1

AOMA TCM Dermatology William R. Morris

2008

TABLE OF CONTENTS
History of TCM Dermatology .......................................................................................................................................3 The Structure and Development of the Skin..................................................................................................................4 Descriptive Terms in Dermatology ...............................................................................................................................7 Etiology of Skin Diseases..............................................................................................................................................9 External Causes .........................................................................................................................................................9 Internal Causes Seven Emotions .............................................................................................................................14 Non-internal, non-external causes ...........................................................................................................................14 Eczema ........................................................................................................................................................................16 Psoriasis.......................................................................................................................................................................19 Urticaria.......................................................................................................................................................................23 Treatment.................................................................................................................................................................27 Internal treatment.........................................................................................................................................................27 Prevention....................................................................................................................................................................28 Herpes Simplex ...........................................................................................................................................................30 Acne.............................................................................................................................................................................32 Acupuncture ............................................................................................................................................................33 Prevention................................................................................................................................................................33 Tinea............................................................................................................................................................................36 Warts ...........................................................................................................................................................................40 Systemic Lupus Erythematosus Diagnosis and Treatment .........................................................................................46 Selection of Externally Used Herbs.....................................................................................................................55 Oleation Therapy .........................................................................................................................................................57 Oleation Ben Cao.........................................................................................................................................................58 Plasters .........................................................................................................................................................................61 Dermatological Pharmacopoeia...................................................................................................................................63

History of TCM Dermatology Yellow Emperors Classis records more varieties of skin disorders than any other medical work of that era. Examples include fei for mileria, yangjie for candidiasis, qiyang for itching, tu for eczema or tinea of the head, lan for ulcer, you zhui for warts, and zuo and zha for acne and roseola. Itching around the scalp and head is usually fungus.Leg or tongue ulcer is called lan in Chinese, these can be treated by herbs. You Zhai are warts due to viral infections. Zhu is he acne Zhang Zhong Jing in Golden Cabinet yin zhen for urticaria. Yin in this case is urticaria, it has a wheel shape that appears and disappears this is Yin Zhen. Jin yin chuang is exfoliative dermatitis with peeling and scales this corresponds with acute dermatitis or acute eczema. Huang Lian is often used for these kind of disease such as acute eczema and dermatitis. Hu Huo Bing Hu is a fox that hides, bing is disease it is like Behcets an entity not recognized in the west until 20th century. Tx includes Gan Cao for corticosteroidal effect and wash w/ Ku Shen Tang. Also good for candida and parasite infection causing genital itching, it drains damp heat and reduces genital itching. In 610 during the Sui dynasty Chao Yuan-fang described almost 100 skin disorders. He preceded Linnaeus by 1100 years for scabies dx as a parasite. He used Liu Huang and Ku Shen in place of cortisone. During the Song Dynasty, blood-letting was used. A pyramidal needle knifes etc were used to drain stagnant heat toxins from the body via the blood to reduce swelling and pain During the Yuan Dynasty, Qi De-zhi introduced the wet compress still used today in his Essence of External Diseases (1335). Ming dynast Wang Kentang (1549-1631) categorized skin conditions by anatomical region 15th century syphillis was described as guangdong (flower) sores. Chen Sichengs Secret Records on Bayberyy Flower Sores (1632) described syphilis as due to unclean intercourse. Use Tu Fu Ling. Formal dermatological texts were published in the 60s and classics were reprinted. Combine western-eastern epistemologies for dermatological care. For instance, combine prednisone with agents that clear heat, cool blood and eliminate toxins in order to reduce cortisone dosage. Sheng Ma, Sheng Di, and Mai Dong can be used in combination to supplement Qi and Yin, cool the blood and clear heat. Yi Mu Cao and Mu Dan Pi are good for autoimmune skin diseases. Not until the mid 20th century with the appearance of several texts devotes solely to dermatology was TCM recognized as a separate specialty.

The Structure and Development of the Skin The integument is the most exterior organ of the body. It has close relationship with internal organs. The skin is the largest organ of the body, covering over 7,600 cm (3,000 sq in.) in the average adult. The thickness of the skin varies on different area of the body, from 0.5-4 mm. It is thicker on the extensor surface than the flexor surface of the four digits and trunk. It is the thinnest on the eyelids, external genitalia, ear and breasts; it is the thickest on palms and soles. It accounts for approximately 5% of a persons body weight. Because of the variation in concentration of pigmentation, numbers of blood vessels, thickness of stratum corneum and stratum granulosum, the skin color various in each individual, especially in individual of different races. The skin and its accessory organ (hair, glands, and nails) constitutes the integumentary system. The skin surface has sweat glands that secrete sweat, and sebaceous gland that secrete sebum. There are hairs of various length and thickness on the surface of the skin including scalp hair, eyelashes, eyebrows, postpubertal hair of axillae and pubis, moustache, beard, and chest hairs of males. At the end of the extremities, there are fingernails and toenails. The skin consists of epidermis, dermis and hypodermis (subcutaneous tissue). The epidermis is the most superficial layer and is composed of dense stratified squamous epithelium cells. Dermis lies beneath the epidermis, mainly composed of connective tissue. The subcutaneous tissue includes large amount of lipid. Hair, pilosebaceous units, sweat gland (sudoriferous glands), and nails are epidermal appendages. Epidermis The epidermis is developed from the ectodermal germ layer. It is a compound tissue consisting mainly of a continuously self-replacing stratified keratinized squamous epithelium. It is divided into a number of strata from deep to superficial as follows: stratum basale, stratum spinosum, stratum granulosum, stratum lucidum (where present) and stratum corneum. There are sweat glands in the epidermis. Stratum basale (stratum germinativum) is the deepest layer adjacent to the dermis. It contains cells capable of mitotic division. When new cells are formed, they undergo morphologic and nuclear changes as they move towards the most superficial layer. Simultaneously, these cells give rise to all other layers of the epidermis. Stratum basale is mainly composed of two types of cells: basic cell and melanocytes. Dermis (Corium, derma cutis vera) The dermis is deeper and thicker than the epidermis. The elastic and collagenous fibers are arranged in definite patterns, producing lines of tension in the skin, and providing skin tone and elasticity. The extensive network of blood vessels in the dermis provides nourishment. The

dermis also contains lymph duct, glands (sweat glands and sebaceous glands), hair follicles, muscle tissue, nerve, nerve endings and lipid tissue which is extension of dermis tissue. About 98% of the connective tissue is collagen fibers. Elastin fibers are thinner than collagen fibers and are distributed sparsely among collagen fibers. The dermis is composed of two layers. Stratum papillarosum and stratum reticularosum. Within this layer are more dense and regularly arranged to form a tough, flexible mesh work. Subcutaneous tissue (hypoderm) Hypodermis binds the dermis to underlying organs. The hypodermis is composed of loose connective tissue and adipose cells interlaced with blood vessels. This layer functions to store lipids, insulate and cushion the body from injury, and regulate temperature. Subcutaneous tissue contains the base of the hair follicles and sweat glands. Blood Vessels and Lymph Ducts Blood Vessels. There are extensive blood vessels in the skin. It can store up to 1/5 of the blood of the whole body. Lymph Ducts Lymph ducts form superficial plexus in the papillary layer of the dermis, and deep plexus in the deep layer of the dermis. They connect to the adjacent lymph nodes through dermal lymph ducts. Nerves of the Skin Both myelinated and non-myelinated nerve fibers are present in the skin. Myelinated fibers are part of afferent motor nerve fibers of central nervous system. They receive sensory stimulation and transmit them to the brain. Non-myelinated nerve fibers are part of the sympathetic system of the autonomic nervous system. It controls blood vessels, erector muscles, sweat glands (eccrine glands and apocrine glands). The nerve endings of the myelinated nerve fibers do not have a myelin sheath. Integumentary Muscles The Integumentary muscles are mainly smooth muscles (non-voluntary muscles). Only a few muscles on the face are muscular muscles (voluntary muscles). Sweat glands There are two types of sweat glands: Eccrine glands secret clear sweats. They are widely distributed all over the body. Apocrine glands are those in which the secretion accumulates on the surface of the secretory cell; then, a portion of the cell, along with the secretion, is pinched off to be discharged. They are much larger than the eccrine glands. It has two components: secretary cells and cells that form the walls of the ducts. They are mainly found in pubic regions,

where they secrete into hair follicles, and their odoriferous secretion is thought to act as a sexual attractant. Mammary glands, found within the breasts, are specialized sudoriferous gands that secrete milk during lactation. Other apocrine glands are found around the axillary, pubic, anus, and nipples. Sebaceous Glands Sebaceous glands are a type of holocrine glands, in which the entire secretory cell is discharged, along with the secretory product. Sebaceous glands are all over the body except on palms and soles. The face, especially around the nose, contain larger sebaceous glands, therefore acne easily occurs on the face, especially during teenage years. Sex hormones regulate the production and secretion of sebum. Hair Humans have three distinct kinds of hair. 1. Angora. Angora hair grows continuously. It is found on the scalp and on the faces of mutual males. 2. Definitive. Definitive hair grows to a certain length and then stops. Eyelashes, eyebrows, pubic, and axillary hair, hair in the nose and external ears are all this type of hair. 3. Fair hair. Fire hair is a soft fine, silky hair that appears on the skin. It doesnt contain pigmentation nor medulla. The life span of a hair varies from 3 to 4 months for an eyelash to 3 to 4 year for a scalp hair. Each hair lost is replaced by a new hair that grows from the base of the follicle and pushes the hair out. The growth of hair is related to age, health, and constitution of an individual. Normally, hair grows 2 cm in 2 months. Nails The nails on the ends of the fingers and toes are formed from the compressed out layer (stratum cornuem) of the epidermis. The normal growth rate o finger nails is 0.5-1.2 mm per week. The growth rate for toe nails is 1/3 less.

Descriptive Terms in Dermatology Macules These are distinguished by a change in color. A large macule (diameter greater than 15-20 mm) can be called a patch, but this term is also sometimes confusingly applied to thin plaques. Most macules are darker red or brown compared with normal skin. In diagnosing macular lesions, it is useful to describe the color, shape, and general characteristics of the border, the presence of scaling, and the presence of atrophy. Purpura A purpura is a good example of a dermal macule and is caused by extravasation of blood from capillary vessels without epidermal change. With finger pressure on the skin surface, a macule will disperse but purpura will not. This is because purpura involves capillary bleeding but macules do not. Plaques Plaques are areas of raised or textually altered skin with a flat top. Scaling is usually present. The diameter of a plaque is much greater than the degree of elevation above the skin. Papules and Nodules Papules are discrete lesions that are usually visibly raised above the skin surface and which mainly originate in the dermis. A papule is usually smaller than 5-10 mm in diameter. Lesions between 5-10mm in diameter will be called large papules or small nodules. Those larger than 10mm in diameter are usually referred to as nodules. Nodules are also different in that they may or may not protrude from the skin surface. Other useful characteristics to note include color, shape, and surface changes. Vesicles Vesicles and bullae are terms used to describe different sizes of blisters. Blisters contain fluid, so that if the blister is pricked or breaks, the contents run out and the blister collapses. Blisters may form within or just below the epidermis depending on the disease process. In general, the term vesicle is used to describe e a small (5mm diameter) blister and bulla a large blister (5-10mm). Bullae may form from a single expanding vesicle, from a large bulla at the outset or by coalescence of adjacent vesicles. An example of large blisters are pemphigoid lesions. These are tense blister mainly 10-20 mm in diameter and are unilocular. Multilocular blisters are characteristic in eczema.

Pustules Pustules are epidermal (or upper dermal) accumulations of pus. They are clinically turbid and yellow or green in color. There may be a stage between a clear vesicle and a turbid pustule during which the vesicle contains cloudy fluid and known as a vesicopustule. The most important morphological feature of a pustular eruption is whether the pustules do or do not arise from the pilosebaceous (hair) follicles. Wheals Wheals are transient swellings of the skin due to dermal fluid. They are similar to blisters but the fluid content is dispersed within the dermal tissue and does not form a localized collection, so that the lesion cannot burst and leak fluid. Wheals can be of various size and shapes, and thus form papules, nodules or plaques. They have the following special features: An individual lesion lasts less than 24 hours. New lesions may come and go, but any one lesion will disappear after minutes or hours, leaving little or no visible residual abnormality. Severe attacks may leave residual purpura. The swelling is due to dermal fluid, and this produces a sharply defined border. There is no epidermal component, so there is no associated scale or surface change. The pink or red color is due to vasodilation. However, if a lot of fluid accumulates quickly, the dermal vessels are compressed, and the wheal often becomes white. The surrounding flare or border of non-palpable, red color is due to vasodilation, e.g. urticaria. Scale and Crust Scales and crust usually occur together. Scale is flaking of the skin surface due to increase loss from the stratum corneum. The presence of scaling implies an abnormality in stratum corneum formation or damage to the epidermis. Crust is dried exudate of blood or serous fluid on the skin or lesion surface and is commonly known as a scab. Female fingers itch, papal urticaria, usually you can see wheels, this is more like eczema,

Etiology of Skin Diseases Traditional Chinese medicine views all diseases according to the same fundamental premise: There is homeostasis within the body, between zangfu organs, and between the body and external environment. The homeostasis maintains the normal physical activity. If the balance is disrupted for any reason, and can not be self adjusted, diseases occur. There are various reasons for skin diseases. In general, the etiology in skin disease is the same as for zang fu syndromes. External causes include the six external pathogenic factors, internal causes include the seven emotions, and neither internal, nor external causes include toxic, insect bites, phlegm, and blood stasis. No matter whether which cause, they all cause dysfunction of Yin, Yang, Qi, blood and function of zang fu organs. However, since the dysfunction manifests on the exterior of the body, it is a skin disease. External Causes The six Excesses Six pathogenic factors include wind, cold, summer heat, dampness, dryness and fire. In normal circumstances, these six climatic factors are called Six Qi. Only when the weather changes suddenly, or when the righteous Qi is deficient, or the immune system is low, does the Six Qi become pathogenic and cause disease. Only then do the Six Qi become the Six pathogenic factors. The etiology from six pathogenic factors is related to weather, seasons, and living environment. For example, Wind often is prevalent is spring, heat in summer, dampness in late summer or early fall, cold in winter. Living in damp place for a long time can induce dampness. Working in high temperature can cause dry-heat and fire. Six pathogenic factors can invade the body as a single factor, or can combine together to cause diseases. During the process of a disease, six pathogenic factors can affect each other, and transmit to another under certain circumstances. For example, cold evil can transmit into interior heat. Wind The Characteristics of Wind: Wind is the leader of hundreds diseases. Many skin diseases have a close relationship with wind. Wind causes Disease directly: Such as in Urticaria. Wind combines with other evils: Wind combines with cold, dampness, dryness, and heat. Such as wind- cold causes frost bite, and wind-damp-heat causes eczema.

10

Etiology of Wind (pathomechanism) Superficial defensive Qi is deficient, so that Wind evil penetrates into the skin, and obstructs the skin. Qi can not communicate between the interior and exterior. Ying-Wei lose harmony, Qi and blood can not circulate properly, skin and muscle lack of nourishment, therefore cause skin diseases. There are two articles on using the pulse to assess the flow of wei qi: http://pulsediagnosis.com/NeoclassicalTradition.htm. Characteristic of the Wind 1. Wind is associated with movement and change. It can rise up at any time. It moves around. The onset is sudden, and it disappears suddenly. The duration of the disease is short, and it relapses easily. For example, urticaria. 2. The Wind rises up. It often effects the upper part of the body (face and head), such as lost of hair. 3. The Wind causes itchiness. The wind invades the skin and muscle, and causes the conflict between Qi and Blood. As a result, pruritus occurs. Pruritus often causes dry itching. 4. Wind causes dryness. If it stays for a long time, it causes dryness of blood, and deficiency of blood. Blood deficiency causes wind, and it deprives of skin of nourishment. Blood Deficiency is often the cause of dry skin, scales, rough skin, and even skin fissure. Wind Syndromes 1. Wind-Cold: Skin lesion is pale or white, severe aversion to cold, mild aversion to heat, muscle ache, painful joints, absence of sweating, thin white tongue coating, superficial and tight pulse. 2. Wind-Heat: Skin lesion is red, fever, headache, sore throat, painful joints, red tongue, thin yellow coating, superficial rapid or slippery pause. Cold The Characteristics of Cold Cold congeals. Cold is the dominating climatic factor in winter. When the temperature is low, or the temperature decreases suddenly, or people do not dress or cover themselves properly, or when people are caught in wind, or wade in water, or exposed to wind while sweating, cold invades easily.

11

Etiology of Cold Cold evil invades the skin surface, obstructs Wei Yang; or Yang Qi of the organs are deficient, deprives the skin of warmth. The Characteristics of Cold-induced diseases 1. Cold evil invades, Ying and Wei lose harmony, Qi and blood can not circulate smoothly, these cause the numbness of the skin and muscle ache, as in Raynauds, and sclerosis. 2. Cold evil invades, causes coldness of skin. Skin color is pale or cynotic. Tendons and sinews contract. There is difficulty moving the joints. For example, frost bite, Bergers Disease. The Syndromes of Cold Cold-damp obstructs channels and collaterals, manifests as joint pain, muscle ache, spasm and stiffness, difficult movement, lose of flexibility, pale tongue, thin white coating, deep and thready pause. Summer Heat Summer Heat is the dominating climatic factor in summer. It is also a common pathogen in moist warm climates. Etiology Summer Heat invades skin and muscle, and obstructs the surface of the skin. Sweat can not dissipate, thus cause disease. Summer- Heat- Dampness can also invades the skin and cause disease. Characteristic of Summer- Heat induced Diseases 1. Summer Heat is Yang Evil. It is hot in nature. It causes miliariai, carbuncles, and summer dermatitis. 2. Summer Heat is often combined with Dampness. Dampness causes pustules. Syndromes of Summer-Heat 1. Syndromes of Summer-Heat: fresh red skin lesion with burning sensation & pain accompanied by fever, thirst, irritability, red tongue, thin coating, rapid pulse. 2. Syndromes of Summer-Dampness: Red and Moist skin lesion with erosion, oozing, accompanied by oppression in the chest, decreased appetite, fatigue, yellow dark urine, thin greasy tongue coating, soft and thready pause.

12

Dampness The Characteristic of Dampness Dampness is sticky and heavy. It is the dominating climatic factor in later summer. Dampness is mainly caused by damp weather, wading in water or caught in the rain, or living in damp environment. The Etiology of Dampness Damp Evil invades the skin. It is obstructed under the skin layer, impairs the circulation of Qi and Blood therefore cause disease. Damp evil can damages Yang, and allows external pathogen to gain entry to the body and causes disease. The characteristics of Dampness-induced diseases: 1. Dampness is sticky. It lingers and hard to expel, such as in urticaria. 2. Dampness is heavy. It mimics water, therefore, there are skin lesions such as vesicles, edema, erosion, and oozing. 3. Dampness descends. It usually affects the lower part of the body (lower extremities, external genitalia. Such as fungus, or eczema of the genital area. 4. Dampness often stays in organs, channels, and collateral. Therefore Dampness can cause disease in any parts of the body. It can even invade bones and internal organs. 5. Dampness often combines with other evils, therefore the disease patterns is complicated and easy to change. The syndromes of Dampness 1. Dampness obstructs Spleen and Stomach: Skin erosion, edema accompanied by oppression of the chest, lose of appetite, tiredness of extremities, bland taste in the mouth, low grade fever, pale tongue, greasy coating, soft pause. 2. External Damp-Heat: Skin fresh red with burning sensation, oozing, accompanied by fever, hypochondriac fullness, bloating and pain in abdomen, nausea and vomiting, no appetite, constipation or diarrhea, scanty, yellow urine, yellow, thick, greasy tongue coating, soft, rapid or slippery, rapid pause.

13

Dryness The characteristic of dryness The Dryness is the main climatic factor in autumn. Its clear and it tends to go down. Its nature is dry and rough. If the weather is dry and there is not much rain, there is not enough water vapor in the air, there will be dryness. Etiology Dryness of the weather and environment injury Yin and body fluids, and cause dryness of the skin, thus skin diseases occur. The characteristic of Dryness-induced diseases: Dryness as a pathogenic factor is dry and non-smooth. It easily damages body fluids. The skin lost nourishment and becomes dry, scaly with fissure. Hair lost luster and becomes dry and brittle. For example, hand and foot chipping, dry skin, Sajority. The syndromes of Dryness Skin dryness, scaly, chipping, accompanied by dry throat and mouth, thirst with desire to drink, constipation, dry and red tongue without coating, thready pulse. Fire (Heat) The characteristic of Fire Fire is Yang evil. It is commonly seen in spring and summer. However, wind, cold, dryness and dampness can all transform into fire, therefore, fire can cause diseases in any season. Severe sunburn, working under high temperature, burning from water and fire can all cause injury directly, or it can combine with wind, dampness or dryness evils. Etiology 1. Fire is Yang evil. It rises up and affects the upper part of the body (face and head). For example, erysipelas, simplex. 2. Fire easily consumes Qi and injures body fluids and Yin, therefore the injury of the mucous is often related with fire evil. For example, ulcer of the oral mucous membrane. 3. Fire easily stirs up wind and agitates blood. Therefore plaque, bleeding, redness of skin is very common. For example, purpura, and drug dermatitis.

14

4. Fire evil transforms into toxin causing redness and swollen, and pain. For example, pustules, furuncles and carbuncles. The syndromes of the Fire Fresh red skin with pus, burning sensation, pain, accompanied by fever, thirst with desire to drink, constipation, dark urine, yellow greasy coating, flooding rapid pause. Internal Causes Seven Emotions Injury of the seven emotions The seven types of emotional changes include: joy, anger, worry, pensiveness (over-thinking), sadness, fear and freight. They reveal the emotional condition of the body and are the responses of human being under the influence of the environment. Under normal circumstances, they do not cause disease. Only when exposed to sudden, strong or long term emotional stimuli that exceed our adaptive capacities, does function become disrupted. Zang Fu, Yin Yang, Qi and blood can all lose harmony and disease may occur. The skin is an organ of the body, and the seven emotions are factors that can induce or aggravate the skin diseases. Emotions have close relationship with internal organs. Five organs produce five Qi. Five Qi produce seven emotions. Therefore, expression of emotion must be based on essential Qi of five organs. Each organ has its own emotion. For example, anger injures the Liver, joy injures the Heart, over-thinking injures the Spleen, sadness injures the Lung, fear injured the Kidney. In clinical practice, we see that different emotional stimuli have different influence on the corresponding organs. However, the body is a closed system. All types of emotions eventually connect with heart. The injury to Shen can involve other organs. The diseases of emotional injury mainly manifest as Heart, Liver, and Spleen dysfunction, and Qi and Blood disharmony. Over-thinking injures heart and spleen, causes both heart and spleen Qi-Blood deficiency. In clinical practice, we see lose of hair and pruritus. Anger injures the liver. Liver Qi rising causes blood rebelling upward with rebellious Qi. It manifests as hypochondriac fullness and pain, irregular menstrual cycle. Emotional changes cause psoriasis or Zoster virus infection.

Non-internal, non-external causes

15

Insects Common types 1. Insects cause diseases directly. Insects bite can cause body injury, or dermatitis. For example, Scabs can cause scab sore. 2. Toxins from insects. The toxin, sting, toxic hair or secretion of the insects irritate skin, causing insect dermatitis. 3. Damp-Heat caused by ovum of the insects. Parasites can cause dysfunction of the spleen and stomach, generating heat and damp. Damp Heat accumulation in the skin can cause urticaria and anal pruritus. Etiology Evil invades the skin from insects bite, toxicity irritates the skin, parasites invade the body directly; or parasites cause dysfunction of spleen and stomach, generating damp-heat. Damp-heat accumulation in the skin causes diseases. The Syndromes of Insects Skin lesions such as papule, blister, erosion, oozing, redness and swollen. Sensation of itching, pain accompanied by fever, lose of appetite, abdominal pain, diarrhea, high fever, severe joint pain, delirium, and other general body syndromes. Toxin The loosely defined Toxin includes various elements that can cause diseases, such as epidemic factor, drug toxin, food toxin, paint toxin, heat toxin, and damp toxin. The common characteristics are sudden onset, and rapid deterioration.

16

Eczema Common allergic inflammatory dermatitis. It may be acute, subacute, or chronic. The clinical manifestations are skin lesions of various types including erythemas, papules, vesicles, oozing, erosion, crust, scales, etc. The lesion may be symmetrical or all over the body with severe itching. It may have many relapses and has a tendency to become chronic. It affects both female and males of all ages. Eczema is called shi zhen in TCM. Often other names such as chuang (sore) xian (fungus), feng (wind) also indicate eczema. Etiology of Eczema Genetic complicated family history of eczema External factors include wind damp and evil heat weather changes Acute: crusting and erosion, red macules on leg w/ unclear borders and papules and blisters among them. Some merge into patches Subacute often develops from acute. Usually papules, crusts, scales accompanied by pustules and blisters. There is severe itching and small patches of erosion, but oozing is decreased in comparison to the acute form. Acute attack may be aggravated by various stimuli. Appearance of Eczema There may be: Multiple skin lesion Easy recurrence Intense itching Even distribution

Chronic may begin from acute or subacute The skin is thickened, rough and dry, scaling, brownish red, or grey pigmentation. Lichenification occurs in various degrees. Varicose veins can cause varicose vein eczema and there may be lichenification Differentiation 1. drug dermatitis with acute eczema sudden onset various types of lesions. History of drug consumption prior to onset. 2. Contact dermatitis. Limited where contact occurs. Border is easily defined. Short duration. Causative agent can be found.

17

3. Neurodermatitis, itchy sensation occurs first before skin lesion occurs. It mostly affects parts of skin with most friction such as neck limbs (extensor side) obvious lichenification Treatment of Eczema Internal 1. Acute eczema clear heat and dispel wind damp Ji Yin Hua 9 Lian qiao 9 Dan pi 9 Ku shen 12 Cang zhu 6 Huang bai 9 Fu ling pi 12 Yin chen 12 Gan cao 4.5 Jing jie 9 Fang feng 9 2. chronic eczema nourish blood, dispel wind, clear heat, transform damp dang gui 9 bai shao 9 sheng di 12 hu ma 12 ku shen 12 bie xie 12 fu ling pi 12 di fu zi 18 bai xian pi 9 ku shen, di fu zi , and bai xian pi are very affective as a group for eczema External Treatment Erosion doesnt permit lotion 1. acute eczema oozing use haung bai liquid compress 100 cc water 10g herb = 10% solution for erythema and papules use san huang wash (huang lian, huang bai, huang qin, ku shen) three times daily 2. chronic eczema a. Qing Dai ointment three times daily (qing dai, huang bai, hua shi, shi gao) b. Qing Dai patch heat up patch and apply once daily Mix w/ olive oil to reduce itch if there is no oozing

18

Prevention 1. avoid washing the affected area with hot water, soap or any detergent that irritates the skin 2. try to minimize scratching. Keep fingernails short. Break the itch scratch-itch cycle. 3. Avoid food that produces damp and heat such as spicy or greasy foods such as lamb, chicken, beef, duck, and seafood. 4. Do not give immunizations during acute stage. For best results treat at least 2xs a week for a month then reduce to once a week. This is an allergen disease must remove allergens

19

Psoriasis Psoriasis, called yin xie bing, silver scale disease in Chinese medicine, is a chronic, recurrent disease marked by thickened patches of inflamed, red skin, frequently covered by silvery scales. Psoriasis is common chronic and intractible Yin Xie Bing silver scale disease Thickened, patches of inflamed, red skin, frequently covered by silvery scales. The biomedical cause is unknown; there is a genetic predisposition that may be related to a defect in the production of the epidermal layer of the skin. New cells are formed about ten times faster than normal but the rate of shedding the old cells remains the same thus the live cells accumulate and form the characteristic thickened patches covered with dead, flaking cells. Caucasians are affected more than other races. 2-5 million suffer psoriasis in the US. In Denmark there is an island where every family has psoriasis. Etiology 1. genetic predisposition 2. External environment: weather change, season, sunshine, trauma, vaccination (most psoriasis is reduced in summer and worse in winter) 3. Internal environment: emotion, stress, menstruation, pregnancy, delivery, hormonal change, diet. Etiology and pathogenesis The major external cause is wind, or wind combines with heat, damp, or cold. The major internal cause is Blood heat, blood dryness, or deficiency. From a Zang fu perspective, the major organs are Lung Sp. K, and Liver. The biomedical cause of psoriasis is unknown. There appears to be a genetic predisposition that may be related to a defect in the production of the epidermal layer of the skin. New skin cells are formed about ten times faster than normal, but the rate at which old cells are shed remains the same. Thus, live cells accumulate and form the characteristic thickened patches covered with dead, flaking cells. Caucasians seem to be more affected than other races. The condition typically recurs in flare-ups which may be precipitated by such factors as illness, emotional stress, and skin damage. Divide into three phases, acute, stable, and dispersing stage there will always be itching, papules, and redness whereas the chronic will have lichnenification. Then as it gets chronic, the Qi and Blood are affected. 1. In early psoriasis the causal basis is attack by wind cold or wind heat causing disharmony between the Ying and Wei and disrupt the flow of Qi and Blood so the pathogenic factors become lodged in the tissue and skin.. 2. In some cases, damp-heat accumulates in the tissue and skin blocking the communication of the exterior and interior and causing stagnation.

20

3. As the disease progresses unresolved wind cold, wind heat, and damp heat transform into dryness. Dryness injures and consumes qi and blood, generates wind, and deprives the skin of its nourishment. 4. Some patients have preexisting genetic weakness and Liver and Kidney deficiency. Deficiency of these two organs results in disharmony between the Chong and Ren leading to psoriasis. Signs and symptoms of Psoriasis Onset of psoriasis is often slow. Sites typically affected include scalp, elbows, knee, palms, soles, and buttocks also sacrum and coccyx. In about a third of the cases, the nails are involved. Lesions are characteristically round, well-demarcated, pink, scaling plaques of various sizes covered with large adherent silver scales. When the nails are affected, pitting of their surface is common. In psoriasis, traumatic removal of the superficial scales will typically reveal tiny bleeding points known as Auspitzs sign. Differential Diagnosis of Psoriasis The diagnosis of psoriasis is usually obvious. However, the many different sizes and shapes of lesions may be misleading , and skin biopsy may be necessary to confirm the diagnosis. Skin diseases that may be confused with psoriasis include seborrheic dermatitis, secondary syphillis, fungal infections and eczema. 1. Seborrheic dermatits: red lesion not well demarcated, seborrheic sealing, hair does not form, no bleeding spots on scraping (negative Ausptiz sign), accompanied by hair loss. 2. Tinea of scalp (tou xian) commonly seen in children, lesion is gray white with scale patches, brittle hair, Fungus can be found in the affected hair or scales. This must be differentiated from alopecia. 3. Chronic eczema: commonly seen on flexor side, intense itching with pigmentation, less scales, color is not silver, white or bleeding spots upon scratching. Psoriasis on extensor side and eczema is on flexor side. 4. Pityriasis rosea (feng re chuang or mei gui kang zhen): commonly seen on trunk and limbs, skin fresh red with macules, less scales. Most cases recover within 1-2 months. The first lesion to appear is the mother skin lesion. The biggest was the first to appear. Etiology and Pathogenesis The major external cause is wind, or wind combines with heat, dampness or cold. The major internal cause is Blood heat, dryness of Blood or Blood deficiency. In Zangfu perspective, major Organs involved are Lung, Spleen, and Kidney. 1. In early psoriasis, the causal basis is the attack by wind-cold or wind-heat causing disharmony between protective and nutritive levels, and disrupting the flow of qi and blood so that the pathogenic factors become lodged in the tissue and skin, transforming into heat.

21

2. In some cases, damp-heat accumulate in the tissue and skin, blocking the communication of interior and exterior and causing stagnation. 3. As the disease progress, unresolved wind-cold, wind-heat, and damp-heat transform into dryness. Dryness injures and consumes qi and blood, generates wind, and deprives skin of its nourishment. 4. Some patients have pre-existing genetic weakness and Liver and Kidney deficiency. Deficiency of these two Organs results in disharmony between the Chong and Ren, leading to psoriasis. Internal Treatment of Psoriasis The major patterns of psoriasis and their treatment are described below. 1. Blood Heat. The lesions of this pattern are red macules or papules that increase and proliferate rapidly. The scales are heaped up, and are easily shed when scratched. Inching is sometimes intense. Generalized symptoms may include aversion to heat, restlessness, thirst, dry stools, yellow and scanty urine, a red tongue with a thin yellow or white coating, and a slippery, rapid pulse. Treatment principle is to clear heat, cool blood, relieve toxin and expel wind. Formula recommended for this pattern is Modified Liang Xue Di Huang Tang. Sheng di 12, chi shao 9, dan pi 9, shui niu jiao 30 (cook first), bai hua she she cao 15, ban lan gen 15, da qing ye 15, bai xian pi 9, di fu zi 12, ku shen 12, pu gong ying 12, tu fu ling15, etc. Modification: Initial attack or children: add jing jie 9, fang feng 9, chan yi 9; With skin erosion and oozing: add che qian cao 12, fen bei xie 12; If related with menses or pregnancy, add yi mu cao 12, xian ling pi 12; With upper respiratory infection, add niu bang zi 9, jin yin hua 12, huang qin 9. 2. Blood Stasis. Cases are usually chronic and recurrent. The lesions are dark or hyperpigmented and covered by thick, hard and adherent scales. Occasionally, lichenification has developed. There may be fissures on extensor side with pain accompanied by dizziness, fatigue, and white face. The tongue is pale or purple or with purple spots, and is covered by a thin coating, and the pulse is generally choppy or thin and soft. The treatment principle is to invigorate blood, moisten dryness, and expel wind. Formula recommended is modification of Xiao Feng San. Sheng di 12, shu di 12, dang gui 12, chi shao 12, dan shen 12, ji xue teng 12, chuan xiong 9, bai xian pi 12, wu shao she 6, zhi di long 9, sheng gan cao 6.

22

Modification: Chronic case with lichenification, hyper-pigmentation and purple lesion: add san leng 12, e zhu 12, tao ren powder 9. 3. Liver and Kidney deficiency: Shu Di 12, Dang Gui 9, Bai Shao 12, He Shou Wu 12, Xian Mao 9 Huang Jing 15, Tu Si Zi 12, Di Long 10, Yin Yang Huo 12 3. Damp Heat: Cang Zhu 9, Huang Qin9, Be Xie15, Pu Gong Yin 15, Yi YI Ren 12, Tu Fu Ling 30, Jin Yin Hua 15, Dan Shen 12, Ze Xie 12, Ze Lan 12 4. Blood Toxin: Sheng Di 12, Chi Shao 9, Dan Pi 9, Shui Niu Jiao 30, Di Ding 30, Zi Cao 12, Lian Qiao 12, Jin Yin Hua 12, Huai Hua 9 always use for psoriasis later studies, Huang Qin 9 Empirical Remedies: 1. Wu Mei 60 grams, sheng gan cao 6 grams, decoction. Three weeks is one course. Caution and Contraindication: Ulcer. 2. Ji xue teng, 30 grams, decoction. 3. Wu Shao She 3-6 grams poweder, dang gui powder 3-6 grams take for one to two months 4. Zhong Hong Hua 15 grams from Tibet very affective very expensive used .3 gams on psoriatic ulcer on coccyx and worked External Treatment Lu Lu Tong Wash Lu lu tong 60g,, cang zhu 60g, bai bu 15g, ai ye 15g, ku fan 15g. Decoct the ingredients in 1-1.5 liters of water for 20 minutes. Discard the dregs and wash the affected sites with the warm decoction 1-2 times daily. Prevention: 1. Pay attention to weather change. Avoid cold and upper respiratory infection. 2. Avoid sea food, greasy food, alcohol and strong coffee, and spicy pungent food.

23

Urticaria Background Urticaria, or hives, is the most frequently appearing dermatologic disorder in the clinic. It appears as raised, circumscribed areas of erythema and edema involving the dermis and epidermis that are very pruritic. Urticaria may be acute (lasting less than 6 wk) or chronic (lasting more than 6 wk). A large variety of urticaria exist, including acute immunoglobulin E (IgE)mediated urticaria, chemical-induced urticaria (non-IgE-mediated), urticarial vasculitis, autoimmune urticaria, cholinergic urticaria, cold urticaria, mastocytosis and Muckle-Wells syndrome. Acute IgE-mediated urticaria is the most benign form of anaphylaxis. It usually occurs independently, but it may be accompanied by the more serious clinical manifestations of anaphylaxis, angioedema, and anaphylactic shock. The etiology of both acute and chronic urticaria are numerous (see Causes below). The etiologic agent is more likely to be identified in acute urticaria (40-60%) than in chronic urticaria (10-20%). The lesions of IgE-medicated urticaria usually last less than 24 hours and are often migratory, leaving no residual skin abnormalities. The lesions of urticarial vasculitis usually last longer than 24 hours, are both painful and pruritic, and often leave purpuric and hyperpigmented lesions. Pathophysiology Urticaria results from the release of histamine, bradykinin, leukotriene C4, prostaglandin D2, and other vasoactive substances from mast cells and basophils in the dermis. These substances cause extravasation of fluid into the dermis, leading to the urticarial lesion. The intense pruritus of urticaria is a result of histamine released into the dermis. Histamine is the ligand for 2 membrane-bound receptors, the H1 and H2 receptors that are present on many cell types. The activation of the H1 histamine receptors on endothelial and smooth muscle cells leads to increased capillary permeability. The activation of the H2 histamine receptors leads to arteriolar and venule vasodilation. This process is caused by several mechanisms. The type I allergic IgE response is initiated by antigen-mediated IgE immune complexes that bind and cross-link Fc receptors on the surface of mast cells and basophils, thus causing degranulation with histamine release. The type II allergic response is mediated by cytotoxic T cells, causing deposits of immunoglobulins, complement, and fibrin around blood vessels. This leads to urticarial vasculitis. The type III immune-complex disease is associated with systemic lupus erythematosus and other autoimmune diseases that cause urticaria. Complement-mediated urticarias include viral and bacterial infections, serum sickness, and transfusion reactions. Urticarial transfusion reactions occur when allergenic substances in the plasma of the donated blood product react with preexisting IgE antibodies in the recipient. Certain drugs (opioids, vecuronium, succinylcholine, vancomycin, and others) as well as radiocontrast agents cause urticaria due to mast cell degranulation through a non-IgE mediated

24

mechanism. The physical urticarias in which some physical stimulus causes urticaria include immediate pressure urticaria, delayed pressure urticaria, cold urticaria, and cholinergic urticaria. Finally, there are urticarias, especially chronic urticarias, for which no cause can be found, despite exhaustive effortsthe so-called idiopathic urticarias. Urticaria, or hives, is essentially anaphylaxis limited to the skin and subcutaneous tissues characterized by local pale or red wheals with intense itching. It comes on suddenly and disappears suddenly. It can affect anywhere in the body. There is no mark left on the skin after the attack. In TCM it is called wind-type concealed rash (feng yin zhen) or wind rash lumps (feng zhen kuai). Uticaria is an allergic reaction limited to the skin. It often results from: an allergy to certain foods; medications; insect stings or bites. Hives may appear as a symptom of some viral infections such as hepatitis, measles, and mononucleosis. Parasitic infections are common causes of urticaria in tropical climates. Non-infectious diseases are sometimes associated with urticaria, including lupus erythematosus, and hyper- and hypothyroidism. Some women develop urticaria during menstruation. Psychological factors may play a role in the etiology of chronic urticaria. Types of Urticaria 1. Urticaria Factitia (Dermatographism) Skin lesion includes red line, redness, and edema upon scraping. No urticaria present on other parts of body. Skin lesion soon disappears gradually and naturally. 2. Pressure Urticaria Appear on area of friction and pressure, such as under the belt. After pressing for 4-6 hours, there is swelling, distension and deep-seated pain with urticaria. It disappears within 8-24 hours. 3. Cold Urticaria (hereditary or acquired) Hereditary cold urticaria manifests during infantile and may last for lifetime. Four hours after cold exposure or cold attack, urticaria appears with burning sensation and mild itching accompanied by headache, fever, joint pain, and increased white blood cell. Acquired cold urticaria often affect children or young people. When the temperature drops suddenly, or person soaks skin in cold water or contact cold objects, exposure part of the skin such as face, hands and feet suffer from edema, urticaria and wheals within minutes of the exposure. 4. Cholingernic urticaria Onset following emotional stain, intensive exercise or labor, staying in high temperature environment, or intake of high calorie food. Its induced easily when there is perspiration. Skin lesion is wheal mixed with itching. It can affect any part of the body. When it is severe, there could be headache, abdominal pain, diarrhea, or even shock. Wheals usually disappear within 12 hours, but can relapse and last for months or years.

25

5. Solar urticaria (urticaria photogenica) Appear within minutes of exposure to sunshine. Affected area has pricking pain, itching, erythema, and urticaria. It disappears within one to several hours. In severe cases, it could be accompanied by shaking chills, tiredness, abdominal pain and even shock. Ultraviolet, visible light or invisible light can all cause this type of urticaria. 6. Angioedema Other names include edema angioneuroticum, urticaria gigans, or hereditary angioedema. Angioedema is caused by rapid blood vessel dilation in dermis and subcutaneous tissue. Large amount of serum filters to the loose tissue from blood vessel. Angioedema sometimes co-exist with urticaria. Patient often experiences abdominal pain and stomach discomfort. If lesion affects mouth and pharynx, can cause edema of the pharynx, difficult swallowing and difficult breathing. Etiology: There is different etiology. One is allergic response from the interaction of antigen and antibody. Most urticaria especially acute urticaria is due to immune response. Second kind is due to histamine release. The third is factors cause blood vessel dilation. Fourth etiology is from irritation of blood vessel and inheritance. Allergic reaction is the most common reason for urticaria. Some biological, chemical and physiological factor can directly stimulate the release of histamine. Emotional stimuli, exercise can stimulate the release of histamine also. Urticaria can also be caused by lack of certain digestive enzymes. Some drugs, emotion, drinking alcohol can induce urticaria in sensitive people due to blood vessel dilation. Hereditary: Urticaria patient often has family history of allergies. Causative Factors: Food, drugs, infection, insect bite, emotion, physical stimulation can all cause urticaria. 1. Food: Food is often the major causative factor in acute urticaria. Such as seafood, shell fish, chicken, eggs, tomato, strawberry, garlic, etc. 2. Drugs: such as vaccine, aspirin, and insulin. 3. Inhaled particles: pollen, dust, and animal dander. 4. Infection: Bacterial infection such as tonsillitis, sinusitis, UTI, upper respiratory tract infection, prostitis, hepatitis, and parasite ovum. 5. Insect bite: insect sting often causes urticaria. Mite, tic often cause urticaria papulosa. 5. Physical factor: Cold, heat, sunshine, friction and pressure can cause immune or non-immune urticaria.

26

TCM Etiology and Pathogenesis 1.Wind-cold. The initial onset occurs during attack by wind-cold, when the protective and nutritive levels are in disharmony. 2. Wind-heat. The initial onset occurs when wind-heat attacks. 3. Wind-dampness. This is often due to improper diet. 4. Spleen/Stomach dysfunction. Pre-existing Spleen/Stomach dysfunction is the source of this pattern. 5. Disharmony between the conception vessel and penetrating channel. This type occurs in women especially during menstrual period or after child-birth. Signs & Symptoms The first symptom is intense itching, soon followed by the development of large or small pink wheals caused by vascular dilatation and edema. The lesions vary from a few millimeters to several centimeters in diameter. It can be as small as a sesame seed or as large as a walnut. The color could be fresh red, light yellow or normal skin color. The number and size of the wheals may increase with scratching. There could be variety of shapes: circular, oval, patches, ring, map-like, etc. It often comes on suddenly, lasts for a few minutes or a few hours and disappears without any mark. It may recur in a few hours and then remit. It can affect any part of the body. In most cases, it affects the whole body, but it can affect only limited areas. Generalized symptoms include aversion to cold, fever, headache, and poor appetite. In severe cases, there is palpitation and irritability. If the allergy affects the deep dermis and subcutaneous tissue and mucous membrane, it can cause mucous damage of the spleen and stomach, and patient may experiences nausea, vomiting, abdominal pain, diarrhea, swelling of the throat, difficult breathing, or even loss of consciousness. According to its duration, it is divided into two categories: acute urticaria and chronic urticaria. Acute hives generally has a course between a few hours to one to two weeks with relapse in between. After treat the root cause, the patient has total recovery within one to two months. With chronic conditions, urticaria comes on and off or months or years. Unexplained remissions may recur up to years later. Differential Diagnosis Other skin conditions sometimes confused with urticaria include allergic contact dermatitis, erythema multiforme, multiple insect bites, pityriasis rosea and scabies. The specific differentiation can often be made by history and physical examination, or biopsy if the diagnosis is in doubt. In chronic urticaria, an underlying chronic disease should be ruled out through a careful history and physical examination, and routine screening tests.

27

Treatment Internal treatment 1. Wind-cold. Harmonize the protective and nutritive levels. Formulas: Jing Fang Bai Du San Jia Jian Jing jie 4.5, fang feng 4.5, gui zhi 4.5, ma huang 4.5, bai shao 4.5, chan tui 6, bai xian pi 4.5, fu ping 4.5, sheng jiang 3 slices, gan cao 1.5. 2. Wind-heat. Use pungent and cool herbs to release the Evil. Formula: Yin Qiao San modification Jin yin hua 12, lian qiao 12, dan dou chi 12, chai niu bang zi 9, da qing ye 9, da zao 9, gan cao 6, jing jie 6, lu gen 15, bo he 3. 3. Spleen/Stomach not harmonized. Tonify Spleen, expel wind, transform dampness, unblock the Fu Organs. Formula: Zhi Zhu Wan modification Zhi ke 9, bai zhu 9, chen pi 9, dang shen 12, fu ling 12, gan cao 3, jiu da huang 4.5. Modification: With diarrhea: add huang lian 6, mu xiang 6; With parasites: add shi jun zi, lei wan, bing lang. 4. Yin deficiency and blood dryness. Nourish Blood and moisten the skin. Expel wind and stop itching. Formula: Shi Er Wei Di Huang Yin Jia Jian Sheng di 9, shu di 9, hu ma 12, he shou wu 12, xuan shen 9, jiang can 9, e jiao 9, dang gui 9, ci ji li 15, gou teng 15, dan pi 6, gan cao 6, hong hua 3. 5. Liver/Kidney Deficiency. Nourish Liver and Kidney. Formulas: Si Wu Tang and Er Xian Tang modification Dang gui 9, bai shao 9, sheng di 8, tu si zi 12, yin yang huo 12, rou cong rong 12, xian mao 4.5, ye jiao teng 24, zhen zhu mu 30 (cook first), zhi gan cao 6.

28

External Treatment For all patterns, itching may be relieved by decocting together 2-3 of any of the following herbs in equal amounts, and then using the warm decoction as wash: Yin chen, ku shen, zhang mu, zi su ye, cang er zi, fu ping, wei ling xian. Prevention Elimination or avoidance of the causative agent is the best prevention. A correct pattern differentiation and appropriate traditional treatment can help prevent future attacks. Individuals prone to damp-heat accumulation should either moderate their intake or abstain from certain foods and beverages, such as spicy and greasy foods, sweets, lamb, scallop, shrimp, alcohol and coffee. Skin Condition Differential Diagnosis with Urticaria Anthrax: Skin lesion in early stage is red papule, rapidly turns to vesicles. Picture shows pathological change from vesicles to pustules, and tissue necrosis. Center of the skin lesion form obvious pitted black crust. In the surrounding area, skin is red and swollen. Basalioma (ulcerative type): Ulcer that expands slowly. Around the skin lesion, there are pearllike elevated border with crust in the center. It invades to deeper tissue. Keloid: Affect chest with elevated and thickened scar. It forms irregular patches like crab foot. Squamous-cell Carcinoma: Cauliflower-shaped lumps, ulcer and pustules on the penis with terrible smell and easy bleeding. The base of the tumor is firm and it invades to surrounding tissues. Freckles: Yellowish brown pin size spots on face. It often appears at about five years old and increases with age. It is associated with exposure to sunshine. Chloasma: Pale brown or brown patches on cheek, eyebrow, forehead, nose and upper lips. Irregular shape, symmetrical distribution, no abnormal sensation and discomfort. Scabies: mites lodge in the skin surface and cause skin lesion manifesting as pin spots, papule, and vesicles. The distribution is scattered and it has intense itching. It affects area between fingers, flexor side of wrist, elbow, armpit, pubic area, and medial side of thigh. The picture shows papules, vesicles, peeling off of the dermis and crust on external genitalia, medial thighs and low abdominal area. Scabies: Between fingers, pin size papules, vesicles, pustules and yellow crust caused by secondary infection from scratching.

29

Xanthelasma: Orange color circular or oval patches on upper eye lid. It often has symmetrical distribution. It progresses gradually and fuses together. Erythema Multiforme: Often seen as multiple size macules and papules. Edematous red macules distributed symmetrically on back of hands, forearms, and back of feet. Skin lesion expands from proximal to distal area of the limbs. The edge of the skin lesion is dark red. The center has vesicle or purpura. Scleroderma: Facial skin firm and shinny, gray yellow color with wax like shinny luster on face. Facial expression is rigid like wax figure. Patient typically has pointed nose, thin lips, and narrowed opening of the mouth.

30

Herpes Simplex Herpes simplex is a common viral disease characterized by clusters of blisters on the skin or mucous membranes. In TCM, the disease was called heat sores because the lesions usually appear following febrile conditions. Biomedically, herpes simplex is caused by the herpes simplex virus. Signs and symptoms: The first infection begins with local tenderness lasting one to two days. Small clusters of vesicles then appear; at this time, the pain may be severe. Accompanying symptoms may include high fever and swelling of tenderness of the lymph nodes. Crusting of the lesions begins after three to four days of onset and complete healing within three weeks.

Etiology: 1. 2. 3. Wind heat with toxin invades the skin and mucosa. Liver and gallbladder damp heat accumulate in the pubic and genital areas. Spleen and stomach damp heat damages the body fluids. This arises from internal heat from yin deficiency.

Differentiation: Herpes should be distinguished from herpes zoster, chicken pox, impetigo, and drug eruptions. Internal Treatment: 1. Xin Yi Qing Fei Yin Ingredients: xin yi hua, 9g; gan cao, 9g; duan shi gao, 30g; zhi mu, 12g; zhi zi, 9g; huang qin, 9g; pi pa ye, 9g; sheng ma, 9g; bai he, 9g; mai men dong, 9g. Long Dan Xie Gan Tang Ingredients: long dan cao, 9g; huang qin, 9g; zhi zi, 9g; ze xie, 9g; mu tong, 9g; che qian zi, 9g; dang gui, 9g; sheng di huang, 12g, chai hu, 9g; gan cao, 6g. Zhi Bai Di Huang Wan Jia Jian Ingredients: zhi mu, 9g; huang bai, 9g; sheng di huang, 12g; xuan shen, 9g; mai men dong, 12g; yi yi ren, 12g; bai hua she she cao, 15g; gan cao, 6g; fu ling, 12g; ze xie, 9g. Experience Prescription: Ingredients: ma zi jie, 30g; ban lan gen, 15g; ze cao, 9g; bai jiang cao, 10g;

2.

3.

4.

31

External treatment: Qing Che Kou powder or ointment. Ingredients: dan shi gao, 9g; bo he, 1g; huang lian, 2g; huang bai, 2g; qing dai, 3g; bing pian, 1g. These should be ground into powder and made into an ointment.

Herpes Zoster Or shingles is an infection of the nerves that supply certain areas of the skin. The condition is characterized by painful vesicular eruptions along the dermatome. The onset is sudden. The pain is sharp and accompanied by lymph node swelling. Recurrence is rare. It usually occurs in spring and fall and mostly affects adults. In TCN it was called snake cluster sores (she chuan chuang).

32

Acne Acne is a chronic skin condition caused by inflammation of the hair follicles and sebaceous glands. In Chinese, the condition is called Fen Ci, white thorns because of the resemblance of the lesion to thorns, and because of the white fluid that exudes when the lesion is squeezed. The characteristics of acne are white thorns, papules, pustules and inflamed follicles. The onset of the condition occurs mostly during puberty, although it can appear in persons in their middle age. Biomedically, the lesions arise following sebaceous overactivity leading to plugging of the follicles by sebum. Bacteria, in particular Propionibacterium acnes, are trapped in the sebum plug, causing release of and irritation by accumulated fatty acids. Androgen hormones appear to activate sebaceous glands. Etiology The primary causes of acne are Lung heat, Stomach heat, blood heat, heat toxin, and damp toxin with blood stasis. 1. Lung Heat: this is caused by the invasion of external wind. 2. Stomach Heat: this is typically caused by a high-fat diet or overacting of fried and /or spicy foods. 3. Blood Heat: this type of acne often has emotional disturbance as its source. This results qi stagnation. 4. Heat toxin: this is the result of the external toxin to form heat toxin that rises upward and lodges in the skin. Categories 1. Punctate main leion is cheeslike w/ blackhead comedomes at the opening of hair follicles. 2. Papulosa light or dark red color due to inflammation of comedome 3. Pustulosa pusutles fomr from secondary infection 4. Indurata if it occurs on a deep level pustules can become red or purple color 5. Atrophica papules or pustules cause damage to glands pitted scar and atrophy 6. Cystica deep infection causes huge pustules and swelling 7. Conglobata most serious lesion with multiple shaped lesions such as comedomes papules, pustules, pus, gland swelling, and fistula, scars fomr after healing. It often spreads to the back and buttocks. Signs and Symptoms Lesions of acne appear most frequently on the face, chest and back, where the sebaceous follicles are large. The first lesions are noninflammatory comedones (plugs of keratin and sebum in hair follicles). Open comedones are known as blackheads, closed ones as whiteheads. As time progresses, the dome-shaped comedones may develop into inflamed papules, superficial cysts and pustules . In severe cases, deep inflamed nodules and pus-filled cysts are present, with some

33

having their openings on the skin surface where their contents are discharged. The scars that usually result from acne are pitted. Acupuncture Li11, Li4, GB20, ST40, ST36, SP6, 9, 10, LU7, GB41, ST3, LI20, LV3, SJ5. The following associated points may be treated: BL15, 13, 18, 20, 23. Select 2-3 points at the first session, then alternate points during subsequent sessions. Ear Acupuncture: LU, Endocrine, Testicles and Cheek. Treat any two points during the first session, then alternate the points during subsequent sessions. Treat every other day, retaining needles for 20-30 minutes. Prevention The course of acne varies greatly. Untreated acne can last for several years. Patients should be advised not to pick the lesions, particularly the crust covering an opened lesion; such manipulation may delay healing and produce a pitted scar. Women should avoid using comedogenic cosmetics, especially those that contain oils. Frequent washing of the face with soap and water is good practice for all acne patients. Food and beverages that can produce dampness and heat, such as spicy and greasy items, should be avoided. Alcohol and smoking can give rise to acne. Empirical Sheng Di 15 Xuan Shen 12 Shi Huo 12 Shan Bai Pi 12 Shan Zha 12 drain damp and drain fat and lipids in the Yang Ming and San Jiao Bai Hua She She Cao 30 balance endocrine hormone, such as elevated testosterone Sheng Gan Cao 5 Internal treatment Although skin diseases manifest on the exterior surfaces of the body, their occurrence usually reflects the health of deeper physiologic functions the Organs, channels and collaterals, and bodily substances (qi, blood and fluids). Thus, in traditional Chinese medicine, skin diseases are treated both internally, to affect the whole system (through oral medication), as well as externally, to treat the local manifestation of the disorder (through topical application of the medicine). 1. Lung Heat: Lesions of this pattern are characterized by whiteheads and blackheads that are papular and sometimes slightly itchy. The forehead, as well as the areas proximal to the nose, are most commonly affected. Generalized symptoms may include dryness of the nose and mouth,

34

dry stools, a slightly red tongue with a thin white or yellow coating, and a floating, slippery pulse. The treatment principle is to clear and drain Lung heat. Formula recommended for this pattern is Pi Pa Qing Fei Yin modification. Pi pa ye 6, sang bai pi 9, huang lian 3, huang bai 3, sheng di huang 30, mu dan pi 9, chi shao 9, zhi mu 9, sang bai pi 9, gan cao 5. 2. Stomach heat. This pattern is characterized by whiteheads and blackheads that are papular. The areas around the mouth, chest and upper back are commonly affected. The face is prone to oiliness. Treatment principle is to clear Stomach heat. Formulas recommended for this pattern are modification of Tiao Wei Cheng Qi Tang and Tao Hong Si Wu Tang. Da huang 12, gan cao 6, chuan xiong 3, dang gui 6, bai shao 6, sheng di huang 6, tao ren 6, hong hua 3, yi mu cao 12, pu gong ying 12, shan zha 12. External Treatment 1. Dian Dao San Upside Down Powder Da haung 10, liu huang 5. Separately grind the two ingredients into powder. Then combine the powders and grind again until extremely fine. Mix with cold water to form a liquid paste. Apply a thin layer of the herbal paste with cotton ball 1-2 times daily. 2. San Huang Wash Da huang, huang bai, huang qin, ku shen, 5 grams each grind into fine powder. Mix with water 200 cc and apply to affected area with a sterile cotton ball 1-2 times daily. Stir and mix well each time before use. General Internal Treatments for Skin Conditions 1. Dispelling Wind & Scatting Cold Pattern: wind-cold or disharmony of Ying and Wei Formula: Gui Zhi Tang Herbs: gui zhi, jing jie, fang feng, bai xian pi Common skin disorders: Frostbite, urticaria 2. Expelling Wind & Clearing Heat Pattern: wind-heat Formulas: Yin Qiao San, Xiao Feng San Herbs: jin yin hua, lian qiao, sang ye, bo he, ju hua, shan zhi zi Common skin disorder: acute eczema 3. Clearing Heat & Draining Dampness Pattern: damp-heat Formula: Long Dan Xie Gan Tang, Bei Xie Shen Shi Tang Herbs: yin chen, long dan cao, shan zhi zi, huang bai, che qian zi, yi yi ren Common skin disorders: eczema, herpes zoster (acute stage)

35

4. Cooling Blood & Relieving Toxins Pattern: Blood-heat Formula: Qing Ying Tang Herbs: sheng di, mu dan pi, chi shao, ban lan gen, zi cao Common skin disorders: psoriasis, purpura 5. Invigorating Blood & Transforming Stasis Pattern: Qi stagnation and Blood stasis Formula: Tao Hong Si Wu Tang Herbs: tao ren, hong hua, dan shen, dang gui, chi shao Common skin disorder: varicose vein, eczema, sequela of herpes zoster, and warts 6. Transforming Phlegm & Softening Hardness Pattern: Phlegm stagnation Formula: Er Chen Tang Herbs: ban xia, chen pi, xia ku cao, kun bu, hai zao Common skin disorders: subcutaneous nodules, lipoma 7. Nourishing Yin & Clearing Deficient Heat Pattern: Yin deficiency with internal heat Formula: Zhi Bai Di Huang Wan Herbs: sheng di, xuan shen, mai dong, zhi mu, bai hua she she cao Common Skin disorder: lupus 8. Nourishing Blood & Moistening Dryness Pattern: Blood deficiency with wind dryness Formula: Si Wu Tang Herbs: sheng di, shu di, dang gui, chuan xiong, bai shao, ji xue teng Common Skin disorders: alopecia, Sjogrens syndrome

36

Tinea Tinea Versicolor (Pityriasis versicolor) Yellowish brown or brown macule patches on skin with scales upon scraping. Some have pale white macules results from hypo pigmentation. It affects chest, back, armpit, neck, upper arm, abdomen and lateral thigh. The itching is mild. It is more prevalent in summer season in young and middle aged people who perspire easily. It should be differentiated with sebaceous dermatitis and vitiligo. Tinea Cruris One type of Tinea Corporis which affect upper and medial thigh. In male, it affects inguinal area. It represents with red patches with scales and eruption. It expands gradually with clear margin. Skin lesion often combines with crust and vesicles. The affected local area is warmer and moist. Because of perspiration and rubbing, the skin easily has erosion. The lesion is usually symmetrical. When Tinea Cruris expands to buttocks, it is called tinea corporis or tinea on buttock. The affected local area has itching and heat sensation. Skin lesion is red macule, papule with scales. Tinea Capitis Fungus infection on scalp. It may be white or black or pustule tinea. On affected area, hair lost luster and become dark, gray and brittle. Tinea Pedis (Athletes foot) It affects soles and area between toes causing erosion, vesicle and scales. It is the most common type of fungus infection. Tinea pedis can be divided into Sweat-vesicle type, folder-erosion type, and scale-keratin type. Sweat-vesicle type has multiple vesicles leading to blisters and combines intense itching. Foldererosion type affect area between toes where it is moist due to sweating. It leads to erosion and whitening of skin with scales and intense itching. If scratching causes exposure of fresh red skin, it easily causes lymph duct infection and erysipelas. Scale-keratin type easily leads to fissure and pain.

37

Common people have fungus on their feet, but it does not manifest as tinea pedis. They are only carrier of fungus. Only when local area is moist, sweating, or person wear tight shoes that doesnt allow the sweat and heat to come out, or the persons immune system is low, it induces the onset. Tinea pedis is most common type of tinea because the sweating on the feet creates a suitable environment for the survival and multiplication of fungus. Plus there is no sebaceous gland on the foot. The lack of sebaceous acid cannot inhibit and growth of fungus.

Tinea Manam Tinea on the hands, which is transmitted from tinea on the foot. It has the same manifestation as Tinea pedis. Tinea Unguium It affects the nails of the fingers and toes and it co-exists with tinea on the hands and feet. The affected nails become less transparent. The texture is loose and brittle. The nail loses luster and looks dark yellow or gray. The surface is either pitted or elevated. The nail thickens and the free edge tiles upward. Candidiasis It affects the mucosa, or where mucosa connects with skin, or where skin folds. It may cause acute or chronic skin lesion. It mostly affect over-weight babies or babies who suffer from diarrhea. The neck, trunk, armpit or inguinal area are mostly affected. When it affect areas around the mouth, it should be differentiated with acute eczema which manifest as similar skin lesions. Tinea Corporis Tinea corporis is a common, noninvasive cutaneous infection caused by fungal disease. It affects body areas except hair, fingernails and toenails, hands and feet. The yuan xuan (round tinea) in TCM is very similar to Tinea corporis in western medicine. Biomedically, tinea is caused by fungi that invade the cornified components of the skin. The genera of causative fungi are Trichohyto, Epidermohyton and Microporum. Etiology Tinea is caused by the invasion of wind and damp-heat into the skin. Individuals who are overweight and have pre-existing phlegm and dampness are prone to tinea. The condition may also be caused by transmission from other individuals or sources.

38

Signs and Symptoms Tinea lesions are disc-like with sharply defined, raised borders that expand peripherally and clear centrally. Often there is red scaling with varying degrees of itching. Blisters and pustules may appear on the border. Continuous scratching may result in lichenification. Lack of signs of central healing may result in misdiagnosis of eczema or dermatitis. Tinea tends to flare up during the summer and improves or resolves during the winter. Tinea corporis is more common in adults. In humid, tropical parts of the world, much of the population is affected. Differentiation Diagnosis Tinea is confirmed by demonstrating the pathogenic fungi in scraping lesions, either by microscopic examination or by culture. During examination, tinea should be differentiated from chronic eczema, which has undefined borders, erythema, erosion, crust and scales. Localized scratch dermatitis (neurodermatitis) has shiny papules, marked lichenification, severe itching and lacks pustules. Pityriasis rosea has numerous lesions, but unlike tinea, the borders are not as neat, there is no centrally hearing center, and once the acute lesions are healed, they usually do not recur. Psoriasis has erythematous papules or plaques covered with overlapping, opalescent, shiny scales, and lacks a centrally healing center. Treatment Internal Treatment Bei Xie Sheng Shi Tang Yin chen 30, yi yi ren 30, lian qiao 12, chi fu ling 12, bei xie 15, pu gong ying 15, cang zhu 9, bai zhu 9, qing pi 9, bing lang 9, fang ji 9. External Treatment 1. Qiing Dai Ointment Qing dai, shi gao, hua shi, huang bai. Grind the ingredients into a fine powder and mix with petroleum jelly. Spread the ointment onto sterile gauze and apply to the affected area once daily. 2. Hua Tuo Shen Xiao Xuan Yao Bai bu, bing lang, tu jing pi, lu lu tong, bai ji, chuan jiao. Steep the ingredients in hot grain alcohol for 30 minutes. Apply as a wash to the affected area 67 times daily. 3. Ku Suan Cu Jin Pao Sophora and Allium Vinegar Soak Ku shen 30, da suan 30, shi liu pi 30, wei ling xian 20, table vinegar 1 liter.

39

Steep the herbs in the vinegar for 48 hours. Then decoct over low heat for 20-30 minutes. Pour the liquid into another glass container, discarding the dregs. Wash or soak the affected area for 15-30 minutes once daily before bedtime. After applying the remedy, do not wash the area until before the next application. 4. Tu jing pi 30, di fu zi 15, she chuang zi 15, bai xian pi 15, bai bu 15, ma chi xian 15, hua jiao 10, jin yin hua 15. Soak with 50% of alcohol for 7-10 days before use. Acupuncture LI15, PC3, LI4, GB31, SP10, SP6, BL40, LI11, ST44, GB41, SJ5, LV2.Do not retain the needles. Treat twice weekly, with ten treatments as one course. Prevention Prompt treatment is important once tinea is diagnosed. Personal hygiene is important in preventing spread of the disease, particularly among family members. Clothing and washcloths should be laundered frequently.

40

Warts Warts are common benign skin tumors caused from virus infection due to skin contact. In Chinese medicine, warts are called "you", which means an extraneous growth on the body. Clinically, common warts, flat warts, contagious warts, plantar warts, venereal warts are most common. The one thousand day sores (qian ri you) in classic literature is similar to contagious warts. Other warts are called hou zi in Chinese language. Biomedically, warts are caused by many types of human papilloma virus. Etiology 1. Worry and depression injures Liver. Liver deficiency and blood dryness fail to nourish tendons. Wind evil contends in skin and muscle and give rise to warts. 2. Local trauma allows virus to invade the body when the immune is deficient. It can also be transmitted from skin contact of other individuals or self-transmission from one area of the body to another. Signs and Symptoms Common Warts mostly affect back of hands, fingers and toes. The initial lesion is as large as a pin of a needle or a soy bean, or larger extraneous growth. The top is loose and dry, like a lotus flower. It may appear as a single lesion or in clusters. Those that grow near the nails can grow into the nail beds. Common warts are generally painless unless squeeze, but plantar warts and those that grow into the finger or toenails can be extremely painful. Patient can feel pain. It bleeds easily upon bumping or rubbing. When the mother warts is healed, other warts may disappear by themselves. Flat warts affects face or back of the hands in young adults. The lesion is flat firm papules with size varying from a pin to a soy bean. The color is light brown or close to skin color. Most patients do not have any abnormal sensation. In some cases, there is mild itchy sensation. Contagious warts affect chest and trunk with round soy bean sized raised lesion. It is dipped in the middle, has wax like shiny surface. It may be scattered or clustered. It is commonly seen in children. Plantar warts grow under the sores or in between toenails. The lesion is soybean size or even bigger cornified papules. It looks firm and tough. It is sensitive upon pressure. When there are many plantar warts, it appears like patches. Foot trauma or sweating can induce plantar warts. Venereal warts affects the junction of skin and mucosa, mostly affects anus and external genitalia. The lesion is pale or dark with cauliflower appearance. Patient experiences itching sensations.

41

Differentiation Common warts should be distinguished from keratoacanthoma; Flat warts should be distinguished from flecks. Flecks are flat, not raised, color is brown or dark brown. It has genetic tendency. Venereal warts must be differentiated from flat0topped hypertrophic areas typical of secondary syphylis; Plantar warts should be distinguished from corns. Diagnosis of warts is made through laboratory demonstration of the presence of human papilloma virus. Treatment Internal Treatment 1. Common warts: No internal treatment is necessary if the number of warts is small. If the number is large, treatment principle is to nourish and invigorate blood, clear heat and toxins. Formula: shu di 12, chi shao 9, chuan niu xi 9, tao ren 9, hong hua 9, bai zhu 9, chi xiao dou 9, dan pi 9, ban lan gen 15, tu fu ling 15, sheng yi ren 12. One pack daily. 2. Flat Warts: Treatment principle is to dispel wind, clear heat and toxin, and invigorate blood. Formula: Sang ye 9, huang ju hua 9, jin yin hua 9, huang qin9, bai xian pi 12, bai hua she she cao 15, tu fu ling 15, hong hua 9, sheng yi ren 12. Emperical Formula: * Sheng yi ren 60g for adult, 30g for children, cook as a congee or decoction, take for 2-3 weeks, until the warts fall out. * Ban lan gen 30g, decoction, one pack daily for a month. 3. Contagious warts: Generally, no internal treatment is necessary. If there are numerous warts, treatment principle is to expel wind, clear heat and drain dampness. Formula: Sang ye 9, huang ju hua 9, jin yin hua 9, zi cao 12, ban lan gen 15, ma chi xian 12, sheng yi ren 12, tu fu ling 15, bai xian pi 12.

42

4. Venereal warts: Treatment principle: drain dampness, clear heat and toxin. Formula: Modification of Bei xie shen shi tang. Bei xie 12, huang bai 9, cang zhu 9, sheng yi ren 12, tu fu ling 15, dan pi 9, chi shao 9, zi cao 12, ma chi xian 12, da qing ye 12, ze xie 9, tong cao 6, sheng gan cao 3. Emperical Formula: Sheng di 30, chi shao 9, ye ju hua 9, bai xian pi 30, she chuang zi 9, ku shen 9, che qian cao 30, ban lan gen 30, da qing ye 30, ma chi xian 30, sheng gan cao 6. 5. Plantar warts: Treatment principle: clear heat & toxin, drain dampness, soften hardness. Formula: Ban lan gen 15, da qing ye 15, bai hua she she cao 15, ma chi xian 15, sheng yi ren 12, ku shen 12, sang leng 12, e zhu 12, hong hua 12. Emperical Formula: Ku shen 9g, decoction, one pack daily. External Treatment 1. Ya Dan Zi Fu Tie Brucea Poultice Ya Dan Zi 30 g. Remove the shells and mash the kernals thoroughly. Swab the wart with alcohol, and lance the skin over the wart until a few drops of blood appear. Dab a small amount of the mashed herb on the wart. Cover with a sterile bandage and affix with skin tape. Avoid wetting the area. Reapply the remedy every 3-4 days. The wart usually drops off within ten days. Caution: This herb has a cauterizing action. Avoid contact with normal skin. 2. Xiao You Ye - Reduce Wart Liquid Yi yi ren 60, ban lan gen 60, mu zei 30, lu feng fang 20, wei ling xian 20, mang xiao 20. Steep the ingredients in 0.5 liter of vinegar in an airtight glass container for five days. Rub the liquid on the wart 3-5 times daily. 3. Ma Dan Zi You Brucea Liniment Ya dan zi (shells removed), 3 parts, vegetable oil, 1 part. Steep the herb in the vegetable oil for two weeks. Apply the liniment twice daily. Caution: This remedy has a cauterizing action. Avoid contact with normal skin.

43

Acupuncture The following two methods of acupuncture may be used alone or in conjunction with each other. A: Select channel points neighboring the lesions, and treat every other day. B: Piercing the original mother wart: one method involves inserting a needle horizontally through the wart, and then removing the needle. The second method calls for inserting a needle perpendicularly through the tip of the wart to its base. In both cases the wart is first pinched tightly until it turns pale, then the needle is inserted swiftly. One or two drops of blood should be let. Use a 32-34 gauge, 0.5 cun needle. Treat every other day. By the fourth treatment the wart will usually begin to resolve. Moxibustion First sterilize the wart with alcohol. Then burn a small moxa cone about the size of a mung bean on the wart. Allow the cone to burn down to the base, at which time a popping noise will be heard. Treat daily. Usually, after several treatments, the wart would be removable by tweezers or a scalpel. Prevention Trauma and irritation to existing warts should be avoided in order to prevent spread. Eliminating the mother wart should be tried as both treatment and prevention of other warts. J Natl Cancer Inst Monogr. 2003;(31):117-24. Chapter 17: Genital human papillomavirus infections--current and prospective therapies. Stanley M. Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1Q0, UK. mas@mole.bio.cam.ac.uk Many therapies are available for the treatment of human papillomavirus (HPV)-associated disease, particularly external genital warts. However, at present, these therapies aim to remove the lesion rather than specifically target HPV infection. When disease and infection are local, as in cervical intraepithelial neoplasia (CIN), excisional therapies removing lesion and transformation-susceptible cells are highly effective. However, when infection is regional, as is usually the case for the anogenital warts, vulval intraepithelial neoplasia (VIN), anal intraepithelial neoplasia (AIN), penile intraepithelial neoplasia, and vaginal intraepithelial neoplasia, then current treatments are generally inadequate, with high

44

recurrence rates. Future therapies will be directly or indirectly antiviral, targeting HPV protein functions or enhancing the ability of the immune system to resolve infection or inducing apoptosis indirectly in HPV-infected cells. In the short to the medium term, immunotherapies for low-grade disease are the most likely to be in the clinic. Vaccines targeting the E1 and E2 early proteins combined with immunomodulators or conventional adjuvants that induce a strong cell-mediated HPV antigen-specific response and good immune memory would be the predicted combination. Vaccines designed to target high-grade intraepithelial disease, even when used in combination with immunomodulators, are unlikely to effect lesion clearance in more than a fraction of the cases. However, they may have a role as adjunct therapy after cervical conization to prevent the recurrence of CIN or HPV reinfection. They certainly appear to have a role in multifocal disease, such as VIN and AIN, where partial clearance may be effected and lesion size reduced enough for effective ablative or excisional therapy. It seems unlikely that anti-HPV chemotherapies specifically targeting HPV protein functions will be in the clinic in the medium term. However, agents such as indole-3-carbinol have shown efficacy in small clinical trials, and if these effects are confirmed in larger, randomized, placebo-controlled trials, they could be clinically useful. Unlike regular warts, once the HPV lesion is removed the virus does not continue to live in the bloodstream or tissue. HPV is the most common sexually transmitted disease in the world and the cause of virtually all cervical cancer. The granuloma's or warty lesions are very unlikely to become cancerous while the flat lesions (sometimes as small as a pinhead) are the stain that can cause cervical cancer. Co-infection of HPV and genital herpes greatly increases the chances of cervical cancer. Thuja used topically, orally and homeopathically has a long history of use for HPV. The Eclectic's used a preparation called Longs Thuja (an alcohol free topical application, there is no record I can find of how it was made) topically. The tincture was taken orally. I have never seen the tincture or the use of homeopathic Thuja by themselves cause the lesions to disappear. HPV is much less likely to than common warts to resolve without treatment. Orthodox treatments all work (Cryo, Leap, TCE, Podolotox), but can be painful. The treatment I use for HPV takes several months but works most of the time. I have had cases of cancer in-situ resolve using this protocol. This is what I call the medicinal diaphragm. The patient needs to have a diaphragm that can be old, have small holes, etc, It is not to be used for birth control. I combine finely powdered Hydrastis (1 Tbsp), with finely powdered Calendula flowers (1 tsp), fresh plantago major leaf (5- 7 leaves), Echinacea angustiflolia (fresh root if available - 1 tbsp, tincture if not - 1 tsp), Wild Indigo tincture (10 gtt) and 5 gtt Thuja tincture. This is put in a cusinart with enough water to make a slurry (the texture of loose

45

oatmeal). Place the mixture in the diaphragm, insert before going to bed and leave in over night. Remove in the morning. I usually recommend doing this 4 nights in a row, take 2 nights off. As I said it should be continued for at least several months. The beauty of this therapy is that it gets the medicines right where you want them and keeps it there for an extended period of time. Tori Hudson also has an intra-vaginal treatment protocol for HPV as well. Be aware that infected sexual partners can easily re-infect the patient so men should be checked for penile HPV and treated as well. Soaking the penis in white vinegar causes the lesions to turn white and makes them easy to identify. Cryo (freezing) may be the simplest removal technique for most men. For both men and women oral immune stimulants and antiviral herbs may help to enhance immunological response.

46

Systemic Lupus Erythematosus Diagnosis and Treatment

Western Diagnosis and Treatment Diagnostic Features: *Occurs Mainly in young women *Rash over areas exposed to sunlight *Joint Symptoms in 90% of patients *Multiple system involvement *Depression of hemoglobin white blood cells and platelets *Antinuclear antibody with a high titer to native DNA 1 According to the American Rheumatism Association, a diagnosis of SLE can be made with reasonable probability if 4 of the following 11 criteria are present simultaneously or serially, during any interval of observation: malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, serositis, renal disorder, neurologic disorder, hematologic abnormality (hemolytic anemia, leukopenia, lymphopenia, or thrombocytopenia), immune dysfunction (positive LE preparation, antinative DNA, false-positive syphilis serologic tests over 6 months), and positive antinuclear antibody. Demographics: SLE appears most commonly in young women ages 13-45. More than 16,000 Americans develop Lupus each year with an estimated 500,000 currently suffering. 90% of all cases reported are female. Lupus strikes 1 in 400 white woman and 1 in 250 black women, it is also common in China; all races can be subject. Prognosis: The 10 year survival rate is exceeding 85% according to recent reports. In most patients, the disease pursues a mild course with occasional flaring of activity. The severity of the disease tends to diminish with time. It is common to find normal lab levels after five years. Standard Western Therapies: Aspirin and other NSAIDs are used to treat the milder symptoms of Lupus, such as joint pain, fever, etc.. The problem here is increased permeability of the gastric mucosa. This increases the likelihood of large size protein molecules crossing the gut-immune barrier. This renders NSAIDs inefficient as a long term solution due to antigen-antibody increased musculoskeletal inflammation. Antimalarial drugs are being used to treat skin lesions, although side effects such as visual disturbances and nausea can occur in the course of prolonged treatment (possible use of Artemisia ching hao). The standard drug treatment for the more severe SLE is corticosteroid therapy, most commonly prednisone. Side effects can include acne, sleep disturbances with resulting fatigue and irritability, personality changes, susceptibility to infections, weight gain, and symptoms similar to Cushing's Disease (moon-like face, changes in posture, high blood pressure, diabetes, absence of menstruation, purple skin markings, etc.). Prolonged, intensive

47

corticosteroid therapy can also cause psychiatric disturbances known as "steroid psychosis." This can mimic psychosis due to Lupus' effects on the central nervous system and may be difficult to distinguish from it. Other possible side effects of long-term steroid use are osteoporosis or osteonecrosis. Oriental Medicine: Diagnosis and Treatment of SLE Professor Ding Jie Ming's Treatment of SLE SLE was not described in classic literature other than as fragments of internal or external syndromes. Professor Ding Jie Ming has treated over 500 SLE patients during the course of 5 years. According to Professor Ming, etiological factors considered in the development of SLE include wind, damp, and cold. The result of this is slow developing inflammation of the joints. The pathogenesis then progresses into the tissues of skin, nerves, and blood. Focus of the therapy is adjusted according to the location of the internal SLE lesions. The following are the treatment protocols given by Professor Ming in lecture sponsored by the Research Institute of Chinese Medicine. Base Formula: Cinnomomi cassiae Ramulus (Gui Zhi) Bupleurum chinense (Chai Hu) Lycopodium clavatum (Shen Jin Cao) Glycyrrhiza uralensis (Gan Cao) For lesions in the brain and CNS, add Cicada periostricum (Chan Tui) and Polygala tenuifoliae (Yuan Zhi) to the base formula. Liver lesions: For severe headache (wind) add Uncariae cum uncis (Gou Teng) and Peonia alba (Bai Shao). To tonify yin add Ecliptae prostatae (Han Lian Cao), Ligustri lucidii (Nu Zhen Zi), Scrophularia ningpoensis (Xuan Shen), and Haliotidis concha (Bao Yu). For hypochondriac pain add Scutellaria baicalensis (Huang Qin), Moutan radicis (Mu Dan Pi), Cyperi rotundis (Xiang Fu Zi). Spleen lesions: 1.If the Spleen is enlarged add Coptis chinensis (Huang Lien), Atractylodes macrocephala (Bai Zhu), and Hordeum vulgaris (Mai Ya). 2.For diarrhea or loose stool remove Scrophularia ningpoensis (Xuan Shen). Add Dioscorea oppositae (Shan Yao), Massa fermentata (Shen Qu), Saussurea lappa (Mu Xiang), Carbonized Zingiberis officinalis (Gan Jiang), and Atractylodes macrocephala (Bai Zhi).

48

3.For severe dampness of the spleen, subtract Scrophularia ningpoensis (Xuan Shen); add Coicis lachryma-jobi (Yi Yi Ren) and Atractylodes macrocephala (Bai Zhi). 4.For thin muscles and fatigue add Astragalus membranaceus (Huang Qi), Angelica sinensis (Dong Gui), Lycopi lucidus (Ze Lan), and Salvia miltiorrhiza (Dan Shen). Lung lesions: Add Ephedra (Ma Huang), Peucedani praeruptorum (Qian Hu), Platycodon grandiflorum (Jie Geng), and Polygala tenuifolia (Yuan Zhi) to open the lungs, and dissolve phlegm. When Lung is inflamed, add Cortex of Mori alba radicis (Sang Bai Pi). Coughing blood add Ophiopogonis japonicus (Mai Men Dong), Nelumbinis nucifera (Lotus Root or Ou Jie), Biota orientalis (Bai Zi Ren), Caucumen biota (Ce Bai Ye). Skin lesions: Use Astragalus membranaceus (Huang Qi), Angelica sinensis (Dong Gui), and Clematidis chinensis (Wei Ling Xian). The treatment strategy is to nourish Qi and Blood, and disperse wind. Ascites: Areca catechu Shell (Da Fu Pi) to relieve damp. When the lesion is in the kidney, Warm the Yang, Expel Wind, and Benefit the Kidney. Xien Ling Pi is the base formula for this: Aconite carmichaeli (Zhi Chuan Wu), Lycopodium clavatum (Shen Jin Cao), Scrophularia ningpoensis (Xuan Shen), Glycyrrhiza uralensis (Gan Cao), Cinnamomi cassia Ramulus (Gui Zhi), Atractylodes alba (Bai Zhu), Astragalus membranaceus (Huang Qi), Coicis lachryma-jobi (Yi Yi Ren), Achyranthes bidentatae (Niu Xi), Chaenomeles lagenaria (Mu Gua). Modification for Yang Deficiency: subtract Scrophularia ningpoensis (Xuan Shen). Add Achyranthes bidentatae (Niu Xi), Cistanches salsa (Rou Cong Rong), Eucommia ulmoidis (Du Zhong), Aconite carmichaeli (Fu Zi). Modification for Yin Deficiency: increase Scrophularia ningpoensis (Xuan Shen) and add Rehmannia glutinosae Raw (Sheng Di Huang). Proteinuria: add Astragalus membranaceus (Huang Qi), Atractylodes alba (Bai Zhu), Zea mays (Yu Mi Shu), Coicis lachryma-jobi Radix (Yi Yi Ren Gen), and Blackbeans. Elevated BUN: Add Achyranthes bidentatae (Niu Xi), Chaenomeles lagenariae (Mu Gua). For Heart Lesions: make the following modifications to the above kidney based formulas. Heart Yin deficiency

49

add more Scrophularia ningpoensis (Xuan Shen); also add Ophiopogonis japonicus (Mai Men Dong), Polygonum multiflori Caulis (Ye Jiao Teng), Biota orientalis (Bo Zi Ren), and Schisandra chinensis (Wu Wei Zi). Heart Yang deficiency remove Scrophularia ningpoensis (Xuan Shen); add Aconite carmichaeli Cx (Fu Zi), Salvia miltiorrhiza (Dan Shen), Catharsius malosis (Chiang Lian Chung) 2 , Acori graminei (Chang Pu), and Polygalae tenuifolia (Yuan Zhi). Practical Surgery of Chinese Medicine gives three differentials for Lupus they are: 3 1.Yang deficiency of Spleen and Kidney presenting with a cluster of the following; mild erythema, bluish-brown subcutaneous purpura, chills, cold extremities, mild fever, aching in the joints, low back pain, sparse hair, irregular menses, fatigue, perspiration, weakness of the arms and legs, edema, loss of appetite, muddy stools, scanty urine, swollen tongue, weak pulse. 2.Yin Deficiency with Internal Heat has a cluster of the following; constant low-grade fever, skin injuries, occasional erythema, palpitations, insomnia, dry mouth, dry throat, vertigo, tinnitus, joint aching, low back pain, night sweats, significant hair loss, irregular menses, dry stool, yellow urine, a red tongue with a thin yellow coat, and a thready rapid, tense pulse. 3.Excess Toxic Heat symptom clusters may be; fresh erythema, hemorrhagic blisters, purpura under nails or on conjunctiva, high fever, irritability, fainting, thirst, constipation, decreased urine, red tongue with thin dry yellow coat, and a tense rapid pulse. 1.For Spleen-Kidney Yang Deficiency use Eucommia and Rehmannia Formula (You Gui Wan) as general treatment. A specific formula used contains Curculiginis orchioides (Xian Mao) 15g, Epimedium sagittatum (Yin Yang Huo) 15g, Cuscuta chinensis (Tu Si Zi) 15g, Cynomorium coccineum (Suo Yang) 9g, Atractylodes alba (Bai Zhu) 9g, Codonopsis pilosula (Dang Shen) 9g, Smilax glabra (Tu Fu Ling) 30g, Glycerrhizae uralensis (Gan Cao) 6g, Antelopis cornu (Ling Yang Jiao) 3g. Goat horn is a possible replacement for antelope. 2.For yin deficient internal heat use Rehmannia glutinosae (Shou Di Huang) 18g, Scrophularia ningpoensis (Xuan Shen) 12g, Ophiopogon japonicus (Mai Men Dong) 12g, Peonia alba (Bai Shao) 9g, Testudinis plastrum (Gui Ban) 18g, Lycium chinensis (Gou Qi Zi) 15g, Anemarrhena asphodeloides (Zhi Mu) 9g, Phellodendron amurense (Huang Bai) 9g, Smilax glabra (Tu Fu Ling) 30g, Rubus parvifolius (Ci Bo) 15g, Glycyrrhizae uralensis (Gan Cao) 3g. 3.For Excess Toxic Heat use Rehmannia glutinosae Fresh (Sheng Di Huang) 30g, Peonia alba (Bai Shao) 12g, Moutan radicis (Mu Dan Pi) 9g, Gypsum fibrosum (Shi Gao) 30g, Anemarrhena asphodeloides (Zhi Mu) 9g, Isatis tinctoris (Ban Lan Gen) 9g, Lithospermum erythrorhizon (Zi Cao) 9g, Glycerrhizae uralensis (Gan Cao) 3g. For severe aching of the joints, add Polygoni cuspidatum (Hu Chang) 15g and Clematis chinensis (Wei Ling Xian) 12g. For purpura, add Ecliptae prostratae (Han Lian Cao) 15g.

50

As is true for most clinical situations, treat what you find. Patients have had remarkable improvement using simple patent Yin Tonics when appropriately indicated. Classic Formulas Used in the Treatment of SLE Clematis and Stephania Combination (Shu Jing Huo Xue Tang): Activates Blood, Dispels Wind and Dampness. Use for pain in muscles, nerves, joints (esp. below the waist) and purpura. Angelica sinensis (Dang Gui) 2g Peonia alba (Bai Shao Yao) 2.5g Ligustici wallichi or Cnidium (Chuan Xiong) 2g Rehmannia glutinosa (Shou Di Huang) 2g Persica (Tao Ren) 2g Poria cocos or Hoelin (Fu Ling) 2g Atractylodes alba (Bai Zhu) 2g Citri leiocarpae (Chen Pi) 1.5g Notopterygii incisium (Qiang Huo) 1.5g Angelica dahurica (Bai Zhi) 1g Clematis chinensis (Wei Ling Xian) 1.5g Stephania tetrandra (Fang Ji) 1.5g Gentiana scabrae (Long Dan) 1.5g Sileris or Ledebouriella (Fang Feng) 1.5g Achyranthes bidentata (Niu Xi) 1.5g Zingiberis recens (Sheng Jiang) 1.5g Glycyrrhiza uralensis (Gan Cao) 1g Stephania and Carthamus Combination (Shu Feng Huo Xue Tang): Activates Blood, Dispels Dampness, Opens the Channels, Clears Heat and removes Phlegm. Use for pain in the muscles, nerves, joints, purpura. There is stabbing pain and the joints are red and swollen. Clematis chinensis (Wei Ling Xian) 2.5g Arisaema consanguineum (Tian Nan Xing) 2.5g Atractylodes lancea (Cang Shu) 2.5g Notopterygii incisium (Qiong Huo) 2.5g Angelica sinensis (Dang Gui) 2.5g Ligustici wallichi or Cnidium (Chuan Xiong) 2.5g Stephania tetrandra (Fang Ji) 2.5g Phellodendron amurense (Huang Bai) 2.5g Carthamus tintoris (Hong Hua) 1g Cinnamomi cassia (Gui Zhi) 2.5g Zingiberis recens (Sheng Jiang) 1g Bupleurum and Rehmannia Combination (Chai Hu Qing Gan Tang): Cool the Blood, Dispel Wind Heat, Clean the Liver. Use for adenopathy, skin rash, pleurisy; to improve physical condition. A classic abdominal conformation for this formula is tight rectus abdominus muscles and flaccid tissue below the naval.

51

Bupleurum falcatum (Chai Hu) 2g Platycodon grandiflori (Jie Geng) 1.5g Glycyrrhiza uralensis (Gan Cao) 1.5g Mentha haplocalyx (Bo He) 1.5g Arctium lappa (Niu Bang Zi) 1.5g Forsythia suspense (Lian Qiao) 1.5g Trichosanthes kirlowii Rt (Gua Lou Gen) 1.5g Scutellaria baicalensis (Huang Qin) 1.5g Coptidis chinense (Huang Lian) 1.5g Phellodendron amurense (Huang Bo) 1.5g Gardenia asphodeloides (Zhi Zi) 1.5g Angelica sinensis (Dang Gui) 1.5g Peonia alba (Bai Shao Yao) 1.5g Rehmannia glutinosa raw (Sheng Di Huang) 1.5g Ligustici wallichi or Cnidium (Chuan Xiong) 1.5g Tang Kuei and Astragalus Combination (Dang Gui Bu Xue Tang): Blood Deficiency with Qi Deficiency. There is a red face, irritability, thirst with preference for warm beverages, hot sensation in the muscles, pale tongue, fidgeting, the pulse is large and empty. The red face is due to heat generating in the presence of blood deficiency. Astragalus membranaceus (Huang Qi) 30g Angelica sinensis (Dang Gui) 6g Jujube Combination (Shi Zao Tang): Dispel Water Stagnation. Used for Uremia from SLE. This is a very strong, toxic formula due to the Euphorbia content (Gan Sui & Da Ji). It should be used only for a strong constitution, under control and if absolutely necessary. Begin administering the formula in small amounts initially, then gradually increase the dosage. Euphorbia kansui (Gan Sui) 1g Daphne genkwa (Yuan Hua) 1g Euphorbia pikinensis (Da Ji) 1g Zyziphi jujube (Da Zao) 4g

Minor Bupleurum Combination (Xiao Chai Hu Tang): Sooth the Liver, Cleanse the Gallbladder, Tonify Spleen, Half Internal Half External (Shao Yang) condition. Use for chest distension, pain below the ribs and a tubercular constitution. Add Cinnamon and Hoelin Formula (Gui Zhi Fu Ling Wan) with blood stagnation. Add Hoelin Five Combination (Wu Ling San) with fluid stagnation and wind attack. iv Xiao Chai Hu Tang Bupleurum falcatum (Chai Hu) 7g Scutellaria baicalensis (Huang Qin) 3g Pinellia ternata (Ban Xia) 5g Zingiberis recens (Sheng Jiang) 4g Panax ginseng (Ren Shan) 3g Zyziphi jujube (Da Zao) 3g Glycyrrhiza uralensis (Gan Cao) 2g Gui Zhi Fu Ling Wan Cinnamomi cassia (Gui Zhi) 4g Moutan radicis (Mu Dan Pi) 4g Paonia alba (Shao Yao) 4g Prunus persica (Tao Ren) 4g Poria cocos or Hoelen (Fu Ling) 4g Wu Ling San Poria cocos (Fu Ling) 5g Atractylodes alba (Bai Shu) 4g Panax ginseng (Ren Shen) 3g Citri leiocarpae (Chen Pi) 3g Autantii immaturis (Zhi Shi) 1.5g Zingiberis recens (Sheng Jiang) 3g Bupleurum & Schizonepetae Combination (Shi Wei Bai Du San): Dispel Wind and Detoxify. Bupleurum conformation (full, tender and tight below the ribs) plus skin rash or boil. Bupleurum falcatum (Chai Hu) 3g Zingiberis recens (Sheng Jiang) 1g Schizonepeta tenuifolia (Jing Jie) 1g Siler or Ledebouriella (Fang Feng) 2g Prunus serotina (Ouhi) 3g Angelica duhuo (Du HUo) 2g Poria cocos (Fu Ling) 2g Platycodon grandiflori (Jie Geng) 3g Glycyrrhiza uralensis (Gan Cao) 1g Ligustici wallichi or Cnidium (Chuan Xiong) 3g

53

Research From China Treatment principles being researched in China include: dispel noxious heat from blood, replenish the vital essence, invigorate blood circulation and resolve the stagnation. Salvia miltiorrhiza and Lonicera japonica are two typical herbs used in these studies. There was an effectiveness rate of 92% for 230 SLE patients treated with TCM and corticosteroids, 85% for 76 patients treated with TCM alone, 79-89% for rash, trichomadesis, oral or nasal pharynx ulcer patients. The ANA titer was decreased markedly for 75% patients. TCM had no side effect and could take in part the place of hormone in dosage and lessen its side effect. v Sixty-two cases of systemic lupus erythematous (SLE) were treated with Gentiana Combination. 5 tablets three times per day or 10 tablets twice per day and prednisone 10-30 mg per day were reported. As controls, 19 cases of SLE were treated with prednisone alone at the same time. The results showed complete remission in 86.46% (50/62) cases in the observation group and 31.57% (6/19) cases in the control group. Eight cases of SLE treated with Gentiana Combination alone also achieved complete remission in 6 cases and improvement in 2. There was very significant statistical difference between the two groups (P less than 0.001). The Gentiana Combination was more effective on the improvement of nephropathy, arthralgia, erythema and restoration of ESR, LE cells and CH50, C3 than prednisone alone. No apparent side effects of Gentiana Combination were found in this observation. vi Food Therapies As SLE can be considered a rheumatic condition, the use of foods for wind, cold, damp and heat are indicated. For Cold type arthritis: garlic, green onions, pepper, black beans, sesame seeds, chicken, lamb, mustard greens, ginger, spicy foods, grapes, grape vine tea, parsnip. Avoid cold foods, raw foods and cold weather. For Wind type arthritis: scallions, grapes, grapevine tea, black beans, most grains, green leafy vegetables. Avoid meats, shellfish, sugar, alcohol, smoking and stimulants. For Damp type arthritis: barley, mung beans, mustard greens, red beans, millet, sweet rice wine with meals, cornsilk tea; diuretic foods and herbs. Avoid cold foods, raw foods, and dairy products. For Heat type arthritis: fresh fruits and vegetables, dandelion, cabbage, mung beans, winter melon, and soybean sprouts. Avoid spicy foods, alcohol, smoking, stress, green onions, and red meat. vii

53

54

General Dietary Recommendations: 1.Avoid food sensitivities: particularly chicken, seafood, and pickles. Dairy, spinach, asparagus, rhubarb, vegetables from the nightshade family: tomatoes, green peppers, potatoes, pimentos, and eggplant; coffee, caffeine, sugar, refined foods, and fried foods. 2.Eat a low calorie, low fat diet. Mouse model studies clearly show benefit from this diet, suggesting that the same would be true for humans. viii 3.Limit beef and dairy, the same study as number two above, suggesting benefits to humans in Lupus. 4.Consume ample sesame seeds, kale, artichokes, green beans, millet, celery, barley, okra, almonds, collards, turnip greens, raw goat's milk, goat whey and black mission figs, gelatin (make a gelatin mold with cherry concentrate no sugar), burdock root, cherries, pineapple, quince, watercress, blackberries, black currants, mustard greens, limes, lettuce, olive oil. 5.Avoid alfalfa as it may aggravate Lupus, or possibly create a Lupus-like syndrome. Lcanavanine sulfate, a constituent of alfalfa was incorporated into the diet and reactivated the syndrome. ix Other considerations in the treatment of Lupus. There are at least 37 published references for the use of Centella asiatica (Gotu Kola or Zhi Xue Cao) in the treatment of Lupus. It appears as though Centella's prime action is on the connective tissue. x The use of Omega 3 fish oils (EPA) also show to be promising in rheumatic conditions and autoimmune problems. Interestingly, over the counter snake oil remedies purchased in Chinatown have been shown to contain 20% EPA. Apparently, the snake being cold blooded, produces Omega-3 essential fatty acids as an adaptation response to cold temperatures. xi In my personal experience, all rheumatic conditions respond better when combined with topical oleation therapy. Using a sesame oil as a base, add a powder of the indicated formula and apply regularly.Hydrochloric Acid deficiency can be a factor in the Lupus picture. Out of 9 patients with Lupus erythematosus, none had normal HCL levels, 2 had no detectable HCL. xii Deficiency of HCL is best quantified with the use of a Heidelberg Gastrometer (the swallowing of a capsule which measures HCL). Jonathan Wright, M.D. offers a provocation determinant for HCL: On three consecutive mornings, take one, two then three HCL tablets on an empty stomach. If there are no adverse reactions then use one or two tablets of HCL with each meal for a week. If there is some improvement, you have a confirmative result. If there are GI distress symptoms, discontinue the HCL, as there is ample. If there is too strong a reaction, it can be neutralized with baking soda or

54

55

milk. Remember not to use HCL with Aspirin or other NSAIDs due to the possibility of increasing the risk of ulcers. Chemical sensitivities should also be ruled out as Lupus patients have been shown to have higher than normal levels of sensitivity to foods and other substances. 4 patients with SLE developed remissions when given an elimination diet and nutritional supplementation. Another 70 patients with Lupus and Lupus-like syndromes showed similar improvement. xiii

External Treatment External treatment methods are an important component of traditional Chinese dermatology. External treatment is effective along, or in combination with internal treatment. Because external medicines are applied directly to the skin, they are absorbed quickly and rapidly. External medicines are composed of two parts: the active ingredient and the vehicle (base or carrier). Commonly used forms of external medicine include lotion, solution, powder(s), ointment, cream, and tincture. According to the types of skin lesion and different etiology, different herbal medicine and base are selected. Skin lesion with acute inflammation such as erythma, papule and vesicles without erosion can select topical wash or powder. Skin lesion with erosion, oozing, redness and swollen should select local wet compress with solution. Skin lesion in sub-acute stage with scale or scab can use ointment. Skin lesion with chronic inflammation, fissure and lichenification should select creams. Selection of Externally Used Herbs In Infectious skin diseases, use herbs that clear heat and relieve toxins, such as da huang, huang qin, huang bai, jin yin hua, da qing ye. Skin diseases that caused by fungus and scabies can be treated with herbs that kill insects and resolve dampness, such as ku shen, bai bu, tu jin pi, and liu huang. Allergic skin diseases can be relieved by herbs that expel wind, stop itching, clear heat and drain dampness, such as bai xian pi, di fu zi, and bo he. Caution 1. Initially, apply topical herbs to only small area on the skin. If no negative reaction is reported, apply to larger area. 2. Choose mild herbs with low concentration first. Increase the concentration gradually.

55

56

3. Stop using the herbs as soon allergic reaction is detected. 4. Do not apply herbs that irritate skin on facial or genital area. 5. Do not use herbs that irritate skin or herbs with high concentration with female or children.

56

57

Oleation Therapy Oleation therapy is the use of oils in the treatment of various conditions. The oils may be derived from plant or animal sources. The animal fats include materials such as butter or animal tissues such as fish. Plant sources include nuts, seeds, beans and oily vegetables. Oleation therapy may be found in most indigenous cultures. Arthritis treatment is greatly enhanced by oleation therapy especially when the condition is complicated with dryness. Oils in general tend to taste sweet and bland and have a warming quality. They tend to reduce the pathogenesis of dryness and wind. They increase dampness, phlegm and heat. The heating quality is increased by use in cooking. he heating quality is reduced by combining cooling herbs such as Radix Scutellaria baicalensis (Huang Qin). Oleation therapy is contraindicated for damp heat and blood heat with symptoms such as: red or oozing skin conditions and pain that is severe with palpation. Transdermal transport of oils and any herbs contained therein are potentiated when aromatics such as camphor or borneol are combined. Lipids are divided into three major classes: triglycerides, phospholipids (lecithin), and cholesterol lipids. Lipids are a vital component of nutrition and perform necessary functions including the basic component of cell membranes, cell metabolism, enzyme reactions, synthesis and utilization of sterol hormones and hormone-like prostaglandins, carrying fatsoluble vitamins A, D, E and K, memory and nervous system function. All fats and oils are a combination of saturated and unsaturated fatty acids. Fats are classified by the fatty acid structure of the major constituent oil. Saturated fats are derived from animal products and are solid at room temperature (butter, lard). The fatty acid chain contains no double bonds all the bonds are "saturated" by hydrogen atoms. Polyunsaturated fats are liquid at room temperature they are derived from plant sources. The fatty acid chain contains two or more double bonds and therefore is more easily oxidized by light, heat and air to become rancid. These lipids lower total serum cholesterol by lowering both HDL and LDL. Monounsaturated fats are liquid at room temperature. They are derived from plant sources. The fatty acid chain contains only one double bond; therefore are more resistant to oxidation. They lower total serum cholesterol by lowering LDL and leaving HDL levels unchanged. Omega 6 Essential fatty acids: Omega 6: linoleic acid (LA) and gamma-linolenic acid (GLA) promote the production of the Series-1 prostaglandins, which have been experimentally shown to be anti-inflammatory and anti-atherogenic.

57

58

Sources: Linoleic acid (LA): vegetable, nut and seed oils: corn, safflower, soy, canola, sunflower gamma-linolenic acid (GLA): breast milk, evening primrose oil (EPO), black currant oil, and borage oil Therapeutics: Autoimmune conditions: rheumatoid arthritis, systemic lupus erythematosis, scleroderma, multiple sclerosis asthma, hayfever, hives and hypertension. Omega 3 Essential fatty acids: Omega 3: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA) promote the production of the series 3 prostaglandins which have been experimentally shown to be anti-inflammatory and anti-atherogenic; eicosapentaenoic acid has also been shown to inhibit lipoxygenase activity and therefore decrease levels of the series-4 leukotrienes. Sources: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA): cold water fish (salmon, herring, mackerel, sardines); cod liver oil (caution regarding vitamin A toxicity if the patient is using a product with vitamin A) alpha-linolenic acid (ALA): flaxseed (linseed) oil, soy oil, chloroplasts Therapeutics: Cardiovascular disease, hypercholesterolemia, hypertriglyceridemia, hypertension, autoimmune conditions: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosis, scleroderma, multiple sclerosis, migraine headaches, diabetes mellitus, asthma, allergies, premenstrual syndrome. Oleation Ben Cao Almond oil is sweet, slightly bitter and warm, and it enters the lung and kidney. Almond oil reduces dryness, wind and cold. It moistens the lungs and expectorates, nourishes Jing, and benefits the marrow. It may be used for wasting diseases of the lung and kidney. Almond oil sooths skin and muscles. As does most oils, it increases heat and damp. Avocado oil is sweet and astringent, and it enters the liver. It also reduces dryness, wind and cold. Caution is used since like most oils, it increases dampness and phlegm. Canola oil is sweet and bland; it reduces phlegm, damp, and heat. Canola oil increases dryness, avoid it in deficiency conditions. Flaxseed oil treats a wide variety of conditions and contains both Omega 6 and Omega 3 oils. It may be used to treat conditions such as cardiovascular disease, hypertension, atherosclerosis, strokes, hypercholersterolemia; autoimmune conditions such as multiple

58

59

sclerosis, lupus, scleroderma, rheumatoid arthritis; it may also be used to treat impotence and glandular problems, asthma, and migraine headaches. Special Considerations Pesticides, which are fat soluble, tend to be concentrated in oil products; therefore it is a good idea to buy organic oils whenever possible. Oils that tend to be especially high in pesticide residue include soy, corn, cottonseed, and canola. Store oils in refrigerator, tightly capped away from light buy oils in small quantities and use before they become rancid. Castor oil pack 1. Fold flannel into three thicknesses 2. Cut piece of plastic larger than flannel 3. Soak flannel in warm oil 4. Place flannel over abdomen or lower if indicated, then place plastic over this 5. Leave in place from 30 min. to 2 hr. 6. Rest 7. Oil may be washed with baking soda This treatment is used for various types of masses and Liver Qi stagnation or Blood Stasis. Use the oil pack over the affected tissues and/or organs. Mustard plaster 1. Mix dry mustard with egg white or one tablespoon vegetable oil until it is strong enough for fumes to burn eyes 2. Wring out washcloth in warm water and apply mustard preparation over a quarter of the washcloth 3. Fold washcloth in quarters so that mustard is on the inside 4. Apply washcloth over umbilicus so that there is only one layer of the washcloth between mustard and skin, then cover with wool 5. Leave it in place until the skin turns pink and becomes sweaty under the compress, usually 5 to 7 min. 6. Carefully time length of application (this treatment can burn.you are warned!!!) 7. Apply cold compress over the umbilicus for exactly the same length of time 8. Repeat 5 and 7 twice more Use this treatment for phlegm accumulation, and Wind Cold attacking the Lungs. Contraindications: Organic gastrointestinal diseases or cramping Notes: 1. This treatment can be altered for chest complaints by using a larger cloth to cover chest 2. Above treatment is especially effective for acute nausea and vomiting with dry heaves

59

60

Jeffrey Yuen discusses the external application of essential oils to acupoints. His information nicely bridges Chinese herbalism and point theory. Blends are made according to TCM formula structure with a chief oil, associate, envoy and a mid-note harmonizer. Sharp oils are balanced with softer oils. For example middle note essential oils like corriander, anise, fennel, ginger, garlic and basil, which tend to last around 6 hours, serve metabolic functions, affect ying qi and digestion. They harmonize the ST/SP, work on nausea, vomiting, epigastric distention, flatulence. Base note oils which take 2-3 days to evaporate include sandalwood, myrrh, ylang ylang, jasmine, narcissus, vanilla, camphor, cedar and styrax, affect the yuan qi, are steroidal or steroid-like and tend to be grounding. Top note oils tend to evaporate rapidly and are more yang. They include lavender, evergreen oils, citrus oils, basil and rosemary (the most yang EO) . These are used in acute conditions and must be reapplied every 2-3 hours. Rosemary, for example, would be used on GV4 for impotence, but is contraindicated for patients with hypertension or rising liver yang. It regulates constrained liver qi by dispersing. Terebinth, another example, is extracted from the sap of the pine and helps move wind. It is a good associate oil for wind cold, damp or heat and works well on wei qi. It will promote healing crises if one is not sick. It tends to be effective on wind points: GB20, BL12, GV16, GB31, SI12 and SJ17. Pine oil which tonifies lung qi might be the chief in a formula with terebinth as deputy, with frankincense as a harmonizer, fixative and expectorant. This would be used for a chronic wind condition with lung qi deficiencies. The intensity of aroma determines whether the aroma affects shen (strong intensity) or invigorates blood (weaker intensity). Mid level intensity breaks stagnation. Carrier oils affecting the wei level include sweet almond, grapeseed, canola and peach kernel. Ying level carrier oils include olive oil, avocado, green oils, St. John's wort oil infused in olive oil, and tend to affect the blood. Safflower oil invigorates the Blood, but goes rancid rapidly. Yuan level carriers include cold-processed sesame oil, jojoba oil, walnut and hazelnut oil. Yuen tends to apply the 2% oil blends on points during treatment after the needles are in place, around the base of the needles. For bi conditions and general systemic treatment he will massage the oils into the affected areas. Spice oils can irritate mucous membranes and the skin so are generally applied to the sole of the feet.

60

61

Plasters E Mei Medicated Plaster Hua Tuo Medicated Plaster Temporary relief of minor pains of muscles and joints due to: back pain, arthritis, strains, bruises, sprains menthol, camphor, alsocontains wintergreen oil Invigorating Blood Circulation, Curing Injuries from falls, sprains & Rheumatalgia Ding Xiang Oil, Rou Gui Oil, Bo He Oil, San Qi, Sheng Cao Wu, Jiang Xiang, E Zhu, San Leng, Hot Pepper Invigorating Blood Circulation, Curing Injuries from falls, sprains & Rheumatalgia She Xiang, Bing Pian, Rou Gui Oil, Zhang Nao, Bo He Oil, Ding Xiang oil Temporary relief of minor pains of muscles and joints due to: back pain, arthritis, strains, bruises, sprains Menthol Chili Brand Plaster Axe Brand painrelieving lotion Eagle Brand Medicated Oil Temporary relief of minor pains of muscles and joints due to: back pain, arthritis, strains, bruises, sprains Capsaicin Temporary relief of minor pains of muscles and joints due to: back pain, arthritis, strains, bruises, sprains Menthol, Methyl Salicylate & Camphor Temporary relief of minor pains of muscles and joints due to: back pain, arthritis, strains, bruises, sprains Menthol, Methyl Salicylate, Chlorophyll, Mineral Oil, Otto of Roses Kwan Loong Oil Temporary relief of minor pains of muscles and joints due to: back pain, arthritis, strains, bruises, sprains Menthol, Methyl Salicylate Po Sum On Oil Temporary relief of minor pains of muscles and joints due to: back pain, arthritis, strains, bruises, sprains Menthol, Peppermint Oil, Cinnamon Oil, Licorice Die Da Yao Jing Hemorrhage, inflammation, swelling, infection, ulceration; sprains of tendons; blood clotting Xue Jie, Ru Xiang, Mo Yao, Hong Hua, San Qi, Lu Hui, Dang Gui wei, Er Cha First aid to help prevent the skin infection in minor cuts, scrapes & burns Tian Qi

Moschus Rheumatic Plaster

Yun Nan Bai Yao Plaster

Die Da Tian Qi Yao Jiu

61

62

Tu Jin Liniment

For scabies, itch of toes and skin, etc; fungus infection Tu Jin Pi, Shui yang Suan, Alcohol

Wan Hua Oil

White Flower Oil

Vulnerary (stricken or fallen), shocken and twisten septic burns & hemorrhagia Mo Yao, Ru Xiang, Hong Hua Oil, San Qi, Hong Hua, Gu Sui Bu, Xue Jie, Song Jie Oil Temporary relief of minor pains of muscles and joints due to: back pain, arthritis, strains, bruises, sprains Whitegreen, Menthol, Camphor, Peppermint, Lavender, Eucalyptus Temporary relief of minor pains of muscles and joints due to: back pain, arthritis, strains, bruises, sprains Menthol, Methyl Salicylate & Camphor Temporary relief of minor pains of muscles and joints due to: back pain, arthritis, strains, bruises, sprains Hu Zhang, Ji Gu Xiang, Bai Zhi, E Zhu, San Qi, Qian Jin Ba, Water, Alcohol For those who are afraid of acupunctural needles Unknown

Wood Lock Oil

Zheng Gu Shui

Acupuncture Ointment

Ching Wan Hong

Temporary relief of minor pains of muscles and joints due to: back pain, arthritis, strains, bruises, sprains Sesame Oil, Beewax, Mo Yao, Dang Gui, Hong Hua, Ru Xiang, Mu Gua, Di yu Hemorrhoids She Xiang, Bing Pian, Niu Huang, Zhen Zhu

Musk Hemorrhoids Ointment

Hua Tuo Gao

Fungus Infection An Xi Xiang Suan, Shui Yang Suan, Bai la, Zhang nao, La Mei Oil

Tiger Balm

Temporary relief of minor pains of muscles and joints due to: back pain, arthritis, strains, bruises, sprains Menthol, Camphor

62

63

Dermatological Pharmacopoeia Wind Cold TT Ma i Lu St Lu St Lu St Lu St UB Lu Ht s w C pai n * * B i vomit diarrhe a deto x H2O Sinus

Bai Zhi Rx Angelica dahurica Xiang Ru Hb Elsholtziae Sheng Jiang Rz Zingiberis Recens Zi Su Fo Perilla Gui Zhi Rm Cinnamomi

p,w

Yang Ming headache, pus, swelling, skin lesion * * *

p,w

Expel Summer Heat & Damp, swellings, edema * * *

p,w

Warms Middle & Lung, cough, adjust Ying & Wei * * *

p,w

Harmonize Middle, Circ Qi, Calm Fetus, seafd Tx * * *

p,w sw

Warm Channels, Ying & Wei, Ht Yang, Transform Qi

63

64

Wind Heat

TT

Mai

W H Ras h * * *

Sore Throat *

Red Eye *

Raise Yang

Regula te Lv *

Blurred Vision

Bo He Hb Mentha Chan Tui Per Cicadae Ge Gen Rx Pueraria Kudzu Sheng Ma Rz Cimicifuga Chai Hu Rx Bupleuri Niu Bang Zi Fr Arctii

p,c

Lu Lv Lu Lv Sp St UB Lu LI Sp St Lv SJ GB P Lu St

opens the Liver channel * * * * *

sw, c p sw c p sw slc p b c p b c

convulsions, voice loss, tantrum * * *

diarrhea,moisten,release muscles,HiBP Sp-St Qi stag,ear ringing, Xiao Ke * * *

Sp Yang, raises, St fire poison, muscles * * * *

relax stag Lv Qi, resolve Shao Yang heat * * * *

Detox Fire Poison, moisten intestine

64

65

Clear Heat Dry Damp Long Dan Cao Rx Gentianae Scabra Huang Qin Rx Scutellaria baicalensis Ku Shen Rx Sophorae flavascentis Huang Lian Rz Coptidis Chinense Huang Bai Cx Phellodendri amurense

TT

Mai

Bleeding

Fire Purge *Lv

Itch

Drain Damp Heat

b c b c b c b c b c

Lv GB St Lv GB St LI Lu Lv Ht St LI UB Lv Ht St LI K LI UB

Hot damp skin lesions along GB channel. Resentment * *Lu

calm fetus, angry mense fire, Subdue Lv Yang, HiBP * disperse wind, stop itch, promote urine, parasites * *HtSt

most cold & antimicrobial, detox, boils * Yin Shu, Quell K Fire

65

66

Clean Heat Cool Blood Sheng Di Huang Rx Rehmannia (raw) Xuan Shen Rx Scrophularia Mu Dan Pi Cx Moutan radicis Zi Cao Rx Lithospermi

TT

Mai

Stop Bleeding *

Detox

Nourish Yin *

Ying & Xue Heat *

Activate Blood

sw b c sw b sal c b, p sl c

Ht Lv K Lu K St

nourish Yin & Blood, Cool Blazing Heart Fire, Xiao Ke

Detox Fire Poison, dissipates nodules

Ht Lv K Ht Lv

Clear Depletion Fire, Dispels Congealed Blood, Clear Ascending Liver Yang, Pus, Tumors * Clears Damp Heat in Skin, Detox Fire Poison, Induce Eruptions, Moisten Intestines * * *

sw c

Xi Jiao Cornu Rhinoceri Asiatica Chi Shao Rx Peonia rubra

sal c

Ht Lv St Lv Sp

substitute water buffalo horn (Shue Jiao), subdue Lv Wind tremors, Clear Ht calm Spirit * *

b, s c

66

67

Diuretic (Open Lin) Che Qian Zi Sm Plantago asiatica

TT

Mai

Clea n Heat *

Activat e Blood

Bloo dy Lin

Ston ey Lin

Milk y Lin

Painf ull Lin

Itch

sw slc

Lu Lv UB K SI Ht SI UB UB

brighten eyes, Lv Wind Heat, blood heat

Qu Mai Hb Dianthi superbus Di Fu Zi Fr Kochia scoparia Bi Xie Rz Dioscorea officinalis Bishie

b c b slc b slc

crack Xue open mense, topical toxic ulcers * psoriasis, eczema (int-ext) *

Lv St remove WD, milky Lin, UTI

Clean Heat Toxin Chuang Yung Tu Fu Ling Rz Smilax glabrae Si Ji Qing Fo Ilex chinensis Bai Xian Pi Cx Dictamni radicis

TT

Mai

Breast

Eyes

Lung Heat

Reg Blood

Cool Blood

Pus

Skin

sw m n b ast c b c

Lv St syphilis, arthralgia, open H2O, mercury toxicity Ht Lu Sp St Remove Damp Heat, * measles, skin eruptions, fire and hot water burns * *

67

68

1. Shearn MA. Current Medical Diagnosis and Treatment. Appleton & Lange. pp501. 2. Catharsius is a beetle which is a drastic purgative and is toxic. Caution is recommended for its use. It activates blood, purges stool, and calms fearfulness. 3. Hsu HY. OHAI Bulletin. March 1982; 7(2); 34-40. 4.Otsuka, Yakazu. Therapeutic Reference of Chinese Medicine. 5. Wang ZY. Chung Hsi I Chieh Ho Tsa Chih (1989 Aug) 9(8):465-8, 452. 6. Yuan ZZ Feng JC. Chung Hsi I Chieh Ho Tsa Chih (1989 Mar) 9(3):156-7, 133-4. 7. Ni, Mao Shing. The Tao of Nutrition pp103-105. 8. Corman LC. Semin. Arthritis Rheum. 15 (1):61-69, 1985. 9. Malnow MR et al. Systemic lupus erythematosus-like syndrome in monkeys fed alfalfa sprouts: Role of a nonprotein amino acid. Science 216:415-17, 1982. 10. Pizzorno & Murray. A Textbook of Natural Medicine. V-Centel-2. 11. Kunin RA. Snake Oil. Western J Med; 208. 12. Allison JR. The relation of hydrochloric acid and vitamin B complex deficiency in certain skin diseases. Southern Med. J. 38:235-41, 1945. 13. Cook HM, Reading CM. Dietary intervention in lupus erythematosus: 4 cases of clinical remission and reversal of abnormal pathology. Int. Clin. Nutr. Rev. 5(4):166-76, 1985.

68