Herbal Treatment of Disease III

09/23/10

DermatologyGu Family Lineage

Will Morris

Was dean at Emperor’s college where he met Nei Chang Gu. NCG asked for a job in the clinic at Emperors in 2000. Evolved out of external a medical specialty in China. Gu treats dermatology to throat cancer.

Lezine coauthored with Deadman. He will be here for SW Symposium.

Linnaeus gave us our system for categorizing zoological and plant systems.

As a senior class you should be able to speak the dialog and express.

Case: Female. Red rash under right axilla. Itchy last night, perhaps self limiting on the way out. P: lifts/pushes up with more force, width & urgency up as you pull up from the blood depth.

Most likely an allergic reaction/urticaria.

Superficial to deep  qi, xue, zang

Discussions on dermatology

  • Fei – mileria
  • yang jie – candidiasis
  • qi yang – itching
  • tu – eczema or tinea of the head
  • lan - ulcer
  • you zhui for warts
  • Zuo & zha for acne & rosacea.

We will discuss based on layer of anatomy & tissue.

Specialization is completely related to the ability to communicate with Western physicians.Use this brief overview terms to communicate with non TCM practitioners.

  • Purpura: xue re, yu
  • Vesicles (filled w/fluid) Herpes: huo, damp heat. Usually long dan xie gan tang. Toxic re – add bai hua she she cao.
  • Plaques (flat): Psoriatic, related to lupus…
  • Pustules: re in xue, toxic re due to stress, diet, hormones, Rx.
  • Wheals: tend to be circular & flat, but can be raised.
  • Scale & Crust (oozing of serous fluid): diabetics tend to have this. Possible accompanying progressed neuropathy. Foot soaks with qing dai. Packing in dry white sugar helps the most. Continue to treat the interior using 3 burner differentials.
  • Macule flat rash:
  • Maculopapular: Some lesions are flat, some are elevated.

Feng

  • Sudden onset
  • Fast changing
  • Moving
  • Penetrating
  • Previously in history used to describe some diseases that we do not understand
  • Chai hu, bo he, gui zhi neurovascularly relax, tend to cause sweating, enhance microcirculation at the surface, improves circulatory flow. Wind re/han herbs are peripheral vasodilators.

Ying & wei disharmony/Pathomechanisms – see slide #6 -

  • Feng - Superficial Wei Qi Xu, so that feng evil penetrates into the skin, and obstructs the skin. Qi can not communicate between the li and biao. Ying & Wei lose harmony, Qi and xue can not circulate properly, skin and muscle lack of nourishment, therefore cause skin diseases.
  • Han evil invades the skin surface, obstructs Wei – Yang; or Yang Qi of the organs are xu, deprives the skin of warmth.
  • Summer Re (Shu) invades skin and muscle, and obstructs the surface of the skin. Sweat can not dissipate, thus cause disease. Summer- Heat-Dampness (shu-re-shi) can also invade the skin and cause disease.
  • Damp Evil invades the skin. It is obstructed under the skin layer, impairs the circulation of Qi and Xue therefore cause disease. Damp evil can damage Yang, and allows external pathogen to gain entry to the body and causes disease.
  • Zao of the weather and environment injury Yin and jin ye, and cause dryness of the skin, thus skin diseases occur.
  • Syndromes of Summer Heat: fresh red skin lesion with burning sensation & pain accompanied by fever, thirst, irritability, red tongue, thin coating, rapid pulse.
  • 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.

Interior han – ginger bath, with sliced ginger boiled and poured into bath. If patient does not see results notice their pulse and accompanying Sx. P: slow, tight, or deep with low amplitude.

Scars/keloids are not on our list, but are a major topic in Japanese acupuncture. Borneal, mustard seed topicals, etc.

Toxicity Discoloration, Dark color, Pus, Foul smell, Appears toxic, Swellings & lesions

09/30/10

Urticaria or Hives “wind-type concealed rash” feng yin zhen or “wind rash lumps feng zhen kuai (slide 45)

  • Urticaria Factitia (Dermatographia)
  • Pressure Urticaria
  • Han Urticaria – hereditary
  • Cholinergic urticaria
  • Solar Urticaria (urticaria photoenica) – no dang gui, no chuan xiong – photosensitive (similar volatile oils, taste them). Tan Du Yang, descendant of …, SP/ST school.

TCM Patterns

  • WC (tight superficial; pale, purplish)
  • WH (superficial, rapid; red)
  • SP/ST dysfunction (weak, deep; swollen, teeth marks, coat, misshapen [holding fx]; sticky saliva)
  • Yin/Xue Xu (thin, harder vessel – long term, urgent w/no force - recent)
  • LV/KI Xu (2nd/3rd wiry, weak)

Sticky saliva – SP capacity to transform is impaired

Foam – KI (wet clear – fu zi); tan (later)

Ex: Jin gui sheng qi wan – LWDHW, fu ziResearchFireGodsSchool, or HongTianSchool

DD: paper on tongue, if paper is wet probably ok to give fu zi.

Jing Fang Bai Du San

  • Based on Ren Shen Bai Du San, Ma Huang Tang, &/or Gui Zhi Tang
  • Ma Huang Tang: ma huang, gui zhi, xing ren, gan ca

Yin Qiao San – WH

Or Sang Ju Yin

Da qing ye – CHTox

Li xie – internal pathogens. Anger, Joy, pensiveness, grief, fear, shock.

SP/ST – P: middle no root

Parasites – best treated by pharmaceuticals followed by herbs. Boost righteous qi, while pharm clears.

Yin Xu & Xue Zao

  • Hu ma/sesame – oils nourish yin (omega 6), based on Western diet remove this herb.
  • Chen would: Gu ya, ma ya (barley), shen qu (massa fermentata – contains probiotics). cc: gluten sensitivities
  • 6 – 9 months for gluten to clear from the system

LV/KI Xu

  • SWT – nourish/move xue, supplements yin. Historically physicians used this to supplement yin instead of LWDH because of the shu di & bai shao.
  • Er Xian Tong – originally Menopausal HTN

Some philosophies say “do not separate xue & yin.”

Yin Xu – P: thin, rapid, no force, no root, might be floating. T: pale. Under eyelids: pale.

Xue Xu – P: thin, rapid (when very xu), no force, thinness. T: red. Under eyelids: red.

Biao treatments

Warm decoction as a wash.

Herb Summary – Urticaria/Hives

Da qing ye, hu ma, gu ya, ma ya, shen qu

Formulas Summary – Urticaria/Hives

Jing Fang Bai Du San (Based on Ren Shen Bai Du San, Ma Huang Tang, &/or Gui Zhi Tang)

Yin Qiao San

Sang Ju Yin

SWT

Er Xian Tang

Bites – John HF Shen (slide 59)

Dan shen – move/cools/nourishes xue, an shen

Hives – Lu Lu Tang/Liquid Amber/Satan’s Testes – great for itching, in kids, put in bath, take internally.

Huang Ji Jen Jian Tong, lu lu tang, sang ye – skin conditions, allergies

Hu po – unblocks the person who feels depressed, stagnant, unlike Xiao Yao Wan, armoring at the level of the diaphragm

Sinus & Allergy Are Similar & have deep han at the root

Yang depletion type han -

Use a ginger bath – about 1lb of sheng jiang boiled, take out dregs, use about a cup for drinking, use the rest for the bath. Ding family lineage.

Avoid exposure to causative agents – ex: spicy/greasy foods, sweets, lamb, scallop, shrimp, alcohol, coffee

Herpes Simplex

Gan cao is similarto prednisonea synthetic corticosteroid drug that is particularly effective as an immunosuppressant drug

Xiao Feng San + gan cao 30g treats “lobster skin.” May go against Dr. Ma’s conservative principles. In acute conditions take every 2 to 3 hours.

LV/GB Damp Re accumulates in the pubic & genital regions.

Oral – deglycerizinated gan cao has a strong antiviral capacity. Company in Seattle – Scientific Botanicals makes Lycro Gel. Need your license to purchase. Gel compound with mint. Can work with shingles too.

Genital -

Xin Yi Qing Fei Yin

Qing re from qi level (superficial herbs). No clear xue re herbs.

Supplements yin

Dispels feng re – jin yi hua, pi pa ye

Long Dan Xie Gan Tang

Acute recurrent stage

Cc: may damage SP/ST & yin d/t harsh, drying nature.

Zhi Bai Di Huang Wan

Outside of acute stage

Formulas Herpes: Xin Yin Qing Fei Tang, Long Dan Xie Gan Tang. Zhi Bai Di Huang Wan, Qing Che Kou, Xiao Feng San, Lycro Gel

Top 20 Western herbs

Echinacea, garlic, ginsengs…

Chinese Abdominal Dx (charting)

  • Circle – hollow
  • Straight line – pain
  • Waves – shui
  • X –
  • Earth in middle, huo is north, etc.

Warts

Yi Yi ren (pearl barley) – best way to remove. Congee, part of their lifestyle.

Under what circumstances would emetic treatment be appropriate for skin conditions? Generally used in upper body, toxic reactions, nausea, feeling of vomit.

Rhubarb pulls toxins out of the blood to eject toxins.

  • Chai Hu Long Gu Mu Li Tang – minor function of purging, loosen stools
  • Ma Zi Ren Wan – easy purge
  • Da Chai Hu Tang

Exam Review

  1. Pathomechanism – etiology – how did it get there, diet, hormones, stress, etc.
  2. Dx – Western, Eastern also pattern discrimination. Bian bing (
    psoriasis) - disease vs. bian zhang (jiong?) - pattern (WH, WC, etc)
  3. Treatment Plan
  4. Treatment – must match plan; li & biao

Ex. supplement xue, nourish xue, drain d-re, boost qi

Sen Chuan Da Bu Tang

Ba Zhen Tang + drain D-re herbs

Also OK to give the king herbs forma handful of formulas:

  • SWT – K: SD, DG
  • SJZT – RS
  • BZYQT – HQ, SD, DG
  • Huang Lian Wen Dan Tang – D-re – HL

Ex: PsoriasisAutoimmune, diet, hereditary, stress, latent pathogen

Topical mediums – sesame, grape seed (tiny molecule that penetrated well), bing pian, Vicks vapor rub

Dosages = extra credit

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Treat what you see. Some dermatologists treat solely by what they see.

Do understand internal physiology for acne.

Lu lu tong – hives

Ku shen – qing re

Bai hua she she cao – hormones, long term use, supplements qi/jing, use on proliferative conditions (cancer, etc).

Erosion – huang qi

da huang, fu zi (only good herbalists rx this)

Dr. Jin is an expert in the fire god school.

Herb Summary

  • Bai hua she she cao – hormones, long term use, supplements qi/jing, use on proliferative conditions (cancer, etc). Vesicles (filled w/fluid) Herpes: huo, damp heat, toxic re.
  • Chai hu, bo he, gui zhi – release biao herbs: neurovascularly relax, tend to cause sweating, enhance microcirculation at the surface, improves circulatory flow. Feng re/han herbs are peripheral vasodilators.
  • Da huang, fu zi (only good herbalists rx this)
  • Dang gui, chuan xiong – do not use in Solar Urticaria (urticaria photoenica) du to photosensitivity; (similar volatile oils, taste them).
  • Dan shen – move/cools/nourishes xue, an shen
  • Jing jie & fang feng when he felt that LV Qi yu caused skin conditions. Small doses 3-4g. John HF
  • Gu ya, ma ya (barley), shen qu (massa fermentata – contains probiotics). cc: gluten sensitivities Chen would use these inYin Xu & Xue Zao
  • Huang qi- erosion
  • Hu ma/sesame – oils nourish yin, xue zao(omega 6), based on Western diet remove this herb.
  • Hu po – unblocks the person who feels depressed, stagnant, unlike Xiao Yao Wan, armoring at the level of the diaphragm
  • Lu lu tong – hives
  • Sheng jiang - Interior han – ginger bath, with sliced ginger boiled and poured into bath. If patient does not see results notice their pulse and accompanying Sx. P: slow, tight, or deep with low amplitude.

Formula Summary

  • Long Dan Xie Gan Can - Vesicles (filled w/fluid) Herpes: huo, damp heat, toxic re.
  • Jin Gui Shen Qi Wan – LWDHW, fu zi – urticaria, or hives
  • SWT – nourish/move xue, supplements yin. Historically physicians used this to supplement yin instead of LWDH because of the shu di & bai shao.
  • Er Xian Tong – originally Menopausal HTN
  • Huang Lian Wen Dan Tang – D-re – HL

FYI

Pulse: Superficial to deep  qi, xue, zang

Pulse speed happens at beats per minute and rate of arrival. Talked about more in early traditional books.

Clocks have only been used for about 300years.

Bob Flaws’ secret to pulse dx: be able to describe it to be able to diagnose. Tight: tense, forceful, twisted like a rope.

The fault in the west is that we live in an objective world. Collection of numerical data to make an assessment: BP, ROM, temp, etc.

Rate of arrival is subjective. It is on a continuum of what is fast to slow, force to none.

The entire field of our findings is subjective. A deceit propagated on the minds of the western thinker that somehow the objective is more truthful or more real than the subjective. Scientists say from a 3rd person voice that findings work. They don’t mention their subjective view to pick up or choose the work. We tend to dismiss our observations that make a difference.

Differences of technique, assumptions of what is known.

Let go of what you believe is true and look at cases from various points of view.

In the 50s many pulse diagnoses experts were brought in from China. The inconsistencies lay with technique. All were correct in their own way.

Qi Dao Dong Pulse Dx

No sign or symptom will be unaccounted for. Identify each pulse and know what they mean.

John HF Shen (Hammer & Will’s teacher, Maciocia was influenced by him) used jing jie & fang feng when he felt that LV Qi yu caused skin conditions. Used in small doses 3-4g.

Conventional Chinese teachers do not agree upon family lineages because they are not taught in modern schools.

Closest place to see the xue is under the eyelids and under the tongue. Veins go sideways under the eyelid

All of us should be publishing to make our space in the world.

Evidence based medicine is part of competencies. It is critical to skin diseases. Include Latin binomial

Xie qi – Evil qi (pathogens). Shang & Zhou Dynasty burned materials like ru xiang, mo yao, etc. Later was the evil eye type thing. Fang Feng in particular was used to ward off evil eye. Today various herbs are still used in China for this reason. Culturally sensitive patient sensitive care is important here.

References

We have most every major book written on dermatology in the library.

Li Zhi Shen’s Pulse study’s with Will M. will be out soon.

The Conundrum of the Choppy Pulse

Treatment of Psoriasis w/TCM – Li Lin

A handbook of Traditional Chinese Dermatology – Liang Jian-Hui, Bob Flaws

Dermatology in TCM – Xi Yi hou

Endnote, Pubmed

Western herb books: Jade Pharmacy, Thomas Abefree Garen

Tori Hudson – presentation on Warts, possibly due to Vit A xu