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Named after Turkish dermatologist Hulusi Behçet who in 1936 published his findings in a medical journal, this illness is also described by Hippocrates in the 5th century. Interestingly, sometime between the first and second century, a chinese medicine great by the name of Zhang Zhongjing had already documented treatment for a disease called 狐惑病. The expression of the disease is strikingly similar to that described in Behçet’s disease.

The disease as it is known today:

The hallmark of the disease is ulcerations. Oral ulcers are the first thing to spot. And the next thing to query is if there are genital and anal ulcers, skin lesions and eye inflammations. Although it doesn’t follow the usual pattern of autoimmune diseases, it is a problem with the immune system. Inflammation is not controlled and happens in excess, especially where there are blood vessels, usually small ones.

As described in 《金匮要略》：

狐惑之为病，状如伤寒，默默欲眠，目不得闭，卧起不安，蚀于喉为惑，蚀于阴为狐，不欲饮食，恶闻食臭，其面目乍赤、乍黑、乍白。

We focus first on the second half the illness delineation.  The description used the word 蚀, as in “worms eating at.” The illness is called 惑 when the oral cavity is being “eaten through.” It is called 狐 when the genital and anal areas are “being eaten through.” Then we have something about the person’s reaction to food. Probably because he knows eating causes pain, he has no desire to eat, nor smell food which is considered smelly. The last part mentiones the eyes and face, where the color changes suddenly, from red to black to white. This I associate with inflammation of the eye area.

Interestingly, the author of 《金匮要略》mentions other interesting signs in the first part of the delineation. He says that the patient will experience exterior signs not dissimilar to 伤寒. He also notes that the person will want very much to sleep, but will have trouble closing his eyes and not experience good sleep. Which is not surprising, given the pain he’s going through.
Treatment:

Corticosteroids are an obvious consideration, however immune modifiers are cited in my sources, including anti-TNFs and interferons.

The formula used by Mr. Zhang is very interesting. It’s 甘草泻心汤, which is exactly the same as 半夏泻心汤 BUT with a very strong dose of licorice（甘草）- four 两. Although it just says licorice (not mentioning how to prepare it) in the original formula, some people may infer that honey-fried licorice（炙甘草）should be used. Why? To tonify, perhaps tonification would balance the immune system. If used in such a manner, this formula is certainly good for stomach diseases, e.g. inflammation or ulcers, and it would be a stretch to infer that the honey-fried licorice is what solves the immune problem.

Looking at the textbooks on herbs, we know that honey-fried licorice helps boost qi. That’s certainly needed here, but we need look further to find that raw licorice is useful in clearing heat and getting rid of poisons（清热解毒）.

For further confirmation, let’s look at a clinical case put out in the most recent edition of 中国中医药出版社，金匮要略. A lady, 36 years of age, had ulcers in the mouth and her genitalia for half a year. Diagnosed as Behçet’s disease, she used corticosteroids to no avail. Then she came to see a chinese doc, who gave her 甘草泻心汤. Raw licorice was used. The formula:

• 生甘草 30g
• 党参 18g
• 生姜 6g
• 干姜 3g
• 黄连 6g
• 黄芩 9g
• 生地 30g
• 大枣 7枚

From the formula above, one will notice two things:

1. The first is the emphasis on clearing heat. 连、芩 are effective in clearing heat, and also are strong dehydrating agents that take out dampness - useful especially with all those ulcers appearing everywhere. But that’s not interesting. What’s interesting is the 30g of raw licorice and raw rehmannia he’s added. I think that these two are strongly tonifying but in a cooling sort of way.
2. The other interesting thing is that he didn’t use just dried ginger（干姜）which makes sense if you have a stomach problem due to deificient-cold. No, he used 66% fresh ginger instead, good for the tummy, but perhaps a little less on the heat.

The chinese doc also had an external wash formula made up of 苦参 12g and 生甘草 12g. 苦参 is very similar to 黄芩、黄连 in terms of property classification. They are bitter, cold and drying. 苦参 is useful for external wash and can also be classified with other liver meridian damp-heat herbs like 黄柏、龙胆草、木通、车前子、赤小豆 to get rid of lower jiao heat and damp. 蛇床子 (cnidium) is another possible addition, but we must remember that it is has more warming properties (hence allowing it to “warm the kidney also.”)

Which brings us to external treatment alternatives proposed in the ancient classic. I won’t quote, but this is the gist:

1. Use sophora（苦参）as an external wash for the genitalia
2. Use red orpiment（雄黄 aka AS₂S₂）for anal ulcers

For the skin:

Well, so far, we’ve been talking about the ulcrs in the oral cavity, the genitalia and the anal region. Also inflammation of the eyes. But we’ve left out skin problems. 赤小豆  (cnidium monnieri) is actually good for skin problems. It can 清热渗湿、解毒排脓.

In fact, 赤小豆当归散 has been useful for a host of skin problems where there is exudation e.g. eczema, contact dermatitis, impetigo herpetifomis.

That said, the original use of the formula is not so much skin-focused but abscesses.  It can be consumed and also used as an external wash.

In all cases, use of any formulae mentioned here must accompany 甘草泻心汤. Keep that in mind.

Sources:

1. http://en.wikipedia.org/wiki/Beh%C3%A7et’s_disease
2. http://www.gulouhospital.com/zhuanti/baisaizhenghe/index.htm
3.  中国中医药出版社，金匮要略
4. http://en.wikipedia.org/wiki/Cnidium