Preventive and therapeutic effect of long snake moxibustion on psoriasis with yang deficiency and external cold syndrome based on the theory of"treatment of winter disease in summer"

Wen-Ya Feng, Wen-Bin Li, Xiao-Ning Yan

1. Shaanxi University of Traditional Chinese Medicine, Xianyang 712046, China

2. Shaanxi Hospital of Traditional Chinese Medicine, Xi 'an 710003, China.

Keywords:Psoriasis Yang deficiency and external cold syndrome Treatment of winter diseases in summer Long snake moxibustion Prevention and treatment

ABSTRACT Psoriasis is a chronic inflammatory skin disease with multiple layers of silvery white scales on the surface of erythema papule as the main clinical characteristics, of which yang-deficiency external cold psoriasis is refractory, recurrent and severe in winter and mild in summer, which has a great impact on patients' physical and mental health and quality of life. Traditional Chinese medicine has unique insights in the treatment of psoriasis, both curative effect and safety, have obvious advantages. Based on the concept of "winter disease and summer treatment", long-snake moxibustion gives full play to its functions of warming the kidney,invigorating the marrow, warming the meridians, activating blood circulation and removing blood stasis, so as to restore the deficiency of Yang in patients with psoriasis with external cold syndrome, enhance disease resistance, and prevent psoriasis recurrence or aggravation in winter. Therefore, based on the theory of "winter disease and summer treatment", this paper preliminarily discusses the mechanism of long-snake moxibustion in the prevention and treatment of psoriasis with external cold syndrome of Yang deficiency, and provides new ideas and directions for the prevention and treatment of psoriasis with traditional Chinese medicine.

1. Introduction

Psoriasis is a chronic inflammatory systemic disease caused by the interaction between genetic factors and external environmental factors. It is clinically characterized by large amounts of erythema,papules and silvery white scales on the skin, often accompanied by intense itching. Its course of disease is slow, easy to relapse, with the characteristics of lifetime. Most scholars believe that this disease is related to genetics, immunity, environment, infection and many other factors [1-3]. Throughout the domestic and foreign scholars has been the development of more effective drugs for prevention and treatment of psoriasis, so far, the treatment of psoriasis efficiency.the main A, immunosuppressants, glucocorticoid and biological agents, etc., but these drugs long-term application has the side effects, such as liver and kidney function influence, bone marrow suppression and treatment for A long time to also take up A lot of medical resources, increase the burden on society, therefore, how to prevention and treatment of psoriasis is urgent needs to solve the problem.

2. Psoriasis with external cold syndrome of Yang deficiency

2.1 Analysis of psoriasis with Yang deficiency and external Cold syndrome

Yang deficiency and cold syndrome of psoriasis was proposed by Professor Liu Aimin, a famous Chinese medicine doctor in Henan Province, based on the traditional psoriasis syndrome differentiation,breaking through the previous limitations and combining more than 30 years of clinical experience in skin diseases, to enrich the syndrome differentiation of psoriasis. In treatment, the method of warming Yang to dissipate cold was adopted, which achieved good results [4].

2.2 Pathogenesis of psoriasis with external Cold syndrome due to Yang deficiency

Professor Liu Aimin thought that the traditional syndromes of psoriasis were slightly limited, so he innovatively put forward the syndrome type of "Yang deficiency and external cold" based on the previous experience. Su Wen · Angry tongtian Theory, said:"Yang Qi, if the day and the day, lost its place, it is shortened and not out." Therefore, Yang Qi plays an important role in the human body. Yang Qi can resist the invasion of Yin evil, restrain and dispel Yin evil, inhibit the transmission of Yin cold syndrome and prevent the recurrence of the disease. The pathogenesis of cold psoriasis caused by Yang deficiency can be described as following: (1) People who live in cold areas in winter for a long time, suffer from cold and attack skin. MAO TOU justified occlusion, skin heat caused by cold skin over time, blockage of meristem operation leading to blood stasis. (2) the psoriasis course is slow, has the characteristics of risk for a lifetime, a long illness injury, sun be the spirit cut and meridians can not run normally, the body loss wander, can't resist cold Yin qi, cold from within, combined with a certain stage of modern depression, YuJiu hot, mind you, or spicy, hot not solution,often show the school like [5] of Yang deficiency cold outside; At present, the traditional Chinese medicine treatment of psoriasis is based on the principle of "blood differentiation and treatment".Patients with psoriasis take traditional Chinese medicine to clear heat and cool blood for a long time [6], resulting in deficiency of Yang qi, resensible the evil of wind and cold, blocking the skin and forming a condition of "deficiency of Yang with cold on the surface",namely, deficiency of Yang with cold on the surface ". Therefore, in the clinical treatment of such patients, we should not blindly stick to clearing away heat and cooling blood, but attach importance to invigorating Yang Qi, dispelling wind and dispersing cold, or combining warming Yang with cooling blood.

3. Treatment choice of external cold syndrome of Yang deficiency in psoriasis

At present, a variety of studies have shown that long snake moxibustion combined with "winter disease and summer treatment"therapy can effectively act on yang-deficiency syndrome. "God moxibustion Theory" records: "Moxibustion with fire heat to speed,the body soft and rigid, can eliminate the Yin yi, walk but not keep,good into the viscera. Take the spicy wormwood as a pillar, can pass twelve channels, into three Yin, regulate qi and blood, to treat all diseases as effective as reverse palm. Therefore, the long snake moxibustion therapy can harmonize qi and blood, balance Yin and Yang, keep out cold and dispel evil, then the disease will heal itself."Su Wen · Four Qi Tone Theory of God," said, "The husband of the four seasons of Yin and Yang, the fundamental of all things, so the sage in spring and summer Yang, autumn and winter Yang, from its roots. Therefore, the theory of "winter disease and Summer cure"holds that in summer, during the dog days of summer, the human body can better absorb the heat of thermo-yang medicine by virtue of the Yang qi in nature, so as to nourish the healthy qi and enhance the body's resistance. The so-called "healthy qi is stored in the body,and evil spirits cannot be dried". Therefore, we believe that using long snake moxibustion based on the theory of "winter disease and summer treatment" can effectively treat yang-deficiency syndrome and prevent the disease from winter onset.

3.1 Long snake moxibustion and Yang Deficiency syndrome of external cold

Long snake moxibustion, also known as "governor moxibustion"and "shop moxibustion ", is a kind of traditional Chinese medicine outside treatment with ginger moxibustion on the spine section of the Du meridian and bladder meridian, and is a representative technique for winter and summer treatment. "Su Wen · Bone Theory" said, "To cure the illness of the governor pulse, treatment in the bone". "Lingshu · Shou Yao Rigid soft" records "thorn cold bi internal heat... Iron it with medicine ". "It is not for the needle,but for the moxibustion," says The Philosopher's Shu, Guanneng.Long snake moxibustion is based on the theory of "treating on the bone", "treating with medicine and iron", and moxibustion between objects. It integrates multiple factors including meridians,acupoints, drugs and moxibustion, and stimulates the healthy qi of the human body through warming the meridians, activating blood circulation, removing blood stasis, warding off cold and removing evil, and balancing Yin and Yang, so as to achieve the purpose of preventing and curing diseases [7]. The Du meridian is "the sea of Yang meridians", whose veins meet with the three Yang meridians of the foot at dazhui point, and then meet with the Yang meridians of the head, so it can overflow and regulate the qi and blood of the Yang meridians of the whole body. And du meridian and brain, marrow and kidney function activities are closely related, so it can regulate zangfu, warm kidney bone, complement lean marrow. The bladder meridian is "the genus of all Yang", which is connected with the du meridian and the Du meridian, and unified the guard of the body,among which the first lateral line of the bladder and the Du meridian are the barriers of Yang qi [8]. Moxibustion, with warm and thermal stimulation as its initial motivation and dredging the channels and collaterals as its mechanism of action, can warm Yang, dissipate cold,clear collaterals and relieve pain [9]. Ginger, with its temperature, can relieve sweating and stop vomiting, is a product that helps Yang to disperse cold. It can also concentrate the heat of ai rong to penetrate the bones and reach the tendons [10, 11]. Therefore, the long snake moxibustion therapy can invigorate the Yang qi, harmonize qi and blood, nourish qi and dispel evil, improve the function of zang-fu organs, make the patients recover Yang deficiency, Yin and Cold get powder, Yin and Yang balance. The treatment is easy to operate,effective, safe and reliable, and widely applicable, so it is widely accepted by patients.

At present, snake moxibustion in the treatment of psoriasis,rheumatoid arthritis, disc herniation, functional diarrhea and other diseases of the deficiency of the standard. Tang Suwei et al treated quiescence psoriasis vulgaris with A total effective rate of 83.3%,which was significantly better than the control group (72.2%) in oral administration of Avitamin A capsule, indicating that du-moxibustion combined with cupping can inhibit inflammation, improve skin lesions, and improve the quality of life by inhibiting IL-23/Th17 inflammatory axis. Duan Jianwei [12] found that moxibustion can improve the effective rate of patients with psoriasis. Tang shu ting[13] use of long snake moxibustion treatment of spleen and kidney Yang deficiency type functional diarrhea, the clinical symptoms integral and total integral were significantly improved, the intestinal flora also changed obviously, treatment the total effective rate was 73.33%, significantly better than that of control group, long snake moxibustion can regulate intestinal flora, improving immunity,correcting the Yang deficiency. According to research findings, the effective rate of treating cold-dampness type lumbar disc herniation in the long-snake moxibustion group was 93.55%, and the visual simulation score, dysfunction index score and Yang deficiency score were significantly lower than those of the acupuncture group and the Western medicine group, indicating that long-snake moxibustion can effectively treat cold-dampness type lumbar disc herniation and improve the patient's physical condition [14]. The results of these experiments show that the long-snake moxibustion has an obvious intervention effect on the syndrome of external cold caused by Yang deficiency, which can not only dispel the cold and dissipate pathogenic factors and activate blood circulation, but also improve the yang-deficiency body and improve immunity. It has a significant effect on the diseases caused by external cold caused by Yang deficiency.

3.2 Theory of "Winter disease and Summer Treatment" and External Cold syndrome of Yang Deficiency

"Su Wen · Four Qi Tune on The Great Treatise on God said," Is why the sage has not cured the disease, has not cured the disorder "."Summer" winter disease of traditional Chinese medicine (TCM) is the timing of making methods, originates from the "Yang chun xia"and "cure not ill" theory, then to yin-yang five elements theory, four climate theory, physical theory as the theoretical basis, such as for winter good hair or aggravate the Yang deficiency cold syndrome disease outside in winter, the sun be the spirit in the body and the nature of the dog days give Yang therapy, drugs can help in the summer the sun be the spirit of the better absorption, in order to eliminate pathogenic cold, warming the kidney and strong bone, xu Yang to make patients recover, enhance the ability of resistance, are stored for the winter sun be the spirit, so as to prevent the happening of the disease in the winter [15].

"Winter disease and summer treatment" therapy includes moxibustion, sticking, cupping, acupuncture and moxibustion, etc.It is widely used in chronic obstructive pulmonary disease (COPD),allergic rhinitis, bronchial asthma, rheumatoid arthritis, chilblains and other diseases mainly characterized by Yang deficiency. Most of these patients are heat-resistant but not cold-resistant, and their condition aggravates in winter [16]. Zhang Et al. [17] found in their study that the TCM acupoint sticking therapy for winter diseases and summer treatment could stimulate Yang Qi in the human body,dispel Yin and evil in the body, thus treating both the symptoms and the root causes, nourishing the lungs and kidneys, reducing the number of acute attacks and hospitalizations of COPD patients in winter, improving dyspnea, and improving the body's resistance.Yang Chengwu et al. [18] found that acupoint application in winter and summer could improve the control rate of bronchial asthma,improve lung function indexes such as FEV1, FEV1/FVC and PEF,reduce the incidence degree, and significantly reduce the number of acute attacks of asthma in winter. Xu Guomeng etc. [19] the study found that three lie down this huoxue plaster apply can effectively treat heart kidney Yang deficiency syndrome angina pectoris,reducing patient angina symptoms, compared with normal control group, experimental group patients were significantly lower usage of nitroglycerin, 60 patients, 11 cases of electrocardiogram returned to normal, 32 cases of normal, the total effective rate was 71.7%,significantly higher than the normal control group. The results of these experiments all indicate that the "winter disease and summer treatment" therapy is helpful for TCM to enhance its efficacy by virtue of the Yang qi in summer, so as to achieve the purpose of strengthening the Yang to remove the Yin and evil in the body, thus improving patients' disease resistance ability, especially suitable for this kind of yang-deficiency diseases that are heavy in winter and light in summer.

4. Long-snake moxibustion is based on the theory of"winter disease and summer treatment" to prevent and treat psoriasis with external cold syndrome of Yang deficiency

"Plain ask · Angry tongtian record:" Yin Pingyang secret, spirit is governance, Yin and Yang from the resolution, vital qi is absolutely ".It shows that the human body should maintain a balance of Yin and Yang, so that pathogenic factors cannot make us sick. The so-called"Yin and Yang can eliminate all diseases at once". Jia Zhonglin et al.[20] found that the long-snake moxibustion combined with acupoint application in the dog days has a significant effect on people with Yang-deficiency constitution. After treatment, 136 of 156 patients with Yang-deficiency constitution were significantly improved and 16 were basically improved, with a total effective rate of 97.44%.Therefore, according to the view of "treating different diseases together" in Traditional Chinese medicine, long-snake moxibustion combined with the idea of "treating winter diseases in summer" can also act on the psoriasis with cold syndrome of Yang deficiency.

Psoriasis is characterized by deficiency of Yang qi in patients with external cold syndrome, loss of warmth and warmth in the body,prosperity of Yin and cold in the body, and the presence of cold pathogenic factors that have no way out. Clinical found that part of the patients with psoriasis longer course of disease, recurrent,touching painless, her lesions show pink or dark red, with thin scales, and the onset of winter, the summer faded, so-called "spring and summer, and can't" qiu dong, cool everyday and cold limbs,tastelessness not thirsty, or fatigue, god was white, pale tongue fat,moss white slippery pulse heavy late, is typical of the characteristics of Yang deficiency cold syndrome outside. In view of this characteristic, we deduced based on the theory of "winter disease summer" using the long snake moxibustion to Yang deficiency cold outside intervention in patients with psoriasis treatment in TCM syndrome differentiation and treatment, namely in the summer the sun be the spirit of the dog days, and Yang deficiency cold syndrome psoriatic patients outside the lightest, using long snake moxibustion therapy treatment, which can effectively prevent recurrence in patients with psoriasis, this is the traditional Chinese medicine"cure not ill" and the idea of "winter disease summer". On the one hand, the long snake moxibustion can make use of the warm and warm permeability of moxibustion, the warm and warm flowing of ginger, as well as the effect of regulating the arteries and collaterals,invigorating Yang qi, so as to achieve the purpose of warming Yang and activating the arteries and veins, supporting the health and dispelling evil. On the other hand, in the dog days of summer heat, the natural Yang qi is the most sufficient, the weather is hot,at the same time human body rationale for osteoporosis, meridian occlusion, the disease is the lightest, at this time using long snake moxibustion can effectively absorb ginger, ai heat, with the help of nature Yang Qi, force the body Yin evil outside, to solve the table to disperse cold, dredges the role of collaterals. Therefore, we believe that long snake moxibustion combined with the concept of "winter disease and summer treatment" can improve the yang-deficiency constitution of patients with external cold psoriasis, correct their yang-deficiency state, disperse the pathogenic factors, balance Yin and Yang, harmonize qi and blood, and enhance the patient's disease resistance ability, thus effectively preventing the recurrence of yangdeficiency external cold psoriasis. Modern studies have also proved[21] that when the moxibustion temperature reaches 43℃ ～ 45℃,the anti-inflammatory effect is the strongest, which can effectively inhibit inflammation and promote the recovery of skin lesions.

5. Summary

From the theoretical level analysis, psoriasis is a chronic inflammatory disease, is associated with genetic, immune and other factors, in the absence of specific medicine at present, our creative use of traditional Chinese medicine theory, based on Yang deficiency cold syndrome psoriatic outside relapse easily and the clinical characteristics of winter heavy summer light, analysis of the use of long snake moxibustion on summer remission in patients with Yang deficiency cold syndrome outside intervention treatment,can improve patients health, reduce the recurrence of psoriasis frequency or reduce incidence degree. However, in practical clinical applications, snake moxibustion is mostly used in ankylosing spondylitis, rheumatoid arthritis, intervertebral disc herniation,chronic obstructive pulmonary disease, postpartum body pain,chronic fatigue syndrome, intractable cough, constipation, insomnia and other diseases. At present, there are few relevant literatures on snake moxibustion in the treatment of psoriasis. In preliminary studies, we according to Yang deficiency cold syndrome psoriatic outside the characteristics of winter heavy summer light, for such patients who were in the summer of "winter disease cure" long snake moxibustion treatment, found that patients with a normal recurrence lesion severity significantly decrease, but the case is less, it cannot yet effectively prove long snake moxibustion with Yang deficiency cold syndrome psoriatic exact curative effect, we will continue to follow up to observe the clinical results of such patients, gather enough clinical material, form a scientific standard of symptomatology, expand the "summer" winter disease and the range of long snake moxibustion vision development, but also open up new methods for the treatment of psoriasis.