Arno Kroner, DAOM, LAc, is a board-certified acupuncturist, herbalist, and integrative medicine doctor practicing in Santa Monica, California.

Using Chinese herbs to treat psoriasis is considered an alternative therapy in the West with little clinical evidence and experience to support their use. But, for the billion-plus people living in China, traditional medicines are considered mainstream options for the treatment of this skin condition.

Although many people want to embrace a more "natural" approach to psoriasis given the side effects of methotrexate and Soriatane (acitretin), there are pros and cons to the use of traditional Chinese medicine.

The way in which psoriasis is approached in traditional Chinese medicine (TCM) is fundamentally different from how it is diagnosed and treated in the West.

Psoriasis, known as bai bi in traditional Chinese culture, is said to be caused by heat pathogens, wind, or toxins that trigger the characteristic redness of the skin. Bai bi means White Dagger sore (White crust). Psoriasis in China is also called Gan Xian (Dry Lichen), She Shi (Snake lice), or Song Pi xian (Pine skin lichen).

As the disease progresses, blood "dryness" and "stagnation" are believed to cause the itching, discomfort, and scaly plaque formations that typify the autoimmune disorder.

If you decide to see a TCM practitioner for treatment of your psoriasis, they will start by identifying the pattern (blood heat, damp heat, wind etc) and then writing a custom formula and topical for your treatment.

Self-medication with herbs is not recommended because you might use the wrong herbs or combination or end up with low-grade compounds. TCM only works when performed by skilled board-certified doctors.

Because TCM is based largely on impression and personal experience, recommended treatments can vary from one practitioner to the next.

Psoriasis has many different clinical presentations (plaque, guttate, pustular, arthritic etc). Based on TCM diagnosis, there are several different patterns (heat in the blood, toxin, wind, dryness in the blood and yin deficiency, damp heat, blood stasis). They all call for different combinations of herbal formulas and single herbs are not used that often.

Examples of herbs used to treat psoriasis in Chinese medicine:

TCM remedies are often mixed and matched to target individual imbalances. If blood heat is the primary concern, herbs that clear heat would be used in greater quantity than those used to relieve stagnation or dryness.

Sheng di huang is the root of the Chinese foxglove herb (Radix rehmanniae). One of the more common TCM remedies used for psoriasis, it is believed to have potent blood-cooling properties and to relieve pain caused by wind dampness (one of the properties that obstruct qi).

A 2013 study from the General Hospital of Beijing reported that an R. rehmanniae extract used in mice increased the production of skin glutathione when used with ultraviolet (UV) light therapy. Glutathione is an antioxidant used in many health supplements and is believed to have anti-aging properties.

Proponents believe that these effects can be beneficial for people with psoriasis, although it is unclear how.

Bai hua she she cao is a plant known in the West as snake-needle grass (Herba hedyotis). It, like other TCM herbs in the same category, is believed to have potent blood-cooling properties.

Test tube studies have also shown that bai hua she she cao is able to reduce inflammatory compounds associated with psoriasis and other inflammatory diseases, such as tumor necrosis factor-alpha (TNF-a) and interleuken-6 (IL6). Whether the same effect might occur in humans is unclear.

The overuse of bai hua she she cao can cause decreased libido and lower sperm count.

There remains significant concern about the safety of imported Chinese herbs given the limited regulation of dietary supplements in the United States. According to the National Center for Complementary and Integrative Health, some imported Chinese remedies have been found to be tainted with heavy metals, pesticides, sulfites, and even drugs.

Some manufacturers in Taiwan and mainland China provide certificates of origin and purity.

If you decide to use traditional Chinese herbs to treat psoriasis, let your healthcare provider know. They can monitor liver enzymes and kidney function and identify any side effects or drug interactions before they become serious.

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Sui, Z.; Li, L.; Liu, B. et al. Optimum conditions for Radix Rehmanniae polysaccharides by RSM and its antioxidant and immunity activity in UVB mice. Carbohydr Polym. 2013 Jan 30;92(1):283-8. doi:10.1016/j.carbpol.2012.08.087

Zhang, Y.; Liang, Y.; and He, C. Anticancer activities and mechanisms of heat-clearing and detoxicating traditional Chinese herbal medicine. Chin Med. 2017;12: 20. doi:10.1186/s13020-017-0140-2

National Center for Complementary and Integrative Health. Traditional Chinese Medicine. Bethesda, Maryland.

Lin, Y.; See, L.; Huang, Y. et al. Comparison of Refined and Crude Indigo Naturalis Ointment in Treating Psoriasis: Randomized, Observer-Blind, Controlled, Intrapatient Trial. Arch Dermatol. 2012;148(3):397-400. doi:10.1001/archdermatol.2011.1091

Teschke, R.; Zhang, L.; Long, H. et al. Traditional Chinese Medicine and herbal hepatotoxicity: a tabular compilation of reported cases. Ann Hepatol.

Verucchi, G.; Calza, L.; Attard, L. et al. Acute hepatitis induced by traditional Chinese herbs used in the treatment of psoriasis. J Gastroenterol Hepatol. 2002 Dec;17(12):1342-3. doi:10.1046/j.1440-1746.2002.02887.x

Zhou, L.; Lin, Z.; Fung, K. et al. Ethyl acetate fraction of Radix rubiae inhibits cell growth and promotes terminal differentiation in cultured human keratinocytes. J Ethnopharmacol. 2012 Jun 26;142(1):241-7. doi:10.1016/j.jep.2012.04.051

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