Simpson: Dermatology and herbal medicine

Since the mid-20th century, allergic and autoimmune diseases have been more prevalent among the global population. Modern life has done so much to improve our health (Calvin Coolidge might faint in today’s supermarket!) but as the saying goes, we take the good with the bad. For instance, research shows that babies born by cesarean suffer an increased risk of atopic disease, and children given antibiotics before age 1 are twice as likely to develop it.

The modern diet, which is dominated by much that is not actual “food,” as well as being increasingly stationary or desk-bound as work and play becomes more digitized, and prolonged use of pharmaceuticals, may be exacerbating risk factors. In so many ways, the discovery and application of antibiotics and steroids have been invaluable in humanity’s general fight against disease, but dermatology stands out among medical disciplines where overuse of those treatments show diminishing returns over time.

Conditions of the skin are quite literally laid bare for the world to see, causing tangible harm to a patient’s physical and emotional health. With the increase of global pathogens, antibiotic-resistant strains of disease, and the exponentially detrimental effects of extended steroid use, skin condition sufferers and physicians could really benefit from a different method of treatment. Herbal medicine is used widely in Japan, China and Korea, and increasingly in Europe and the United States. Herbal therapy offers more sustainable solutions for everyone’s long-term dermatological health without the individual side effects of long-term steroids and the global ramifications of prolonged antibiotics.

In acutely traumatic cases such as erythrodermic psoriasis (what herbal medicine might call “pine skin lichen”), this is a severe emergency and in these cases, the typical allopathic method is very helpful to get the patient out of crisis. But in cases where the patient suffers from a chronic and recalcitrant skin condition, medicine which has a more harmonious and less injurious action in the body, should be considered more often than is being done currently. In Japan for example, over 70% of all medical school-trained physicians who know and have access to pharmaceutical compounds, also use and prescribe over 140 different standardized herbal medicine formulas today.

The method of diagnosing treatment is fairly straightforward, the skin doesn’t lie. Is the skin red or purple, dry or damp, itchy or not itchy, with scaling or no scaling, raised skin (plaques) or no raised skin (macules)? All of these and more help in the determination of the specific constellation of herbs used to resolve inflammation and return the skin to a stable and healthy condition.

For example, two of the likely herbs in either of the more prevalent skin conditions psoriasis (“dry lichen”) and eczema (“four crooks wind”), are foxglove root (rehmannia radix) and peony root bark (moutan cortex). Whereas steroids are used to halt the inflammation process, that treatment tends to ignore what is causing the inflammation. It’s like responding to a loud smoke alarm by just removing the battery — it may be quiet now but the fire smolders on.

As we remind ourselves that inflammation is the body’s “call to arms,” we may do better to hurry the process through to completion rather than arrest it. The combination of those two herbs in particular work beautifully to soothe and resolve particularly red and hot skin with wide patches of redness (erythema) and is appropriate for long-term use without damaging the skin, as will invariably be the case with prolonged application of steroids.

And while there is some pharmaceutical research being done to exploit the “active ingredient” and isolating chemical components such as Rehmannioside, benzoic acid, gallic acid, adenosine, or Paeonol, it is helpful to sometimes compare the strategy with something more familiar to us. Vanilla is a flavor that so many of us know and enjoy, and are aware of at least the price difference, if not the taste difference, between a synthesized vanilla extract versus a whole-bean extract. Synthesized vanilla contains only the active ingredient vanillin and so is quite easy and straightforward to make, but whole bean vanilla has hundreds and hundreds of other compounds which, while not perhaps contributing to the named flavor, they hold a plurality of what makes whole vanilla, vanilla, with a substantial deal of difference to the overall flavor and effect.

So, more than a specific one-dimensional chemical compound like a steroid or an antibiotic, considering herbal formulas for treatment with multifaceted whole medicine like foxglove and peony, is perhaps a better way forward in treating skin conditions long-term.

David Simpson is an acupuncturist and herbalist at Moon Brook Medicine.