The Power of Chinese Herbal Medicine

The effectiveness of Chinese herbal medicine in the treatment of dermatological conditions is hard to deny.  I was just thinking about an elderly patient who was told by the medical community that she would inevitably need to have her lower leg amputated due to gangrene.  Being a very strong woman, and confident in natural treatment approaches she decided that she would only agree to having the gangrene area removed surgically but leave the remainder of the foot and leg to heal on its own.  At first, she was not allowed this option but the surgeon finally decided that he would be willing to honor her wishes.  She mentioned to me that they told her numerous times that she would not heal from the surgery due to the poor blood flow at the foot and that they really would need to amputate further up the leg where the circulation would be less impeded in order for her to heal.  She was adamant that she would only agree to having the gangrene tissue removed and the remainder of the foot to heal naturally.    

When first observing her legs, it was clear that the circulation into her lower extremities was impeded.  There was a purplish hue to the legs, mild edema, varicosities, and a cool sensation when palpating the feet.  We worked together using acupuncture and Chinese herbal formulas internally for approximately 2 years.  Over this time period there was gradual improvement at the surgical site and of the lower extremities.  The edema decreased, the tissue of the legs became a pinker hue, and the feet became more perfused with blood giving them a warmer sensation.  There were some set backs during the course of the treatment but we worked through those issues as they arose by modifying the herbal formula.

More recently, a small lesion on the top of the foot would not completely close, while the remainder of the foot had healed from surgery.  There were recurrent infections occurring over the lesion site that were not allowing the tissue to heal.  When these infections occurred, I advised her to see her vascular team so that they could culture and prescribe an appropriate antibiotic.  Over time it appeared evident that the antibiotics were stopping the infections but they would reoccur some time later.  These recurrent infections were slowing the wound healing at this small lesion and left it lingering as an open ulcer.  We decided that she would continue with the antibiotics topically as they were prescribed but she would also begin a topical herbal compress.  The two treatments would complement one another very well.  Within a single week, she returned to the office to show me the lesion.  It had literally scabbed over and the tissue was showing signs of closing!  I was astonished at the speed at which her foot was healing and so were the nurses and doctors on her vascular team.  In fact, they still tell her that no one ever expected her foot to heal as it has from the surgery.  They were all quite sure that she would have had to have her foot amputated post-surgery.  I'm just glad that I was able to be a part of her healthcare and allow her to save her leg and foot and keep her mobility and independence.

Unfortunately, far too few people are aware of this treatment approach and never have an opportunity to explore this option.  I hope through this blog and my practice that this treatment approach gains more attention in the public eye.  The treatment of dermatological conditions with Chinese herbs requires specific training and education and without these skills it is much more difficult to effectively treat these stubborn conditions.  Over the years I've successfully treated a number of stasis eczema cases as well as ulcerations on the lower extremities.  Cases of ulcerations take time to heal and therefore require patience on the part of the patient.  Compliance with the treatment protocol often times leads to complete resolution of the ulcer.  These conditions typically require the use of both internal and external herbal treatments to achieve optimal results.  Wishing you good health. 

Balancing Stress to Benefit Your Skin

Here in the Pacific Northwest we were fortunate to have a long lasting stretch of warm and sunny days that seemed endless.  However, fall has come, and with the changing of the seasons comes the arrival of the holidays.  Often the arrival of these times of gathering and festivity brings an element of stress into our lives.  Whether it is the expectations we place upon ourselves or it's the last minute scramble to prepare for the upcoming holiday, the stress of the holidays is something that most everyone can relate to.  Unfortunately, when we are unable to manage our stress effectively it begins to take a toll on our health.  In addition, our eating habits over the holiday seasons typically worsen.  On top of this, with all the preparation for the gatherings we often find ourselves falling out of our typical fitness routines.  Between the poor diet, decrease in exercise, and stress, it is clear that the holiday season can have a negative impact on our health.  

These stress triggers in our lives can often be aggravating factors for new and pre-existing skin conditions.  This is especially upsetting during seasons when we want to look our best, as we get together to celebrate with friends and family.   In response to these stressors, the skin can flare.  So why is this?  Stress often disrupts our immune response and affects our adrenal glands.  Within our immune system there is an inflammatory response (innate immune response) and an adaptive immune response.  Often times stress can cause the immune response to fall in favor of a more intense inflammatory response leading to an aggravation of one's skin.  However, don't view inflammation as a negative process.  It is essential for an effective immune response.  Without it white blood cells wouldn't know where to go to fight off infections and repair damaged tissue.  Think of it as a signal to flag down the repair crew of our body.  The key is to have a balanced inflammatory response, rather than one that is over reactive. 

So where do the adrenal glands play in this picture?  With long-term stress and a high paced life, the adrenal glands can become weakened due to the continual demand that is placed on them.  Over time, they can't keep up and they begin to decline in function.  With this decline comes a decline in cortisol in the body.  Cortisol acts as an anti-inflammatory in our body and can thereby manage excess inflammation that may arise.  However, with a decline in this management system, the increase in inflammation in the body cannot be adequately controlled. When this occurs we begin to see the skin become more active with the appearance of new lesions. 

In Chinese Medicine, stress is also identified as a trigger for numerous skin conditions but is often discussed using different terminology.  When stress occurs, the liver Qi becomes stagnant or doesn't flow smoothly.  With impeded flow of Qi in the body, heat begins to generate.  Over time this heat builds up and creates stagnant heat which can be viewed as inflammation.  This is the very basic foundation of this concept of liver Qi stagnation generating heat.  There are many other elements that can play a role in this pathology which can further perpetuate this concept of stagnant heat or aggravate the condition.  A concept known as dampness which often arises from a weakened digestive tract, poor eating habits, or inactive lifestyle can often aggravate the presence of heat.  By adding an element of dampness, flow is impeded even further and leads to the generation of more heat, often described as damp heat.  This brief explanation of stress induced stagnant heat gives you an introduction to the concept in Chinese medicine.  Unfortunately, there isn't enough time in this article to discuss all the variants of stress induced stagnant heat.

From both a biomedical and Chinese medicine view, it is clear that stress can disrupt the balance of our body leading to inflammation or stagnant heat.  Conditions such as nummular eczema, pompholyx eczema, seborrheic dermatitis, lichen simplex, rosacea, acne, perioral dermatitis, psoriasis, herpes simplex, pityriasis versicolor, and even some forms of urticaria all have a connection to emotional stress.  This illustrates the vast array of conditions that can be affected by this omnipresent factor in our lives. 

With the trigger being stress, thinking of ways in which to reduce this element is crucial for effective and long-term management.  The number one self care tip is to maintain an active lifestyle by exercising for a minimum of 30 minutes a day.   Studies have shown that regular exercise has a favorable effect on the immune response and is an effective means of stress relief.  Second, trying to maintain a predictable sleeping schedule where you go to bed at the same time and wake at a similar time.  This goes for the weekends as well.  While sleeping our body produces growth hormone which not only assists with growth and development but also triggers a healing response in the body.  So it is essential to ensure that adequate sleep is a part of the daily regimen to encourage this natural healing process.  Third, diet should be considered, since a poor diet will lead to fatigue, poor health, and ultimately poor skin quality.  In particular, overconsumption of sugar has a suppressive effect on the immune system.  On top of the list of food items to avoid are excess sugar, processed foods, fried foods, greasy foods, hot and spicy foods, caffeine, shellfish, and alcohol.  Often times people will have particular food sensitivities as well, and it is imperative that these foods be removed from the diet to avoid any additional inflammation that may be triggered by the consumption of these items. 

For some, these fundamental changes make a big difference in skin quality.  However, sometimes strict adherence to these measures proves ineffective.  When these lifestyle changes prove to be inadequate in controlling a person's dermatological complaint then further intervention is warranted.  The use of Chinese herbs is a safe and effective treatment approach that is often overlooked when seeking help for skin problems.  Herbs are used both internally and externally to address the affected areas.  Before formulating a treatment approach the skin is closely examined and a thorough history is taken to determine the root cause of the disease.  Each person will require an individualized treatment designed to meet their own skin needs.  For example, if the lesions on the body are showing more weeping or erosion, then the formula is directed at addressing more damp heat and if the lesions present with more dryness and erythema then a blood heat treatment is necessary.  Lesions that are very active and present with vesicles or pustules would require the addition of herbs to address more fire toxin in the presentation.  The treatments can become very refined, as no two individuals have exactly the same skin concerns. 

During the course of treatment with Chinese herbs, the formula will need to be modified to address changes in the skin.  As the lesions begin to clear, the formula will be changed to correctly address the current presentation.  It can almost be viewed as guiding heat out of the body.  So as the damp heat is cleared, there may be more blood heat present that must then be cleared using different herbs.  If dryness plays a part in the picture, then specific nourishing herbs would be introduced only after the heat has been removed.  If the dry element is addressed too early the skin may become irritated.  It is these individualized and fluctuating treatment approaches that make Chinese medicine so powerful in addressing these acute and chronic skin conditions. 

If you or someone you care about is struggling with a skin condition, try to think about the ways in which stress, diet, exercise and sleep can be improved.  Assess your level of stress.  Whether it is a family reunion, holidays, weddings, or just day to day stressors, think about how stress may be impacting your health and skin.  Are you getting enough exercise?  Are you sleeping adequate hours and soundly?  How is your diet, and are you eating too many of the foods that can cause problems for your skin?  If you already have these lifestyle elements in place, or if you get them into place and are still having problems with your skin, then consider implementing a supportive treatment such as Chinese herbal medicine.  Your skin is a reflection of your underlying health, and working towards achieving clear skin in a holistic way will help you take steps toward overall wellness, improved self esteem, and stress reduction.   

  

I've tried Chinese herbs for my skin

Chinese medicine is a vast and complex form of medicine.  The treatment approaches with Chinese herbs can be very complex and require much training and skill to properly formulate an effective treatment.  So going to any acupuncturist in your area to address your skin complaint isn't a wise decision.  Dermatology in Chinese medicine requires specific training and knowledge to properly diagnosis and treat the condition.  So if your intentions are to treat your skin naturally, seek out a skilled practitioner, such as myself, that has specialized in this field of study in order to receive an appropriate herbal treatment.

Just as the allopathic medical community has specialization, so does the field of Acupuncture and Chinese medicine.  Some practitioners have a practice focusing more on fertility and gynecology, some men's health, others more pain management, or dermatology; the list goes on.  But the thing to remember is don't just assume that the Acupuncturist or Chinese medicine practitioner you go to see has training or specializes in dermatology.  And don't assume that all Acupuncturists practice Chinese herbal medicine, for many have minimal training in the the use of herbs.  So, you may have tried Chinese herbs to address your skin but did you seek out a qualified Chinese medicine practitioner that specializes in Dermatology?

Evolving Traditional Chinese Medicine Treatments

Last month I traveled to London to study with my mentor Mazin Al-Khafaji.  It was interesting to note the ways in which his treatment approaches have shifted ever so slightly.  Even with his already highly effective treatments, he was finding that certain herbal combinations and their use in particular dermatological presentations could produce a more desirable outcome.  It goes to show that attention to details in the progress of our patients is a must to maximize the treatment results.  Not only this but it gives us insight into what herbs are helping with a particular aspect of the skin presentation.  Once we find a result that can be repeated, we can evolve our medicine to better address the pathology of modern day skin disorders.

I often find myself reviewing and comparing my formulas in clinic to look at how the skin is shifting in relation to modifications made to the formulas.  This is often enlightening and gives me a better understanding of when the formula needs a shift in focus so that the patient can continue on the path of healing.  This process is necessary to continue to benefit our patients and to evolve our medicine.  Just as disease evolves and shifts, so do our bodies and so should our medicine.  If we rely solely on classical formulas and never question the efficacy of our treatments we will fall behind.  I would like to quickly say that the classics are full of wealth and we often look to them for guidance, but we still must follow the progress of our patients so that the treatment is properly tailored to the current presentation.  Even the herbal formulations of Zhang Zhongjing shifted over the years as different treatment approaches evolved in Chinese medicine.   This is a trend that should continue so that we can optimize the efficacy of Chinese medicine.

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.

A variant of eczema...Pompholyx

Most often when people think of eczema they don't realize that there are variations of this disease.  A very common subtype of eczema is pompholyx eczema.  It accounts for about 20% of eczema cases seen and affects the fingers and palms as well as the soles of the feet and toes.  About 80% of pompholyx cases affect the hands and 20% affect the feet.  What makes this form of eczema so unique is that it tends to form vesicles that can either rupture or be reabsorbed into the skin.  In both cases, the vesicular phase which last for about one to two weeks is followed by a dry phase during which scaling can occur.  In the case of the ruptured vesicles, exudate can form as well as crusting.  This form of eczema is also referred to as dishidrotic eczema since it is commonly seen in individuals with excessive sweating of the palms and soles.  It was once thought that the sweating was the cause of this form of eczema but this is not the case. 

Pompholyx eczema tends to go through a cyclical pattern.  It begins with the vesicular phase and then transforms into a dry phase.  In the vesicular phase, small pearly white vesicles form on the skin surface of the palms, soles and/or between toes and fingers.  These vesicles can coalesce and form larger more painful bullae.  If these vesicles or bullae rupture, yellow or white exudate will be expressed from the lesions as well a blood tinged crusting.  When vesicles rupture the epidermis is damaged and this can lead to erosion of the skin surface.  In the case of erosion, crusting is almost always present.  During the dry phase, we begin to see scaling, fissures, and/or lichenification (thickening of the skin).  In more chronic cases of pompholyx eczema lichenification and fissures will be seen due to the continued assault on the skin.

When seeking help for this condition, Chinese herbal medicine should be the first treatment approach utilized. Those using Chinese herbs respond quite well to this stubborn skin condition.  Both internal and topical herbs can be used to address the problem from the root and branch thereby eliciting a shift in the body.  By utilizing this modality the body can be rebalanced and the disease stabilized while discontinuing the herbs following a course of treatment.  Unfortunately, many people are unaware of the effectiveness of these modalities and seek out conventional medical treatments.  These types of treatments can be detrimental to the already damaged tissue.  Most treatments will include the use of strong topical steroids due to the thick nature of the skin where pompholyx eczema manifest's itself.  These steroids must be used long term to keep the condition under control.  Using these agents for an extended period of time will result in displacement of the fatty tissue thereby thinning the skin and weakening the structure and ultimately slowing the healing process.  As with all steroid use, inflammatory processes are suppressed during their use but will rebound once the inhibitory agents are discontinued.  If you would like to address such a skin concern naturally, please contact the clinic.