Psoriasis is a recurrent skin disease with chronic papule, scales and erythema. In Traditional Chinese medicine, psoriasis is referred to as “white scab”. The main cause of psoriasis is the excessive heat in blood, or fever due to deficiency of blood with external pathogenic Wind, as well as the disharmony between nutrient Qi and blood, causing the excretion of pathogenic toxin which accumulates on the skin, thus developing the symptoms of psoriasis. Majority of cases are established on the theory of blood-heat and blood deficiency, which are treated by clearing heat, cooling and nourishing blood.
Shanxi Yuncheng Xiamin Psoriasis Specialist Hospital is a clinical base for the prevention and treatment of psoriasis in China, specializing in research and clinical practice of psoriasis. Through nearly 30 years of practice, Director Xia-Min Jing revealed that the basic pathogenesis of psoriasis is Kidney Yang deficiency, blood stasis, pathogenic wind that exerts on the exterior body. The treatment principle of “strengthening the kidneys, promoting blood circulation and removing blood stasis, resolving exterior and eliminating ecchymosis” has been applied to the psoriasis treatment and has achieved good results. It is summarized as follows:
- Clinical experience of applying “warming Yang, promoting blood circulation, and resolving exterior therapy” to cure psoriasis
The method is mainly aimed at the syndromes of Kidney Yang deficiency, Qi and blood stasis. To promote blood circulation for removing blood stasis and to resolve exterior by dispersing lung Qi. It is believed that kidney deficiency is the basic reason for the disease, and blood stasis runs through the entire process of the disease. We take the method of warming Yang, promoting blood circulation and resolving exterior therapy as the basic rule, which has a good effect on the treatment of psoriasis.
1) The basic principles of warming Yang, promoting blood circulation, and resolving exterior therapy：
The method of warming Yang, promoting blood circulation and resolving exterior therapy is the basic rule for the treatment of psoriasis. It mainly uses the medicine that warms Yang, strengthens the kidneys promotes blood circulation and removes blood stasis to “strengthen the body”. Herbal ingredients with the effect of warming Yang and strengthening the kidneys can improve the body’s immunity；ingredients with the effect of promoting blood circulation and removing blood stasis can improve and enhance vascular permeability；ingredients with anti-spot effect can promote the body’s metabolism and restore the excretory function of sweat glands and sebaceous glands.
2) Do not forget to strengthen the spleen and Qi in the practice of warming the kidneys, promoting blood circulation and removing blood stasis.
The spleen and stomach are the foundation of acquired life and the source of Qi and blood. If the spleen is strong, it can protect the whole body each season. If the spleen and stomach are weak, they cannot help digest and transform the nutrients from the food and raise the vitality of Yang to protect the whole body. Deficiency of Spleen Yang cannot nourish the lungs, neither can it warm the kidneys to restrain water, then the cold Qi from water damages the Kidney Yang. When Yang Qi is weak, phlegm and blood stasis will be produced. Phlegm and blood stasis are Yin, causing Yang deficiency, even more, forming a vicious circle. As Zi-Gan Zhou points out in Shen-Zhai ‘s Posthumous Work (Shen Zhai Yi Shu), “All uncured diseases will find their roots in the spleen. All matters stems from the soil and returns to the soil.” If the spleen and stomach are strong, they can replenish Qi and blood, and benefit the five internal organs, thereby enhancing the immune system, so that the body can heal itself. Therefore, it is necessary to maintain strong spleen Qi while warming Yang and invigorating the blood.
3) Pay attention to your Qi while warming the kidneys and promoting blood circulation.
“Qi boosts the blood.” While warming Yang and strengthening the kidneys, we need to regulate Qi. It is pointed out in the Nan-ching– The Classic of Difficult Issues that “Qi is the body’s foundation. If Qi is unobstructed, you will not get sick.” So there is a saying that “all diseases are born in Qi”.
The book Treatise on Blood (Xue Zheng Lun) Troubles emphasizes that “all blood stasis will block the flow of Qi, thus stagnating the growth of the body.” Therefore, blood stasis stagnates Qi and damages the body. Regulating Qi must go along with resolving blood stasis. The medicines used for such treatment are pungent, bitter, warm and aromatic that can dispel the cold and warm the body. The aromatics help with clearing stagnated heat in liver and regulating the flow of Qi, thus soothing the Qi, dispersing stagnated Qi and benefits the resurrection of Yang Qi.
4) Dispelling blood stasis is the most important thing in the therapy of warming Yang and strengthening the kidneys, promoting blood circulation and removing blood stasis
“Long-term illness causes roughness in skin and obstructed immune function.”。Tian-Shi Ye further pointed out that “long term sickness is caused by blood stasis”. The warmth of Kidney Yang and the nourishment of Kidney Yin are important guarantees for blood generation, circulation, and body fluid output. Insufficiency of kidney essence leads to the deficiency of Kidney Qi, inability to warm up, stimulate and activate other organs. Failure to transform the essence to blood or deficiency in Yin blood leads to the loss of nourishment in organs and limbs, abnormal Qi movement, obstructed blood flow, astringent pulse and blood stasis. Blood stasis blocks the Qi, the circulation of Qi and blood is blocked so that the kidney deficiency leads to blood stasis, and the relapse of blood stasis aggravates kidney deficiency and causes various related diseases in the viscera. Therefore, kidney deficiency and blood stasis coexist. The deficiency of Kidney Yang leads to blood stasis, blood stasis obstructs blood vessels, hinders the rise of Yang, then causes kidney deficiency Therefore, we say: blood heat is an illusion, blood stasis is the essence. Kidney deficiency is the cause, blood stasis is the result. Blood stasis has become a new pathogenic factor, which aggravates kidney deficiency and forms a bad circulation.
5) Don’t forget to resolve the exterior and promote perspiration while warming Yang and enhancing blood circulation.
As recorded in Yellow Emperor’s Inner Canon (Huang Di Nei Jing) Su Wen: The Generation of the Five Zang Organs, “the lungs coexist with the skin and nourish skin and hair”. This shows that the skin, sweat glands, sebaceous glands, and other tissues can diffuse Lung Qi through sweat glands, help the lungs to breathe, and have the functions of secreting sweat, moisturizing the skin and resisting pathogenic factors. In Yellow Emperor’s Inner Canon (Huang Di Nei Jing) Ling Shu: Acupuncture, it is recorded that “the lungs coexist with the large intestine, which is the gastrointestinal tract and of the digestive system” The function of the large intestine relies on Lung Qi to make the excretion of stool normal, which also plays an important role in excreting pathogens. In addition to dispelling the wind and resolving the exterior, the exterior-resolving medicine also has the functions of expelling ventilating Qi and blood, dispelling wind and activating collaterals, and promoting Yang Qi. Its application is not limited to external syndromes and can be widely used in a variety of internal and external disease syndromes with the treatment method of warming Yang and promoting blood circulation. The medicine used here is not just to relieve exterior syndromes with pungent and warm natured medicines and perspiring, but also to enhance the resistance of the lungs and protect the Qi, so that the pathogens can emerge from the skin. It means that Qi will be strengthened, and disease cured when pathogenic factors are dispelled from the body, which introduces a method beyond merely relieving the external syndromes by sweating.
- Regularity and modern research of warming Yang, promoting blood circulation and resolving exterior medicine therapy
Clinically, Ephedra sinica, Cinnamomum cassia, Panax ginseng root, Velvet antler, prepared common Monkshood daughter root, Cinnamon, etc. are used to achieve the effect of warming Yang and strengthening the kidneys. Angelica, Ligusticum chuanxiong, Carthamus tinctorius, Salvia miltiorrhiza, and Spatholobus suberectus are used for blood circulation. Xanthium sibiricum seed, Angelica dahurica, Schizonepeta tenuifolia, Saposhnikovia divaricata, Notopterygium forbesii are formulated to achieve the effect of relieving exterior syndromes. With the traditional Chinese theoretical guides of “strengthening vital Qi to eliminate pathogenic factor”, these medicines have been formulated and applied in the treatment of psoriasis and have achieved significant effect. Modern pharmacological studies have also confirmed the therapeutic effects of such medicines.
1) Traditional Chinese medicines for warming Yang and promoting blood circulation：
Medicines commonly used for warming Yang：Panax ginseng root, Deer Velvet Antler, Ginger Dry, Cinnamomum cassia, etc. These herbal medicines have the effect of warming Yang and strengthening the kidneys. Monkshood Daughter Root, Cinnamomum cassia have the effect of warming Yang and dispelling cold to relieve pain.
Ginseng is sweet and slightly bitter, slightly warm but not dry, and is good at supplementing vitality, spleen and lungs, replenishing fluid and calming mind. It is called “the most important medicine for the treatment of internal injuries”. Deer Velvet Antler is sweet and warm. The Compendium of Materia Medica (Ben Cao Gang Mu) describes Deer Velvet Antler as“energy replenishment that helps nourishing the blood, benefiting Yang and strengthening muscles”. When used together, these two traditional Chinese medicines can significantly replenish vitality, as well as strengthening the kidneys and enhancing the essence. The combination of the two medicines boosts Yin and Yang to reach harmony in the body, thus supporting Kidney Yang, the essence and blood.
Modern pharmacological studies have confirmed that the combination of the two medicines can enhance coronary flow, reduce whole blood viscosity, improve blood rheology, promote circulatory metabolism, enhance immune function, and fight cortisone-induced immune organ atrophy. Plant hormones with bidirectional regulation. 
Commonly used medicines for blood circulation：Angelica root dry, Ligusticum sinense,Carthamus tinctorius, Spatholobus suberectus, etc. These traditional ingredients have a wide range of pharmacological effects including increasing coronary blood flow, exciting the heart, improving myocardial blood supply, and enhancing myocardial contractility.
2) Traditional Chinese medicines for warming Yang, promoting blood circulation and strengthening Qi：
Commonly used ingredients for replenishing Qi：Codonopsis pilosula, Atractylodes macrocephala, Smilax glabra, Glycyrrhiza uralensis, etc. The Major Four Herb Combination decoction can nourish the spleen and Qi, make the spleen strong and make the stomach function normal. The Combination can also increase coronary blood flow, inhibit platelet aggregation, improve blood circulation, and reduce blood lipids to replenish essence in the lungs and disperse Lung Qi to lower adverse Qi.
3) Traditional Chinese medicines for warming Yang, promoting blood circulation and regulating Qi：
The common medicines are：Citrus aurantium, Citrus reticulata, Monkshood Daughter Root, and Bupleurum falcatum, etc.
For those who have stasis due to poor Qi, the key is to regulate the Qi and use the method of soothing the liver and Qi to eliminate the blood stasis caused by the poor Qi. We usually use Citrus aurantium, Citrus reticulata, Monkshood Daughter Root, and Bupleurum falcatum, etc.
For blood stasis caused by deficiency, the Qi should be emphasized during treatment. We can use Codonopsis pilosula and Atractylodes macrocephala, etc. to administer blood.
The traditional Chinese medicines with the function of regulating Qi has an obvious role in regulating body functions and correcting the imbalance of Qi and blood. Studies have shown a close relationship between such medicines with anticoagulation mechanisms. This confirms the theory of traditional Chinese medicine that “Qi travels while blood travels, Qi stagnation leads to blood stasis”. Such medicines can also increase the number of T cells, adjust the proportion of T cell subsets, increase the activity of NK cells, and improve the body’s non-specific immune function. 
4) The warming Yang, promoting blood circulation method focuses on removing obstruction in collaterals and eliminating ecchymosis
For blood stasis, we use Salvia miltiorrhiza, Panax notoginseng, Persic oil, Carthamus tinctorius, etc. Medicines used for regulating and tonifying the blood have a relatively milder effect, such as Angelica root dry, Ligusticum sinense, Salvia miltiorrhiza, etc., we use them for curing mild blood stasis. Medicines for relieving stasis have a stronger effect, such as Panax notoginseng, Persic oil, Carthamus tinctorius, etc. Especially Rheum palmatum, which is used to regulate both Qi and blood, which is good for promoting blood circulation and removing blood stasis. All external symptoms caused by the disharmony of Qi and blood that appear in collaterals or on the skin can be treated with Rheum palmatum, instead of generalizing the treatment method to expelling water retention by purgation.
Modern pharmacological studies have confirmed that such medicines have the effects of dilating blood vessels, accelerating blood flow, improving microcirculation, improving blood rheology, inhibiting keratinocyte proliferation, and promoting keratinization.
5) Focus on resolving exterior syndromes and eliminating ecchymosis
We usually use Ephedra sinica, Cinnamomum cassia, Schizonepeta tenuifolia, and Saposhnikovia divaricata, etc. to relieve the exterior. To eliminate ecchymosis, we use Angelica dahurica, and Xanthium sibiricum seed, etc. We use Ephedra sinica and Cinnamomum cassia to treat psoriasis, the intention is to promote the Lung Qi, induce sweat, and generate Yang. Although patients with psoriasis suffer from deficiency in internal organ Qi and blood loss, the symptoms of stasis will show on the external skin surface, the lungs are closed, the striae of the skin, muscle and viscus is obstructed. Therefore, it is necessary to use a large amount of pungent-hot Ephedra sinica and Cinnamomum cassia in the medication. The dose of Ephedra sinica sometimes requires 36 grams. Ephedra sinica is a mild medicine that treats exterior symptoms. Ben Cao Zheng Yi records, “Ephedra sinica clears up the heat and lungs, ventilates and opening lines for Qi, it is the best medicine for treating cold. Although it is said to relieve the exterior, it is actually to unblock the lungs. Although it is said to dispel the cold, it is actually to resolve the pathogens.” Cinnamomum cassia is pungent and warm, which helps balancing the harmony between nutrient Qi and defensive Qi that travels through the interspaces of the skin, muscle and viscus. According to Explanation and Demonstration of The Divine Husbandman’s Classic of Materia Medica (Ben Jing Shu Zheng), Cinnamomum cassia has effects including harmonizing nutrient Qi, tonifying Yang and dispelling blood stasis.
Modern pharmacological studies have proved that Cinnamomum cassia can dilate peripheral blood vessels and promote blood circulation on the skin surface. Reaching the Source of Materia Medica (Ben Jing Feng Yuan) reported that “Although Ephedra decoction is a strong and diaphoretic medicine that contains Great Yang, it actually dispels the pathogens from the lung collateral. If the interspaces of skin and muscles is loose, the fluid will be expelled from the body, which leads to Lung Qi deficiency. The mother of Qi should be tonified. Cinnamomum cassia and Glycyrrhiza uralensis can be combined to dispel the wind pathogens to relieve exterior symptoms and prevent the liver from exhausting the spleen. Paeonia lactiflora can be added in the formula to disperse fluid and consolidate the spleen, which benefits the spleen and lungs. Therefore, although Cinnamomum cassia is a mild medicine that contains Great Yang, it indeed is a medicine that helps regulate the spleen and restore the lungs.” Among the medicines for psoriasis， Ephedra sinica and Cinnamomum cassia are chosen in a formula. They are pungent and warm natured drugs that helps opening up interspaces of skin and muscles, as well as opening up the pores, so that the medicines can boost Yang Qi to reaches the surface of the skin and moisturize the skin, thus achieving the desired treatment result.
Ephedra sinica has a wide range of pharmacological effects. Proven effects include perspiring, diuretic, cough relieving, anti-asthmatic, anti-allergic, increasing blood pressure, exciting central nervous system, antipyretic, antiviral, and influencing neuromuscular transmission. Recent studies have found that Ephedra sinica has an inhibitory effect on cellular immunity. It can atrophy the thymus gland and lead to a decrease in T lymphocytes. On the other hand, Ephedra sinica may be influncial to the ratio of helper T cells and suppressor T cells.
According to modern pharmacological research, Schizonepeta tenuifolia and Saposhnikovia divaricata are slow-response substance (SRS-A) antagonists, which can inhibit the release of SRS-A and inhibit delayed skin hypersensitivity. 
In Huang Di Nei Jing, diaphoretic medicines are featured with “pungent-sweet-hot” which can cure the diseases by sweating and dispersing. Theories like “inducing perspiration to treat diseases” and “opening up the sweat glands” are mentioned. In Huang Di Nei Jing Su Wen: The Theory of Yin and Yang Applied to the Nei Ching, the idea of “inducing perspiration through infusion in decoction to disperse the pathogens from the skin” is introduced. There are different diseases and physiques. Although the symptoms are the same, there are differences between deficiency and excess, accompanied blood stasis, and accompanied heat. Therefore, the treatment methods cannot be generalized and fixed during the clinical trial. In particular, several points should be paid attention to when stimulating perspiration: 1. Control the dosage reasonably, stop at the right amount, and prevent excessive sweating from harming the body’s defense ability. Treatise on Febrile Diseases Caused by Cold (Shang Han Lun) states that “To cover up the body and keep warm after taking decoction until slight perspiration over the body, avoid sweating, otherwise the disease cannot be cured.” Therefore, if the patient sweats, he should stop taking the medicine to prevent excessive sweating and loss of vitality, even more, impairing Yin and Yang. Ginseng can be added to prevent excessive sweating. As is stated in Newly Edited Pharmacopoieia (Ben Cao Xin Bian), “By increasing the dose of Ephedra sinica and decreasing the dose of Ginseng in the formula, the pathogens can be dispelled without impairing vital Qi. Therefore, excessive sweating can be avoided.” 2. Pay attention to the method of decoction. Most pungent-cold-hot and pungent-warm-hot exterior-relieving drugs are mild medicines to help relieving exterior. It is not advisable to decoct them for a long time, which might dissipate the medicine and weaken the effect. 3. Avoid excessive replenishment, which might result in accumulating pathogens. The dosage of ingredients that support the vital Qi and resolve the exterior should be controlled to avoid restraining pathogens within the body.
According to modern medical researches, the main effects of traditional Chinese diaphoresis medicines are as follows: (1) Promoting secretion through sweat glands and sebaceous glands and increasing the vasodilation to help eliminate pathogens, which may include the excretion of endotoxins, neutralization of toxins, inhibition of bacteria and viruses, and increasing the defense ability of the body’s phagocytes, etc.; (2) Dilate the surrounding blood vessels to dissipate body temperature and bring down the fever; (3) Improve circulation, promote the excretion of metabolites and relieve local inflammation; (4) Increase the function of glomerulus by sweating and strengthening circulation functions to remove excess water in the body.
In summary：Although the symptoms of psoriasis appear on the skin, the fundamental reason is rooted in the kidneys and the vitality of the body. The treatment of psoriasis must start from the kidneys and improve the vitality of the body. Our paper published in the same journal also confirms that the pathology of psoriasis is immune dysfunction, microcirculation disorder, and capillary stasis, which leads to metabolic disorders, decreased blood circulation, and shortened cell cycle, leading to desquamation. Therefore, Xiamin Jing concluded “blood heat is an illusion, blood stasis is the essence.”. Psoriasis is mainly caused by the deficiency of the vital Qi. If this pathogenesis is met in the clinical syndrome differentiation, the basic principle of warming Yang, promoting blood circulation to resolve exterior syndromes and eliminate ecchymosis can be used. If the kidneys are full of vitality, the essence and blood will be unblocked, so that the Qi and blood can warm the five internal organs, and the disease will heal. However, the patients’ conditions differ, so the performances are vastly different. The situation of individuals should be taken into consideration in the specific treatment application. The method of replenishing Qi, regulating Qi, relieving the exterior, and removing ecchymosis should be used on the basis of warming Yang and promoting blood circulation. To achieve the treatment effect, there should be a thousand formulas for a thousand patients. As Lu Jiuzhi said“Medication depends on the time, place, and person. The aim is to conquer the disease, not to adhere to the old routines.”
Although the method we discussed is different from the current mainstream treatment method, it does not violate the theoretical essence of traditional Chinese medicine. On the contrary, through reverse thinking on the etiology, pathology and treatment of psoriasis, the effectiveness of relevant clinical reasoning also reveals the feasibility and correctness of this method. The application of “warming the kidneys, promoting blood circulation, relieving exterior syndromes and eliminating ecchymosis” therapy in the treatment of psoriasis fully embodies the advantages through the holistic view of traditional Chinese medicine. With the gradual development of researches in traditional Chinese medicine, it is reasonable to believe that the unique advantages of traditional Chinese medicine in the field of psoriasis will capture further attention.
- 丁华，杨文凯，张世玲，等．健脑补肾丸补肾作用韧探[J]中草药，1990，21(6) :22—25．
- 人参与鹿茸配伍的作用机理研究. 张红梅中医药学刊 2001 年第 19 卷.
- 叶 加 蒋益民 钱伯文一于尔辛⋯理气药对荷瘤小鼠免疫功能的影响《中草药》1996 年第 27 卷第 2 期.
- 卞如谦．荆芥油药理研究[J]．浙江医科大学学报,1981, (5):219.
- 荆夏敏. 银屑病理论与实践 山西科学技术出版社.2001.P11.