The Idea of "Yang Deficiency, Cold and Wet Stasis as the Standard" to Treat Psoriasis Based on Various Theories

: Psoriasis, as one of the nondestructive skin diseases, has a lingering course, heavy winter and light summer, easy to attack repeatedly, and has a great impact on the physical and mental health of patients. The treatment of psoriasis in traditional Chinese medicine is mostly based on the ideological system of "blood treatment", but in the clinical work, the classification of "blood treatment" is too simple, and blood content and fever into the disease. At present, the diagnostic criteria of psoriasis are attributed to the treatment of blood theory, and the evolution of blood fever, blood stasis and blood dryness etiology can not well explain the intermittent development and change of psoriasis, and the classification of syndrome is not unified. Based on various theories, based on the theory and practice of traditional Chinese medicine, this paper believes that the key pathological factor for the onset of psoriasis is Yang deficiency, and the fundamental pathogenesis is cold, dampness and toxic stasis. The treatment should follow the "deficiency is tonic, but actually diarrhea", along with the prescription.


Introduction
Psoriasis (psoriasis) is characterized by erythema, scales and papules, and common clinical recurrent and inflammatory skin diseases, the incidence trend is often heavy in winter and light in summer, lingering course of disease, easy to recurrent [1].According to statistical analysis, the number of patients with psoriasis in the world is increasing year by year, accounting for about 3% of the total population [2].The incidence rate of psoriasis is also rising in China and shows age-related differences, see Figure 1 and Figure 2. Its etiology is not yet clear, and modern medicine believes that [3] is affected by genetics, immunity, environment, spirit and other factors, and its pathogenesis is related to immune inflammation, oxidative stress, cell proliferation and apoptosis.Treatment is usually selected based on the severity of the disease, with moderate and severe treatment, but there are limitations of obvious adverse reactions, high recurrence rate, long course of disease, expensive price and so on, so the new multidimensional treatment system is urgently needed to be solved in clinical practice.Psoriasis belongs to the traditional Chinese medicine "white", "tinea", "tinea", "white shell sores" category [4], throughout the motherland medical dialogue cause of understanding, from the initial exogenous disease, to the middle of the viscera syndrome differentiation, to the last from the blood theory, basic formed with "blood stasis, blood heat, blood dryness" based on the "blood theory" ideological system.But professor xiao-ning yan found in clinical work, due to the north and south region has different climate, diet and living habits, psoriasis patients' physique, and syndrome differentiation is too simple "blood treatment" thought system cannot meet clinical needs, so tutor professor xiao-ning yan based on many years of clinical experience, Yang deficiency, cold poison stasis for the " new point of view, has certain theoretical significance and practical value, hereby elaborated as follows.

Lung, spleen, kidney and viscera
The theory on the sources of various Diseases takes the qi and blood of the zang and fu organs as the core, follows the academic thought of "evil place, its qi will be empty", and has conducted indepth and meticulous research and summary in the field of traditional Chinese medicine dermatology, and makes great contributions."The source of the disease" said "rheumatism evil, guest in Cou reason, the value of cold and wet, and blood gas fight, if the wind gas, less moisture, the wind into the deep, so no juice, for dry tinea also" [5].It expounds that the pathogenesis of psoriasis can be explored on the pathogenesis of psoriasis from the viscera qi and blood as the core.Professor xiao-ning yan from the perspective of lung spleen kidney viscera think the body after initial wind cold wet evil, evil qi remain in the body, long into phlegm, stasis, poison in the human body, human body upright deficiency, external wind cold damp qi or internal injury lead fu evil or external evil stimulate the body caused by adverse factors such as mood, fu evil in lung collaterals, spleen and kidney."Lung main fur" is the basic theory of traditional Chinese medicine.The lung, fur, large intestine and nose constitute the "lung system", which are physiologically interdependent and closely related in pathology [6].Modern medicine or animal experiments have also confirmed the existence of a close connection between the lung and the skin from different angles.From the characteristics of psoriasis, good season, common causes, skin lesions, accompanying symptoms suggest that psoriasis should be treated from the lung.Among them, the relationship between feeling cold evil is the most close, psoriasis skin lesions recurrence is often accompanied by sore throat, cold fever, runny nose and other superficial symptoms.And the rash in the autumn and winter season, spring and summer reduced because the summer high temperature, Cou reason loose, evil gas with sweat, did not hinder the normal operation of qi, blood and body fluid, so scales reduced, rash color light.Autumn and winter season weather is cold, the human body is invaded after the sweat hole is closed, evil is not easy to disperse, so encounter cold and aggravate.Therefore, the wind, cold and wet evil guest in the body is the cause of psoriasis.The occurrence of skin lesions in psoriasis is the result of external evil and endogenous phlegm, dampness and stasis.Psoriasis patients stay in the evil qi, long accumulate into wet, stasis, poison in the human body, resulting in the appearance of phlegm turbidity and stasis poison and other pathological products.The initial pathogenic factor of psoriasis is wind cold dampness, among which cold is Yin evil, which is easy to damage Yang, and the course of psoriasis is long and easy to relapse, easy to damage Yang, patients are often accompanied by waist and knee weakness, chills, cold, edema and other manifestations of Yang deficiency, so the later stage of the disease is based on Yang deficiency.

Fu Xie (the incubated diseases in TCM) theory
The theory of Fu Xie originated from the Huangdi Neijing: "Hidden in the blood, between the flesh".Later, it was considered by doctors that this was the origin of "Fu xie caused bi"."The New Book of Fu Xie" discusses several forms of Fu Xie: "feeling six prostitution and not the disease, after the rear hair, the total is called Fu evil.Fu evil can not only come from the outside, but also come from the inside.This deficiency and evil qi subsidence is the key to "fu evil" [7].Psoriasis can be due to the wind, cold, heat, wet different evil, can also be because of seven feelings of internal injury, qi block, or because of food loss, fat, sweet taste, xin scattered products, resulting in the loss of spleen and stomach, qi is not smooth, long heat, fire poison endogenous [8].Usually, the local temperature of psoriasis skin lesions is higher than that of normal skin, and the skin lesions show invasive erythema and papules.From the analysis of its pathogenesis, considered in the body cannot disperse, resulting in local gas block to stay in muscle cou, manifested as red papules, light scraping the surface visible point bleeding; heat Sheng wind and dry, scales, and accompanied by different degrees of itching.Psoriasis is easy to repeated attack repeatedly, long disease and kidney, in the treatment of long-term use of warm Yang product is easy to damage fluid consumption caused by lack of kidney essence, kidney essence is the human body sufficient, has the role of resisting external evil and make people from disease, kidney essence deficiency can not nourish the skin, resulting in layers of scales [9].To sum up, it can be seen that the length of the hiding time is determined by the strength of the human body, and it occurs from the body when stimulated or activated by the relevant factors.

The blood theory
In the Qing Dynasty, Ye Tianshi Institute founded the theory of blood syndrome differentiation, whose theory used the concept of blood blood in the analysis of the evolution law and the development stage of febrile disease, and highly summarized the pathological changes and syndrome types of febrile diseases.Ye Tianshi said in "warm theory" "after Wei dialect gas, after camp dialect blood" [10].Wei gas camp blood is closely related, wei gas belongs to Yang, camp blood is Yin, the table of the gas for wei, the deep camp for blood, clarify warm evil treatment first in the wei, over time into the air point, qi points evil heat does not retreat, then deep camp blood, the condition is critical.Wei, qi, battalion and blood syndrome reflect different disease location and disease degree.In "On Warm", Ye Shi said that "on the warm evil, the first lung".He believed that at the beginning of warm disease, the first hand too Yin lung meridian, and the syndrome differentiation of lung health [11].The initial clinical manifestations of psoriasis are similar to the location of the first lung.Therefore, the syndrome differentiation of psoriasis can be learned from the syndrome differentiation of health, qi, camp and blood syndrome.In the early stage of psoriasis, mostly drip skin lesions, multifactor body recovery of cold, wind heat evil, and heat caused by.The first symptoms are drip skin lesions, red color, no scales or covered with fine scales, can be accompanied by symptoms of upper respiratory tract infection, cough, sore throat, fever, cold, runny nose.After the dialect gas, the symptoms of the syndrome are not obvious, often ignored, evil into, leading to the disease [12].Diseases such as gas points can be seen psoriatic skin damage is patchy, bright red color, medium scale, dry scales, easy to peel off, scales color is silver white or white, skin damage slightly higher than the normal skin surface, slightly infiltrated, base flushing, dry scales, easy to peel with obvious thirst, greedy cool drink, etc.If who points, gas stages cure, or directly reverse pericardium, lead to poison evil invasion camp, burn Yin, if the disease in patients with psoriasis skin damage characteristics of plaque or oyster shell, dark red, scales, plaque quantity is more, patches to the surrounding, burning Yin, distracted, patients often accompanied by body hot night, anxiety, mood upset, red tongue, pulse and other symptoms.If evil heat into the blood points, skin damage as a map, dark red or red with a large number of scales, scales thick, layers, accumulation shape, color is white or brown, skin hypertrophy, uplift obviously because of burning meridians, easy to consume blood, evil heat blood, blood, blood is both pathological product and pathogenic factors, in turn, block the gas, lead to heat knot appear face dark, dark lips, skin nail or skin burning, restless, itching, insomnia, dream, all at night, tongue red purple, pulse.The syndrome differentiation of blood also provides a guiding ideology for the syndrome differentiation of psoriasis.According to the theory of warm psychology, we classify psoriasis according to the syndrome differentiation and choose reasonable treatment prescriptions, which can shorten the course of patients, eliminate skin lesions, reduce the pain of patients and improve the clinical effect.

Yang deficiency for this, cold dampness toxic stasis as the standard treatment of psoriasis
So far, the treatment plan of psoriasis in modern medicine has some limitations, such as obvious adverse reactions, high recurrence rate, long course of disease and expensive price.Therefore, it is urgent to seek new methods with high cure rate, low price and small adverse reactions.Professor Yan Xiaoning believes that psoriasis is positive and evil, which is based on Yang deficiency, and cold dampness, cold poison and blood stasis are the basic pathogenesis.Its clinical effects can affect different viscera due to the pathological products such as cold dampness and stasis, resulting in the overall or adverse operation of local qi and blood, and a variety of different types, and the pathogenesis and syndrome are not the same.Therefore, for this reason, Professor Yan Xiaoning proposed, based on years of clinical experience, taking the idea of "Yang deficiency as the standard and cold dampness and toxic stasis as the standard" to treat psoriasis.Professor Yan Xiaoning believes that the treatment of psoriasis in traditional Chinese medicine should be treated from three aspects: strengthening warm Yang, dispersing cold and clearing dampness, promoting blood circulation and dispersing blood stasis.

Warm Yang and tonify the kidney, and protect Yang Qi
Psoriasis each repeated, it is more injury Yang, and in the later period of psoriasis patients, true Yin loss, Yin loss and Yang; or with bitter cold, consumption of Yuan Yang, or abuse of hormones, improper reduction, resulting in less fire, so to protect Yang, Yang kidney, strengthen the disease again, and can cure the disease, specimens.For congenital endowment deficiency should fill its kidney Yang; elderly body deficiency, should fill qi and blood [13]; for patients with long injury, treatment effect is not lasting and simultaneously appear cold limb cold, fatigue Yang deficiency symptoms should pay attention to fill Yang, treatment to add warm spleen kidney medicine, for some incurable psoriasis can often achieve good effect.Yang Guilian et al. [14] using warm Yang Yu prescription combined phototherapy for psoriasis patients, found that the serum inflammatory factor and blood rheological indicators in psoriasis patients, so as to alleviate its scales, itching and other symptoms; Xu Mian [15] in syndrome differentiation treatment, concluded that "Yang deficiency cold coagulation, xuan Fu closed depression, wet poison" may be the core pathogenesis of psoriasis, using "warm Yang blood circulation, open xuan fu, dehumidification and detoxification", its effect is very good.Shu Chang [16] The effect of The soup and Guizhi Fuling pill combined with moxibustion puncture and release method in the treatment of stationary psoriasis is very good.The soup is derived from "Theory on typhoid fever", which is the main prescription for the treatment of cold syndrome in Yang deficiency.With aconite, dry ginger and other warm products to resist the internal and external cold evil, and then make licorice, with the essence of Yang, stimulate the corresponding acupoints can achieve warm Yang dispersing cold, qi, fuzheng and dispel evil and other functions.

Spread cold and dispel dampness, promote blood circulation and remove blood stasis
From the theory of viscera theory, the lung is the main qi, lung dysfunction is qi disorder, qi is the handsome blood, qi stagnation is blood stasis; spleen main blood, spleen dysfunction cannot take blood, blood overflow in the blood outside the pulse, and blood stasis influence each other, any viscera dysfunction may lead to blood stasis.Psoriasis is often show thick skin lesions, hard and firm, even can even be fused into a map, surface scales attached tight, often for dark red rash with new bright red rash, the cause of the rash is cou reason yu closed and lead to cold inside heat "cold fire" sign [17], rather than pure heat.The treatment should be added on the basis of clearing away cold and dampness to promote blood circulation and remove blood stasis, dispel the external cold and penetrate the evil of depression, so as to prevent the further development of the disease.For those with hypertrophic plaques or abnormal lipid metabolism, it is caused by internal phlegm, dampness and dampness.At this time, it is necessary to remove phlegm and phlegm, remove phlegm and reduce turbidity, promote blood circulation and remove blood stasis.Yang Suqing et al. [18] observed the efficacy of centipede poison drink and fire needle on plaque psoriasis, and explored its effect on blood rheology.The results showed that with the regression of skin lesions after treatment, the whole plasma viscosity, low blood viscosity and hematocrit level of the patients were significantly lower than before treatment (P <0.05).Mi static [19] using detoxification stasis soup (yellow, soil, root, angelica, peach, safflower, etc.) treatment of 40 cases of blood stasis syndrome psoriasis patients, the results showed that the serum of the tumor necrosis factor (TNF-α), interleukin 8 (IL-8) levels compared are significantly lower before treatment, the difference is statistically significant (P <0.05).Xuan Guowei professor [20] treatment of psoriasis often on the basis of clearing heat and cooling blood, nourishing blood to moisten the dryness of qi, dispersing knot, blood circulation drugs to treat the deep infiltration of the rash.This is not only conducive to the removal of phlegm, turbidity, blood stasis and other pathological products, but also conducive to the external wind and cold dampness in the body, which is conducive to the recovery of the disease.

Perthe evil throughout
According to the theory of lung, spleen, kidney and viscera, wind, cold and dampness are the original and aggravating factor of psoriasis, especially cold evil, so the treatment should be permeated throughout the [21].Professor Tong Xiaolin [22] believes that some diseases that are difficult to be cured for a long time often use the table method for good treatment effect, often used ephedra sweating, cold, Elsholtzia, clear linen, pollen, mustard wind, poria wet, using different treatment methods to go out to dispel evil from various ways.Therefore, in the treatment, we should first dispel the evil, solve the cold, to give the evil a way out, to prevent the evil from deepening and hurting the healthy qi, so that the disease to heal.To prevent evil gas behind closed doors, treatment when treatment is given priority to with qing zi kidney, Fan Ying [23] think on the treatment of fairy hair, fairy spleen, virgin, ink lotus, euzhong, wei ling fairy kidney Yin, nourishing Chinese medicine, it can clear evil out, and clear kidney deficiency, prevent evil inside, can early, quickly control the development of the disease, reduce the affected area.In addition to drug treatment of psoriasis, patients can also live in warm and pleasant places with sufficient sunshine in winter or appropriately increase the sun exposure, strengthen sports in winter, and follow the principle of "treating winter diseases in summer" and "raising Yang in spring and summer" [24].Finally psoriasis patients prevent recurrence of the key is "cure not disease", and fu evil is the breakthrough point of [25], so light diet, avoid temperature dry hot products, quit smoking, avoid wine, high fat, high sugar diet, avoid heat evil endogenous, consumption Yin essence, regular schedule, chang mood, adjust from the habits to help vital qi against evil v to reduce the recurrence of psoriasis, prolong remission, stable condition is very important.Both doctors and patients should also pay close attention to the changes of patient skin lesions, so as to prevent small things.

Summary
The tutor, Professor Yan Xiaoning, deeply studied and explored the theoretical elements of traditional Chinese medicine classics, and discussed the ideas and methods of dermatology syndrome differentiation treatment based on the clinical practice of traditional Chinese medicine dermatology, combined with the modern medical research results and his own clinical experience.Professor Yan Xiaoning proposed that "Yang deficiency is based, cold and dampness poison stasis as the standard" is the key factor in the occurrence and development of psoriasis.Cold and dampness poison are endogenous, and stasis and blood accumulation is the underlying pathogenesis.Not only pay attention to the local skin lesions, but also pay attention to the overall imbalance of the viscera and qi and blood, and strive to give consideration to the local and the whole.In terms of overall syndrome differentiation, it pays attention to the syndrome differentiation of viscera and meridians, and in terms of micro syndrome differentiation, it pays attention to "cold evil", "wet evil" and "toxic evil".When the treatment strategy follows the "Internal Classics" "false supplement, actually diarrhea", with the addition and decrease of evidence, the clinical effect can be achieved [26].TCM treatment for psoriasis has potential advantages and deserves attention.Of course, the theory of "treating psoriasis based on Yang deficiency, cold, dampness and toxic blood stasis as the standard" is still in the preliminary exploration stage, both in the induction and arrangement of the clinical manifestations of patients, or in the specific intervention measures are more in-depth and detailed observation and research.It is hoped that under the guidance of Professor Yan Xiaoning's academic thought of equal emphasis on Chinese medicine and western medicine and integration of Chinese medicine and western medicine, we can have a deeper and comprehensive understanding of psoriasis, so as to find a more reasonable and effective treatment plan.

Figure 1 :Figure 2 :
Figure 1: Prediction of the number of psoriasis patients in China from 2019 to 2030