"Herbal Remedies - Selected Papers of Academic Inheritors from the Shanghai National Third Batch TCM Apprenticeship Program (Selected Papers of Academic Inheritors from the Shanghai National Third Batch TCM Apprenticeship Program)"

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Publish Date: 2006-10-01
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1. Academic Origins
1. The etiology and pathogenesis of psoriasis are related to the "five zang organs," but it is most closely associated with the "liver"
Psoriasis is a common, recurrent, acute, chronic, inflammatory, erythematous, and scaly skin disease. In traditional Chinese medical literature, it is referred to by names such as "dry scaly dermatitis," "loose bark dermatitis," and "white scales." For example, in the Sui Dynasty's Treatise on the Causes and Symptoms of Diseases·Diseases of Sores and Eruptions, it is described as: "Dry scaly dermatitis has distinct borders, dry and tight skin with itching, and white scales appear when scratched." The Ming Dynasty's Comprehensive Experience in Treating Sores and Ulcers·Dermatitis also has similar records, such as: "Dry scaly dermatitis, when scratched, produces white scales, and the skin becomes dry and shriveled, resembling the shape of a crab's track." To this day, in Japan and Southeast Asia, the term "dry scaly dermatitis" is still used. The Qing Dynasty's Essentials of Medical Classics·Key Methods for External Surgery refers to it as "white scales," stating: "The appearance of white scales is like rashes and scabies, with white color and itching that is often uncomfortable. It is caused by wind pathogens invading the skin, but also by blood dryness and inability to nourish the exterior." The Qing Dynasty's Comprehensive Treatise on the Treatment of External Diseases also records similar information. Higher TCM medical schools began using the traditional Chinese medical name "white scales" for psoriasis in the External Surgery of TCM (Fifth Edition) and have continued to use it to this day. Professor Ma Shaoyao initially believed that psoriasis often begins due to invasions of wind-cold or wind-heat pathogens, leading to disharmony of ying and wei, unsmooth qi and blood flow, and blockage of the surface, which gradually turns into heat. Some cases are caused by spleen deficiency and impaired transportation, leading to accumulation of damp-heat, inability to expel externally or regulate internally, and stagnation in the skin. Others are due to wind-cold, wind-heat, and damp-heat pathogens gradually turning into heat and dryness, depleting qi and blood, resulting in wind and dryness, loss of skin nourishment, and blood stasis on the surface. Some cases are also caused by congenital deficiency, liver and kidney deficiency, and disharmony of, leading to the onset of the disease (Ma Shaoyao, Practical TCM Dermatology, 1995 edition). In recent years, due to an increase in cases and accumulated experience, his academic thoughts have expanded. He believes that this disease is a systemic illness, involving both external skin trauma and internal organ injury, and is related to all five zang organs, especially the "liver."
The Nei Jing states: "The heart is the sovereign organ, governing the body's blood vessels, and all blood belongs to the heart; it stores blood and governs consciousness." The Ling Shu·Essence of the Spirit says: "The heart governs the reception of external things." The Mencius·Gaozi says: "The heart is the organ of thought." Mental activities involve the five zang organs, primarily attributed to the heart. The heart is the root of life, and when it is clear, the body is at peace; when it is unclear, the twelve organs are in danger. Its manifestation is in the face, and its nourishment is in the blood vessels. Psoriasis's onset and recurrence are closely related to mental factors. In clinical symptoms, acute phases present with blood heat, stable phases with blood dryness, and chronic phases with blood stasis. The liver is the general's organ, where strategies originate, governing the dispersal of qi, and storing blood. The Su Wen·Generation of the Five Zang Organs states: "The heart combines with the vessels, and the liver combines with tendons. Its manifestation is in the nails. All blood belongs to the heart, and when a person sleeps, blood returns to the liver." Zhu Danxi in the Treatise on the Residual Principles of Learning says: "The liver governs the dispersal of qi." The liver's manifestation is in the nails, its nourishment is in the tendons, and it generates qi and blood. (The Su Wen·Six Jie Zang Xiang Lun) The liver takes blood as its substance and qi as its function. Liver deficiency often leads to blood deficiency, which is seen in psoriasis with blood deficiency symptoms. Liver qi stagnation is often caused by mental stimulation and disharmony of qi flow. The Treatise on Diseases with Similar Symptoms·Treatment Methods says: "The liver, being a wood element, has an upward and dispersing nature and cannot tolerate suppression. When suppressed, the meridian qi reverses." This is an important triggering factor for this disease, especially in female patients. Liver heat or prolonged liver qi stagnation turning into fire, as the saying goes, "excess qi becomes fire." The Treatise on Diseases with Similar Symptoms points out: "When wood is stagnant, it turns into fire," accompanied by symptoms such as acid regurgitation and hypochondriac pain.