從小到大的頭皮乾癬，跑了幾趟彰化就好了！

初次見面的時候，他剛從急診回來，滿臉血淋淋的。小廖醫師大吃驚，發生了什麼事？患者的媽媽沒好氣的說，「就網路上看到你們玉衡治療有效，趕著要過來，結果發生車禍，牙齒都掉了。」
When I met the young man, he just came back from ER with bloody face. " What happened?" I was scared. "He had an traffic accident on the way here" said his Mon, "He heard your therapy works really, so he ride too quickly to lose his teeth."



小廖醫師無言地看著這位弟弟，還好下巴還在，以往小廖醫師守急診室的時候曾遇過機車車禍到下巴整個磨平的。弟弟的情緒算是很穩定，雖然嘴巴很痛。小廖醫師看了看他的乾癬，雖然病史很長，超過十年，不過還好，乾癬上的屑屑都還在。
What a sad story, and fortunately he still had his chin. I've seen someone lost his chin in motor accident when I was in ER 20 years ago. The young man is stable in mood even ache on his mouth. I checked his psoriasis and found complete scaling on his scalp even he had a long story of psoriasis.

對中醫而言，乾癬上的屑屑是很重要的保護角色。小廖醫師如果看到乾癬表面光光的沒有一層皮屑，都會覺得很棘手，因為這代表了乾癬常常受到患者的破壞，抓搓摳都有。這位阿弟的皮屑很厚，在西醫的評份標準PASI上也是一個嚴重度的指標。但在小廖醫師看來，有屑屑好！能脫屑的乾癬才是好乾癬啊！
For Chinese traditional medication, scaling on psoriasis is important because it protect psoriasis below them. I feel tricky when I found no scaling on psoriasis because it means scratching injury. The young man had thick scales. Scales is an index on PASI, but in my opinion, psoriasis with scaling is much easier to treat than without scaling.

無論什麼程度的乾癬，它都是乾癬，都不是幾天就會好的。治療上就是必須逐步前進，皮屑慢慢變薄，發紅程度下降。
Psoriasis takes time to heal, and no short cut to to follow. Scaling and reddish decrease as time goes by.

讓我驚訝的是，阿弟的配合度非常好，讓不熬夜就不熬夜，讓不吃辣就不吃辣，很快的，他的皮屑就掉光了，而且紅腫程度下降很多，就剩下肉眼可見的發紅。這個時候還是不能夠停止，還是要繼續治療的。
It's so surprised to me the young man cooperates so much. No more staying up, no more spicy food. His symptoms diminished quickly, and he persisted.

等到紅色的疤痕恢復到灰色的時候，大概就可以讓患者畢業了。整個治療流程大概是四個多月。我們常聽到患者說他的病程多久多久，看過多少醫生，台灣頭醫到台灣尾，其實這些都不重要。重要的是：
The patient graduates from our clinic when the scar change from red to gray, and the total time takes about 4 more months. It doesn't matter how many Dr.s you met, and it matters:

1. 你有沒有還在使用類固醇？有的話，快丟掉！
2. 你能不能乖乖聽醫生的話，改變生活習慣？
3. 你肯不肯每天花一小時的時間來治療乾癬呢？等待時間是可以滑手機的，但必須堅持四個多月以上。
1. Still steroid using? Give up now!
2. Could you change life habit as Dr's order?
3. Would you spend one hour everyday to treat psoriasis for at least 4 month?

當我跟阿弟說再見的時候，他的假牙還沒弄好…衷心希望以後阿弟騎車都平平安安！
Patient is important. Finally I said goodbye to the young man, and I wish him ride safely in the future.