Herbals & Eczema: Skimming the Surface

Oscar Sierra, L.Ac. Dipl. CH, RH(AHG)

 

A search on the Internet for the prevalence of eczema diagnosis will produce a startling number of studies that highlight its rise within the last century. Many people complain of red, irritated skin that may also be bumpy, flaky, itchy, or have fissures or cracks. It is an uncomfortable condition that can manifest spontaneously without warning and can affect us mentally and emotionally by diminishing self-confidence in our appearance.

 

Conventional treatments from a Western medicine provider may come in the form of topical pharmaceuticals, such as steroids or antihistamines. And while there may be some benefit and relief by using these prescriptions, we should ask: is the problem only skin deep?

 

Functional Medicine and Traditional Chinese Medicine (TCM) are similarly focused on treating the root cause of an ailment, despite being juxtaposed by thousands of years.  TCM views ALL disease, from cancer to hepatitis, hangnails, and eczema, as manifestation of the same fundamental premise:  The body as a whole and the body with context of physical, societal, spiritual, & climacteric environments. 

 

Wise Man Say:

“When normal Qi is harbored internally, harmful factors cannot affect [the body]”

 

TCM and Dermatology

 

It should be noted that the Yellow Emperor’s Huangdi Neijing, or  “Classic of Internal Medicine,” records more skin ailments than any other medical text of that era. Here are a few examples of the samples*:

Qiyang = itching.

Yangjie = candidiasis.

Tu = eczema or tinea on the head, or scalp.

Jin Yin Chuang = exfoliative dermatitis w/ peeling & scales, acute dermatitis/eczema.

*Source: William Morris, PhD, L.Ac. 

 

TCM and Eczema

 

According to TCM, eczema is going to be a manifestation of an imbalance within some aspect: Deficiency vs Excess; Yin & Yang; Qi & Blood;and/or Organ dysfunction. The patient’s diet and lifestyle play a role in all of these. 

 

There are 6 external excesses that can contribute to eczema:

1. Wind (feng)—itchy, mobile, changy, sudden onset, especially during Spring, typically expressed in the upper body first, as open pores, or pruritus.

Can carry Damp, Heat, Cold, & Dry with it

 

1. Cold—Causes constriction, stagnation, localized pain, masses, slow to resolve, Dark/purple cool vs red & warm to touch, susceptible when one sweats or gets wet then immediately exposed to cold air/wind. 

 

1. Damp—Especially common in summer or post exposure to wet environments. Has a heavy or sinking nature, feeling of fatigue, weak limbs, open sores, blistering, pus, recalcitrant, swelling, potential necrosis, can also have extreme itch.

 

1. Dry—Most common in Fall with cracked or scaly skin, carbuncles/furuncles of hands/feet, righteous body juices (Blood & Yin) are consumed, Lungs are affected.

 

1. Heat 6) Fire—Too much Yang can leave you feeling hot, burny, typically with rapid onset, often upper body/head, red, sheen on skin, can be very painful. Sometimes can be Fire when internal organs are involved and/or with infection, purulence, necrosis, red/purple macules, petechiae etc. Strong emotions can also engender rising Fire excess.

 

How to Diagnose? 

 

A low tech, immediate diagnosis can come from a TCM approach, which involves looking and asking. 

 

Appropriate questions are asked to the patient while at the same time looking over their body to “listen” for non-verbal answers. Tongue and pulse diagnosis are used to see if the pulse is fast, staccato, floating, deep, and if the tongue is red, dry, scalloped, wet or coated. 

 

The modern Functional Medicine approach will involve similar question asking, however, it also utilizes modern lab testing to determine underlying biologic and genetic conditions that may be contributing to the issue at hand. Testing may include food sensitivities panels, vitamin, blood and blood protein tests, or urine yeast testing.

 

• ELISA/LRA for Food/Env. Sensitivities
• Vit. D ideally >70
• CRP ideally <1.0
• Eos ideally <1.0%
• Ttl. IgA, IgE, IgG: ideally mid range
• Urine yeast metabolites: OAT (GPL)

 

SBCM Model

 

The SBCM model is based on the Eclectic Triphasic Medical System (ETMS) developed by renowned Clinical Master Herbalist and Certified Nutritionist, Donnie Yance, wherein the whole micro and macro cosom of the patient is considered. An immediate diagnosis is usually available through TCM tongue and pulse assessments, allowing us to provide recommendations in the short-term while we wait for conventional lab testing to confirm and narrow our awareness to the root cause of the patient’s symptoms. 

 

Treatments

Cold to treat Heat

Remember that in TCM, we want to find balance. If there is an excess, then there must exist a deficiency.

Below are some ways to use cold, or cooling type remedies to address an excess of heat.

 

Eg Huang Lian/Coptis (berberine et al) used to treat Hot types.

Liu Huang/6 Yellows—mostly in a topical application. 

Ku Shen/Sophora—used to treat itchiness.

Bleeding

Bloodletting (small lancing) can be used to drain stagnant heat toxins, relieve swelling, and/or pain. However, we are not releasing a lot of blood, nor are we attaching leeches to the body (necessarily). Instead, specific acupuncture points are chosen and only a few drops of blood are released. This can have a profound immediate effect.

 

Compresses / Poultices

Topical herbal treatments span the history of human healing remedies. De-Zhi discusses wet topical compresses for the treatment of skin disorders in 1335 AD.

 

Common, proven herbs used as compresses include: 

Calendula, or marigolds

Saint John’s Wort

Avena sativa, or milky oats.

 

Example treatment for acute damp heat, in a situation where oozing limits lotion topicals:

 

Huang Bai compress

100ml water, 10g herb = 10% solution; 

Add Huang Lian (coptis) and Huang Qin (Chinese skullcap) to Huang Bai (San Huang) and Ku Shen if erythema or papules exist; three (3) times a day. 

Custom Tinctures and Granules

 

In addition to topical solutions, TCM offers us the ability to use concentrated herbal formulas in the form of alcohol-based tincture extractions and decoction-dried herbal extractions. These formulations allow increased potency compared to dried herbs alone.  Below are a couple sample formulas. 

 

Acute Eczema: Clear Heat, Dispel Wind Damp   Jin Yin Hua/Lonicera 9g Lian Qiao/Forsythia 9g Mu Dan Pi/Moutan Rdx 9g Ku Shen/Sophora 12g Cang Zhu/Atractylodes 6g Huang Bai/Phellodendron 9g Fu Ling Pi/Poria 12g Yin Chen Hao/Artemesia s. 12g Gan Cao/Licorice 4.5g Jing Jie/Schizonopta 9g Fang Feng/Ledebouriella 9g

Chronic Eczema: Nourish Blood, Dispel Wind, Clear Heat, Transform & Drain Damp   Dang Gui/Angelica s. 9g Bai Shao/Peony l. 9g Sheng Di/Rehmannia 12g Hu Ma/ Boehmeria 12g Ku Shen/Sophora 12g Bie Xie/Diascorea h. 12g Fu Ling Pi/Poria 12g Di Fu Zi/Kochia 18g Bai Xian Pi/Dictamnus 9g

 

Conventional Treatments

 

  Corticosteroids are anti-inflammatory medications that are prescribed to treat a broad range of conditions, including eczema. From a TCM perspective, these steroids work by introducing a Cold and powerful “Exterior Resolving” (pushing things up & out) agent to push Stagnant Heat out of the body. Generally, they work well for this purpose, however, they can also push out the righteous Qi & Fluids as a side effect. In the short term, they can provide a quick and strong response that relieves swelling, heat, pain, and itching.  Care should be taken to prevent/mitigate side effects if employed. 

Best of Both Worlds

Creating Synergy

It is possible to combine herbal and Traditional Chinese Medicine (TCM) WITH conventional Western medicine. By combining exterior resolving (diaphoretics & peripheral vasodilators) herbals, which can clear Heat and Wind, along with corticosteroids, it is possible to synergize our treatment. By doing this, it is possible to:

• LOWER the dose of a corticosteroid.
• SHORTER duration the prescription is used.

 

Example, when combine with Gan Cao, or licorice:

• Potentiates corticosteroids, making it stronger and more effective.  
• Mitigates Qi and fluid depletion.
• Vitamin C is good to take here too before/during/after.

 

Mitigating Side-effects

Not only are herbs useful in complimenting the efficacy of conventional treatments, they can also be used to MITIGATE side effects of Corticosteroids. These herbs nourish fluids and to some extent also synergize with the cooling aspect of steroids: 

 

• Sheng Ma – Actea, baneberry
• Sheng Di – (raw) Rehmannia root
• Mai Men Dong – Ophiopogon

 

Prevention

Prevention can take many forms, from the commonsensical to abstract. When considering the agitation that can be experienced with bouts of eczema, it would make sense to avoid introducing any more agitation. Washing the affected area with hot water or abrasive soaps; keeping fingernails short and breaking the itch cycle, these are common sense approaches. However, what about diet or allergy? TCM would recommend we avoid Damp Hot foods, qualities similar to our condition, such as meats and seafood, spicy or greasy foods. Functional medicine would ask us to consider environmental allergens and foods.

 

Topical Recommendations

Soap 

Emily’s Soap – Formulated by a fellow herbalist and acupuncturist to address his baby daughter’s severe dry eczema.

Oil

Sea Buckthorn – this herb can be administered topically, as well as orally, to stabilize & moisten Hot, Dry type dermatitis. Potential dose could be: 500mg-1g/ day.

Body Wash, Feminine specific

Over-the-counter Yin-care®Herbal Wash is a comprehensive can be applied as a wash, rub, sitz bath or compress and is a great liquid topical wash especially for Wind, Heat, Toxic Heat type presentations.

Bath

Avena sativa, or oats, are a centuries old skin remedy that can have benefits when made into a colloidal mixture. 

Oat Bath Recipe:

Using organic steel ground oats, rinse and let dry. Grind or mill them into a powder, using a coffee grinder or blender. Add ½ – 1 cup of powder to a tub of water. 

Plaster

*A plaster of the above recipe can also be made and applied for 20 minutes to treat dry itch.

Yi Yi Ren/Hato Mugi/Job’s Tears plaster can be used to treat Damp eczema.

 

Job’s Tears Recipe:

Rinse, Cook, Overcook w/ more water, mash (like potatoes, frijoles), add unbleached organic wheat flour to thicken to a consistency similar to creamy peanut butter. Apply paste on to a paper towel or clean cloth and apply to the affected area for 15-25 minutes. 

Add more organic flour if drying out occurs. 

 

Dietary Recommendations

Cleanse

Potential dietary treatments could include a guided cleanse for 6-14 days. 

Example routines could include just squash & Hato Mugi (Job’s Tears), gradually adding hypoallergenic protein powders, sweet potato, kitcheree or congee, lotus root, burdock root.

Immune Boosters

Mushrooms are generally recommended for immune dysregulation. There is one account of childhood eczema resolution after the father added Pleurotus ostreatus, or oyster mushrooms, to his morning omelette. 

*Caution: Shiitake Dermatitis 

There are cases of individuals who experience toxic reactions to Lentinula edodes, or Shiitake mushrooms, that can resemble eczema. 

 

Patient testimonial: 

“I have unknowingly had toxic responses to shiitake mushrooms for as long as they have been available at the grocery store near me. It produced highly sensitive and very itchy “scratch” marks and bumps everywhere except my legs, including my face and head. It was originally diagnosed as eczema. but would not improve for nearly 2 weeks each time.” 

 

“I have eaten shiitake for the last 20 years or so. Because I didn’t react when I consumed it cooked, and because the symptoms take AT LEAST 24 hrs to surface, I was never able to connect the dots. I would not have figured it out if it was not for NAMA’s website.”

 

Patient Treatment:

4oz Aloe Vera juice, 2 times a day for 3 – 4 days. Aloe drains Heat

 

Alternative Recommendations

Colonic

With guidance, up to 5 within 3 weeks. Colonics can be used to flush the large intestine, potentially removing toxins and accumulated wastes. 

Retention Enema

Enemas can be used to clean up and clear out. We recommend using reverse osmosis water, combined with binders to eliminate toxins. They can also be used to administer treatments rectally. 

Bitter Clear Ht. Fx’s

Butyrate, Colostrum

Lung and Large Intestine Energetics

Considering an integrative perspective of the body, we can note that both the lungs and digestive tract are composed of epithelial tissues and layers. We can practice “releasing” or “letting go” by being mindful of our breath and practicing breathing exercises.