Positive Health Online

Introduction

Skin disease can be a very distressing form of illness for those afflicted by it, not only because of the general unpleasantness and discomfort associated with it, but also because of its high visibility, which in extreme cases – particularly ones in which the face is affected – can lead to sufferers becoming socially isolated. The limited results often obtained with conventional treatment mean that many patients turn to alternative, and particularly herbal, therapies.

Traditional Approach

The skin that envelops us represents, of course, a major system of protection against the hazards of the environment in which we live – any breach in it exposes our organism to potentially life-threatening bacteria and other pathogens. But for herbal practitioners (phytotherapists) the health of the skin is also a reflection of the equilibrium of the organism as a whole, which is why a lengthy consultation and examination is carried out in an attempt to arrive at an overall understanding of the patient's bodily functioning.

Traditionally, many skin problems have been considered to arise from, or at least be exacerbated by, a state of increased toxicity: there is, therefore, a focus on the eliminatory functions performed by the liver, kidneys and gut; indeed, in many cases a simple 'drainage' of one or more of these organs with medicinal plants can bring about a remarkable transformation (see Case Study 1). Recent advances in pathophysiology have in many ways vindicated this approach, underlining the close link between digestive health and overall wellbeing: for example, the connection between immunological events – as in autoimmune and allergic conditions – and the condition of the gut wall and bowel flora has been well documented.[1][2] This increase in knowledge has in turn helped phytotherapists to refine and deepen their approach.

An important role was, and still is, played in the herbal treatment of skin disorders by a group of plants known variously as blood cleansers, alteratives or skin drainers: these include heartsease, burdock root, fumitory and nettle. Although these herbs are more or less specific for the skin, it is likely that their effect is also mediated by other pathways: fumitory, for example, is indicated in eczema, particularly if the liver or gall bladder is thought to be a factor in the illness, and there is in fact evidence that it has a normalizing effect on bile flow.[3]

Common thyme (Thymus vulgaris), an antispasmodic plant used
to reduce parasympathetic activity (copyright© P. Jarrett)

Heartsease (Viola tricolour), a ‘skin drainer’ used
traditionally for eczema (copyright© P. Jarrett)

Lady’s mantle (Alchemilla vulgaris), an astringent herb considered to
have progesterone-like properties (copyright© P. Jarrett)

Gromwell (Lithospermum officinale) reduces the secretion of FSH
and LH by the pituitary (copyright© P. Jarrett)

As one would expect, with skin disease there is plenty of scope for topical applications, even where it is considered that the 'in-depth' treatment should come from within. Anti-inflammatory plants such as German chamomile (in the form of creams or lotions) are extremely valuable in relieving inflammation and itching;[4] far from being purely symptomatic, their use promotes healing[5] and helps to break the vicious cycle of irritation and re-infection caused by scratching, especially where children are concerned. Another advantage of such applications is that they allow patients to reduce or even eliminate the use of steroid creams,[4] whose harmful effects on the skin are well known.

In certain cases, topical treatment alone may be enough to bring about healing: fungal infections such as athlete's foot often respond to essential oils such as tea tree,[6] thyme[7] or Greek sage,[8] applied diluted in a cream or gel. (Note that essential oils should never be applied to eczematous skin, even in very dilute form.) But where the infection or inflammation is chronic or widespread, it is unlikely that a topical treatment alone will be enough; a treatment of the patient's whole terrain (as outlined below) is called for.

Endobiogenic Approach Developed in France by Drs Christian Duraffourd and Jean-Claude Lapraz on the basis of 30 years' intensive clinical practice, the endobiogenic approach of clinical phytotherapy is one that incorporates aspects of traditional phytotherapy, as described above – 'drainage' of the organs of elimination, topical applications, etc., – and that also depends almost exclusively on medicinal plants as its therapeutic modality. However, its key feature, and most important contribution, is a sophisticated means of analysis of the state of equilibrium of the endocrine system, which is seen as the organizing principle of any living organism. Information about the endocrine balance of an individual is arrived at by a detailed case history, full clinical exam, and (in very complex or serious cases) a recently developed diagnostic test, the Biology of Functions. Medicinal plants (as well as dietary and/or lifestyle changes) are then prescribed in order to modify the individual's endocrine terrain and thereby promote healing.

That hormonal events play a role in disease is of course recognized by modern herbalists, particularly in regard to gynaecological problems – but the sequencing of hormonal events, the complex inter-relationships between them, and their consequences for overall health and disease, have never before been explored in this kind of depth.

The implications of this approach for skin pathology, with all its complexity and intractability, are profound, since hormones play a role in almost every aspect of skin metabolism: hence hormonal imbalances or surges arising from other factors (such as puberty) affecting this organ.

I have looked in some detail at one common skin disorder, acne, to illustrate this approach, which of course can be applied to other skin disorders, or disorders affecting other systems.

Fumitory

Nettle

Acne

Most people are aware of the link between androgens (e.g. testosterone) and adolescent acne in both males and females: testosterone stimulates the sebum-producing cells, increasing the rate of cell division (mitosis), the size of the sebaceous cells, and the intracellular synthesis of sebum. It is also known that the adrenal glands can play a role in the sequence of events leading to acne. Since cortisol has an anti-inflammatory action, lack of cortisol will exacerbate the condition; cortisol also combats acne by its anti-mitotic action on the germinal cells, opposing the action of the androgens. What is less appreciated is how these and other hormones may interact to produce acne: depressed cortisol production by the adrenal cortex will lead, by a negative feedback mechanism, to an increased secretion of the pituitary hormone ACTH, in an attempt to stimulate corticoid production; however, since ACTH exerts a general effect on the cortex, it also boosts the secretion of other adrenal hormones including androgens, and sets the scene for an eruption of acne. This explains why, in certain cases of acne, using herbal preparations specifically aimed at supporting cortisol production – for example, a glycerine macerate of blackcurrant buds – can have quite dramatic results.

Other modifications of the terrain may also increase the likelihood of acne. In women, an increase in androgens may be linked to an inadequate secretion of progesterone, prompting an increase in luteinising hormone (LH) secretion by the pituitary in an attempt to raise progesterone levels. But LH also raises ovarian androgen production, again setting the scene for acne. In this case the treatment would be entirely different from that described above, and would focus primarily on increasing progesterone secretion with luteotropic herbs such as lady's mantle (see Case Study 2).

The pancreas may also be involved in this complex tableau: sufferers may have high insulin levels, linked to the need for an increased supply of energy to the skin (because of cutaneous hypertrophy), and to disturbances in blood sugar regulation, which in turn are tied to all the other endocrine and autonomic nervous system imbalances: such patients often exhibit a general over-activity of the parasympathetic nervous system. Duraffourd and Lapraz consider insulin to be a major element in the induction of acne, since it provides the requisite building materials to the other growth factors.[9] These patients will benefit from the adoption of a low-glycaemic-index diet, while herbal options include pancreatic regulators, such as walnut leaf, and plants that dampen parasympathetic function, such as thyme.

Again, pituitary hormones may play a role: growth hormone and prolactin have anabolic activity and, in synergy with androgens, encourage the ultiplication and growth of cells generally and of sebaceous cysts in particular, and set the scene for super-infection. Treatment options here include strawberry root (anti-GH) and salad burnet (anti-GH and prolactin). Hyperfunction of the thyroid axis also stimulates cellular multiplication and the growth and proliferation of cysts, and may respond to herbs such as (depending on the nature of the imbalance) bugleweed, pichi, or fennel. Duraffourd and Lapraz have observed that when GH, prolactin and TSH are lacking, acne does not appear, even though there may be hyperseborrhoea.[9]

Finally, as in traditional herbalism, attention must always be paid to elimination: the skin is part of an organism of which it is one of the emunctories (organs of elimination); and the greater the deficiency of the other emunctories, the more the skin will be called upon to play this role. Functional insufficiency of the liver, for example, leads to a decrease in the elimination of toxins, as well as a slowdown in intestinal function. The net result is a rise in toxicity and greater demands on the skin as an eliminatory organ; this will aggravate any local imbalances affecting the sebaceous glands, and increase the risk of infection.

It should also not be forgotten that the liver plays an important role in maintaining the equilibrium of circulating ovarian, glucocorticoid, androgenic and thyroid hormones, i.e. the four primary factors involved in cutaneous imbalance.

Phytotherapists have at their disposal a vast array of medicinal plants that affect various aspects of liver function, among them globe artichoke[10] and dandelion root,[11] which increase bile secretion and flow, and turmeric[12] and lemon essential oil, which stimulate detoxification mechanisms (Phase 2 Biotransformation).

Treatment of acne may also include local applications, such as masks of medicinal green clay, and dietary recommendations, including the elimination of refined carbohydrates, fried or fatty foods, highly spiced food, and alcohol; and an increase in the consumption of vegetables and fruit.

Conclusion

As any practitioner knows, many skin conditions are notoriously difficult to treat. However, as the above text shows, relatively simple 'drainage' strategies can sometimes produce dramatic results. In more complex cases, the analytical approach of clinical phytotherapy can provide an insight into the euroendocrine imbalances underlying the pathology. Such an approach requires the practitioner to have a thorough understanding of the 'endobiogeny' of the patient, arrived at through an exhaustive overview of the patient's entire medical history (possibly with the use of a pre-consultation questionnaire), a full physical examination and, preferably, a 'Biology of Functions' exam (which requires a simple blood test). It equally requires the practitioner to be familiar with the endobiogenic imbalances that characterize different pathological conditions, such as – in the case of dermatology – acne, eczema, psoriasis, herpes, etc. These last three conditions will form the subject of a later article.

References

1. Plummer N. The Lactic Acid Bacteria – Their Role in Human Health. Biomed Publications. Shirley. 1992.
2. Schleich T and Schmidramsl H. The therapeutic use of lactobacillus. Brit J Phyt. 3(1): 38-46. 1993/94.
3. Hentschel C, Dressler S and Hahn EG. Fumaria officinalis (fumitory) – clinical applications [German]. Fortschritte der Medizin. 113(19): 291-292. 1995.
4. Nissen HP et al. Profilometry, a method for the assessment of the therapeutic effectiveness of Kamillosan ointment [German]. Zeitschrift für Hautkrankheiten. 63(3): 184-190. 1988.
5. Glowania HJ et al. Effect of chamomile on wound healing – a clinical double-blind study [German]. Zeitschrift für Hautkrankheiten. 62(17): 1262, 1267-1271. 1987.
6. Concha JM et al. Antifungal activity of Melaleuca alternifolia (tea-tree) oil against various pathogenic organisms. J Amer Pod Med Assoc. 88(10): 489-492. 1998.
7. Siméon de Buochberg M. De l'activité antimicrobienne de l'huile essentielle de Thymus vulgaris L. et de ses constituants. Montpellier. 1976. (Thesis.)
8. Hilan C et al. Antimicrobial effect of essential oil of Salvia libanotica (sage). Brit J Phyt. 4(4): 155-162. 1997.
9. Lapraz J-C. Acne. Clinical Phytotherapy Seminar Series No. 3: Dermatology. Middlesex University, London. 13-15 February 2004. (Seminar notes.)
10. Kupke D et al. Prüfung der choleretischen Aktivität eines pflanzlichen Cholagogums. Z Allg Med. 67: 1046. 1991.
11. Böhm K. Untersuchungen über choleretische Wirkungen einiger Arzneipflanzen Arzneimittelforschung. 9: 376-378. 1959.
12. Goud VK et al. Effect of turmeric on xenobiotic metabolizing enzymes. Plant Foods Hum Nutr. 44(1): 87-92. 1993.

Case Study 1

Female, aged 22
Presenting complaint Eczema on hands and wrists, intermittent over several years; Fatigue for many years – worsening; Constant headache (three years) – sometimes migraine and nausea.
Previous medical history Five chest or ear infections in last 15 months (antibiotics); Heavy sweating since age eight.
Clinical features Feels continuously cold; Constipation (up to two weeks), with abdominal pain and flatulence; Stools sometimes very light or yellow; Bad PMT and dysmenorrhoea (period pains); Liver/gall-bladder sensitive on palpation.
Treatment
1. Tinctures of: Sage – antihydrotic, depurative, choleretic, oestrogenic. Milk thistle – hepatoprotective, hepatoregenerative, hepatobiliary drainer, portal decongestant. Dandelion (root) – chikeretic, cholagogue, digestive hepatic tonic, diuretic, mild laxative;
2. One tbs of linseed, with 1-2 glasses water, twice a day: bulk laxative. Outcome (one month)
Eczema on hands and wrists has cleared; Much brighter, less fatigued, more able to cope; Constipation improved, though some flatulence; Feels more able to keep warm; Headaches more infrequent and less severe; no migraines; Liver still a little tender, but much less so.
Comments
Poor liver function is the outstanding clinical feature in this young woman: the resulting high level of toxicity doubtless plays a significant role in her eczema, as well as her fatigue and headaches and, indeed, her severe constipation – a feature that in itself will increase both toxicity and pelvic congestion (note the severe dysmenorrhoea). Inadequate detoxification by the liver will also exacerbate the hormonal imbalances responsible for her PMT. This simple 'drainage' treatment has achieved good results, but a more in-depth endobiogenic treatment will be required to resolve some of the underlying problems, such as the heavy sweating and chronic respiratory infections.

Case Study 2 (Dr J-C Lapraz)

Female, aged 46
Presenting complaint Cystic acne, worse in the second half of the cycle.
Clinical features; Menstrual cycle is rather long (35 days); Suffers from PMS, with pelvic congestion and breast tenderness; Quite heavy periods, with clotting on days 2 and 3; Uterine fibroids.
Treatment
1. Tinctures of: Gromwell – inhibits FSH and TSH. Burdock root – anit-infectious, hepatopancreatic and skin drainer. Butcher's broom – venotonic, anti-inflammatory, pelvic decongestant;
2. Tincture of lady's mantle: progesterone-like from day 8 to end of cycle;
3. Sulphur oligo-elements: hepatic and cutaneous properties;
4. Infusion of: Red vine (leaf) – venotonic, venoprotective. Fumitory – heapatobiliary drainer;
5. Local applications: A lotion with essential oils of lavender and clary sage in marigold tincture. Masks of green clay.
Outcome
Almost total disappearance of the acne after two months of treatment; No recurrence after nine months.
Comments
Oestrogenic plants – apart from local treatment – should be used with great care, taking account of the hyperoestrogenic state (relative to the lack of progesterone) common in the pre-menopause. This is particularly the case if there are problems such as uterine fibroids or mastosis.

Bibliography

Duraffourd C and Lapraz J-C. Traité de phytothérapie clinique. Masson. Paris. 2002.