How does TCM treat psoriasis based on syndromes in clinic?
中医药治疗银屑病已有上千年的历史，在中医文献《黄帝内经》等古籍中对银屑病均有“白疕”、“蛇虱”、“松皮癣”的论述，如《医宗金鉴》中记载：“生于皮肤，形如疹疥，色白面痒，搔起白皮，由风气客于皮肤，血燥不能荣养所致。”此段文字生动地记载了银屑病的临床表现和病因病机。
TCM treating psoriasis has thousand years, there also has the discussion of “baibi”, “sheshi”, “songpixian” in TCM literature Huang Di Nei Jing and other ancient books, for example the records in the Golden mirror of medicine: “born from skin, like rash and scabies, white color and itch in surface, white skin appears when scratch it, caused by wind in the skin and blood dryness without nutrition.” These words vividly record the clinical manifestation and etiology and pathogenesis of psoriasis.
目前银屑病的中医辨证论治各家分型较多，综合可分为以下几型。
There are many types of syndrome differentiation and treatment in Chinese medicine about psoriasis at present; there are the following types in summary.
① 血热型：多见于银屑病进行期，表现为皮损焮红，皮疹不断增多，瘙痒剧烈，露滴现象明显，有同形反应，常伴有心烦，失眠，口干渴，大便干结，小便短赤，舌红苔黄，脉滑数。治宜清热凉血解毒。
① Blood heat: it can be found in the active stage of psoriasis, its manifestations are skin damage and scorching redness, increased rash, severe pruritus, obvious dew drop phenomenon, isomorphic reaction, accompanied with upset, insomnia, mouth dry and thirsty, dry stool, scanty dark urine, red tongue with yellowish fur and slippery and rapid pulse. The better treatment method is removing pattogenic heat from the blood and toxic material from the body.
② 血瘀型：多见于病程较长，反复发作的寻常型银屑病，亦见于关节病型银屑病。表现为皮损暗红、肥厚，鳞屑较厚，或伴关节活动不利，面色晦暗。舌暗红，可见瘀点瘀斑，脉涩。治宜活血化瘀润燥。
② Blood stasis: it can be found in the vulgaris psoriasis with long disease course and recurrent attack, also can be found in arthritic psoriasis. Its manifestations are skin damage and dark red, hypertrophy, thicker scale, or accompanied with inflexible joint motion and gloomy complexion, dark-red tongue with petechia and ecchymosis, uneven pulse. The better treatment method is promoting blood circulation to remove blood stasis and moistening dryness.
③湿热型：湿为阴邪，其性黏滞，难以速去。故此型多见于缠绵难愈者，亦见于掌跖脓疱型银屑病。表现为皮肤潮红肿胀，红斑上可见脓疱，皮损多发于掌跖和下肢，遇阴雨天病情往往加重。伴体倦乏力，纳呆，便溏，舌红，苔黄腻，脉滑数。治宜清热利湿解毒。
③ Damp heat: damp is yin pathogen with viscosity, it is hard to remove. So this type can be found in patient with refractory psoriasis, it also can be found in palmar and plantar pustula psoriasis. Its manifestations are flush and swollen skin, pustule in erythema, skin damage in palmoplantar and lower limbs, patient’s condition exacerbates when in rainy day. It accompanied with tired and weak body, anorexia, loose stool, and red tongue, and yellow greasy fur, slippery and rapid pulse. The better treatment method is clearing heat and promoting diuresis and detoxification.
④火毒型：多见于红皮病型银屑病。表现为全身皮肤弥漫潮红，常伴有发热，口干渴，心烦失眠，大便干结，小便黄。舌绛红，苔黄，脉滑数。治宜泻火解毒凉血。
④ Fire toxin: it can be found in erythrodermic psoriasis. Its manifestations are the whole body with diffuse flush, often accompanied with fever, dry and thirsty mouth, upset and insomnia, dry stool, yellow urine, crimson tongue, yellow fur, slippery and rapid pulse. The better treatment method is purging fire for removing toxin and cooling blood.
⑤血虚型：此型相当于缓解期银屑病，病情稳定，皮损为钱币状，或环状，或地图状，鳞屑逐渐消退，皮肤干燥，伴口干舌燥。治宜养血滋阴润燥。
⑤Blood deficiency: this type is equivalent to the psoriasis in remission stage, with steady condition, coin-liked skin damage, or cycle-liked skin damage, or map-liked, scale gradually fade away, dry skin, accompanied with parched mouth and scorched tongue. The better treatment method is nourishing blood and yin and moistening dryness.
⑥脓毒型：皮损泛发全身，损害上有密集针头或米粒大小脓疱，表面有不典型银屑病鳞屑，同时伴有发热，关节疼痛和肿胀，治宜清热解毒化湿、活血通络。常用龙胆泻肝汤和消毒饮，如玄参、土茯苓、苦参、地肤子、威灵仙和蜂房等治疗。
⑥Sepsis: skin damage in the whole body, there are intensive needle-liked or rice-liked pustules in the damaged parts, there are atypical psoriasis scales, at the same time, accompanied with fever, arthralgia and swelling, the better treatment is clearing heat and removing toxicity and dampness, promoting blood circulation to remove meridian obstruction. Longdanxiegan decoction and toxin-dispersing beverage are usually used, such as radix scrophulariae, glabrous greenbrier rhizome, sophora, belvedere fruit, radix clematidis, and honeycomb and other treatments.
银屑病的临床和症状千变万化，许多文献报道的各种经验方和有效方药，仅是以上中医症型和方药的演变和延伸。关键是正确辨证施治，坚持治疗，患者就能达到较为满意的效果。
The clinic and symptoms of psoriasis are ever-changing; many kinds of empirical formula and effective prescription are just the evolution and extension of the above TCM diagnosis and formulas. The key is correct diagnosis and treatment based on an overall analysis of the illness and the patient's condition, keeping on treatment, so the patients can reach their satisfactory effect.
