Major complaint: The patient
suffers from psoriasis for
nine years with erythema over the whole body as well as
desquamation. The condition had recurred
repeatedly over the nine years and aggravated for one year.
Present illness:In 1999,
there appeared some erythema on his lower leg which as big as a coin in size,
accompanying with desquamation without any inducement. The condition was
aggravated progressively and spread throughout the whole body. The patient was
under treatment in some hospitals from Jordan, Turkey and UAE, but he got no
obvious improvement. To seek better result, he hospitalized in our hospital on
March 14th2008.
The erythema existed
throughout the whole body, and there are some silvery white and dry squame on
the erythema. The squame is easy to fall off and itching. His head, face, trunk
and four limbs appeared erythema in widespread. To scrape it, it will find the
phenomena of the pellicle and the blood spot as sieve. He felt pain of the
finger and elbow joint. He feels thirty and likes cold
drink. Normal food intake. His bowel movement is normal. Burning sense in
urination. Poor sleeping quality. The spirit is fine.
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 preventing vaccination was unknown.
PPersonal history: He was born in Jordan and traveled
to many countries. No contact history of the schistosome. His living condition
was dry. His is mild-tempered. He smokes and drinks a little. He ate more snacks
and the fried food was his favorite.
Marital history:
He was married at 25 years old. His wife is healthy. He has three sons.
Family history:
His parents are both healthy. His two brothers have the similar disease.
He developed normally and had
mid-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 the red pharynx. No swelling
of tonsil. The neck was soft. The trachea placed in the middle. No enlargement
of the thyroid gland. No thoracic deformity. Through the clear percussion sound,
the sound of breath was normal on bilaterally lung. No sound of the gong. Heart
beat 79t/m. Cardiac rhythm was regular and no pathology souffle. Abdomen was
flat and soft. No tenderness or the rebound tenderness. No percussion pain on
the kidneys area. The reflection of the four limbs was normal. No causes of the
pathology reflection. His tongue was light with thin yellow and greasy tongue
coating. The pulse was stringy-like and slippery.
Special examination:
The soaking erythema spread on the
head, face, trunk and four limbs. His skin was covered by many silvery-white
scales which were shedding easily and itching. To scrape it, there were the
phenomena of the pellicle and the blood spot as sieve. He felt pain of the
finger and elbow joints.
Patient Ihab Khalil, a 35 years old
male, had suffered form psoriasis for nine years with erythema over the whole
body as well as desquamation. The condition had
recurred repeatedly over the nine years and aggravated for one year. He was
picked up by our staff to have the treatment in our hospital at 7:00, on March
14th, 2008.
The character of the disease:
1. His whole body had the erythema
and shedding which had recurred again and again nearly 9 years and aggravated
for 1 year.
2. In
1999, the patient¡¯s calf had the erythema which the size as big as the coin
accompanying with the shedding without any inducement, then aggravated
progressively in the whole body. He once was treated in Jordan, Turkey, The
United Arab Emirates and some other hospitals (the details of the treatment was
unknown), bur he didn¡¯t get obviously improvement. So he came to our hospital
for treatment on March 14th, 2008. His whole body was full of
erythema, there was covered by many silver-white and dry scales which were easy
to shed and itch. His mouth was dry and he preferred for soft drink. He reduced
food intake. His bowel movement and urination were both normal. There was the
blooding in the erythema and it had a little pain. 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.
4. He developed normally and had
mid-nutrition. His mind was clear. He was overweight. He was cooperative in
treatment. No thoracic deformity. Through the clear percussion sound, the sound
of breath was normal on bilaterally lung. No sound of the gong. Heart beat 79
t/m. Cardiac rhythm was regular and no pathology souffle. His tongue was light
and the fur was thin, yellow and greasy. The pulse was stringlike and slipper.
5. Special examination: The
patient¡¯s head, face, trunk and four limbs had the erythema in widespread area.
His skin was covered by many silvery-white scales which were easily shedding and
itching. To scrape it, there were the phenomena of the pellicle and the blood
spot as sieve. He felt pain of the figure and elbow joint.
6. Supplement examination: Not
provided.
Diagnosis basis:
Chinese diagnosis:
the patient preferred to ear the fried food, which led to the wet evil
congesting the spleen and stomach, obstruction of the channels and network
vessels, the inhibited qi dynamic, movement abnormal, then the depression
transfers to heat and hides in the blood, future contraction of external evil,
at last two evils connect together, the erythema appeared on the skin. All of
these led to the disease. The blood aspect brews the heat accompanying with wet
evil. So that he had the eyathema progressively in the whole body. Some times
there was the phenomena of blood flowing and effusion. The joint pains of the
elbow and figure were caused by the obstruction of channels and network vessels
as well as the inhibition of the qi-blood. Heat evil burning the body fluid and
could not ascending results in his dry mouth with preference for cold drink.
Heat evil disturbing the spirit results in his unquiet sleep. The tongue was
light and the fur was thin, yellow and greasy. His pulse was stringlike and
slippery. All of these were the phenomena of the wet-heat brewing. Making a
comprehension view from the syndrome of tongue and pulse, it is not difficult to
diagnose as wet-heat syndrome and sthenia syndrome and the local of disease was
in the blood and skin. It belongs to the wet-hear brewing white crust.
Western diagnosis: There were large acreage of
progressively soaking eythnema in the head, trunk and four limbs. It was covered
by many white-silver scales. To scrape it, there was the pellicle and the blood
spot as sieve. So it can be diagnosed as psoriasis.
Diagnosis differentiation:
Chinese Medicine:
The patient had the eythnema in the
whole body, and his skin was covered by white-silver scales which were easy to
shed. To scrape it, there was the blood flowing. It belongs to the white crust
in the Chinese medicine. It should be distinguished with chronic eczema.
Although the chronic eczema has eythnema and scales, but the place of the damage
skin is often in the flexor aspect, and itching heavily, the little scales and
is not the white-silver. To scrape it, there will not the blood spot. So it is
not hard to identify.
Western medicine:
It should be distinguished with
dermatitis exfoliativa. Both of them have the abnormal of shin and shedding. But
the dermatitis exfoliativa is mainly the shedding and the skin is flare, no
white-silver scales. So it is not hard to identify.
First diagnosis:
Chinese diagnosis: White Crust
Western medicine: Psoriasis
The
plan of the diagnosis:
¡¡
1.On
routine care of the Chinese medicine department of dermatology.
2.Take
second Grade care
3.Avoid
eating the acridity and stimulative food.
4.Herbal
tea: clear heat and dispel dampness; cool the blood and free the network
vessels. The formal was made by the doctor himself.
The
main herbs were Shendi 30g; Chishao 15g; and so on.
Using
the water to decocte, three dosages in total, one dosage a day and drink twice.
5.Acupuncture
and massage once a day.
6.Perfect
all the examination.
Date: March 15th,
2008 Time: 8: 30
Today the patient complained to Dr. Yan that he had
erythema and shedding in the whole body which had recurred again and again
nearly 9 years and aggravated 1 year. The physical examination was: T: 36.3¡æ,
P: 80 t/m, R: 20 t/m, BP: 130/80mmhg. Heart and lung (-). The abdomen was flat
and soft. The special examination: head, trunk and four limbs were full of the
soaking erythema. It was covered by many white-silver scales. To scrape it,
there was the thin pellicle and blood spot. His mouth was dry and preferred for
cold drink. His sleep was unquiet. Sometimes he had the felling of urination
burning. His tongue was light and his fur was thin, yellow and greasy. His pulse
was stringlike and slippery. Doctor Yan¡¯s analysis:
1. The patient¡¯s whole body had the erythematic and
shedding which had recurred again and again nearly 9 years and aggravated 1
year.
2. The
special examination: head, trunk and four limbs were full of the soaking
erythema. It was covered by many white-silver scales. To scrape it, there was
the thin pellicle and blood spot.
3. His
mouth was dry and he preferred for cold drink. His sleep was unquiet. Sometimes
he had the felling of urination burning.
4. His
tongue was light and his fur was thin, yellow and greasy. His pulse was
stringlike and slippery.
FFrom 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 wet-heat brewing, the treatment
strategy was to clear heat and dispel dampness; cool blood and free the network
vessels. And doctor Yan prescribed that adding such medicine which used to clear
or wash but based on the taking herbal tea, then prefect all the examination.
Date: March 16th,
2008 Time: 8: 30
Today the patient complained that
there was not obviously improvement and he felt itch and pains in the abdomen
skin damage. He felt dry mouth and his sleep was unquiet. But there was some
improvement in the shedding of the scales. The checking reflection was: ESR:
18mm/h; blood exam was normal. The uric acid was higher than normal 525umol/l.
The function of liver and kidney was found. The rest was normal. And the
treatment strategy was the same before.
Date: March 19th, 2008
Time: 8: 30
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 was no pain of the joints. The phenomena of
scales shedding were decreasing. He only complained that the area of abdomen
lesion was dry. Checking: the skin erythema had decreased in the upper limbs and
abdomen lesion. The scales were decreasing. There were no phenomena of blooding.
But the erythema of lower limbs was still as same. The treatment strategy was
the same as before.
Date: March 22nd,
2008 Time: 8: 30
Today the patient complained that
the skin color of the lesion area in upper limbs and abdomen became lighter
gradually. During the several days, there was no scales appearance and no
phenomena of the itching and paining. And the scales in lower limbs were still
obvious, but the area had decreased. There was no phenomenon of seeping and
blooding. His weight had decrease nearly 10kg 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 fur was thin, yellow and greasy. His pulse was soggy and slippery.
Considering that the patient¡¯s condition had changed better, so the treatment
strategy was the same as before as well as the formal.
¡¡
Date: March 25th,
2008 Time: 8: 30
Today
the patient complained that his syndrome had got a further improvement and the
rest was normal. Checking£ºThe
area of the lesion had decreased clearly. The lesion color in upper limbs and
check abdomen became lighter. There is no scales appearance and it was in a
healing state. The left calf lesion was still in deep red and there were no
phenomena of blooding. He felt a little itching. He did not complaint that the
pain of the four limbs. His tongue was light and his fur was red. His pulse was
forceful. The patient had improvement further more so the treatment and formal
were the same as before. Using the water to decoct, but four dosages in total,
one dosage a day and drink twice.
¡¡
Date:
March 30th, 2008 Time: 8:30
¡¡
Today
the patient complained that his whole lesion skin had further improvement. He
only felt that the left lesion skin was still obviously and had a little
itching. His sleep was quiet. He reduced food intake. His bowel movement and
urination were normal. His tongue was light and his fur was thin, yellow and
greasy. His pulse was forceful. The treatment strategy and the formal were the
same as before.
¡¡
Date:
April 3rd, 2008 Time: 8:30
¡¡
Today
the patient complained that the syndrome had further improvement. The area of
the lesion had decreased. The color and lustre of the skin became normal
gradually. The itching of the whole body was disappearance. The color and luster
of the part of the lesion area in calf became deeper where few scales had. His
spirit was normal. His sleep was quiet. He reduced food intake. His bowel
movement and urination were normal. So the treatment strategy and formal were as
the same as before.
¡¡
¡¡
¡¡
¡¡
Date:
April 7th, 2008 Time: 8:30
¡¡
Today
the patient complained hid spirit was normal. His sleep was quiet. He reduced
food intake. His bowel movement and urination were normal. The lesion skin had
further improved. His whole body had no pain and itching. The color and luster
of the left part of the in calf became deeper, which the area had 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 medicine which is to enrich the yin and moisten
dryness; quicken the blood and transform stasis was added in into it.
¡¡
¡¡
Date:
April 7th, 2008 Time: 8:30
¡¡
Today
the patient said that there was something happened in his family, so he had to
go home at once. The doctor agreed him to take the medicine home to continue the
treatment and he left the hospital.
¡¡
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