Record
of Herbal Treatment Of Ihab from Jordan Improvement Of
Psoriasis
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Brief
Summary: On May 2, 2008,
Ihab, a Jordan patient, who suffered
from psoriasis with erythema all over the body as well as
desquamation, was hospitalized
in our hospital. After more than 20-day TCM treatment, his skin
has been improved 60%.
Complainer: The
patient himself Date of Admission: March 14,2008
Major
Complaint: The
patient has suffered from psoriasis for nine
years with erythema over the whole body as well as
desquamation. The condition has
recurred repeatedly over the nine years and has been aggravated
for one year.
Present Illness:In 1999,
there appeared some erythema on his lower leg which was as big
as a coin in size, accompanied with desquamation without any
reasons. The condition was aggravated progressively and spread
throughout the body. The patient was under treatment in some
hospitals in Jordan, Turkey and UAE, but he got no obvious
improvement. To seek better treatment, he was hospitalized in
our hospital on March 14, 2008.
The
erythema existed throughout the whole body, and there were some
silvery, white and dry squame on the erythema. The squame was
easy to fall off and itching. His head, face, trunk and four
limbs had erythema in the widespread way. To scrape it, doctors
would find the phenomena of the pellicle and the bleeding spots
as a sieve. He felt pains in the fingers and elbow joints. He
was thirsty and eager to drink. His food
intake was normal, so was his bowel movement. But there was a
feeling of burning sense in his urination. His sleep was poor
but the spirit was good.
Disease History: No history of
hepatitis, typhoid, tuberculosis, malaria and other infectious
diseases. No history of trauma and surgery. No allergic history
of food or medicine. No history of blood transfusion. The
history of preventive vaccination was unknown.
Personal History:
He was
born in Jordan and traveled to many countries. No contact
history of the schistosome. His living environment was dry. He
is mild-tempered. He smokes and drinks a little wine. He ate
more snacks and the fried food was his favorite.
Marital History:
He got married at the age of 25. His wife is healthy. He has
three sons.
Family History:
His parents are both healthy. His two brothers have the similar
disease.
Physical
Examination:
T 36.4¡æ,
P 79 beats/minute, R 20 times/minute, BP 130/80 mmHg.
He grew normally
with common nutrition. His mind was clear. He was overweight. He
was cooperative in treatment. No jaundice in the sclera. His
skin was moist. No enlargement of the superficial lymph nodes.
The bilateral pupils were round and equal in size.
He had red pharynx.
No swelling of the tonsil. The neck was soft. The trachea is
located in the middle. No enlargement of the thyroid gland. No
thoracic deformity. The sound of breath was normal in the
bilateral lungs. Heart beat was 79 times/minute. Cardiac rhythm
was regular and no pathologic murmurs. Abdomen was flat and
soft. No tenderness or the rebounding tenderness. No percussion
pain on the kidneys¡¯ area. The reflection of the four limbs was
normal. His tongue was light with thin, yellow and greasy tongue
coating. The pulse was string-like and slippery.
Special
Examination:
The soaking
erythema spreads on the head, face, trunk and four limbs. His
skin was covered with many silvery-white scales which were easy
to fall off and itching. To scrape it, there were the phenomena
of the pellicle and the bleeding spot as a sieve. He felt pains
of the fingers and elbow joints.
Patient Ihab, a
35-year-old male, has suffered from psoriasis for nine years
with erythema over the whole body as well as
desquamation. The condition has
recurred repeatedly over the nine years and has been aggravated
for one year. He was picked up by our staff to have the
treatment in our hospital at 7:00 a.m. on March 14,
2008.
Essentials for
Diagnosis:
1. His whole body
had the erythema and falling-off of the scales which has
recurred again and again nearly 9 years and has been aggravated
for 1 year.
2. In 1999, the
patient¡¯s calf had the erythema as big as the coin accompanied
by the falling-off of the scales without any reasons, and his
condition was aggravated progressively all over the body. He
once was treated in Jordan, Turkey, The United Arab Emirates
(the details of the treatment were unknown), but he didn¡¯t get
obviously improvement. So he came to our hospital for treatment
on March 14,2008. His whole body was full of
erythema, there was covered by many silver-white and dry scales
which were easy to fall off and itch. His mouth was dry and he
preferred soft drinks. He reduced food intake. His bowel
movement and urination were both normal. There was bleeding in
the erythema and it had a little pains. The urination had the
feeling of burning. His sleeping was unquiet. His spirit was
normal. He ate more snacks and the fried food was his favorite.
3. T 36.4¡æ,
P 79 beats/minute, R 20 times/minute, BP 130/80 mmHg.
4. He grew normally
with common nutrition. His mind was clear. He was overweight. He
was cooperative in treatment. No thoracic deformity. The sound
of breath was normal in the bilateral lungs. Heart beat was 79
times/minute. Cardiac rhythm was regular. No pathologic murmurs
exist. His tongue was light and the tongue fur was thin, yellow
and greasy. The pulse was string-like and slippery.
5. Special
examination: The patient¡¯s head, face, trunk and four limbs had
the erythemata in the widespread way. His skin was covered with
many silvery-white scales which were easily falling off and
itching. To scrape it, there were pellicles and bleeding spot as
a sieve. He felt pains of the figures and elbow joints.
6. Supplement
examination: Not provided.
Diagnosis Basis:
Traditional Chinese
Medicine: The patient preferred to eat the fried food, which led
to the dampness evil congesting the spleen and stomach,
obstruction of the channels and network channels, the inhibited
qi flowing, then the depression produces heat and the heat hides
in the blood. If the heat meets the external evil, at last two
evils combine together. Thus erythema appears on the skin. All
of these led to this disease. The blood aspect brews the heat
which is combined with the damp evil, so he had the erythemas
progressively all over the body. Sometimes there was the
phenomena of blood flowing and effusion. The joint pains of the
elbows and figures were caused by the obstruction of channels
and network channels as well as the inhibition of the qi and
blood. Since heat evil burns the body fluid with the failure of
ascending result in his dry mouth, he preferred to cold drinks.
Besides, with heat evil disturbing the spirit, his sleep was
poor. The tongue was light and the tongue fur was thin, yellow
and greasy. His pulse was string-like and slippery. All of these
were the phenomenon of the damp-heat brewing. Making a
comprehensive view from the syndrome of tongue and pulse, it is
not difficult to be diagnosed with damp-heat syndrome and
deficiency syndrome and the location of disease was in the blood
and skin. It belongs to the white crust of the damp-heat
brewing.
Western Medicine:
There were large areas of progressively soaking erythemas over
the head, trunk and four limbs. It was covered with many
white-silver scales. To scrape it, there were the pellicles and
the bleeding spots as a sieve. So it can be diagnosed with
psoriasis.
Diagnosis
Differentiation:
Traditional Chinese
Medicine:The patient had the
erythemas over the whole body, and his skin was covered by
white-silver scales which were easy to shed. To scrape it, there
was bleeding. It belongs to the white crust in Chinese medicine.
It should be distinguished with chronic eczema. Although the
chronic eczema has erythemas and scales, but the area of the
damaged skin is often in the flexor aspect, and it itches
seriously, the little scales are not like the white silver. To
scrape it, there will be no bleeding spots. So it is not hard to
be identified.
Western Medicine:It should be
distinguished with dermatitis exfoliativa. Both of them have
abnormal skin and scale shedding. But the dermatitis exfoliativa
is mainly the scale shedding and flaring skin, but there were no
white-silver scales. So it is not hard to be identified.
First Diagnosis:
TCM diagnosis:
White Crust
Western medicine
diagnosis: Psoriasis
Plans for treatment
strategy and nursing:
1. On routine
care of the Chinese medicine department of dermatology.
2. Take Grade¢òcare.
3. Avoid eating
the pungent and stimulative foods.
4. Herbal tea:
Clear heat and dispel dampness; cool the blood and free the
network channels. The formula was made by the doctor himself.
The main herbs as
follows: red peony root,
cooked rehmannia root, etc.
Using the water to
decoct it, three dosages in total, one dosage a day and drink
twice.
5. Acupuncture
and massage once a day.
6. Have more
medical examinations if necessary.
Date: March 15,
2008 Time: 8: 30 a.m.
Today the patient said to Dr. Yan
that he has suffered from erythema and scale shedding all over
the body. Besides, his condition has ever recurred again and
again for nearly 9 years and has been aggravated for 1 year. The
physical examination: T 36.3¡æ,
P 80 beats/minute, R 20 times/minute, BP 130/80 mmHg. Heart and
lungs (-). The abdomen was flat and soft. The special
examination: head, trunk and four limbs were full of the soaking
erythemas. The erythemas were covered by many white-silver
scales. To scrape it, there were thin pellicles and bleeding
spots. His mouth was dry and he preferred cold drinks. His sleep
was unquiet. Sometimes he had the feeling of urination burning.
His tongue was light and his tongue fur was thin, yellow and
greasy. His pulse was string-like and slippery. Doctor Yan¡¯s
analysis:
1. The patient
has suffered from erythemas and
scale shedding all over the body. The condition has recurred
repeatedly over the nine years and has been aggravated for one
year.
2. The special
examination: The head, trunk and four limbs were full of the
soaking erythemas. They were covered by many white-silver
scales. To scrape it, there were thin pellicles and bleeding
spots.
3. His mouth was
dry and he preferred cold drinks. His sleep was unquiet.
Sometimes he had the feeling of urination burning.
4. His tongue was
light and his tongue fur was thin, yellow and greasy. His pulse
was string-like and slippery.
From the above
materials, the Chinese medicine diagnosed as White Crust.
According to the patient¡¯s condition, Dr. Yan thought that this
disease was due to the damp-heat brewing, the treatment strategy
was to clear heat and dispel dampness; cool blood and free the
network channels. And doctor Yan prescribed that adding such
herbs which are used to clear heat based on the currently taking
herbal tea, then prefect all the examinations.
Date: March 16,
2008 Time: 8: 30 a.m.
Today the patient
complained that there was not obvious improvement and he felt
itching and pains in the abdomen where the skin damage exist. He
felt dry mouth and his sleep was unquiet. But there was some
improvement in the shedding of the scales. The checking result
reveals: ESR: 18mm/h, blood exam was normal. The uric acid was
higher than normal 525umol/l. The function of the liver and
kidneys was sound. The rest was normal. And the treatment
strategy was the same before.
Date: March 19,
2008 Time: 8: 30 a.m.
Today the patient
complained that he felt further improvement than yesterday. He
can sleep quiet. He reduced food intake. His mouth was not dry.
There were no pains of the joints. The phenomenon of scales
shedding was decreasing. He only complained that the area of
abdomen lesion was dry. Checking: The skin erythemas have
decreased in the upper limbs and abdomen. The scales were
decreasing. There was no phenomenon of bleeding. But the
erythemas of the lower limbs were still the same. The treatment
strategy was the same as before.
Date: March 22,
2008 Time: 8: 30 a.m.
Today the patient
said that the skin color of the lesion area in the upper limbs
and abdomen became lighter gradually. During the several days,
there was no scales appearance and no itching and pains in these
areas. And the scales in lower limbs were still obvious, but the
area has decreased. There was no phenomenon of seeping and
bleeding. His weight has decrease nearly 10 kg since he came to
our hospital. His sleeping was quiet. He reduced food intake.
His bowel movement and urination were normal. There was a little
pain in the left elbow joint. His tongue was red and his tongue
fur was thin, yellow and greasy. His pulse was soggy and
slippery. Since the patient¡¯s condition has been improved, the
treatment strategy kept the same as before as well as the
formal.
Date: March 25,
2008 Time: 8:30 a.m.
Today the patient
said that his syndrome had got further improvement and the rest
was normal. Checking£ºThe
area of the lesion has decreased clearly. The color of the skin
lesion in the upper limbs and abdomen became lighter. There is
no scales appearance and it was in a healing state. The lesion
of the left calf was still in deep red and there were no
phenomenon of bleeding. He felt a little itching. He did not
complain about the pains of the four limbs. His tongue was light
and his tongue fur was red. His pulse was forceful. The patient
had further improvement so the treatment and formula kept the
same as before. Using the water to decoct, but four dosages in
total, one dosage a day and drink twice.
Date: March 30,
2008 Time: 8:30 a.m.
Today the patient
complained that his whole damaged skin had further improvement.
His sleep was quiet. He reduced food intake. His bowel movement
and urination were normal. His tongue was light and his tongue
fur was thin, yellow and greasy. His pulse was forceful. The
treatment strategy and the formula were the same as before.
Date: April 3,
2008 Time: 8:30 a.m.
Today the patient
said that the syndrome had further improvement. The area of the
skin lesion decreased. The color of the skin became normal
gradually. The itching of the whole body was disappearing. The
color and luster of the part of the lesion area in calf became
deeper where few scales exist. His spirit was normal. His sleep
was quiet. He reduced food intake. His bowel movement and
urination were normal. So the treatment strategy and formula
were the same as before.
Date: April 7,
2008 Time: 8:30 a.m.
Today the patient
said his spirit was normal. His sleep was quiet. He reduced food
intake. His bowel movement and urination were normal. The skin
lesion has been further improved. His whole body had no pains or
itching. The color of the left part of the calf became deeper,
and the affected area has decreased. There were the scales. The
lesion area was a little decreased. His skin was dry and the
rest was normal. According to the patient¡¯s condition and based
on the previous treatment strategy, the herbs will help to
enrich the yin and moisten dryness; quicken the blood and
transform stasis.
Date: April 7,
2008 Time: 8:30 a.m.
Today the patient said that there happened something in his
family, so he had to go home at once. The doctor advised him to
take the herbs home to continue the treatment and he left the
hospital.
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