Skin Diseases in General

Traditional Classification of Skin Diseases:

Skin diseases cover a broad category of diseases. In classical texts, skin diseases were often combined together as the basic pathology and treatment principle is usually similar, depending on differential diagnosis.

Traditional classifications of Skin in the West were as follows:

• Scabs: crusty, itchy, or ulcerated skin conditions, which may include Psoriasis and Leprosy
• Scurf: dry, flaky, and scaly matter that peels off the skin or scalp. Often associated with Dandruff, it was also used for other diseases.
• Tetter: itchy, scaly, or vesicular skin diseases that form scabs or pustules; includes Eczema, Impetigo, Psoriasis, or Ringworm (tinea).
• Erysipelas: An ancient term for a severe, red, spreading bacterial infection of the skin.
• Impetigo (“to attack”): pustular skin disease or cutaneous eruptions with honey-coloured fluid; It is the same as the Impetigo known today, often as School-Sores. It is a highly contagious bacterial infection.
• Herpes: from the Greek for “creeping,” this term was used to describe spreading skin lesions, including Herpes and Shingles
• Lupus (“Wolf”): ulcerating skin condition that seemed to consume the skin
• Lichen: rough, thick, papular skin eruptions that are very itchy; a type of Dermatitis
• Morphew: used to describe spots, blemishes, or lesions or other skin discolouration, often associated with Scurvy
• Vitiligo: skin pigmentation disorder

Ayurveda has a general term Kushtha which is defined as “:obstinate skin diseases including Leprosy”

Cause

Skin diseases are generally acknowledged to be due to Blood disorder, especially Heat or Heat and Toxin of the Blood. Cases with Burning indicate excess Heat; when there is itching, Wind is involved. Weeping as is seen in ‘Wet Eczema’ indicates involvement of Damp.

Skin diseases may also be associated with Deficiency of Blood, in which case the skin is pale, the pulse weak, and the body is cold and weak. In other cases, Blood stagnation may be related. In such cases, there may be dark colored lesions, such as with nodular acne with dark purplish color.

In modern medicine, many simple skin diseases can result from bacterial infections and may be treated with antibiotics. Chronic inflammations are treated with steroids..

Differential Diagnosis:

Blood Heat: red skin lesions or rash, maybe with bleeding,
Heat and Toxin: red lesion or swellings with pus and pain
Wind-Heat: Itchy, red, raised and bleeding skin lesions
Wind-Damp: itchy, weeping skin lesions that are not red, or pale red, weeping clear fluid
Salt-Phlegm: itchy, scaly and destructive skin lesions

Humoral Differential Diagnosis:

1. Blood Humor — Hot and Moist

An excess of blood manifested in conditions that were red, hot, inflamed, and throbbing. These were acute, often febrile presentations:

• Erysipelas (ignis sacer, “St. Anthony’s Fire”): a spreading, fiery red inflammation of the skin, hot and smooth to the touch, the classic blood-excess disorder. The redness and heat directly reflected the hot, moist nature of plethoric blood.
• Rosacea: chronic redness, especially of the face, attributed to excess blood pooling in the surface vessels.
• Inflammatory Boils, Carbuncles and Furuncles: hot, red, painful, pointing — excess blood becoming corrupt and seeking exit through the skin.
• Urticaria and Erythemas: sudden red eruptions with heat.

The diagnostic indicators were: redness, warmth, throbbing, swelling, rapid onset.
Treatment was by phlebotomy, cooling diet, and avoiding hot, moist foods. Purging and Cooling medicines are used.

2. Bile Humor — Hot and Dry

Yellow bile, originating in the liver and gallbladder, produced conditions that were yellow, burning, intensely itchy, dry, and sharp:

• Herpes (herpetic conditions, meaning “creeping” eruptions): intensely burning, spreading vesicular or crusting lesions, attributed to the acrid, caustic quality of yellow bile. The term covered what we might now call shingles, impetigo, and ringworm.
• Acute Eczema, Skin Eruptions with yellow discharge: the yellow, watery, burning exudate was literally interpreted as bile reaching the skin surface.
• Psora (itching scurf): in its acute, hot, burning form attributed to yellow bile.

The diagnostic indicators were: yellow or orange tinge, intense burning itch, acrid smell, spreading character.
Treatment was by purging, avoiding hot and dry foods, cooling medicines.

3. Phlegm (Pituitous) Humor — Cold and Moist

Phlegm produced conditions that were white, pale, moist, soft, slow-developing, and relatively painless:

• Lepra (not modern leprosy but the Galenic term, covering psoriasis, seborrhoeic conditions, and chronic scaling disorders): white, scaly, thickened skin, attributed to cold, sluggish phlegm settling in the skin. Tubercles, pustules, catarrh, and nodules; all lesions that are cool, puffy, and white, were attributed to excesses of phlegm.
• Alphos (a white, non-itching scurf): specifically assigned to cold, white phlegm; one of the clearest phlegmatic skin signs.
• Leukoderma (white patches): depigmented areas attributed to phlegm displacing the normal blood colour from the skin; known today as vitiligo.
• Scrofulous skin conditions: boggy, pale swellings, sinus tracts, associated with phlegmatic constitutions. For a patient with scrofula (swellings of the lymph nodes) the Galenic physician would conclude the patient had too much phlegm.
• “Salt Phlegm” (Pituita Salsa): This is the specific concept you mention. Salt phlegm was a degenerate or corrupted form of phlegm; phlegm that had become heated, acrid, and saline through putrefaction. It was considered an intermediate state between cold phlegm and yellow bile, producing intensely itchy, weeping, crusting eruptions. It was the primary humoral fo Eczema and Atopic Dermatitis, the crusty, weeping, intensely itchy skin disease of the scalp and flexures in children especially. The saltiness referred to the sharp, stinging quality of the exudate. Salt phlegm was also invoked in Tinea capitus (scalp ringworm with crusting) and some forms of Seborrhoeic Dermatitis.

The diagnostic indicators for phlegm conditions were: pale or white colour, coldness, moistness, soft texture, slow onset, minimal pain but possible itch, pale or clear discharge.

4. Black Bile (Melancholia, Atra Bilis) Humor — Cold and Dry

Black bile was regarded as the most dangerous humour in skin disease, producing the most severe, chronic, and difficult-to-treat conditions:

• Leprosy, Elephantiasis (true leprosy/Hansen’s disease in the ancient terminology): Galen attributed the origin of leprosy to the excess accumulation of black bile in the veins, and this theory was later developed by Paul of Aegina to include two types: a lesser type from the build-up of black bile, and a more severe type when overheated yellow bile in the vessels corrupted the black bile. Leprosy was the par excellence melancholic skin disease — dark, thickening, insensate, progressive destruction of tissue.
• Cancer of the skin: Cancer was attributed to an excess of black bile concentrated in a specific area. The dark, hard, cold, spreading quality of a cutaneous tumour mapped precisely onto black bile’s qualities.
• Psoriasis (in its chronic, severe form): In the Greco-Arab tradition, psoriasis (called Juzam or Taqashshur al-Jild) was considered to be caused by khilt ghair tabai sauda — abnormal or unnatural melancholic humour — and characterised by roughness of skin, severe itching, and peeling of large round scales like fish scales.
• Chronic Melancholic Ulcers: dark-edged, slow-healing, indolent skin ulcers with dark, thin discharge.
• Vitiligo (in some accounts): the darkest, most entrenched depigmented patches attributed to black bile destroying the normal complexion.
• Alopecia areata: patchy, cold, dry hair loss on the scalp attributed to melancholic humour drying the roots.

Summary of Humoral Differential Diagnosis

Treatment

In cases of Heat and excess, Bloodletting is very useful.
In cases of Heat, Bile or Excess, Purging is used.
Purging and cleansing medicines appropriated to the Humor involved are used.
In many cases, medicines that clear Heat or Heat and Toxin form the Blood are used.

See also

Acne
Boils and Abscesses
Eczema & Psoriasis
Vitiligo, Leucoderma
Ringworm & Tinea
Materia Medica for Skin Diseases

Primary Herbs for Skin Diseases

Secondary Herbs for Skin Diseases

Ayurvedic Groups for Skin diseases

Kushthaghna is the Ayurvedic Herbal group used for obstinate and chronic Skin diseases:
Acacia catechu, Chebulic Myrobalan, Emblic Myrobalan, Turmeric, Semecarpus anacardium, Echites scholaris bark, Cassia fistula, Nerium odorum, Embeila ribes, Jasminum grandiflorum leaf

Kandughna is the group used to cure Pruritus:
Red Sandalwood, Andropogon muricatum, Cassia fistula, Pongamia glabra, Melia azadirachta, Holarrhena antidysenterica, Mustard seeds, Licorice, Barberry bark, Cyperus rotundus

Differential Diagnosis and Treatment

Wind and Heat

Wind and Heat typically is an acute condition, however in certain skin diseases it can become chronic. The main signs include both redness and itchiness. It can come as a result of an allergic reaction from contact Dermatitis or may be associated with Eczema, Psoriasis, Pruritus, Hives, Vitiligo etc.

Simples:

Compounds:

Wind and Phlegm / Damp

Some skin conditions manifest without redness or inflammation. There maybe itching and oozing clear fluid. This is seen in some forms of Dermatitis and Eczema.

Simples:

Compounds:

Heat and Toxin

Heat and Toxin refers to a toxic state of the Blood. The skin often looks ‘dirty’ and may be prone to spots, inflammations and rashes. The tongue will be red with a dirty coat. The pulse is fast and big. Toxic heat often makes the person feel ‘sick’ with Headache and a general feeling of being unwell. In acute and severe conditions, there may be Fever.
This may be seen in various skin diseases such as Acne, Boils and Carbuncles, Dermatitis, Eczema, as well as Syphilis and the early stages of diseases like Leprosy.

Simples:

Compounds:

Damp-Heat

Damp-Heat is similar to Heat condition except that there is more fluid associated. So there will be redness, fast pulse and maybe fever, but with signs of Damp such as Diarrhea, Yellow Urine etc. In skin conditions, Damp-Heat has yellow fluid or weeping of fluid. This is seen in conditions such as Acne, Boils, and Moist Eczema.

Simples:

Compounds:

Blood Heat

Blood heat causes red, inflamed lesions but with less signs of toxic heat, but signs of Blood-Heat. The skin complexion is high, red cheeks, and a full and strong pulse. Females will have strong periods and thick hair.
Blood Heat is generally a deeper condition than Toxic-Heat or Damp-Heat. It also can be associated with Hormones, for example the premenstrual or menopausal acne some women experience. It can be associated Acne and Boils, but also with more obstinate skin diseases such as Eczema, Psoriasis.

Simples:

Compounds:

Melancholy

Melancholy is also associated with more severe and obstinate skin diseases. Nodular, scarring and fibrotic skin diseases are associated with Melancholy. Leprosy and Elephantiasis were the classical Melancholy diseases of the skin. But also nodular and cystic types of Acne are of this type. The complexion is dull or dark, the tongue dry or with a dry, dirty tongue coat. The pulse is low and weak.

Simples:

Compounds:

Blood Stasis

Blood stasis is seen in cases with dark, purplish discoloration. For example, some cases of Acne and Boils are very dark around the perimeter. The lips, tongue and nail beds will be dull or purplish, the pulse tends to be choppy.
This can be noted in Acne and Boils, but also in some cases of other skin diseases such as Eczema where there is slowness to be relieved with dark scarring.

Simples:

Compounds:

Special Formulas

‘Obstinate Skin Diseases’

In Ayurveda and Tibetan Medicine, there is a class of diseases called ‘Obstinate Skin Diseases’. This refers to chronic and obstinate skin diseases which includes Psoriasis and Leprosy. They are classed together as their etiology and treatment is often similar, the formula used being applicable to various obstinate and chronic skin diseases.
Bezoardic Powder of Viper
Arab Confect Purging Melancholy (Confectio Hamech)
Garuda 5 (Khyung Lnga) (Tibetan Medicine)
Wish-fulfilling Jewel (Bsam phel nor bu) (Tibetan)
Manjistha Kvatha (Madder Decoction)

Research:

1. The efficacy and safety of herbal combination of Unani Medicine in chronic urticaria: A randomized, controlled study