Progress of blood-letting puncture on the treatment of psoriasis

1College of Traditional Chinese Medicine,Hebei University,Baoding,Hebei,China;2Traditional Chinese Medicine Department, Chinese people’s liberation Army 252 Hosptital,Baoding,Hebei,China.

Abstract

Key words:Psoriasis,blood-letting puncture,Mechanisms,Clinical effects,Acupoint selection

Introduction

Psoriasis is a chronic skin disease characterized by localized orwidespread squamouserythemaor plaque.Atpresent,the incidence ofpsoriasis worldwide is about 0.1%-3%[1].The pathogenesis is complicated and from the view point of modern study, it is related to heredity, metabolism,environment and autoimmunity.Therefore,the main therapeutic principles are inhibiting the proliferation of keratinocyte, regulating autoimmunity and controling infection.However,the effect is not so significant and is complained with some side effects,such as abdominal pain,diarrhea,and even severe bone marrow depression[2].The compliance of patients to these drug therapies is poor,which will cast a negative effect onto the healthy and quality of life.

There isno exactrecord of “psoriasis” in traditional Chinese medicine(TCM).According to its clinical manifestations, psoriasis is generally considered as “Bai Bi”or “Gan Xuan”, “Song Pi Xuan”, “BaiKeChuang”, “SheShi”.Many physicians have different views on the etiology and pathogenesis of this disease.Most of them believe that psoriasis results from internal heat toxin and the deficiency of blood,Initially,most of them have internal heat accumulation,once encountered with wind-cold or wind-heat evil,leading to the blood stasis on the skin.After a long course of illness,the movement of Qi and blood is not smooth,resulting in blockage of meridians,stagnation of Qi and blood,skin dystrophy and repeated failure to heal[3].In the beginning,clearing heat and cooling blood is the main treatment principle,while in the static stage and regression stage,nourishing blood and moistening dryness,activating blood circulation and removing blood stasis are the main treatment methods.Modern physicians think blood stasis exists throughout the disease,the treatment should focus on promoting blood circulation and removing blood stasis[4].Blood-letting puncture is an important TCM external treatment,and its clinical effect is definite.It puncture the skin with triangular needles or other needles to release some blood according to meridian theory.The history of blood-letting puncture is long,which was mentioned inShuowen Jiezidating from the Easter Han dynasty(206BC-AD220).Huangdi Neijinghad a systematic theoretical record andSu Wenalso emphasized the importance of blood-letting puncture.According to TCM theory,blood-letting puncture has the functions of activating blood circulation and removing blood stasis,clearing away heat,and nourishing blood.It has good therapeutic effects on headache,acromitis,osteoarthritis and acute gout[5-9],especially plays an important role in the treatment of dermatosis.Zhenjiu Dachenghad recorded,“blood-letting puncture can be used to remove Qi stagnation,promote blood circulation and remove blood stasis”.This therapy has significant clinical effects on acne,herpes zoster,chronic urticaria,psoriasis and other skin diseases[10-14].This article reviews the mechanism and clinical application progress of blood-letting puncture in the treatment of psoriasis,with a view to provide new ideas for clinical treatment.

The mechanism of blood-letting puncture in the treatment of psoriasis

In TCM theory,the normal physiological function depends on the normal operation of Qi and blood,while the circulation of Qi and blood depends on the unobstructed meridians.Once the meridians are blocked,Qi and bloodareon bad terms,which will lead the diseases.“Harmonizing Qi and blood,dredging channels and collaterals”is the basic mechanism of blood-letting puncture [15].Blood-letting puncture can balance Qi and blood through stimulating the meridians,forcing evil Qi to go out,so as to dispel pathogenic factors and dredge the meridians.With the development of modern medicine,ithasbeen found thatblood-letting puncture can change micro-circulation disorder,alleviate red blood cell aggregation,increase blood oxygen content,and reduce blood vessel exudation[16].It can reduce blood viscosity[17],accelerate human metabolism,effectively improve blood vessel function and reduce blood stasis[18].

Clinical study of blood-letting puncture on psoriasis

According to its clinical characteristics,modern medicine divides psoriasis into three types：vulgar type, arthropathy type, pustular type and erythroderma type.Among them,vulgartype accountsforthe largestproportion.In clinical research,it is also found that blood-letting puncture is more effective in the treatment of psoriasis vulgaris. Psoriasis vulgaris patients often accompanied by rough skin,hypertrophy,scaling,skin nail errors and other symptoms,which show loss of nourishment due to venation obstruction.In addition,cutaneous pruritus is mostly caused by wind evil,or blood deficiency,or wind dryness.according to the TCM theory,“nourishing blood at first,then the wind will extinguish by itself”.Modern physicians believe that“all the stubborn syndromes with irregular Qiare beyond the reach of a single needle”, which illustrates the importance of blood-letting puncture.

In the clinical study [19],72 patients were randomly divided into two groups.The control group was given vitamin A capsule orally,and the treatment group was treated with blood-letting puncture with beryllium needle. The results confirmed that blood-letting puncture had advantagesoverthe vitamin A and showed significant effects on the patients with psoriasis[19].Blood-letting puncture also showed advantageswhen combined with Chinese herbal medicine,as in a research 60 patients with psoriasis vulgaris were randomly divided into two groups.The treatment group was treated with blood-letting puncture combined with Huayu Xiaoyin Decoction plus Vaseline for external use,while the control group was treated with Huayu Xiaoyin Decoction plus Vaseline for external use.The results showed that the treatment group had higher efficiency,faster onset and fewer adverse reactions than the control group.At the same time,physician Wang Y Hetal[21]treated 52 cases of psoriasis vulgaris with blood-letting puncture at Shu acupoints of Wu Zang with triangular needle at selected points,then conducted cupping for 25 minutes to dredge meridians and collaterals.The total effective rate was 94.23%,which showed that the curative effect was reliable;Han QC and other clinicians[22]randomly divided 100 patients with plaque psoriasis vulgaris into two groups.The control group was treated with Budesonide cream and the experimentalgroup wastreated with blood-letting puncture.The results showed that the Psoriasis area and severity index(PASI)scores of the two groups were significantly reduced.The PASI scores of the experimental group were significantly lower than those of the control group,and the total effective rate was significantly higher than that of the control group.Research also found that[23]Jiaji(EX-B2)acupoint puncture bloodletting therapy for psoriasis vulgaris can effectively alleviate the symptoms,shorten the course of treatment.In addition,there are also cases reported[24]that acupuncture plus bloodletting therapy is effective in the treatment of psoriasis vulgaris,which can relieve the clinical symptoms quickly

Implementation methods of blood-letting puncture

Blood-letting puncture is generally applicable to vulgarispsoriasis.The acupointswere selected according to syndrome differentiation.The main acupoints were Dazhui(GV14,the depression under the seventh cervical spinous process),Feishu(BL13,1.5 inches below the third thoracic spinous process),Geshu(BL17,below the seventh thoracic spinous process,1.5 inches beside the left and right),Ganshu(BL18,the ninth thoracic spinous process,1.5 inches beside the left and right),Shen Shu(BL23,below the eleventh thoracic spinous process,1.5 inches beside the left and right).The commonly used acupoints are shown in Figure 1.

Operational methods：on the course of treatment,the patients are enjoined to lie on horizontal bed,sufficiently exposure skin lesions and acupoints,routine scavenge,puncturethe acupoints with a plum blossom needle until slight bleeding.The selected acupoints were Dazhui(GV14),Geshu(BL17),Ganshu(BL18),Feishu(BI13)and the periphery of itchy skin in turn.After puncturing,synchronized cupping was conducted and kept for 5 minutes.After lifting the cupping,wipe the blood with a cotton swab and disinfect the skin again.

Figure1 Acupoint Location

Discussion

Psoriasis is a common chronic recurrent inflammatory skin disease[25].Modern drug therapy can only control its progress and alleviate symptoms,but can not completely prevent itsrecurrence.According to the TCM theory,blood-letting puncture can be used to remove Qi stagnation,promote blood circulation and remove blood stasis,which has significant clinical effects on psoriasis,especially on the vulgaris psoriasis.

The clinical efficacy of blood-letting punctureis related to the acupoints.For the psoriasis treatment,Feishu(BL13)was selected to soothe wind and dissipate heat;Ganshu(BL18)can smooth blood vessels;Situmlating the Shenshu (BL23) can strengthen spleen and regulate blood circulation.Puncturing these acupoints together could remove blood stasis and dredge collaterals,which have unique advantages on the treatment of vulgaris psoriasis.The current clinical studies also proved the significant effects with rapid action,easy operation,cheap and safe.

Studies have also confirmed that[26]blood-letting puncture for psoriasis does not induce“isomorphic response”and there are no reports of relevant cases.But on the one hand,the lack of unified treatment standardsand related quantitative indicators in clinical practice leads to limited promotion,which requires the continuous efforts to standardize treatment methods,fully tap the advantages.