Objective

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The study aimed to elucidate the evolution of the syndromes in Traditional Chinese Medicine (TCM) and TCM syndrome elements in different chronic stages of psoriasis vulgaris.

Methods

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A database was constructed using electronic medical records collected from July 2019 to March 2024 from 1

049 patients with psoriasis vulgaris. The study used Sankey diagrams and network association graphs to analyze the evolution of TCM syndromes and their elements in patients at the different stages: initial diagnosis

progressive stage (Week 2-3)

progressive stage (Week 4-5)

skin lesion improvement stage (Week 6-7)

and remission stage. The syndrome elements network was constructed using community detection algorithms

and the association rules between local skin lesion syndrome differentiation and overall syndrome differentiation were displayed using heatmaps.

Results

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(ⅰ)Initial diagnosis. In the syndrome differentiation of local skin lesions

blood heat syndrome was the most common (79.79%); among the disease location of TCM syndrome elements (called "disease location" )

liver was the most prevalent (35.62%); and among the pathological factors of TCM syndrome elements (called "pathological factors" )

fire (heat) was the most common (75.48%). (ⅱ) Active stage (Week 2-3). In the syndrome differentiation of local skin lesions

blood heat syndrome remained the most prevalent (73.13%); among the disease location

liver was still the most prevalent (31.71%); and among the pathological factors

fire (heat) continued to be the most common (82.11%)

while dampness (22.26%) and qi stagnation (8.39%) began to increase. (ⅲ) Active stage (Week 4-5). The syndrome differentiation of local skin lesions was dominated by blood heat syndrome (45.91%) and blood dryness syndrome (37.19%); among disease location

the interior was the most prevalent (15.25%); and among the pathological factors

fire (heat) remained the most common (50.66%)

with an increase in yin deficiency (34.26%). (ⅳ) Skin lesion improvement stage (Week 6-7). In the syndrome differentiation of local skin lesions

both blood dryness syndrome (49.44%) and blood stasis syndrome (33.33%) increased; among the disease location

meridians increased most significantly and became the most prevalent (13.44%); and among the pathological factors

blood stasis increased most significantly and became the most prevalent (28.20%). (ⅴ) Remission stage. In the syndrome differentiation of local skin lesions

blood stasis syndrome became the primary (55.69%)

while the percentage of blood dryness syndrome decreased (21.16%); meridians (25.71%) and blood stasis(62.34%) remained the most predominant syndrome elements related to disease location or pathological factors.

Conclusion

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The overall pattern of TCM syndromes in psoriasis vulgaris evolved from excess to deficiency. From the initial diagnosis to the active phase (Week 2-3)

heat syndrome dominated; during the active phase (Week 4-5)

heat syndrome coexisted with damp syndrome or yin deficiency syndrome; changes in the syndrome element network were the most significant during the lesion improvement phase

with blood stasis gradually increasing and peaking during the remission phase. Blood stasis

dampness

and qi stagnation were pervasive throughout psoriasis vulgaris; qi stagnation and blood stasis may be the main elements causing further deterioration and prolonged course of the disease during the active phase in patients.