Tuesday, November 1, 2011

I thought I was just a blusher

Have you experienced flushing of the face throughout your life and always just thought nothing of it until the redness stopped fading off?  You may be suffering from a common dermatological complaint known as rosacea.  It is most common in Celtic women between the ages of 30-50 with a peak occurrence between the ages of 40-50.  As mentioned, the first stage of rosacea generally involves periodic flushing of the face triggered by hot weather, consumption of greasy and spicy foods, alcohol, or emotional triggers such as stress.  As the flushing continues over time the transient nature of the flushing fades and becomes more persistent lasting days, weeks, or months.  With persistent flushing the capillaries becomes damaged and the appearance of broken blood vessels (telangiectasia) occurs.  For some the formation of papules occurs.  These papules do not typically hurt as is the case with acne.  Pustules may also form for some, but this only occurs in about 20% if patients.  In more severe cases, rhinophyma, where there is hyperplasia of the connective tissue and sebaceous glands of the nose,  may occur but this is often only seen in males.

Rosacea also takes on a very characteristic distribution on the face.  The areas most often affected are the cheeks, chin, nose, and forehead.  On very rare occasions the neck can be affected.  Ocular changes are often times associated with rosacea and can be seen in about 60% of cases.  The typical complaint is one of dry, gritty eyes and there is often redness visible on the conjunctiva.   So looking into the history of past episodes of conjunctivitis, blepharitis, keratitis, etc. are often useful in clarifying the diagnosis of rosacea due to its sometimes subtle appearance.

In Chinese medicine we see rosacea as a pathology involving excess heat in the body as well as an element of blood stasis.  As the pathology persists for longer periods of time we typically see a larger amount of blood stasis in the presentation.  Therefore, depending on the presentation of the rosacea, the Chinese herbal formula will vary for each individual.  Also, as the treatment moves forward changes in the formulation will occur as well.  This is because the body will be healing during the course of treatment and certain aspects of the disease become less relevant as they improve.

Western medicine typically treats rosacea through the use of topical antibiotics such as metronidazole and other oral antibiotics.  When topicals are proving to be ineffective, the use of oral antibiotics such as minocycline, tetracycline, or doxycycline are utilized.  Oral antibiotic use typically involves long term use to control rosacea and this type of approach can be detrimental to the health of the patient's gut.  The use of these harsh antibiotics will damage the natural gut flora and could further aggravate the digestive tract.  In rosacea, there is often a prevalence of low stomach acidity and slow gastrointestinal transit time and so the aggravation of the gut through long term antibiotic use could further irritate the situation.  It is this concept of addressing the manifestation of the problem rather than the root cause that can be problematic in stabilizing the condition long term.  The skin may improve through the use of the antibiotics but there is the consequence of irritating the gut that will prevent the skin from remaining stable and healthy following the discontinuation of the medication.

If you suffer from rosacea and would like to address this condition with a more natural approach I would encourage you to seek out a qualified Chinese herbal practitioner such as myself that has specialized in the treatment of these stubborn dermatological conditions.  If you're going to put time and money into this form of treatment make sure that your practitioner has done the same. 

A discussion of Chinese Medicine

Chinese herbal medicine has a long history of use dating back several thousands of years.  Throughout the ages it has been a system of medicine used in the treatment of all ailments, just as we use modern medicine.  As Chinese medicine migrated to a western world dominated by modern medicine, skepticism surrounded this foreign model.  Something so foreign to the scientific minds of the west was often times viewed as quackery.  This perspective doesn't come as a surprise, as many were unfamiliar with the depth of the medicine and eager to perpetuate modern medicine.  A similar change occurred in China as well, but there still remain designated Traditional Chinese Medicine (TCM) hospitals that continue to utilize these ancient techniques in the treatment of modern diseases.  Just as diseases have evolved over thousands of years, so has Chinese medicine.  It is in the settings of these TCM hospitals that there is an integrated use of pharmaceuticals, surgery, Chinese herbal medicine, and acupuncture.  The use of pharmaceuticals and surgery are avoided when possible and utilized when necessary.  It is this recognition of when certain modalities are most warranted that the patient benefits the most.

When we look at pharmaceutical drugs that have been developed over the years, we see that many have been derived from botanicals used in traditional medicine.  In the case of statin medications, these were derived from Red Yeast Rice, Hong Qu, a Chinese herb that has been recognized to help with the consumption of foods high in cholesterol.  In fact when you look at Peking duck and see the red color on the exterior you are looking at Hong Qu.  These facts illustrate the early knowledge of the herbs ability to counter the effects of fatty foods.  Qing Hao, artemisinin, is another Chinese herb that has been utilized in modern medicine in the development of anti-malarial drugs.  In fact, more recently research has come out illustrating the potential use of this herb as an anti-cancer agent.  Clearly, there is a world of wealth tucked away in the Chinese Materia Medica and it would be a shame to simply push this model aside.  We have learned so much from thousands of years of clinical observation of Chinese medicine but we have only touched upon this with modern medicine. Through longer periods of clinical observation we begin to see the long term effects (beneficial and deleterious) from the use of herbs and medications.  Once again we can see what will be of most benefit to the patient without creating any ill side effects.

From the examples above, we can see that there are potentially thousands of therapeutic agents inside these Chinese herbs that we have not yet validated in a scientific arena.  However, we know through  thousands of years of clinical observation that there are indeed countless therapeutic agents within the herbs in the Materia Medica.  This is the advantage of Chinese medicine when it comes to treating diseases that are not addressed well in the modern arena with pharmaceuticals.  Through the use of Chinese herbs we have access to therapeutic agents that have been proven effective for the treatment of numerous ailments.  In the case of psoriasis, most patients that see an allopathic dermatologist will be prescribed methotrexate and steroids to address the autoimmune and inflammatory component of the disease.  Unfortunately there are many side effects associated with long term use of these medications and the beneficial effects are short lived.  That is to say that once discontinued the skin will flare and the psoriasis will have returned or worsened.  The disease of psoriasis is not well understood but it is known to be an autoimmune disorder that alters the rate at which keratinocytes differentiate.  Keratinocytes are cell that change structure as they migrate to the skin surface and then slough off and die.  Unfortunately, in psoriasis the rate at which this differentiation occurs is 10 times more rapid and therefore, there is an overgrowth of scaling on the skin.  Through the use of particular Chinese herbs we are able to control this mechanism and actually restore normalcy to the biological process.  Often times, we see a stabilization of the condition following the herbal treatment.  Additionally, the inflammatory process of the disease can be controlled through the use of herbs as well.  When the redness or erythema of the skin clears we begin to see evidence that the inflammation is resolving.  Many times psoriasis patients mention that the lesions feel hot to touch and/or they themselves feel hot all the time.  These complaints of heat cannot be overlooked as clear signs of inflammation.  These systemic signs of heat often times clear with the herbal treatment as well.  When such an option for treatment is available without the deleterious effects of steroids and immunosupressants then why not offer these treatment options to patients?

The effectiveness of Chinese herbs in the treatment of dermatological disorders is hard to deny.  The great results we see in patients is proof of how well these herbs are working.  It is this cut and dry evidence that has raised the brows of western dermatologists.  They too are curious about what is going on and how these herbs are working.  However, keeping these herbs in their natural format is essential to preserve the safety of the treatment.  I say this since we can see from all the pharmaceuticals created from plant matter that once they isolate an active ingredient it takes on new characteristics and ultimately negative side effects.  The use of a single agent to elicit an effect is a concept that has come from modern medicine.  Most traditional medicine utilizes the combination of numerous agents to elicit a therapeutic effect.  Why remove these therapeutic agents from their natural form?  Why not keep them in a safe and effective form that they are in as dried plant matter?  Clearly the therapeutic effect is being achieved. 

Through the combination of botanicals a stronger and whole new therapeutic effect than any single agent can be created.  The synergistic effects that occur through the combination of botanicals and other therapeutic agents is a concept that many pharmaceutical companies are now exploring.  In fact, during my days as a biochemist I recall working with chemical agents to determine their effect on a cellular process.  Many of the agents didn't elicit an effect but when combined an observable effect suddenly occurred on the cellular process under study.  This clearly illustrates the point that a much stronger and also a new therapeutic agent can be created through the combination of compounds.  This is the essence of Chinese herbal medicine.  When formulating a Chinese formula for a patient approximately 10 herbs are combined to create a therapeutic herbal tea.  It is the appropriate combination of herbs that delivers the desired effect in the patient.  This is something that can be achieved when the practitioner is skilled in the field of study.

This ancient therapy has survived the test of time for a reason.  Today modern medicine is making it much more evident to the skeptic and scientific community why this modality survived the test of time. By understanding the herbs in a biochemical manner the scientific community is much more apt to view these Chinese herbs as an efficacious treatment.  But what we must remember is that by keeping these botanicals in their natural format we preserve the therapeutic compounds within them in a much safer form.  Also, all the clinical observations of these herbs have been done in the raw herbal format and therefore when they are taken out of this format we can no longer rely on the thousands of years of clinical experience we have in the Chinese medicine texts.  And that is when we run into the issue of safety for the patient.  I understand the need to advance medicine but sometimes we need to put the patient first and find the safest and most effective means of addressing their ailment.  I believe that through the vast knowledge of Chinese medicine this is something we can do for our patients that are suffering from a variety of health complains, especially dermatological complaints.