Botanicals in Dermatology PDF

Botanicals in Dermatology Chris Pickrell, ND, Herbalist, TCM Practitioner Key Actions: Alterative, Hepatic, Laxative The herbs in this section tend to be cold and bitter. Key treatment The stronger the presentation, the stronger the requ...

Botanicals in Dermatology Chris Pickrell, ND, Herbalist, TCM Practitioner Key Actions: Alterative, Hepatic, Laxative The herbs in this section tend to be cold and bitter. Key treatment The stronger the presentation, the stronger the required principles: treatment. If there is constipation, get the bowels moving Arctium lappa (Burdock) Berberis vulgaris (Barberry) Coptis sinensis (Coptis, Golden thread) Key Herbs: Rumex crispus (Yellowdock) Glycyrrhiza glabra (Licorice) Trifolium pretense (Red clover) Round out your formulas with ginger or cinnamon to minimize Pro tip: digestive side-effects Summary Review of Botanicals in Dermatology by Category and Condition  Proportion Primary Botanical Primary Herbs to Broad Category Condition Optimal Application Sample Formula in Sample Dosing Cautions Actions Consider 100g/mL Comfrey "Green Salve" Calendula Comfrey 50 Topical application 2- Abraisions Vulnerary Chamomile Salve Calendula 30 3x/day Plantago Plantago 20 Comfrey Comfrey 25 Calendula Calendula 25 Topical application 1- Ulcers Vulnerary, Anti-microbial Black tea Poultice Black tea 25 2x/day for about 40 With any open lesion, Topical Injury Yarrow Yarrow 25 minutes. monitor for signs of infection Calendula Calendula 40 Bites, puncture, Topical application 2- Vulnerary, Anti-microbial Yarrow Poultice Yarrow 30 surgical 3x/day Black tea 30 Jojoba oil Comfrey 70 Topical application 2- Comfrey Oil or salve Green tea 30 Scars Vulnerary 3x/day Green tea Eucalyptus Topical essential oil 2-5 drops, 2-3x/day Topical essential oils Lavender Topical essential oil 2-5 drops, 2-3x/day may irritate sensitive skin, try a test patch first. Fungal Anti-fungal Topical powder, 1/2 - 1 tsp powder Black walnut Do not use essential oils internal tincture over affected area on active wounds or deep cuts Sage Lavender If using undiluted, mint Bacterial Anti-microbial Topical essential oil 2-5 drops, 2-3x/day can create a burning Mint sensation Topical Infection St. John's wort St. John's wort 40 Apply topically 2- Warts Anti-viral Licorice root Infused in olive oil Licorice 20 3x/day Chelidonium Chelidonium 40 St. John's wort St. John's wort 40 Apply topically up to Herpetic Licorice Licorice 30 5x per day. Best used Anti-viral Infused in olive oil Infections Lemonbalm Lemonbalm 30 it applied in prodromal phase  Proportion Primary Botanical Primary Herbs to Broad Category Condition Optimal Application Sample Formula in Sample Dosing Cautions Actions Consider 100g/mL Yellowdock Yellowdock 40 Burdock Burdock 30 Yellowdock contains Barberry Spearmint 20 2tsp, bid between anthraquinone Acne Hepatic, laxative Tincture meals glycosides and acts as a stimulating laxative Red clover Ginger 10 Turkey rhubarb Coptis 30 Coptis Rheum 15 Rheum palmatum 2-3 tsp, bid between contains anthraquinone Psoriasis Hepatic, laxative Gentian Tincture Bupleurum 25 Inflammatory meals glycosides and acts as a Licorice 20 stimulating laxative Cinnamon 10 Yellowdock Yellowdock 10 Burdock Burdock 15 Yellowdock contains Ginger Fang feng 25 2-3 tsp, bid between anthraquinone Eczema (wet) Hepatic Tincture Lobelia 15 meals glycosides and acts as a stimulating laxative Coleus 15 Gotu kola 20 Ginger Ginger 20 Licorice Licorice 40 1tbsp/cup, steep 20+ Dry skin Adaptogen Infusion, tincture minutes. Have 2 cups Ashwagandha 40 a day between meals Burdock Tulsi 25 Licorice Licorice 25 2tsp, bid between Eczema (dry) Adaptogen, hepatic Infusion, tincture Gotu kola Gotu kola 25 meals Deficiency Rosehips 25 Tincture: 2tsp, bid Astragalus Astragalus 30 between meals Panax q. Panax q. 30 Recurrent Decoction: 5tbsp/1L Adaptogen Decoction, tincture infection Reishi Reishi 20 water, simmer for 3+ hours or oevernight in a slow cooker Echinacea Echinacea 20 Sample Case Presentation A 26-year-old male presents with silver, scaly lesions of the lower legs and hair line. He reports that these have been more or less present most of his life, with varying degrees of severity, but are worse during times of stress, which he describes as a regular challenge in his life. Associated. Patient regularly gets low-grade headaches and tends to constipation. Outcome Measures  decrease size and severity of lesions  increase time between flares to allow skin to heal between flares  prevent progression of possible psoriatic arthritis Desired Botanical Actions Primary: alterative hepatic laxative Secondary or Supportive: anti-inflammatory warming carminative Selected Herbs by Botanical Actions Actions Herbs Hepatic Yellow dock (Rumex crispus) Blue flag (Iris versicolor) Oregon grape (Berberis aquifolium) Dandelion root (Taraxacum officinalis radix) Barberry (Berberis vulgaris) Bupleurum (Bupleurum sinensis) Coptis (Coptis sinensis) Burdock (Arctium lappa) Laxative Yellowdock (Rumex crispus) Turkey rhubarb (Rheum palmatum) Herb Selection and Formula Coptis (Coptis sinensis) 30 Burdock (Arctium lappa) 20 Bupleurum (Bupleurum sinensis) 20 Yellow dock (Rumex crispus) 20 Cinnamon 10 100 NOTE: Coptis is chosen here, though it is not commonly used in western botanical medicine. It is similar to Berberis vulgaris and Hydastis canadensis, and falls between them in terms of its ‘strength’ as a hepatic, and it is specifically well indicated for skin conditions. Dosage Tincture or powder: 2 tsp (10 mL) twice per day in a mug of warm water; take at any time. Infusion: Not optimal as infusion. Decoction: Add 5 tablespoons to 4 cups (1 L) of boiling water, boil on medium for ~45 min Alternatively, cook on low overnight in a slow cooker. Duration: Continue for 3 weeks. Cautions, Contraindications, and Potential Side Effects Yellow dock is a stimulating laxative, and all four herbs are hepatics; an increase in bowel movements is to be expected and is considered to be therapeutic. Relevant Herb-Drug Interactions None anticipated, but any formula that affects activity of the liver has the potential to alter drug metabolism Other Effective Therapies  Identification of physical and psychological triggers  The elimination diet can be excellent for ameliorating symptoms and at least transiently reducing inflammation.  Acupuncture is likewise highly effective at ameliorating psoriasis.  Some supplements, particularly those that support healthy epithelial cells, may yield modest improvements  Topical botanical treatments such as a green salve should be viewed as effective symptomatic management.  Consider a more direct immune formula, including immune modulators and immune stimulants  Selected Botanical Monographs Arctium lappa (Burdock) Primary Actions: Alterative, hepatic, mild laxative, mild adaptogen. Constituents: Lignans, carbohydrates, inulin. Indications: Hepatic congestion, sluggish bowels, acne, eczema and other skin conditions, IBS, type II diabetes, nausea. Cautions/Contraindications: Considered safe, even nutritious. Extra Information: Burdock is abundant throughout most of North America and the root acts as an excellent alterative, often in combo with other primary alteratives. Burdock’s sweet flavor makes it a useful partner to ginger in addressing nausea. Part Used: Root Daily Therapeutic Dose Tincture: 9-18 mL (1:5 in 30%) Daily Therapeutic Dose Infusion or Decoction: 2-12 g root Pairs Well With: Zingiber officinalis for nausea of deficient stomach. Closest Substitute: Taraxacum officinalis. Berberis vulgaris (Barberry) Primary Actions: Hepatic, cholagogue, antimicrobial, bitter, anti-inflammatory, alterative, endocrine modulator (insulin). Constituents: Isoquinoline alkaloids (berberine, hydrastine, berbamine) Indications: General infections, GI infections, hepatic or gallbladder conditions, constipation, type II diabetes, PCOS, any inflammatory skin condition Cautions/Contraindications: Non-toxic but strongly bitter. Avoid during pregnancy and lactation. Extra Information: Sometimes thought of as a poor cousin to hydrastis, barberry (which is indeed considerably more affordable and less endangered) is a potent antimicrobial and excellent hepatic. Useful as an alterative during and post-infection, and useful in stimulating digestion. Though research is still early, barberry is beginning to show promise in the regulation of blood sugar, suggesting possible use in treating type II diabetes and PCOS. Part Used: Root. Daily Therapeutic Dose Tincture: 3-9 mL (1:5 in 40%). Daily Therapeutic Dose Infusion or Decoction: 4-6 g dried root. Pairs Well With: Bupleurum sinensis in hepatic infections. Galega officinalis in type II diabetes. Chelidonium majus and Peumus boldo in addressing gallstones. Closest Substitute: Berberis aquifolium. Coptis sinensis (Coptis, Goldenthread) Primary Actions: Antimicrobial, , anti-inflammatory, hepatic, bitter Constituents: Isoquinoline alkaloids (hydrastine, coptisine) Indications: Chronic or actue skin characterized by inflammation, acute GI infections, chronic sinusitis, hepatitis Cautions/Contraindications: Non-toxic but very strongly bitter. Avoid during pregnancy and lactation. Not generally used more than 3 weeks consecutively. Extra Information: Notably strong and bitter. Considered specific for any skin conditions characterized by inflammation. Part Used: Root. Daily Therapeutic Dose Tincture: 3-8 mL (1:5 in 40%). Double or triple the dose may be used during acute infection. Daily Therapeutic Dose Infusion or Decoction: 2-4 g Pairs Well With: Bupleurum sinensis, Rheum palmatum, Glycyrrhiza glabra Closest Substitute: Berberis vulgaris. Glycyrrhiza glabra (Licorice root) Primary Actions: Adaptogen, particularly to the adrenals; anti-inflammatory, demulcent, antiviral, hypertensive, laxative (in high dose) Constituents: Triterpene saponins (glycyrrhizin) Indications: Ongoing stress, hypotension, asthma, eczema, chronic or acute bronchitis, emphysema, URTI, post-viral cough, stomach ulcers (mostly DGL). Cautions/Contraindications: CI in hypertension. Preg A, Lact C. Extra Information: Licorice acts primarily as an aldosterone-like endocrine modulator. Thought of as specific to cases of deficiency presenting with dizziness and hypotension. Excellent in URTI as an antiviral and demulcent. Excellent for lingering post-viral cough. NOTE: In higher doses (12+mL of tincture, 9+ grams of root, Licorice acts as a laxative) Part Used: Root. Daily Therapeutic Dose Tincture: 3-9 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 2-9 g dried root. Pairs Well With: Rosmarinus officinalis for coughs, especially viral coughs. Bupleurum sinensis in anti-inflammatory combos where clearance by the liver is suboptimal. Hypericum perforatum and Melissa officinalis (as infused oil) for the topical treatment of herpes infections. Closest Substitute: None. Rumex crispus (Yellow dock) Primary Actions: Alterative, laxative, hepatic, astringent, mild adaptogen. Constituents: Anthraquinone glycosides, tannins. Indications: Chronic skin conditions, constipation, convalescence. Cautions/Contraindications: Not to be eaten fresh, potentiates other stimulating laxatives. Preg B, Lact CC. Extra Information: Thought of as one of the best “blood purifiers” by the eclectics. Strong and effective alterative, also useful in building the blood. Laxative, though milder than the other anthraquinone-containing laxatives such as Rheum palmatum and Rhamnus spp. Part Used: Root. Daily Therapeutic Dose Tincture: 3-6 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 2-4 g dried root. Pairs Well With: Berberis vulgaris in chronic skin conditions. Inonotus obliquus, Smilax officinalis, and Polygonum multiform as convalescent adaptogen. Closest Substitute: Rheum palmatum. Trifolium pratense (Red Clover) Primary Actions: Alterative, lymphatic, mild female endocrine modulator (phytoestrogen), mild diuretic, mild anti-inflammatory. Constituents: Isoflavones (diadezin, genistein), coumarins. Indications: Skin conditions, PCOS, irregular menses, menopausal hot flashes. Cautions/Contraindications: No safety or toxicity concerns noted, may interact with anticoagulants. Extra Information: A useful alterative, especially in female endocrine conditions including acne and irregular menses. Contains phytoestrogens, though their efficacy is only modestly supported by the literature and outcomes vary significantly among individuals. Shows some benefit in treating hot flashes of menopause. Part Used: Flowers, aerial parts. Daily Therapeutic Dose Tincture: 6-12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 5-15 g dried flower tops. Pairs Well With: Iris versicolor and Arctium lappa for acne. Urtica dioica leaf for childhood eczema. Actaea racemosa for hot flashes of menopause. Closest Substitute: Rubus idaeus. References: Advanced Botanical Prescribing, Pickrell, 2016 Principles & Practices of Naturopathic Botanical Medicine, Saunders and Barlow, 2022 Chinese Medicine Materia Medica, Bensky, Clavey, Stoger, 2004