Evidence Quality Of The Included Srs/mas
The details of the GRADE assessment of 45 outcomes in 14 SRs/MAs are presented in . The results indicated that 15 , 16 , and 14 outcomes were rated as moderate, low, and very low quality, respectively. No outcome of high-quality evidence was found. The experimental designs of all the original RCTs had a serious risk of bias, which was the main factor for the downgrading of the evidence quality. The secondary factors for downgrading were publication bias , inconsistency , and imprecision .
Chinese Herbal Medicine For Psoriasis: Evidence From 11 High
- 1Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- 2Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
- 3Shanghai Dermatology Hospital, Tongji University, Shanghai, China
Background: Chinese herbal medicine provides a theoretical basis for the treatment of psoriasis with considerable benefits and a low toxicity. The purpose of this quantitative study was to show high-quality evidence of the efficacy and safety of CHM for the treatment of psoriasis to promote its clinical application.
Methods: Several databases were systematically searched including PubMed, Embase, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure, Chinese Scientific Journals Database, and Wan Fang Database. High-quality randomized controlled trials that compared CHM with non-CHM interventions were included. The RevMan5.3 software was used to calculate risk ratios at 95% confidence intervals and conduct the meta-analysis.
CHM appears safe and effective in the treatment of psoriasis and has a great positive impact on the DQLI of patients however, CHM could not completely eliminate skin lesions, improve pruritus severity, and reduce the recurrence rate.
Characteristics Of Psoriasis Vulgaris In China: A Prospective Cohort Study Protocol
Ying Luo1#, Yi Ru1#, Xiaoying Sun2, Yaqiong Zhou2, Yingyao Yang1, Tian Ma1, Rong Xu1, Jie Chen1, Mi Zhou1, Kan Ze1, Li Ju1, Yanjiao Wang1, Qingfeng Yin3, Ruiping Wang4, Bin Li1,2, Xin Li1,2
1Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai Academy of Traditional Chinese Medicine , 3Jiangsu Famous Medical Technology Co. Ltd, Nanjing University of Traditional Chinese Medicine , 4Office Clinical Research Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , , China
Contributions: Conception and design: X Li, B Li Administrative support: X Li, B Li Provision of study materials or patients: X Sun, Y Zhou, Y Yang, T Ma, R Xu Collection and assembly of data: J Chen, M Zhou, K Ze Data analysis and interpretation: Q Yin, L Ju, R Wang Manuscript writing: All authors Final approval of manuscript: All authors.
#These authors contributed equally to this work.
Correspondence to:
Trial registration: The trial has been registered at ClinicalTrials.gov .
Keywords: Psoriasis characteristics cohort study Chinese Medicine protocol
Submitted Sep 18, 2019. Accepted for publication Oct 10, 2019.
doi: 10.21037/atm.2019.10.46
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Understanding Psoriasis From A Traditional Chinese Medicine Perspective
Psoriasis is a chronic inflammatory skin condition that affects more than 7 million Americans. This skin condition is seen throughout the world and affects people of all races and ethnicities.
Conventional medicine and modern scientific understanding of this disease attribute much of the underlying mechanisms to dysregulation of the immune system. Hence, modern treatment includes topical steroids, and various biologics that target TNF-a, or IL-17. These newer treatment modalities are very successful in suppressing inflammation and achieve near-complete clearance of skin disease.
Traditional Chinese medicine , has also been used to treat psoriasis and other skin conditions. It uses acupuncture, massage, and herbal skincare, and it has a very long tradition spanning over thousands of years of clinical experience. In the recent decade, TCM has become more popular in the US, Australia, and countries in Europe. Many patients who gravitate towards natural options are seeking care through TCM.
What are the general concepts in Traditional Chinese Medicine? How does TCM health care providers think about psoriasis? What do they use? Lastly, what do patients seeking TCM need to know?
Oral Chinese Herbal Medicine For Psoriasis Vulgaris: Protocol For A Randomised Double
BMJ Open 2017 November 3, 7 : e014475
INTRODUCTION: Psoriasis vulgaris is a common skin disease that is characterised by persistent localised erythematous scaly plaques. Yinxieling is a Chinese herbal formula for psoriasis that has been used for more than 20 years in China. To facilitate application, PSORI-CM01 was developed based on the optimisation and simplification of Yinxieling tablets performed in a previous study and in clinical practice. However, the scientific evidence regarding whether PSORI-CM01 is more effective for psoriasis than the original Yinxieling remains insufficient. Therefore, we designed a randomised clinical trial to investigate the effect, safety and cost-effectiveness of PSORI-CM01 granules compared with those of Yinxieling tablets for the treatment of patients with psoriasis.
ETHICS AND DISSEMINATION: This research protocol had been reviewed and approved by the institutional review boards of three trial centres , Affiliated Hospital of Tianjin Chinese Medicine Academy and Third Hospital of Hangzhou ). The findings will be disseminated to the public through conference presentations and open-access journals.
TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry Pre-results.
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Treatment Approach For Psoriasis
The way in which psoriasis is approached in traditional Chinese medicine is fundamentally different from how it is diagnosed and treated in the West. Psoriasis, known as bai bi in traditional Chinese culture, is said to be caused by “heat pathogens” that trigger the characteristic redness of the skin.
As the disease progresses, blood “dryness” and “stagnation” are believed to cause the itching, discomfort, and scaly plaque formations that typify the autoimmune disorder.
Because TCM is based largely on impression and personal experience, recommended treatments can vary from one practitioner to the next. Unlike Western medicine, TCM remedies don’t so much treat the disease as correct the imbalances that give rise to conditions like heat, dryness, and stagnation.
TCM remedies are often mixed and matched to target individual imbalances. If blood heat is the primary concern, herbs that “clear heat” would be used in greater quantity than those used to relieve stagnation or dryness.
While the effectiveness of TCM in treating psoriasis in largely unproven, there have been some promising findings.
Chinese Medicine For Psoriasis Vulgaris Based On Syndrome Pattern: A Network Pharmacological Study
Jiangyong Gu
1Dermatology Hospital of Southern Medical University, Guangzhou 510091, China
2Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510006, China
3The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
4Department of Biochemistry, School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
Academic Editor:
Abstract
1. Introduction
TCM formulae are mainly oral systematic drugs and the selection of appropriate treatment is based on the different syndrome type of psoriasis. These formulae can be used in the form of Chinese herbal medicine decoction or commercial products, such as pills and tablets.
2. Materials and Methods
2.1. Data Collection
The herbal compositions of the three formulae were collected from the Chinese Pharmacopoeia . Subsequently, the chemical identifications, physicochemical properties, and 3D structures of compounds which existed in each herb were retrieved from the Psoriasis Database of Traditional Chinese Medicine . The structures of the FDA-approved drugs for psoriasis were downloaded from DrugBank . The psoriasis-associated proteins were collected from three sources: the targets of psoriasis drugs from DrugBank, the psoriasis-related targets from the Therapeutic Target Database and PDTCM, and the targets summarized from the literature which have been reported in a previous work .
2.3. Molecular Docking
3. Results
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Dietary Guidelines For Psoriasis
Diet can influence the development of psoriasis. Chinese medicine recommends staying away from rich, fatty foods especially sea food, because it causes the accumulation of heat in the body. Spicy foods as well exacerbate heat conditions. Instead, eat fish rich in omega 3 fatty acids such as salmon and sardines. Focusing on a diet rich in omega 3 has been suggested to help psoriasis.
Research On Herbal Medicine For Psoriasis
There have been a number of interesting studies looking at the effects of Chinese herbal medicine as a treatment for psoriasis.
For instance, Zhang et al compared the herbal Compound Zeqi Granule with acitretin a medication used for psoriasis. The authors concluded that the formula could remarkably alleviate the symptoms of the disease and decreased the abnormal serum levels of TNF- and IL-8.
Fan et al compared a different formula with vitamin A acid tablets in patients with psoriasis. After 60 days, there were no significant differences between the two groups, which had both seen improvements.
However, the levels of Adverse Effects was 3.1% in the herbal treatment group and 92.5% in the control group . The authors concluded that Lanchuan Qingre decoction was an effective formula for psoriasis with significantly fewer side-effects than vitamin A acid tablets.
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Classification Of Psoriasis According To Traditional Chinese Medicine
Psoriasis is commonly classified into three main syndromes namely Blood Heat, Blood Dryness and Blood Stasis.
- Blood Heat Syndrome. Patients in this category usually present with an acute eruption of numerous bright, active, red lesions that can spread quickly and have an irregular and guttate pattern. Patients often complain of intense itch. Looking at the Western conventional classification, Blood Heat Syndrome most closely resembles that of guttate psoriasis which can occur after a bacterial infection.
- Blood Dryness Syndrome. Patients in this category present with more of chronic diseases with large and coalescent plaques. Skin lesions tend to be thicker and hard to peel off. In addition, the skin is dry and cracked. In terms of classifications by conventional medicine guideline, Blood Dryness Syndrome resembles that of psoriasis vulgaris, the most common type of psoriasis.
- Blood Stasis Syndrome. Patients in this category have a chronic condition with clearance and relapse of skin lesions. The lesions are asymmetrically distributed throughout the body. Psoriatic plaques can vary in size and thickness, and most lesions have dull red colors. Blood Stasis Syndrome does not have a clear counterpart in western classification.
Traditional Chinese Medicine Treatment For Psoriasis
In my 15 years as a Chinese medicine practitioner, I have helped many people with psoriasis. When you start treatment, our first consultation will review your complete medical history and the development of the psoriasis. This, along with looking at your skin, will provide the information needed to identify the nature of the psoriasis.
We will then use acupuncture, string herbal teas called decoctions, and topical herbal medicine to treat your psoriasis. The therapies are customized to address the specific type of psoriasis you are experiencing.
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Chinese Herbal Medicine Treatment Of Psoriasis
Chinese herbal medicine is most often given in multiherb formulas which are drank as a tea. The herbs are personalized for each patient based upon their specific symptoms and work synergistically with other herbs in the formula to target the imbalances underlying the psoriasis.
TCM herbal medicine is a standard therapy for psoriasis throughout China. Herbs are given in formulas that contain a combination of many herbs, each one having a healing function geared toward resolving the underlying disharmony. Herbs are often given in teas or pills as well as external soaks and creams, which are very important for psoriasis treatment.
There are hundreds of herbs used in Chinese medicine for treating psoriasis. Here is a profile of just a few common herbs used for different types of psoriasis. Many of the herbs for clearing heat have been shown to reduce inflammation.
This article is for educational purposes only does not serve as medical advice. Please consult a Chinese Medicine Practitioner before taking Chinese herbal medicine.
For treating heat, the herbal formula will focus on herbs that are cooling. Sheng di huang and Zi cao are both cooling herbs that are central in the treatment of heat. These herbs have been shown to reduce the inflammatory cytokine TNF-,which is active in psoriasis.
Traditional Chinese Medicine Offers Treatment For Psoriasis
A treatment for plaque-type psoriasis has been discovered in Traditional Chinese Medicine . An ointment produced from the plant-based powder indigo naturalis, a TCM herb, has been proven to be effective in the treatment of the skin condition. The study appears in the November issue of Archives of Dermatology.
Psoriasis is a chronic skin disease for which no cure exists present therapies can lead to remission of the skin condition. The recent study was carried out by Yin-Ku Lin, M.D. and colleagues from the Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
In TCM, indigo naturalis is used in combination with heat-clearing and blood-cooling herbs for blood detoxification. Indigo naturalis for the treatment of psoriasis is a safe long-term therapy with prolonged efficacy that has virtually no adverse side effects. Because the disease is resistant to conventional therapies, developing an alternative treatment is necessary.
TCM has been documented for over 1000 years for the effective treatment of various inflammatory skin diseases. Recalcitrant psoriasis, when treated with indigo naturalis composite ointments, can show significant clinical improvement, leading to long-term remission of the condition.
At twelve weeks of treatment, the scaling, redness and hardening of the skin plaques significantly improved for the plaques treated with the indigo naturalis composite ointment in comparison with the plaques treated with the non-medicated ointment.
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Acupuncture Treatment For Psoriasis
Acupuncturist may use needles around a psoriasis flare, attempting to bring more qi to the affected area and balance the immune system. This is called surrounding the dragon. There is no strong evidence support that acupuncture can be an effective treatment for psoriasis. Some studies have shown acupuncture helps to relieve psoriasis symptoms. Some studies claim that there is no benefit from acupuncture. Many TCM practitioners believe herbal medicine often generate better results for skin conditions.
Risk Of Bias In Individual Studies
For each included study, two investigators completed the Jadad scale used specifically for the quality of the evaluation method. A third-party researcher was consulted whenever there was a disagreement between the two investigators. Four dimensions of the Jadad scale were applied in this research, namely randomization, concealment, blind method, and reports of withdrawals and dropouts. Trials scoring 1â3 points were considered low quality and 4â7 as high quality.
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Chinese Herbal Bath For Psoriasis
Itching is the most common symptom of psoriasis. For people with psoriasis, the immune system incorrectly triggers inflammation, which leads to itching. Scratching the itchy patches will make the plaques worse and increase the risk of infection. In Chinese medicine, Ku Shen is known for its ability to reduce itching.
Bathing once a day in a decoction made from the following ingredients: 60g Ku Shen 30g Tu Fu Ling 30g Yin Chen Hao 30g Da Huang 30g Ye Ju Hua 30g Zi Hua Di Ding 30g Gan Cao
Description Of The Chm
A total of 110 formulas were found in the intervention group of CHM decoction, and the top eight high-frequency used herbs were used more than 50 times including Radix rehmanniae preparate, Cortex moutan, Radix peoniae rubra, Radix salvia miltiorrhizae, Rhizoma smilacis glabrae, Flos lonicerae, Radix arnebiae seu lithospermi, and Radix glycyrrhizae uralensis. Thirty formulas were applied in the intervention group treated with CHM bath, and the top seven most frequently used herbs were Fructus kochiae scopariae, Cortex dictamni, Radix sophorae flavescentis, Radix salvia miltiorrhizae, Radix angelicae sinensis, Rhizoma smilacis glabrae, and Cortex phellodendri. In the intervention group receiving the CHM fumigation, 13 formulas were used and the herbs that were used more than 5 times consisted of Radix sophorae flavescentis, Cortex dictamni, Flos lonicerae, Radix rehmanniae preparate, Flos chrysanthemi indici, and Radix angelicae sinensis. The details of high-frequently used herbs for psoriasis in the intervention group of CHM decoction, bath, and fumigation are generalized in . A total of 10 CHM patent medicines were used in these included studies, and the xiaoyin granule was the most commonly used drug. The composition of Chinese patent medicines used in the included studies is presented in .
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Risk Of Bias Of The Included Srs/mas
The risk of bias of all SRs/MAs in phase 1 and domain 1 evaluated by the ROBIS tool was rated low. Domain 2 assessed the identification and selection of studies, in which 4 articles were rated low risk. Ten articles were rated as low risk of bias in domain 3 , six articles were rated as low risk of bias in domain 4 , and seven articles were rated as low risk of bias in phase 3 . The details of the ROBIS assessment of the included SRs/MAs are shown in .
Data Management And Monitoring
All study data including informed consent forms, will be collected and maintained in a dedicated database for medical research records and must be submitted by investigators at the end of the follow-up period. The principal investigators at the participating hospitals are responsible for collecting the medical research records from the study investigators, as well as for reviewing and storing these records.
The data report adopts the electronic Case Report Form , and a specially-assigned person is in charge of data entry at each center. To ensure the quality and consistency of the source data and the database input, two researchers will work independently to verify the source data with the eCRF data. In case of any discrepancy, a query list will be created, and the researchers must respond to the query list to resolve the discrepancy. All documentation related to quality control will be maintained to allow future objective evaluation of the safety and critical efficacy outcomes.
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