Chinese medical dermatology, some history and perspective.

Chinese medicine has treated the complexities of skin disease for literally thousands of years, and the practice of dermatology may in fact be one of its oldest specialties. In the Zhou Li (Book of rites), written around 300 BC, physicians were divided into various categories; veterinarian, dietician,  internal disease, and external disease (Wai Ke, or dermatology/ surgery). Apparantely, external medicine doctors held the highest rank. [A]

Specific treatments for the diseases of the skin, like cellulitis, furuncle and carbuncle appeared not long after in the Huang Di Nei Jing (Yellow Emperor’s Internal Medicine), written around the 2nd century BC. The methods discussed are related more to acupuncture and moxibustion, than to herbal medicines.

The first materia medica, or herbal medicine encyclopedia, that we know from China is called the Shen Nong Ben Cao jing and was compiled sometime between 300 BC and 200 AD. It contains a list of roughly 365 herbs, giving common medical usages for all of them. Many of these herbs were specific to the treatment of various skin disorders, including Huang Qin (Radix scutellariae Baicalensis), which is a major herb still used in the prescriptions I write today.

“Huang Qin is bitter and balanced. It mainly treats various [kinds of] heat, jaundice, intestinal afflux, diarrhea and dysentery. It expels water, precipitates blood block, and [treats] malign sores, flat abscesses, erosion [of flesh] and burns…” [1]

Around the same time period came the famous works of Zhang Zhong Jing, the Shang Han Lun and Jin Gui Yao Lue. These classic texts formed the basis for Chinese medical theory and formula writing, with roughly 269 prescriptions being described. Amongst this work is the specific herbal treatment for different skin diseases, possibly including eczema, impetigo, and even syphilis.

“Huang lian fen (Coptis powder) treats chronic, spreading effusive sores.” [2]

While most of the early classical literature contained small elements dedicated to dermatology, many scholars agree that it wasn’t until 1263 AD that the first actual book dedicated solely to the practice of external medicine, or dermatology, appeared. It was the Wai Ke Jing Yao (Essence of Diagnosis and Treatment of External Diseases) by Chen Ziming. From this work, the modern practice of Chinese medical dermatology began.

Over time the physician’s knowledge and skill set for treating stubborn skin disorders expanded into different currents, or schools, of practice. The traditional school, as mentioned in the great book of 1617 by Chen Shigong titled, Wai Ke Zheng Zong (An orthodox Manual for External Diseases), offered a lot of new therapeutic advice for skin disease. I myself make for my patients a cream that came out of this very same book called Run Ji Gao (Flesh-moistening paste). It is extremely useful for the treatment of dry and scaly disorders of the skin, like psoriasis and eczema.

As time went on, the art of dermatology became more and more sophisticated. Physicians practicing this specialty knew full well that most skin disorders were stemming from the internal environment and as such needed internal medicines to effect a proper cure. This idea cannot be expressed more elegantly than what is written in the Lin Zheng Zhi Nan Yi An: Yang Ke (Case Guide to Clinical Symptoms: Skin Diseases), written in 1766 by Ye Gui:

“Treatment of the external must be based on the internal; treatment of the internal is also treatment of the external.” [3]

These words are made all the more clear in our modern “scientific” world, as many skin disorders are now being shown to have systemic roots; including psoriasis, atopic eczema, and acne. The simple use of topical medicines like steroidal creams are not addressing the problem deep enough.

The practice of dermatology using Chinese medicine evolved over time to be a very specific specialty indeed. The knowledge of how to properly treat skin disorders was gained through training under, or through studying the works of, accomplished Doctors who had already achieved great success. Trying to treat chronic and complicated skin problems using only the general education and literature available to the learning physician was and is very difficult. Making it very similar to the way in which modern specialty medicine is practiced today, with general physicians (GP’s) referring out to dermatologists in cases they are unfamiliar with. Thus the words of Hsu Ta-Chun, as he writes in his 1757 edition of Lost Traditions of Ancient Chinese Medicine,

“This knowledge is handed on by the teachers separately from the traditions of literary scholarship (Learning medicine through studying the main classical texts). That is to say, the speciality of external medicine (dermatology) is mostly based on specific knowledge transmitted by a teacher. To rely solely on literary scholarship – as broad as it may be – is of no use.” [4]

This sentiment is echoed by my teacher, Mazin Al Khafji, when he states,

“In order to learn how to successfully treat skin disorders, study the works of the famous doctors.”

Which is exactly what Mazin went on to do after he graduated in 1987 from a Chinese medicine university in Shanghai, China. Mazin delved into the works of one of the most famous modern dermatologists in China, the late Zhu Renkang. Through these studies Mazin has now achieved great success and over the last 25 or more years has helped thousands of patients overcome chronic skin problems. Through the proof of his extensive case studies, Mazin has trained hundreds of other doctors to achieve good success in their own clinic, including western Doctors working in major hospitals throughout Europe. Mazin was also asked by the World Health Organization (WHO) to help with the treatment of skin disease in Africa, using Chinese herbal medicine.

Chinese medical dermatology has contributed a lot to the treatment of both chronic and acute skin disease. The methods are safe, effective and usually offer good long term benefit. Over the last few thousand years, literally millions of individuals have benefited. Today, hospitals throughout Asia have major dermatology wards, whereby Chinese herbal medicine is the main treatment method. I myself trained in one at the First Affiliated Hospital of Hunan College of TCM in Chengsha, China (Picture below). I was amazed at the level of faith and dedication people held towards herbal medicines ability to treat the worst looking skin disorders one could ever imagine. A faith that was obviously based on thousands of years of great success.

Wishing you health,

Dr. Trevor Erikson

Referrences:

[A] Zhu Renkang – from the preface he wrote for Practical Traditional Chinese Dermatology by Li Lin.

[1] The Divine Farmer’s Materia Medica (Shen Nong Ben Cao Jing),  by Blue Poppy Press

[2) Jin Gui Yao Lue (Synopsis of Prescriptions of the Golden Chamber), by Shanghai science and technical publishers

[3] Dermatology in Traditional Chinese Medicine, Xu Yihou

[4] Forgotten Traditions of Ancient Chinese Medicine (The i-hsueh Yuan Liu Lun of 1757 by Hsu Ta-ch’un), translated by Paul Unschuld