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TREATMENT OF A PARTICULARLY DIFFICULT CASE OF PSORIASIS

Michael Tierra EWCH, OMD, AHG

A man, age 65, arrived at my East West Clinic with the worst case of psoriasis I've ever seen in the 35 years of my practice.

He has had a lifetime of acute rosacea which his 97 year-old mother also has, and he also has terrible halitosis. There's an emotional background of shyness with women even prior to these complaints becoming so acute. The conditions resulted in chronic shame.

The psoriasis was all over his groin, head, outer legs, abdomen and back, with scales embarrassingly falling off. It was very itchy and sometimes he would scratch until these areas would bleed. He tried various ointments, salves and Internet miracle cures, but when the scabs would dry over the scar tissue made his skin look like elephant skin.

His tongue was without coat on the sides but greasy with a yellow coat in the center.

Pulse was slippery and full.

I decided that the diagnosis was to clear heat and I gave him a strong tea to be taken, one cup three times daily. It consisted of the following herbs:

Burdock root, dandelion root, sarsaparilla root, red clover, chapparal.

In addition, he took Planetary formulas Triphala and Bupleurum Liver Cleanse Formula, and an anti-itch, cooling herbal salve. As a supplement, I had him take a tablespoon once or twice a day of a high quality, omega-3-rich fish oil.

I also gave him one or two different types of pills for the skin: "Tri-snake pills," and a dried extract of the TCM formula Dang Gui and Arctium combination, Xiao Feng Wan also known as "Formula for Dispersing Pathogenic Wind." This latter formula is very specific for eliminating heat, dispersing wind, relieving itching and dampness.

Diet: strict avoidance of alcoholic beverages, limit coffee, sugar and red meat. I recommended more green vegetables, rice, chicken, eggs and fish.

Previously and during my working with him he tried various Internet cures and salves some with limited, short-term results. One Chinese herbalist sold him a "secret" pearl crème formula, purported to be based on an extract of powdered pearl. This practice is quite rampant and what patients don't know is that usually these '˜secret formula' ointments contain cortisone, which is why they seem to work for awhile. Eventually the body builds up a tolerance to cortisone so that those who use them soon require higher doses just to maintain the effect.

He also saw a Western medical dermatologist who also prescribed a cortisone crème. Even externally applied, cortisone has mild to severe adverse effects, especially when it is continuously used to control a chronic condition such as psoriasis. Cortisone is used as an anti-inflammatory 'suppressive' medicine. Harmful reactions occur as it gradually supplants the job of the adrenals to secrete natural anti-inflammatory chemicals into the blood stream. In Traditional Chinese Medicine (TCM) this is classified as a Kidney Yin function. With increasing dosage and long term use, however, the danger of cortisone overuse is a dependency on the drug with the kidneys shutting down their own natural secretion of cortisone. With excess cortisone use, a patient can develop symptoms of fluid retention, weight gain and aldosteronism, which in TCM would be classified as dampness accumulation.

While cortisone can be a big help in relieving certain acute conditions, it is far less desirable as a long term management of chronic skin conditions such as psoriasis and eczema.

Along with the dietary and herbal therapy, I had him come in weekly where I would administer acupuncture treatments since dietary, herbal and acupuncture complement each other in the treatment of difficult diseases such as psoriasis.

This first treatment protocol, however, which worked well for a number of patients in the past, exhibited only slight improvement.

Reconsidering the case more carefully, especially how the various factors of severe itching and scaling psoriasis, rosacea (bright red face syndrome), yellow greasy coated tongue, embarrassing halitosis, and slippery full pulse formed a pattern of disharmony that required all elements of the imbalance leading to his psoriasis would be assessed in TCM as external pathogenic wind heat, it was clear that while I had been basically applying the right treatment strategy '“ to clear heat '“ from the outset, the herbal treatments were simply not strong enough. Further, my treatment did not include as a strong component to clear 'Stomach fire' which in TCM can be implicated with all these symptoms, especially rosacea. From a standpoint of western natural medicine, rosy cheeks can be a sign of poor digestion as a result of inadequate levels of hydrochloric acid and pepsin secretion. This certainly would fit with many of his symptoms that seemed to originate in his stomach (as so many chronic diseases do).

Instead of the pills and powder I used previously I decided to have him take two daily cups of a strong Chinese herb tea consisting of 13 herbs to which I added chuan tui (cicada molting shells) which is specific for external wind heat affecting the skin. I prepared a bag of these herbs per day for 7 to 14 days to be boiled in six cups of water slowly down to two. He was to take one cup morning and early evening together with 2 capsules of the extract of the formula called Dang gui and Tribulus (Dang Gui Yin Zi). In addition he took a teaspoonful of the powdered extract of White Tiger formula (Gypsum Combination or Bai Hu Tang) which is a traditional formula good for children's fevers and for clearing toxic heat from the Stomach (known in TCM as the yang ming area. This is particularly indicated for Stomach heat patterns manifesting on the cheeks and in this case with severe halitosis and itchy red rash along the Stomach meridian down the outer side of the tibia of both legs (characteristic with psoriasis).

Intuitively I recommended that he take a peat moss bath made by simmering four large handfuls of peat moss over a low flame for 20 minutes. This should be poured into a hot bath in which he would immerse himself daily or as often as convenient. He also found that the frequent application of good quality aloe vera gel over all areas of the body helped relieve the inflammation and the itching.

This last treatment protocol beginning with the herbal and acupuncture treatment, culminated with a night of exacerbation of itching sleeplessness. The next morning, he called me and said that he thought he had hit rock bottom and despite the exacerbation, he had a distinct impression of a profound internal shift in his body. It was in fact as the Chinese classics describe the treatment of rashes, using herbs and treatment to ripen them and bring them out to completion. The only thing was that I didn't realize that this could occur with a psoriasis rash. However, true to form, since that night after which he awoke somewhat happier and relieved for reasons he did not completely understand, his condition continuously improved with less itching and a restoring of normal pigmentation and skin density. He called it "the fading of elephant man syndrome," referring to a lessening of the thick raised skin described above.

For some, psoriasis may be impossible to completely cure, especially when there is a hereditary factor involved and the condition is a severe as this man's was. However, this case demonstrates a case where herbs proved to be more effective and satisfactory than standard Western medicine. This patient continues to express his gratitude to me by continually referring patients with intractable conditions to my care.

While every case would be treated individually and differently, for those who may be interested following are a list of acupuncture points I used and the herbs in each of the formulas he was given:

Acupuncture points:
SP 10, LI 11, LI 4 and LV3. This was alternated with a special set of points known as 'Tong's Points" from the practice of a very famous Chinese acupuncturist of the early 20th century.

Following are the Chinese Herbal Prescriptions:

Dispersing Pathogenic Wind (Xiao Feng San) consists of:

Ledebouriella divaricata root, Sophora flavescens root, Gypsum fibrosum mineral, Rehmannia glutinosa root-raw, Schizonepeta tenuifolia herb, Cryptotympana atrata moulting, Arctium lappa fruit, Sesamum indicum seed, Anemarrhena asphodeloides rhizome, Angelica sinensis root, Atractylodes lancea rhizome, Akebia trifoliata stem, Glycyrrhiza uralensis root. (Fang feng, Ku shen, Shi gao, Sheng di huang, Jing jie, Chan tui, Niu bang zi, Hei zhi ma, Zhi mu, Dang gui, Cang zhu, Mu tong, Gan cao.)

Dang gui and Tribulus (Dang Gui Yin Zi) consists of:

Angelica sinensis root, Rehmannia glutinosa root (raw), Ligusticum wallichii rhizome, Ledebouriella divaricata root, Paeonia lactiflora root, Tribulus terrestris fruit, Polygonum multiflorum root, Astragalus membranaceus root, Schizonepeta tenuifolia herb, Glycyrrhiza uralensis root. (Dang gui, Sheng di huang, Chuan xiong, Fang feng, Bai shao, Bai ji li, He shou wu, Huang qi, Jing jie, Gan cao.)

White Tiger (Bai Hu Tang) powdered extract consists of:

Gypsum fibrosum mineral, Dioscorea opposita rhizome, Anemarrhena asphodeloides rhizome, Glycyrrhiza uralensis root (prepared). (Shi gao, Shan yao, Zhi mu, Zhi gan cao.)

In addition, he continued to take Planetary Herbals' Triphala because of its gentle detoxification of the GI tract and the liver and Guggul for its known anti-inflammatory, detoxifying and circulation enhancing properties. Both of these formulas have potent antioxidant properties.

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