Case Study & Research of Acne Rosacea Patient
The patient is a 23 year old female whose main complaint is acne rosacea, localized more on the cheeks than the nose. She has had it for almost 2 years. Currently, she is using metronidizaloe cream/gel .75% applied twice a day as treatment. In the past, courses of erythromycin and tetracycline have been tried. The antibiotics worked to some extent, but only as long as she was taking them. Her secondary complaint was tendinitis of the wrist joint, mostly on the anterior side near the carpal tunnel but no other signs of carpal tunnel syndrome were present.
Other symptoms included mild dizzy spells for the past year, generalized headaches with no specific location a few times a week, stiffness in the trapezius, trouble falling asleep, and general stress. She is slightly irritable, especially before her periods which were towards the darker side with some clots lasting for 5 days. The patient runs on the cold side, often has an insatiable thirst, yet the stools and urine were normal. Her tongue was slightly red with a normal coat, and the pulse was wiry on the left and slippery on the right.
My initial diagnosis was liver qi stagnation, which may be turning into yang rising. It is possible that this is causing the wind and heat which may be perpetually flushing her face. Initially I considered blood deficiency, but the length of her menstrual cycles with clots plus the tongue and pulse led me differently. My point selections were chosen from both the diagnosis and the research I will present below, with consideration to the fact that this is America and many of the treatments in the research wouldnít fly so well here.
The treatment involved needling the following points: Yin Tang, LI 20 to Bi Tong, LI 11, LI 4, LV 3, ST 36, ST 44, GB 20. In addition, cupping with bloodletting was applied to GV 14. As of yet the patient has only had one treatment and results are yet to be determined. Follow up treatments may include the addition of points locally for the tendinitis but immediate concentration is currently on the rosacea. Also, she is not the greatest with needles so the fewer used, the better.
An interesting thing to note is that the major pathology that acne rosacea usually falls into is one of Lung heat with Large Intestine dry. However, some discussion about the causes have stated that stagnation of Liver qi or heat in the Stomach and Spleen can also be the cause. Many of the published cases involve patients where the rosacea is concentrated in the male population, and are many times accompanied by severe constipation.
It seems almost like there are two different types of this disease. On the one hand are males, usually older than 30, which show much of the Lung heat and Large Intestine dry symptoms. Also the disease can progress further in a male to nasal rhinophoma and sometimes extended systemically. On the other you have females, ranging from 18-50, with more Liver qi stagnation symptoms where the disease goes no further than the face.
A thorough search of the major publications of oriental medicine came up with three articles which influenced the treatment protocol used here. There were another seven articles which revolved area general acne and acne vulgaris, but after reading them little was found that was relevant to acne rosacea. This was mostly because the symptoms and pathology were different enough for them to have not been relevant here.
The first study involved 32 cases that were treated with regular acupuncture along with fire-needle techniques. Most of the patients were male and the author attributed the disorder to accumulation of heat within the Lung and Stomach which manifested by attacking the nose and cheeks. The treatment protocol involved two things. The first was a treatment protocol of the points: LI 20, LI 11, TW 5, LI 4, ST 36, ST 40 and LV 3. The points were treated once a day for ten days as one course of treatment, with three days in between each course.
The interesting addition to their treatments was the use of the fire-needle which was applied to the nose mostly. Fire-needle was done by putting a needle to flame until the shaft gets red hot. It is then quickly inserted and withdrawn with one fluid motion. It was unclear as to how many times the fire needle was done per treatment.
The results of the study were extremely promising. 84.4% of the cases showed marked improvement with 75% showing a complete cure and were symptom free after a 2 year follow up. Unfortunately, fire-needle is not something that this particular patient would allow. Her fear around needles in general is high enough without the addition of a glowing red needle. Itís also unclear why fire needle was used, since the conditionís pathology is based on heat.
The next study was a report of 26 cases, this time mostly female. All of the patients were concurrently utilizing some form of external medicine all to no avail. This study also attributed the cause of the disease to heat stasis in the Lungs. It again cited that the lung opens into the nose and thus that is where the heat is stagnated. Most of the patients in this study as well had a central location of the disorder on the nose.
Four points were used here; DU 14, BL 13 and 15 (both bilateral), and LI 11 (bilateral). The points were all punctured with a three-edged needle (lancet) and then cupped. The cup stayed on for 15 minutes. The treatments were given once every other day with 6 treatments being considered a course. 2-3 courses were usually enough to show results. In addition, the patients were all given an herbal decoction. The decoction was not given until after the third treatment, was taken twice a day, and continued throughout the rest of the courses.
This study had similar results as the first. 92.3% of the patients had marked improvement with 80% completely cured even after a 1 year follow-up. The average patient showed results by the third treatment, and was usually at itís best after 2 courses. Itís curious why they added the herbal decoction after the third treatment since by then they were seeing results with blood-letting and cupping alone. A follow up to the study could be a separation of the two, with one group getting the herbs, and another getting just the cupping and seeing how they were in relation to the combination.
The last study did not focus solely on rosacea but on acne in general. Of the 120 cases, 61 were pustular acne (which rosacea falls under), 29 were pustular, 19 were nodular, and 11 were mixed. The distribution was more even between male and female, though slightly more on the female, and the age range was slightly younger since it involved some cases that were under 18. Their explained pathology didnít say either Lung or Liver, but instead simply said that stagnation of blood-heat was the cause, and this stagnation rose to the face.
Their treatment involved one thing only. The point GV 14 was pricked with a three-edged needle (lancet) and then a fire-cup was placed on top of it. The cups were in place for no more than five minutes. The treatments were given once a week, and a course of treatment was considered 3 treatments. It didnít say if there was a spacing between courses of treatment. The study also prohibited the use of any type of drug during the study.
Again the results were outstanding. 95.8% showed marked improvement with 70% showing complete cure with no recurrence of symptoms after 2 years. Most results were seen after one course, and 2-3 courses were usually enough to reach maximum. Some, however, did require an extra 1 or 2 treatments (not courses). The study said that GV 14 was the perfect point since the 3 Yang meridians met there and that the etiology of the stagnant heat was in the Yangming. It was amazing that with such minimal treatment amazing results could be had.
The point prescription for the original patient was chosen for three reasons. Since the treatments are being done in the student clinic, herbal medicine cannot be given without a separate consult. Secondly, the patient could only come once a week as that is the nature of the clinic. Finally, the patients condition is slightly different than the Lung heat which is apparent in the first two studies, especially since the concentration of her problem is not on the nose.
In many ways the prescription would be only slightly different if used for treating Lung heat. The points GB 20 and ST 44 could be removed and replaced with ST 40 to match almost exactly to the first study. At the same time, with just GV 14 the third study was able to show amazing results once a week. With that kind of success it wasnít necessary to add BL 13 & 15 into the bloodletting and cupping, and LI 11 was already being needled.
Since only one treatment thus far has been given, more time is necessary to test the results. If by the third treatment little progress is seen, possibly an herbal consult would be worthwhile or possibly changing LI 11 to cupping with bloodletting. It would be interesting to see if these studies included the signs and symptoms their patients presented with to see if truly they all fell into this Lung heat category or if some other diagnosis could have been given.