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%.

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Records of Hospitalization

Name: Ihab                                         Sex: Male

Age: 35                                               Profession:  Businessman

Country: Jordan                                  Marital Status: Married

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℃, 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.

Supplementary examination: Not provided.

Chinese medicine diagnosis: White Crust   （Damp heat accumulation）

Western medicine diagnosis: Psoriasis

First Medical Record

At 7:50. On March 14, 2008

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℃, 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 GradeⅡcare.

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℃, 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：The 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.