Integrated Traditional & Western Medicine:
The Gut is the Seat of Skin Disease
By Angela Carroll Adv. Dip. H.Sc. (Nat.), Adv. Dip. H.Sc. (Acu.), Adv. Dip. H.M.
The Skin: A Sentinel of Imbalance
The skin, being the exterior of the body, pertains to Yang. It has the function of protecting the body from exterior pathogenic factors. The health of our skin is dependent on the health of the Lungs, the Stomach, the Liver and Gall Bladder, the Large Intestine, the Kidney, the Blood and the presence of Heat and Wind. Skin is not only a protector, it is also a significant sentinel of imbalance; it warns us when there is anything wrong or out of balance within other organs and tissues. Therefore, to treat skin disorders, we, as Practitioners, must understand and correct any imbalances to restore order, allowing our skin to better do its job of protecting us.
Interestingly, the health of the organs and tissues that determine skin health is determined by the health of just one area of our body: our gut! Essentially, the gut is the seat of skin disease. In this article, we will be reviewing the factors that impact on gut health, giving you an insight into the underlying drivers of skin disease – particularly allergic skin disease. This deeper understanding will allow you to put in place a more comprehensive treatment protocol for patients with eczema and other atopic skin conditions.
The Many Faces of Allergy
Allergy is an immune-mediated inflammatory response to common environmental antigens that are otherwise harmless. These reactions can occur in almost any tissue, including the skin. Eczema is the most common allergic skin condition and has been described as the cutaneous manifestation of the same immunological dysfunction that gives rise to asthma, food allergy and allergic rhinitis. These conditions are all characterised by increased serum immunoglobulin E (IgE) levels and peripheral eosinophilia, and are, therefore, classified as IgE-mediated allergic conditions.
There are two types of allergic reactions: IgE-mediated reactions, which occur within minutes to a few hours after exposure, and non-IgE-mediated reactions, in which symptom appearance may occur hours to days after antigenic exposure. Eczema is most commonly an IgE-mediated reaction, but may occur as a result of a combination of both types of immunological responses. With either of these types of reactions, however, the health of the gut needs to be the focus of your treatment strategy.
The Gut Regulates Immunity
There is a very strong physiological correlation between the gut and the immune system. Much of our regulatory immune function resides in the digestive tract, and gut dysfunction can detrimentally affect immune function. For example, when there is inflammation in the gut, the immune system becomes imbalanced, often skewing to a T-helper 2 (Th2) dominant profile, which causes allergies. For details, please see the article “Eczema - a Chinese medicine perspective” in this newsletter.
Inflammation in the gut can be due to factors such as stress, poor dietary and/or lifestyle choices, dysbiosis and/or leaky gut, certain medications and poor digestion. Treating these driving factors is therefore important, as is restoring health and balance to the gut and related immune organs. Using formulas such as Bu Zhong Yi Qi Tang [Ginseng and Astragalus Combination] reduces the inflammation in the gut and helps to rebalance the allergic immune profile by reducing elevated Th2 levels.
The Relationship Between the Gut and the Lungs
In TCM, we say that the Spleen produces Damp and the Lungs store Damp. Modern research has confirmed this. All the mucous membranes in the body are intimately connected – what happens in the gut affects the Lungs and vice versa. One of the classic features of excessive Damp is a state of inflammation; therefore, inflammation, induced by a damaged gut, will induce inflammation and mucus production in the Lungs, causing eczema and asthma. So, too, we find that inhaled allergens or irritants like cigarette smoke will cause inflammation in the Lungs and induce a systemic inflammatory response, again seen as eczema and asthma. As the Lungs moisten the skin, treating the Lungs with a formula like Su Zi Jiang Qi Tang [Perilla Fruit Combination] is an effective way to moisten a Wind-Heat eczema pattern.
The Relationship Between the Gut and the Liver
The dispersing action of the Liver is strongly affected by toxin build up and an inability to clear toxins, and an under-functioning gut increases the toxic load delivered to the liver significantly. The gut detoxifies approximately 25% of toxins we are exposed to, and, essentially, every toxin molecule the gut effectively deals with is one less toxin the liver and kidneys have to process. If gut wall integrity is compromised due to leaky gut, inflammatory cytokines and toxins are carried directly to the liver via the portal vein, placing the liver under increased toxic load and contributing to the development of pathologies involving Heat, Wind and Stagnation – all of which can manifest as eczema. In these cases, formulas such as Jia Wei Xiao Yao San [Bupleurum and Peony Formula], Long Dan Xie Gan Tang [Gentiana Combination Formula] or Yi Gan San [Bupleurum Formula] may be considered.
Note: A significant component of Liver function, as understood by TCM, is translated in Western Medicine to the nervous system, which is addressed below.
The Relationship Between the Gut and the Kidneys
The Kidneys are interesting in TCM with regard to the skin because they control water regulation. This action relates to our ability to clear toxins and to maintain a healthy blood pH. For the kidneys to effectively clear toxins from the body, urine needs to be neutral to slightly alkaline – a urinary pH below 6.0 results in a build up of circulating toxins. An increase in inflammation due to poor gut health lowers blood pH and puts added stress on the kidneys, predisposing a patient to toxin build-up and skin disorders. Diuretic formulas, such as Zhu Ling Tang [Polyporus Combination], can be useful in the management of Damp-Heat eczema due to its effects on the Kidneys, helping increase toxin clearance.
The Relationship Between the Gut and the Blood
Blood carries nutrients and oxygen to the skin and carries toxins and metabolic waste products away from the skin. How effective the Blood is at doing these tasks depends on the quality and quantity of the Blood. Gut function can affect both of these. For example, poor digestive function limits the amount of nutrients absorbed from our diet and impairs the breakdown of the macronutrients. Since red blood cell quality relies on adequate protein, vitamin B12, folate and iron consumption and absorption, impaired digestive function can impair Blood formation. Low stomach hydrochloric acid levels and reduced pancreatic protease production impairs key nutrient absorption and results in inadequate levels of protein, iron and vitamin B12 being available for blood production, reducing the quantity and quality of Blood.
Further, reduced digestive capacity reduces our ability to digest proteins and break dietary proteins down into small di- and tri-peptides. Peptide chains longer than three amino acids are recognised by the immune system in the gut as allergenic substances. The presence of these undigested peptides in the lower digestive tract will induce an allergic inflammatory reaction which we see as a Damp manifestation. To improve the quality of the Blood, Si Wu Tang [Dang Gui Four Combination] is an effective option, and to improve Stomach and Spleen function to enhance absorption of nutrients and ensure effective protein break-down, Xiang Sha Liu Jun Zi Tang [Saussurea and Cardamon Combination] may be considered.
The Relationship Between the Gut and the Nervous System
The gut and the nervous system are intimately connected, with gut health impacting on nervous system activity and the nervous system impacting on gut function. TCM has long recognised these connections, as seen in the diagnosing terms of “Phlegm misting the Mind”, “Phlegm blocking the Heart orifices”, “Liver Qi stagnation”, “Liver Qi invading Spleen”, “Liver Fire”, “Liver Yang rising”, and so on. Some of these drive common skin disorders and need to be considered in patients to achieve resolution.
It is interesting to note that the immune systems of those with eczema are more reactive to the effects of stress than the immune systems of those that are healthy. Stress induces changes in these atopic individuals that include increases in eosinophil levels. Clinically, this means that atopic individuals will have a propensity to more pronounced allergic responses in times of stress. By strengthening the gut and conditioning the nervous system we are going to be able to reduce this hyper-reactive response and reduce the incidence of eczema flare-ups in times of stress. Suan Zao Ren Tang [Zizyphus Combination], Gan Mai Da Zao Tang [Licorice and Jujube Combination], Jia Wei Xiao Yao San [Bupleurum and Peony Formula] or Gui Pi Wan [Ginseng and Longan Combination] can all be recommended, depending on the patient’s presenting pattern.
More Than Skin Deep...
Whenever we are faced with the task of managing patients with skin disorders, and, in particular, those with allergic skin disorders, it is prudent to remember the appearance and location of the presentation is the body’s way of letting us know what the real problem is and where it lies. Understanding the message the body is giving us and choosing the appropriate formula to correct the imbalance(s) driving the skin condition is the only way to achieve exceptional clinical results for patients with skin disorders.
*Reproduced with kind permission from Health World Limited - Australia and New Zealand
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