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Before delving into the efficacy of TCM herbs in TSW, it’s essential to grasp the complexities of the condition. Topical steroids, commonly prescribed for various skin conditions like eczema and psoriasis, can lead to dependency and rebound effects upon cessation of use.

This withdrawal process triggers an array of symptoms, including intense itching, burning sensations, redness, and flaking skin. There are many approaches to helping you get through steroid withdrawal, and herbal approaches can really shift your condition because it is multi-pronged and allows for very nuanced pivoting.

The rest of the article is a list of which herbs we use, and why we use them. Some herbs are more suitable for a papular-pustular presentation, others better for a erythema-edematous presentation. Ultimately, many patient come with a mixed presentation and we work closely with what arises, so we can treat what we see in front of us. Herbs are mixed and matched to fit the presentation you come in with, and formulations are modified as you recover.

PS: This article is a work in progress. We hope to provide even more information as this article evolves.

Herbs With Predominantly Antimicrobial Action

These are herbs that we might employ in a situation where there is some level of inflammation or infection. These Chinese herbs all have some level heat clearing effect, and they tend to dry out lesions or even cause the skin to be drier.

Da Qing Ye | Folium Isatidis

Pharmacology: Contains indole alkaloids and flavonoids with antimicrobial and anti-inflammatory effects.

Mechanism of Action: Inhibits microbial replication and reduces inflammation, potentially alleviating symptoms of TSW exacerbated by microbial  infections.

Jin Yin Hua | Flos Lonicera

Pharmacology: Contains phenolic compounds with antimicrobial and anti-inflammatory effects.

Mechanism of Action: Combats microbial infections and reduces inflammation, potentially alleviating symptoms of TSW and promoting skin healing.

Huang Bai | Cortex Phellodendri Chinensis

Pharmacology: Contains berberine alkaloids with antimicrobial and anti-inflammatory effects.

Mechanism of Action: Combats microbial infections and inhibits inflammation, offering relief from skin symptoms associated with TSW.

Huang Qin | Scutellaria Baicalensis

Pharmacology: Huang Qin contains bioactive compounds like baicalin and baicalein, which possess potent anti-inflammatory properties by inhibiting pro-inflammatory cytokines and enzymes.

Mechanism of Action: By reducing inflammation, Huang Qin helps alleviate the redness, swelling and sometimes itching associated with TSW. It also modulates the immune response, rebalancing the Th2/Th1 ratio towards a more regulated state.

Ku Shen | Sophora Flavescens

Pharmacology: Ku Shen contains alkaloids such as matrine and oxymatrine, which exhibit antimicrobial, anti-inflammatory, and immunomodulatory effects.

Mechanism of Action: Ku Shen’s antimicrobial properties combat secondary infections that often exacerbate TSW symptoms. Additionally, it suppresses the production of pro-inflammatory mediators, reducing skin inflammation and promoting healing.

Long Dan Cao | Radix Gentiana

Pharmacology: Contains bitter compounds like gentiopicrin, which possess anti-inflammatory and hepatoprotective properties.

Mechanism of Action: Helps reduce inflammation and support liver function, which may indirectly benefit individuals undergoing TSW by promoting detoxification and immune regulation.

Lian Qiao | Fructus Forsythia

Pharmacology: Rich in phenolic compounds and lignans with antioxidant and anti-inflammatory effects.

Mechanism of Action: Reduces oxidative stress and inflammation, potentially alleviating skin symptoms associated with TSW and supporting immune modulation.

Huang Lian | Coptis Chinensis

Pharmacology: Huang Lian contains berberine alkaloids, which are potent anti-inflammatory and antimicrobial compounds. Berberine is known for its broad-spectrum antimicrobial activity against bacteria, fungi, and protozoa, as well as its ability to modulate immune responses.

Mechanism of Action: In the context of TSW, Huang Lian’s anti-inflammatory properties help alleviate skin inflammation and redness, providing relief from symptoms such as itching and irritation. Its antimicrobial effects may also help prevent or treat secondary infections that can exacerbate TSW symptoms. Furthermore, Huang Lian’s ability to modulate immune responses may contribute to rebalancing the immune system, promoting a more regulated and controlled inflammatory response.

Zhi Zi | Fructus Gardenia

Pharmacology: Contains iridoid glycosides with anti-inflammatory and antioxidant effects.
Mechanism of Action: Reduces inflammation and oxidative stress, potentially alleviating symptoms of TSW and promoting skin health.

Herbs That Clear Out Damp

These are herbs that are useful for resolving inflammation that presents as Damp in Chinese medicine. Some of these herbs are diuretics, others are anti-pruritic. In generally, these herbs are not as drying as the anti-microbial herbs.

Bai Xian Pi | Dictamnus Dasycarpus

Pharmacology: Bai Xian Pi contains flavonoids and coumarins with anti-inflammatory and antioxidant properties.

Mechanism of Action: Bai Xian Pi soothes irritated skin and relieves itching by inhibiting inflammatory pathways. Its antioxidant activity protects the skin from oxidative stress, aiding in tissue repair and regeneration.

Di Fu Zi | Kochia Scoparia

Pharmacology: Di Fu Zi contains flavonoids and polysaccharides with anti-inflammatory and anti-pruritic effects.

Mechanism of Action: Di Fu Zi relieves itching and discomfort by inhibiting histamine release and modulating sensory nerve activity. It also promotes wound healing and prevents bacterial colonization, reducing the risk of infection in compromised skin.

Tu Fu Ling | Rhizoma Smilacis Glabra

Pharmacology: Contains saponins and flavonoids with anti-inflammatory and antioxidant effects.

Mechanism of Action: Suppresses inflammation and protects against oxidative stress, potentially supporting skin healing in individuals undergoing TSW.

Fu Ling | Poria Cocos

Pharmacology: Contains polysaccharides and triterpenes with anti-inflammatory and immunomodulatory properties.

Mechanism of Action: Modulates immune responses and reduces inflammation, potentially contributing to the management of TSW symptoms.

Bai Zhu | Rhizoma Atractylodis

Pharmacology: Contains sesquiterpene lactones and polysaccharides with anti-inflammatory and digestive properties.
Mechanism of Action: Reduces inflammation and supports digestive function, potentially aiding in the management of TSW symptoms and promoting overall well-being.

Herbs That Cool Blood

These are herbs that can help reduce inflammation in another manner, by clearing out Blood Heat. They are used whenever the tongue and pulse indicate some level of Blood Heat.

Bai Wei | Cynanchi Atrati

Pharmacology: Contains triterpenoid saponins with anti-inflammatory and immunomodulatory effects.

Mechanism of Action: Modulates immune responses and reduces inflammation, potentially alleviating symptoms of TSW and promoting skin healing.

Mu Dan Pi | Cortex Moutan

Pharmacology: Contains phenolic compounds with antioxidant and anti-inflammatory effects.

Mechanism of Action: Reduces oxidative stress and inflammation, supporting skin health and potentially easing symptoms of TSW.

Zi Cao Gen | Radix Arnebia

Pharmacology: Contains naphthoquinone pigments with anti-inflammatory and wound healing properties.

Mechanism of Action: Reduces inflammation and promotes wound healing, potentially aiding in the recovery of skin affected by TSW.

Di Huang | Rehmannia

Pharmacology: Contains iridoid glycosides and phenolic compounds with anti-inflammatory and immunomodulatory properties.

Mechanism of Action: Helps regulate immune responses and reduce inflammation, contributing to the management of TSW symptoms such as itching and redness.

Shao Yao | Paeonia lactiflora

Pharmacology: Chi Shao contains bioactive compounds such as paeoniflorin and flavonoids, which possess anti-inflammatory and antioxidant properties. Paeoniflorin, in particular, has been shown to inhibit inflammatory mediators and reduce oxidative stress.

Mechanism of Action: Chi Shao’s anti-inflammatory effects help alleviate skin inflammation associated with TSW, providing relief from redness, swelling, and discomfort. Its antioxidant properties protect the skin from oxidative damage, supporting tissue repair and regeneration. Additionally, Chi Shao may help regulate immune responses, contributing to the resolution of TSW symptoms and promoting overall skin health.

Mu Li | Concha Margaritifera

Pharmacology: Contains minerals and proteins with moisturizing and soothing properties.

Mechanism of Action: Hydrates and soothes irritated skin, potentially alleviating symptoms of TSW and supporting skin barrier function.

Herbs That Extinguish Fire and Create Moisture

In some cases of inflammation, dryness is extreme and the whole body (the skin as well as the inside of your body) is in need of lubrication. These herbs are able to cool down the body and create moisture in the body.

Shi Gao | Gypsum Fibrosum

Pharmacology: Contains calcium sulfate with cooling and drying properties.
Mechanism of Action: Cools and dries dampness in the body, potentially relieving heat and moisture-related symptoms of TSW.

Lu Gen | Rhizoma Phragmitis

Pharmacology: Contains polysaccharides and flavonoids with anti-inflammatory and immunomodulatory properties.

Mechanism of Action: Modulates immune responses and reduces inflammation, potentially alleviating symptoms of TSW and promoting skin healing.

Dan Zhu Ye | Lophatherum Gracile Brongn

Pharmacology: Contains flavonoids and polysaccharides with antioxidant and anti-inflammatory effects.

Mechanism of Action: Reduces oxidative stress and inflammation, potentially supporting skin healing and alleviating symptoms of TSW.

Herbs That Resolve The Skin Layer

Many of these herbs are anti-pruritic in nature, and may increase micro circulation in the epidermis. Care has to be taken when using it in TSW, but when titrated correctly, they can be extremely useful in skin recovery and regeneration.

Cang Er Zi | Fructus Xanthi

Pharmacology: Contains sesquiterpene lactones with anti-inflammatory and immunomodulatory effects.

Mechanism of Action: Modulates immune responses and reduces inflammation, potentially alleviating symptoms of TSW and promoting skin healing.

Jing Jie | Herba Schizonepeta

Pharmacology: Contains volatile oils and flavonoids with anti-inflammatory and antipyretic properties.

Mechanism of Action: Inhibits inflammatory mediators and reduces fever, potentially soothing inflamed skin and alleviating discomfort in individuals undergoing TSW.

Fang Feng | Radix Saposhnikovia

Pharmacology: Contains coumarins and polysaccharides with anti-inflammatory and immunomodulatory effects.

Mechanism of Action: Modulates immune responses and inhibits inflammatory pathways, promoting skin healing and reducing symptoms of TSW.

Bai Zhi | Radix Angelica Dahurica

Pharmacology: Contains coumarins and essential oils with anti-inflammatory and analgesic properties.

Mechanism of Action: Relieves pain and inflammation, potentially easing discomfort associated with TSW and supporting skin recovery.

Bai Ji Li | Fructus Tribuli

Pharmacology: Contains saponins and flavonoids with antioxidant and anti-inflammatory effects.

Mechanism of Action: Protects against oxidative stress and reduces inflammation, contributing to the management of TSW symptoms and promoting skin health.

Xi Xian Cao | Herba Siegesbeckia

Pharmacology: Contains sesquiterpene lactones with anti-inflammatory and analgesic effects.

Mechanism of Action: Inhibits inflammatory pathways and relieves pain, potentially alleviating discomfort associated with TSW.

TCM Herbs That We Omit For Vegans & Vegetarians

cicada shell animal products in tcm herbs for tsw

Chan Tui | Periostracum Cicada

This is the shell that has been shed by the Cicada.

Pharmacology: Contains proteins and amino acids with moisturizing and soothing properties.

Mechanism of Action: Hydrates and soothes irritated skin, potentially alleviating dryness and discomfort associated with TSW.

Di Long | Pheretima

This is the earthworm

Pharmacology: Di Long contains bioactive compounds such as mucopolysaccharides and enzymes, which contribute to its anti-inflammatory and antithrombotic properties.

Mechanism of Action: In the context of TSW, Di Long may help alleviate inflammation. Its anti-inflammatory effects may reduce skin irritation and redness, aiding in tissue repair and even helping with itch.

Even TSW Presents Very Differently Across Individuals

Having shared this extensive list of TCM herbs and briefly explained the pharmacology and mechanisms of action for each of them, we hope you get a better sense that Chinese herbs having been studied time time immemorial, and alot of the more recent research is regarding the pharmacological action of specific active ingredients in these herbs.

Ultimately, in the context of treating Topical Steroid Withdrawal (TSW), it is an empirical science that has been honed in our clinic in the last decade. We try our best, and do a reasonable job in tweaking the herbs so they can help you recover.