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T2 Liu Psoriasis

T2, Psoriasis, Liu, Bastyr

QuestionAnswer
Chinese name for Psoriasis: Psoriasis is also known as Niu Pi Xian (“cow skin tinea”) because the affected area is like cow’s skin, thick & tough •Also, In TCM, it is called Yin Xue Bing 銀屑病
Describe Psoriasis: It is a common, chronic, recurrent disease • It varies in severity from one or two lesions to widespread dermatosis, sometimes associated with disabling arthritis or exfoliation
Who is effected by Psoriasis: • ~2-4% of whites and far fewer blacks are affected
Onset of Psoriasis: Onset is usually between ages 10-40, but no age is exempt. A family history of psoriasis is common
TCM Etiology of Psoriasis: Wind heat damp on the skin – channels and collaterals are blocked 
Main organs involved w Psioriasis: LV, LU, SP, ST 
Two primary causes that lead to Psoriasis: Stress and Genetic
WM cause of Psoriasis: In western medicine, the cause of psoriasis is unknown, but the response of psoriasis to the immunosuppressive drug cyclosporine suggests that the primary pathogenetic factor may be immunologic The thick scaling has traditionally been attributed to epide
Describe Factors precipitating psoriasis flare-ups: Local trauma, Irritation, severe sunburn, viremia Allergic drug reactions, topical and systemic drugs (ex. chloroquine antimalarial therapy, lithium, b-blockers, inferteron)  Withdrawal of systemic corticosteroids 
Onset of Psoriasis: Usually gradual onset 
Typical course Psoriasis: Chronic remissions & recurrences, or occasionally acute exacerbations that vary in frequency and duration 
Areas affected by Psoriasis: mostly on yang side of the body Scalp, including postauricular regions. Extensor surface of extremities, especially elbows and knees Sacral area, buttocks, penis Nails, eyebrows, axillae, umbilicus, or anogenital region may also be affected Occasiona
Typical lesions of Psoriasis: Sharply demarcated Pruritic in various degrees. Ovoid or circinate erythematous papules or plaques covered with overlapping thick silvery micaceous or slightly opalescent shiny scales. Papules sometimes extend and coalesce to produce large plaques in annu
Sx of Psoriasis: Itchiness worse at night. Rash with scratching, getting brown. Aggravated recurrence with emotional stimulation. Repeated recurrences make the skin of psoriatic patches thick, dry and tough, cause lickenized change, often symmetric, skin crumb falls off
What are the 2 TCM types of psoriasis: Wind damp heat Wind dry with blood deficiency
Describe Wind damp heat Psorasis: – Initial stage: papules, erosion, red patches, severe itchiness, oozing, scratching and scar, irritability, etc. 
Describe Wind dry with blood deficiency Psoriasis: – Chronic and recurrent attacks: psoriatic patches appear dry and thick, lickenized change, scaling, itchiness worse at night, etc. 
Wind damp heat Psoriasis Treatment principle: – Disperse wind – Transform damp – Clear heat: must promote bowel movement to release heat 
Acupuncture prescriptions for Wind damp heat Psoriasis: – GB 20: clear wind – LI 11 (he sea): clear wind damp heat, alleviate itching – SP 10: blood mover – UB 12 風門 (wind gate): clear wind – SP 6 三陰交 tonify SP, resolve dampness – LI 4 (yuan source): clear wind, move qi 
Treatment principle Wind dry with blood deficiency Psoriasis: – Nourish blood – Moisten dryness – Dredge the channels 
Acupuncture prescriptions for Wind dry with blood deficiency Psoriasis: – UB 17 (influential point of blood): nourish and move blood – LI 4 (yuan source): clear wind, move qi – LI 11 (he sea): clear wind, alleviate itching – ST 36 (he sea): nourish blood and yin – SP 9 (he sea): regulate urination – REN 6 氣海
Treatment for Wind dry with blood deficiency Psoriasis: tonify qi, harmonize blood 
Secondary points for Psoriasis: Ashi points
Points for Severe itching and irritability: KD 6, HT 7 (yuan source)
Points for Lesion on the nape: – calm shen LU 7 (luo-connecting), UB 40 (he sea)channels go to the nape
Points for Lesion in the elbow: LU 5 (he sea), P 4 (xi-cleft), P 8 (fire)
Points for Lesion in the popliteal fossa: UB 37, UB 40 (he sea), UB 60 (fire)
Points for Lesion in the upper eyelid: ST 8, DU 20 
Describe four corners treatment for psoriasis: In addition, four needles at four “corners” surrounding the area of psoriasis; or transverse needling to make the needles criss-cross the tender point at the focus of the psoriasis.
Other therapies for psoriasis: Moxibustion: BID Seven star needling and cupping: once every other day, Vaseline
How do you make Diagnosis of Psoriasis: Psoriasis may be confused with seborrheic dermatitis. Diagnosis by inspection is rarely difficult; e.g. well-defined, dry, heaped-up psoriatic lesions with large silvery scales are distinguishable from diffuse, greasy, yellowish scaling of seborrheic derm
Is biopsy diagnosis useful for Psoriasis: Although biopsy findings of typical lesions are generally characteristic, atypical lesions have atypical features making biopsy less helpful. Some other skin disorders may have psoriasiform histologic features that may make microscopic diagnosis difficult
Prognosis of Psoriasis: Prognosis depends on extent and severity of the initial involvement – usually the earlier the age of onset, the greater the severity Acute attacks usually clear, but permanent remission is rare 
Can Psoriasis be cured: No therapy is curative, but most cases can be adequately or well controlled 
Over the counter treatment for Psoriasis: Lubricants, keratolytics, topical corticosteroids, topical vit D derivatives, anthralin (Dritho-Scalp, Drithocreme) should be tried first in patients with a limited number of lesions 
Is sunlight good for Psoriasis: Exposure to sunlight is beneficial, but occasionally sunburn may induce exacerbations 
Complications of western treatment of Psoriasis: Systemic antimetabolites (ex. methotrexate) should be used only in patients with severe skin or joint involvement. Immunosuppressive drugs (ex. cyclosporine, tacrolimus) have been used in severe and recalcitrant cases. Systemic corticosteroid should not b
Created by: bastyr41