, and often follows a strep throat infection. The small size of the lesions and their superficial, milder characteristics and lack of thick scales indicate that the psoriasis in this case is not quite as “toxic” as in the previous, deep-rooted pattern. Therefore, some of the herbs we use will be lighter and milder. They include burdock seeds, cicada skin, and ledebouriella root. These herbs have the ability to disperse heat outward and extinguish wind (quickly appearing rashes are ‘Wind’ in TCM).
Hard, tough, purplish lesions with yellow-brown, thick crusts are the most stubborn presentation of psoriasis. The plaques are deeply rooted in the skin and have been there for a long time, intractable and unresponsive to any treatment. They feel and sound like wood, if you tap them.
With this type of psoriasis, altogether different herbs are needed, the same ones that TCM uses to break down masses, tumours, or fibroids. These include Sparganium root, Curcuma root, and peach pit.
DAMP HEAT AND TOXINS
Pustular psoriasis falls into this category. While most psoriasis is overwhelmingly dry, pustular psoriasis presents often as a “damp” pattern, i.e. there is a lot of toxic mucus in the body. This leads to the appearance of the typical yellowish/brown pustules, most painfully on the feet and hands, accompanied by swelling and redness. Now it is time to employ bitter herbs to remove the damp heat. Many of these bitter herbs are yellow coloured roots, a reflection of their active ingredients, such as berberine. In the past, berberine was used as a natural dye, which also lent a strongly anti-microbial property. Two wonderful examples are Coptis root and Phellodendron bark.
In all cases, the herbs are taken in the form of boiled decoctions, prepared much like soup. Although the taste is strong, earthy and often bitter, most patients find it a small price to pay for the improvement of their condition.
This improvement needs to be clearly observed by six to ten weeks of treatment, with noticeable reduction in the size of the plaques, most commonly starting as clearing from the centre. We look for islands of normal skin to appear once the scales and redness subside. After this, persistence with treatment is key to further success, as it can take many months, and occasionally as long as a year, for the largest lesions to disappear entirely. Topical herbal creams are sometimes added to speed the progress. Certain dietary triggers should be avoided entirely during treatment: alcohol, tobacco, garlic, ginger, cinnamon, hot peppers, and excessive coffee. Another common trigger is infection with strep bacteria, so if the patient experiences frequent strep infections or recurrent tonsillitis, these must be addressed concurrently, either with anti-infective herbs or referral to an ear, nose, and throat specialist for possible removal of the tonsils.
In recent years, even conventional dermatologists have acknowledged that psoriasis is more than skin deep. At the meeting of the American Academy of Dermatology in 2009, several papers were presented which link psoriasis with cardiovascular disease, diabetes, hypertension, and high cholesterol – chronic conditions which are increasingly understood to be inflammatory in nature. Interestingly, many of the herbs traditionally used in psoriasis treatment in TCM can also be found in formulas that treat such internal problems.
Unfortunately, very many people are still largely unaware of how much TCM could help their psoriasis. Conventional patient support and advocacy groups in Canada are firmly under the control of conventional dermatology and are quite reluctant to host talks or publish any information on TCM or other complementary treatments. I hope that in time, through word of mouth, and with the invaluable assistance of publications such as Vitality Magazine, this will change.