Morphology 2 (1) PDF - Skin Lesions and TCM

ii) SECONDARY LESIONS - represent the evolution and subsequent manifestations of primary lesions, either naturally or more often as a result of treatments 1. Scale - shedding of uppermost layer of skin (stratum corneum), leading to formation of heaped up particles of the epidermis on the surfac...

ii) SECONDARY LESIONS - represent the evolution and subsequent manifestations of primary lesions, either naturally or more often as a result of treatments 1. Scale - shedding of uppermost layer of skin (stratum corneum), leading to formation of heaped up particles of the epidermis on the surface. - dry white scale on red background: Extreme Heat generating Wind - dry white scale with a pale or brownish background: Blood Xu with Wind, or Blood Stasis with Wind - greasy, larger and yellow scale: Damp Heat with Wind or Fire toxin 2. Erosion - partial break in the epidermis, no scarring after healing. usually after scratching off vesicles, bullae or edematous lesions - always shows Damp Heat 3. Ulcer - loss of epidermis, with scarring after healing - Damp Heat with Fire Toxin, on background of Qi Xu and Blood Stasis 4. Crust - dried exudate which is forms after clear, purulent or bloody discharge - golden yellow: staphyloccocus - damp heat with fire toxin - bloody: blood heat - purulent brown: damp heat, fire toxin 5. Excoriations (scratch marks) - shallow excavation in top layer of skin from scratching. linear or discreet - bloody, on red (erythematous) background : blood heat with wind, light fire toxin - with no red background, or pale red: blood xu with wind - with lichenification (thickening of skin) : blood stasis, blood xu, with wind - with edematous erythema and yellow brow scabs: damp heat fire toxin 6. Fissure - cracks in the epidermis and extending into the dermis - extreme dryness due to heat, blood xu, fire toxin - occasionally due to damp heat, if accompanied by vesicles or swelling, (pomphoyx eczema) 7. Lichenification: - thickening of the skin with accentuation of skin creases - blood xu, yin xu, blood stasis 8. Atrophy - thinning and transparency of skin caused by diminution of epidermis, dermis, subcutaneous tissue. parchment like skin, with wrinkling and loss of skin markings. skin breaks and bruises easily - topical steroids cause it, certain skin diseases (lichen sclerosis and atrophicus) - unless very superficial, it is irreversible 9. Hypo and hyperpigmentation - usually a post inflammatory process which leaves qi and blood not harmonized in the skin - or qi, blood, kidney xu - sun damage can cause it ESSENTIAL POINTS FOR SUCCESSFUL DERM TREATMENT The vast majority of dermatological diseases, whether inflammatory, infective or parasitic, present with strong excess factors: - heat - the most common and significant excess found in skin diseases - heat often combines with dampness, toxins, wind or stasis to produce even more knotted and tenacious excesses - establishing the location of the excess factors is paramount: i.e. wei level, qi level, organ level, blood level - even chronic dermatological disease often presents with excess pathogenic factors, i.e. chronic does not always imply deficient in the case of skin disease - treatment must always tackle the branch - i.e. the excess - before attempting any tonification. ***premature or simultaneous tonification will aggravate the disease - the order of treatment is to clear, vent or drain, followed by harmonization, followed by tonification - symptoms such as dryness or fissures are most often due to heat, damp or stasis, rather than deficiency of blood or yin. look for clues in the degree of erythema and the presence of other symptoms such as swelling, weeping or petecchia. - cold and bitter herbs and formulas are surprisingly well tolerated over long periods of time, if there is no pronounced and pre-existing spleen qi deficiency - Deficient Blood or Yin with Wind is an exceedingly rare pattern encountered in clinical derm practice - tonics are the least commonly used category of herbs used in derm practice - it is important to become very familiar with the taste, nature and therapeutic actions of the most commonly used derm herbs from the categories expel Wind Heat, Clear Qi Level Heat, Damp Heat, Toxic Heat, Blood Heat. PRECISE DIAGNOSIS - morphology of skin lesions and their TCM correspondence is primary for diagnosis - tongue diagnosis is useful, but not absolute, and is trumped by the skin presentation: e.g.: a cracked, peeled and geographic tongue does not preclude a diagnosis of damp heat if there are weeping skin lesions. (although the tongue presentation might caution against the use of the most bitter and cold herbs.)  e.g. a pale tongue with a normal coat does not preclude a diagnosis of extreme heat and fire toxin, or of damp heat, if that is what the skin disease is showing - seeing the skin in an untreated state gives the best hope for accurate diagnosis. cortisone cream, moisturizers, salves, baths, scrubs, etc will change the look of the lesions and obscure the diagnosis. patients must be counselled to present their skin as is, as much as possible - you must enquire in great detail about topical creams, balms, salves and oils that patients are self treating with , as they often cause harm. this includes “all natural products”. greasy salves, coconut and other oils, essential oils irritate and aggravate any heat patterns by trapping and insulating the heat in the skin. - common food and nutraceutical supplements can be of dubious use or cause harm when there are excess factors: fish oils, coconut oils, probiotics, kombucha, “immune boosting” supplements, garlic, ginger - food sensitivities are rarely relevant and should only be suspected if there are pronounced symptoms of poor digestion. and even then, avoiding dairy, wheat, gluten etc is extremely unlikely to improve a skin disease - pet and dander allergies, on the other hand, are a great concern with atopic or hand eczema sufferers, many of whom live with pets. - the pulse is not particularly diagnostic in dermatology treatment