The skin is the largest human organ and acts as barrier to protect us from the environment or infections and it enables us to feel (heat, cold, touch, pain, or vibration). It also contributes to the immune system. As adults, we carry around 3.6 kg of skin that stretches out to 2 square meters. The skin assists with body temperature regulation and moisture evaporation.
As part of our anatomy, the skin is affected by disease or imbalance as much as any part of our bodies. Dermatology is a “specialist” area in TCM as it is in biomedicine too. I am not a specialist in dermatology but I believe even basic approaches in treating dermatological conditions with TCM can be highly effective. One of the reasons is that we completely tailor herbal medicines and approach the treatment in internally and topically at the same time. Topically, we can use different vehicles to apply the “medicine”. Choices largely depend on the condition that we are treating, so here is a table from Rabindranathnambi A & Abid M (2021):
|Greasy preparations, their occlusive effect leads to greater percutaneous absorption of the active ingredient (Chen and Obayan, 2015)
|Lotions, oils, foams
|Easy to apply formulations in a liquid or foamy base
|Emulsions of oil in water which are generally well absorbed
An example of choosing the carrier is, that if you are using a cream base, the medicinals are well absorbed, but you can’t use a cream if the skin condition that you are treating (acne) resist “clogging” for such conditions, it’s better to use a lotion or a foamy base. However, if the skin condition doesn’t mind to be nourished (psoriasis) then, a cream or an ointment would be more suitable.
Let’s have a look at some common skin conditions that our patients present with. It might be something that they seek treatment for as a primary complaint or it could be something that they “always” had and it accompanies another main complaint. I have divided six common conditions into internally generated or externally contracted as I believe, they are either more dependent on the internal environment or more connected with what’s happening outside us. It’s important to say it’s never only one factor, the skin is part of our anatomy and so what’s going on inside affects the outside and vice versa.
|Internally generated (internal state of Qi, blood, emotions, and diet)
|Externally contracted (more external factors)
|1. Different types of acne
|4. Different types of dermatitis
|2. Different types of psoriasis
|3. Different type of eczema
|6. Herpes simplex
Each skin conditions has a different appearance and might include the formation of pus, fluid, or blood-stained excretion. They might also be accompanied by itching (pruritus), and various levels of redness, inflammation, and pain. The condition might respond to seasonal or hormonal flare up or occur when the patient is tired, stressed, had been following a sub-optimal diet or all those factors combined. So common treatment strategies are:
- Clear heat & toxins
- Kill parasites
- Dispel wind
- Stop pain
- Reduce swelling & pus
- Transform dampness
- Cool blood
- Nourish blood
- Move Qi and/or blood
- Nourish Yin and moisten dryness
- Generate flesh
All strategies can be combined, however, it’s always best to clear excess and then move and/or nourish. So, in many instances, skin conditions need to be treated with that initial strategy in mind: If there is heat and dampness, clear and transform damp-heat, kill parasites, and then replenish.
Following are six of the key skin conditions with basic characteristics and suggestions for topical treatments. The internal or constitutional formula could be prescribed at the same time.
- Acne cause spots or pimples on the face, neck, back or chest and affects people between 15 and 24 years of age, or patients who have oily skin. These pimples occur when the when dead skin cells and oil from the skin clog hair follicles.
- The internal formula might be prescribed to treat the imbalance patterns (such as hormonal imbalance as well as manifesting signs and symptoms)
- The external formula should be prescribed with a foamy or lotion base as creams or oils will further block the follicles, examples are Dian Dao San Gao, Si Huang Gao or San Huang Xi Ji Gao (remember that all products can be customised, so you might choose a combination of those formulas)
- Advice patient on dietary changes and hand hygiene
- Psoriasis is a long-term inflammatory disease that affects the skin and nails and is caused by the cells growing too quickly, causing red, scaly lesions that can be painful. There is different stages of psoriasis so it’s important to differentiate. The differentiation is easily done by observing the skin (is it redder and painful or is it silvery scaly and dry). If the patients also has sore and inflamed joints, it’s called psoriatic arthritis.
- Psoriasis has stronger genetic tendency as patients’ immune systems react to triggers such as bacterial, viral infections or severe stress. Smoking and excessive alcohol consumption might also trigger an episode. Psoriasis is difficult to fully resolve and lifelong management and/or treatment might be necessary.
- The internal formula should be prescribed according to pattern differentiation and the external treatment should vary according to the stage of the psoriasis (is it acute with red, swelling, pain or is it more purple in appearance with silvery scales). Topical treatments might be Si Huang Gao, Jin Huang San or Yin Xie Bing Yu Ji Gao in phase one followed by Run Ji Gao in the phase following the inflammation and pain.
- Stress management is an important factor with these patients as well as dietary guidance (seasonal, unprocessed, organic food)
- Eczema is a skin condition with dry, itchy, and easily irritated skin. Common areas that are affected are the creases of the elbows, behind the knees and wrists or ankles. These areas might require special attention when after flare ups as they might appear dry and become itchy.
- This condition can be more common in babies and toddlers. The causes of eczema are largely unknown but a strong hereditary factor is possible. With certain types of eczema such as atopic eczema, there could be range of other allergic conditions such as hay fever or asthma.
- As usual, the internal treatment will be based on the pattern that the patients presents with, especially if other conditions such as asthma and hay fever require treatment. For topical treatments, my number one cream is Qing Dai Gao (especially in babies and toddlers), it’s a highly effective treatment. But other formulas or combinations might be applicable such as Gan Cao You, San Huang Xi Ji Gao, or Huang Lian Su Gao
- In babies and toddlers, a dairy free regime might be considered but only if lactose creates flares. External factors (anything that touches the skin) might need to be assessed and in adults, dietary and lifestyle advice could be a good measure
- There are two types of contact dermatitis: Allergic contact dermatitis and irritant contact dermatitis. The first one is caused by an allergen and the second one by an irritant. But they are similar in appearance with inflammation when the skin is exposed to the irritant or the allergen
- Causes for allergic contact dermatitis are nickel, plants, chemicals, cosmetics, creams, and ointments whereas irritant contact dermatitis can be caused by frequent handwashing, topical medications, cosmetics, dyes, chemicals, rubber and glues and plants
- The skin will be vulnerable in the areas that the dermatitis affected it. After reducing the allergens and irritants (or at least reducing exposure to them), the skin might require replenishing because it has lost its consistency, elasticity, and nourishment. The same principle applies to skin that was exposed to topical steroids as using those over a long period of time they might cause skin thinning, stretch marks, easy bruising, tearing, enlarged blood vessels and localised hair thickness and length
- A possible internal treatment could include balancing the Wei Qi, tonification of Qi, Blood, and Yin. Topical treatments are San Huang Xi Ji Gao and Gan Cao You and or a combination
- Hives, also known as urticaria or nettle rash is a skin rash that can be triggered by allergic reactions, medicines, or an infection. They typically appear as itchy, raised red or skin-coloured bumps or welts on the skin. The reaction can last between a few minutes to several hours. This reaction is caused by the body producing a substance called histamine, which is a protein to fight off viruses and bacteria (in an immune response). The rash may occur when there is an infection, an insect sting or bite, touching an animal or plant you are allergic to. Hives can also be triggered by cold air, cold water, heat, sunlight, vibrations, scratching, exercise, sweating, stress, dye injected as part of radiological testing, spicy food, alcohol, or coffee. Children might have hives triggered by a virus
- The main treatment for hives would be to address imbalances with Wei Qi and treat constitutionally. I would also use acupuncture to calm the skin, settle the mind and harmonise Wei Qi
- Herpes simplex
- Herpes simplex causes common cold sores which are blisters usually appearing in or around the mouth or nose. They often appear in times of additional stress, fatigue, or intense sunlight. Systemic symptoms such as headaches, fever, sore throat or nausea can occur. Blisters often start with a tingling sensation; they can be painful and are highly contagious
- Internally, the treatment would focus on harmonising (Shaoyang: Xiao Chai Hu Tang, modified if necessary) and externally, Hu Chun Gao is the preferred cream.
This information only touches the surface of dermatological TCM treatments. But the most important take away message is that we treat the patient and not the disease. Consequently, it is essential to diligently observe the the manifestation of the skin disorder and treat accordingly. If there is more heat (redness, swelling, pain), then use a combination of herbs to address that and if there is more dampness (itching, pale colour) then damp-transforming herbs need to be use. Also, if the skin condition is acute, the patient might need extra clearing herbs for a short period of time before going back to a constitutional formula, however, as Jing Fang practitioner myself, I tend to avoid too many cold herbs because it could make the situation worse. In my world, only a patient with an abundance of yang could tolerate too many cooling herbs. Complex skin conditions such as psoriasis will require a long-term plan and dedication by the patient to potentially embrace dietary and lifestyle changes.