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:
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:
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:
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
Qi & Blood Stasis
Heat Toxin/Damp Heat
Blood Deficiency & Dryness
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.
Disharmony of Ren & Chong Mai
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
As a group, systemic medications are used for severe or treatment-resistant psoriasis and have a tendency for more severe side effects.
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:
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
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.
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