NMT150 wk 3

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Questions and Answers

What is the primary difference between a poultice and a paste?

A poultice is used for internal use, while a paste is used topically.

A poultice is a solid herb, while a paste is a mixture of powder in a liquid base. (correct)

A poultice is a mixture of powder in a liquid base, while a paste is a solid herb.

A poultice is used topically, while a paste is used for internal use.

What is an example of a herbal action that can be used internally to treat dermatitis?

Diuretic

Laxative

Expectorant

Anti-inflammatory (correct)

What is the primary benefit of using creams and lotions topically?

They are absorbed quickly and provide intense moisturizing. (correct)

They are absorbed slowly and provide intense moisturizing.

They are absorbed quickly and provide long-lasting moisturizing.

They are absorbed slowly and provide long-lasting moisturizing.

Which of the following herbs is NOT mentioned as an option for internal use to treat dermatitis?

Calendula officinalis Signup and view all the answers

What is the main benefit of using herbal remedies topically to treat skin conditions?

All of the above. Signup and view all the answers

What is the primary benefit of a healthy attachment style?

Better physical and mental health outcomes Signup and view all the answers

Which of the following statements is true about attachment styles?

Attachment styles are malleable with experience and intention Signup and view all the answers

What is the common denominator in insecure styles of attachment?

An insecure sense of self rooted in shame Signup and view all the answers

Which attachment style is characterized by a need for constant reassurance and a fear of abandonment?

Anxious style Signup and view all the answers

What is the primary difference between the avoidant and anxious attachment styles?

Equation of intimacy with a loss of independence Signup and view all the answers

What is the primary function of the Corporeal Soul in Traditional Chinese Medicine?

To transport Essence and defend against pathogenic factors Signup and view all the answers

Which of the following is a key aspect of the Lungs' function in TCM?

Diffusing and descending Qi Signup and view all the answers

What is the primary consequence of Qi stagnation in the Large Intestine?

Distension and constipation Signup and view all the answers

What is the main mental-emotional aspect associated with the Large Intestine?

Not dwelling on the past Signup and view all the answers

What is the final transformation of digested food in the Large Intestine?

Formation of stools Signup and view all the answers

What is a characteristic symptom of LI Heat Consumption of Fluid?

Constipation with dry stools Signup and view all the answers

Which of the following is a cause of LI Dryness?

Blood or Yin deficiency Signup and view all the answers

What is a characteristic tongue appearance in LI Qi Stagnation?

Normal to slightly red sides Signup and view all the answers

Which of the following is a symptom of LI Collapse?

Fatigue after bowel movements Signup and view all the answers

What is a characteristic pulse in LI Heat Consumption of Fluid?

Full and rapid Signup and view all the answers

What is the recommended bathing technique for people with atopic dermatitis?

Minimize contact with warm water and use mechanical cleansing Signup and view all the answers

What is a benefit of using colloidal oatmeal suspensions?

It relieves itching and has anti-inflammatory properties Signup and view all the answers

When should emollients be used to retain hydration in the skin?

Immediately after bathing, within 3 minutes of drying off Signup and view all the answers

What type of emollients tend to work best for skin health?

Ceramide-based emollients Signup and view all the answers

What should be avoided when choosing an emollient?

Parabens and common allergenic preservatives Signup and view all the answers

What percentage of children with Atopic Dermatitis showed improvement after eliminating cow's milk for 4 weeks?

80% Signup and view all the answers

Which of the following is a rich source of zinc?

Shellfish, beef, and other red meats Signup and view all the answers

What is the vitamin that is associated with the risk of psoriasis and atopic dermatitis?

Vitamin D Signup and view all the answers

What is the primary benefit of supplementing with vitamin D in patients with eczema?

Reducing inflammation and symptoms Signup and view all the answers

What is the primary source of vitamin D3?

Synthesis in the epidermis of the skin from UVB Signup and view all the answers

What is the daily therapeutic dose infusion or decoction of Glycyrrhiza glabra?

2-4 g Signup and view all the answers

What is the closest substitute for Glycyrrhiza glabra?

Berberis vulgaris Signup and view all the answers

What is the primary action of Rumex crispus?

Alterative Signup and view all the answers

What is the part used of Glycyrrhiza glabra and Rumex crispus?

Root Signup and view all the answers

What is the indication of Glycyrrhiza glabra in cases of deficiency?

Dizziness and hypotension Signup and view all the answers

Which remedy is most likely to be associated with herpes simplex eruptions at the corner of the lips and behind the ears?

Graphites Signup and view all the answers

Which symptom is a keynote of Sulphur?

Not hungry in the morning, until about 11am Signup and view all the answers

Which remedy is characterized by a swollen, painful rash that makes the child cry out?

Apis Signup and view all the answers

Which remedy gets worse after the menstruation ends?

Graphites Signup and view all the answers

Which remedy is characterized by restless superstitious behaviour?

Apis Signup and view all the answers

What is the primary benefit of using ointments as a topical drug vehicle?

They offer the best vehicle to allow the drug to permeate the skin. Signup and view all the answers

What is a characteristic of gel as a topical drug vehicle?

It is an alcohol-based vehicle that can cause stinging and irritation. Signup and view all the answers

What is the classification of topical corticosteroids (TCSs) based on?

Their potency, divided into seven classes. Signup and view all the answers

What is a characteristic of lotion as a topical drug vehicle?

It is useful for larger areas or hairy skin areas and evaporates well, leaving minimal residue. Signup and view all the answers

What is a characteristic of foam as a topical drug vehicle?

It is an aerosolized oil-based formulation that allows for application to hard-to-reach areas. Signup and view all the answers

Study Notes

Dermatitis – Skin Rash

Dermatitis is a general term that describes a common skin irritation, which can be caused by virus, bacteria, fungus, irritant, or allergen etiologies.
Most common types of dermatitis: Atopic dermatitis, Contact dermatitis, Seborrheic dermatitis, Cradle cap, and Diaper rash.

General Signs & Symptoms

Pruritus
Dry skin
Erythema
Bumps or raised patches

Botanical Treatment Strategies

Identify and treat the cause
Prevent/treat infection
Soothe irritation
Reduce pruritus
Prevent spreading and/or recurrence

Herbal Actions (Topical)

Emollients
Vulneraries
Antimicrobials / Antiseptics
Anti-inflammatories
Anti-pruritics
Lymphatics
Astringents
Connective tissue tonics

Materia Medica – Topical

Aloe barbadensis
Arnica montana
Avena sativa
Calendula officinalis
Centella asiatica
Glycyrrhiza glabra
Hamamelis virginiana
Matricaria recutita
Plantago spp
Stellaria media
Symphytum officinale
Urtica dioica

Calendula Officinalis (Marigold / Calendula)

Part used: Flowerheads & petals
Main Actions: Antimicrobial, lymphatic, antiseptic, anti-inflammatory, vulnerary, demulcent/emollient
Main Constituents: Flavonoids (isohamnetin & quercetin) & carotenoids (xanthophylls), saponins, polysaccharides, VO, mucilage & resins
Pharmacology: Stimulates drainage of enlarged and inflamed lymph nodes, immuno-stimulatory activity, vulnerary activity, antifungal activity
Pharmacy: Infusion, tincture, creams, ointments, poultices, suppositories, fresh plant succus applied BID or PRN
Safety: Generally a safe herb, caution for Asteraceae family allergy

Centella Asiatica (Gotu Kola)

Part used: Aerial
Main Actions: Anti-inflammatory, CT builder, vulnerary, adaptogen, nervine tonic
Main Constituents: Saponins (asiaticoside, madecassoside, brahmoside), flavonoids (quercetin & kaempferol), allantoin, VO, alkaloids, phytosterols
Pharmacology: Speeds up skin collagen formation and angiogenesis, anti-inflammatory action, anti-allergy activity, increased antioxidant levels
Pharmacy: Infusion, tincture, standardized extracts, topical creams, ointments, and poultices
Safety: Toxicity associated with internal use, GIT upset, contact dermatitis, sedation, headaches, carcinogenic concerns with long-term topical use

Plantago Lanceolata & Major (Plantain / Toadstool / Ribwort)

Parts used: Leaves
Main Constituents: Mucilage, tannins, flavonoids (baicalein, hispidulin, scutallarein and plantaginin), resins, alkaloids, allantoin, iridoid glycosides, saponins, minerals: Zn, K+, Mg, P
Main Actions: Anti-microbial, lymphatic, anti-inflammatory, astringent, anti-hemorrhagic, emollient, vulnerary, connective tissue tonic, anti-pruritic
Pharmacology: Emollient, vulnerary, and anti-inflammatory, promotes cell proliferation, induces transition of fibroblasts into myofibroblasts, inhibits COX and LOX

Herbal Pharmacy for Skin Rash

Poultices: solid herb in some form (mashed/blended/cut), placed directly on skin, held in place with cloth
Pastes: mixture of powder in a liquid base, keep herbs on the surface for a longer period of time, but contents are not well absorbed
Creams/lotions: suspensions of oil in water blended together, often absorbed faster and more moistening for the skin

Internal Considerations for Dermatitis

Herbal actions to consider for internal use: Alteratives, Hepatics, Lymphatics, Anti-microbials, Adaptogens & nervine tonics / relaxants, Anti-inflammatories
Herbal options with dermatological benefit: Arctium lappa, Galium aparine, Glycyrrhiza glabra, Iris versicolor, Rumex crispus, Trifolium pratense, Urtica dioica

Authenticity

Authenticity is the alignment of head, mouth, heart, and feet: thinking, saying, feeling, and doing the same thing consistently.
It is the courage to be imperfect and vulnerable, believing that we are fundamentally worthy of love and acceptance, just as we are.
Practicing authenticity invites more grace, gratitude, and joy into our lives, even when it's hard.

Authenticity vs Attachment

The need for authenticity can compete with the need for attachment, leading to beliefs that we are not acceptable or lovable as we are.
Suppressing our authenticity to meet our attachment needs can lead to:
- Minimizing, dismissing, or invalidating our own experiences
- Putting others' needs before our own
- Developing compulsive needs to fulfill duty and responsibility
- Suppressing strong emotions
- Disconnecting from our physical experience and bodily sensations
- Believing we are responsible for others' feelings

Reflecting on Authenticity

Questions to reflect on our authenticity:
- Am I in touch with my bodily experience and emotions?
- Do I honor and meet my own physical and emotional needs?
- Who do I think I am supposed to be?
- In what ways do I judge myself and others?
- What do I believe about myself that tells me my experience is wrong?

Authenticity and Trauma

Authenticity can heal trauma, as seen in the 18-minute video "Authenticity Can Heal Trauma" by Gabor Mate, MD.

Attachment

Attachment is a survival need, hard-wired into our mammalian biology.
It provides a perceptual template that shapes our worldview, influencing our brains, emotions, thoughts, and relationships.
Secure attachment is essential for emotional regulation, trust, and a healthy sense of self.

Secure vs Insecure Attachment

Secure attachment: consistent, predictable, nurturing caregiving, leading to a sense of safety and trust.
Insecure attachment: inconsistent, unpredictable, chaotic interactions, leading to adaptations that promote attachment but may lead to negative outcomes later in life.
Three insecure styles of attachment:
- Anxious style: safety in the presence of another, preoccupied with relationships, high dependence, and low avoidance.
- Avoidant style: safety in disconnection from others, equating intimacy with loss of independence, low dependence, and high avoidance.
- Disorganized style: no template for safety, resulting in chronic tension between connection and disconnection, high dependence, and high avoidance.

The Common Denominator

The common denominator in insecure styles of attachment is an insecure sense of self, rooted in shame.

TCM Organs and Vital Substances

TCM organs ensure the production, maintenance, replenishment, transformation, and movement of Vital Substances.
Understanding organ functions is crucial to understand pathology.

Introduction to TCM Organs

Zang organs are Yin and store essences of the body.
Fu organs are Yang and are involved in the digestion and processing of food and fluids.
Each internal organ is correlated to a particular emotion, tissue, sense organ, mental faculty, color, climate, taste, smell, and more.

TCM Lung Function

Lungs govern Qi and respiration.
Lungs extract 'clean Qi' for the body and spread it to nourish tissues and promote physiological processes.
Lungs diffuse and descend Qi to distribute Defensive Qi, warming the skin and muscles, and protecting the body from external pathogenic factors.
Lungs control the skin and the space between skin and muscles, regulating pores and sweating.
Lungs manifest in body hair, nourishing and strengthening it.
Lungs open into the nose, and the nose is the opening of the lungs.
Lungs control nasal mucous, lubricating and moistening the nose.
Lungs house the Corporeal Soul or 'Po', the physical manifestation of the soul.

TCM Large Intestine Function

Large Intestine controls passage and conduction, receiving digested food from the small intestine and transforming it into stools.
Qi has a downward movement, and stagnation of Qi often affects the Large Intestine, resulting in distension and constipation.
Large Intestine transforms stools and reabsorbs liquids.
The mental aspect of letting go is a key function of the Large Intestine, affecting the capacity to let go of the past and calm the mind.

Metal Element: Lung and Large Intestine

Emotional sound: Weeping or crying
Emotions: Sadness, grief
Sense: Smell
Season: Autumn
Climate: Dry and cold
Odor: Rotten
Flavors: Pungent and spicy
Mucous: Secretion
Illness sound: Coughing

Lung Functions

Governs Qi and Respiration
Controls Descending and Dispersing Qi
- Descends Qi to the Kidney
- Disperses Qi throughout the body, especially skin and pores
Ensures availability of Wei Qi throughout the body
Regulates Water Passages or Channels
- Water descends (like to the Kidneys)
- Vapor circulates or ascends (like to the skin and hair)
Controls Skin
- Manifests in body hair
- Opens into the nose
- Affects nasal mucous
Houses the Po (Corporeal Soul)
- The 'physical' soul
- Affected by grief and sadness

Wind-Cold and Wind-Heat

Wind-Cold:
- Aversion to cold and/or wind
- Occipital stiffness and aches
- Sneezing
- Cough
- Runny nose with white discharge
- Slight or no fever
- Tongue: Thin, white coat
- Pulse: Floating, tight
Wind-Heat:
- Aversion to cold (Wei Qi warms, so an impairment makes it susceptible to cold)
- Itchy and sore throat
- Swollen tonsils
- Thirst
- Sneezing
- Cough
- Runny nose with slight yellow mucus
- Slight sweating
- Pulse: Floating and rapid

Lung Qi Deficiency

Causes:
- Chronic cough or asthma
- Insufficiency of Qi production
Symptoms:
- Feeble cough or asthma
- Dizziness
- SOB, worse on exertion
- Low and/or hoarse voice
- Fatigue
- Pale face
- Watery or thin/clear sputum
- Catches colds easily
Tongue and Pulse:
- Tongue: Pale with a thin, white coating
- Pulse: Weak or empty pulses, especially right cun position

Lung Yin Deficiency

Causes:
- Prolonged cough
- Heat disorders that injure the Lung
- Prolonged dryness
Symptoms:
- Dry cough
- With small amounts of sticky sputum
- With blood-tinged sputum
- Afternoon fever
- Malar flush
- Night sweats
- Dry mouth and throat
- Heat sensation in 5 centers
Tongue and Pulse:
- Tongue: Red body with a dry coat or little coating, and maybe cracks or peeling
- Pulse: Rapid and thready

Lung Cold, Lung Heat, Lung Dryness, and Phlegm-Damp Retention

Lung Cold:
- Causes: Pathogenic cold in the Lung, Wind Cold
- Symptoms: Cough, Asthma, Thin, white sputum, Absence of thirst, Runny nose with clear mucus
- Tongue and Pulse: Tongue: White coat, pale body, Thin in Wind Cold, Thicker in Pathogenic Cold, Pulse: Slow, strong, and tight
Lung Heat:
- Causes: Pathogenic Heat, Pathogenic Cold turning to Pathogenic Heat in the Lung, Wind Heat
- Symptoms: Cough, Asthma, Yellow sticky sputum, Thirst, Sore throat, Chest pain, Scanty, concentrated urine
- Tongue and Pulse: Tongue: Red body & thin, yellow coat, Pulse: Rapid and strong
Lung Dryness:
- Causes: Pathogenic Dryness, Stomach Yin Deficiency, Wind Heat, Wind Dryness
- Symptoms: Dry cough with little sputum, Chest pain, Dry skin, Thirst, Hoarse voice, Dry nose and throat
- Tongue and Pulse: Tongue: Dry tongue with thin coating, Pulse: Rapid and thready
Phlegm-Damp Retention:
- Causes: Pathogenic Wind, Cold & Damp, Prolonged Cough or Asthma, Spleen dysfunction of transportation
- Symptoms: Cough with frothy or white, sticky sputum, Sputum is easy to expectorate, SOB, Dislikes lying down, Stuffiness and fullness in the chest
- Tongue and Pulse: Tongue: Pale with a white, sticky coat, Pulse: Wiry, slippery, and strong

Large Intestine Functions

Receives food and drink from the Small Intestine and extracts fluids from it
Excretes stools
Mentally in charge of "Letting Go"

LI Damp Heat, LI Heat Consumption of Fluid, Cold Invading LI, LI Dryness, LI Qi Stagnation, and LI Collapse

LI Damp Heat:
- Causes: Excessive consumption of hot and greasy foods, Pathogenic summer heat, damp and heat
- Symptoms: Abdominal pain, Offensive stool odor, Tenesmus, Thirst with no desire to drink, Blood and mucus in the stools, Scanty, deep yellow urine, Fever, Sweating
- Tongue and Pulse: Tongue: Red body with yellow, sticky coating, Pulse: Rapid, slippery, and strong
LI Heat Consumption of Fluid:
- Causes: Excessive consumption of hot foods (lamb, beef & alcohol)
- Symptoms: Constipation with dry stools, Burning sensation in the mouth, Burning and swelling in the anus, Dark, scanty urine
- Tongue and Pulse: Tongue: Red body with thick yellow or brown, dry coat, Pulse: Full and rapid
Cold Invading LI:
- Causes: Chronic exposure to cold weather with abdomen exposed, Sitting on cold, wet surfaces for long periods
- Symptoms: Sudden abdominal pain, Diarrhea with pain, Feeling of cold, Cold sensation in the abdomen
- Tongue and Pulse: Tongue: Thick, white coating, Pulse: Deep, wiry, slow, and strong
LI Dryness:
- Causes: Blood or Yin deficiency, Elderly, Women after a delivery, Late stages of febrile disease, Dry and warm climates
- Symptoms: Dry stools, Constipation, Dry mouth and throat, Yellow, scanty urine
- Tongue and Pulse: Tongue: Dry, red or pale body without coating, Pulse: Thready
LI Qi Stagnation:
- Causes: Irregular eating habits, Frustration, anger
- Symptoms: Abdominal distention & pain, Constipation with bitty stools, Irritability, Aggravated by mood
- Tongue and Pulse: Tongue: Normal to slightly red sides, Pulse: Wiry on both chi positions
LI Collapse:
- Causes: Spleen & Stomach deficiency, Excessive physical work
- Symptoms: Chronic diarrhea, Cold limbs, Anal prolapse, Hemorrhoids, Fatigue after bowel movements, Mental exhaustion
- Tongue and Pulse: Tongue: Pale, Pulse: Deep, fine, weak

Bathing Education for Atopic Dermatitis

Minimal contact with warm (not hot) water for as little time as possible
Mechanical cleansing is generally superior to antiseptic cleansers
Avoid adding oils to bath water as it is ineffective
Pat skin dry instead of rubbing it aggressively

Colloidal Oatmeal

Colloidal oatmeal suspensions have been shown to have benefits in several studies
Can be found in soap, shampoo, emollients, or used in bath water
Avenanthramides in colloidal oatmeal have anti-inflammatory properties and may relieve itching
May offer a prebiotic effect and improve the dermal microbiome

Emollients

Also known as moisturizers
Regular use of emollients should be encouraged at all times except during active flare-ups
Use emollients immediately after bathing to retain hydration gained (within 3 minutes of drying off)

Choosing an Emollient

Ceramide-based emollients tend to work best
Can be as effective as a low-medium potency topical corticosteroid
Avoid scented emollients
Avoid emollients with unnecessary botanical ingredients
Glycerol-based emollients are better tolerated than urea/sodium chloride-based
Avoid using olive oil
Avoid emollients with common allergenic preservatives such as parabens, phenoxyethanol, imidazolidinyl urea, methylchloroisothiazolinone, quaternium-15, and formaldehyde

Treatment Goals

Address presenting symptoms and improve patient comfort
Support full and speedy recovery to return to regular activities
Patient education
Monitor and prevent complications

Food Sensitivity

80% of 59 children with Atopic Dermatitis (AD) showed improvement after eliminating cow's milk for 4 weeks
74% of 91 children with AD showed improvement on an elimination diet
63.5% of 50 adults with AD had positive responses to a 6-week diet excluding pseudo allergens
Some studies have failed to show the role of food sensitivity in AD
Conventional medicine: food allergy (sensitivity) rarely plays a role in the etiology of AD

Zinc

Supplementing with zinc may help reduce eczema severity, especially if there is a deficiency
Rich sources of zinc: shellfish, beef, and other red meats
Good plant sources of zinc: nuts and legumes

Vitamin D

Vitamin D deficiency is associated with the risk of psoriasis and atopic dermatitis
Supplementing with vitamin D may reduce inflammation and symptoms of eczema
Cholecalciferol (Vitamin D3): synthesized in the epidermis of the skin from UVB, found in animal sources (saltwater fish, liver, meats, egg yolks, and fortified foods)
Ergocalciferol (Vitamin D2): found in plant sources (mushrooms, alfalfa sprouts) and fortified foods

Fish Oil

Research has shown promising findings on the effects of fish oil supplements on eczema

Botanicals in Dermatology

Key actions of botanicals in dermatology: alterative, hepatic, laxative, and they tend to be cold and bitter
Key treatment principles: the stronger the presentation, the stronger the required treatment; if there is constipation, get the bowels moving

Key Herbs

Arctium lappa (Burdock): key herb in dermatology
Berberis vulgaris (Barberry): key herb with primary actions of hepatic, cholagogue, antimicrobial, bitter, anti-inflammatory, and endocrine modulator (insulin)
Coptis sinensis (Coptis, Golden thread): key herb with primary actions of antimicrobial, anti-inflammatory, hepatic, and bitter
Rumex crispus (Yellowdock): key herb with primary actions of alterative, laxative, hepatic, astringent, and mild adaptogen
Glycyrrhiza glabra (Licorice): key herb with primary actions of adaptogen, anti-inflammatory, demulcent, antiviral, hypertensive, and laxative (in high dose)

Topical Injury and Conditions

Abrasions: primary botanicals include Comfrey, Calendula, and Plantago; optimal application is topical; sample formula is "Green Salve"
Ulcers: primary botanicals include Comfrey, Calendula, and Black tea; optimal application is poultice; sample formula is Comfrey and Black tea
Eczema (dry): primary botanicals include Gotu kola, Astragalus, and Licorice; optimal application is infusion or tincture; sample formula is Gotu kola and Licorice

Sample Case Presentation

26-year-old male presents with silver, scaly lesions on the lower legs and hairline, with varying degrees of severity, and is worse during times of stress
Associated symptoms include low-grade headaches and constipation
Primary herb indicated is Berberis vulgaris (Barberry) due to its actions on the liver and gallbladder, and its ability to treat inflammatory skin conditions and constipation

Individual Herb Profiles

Berberis vulgaris (Barberry)

Primary actions: hepatic, cholagogue, antimicrobial, bitter, anti-inflammatory, and endocrine modulator (insulin)
Constituents: Isoquinoline alkaloids (berberine, hydrastine, berbamine)
Indications: general infections, GI infections, hepatic or gallbladder conditions, constipation, type II diabetes, PCOS, and any inflammatory skin condition
Cautions/Contraindications: non-toxic but strongly bitter; avoid during pregnancy and lactation
Pairs well with: Bupleurum sinensis in hepatic infections, Galega officinalis in type II diabetes, and Chelidonium majus and Peumus boldo in addressing gallstones

Coptis sinensis (Coptis, Golden thread)

Primary actions: antimicrobial, anti-inflammatory, hepatic, and bitter
Constituents: Isoquinoline alkaloids (hydrastine, coptisine)
Indications: chronic or acute skin characterized by inflammation, acute GI infections, chronic sinusitis, and hepatitis
Cautions/Contraindications: non-toxic but very strongly bitter; avoid during pregnancy and lactation; not generally used more than 3 weeks consecutively
Pairs well with: Bupleurum sinensis, Rheum palmatum, and Glycyrrhiza glabra

Glycyrrhiza glabra (Licorice root)

Primary actions: adaptogen, anti-inflammatory, demulcent, antiviral, hypertensive, and laxative (in high dose)
Constituents: Triterpene saponins (glycyrrhizin)
Indications: ongoing stress, hypotension, asthma, eczema, chronic or acute bronchitis, emphysema, URTI, post-viral cough, and stomach ulcers (mostly DGL)
Cautions/Contraindications: CI in hypertension; Preg A, Lact C
Pairs well with: Rosmarinus officinalis for coughs, Bupleurum sinensis in anti-inflammatory combos, Hypericum perforatum and Melissa officinalis for the topical treatment of herpes infections

Homeopathy Study Notes

Urtica Urens

Ailments from suppressed nettle-rash
Itching, burning, and stinging sensations
Burns and scalds of first and second degree
Insect bites and stings
Allergic reaction after eating shellfish
Rheumatism (RA) associated or alternating with hives-like eruptions
Uric acid diathesis: gout, kidney stones

Apis Mellifica

Affinities: Skin and membranes, kidneys, mind
Symptoms: Passionate, intense emotions, busy, ambitious, restless, irritable, quarrelsome, jealous
Fear of birds, apathy, indifference, weepy
Examples of Apis cases: Sore throat, measles, mumps, kidneys, cystitis

Rhus Toxicodendron

Affinities: Skin, mucous membranes, fibrous tissue, aponeurosis
Rheumatism (RA), stiffness, and pain
Itchy skin, red, chicken pox, herpes, psoriasis, urticaria, cellulitis
Worse at rest, initial movement, cold damp, better with heat, hot baths, stretching
Mind: Busy, restless, dreams of travel, work, superstitious or ritualistic behavior

Sulphur

Affinity: Skin
Itchy skin < heat, red orifices
Slouches, stooped, pain from standing
Keynotes: Opiniated, critical, independent
Polychrest remedy
Sulphur types: Nervous, quick-tempered, plethoric, skin sensitive to weather changes
General symptoms: Burning discharges, hot, hungry for fresh air, periodicity, desires sweets, spicy, fat, meat, alcohol
Mind: Self-critical, critical of others, high confidence, egotism, selfishness, anxiety for family member, creative mind

Review Questions

Review question #2: Graphites is the remedy for herpes simplex, where eruptions appear at the corner of the lips and behind the ears
Review question #3: Not hungry in the morning, until about 11am is a keynote of Sulphur

DERMATOLOGICAL PHARMACOLOGY

Introduction

Dermatological pharmacology deals with a large number of conditions causing rash, pruritis, or both.
Treatment for rashes secondary to infectious etiologies focuses on the infection itself.
Secondary infections are possible.
For conditions like atopic dermatitis (eczema), pruritis is the most important symptom to control.

Corticosteroids

There are two main subclasses: glucocorticoids and mineralocorticoids.
Glucocorticoids affect carbohydrate, fat, and protein metabolism and have anti-inflammatory, immunosuppressive, anti-proliferative, and vasoconstrictive properties.
Mineralocorticoids are primarily involved in electrolyte regulation by modifying renal excretion mechanisms.
Both mineralocorticoid and glucocorticoid receptors are expressed in the skin.

Topical Corticosteroids

The hydrocortisone backbone provides the basic structure from which all other topical corticosteroids are derived.
Fluorinating or esterifying certain carbons in the four-ring backbone can increase the potency of TCS.

Mechanism of Action

TCSs interact with intracellular glucocorticoid receptors, leading to gene transcription changes in the nucleus.
General upregulation of anti-inflammatory mediators and downregulation of inflammatory mediators.
Vasoconstrictive effect reduces delivery of inflammatory mediators and improves erythema.
Anti-mitotic effect inhibits cell proliferation and collagen synthesis.
Immunosuppressant effect.

Adverse Effects

Many adverse effects are caused by overstimulation of glucocorticoid receptors.
Stimulation of mineralocorticoid receptors in the skin may reduce the severity of some adverse effects.
Adverse effects include: perioral dermatitis, stinging or burning sensation, acne, purpura, dermal atrophy, striae, rosacea, delayed wound healing, and skin pigment changes.

Fingertip Units

Fingertip unit (FTU) is a measure of TCS application developed to help patients apply appropriate amounts.
One FTU is approximately 0.5 g and covers an area equal to 2 adult handprints with fingers together.
FTUs required for one application vary by age group and body area.

Topical Drug Vehicles

Creams: fairly standard, patient-preferred, tend to cause irritation, and are the least effective vehicle for skin penetration.
Gel: alcohol-based, useful for hairy areas and oily skin, can cause stinging and irritation.
Lotion: often alcohol-based, evaporates well, useful for larger areas or hairy skin areas, can cause stinging and irritation.
Ointment: thick, greasy base, best vehicle for skin permeation, causes little to no irritation, emollient effect.
Foam: aerosolized oil-based formulation, allows application to hard-to-reach areas, tends to leave a greasy residue.

Potency

TCSs are classified by potency into seven classes, with Class 1 being the highest potency (superpotent or ultra-high class).

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This quiz covers the botanical treatment strategy for skin inflammation and irritation, identifying herbal actions and herbs beneficial for dermatitis, and formulating a topical herbal remedy.