Internal treatment of skin problems will often be relevant, but it may be appropriate to also apply herb externally for local effects.
As with the musculoskeletal system, the skin is often the focus for manifestations of systemic illness. For the phytotherapist, it should come as no surprise that alterative herbs are again the cornerstone of any fundamental healing transformation. The therapist is continually faced with the challenge of selecting appropriate alteratives for given individuals. Because of its focus on secondary actions and system affinities, our herb selection model often helps, but sometimes it is not the answer.
I have found the following generalization to be helpful. Bear in mind that as with all generalizations, there are many exceptions. However, it is possible to broadly group alterative herbs according to their botany and their impact on elimination.
Table Alteratives Grouped by Plant Part and Route of Elimination
|PLANT PART USED||PRIMARY ELIMINATION PATHWAY/ACTION||HERBAL EXAMPLES|
|Leaf||Kidney/diuretic||Galium aparine, Trifolium pratense, Urtica dioica|
|Root, rhizome, wood||Liver/hepatic||Arctium lappa, Mahonia aquifolium, Rumex crispus|
Herbs for Topical Application
Herbs offer a range of actions that directly impact the skin, and can be applied directly by choosing the most relevant method. Stellaria media (chickweed), for example, is an extremely effective remedy for the relief of itching. The only itching for which it offers little relief is that due to jaundice. It is most effective in a nongreasy form, such as a bath, fomentation, poultice, lotion, or cream.
Herbal actions useful for topical application can be divided into two broad groups.
1. Actions that exert specific local effects on areas of skin to which herbs are applied include anti-inflammatory, antimicrobial, antipruritic, astringent, emollient, rubefacient, and vulnerary.
2. Actions intended primarily for internal effect but enter the body via absorption through the skin potentially include all herbal actions. However, alterative actions have been most commonly applied in this way.
Table Herbs and Actions for Topical Use
|Antipruritic||Calendula officinalis, Hamamelis virginiana, Hypericum perforatum, Stellaria media|
|Anti-inflammatory||Calendula officinalis, Hypericum perforatum, Matricaria recutita, Plantago spp, various anti-inflammatory essential oils|
|Emollient||Althaea officinalis, Malva sylvestris, Symphytum officinale, Ulmus rubra|
|Astringent||Achillea millefolium, Geranium maculatum, Hamamelis virginiana|
|Antimicrobial||Allium sativum, Commiphora molmol, Hydrastis canadensis, strongly antimicrobial essential oils including Thymus vulgaris, Eucalyptus globulus, Melaleuca spp.|
Herbs for Topical Application: Pharmacy Considerations
The whole array of topical herbal formulations developed over the years deserves a special mention. See chapter 11 for more details on these various applications.
Baths, also known as balneotherapy, represent one of the most pleasant ways to apply medications to the skin! They are especially useful in treating widespread skin eruptions, removing crusts and scales, and relieving inflammation and itching. In short, any remedy added to a bath counts as balneotherapy. Some commonly used bath additions are:
Salts. These range from simple table or Epsom salts to the therapeutically important salt from the Dead Sea.
Oils. Essential oils can be added to supply a wide range of properties. In the bath, they act through the skin but also via the nose. Fixed oils may be added to baths too, for their lubricating and softening properties.
Herbal extracts. These can be infusions, decoctions, or tinctures.
Colloidal oatmeal. This remedy can be very antipruritic and drying for conditions such as weeping eczema and psoriasis.
Fomentations and Compresses
These methods facilitate the local application of liquid formulations. They have the advantage of convenience and relative cleanliness, as compared with poultices. Infusions, decoctions, tinctures, and oils can all be applied in this way.
Poultices are similar to fomentations and compresses but instead incorporate the herb in some solid form, whether whole leaf, mashed cut herb, or any relevant plant part applied directly to the skin and held in place with a cloth.
Lotions are liquid formulations for carrying the herbs. The specific effects will depend upon both herbs and vehicle. However, no matter what remedies they contain, lotions will usually have a cooling effect due to evaporation. They rarely need to be washed off> as part will be absorbed and the rest will evaporate.
Creams are suspensions of oil in water, and can be formulated to be either greasy or nongreasy. They are primarily emollient and protective. An advantage of creams is that they do not insulate the skin too much and thus will not cause a localized increase in skin temperature. Overheating can aggravate itching in many skin problems.
An ointment is a semisolid, lipid-based application. Because fats are used as ointment bases (for example, cocoa butter and beeswax), they extract plant constituents well. In addition, the fats soften at skin temperature and thus make the extracted material available to the skin. Like creams, ointments and salves are emollient and protective, but they remain on the skin longer. This tenacity will confer a local warming effect.
A paste, or a mixture of powder in an ointment base, is a traditional pharmaceutical formulation that is, unfortunately, becoming rare. This is largely a matter of convenience for dispensers, because they can be very time-consuming to make. Pastes are indicated when the goal is to keep the effects of the herbs on the surface for extended periods of time. Their contents are not absorbed well, but do impact the skin surface. They are useful in conditions such as psoriasis, in which they facilitate the removal of scales.
These are dry, finely powdered herbs or minerals. Examples include colloidal oatmeal, Lycopodium powder, cornstarch, and various clays. Their primary benefit is that they take up moisture — for example, perspiration or exudates of eczema. They can also be antipruritic and antimicrobial.