Case of severe acne

[Guest guest]

Dear Lori,

What you have here is a classic case of surface deficiency due to underlying

kidney qi deficiency. This is the way to understand this condition: the yang

always moves from the centre of the body to the surface and then out through

the skin. When there is a deficiency of yang then it only moves as far as

the skin level and then gets stuck, this is also the cause of fever of

unknown etiologies etc. I am assuming that he has severe acne pustules or is

his acne small and red? Please describe. But anyway his formula must be

based on a yang tonic with surface clearers. This is definitely a case of

treating what is probably looking like a toxic heat condition on the surface

with hot herbs, but as you can see his signs and symptoms are all cold and

deficient. If you can say what the acne looks like then we can modify a yang

tonic formuls for him. ( and no you wont find any theory of this in modern

TCM but if you check Benskys book of herbal formulas you will find a formula

for skin rash etc in the tonify kidney yang area.

Best Wishes

Anita

-

" Lori Barns " <loribarns

<Chinese Medicine >

Saturday, September 18, 2004 11:42 PM

Case of severe acne

 

 

>

>

> Greetings,

>

> Have been quietly listening for a while. I have only been practicing for a

couple of years, a small practice. Thought that someone out there might be

able to give me some guidance on a difficult case. (At least difficult to

me, this is my first dermatology case that I have treated, counting my

experience in school.)

>

> He is a physically fit 45 year old male, approx 25 year history of severe

acne. Appears mostly on his face, some small outbreaks on chest and legs,

none on his back. He is usually cold to the touch, hates cold weather.

Functions best on a restricted diet, staying away from red meat, oils,

certain fruits and vegetables. This diet was prescribed by a practitioner of

Korean constitutional acupuncture, who told him he was a " Hespera " and that

his Liver was " almost dead. " Experiences night time urination, awakening 2

to 3 times per night. The only other physical symptom is some low back

stiffness upon awakening that goes away with movement. He works with another

holistic practitioner that does some Kinesiology with him, was told that he

was healthy except for needing some emotional release, which he did. Was

told by an endocrinologist about 10 years ago that he had twice the

testosterone of a teenager.

>

> Tongue is swollen, pale with a purplish tine, coat is thin white (some

greasy white at the base of tongue the first time I saw him, have only seen

him twice). Pulse is weak and thin, especially on the left guan and chi

positions. Abdomen shows tenderness on left side along ribs.

>

> Most pattern differentiation that I have looked up talks up heat in the

stomach, or damp heat. Neither his tongue or pulse show heat. I suspect a

kidney/liver yin deficiency from his pulse, but there seems to be very few

symptoms to confirm this.

>

> Any thoughts?

>

> Lori Barns, L.Ac.

[Guest guest]

Greetings,

 

Have been quietly listening for a while. I have only been practicing for a

couple of years, a small practice. Thought that someone out there might be able

to give me some guidance on a difficult case. (At least difficult to me, this is

my first dermatology case that I have treated, counting my experience in

school.)

 

He is a physically fit 45 year old male, approx 25 year history of severe acne.

Appears mostly on his face, some small outbreaks on chest and legs, none on his

back. He is usually cold to the touch, hates cold weather. Functions best on a

restricted diet, staying away from red meat, oils, certain fruits and

vegetables. This diet was prescribed by a practitioner of Korean constitutional

acupuncture, who told him he was a " Hespera " and that his Liver was " almost

dead. " Experiences night time urination, awakening 2 to 3 times per night. The

only other physical symptom is some low back stiffness upon awakening that goes

away with movement. He works with another holistic practitioner that does some

Kinesiology with him, was told that he was healthy except for needing some

emotional release, which he did. Was told by an endocrinologist about 10 years

ago that he had twice the testosterone of a teenager.

 

Tongue is swollen, pale with a purplish tine, coat is thin white (some greasy

white at the base of tongue the first time I saw him, have only seen him twice).

Pulse is weak and thin, especially on the left guan and chi positions. Abdomen

shows tenderness on left side along ribs.

 

Most pattern differentiation that I have looked up talks up heat in the stomach,

or damp heat. Neither his tongue or pulse show heat. I suspect a kidney/liver

yin deficiency from his pulse, but there seems to be very few symptoms to

confirm this.

 

Any thoughts?

 

Lori Barns, L.Ac.

 

 

 

[Guest guest]

Hi Lori,

 

How are you? Well I hope!

 

I work a lot of severe acne cases and would be glad to give you some ideas off

thread if you don't mind. You can relay a work URL to me if you feel

comfortable. If not...the dead liver scenario sounds like a place to start.

 

 

Take care,

 

David

 

Lori Barns <loribarns wrote:

 

Greetings,

 

Have been quietly listening for a while. I have only been practicing for a

couple of years, a small practice. Thought that someone out there might be able

to give me some guidance on a difficult case. (At least difficult to me, this is

my first dermatology case that I have treated, counting my experience in

school.)

 

He is a physically fit 45 year old male, approx 25 year history of severe acne.

Appears mostly on his face, some small outbreaks on chest and legs, none on his

back. He is usually cold to the touch, hates cold weather. Functions best on a

restricted diet, staying away from red meat, oils, certain fruits and

vegetables. This diet was prescribed by a practitioner of Korean constitutional

acupuncture, who told him he was a " Hespera " and that his Liver was " almost

dead. " Experiences night time urination, awakening 2 to 3 times per night. The

only other physical symptom is some low back stiffness upon awakening that goes

away with movement. He works with another holistic practitioner that does some

Kinesiology with him, was told that he was healthy except for needing some

emotional release, which he did. Was told by an endocrinologist about 10 years

ago that he had twice the testosterone of a teenager.

 

Tongue is swollen, pale with a purplish tine, coat is thin white (some greasy

white at the base of tongue the first time I saw him, have only seen him twice).

Pulse is weak and thin, especially on the left guan and chi positions. Abdomen

shows tenderness on left side along ribs.

 

Most pattern differentiation that I have looked up talks up heat in the stomach,

or damp heat. Neither his tongue or pulse show heat. I suspect a kidney/liver

yin deficiency from his pulse, but there seems to be very few symptoms to

confirm this.

 

Any thoughts?

 

Lori Barns, L.Ac.

[Guest guest]

Lori,

 

 

 

Fortunately and unfortunately in dermatological cases such as acne the

differential dx is more dependent on what the actual acne looks like vs.

internal signs (i.e. tongue pulse etc). Patterns to consider for him are:

1) lung heat with fire toxin, 2) yang ming damp heat with fire toxin, & 3)

fire-toxin with phlegm stasis. These are in order of severity. Herbally

one must use very high doses (most of time) to have an effect cure. hope

this helps

 

 

 

-

 

 

 

_____

 

Lori Barns [loribarns]

Saturday, September 18, 2004 7:43 AM

Chinese Medicine

Case of severe acne

 

 

 

 

Greetings,

 

Have been quietly listening for a while. I have only been practicing for a

couple of years, a small practice. Thought that someone out there might be

able to give me some guidance on a difficult case. (At least difficult to

me, this is my first dermatology case that I have treated, counting my

experience in school.)

 

He is a physically fit 45 year old male, approx 25 year history of severe

acne. Appears mostly on his face, some small outbreaks on chest and legs,

none on his back. He is usually cold to the touch, hates cold weather.

Functions best on a restricted diet, staying away from red meat, oils,

certain fruits and vegetables. This diet was prescribed by a practitioner of

Korean constitutional acupuncture, who told him he was a " Hespera " and that

his Liver was " almost dead. " Experiences night time urination, awakening 2

to 3 times per night. The only other physical symptom is some low back

stiffness upon awakening that goes away with movement. He works with another

holistic practitioner that does some Kinesiology with him, was told that he

was healthy except for needing some emotional release, which he did. Was

told by an endocrinologist about 10 years ago that he had twice the

testosterone of a teenager.

 

Tongue is swollen, pale with a purplish tine, coat is thin white (some

greasy white at the base of tongue the first time I saw him, have only seen

him twice). Pulse is weak and thin, especially on the left guan and chi

positions. Abdomen shows tenderness on left side along ribs.

 

Most pattern differentiation that I have looked up talks up heat in the

stomach, or damp heat. Neither his tongue or pulse show heat. I suspect a

kidney/liver yin deficiency from his pulse, but there seems to be very few

symptoms to confirm this.

 

Any thoughts?

 

Lori Barns, L.Ac.

[Guest guest]

Hi Lori

 

Have you thought about Liver qi and blood stagnation? The thin weak

pulse on the left guan could reflect " choppy " with this being

principally blood stasis probably due to long term qi stagnation.

This stagnation often causes constrained heat with apparent cold

symptoms--cold extremities. Slow pulse is also often associated with

this syndrome as well. I doubt any of the " cold " stuff is due to

deficiency since he's " fit " and there's no mention of fatigue. The

high testosterone number suggests qi stagnation to me as well--

probably irritable, volitile. Morning stiffness better with movement-

-stagnation. This lower jiao stagnation creates heat which injures

fluids creating damp which is carried up disturbing Lu/St channels

when/if the qi rebells. Premenstrual acne can come on this way too I

have heard. The Liver channel reaches the chest and, of course the

legs--is the acne mostly at the inner thighs, near the crotch? Could

the night time urinatation be a slight Qi Lin Syndrome--really more

like feeling like one needs to urinate, even when empty--

unsatisfying urination? Any " prostate " type difficulty? Has he ever

had blood in the urine? (Qi Lin with blood stasis?).

 

If any of this sounds familiar, try Tao Hong Si Wu Tang with Jing

Jie if also with aversion to wind and cold/wind cold allergy

symptoms; Zhi Zi with red tongue tip, irritability; Shi Wei, Xiang

Fu, Hua Shi, Dong Kui Zi, Fu Ling with Qi Lin--damp tends to

stagnate with Qi so can add Qian Shi, Bi Xie etc for that thick

coating at the back of the tongue. I left Shu Di out of the mix for

now since my patient also had the thick coating at the root and

active Lin Syndrome. See Manual of Dermatology in

by Shen De-Hui, Wu Xiu-Fen and Nissi Wang for this and more

differentiations on acne. Macciocia has a good Lin Syndrome

discussion in his big gold book, Treatment of Disease with

Traditional (?).

 

I currently have a female patient with a very similar presentation

(rosacea/Lin Syndrome) and this is what I have come up with. Not

sure about results yet (I gave her the herbs yesterday). I'm a

beginner too so, having said all this, here's the big grain of salt

to go with it :-). Funny how these things come up in synchrony, no?

Maybe 'tis the season.

 

Good Luck, Shanna

 

Chinese Medicine , " Lori Barns "

<loribarns@e...> wrote:

>

> Greetings,

>

> Have been quietly listening for a while. I have only been

practicing for a couple of years, a small practice. Thought that

someone out there might be able to give me some guidance on a

difficult case. (At least difficult to me, this is my first

dermatology case that I have treated, counting my experience in

school.)

>

> He is a physically fit 45 year old male, approx 25 year history of

severe acne. Appears mostly on his face, some small outbreaks on

chest and legs, none on his back. He is usually cold to the touch,

hates cold weather. Functions best on a restricted diet, staying

away from red meat, oils, certain fruits and vegetables. This diet

was prescribed by a practitioner of Korean constitutional

acupuncture, who told him he was a " Hespera " and that his Liver

was " almost dead. " Experiences night time urination, awakening 2 to

3 times per night. The only other physical symptom is some low back

stiffness upon awakening that goes away with movement. He works with

another holistic practitioner that does some Kinesiology with him,

was told that he was healthy except for needing some emotional

release, which he did. Was told by an endocrinologist about 10 years

ago that he had twice the testosterone of a teenager.

>

> Tongue is swollen, pale with a purplish tine, coat is thin white

(some greasy white at the base of tongue the first time I saw him,

have only seen him twice). Pulse is weak and thin, especially on the

left guan and chi positions. Abdomen shows tenderness on left side

along ribs.

>

> Most pattern differentiation that I have looked up talks up heat

in the stomach, or damp heat. Neither his tongue or pulse show heat.

I suspect a kidney/liver yin deficiency from his pulse, but there

seems to be very few symptoms to confirm this.

>

> Any thoughts?

>

> Lori Barns, L.Ac.

>

>

>

[Guest guest]

David Akrish wrote:

> Hi Lori,

>

> How are you? Well I hope!

>

> I work a lot of severe acne cases and would be glad to give you some

> ideas off thread if you don't mind. You can relay a work URL to me

> if you feel comfortable. If not...the dead liver scenario sounds

> like a place to start.

 

Hi David!

 

It would be all right, and quite interesting, to post your acne cures to

the list rather than " off thread " as you put it. Unless your protocol is

" secret " like many in China, of course.

 

Regards,

 

Pete

[Guest guest]

Just a minor bit of advice on severe acne cases or similar: When weighing the

signs and symptoms to arrive at a differential diagnosis, also take family

history into account. Is there a history of similar problems in the family?

Problems with a family history of the same disorder do not need the same level

of " imbalance " to create them as would be the case in one without a family

history of the disorder. This patient may not show much heat because his

inherited constitution does not require the same level of heat as would others

w/o the family history. You still do the differential diagnosis and act on what

you find, but your expectations for success will also be slightly lower as would

be the case in one w/o a family history. In other words - there are practical

clinical distinctions between inherited and acquired (lifestyle imbalance)

disorders. - Matt

-

Lori Barns

Chinese Medicine

Saturday, September 18, 2004 6:42 AM

Case of severe acne

 

 

 

Greetings,

 

Have been quietly listening for a while. I have only been practicing for a

couple of years, a small practice. Thought that someone out there might be able

to give me some guidance on a difficult case. (At least difficult to me, this is

my first dermatology case that I have treated, counting my experience in

school.)

 

He is a physically fit 45 year old male, approx 25 year history of severe

acne. Appears mostly on his face, some small outbreaks on chest and legs, none

on his back. He is usually cold to the touch, hates cold weather. Functions best

on a restricted diet, staying away from red meat, oils, certain fruits and

vegetables. This diet was prescribed by a practitioner of Korean constitutional

acupuncture, who told him he was a " Hespera " and that his Liver was " almost

dead. " Experiences night time urination, awakening 2 to 3 times per night. The

only other physical symptom is some low back stiffness upon awakening that goes

away with movement. He works with another holistic practitioner that does some

Kinesiology with him, was told that he was healthy except for needing some

emotional release, which he did. Was told by an endocrinologist about 10 years

ago that he had twice the testosterone of a teenager.

 

Tongue is swollen, pale with a purplish tine, coat is thin white (some greasy

white at the base of tongue the first time I saw him, have only seen him twice).

Pulse is weak and thin, especially on the left guan and chi positions. Abdomen

shows tenderness on left side along ribs.

 

Most pattern differentiation that I have looked up talks up heat in the

stomach, or damp heat. Neither his tongue or pulse show heat. I suspect a

kidney/liver yin deficiency from his pulse, but there seems to be very few

symptoms to confirm this.

 

Any thoughts?

 

Lori Barns, L.Ac.