Wednesday, September 25, 2013

Notes for My Webinar on Skin Diseases

Thanks for attending my Webinar on September 26th. I hope you got a few useful pieces of information from the presentation.
Here's the notes from the presentation.

Skin Conditions: Internal and External Formulas plus Acupuncture work Best
with Honora Lee Wolfe
Copyright 2013 • All rights reserved.

What is easy about skin conditions is…
You can see them! Which makes them easier to pattern discriminate, and…
You can tell how you are doing immediately as a clinician!
The patterns and treatments are logical based on the morphology of the lesions.

Wai Ke and Nei Ke
Dermatology is classified as a group of diseases in the “wai ke” or category of diseases occurring in or on the exterior or outside of the body.

Skin Disease Mechanisms
“Chong” or insects/parasites
Blood stasis

Pattern Discrimination of  Dermatological Conditions
Redness = heat
Purple red = heat toxins &/or stasis heat
Dark red = depressive or stasis heat
Blisters &/or suppuration = dampness
Purulence = heat toxins
Scaling = dryness
Pigmentation & lichenification = stasis
Itching = wind
Heat = heat
Pain = stasis

Therapies that can be helpful
Macerated wet herbs
Herbal pastes
Resolvant powders
Medicated oils
Medicinal baths
Body and ear needles

Acu-Moxa Therapy
To clear heat from whole body: Da Zhui (GV 14), Qu Chi (LI 11)
To course the liver & resolve depression: Tai Chong (Liv 3), He Gu (LI 4)
To clear heat & resolve depression: Xing Jian (Liv 2)
To clear heat from the blood aspect: Xue Hai (Sp 10), Wei Zhong (Bl 40)
To fortify the spleen & supplement the qi: Zu San Li (St 36), San Yin Jiao (Sp 6)
To seep dampness: Yin Ling Quan (Sp 9)
To nourish the blood: Ge Shu (Bl 17), Gan Shu (Bl 18)
To quicken the blood: Xue Hai (Sp 10)
To quiet the spirit: Shen Men (Ht 7)
To stop itching: Shao Fu (Ht 8)
Treat once per day or at least 2X per week for one month. Then treat once per week as needed.

“Eczema” the most common skin condition
Strictly speaking, Eczema is not one disease, but a group of diseases
1. Atopic eczema
2. Contact dermatitis
            A. Allergic contact dermatitis
            B. Irritant contact dermatitis
3. Seborrheic eczema
4. Varicose eczema
5. Discoid eczema
In U.S., 15 million have some form of eczema
10-20% of world population affected by eczema in childhood
Not contagious • No known WM cure

Atopic Dermatitis
Most common in infants and young adults
In U.S., 10% of infants have AD
3% of total population
50% of patients affected throughout life
Increased genetic sensitivity to allergens, & excessive immune reactions
Atopic describes a tendency to excess inflammation of the skin, linings of the nose & lungs
Closely linked to allergic rhinitis & asthma

Nutritional Supplementation
B complex for dry, itchy skin
Beta-carotene to promote moisture retention
Vitamin C as natural antihistamine
GLA (gamma-linoleic acid) as anti-inflammatory
Quercetin (bioflavonoid) to prevent allergic response
Zinc often deficient in people with E, especially if taking longterm steroids

The Main CM Disease Mechanisms of AD
Spleen vacuity (leads to dampness)
Liver depression (leads to heat)
Wind heat, blood heat
Yin-blood-fluid vacuity malnourishment
Blood stasis
Simplified, the most commonly seen are:
Wind heat type: Erythema, no suppuration
Damp heat type: Suppuration
Wind dryness type: Lichenification, dryness, scaling  

About Psoriasis
A non-contagious, chronic skin disease of unknown etiology
Most researchers agree it is an immune-mediated disorder with a strong genetic component.
An estimated 4% of the U.S. population or more than seven million Americans suffer from psoriasis.
Incidence of psoriasis rises to 28% if one parent has this condition and to 68% if both parents suffer from psoriasis.
May occur at any age, but most patients do not show signs till their 20s, with an average age at diagnosis of 28.
Somewhere between 150,000-260,000 new cases of psoriasis are diagnosed per year in the U.S.

CM and Psoriasis
In Chinese medicine, psoriasis is thought to be due to heat toxins in the blood damaging the blood and body fluids and, therefore, secondarily causing dryness and stasis.
The Tx Principles are, therefore, to nourish and quicken the blood, moisten dryness, clear heat, and resolve toxins
There are many possible internal formulas to use for this condition depending upon the specific pattern combination the patient present

Formulas & Diet for Psoriasis
Huo Xue San Yu Tang, Bai Bi Tang, Gui Zhi Tang Jia Jian, Bei Xie Shen Shi Tang Jia Jian, Huang Lian Jie Due Tang Jia Jian, Sheng Xuan Yin, Long Dan Xie Gan Tang jia Jian, Mai Wei Di Huang Tang, Er Xian Tang Jia Jian
Low-fat low-calorie diet reduces inflammation; avoid alcohol to clear heat from the liver.
Include Fish oil as an anti-inflammatory and as many anti-oxidants as possible.

Basic Principles for Using External Remedies in CM Dermatology
1. Primarily treat the tips or branches with external remedies
2. Do not use oil-based remedies for wet, suppurating lesions
3. Use water or alcohol based remedies or powders for wet, suppurating lesions
4. Use oil-based remedies for dry, nonsuppurating lesions
5. Determine the relative proportions of the disease mechanisms at work & then choose 2-3 medicines for each mechanism
6. Use medicinals known to be empirically effective when applied externally
7. Feel freer to use inferior grade medicinals when treating externally

Blue Poppy External Remedies
Acne Tincture clears heat, dispels wind and resolves toxins
Antifungal Ointment clears heat, resolves toxins, disperses inflammation and stops itching
Clear Heat Ointment (Si Huang Gao) clears heat, resolves toxins, disperses swelling and stops pain (infected lesions that are hot to the touch)
Cut & Sore Ointment, clears heat, resolves toxins, moves the blood and stops pain, engenders new flesh
Eczema Ointment clears heat eliminates dampness, dispels wind and stops itching in wind damp heat eczema
Herpes Zoster Ointment clears heat and eliminates dampness, courses wind and resolves toxins
Jade Dew clears heat and cools the blood, disperses swelling and resolves toxins in herpes simplex
Psoriaquell Ointment nourishes and quickens the blood, moistens dryness and clears heat
Psoriasis Tincture dispels wind and clears heat, eliminates dampness and resolves toxins, kills parasites, and stops itching.

Anti-fungal Ointment
Oil and beeswax plus Shi Gao, Hua She, Qing Dai, and Huang Bai
For chronic dry eczema or dry fungal skin conditions such as ringworm.
Clears heat, resolves toxins, disperses inflammation and stops itching

Eczema Ointment
Oil and beeswax plus Da Huang, Huang Bai, Cang Zhu, She Chuang Zi, Bai Zhi, Ku Fan, and Tian Hua Fen
For wind damp heat eczema
This formula moistens dryness sufficiently to keep the other ingredients fro damaging fluids.
Psoriaquell Ointment
Dang Gui, Zi Cao, Da Huang, Lu Hui Zhi, Bing Pian in a veg oil, beeswax and vitamin A, D, & E base.
For blood heat psoriasis with dry, red lesions and silvery scaling
Do not use in cases of wet, suppurating psoriasis.

White Pearl
Mu Li, Huang qi, Dang Shen, Fu Ling, Shan Yao, Pei Lan, Bai Xian Po, She Chuang Zi, Bai Zhu, Fang Geng, Dan Pi, Zi Cao, Jing Jie, Jiang Can, and zhi Gan Cao
Treats spleen qi xu resulting in a defensive qi insecurity with easy invasion of wind complicated by dampness, heat, toxin, and blood stasis manifesting as chronic hives, eczema, or psoriasis
Can be used for any skin conditions that presents with these patterns

Little Pearl
Ren Dong Teng, Shan Zha, Shen Qu, Mai Ya, Fu Ling, Bai Zhu, Bai Bian Dow, Yi Yi Ren, Chen Pi, Ma Chi Xian, Bai Mai Gen, Dan Pi
Specifically for pediatric eczema due to spleen qi xu with damp heat and possible food stagnation. This eczema will be damp, itchy, and possibly weep

Final Advice for Tx Skin Conditions
1. Check your pattern discrimination
2. Check that your medicinals are appropriate for the pattern
3. Check the dosage
4. Add an external remedy if not using one
5. Check that external remedy is correct if using one
6. Be sure patient is adherent to diet & lifestyle modifications
7. Check for other aggravating factors possibly overlooked before
8. Consider adding acupuncture


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