This case reviews Lichen Planus treated with Chinese Herbal Medicine.
Lichen Planus is an extremely itchy skin disorder that is treatable with herbal medicine. Lichen planus is often characterized often by small, purple, papules, that are extremely itchy. Known by a few names in Chinese Medicine, including Purple Patch Wind (Zi Dian Feng). Wind here refers to both the cause and presence of the itching.
This case involves a 55 year old male whom I treated in 2019. He reported intense itching from Lichen Planus on his upper back and shoulder. Lichen Planus can be categorized into various presentations in both Western and Chinese Medicine. This patient presented with a localised papular form, meaning it presented in one place with only papules. Usually this form appears on the wrists, arms, legs, or mouth but as with this patient, any body part can be affected.
The patient stated that he had been misdiagnosed for a few months by another doctor seeing little to no improvement with treatment. Lichen Planus was diagnosed after a biopsy. Topical steroids were then prescribed. However, the patient reported that steroids brought little relief. All together he had tried other treatments for about a year before coming to see me.
As I mentioned earlier, Lichen Planus or Zi Dian Feng can be sub differentiated into types or patterns, each with their own treatment strategy and therfore different selection of herbs. I diagnosed this patient with what is called Wind Heat Binding The Exterior but I also thought he suffered from Yin and Fluid Deficiency and some Blood Stasis.
After starting on herbal medicine, he stated that the unbearable itch started to reduce on the fifth day. Improvement continued as he kept up with the herbs. All in all he skin was completely clear in a about a month and a half. That is a fast recovery! At the time of publishing this now, 12 months later, he has not had a relapse of Lichen Planus.
I saw the patient 3 times and made minor modifications to the herbs along the way. For the most part though I chose herbs to Release Exterior Wind Heat,Expel Wind Damp, Open The Collaterals, Nourish Yin and Fluids, and Move Qi and Blood.
A Few Thoughts On The Overall Process
I realize that most people will not be able to make sense of the TCM diagnosis, treatment principles, herbs, etc. I share my thought process though so you can understand it’s not as simple as thinking, “What herbs are good for Lichen Planus?” and then throwing them all together. More than just theory, a long history of clinical practice has refined these concepts so that practitioners use them in ways that parallel Modern Medicine: there is observation of the presentation, interview to find out more about the patient these two lead to a diagnosis and/or working pattern(s), the appropriate course of action or treatment principles are determined by the diagnosis/ pattern, and treatment, in this case herbs, are determined by that course of action.
Herbal Formula Ingredients
The following is the formula which the patient was on for most of his treatment.
Pt. purchased granulated herb extracts, 1g of granules is equivalent to 5g of raw herbs (5:1) unless otherwise noted in parentheses. Dosage: 16g, twice per day. Total grams per granular extract per day:
Fang Feng(6:1) 2g
Jing Jie(10:1) 1g
Niu Bang Zi 3g
Qiang Huo 2g
Lu Lu Tong 2.5g
Di Fu Zi (10:1) 1g
Lian Qiao(10:1) 2g
Xu Chang Qing 2.5g
Sheng Di Huang 3g
Xuan Shen (6.7:1) 3g
Mai Men Dong 2g
Chai Hu 2g
Dan Shen(6.7:1) 3.5g
Fu Ling (10:1) 1.5g
Gan Cao 1g
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