PSORIASIS

GENERAL

Clinical Manifestations

Common Psoriasis

  • The skin eruptions may appear on any part of the body. Most likely on the scalp, outer side of the limbs and the lumbosacral area.
  • At first the eruption is in the form of red papules or maculopapules, the size of a grain of rice or a soybean. It gradually grows bigger and merges into one another.
  • The distinct edges may appear as dots. The area is shaped like a coin and covered with multi-layered scales.
  • When the scales are removed, a thin translucent membrane can be seen (membrane phenomenon).
  • When the membrane is removed some bleeding in the form of dots is seen (dew-drop phenomenon).
  • The skin eruptions on the scalp is dark red and covered with thick, grayish white scales.
  • The hair is often bundled up due to the adhesion of the scales, but does not shed.
  • There may appear tiny concave dots on the nail when they are affected.
  • The onset is acute in most cases and the course is protracted with likely relapses.
  • The symptoms worsen in winter and become less severe in summer.
  • For some patients the seasonal nature may be the reverse.

There three stages associated with the eruptions:

  • Active stage: new eruptions emerge while the old ones grow larger and thicker. There is clear inflammation surrounded by areolae. Eruptions occur on a skin wound or around a sty. (isomorphic reactions)
  • Resting stage: The condition stays unchanged.
  • Extinctive stage: The eruptions become flat and smaller until they disappear

Articular Psoriasis:

  • In addition to the Common Psoriasis type eruptions, symptoms similar to rheumatoid arthritis appear (fever, arthralgia).
  • The severity of the arthritic symptoms vary with the changes in the eruptions.
  • Most often small joints are involved, but occasionally large joints are involved.
  • In protracted cases, the joints stiffen and deform.

Pus-Pocket Psoriasis:

  • This type tends to attack the palms of the hands and soles of the feet.
  • In severe cases it can attack any area of the skin.
  • It manifests as tiny pus-pockets on the surface of the erythema.
  • if the area affected is large, the patient may experience aversion to Cold, fever and arthralgia

Erythroderma Psoriasis:

  • This type usually stems from the Common Type with flushing or purplish redness of the whole body.
  • The area is moist with a large amount of desquamation.
  • Only a small portion of the skin remains normal as patches.
  • It is accompanied by fever, cornification of the palms and soles, and thickening of the nails
Treatment Principle
 
Herb Formulas
Points

WIND HEAT

Clinical Manifestations
  • The lesions tend to develop on the lateral aspects of the extremities
  • They are especially severe on the lateral sides of the elbows and knees
  • They may also concentrate on the trunk and scalp
  • The lesions are pink or red papules and plaques with distinctive borders. Itching is intense
  • The lesions are characterized by many layers of dry, silvery scales
  • If lightly scraped, a pink , semi- transparent membrane is formed
  • If continually scraped, tiny spots of blood may develop
  • Scalp lesions will be dark red and covered with grayish white scales from which hair may grow in bundles
  • The hair will not fall out
  • The lesions may vary in size from dots to coins and may be either circular or geographic
  • Lesions on the fingernails and toenails will appear as dotted depressions
  • Cough with thick sticky, yellow sputum
  • Sore, red, swollen throat
  • Thirst, with a desire to drink cold liquids
  • Runny or blocked nose with thick yellow discharge
  • Fever with perspiration
  • Slight chills
  • Aversion to Wind
  • Headache
  • Maybe dyspnea with flared nostrils
  • Maybe chest pain
  • T: Red tip
  • C: Thin and yellow
  • P: Superficial and rapid
Treatment Principle
  • Dispel Wind and Heat
  • Moisten Dryness
Herb Formulas
Points

WIND-DAMPNESS DUE TO BLOOD DRYNESS

Clinical Manifestations
  • The lesions tend to develop on the lateral aspects of the extremities
  • They are especially severe on the lateral sides of the elbows and knees
  • They may also concentrate on the trunk and scalp
  • The lesions are pink or red papules and plaques with distinctive borders. Itching is intense
  • The lesions are characterized by many layers of dry, silvery scales
  • If lightly scraped, a pink , semi- transparent membrane is formed
  • If continually scraped, tiny spots of blood may develop
  • The lesions may vary in size from dots to coins and may be either circular or geographic
  • Scalp lesions will be dark red and covered with grayish white scales from which hair may grow in bundles
  • The hair will not fall out. Lesions on the fingernails and toenails will appear as dotted depressions
Treatment Principle
  • Dispel Wind and Dampness
  • Cool Blood
  • Nourish and Activate the Blood
  • Moisten Dryness
Herb Formulas
Points

WIND-COLD-DAMP BI

Clinical Manifestations
  • Articular type psoriasis
  • Small coin sized pale red lesions located on the scalp, body, extremities and other areas
  • There is a covered scale
  • The scales are white and thick
  • The scales are easily shed when scratched
  • The lesions heal without scarring
  • Minimal itching
  • Recurs or is exacerbated in the winter or cold weather
  • Improves or disappears during summer
  • Aversion to cold
  • Joint soreness or pain
  • Articular swelling or stiffness
  • Joint deformation
  • T: Pale
  • C: Thin and soggy
  • P: Slippery
 
Treatment Principle
  • Dispel Wind and Dampness
  • Scatter Cold
  • Nourish and Activate the Blood
  • Moisten Dryness
  • Regulate the Channels
Herb Formulas
 
Points

YING STAGE HEAT

Clinical Manifestations
  • Small coin sized red maculae located on the scalp, body, extremities, and other areas that increase rapidly
  • There is a covered scale.
  • Removing the scale reveals a light pink shining membrane
  • Beneath the membrane are petachiae
  • Most severe during the summer
  • Chronic patients may see it in any season
  • The lesions heal without scarring
  • There may be nail involvement with stippling or pitting of the nail plate
  • Rarely presents as diffuse redness of the skin covered by fine scales. Itching may be intense
  • Aversion to Heat
  • Restlessness
  • Thirst
  • Dry stools
  • Yellow, scanty urine
  • T: Red
  • C: Thin yellow or white
  • P: Slippery and rapid
Treatment Principle
  • Dispel Wind and Dampness
  • Scatter Cold
  • Nourish and Activate the Blood
  • Moisten Dryness
  • Regulate the Channels
Herb Formulas
Points

LIVER AND KIDNEY DEFICIENCY

Clinical Manifestations
  • Lesions are pale red and are covered by a thin layer of grayish white scales
  • Low back soreness
  • Weak extremities
  • Joint pain
  • Light-headedness
  • Tinnitus
  • T: Thick with teeth marks
  • C: Thin
  • P: Soggy and thin
Treatment Principle
  • Nourish the Liver
  • Enrich the Kidney
Herb Formulas
Points

BLOOD HEAT

Clinical Manifestations
  • Small coin sized red maculae located on the scalp, body, extremities, and other areas that increase rapidly
  • The area involved is large
  • There is a covered scale
  • The scales are heaped up
  • The scales are easily shed when Scratched
  • Usually affects people under age 40
  • Itching may be intense
  • Worse during the summer
  • Aversion to Heat
  • Irritability
  • Restlessness
  • Thirst
  • Dry throat
  • Dry tongue
  • Bitter taste in the mouth
  • Dry stools
  • Constipation
  • Yellow, scanty urine
  • T: Red or Dark red
  • C: Thin yellow or white or Yellow and grimy
  • P: Slippery or Taut and rapid or Thin and rapid
  • With Dryness:
    Lesions are on the elbows, knees or lumbar area
    They are reddish at the beginning
    White covered lesions become fissures
    Pain
    T: Red
    C: None
    P: Thready and rapid
Treatment Principle
  • Cool Blood
  • Activate Blood
  • Clear fever
  • Eliminate toxin
  • Reduce spots
Herb Formulas
Points

BLOOD HEAT LEADING TO BLOOD STAGNATION

Clinical Manifestations
  • Small coin sized red maculae located on the scalp, body, extremities, and other areas that increase rapidly
  • The area involved is large
  • There is a covered scale
  • The scales are heaped up
  • The scales are easily shed when scratched
  • There may be a thick hard, adherent covered scale
  • Removing the scale reveals a light pink shining membrane
  • Beneath the membrane are petachiae
  • Usually affects people under age 40
  • Worse during the summer
  • Longstanding lesions may overlap
  • Lesions may be painful or fissured
  • Chronic patients may see it in any season
  • The lesions heal without scarring
  • The lesions take a long time to heal
  • Itching may be intense
  • There may be nail involvement with stippling or pitting of the nail plate
  • The lesions are dark red or neutral
  • The scale is thick and in the shape of psoriasis
  • There may be joint malfunction
  • Aversion to Heat
  • Irritability
  • Restlessness
  • Thirst
  • Dry throat
  • Dry tongue
  • Bitter taste in the mouth
  • Dry stools
  • Constipation
  • Yellow, scanty urine
  • T: Red or Dark red or Purple or with purple spots
  • C: Thin yellow or white or Yellow and grimy or Normal
  • P: Slippery or Taut and rapid or Thin and rapid or Choppy or Thin and slow or Weak and choppy
Treatment Principle
  • Cool Blood
  • Activate Blood
  • Clear fever
  • Eliminate toxin
  • Reduce spots
Herb Formulas
Points

BLOOD DEFICIENCY

Clinical Manifestations
  • Small coin sized pale red maculae located on the scalp, body, extremities, and other areas
  • There is a covered scale
  • Removing the scale reveals a light pink shining membrane
  • Beneath the membrane are petachiae
  • Most commonly seen in winter and spring
  • Chronic patients may see it in any season
  • The lesions heal without scarring
  • There may be nail involvement with stippling or pitting of the nail plate
  • Rarely presents as diffuse redness of the skin covered by fine scales
  • Pale complexion
  • Pale lips
  • Blurred or failing vision
  • Spots before eyes
  • Dizziness
  • Dry eyes
  • Pale nail beds
  • Irritability
  • Frightens easily
  • Insomnia with much dreaming
  • Tinnitus
  • Numbness of limbs
  • Light menses or amenorrhea
  • Late menses
  • T: Pale
  • C: Little
  • P: Thready
Treatment Principle
 
  • Nourish Blood
  • Relieve Dryness
  • Clear Heat
  • Detoxify
Herb Formulas
Points

INTERNAL WIND DUE TO BLOOD DEFICIENCY

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Clinical Manifestations
  • Copious dry, small coin sized pale red maculae located on the scalp, body, extremities, and other areas
  • There is a covered scale
  • Removing the scale reveals a light pink shining membrane
  • Beneath the membrane are petachiae
  • Most commonly seen in winter and spring
  • Chronic patients may see it in any season
  • The lesions heal without scarring
  • There may be nail involvement with stippling or pitting of the nail plate
  • Rarely presents as diffuse redness of the skin covered by fine scales
  • Pale complexion
  • Pale lips
  • Blurred or failing vision
  • Spots before eyes
  • Dizziness
  • Dry eyes
  • Pale nail beds
  • Irritability
  • Frightens easily
  • Insomnia with much dreaming
  • Tinnitus
  • Numbness of limbs
  • Light menses or amenorrhea
  • Late menses
  • Tremor, spasms or involuntary movements (chorea)
  • Involuntary shaking of head
  • Tic or tremor of hands and feet
  • Maybe trismus
  • T: Pale
  • C: Little
  • P: Thready and wiry
Treatment Principle
 
  • Nourish Blood
  • Relieve Dryness
  • Clear Heat
  • Detoxify
Herb Formulas
Points

BLOOD AND YIN DEFICIENCY

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Clinical Manifestations
  • Small coin sized pale red maculae located on the scalp, body, extremities, and other areas
  • There is a covered scale
  • Removing the scale reveals a light pink shining membrane
  • Beneath the membrane are petachiae
  • Most commonly seen in winter and spring
  • Chronic patients may see it in any season
  • The lesions heal without scarring
  • There may be nail involvement with stippling or pitting of the nail plate
  • Rarely presents as diffuse redness of the skin covered by fine scales
  • Pale complexion
  • Pale lips
  • Blurred or failing vision
  • Spots before eyes
  • Dizziness
  • Dry eyes
  • Pale nail beds
  • Irritability
  • Frightens easily
  • Insomnia with much dreaming
  • Tinnitus
  • Numbness of limbs
  • Light menses or amenorrhea
  • Late menses
  • Impaired vision
  • Night blindness
  • Headache
  • Nervousness
  • Dry throat
  • Thirst
  • Five sole Heat
  • Night sweats
  • T:Pale or Red
  • C: Little
  • P: Thready or Thready, wiry and rapid
Treatment Principle
 
  • Nourish Blood
  • Relieve Dryness
  • Clear Heat
  • Detoxify
Herb Formulas
Points

BLOOD DRYNESS

Clinical Manifestations
  • Small coin sized moist pale red maculae located on the hand, arm, dorsum of the hand, top of the fingers, toes or head
  • There is a tightly covered scale
  • Removing the scale reveals a light pink shining membrane
  • Beneath the membrane are petachiae
  • Progress of disease is slow
  • New lesions appear sporadically
  • Chronic patients may see it in any season
  • The lesions heal without scarring
  • There may be nail involvement with stippling or pitting of the nail plate
  • Rarely presents as diffuse redness of the skin covered by fine scales
  • The eruption persists for a long time
  • The rash ceases to grow and may be disappearing
  • The eruption is dry
  • The color has faded
  • The scales are reduced
  • Light-headedness
  • Pallor
  • Broken skin
  • Dry skin
  • Sometimes bleeding and pain
  • Worse in cold weather
  • Better during the summer
  • T: Pale or pink
  • C: Thin white
  • P: Thin, or Weak and taut or Deep
Treatment Principle
 
  • Nourish Blood
  • Dispel Wind
  • Moisten Dryness
Herb Formulas
Points

BLOOD STAGNATION

Clinical Manifestations
  • Small coin sized dark or hyperpigmented lesions located on the scalp, body, extremities, and other areas
  • There is a thick hard, adherent covered scale
  • Removing the scale reveals a light pink shining membrane
  • Beneath the membrane are petachiae
  • Longstanding lesions may overlap
  • Lesions may be painful or fissured
  • Chronic patients may see it in any season
  • The lesions heal without scarring
  • There may be nail involvement with stippling or pitting of the nail plate
  • The lesions take a long time to heal
  • The lesions are dark red or neutral
  • The scale is thick and in the shape of psoriasis
  • There may be joint malfunction
  • T: Purple or with purple spots
  • C: Normal
  • P: Choppy or Thin and slow or Weak and choppy
Treatment Principle
  • Invigorate the Blood
  • Break up Stagnation
Herb Formulas
Points

DAMP-HEAT

Clinical Manifestations
  • Dark red lesions of uneven size
  • Lesions are covered by greasy or thick crusty scales
  • The skin below scales may be moist or show weeping exudate
  • Pustules may be present
  • Usually on palms, soles of the feet, trunk, extremities and skin folds
  • Worse with humidity
  • Chest oppression
  • Poor appetite
  • Heaviness of the lower extremities
  • Increased vaginal discharge
  • T: Normal or Thick
  • C: Thin, yellow and sticky
  • P: Soggy and/or slippery
Treatment Principle
  • Clear Heat
  • Drain Dampness
Herb Formulas
Points

FIRE OR HEAT TOXIN

Clinical Manifestations
  • Erythroderma type psoriasis Lesions develop and spread quickly
  • Lesions often coalesce together
  • Lesions may be yellow
  • Lesions are covered by fine
  • scales that shed easily
  • Protracted cases have moist, thick lesions
  • The nails are severely affected
  • Aversion to Cold
  • Restlessness
  • Itching
  • Burning
  • Pain
  • High fever
  • Thirst
  • Dry stools
  • Yellow urine
  • Constipation
  • Frequent urination
  • T: Scarlet
  • C: Thin and yellow
  • P: Wiry, slippery and rapid
Treatment Principle
  • Cool Blood
  • Clear Heat
  • Relieve Toxin
Herb Formulas
Points

TOXIC HEAT AND DAMPNESS

Clinical Manifestations
  • Pus-pocket type of psoriasis
  • Flush, erosion, exudation or other skin lesions
  • In severe cases:
    Thirst
    Fever
    Constipation
    Yellow urine
    T: Red
    C: Yellow or Greasy yellow
    P: Taut or Slippery
Treatment Principle
  • Clear Heat and toxin
  • Remove Dampness
Herb Formulas
Points

DISHARMONY OF THE CHONG AND REN CHANNELS

Clinical Manifestations
  • Generally found among females
  • History of Liver and Kidney Deficiency
  • Lesions are pale red and are covered by a thin layer of grayish white scales
  • Low back soreness
  • Weak extremities
  • Joint pain
  • Light-headedness
  • Tinnitus
  • Impotence
  • Lumbago
  • Headache
  • Spermatorrhea
  • Irregular menstruation
  • Infertility
  • Improvement or remission of lesions during pregnancy
  • Recurrence of lesions after giving birth
  • T: Thick with teeth marks
  • C: Thin
  • P: Soggy and thin
Treatment Principle
  • Regulate and tonify the Chong and Ren channels
  • Support the Yang
  • Harmonize the Blood
Herb Formulas
Points