How to Treat Psoriasis with Chinese Herbal Medicine

 Tiejun Tang

Psoriasis is a chronic inflammatory skin disease characterized by red, scaly patches that can cause severe physical discomfort and psychological distress. The disease is prevalent in the UK, and modern medicine offers limited treatment options with often unsatisfactory efficacy. Can traditional Chinese medicine (TCM) treat psoriasis? How effective is it? What are the underlying mechanisms? This paper aims to answer these questions from the perspective of patients.

Incidence of Psoriasis in the UK and Worldwide

Psoriasis affects approximately 1.7% of the UK population, equating to around 1.1 million individuals^.[1] Globally, prevalence rates vary significantly, with Western countries reporting rates of around 2%, while East Asia has a notably lower prevalence of approximately 0.12%. These variations may be influenced by genetic, environmental, and lifestyle factors.

Western Medicine Treatment Principles

In Western medicine, psoriasis is understood as an immune-mediated disorder involving the overproduction of skin cells. Treatment strategies aim to reduce inflammation and slow skin cell turnover through the following approaches:

·       Topical Treatments: Corticosteroids, vitamin D analogs, and moisturizers are commonly used for mild to moderate psoriasis.

·       Phototherapy: Controlled exposure to ultraviolet (UV) light can help reduce symptoms in moderate to severe cases.

·       Systemic Medications: For severe psoriasis, systemic treatments include methotrexate, cyclosporine, and biologic agents targeting specific immune pathways.

Despite these options, challenges persist, including variable patient responses, potential side effects, frequent relapse after drug withdrawal, the high cost of biologic therapies, and long waiting times for phototherapy in the NHS^.[2]

Traditional Chinese Medicine Perspectives on Psoriasis

TCM conceptualizes psoriasis as a manifestation of internal disharmony, often attributing it to factors such as blood heat, blood dryness, blood stasis, and blood deficiency^.[3] According to TCM theory, these imbalances disrupt the flow of Qi and blood, leading to skin lesions. External factors such as wind, dampness, and heat, along with emotional stress and dietary habits, are also considered contributory. This holistic perspective emphasizes the interconnectedness of bodily systems and the need to address underlying imbalances. TCM employs a personalized approach, tailoring treatments based on individual presentations and underlying patterns.

The Efficacy of TCM in Treating Psoriasis

The efficacy of Chinese medicine in treating psoriasis has been found to be satisfactory. A review of 40 clinical research reports found that:

·       15 studies used Chinese herbal decoctions based on syndrome differentiation,

·       5 studies used Chinese patent medicines,

·       10 studies used Chinese herbal fumigation combined with narrow-band ultraviolet (NB-UVB) phototherapy,

·       10 studies used Chinese herbal baths combined with phototherapy.

              The reported efficacy in these studies ranged between 90% and 100%. ^[3]

Modern Pharmacological Research on TCM Treatments

Research has identified a close association between the AhR/NF-κB axis and the inflammatory response in psoriasis. Indigo Naturalis (IDG) is a commonly used traditional Chinese medicine for psoriasis treatment. Studies suggest that its mechanism may involve the regulation of the AhR/NF-κB signaling pathway. Experimental research has demonstrated that IDG treatment significantly reduces TNF-α, IL-6, and NF-κB mRNA levels while enhancing the expression of AhR and CYP1A1 mRNA. Additionally, IDG promotes the translocation of AhR from the cytoplasm to the nucleus. In psoriasis-like mouse models, IDG significantly improved skin lesion severity, reduced inflammatory cytokines (such as IL-6, IL-17A, MCP-1, and TNF-α), increased CYP1A1 protein expression, and inhibited p65 and p-p65 protein expression. ^[4]

Shengma Jiedu Decoction is a commonly used TCM prescription for psoriasis treatment. The key ingredients, Shengma (Cimicifugae Rhizoma) and Tufuling (Smilax glabra Roxb), have been studied using network pharmacology combined with RNA sequencing. Research suggests that this herbal pair significantly improves psoriasis lesions, reduces inflammatory cell infiltration, and suppresses keratinocyte proliferation. Potential targets include TNF, JNK, IL-6, and IL-1β. ^[5]

Jingfang Granule (JFG) is derived from the ancient prescription Jingfang Baidu San. Research utilizing network pharmacology and molecular biology techniques has shown that JFG improves psoriasis by inhibiting the maturation and activation of BMDCs and reducing keratinocyte proliferation and inflammation. ^[6]

Shibiman (SBM) is a traditional Chinese medicine preparation composed of Renshen (ginseng), Danggui (angelica), Heshouwu (Polygonum multiflorum), and Luhui (aloe vera). Studies indicate that SBM significantly alleviates imiquimod-induced psoriatic skin inflammation in mice by inhibiting the IL-23/Th17 axis and CXCL16-mediated endothelial activation. ^[7]

Conclusion

A large number of clinical randomized controlled trials (RCTs) have demonstrated that Chinese medicine is effective in treating psoriasis, with a favorable safety profile and minimal side effects. The mechanisms of action have been supported by extensive molecular biological research. Whether through single herbs, compound decoctions, or patent remedies, TCM provides multiple viable options for psoriasis treatment.

References

1.     https://cks.nice.org.uk/topics/psoriasis/background-information/prevalence

2.     SP. Smith. "The Landscape of Psoriasis Provision in the UK." Clin Exp Dermatol. 2020 Dec;45(8):1040-1043.

3.     Yang Su. "A Review of Chinese Medicine for the Treatment of Psoriasis: Principles, Methods, and Analysis." Chin Med. 2021 Dec 20;16:138.

4.     Yu Lin. "Indigo Alleviates Psoriasis Through the AhR/NF-κB Signaling Pathway: An In Vitro and In Vivo Study." PeerJ. 2024 Oct 21;12:e18326.

5.     Xueqing Hu. "Combining Network Pharmacology, RNA-seq, and Metabolomics Strategies to Reveal the Mechanism of Cimicifugae Rhizoma - Smilax Glabra Roxb Herb Pair for the Treatment of Psoriasis." Phytomedicine. 2022 Oct;105:154384.

6.     Qingqing Xu. "Jingfang Granules Exert Anti-Psoriasis Effects by Targeting MAPK-Mediated Dendritic Cell Maturation and PPARγ-Mediated Keratinocyte Cell Cycle Progression In Vitro and In Vivo." Phytomedicine. 2023 Aug;117:154925.

7.     Chenyang Zhang. "Traditional Chinese Medicine Shi-Bi-Man Ameliorates Psoriasis via Inhibiting IL-23/Th17 Axis and CXCL16-Mediated Endothelial Activation." Chin Med. 2024 Mar 1;19:38.

How Cupping Works: from Practice to Mechanism

Tiejun Tang

Cupping therapy is a traditional healing practice that has gained significant attention in recent years due to its purported health benefits. Rooted in ancient medical traditions, cupping is used in various cultures to treat a range of ailments. This article explores the history, clinical indications, contraindications, and scientific mechanisms underlying cupping therapy.

History of Cupping Therapy

Cupping therapy dates back thousands of years and has been used in different forms across many civilizations. The earliest recorded use of cupping can be traced to ancient Egyptian, Chinese, and Middle Eastern cultures. Egyptian medical texts, such as the Ebers Papyrus (circa 1550 BC), mention cupping as a method to remove toxins from the body. In Traditional Chinese Medicine (TCM), cupping is associated with promoting the flow of Qi (vital energy) and blood circulation. Islamic medicine, as documented by renowned scholars like Avicenna, also advocated for cupping as a therapeutic intervention for various diseases. The tools for cupping have evolved from animal horns used in ancient times to bamboo, pottery, glass, etc.

Clinical Indications of Cupping Therapy

Cupping is commonly used for a variety of conditions, including:

• Musculoskeletal pain: It is frequently applied to alleviate conditions such as back pain, neck pain, and arthritis.
• Respiratory issues: Cupping has been traditionally employed to relieve symptoms of colds, asthma, and bronchitis.
• Stress and anxiety: The relaxing effect of cupping may help in reducing mental stress and tension.
• Digestive disorders: Some practitioners use cupping to aid digestion and treat gastrointestinal conditions.
• Sports recovery: Many athletes incorporate cupping to reduce muscle soreness and improve recovery time.

Contraindications of Cupping Therapy

While cupping is generally considered safe, it is contraindicated in certain conditions, including:

• Skin infections or open wounds: Cupping over compromised skin can lead to infections.
• Bleeding disorders: Individuals with hemophilia or those on anticoagulant therapy should avoid cupping due to the risk of excessive bruising.
• Pregnancy: Cupping should be avoided over the abdomen and lower back in pregnant women.
• Severe cardiovascular conditions: Those with uncontrolled hypertension or cardiac disease should seek medical advice before undergoing cupping therapy.

Scientific Explanation of the Mechanism of Cupping

Cupping is believed to promote healing by enhancing blood flow, reducing pain, and removing toxins. Modern research suggests that cupping therapy exerts its effects through multiple physiological mechanisms:

1.    Pain Modulation via Diffuse Noxious Inhibitory Controls (DNICs):

Cupping may activate the body's DNIC system, where the introduction of a new noxious stimulus (the suction) can diminish the perception of pre-existing pain. This "pain inhibits pain" phenomenon suggests that the discomfort from cupping can trigger the body's pain-relief mechanisms.^[1] ​

2.    Enhanced Blood Circulation and Nitric Oxide Release:

The suction effect of cupping causes localized vasodilation, increasing blood flow to the treated area.^[2] This process may involve the release of nitric oxide, a molecule that regulates blood pressure and promotes vascular health. Improved circulation can facilitate the removal of toxins and supply oxygen-rich blood to tissues, aiding in healing and reducing muscle tension.^[3] ​

3.    Reflex Zone Stimulation:

According to reflex zone theory, stimulating specific skin areas through cupping can influence corresponding internal organs and tissues. This suggests a neurobiological connection where cupping affects deeper structures via skin receptors, potentially improving organ function and alleviating discomfort.^[1]  ​

4.    Activation of Endogenous Analgesic Systems:

The mechanical action of cupping may stimulate mechanosensitive nerve fibers (Aδ and C fibers), leading to the release of endorphins—natural pain-relieving chemicals. This mechanism is similar to that proposed for acupuncture, where physical stimulation results in analgesia.^[2] ​

5.    Hemorphin Release from Hemoglobin Degradation:

Cupping can cause minor bleeding under the skin, leading to the breakdown of hemoglobin. This process may release hemorphins, peptides with analgesic properties, contributing to pain relief experienced after cupping sessions.^[2] ​

The above studies provide scientific evidence for the mechanism of cupping therapy, and further scientific research is needed to fully reveal the mystery of cupping therapy.

Conclusion

Cupping therapy remains a widely practiced and valued treatment in both traditional and contemporary medicine. While scientific evidence continues to evolve, many individuals report significant relief from various ailments. However, it is crucial to consult a qualified healthcare provider before undergoing cupping therapy, especially for those with underlying health conditions.

As interest in alternative medicine continues to grow, further research will help clarify the full range of benefits and mechanisms behind this ancient therapeutic practice.

  Reference:

1.    Abdullah MN Al-Bedah .The medical perspective of cupping therapy: Effects and mechanisms of action. J Tradit Complement Med. 2018 Apr 30;9(2):90–97

2.    Changzheng Song. Hemorphin-Based Analgesia: A Mechanism of Cupping Technique? J Pain Res. 2023 May 29;16:1751–1754.

3.    Dominador Perido. How does cupping work? Mechanisms of action explained. Massage Magazine 2022; Dec. 12.