Exploring the pathogenesis evolution and treatment strategies of psoriasis from "four-layer method for differention toxin depth"

Psoriasis is characterized by a lingering course and a tendency for recurrence. The "four-layer method for differentiating toxin depth" dynamically analyzes pathogenic evolution and treatment by categorizing toxin-induced diseases into four sequential stages: superficial, dynamic, deep, and latent, based on the progression from exterior to interior. Its core pathogenesis is identified as healthy qi deficiency with toxin invasion, with the conflict between healthy qi and pathogens demonstrating distinct layer-based transmission features as the disease evolves. This paper posits that psoriasis is rooted in healthy qi deficiency, with toxin invasion as the manifestation. Specifically, in the superficial layer, when pathogenic toxins invade the exterior of the skin and the condition is mild; the treatment should focus on releasing the exterior and dispersing toxins, which is assisted by boosting qi, using the modified Jiedu Fuwei Decoction. In the dynamic layer, heat-toxin is abundant in the blood, and an intense struggle exists between vital qi and pathogenic factors. Hence, the treatment should focus on cooling the blood and counteracting toxins, combined with nourishing yin, using the modified Liangxue Baidu Decoction. In the deep layer, stagnant toxins and blood stasis bind together, obstructing blood vessels; thus, the treatment should focus on resolving stasis and detoxifying, as well as nourishing blood and unblocking collaterals, using the modified Huayu Jiedu Decoction. In the latent layer, toxins are hidden and vital qi is deficient. In such conditions, the treatment should focus on boosting qi to expel toxins and harmonizing the nutritional and defensive levels using the modified Yiqi Fuzheng Decoction. The transmission of pathogenic toxins through the superficial, dynamic, deep, and latent layers in psoriasis embodies the dynamic process of moving from the exterior to the interior and from excess to deficiency. By tailoring treatment according to the toxin layer and the relationship between healthy qi and pathogens in clinical practice, allowing for dynamic adjustments, this approach provides a clear framework for the differentiation of the syndrome and treatment of psoriasis using a traditional Chinese medicine approach.