Scleroderma Should Be Treated as TCM Yin Nodules

Scleroderma is one of the connective tissue diseases with the highest mortality. Its main symptoms are generalized sclerosis of the skin and viscera, with vasculitis and fibrosis occurring throughout the body's organs; it is called scleroderma because of the hard lesions of the skin. The age of onset is mostly 30–50; women are more frequently affected than men, especially women of childbearing age, with a male-to-female ratio of 1:3–1:7.

Scleroderma is divided by extent of involvement into localized scleroderma and systemic sclerosis. Localized scleroderma mainly affects the skin without visceral damage, and most cases have a good prognosis. Systemic sclerosis presents with widespread skin sclerosis accompanied by atrophy and damage of multiple organs and tissues; the condition is generally more severe with a poor prognosis. Although it is not cancer, its fatality rate is also high, and its progression resembles cancer.

The cause of scleroderma is unknown; it may be related to genetics and immunity. Modern medicine has no specific therapy for this disease and can only provide symptomatic supportive treatment, making it difficult to halt the worsening and death of patients. But this disease has existed since ancient times, and TCM surgery mostly names it "yin nodules" (yinju). In scleroderma patients, the hardened or raised skin has an unchanged color with no obvious redness, swelling, heat, or pain, making it a typical yin nodule rather than a yang abscess.

According to the two principles of yin-yang differentiated treatment in Wang Hongxu's Records of Surgical Patterns and Treatment (Waike Zhengzhi Quansheng Ji) of the Qing Dynasty, diseases like scleroderma should be treated with formulas of the Yanghe Tang (Yang-Soaking Decoction) type: warming yang and unblocking the interstices; once yang qi is warmed, the yin nodules naturally resolve. Wang said: "All nodules that are white and sunken are caused by the congelation of deficiency-cold of qi and blood. At the outset the toxin sinks into the yin division; without Yanghe to unblock the interstices, how can one resolve the cold congelation?" Therefore Wang used Yanghe Tang to treat yin nodules, using Deer-Horn Glue (Lujiao Jiao) and prepared Rehmannia (Shudi) to supplement qi and blood and warm yang and unblock the interstices, while using Ephedra (Mahuang), blast Ginger (Paojiang), and Cinnamon (Rougui) to scatter cold and dissolve congelation, White Mustard Seed (Baijiezi) to resolve phlegm and disperse nodules, and raw Licorice (Sheng Gancao) to harmonize the herbs and prevent excessive warming-dryness from damaging fluids. This formula has a simple composition and outstanding efficacy, so it is listed as the number-one TCM formula for treating yin nodules.

But among the medical cases listed by Wang, there is no clearly scleroderma case. However, there are many contemporary practitioners who treat scleroderma with Yanghe Tang, and many are cured. Searching with Yanghe Tang and scleroderma as keywords yields a large number of papers and clinical reports.

The contemporary famous surgeon, the veteran Doctor Zhu Yongxian, in his Records of Zhu Yongxian's Clinical Cases, also records several cases of treating scleroderma; the treatment approach resembles Wang Hongxu's Yanghe Tang, also mainly warming yang. But Dr. Zhu Yongxian treated scleroderma as an impediment syndrome, with the treatment principle of warming yang and unblocking the vessels, moving qi and activating blood.

Zhu mostly treated with Taohong Siwu Tang (Peach Pit and Safflower Four-Substance Decoction) plus Aconite (Fuzi), Cinnamon Twig (Guizhi), Astragalus (Huangqi), Deer-Horn Glue (Lujiao Jiao), Psoralea (Buguzhi), Notopterygium (Qianghuo), Angelica Pubescentis (Duhuo), Salvia (Danshen), Curculigo (Xianmao), and Turmeric (Jianghuang). Sometimes he also moxabusted points such as Zusanli (ST36), Quchi (LI11), and Hegu (LI4), 15–20 minutes per point per day. The three scleroderma cases recorded in Zhu's medical cases were all treated with this approach, and after several months of treatment most patients achieved clinical cure.

It can be seen that TCM has certain advantages in treating this kind of intractable disease that modern medicine cannot cure.