Originally published by Sydney Malawer on March 27th, 2018
What is Psoriasis?
Psoriasis (Psoriasis Vulgaris) is a chronic, non-contagious, hereditary, dermatological disease that has stumped medical communities “since Biblical times”.1 It is an autoimmune condition characterized by red, pale, or purple lesions on the skin covered by silvery scales.2 Biomedically, psoriasis occurs due to a wildly accelerated cell growth process, with skin cells forming every six to eight days rather than every twenty-eight to thirty days as with normal cell maturity.1 From the greek psōra, meaning “itch”, psoriatic lesions are often accompanied by mild to severe episodes of itching and/or burning of the skin.3 In traditional Chinese medicine, psoriasis is known today as yin xie bing (disease of the silver squames), but in ancient texts it has been referred to by many names such as bai bi (white dagger sore), she shi (snake lice), and song pi xuan (pine skin tinea).4 Psoriasis affects about 1% of the global population, and there has been found to be a genetic predisposition most predominantly among those of Caucasian descent, which makes the prevalence of psoriasis among the European and United States populations up to 3%. 4,6 It occurs with equal frequency in both sexes, with the mean age of onset at 27 but can occur during a wide-range of ages - from just a few months old to well into one’s 70’s. The course and cadence of psoriasis flare-ups are inconsistent and unpredictable, with a tendency to recur and persist.4
There is an internal manifestation of psoriasis known as psoriatic arthritis, which affects the joints. This paper will not address psoriatic arthritis directly.
Types of Psoriasis
Psoriasis can be found virtually anywhere on the body, but there are a few areas that are especially prone: skin folds (i.e. elbows and knees), scalp, hands, feet, nails, and genitals.2,7 There are five commonly identified types of psoriasis based on morphology of the lesions2,8:
- Plaque Psoriasis
- : This is the most common form of psoriasis, presenting as raised, red patches with silvery scales that tend to be itchy and/or painful with frequent cracking and/or bleeding. It is often found on the scalp, knees, elbows, and lower back.
- Guttate Psoriasis
- : The second-most common form, this form of psoriasis appears as small, bright red or pink, numerous tear-shaped lesions with fine scales that shed easily (a phenomenon known as Auspitz’s sign). Often triggered by a streptococcal throat infection, it often spreads across the torso, back, and limbs, and is most common in children, adolescents, and younger adults.
- Inverse Psoriasis
: This form of psoriasis presents as bright red, smooth, shiny lesions without scales. It almost exclusively appears in skin folds, such as behind the knee, under the arm, under the breast, and in the groin.
- Pustular Psoriasis
: As indicated in the name, this form of psoriasis presents as red lesions with defined white pustules. Although it presents as pustules filled with white blood cells, it is not an infection nor is it contagious. It can appear anywhere on the body, but has a tendency to manifest on the hands and feet.
Clinically, patients tend to present with more than one type at a time, and different types tend to require different treatment.7
Causes of Psoriasis
Western Medicine Perspective
Psoriasis is a hereditary autoimmune disorder that is triggered by infections or psychogenic factors.2,5 As explained earlier, psoriasis is the result of a “super-speed” skin cell replacement process, where the skin cells renew themselves every three to seven days rather than every 28 days, leading to an accumulation of cells forming raised ‘plaques’ on the skin. Research has found that this process is initiated from an immune response where the T cells become triggered and overactive.8 They act as if there were an infection or wound, and in turn attempt to regenerate the skin cells that are perceived to be lost and release inflammatory chemicals into the system. This is what causes the skin cell overgrowth as well as the red, itchy skin. What is still unclear is what causes the T cells to malfunction in the first place, although researchers believe that genetics and environmental factors play the most significant role.9 Because of the hyperproliferation of skin cells characteristic of all forms of psoriasis, it is sometimes referred to as “The Living Cancer.” 10
There are certain factors that will increase a person’s risk for developing psoriasis9:
- Family History
- : As stated before, psoriasis has been proven to be a hereditary condition. There is a 28% chance of developing psoriasis if one parent already has it, and a 65% chance if both parents have it.
- Viral & Bacterial Infections
- : Those whose immune systems have been compromised, such as those who are HIV positive or suffer from chronic ear infections, are more likely to develop psoriasis than those with healthy immune systems.
- : High levels of stress can compromise your immune system, increasing your risk of psoriasis.
: Considered a comorbidity, excess weight increases risk for inflammatory diseases such as diabetes, high blood pressure, and psoriasis.11 It also increases the risk for inverse psoriasis specifically, since it has a tendency to develop in skin folds and creases.
: The chemicals found in cigarette smoke alter the immune system and directly affect skin inflammation.
So what triggers psoriasis? Triggers seem to differ from person to person and from flare-up to flare-up (meaning not every flare a psoriasis patient experiences is initiated by the same trigger), but there are some commonly found triggers amongst psoriasis patients 9, 13:
- : Psycho-emotional distress, overwork, and chronic stress tends to aggravate existing psoriasis lesions, but it can also be the main trigger of a psoriasis flare. Psoriasis can also be referred to as an “infection of the nervous system” because of the substantial role the nervous system plays in the onset, exacerbation, and remission of flare-ups.
- Injury to Skin
- : Lesions can appear in areas that have suffered injury and trauma. This can include sites of injection, sunburn, and scratches. This reaction is known as the Koebner phenomenon.
- : Since psoriasis is an immune-mediated response, infections such as upper respiratory infections are a common trigger for flare-ups. This is particularly true of streptococcus infection triggering guttate psoriasis.
- : There are specific medications that have shown to trigger and aggravate psoriasis, such as Lithium, antimalarials (such as Plaquenil, Quinacrine, Chloroquine, and Hydroxychloroquine), Inderal (a beta-blocker for high blood pressure), Quinidine (an antiarrhythmic agent), and Indomethacin (an anti-inflammatory used for arthritis).
- Diet & Increased Intestinal Permeability
: There has been significant evidence found in the relationship between psoriasis and metabolic disorders related to increased intestinal permeability, more colloquially known as “leaky gut”. 15 Since leaky gut is mediated by proper diet, there is a direct correlation between a person’s diet and their propensity for psoriasis. This is expanded upon in the Lifestyle Perspective section below.
- Smoking & Alcohol Consumption
: Cigarette smoke, as described before, contains numerous chemicals that have shown to initiate and aggravate psoriasis flare-ups. Excessive alcohol consumption has been shown to compromise the immune system through its effect on the liver, leading to dehydration and vitamin deficiency, and produce inflammatory cytokines and cell cycle activators.16
- Vitamin D Deficiency
: Vitamin D deficiency doesn’t directly cause psoriasis, but it may affect the body’s ability to maintain healthy skin.17
Psoriasis was once thought to be a purely dermatological condition, but has recently been proven to be a multisystem disorder.18 Although the etiology of the condition is little known, there is significant evidence that genetic predisposition, environmental factors, immunologically-related inflammation, and psycho-emotional factors contribute significantly.
It is important to highlight the dietary and lifestyle factors that contribute to psoriasis that do not neatly fall into the Western medicine nor the TCM perspectives. In recent years there has been a growing body of evidence demonstrating how autoimmune disorders, including psoriasis, are directly correlated with dietary and lifestyle habits. According to Dr. John O.A. Pagano, a leading expert on psoriasis in the natural medicine community, psoriasis is the body’s reaction to the overtaxing of the body’s detoxification organs through a buildup of toxins that are released through the skin.19 Toxins buildup in the system when the other organs in the body’s detoxification system, primarily the intestines and the kidneys, are unable to filter out toxins at the same rate as they are building up. The toxins are then transferred to the blood, and while the liver is responsible for removing these toxins from the blood, if it is overloaded as well the body attempts to eliminate the toxins through the skin. This is what causes inflammation of the skin in psoriasis and related ailments such as eczema.
The buildup of toxins in the system can be due to various factors, including hyperpermeable intestines (caused either by diet or spinal subluxation that compromises the integrity of the intestinal wall), food allergies (especially gluten & dairy), an inflammatory diet (especially when it includes processed foods, hydrogenated oils, fried foods, and factory-farmed meats), acidic blood pH, candida overgrowth, difficulty digesting protein, poor liver function, a sedentary lifestyle, and emotional stress. 20
Psoriasis can be due to multiple pathogenic Zang Fu patterns and Qi, Blood, and Body Fluid patterns depending on how it manifests on the skin - in fact the Chinese medical community cannot agree as to how many patterns there are, ranging from anywhere from three to eight. It is more commonly accepted that psoriasis, along with all other autoimmune syndromes, actually originates from a long-term Spleen deficiency that results from any number of disharmonies, and according to meridian theory it stems from a Spleen Deficiency Yin Deficiency Deficient Heat pattern.21 Since this theory isn’t applied clinically in TCM treatments as often as the others that are to be mentioned, we will not focus on it for the sake of this literature review.
The predominant pathogenic factors are wind and heat, either due to exposure to external pathogenic factors of wind, dampness, dryness, poison, cold, or heat, or due to internal factors such as qi stagnation and blood stasis. 4, 22 These internal factors could be due to excess or deficiency syndromes, in particular Liver and Kidney Qi Deficiency and Blood Deficiency.4
The patterns can be differentiated by Lesions (color, shape, lesion type), Associated Factors, Physical expression, Tongue presentation, and Pulse presentation. Below is a compiled list of the patterns that have been shown to be related to psoriasis and their pathological presentations based on multiple credible sources4,5,10,22:
Heat in the Blood
- Lesions: Bright red lesions (erythema) with scales that can easily be shed. Lesions start out small and circular (spot-like), with smaller lesions spreading into one another to create larger circular lesions. They can also be raised and swollen due to acute inflammation.
- Associated Factors: Heat (red lesions and tongue) and Wind (acute onset, intense itching and rapid spreading)
- Physical expression: Spot-like erythema and scales appear throughout the body, typically starting on the trunk and limbs then rapidly expanding throughout the body. Accompanying symptoms are usually intense itching (although not always), aversion to heat, restlessness, thirst, a bitter taste in the mouth, possible sore throat, slight fever, constipation, yellow and scanty urination.
- Tongue presentation: red or crimson-red body with a thin yellow (possibly thin white) coat
- Pulse presentation: rapid & wiry or slippery
Qi & Blood Stasis
- Lesions: Red or red-purple macules that are moist and covered by thick white scales that do not shed easily. The lesions are circular of varying sizes with thick scales that appear like “oyster shells” after a prolonged period of time.
- Associated Factors: Stagnation (slow onset and prolonged duration in one area)
- Physical expression: New lesions appear sporadically and persist for a prolonged period of time. It tends to be accompanied by dry mouth, painful and/or heavy menses, and possible itching that varies in intensity.
- Tongue presentation: Red or purple-red body with a thin yellow coat
- Pulse presentation: slippery; thready, slippery, and forceful; or wiry/choppy (and possibly deep)
Heat Toxin/Damp Heat
- Lesions: Dark red or hyperpigmented plaque-like lesions covered by thick, yellow or yellowish-brown scales. The lesions have a tendency to form small pustules depending on toxicity.
- Associated Factors: Heat (red lesions, burning sensation), Dampness (pustules, arthralgia)
- Physical expression: Lesions can appear anywhere on the body and have a sudden onset, with the nail bed being particularly vulnerable. The lesions can have a strong burning sensation. This presentation is often accompanied by other upper respiratory tract inflammatory conditions such as tonsillitis, foul smelling stools, constipation, and/or arthralgia.
- Tongue presentation: red body with a thin yellow or greasy-yellow coat
- Pulse presentation: rapid, wiry or slippery
Blood Deficiency & Dryness
- Lesions: Pale-red, thin lesions with little to no scales that are coin-shaped and/or merge into patches. These lesions persist for a long time.
- Associated Factors: Stagnation (slow onset and prolonged duration in one area), Wind-Dryness (itching, severe skin dryness)
- Physical expression: Lesions can appear anywhere on the body and come-on slowly and last for a prolonged amount of time. This presentation is often accompanied by vertigo, insomnia, fatigue, and/or constipation.
- Tongue presentation: Pale body with a thin-white or scanty coat
- Pulse presentation: deep-thready or wiry-thready; moderate & loose
Liver & Kidney Yin Deficiency - This pattern can emerge as the underlying etiology of heat in the blood, qi & blood stasis, and/or blood deficiency & dryness patterned psoriasis. Therefore the presentation will be similar to these patterns, but the treatment principles would focus on tonifying the deficiency of the Liver and Kidney.
- Lesions: Refer to heat in the blood, qi & blood stasis, and/or blood deficiency & dryness patterns.
- Associated Factors: Refer to heat in the blood, qi & blood stasis, and/or blood deficiency & dryness patterns.
- Physical expression: Depending on the presentation, this presentation would be similar heat in the blood, qi & blood stasis, and/or blood deficiency & dryness patterns with the addition of yin deficiency patterns such as night sweats, malar flush, dry mouth, and 5-palm heat.
- Tongue presentation: Pink and/or red body with scanty/peeled tongue coating
- Pulse presentation: thready/wiry, and rapid when heat is present
Disharmony of Ren & Chong Mai
- Lesions: Bright or pale red lesions with silvery scales that are widely distributed across the body. Lesions tend to itch less or not itch as compared to other psoriasis presentations.
- Associated Factors: Heat (irritability, red lesions)
- Physical expression: In this presentation, psoriasis flare-ups have a strong relationship with a woman’s menstrual cycle, pregnancy, and/or childbirth. Lesions can be aggravated by before menses or directly after, or can disappear during pregnancy and return after childbirth. Accompanying symptoms to this presentation are painful/irregular menses, PMS, fatigue, and/or dizziness.
- Tongue presentation: red or dusky body with a thin coat
- Pulse presentation: varies
Treatment of Psoriasis
Western Medicine Approach
Western medicine approaches the treatment of psoriasis using three different modalities: topical treatments, phototherapy, and systemic medications.9 Mild to moderate presentations of psoriasis tend to be treated with topical treatments and phototherapy, while more severe presentations are recommended for systemic treatment, possibly in combination with topicals and/or phototherapy. It is important to note that many of these treatment modalities have mild to severe side effects, ranging from minor skin irritation to increase in risk for cancer.9 Below is a list of the uses and possible side effects of topical treatments, phototherapy, and systemic medications frequently used in the treatment of psoriasis in Western medicine.2,7,9
- Topical Corticosteroids
- : Frequently prescribed for mild to moderate psoriasis flare-ups, corticosteroids reduce inflammation and relieve itching. They do this by switching off genes that trigger inflammation while also suppressing the immune system so that it doesn’t attack the body’s own tissue.
32 Long-term use can lead to the thinning of the skin, glaucoma and cataracts, lower-leg edema, high blood pressure, increased blood sugar, higher risk of infections, osteoporosis, and psychological problems such as poor memory and mood swings.24
- Topical Retinoids
- : As a vitamin A derivative, retinoids reduce inflammation especially in skin conditions because they prompt skin cells to turn over and die rapidly, allowing for new skin cells to come to the surface.
24 Possible side effects are skin irritation, increased sensitivity to sunlight, and possible birth defects (although less for topical retinoids as opposed to oral retinoids).
- Vitamin D Analogues
- : Although the mechanism for how it works is still unclear, synthetic forms of vitamin D such as calcipotriene (Dovonex) and calcitriol (Vectical) have proven effective in treating mild to moderate psoriasis. The most common side effects are skin irritation and increased itching.
- Calcineurin Inhibitors
: Calcineurin inhibitors reduce inflammation and plaque build up by suppressing the production of T cells, thereby suppressing the immune system.26 They are recommended over retinoids and corticosteroids for sensitive areas and areas of thin skin such as the eyelids. Possible side effects of long-term are increased risk of skin cancer and lymphoma.
: A manmade version of a substance found in goa powder from the araroba tree, Anthralin (known pharmaceutically as Dritho-Scalp) slows the growth of skin cells and is used specifically for scalp psoriasis.27 Possible side effect is skin irritation.
- Salicylic Acid
: Available both over-the-counter and in prescription strength, salicylic acid helps psoriasis by promoting the sloughing of dead skin cells and is relatively safe to use. Long-term use in larger areas of skin could lead to salicylic acid toxicity, and it is not recommended for women who are pregnant or breastfeeding.28
- Coal Tar
: Also available both over-the-counter and in prescription strength, coal tar helps psoriasis by soothing the skin, reducing scaling, itching, and inflammation. Possible side-effects are skin irritation, and it is not recommended for women who are pregnant or breastfeeding.
- Daily exposure to small amounts of ultraviolet rays in sunlight have shown to slow the turnover of skin cells and reduce scaling and inflammation, and is therefore recommended for mild to moderate psoriasis. However, too much sun exposure has proven to worsen symptoms and damage the skin further.
- UVB Phototherapy
- : Both broadband and narrow band UVB therapy work using the same mechanism as sunlight but are administered in a more controlled, area-specific, and dosage-regulating manner. Possible short-term side effects are redness, itching, and dry skin, with narrow band UVB phototherapy possibly causing more severe and longer-lasting burns.
- Goeckerman Therapy
: This treatment is a combination of UVB treatment and coal tar treatment, as the coal tar increases the skin’s receptiveness to UVB light rays.
- Psoralen Plus Ultraviolet A (PUVA)
: A form of photochemotherapy, this treatment is a combination of an oral medication (psoralen) and UVA phototherapy, as psoralen increases skin’s responsiveness of UVA light rays. As UVA rays penetrates deeper into the skin than UVB rays, this therapy is recommended for moderate to severe psoriasis. Since this is a more aggressive treatment, the side effects have a tendency to be more severe. Possible short-term side effects are nausea, headache, skin burning, and itching; possible long-term side effects are dry, wrinkled skin, freckles, increased sensitivity to the sun, and an increased risk of developing skin cancer.
- Excimer Laser
: As a controlled beam of UVB light, this treatment treats only the psoriatic lesions themselves without affecting the healthy skin around it. It is used to control scaling and inflammation in mild to moderate psoriasis. Possible side effects are redness and blistering
As a group, systemic medications are used for severe or treatment-resistant psoriasis and have a tendency for more severe side effects.
- Oral Retinoids
- : Similar to topical retinoids, oral and injected retinoids reduce inflammation especially in skin conditions because they prompt skin cells to turn over and die rapidly, allowing for new skin cells to come to the surface.
25 The possible side effects, however, are much more severe and include lip inflammation, hair loss, and severe birth defects. Women are told to avoid pregnancy for at least three years after terminating treatment.
- : Taken orally, methotrexate (pharmaceutically known as Rhematrex) treats psoriasis by blocking the metabolism of cells and killing rapidly growing cells, decreasing skin cell production and suppressing inflammation.
29 Short-term side effects include upset stomach, loss of appetite, and fatigue. Possible long-term side effects are much more severe, and can include liver damage and decreased production of red and white blood cells and platelets.
: An immunosuppressant, cyclosporine (pharmaceutically known as Gengraf or Neoral) suppresses inflammation. It can only be taken in the short-term, as possible side effects include increased risk of infection, cancer, kidney problems, and high blood pressure.
: This group of drugs works in treating moderate to severe psoriasis by altering the immune system and in effect suppressing it’s normal action to mitigate infection in the body. Pharmaceutically they are known as Enbrel, Remicade, Humira, Stelara, Simponi, Cosentyx, Taltz, and Otezla, all of which are administered by injection except for Otezla, which is administered orally.
: Usually used in the treatment of cancer, thioguanine (pharmaceutically known as Tabloid) and hydroxyurea (pharmaceutically known as Droxia or Hydrea) are used in cases of severe psoriasis when other drugs are not applicable.
Since psoriasis is considered a reaction to high toxicity in the body, the treatment from a diet and lifestyle perspective would be to decrease toxicity in the body. The process to decrease toxicity in the body starts with removing the toxins that are currently in the body, repairing any structural or functional issues that could increase the body’s toxicity such as leaky gut, and limiting exposure to dietary and environmental toxins.19 The first step to removing toxins from the body is to perform a detoxification that focuses on supporting the organs of the detoxification system, specifically the liver, kidneys, and large intestines. Dr. Pagano suggests a 3-day apple (or any other low-acidic fruit) cleanse followed by a colon cleanse or enema as this starts your body off with a “clean slate”.
Once the body has gone through the detoxification process, there are a number of health-supportive habits to cultivate in order to prevent future psoriasis flare-ups19,20:
- Perform an Elimination Diet
- : This will help identify any food triggers that could be contributing to psoriasis flare-ups.
- Adopt an Alkaline and Anti-Inflammatory Diet
- : A diet that is high in alkaline forming foods such as vegetables and fruit (75% of the diet) and low in acid forming foods such as meat and grains (25% of the diet) is recommended for patients with psoriasis. Eating foods that are high in probiotics, fiber, antioxidants, zinc, omega-3 fatty acids and vitamin A and adding anti-inflammatory spices such as turmeric as well as aloe vera promotes healthy digestion and increased intake of vital vitamins. It is important to limit and/or avoid inflammatory foods such as processed foods, simple sugars, alcohol, conventional dairy and meats, hydrogenated oils, fried foods, caffeine, nightshades, and eggs, as well as any other identified food allergies.
- Exercise properly
- : Exercising promotes sweating, healthy digestion, and improved circulation of blood and lymph, all of which aid the detoxification organs in eliminating toxins from the body.
30 It also promotes a healthy immune system and can be used as a stress management technique, all of which help in treating psoriasis.
- Drink Water
- : Dr. Pagano emphasizes the importance of drinking a minimum of 6-8 8oz glasses of water per day as it helps hydrate the body (and therefore the skin) as well as promotes the elimination of toxins through the urine.
- Manage Stress
: Chronic stress taxes the liver, kidneys, and digestive tract, compromising their ability to eliminate toxins from the body and therefore encouraging psoriasis flare-ups. The body’s stress response stimulates the adrenal cortex, adding more cortisol and aldosterone into the bloodstream and making the blood more acidic. Stress management techniques such as prayer, meditation, and hypnosis help reduce severity and length of psoriasis flare-ups.
- Take Herbs & Supplements
: Specific herbs and supplements that have shown to promote healthy skin and encourage psoriasis remission are Omega-3 fish oils and/or flax oils (anti-inflammatory), probiotics (pro-digestive), hydrochloric acid (promotes protease), Oregon grape extract and milk thistle (hepatoprotective), and vitamin D3 (promotes healthy skin). Slippery Elm Bark powder and American Yellow Saffron tea daily has been shown to improve digestion and aid in reducing inflammation specifically for psoriasis patients.33
- Adjust the Spine
: Adjusting the 6th and 7th dorsal vertebrae helps to stimulate the immune system, regulate the visceral organs, and maintain the integrity of the intestinal wall by ensuring the proper distribution of nerve impulses.
- Adopt a Positive Mindset
: Negative emotions turn the blood acidic while positive emotions turn the blood alkaline, so adopting a more positive mindset will help reduce stress and support the digestive system in maintaining a more alkaline pH.
When treating psoriasis from a TCM perspective, the focus is on the etiological pattern that is causing the psoriasis with the addition of psoriasis-specific points. There are a number of acupuncture points and modalities as well as herbal formula prescriptions that are commonly used in treating patients with psoriasis with different constitutional and pathogenic patterns.
There are several methods of treatment for psoriasis using body acupuncture, ear acupuncture, bloodletting, plum-blossom needling, and cupping. A full breakdown of the acupuncture points and modalities commonly used can be found in Table 1. The treatments focus both on clearing the heat, wind, and/or toxins that are causing the lesions as well as tonifying the underlying deficiencies that have compromised the body’s ability to maintain proper homeostasis against the heat, wind, and/or toxins.4,5
TABLE 1: Acupuncture points and modalities by region of the body4,5,31
Acupuncture Treatment Methods
- Body Acupuncture: Stimulate needles moderately and retain them for 30 minutes. Manipulate them again once every few minutes. Treat every other day.
- Ear Acupuncture: Stimulate needles moderately and retain them for 30 minutes. Treat every other day. Retaining seeds in these points post-treatment is also effective.
- Bloodletting: Squeeze 1-2 drops of blood from the point. Treat either once daily (preferably in the morning) or every other day.
- Plum-Blossom Needling: Tap lesions persistently, circling from the edge to the center, until small drops of blood appear. Treat once daily.
- Cupping: Can be applied alone or after an acupuncture treatment at the appropriate points. Treat once every other day.
Length of Treatment
The length of time the patient has had psoriasis dictates the length of time it should be treated - the longer the illness, the longer the treatment.5 The two biggest hurdles to patient recovery is a “recovery plateau” after the first few weeks and possible relapse of the condition. Qiang recommends mitigating both of these conditions with the herbal formula Wu Wei Xiao Du Yin.
Herbal treatments (also known as phytotherapy) is thought to be the most effective TCM treatment for psoriasis.4 It is the therapy most closely related to harmonizing the main pattern that is causing the psoriasis flare-up. There are a variety of formulas that can be used in the treatment of psoriasis because of the variety of underlying patterns that cause it, but there are specific formulas that have shown to have results in healing lesions and reducing the recurrence of flare-ups. These formulas are outlined in Table 2, Table 3, and Table 4. Formulas should be taken until symptoms subside or if symptoms come back after the patient stops taking the formula.5
TABLE 2: Ten most common herbal formulas prescribed for treatment of patients with psoriasis from 2000 to 2010 in Taiwan6
TABLE 3: Prescriptions for psoriasis differentiated by treatment principle5
TABLE 4: Prescriptions for psoriasis differentiated by pattern4
Psoriasis is a complex, stubborn, multi-system disorder that presents in a markedly individualized manner, making it difficult to find a universally effective treatment. Western and TCM diagnosis treatment methods are presented side-by-side for comparison. Western medicine views psoriasis as a hereditary, autoimmune disease exacerbated by environmental and emotional factors. TCM views it as a heat pathogen in the blood, which is usually due to a variety of underlying deficiencies. The lifestyle approach to psoriasis views it as hyper-toxicity of the body caused by an overtaxed detoxification system. For patients suffering from psoriasis, it is important to know the treatment options available, both contemporary and alternative, in order to find the treatment modalities that work best for them.
- Ford, Prudence Craig; Ford, Roberta Jeanne; and Swanson, Susan, "A study of psoriasis : a methodological critique" (1979). Dissertations and Theses. Paper 2688.
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- Weng SW, Chen BC, Wang YC, et al. Traditional Chinese Medicine Use among Patients with Psoriasis in Taiwan: A Nationwide Population-Based Study . 2016. Available from Hindawi Publishing Corporation, Evidence-Based Complementary and Alternative Medicine. doi: 10.1155/2016/3164105. Accessed February 27 2018.
- Cipriano SD, Meinhardt E, Berger TG, et al. Psoriasis: Basic Dermatology Curriculum. (2015) American Academy of Dermatology.
- Types of Psoriasis. (n.d) https://www.psoriasis-association.org.uk/psoriasis-and-treatments/types-of-psoriasis. Accessed on March 2, 2018.
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- Swanbeck G, Inerot A, Martinsson T, et al. A population genetic study of psoriasis. Br J Dermatol. July 1994; 131(1):32-9.
- Causes and Triggers. (n.d)
- Cashin-Garbutt, A. Psoriasis and the nervous system: an interview with Dr Nicole Ward, Case Western Reserve University. (September 27, 2013) News Medical Life Sciences. Available at:
- Romani J, Caixas A, Escote X, et al. Lipopolysaccharide-binding protein is increased in patients with psoriasis with metabolic syndrome, and correlates with C-reactive protein. Clinical and Experimental Dermatology. 2012. doi:10.1111/ced.12007
- Fitzgerald J. Psoriasis and Alcohol: What’s the Link? (December 11, 2016) Medical News Today. Available at:
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- Yang X, Chongsuvivatwong V, Lerkiatbundit S, et al. Identifying the Zheng in psoriatic patients based on latent class analysis of traditional Chinese medicine symptoms and signs. Chinese Medicine 2014, 9:1.
- Zhang GZ, Wang JS, Wang P, et al. Distribution and Development of the TCM Syndromes in Psoriasis Vulgaris. Journal of Traditional Chinese Medicine. September 2009; 29(3): 195-200.
- Mayo Clinic Staff. Prednisone and other corticosteroids. (n.d.)
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- Utecht KN, Hiles J, Kolesar J. Effects of Genetic Polymorphisms on the Pharmacokinetics of Calcineurin Inhibitors. Am J Health Syst Pharm. 2006;63(23):2340-2348.
- Anthralin (for scalp only) - topical, Dritho-Scalp. (March, 2013)
- Uva L, Miguel D, Pinheiro C. Mechanisms of Action of Topical Corticosteroids in Psoriasis. Int J Endocrinol. November 2012; 2012: 561018. doi: 10.1155/2012/561018
- Ogbru O, Marks JW. Methotrexate. (n.d.)
- Doyle M, Deng J, Zhang AL, et al. Acupuncture Therapies for Psoriasis Vulgaris: A Systematic Review of Standardized Control Trials. Forsch Komplementmed 2015;22:102–109. doi: 10.1159/000381225
- Barnes PJ. How corticosteroids control inflammation: Quintiles Prize Lecture 2005. Br J Pharmacol. 2006 Jun; 148(3): 245–254. doi: 10.1038/sj.bjp.0706736
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