SCLERODERMA

Clinical Manifestations
  • Scleroderma is a kind of skin disease of connective tissue caused by sclerosis of the skin.
  • It is divided into two types: localized and systemic types.
  • Generally, it undergoes three stages:
    Red swelling
    Sclerosis
    A
    trophy
  • Advanced stage:
    The affected skin will be adhered to the deep tissue and produce functional disturbance of corresponding organs.
  • Localized scleroderma:
    Part of the skin has a sensation of burning heat and itching, then slightly elevated patches in red or purple color.
    The lesion may be tenioid or elliptical in shape, and its border is clear with purple halos around it.
    The central part is sunken and then the color of patches will become yellow, brown and pale.
    The skin will be indurated and adhesive to the subcutaneous tissue
    Then the cleavage lines will disappear.
    Its surface is smooth and then will become atrophied and thin, and will lose elasticity.
    There are branny desquamations and pigmentations on the skin lesion.
    At first the patient may have an unusual feeling or a sense of itch, then the skin becomes blunt and insensitive.
    It often occurs on the head, face, neck and limbs, especially among the young and middle-aged women
    Scleroderma which occurs at the terminal end of limbs of young women is known as "acrosclerosis."
    The course of this disease is chronic.
  • Systemic scleroderma:
    The skin lesion begins in the face or the skin of the distant end of limbs, symmetrical in distribution, then gradually spreads throughout the whole body, or is generalized from the beginning. It often attacks the face, limbs, neck and trunk, mostly among middle-aged women.
    At first the skin becomes thick and swollen, its surface is smooth and cleavage lines disappear.
    The skin shows parenchymatous edema (at edema stage), then gradually becomes adhered to the subcutaneous tissue
    It becomes hard, sallow in color and its border is clear (at sclerosis stage).
    Finally, the skin becomes atrophied and thin, and the hair may fall off.
    Sweat obstacle may appear.
    The skin and muscle will stick to the bone and become stiff (at atrophy stage).
    At the beginning, there are unusual, tense and itching sensations locally, and then the sensations become blunt and gradually or entirely lost
  • General constitutional symptoms:
    At the beginning:
    General malaise
    Arthralgia
    Loss of weight
    Stiff fingers
    Spasm of terminal arteries of limbs
    At the advanced stage:
    Emaciation
    Weakness
    Low grade fever
    The face may be involved and looks awkward
    The nose will be sharp and the ears thin
    The movement of the mouth and eyes and chewing will be restricted
    If thoracic wall is involved, respiration may be limited
    If the four limbs are invaded, the joints will become stiff and motions limited
    If the digestive tract is involved, there will be difficulty swallowing, with vomiting, nausea, abdominal distention and diarrhea
    If the Lungs are invaded, vital capacity will be reduced. I
    If the Heart is involved, Heart failure will occur.
    If the Kidneys are involved, renal hypertension and uremia may appear
Treatment Principle
  • Disperse Wind-Dampness
  • Stop Bi pain
  • Tonify the Kidneys and Liver
  • Tonify Qi
  • Nourish the Blood
Herb Formulas
Points
Clinical Manifestations
  • Scleroderma
  • Severe chills
  • Mild or no fever
  • Headache
  • Generalized discomfort
  • Stiff neck and shoulders
  • Body aches
  • Joint ache
  • Nausea
  • Vomiting
  • Hiccups
  • Anhidrosis
  • Gasping
  • Stabbing joint pain
  • Itchy throat
  • Cough
  • Asthma
  • Aversion to Wind and Cold
  • Maybe low back pain
  • Maybe frozen shoulder
  • Maybe dyspnea
  • Maybe epistaxis (severe)
  • T: Normal
  • C: Thin and white
  • P: Floating and tight
Treatment Principle
  • Relieve the Exterior
  • Expel Cold
  • Disperse the Lungs
  • Stop asthma
Herb Formulas
Points
Clinical Manifestations
  • Itching or tickling in the throat
  • Wheezing
  • Sneezing
  • Gasping
  • Cough with expectoration of thin, watery or frothy white sputum
  • General body aches
  • No thirst
  • Dyspnea
  • Headache
  • Body aches
  • A sensation of heaviness
  • Chills with low grade fever
  • Maybe asthma
  • Intolerance of Cold
  • Anhidrosis
  • Blocked and/or runny nose with watery nasal discharge
  • Chest discomfort
  • Neck stiffness
  • Irritability
  • T: Pink
  • C: Thin, white and moist
  • P: Superficial and tight
Treatment Principle
  • Disperse Wind-Cold
  • Induce diaphoresis
  • Dispel Dampness
Herb Formulas
Points
Clinical Manifestations
  • Scleroderma
  • Heavy, painful head
  • Generalized sensation of heaviness
  • Back pain
  • Generalized pain or muscle ache
  • Difficulty bending or rotating trunk
  • Mild fever
  • Slight aversion to Wind and Cold
  • Dizziness
  • Anorexia
  • Anhidrosis
  • Stiffness of the neck
  • Sciatica
  • Chest oppression
  • Chills
  • No perspiration
  • Aversion to Cold
  • Lassitude
  • Scanty urination
  • T: Pink
  • C:White or Greasy and white
  • P: Superficial or Superficial and slow or Superficial and soft or Superficial and tight
Treatment Principle
  • Dispel Wind
  • Eliminate Dampness
  • Relieve the Exterior
  • Alleviate pain
Herb Formulas
Points
Clinical Manifestations
  • Scleroderma
  • Painful joints
  • Heavy and painful sensations at fixed locations in lower back and extremities with weakness and stiffness or hypertonicity and immobility
  • Aversion to Cold
  • Attraction to warmth
  • Palpitations
  • Pain in the midline and back during pregnancy
  • Pain worse at night
  • General coldness
  • Sallow complexion
  • Wandering pain
  • Pale complexion
  • Shortness of breath
  • May be paresthesia and numbness
  • Cold pain in the low back and knees
  • Limited movement
  • Soreness, weakness and numbness of the joints
  • Tinnitus
  • Muscle spasms
  • Dizziness
  • T: Pale
  • C: Thin and white or White and moist
  • P: Thin, weak and slow or Deep, thready and weak or slippery
Treatment Principle
  • Disperse Wind-Dampness
  • Stop Bi pain
  • Tonify the Kidneys and Liver
  • Tonify Qi
  • Nourish the Blood
Herb Formulas
Points
Clinical Manifestations
  • Localized scleroderma (morphea)
  • Generalized morphea
  • Linear scleroderma (the lesions usually follow the course of a nerve, involving underlying muscle and bone leading to atrophy of the skin and muscle and skeletiztion)
  • Morphea profunda (sclerosis affects the subcutaneous fat)
  • Eosinophilic fascitis (fibrous tissue affects the fascia which limits movement)
  • Pan-sclerotic morphea (underlying muscle tissue may be inflamed and sclerotic)
  • Starts with indurated pink-red to blue-red patches that are smooth and shiny but feel firm
  • Sclerosis may be limited to the dermis
  • The lesions later change to hard, slightly yellow plaques surrounded by violet borders
  • The entire skin may become involved
  • Cosmetic appearance is disturbed if the face and scalp are involved
  • Numbness and heaviness of the extremities
  • Soreness and fixed pain of joints
  • Stiffness or numbness of the muscles or skin
  • Pain worse on cloudy or rainy days
  • Maybe peripheral or systemic edema
  • Pain is alleviated by pressure and warmth
  • Pain lingers and is recalcitrant to treatment
  • Worse during cloudy or wet weather
  • Limited movement
  • Edema
  • Maybe stifling sensation in chest
  • Maybe anorexia or indigestion
  • Maybe abdominal distention
  • Maybe loose or semi-liquid stools
  • Muscle aches
  • Radiating pain in the legs
  • Low back pain
  • Numbness in the lower extremities
  • Pain in the trunk and extremities
  • Abdominal pain
  • Sciatica
  • Aversion to Wind and Cold
  • Knee pain
  • T: Pale or Pink with purple spots
  • C: Normal or Greasy and white
  • P: Choppy or Taut
Treatment Principle
  • Disperse Wind-Cold-Dampness
  • Stop Bi pain
  • Move Qi
  • Invigorate the Blood
Herb Formulas
Points
  • DU-14, GB-31, SP-6, SP-9, SP-10, ST-36, UB-23
  • Apply moxa using a moxa roll to the affected area for about 20 minutes two to three times a week.
  • Ear: Lung, Occiput, Endocrine, Adrenal. Spleen Liver
Clinical Manifestations
  • The skin is sclerotic and atrophied
  • Fatigue
  • Loss of appetite
  • Abdominal pain and distension
  • Loose stool
  • T: Echymosis
  • C: Normal
  • P: Thready and moderate
Treatment Principle
  • :Strengthen the Spleen
  • Replenish Qi
  • Invigorate the Blood c
  • Remove Blood Stasis
Herb Formulas
Points
Clinical Manifestations
  • Scleroderma
  • Intermittent abdominal and gastric fullness and distention after eating
  • Vomiting of partially undigested food about 12 hours after eating which relieves the discomfort
  • The vomitus is relatively inoffensive with clearly identifiable food and possibly watery mucus-like material
  • Waxy, pale complexion
  • Anorexia
  • Weight loss
  • Emaciation
  • Loose stools or
  • Diarrhea
  • Fatigue
  • Weakness
  • Listlessness
  • Increased desire to sleep
  • Cold abdomen
  • Cold extremities
  • Intolerance of Cold
  • T: Pale and swollen
  • C: White
  • P: Thready, deep and weak
Treatment Principle
  • Warm and strengthen the Spleen and Stomach
  • Harmonize the Stomach
  • Descend Qi
Herb Formulas
  • Ding Kou Li Zhong Wan modified
  • With Qi Stagnation: Ding Xiang Tou Ge San
  • With Kidney Yang Deficiency: Fu Zi Li Zhong Wan  modified
  • For severe, resistant or unresponsive cases with Phlegm Accumulation: Xuan Fu Dai Zhe Tang
  • Chinese Patent Medicines:
    For Spleen Yang Deficiency with Cold: Fu Zi Li Zhong Wan
    For Spleen Yang Deficiency: Li Zhong Wan
    For Spleen Qi Deficiency: Xiang Sha Liu Jun Zi Wan
    For Kidney Yang Deficiency: Jin Gui Shen Qi Wan combined with one of the above formulas
Points
Clinical Manifestations
  • Scleroderma
  • Body cold
  • Limbs icy
  • Complexion white and shiny
  • Low back, knees and abdomen feel cold and painful
  • Lower abdomen feels cold and painful
  • Loose stools containing undigested food
  • “Cock-crow” diarrhea (occurs at about 5 am)
  • Edema of face and limbs
  • Dysuria
  • Severe:
    Abdominal ascites
  • T: Pale, moist and swollen
  • C: Thin and white or White and greasy
  • P: Deep, thready, weak and maybe slow
Treatment Principle
  • Warm and Reinforce the Spleen and Kidneys
Herb Formulas
Points
Clinical Manifestations
  • Scleroderma
  • Intermittent epigastric and abdominal distention and fullness after eating followed 12 hours later by vomiting of partially digested food, which relieves the distention
  • Vomitus may be sour and offensive
  • Irritability
  • Restlessness
  • Red complexion and lips
  • Halitosis
  • Thirst
  • Dry mouth and lips
  • Tendency toward constipation and rarely, diarrhea
  • Concentrated urine
  • T: Red and dry
  • C: Thick and yellow or Thick, greasy and yellow
  • P: Slippery and rapid
Treatment Principle
  • Clear Heat from the Stomach
  • Harmonize the Stomach
  • Descend Qi
Herb Formulas
  • Zhu Ru Tang
  • With damage to Qi and Yin: Da Ban Xia Tang
  • With excessive alcohol consumption creating Damp-Heat: Ge Hua Jie Cheng San
  • For Heat, Cold and Deficiency with a sensation of blockage, distention, fullness and discomfort in the epigastrium: Ban Xia Xie Xin Tang
  • Chinese Patent Medicine:
    With Damp-Heat: Huang Lian Jie Du Wan
    With Phlegm-Heat: Wen Dan Wan
    With constipation: Niu Huang Qing Huo Wan
Points
Clinical Manifestations
  • The skin becomes thick, sclerotic, or atrophied and thin
  • Pain in the knees and waist
  • Tinnitus
  • Vertigo
  • Impotence
  • Premature ejaculation
  • Low grade fever
  • Spontaneous perspiration
  • T: Echymosis
  • C: Normal
  • P: Deep and fine
Treatment Principle
  • Nourish the Kidneys
  • Warm the Blood
  • Promote Blood circulation
  • Remove blood stasis.
Herb Formulas
Points
Clinical Manifestations
  • Localized painful swellings without heads that bleed into the surrounding tissues and do not affect the color or texture of the skin
  • The swellings are not hot to the touch
  • No thirst
  • Swollen and painful joints
  • Wasting of the muscles of the thigh and calf
  • With Wei Qi Deficiency and External Invasion:
    Localized type:
    1. Plaque-like lesions of different sizes:
    Skin may appear tense and waxy with variably tinged plaques
    Telangiectasis around the head and facial areas
    Irregular stripes on the scalp
    2. Girdle-like lesions:
    Distributed over the limbs and costal areas like a girdle
    3. Gutate lesions:
    Whitish or ivory colored
    Small plaques with a distinctive border
    Widely spread distribution
    Smooth and shiny with purple-red borders
    Feel hard
    Develop over the trunk
    Effusive type:
    1. The initial symptom is substantial edema
    Skin gradually hardens and turns waxy-bright
    May be increase of pigmentation
    Hair gradually falls out
    Subcutaneous tissues and appendages are severely atrophic and tightly attached to the bone, forming a plaque as hard as a board
    Confined to the limbs initially
    May spread widely
    2. Systemic symptoms:
    Vasomotor disturbances
    Soreness and pain of the joints
    Fever
    Poor appetite
    Malaise
    Emaciation
    3. May involve the digestive tract, Heart and Lungs
    4. Often accompanied by:
    Sore lower back
    Hair loss
    Loose teeth
    Aversion to Cold, Cold limbs
    Spontaneous sweating
    Loose stools
    Impeded sexual function
    Irregular menstruation
  • T: Very pale or Pale-pink
  • C: White
  • P: Thready and forceless or Deep and slow
Treatment Principle
  • Warm the Yang
  • Tonify the Blood
  • Disperse Cold
  • Eliminate Stagnation
Herb Formulas
Points
Clinical Manifestations
  • Scleroderma
  • Dizziness
  • Tinnitus or deafness
  • Poor memory
  • Aching, soreness or weakness of the low back
  • Spermatorrhea or
  • Premature ejaculation
  • Aching in the bones
  • Aching in the leg and heel
  • Dry mouth
  • Thirst
  • Night sweats
  • Five Sole Heat
  • Malar flush
  • Low grade fever in the afternoon
  • Dry throat, maybe recurrent sore throat
  • Dry stools and/or
  • Constipation
  • Urine short and red
  • Heightened libido
  • If Heart Fire also Flares:
    Insomnia
    Frequent dreams
    Palpitations
  • If Liver Yang also Rises:
    Dizziness
    Blurred vision
  • T: Red
  • C: Little or None
  • P: Thready and rapid
Treatment Principle
  • Nourish Yin
  • Subdue Fire
  • Detoxify
Herb Formulas
Points
Clinical Manifestations
  • Scleroderma
  • Fatigue
  • Loose stools
  • Anorexia
  • Dizziness
  • Pale face
  • Weak voice
  • Reluctance to speak
  • Sweating with little or no exertion
  • Chills
  • Cold limbs
  • Inability to get warm
  • Profuse clear urine
  • Lassitude
  • T: Pale
  • C: White
  • P: Empty or Slow, deep and weak
Treatment Principle
  • Warm Yang
  • Tonify Qi
  • Clear Heat
Herb Formulas
Points
Clinical Manifestations
  • Scleroderma
  • Hemiplegia
  • Paralysis
  • Atrophy of the lower limbs
  • Facial paralysis
  • Slurred speech
  • Drooling
  • Dry stools
  • Frequent urination
  • Urinary incontinence
  • Deviation of the eyes and mouth
  • Excess salivation
  • Cold extremities
  • Asthenia
  • T: Normal
  • C: White
  • P: Moderate
Treatment Principle
  • Tonify Qi
  • Invigorate the Blood
  • Unblock the channels
  • Promote movement in the limbs
Herb Formulas
Points
Clinical Manifestations
  • Fatigue
  • Anorexia
  • Dizziness
  • Pale face
  • Weak voice
  • Reluctance to speak
  • Sweating with little or no exertion
  • Dizziness
  • Palpitations
  • Insomnia
  • Dry skin
  • Dry hair
  • Poor memory
  • Paleness
  • Scanty periods
  • Chills
  • Cold limbs
  • Inability to get warm
  • Loose stools
  • Profuse clear urine
  • Spontaneous sweating
  • Lassitude
  • T: Pale
  • C: White or Thin, white and dry
  • P: Slow, deep and weak or Empty or Thready and rapid or Weak
Treatment Principle
  • Tonify Qi
  • Nourish the Blood
  • Warm Yang
  • Invigorate the Blood
Herb Formulas
Points
Clinical Manifestations
  • The skin becomes hypertrophic and elevated or sunken and hard
  • It may be bright red, purplish red, yellowish red or brown is color
  • Frequent epigastric and abdominal distention which is worse after eating followed 12 hours later by vomiting of partially digested food, relieving the discomfort
  • Maybe brown or blood-streaked material in the vomitus
  • Localized or stabbing epigastric pain or
  • Firm abdominal masses which are painful when palpated
  • Tarry, black stools or
  • Streaks of Blood in the stools
  • Broken n vessels or spider naevi on the face, trunk, inner knees and ankles
  • Purplish lips, sclera, conjunctiva, nails,
  • Dark rings around the eyes
  • Irritability
  • A short temper
  • Depression
  • Mood swings
  • Dizziness
  • Forgetfulness
  • Dry, scaly skin
  • Hair loss on the head and body
  • T: Dark, red or Light purple with echymosis, Sublingual veins are distended and dark
  • C: Normal
  • P: Choppy or Choppy and rapid or Thready and choppy or Wiry
Treatment Principle
  • Invigorate the Blood
  • Eliminate Stasis
Herb Formulas
  • Tao Hong Si Wu Tang modified
  • Gui Zhi Fu Ling Wan
  • Ge Xia Zhu Yu Tang
  • Wth a mild attack of Wind-Cold and Blood Deficiency: Huang Qi Gui Zhi Wu Wu Tang
  • Chinese Patent Medicine:
    For severe Blood Stasis with masses: Tong Jing Wan
    For Qi and Blood Stagnation: Xue Fu Zhu Yu Wan
    For stronger pain relief: Shi Xiao Wan
    With Qi or Yang Deficiency: Fu Ke Wu Jin Wan
    For mild bleeding: Sheng Tian Qi Pian
    With Blood Deficiency: Tao Hong Si Wu Wan
Points
Clinical Manifestations
  • Scleroderma with inflammation
  • Acne
  • Pustules on an erythematous base
  • Local inflammation with pus
  • Deep-rooted, hard and painful boils
  • Larger, more inflamed, angrier and more pus-filled lesions
  • Erythema
  • Swelling
  • Lesions on the chest and upper back
  • Residual scarring usually occurs after healing
  • Heat
  • Carbuncles
  • Furuncles
  • Fever and chills
  • Pain
  • Dry stools
  • Constipation
  • Scanty, yellow urine
  • T: Red
  • C: Yellow or Yellow and dry or Yellow and greasy
  • P: Rapid or Wiry, slippery and rapid
Treatment Principle
  • Clear Heat
  • Detoxify
  • Invigorate the Blood
Herb Formulas
Points
Clinical Manifestations
  • Scleroderma
  • Progressive dysphagia
  • Vomiting immediately after eating
  • Vomiting of saliva and undigested food
  • Chest pain
  • Emaciation
  • Loss of appetite, especially for meat
  • Stomach distention
  • Hard stools
  • Dull pain
  • A rancid taste in the mouth
  • T: Normal or Cyanotic
  • C: Thick and white
  • P: Weak and choppy
Treatment Principle
  • Transform and eliminate Phlegm
  • Descend Rebellious Qi
Herb Formulas
Points