Scholarly article on topic 'XU Yi-hou's Experience in Herbal Administration for the Differential Treatment of Skin Diseases'

XU Yi-hou's Experience in Herbal Administration for the Differential Treatment of Skin Diseases Academic research paper on "Clinical medicine"

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Academic research paper on topic "XU Yi-hou's Experience in Herbal Administration for the Differential Treatment of Skin Diseases"

XU Yi-hou's Experience in Herbal Administration for the Differential Treatment of Skin Diseases

LI Bo SHI Yue-jun ^EM, SONG Shun-peng & ZHAN Cheng

Department of Dermatology, Dalian Municipal Hospital of Dermatology, Dalian, Liaoning 116021, China

Prof. XU Yi-hou, director of the Department of Dermatology of Wuhan Hospital of Traditional Chinese Medicine, is a famous expert in dermatology of combined Chinese and western medicine, and awarded special governmental subsidy granted by the State Council. He has engaged in medical practice for more than 40 years, devoting himself in the clinical research of skin diseases treated by the combined Chinese and western medicine. In the TCM differential treatment of skin diseases, Prof XU has his special principles in the administration of herbs, such as administration based on the causative factors, zang-fu organs, the affected channels and collaterals, the skin damage, pair drugs, and special prescription for individual problem, which fully embodies the TCM concept of wholism and the essence of TCM differential treatment. The authors have had the fortune to follow Prof. XU in the study and have learned a lot from him. The following is a brief account of Prof. XU's experience in the administration of herbs based on syndrome differentiation for treatment of skin disease.

Administration based on the Causative Factors

The causative factors of skin diseases mainly involve the six climate exopathogens, seven emotions, and irregular food intake. Careful study on the causative factors is usually the guide for precise TCM syndrome differentiation, which can provide bases for the treating principle and the administration of herbs. Here, the nature of yin-yang of the causative factors must be first differentiated. For instance, in the six climate exopathogens, wind, summer-heat, dryness, and fire belong to yang; while cold and dampness belong to yin. The former have mostly the

location in the muscles, which should be dispelled, cooled and dispersed, while the latter have mostly the location in the channels and collaterals or in the zang-fu organs, which should be warmed and resolved. Take patients with itching due to wind for example. For those with heat prevailing, Fu Ping (^ ^ Herba Spirodelae), Bo He Herba Menthae), Fang Feng (IM Radix Saposhinkoviae), and Niu Bang Zi Fructus Arctii) are usually selected;

while for those with cold prevailing, Ma Huang (0 M Herba Ephedrae), Gui Zhi (^ ft Ramulus Cinnamomi), Wei Ling Xian ( ^ ^ ^ Radix Clematidis), and Bai Zhi (^ ^ Radix Angelicae Dahuricae) are selected. For patients with itching due to dampness, according to the depth of pathogenic invasion, herbs can be used in three ways: the first way is the use of aromatics to eliminate dampness, such as Huo Xiang (M^ Herba Agastachis), Pei Lan (ft^ Herba Eupatorii), and Sha Ren Fructus Amomi), which are suitable for the initial stage of the illness, without much exudates and itching sensation; the second way is the use of herbs pungent and warm in nature to eliminate dampness, such as Cang Zhu Rhizoma Atractylodis), Hai Tong Pi (^IM^ Cortex Erythrinae), and Chi Shi Zhi (^^ M Halloysitum Rubrum), which are suitable for patients with latent popular eruption and herpes affecting the muscles, accompanied with sharp itching; and the third way is the use of diuretics to dispel dampness through urination, such as Fu Ling Poria), Ze Xie Rhizoma Alismatis), and Hua Shi Talcum), which are suitable for downward flow of dampness, with location of the illness in the pudenda or the lower limbs. Besides, the treating principles can be adopted flexibly, such as the principle of

nourishing yin and eliminating dampness, treating dryness and dampness at the same time, and dispelling wind and removing dampness.

Administration based on the Affected Zang-Fu Organs

In clinical practice, we must study carefully the inter relationship between the zang-fu organs. For a same disease, in the process of development, zang disease can transform to fu disease, and fu disease can also transform to zang disease. Therefore, we should be first clear about the regularity of transformation of the disease, and then formulate the prescription. For instance, at the initial stage of acne, there can only be seen inflammatory popular eruption, herpes and oily skin, which is mostly due to wind-heat in the lung. The commonly-used herbs of mild action capable of opening the inhibited lung-gi can be used, such as Pi Pa Ye (t№n+ Folium Eriobotryae), Sang Bai Pi (# S & Cortex Mori), Huang Qin (M ^ Radix Scutellariae), and Jiao Zhi Zi (^MMT charred Fructus Gardeniae). In prolong cases, there can be appearance or increase of pustules, and obvious redness and swelling of the skin, when the heat has turned into toxin, and herbs capable of clearing away the heart-fire should be selected, such as Lian Zi Xin (^ T'fr Plumula Nelumbinis), Lian Qiao (^M Fructus Forsythiae), Jin Yin Hua Flos Lonicerae),

and Ling Xiao Hua (^ff^ Flos Campsis). If there appears nodule, cyst, even the severer symptom of scar, toxic heat mixed with phlegm and blood stasis is indicated, then drugs capable of removing blood stasis and softening hard masses should be added in the prescription, such as Zhe Bei Mu Bulbus

Fritillariae produced in Zhejiang Province), Tao Ren

Semen Persicae), Chuan Shan Jia Zhu ^ scales of Squama Manitis), and Zao Jiao Ci (^ft $l| Spina Gleditsiae).

Administration based on the Affected Channels and Collaterals

In the treatment of obstinate skin diseases, administration of herbs based on the theory of Eight Extra-channels, can often obtain quick therapeutic effects. Take the adult scleroderma for example. The

diseased area usually centers on the shoulder and back parts. The treatment should take the Bladder Channel into consideration. If the effect is not so obvious, drugs for treating the Du Channel can be added, such as Lu Jiao Pian (^ft^ pieces of Cornu Cervi), Zhi Fu Zi Radix Aciniti Preparata),

Rou Gui Cortex Cinnamomi), Qiang Huo (^ ^ Rhizoma seu Radix Notopterygii), Du Huo Radix Angelicae Pubescentis), and Shan Zhu Yu (Ù ^^ Fructus Corni) can be added, combined with drugs capable of eliminating wind and dredging the collaterals, such as Zhi Ma Huang Herba

Ephedrae Preparata), Gui Zhi ( ^ ft Ramulus Cinnamomi), Lu Lu Tong ( M Fructus

Liquidambaris), Dan Shen ( ^ # Radix Salviae Miltiorrhizae), Chuan Shan Jia Zhu scales

of Squama Manitis), Xi Xin (M ¥ Herba Asari), and Huang Qi (M^ Radix Astragali), which can warm and dredge the Du Channel, activate yang-qi, and eliminate the yin-cold.

Administration based on the Skin Damage

The TCM differential administration of herbs for skin diseases are often based on the appearance, color and the distributing area of the skin damage. Doctors must pay great attention to the characteristics of the damaged skin. For instance, for the skin damage with popular eruption prevailing, no matter acute or chronic, treatment should be mostly given based on the differentiation of the lung, with drugs having mild actions in opening and dispersing the inhibited lung-qi. Flower drugs are commonly used, such as Ju Hua Flos Chrysanthemi), Jin Yin Hua Flos Lonicerae), Ye Ju Hua (wild Flos Chrysanthemi), Huai Hua Flos Sophorae), Hou Pu Hua Flos Magnoliae Officinalis), Hong

Hua Flos Carthami), Kuan Dong Hua Flos Farfarae), Ling Xiao Hua (^W^ Flos Campsis), Yue Ji Hua H ^^ Flos Rosae Chinensis), and Mei Gui Hua (^^^ Flos Rosae Rugosae). This is because flower drugs tend to be very light, capable of rising and floating, and dispersing and infusing, and thus having the mild and dispersing effects. If spot prevails, the treatment should be based on the differentiation of the color of the spot. White-colored

spots often indicate disharmony between qi and blood, and the treatment should be based on the principle of soothing the liver-qi. The drugs used would include Chai Hu (^ Radix Bupleuri), Dang Gui Radix Angelicae Sinensis), Chuan Lian Zi (J 11ST Fructus Toosendan), and Wu Yao (^^ Radix Linderae). Red spots often indicate burning heat in the ying system, and the treatment should be given for the stomach by clearing up the ying system. The drugs used usually include Shi Gao Gypsum

Fibrosum), Zi Cao Radix Lithospermi), Zhi Mu Rhizoma Anemarrhenae), and Bai Mao Gen (S^tS Rhizoma Imperatae). Purplish spots indicate excessiveness of fire-toxin. The treatment should be given for treating the heart to remove the spots. The drugs used include Shui Niu Jiao Cornu

Bubali), Lu Dou Yi (^M^ Semen Coat Phaseoli Radiati), Sheng Di Huang ( tl| Radix Rehmanniae), and Chao Mu Dan Pi ( parched Cortex Moutan). Black spots indicate consumption and deficiency of the kidney, with its own color showing exteriorly. The treatment should be based on the principle of warming the kidney. The drugs used include Zhi Fu Zi Radix Aconiti

Preparata), Rou Gui Cortex Cinnamomi), Tu Si Zi (^^T Semen Cuscutae), and Ba Ji Tian (E^M Radix Morindae Officinalis). Pustule without diabrosis often indicates toxic heat, while pustule with diabrosis indicates toxic dampness. For the former, the heart should be treated to eliminate toxin, with Ye Ju Hua Flos Chrysanthemi Indici),

Pu Gong Ying Herba Taraxaci), Zi Hua Di

Ding Herba Violae), and Lian Zi Xin (^

T'fr Plumula Nelumbinis), while for the latter, the spleen should be treated to resolve dampness, with Bai Xian Pi Cortex Dictamni), Yin Chen (W

^ Herba Artemisiae Scopariae), Sheng Yi Yi Ren (^ Semen Coicis), and Chi Xiao Dou (^'hM Semen Phaseoli).

The skin damage usually occurs in a certain area, and the administration of herbs has also a definite regularity. For instance, if the skin damage locates on the four limbs, the spleen should be treated, with herbs such as Cang Zhu Rhizoma Atractylodis),

Bai Zhu (S^ Rhizoma Atractylodis Macrocephalae), Shan Yao Rhizoma Dioscoreae), Chao Bian

Dou (№ M parched Semen Dolichoris), and Fu Ling Poria). For skin damage on the trunk, the liver and spleen should be treated, with herbs such as Chuan Lian Zi (J 11ST Fructus Toosendan), Yu Jin Radix Curcumae), Jiao Zhi Zi (^MMT charred Fructus Gardeniae), Chi Fu Ling (^^^ Poria Rubra), and Chen Pi (^ ^ Pericarpium Citri Reticulatae). For skin damage at the two orifices, the liver and kidney should be treated, with herbs such as Chao Long Dan Cao (^ parched Radix Gentianae), Ze Xie Rhizoma Alismatis), Chai Hu (^iH Radix Bupleuri), and Chen Xiang (X# Lignum Aquilariae Resinatum). For skin damage on the head and face, the treatment is usually given for eliminating wind-heat, with herbs such as Fu Ping ( ^ W Herba Spirodelae), Chan Tui ( № ^ Periostracum Cicadae), Da Qing Ye (^Wf Folium Isatidis), and Xuan Shen Radix Scrophulariae).

Administration of Pair Drugs

In clinical practice, Prof. XU always uses compatible pair drugs, one of cold nature and one of warm nature; one for relieving the superficial syndrome and one for relieving the interior syndrome; one for yin and one for yang; one for qi and one for blood; and one for zang organs and one for fu organs. For instance, for skin damage with herpes prevailing, Zi Cao Radix Lithospermi) is used in combination with Fu Ling Poria); for skin damage with bloody

herpes prevailing, Zi Cao Radix Lithospermi) is combined with Hong Hua (^X^ Flos Carthami); for itching limited in the area of scrotum, Du Zhong Cortex Eucommiae) is combined with Chen Xiang (Lignum Aquilariae Resinatum); for itching limited in the pudendum of female, Du Zhong Cortex Eucommiae) is combined with Xiao Hui Xiang Fructus Foeniculi); for urticant

itching of the skin, Fu Ping (^W Herba Spirodelae) is combined with Sheng Shi Gao Gypsum

Fibrosum); and for itching like insect crawling, Fu Ping (^W Herba Spirodelae) is combined with Bai Mao Gen (S^tS Rhizoma Imperatae).

Besides, the pair drugs, one for the superficial and one for the interior, Chai Hu (^SJI Radix Bupleuri) and Huang Qin (M^ Radix Scutellariae) can treat all kinds of skin itching; the pair of Cang Zhu Rhizoma Atractylodis) and Shu Di Huang Radix Rehmanniae Preparata), one yin and one yang, can treat pustulosis palmaris et plantaris; the pair of Huang Lian (M^ Rhizoma Coptidis) and Rou Gui (Cortex Coptidis), one cold and one warm in nature, can treat aphthous stomatitis; the pair of Chan Tui Periostracum Cicadae) and Sheng Shi Gao Gypsum Fibrosum), one light and one heavy, can treat dermatitis in summer; and the pair of Shi Chang Pu (^S^ Rhizoma Acori Graminei) and He Shou Wu (M^^ Radix Polygoni Multiflori), one open and one closed, can treat circular alopecia. The use of pair drugs has always proved very effective.

Administration based on Special Prescription for Special Problem

Based on his long years of clinical experience, Prof. XU has summed up the prescription mainly indicated for infantile eczema Sanxin Daochi Yin Three Kinds of Plumula for Clearing the heart and Promoting Urination), containing Zhi Zi Xin (MMT'fr Plumula Gardeniae), Lian Zi Xin (^T'fr Plumula Nelumbinis), Lian Qiao Xin (^ M Plumula Forsythiae), Sheng Di Huang ( Radix

Rehmanniae), Dan Zhu Ye ( ffe ^ f Herba Lophatheri), Mu Tong (^ffi Caulis Aristolochiae Manshuriensis), Chi Xiao Dou (^ h S Semen Phaseoli), Huang Qin (M^ Radix Scutellariae), Che Qian Zi Semen Plantaginis), Che Qian Cao

( ^ ^ ^ Herba Planginis), Chan Tui ( M ^ Periostracum Cicadae), and Gan Cao Radix

Glycyrrhizae). In the prescription, Zhi Zi Xin (MMT Plumula Gardeniae), Lian Zi Xin (^T'h Plumula Nelumbinis), and Lian Qiao Xin (^M'h Plumula Forsythiae) are used for eliminating heat syndrome in new born and fetal toxicosis, combined with Sheng Di Huang Radix Rehmanniae), Che Qian Zi

(i^T Semen Plantaginis), Che Qian Cao Herba Planginis), Dan Zhu Ye (^ffif Herba Lophatheri) and Chi Xiao Dou (^hfl Semen Phaseoli), which are sweet, cold, tasteless and

infusing in nature and will not injure the vital-gi; small doses of Mu Tong (^ffi Caulis Aristolochiae Manshuriensis) and Huang Qin ( M ^ Radix Scutellariae) can upwardly clear away heat from the lung and downwardly treat deep yellow urine; and Chan Tui Periostracum Cicadae), light and

dispersing, can lead the drugs to the superficial part of the body. And when heat is cleared away and the superficial symptoms are relieved, the itching is bound to be checked.

The modified Xiehuang San (^M^ Powder for Dispelling Spleen-heat) can be used to treat perioral dermatitis and multilocular eczema, which contains Huo Xiang Herba Agastachis), Pei Lan (ft^ Herba Eupatorii), Fang Feng ( I M Radix Saposhinkoviae), Jaio Zhi Zi (^MT charred Fructus Gardeniae), Sheng Shi Gao (^ ^ # Gypsum Fibrosum), Gan Cao (^^ Radix Glycyrrhizae), Huang Qin (M^ Radix Scutellariae), Hong Hua (^X ^ Flos Carthami), Ling Xiao Hua (^ff^ Flos Campsis), Chao Huai Hua parched Flos

Sophorae), and Sheng Ma ( ^ 0 Rhizoma Cimicifugae). The mouth is the orifice of the spleen, and the lips manifest the condition of the spleen. The skin diseases round the mouth are all related with fire in the spleen. Fire in the spleen and stomach accumulating in the middle-jiao can make failure of the lucid yang in ascending and turbid yin in descending, leading to retention of damp-heat to cause the disease. When used, the above prescription can help reducing the accumulated damp-heat in the spleen and stomach, so as to treat dermatitis round the mouth. Flower herbs can be added accordingly to this prescription due to their light, purging and dispersing nature, which can help eliminating heat in the spleen and stomach so to cure the skin damage. Zhi Zhu Chixiaodou Yin (ft^Jhsft) for treating popular urticaria contains Zhi Qiao Fructus

Aurantii), Sha Ren Fructus Amomi), Yi Mu

Cao (Herba Leonuri), Chan Tui ( Periostracum Cicadae), Bai Zhu (S ^ Rhizoma Atractylodis Macrocephalae), Jing Jie Herba

Schizonepetae), Chi Xiao Dou (Semen Phaseoli), Fang Feng (IM Radix Saposhinkoviae),

and Chi Shao Radix Paeoniae Rubra). In the

prescription, the aromatics Bai Zhu (S^ Rhizoma Atractylodis Macrocephalae), Sha Ren (^t Fructus Amomi), Zhi Qiao Fructus Aurantii), and Chi Xiao Dou (fM Semen Phaseoli) can strengthen the spleen and stomach and remove dampness; Chan Tui Periostracum Cicadae), Fang Feng (IM

Radix Saposhinkoviae) and Jing Jie (^^ Herba Schizonepetae) can eliminate the pathogenic wind to stop the itching; and Chi Shao Radix Paeoniae Rubra) and Yi Mu Cao Herba Leonuri) can

give the effect of 'treating blood first in order to treat wind, and the wind being surely stopped when free flow of blood being ensured', and they can also enhance the effect of Jing Jie ( ^ ^ Herba Schizonepetae) in checking itching. Especially, the two main herbs of Bai Zhu ( S ^ Rhizoma Atractylodis Macrocephalae) and Zhi Qiao (^^ Fructus Aurantii), one tonifying and one reducing, can make the vital-qi strengthened, the pathogens removed, and the channel-qi in free flow, hence the relief of all the symptoms.

Sample Cases

Case 1: A female patient, aged 42 years, stated that she had had subacute systematic lupus erythematosus for 2 years. She was taking prednisone 15 mg daily, and she still had pain of joints of the four limbs. The examination at the moment showed swelling and soreness pain in both knee joints. She stated that she had the symptoms of palpitation and shortness of breath, lassitude, and insomnia. She also presented with a thredy-weak-forceless pulse, and red tongue proper with little coating. The TCM differentiation was loss of yin of the liver and kidney, malnutrition of the four extremities, and obstruction of the channels and collaterals. The principle of the treatment was nourishing yin with herbs sweet and cold in nature, and promoting circulation of blood in the collaterals. The prescription: Sheng Di Huang (^ Radix Rehmanniae) 12g, Shan Zhu Yu (¿^^ Fructus Corni) 12g, Bai Shao (S^ Radix Paeoniae Alba) 12g, Ye Jiao Teng (^^0 Caulis Polygoni Multiflori) 12g, Ji Xue Teng (^ 0 Caulis Spatholobi) 12g, Shi Nan Teng (^10 Caulis

Piperis wallichii) 15g, Hai Feng Teng (^M0 Caulis Piperis Kadsurae) 15g, Luo Shi Teng (^^0 Caulis Trachelospermi) 15g, Tai Zi Shen (AT# Radix Pseudostellariae) 10g, Tian Dong (Radix Asparagi) 10g, Sang Ji Sheng Herba Taxilli)

10g, and Niu Xi Radix Achyranthis Bidentatae) 10g. After taking 7 doses of the above prescription, the swelling and pain of joints were obviously alleviated. She continued taking the original prescription for another 15 doses. Then, the joint pain disappeared. She decreased the dose of prednisone to 5 mg/per day. She could then walk all by herself.

Comment: Joint pain is the main symptom of lupus erythematosus. In the treatment, the superficiality and origin of the disease should be first made clear, and then the precise prescription. For this patient, prolonged illness has made consumption of the yin fluid. Therefore, herbs sweet, cold, soft and moistening in nature are used for nourishing yin of the liver and kidney, such as Di Huang (№M Radix Rehmanniae), Bai Shao (S^ Radix Paeoniae Alba), Shan Zhu Yu (¿^^ Fructus Corni) and Tian Dong Radix Asparagi). And herbs of caulis are added in the prescription for removing stagnancy to stop pain. The whole prescription can make the deficient vital-qi strengthened and excessive pathogens eliminated.

Case 2: A female patient, 29 years old. The patient complained that one year before she got motor impairment in the nape part in forward and backward bending. Then she found swelling and hardness of the local skin, developing to the shoulder and back part. She felt tension of the affected part, like wrapped by rope. The pathological diagnosis was adult scleroderma. Her pulse was deep and hesitant, and her tongue proper was light-red, with thin-white coating. The TCM differentiation was deficient hollow of the Du Channel, invasion by mixture of wind, cold and damp, blockage of the channels and collaterals, and stagnation of qi and blood, which developed into protracted arthralgia. The treating principle was supplementing qi and restoring yang, and replenishing essence and tonifying the marrow. The prescription: Zhi Ma Huang (Herba

Ephedrae Preparata) 10g, Bai Shao ( Radix Paeoniae Alba) 10g, Dang Gui Radix Angelicae Sinensis) 10g, Qiang Huo Rhizoma seu Radix Notopterygii) 10g, Du Huo Radix Angelicae

Pubescentis) 10g, Lu Jiao Jiao (^ftK Colla Cornus Cervi) (melted) 10g, Xu Duan Radix Dipsaci) 10g, Hua Jiao Pericarpium Zanthoxyli) 6g,

Chuan Shan Jia Zhu scales of Squama

Manitis) 6g, Rou Gui Cortex Cinnamomi) 6g, Xi Xin ( Herba Asari) 6g, Zhi Qiao ( Fructus Aurantii) 6g, Huang Qi (M"K Radix Astragali) 30g, Gou Ji (^W Rhizoma Cibotii) 12g, and Sang Ji Sheng Herba Taxilli) 12g, which were mixed

and decocted with water. The patient took the decoction, one dose daily in three separate times. After taking 15 doses of the prescription, the patient had free movement of the nape, with complete disappearance of the rope-wrapping tension sensation. She continued to take Quan Lu Wan (^^A), 6g each time, twice daily. On her return visit one month

later, she was cured, with all the symptoms gone.

Comment: The Du Channel passes through the middle of the spine, controlling both sides. When the Du Channels is deficient, the exopathogens will take the advantage to invade and cause obstruction in the shoulder and back, leading to the various symptoms. Drugs capable of activating yang, such as Fu Zi (^ T Radix Aconiti Preparata), Hua Jiao (^ ® Pericarpium Zanthoxyli), Xi Xin Herba Asari), Qiang Huo Rhizoma seu Radix Notopterygii), Du Huo Radix Angelicae Pubescentis), Rou

Gui Cortex Cinnamomi), and Lu Jiao Jiao (^ ft K Colla Cornus Cervi) can directly reach the Du Channel. When the yang-qi is invigorated, the yin-cold is sure to go away, and all the symptoms disappear.

(Translated by WANG Xin-zhong

Received May 11, 2010