According to the opinion of the writer, the root etiology of scleroderma circumscriptum is the deficiency of Yang Qi and Yin-blood, healthy Qi deficiency, unconsolidation of defensive qi, the exogenous evil attaching the skin easily, which results in the blockage of the collaterals, the corresponding symptoms are skin swelling, atrophy and sclerosis.
The primary herbs in the prescription should be the ones with function of nourishing Qi and blood, the prescription is the combination of Huang Qi  Bu Xue decoction and Si Wu decoction, which can reinforce Qi and Blood greatly, promote healthy Qi, and adjust the immune system.
At the meantime, using Gui Zhi , Bai Shao  Yao to keep Ying and Wei qi in balance, warm Yang and promote the blood circulation, disperse evil from the exterior, which can finally promote Qi and strengthen the exterior.
It has been reported that if the healthy Qi is insufficient, the mutations of gene is easily caused, which leads to abnormal immune response that causes T cell activation that induces autoimmune diseases. The herbs with function of reinforcing Liver and Kidney could regulate the immune system, combining the herbs with function of warming and reinforcing Kidney Yang (e.g. Rou Gui , Yin Yang Huo , Bu Gu Zhi , Tu Si Zi  etc.) to benefit Qi and warm Yang, so as to dredge the blockage.
In addition, to greatly use Jiang Huang , Dang Gui , Chi Shao  Yao, Chuang Xiong, ji Xue Teng , Dan Shen , Tao Ren , Hong Hua  etc. to activate blood circulation and dredge the blockage, which can promote the absorption of inflammation, localize and reduce the capillary permeability, improve the vascular function, repair the vascular injury.
Finally, applying a group of herbs to dispelling wind and eliminating dampness, expelling phlegm and dredging blockage, these herbs include Qiang Huo , Fang Feng , Sang Zhi , Shen Jin Cao, Bai Jie Zi , Xi Xin  etc. that have the function of eliminating dampness and dispersing blockage, antiing fibrosis, promoting skin to heal.
It indicates in the study that the early internal and external combined treatment for scleroderma circumscriptum may enhance the phagocytosis of macrophage, improve the lymphocyte transformation rate, increase the content of serum gamma globulin ratio and skin bubble liquid in IgA, IgG, increase the content of plasma cortisol, reduce the number of eosinophils in blood. With external paste, the cellular immunity and humoral immunity ability are improved,
the endocrine function of hypothalamic pituitary adrenal cortex system are also improved, the defense function of human body is strengthened, the resistance ability against the diseases is enhanced, the allergic phenomenon reduces or disappears, the physical condition is improved.
Key words: Scleroderma Circumscriptum, Internal and External Combined Treatment
Writer: Aiyu Han
TCM department, Gushuyuan Mine hospital, Jincheng coal group, Shanxi province (048000)