I am hoping that someone may be able to help me with a patient who has been diagnosed with lichen planus. She is a 64 year old woman who has had this for five years now. It started on the right calf, along the stomach meridian and is now spreading to her left calf in the same spot as the right. The lesion is very red to purple in colour and was intensely itchy. Her tongue is very red and cracked, fat with a dry yellow coating in the back. Pulse is slippery, wiry. She has very odouress bowel movements, some bloating, history of headaches behind the right eye with dryness and irritation of the eyes. She is under a lot of stress as she has had both her husband and future boyfriend pass away in the last 9 years.I have diagnosed her with liver yang rising, liver wind and blood heat. I have given her the following formula sheng di huang 20g, huang qin 12g, fang feng 12g, chi shao 15g, ku shen 12g, mu dan pi 10g, tian ma 9g, jing jie 9g , cang er zi 9g, gan cao 6g. She has been on this formula for the past 2 months. Her itching has gotten much better, almost none existent however the lesions are still the same size and colour. I am thinking of adding some blood movers ? Love some suggestions.
Lichen Planus
dabtcm
Hello Michelle,
Here are some ideas for treatment, and might give you some help/insight as to how to manage this patient in the treatment of her lichen planus.
1) Lichen planus is a disorder of the skin and mucous membranes resulting in inflammation, itching, and distinctive skin lesions.Lichen planus is an uncommon disorder involving a recurrent, itchy, inflammatory rash or lesion on the skin or in the mouth. The exact cause is unknown, but the disorder is likely to be related to an allergic or immune reaction, and commonly can be related to stress. INCIDENTALLY, it may also occur in some patients that are infected with Hepatitis C.
So, it might be advisable to pass this information on to your patient also, as I have seen this clinically.
2) It is a condition that may spontaneously resolve and recurr on its own with no particular reason. Although it is commonly seen in relation to stress....so stress management figures prominently in the management of this condition.
3) Be sure when doing tongue diagnosis to look at her oral cavity (mouth) as it does sometimes occur in the mouth, and in some can also be relater to pre-cancerous changes. No harm in knowing too much and being one step ahead of the game is how I see it, your patients will only thank you for knowing more !
Among the most germane medicinals in the treatment of this condition consider using / including:
Radix Sophorae Flavescentis (KU SHEN)
Fructus Kochiae Scopariae (DI FU ZI)
Radix Scutellariae Baicalensis (HUANG QIN)
Radix Ledebouriellae (FANG FENG)
Rhizoma Coptidis (HUANG LIAN)
Semen Coicis (YI YI REN)
Cortex Dictamni Radicis (BA XIAN PI)
Semen Hydnocarpi (Da FENG ZI)
Fructus Mume (WU MEI)
Incidentally many of them enter into the Stomach Channel (not all) and are the most "empically used" medicines in the treatment and management of this condition that we used in China.....Hope this helps give you some insight into the care and management of this condition and in the care of your patient.
Topical Western medicines include corico-steroids, but in conservative management the use of Aveeno cream (oatmeal colloidal) that is available most anywhere provides good surface relief until the herbs do affect this conditon.
HOPE all this helps give you some ideas for treatment.
Hi
Just to add that I have seen this in pregnancy (unfortunate women had it affecting her anus and genital area)
Used acupuncture – treating her stress (LIV 3), boasting her immunity (ST 36) and points focused on reliving the itching – (as it involved the genitals LIV 5)
She found it effective and came back for further flare ups – was never interested in taking herbs.
PS This women was interesting as she was working as a scientist, part of her stress involved problems she was having with her 2 yr old (nightmares every night and screaming if she went out of his sight etc - all since she had been way for work) – I recommended she try homeopathy for him , which she tried, on next visit she remarked that he was much better, but didn’t think it was the homeopathy, he had probably just been going through a stage ….she had been investigating and didn’t see how it could have possibly been the treatment - the dosage given would have been so ineffective …
All this while on the table with needles in saying how much difference she thought the acupuncture made – to her it was real (she could feel effects from the needles – especially LIV 5 ) and there was research to satisfy her that acupuncture had a real mechanism …..
d betts
Have you ever thought about using topical applications of Essential Oil
Melaleuca Alternifolia, applicate twice daily....
Best regards
Stefano J. Chiola
Centro di Naturopatia & Energetica Olistica
Centro BioFitness & Fit Training Center
Chiavari
Hi Michelle,
As mentioned above, lichen planus can be due to autoimmune issues. I have personally seen this in clinic whereby a woman originally had vitiligo, then premature ovarian failure (early menopause at age 43), and then developed the lichen planus- all of these are related to autoimmune problems and have been sown to co-exist- meaning they most likely cross over into each other.
Good job on clearing the itch!
So to go deeper, adding herbs to invigorate blood is a good idea. As is the addition of herbs to clear fire toxin very important. One specific herb for lichen planus is Ma Ti Jin.
Some other common herbs, some already mentioned:
Tu fu ling, Bai hua she she cao, Hong hua, Hong teng, Tao ren, Yi yi ren, Mu dan pi, Chi shao, E shu, Ze lan
External washes to clear fire toxin and invigorate and cool the blood would also benefit.
Good luck,
Trevor