Treating Eczema and other Inflammatory Skin Diseases

Michael Tierra

In the treatment of skin conditions such as eczema and psoriasis we are primarily dealing with the two external causes of Heat and Dryness. Underlying most chronic conditions there is usually a deficiency, some fundamental regulating mechanism that is not able to maintain homeostasis. So the Chinese treatment fact principle, “always identify the deficiency”. Deficiency, in TCM terms, involves Qi, Blood, Yin and/or Yang because there can be and often is more than one deficiency.

Because herbs are mild they are usually not strong enough like drugs, to overwhelm the body’s innate defenses to cancel a symptom without causing some damage. In the case of many skin diseases, the Western medical treatment usually involves the use of cortisone, a substance that naturally mimics the effects of an adrenal secretion (TCM Kidneys), which because it is anti-inflammatory is usually termed Kidney Yin. Blood is the foundation that builds Yin in the body so for chronic skin diseases like eczema and psoriasis, we look to treat Blood and/or Yin deficiency as the root of the problem.

Thus following the initial 8 principles of a condition like skin disease we would come up with something like External, Heat, Excess or Deficiency, Yin as a likely diagnosis for most appearances. So let us further define the two categories of Heat and Dryness as a foundation to our understanding:

Heat
TCM describes to types of heat one is measurable such as a fever while the other is not like a hot flash. n terms of Traditional Chinese Medicine (TCM), Heat refers to heat you can measure, like a fever, or heat you can’t measure, like a hot flash. No matter the type or source of it, Heat generates movement and activity and is a over-stimulation or hyper-metabolic condition.

There is ‘true’ or ‘righteous’ necessary for normal life activities and there is ‘false’, ‘abnormal’ or Heat. In disease Heat is abnormal and can be the result of either excess or repletion or Deficiency or inner vacuity. There may even be a mixed combination of Yin vacuity with Internal Coldness and External Heat which can be the case for chronic diseases such as Eczema and psoriasis (both skin diseases are essentially treated the same herbally with psoriasis being even more chronic a difficult to complete resolve).

Evil Heat occurs when the body’s normal Heat regulating mechanisms, Kidney Yin, are overwhelmed. This may initially occur as a result of toxic overload, from bad diet, chemicals, alcohol, excess of strong spices, too much stress and hard physical activity — and at this early stage we look to the possibility of eliminating the excess to resolve the problem. However, eventually if the inner condition of excess persists, the body’s normal regulating mechanism, Kidney Yin becomes depleted and the condition assumes a more chronic character and as a result it is no longer enough to simply remove the excess and we must look to the inclusion of Blood and Yin tonics to supplement the deficiency. It is at that stage that the use of strong pharmaceutical drugs such as cortisone can further deplete the body’s innate reserves. In this case, the body becomes dependent on the external source of cortisone and gradually does not make its own in the adrenals. With too frequent use, patients become increasingly dependent with no innate regulatory mechanism unctioning, it becomes vulnerable to diseases of excess cortisone which include fluid retention, weight gain and other symptoms associated with hyperaldosteronism.

Certainly dietary factors and allergies can cause Heat but we need to ask ourselves whether the dietary factor, an intolerance to certain foods such as soy, wheat, spices, alcohol, coffee and strong spices is also the result of inner Yin deficiency. Hormonal activity such as an excess of adrenal from continued mental and physical stress or the imbalance that comes from the natural waning of hormones such as estrogen, progesterone, testosterone is the cause of such Heat. An overly stimulating diet can also cause excess Heat as can a hyperactive mind or lifestyle. Emotional constraint such as anger, sadness, depression, frustration can cause friction, these are also seen as a cause of Heat as well.

So why some people seem to be able to better endure such physical and emotional stress without developing disease while others have a much lower tolerance is due to innate reserves from birth (called source or yuan qi) and factors of stressful life experience and age.

Our skin reflects heat as rashes, redness, pimples, boils, dryness, infections, and other skin inflammations. Blood is the source that nourishes Qi and generates Yin fluids. So sometimes heat is caused by Blood Deficiency. If blood is deficient, it can cause more problems than just dryness. Deficient blood cannot properly dilute normal cell wastes (toxins) which must be transported in the blood. Toxic Heat in the Blood will result. This condition will be diagnosed as many different inflammatory skin diseases. Specifically there is a TCM category of heat clearing, anti-inflammatory herbs known as clearing heat from the blood. This includes a number of herbs including cow horn, unprocessed rehmannia and scrophularia root to name a few. These have both nourishing and heat clearing properties. The dryness on the skin is a symptom of Blood deficiency which includes lack of blood and poor circulation of blood. Eczema is usually diagnosed when internal heat generates dryness in the skin.

Dryness
Dryness when it is a cause of disease is one of the eight atmospheric or external pathogens or evils. It can come from heat, fluid deficiency, or a dry environment. Individuals have certain humoural propensities both from birth and acquired in life, in Ayurveda this is fundamental and diagnosed as a propensity towards higher metabolism (pitta), higher nervous sensitivity (vata) and higher phlegmatic or fluid propensity (kapha). This helps us to understand the underlying differences and susceptibility of people outside of a purely pathogenic perspective. It also informs us as to the greater or lesser effects of conditions such a dry weather, wind, drying substances (alcohol for instance) and other factors. In TCM dryness Dryness can also come from deficiency of blood or other fluids. Internal heat, whether from feverish disease or from fluid deficiency that will further scorch the fluids, causing more dryness. So determining that cause of dryness is important, whether it is a reflection of a normal inherited tendency described as vata dosha in Ayurveda or an abnormal depletion of yin fluids. When symptoms of dryness, heat, etc correspond with the underlying normal humoural predisposition from birth, the condition is most likely incurable and learning how to be manage it with the ongoing and judicious use of foods, drugs, activity and/or herbs will be the best course of action.

Eczema and psoriasis is usually a sign of Interior Heat and Dryness.
Several different conditions are diagnosed as eczema and psoriasis.
Heat in the Blood, Yin Repletion Heat, Blood Deficiency Dryness are all called eczema.

Diet as a cause and possible treatment FOOD as MEDICINE

(THIS IS A GOOD CHART FOR YOU TO KEEP FOR YOUR PAIENTS AND REFERRAL)

Dietary imbalances or extremes will negatively effect the organs and the qi. An excessively stimulating diet, for example, will stimulate body processes, triggering infinite variations of inflamation, fever, hyperactivity, or hormonal abnormalities.

Such patterns appear as fevers, sweats, insomnia, hyperthyroid, inflamatory skin conditions, etc,. These conditions will be worsened by over-consumption of foods considered “hot”, stimulating, or yang in nature. Overstimulated people may benefit from foods that are considered “cool”, “calming”, or “yin”.

Conversely, those who have cold, or “yang deficient” conditions such as low blood pressure, hypersomnia, sciatica, hypothyroid, Hashimoto’s complex, etc., may do better with a more stimulating (yang) diet.

Keep in mind, when altering your diet, that moderation rules. Changes are most sustainable when they are introduced gradually.

STIMULATING (yang) Apricots* Artichoke Basil Beef* Black tea Butter Butterfish Carp* Cayenne Celery* Cherries Chestnuts Chicken Chili Cinnamon Chives Coconut Coconut milk Cod Coffee Coriander Dates Egg, yolk Fennel Garlic Ginger Goose* Grapes* Green onion Ham Lamb Malt Mussels Mustard Mustard Greens Nectarine Oats Olives Onions Oolong tea Parsley Peach Pepper Pinapple* Pine nut Plums* Safflower Shrimp Soy oil Sugar, brown Sweet potato Turkey Turmeric Vinegar Walnuts Wine

NEUTRAL Almonds Apples** Art i c ho k e, Jerusalem Art i c ho k e Beans, Kidney** Bean sprouts Beets Black mushrooms Blueberries Cabbage Carrots Catfish Cauliflower Carob Cheese Clams** Coconut Oil Corn Currant Eel Figs Guava Grits Honey Huckleberries Mackrel Maple Syrup Milk Nutmeg Okra Olive Oil Papaya Peanuts Pecans Perch Pinto Beans Pork Potatoes Pumpkin Seeds Quail Raisin* Rice Sardines Sesame seeds Shark Shitake Mushroom Sugar, white Strawberries String bean Sturgeon Tapioca Taro Turnip Vanilla Whitefish Winter squash Yam Yogurt

CALMING (yin) Abalone Agar Banana Barley Beer Beans** Beancurd** Bran Buckwheat Cottage cheese Crab Cucumber Duck** Eggplant Egg, white Frog’s Legs Gluten Kelp Lettuce Lotus Root Malt Mango Marrow Melon Millet Mulberries Mung Beans Mushrooms Octopus Oysters Pears Peas Persimmons Pumpkin Rabbit Rock salt Rhubarb Seaweed Sesame oil** Snails Spirulina Sugar, cane Summer squash Sunflower seeds Tangerine Tea, green Tofu Tomato Water Chestnut Watercress Watermelon Wheat Wheatberries Wheat germ White fungus

For the treatment of inflammatory skin diseases such as eczema and psoriasis one strictly limits foods in the stimulating or yang category uses some foods in the neutral category and therapeutically emphasizes herbs in the third, calming or yin category. This is a good basic chart that one can modify or add to as an aid for treating all diseases.

Herbs and the Treatment of Skin Diseases

The classification of Chinese herbs based on thousands of years of experience serves as a standard for herbal use. Herbs and foods are conveniently classified according to the diagnostic indications making a closed system of diagnosis followed by treatment. Non-Chinese herbs have yet to go through the sifting process of millennia but by understanding how and what Chinese herbs are classified, what characteristics and properties they exhibit we are able to at least begin the process of classifying and corresponding non-Chinese herbs with the Chinese and diagnostic method. Because there are similar energetic classifications in Ayurveda, we can also utilize Ayurveda as a diagnostic and treatment modality as well.

Doing such, we soon learn that there are some levels of diagnosis for which Western herbal medicine has no corresponding herbal protocols and thus we must rely first on a diagnosis, developing a treatment principle from the diagnosis and then the Chinese materia medica and formulas to develop a treatment protocol.

Following are herbs useful following the diagnosis and treatment protocol of most causes of inflammatory skin diseases:

Heat in the Blood — unprepared rehmannia, asparagus root,
Yin Repletion Heat — Gypsum (shi gao), lonicera, gentiana, sophora, lithospermum root, lycii bark, Chinese lobelia root, scutellaria baicalensis, Mu Dan pi (tree peony bark) and anemarrhena root.

Because it is a mineral Gypsum (powdered soapstone) is always added in double or four times the amount. It treats severe ‘yang ming’ stage fever and heat, very specific for lowering childhood fevers, but is very effective for uprising heat especially in the upper quadrant (face, chest, arms, palms, etc). I always using it in formulas for rosaceae for instance.

Sophora (Ku shen) and Gentian root (Long dan) are two of the best herbs for clearing ‘damp heat’.

The combination of tree peony (Mu dan pi) and anemarrhena root (Zhi mu) are famously ‘dui yao‘ (two herb treatment) for deficiency heat. They are famously used in the formula Anemarrhena and Phellodendron Combination (Zhi mu di huang wan) which is rehmannia six plus anemarrhena and phellodendron. This is the pre-eminent formula for treating yin deficiency with heat and is comprised of Rehmannia Six (Liu Wei) plus Anemarrhena and Phellodendron. Mu dan pi is al ready one of the ingredients in Liu Wei. Anemarrhena clears heat and moistens dryness making it very important for eczema.

Niu bang zi or ground burdock seed, in which form it is even more specific traditional Western herbal medicine for treating skin diseases than burdock root.

Wind is almost always a component in external diseases. Wind reflects the sensitivity of the disease to factors such as wind but other changeable conditions such as emotional stress. Wind therefore reflects the ability of a disease to proliferate and spread. Wind readily combines with other factors such as ‘wind cold’ or ‘wind heat’. Inflammatory skin diseases such as psoriasis and eczema are described as ‘wind heat’. Adding herbs that ameliorate or calm wind, irrespective of whether they may be warm natured is important. Ledebouriella (fang feng) as an herb that treats external wind is very important as part of the treatment protocol. Similarly if the problem is exacerbated on the scalp we use the warm natured herb, ligusticum wallichii (chuan zong) combined with the cold herb huang qin (Chinese scutellaria). Ligusticum chuan zong usually used for headaches, directs the cooling properties to the head, huang qin or Chinese scute clears heat from the upper warmer of the body. The nearest correspondence to the concept of TCM wind is the histaminic reaction of the body to various irritants that cause the condition to persist and spread. Nevertheless it may be a stretch to directly regard external wind herbs as anti-histamines as they don’t necessarily have the other sedative properties of histaminic drugs.

A perfect candidate for the doctrine signatures is the molted outer casings of the cicada (chan tui) for all skin diseases. In places where they are seasonally abundant cicada moltings are easily gathered and saved for inclusion in teas for all skin diseases. Most of us might feel repulsed by the use of insects as part of herbal medicine, at the same time, we would tolerate drugs and substances like vaccines manufactured from horse urine or the strong effects of chemical drugs. Insects in TCM are used to treat many conditions but usually also treat symptoms of wind.

Dampness can be another element especially in what is described as ‘weeping eczema’. The premiere and most balanced herb for treating dampness is Coix barley (yi yi ren). It is also commonly known in the west as Job’s tears. The grain barley is different but also possesses some of the damp clearing properties of coix. Coix is often taken alone in soups, cereals and in pills to alleviate such damp conditions as lymphedema and swollen ankles, though it the lymph swelling is caused by removal of actual lymph glands its benefit is much less.

Treating inflammatory skin diseases such as eczema and psoriasis requires first a correct diagnosis and then the appropriate use of life style adjustment, diet, and acupuncture. With the correct diagnosis, we can approach it from many perspectives. We can try to address all the components of the disease in a single formula, which in such an instance would be a tea or we can use a combination of a limited number of herbs in dried powdered extract together with pills of other formula according to the indications of the patient.

A basic combination for the treatment of inflammatory skin diseases such as eczema should include the following:

Tian Men Dong — (6-9 grams) or 4 parts of the powder
Fang Feng — (6-9 grams) or 4 parts of the powder
Niu Bang Zi — (6-9 grams) or 4 parts of the powder
Chan Tui — (6-9 grams) or 4 parts of the powder
Ku Shen — (6-9 grams) or 4 parts of the powder
Yi Yi Ren — (6-9 grams) or 4 parts of the powder
Zhi Mu — (6-9 grams) or 4 parts of the powder
Sheng Di Huang — (6-9 grams) or 4 parts of the powder
Shi Gao — (20 grams) or 4 parts of the powder
Mu Dan Pi — (6-9 grams) or 4 parts of the powder
Gan Cao — 3 to 6 grams of 2 parts of the powder

This formula works best when heat from dietary sources are minimized. If you make it as a concentrated powder The formula is available as a concentrated powder, which is dissolved in water or other liquid. Normal dose is 6 grams per day or about 1 teaspoon 2 or 3 times daily in warm water. Normal course of treatment is one month at a time.

In addition one should consider taking the following as appropriate to the needs of the individual patient.

Common sources of heat and possible remedies

Finally symptomatically we can apply topical baths, herbal fomentations, ointments and lotions to assuage the condition. Calamine lotion is typically sold in pharmacies and can be used to temporarily relieve the itching. The mineral Calomelas is also used in TCM. The combination of borax, borneol (camphor), calomel can be combined and used as an occasional topical lotion. Western herbalists apply chickweed oil which is fresh chickweed that has been macerated in olive oil. Chinese pharmacies sell an inexpensive herbal burn ointment that is cooling that can be topically applied to relieve irritation and burning. Some get fantastic results from finely powdered pearl cream. However, be aware that many Chinese herbalists sell what they describe as a secret pearl cream that works fantastically well because it contains cortisone. While considering the severety of discomfort, making its victim, whether adult or juvenile, absolutely miserable, I’m not opposed to the occasional responsible use of cortisone creams. Keep in mind, however that these have no curative value, eventually lose their efficacy requiring higher doses and because cortisone is absorbed through the skin, carry the same risk as the cortisone dependency. Finally cortisone suppresses symptoms, driving them into the body causing internal deficiencies later. They also slow the body’s ability to respond to herbal and other physiotherapeutic methods. Therefore one should try to resist their use as much as possible.

Many Chinese herbalists make it a specialty to treat skin diseases and get phenomenal results. Chinese medicine can be as complex as Western conventional medicine, and learning all one can about a certain condition is one of the best ways to assure a successful clinical practice.