Patient with open lesions

[Guest guest]

Hi All,

 

I could really use some help with the following patient who I began treating in

late Dec '07:

 

Woman in early 30s, very healthy weight and eating and sleeping habits,

exercises regularly.Blood pressure is normal, she has rare migraines, gets

Raynaud's dz (since college) and eczema (pink, dry, itchy, stress-related, since

grad school) in winter. Her western medical tx has been at Dartmouth/Hitchcock

and Fletcher Allen.

Between 2001-2006, she experienced, 4 times, a recurring wound on her left

elbow that always began in either May or June, and would begin with redness,

increased vascularization, slowly open (over the course of a week), extremely

painful only during the time the lesion was actually opening and until it begins

to heal, would open to about 1 inch round diameter, and very slowly heal, taking

about 2 months from first redness to final healing. Once healed the skin would

be purple then fade to a brown stain, not palpable.

Beginning in Oct 2006, this opening of lesions continued on her left ankle.

She notes that while she is unaware of any trauma to her elbows, the first

lesion on her ankle was indeed in a spot that she occasionally kicks with her

other foot, although a biopsy was done which showed blood clotting and

vascularization but no evidence of trauma. Her clotting times showed normal, and

she tested negative for lupus. In November a 2nd lesion began 2 inches below the

first, took more than a month to open. Since that date she has had more than 18

new lesions, all on inner ankles (next to, above, below, or wrapping around the

malleolus) or on one or the other elbow; sometimes 2 lesions at a time. In 2005,

she had no wounds.

Her MDs are stumped; " perivascular and periadnexal lymphocytic inflammatory

infiltrate; collagen vascular Dz can't be ruled out. " They have considered

calcification and wouldn't rule out CREST syndrome or scleroderma, but a biopsy

showed no evidence of calcinosis or foreign body.

She has tried Kenalog and Triamcinolene cream with no results. In 2006,

tried Protopic which may have slightly slowed the lesion's opening; also

Minocycline, with no help. Xrays, CT scans where done and repeated, nothing

shows. In 2007 she was diagnosed with Livedoid vasculopathy, took Trental for 4

months with no help, saw a hematologist who again was stumped. Tried

hydroxychoriquine beginning Aug 2007, and in November added persantine; the

hydroxy... seems to make her feel worse, she stopped all pharmaceuticals in Jan

'08 as nothing seemed to help and most made her feel worse.

She covers the opened lesions with Duoderm and there's some question as to

whether new lesions on her ankles are opening where the edge of the Duoderm on a

previous lesion ended, but this isn't clear. She takes Advil, Aleve, Tylox

(codeine plus tylenol) as needed for pain. Her MDs want to put her on Coumadin,

which she wants to avoid.

Since I began treating her, she's had several lesions, 2 on ankles, 1 on

elbow. They begin as pink becoming red skin, very warm to touch; the center

eventually turns purple and the lesion opens from there. Once open, the area

around the lesion continues reddish-purple and warm on all sides except above,

which is cool-normal, the lesion itself looks like a circle of dead skin with a

clear ooze, sometimes slightly tinted red, no pus. She describes the pain as

strong dullish throb with sharp shooting sensations from time to time, often

accompanied by nausea. Healing can take weeks.

My diagnosis showed fast pulse, SP overfull and thready, LV very

constrained, K pulses soft and thin, the rest soft. Tongue shows teethmarks,

shallow center crack not to tip, red tip and red dots, slightly heavy light

yellow coat, thin body, slightly purple sublingual veins. She complained of

painful menstruation with clots and bad cramping, very heavy bleeding with

bright red blood, tiredness for 2-3 days following menstruation;fibrocystic

breasts; frequent urination (as often as every hour during the daytime, waking

2x/night) with occasional urgency; inconsistent bowel movements, urgent with

diarrhea post-lunch, 2-3x without urgency in AM with varying stool consistency

of loose to firm, again in the PM, and foul odor and often not formed. She

bruises easily. Dark smudges below her eyes. Plane flights may start a lesion -

she seems to get one following each flight. She is experiencing a great deal of

emotional stress from her lesions, but also from her life situation, which she

believes is adding to if not causing the lesions - she and her husband, who is

an academic specializing in a very small area of science, have found that they

hate this area and are having a hard time making friends, and have been trying

to find him another job for many years with no luck, so they're feeling trapped

and helpless.

I diagnosed spleen qi deficiency, liver qi constraint with heat and blood

stagnation, and began her on Bu zhong yi qi tang and Xiao yao san, and

Springwind's Eleuthero (all formulas in pill form, she found teas made her gag).

I also gave her Springwind's burn creme to massage into all the old lesion areas

that are brown or slightly purple, and asked her to use it also on any new area

that might appear, before it starts opening. The next time a lesion started, I

also had her take 2 weeks of Wu Wei Xiao Du Yin plus coptis.

The Wu Wei had no affect on her lesions; we tried this twice, same result

both times. The burn creme is slowly turning the old lesion skin back to a

normal color, but has had no discernible affect on new lesions. The Bu zhong,

Xiao yao and Eleuthero are doing what I expected, her moods are much better, her

bowels are mostly normal, her energy is improved, she no longer has frequent

urination, tongue coat is now normal and teethmarks are disappearing.

I put her on 3 weeks of Evergreen's Circulation SJ, followed by

GoldenFlower's Ji Xue formula to attempt to affect the blood stagnation, and all

I can say is that the most current lesion took many weeks to develop before it

began to open, but it did, indeed, eventually open. Acupuncture around the

lesions makes them feel worse for 24 hours then significantly reduces the pain,

and her most recent lesion but one healed remarkably quickly - beginning to end

was about 2 weeks rather than the usual month or so. However!

I really feel like I'm shooting in the dark at these lesions; no idea how

big a dose of Ji Xue will be big enough (she's small, 120 lbs, I have her taking

5 pills 3x day which I don't think is a big dose) or how long it might take to

make a difference, or even if it's the right approach.

Any help would be greatly appreciated. Sorry for the length!

 

---Deb Marshall

 

 

 

 

 

 

[Guest guest]

Deb,

 

Just from a quick scan through your notes, you might consider if the

condition is a type of Pyoderma Gangrenosum, which is a type of open

wound that tends to ulcerate, bleed and be very painful. These sores

heal very slowly and can occur anywhere but are more likely on the

lower legs. There is no Known cause, but it is associated with

autoimmune disease and imflammatory bowel disease, which it sounds as

if she may have. 2% of people with Crohn's disease suffer with this.

 

So this means that improving her digestive complaints may be critical

to her healing. I would consider supplementing spleen Qi, while at the

same time draining dampness, resolving fire toxin, coursing Qi and

invigorating blood.

 

An external powder of the following can be sprinkled on 2 times a day

to speed up the healing and stop bleeding.

Qing Dai

Huang Bai

Zhen Zhu

 

Good luck

Trevor

 

 

, " Deb Marshall "

<taichideb wrote:

>

> Hi All,

>

> I could really use some help with the following patient who I began

treating in late Dec '07:

>

> Woman in early 30s, very healthy weight and eating and sleeping

habits, exercises regularly.Blood pressure is normal, she has rare

migraines, gets Raynaud's dz (since college) and eczema (pink, dry,

itchy, stress-related, since grad school) in winter. Her western

medical tx has been at Dartmouth/Hitchcock and Fletcher Allen.

> Between 2001-2006, she experienced, 4 times, a recurring wound

on her left elbow that always began in either May or June, and would

begin with redness, increased vascularization, slowly open (over the

course of a week), extremely painful only during the time the lesion

was actually opening and until it begins to heal, would open to about

1 inch round diameter, and very slowly heal, taking about 2 months

from first redness to final healing. Once healed the skin would be

purple then fade to a brown stain, not palpable.

> Beginning in Oct 2006, this opening of lesions continued on her

left ankle. She notes that while she is unaware of any trauma to her

elbows, the first lesion on her ankle was indeed in a spot that she

occasionally kicks with her other foot, although a biopsy was done

which showed blood clotting and vascularization but no evidence of

trauma. Her clotting times showed normal, and she tested negative for

lupus. In November a 2nd lesion began 2 inches below the first, took

more than a month to open. Since that date she has had more than 18

new lesions, all on inner ankles (next to, above, below, or wrapping

around the malleolus) or on one or the other elbow; sometimes 2

lesions at a time. In 2005, she had no wounds.

> Her MDs are stumped; " perivascular and periadnexal lymphocytic

inflammatory infiltrate; collagen vascular Dz can't be ruled out. "

They have considered calcification and wouldn't rule out CREST

syndrome or scleroderma, but a biopsy showed no evidence of calcinosis

or foreign body.

> She has tried Kenalog and Triamcinolene cream with no results.

In 2006, tried Protopic which may have slightly slowed the lesion's

opening; also Minocycline, with no help. Xrays, CT scans where done

and repeated, nothing shows. In 2007 she was diagnosed with Livedoid

vasculopathy, took Trental for 4 months with no help, saw a

hematologist who again was stumped. Tried hydroxychoriquine beginning

Aug 2007, and in November added persantine; the hydroxy... seems to

make her feel worse, she stopped all pharmaceuticals in Jan '08 as

nothing seemed to help and most made her feel worse.

> She covers the opened lesions with Duoderm and there's some

question as to whether new lesions on her ankles are opening where the

edge of the Duoderm on a previous lesion ended, but this isn't clear.

She takes Advil, Aleve, Tylox (codeine plus tylenol) as needed for

pain. Her MDs want to put her on Coumadin, which she wants to avoid.

> Since I began treating her, she's had several lesions, 2 on

ankles, 1 on elbow. They begin as pink becoming red skin, very warm to

touch; the center eventually turns purple and the lesion opens from

there. Once open, the area around the lesion continues reddish-purple

and warm on all sides except above, which is cool-normal, the lesion

itself looks like a circle of dead skin with a clear ooze, sometimes

slightly tinted red, no pus. She describes the pain as strong dullish

throb with sharp shooting sensations from time to time, often

accompanied by nausea. Healing can take weeks.

> My diagnosis showed fast pulse, SP overfull and thready, LV very

constrained, K pulses soft and thin, the rest soft. Tongue shows

teethmarks, shallow center crack not to tip, red tip and red dots,

slightly heavy light yellow coat, thin body, slightly purple

sublingual veins. She complained of painful menstruation with clots

and bad cramping, very heavy bleeding with bright red blood, tiredness

for 2-3 days following menstruation;fibrocystic breasts; frequent

urination (as often as every hour during the daytime, waking 2x/night)

with occasional urgency; inconsistent bowel movements, urgent with

diarrhea post-lunch, 2-3x without urgency in AM with varying stool

consistency of loose to firm, again in the PM, and foul odor and often

not formed. She bruises easily. Dark smudges below her eyes. Plane

flights may start a lesion - she seems to get one following each

flight. She is experiencing a great deal of emotional stress from her

lesions, but also from her life situation, which she believes is

adding to if not causing the lesions - she and her husband, who is an

academic specializing in a very small area of science, have found that

they hate this area and are having a hard time making friends, and

have been trying to find him another job for many years with no luck,

so they're feeling trapped and helpless.

> I diagnosed spleen qi deficiency, liver qi constraint with heat

and blood stagnation, and began her on Bu zhong yi qi tang and Xiao

yao san, and Springwind's Eleuthero (all formulas in pill form, she

found teas made her gag). I also gave her Springwind's burn creme to

massage into all the old lesion areas that are brown or slightly

purple, and asked her to use it also on any new area that might

appear, before it starts opening. The next time a lesion started, I

also had her take 2 weeks of Wu Wei Xiao Du Yin plus coptis.

> The Wu Wei had no affect on her lesions; we tried this twice,

same result both times. The burn creme is slowly turning the old

lesion skin back to a normal color, but has had no discernible affect

on new lesions. The Bu zhong, Xiao yao and Eleuthero are doing what I

expected, her moods are much better, her bowels are mostly normal, her

energy is improved, she no longer has frequent urination, tongue coat

is now normal and teethmarks are disappearing.

> I put her on 3 weeks of Evergreen's Circulation SJ, followed by

GoldenFlower's Ji Xue formula to attempt to affect the blood

stagnation, and all I can say is that the most current lesion took

many weeks to develop before it began to open, but it did, indeed,

eventually open. Acupuncture around the lesions makes them feel worse

for 24 hours then significantly reduces the pain, and her most recent

lesion but one healed remarkably quickly - beginning to end was about

2 weeks rather than the usual month or so. However!

> I really feel like I'm shooting in the dark at these lesions; no

idea how big a dose of Ji Xue will be big enough (she's small, 120

lbs, I have her taking 5 pills 3x day which I don't think is a big

dose) or how long it might take to make a difference, or even if it's

the right approach.

> Any help would be greatly appreciated. Sorry for the length!

>

> ---Deb Marshall

>

>

>

>

>

>

[Guest guest]

Thanks Trevor; your treatment suggestions are what I've been doing, which is

encouraging, but the fire toxin treatment had no effect. Her bowel issues are

now mostly under control, but again, no apparent effect on incidence of lesions,

so far. Ditto with qi tonifying, damp transforming and blood moving. I'll try

some of the powder you suggested.

Anyone else have any ideas or see anything I've missed or misinterpreted?

Many thanks!

---Deb

 

 

 

[Guest guest]

Hi Deb,

 

In all honesty, I would have to say that from my clinical experience

and that of many others and teachers, unless one is using herbs at the

right dosage as that of the raw decoction form we cannot really judge

if our treatment is working properly or not. Meaning we may still have

the right Dx and formula but the herbs, quality and dosage, are just

not good enough.

 

I think skin conditions are very much like this. Often times the

conditions are stubborn and deep. Many of my prescriptions are in the

range of 150-180 grams per day. Unless you are giving the equivalent

dose in granule form (which it sounds like you are using), then I

truly believe we cannot say the herbs are the right fit or not. In

other words we cannot say that fire toxin resolvers aren't working.

These medicinals are very powerful, but need to be at the right

strength to have the right effect.

 

I understand that your patient has a gag reflux to the taste of the

herbs and so are using these pills. It may not be the fault of the

herbs or formula you are using. It just may be the way you are needing

to administer them and the dosages you are using.

 

I use E Fong granules in my practice and I do get results, but I make

sure that the doses match up, I have been disappointed otherwise.

 

Trevor

 

 

 

, " Deb Marshall "

<taichideb wrote:

>

> Thanks Trevor; your treatment suggestions are what I've been doing,

which is encouraging, but the fire toxin treatment had no effect. Her

bowel issues are now mostly under control, but again, no apparent

effect on incidence of lesions, so far. Ditto with qi tonifying, damp

transforming and blood moving. I'll try some of the powder you suggested.

> Anyone else have any ideas or see anything I've missed or

misinterpreted?

> Many thanks!

> ---Deb

>

>

>

[Guest guest]

Hi Trevor,

 

Dose size has been one of my big concerns with this patient. Other times I've

managed to get good results with pills in large doses, but there comes a time

when it feels like the patient's eating so many pills there's no room for food.

And combined with her spleen qi deficiency, the fire toxin formula was difficult

for her to digest.

Since she couldn't tolerate the taste of decoction, maybe I'll try the fire

toxin formula in granules and try administering them in applesauce or something

and see if she can get a larger dose down that way. Her spleen deficiency is

significantly better now, so maybe she'll be able to tolerate it better. She's

willing, she just may not be able. Do you have any suggestion besides Wu Wei

Xiao Du Yin plus coptis?

Thanks for your help.

---Deb

 

 

 

 

[Guest guest]

Deb,

Does the patient still have loose stools with a foul smell?

 

If so then you may look at using herbs like:

 

Si Miao San with Bi Xie to clear out damp heat from the lower jiao.

 

Ma Chia Xian to clear fire toxin and cool the blood to stop bleeding.

It is a specific for weeping skin lesions and is also good for the

intestines. Use a bigger dose of 24 to 30 grams.

 

Bai Jiang Cao to clear damp heat/ fire toxin from both the skin and

intestines and as well invigorate the blood.

 

Chi Shao to invigorate and cool blood.

 

Ze xie and Hua Shi to drain the damp.

 

Ru xiang and Mo Yao to stop pain.

 

The external powder I mentioned earlier or any other that will help to

stop bleeding and promote tissue growth will help greatly. An An

ointment may be too moist.

 

This would be a place to start from anyways. I am not sure how you

would figure out this in a pill form?? I have access to Bema herbs up

here in Vancouver who will put any granule formula that I design into

a tablet or capsule within 24 hours, pretty convenient. But I know

what it is like trying to convince people to take 20 or so pills 2

times a day, not easy!!

 

Good luck,

Trevor

 

 

 

 

 

 

, " Deb Marshall "

<taichideb wrote:

>

> Hi Trevor,

>

> Dose size has been one of my big concerns with this patient. Other

times I've managed to get good results with pills in large doses, but

there comes a time when it feels like the patient's eating so many

pills there's no room for food. And combined with her spleen qi

deficiency, the fire toxin formula was difficult for her to digest.

> Since she couldn't tolerate the taste of decoction, maybe I'll

try the fire toxin formula in granules and try administering them in

applesauce or something and see if she can get a larger dose down that

way. Her spleen deficiency is significantly better now, so maybe

she'll be able to tolerate it better. She's willing, she just may not

be able. Do you have any suggestion besides Wu Wei Xiao Du Yin plus

coptis?

> Thanks for your help.

> ---Deb

>

>

>

>

[Guest guest]

Have you considered treating Blood stasis? You might try looking at

the Xue Fu Zhu Yu Tang variations and placing a heavier emphasis on

treating stasis first and consider the Sp Qi if needed. The lesion

description sounds like Blood stagnation rather than Toxic heat since

there's no pus.

 

Geoff

 

 

, " Trevor Erikson "

<trevor_erikson wrote:

>

> Deb,

> Does the patient still have loose stools with a foul smell?

>

> If so then you may look at using herbs like:

>

> Si Miao San with Bi Xie to clear out damp heat from the lower jiao.

>

> Ma Chia Xian to clear fire toxin and cool the blood to stop bleeding.

> It is a specific for weeping skin lesions and is also good for the

> intestines. Use a bigger dose of 24 to 30 grams.

>

> Bai Jiang Cao to clear damp heat/ fire toxin from both the skin and

> intestines and as well invigorate the blood.

>

> Chi Shao to invigorate and cool blood.

>

> Ze xie and Hua Shi to drain the damp.

>

> Ru xiang and Mo Yao to stop pain.

>

> The external powder I mentioned earlier or any other that will help to

> stop bleeding and promote tissue growth will help greatly. An An

> ointment may be too moist.

>

> This would be a place to start from anyways. I am not sure how you

> would figure out this in a pill form?? I have access to Bema herbs up

> here in Vancouver who will put any granule formula that I design into

> a tablet or capsule within 24 hours, pretty convenient. But I know

> what it is like trying to convince people to take 20 or so pills 2

> times a day, not easy!!

>

> Good luck,

> Trevor

, " Deb Marshall "

> <taichideb@> wrote:

> >

> > Hi Trevor,

> >

> > Dose size has been one of my big concerns with this patient. Other

> times I've managed to get good results with pills in large doses, but

> there comes a time when it feels like the patient's eating so many

> pills there's no room for food. And combined with her spleen qi

> deficiency, the fire toxin formula was difficult for her to digest.

> > Since she couldn't tolerate the taste of decoction, maybe I'll

> try the fire toxin formula in granules and try administering them in

> applesauce or something and see if she can get a larger dose down that

> way. Her spleen deficiency is significantly better now, so maybe

> she'll be able to tolerate it better. She's willing, she just may not

> be able. Do you have any suggestion besides Wu Wei Xiao Du Yin plus

> coptis?

> > Thanks for your help.

> > ---Deb

> >

> >

> >

> >

[Guest guest]

Hi Trevor, Geoff and all,

 

Trevor, my patient reports that her foul-smelling loose stools have become

mostly normal stools; she's having fewer bowel movements per day, no foul smell,

soft well-formed with an occ loose one.Tongue no longer has yellow thick coat,

just an almost normal light white one.

 

Geoff, I am giving her blood stasis formula; because of the need to use pills, I

put her on Golden Flowers' Ji Xue formula, which was originally formulated for

chemo patients and Hep C patients who have received Interferon tx. I've treated

one Px with very bad neuropathy in the legs and feet from Interferon tx 20 years

or more ago (Viet vet), and his neuropathy is improved to the point where the

numbness and pain that used to be from knees down is now located only in the

center line of the sole of each foot; and he's regained normal sensation and

pain-free elsewhere. The Ji Xue formula apparently reestablishes

microcirculation pretty rapidly, we had clear changes after only a few weeks on

the formula and he's come this far in less than a year.

 

My concern with this formula as well as the fire toxin formula is how much to

give her, and is this the best formula under the circumstances? Part of the

problem is that her in-laws are taking them to Africa this summer for a month,

and she feels like she needs to make a decision about Coumadin in the next month

or 2 at most, so if she needs to go that route it will be regulated before she

leaves on her trip. She understands that Coumadin might not solve the problem

and would like to avoid it, but the trip is adding a pressure for speedy

results.

 

Thanks guys; eager to hear any other wisdom you can pass along.

 

---Deb

 

 

 

[Guest guest]

HI Deb,

 

I don't know this formula that you mention, but in terms of dosage I

would recommend that you figure out the amount you would give her in a

raw decoction and translate that into the granule ratio you are using.

i am just not always satisfied with results when being limited to

using already set formulas that cannot be modified and when you cannot

give a proper dose.

 

Improving micro circulation will be of great benifit, although as I

mentioned before including the proper dose of the proper type of fire

toxin resolvers with herbs to clear damp heat will also be of benifit,

especially from the description you mentioned about the oozing nature

of the lesion.

 

Take a photograph as well, these go a long way.

 

Trevor

 

 

 

, " Deb Marshall "

<taichideb wrote:

>

> Hi Trevor, Geoff and all,

>

> Trevor, my patient reports that her foul-smelling loose stools have

become mostly normal stools; she's having fewer bowel movements per

day, no foul smell, soft well-formed with an occ loose one.Tongue no

longer has yellow thick coat, just an almost normal light white one.

>

> Geoff, I am giving her blood stasis formula; because of the need to

use pills, I put her on Golden Flowers' Ji Xue formula, which was

originally formulated for chemo patients and Hep C patients who have

received Interferon tx. I've treated one Px with very bad neuropathy

in the legs and feet from Interferon tx 20 years or more ago (Viet

vet), and his neuropathy is improved to the point where the numbness

and pain that used to be from knees down is now located only in the

center line of the sole of each foot; and he's regained normal

sensation and pain-free elsewhere. The Ji Xue formula apparently

reestablishes microcirculation pretty rapidly, we had clear changes

after only a few weeks on the formula and he's come this far in less

than a year.

>

> My concern with this formula as well as the fire toxin formula is

how much to give her, and is this the best formula under the

circumstances? Part of the problem is that her in-laws are taking them

to Africa this summer for a month, and she feels like she needs to

make a decision about Coumadin in the next month or 2 at most, so if

she needs to go that route it will be regulated before she leaves on

her trip. She understands that Coumadin might not solve the problem

and would like to avoid it, but the trip is adding a pressure for

speedy results.

>

> Thanks guys; eager to hear any other wisdom you can pass along.

>

> ---Deb

>

>

>

[Guest guest]

Yes, yes! Trevor beat me to it. With all the discussion regarding

fire toxin etc - we need pictures! My complaint of TCM derm books is

they don't include pictures. I bought a Western illustrated derm

manual that is very good - but someone might do well if they had an

illustrated TCM derm book with photos of the various differential

diagnosis under a specific category.. that's if it's absolutely

necessary to categorize derm lesions under Western headings rather

than the TCM ones.

 

Geoff

 

 

, " Trevor Erikson "

<trevor_erikson wrote:

>

> HI Deb,

>

> I don't know this formula that you mention, but in terms of dosage I

> would recommend that you figure out the amount you would give her in a

> raw decoction and translate that into the granule ratio you are using.

> i am just not always satisfied with results when being limited to

> using already set formulas that cannot be modified and when you cannot

> give a proper dose.

>

> Improving micro circulation will be of great benifit, although as I

> mentioned before including the proper dose of the proper type of fire

> toxin resolvers with herbs to clear damp heat will also be of benifit,

> especially from the description you mentioned about the oozing nature

> of the lesion.

>

> Take a photograph as well, these go a long way.

>

> Trevor

[Guest guest]

Chinese Herbal MedicineHi Trevor,

 

OK, you've convinced me we've got to try the raw herbs again. Maybe if I can

convince her it's the only way we're likely to get faster results that will

affect her gag response.

 

Thank you, thank you, thank you for all the help.

 

---Deb

 

 

 

[Guest guest]

Chinese Herbal MedicineTrevor 'n Geoff,

 

I'll try to get a photo when I see her again in 2 weeks. Stay tuned...

 

---Deb

 

 

 

[Guest guest]

Geoff,

 

Mazin Al Khafi, who I did my dermatology training with, uses slides taken from

his own

clinical experience over the last 20 or so years for all his teachings. Befores

and afters and

all the many variations that a skin disease can take on. His work is amazing and

outsanding, by far the best represented clinical documentation I have ever come

across.

 

Anyways he has been working on a dermatology text book in english that will

display his

wonderful, meticulous photographs. He has been working on it for years and every

time I

meet up with him he says sometime this year, so hopefully this will be true. I

am sure the

book will be thick and full of extremely clinically useful detail.

 

Just for your information traditional dermatology as practiced in china, before

the advent

of western medicine, classified skin lesions by a disease name. The lesion was

then broken

down into its various patterns of manifestation. ie. Psoriasis or Bai Bi due to

Blood heat

and fire toxin, ect.

 

Trevor

 

, " G Hudson " <crudo20 wrote:

>

> Yes, yes! Trevor beat me to it. With all the discussion regarding

> fire toxin etc - we need pictures! My complaint of TCM derm books is

> they don't include pictures. I bought a Western illustrated derm

> manual that is very good - but someone might do well if they had an

> illustrated TCM derm book with photos of the various differential

> diagnosis under a specific category.. that's if it's absolutely

> necessary to categorize derm lesions under Western headings rather

> than the TCM ones.

>

> Geoff

>

>

> , " Trevor Erikson "

> <trevor_erikson@> wrote:

> >

> > HI Deb,

> >

> > I don't know this formula that you mention, but in terms of dosage I

> > would recommend that you figure out the amount you would give her in a

> > raw decoction and translate that into the granule ratio you are using.

> > i am just not always satisfied with results when being limited to

> > using already set formulas that cannot be modified and when you cannot

> > give a proper dose.

> >

> > Improving micro circulation will be of great benifit, although as I

> > mentioned before including the proper dose of the proper type of fire

> > toxin resolvers with herbs to clear damp heat will also be of benifit,

> > especially from the description you mentioned about the oozing nature

> > of the lesion.

> >

> > Take a photograph as well, these go a long way.

> >

> > Trevor

>

[Guest guest]

Sounds like a great resource. If you hear of any updates, please let

us know.

 

Geoff

 

, " Trevor Erikson "

<trevor_erikson wrote:

>

> Geoff,

>

> Mazin Al Khafi, who I did my dermatology training with, uses slides

taken from his own

> clinical experience over the last 20 or so years for all his

teachings. Befores and afters and

> all the many variations that a skin disease can take on. His work is

amazing and

> outsanding, by far the best represented clinical documentation I

have ever come across.

>

> Anyways he has been working on a dermatology text book in english

that will display his

> wonderful, meticulous photographs.