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.