Main Points of Diagnosis

Localized Scleroderma

1. Skin Lesion: 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 them. 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.

2. Symptoms and Signs: At first the patient may have an unusual feeling or a sense of itch, then the skin becomes blunt and insensitive.

3. 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 the young women, is known as "acrosclerosis." The course of this disease is chronic.

Systemic Scleroderma

1. Skin Symptoms and Signs

1) 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 the skin lesion is generalized from the beginning. It often attacks the face, limbs, neck and trunk, mostly among middle-aged women.

2) At first the skin becomes thick and swollen, its surface is smooth and cleavage lines disappear. The skin shows parenchy-matous edema (at edema stage), then gradually becomes adhered to the subcutaneous tissue and 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. And sweat obstacle may appear. The skin and muscle will be stick to the bone and become stiff (at atrophy stage).

3) At the beginning, there are unusual, tense and itching sensations locally, and then the sensations become blunt gradually or entirely lost.

2. General Constitutional Symptoms

1) At the beginning, there are such symptoms as general malaise, arthralgia, loss of weight, stiff fingers and spasm of terminal arteries of limbs. The features at the advanced stage are emaciation, weakness with low fever.

2) 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. In case thoracic wall is involved, respiration may be limited. In case four limbs are invaded, the joints will become stiff and motions limited. In case the digestive tract is involved, there will be difficulty in swallowing, accompanied with vomiting, nausea, abdominal distention and diarrhea. In case the lung is invaded, vital capacity will be reduced. If the heart is involved, heart failure will occur. If the heart is involved, heart failure will occur. If the kidney is involved, renal hypertension and uraemia may appear.

Differentiation and Treatment of Common Syndromes     

Internal Treatment

1) Blood Stasis Type

Main Symptoms and Signs: The skin becomes hypertrophic and elevated or sunken and hard. It may be bright red, purplish red or yellowish red or brown is color. The tongue is light purple with ecchymosis on it. The pulse is rapid.

Therapeutic Principle: Promoting blood circulation and expelling stasis.

Recipe: Decoction of Four Herbs plus Safflower and Peach Kernel and other ingredients

astragalus root

red peony root

red sage root

spatholobus stem

dried rehmannia root

Chinese angelica root

chuanxiong rhizome

honeysuckle flower

peach kernel

safflower

pangolin scale

earth worm

dried body of ground beetle

licorice root

All the above herbs are to be decocted in water for oral administration.

2) Type of Kidney Deficiency and Blood Stasis

Main Symptoms and Signs: The skin becomes thick, sclerotic, or atrophied and thin, accompanied with pain in the knees and waist, tinnitus, vertigo, impotence, premature ejaculation, low fever, spontaneous perspiration, ecchymosis on the tongue and deep and fine pulse.

Therapeutic Principle: Nourishing the kidney and warming, promoting blood circulation and removing blood stasis.

Recipe: Kidney Reinforcing Bolus and Decoction of Four Herbs plus Safflower and Peach Kernel

prepared rehmannia root

multiflower knotweed root

dogwood fruit

eucommia bark

epimedium

morinda root

peach kernel

safflower

red peony root

red sage root

Chinese angelica root

ligusticum rhizome

All the above herbs are to be decocted in water for oral administration.

3) Type of Splenic Asthenia and Blood Stasis

Main Symptoms and Signs: The skin is sclerotic and atrophied, accompanied with fatigue, loss of appetite, abdominal pain and distension, loose stool, ecchymosis on the tongue, thready and moderate pulse.

Therapeutic Principle: Strengthening the spleen and replenishing qi, promoting blood circulation and removing blood stasis.

Recipe: Decoction for Invigorating the Spleen and Nourishing the Heart with additional ingredients

astragalus root

red peony root

red sage root

codonopsis root

big-head atractylodes rhizome

spatholobus stem

poria

Chinese angelica root

aucklandia root

tangerine peel

amomum fruit

longan aril

fresh ginger

Chinese date

All the above herbs are decocted in water for oral use.

4. Other Therapies

1) 10 ml of salvia miltiorrhiza injection with 500 ml of 5% glucose is used for intravenous drip, once a day, The whole course of treatment will be 10 days running and then stop dripping for 7 days. Curative effects can be seen after a month's treatment.

2) Four Worms Pill

Ingredients:

dried body of scorpion

dried body of centipede

dried body of ground beetle

dried earthworm

All the above drugs are made into pills in equal amount each. The size of the pill is the same as that of a mung bean. Take 3-5g each time,  three times a day.

3) Pill of Rhubarb and Ground Beetle

Ingredients:

rhubarb

dried body of ground beetle

licorice root

lactiflora peony root

dried ginger rhizome

rehmannia root

scutellaria root

peach kernel

apricot kernel

gradfly

dried leech

dried grub

All the above herbs are to be ground into fine powder to make pills. 10 grams for each pill. Take one pill each morning and evening.  

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