Objective

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To explore the distribution and evolution patterns of traditional Chinese medicine （TCM） syndromes and syndrome elements in psoriasis vulgaris （PV）.

Methods

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Literature related to TCM syndromes of PV published in databases including China National Knowledge Infrastructure （CNKI）， Wanfang Data Knowledge Service Platform （Wanfang）， VIP Chinese Technology Periodical Database （VIP）， Chinese Biomedical Literature Database （CBM）， PubMed， Embase， and Web of Science from their inception to December 31， 2023， was retrieved. Statistical analysis was conducted on the distribution of TCM syndromes and syndrome elements in the included studies. The data were further categorized into five-year periods to analyze the dynamic changes in syndromes and syndrome elements over time.

Results

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A total of 2

853 studies were included， with 5

896 syndrome occurrences. The most common TCM syndromes in PV were blood-heat syndrome （2

167 occurrences， 36.75%）， blood-stasis syndrome （1

219 occurrences， 20.68%）， blood-dryness syndrome （1

124 occurrences， 19.06%）， and damp-heat syndrome （263 occurrences， 4.46%）. The most frequent syndrome categories included blood syndromes （4

680 occurrences， 79.38%） and dampness syndromes （347 occurrences， 5.89%）. The most common syndrome elements related to disease location were blood division （4

874 occurrences， 94.38%） and spleen （99 occurrences， 1.92%）. The most common syndrome elements related to disease nature were blood-heat （2

213 occurrences， 25.96%）， blood-dryness （1

434 occurrences， 16.82%）， and blood-stasis （1

330 occurrences， 15.60%）. Except for the period 1978-1983， blood-heat， blood-stasis， and blood-dryness syndromes consistently ranked among the top three， with their combined proportion showing an overall upward trend （from 67.65% to 81.69%）. The proportion of spleen deficiency with damp obstruction syndrome also increased （from 0.24% to 1.46%）. In terms of syndrome classification， the proportion of blood syndromes showed an overall upward trend （from 67.65% to 83.46%）， ranking first in all periods. The proportion of dampness syndromes showed a general downward trend （from 17.65% to 4.54%）， ranking second after blood syndromes in most periods except for 1994-1998 and 1999-2003. The proportion of spleen-related syndromes showed an overall increase （from 0.24% to 1.85%）. Regarding disease location elements， the proportion of blood division remained stable above 90%， while the proportion of spleen involvement increased （from 0.68% to 3.23%）. As for disease nature elements， blood-heat （from 19.23% to 33.27%） and blood-stasis （from 1.92% to 20.83%） significantly increased， while dampness initially decreased and then slightly increased （from 11.54% to 5.73%）.

Conclusion

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In the distribution of PV-related TCM syndromes， blood-heat， blood-stasis， and blood-dryness syndromes are the most common. Blood syndromes dominate syndrome classification， with disease location primarily in the blood division and disease nature characterized by blood-heat， blood-stasis， and blood-dryness. Evolutionary trends indicate that blood-heat， blood-stasis， and blood-dryness syndromes remain predominant and are increasing in proportion， while spleen deficiency with damp obstruction syndrome is also rising. Among syndrome classifications， the proportion of blood syndromes is increasing， dampness syndromes are decreasing， and spleen-related syndromes are on the rise. In terms of syndrome elements， blood division remains dominant， while spleen involvement is increasing. The proportion of blood-heat and blood-stasis is significantly increasing， while dampness first declines and then slightly rebounds. Overall， the mainstream TCM perspective of treating PV based on blood differentiation remains unchanged， with syndrome distribution focusing on blood division. The increasing importance of spleen deficiency and dampness in disease pathogenesis represents a new trend.