(257) Q & A: Psoriatic Arthritis

[HB KIM]

Q:  I have a male patient who began to develop psoriasis at age 4 after a bad sunburn.  Since then, it has progressively gotten worse with age.  He was also diagnosed with rheumatoid arthritis and has a full diagnosis of psoriatic arthritis.  At age 50, he has the skin rashes all over his body (patches and spots) and both hands and feet are now deformed-they all have moved out laterally and are of almost no use.

As a new practitioner, I was wondering what the best approach to treatment would be...both acupuncture and herbs, as well as what results would be reasonable to expect.

It is my thought that there is the possibility of latent heat, damp-heat, boney bi and heat in the blood.


A:  Although the current diagnosis is psoriasis, in this case I think the best approach is to follow a theory which always treats the original etiology first; for this patient the precipitating sunburn must be addressed despite the fact that it happened more than four decades ago.

This formula primarily addresses the original etiology, the sunburn:
Jin Yin Hua  12g
Lian Qiao  12g
Che Qian Zi  12g
Zi Hua Di Ding  12g
Pu Gong Ying  12g
Qing Hao  30g
Hua Shi  30g
He Ye  10g
Chi Shao  10g
Ze Xie  10g
Dan Zhu Ye  10g
Gan Cao  10g

After this formula is taken, we can make another formula focusing on the Blood-level and Bone-level.  Changes in the patient's symptoms resulting from taking this formula must be noted before the next formula is prescribed.

For acupuncture, first try using the Four-Needle Technique to tonify the SI: +GB41, +SI3, -UB66, -SI2.  Tonification (+) for this technique means needle following the channel 30-45 at degrees, sedation (-) is against the channel.  This acupuncture treatment will clear the Heat from the Blood level.

This is a long-standing and advanced case.  We have to see the patient's response to the first set of treatments before an acurate prognosis can be determined.  Please let me know what happens.