Guest guest Posted December 9, 2009 Report Share Posted December 9, 2009 Hi all, I have searched for a long time to find information on this very common problem. When I've heard it mentioned sometimes the phrase " adjust hormones " is suggested. What does this mean in terms of treatment principle? The patients I've seen have some PMS but usually no painful or heavy menstruation. Many are perimonopausal and it seems worse if there is a missed menses. The acne lesion is usually quite large up to 1cm, ripens to be filled with pus, warm, very painful, scaring and waxes and wanes with the cycle,usually before and during but sometimes after. There can be insomnia and irritability. The Dx in Xu Yihou's book on Dermatology of pyoderma fascial seems to fit as far as what the lesion looks like but there is no mention about it's being associated with menses, which this always is, nor of it always occuring on the chin specifically below the edges of the mouth. My best results have been with either clearing away heat in the blood and/or moving blood. If anyone knows of a source for information on this problem, I'd be really grateful. Thanks, Shanna Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2009 Report Share Posted December 10, 2009 On Wed, Dec 9, 2009 at 12:42 PM, Shanna Cowell <shannahicklewrote: > > > Hi all, > > I have searched for a long time to find information on this very common > problem. When I've heard it mentioned sometimes the phrase " adjust hormones " > is suggested. > That's because the author is trying to be better understood by a non-CM readership, but you are correct in focusing on the Liver simply because of the acne's association with the menstrual cycle. > What does this mean in terms of treatment principle? The patients I've seen > have some PMS but usually no painful or heavy menstruation. Many are > perimonopausal and it seems worse if there is a missed menses. The acne > lesion is usually quite large up to 1cm, ripens to be filled with pus, warm, > very painful, > These say " local infection " by Western standards. We can call it " heat toxin " for which I have used the formula Wu Wei Xiao Du Yin (Five Flavors to Clear Toxins Decoction). > scaring > Blood stagnation, which you're addressing with the herbs that regulate the Liver blood, though I'd focus on cool herbs such as mu dan pi, chi shao, maybe dan shen. > and waxes and wanes with the cycle,usually before and during but sometimes > after. > Textbooks prefer to see this arise before OR after, but when it cycles back and forth, I admit that it is confounding. Still, the fact that it does arise with the menstrual cycle, we gotta look to the Liver. You can also look at patterns that get into the Chong and Ren Mai as well. > There can be insomnia and irritability. > Heat can arise from anywhere and end up in the Heart. Or arise from the Heart. Heat is the climate of the fire element of course, but I would still look for red dots on the tongue in the Liver area, or a generally red tongue, maybe a thick yellow coating suggesting some food stagnation. > The Dx in Xu Yihou's book on Dermatology of pyoderma fascial seems to fit > as far as what the lesion looks like but there is no mention about it's > being associated with menses, which this always is, nor of it always > occuring on the chin specifically below the edges of the mouth. > Chin says lower jiao (or Liver), but edges of the mouth could have to do with the earth element too. > My best results have been with either clearing away heat in the blood > and/or moving blood. > That's what I'd do, but just add the toxic heat formula (or some ingredients from this formula) and I'd expect that to be of some benefit. -- , DAOM Pain is inevitable, suffering is optional. http://twitter.com/algancao Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2009 Report Share Posted December 10, 2009 Couldn't agree more with Al's clinical reasoning below. Although it may seem overly simplistic, one of the chief indications for Jia Wei Xiao Yao San ( " aka " Dan Zhi Xiao Yao San because of the addition of Mu Dan Pi + Zhi Zi) is for the blood heat which can be created through Liver Qi Depression. Most texts will list perimenstrual acne and/or perimenopause with heat signs aggravated by emotions/stress as possible indications for this formula. Also, I like the idea of Al's recommendation for the Addition of Chi Shao and Dan Shen. Dan Shen is also useful for calming the Shen in cases of Insomnia. It's said that women correspond to the the Liver because they are dominated by the Blood and the Liver stores the blood. There is, also, probably a correspondence between the Liver's association with the emotional ups and downs that early Chinese Physicians noticed occurring cyclically in women, and which we now call PMS. Possible Rx: Jia Wei Xiao Yao San + Chi Shao Dan Shen Pu Gong Ying Zhi Bei Mu Bai Zhi Chuan Xiong (Appropriate dosages apply) Good Luck, Ray Rubio, DAOM (FABORM) On Dec 10, 2009, at 10:48 AM, Al Stone wrote: > On Wed, Dec 9, 2009 at 12:42 PM, Shanna Cowell > <shannahicklewrote: > > > > > > > Hi all, > > > > I have searched for a long time to find information on this very > common > > problem. When I've heard it mentioned sometimes the phrase " adjust > hormones " > > is suggested. > > > That's because the author is trying to be better understood by a non- > CM > readership, but you are correct in focusing on the Liver simply > because of > the acne's association with the menstrual cycle. > > > What does this mean in terms of treatment principle? The patients > I've seen > > have some PMS but usually no painful or heavy menstruation. Many are > > perimonopausal and it seems worse if there is a missed menses. The > acne > > lesion is usually quite large up to 1cm, ripens to be filled with > pus, warm, > > very painful, > > > These say " local infection " by Western standards. We can call it " heat > toxin " for which I have used the formula Wu Wei Xiao Du Yin (Five > Flavors to > Clear Toxins Decoction). > > > scaring > > > Blood stagnation, which you're addressing with the herbs that > regulate the > Liver blood, though I'd focus on cool herbs such as mu dan pi, chi > shao, > maybe dan shen. > > > and waxes and wanes with the cycle,usually before and during but > sometimes > > after. > > > Textbooks prefer to see this arise before OR after, but when it > cycles back > and forth, I admit that it is confounding. Still, the fact that it > does > arise with the menstrual cycle, we gotta look to the Liver. You can > also > look at patterns that get into the Chong and Ren Mai as well. > > > There can be insomnia and irritability. > > > Heat can arise from anywhere and end up in the Heart. Or arise from > the > Heart. Heat is the climate of the fire element of course, but I > would still > look for red dots on the tongue in the Liver area, or a generally red > tongue, maybe a thick yellow coating suggesting some food stagnation. > > > The Dx in Xu Yihou's book on Dermatology of pyoderma fascial seems > to fit > > as far as what the lesion looks like but there is no mention about > it's > > being associated with menses, which this always is, nor of it always > > occuring on the chin specifically below the edges of the mouth. > > > Chin says lower jiao (or Liver), but edges of the mouth could have > to do > with the earth element too. > > > My best results have been with either clearing away heat in the > blood > > and/or moving blood. > > > That's what I'd do, but just add the toxic heat formula (or some > ingredients > from this formula) and I'd expect that to be of some benefit. > > -- > , DAOM > Pain is inevitable, suffering is optional. > http://twitter.com/algancao > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2009 Report Share Posted December 10, 2009 Shanna, You can find a number of articles on acne, including perimenstrual/premenstrual acne, at the TCMinfoline at www.bluepoppy.com. All these articles come from Chinese language Chinese medical journals. However, pattern discrimination in dermatology is simple, at least in terms of acne. Red = heat; very red-purple = heat toxins; purple = blood stasis; pustule = phlegm, dampness & /or turbidity, greasiness = dampness; dryness = blood-yin vacuity; hard subdermal nodulation = phlegm binding. Any give acne lesion is some combination of these. So you analyze the physical lesion based on these parameters, add up what you get, state the treatment principles for the patterns present, and pick Rx and meds to fulfill those principles. Further, speaking as a gynecologist, the heat associated with premenstrual acne is typically depressive heat which begins in the liver but floats up to collect in the stomach and lungs. Therefore, when choosing heat-clearing meds, make sure they clear heat from the liver/gb, stomach & lungs. Ergo, Huang Qin is a famous Chinese med for this kind of acne. In my 30 years experience, menstrual acne typically responds well to Chinese herbal medicine as long as you parse out the patterns present correctly. Blue Poppy also sells an external Chinese herbal lotion to apply topically. In CM dermatology, often it is the combination of internally and externally applied meds that really gets the job done. Last thought, be careful with clearing heat. Don't be too aggressive. There is usually some element of spleen qi vacuity involved in these cases; so you don't want to damage the spleen. Good luck and best wishes. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 11, 2009 Report Share Posted December 11, 2009 Hi Shanna, I have to agree with Al there is an emotional component and focus on the liver is necessary. I've concentrated my practice to a large extent on PMS related/dysmenorrhea issues. My main focus is the liver qi stagnation and thus moving the blood seems to make a big difference all around. Here's the formula I commonly use, standard dosages. Chai Hu Xiang Fu Bai Shao Chuan Xiong Dang Gui Yan hu Suo Chi Shao Niu Xi Mu Dan Pi Gan Cao You may need another herb or two if you've got severe heat symptoms but generally I start with this base and modify as needed. As a shameless plug, I had KPC make this formula for me in instant packets(with a couple additions) it's available at PacHerbs.com , Al Stone <al wrote: > > On Wed, Dec 9, 2009 at 12:42 PM, Shanna Cowell <shannahicklewrote: > > > > > > > Hi all, > > > > I have searched for a long time to find information on this very common > > problem. When I've heard it mentioned sometimes the phrase " adjust hormones " > > is suggested. > > > That's because the author is trying to be better understood by a non-CM > readership, but you are correct in focusing on the Liver simply because of > the acne's association with the menstrual cycle. > > > What does this mean in terms of treatment principle? The patients I've seen > > have some PMS but usually no painful or heavy menstruation. Many are > > perimonopausal and it seems worse if there is a missed menses. The acne > > lesion is usually quite large up to 1cm, ripens to be filled with pus, warm, > > very painful, > > > These say " local infection " by Western standards. We can call it " heat > toxin " for which I have used the formula Wu Wei Xiao Du Yin (Five Flavors to > Clear Toxins Decoction). > > > scaring > > > Blood stagnation, which you're addressing with the herbs that regulate the > Liver blood, though I'd focus on cool herbs such as mu dan pi, chi shao, > maybe dan shen. > > > and waxes and wanes with the cycle,usually before and during but sometimes > > after. > > > Textbooks prefer to see this arise before OR after, but when it cycles back > and forth, I admit that it is confounding. Still, the fact that it does > arise with the menstrual cycle, we gotta look to the Liver. You can also > look at patterns that get into the Chong and Ren Mai as well. > > > There can be insomnia and irritability. > > > Heat can arise from anywhere and end up in the Heart. Or arise from the > Heart. Heat is the climate of the fire element of course, but I would still > look for red dots on the tongue in the Liver area, or a generally red > tongue, maybe a thick yellow coating suggesting some food stagnation. > > > The Dx in Xu Yihou's book on Dermatology of pyoderma fascial seems to fit > > as far as what the lesion looks like but there is no mention about it's > > being associated with menses, which this always is, nor of it always > > occuring on the chin specifically below the edges of the mouth. > > > Chin says lower jiao (or Liver), but edges of the mouth could have to do > with the earth element too. > > > My best results have been with either clearing away heat in the blood > > and/or moving blood. > > > That's what I'd do, but just add the toxic heat formula (or some ingredients > from this formula) and I'd expect that to be of some benefit. > > -- > , DAOM > Pain is inevitable, suffering is optional. > http://twitter.com/algancao > > > Quote Link to comment Share on other sites More sharing options...
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