Chinese Medicine Differential Diagnosis of Psoriasis

This is a page for Chinese medicine professionals who are interested in the traditional disease diagnosis and differentiation of psoriasis. If you are a patient, and would like to know more about the way I use acupuncture and herbal medicine to treat psoriasis, please visit the Psoriasis Page.

There are 5 main types of acne (Fen Ci, or “white thorn”) in Chinese medicine. These types, or patterns, are explained in the language of Chinese medicine. Be sure to have a licensed practitioner diagnose your acne pattern. Do not take any of the herbal formulas listed without the guidance and supervision of a licensed practitioner.

From a Western medical perspective, psoriasis is classified as non-pustular, pustular and other. Additionally, there is guttate and nail psoriasis, and psoriatic arthritis. In Chinese medicine, psoriasis is called Yin xie bing, or Silver Scale Disease. Chinese medicine describes psoriasis as being a disease caused by external Wind lodging in the tissue and skin with concurrent Blood deficiency or dryness. Psoriasis is recurrent and chronic, and most often resistant to treatment. The disease is characterized by silvery scaling plaques and papules (a lesion elevated above the surface of the skin with no visible fluid, ranging in size and color) that are dry and clearly demarcated. Lesions are most commonly found around the knees and elbows, but may appear anywhere on the body (e.g., armpits/axillae, back, buttocks, scalp, bellybutton/umbilicus, and anogenital region. It is common to find lesions more focused on the outsides of the limbs, also known as the extensor surfaces.

Chinese medicine identifies 8 patterns of disharmony for psoriasis:

  1. Wind-Cold: This pattern is more common in children and early cases of psoriasis, and in psoriatic arthitis. Lesions are pale red and scales are white, thick and easily shed. There is only slight itching, if any at all is present. Wind-Cold pattern psoriasis is worse during the cold months of Winter and often resolves entirely during the Summer. Other symptoms may include aversion to cold, and joint pain or soreness. Acupuncture treatments will aim to expel wind and cold. The guiding herb formula is Gui Zhi Tang.
  2. Blood Heat: The Heat in this pattern causes macules and papules to be red and proliferate rapidly. Scales will be “heaped up,” and flake off easily when scratched. Itching may be intense. Symptoms will be worse in the Summer. Other symptoms may include an aversion to heat, restlessness, irritability, dry stools/constipation, yellow, scanty and hot urine. The acupuncture treatment will clear heat, cool the blood and relieve toxicity. The guiding herbal formulas are Xi Jiao Di Huang Tang and Liang Xue Xiao Feng San.
  3. Blood Dryness: Psoriatic lesions are typically pale red macules (a macule is a change in surface color, without elevation or depression) that appear moist, and will be covered by a thin layer of scales. Scales will be tightly and firmly packed together. Other symptoms may include dizziness, pallor, poor memory, and foggy thinking. Acupuncture treatment will nourish the blood and moisten dryness. The guiding herb formulas are Yang Xue Run Fu Yin and Ke Yin Fang.
  4. Blood Stasis: Psoriasis lesions for this pattern are dark or hyper-pigmented. Lesions are covered by thick, hard scales that are difficult to scrape off. Lichenification (the skin has become thickened and leathery) is possible. Long-standing lesions may overlap. Lesions may become fissured (cracked) and painful). Acupuncture treatments will move and invigorate blood. The guiding herbal formulas are Huo Xue San Yu Tang and Bai Bi Tang.
  5. Damp-Heat: Psoriasis lesions will be dark red macules of differing size. Scales will be greasy or thick and crust-like. The skin below the scales may weep exudate when scales are removed or appear moist. In this pattern, pustules may form. Psoriasis will worsen in humid weather, and areas of the body that are not exposed to adequate ventilation will be primarily affected (skin folds, soles of the feet, etc.). The lower body will be more affected than the upper body as Dampness sinks downward. Other symptoms may include heavy sensation in the chest, loss of or impaired appetite, fatigue, a heavy feeling in the lower limbs, leucorrhea (vaginal discharge). An acupuncture treatment will aim to transform dampness and clear heat. The guiding herbal formula is Bei Xie Shen Shi Tang.
  6. Fire or Heat Toxin: Lesions develop quickly, spreading out and often merging together. Lesions are pustular and red. Scales are fine and easily scratched off. It is common to have itching, burning and pain. Other symptoms may include fever, thirst, dry stools/constipation,and yellow urine. Acupuncture treatments will drain fire and relieve toxicity. The guiding herb formulas are Huang Lian Jie Du Tang He Wu Wei Xiao Du Yin, Sheng Xuan Yin and Long Dan Xie Gan Tang.
  7. Liver and Kidney Insufficiency: Lesions are macular and pale. Scales are thin and gray-white. Other symptoms may include sore or weak low back and knees, weakness in the extremities, joint paid, dizziness, and low-pitched tinnitus. Acupuncture will tonify Liver and Kidneys. The guiding herbal formula for this pattern of psoriasis is Mai Wei Di Huang Tang.
  8. Renmai and Chongmai Not-harmonized: This pattern of psoriasis is a sub-pattern of Liver and Kidney Insufficiency. If the above symptoms are combined with the following, this pattern is indicated. In men: impotence, erectile dysfunction, spermatorrhea or nocturnal emissions. In women: irregular menstrual period, infertility or remission of psoriasis during pregnancy followed by recurrence after birth. The guiding herb formula is Er Xian Tang.

External/Topical Application: Pu Ling Gao and Lu Lu Tong Shui Xi Ji. Differential Diagnosis: Rule out seborrheic dermatitis, secondary syphilis, fungal infections and eczema. *In psoriasis, removal of superficial scales will typically reveal tiny bleeding dots, known as Auspitz’s Sign.

My additional training in dermatology allows me to customize each treatment to you, the patient, and make sure you get the results you want.

To make an appointment with me for treatment, please contact me through my Contact page.