XIAO Xue, YANG Su-qing

1. First Clinical Medical School of Heilongjiang university of Chinese medicine, Harbin 150040

2. Department of Dermatology, The First Affiliated Hospital of Heilongjiang

Keywords:Plaque psoriasis Fire acupuncture Midnight-noon ebb-flow Hemorheology

ABSTRACT Objective: To observe the clinical efficacy, immune inflammatory factors and hemorheology of patients with plaque psoriasis by using fire acupuncture combined with the theory of midnightnoon ebb-flow. Methods: Sixty-two patients with plaque psoriasis who met the diagnosis and inclusion criteria were randomly divided into control group and fire acupuncture with midnightnoon ebb-flow, with 31 cases in each group. The control group was treated with carpotriol ointment for external use, while the fire acupuncture group was treated with fire acupuncture with midnightnoon ebb-flow on the basis of the former and selected points by the opening method through midnight-noon ebb-flow theory. The patients in both groups were treated for 8 weeks and followed up for 4 weeks. The levels of PASI, DLQI, PSQI, HAMA, hs-CRP, TNF-α and hemorheology indexes in 2 groups before and after treatment were observed, including the comparison of whole blood viscosity, plasma viscosity and hematocrit. Results: PASI, DLQI, PSQI, HAMA, hs-CRP,TNF-α, blood viscosity and hematocrit levels were significantly improved after treatment (P ＜ 0. 05,P ＜ 0. 01), and the group in fire acupuncture with midnight-noon ebb-flow was significantly better than control group after treatment (P＜0.01). Conclusion: fire acupuncture with midnight-noon ebb-flow can improve the sleep quality of patients with psoriasis, relieve anxiety and effectively improve the blood cell rheology and microcirculation, alleviate clinical symptoms and improve the quality of life.

1. Introduction

Psoriasis is a chronic inflammatory disease[characterized by a well-defined erythematous papule covered with silvery white scales[1].With the acceleration of modern people's life rhythm, staying up late and eating high-fat and high-calorie foods, the factors of human body's biological clock disorder increase. In addition, with the change of environment, the incidence rate tends to increase year by year[2].The results show that the total number of psoriasis cases in China is as high as 8.66 million, and the prevalence rate and incidence rate are 1.95 times of that in 1990[3].Plaque psoriasis, as a high incidence of psoriasis, is more common in middle-aged and elderly patients with chronic disease course, and the treatment is difficult[4].In addition, plaque psoriasis patients may have different degrees of mental health damage and decreased quality of life[5].Therefore, on the basis of effective treatment of skin lesions, it is of great significance to improve the mental health damage and quality of life of plaque psoriasis.

Acupuncture and moxibustion is a common method for the treatment of plaque psoriasis, which has been widely used in clinical practice and achieved good curative effect[6].The theoretical basis of midnight noon ebb flow is an important part of acupuncture and moxibustion theory[7].A large number of studies have shown that midnight noon ebb flow acupuncture has good clinical efficacy in improving sleep and reducing skin inflammation[8-9].In the early stage of the research group, the fire needle surrounding needling method can slow down the skin lesion symptoms of patients with plaque psoriasis, improve the quality of life of patients, reduce the level of inflammatory factors, and the clinical effect is obvious.On the basis of fire needle encircling needling combined with midnight noon ebb flow theory, the research group has achieved good clinical efficacy in the treatment of plaque psoriasis.The report is as follows:

2. Data and methods

2.1 general information

From October 2020 to April 2021, 62 patients with plaque psoriasis were selected from the dermatology department of our hospital.According to the random number table method, they were divided into control group and midnight noon ebb flow fire acupuncture group with 31 cases in each group. They were followed up for 4 weeks.There was no significant difference in gender, course of disease and age between the two groups (P ＞ 0.05).See Table 1 fordetails.

Table 1 Comparison of general data between the two groups (n=31,±s)

Table 1 Comparison of general data between the two groups (n=31,±s)

group Gender Course of disease (month) Age (years) PASI (points)male female control group 17(54.8) 14(45.2) 5.71±3.01 45.24±14.02 20.88±6.09 Ziwu Liuzhu fire acupuncture group 12(38.7) 19(61.3) 6.13±3.89 42.13±15.20 21.03±7.40 t χ2=1.620 1.043 1.127 0.007 P 0.203 0.302 0.264 0.994

2.2 diagnostic criteria

2.2.1 western medicine diagnosisRefer to the Guidelines for Diagnosis and Treatment of Psoriasis in China (2018 Full Edition)[10]The disease manifestations of patients should have the following characteristics: ①Skin lesions are red patches with clear boundaries, covered with silvery white scales, and sieve-like bleeding spots can be seen after peeling off;②The diameter ranges from 1 cm to several centimeters, and the number varies; ③It mainly occurs in scalp and limbs, and can also be distributed all over the body, or even all over the body;④Sudden onset and long course of disease, which can develop with the seasons;⑤Skin lesions have obvious basal infiltration, dark red color, thick scales and tight adhesion.

2.2.2 TCM syndrome differentiationRefer to the standard[in Expert Consensus of Traditional Chinese Medicine External Treatment of Psoriasis Vulgaris[11], the blood stasis type of this disease: the course of disease is prolonged, the rash is mostly patchy, dark red, thick scales, mild or moderate infiltration, slow or astringent pulse, purple and dark tongue, and ecchymosis. And symptoms can be seen as nail-nails, purple lips or dark complexion. Women may have symptoms of blood stasis such as dark menstruation or blood clots.

2.3 inclusion criteria

① Conform to the inclusion criteria of TCM and Western medicine syndrome differentiation of plaque psoriasis; ② 26 to 59 years of age; ③Sign informed consent and continue to complete the treatment.

2.4 exclusion criteria

①Women in pregnancy, pregnancy or lactation; ②Patients with other skin diseases, hematopoietic system and mental diseases.;③Those who are known to be allergic to the components of calcipotriol ointment in this experiment, or who cannot accept fire needle therapy;④In recent 28 days, I have used similar drugs such as Tripterygium wilfordii, Tripterygium wilfordii and immunosuppressants.⑤

2.5 rejection criteria

①Poor compliance of patients;②No use of this medicine, external use or oral use of other drugs;③Affect the judgment of the effect,unable to judge the curative effect.④Failure to complete treatment for some reason and cases of loss of contact.

2.6 shedding standard

① There are obvious adverse reactions or special physiological abnormalities, and it is not appropriate to continue the participants;② Lack of data, which affects the effectiveness control and safety judgment of the test.

2.7 treatment methods

2.7.1 control group

Carbopol ointment for external use (Chongqing Huabang Pharmaceutical Co., Ltd., Sinopharm Zhunzi H20113541,specification: 15g:0.75 mg) is applied to the affected area twice a day

2.7.2 midnight-noon ebb-flow fire acupuncture treatment group

On the basis of the control group, the patients in the treatment group were treated with fire needle midnight-noon ebb-flow acupoint selection and fire needle acupuncture once a week. The specific operation method is as follows: tell the patient to take a comfortable posture and disinfect the acupuncture site. Referring to the method of taking acupoint cards by the midnight-noon ebb-flow[12], at Shenshi (15: 00-17: 00), the acupoints opened by midnightnoon ebb-flow Najia method are used as the main acupoints, and the rest are combined with Ashi acupoints. Hold the fire needle (Huatuo brand single-use acupuncture needle, 0.25×25 mm) with the indicating finger, middle finger and thumb in a "pen-holding style",heat it on the alcohol lamp until it turns red, and quickly prick the skin lesions vertically, straight in and out. The depth of acupuncture is 0.2～1cm just through the lesion tissue. The acupuncture density is about 2-5mm per skin lesion, and the acupuncture is radiated from the center of the lesion. Disinfect with iodophor after acupuncture,and tell patients not to touch water within 24 hours, once a week.

The study duration of both groups was 8 weeks, followed up 28 days after the end.

2.8 observation indicators

2.8.1 skin lesion evaluation standard

According to PASI scoring method in literature, [13]The changes of erythema (E), infiltration (I), scale (D) and skin lesion area (A)in the two groups of patients with plaque psoriasis and blood stasis syndrome before and after treatment were recorded respectively. The scale takes the sum of the product of area score and severity score of different skin lesions as PASI score, with the score range from 0 to 72.

2.8.2 TCM symptom score

Refer to the standard in the literature[14]Implementing TCM symptom score: skin lesion color (close to normal skin color, light red color, deep red color, dark red color), skin lesion thickness(height consistent with normal skin, slightly higher than normal skin,skin lesion with rounded or sloping edge, high elevation and obvious thickening),Tongue collaterals (inconspicuous, occasionally blue and purple with varicose veins, relatively blue and purple with varicose veins, coarse swelling, purple and black with varicose veins). Each score is 0, 2, 4 and 6, and the counting range is 0-18. The larger the score, the more obvious the symptoms of blood stasis in patients with plaque psoriasis.

2.8.3 Clinical curative effect

According to the Guiding Principles of Clinical Research on the Treatment of White Furuncle with New Chinese Medicine [15]The method in was used to judge the curative effect of two groups of patients. Methods: The curative effect index = (pre-treatment PASI score-post-treatment PASI score)/pre-treatment PASI score× 100%.The curative effect index is greater than or equal to 95%, which is judged as clinical recovery. 95%≥ curative effect index ＞ 60% is judged to be effective; 60%≥ curative effect index ＞ 30% is judged to be effective; The curative effect index below 30% is invalid. Total response rate = (number of cured patients + number of markedly effective patients)/number of patients in this group.

2.8.4 skin disease patients' quality of life score

The quality of life of patients in the two groups was evaluated by DLQI score scale in the form of questionnaire. [13] The table is designed with ten questions, including sensory perception, mental health, social relations, work and study, daily life and so on. The score is divided into four levels, from 0 to 3, which respectively represent that the impact on the quality of life is none, slight, obvious and outstanding; There are five grades in total, ranging from 0 to 30.The higher the score, the more seriously the quality of life will be affected. The degree of influence on patients' quality of life is none,weak, moderate, severe and extremely serious.

2.8.5 Analysis of sleep quality in patients with psoriasis

The sleep quality of the patients in the control group and the patients in the treatment group were analyzed, and the PSQI score scale was used for evaluation. [17] From 0 to 21, the higher the index,the more affected the patients' sleep.

2.8.6 Analysis of anxiety state in patients with psoriasisCompare the psychological state of the two groups of patients, and analyze the anxiety state of patients according to HAMA score scale.If the score is less than 7, it is none. 7-14 points suggest that patients may have anxiety; 15-21 points indicate that there is anxiety; 22-29 points indicate obvious anxiety; More than 29 points indicate severe anxiety[18].

2.8.7 Laboratory inspection

Before and after the treatment, the patients were collected early morning venous blood on an empty stomach and centrifuged. The inflammatory immune indexes and hemorheology indexes of the two groups were detected before and after treatment, and the differences were compared. The levels of serum TNF-α and Hs-CRP in the two groups were detected by enzyme-linked immunosorbent assay.In addition, capillary viscosity measurement and rotary viscosity measurement were used to detect hemorheology, including plasma viscosity, whole blood viscosity (high, medium and low shear) and hematocrit.

2.9 statistical analysis

SPSS 23.0 was used for statistical analysis. The counting data was expressed by "n (%)", and the χ2test was used. If the theoretical frequency in the four-grid table was less than 5, Fisher's exact probability method was used. Measurement data is expressed by"(s)", independent sample t test is used for comparison between groups, and paired sample t test is used for comparison within groups. P＜0.05 means that the difference is statistically significant.

3 Results

In this study, 62 cases were actually completed, without rejection and shedding.

3.1 Changes of PASI scores in two groups before and after treatment

The PASI scores of the two groups after treatment and on the 28th day of follow-up were significantly lower than those before treatment, and the difference was statistically significant(t=18.064,P=0.008 in the control group after treatment vs before treatment; On the 28th day of follow-up in control group, before treatment, t=16.313,P=0.013; After treatment vs before treatment,t=23.713,P=0.000 in the midnight-noon ebb-flow fire acupuncture group; Twenty-eighth day of follow-up in acupuncture group with midnight-noon ebb-flow fire vs t before treatment=22.073,P=0.002),and the PASI scores of the midnight-noon ebb-flow fire acupuncture group were significantly lower than those of the control group after treatment and on the 28th day of follow-up, and the difference was statistically significant. See table 2.

Table 2 Changes of PASI scores in the two groups before and after treatment (score,n=31,±s)

Table 2 Changes of PASI scores in the two groups before and after treatment (score,n=31,±s)

Note: *P＜0.05 compared with before treatment in this group; Compared with the control group , #P＜0.05.

group Before treatment After treatment Follow-up on the 28th day control group 19.73±2.67 9.30±1.83* 10.64±2.41*Ziwu Liuzhu fire acupuncture group 19.68±2.87 4.54±2.89*# 4.05±2.81*#0.082 7.750 9.914 P 0.935 0.000 0.000 t

3.2 Comparison of TCM symptom scores between two groups of patients with plaque psoriasis before and after treatment

After treatment and on the 28th day of follow-up, the scores of blood stasis syndrome in the two groups were significantly lower than those before treatment, and the difference was statistically significant (t=2.271,P=0.022 after treatment vs before treatment in the control group; On the 28th day of follow-up in the control group, before treatment, t=1.541,P=0.031; After treatment vs before treatment, t=12.665,P=0.000 in the midnight-noon ebb-flow fire acupuncture group; On the 28th day of follow-up, the acupuncture group with midnight-noon ebb-flow fire (T = 10.486 before treatment, P = 0.000),Moreover, the score of blood stasis syndrome in the acupuncture group of midnight-noon ebb-flow fire after treatment and on the 28th day of follow-up was significantly lower than that in the control group, with statistical significance. See table 3.

Table 3 Comparison of TCM symptom scores between the two groups of patients with plaque psoriasis before and after treatment (score, n=31,±s)

Table 3 Comparison of TCM symptom scores between the two groups of patients with plaque psoriasis before and after treatment (score, n=31,±s)

Note: *P＜0.05 compared with before treatment in this group; Compared with the control group ,#P＜0.05.

group Before treatment After treatment Follow-up on the 28th day control group 13.96±6.42 10.98±3.80* 11.38±4.06*Ziwu Liuzhu fire acupuncture group 12.74±4.56 2.86±1.70*# 4.65±1.99*#0.865 10.851 8.291 P 0.391 0.000 0.000 t

3.3 Comparison of the total response rate of patients with plaque psoriasis in two groups

Comparing the total response rate of the two groups after the course of treatment, the midnight-noon ebb-flow fire acupuncture group was significantly better than the control group, and the difference was statistically significant (P=0.000).. See table 4.

Table 4 Comparison of total response rate between two groups (score, n=31,±s)

Table 4 Comparison of total response rate between two groups (score, n=31,±s)

Note: Compared with the control group ,#P＜0.05.

effect effective be invalid Total response rate (%)control group 3 8 14 6 35.48%Ziwu Liuzhu fire acupuncture group 15 13 2 1 90.32%#group be fully cured show

3.4 Evaluation of quality of life of patients with plaque psoriasis in two groups before and after treatment

The DLQI scores of the two groups after treatment and on the 28th day of follow-up were significantly lower than those before treatment, and the differences were statistically significant(t=8.153,P=0.027 after treatment vs before treatment in the control group; On the 28th day of follow-up in the control group,before treatment, t=8.012,P=0.035; T=9.876,P=0.016 after treatment vs before treatment in the midnight-noon ebb-flow fire acupuncture group; On the 28th day of follow-up in the acupuncture group of midnight-noon ebb-flow fire, vs before treatment,t=10.374,P=0.011),And the DLQI scores after midnight-noon ebbflow fire acupuncture treatment and on the 28th day of follow-up were significantly lower than those in the control group, and the difference was statistically significant. See table 5.

Table 5 Comparison of DLQI scores between the two groups (score, n=31,±s)

Table 5 Comparison of DLQI scores between the two groups (score, n=31,±s)

Note: *P＜0.05 compared with before treatment in this group; Compared with the control group ,#P＜0.05.

group Before treatment After treatment Follow-up on the 28th day control group 25.09±7.61 17.19±2.97* 18.23±3.10*Ziwu Liuzhu fire acupuncture group 24.70±5.69 12.15±3.67*# 11.35±3.67*#0.882 5.954 7.979 P 0.226 0.000 0.000 t

3.5 Changes of sleep quality in patients with plaque psoriasis in two groups

The sleep quality scores of the two groups after treatment and on the 28th day of follow-up were significantly lower than those before treatment, and the differences were statistically significant(t=2.778,P=0.034 after treatment vs before treatment in the control group; On the 28th day of follow-up in the control group, before treatment, t=2.375,P=0.41; After treatment vs before treatment,t=3.647,P=0.021 in the midnight-noon ebb-flow fire acupuncture group; On the 28th day of follow-up in the midnight-noon ebb-flow fire acupuncture group vs before treatment t=2.057,P=0.026),And the sleep quality scores of the midnight-noon ebb-flow fire acupuncture group after treatment and on the 28th day of followup were significantly lower than those of the control group, and the difference was statistically significant. See table 6.

Table 6 Comparison of sleep quality scores between the two groups (score, n=31,±s)

Table 6 Comparison of sleep quality scores between the two groups (score, n=31,±s)

Note: *P＜0.05 compared with before treatment in this group; Compared with the control group ,#P＜0.05.

group Before treatment After treatment Follow-up on the 28th day control group 8.08±2.38 6.67±2.49* 6.73±2.74*Ziwu Liuzhu fire acupuncture group 7.37±3.28 4.29±2.39*# 5.40±1.44*#0.987 3.831 2.387 P 0.328 0.000 0.02 t

3.6 Changes of anxiety state of patients with plaque psoriasis in two groups before and after treatment

After treatment and on the 28th day of follow-up, the anxiety scores of the two groups were significantly lower than those before treatment, and the differences were statistically significant (the control group after treatment vs before treatment t=16.815,P=0.016; On the 28th day of follow-up in control group,before treatment, t=15.689,P=0.022; After treatment vs before treatment, t=14.399,P=0.006 in the midnight-noon ebb-flow fire acupuncture group; Twenty-eight days of follow-up in the midnight-noon ebb-flow fire acupuncture group vs before treatment t=9.428,P=0.013),Moreover, the scores of anxiety state after midnight-noon ebb-flow fire acupuncture treatment and on the 28th day of follow-up were significantly lower than those in the control group, and the difference was statistically significant. See table 7.

Table 7 Comparison of anxiety state scores between the two groups before and after treatment (score, n=31,±s)

Table 7 Comparison of anxiety state scores between the two groups before and after treatment (score, n=31,±s)

Note: *P＜0.05 compared with before treatment in this group; Compared with the control group ,#P＜0.05.

group Before treatment After treatment Follow-up on the 28th day control group 57.99±6.55 46.38±8.16* 49.88±4.41*Ziwu Liuzhu fire acupuncture group 54.57±6.99 42.89±4.14*# 45.77±3.89*#t 1.984 2.112 3.891 P 0.052 0.039 0.000

3.7 Changes of high-sensitivity C-reactive protein and tumor necrosis factor-α in patients with plaque psoriasis in two groups

Compared with before treatment, the laboratory test indexes of the two groups showed that the levels of Hs-CRP and TNF-α were significantly lower than before treatment (hs-CRP in control group after treatment vs before treatment t=2.113,P=0.024;T=1.335,P=0.037 after TNF-α treatment vs before treatment in control group; In the midnight-noon ebb-flow fire acupuncture group,after treatment of hs-CRP vs before treatment, t=4.278,P=0.006; T =1.752 after TNF-α treatment vs before treatment in control group, p= 0.019),And the improvement of laboratory examination results in the treatment group was significantly better than that in the control group, and the difference was statistically significant. See table 8.

Table 8 Comparison of Hs-CRP and TNF-α between the two groups before and after treatment ( n=31,±s)

Table 8 Comparison of Hs-CRP and TNF-α between the two groups before and after treatment ( n=31,±s)

Note: *P＜0.05 compared with before treatment in this group; Compared with the control group,#P＜0.05.

group Hs-CRP (mg/ml) TNF-α (ng/ml)Before treatment After treatment Before treatment After treatment control group 8.93±3.97 6.68±3.44* 2.87±0.44 2.24±0.28*Ziwu Liuzhu fire acupuncture group 9.36±5.07 4.17±1.634*# 2.85±0.27 1.37±0.274*#t 1.356 3.656 2.034 12.532 P 0.475 0.001 0.134 0.000

3.8 Changes of hemorheological indexes in patients with plaque psoriasis in two groups

There was no significant difference in blood viscosity (high,medium and low shear), plasma viscosity and hematocrit between the two groups before treatment. After treatment, the treatment index decreased significantly (the whole blood viscosity of control group after treatment vs before treatment t=1.285,P=0.031;T=1.948,P=0.024 in the control group after high incision treatment vs before treatment; T=0.981,P=0.039 in the control group after middle incision treatment vs before treatment; T=3.641,P=0.026 after low-cut treatment vs before treatment in control group; In the control group, hematocrit after treatment vs before treatment t=5.745,P=0.000; The whole blood viscosity of the midnight-noon ebb-flow fire acupuncture group after treatment vs before treatment t=0.896,P=0.029; In the midnight-noon ebb-flow fire acupuncture group, T = 1.295 after high incision treatment vs before treatment,P = 0.016; In the midnight-noon ebb-flow fire acupuncture group,t=4.775,P=0.008 after central incision treatment vs before treatment;In the midnight-noon ebb-flow fire acupuncture group, after lowcut treatment vs before treatment, t=1.031,P=0.15;The hematocrit of midnight-noon ebb-flow fire acupuncture group after treatment vs before treatment t=3.771,P=0.000), in which the change of midnightnoon ebb-flow fire acupuncture after treatment was better than that of the control group, and the difference was statistically significant.See table 9.

Table 9 Comparison of changes of hemorheology indexes between two groups of patients with plaque psoriasis before and after treatment ( n=31,±s)

Table 9 Comparison of changes of hemorheology indexes between two groups of patients with plaque psoriasis before and after treatment ( n=31,±s)

group period Plasma viscosity (mPa·s) Whole blood viscosity (mPa·s) Hematocrit (%)High cut Medium cut Low cut control group Before treatment 1.78±0.20 7.00±1.76 6.45±1.86 10.94±1.98 55.54±4.35 After treatment 1.43±0.35* 5.07±1.37* 5.48±1.95* 8.86±3.35* 42.43±4.13*Midnight flow fire needle group Before treatment 1.64±0.43 6.46±1.86 7.15±1.93 9.61±3.42 55.34±4.79 After treatment 1.18±0.39*# 4.14±1.07*# 3.93±0.99*# 6.36±1.22*# 41.53±5.29*#

4 Discussion

Psoriasis belongs to the category of "white furuncle" in traditional Chinese medicine, which is caused by blood-gas struggle, resulting in the loss of nourishment of muscle surface. Plaque psoriasis has a large area of skin lesions, or like coins, which can also fuse with each other to form tablets. Traditional Chinese medicine believes that blood stasis is mostly caused by abnormal blood rheology. [19] The blood stasis syndrome of this disease is mostly prolonged from the blood-heat syndrome of psoriasis vulgaris, which is characterized by excessive heat hurting yin, suffering from yin blood, and stagnation of qi and blood. Blood stasis, as the key pathogenesis, runs through the rest stage of psoriasis and affects the outcome and prognosis of the disease. [20] The midnight-noon ebb-flow fire needle needling can dredge qi and blood, promote blood circulation and remove blood stasis. With the unique warm nature of fire needle, the blood can be warmed and moved, and the feeling of needle and heat can help collaterals and blood circulation together, and with the force of fiery heat, the human body can be encouraged to run yang, dredge qi and blood, and purge its evil, so that blood stasis can be transformed and qi and blood can flow smoothly. "The party follows the law,and the law follows the certificate". According to the basic theory of traditional Chinese medicine "Lung governs fur", Hand Taiyin lung meridian belongs to Xinjin, which is a meridian with more qi and less blood. Yinshi (3:00-5:00) is the most abundant time of qi and blood flowing through the lung meridian of foot Taiyin, and the relative Shenshi (15:00-17:00) is the most debilitating time of qi and blood. The pathogenesis of plaque psoriasis is mostly due to the unfavorable movement of qi and blood or the prolonged course of disease, which leads to the obstruction of meridians, qi stagnation and blood stasis, and the loss of moist skin. To establish the pathogenesis of promoting blood circulation and removing blood stasis, Treatment principle of dredging collaterals and detoxicating."In fact, diarrhea is caused by deficiency, but it is supplemented by deficiency". The flow of lung through qi and blood is the weakest period in Shenshi. At this time, fire needle therapy is carried out to dredge meridians, disperse blood stasis and promote qi and blood,so as to stimulate qi and blood in viscera and achieve the function of harmonizing qi and blood in the whole body.Through Li uranium, etc.[21]Scholars have confirmed that psoriasis patients have different levels of anxiety, which will lead to a series of related sleep quality decline. Compared with ordinary people,patients with plaque psoriasis have a higher proportion of shallow sleep and less moderate and deep sleep. The research of heart rate variability shows that the autonomic nerve function of psoriasis patients is impaired, the sympathetic nervous system is different from ordinary people's relaxation level. Abnormal sleep affects immune function, and hinders normal physiological function and disease outcome. The midnight-noon ebb-flow fire acupuncture therapy can effectively improve the patients' internal anxiety and sleep while treating the skin lesions of psoriasis patients, and the score of the scale is significantly higher than that of the control.Therefore, it can be seen that the midnight-noon ebb-flow fire acupuncture has positive therapeutic significance for patients with plaque psoriasis and blood stasis syndrome.

Because of the common pathway mediated by immune T cells,many cytokines, such as TNF-α, show high expression levels in patients with psoriasis, thus stimulating keratinocytes to secrete interleukin. At the same time, infection is one of the important factors that cause psoriasis. The nonspecific inflammatory factor hs-CRP tends to rise[when there is inflammation and virus infection in the body.[22], the levels of TNF-α and hs-CRP in patients with plaque psoriasis were obviously relieved by midnight-noon ebbflow fire acupuncture, and the therapeutic effect was good Plaque psoriasis is caused by blood stasis, and the "blood stasis syndrome"in traditional Chinese medicine is closely related to ischemia and circulatory dysfunction in modern medicine. From the point of view of hemorheology, Abnormal blood physical and chemical levels can be regarded as one of the manifestations of blood stasis. In patients with plaque psoriasis, the plasma viscosity and whole blood viscosity are thickened in different degrees, and the blood viscosity and surface charge of red blood cells are lost. Vayá et al.[23] It is found that abnormal metabolism and immune inflammatory reaction can cause abnormal hemorheology indexes. Compared with healthy people, people suffering from psoriasis have higher plasma viscosity and fibrinogen levels and stronger erythrocyte aggregation ability.Moustafa et al.[24]It is pointed out that the viscosity of erythrocytes in psoriasis patients increases, and the average volume of erythrocytes decreases, which leads to the decrease of deformability of erythrocytes, that is, the ability of erythrocytes to change their shape when passing through microcirculation decreases. In addition, abnormal hemorheology, increased plasma fibrinogen and increased blood viscosity in patients with psoriasis will aggravate the inflammatory reaction of patients. Deterioration[25]. The results showed that the plasma, whole blood viscosity and hematocrit of patients with plaque psoriasis decreased after treatment. The decrease of plasma, whole blood viscosity and hematocrit in patients with plaque psoriasis of qi stagnation and blood stasis type treated by midnight-noon ebb-flow fire acupuncture is obviously better than that in the control group. Treating blood stasis according to the characteristics of hemorheology, reducing the whole blood viscosity and high plasma viscosity and increasing the surface charge of red blood cells are also one of the important topics discussed in domestic medicine at present. By clarifying the action link and principle of hemorheology, the measurement of hemorheology indexes can be used as an index to verify the clinical effect of TCM treatment, and at the same time provide scientific methods and objective data for our clinical evidence-based.At present, there are many shortcomings in the research. At first,the patients with blood stasis syndrome are included. However,the curative effect of midnight-noon ebb-flow acupoint selection combined with fire acupuncture for non-blood stasis syndrome is not clear. Secondly, the follow-up time is short, patients with plaque psoriasis have a long course of disease and show the characteristics of repeated attacks, so the follow-up needs to be further extended in the future research. In order to clarify the long-term effect of midnight-noon ebb-flow acupoint selection combined with fire acupuncture on plaque psoriasis.To sum up, midnight-noon ebb-flow acupoint selection combined with fire acupuncture can effectively improve the inflammatory immune response, hemorheology of blood cells and microcirculation of patients with psoriasis, obviously improve the skin lesion symptoms of patients and improve the quality of life.

Explanation of author's contribution and conflict of interest The author has no conflict of interest, and this paper is directed by Professor Yang Suqing and compiled and written by Xiao Xue.