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H
erbal Medicine
 
A chronic and recurrent disease characterized by dry, well-circumscribed, silvery, scaling papules and plaques of various sizes.

This is a common skin disease of unknown cause affecting up to 3% of the population. Onset is usually before the age of 20, but all age groups are affected. The severity of this condition can vary from 1 or 2 lesions to a body-wide spread, from a benign cosmetic source of annoyance to a physically disabling and disfiguring affliction. General health is not usually effected, unless associated with arthritis. It is not overstating the situation to say that in extreme cases it may be life-ruining, physically, emotionally and economically.

Psoriasis usually develops slowly, following a typical course of remission and recurrence. The characteristic plaques are sharply demarcated, usually not itching, red and raised, covered with silvery scales, that easily bleed. These lesions will heal without leaving scar tissue or effect hair growth. The nails may develop pitting. Some patients have a tendency to develop psoriasis at the sites of physical trauma or irritation (Koebner phenomena). Common sites for psoriasis are:
  • bony prominences (knees, elbows, sacrum),
  • scalp
  • external ears
  • nails, eyebrows
  • back, buttocks and occasionally generalized on the trunk
  • skin folds e.g. umbilicus

Some cases are associated with severe arthritis, called psoriatic arthritis, much like rheumatoid arthritis. This common skin problem is not contagious in any way. To develop a therapeutic approach to this intransigent condition, it is important to understand the processes that underlie the turnover of cells in the skin.

Cell turnover in the skin.
The epidermis is entirely cellular. The innermost cells, called basal cells, are polygonal. They have fibers fixed to small intracellular structures, called desmosomes, that link the cells together. The basal cells divide rapidly, forcing the daughter cells toward the skin surface. Basal cells also synthesize keratin, an inert protein found in hair and nails. The synthesis continues in the daughter cells, so that keratin fills the cells near the surface. The dead surface cells are simply remnants, having lost their nucleus and much of their internal structure. As they are shed, they are replaced by cells from below. Although outer epidermal cells absorb water readily, the deeper cells are watertight. The tree-like melanocyte cells in the deeper epidermis produce a dark brown pigment called melanin. The pigment is introduced into nearby cells through the "branch tips" of the melanocyte cells, in units called melanosomes. A third type of epithelial cell, the Langerhans cell, functions in immune responses of the skin. The epidermis lacks blood vessels and obtains its nutrition by diffusion from capillaries in the dermis. It is well supplied, however, by nerve endings that branch between the epidermal cells.

In normal skin, the time necessary for an epidermal cell to go from creation to shedding or scaling is about 28 days; psoriatic cells complete the process in 3 or 4 days, almost 9 times faster than usual. However, there appears to be no loss of normal regulatory mechanisms of cell division. Thus there can be an enormous buildup, inadequate maturation, and finally plaque formation from the cells so affected. Much of psoriasis therapy is directed towards non-traumatic removal of the plaques as well as easing any attendant discomfort.

Etiology
The underlying cause of the rapid epithelial cell turnover, characteristic of psoriasis is not known. Theories abound and vary depending upon the practitioners particular belief system. Thus some view it as have mainly nutritional cause, others invoke stress and psychological factors, whilst the reductionist inclined put it down to genetics. There is undoubtedly some immune system involvement, leading some authorities to describe psoriasis as an auto-immune condition. It is common for a flare up or worsening to accompany infection, especially upper respiratory. Environmental factors such as injury, stress, climate (cold) are important in some patients. About a third of patients have spontaneous remissions of their disease.

This is a classic example of where an holistic perspective is essential, exploring as many aspects of the individuals life as possible.

Actions indicated for the processes behind this disease ~

Alteratives
are as important here as in all internally caused skin problems. In practice it is often the rooty `hepatic alterative' that work best.

Anti-Inflammatories, as with eczema, if applied topically and taken internally they will speed the curative work of the alteratives, but not replace them. They are most helpful during periods of flare up and exacerbation

Lymphatic Tonics are important from the perspective of helping the internal environment be as healthy as possible.

Nervine Relaxants help with the commonly associated problem of anxiety, and will ease discomfort in the skin because of the relaxing effect upon the peripheral nerves of the autonomic nervous system. This will reduce itching, and even inflammation to some extent.

Diuretics are important in ensuring adequate elimination through the kidneys.

Hepatics will contribute their special support for liver function and the digestive process.

Vulnerary herbs will support the healing of skin lesions when applied topically, but are not as effective as one might think. Remember that there is no wound to heal.

Astringents, used topically, may help in reducing redness, heat and itching through a local vaso-constrictive effect.

Emollients help in the process of scale removal.

Anti-Pruritics may help used topically, but itching is not a major factor in psoriasis.

Diaphoretics have been suggested as a way of increase circulation in the skin, thus promoting elimination and, in theory, general skin health. However, they can aggravated the problem in some people because of local over stimulation, increasing cell replication rates and thus desquamation.

This is not a major contra-indication, but be aware of it.

Specific remedies ~
Many different herbs have been described as specific for the common skin problem, depending upon local botany and cultural preferences. However, it must be said that there are probably no true specifics here. This is only to expected if the multi-factorial, systemic roots of psoriasis are considered. Some people respond incredibly well to one herbs whilst others show non at all. This can prove both challenging and frustrating for the practitioner, let along the patient!

As opposed to eczema, the woody, hepatic alteratives are the closest we have to specifics for here. Herbs that would be included in this group include:

Arctium lappa -- Berberis aquifolium
Rumex crispus -- Smilax spp.


Of course, any of the other alteratives may prove specific in any one individual. Of the leafy alteratives, remember:

Galium aparine -- Larrea divaricata -- Scrophularia nodosa
Trifolium pratense -- Viola tricolor -- Urtica dioica


There are an abundance of relevant herbs for topical application. An important factor is the lifting and removal of scales, whilst reducing local inflammation. This often means that the form of the application is as important as any remedies it contains. Choice of topical form should be governed to some extent by the personal preference of the patient, often necessitating experimentation. Plants that are widely used include:

Calendula officinalis -- Stellaria media T-- huja occidentalis
Plantago spp. -- Populus candicans


For details of herbs and considerations about the appropriate form of topical applications, please refer to the relevant section.

One possible prescription for psoriasis ~
Arctium lappa
Rumex crispus
Galium aparine
Scutellaria spp.
equal parts to 5ml of tincture three times a day
Urtica dioica or Galium aparine
an infusion of the fresh herb drunk 2 or 3 times a day.

This combination for internal use supplies the following actions:
  • Alterative ~ Arctium lappa, Galium aparine, Rumex crispus, Urtica dioica
  • Lymphatic Tonic ~ Galium aparine, Urtica dioica
  • Nervine Relaxant ~ Scutellaria spp.
  • Anti-Inflammatory ~ Galium aparine
  • Diuretic ~ Arctium lappa, Galium aparine, Urtica dioica
  • Hepatic ~ Arctium lappa, Galium aparine, Rumex crispus

One possible prescription for psoriasis with much anxiety and tension ~
Arctium lappa
Rumex crispus
Galium aparine
Valeriana officinalis
Verbena officinalis
equal parts to 5ml of tincture three times a day
Matricaria recutita an infusion of drunk as desired

Note the inclusion of Vervain as part of the nervine component. Why? This combination for internal use supplies the following actions:
  • Alterative ~ Arctium lappa, Galium aparine, Rumex crispus, Urtica dioica
  • Lymphatic Tonic ~ Galium aparine, Urtica dioica
  • Nervine Relaxant ~ Valeriana officinalis, Verbena officinalis
  • Anti-Inflammatory ~ Galium aparine
  • Diuretic ~ Arctium lappa, Galium aparine, Urtica dioica
  • Hepatic ~ Arctium lappa, Galium aparine, Rumex crispus, Verbena officinalis

One possible prescription for intransigent, unresponsive psoriasis ~
Arctium lappa 2 parts
Rumex crispus 2 parts
Smilax spp. 2 parts
Phytolacca decandra 1 part
Valeriana officinalis 1 part 5ml of combined tinctures 3 times a day
Urtica dioica or Galium aparine
an infusion of the fresh herb drunk 2 or 3 times a day.

Care must be taken with this combination, and is not advisable for children, because of the inclusion of Poke. This combination for internal use supplies the following actions:
  • Alterative ~ Arctium lappa, Galium aparine, Phytolacca decandra, Rumex crispus, Smilax spp, Urtica dioica
  • Lymphatic Tonic ~ Galium aparine, Phytolacca decandra, Urtica dioica
  • Nervine Relaxant ~ Valeriana officinalis
  • Anti-Inflammatory ~ Galium aparine
  • Diuretic ~ Arctium lappa, Galium aparine, Urtica dioica
  • Hepatic ~ Arctium lappa, Galium aparine, Rumex crispus, Smilax spp.

One possible prescription for a patient with psoriasis & hypertension ~
Arctium lappa 2 parts
Rumex crispus 2 parts
Galium aparine 2 parts
Valeriana officinalis 1 part
Crataegus spp. 1 part
Tilia spp. 1 part
Achillea millefolium 1 part 5ml of combined tincture 3 times a day
Matricaria recutita, Tilia spp. or Trifolium pratense
an infusion drunk as desired
Allium sativum should be used as a dietary supplement.

This is designed for a case where the hypertension is not the primary concern, thus the main bulk of the dose is alterative rather than hypotensive.. This combination for internal use supplies the following actions:
  • Alterative ~ Arctium lappa, Galium aparine, Phytolacca decandra, Rumex crispus, Smilax spp, Urtica dioica
  • Lymphatic Tonic ~ Galium aparine, Phytolacca decandra, Urtica dioica
  • Nervine Relaxant ~ Tilia spp., Valeriana officinalis
  • Anti-Inflammatory ~ Galium aparine
  • Diuretic ~ Achillea millefolium, Arctium lappa, Crataegus spp., Galium aparine, Tilia spp., Urtica dioica
  • Hepatic ~ Allium sativum, Arctium lappa, Galium aparine, Rumex crispus, Smilax spp.
  • Hypotensive ~ Achillea millefolium, Allium sativum, Crataegus spp., Tilia spp., Valeriana officinalis

Broader Context of Treatment
There are many non-herbal factors for the practitioner to be aware of, and be ready to inform the patient about. This is a condition where empowerment becomes vital. The patient carries around the label psoriasis `sufferer', so they suffer. They are often told little about the range of simple nursing techniques that would make their skin experience easier.

The skin is an interface between the person and their world. It senses and expresses. Psoriasis impacts the individuals experience of being in their world in two broad ways, physically and psychologically:
  • The physical distress makes being at ease difficult.
  • The psychological trauma of feeling `disfigured' may lead to social isolation and depression.

The therapist must be prepared to help and advise with these areas as well as the purely herbal issues. Stress management is crucial, and will ideally be part of a re-evaluation by the patient of their life-style, personal goals and vision.

For the majority of people with psoriasis, exposure to sun-light can alleviate the conditions and sometimes clear it. Unfortunately we have disrupted our environment so much it is no longer to be recommended due to potential damage from UV light let through by the depleted ozone layer.

The Dead Sea is still environmentally safe because it is so far below sea level. Here a quality of UV light occurs, not found anywhere else on the planet. The additional air that the light passes through has the effect of filtering more of the harmful spectrum out. Additionally there are the salts of the sea itself. (This does not take into account possible human dangers, such as war!)

Much of the nutritional advice available for this condition is contradictory. With different patients I have seen success with both a grapefruit fast and a no citrus diet! Psoriasis is the epitome of the `holistic' disease, it being almost impossible to generalize and where specifics of diet must be based upon the individual, not the pathology.
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About The Author
Whilst working in conservation and lecturing in ecology and the eco-crisis for the University of Wales, David Hoffman became convinced that to heal the world, to embrace planetary wholeness and responsibility for it with hope, he as an individual had to be whole within himself....more
 
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Disclaimer: The information provided on HealthWorld Online is for educational purposes only and IS NOT intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek professional medical advice from your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.