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Comparative Analysis of Traditional Chinese Medicine and Contemporary Treatments for Psoriasis Vulgaris
Authors Zhou L, Wang Z, Wang Y, Wu M, Zou Y, Ma Y, Liu W, Zhao J, Zhou D, Li P
Received 8 July 2025
Accepted for publication 10 October 2025
Published 24 October 2025 Volume 2025:18 Pages 2777—2800
DOI https://doi.org/10.2147/CCID.S552325
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Monica K. Li
Lijiaming Zhou,1,2,* Zhengchun Wang,2,3,* Yan Wang,2,* Manning Wu,1,2 Yuemin Zou,1,2 Yueyue Ma,2,3 Wenbo Liu,2,3 Jingxia Zhao,1 Dongmei Zhou,2 Ping Li2
1Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 2Department of Dermatology, Clinical Medical School of Beijing University of Chinese Medicine (Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine), Beijing, People’s Republic of China; 3Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Dongmei Zhou, Email [email protected] Ping Li, Email [email protected]
Abstract: This scoping review synthesizes existing research comparing traditional Chinese medicine (TCM) and contemporary treatments (CTs) for managing psoriasis vulgaris (PsV). A thorough literature search was conducted across multiple databases through February 2024, identifying relevant systematic reviews, randomized controlled trials (RCTs), quasi-experimental, and observational studies that contrast TCM approaches with CTs for PsV. From an initial pool, 195 articles were analyzed, indicating a growing interest in this comparative area, with most studies involving sample sizes between 30 and 100 participants. Key interventions included both internal and topical applications of Chinese herbal medicines, notably Rehmanniae Radix, Arnebiae Radix, and Smilacis Glabrae Rhizoma. Outcomes focused on PASI scores, quality of life metrics, and adverse effects. Results suggest that TCM offers efficacy in improving PASI scores and quality of life; however, evidence concerning toxicity profiles, recurrence rates, and comorbidity outcomes remains sparse. Notable research gaps include a lack of comprehensive data on newer treatment modalities, particularly biologics. Future studies should aim to delineate subjects and interventions in greater detail to support clinical applicability.
Keywords: psoriasis vulgaris, traditional Chinese medicine, evidence map, clinical study, scoping review
Introduction
Psoriasis vulgaris (PsV) is a chronic, systemic inflammatory disorder marked by erythematous plaques topped with silvery scales on the skin, presenting a significant public health challenge worldwide.1 The prevalence of PsV ranges between 2% and 4% in European and American populations.2 While primarily a dermatological condition, psoriasis extends its effects beyond the skin, impacting joints, the gastrointestinal system, metabolic processes, and cardiovascular health.3 Recent studies have increasingly highlighted the complex, systemic nature of psoriasis, including its strong association with psychological disorders. Individuals with psoriasis are notably more susceptible to depression and anxiety than the general population, a consequence likely tied to the stress and social stigma associated with visible skin symptoms.4
Currently, there is no cure for psoriasis. Thus, treatment primarily aims to control and stabilize disease signs and symptoms, prevent recurrence and exacerbation, minimize both short- and long-term adverse drug effects, manage related complications, reduce comorbidity risk, and ultimately improve patients’ quality of life (QoL).5,6
Despite advancements in contemporary treatments for psoriasis vulgaris, several limitations persist. Conventional therapies, include topical corticosteroids, systemic immunosuppressants, and biologics. Throughout this manuscript, we refer to these globally accepted first-line therapies as contemporary treatments (CTs), which often entail significant adverse effects such as skin atrophy, hepatic toxicity, and increased infection risk. Moreover, long-term use of biologics may lead to diminished efficacy due to immunogenicity. Economic burdens and limited accessibility further restrict their widespread application, particularly in low-resource settings. Additionally, these treatments primarily target symptomatic relief rather than addressing the underlying systemic dysregulation, resulting in high recurrence rates. The lack of personalized treatment strategies also contributes to variable patient responses. These limitations underscore the necessity for alternative therapeutic approaches, such as Traditional Chinese Medicine (TCM), which may offer a more holistic and sustainable management strategy for PsV.7,8
Contemporary treatments herein refer to globally accepted first-line therapies for psoriasis vulgaris (eg, biologics, phototherapy), regardless of geographic origin, while Western treatments in the protocol specifically denoted interventions developed within Euro-American medical paradigms. This broader terminology captures evolving treatment landscapes (eg, biologics Yisaipu and small-molecule drugs Benvitimod cream approved in China, phototherapy protocols from Korean). This adjustment aligns with WHO’s classification of traditional and modern medicine (the WHO Beta-3 version of International Classification of Health Interventions (ICHI), 2023).
Traditional Chinese medicine (TCM) is a time-honored medical practice rooted in Chinese culture, with a history spanning thousands of years. Recognized for its efficacy and relatively low toxicity in treating psoriasis vulgaris (PsV), TCM employs various therapeutic methods, including internal use of Chinese herbal medicine (represented by decoctions), external use of Chinese herbal medicine (represented by ointment and bath), acupuncture, ear-acupuncture, fire needle therapy, moxibustion, cupping, bloodletting, as well as dietary and lifestyle modifications. In recent decades, advancements in modern technology have enabled healthcare professionals to rigorously assess the efficacy and safety of TCM in PsV management. Additionally, foundational studies have explored the pharmacological properties of TCM. Tripterygium Wilfordii, a herb commonly used in the treatment of autoimmune diseases, has gained attention for its active component, triptolide. This compound, found in water decoctions of Tripterygium Wilfordii, exhibits immunomodulatory effects and has contributed to the development of new immunomodulatory drugs.
The utilization of TCM in the treatment of psoriasis is predominantly observed in East Asia. The current understanding of TCM’s efficacy for PsV remains limited due to insufficient identification of pertinent evidence and the absence of a comprehensive systematic review. Thus, the precise role of TCM as a viable alternative treatment for psoriasis has not garnered widespread acceptance in the medical community.9,10 Our initial literature review reveals that TCM interventions for psoriasis are rarely included in clinical guidelines outside Asia, and even within Chinese guidelines, the methodological rigor varies considerably. Notably, many recommendations in these guidelines are based on individual primary studies rather than substantiated by systematic reviews (SRs), underscoring the need for more robust evidence to support these practices.11
In addition to adhering to established protocols, it is essential to thoroughly examine all relevant data to identify knowledge gaps, thereby guiding future research and improving patient care. Among research methodologies, a scoping review proves to be a valuable tool for synthesizing evidence. Its strength lies in its ability to systematically map and assess the existing literature on a given topic, providing researchers with a solid foundation for further exploration and insight.12,13 In this study, a scoping review was conducted to identify, elaborate on, and consolidate existing evidence regarding the effectiveness of TCM compared to CTs in individuals diagnosed with psoriasis vulgaris. The primary objective was to map the current evidence and highlight gaps that require further investigation.
Materials and Methods
Protocol and Registration
Our review adhered to the guidelines established by the JBI Scoping Review Methodology Group.14–16 Reporting was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR),17 as well as the methodology recommended by the Global Evidence Mapping Initiative.18 The approach to defining the scope of the content area19–21 involved: (1) setting boundaries and context for the topic; (2) identifying and selecting relevant research; and (3) outlining study outcomes and characteristics.
The protocol of this study was prospectively registered and is openly accessible on FigShare (https://doi.org/10.6084/m9.figshare.25466671.v1).
Eligibility Criteria
The PCC framework was employed to develop the research objective and question, and it also informed the eligibility criteria and search strategy.
Population
The study included adult individuals (aged 18 and above) diagnosed with psoriasis vulgaris, regardless of the severity or whether the condition was at initial onset or a relapse. Variants of psoriasis, such as psoriatic arthritis, pustular psoriasis, and erythrodermic psoriasis, were excluded.
Following PRISMA-ScR Item 7, we excluded psoriatic arthritis studies to maintain focus on cutaneous manifestations, as joint involvement necessitates distinct outcome measures (eg, PASI, ACR50)22 that would confound comparative efficacy analysis. This ensures comparability with our pre-registered comparator interventions.
Concept
The study included adult individuals (aged 18 and above) diagnosed with psoriasis vulgaris, regardless of the severity or whether the condition was at initial onset or a relapse. Variants of psoriasis, such as psoriatic arthritis, pustular psoriasis, and erythrodermic psoriasis, were excluded.8,23
For contemporary treatments (CTs), we referred to the Chinese guideline for the diagnosis and treatment of psoriasis8,23 and the joint AAD-NPF guidelines of care for psoriasis management.7 These treatments included topical medications (eg, vitamin D3 derivatives, corticosteroids, retinoids, vaseline), systemic therapies (eg, immunosuppressive drugs, retinoids, corticosteroids, biologics, small-molecule targeting drugs), phototherapy, and starch baths, either individually or in combination. Studies comparing a combination of TCM and CTs in the experimental group with CTs alone in the control group were excluded.
The primary endpoints of the study included the psoriasis area and severity index (PASI), quality of life (QoL), levels of inflammatory factors (IFL), as well as assessments of recurrence and toxicity. These outcomes were graphically represented to facilitate comprehensive analysis.
Context
We reviewed research conducted in diverse clinical settings, including community clinics, hospitals, and healthcare centers.
Types of Studies
This scoping review focused on methodologies for integrating research investigations in evidence synthesis, emphasizing clear presentation of research inquiries, search strategies, data analysis, and synthesis specifics. The study included various primary research types like randomized controlled trials (RCTs), quasi-experimental studies (Q-Exps), observational studies (OBSes), and secondary research types like systematic reviews (SRs), aligning with JBI Scoping Review Methodology Group guidelines.23 SRs were defined as secondary research meeting specific criteria: clearly stated eligibility criteria or research question, a structured search strategy across at least two databases, a defined screening method, quality assessment for each study, and a transparent data analysis and synthesis approach.24 RCTs were classified as experimental studies with randomized intervention allocation, while Q-Exps included experimental studies with limited randomization or specific designs such as interrupted time series or pre-post studies. OBS referred to observational studies, including case-control and cohort studies, with eligibility criteria requiring controlled parameters and a sample size of at least 30 participants. Exclusion criteria encompassed studies without a control group, clinical practice guidelines, case reports, non-systematic reviews, and qualitative studies. Publications not in Chinese or English were also excluded.
Search Strategy
To ensure a comprehensive review of the relevant literature, we conducted extensive electronic searches across multiple databases, including Excerpta Medica Database (EMBASE), MEDLINE (accessed via PubMed), China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang) and Chongqing VIP Database (CQVIP). These databases were systematically queried to identify studies on the use of TCM methods for treating PsV. The search period spanned from database inception to February 2024, using a strategy that combined subject headings with free-text terms. The detailed search strategy used for MEDLINE (PubMed) is available in Figure 1. Also, we reviewed PROSPERO and Clinicaltrials.gov to find eligible study protocols. Additionally, expert consultations were conducted to identify any further relevant studies.
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Figure 1 PubMed search strategy. |
Study Selection
Two reviewers (L. Zhou and Y. Zou) independently screened studies using ENDNOTE X9. Duplicate records were first removed, after which articles were carefully evaluated against the predetermined eligibility criteria by examining titles, abstracts, and full texts to determine inclusion. Any discrepancies that arose during this process were resolved by consulting a third author (D. Zhou), ensuring a comprehensive and unbiased assessment of the articles.
Data Extraction
Data extraction was independently conducted by two reviewers (Y. Wang and M. Wu), using Excel for data organization. Extracted data included the year of publication, country, study type, conflict of interest, number of studies included addressing our review question (for SRs), number of patients (for primary studies), interventions assessed (TCM methods), comparators (CTs), reported outcome measures, and effect direction classified as “favors intervention, FI” “favors comparison, FC” or “no significance difference, ND”. Additionally, specific treatment principles, methods, and medications for each study were documented. When studies provided multiple follow-up data points, the final follow-up data was extracted. Disagreements were resolved through discussion or consultation with a third party (J. Zhao and P. Li).
Data Synthesis and Result Presenting
We conducted a comprehensive analysis, presenting frequency counts and percentages for various aspects, including study types, populations, publication year, interventions, and outcomes. Results were communicated through narrative descriptions, tables, and diagrams to categorize studies by intervention type, research design, and effect direction.
All TCM interventions were categorized by evidence level: Level 1: Supported by ≥3 RCTs (eg, internal use of Chinese herbal medicine); Level 2: Supported by <3 RCTs but with quasi-experimental studies (eg, fire needle therapy); Level 3: Traditional use with limited contemporary evidence (eg, moxibustion). Claims were weighted accordingly in the analysis.
We employed mapping website (https://www.bioinformatics.com.cn) and packages in R to make diagrams and visualize results. Evidence maps were created as pie matrix plots, providing a visual representation of the evidence. These maps were structured in a grid format, with columns representing different TCM types and rows corresponding to specific outcome measures. Within each grid cell, studies were categorized by study design (RCT, Q-Exp, OBS) and effect direction. Evidence gaps were identified where a specific intersection lacked primary studies.
Results
Study Selection Process and Search results
After removing duplicate records, our comprehensive search identified a total of 6165 articles on various TCM methods. Screening titles and abstracts led to the exclusion of 4424 references. Of the remaining 1741 references, 42 reports were inaccessible, 64 reports were duplicated publications, 177 reports were Reviews, and 365 reports were unsuitable study type. A detailed review of the remaining 1093 full-text articles resulted in the inclusion of 195 studies that met our criteria (Figure 2). Of 195 included studies, 177 were primary researches (RCTs/Q-Exps/OBSes) and 18 were systematic reviews (analyzed separately).
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Figure 2 Flow diagram of the study selection process. |
Characteristics of the Included Studies
Supplementary Table 1 summarized the characteristics of the included studies. In the following paragraphs, we would present the results in turn in the form of descriptions, tables and graphs, based on the contents of each line in Supplementary materials.
Study Type
Of the 195 included studies, 55 were RCTs,24–79 92 were Q-Exps,80–167 30 were OBSes,168–197 and 18 were SRs.10,198–214Figure 3 and Supplementary Table 2 illustrated the number and the proportion of research type in the included literature.
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Figure 3 The number and proportion of research type in the included literature. X-axis: research type of included study; Y-axis: Count. Color: Orange bar/pie indicates randomized controlled trials (RCTs); blue bar/pie indicates quasi-experimental studies (Q-Exps); green bar/pie indicates observational studies (OBSes); yellow bar/pie indicates systematic reviews (SRs). |
Publication Year
The primary studies and secondary researches included both show an upward trend over the time period analyzed, as depicted in Figure 4. Supplementary Table 3 summarized the number of publication year of the included studies. It is important to note that our study concluded in February 2024, leaving 10 months unaccounted for in that year. This partial data gives the impression of a decrease in study quantity in 2024. Based on the observed trajectory, it is reasonable to anticipate that the number of publications in 2024 will ultimately remain elevated. Of the 195 included studies, 90 studies, representing 46.15%, were published within the last decade. A total of 6 studies (3.08%)10,27,202,211–213 were published in English. The included studies originated from four different countries and regions worldwide, with China as the leading contributor, followed by the United States and Sweden.
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Figure 4 Publication year of the included studies. X-axis: publication year; Y-axis: count. |
Sample Size
In all primary researches included, sample sizes ranged from 30 to 553. As showed in Table 1 and Figure 5, 110 studies (62.15% of all primary researches) had sample sizes ranging from 30 to 59. Studies, whose sample sizes ranged from 30 to 39, made up 55.45% of these 110 studies. As well as 47 studies (26.55% of all primary researches) from 60 to 99, 11 studies (6.21%) from 100 to 149, 6 studies (3.39%) from 150 to 100, and 3 studies140,168,215 (1.69%) greater than 200.
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Table 1 The Distribution of Sample Sizes |
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Figure 5 The Proportion of sample sizes. |
Stage and Severity of the Disease
Most of the included primary studies did not limit the stage and severity of the disease. Fourteen studies (7.91%) focused only on patients with mild to moderate PsV, while 6 studies (0.34%) focusing on moderate to severe or severe PsV. Moreover, 27 studies focused on progressive stage, while 11 studies (0.34%) focusing on quiescent state.
Interventions and Comparison
The TCM interventions and corresponding control measures utilized in all included primary studies are presented in Figure 6. Among various study designs, comparisons between internal use of Chinese herbal medicine (eg, oral decoctions) and oral retinoids were most frequently employed to compare treatment efficacy.
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Figure 6 Interventions and comparisons of included primary studies. X-axis: interventions. Y-axis: comparisons. Color: Orange bubbles indicate RCTs; blue bubbles indicate Q-Exps; green bubbles indicate OBSes. Abbreviations: IUCH, internal use of Chinese herbal; EUCH, external use of Chinese herbal; FNT, fire needle therapy; BL, bloodletting; E-Acu, ear acupuncture; MTX, methotrexate; ID, immunosuppressive drugs; OR, oral retinoid; TR, topical retinoids; OG, oral glucocorticoids; TC, topical corticosteroids; TVDD, topical vitamin D3 derivative; LT, light therapy; An, antihistamines; SB, starch bath. |
The clinical evidence depicts a predominant focus on evaluating the efficacy of orally administered Chinese herbs, topically applied Chinese herbs, and their combination, as alternative therapeutic options in comparison to contemporary treatments. Studies on the application of acupuncture, fire needle therapy, cupping, bloodletting, or a combination of these treatments compared to contemporary treatments are scarce, with fewer than 10 studies available. Moreover, studies on the combination of internal use of Chinese herbal medicine with these treatments are also sporadic. It is observed that the number of studies appraising internal use of Chinese herbal medicine surpasses that of external use of Chinese herbal medicine, followed by internal use of Chinese herbal medicine +external use of Chinese herbal medicine.
Among all included primary studies, the number of studies applying internal use of Chinese herbal medicine was the largest, with 108 articles, accounting for 61.02%. Among them, there were 27 RCTs, 59 Q-Exps, and 22 OBSes. The most commonly used control measures for comparison with internal use of Chinese herbal medicine were immunosuppressive drugs (eg, methotrexate) and oral retinoids (eg, acitretin). So, internal use of Chinese herbal medicine were categorized as evidence level: Level 1. The number of literatures for external use of Chinese herbal medicine ranked second, encompassing 17 RCTs, 13Q-Exps and 4 OBSes. There were also 4 RCTs, 10 Q-Exps and 2 OBSes about the combined internal use of Chinese herbal medicine and external use of Chinese herbal medicine. Individual RCTs have reported on the use of acupuncture, moxibustion, fire needle therapy, acupuncture +ear acupuncture, cupping +external use of Chinese herbal medicine, cupping + moxibustion and internal use of Chinese herbal medicine +bloodletting therapy+ cupping therapy, while one or two Q-Exps about cupping, bloodletting therapy, internal use of Chinese herbal medicine +bloodletting therapy, acupuncture +bloodletting therapy and internal use of Chinese herbal medicine +external use of Chinese herbal medicine+ cupping.
Washout Period
Of the initial studies included, 98 articles explicitly defined a washout period (Figure 7). Within these, the literature on internal use of Chinese herbal medicine comprised 19 RCTs, 32 Q-Exps and 12 OBSes.
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Figure 7 The Proportion of washout period studies. |
Outcome Measures
The outcome measures employed in all included primary studies are presented in Figure 8. The most commonly utilized parameters for assessing therapeutic efficacy are associated with the Psoriasis Area and Severity Index (PASI), particularly focusing on PASI improvement rates. Frequently referenced metrics include PASI60, indicating a 60% reduction in PASI from baseline, and PASI30, indicating a 30% reduction from baseline. Many studies use changes in PASI scores to compare the efficacy of TCM with CTs. Additionally, some studies emphasize improvements in patients’ quality of life and mental well-being, employing measures such as the Dermatology Life Quality Index (DLQI), Psoriasis Quality of Life Scale (PQOLS), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS).
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Figure 8 The bubble plot of outcome measures. X-axis: outcome measures. Y-axis: interventions. Color: blue bubbles indicate RCTs; green bubbles indicate Q-Exps; pink bubbles indicate OBSes. Abbreviations: IUCH, internal use of Chinese herbal; EUCH, external use of Chinese herbal; FNT, fire needle therapy; BL, bloodletting; E-Acu, ear acupuncture. |
The included studies also closely monitor the safety and toxicity profile of TCM, with a primary focus on adverse events and safety laboratory indicators. Objective outcome indicators such as cytokines TNF-α, IL-6, IL-8, IL-17, and IL-23 are frequently used to evaluate therapeutic efficacy.
The efficacy of combination therapies (eg, herbal decoctions plus acupuncture) was primarily assessed through composite outcomes such as PASI scores, DLQI, and cytokine levels. Most studies did not compare combination therapies against monotherapies. However, methodological heterogeneity—including variations in treatment duration, acupuncture techniques, and herbal formulations—complicates cross-study comparisons. Few studies employed blinded outcome assessors or used objective biomarkers, highlighting the need for more standardized and rigorous assessment methodologies in future research on TCM combination therapies.
Conflicts of Interest (COI) of Included Studies
COI were not disclosed in 215 studies (96.41%) studies, whereas eight studies (3.59%) explicitly stated that the authors reported no conflicts of interest.
Intervention Components Described in Included Sys
Among the included systematic reviews, 13 articles focused on internal use of Chinese herbal medicine for PsV, while one addressed external use of Chinese herbal medicine. Additionally, four articles explored therapeutic approaches such as acupuncture, moxibustion and cupping. None of the literature specified the disease states or severity levels for inclusion in the study. The most frequently employed comparison was OR. The most common outcome measure was the degree of improvement in PASI.
Evidence Map
Figure 9 provides a comprehensive summary of the collected evidence on PsV, organized by documented outcomes. Additionally, Supplementary Table 4 offers detailed insights into the direction of effects reported by individual studies across all outcomes in this scoping review. Supplementary Table 5 outlines the specific traditional Chinese medicine treatment principles and drugs used in the included studies. Furthermore, Table 2 illustrates the most commonly used Chinese herbal medicines in the studies analyzed.
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Table 2 Commonly Used Chinese Herbal Medicines |
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Figure 9 Evidence map of TCM vs CTs in patients with PsV. X-axis: TCM interventions. Y-axis: outcome measures. Color: Orange indicates FI, favor intervention; dark blue indicates FC, favor comparison; light blue indicates ND, no significance difference; and grey indicate NR, not reported. Abbreviations: IUCH, internal use of Chinese herbal; EUCH, external use of Chinese herbal; FNT, fire needle therapy; BL, bloodletting; E-Acu, ear acupuncture. |
According to Figure 9, many studies have favored TCM treatments to improve the disease with no difference in safety risks. For PASI improvement, 134 studies indicated that TCM treatments yielded significantly better outcomes compared to CTs, while 19 studies found no significant difference between TCM and CTs. And clinical evidence about cupping, fire needle therapy remains conflicting. Two RCTs76,78 reported no significant effect of fire needle therapy, cupping +external use of Chinese herbal medicine on psoriasis severity, while a meta-analysis211 suggested potential benefits in symptom relief but highlighted methodological limitations. While fire needle therapy is widely applied in TCM practice, its efficacy for psoriasis lacks robust support from large-scale randomized trials.212 In terms of life quality outcomes, 17 studies demonstrated significant differences favoring TCM over CTs.
The literature on the toxicity and safety of TCM compared to CTs yielded mixed findings. Of the 90 studies reviewed, no difference in adverse reactions was observed between TCM and CTs, while an additional 42 studies suggested that TCM was associated with fewer adverse reactions. Regarding effects on blood parameters, liver, and kidney function, 32 studies found no discernible differences between the two treatment types, while seven studies indicated that CTs were linked to higher safety levels.
In terms of recurrence rates, 23 studies supported the idea that TCM could lower recurrence rates compared to CTs, while 8 studies found no significant difference between the two. Analysis of 36 studies focusing on cytokine levels showed that only two randomized controlled trials (RCTs) and one quasi-experimental study (Q-Exp) reported no significant differences in serum cytokine levels between TCM and CTs, while the remaining studies demonstrated that TCM effectively reduced cytokine levels in serum.
The primary treatment modality in TCM for psoriasis, as illustrated in Supplementary Tables 4 and 5, predominantly involves the use of herbal medicine, followed by animal-derived and mineral-based treatments. Among the various herbs used, commonly employed ones include Rehmanniae Radix, Arnebiae Radix, Smilacis Glabrae Rhizoma, Moutan Cortex, Salviae Miltiorrhizae Radix et Rhizoma, Dictamni Cortex, Paeoniae Radix Rubra, Glycyrrhizae Radix et Rhizoma, Angelicae Sinensis Radix, Hedyotis Diffusa Herba, Carthami Flos, Spatholobus Suberectus, and Lonicerae Japonicae Flos. This specific selection of herbal remedies reflects the traditional approach to managing psoriasis within Chinese medicinal practices.
Discussion
Summary of Findings
This comprehensive scoping review meticulously examined the existing evidence pertaining to the effectiveness and safety of TCM compared to CTs in managing PsV among patients. A thorough analysis of 195 studies, encompassing systematic reviews, experimental, and observational studies, was conducted. It was observed that while a significant number of studies incorporated a washout period for patients, certain studies failed to disclose the treatment history of patients or mandate a washout of prior treatments. This variability in the approach towards patients’ medical background could potentially create an impression that the patients were being treated for PsV for the first time, which may not have been the case. Furthermore, the definition of CTs as a control group exhibited inconsistency, thereby introducing a potential source of bias that could impact the study outcomes.
The majority of included studies showed a preference for TCM based on Psoriasis Area and Severity Index (PASI) scores, although some studies reported no significant differences between TCM and CTs. Beyond PASI scores, other outcomes—such as quality of life, recurrence rate, and toxicity—also generally favored TCM.
Nevertheless, notable gaps were identified in the evidence, particularly regarding the evaluation of novel treatments such as biologics and small molecule drugs, as well as outcomes related to metabolic indicators, symptom management, and hospital admissions.
Results in Context
This scoping review is a pioneering effort in comparing TCM methods with CTs for PsV. It distinguishes itself through a comprehensive assessment of the scope, methodology, and characteristics of research within this broad field, contrasting with the typically narrower focus of systematic reviews.20 Notably, scoping reviews have previously been utilized in psoriasis research to clarify existing evidence on specific topics and identify future research directions. For example, such reviews have successfully identified and compiled potential biomarkers for monitoring disease progression in psoriasis.216
Our findings indicate that TCM has been used for many years in the treatment of PsV, with studies reported since 2000 showing a continuous growth trend. TCM offers a variety of treatment methods, including Chinese herbal decoctions, herbal ointments and creams, acupuncture, moxibustion, and cupping, among others. Chinese herbal decoctions, herbal ointments and creams have demonstrated efficacy on measures such as PASI90, PASI60, and other commonly used psoriasis outcomes. Preliminary studies77,213 suggest that acupuncture and moxibustion may have adjunctive effects in psoriasis management, but the evidence is not yet conclusive due to small sample sizes and heterogeneity in trial designs. A 2021 meta-analysis212 identified three small RCTs investigating fire needle therapy for psoriasis, reporting modest PASI score reductions. However, the clinical significance remains uncertain due to risk of bias and lack of long-term follow-up. Furthermore, our research suggests that therapeutic effects can be achieved not only through single-use treatments but also through combinations of two or more methods.
The requirement to report funding sources and other forms of support was introduced in the CONSORT checklist for randomized controlled trials (RCTs) in 2010 and has been a part of the PRISMA statement for systematic reviews since 2004.217,218 All systematic reviews (SRs) identified in this scoping review were published after the establishment of the PRISMA statement, with nearly all but two systematic reviews reporting conflicts of interest. Among randomized controlled trials (RCTs), over half were published after 2010, aligning with the inclusion of interest conflict disclosure in the CONSORT 2010 statement; however, only a small proportion adhered to this requirement. Previous research suggests that studies funded by the pharmaceutical industry tend to report more favorable outcomes for the tested drug compared to studies funded by other entities.219,220 However, among those that did, no clear pattern of outcome distortion was observed. Nonetheless, transparency in funding and conflicts of interest is essential for interpreting study validity. We recommend that future studies explicitly report funding sources and adhere to CONSORT and PRISMA guidelines to enhance transparency and reliability.
Gender may influence the prevalence, severity, and clinical presentation of psoriasis. Epidemiological studies suggest a slightly higher incidence in males, while females often report greater psychosocial burden and reduced quality of life.221 Hormonal fluctuations, particularly estrogen and progesterone, may modulate immune responses and disease activity. Furthermore, genetic and epigenetic factors linked to sex chromosomes could contribute to differential disease mechanisms.222 Despite these observations, the majority of included studies did not stratify outcomes by gender, limiting our ability to draw definitive conclusions. Future research should incorporate gender-based analyses to elucidate potential disparities in treatment efficacy and safety, thereby enabling more tailored and effective therapeutic strategies for both male and female patients.
Combination therapies appear to offer enhanced efficacy compared to monotherapies, particularly in refractory cases. However, the safety profile of such combinations requires careful evaluation. While some studies reported reduced adverse events, others noted potential herb interactions, which need warrant further investigation. Overall, current evidence suggests that combination therapy is a promising strategy for improving treatment outcomes in PsV, but its implementation should be guided by robust pharmacokinetic and pharmacodynamic studies to ensure both efficacy and safety.
The extensive research conducted in the field of comparative literature provides detailed insights into the use of traditional Chinese herbal medicine alongside modern therapeutic methods. This study highlights the diverse range of Chinese botanical remedies commonly employed in practice.
Strengths and Limitations
Our research offers several advantages. As the first scoping review comparing TCM and CTs in PsV, it aimed to encompass all relevant outcomes. An extensive search across five databases was conducted to minimize selection bias, and screening and data extraction were independently performed by two reviewers to reduce errors. Additionally, we used color-coded bubbles to visually represent the evidence in an accessible, user-friendly format.
This research may have encountered certain limitations. Notably, non-herbal TCM modalities like acupuncture and moxibustion were underrepresented (11/223 studies, 4.9%), with most evidence coming from single-center trials. While these techniques hold historical significance in TCM theory, their empirical validation requires larger multicenter RCTs, particularly for dose-response relationships and long-term effects. Claims related to these techniques should be interpreted with caution until replicated in rigorously designed studies. A key limitation of scoping reviews is the difficulty in fully eliminating potential publication bias. To address this, we consulted field experts to identify relevant unpublished studies. Additionally, due to the study design, we did not assess the methodological quality of the included studies, analyze effect sizes, or determine the certainty of the evidence. While scoping reviews are not intended to perform these analyses, caution is advised when interpreting the effects of interventions on various outcomes.
Future Perspectives
The broad scope of our scoping review reveals deficiencies in the current evidence and provides direction for future research in PsV. Identifying these knowledge gaps in TCM’s effectiveness on outcomes beyond PASI highlights the need for accurate evaluations of its potential impact on critical aspects such as quality of life, toxicity, and recurrence rates in individuals with PsV.
A notable gap identified in this review is the absence of direct comparative studies between TCM and biologics. While biologics represent a cornerstone in moderate-to-severe PsV management, their high cost, potential for immunogenicity, and risk of serious infections necessitate exploration of complementary or alternative therapies. TCM, with its multi-target and holistic approach, may offer synergistic benefits or serve as a viable alternative in certain patient subgroups. The lack of head-to-head trials precludes definitive conclusions regarding comparative efficacy, safety, and cost-effectiveness. We strongly advocate for future rigorously designed randomized controlled trials that directly compare TCM interventions with biologics, particularly in treatment-naïve or biologic-resistant populations, to address this critical evidence gap.
The importance of rigorously conducted research, particularly randomized controlled trials (RCTs) and systematic reviews (SRs), in comparing TCM with CTs across diverse patient-centered outcomes cannot be overstated. Such research is essential for building a strong evidence base that informs clinical guidelines, supports clinical decision-making, and advances truly patient-centered care.
Based on the accumulating evidence, TCM demonstrates considerable potential for integration into clinical guidelines for PsV management. However, several challenges must be addressed to facilitate this transition. Standardization of TCM formulations, rigorous quality control, and reproducibility of treatment protocols are paramount. Moreover, mechanistic studies elucidating the pharmacologic actions of key herbal compounds would strengthen the scientific rationale for their use. While developing a standardized TCM treatment protocol for PsV is feasible, it requires multidisciplinary collaboration among dermatologists, TCM practitioners, and pharmacologists. Future efforts should focus on establishing consensus-based treatment algorithms, validating biomarker-driven patient selection criteria, and conducting real-world studies to assess long-term outcomes and safety profiles.
These evidence maps can be valuable tools for researchers and field experts, helping to guide research decisions and study designs, avoid redundancies, and effectively address knowledge gaps. Consequently, foundational researchers may further investigate the unexplored pharmacological effects of TCM based on the clinical evidence presented here, paving the way for the development of new drugs.
This scoping review contributes significantly to the global understanding and potential adoption of TCM for PsV by synthesizing a broad spectrum of evidence across diverse study designs and outcomes. By highlighting the efficacy, safety, and limitations of TCM interventions, this review provides a foundational resource for clinicians, researchers, and policymakers interested in integrative dermatology. It also identifies key research gaps that, if addressed, could facilitate the incorporation of TCM into international treatment guidelines. Furthermore, by presenting evidence in a visually accessible format and adhering to rigorous methodological standards, this review enhances the credibility and accessibility of TCM research, thereby promoting its thoughtful integration into global psoriasis care paradigms.
Abbreviations
TCM, traditional Chinese medicine; CTs, contemporary conventional treatments; PsV, psoriasis vulgaris; RCT, randomized controlled trial; Q-Exp, quasi-experimental study; OBS, observational studies; SR, systematic review; Prog, progressive; QS, quiescent state; Res, remission; Mi, mild; Mo, moderate; Se, severe; NS/NC, not specified/not clear; NI, None intervention; IUCH, internal use of Chinese herbal; EUCH, external use of Chinese herbal; fire needle therapy; BL, bloodletting; E-Acu, ear acupuncture; MTX, methotrexate; ID, immunosuppressive drugs; OR, oral retinoid; TR, topical retinoids; OG, oral glucocorticoids; TC, topical corticosteroids; TVDD, topical vitamin D3 derivative; LT, light therapy; An, antihistamines; SB, starch bath; w, week/weeks; m, month/months; DLQI, Dermatology life quality; PGA, physician’s global assessment; VAS, visual analog scale scores for pruritus; AEs, incidence of adverse events; SLI, Safety laboratory indicators, including blood routine, urine routine, blood chemistry tests; RR, Recurrence rate; FI, favor intervention; FC, favor comparison; ND, no significance difference; NR, not reported.
Data Sharing Statement
All data generated or analyzed during this study are included in this published article and its supplementary information files. To facilitate verification and access to the original Chinese-language studies cited in this review, a complete library of all references has been provided as a supplementary file, named references (.enl). This library includes DOIs or direct hyperlinks to the articles on their respective source databases (eg, China National Knowledge Infrastructure - CNKI, Wanfang Data, Chongqing VIP) wherever available. We encourage readers to use this file, along with publicly accessible databases such as CNKI (https://www.cnki.net/) and Wanfang Data (https://www.wanfangdata.com.cn/), to locate the original publications.
Acknowledgments
We express our gratitude to all team members for their sincere collaboration, and acknowledge the original authors of the included studies for their remarkable contributions. We are also grateful to Professor Hu Jing for her guidance.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Funding
This work was supported by a grand from Beijing Municipal Financial Projects (NO. 11000023T000002046922), the National Natural Science Foundation of China (NO. 82274525) and Beijing Hospital Management Center - Key Medical Specialty Development Program (NO. ZYLX202115).
Disclosure
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The protocol of this study is available on FigShare (https://doi.org/10.6084/m9.figshare.25466671.v1).
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