Experience of Professor Li Yuanwen in treating psoriasis

Ci Ling-ling(蔡玲玲), Li Ping(李萍), Wng Yn(王艳), Xu Kituo(许开拓), Shi Jingwen(石静纹), Lin Weihu(林玮华), Wng Dongqi(王东琪), Wu Meicho(吴美超), nd Li Yunwen(李元文)＊

Experience of Professor Li Yuanwen in treating psoriasis

Cai Ling-ling(蔡玲玲)a, Li Ping(李萍)b, Wang Yan(王艳)b, Xu Kaituo(许开拓)a, Shi Jingwen(石静纹)a, Lin Weihua(林玮华)a, Wang Dongqi(王东琪)a, Wu Meichao(吴美超)a, and Li Yuanwen(李元文)a＊

a: Dongfang Hospital, the Second Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100000, China

b: Beijing Hospital of TCM，the Affiliated Hospital of Capital Medical University, Beijing 100000, China

Funding:Open Subject from TCM clinical basic research on Psoriasis of the key laboratory of Beijing; “10 kinds of diseases and 10 kinds of medicines” Subject from Beijing municipal commission of science and technology (number: Z131100002513013); Project from Human Resources Dept of Dongfang Hospital “Dongfang Famous Doctors”

Professor Li has combined TCM and modern medicine in the treatment of skin diseases for more than 30 years and has accumulated rich experience .We summarize some of his clinical experience in treating psoriasis.

Psoriasis; Experience; Li Yuanwen

ADDING COOLING BLOOD CHINESE MEDICINE TO ACUTE PATIENTS

As for the pathogenesis of psoriasis, Prof. Li thought there were internal and external factors, of which the internal factors were the major ones, which included, dysfunction of the heart, liver, spleen and other fi ve zang and six fu organs. The external causes included wind-heat, dampness, wind-cold and so on. Prof. Li held that its main pathogenesis were blood-heat and dampness. In treating psoriasis, he used “eliminating pathogenic factors”as the main therapeutic principle and applied “clearing heat and toxic materials, invigorating spleen to remove dampness” as the basic principle, he added medicinal to remove heat from the blood. Moreover, he believed that either exogenous dampness or endogenous dampness, would easily convert into heat and impair Yin. Besides, using too many dampness-removing herbs, too much exudation, dampness characterized by stickiness, heaviness and turbidity, long treatment course, all of which could impair Yin. So, Prof. Li chose nourishing Yin and blood, moistening medicinal according to TCM theory proposed by Li Zhong-zhi“Treating disease caused by pathogenic wind, we should add medicinal herbs for promoting the blood circulation and enriching blood to tranquilize endogenous wind due to blood def i ciency or stasis and resist the invasion of exogenous wind and dispel it.”

Prof. Li frequently used Chishao (Radix Paeoniae Rubra), Zicao (Radix Arnebiae/Lithospermi) to cool blood. He added Baimaogen (Rhizoma Imperatae) when patients had bright red skin because it belonged to Lung Meridian and Urinary Bladder Meridian and was cold in property and sweet in taste, so it had the efficacy of cooling blood to stop bleeding and increasing secretion of urine. Inducing urination is one of the important methods in treating disease caused by dampness. Choosing the medication to suit the characteristics of the pathogenic factor could improve the situation and make the dampness-heat eliminate through urine. For blood-heat patients, Prof. Li often added medicinal like: Dihuang (Radix Rehmanniae) and Mudanpi (Cortex Mutan). Dihuang (Radix Rehmanniae) could cool blood and protect Yin with bitter taste and cold property. Mudanpi (Cortex Mutan) could clear heat and cool blood by promoting blood circulation to remove blood stasis, and avoiding dampnessheat going into the blood system, eliminating the pathogenic by cooling blood. The two medicines cooperated in clearing heat of blood and removing dampness without harming the Yin and eliminating blood stasis.

EMPHASIS ON HOLISM, COMBINATION OF SIMULTANEOUS ELIMINATION AND REINFORCEMENT

Psoriasis was mainly caused by blood-heat, wind and dampness. It was treated by clearing away heat and toxic materials, cooling blood and expelling dampness. However, more attention should be paid to syndrome dif f erentiation. Dampness or wind was generated from the interior, while the external and the internal were both causes and ef f ects to each other. So, if we didn’t deal with the root cause, the factors won’t disappear. Take dampness as an example, obstinate dampness gathered together and lasted for a long time, therefore the dampness couldn’t be moved away by force and more emphasis should be laid on the transportation and transformation function of spleen. Plain Questions. 21st Section of Meridians ever recorded: “drink andfood were taken into the stomach and transformed into essence, which was transported to spleen and the essence was distributed all over the body through by lung. “Dampness was caused by dysfunction of spleen, the regular function of spleen included removing dampness. Dampness cannot be removed but by Qi, spleen cannot function but by Qi’s nurturing. Cangzhu (Rhizoma Atractylodis), Baizhu (Rhizoma Atractlodis Macrocephalea), Fuling (Poria), Chenpi (Pericarpium Citri Reticulatae) and so on were used to invigorate the spleen to eliminate dampness. Dangshen (Radix Codonopsis), Huangqi (Radix Astragali), Hongjingtian (Rhodiola Rosea) were applied to patients with Qi deficiency to strengthen the clearing and propelling dampness function of spleen. Yin deficiency was induced by long-time illness or intaking diuretics. For psoriasis patients of endogenous wind-dryness due to blood def i ciency TCM syndrome type, the therapy focused on nourishing Yin and blood and activating blood by giving medicinal like Danggui (Radix Angelicae), Bai shao (Radix Paeoniae Alba), Jixueteng (Caulis Spatholobi). He also added medicinal to nourish the essence of liver and kidney for patients with extreme essence and blood deficiency, such as Heshouwu (Radix Polygoni Multiflori), Nuzhenzi (Fructus Ligustri Lucidi), Mohanlian (Herba Ecliptae), Huainiuxi (Radix Achyranthis Bidentatae). Shudihuang (Radix Rehmanniae Preparata) had an absolute effect of nourishing essence and blood, but it’s too hard for the stomach to digest, so Prof.Li seldom used it without Maiya (Fructus Hordei Germinatus), Shenqu (Massa Medicata Fermentata) and others that can protect the function of spleen and stomach.

TREATING PROLONGED DISEASE BY NOURISHING YIN AND ANCHORING MIND METHODS

Psoriasis patients had severe itching which influenced sleep during night and af f ected the normal work and life. Some patients relied on drugs to help sleeping for a long time, which would lead to depression, irritability and neural psychological barriers. In addition to using the wind-dispelling and dampness-eliminating medicinal such as Fangfeng (Radix Saposhnikon’ae), Baixianpi (Cortex Dictamni), Difuzi (Fructus Kochiae), Fuping (Herba Sprdelae), Professor Li also added medicinal for enriching Yin and anchoring mind by following the principle. “The wind can lead to itching, but nourishing blood can dispel the wind caused by def i ciency of blood”. Besides, for patient with preponderance of Yang due to Yin def i ciency syndrome type, it was necessary to replenish Yin to check exuberance of Yang. Or the disease would linger for a long period of time and impair Yin. Therefore, it was suitable to add medicinal such as Shengdihuang (Radix Rehmanniae), Xuanshen (Radix Scrophulariae), Zhimu (Rhizoma Anemarrhenae), Tiandong (Radix Asparagi), Maidong (Radix Ophiopogonis), etc.

According to Yellow Emperor’s Canon: pain or itchy sores indicated heart disorders. The heart was the chief and controlled the mental activity. Prof.Li used anchoring mind with weighty and replenishing heart-Yin medicines such as Suanzaoren (Semen Ziziphi Spinosae), Baiziren (Semen Platycladi), Longgu (Fossilia OssiaMastodi), Muli (Concha Ostreae), Zhenzhumu (Concha Margaritifera) on the patients who were itching acutely, sleeping uncomfortably, dysphoric, anxious in his clinical practice. As for the chronic psoriasis that was hard to cure and with intolerable itching, Prof. Li liked to add Kaixin Powder which originated from Gu Jin Lu Yan and included: Shichangpu (Rhizoma Acori Tatarinowii), Yuanzhi (Radix Polygalae), Fuling (Poria) and Renshen (Radix Ginseng). It was used for symptoms like trance, forgetfulness, severe palpitations, restlessness of heart-qi, deficiency of the five zang-organs and so on. Prof. Li thought it’s necessary to treat chronic psoriasis patients whose emotion was bound to being af f ected and sleep was af f ected by pruritus with adding medicinal for tranquilizing and anchoring the mind, inducing resuscitation with herbal aromatics, arresting convulsion.

TREATMENT OF SKIN DISEASE WITH CORTEX-KIND CHINESE MEDICINES AND DISPELLING WIND WITH INSECTS

Prof.Li was good at using cortex-kind of Chinese medicine to treat skin disease. For example, he used Haitongpi (Cortex Aralia Chinensis), Mudanpi (Cortex Mutan), Sangbaipi (Cortex Mori) frequently. Prof.Li liked compatibility of Mudanpi (Cortex Mutan) and Shengdi (Radix Rehmanniae) because Mudanpi (Cortex Mutan) had bitter taste and slightly cold property, it could go in the blood systems to cool it and go through kidney channel to remove the heat of Yin. Shengdi (Radix Rehmanniae) had sweet taste, cold property and moist quality, it could go in the blood systems. The ef f ects were greatly increased by combining them in cooling the blood and dissipating blood stasis, clearing heat and pacifying vessel, nourishing Yin and body fl uid.

Another valuable experience was applying insects medicine. Wu Ju-tong in the Qin dynasty once said “the flying kinds of sucking blood insects went into Qi system while the walking kinds went in the blood system. They can go everywhere and break anything”. Prof.Li taught us that chronic diseases would transform into collaterals. It needed adding medicinal of activating blood circulation to dissipate stasis and dredge the channels for increasing effect on dispelling wind and arresting itching. Heheld that prolonged psoriasis was caused by heat, dampness and wind collection blocking collaterals. Therefore, he often used lots of medicinal for activating blood circulation to dissipate stasis and dredge the channels with regard to thickening and saddening lesions such as: Quanxie (Scorpio), Shuizhi (Hirudo), Tubiechong (Eupolyphaga seu Steleophaga) and so on. When patients got heavier itching, he added Jiangchan (Bombyx Batryticatus), Chan tui (Periostracum Cicadae), Wugong (Scolopendra), Wushaoshe (Zaocys) etc.

PAYING ATTENTION TO EXTERNAL TREATMENT AND PROTECTING THE BARRIER FUNCTION OF THE SKIN

Psoriasis was a common disease with varied treatments. Prof. Li especially paid attention to TCM external therapy. He invented Qingshizhiyang Ointment (former name: Ganshiqingdai Ointment) to treat neurodermatitis, eczema and psoriasis, the ointment had the function of effectively protecting the skin barrier1-9. From 2007 to 2017, he had used it on more than 300 cases, and the curative effect was compared with that of Hydrocortisone butyrate cream and Binghuangfule ointment. The observation indicated that they had equivalent efficacy, but Qingshizhiyang Ointment had better safety, lasting ef f ect and no adverse reactions .

Qingshizhiyang Ointment was invented based on two theories : fi rstly, “Water generated all things on the earth. Fire restrained all things on the earth. So all diseases were caused by fi re, according to Chen Shi-gong in the Ming Dynasty, who wrote a book named Orthodox Manual of External Medicine. Secondly,”pain or itchy sores indicated heart disorders” from 19 items of Pathogenesis of Plain Question. These theories proved that clearing heat method could treat skin diseases. Qingshizhiyang Ointment was mainly composed of Qingdai (Indigo Naturalis), Luganshi (Galamian), Shigao (Gypsum Filrosum), Huangbai (Cortex Phellodendri), Kushen (Radix Sophorae Flavescentis), Bingpian (Borneolum Syntheticum). It could clear liver-fire and disperse blood stasis, dispel wind to alleviate itching. Qingdai (Indigo Naturalis) had the TCM function of clearing the liver-fire and could inhibit the proliferation of keratinocyte in the pharmological research. Luganshi (Galamian), Shigao (Gypsum Filrosum) had the function of astringency and alleviating itching. Huangbai (Cortex Phellodendri) and Kushen (Radix Sophorae Flavescentis) eliminated dampness to stop itching and killed bacteria. Bing pian (Borneolum Syntheticum) had a cool antipruritic ef f ect and function of softening and resolving hard masses. Modern studies had shown that skin barrier function was particularly important for psoriasis10,11. Qingshizhiyang Ointment was an important external preparation which could ef f ectively protect the skin and promote the recovery of barrier function .

REFERENCES

1 LI Nan, ZHANG Feng-chuan, LI Yuan-wen.The clinical observation on the ef f ects of QingDai ointments on patients with dermatitis and eczema. Global Traditional Chinese Medicine,2009,2(4):280-281.

2 SUN Zhan-xue, LI Yuan-wen, et al.Clinical observation on effects of GanShi QingDai Ointment on 66 patients with neurodermatitis. China Journal of Tradition-nal Chinese Medicine and Pharmacy,2010,25(11):1849-1851.

3 JIANG Ying-juan, LI Yuan-wen, et al. Treating 82 neurodermatitis patients in TCM syndrome of liver Stagnation transforming into fi re by QingGanYiFu decoction combining with GanShiQingDai Cream. Journal of Traditional Chinese Mediciine,2011,52(24):2136-2137.

4 SUN Zhanxue, ZHAO Lijuan, et al. Ef f ects of Ganshi Qingdai Cream intervening Lesions of subacute eczema model in rats. Global Traditional Chinese Medicine,2013,6(3):162-164.

5 SUN Zhan-xue, ZHANG Feng-chuan, LI Yuan-wen. Ef f ects on apoptosis of keratinocyte cells and lymphocytes from eczema model lesions in rats intervened by GanShiQingDai Cream. Chinese Journal of Clinicians (Electronic Edition), 2013,7(3):1146-1150.

6 CAI Ling-ling, LI Yuan-wen, ZHANG Feng-chuan, et al. Clinical research of GanShi QingDai Ointment in treating neurodermatitis. Global Traditional Chinese Medicine, 2013,6(2):95-99.

7 JIANG Jing, LI Yuan-wen, et al. Effects on the Bcl-2 and Bax protein expression Changes of lymphocytes and keratinocyte cells from subacute eczema lesions in Rats intervened by Ganshi Qingdai Cream. Global Traditional Chinese Medicine,2015,8(6):697-701.

8 Miaoliang Zhang, Bilian Yang, Lingling Cai, et al. Experience of clinical application of cordierite antipruritic ointment. Clinical Journal of Chinese Medicine, 2016,8(33):145-147.

9 Xueyan Chen, Li Yuanwen, et al. Clinical observation of Qingshi Zhiyang ointment in treating neurodermatitis. Clinical Journal of Chinese Medicine, 2016,8(27):103-105.

10 Ishida-Yamamoto A, lizuka H. Structural organization of committed cell envelopes and alterations in inherited skin disorders. Exp Dermatol,1998(7):1-10.

11 Feingold KR. Thematic review series skin lipids. The role of lipids in cutaneous permeability barrier homeostasis. J Lipid Res,2007,48(12):2531-2546.

（Accepted: November 19, 2016）

Email: yuan-wen@sohu.com