Chinese Medicine Approach to Acne and Rosacea with Dr. Antonia Balfour

Dr. Antonia Balfour discusses a Chinese Medicine Approach to Acne and Rosacea with Dr. Ben Weitz.

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Podcast Highlights

1:42  Dr. Balfour, a Doctor of Chinese Medicine, recalls treating a patient with very severe eczema while she was a student at Yo San University in Los Angeles.  She was only 18 or 19 years of age and she had skin lesions that would ooze and she could hardly leave her house.  She saw what an important problem skin conditions are. Then Dr. Balfour developed Pruritic urticarial papules and plaques of pregnancy (PUPPP) and she lesions all over her body that would itch like crazy.  She discovered an expert in the use of Chinese herbs for treating dermatological conditions, Mazin Al-Khafaji in England, so she went to study with him and this led her to specialize in the treatment of dermatology with acupuncture and Chinese herbs.

5:14  The Chinese medicine approach has many different ways of analyzing skin conditions and doesn’t just diagnose acne and put the patient on the acne formula. Dr. Balfour treats many patients with acne who have never heard of Chinese medicine treating their condition and many have been on birth control or Accutane and most have tried topicals from the conventional dermatologist and many become frustrated or depressed at the lack of results. In Chinese medicine you treat the whole person, the emotional aspects as well as the physical aspects, and there’s often an interplay between the two.  In Chinese medicine you do analyze the skin but then you need to look at the whole person.  When analyzing the skin, you see if they have redness and inflammation, which indicates “heat” in Chinese medicine. Then you want to look at the lesions and see if the background skin has a deep redness or if it is pale or just flesh colored and has no redness.  If there’s a red ring around a pimple, that might indicate heat toxins.  If they have a pimple that has fluid in it, that is different than a pimple with pus in it. These things might indicate that you should use different herbs. Dr. Balfour will also feel the pulse and ask about their diet and if they have any digestive symptoms.

9:35  Acne.  Acne is a chronic inflammatory skin condition that is very often associated with hormonal shifts in males and females as well as with what we are eating.  If you have been eating a diet of fast foods and develop acne and then adopt a clean, organic diet that is either meat free or only grass-fed beef or hormone free poultry and they may not see any change. These dietary factors are important but not enough to reverse their condition. By using the right herbs for them along with a healthier diet, they will make better results.  Two of the main dietary factors that Dr. Balfour recommends avoiding for patients with acne are sugar and dairy.  Dr. Balfour also mentioned that in Los Angeles a lot of people consume a lot of smoothies and pressed juice and celery juice, while Chinese medicine loves cooked foods and soups, since they are easier on the digestive tract.

14:08  Patients with acne will be treated differently depending upon the appearance of the acne with Chinese medicine.  If the patient has pimples that are large and swollen, that is considered to be damp heat.  If someone has very oily skin, that’s also damp heat. Dr. Balfour will typically make up a Chinese herbal formula with between 12 and 18 herbs.  There are different herbs for chest or back acne versus face acne. If the patient has a deep, hard cyst, it’s a different pattern than just the damp and the heat, which means using different herbs.

19:25  Taking antibiotics is not a good idea for acnes because they mess up your microbiome and cause gut dysbiosis.

20:05  There is nothing wrong with having taken medications like Accutane, though this is a very damaging drug that dries out the sebaceous glands and damages the elasticity of the skin long term.  Young women who are taking Accutane must sign something that they promise to use two forms of birth control because Accutane could cause severe birth defects.

23:47  Rosacea.  Rosacea has an autoimmune component.  It tends to occur in patients in their 30s, 40s or 50s and of Scottish, Irish, Celtic heritage.  Rosacea feels like the skin is burning and it flushes and gets red.  Rosacea is often marked by spider looking veins called telangiectasia that may be around the nose or on the cheeks.  Dr. Balfour will use a different combination of herbs for someone who has flushing rosacea versus bumps or pustules.  And these are different herbs than would be used for acne.  Her mentor, Mazin Al-Khafaji, has a line of Chinese herbal topicals, it’s called Dermatology-M, including some great formulas for rosacea.  Another colleague of Dr. Balfour has some good topicals for rosacea on Zi Zai Dermatology, which is now called CMDSkinSolutions.com.  Dr. Balfour likes to use hydrosols for the skin, since these are much milder than essential oils. Essential oils are very strong and can sting and burn the skin, while hydrosols are made from the water that is used in steaming essential oils, so they are sort of plant water.  Chamomile, calendula, rosemary, and rose water are good hydrosols for the skin.


Dr. Antonia Balfour is an acupuncturist and Doctor of Traditional Chinese Medicine, specializing in dermatology in Pacific Palisades in Los Angeles, California for more than 20 years. In her practice, Yin Yang Dermatology, she treats many patients suffering from acne and rosacea with Chinese herbal medicine. One of the strengths of Chinese herbal medicine is being able to customize herbal formulas to meet the unique needs of each person.  Dr. Balfour studied TCM dermatology with foremost expert, Mazin Al-Khafaji, for more than 10 years, and she is a contributing author of LearnSkin’s e-book – An Introduction to Chinese Medicine Dermatology.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.



Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. To learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.

Hello, Rational Wellness podcasters. Our topic for today is a Chinese medicine approach to acne and rosacea with Dr. Antonia Balfour. Dr. Antonia Balfour has been an acupuncturist and a doctor of traditional Chinese medicine specializing in dermatology in Pacific Palisades, Los Angeles, California for more than 20 years. In her practice, Yin Yang Dermatology, she treats many patients suffering from acne and rosacea, often together with hormonal imbalances and digestive disorders, with Chinese herbal medicine. One of the strengths of Chinese herbal medicine is being able to customize herb formulas to meet the unique needs of each person. Dr. Balfour studied traditional Chinese medicine dermatology with foremost expert Mazin Al-Khafaji for more than 10 years, and she’s a contributing author of LearnSkin’s ebook, An Introduction to Chinese Medicine Dermatology. Dr. Balfour, thank you so much for joining us today.

Dr. Balfour:                         Thanks for having me. I appreciate it.

Dr. Weitz:                            How did you become interested in treating patients with dermatological problems?

Dr. Balfour:                         Dermatology is hard in any modality, really. I would say when I was in acupuncture school, which is back in the ’90s, I was an intern at the student clinic at Yo San University here in LA. At that time, I saw two different patients that had severe skin issues. One of them, she was young, maybe 18 or 19, 20, she had very severe eczema, and she would come to the clinic and we would give her acupuncture and herbs. I remember, it was heartbreaking, because she suffered so much. I mean, she had severe eczema, and she would come in for treatments. I would give her acupuncture, and we’d put table paper on the table, on the acupuncture table. I remember she would get up and there would be spots of wetness all over the table paper because her eczema just oozed all the time, and she didn’t leave the house. She was kind of agoraphobic, and the eczema was so severe that it caused all kinds of other things. She was just stuck in her life at that time.

I remember, as a student, and I was in my 20s, it was heartbreaking for me to see this. One night, I know, after I treated her, it was the only time as a student I cried when I got home, this was so much to see her, but she did get really good results with Chinese medicine, which was great, and it was super motivating for me. But, at the same time, I had another student that I treated who had very severe psoriasis that covered a lot of his body, and he did not get good results with Chinese medicine at the time. I remember this mantra going through my head, “Dermatology is hard, dermatology is hard, dermatology is hard.”

I was young and I wasn’t ready to take it on at that time. It’s like you’re enthusiastic and got the ego, you got to heal everybody. So, I didn’t study dermatology seriously at that time. I was too scared. But then, fast forward a few years, I got deeper into practice. What happened when I was pregnant with my daughter, I developed a skin condition that’s called PUPPP. Anyway, it’s not that common and everybody hasn’t heard of it, but it was incredibly itchy. From my collarbone down to my knee, I would get these lesions all over and every night, itching, itching, itching, itching, itching.

I did see someone else for Chinese herbs at that time. But really what it did is it made me aware, “I don’t know enough.” I was serious about the study of herbs that I didn’t know enough about dermatology. At that same time, I had studied with a mentor who had retired, and I was kind of seeking out a new mentor, and the stars aligned for me then to discover studying with Mazin Al-Khafaji, who you mentioned, he at that time was only teaching in the UK. When my daughter was little, I ended up going back and forth to England to study with Mazin Al-Khafaji, which was great. It really changed the course of my practice so that I really do mostly dermatology in my clinic right now.

Dr. Weitz:                            I think it’s interesting that the Chinese medicine approach has so many different complex ways of analyzing these skin conditions. I remember Woody Allen in one of his comedy routines talking about how there’s like 2,000 different skin conditions, and there’s only three creams. I think conventional dermatology ends up prescribing the same thing for everybody with acne, the same thing for everybody with eczema.

Dr. Balfour:                         Yeah. That’s interesting because I think that that’s one of the areas where Chinese medicine can shine is, when I see patients, and they have never heard of Chinese medicine treating acne before they come in, and they say, “I’ve tried everything. I’ve tried everything. I’ve tried everything.” They’ve been on birth control for their acne. They’ve been on Accutane, and they’ve tried all the topicals from the dermatologist. Really, what happens is they become really frustrated or depressed or upset or angry, whatever it is. In Chinese medicine, when we treat the whole person, you are kind of treating the emotional aspects as well as the physical aspects. There’s often an interplay between the two. Often, it does stem from frustration about the skin condition in the first place.

Dr. Weitz:                            Right. How do you diagnose the underlying problems related to skin conditions like acne and rosacea?

Dr. Balfour:                         Mostly Chinese medicine does look at the whole person. We do first analyze the skin. There are these terms in Chinese medicine where I might say, “You have too much heat in your body,” and that’s such a general thing.  Heat can manifest in so many different ways. But in Chinese medicine, we really are zeroing in to look specifically really what does that mean? Redness and inflammation means heat, indicates heat.  But if you imagine somebody with acne, for example, maybe the background of their skin has a deep dark redness to it, maybe the background of their skin is perfectly pale or white or just flesh colored and there’s no redness.  Sometimes what you’ll see is sort of a modeled redness of some white and some red.  These things in Chinese medicine all indicate heat, but it’s heat that’s added, how deep is the heat?  How severe is the heat?  Each of those things might indicate different herbs that I’m going to use.

We’ll talk about these patterns in Chinese medicine, damp and heat form together, and that could create a pimple. If there’s a red ring around the pimple, that could indicate they’re heat toxins.  But damp heat in a pimple might look different than damp heat in rosacea if there’s a bump and there’s fluid in it, and then they scratch the bump and then watery fluid comes out, that’s different damp heat than puss in a pimple, for example.  These different presentations would lead me to choosing different herbs for the skin.  It starts with analyzing the skin, but your question was really about how do you know when digestive things or other things are involved, too?  We feel the pulse in Chinese medicine, but it’s really mostly about questioning somebody and finding out, doing a deep dive into what are they eating?  What’s in their diet?  How is their digestion?  If there’s acid reflux, that’s going to make me choose different herbs than if they have loose stools or constipation or constant bloating.  One thing we see a lot in rosacea, people often will have digestive problems, it happens in acne, too.

Dr. Weitz:                            Okay, let’s dig into acne. What is acne?

Dr. Balfour:                         Yes. Acne is a chronic inflammatory skin condition that is very often associated with hormonal shifts in males and females, both. We see a lot more adult acne now than we used to years ago. I think that very much dietary, what are we eating and are hormones in the foods that we eat involved? I think so.

Dr. Weitz:                            Talk about hormones in the food.

Dr. Balfour:                         Well, I mean, it’s everything from meats that we eat that the animals have been given hormones to… Yeah, I mean, even people that have, I think, an organic, clean diet. Oftentimes, I’ll see people that feel frustrated, because they may have grown up eating a certain diet of fast food, and then they develop acne, then they’ve tried everything, and they get to a point where they’ve changed their diet and they start to eat only organic foods, maybe no meat, maybe only grass-fed beef or hormone-free poultry. Then, that still hasn’t cured their acne, so they’ll get super frustrated and they’ll see me for the first time and we’ll discuss these things.  But honestly, I can say, sometimes changing your diet like that, it’s not enough to clear the skin and heal the skin. But it’s a great start, because I will see better results with those types of patients that have already changed their diet, then we start them on an herbal protocol, than I do when we’re starting from square one with beginning to make dietary changes. I think that these things really do have clinical results that are definitely noticeable.

Dr. Weitz:                            Do you see certain dietary factors related to acne? Do you recommend specific things related to diets, such as asking them not to eat certain foods, thinking about sugar, dairy, gluten, et cetera?

Dr. Balfour:                         Yeah. For me, the main ones are dairy and sugar that we want to reduce. But I think that, partly, with diet, I really try to encourage people quitting sugar is difficult and cutting back on sugar, it’s difficult. But I think a good starting point is to imagine what do you want to… What are the good things that you’re eating? I try to guide people through getting the rainbow of colors with their fruits and vegetables and listening to their body’s response. Some people even eat great veggies, but then cruciferous vegetables like broccoli and cauliflower cause them bloating. We really want to find what works best for your body. But I think rainbow of colors, plenty of veggies, a good variety, fruit as well, fruit sugar, I’m fine with, but minimizing processed sugar. The other thing that, again, just to go back to the theme in Chinese medicine of heat, we want to clear heat if they have something that’s chronic and inflammatory and causing redness in the skin. So, spicy foods, I want to avoid.

Dr. Weitz:                            Okay.

Dr. Balfour:                         Go ahead.

Dr. Weitz:                            Yeah, no, go ahead.

Dr. Balfour:                         I was just going to say, in LA, a lot of people are heavy on the smoothies and the pressed juice, and celery juice, and all those things. Chinese medicine loves cooked foods. It’s easier on your digestive tract to predigest foods. I tend to believe in moderation, if somebody’s fine drinking celery juice and it feels good and it’s healthier than other options, that’s fine. But in certain circumstances, I do try to push people towards, “Okay, let’s roast your veggies and not have everything raw in the form of green drinks and things like that.” Soups are my preference, but I do work with people to figure out what works best for their lifestyle.

Dr. Weitz:                            I read your chapter in that Yin Yang Dermatology textbook, that Chinese medicine analyzes the lesions in skin conditions like acne, and depending upon the appearance, where the lesions are, et cetera, you treat them all differently. Maybe you can explain how you treat different versions of acne.

Dr. Balfour:                         Yeah. Basically, like I said before, damp heat is a common theme in acne. If somebody has pimples that are big and swollen, that’s damp heat. Somebody has very oily skin, that’s also damp heat. So, it’s the same pattern in Chinese medicine. But in each of those circumstances, I’m going to choose different herbs, because there are different herbs that will help with oil, and there are other herbs that help with a big, swollen, inflamed lesion. What I do is I will write up a herbal formula that has anywhere between 12 and let’s say 15 or 18 ingredients. Many of the ingredients in the formula are addressed at looking at what do these pimples and acne look like and where are they located? So, there are different herbs that I’m going to use for chest or back acne versus face acne. If the distribution is sort of all over, then I’m going to choose different herbs than if it’s just sort on the jawline, we’ll see a lot.

Then, obviously, deep cysts, and Chinese medicine, at that point, will say the damp heat has congealed into phlegm, which of course has nothing to do with the phlegm that you might have in your nose or your lungs, but it’s metaphorical in Chinese medicine. So, if you have a deep, hard cyst, we’ll say the herbs that we use, one of them is literally like a thorn, you look at it and you grab some and it’ll prick your finger, but it’s breaking up, it’s transforming the phlegm and it’s a different pattern than just the damp and the heat. So, getting specific with the look of the lesion is super important. Yeah.

Dr. Weitz:                            Right. It’s interesting that you’re using 12, 15 different herbs all at one time.

Dr. Balfour:                         Yeah, It’s interesting, Chinese medicine dermatology dates back to about 200 BCE, so it’s over 2,000 years old, and it’s the oldest written traditional medical system. There are these texts and some of these formulations that were written hundreds and thousands of years ago. And then people over time will argue and new ideas come about and things evolve and change. But these groupings of herbs, sometimes it’s a pair of herbs, sometimes it’s four herbs or six herbs that are in traditional formulas, they have a synergistic effect that we still use these same modules or groups of herbs now that were used hundreds of years ago. Then we blend them together and we use different things.  But when it comes to pairings of herbs or two, three, four herbs that I’ll use to create an effect for acne, that these things have been used together and there’s a power of cooking them together. I make my herbs into teas. They’ve done some research about cooking them individually and then having somebody drink them versus cooking them together, there’s a different effect. I think it’s almost like cooking a curry on your stove top. It’s different when you cook your spices together, and then there’s that synergy of flavors that comes together. I think something medicinally happens in a comparable way when you cook herbs together in a tea.

Part of it’s going to be analyzing the skin, and then part of it will be looking at the other factors that are involved in somebody’s health picture. If they do break out before their period every month, then balancing the hormonal aspects is going to come into play. Often, I treat surprisingly relatively few teenagers with acne. I think that teenagers, they want to do what their friends have done, or they’ll do Proactiv. I treat more adults with acne that have sort of been through the Western medicine route. They become frustrated, and then they look for the alternative.  But it’s surprising, even a lot of perimenopausal, menopausal women still getting acne or getting acne again, if they haven’t had it for 20 years, you’ll get a lot of jawline acne. Those herbs and that sort of hormonal imbalance state are different than what I might use for a 25 year old, who’s getting a period every month and breaking out every month with their period, which is pretty common.

Dr. Weitz:                            Why is taking antibiotics like tetracycline not a good idea for acne?

Dr. Balfour:                         Well, for one thing, antibiotics are prescribed for so long for these, well, I was going to say for youngsters with acne, but it could be anybody with acne, that they stay on tetracycline for months and months and months. Then what it does to create gut dysbiosis, I think, it’s creating a longer-term problem.

Dr. Weitz:                            Right. By messing up your microbiome.

Dr. Balfour:                         Yeah, yeah, totally.

Dr. Weitz:                            Now, what’s wrong with taking medications like Accutane?

Dr. Balfour:                         Accutane, I mean, when you think about Accutane, anything that makes you sign, I mean, young women on Accutane to sign something promising, they’ll use two forms of birth control, because if they accidentally get pregnant while on Accutane, they could have severe birth defects with the child. I mean, what it’s doing in that scenario, you can only of imagine how strong of a medication this is and what effect it could have on the individual that’s taking it. But I’ve seen a lot of people who had bad side effects from Accutane, and I also try… People sometimes, they’ll come to me and they feel like they have to apologize that they took Accutane in their past. I think we’ve all made decisions about our health, and of course, people will make a decision to take something that they know is cautioned against because they’re so desperate to get rid of their acne.  There’s no judgment about having taken Accutane. But what I do see is because it does dry the sebaceous glands, I think that it does longer-term damage, too, when you’re trying to get the elasticity in the skin back at a later time. I’ve seen patients that are young, in their 30s, that took a lot of Accutane in their teens, and then their skin in their 30s looks a little older than it should, because it’s really dried out and not done so well. I don’t know. I think it’s a little harsh.

Dr. Weitz:                            Right.

Dr. Balfour:                         Yeah.

Dr. Weitz:                            Do you typically recommend taking these herbs? You make them into a tea?

Dr. Balfour:                         Yes.

Dr. Weitz:                            Or do they sometimes take capsules? Or I know some people just take the powder. I had a friend of mine, he would take Chinese herbs and he would just pour the powder in his mouth and then pour some water in.

Dr. Balfour:                         I know, I’ve seen people do that before, and it’s so funny, because I think maybe I tried too once, and I felt like the powder went up my nose and it was too intense even for me. But I have patients, we make the teas into these vacuum-sealed pouches, and I have patients in high school that take them, They’ll open it up like a Capri Sun, and they drink it straight from the plastic pouch, which I couldn’t do that either. But no, the traditional way to take teas and what they do in the dermatology wards, in China, at the traditional Chinese medicine hospitals, they have separate wards for different specialties. The dermatology patients, they take teas, because teas are strong and teas are good.

I do that where we have machines that will cook the herbs at a super high temperature and under really high pressure, when it’s a pressurized system, then there’s no steam escaping, so the volatile oils from the herbs isn’t escaping into steam. All the good stuff goes into the tea, which makes it really strong tasting, and then it’s vacuum-sealed into a pouch, and it’s all BPA free plastic pouch, but it really keeps everything fresh. Then they drink the tea. When patients are traveling, or for some conditions, I’ll recommend powders, but the powders aren’t as strong. Depending on the patient and what they’re presenting with and how severe their condition is, then typically I do teas.

Dr. Weitz:                            What is rosacea and why do people get this condition?

Dr. Balfour:                         It’s newly thought, in more recent times, that rosacea may have an autoimmune component, which people didn’t think before. In an autoimmune condition, then your immune cells that should attack pathogens and allergens and things that are trying to invade your body, your immune cells start attacking your own healthy cells. Basically, with rosacea, it’s typically people in their 30s, 40s, 50s, that will start to get rosacea for the first time. It’s often seen in of Scottish, Irish, Celtic people. I think there’s something about that skin color of the pale skin. But I have certainly had patients of multi-ethnicities that will have rosacea. But sometimes it feels like the skin is burning. Sometimes it’s just that it’s flushes and gets red, and sometimes it’s red all the time. But yeah, rosacea, again, sometimes-

Dr. Weitz:                            How would you describe what rosacea looks like for somebody who’s just wondering, “I wonder if I have rosacea.”

Dr. Balfour:                         In early stages of rosacea, you could just flush, if you’re in the sun, you get pink cheeks, but it’ll come and go and come and go. If you have an alcoholic drink, you might get pink cheeks, and then it goes away by itself. There’s that, it comes and goes and comes and goes. Then sometimes you’ll wonder, “Do I have acne because I went in the sun and suddenly I have these little things that look like pimples on my cheek, little pustules, and then they’ll go away.” But usually you can see that it’s triggered by the sun.  Usually, if somebody’s reached 30s, 40s, 50s, and they’re not getting acne all the time, and this is a new thing, then that’s a clue that it’s rosacea. Oftentimes, you’ll see what’s called telangiectasia, it’s like these little spider veiny looking veins that are descended around the nose a lot of the time. But that could be in the cheeks, too. Then with men, sometimes… My dad has rosacea and he has a bulbous nose that it’s got some bumps and things and misshapen. He’s a Scottish guy with rosacea. But yeah.

Dr. Weitz:                            I treat a lot of patients for digestive disorders like SIBO, and I often see rosacea or sometimes they see rosacea as related to SIBO or other gastrointestinal conditions.

Dr. Balfour:                         Yes. Yeah, we see that a lot. Yeah. When I started practicing, I think, 22 years ago, we didn’t even hear anybody coming in with SIBO. Now it’s a super common diagnosis. I mean, I worked for a website when I was still in acupuncture school, and one of the most popular articles I remember at the time was about irritable bowel syndrome. Now we know that SIBO-

Dr. Weitz:                            And SIBO is the main cause of IBS, right.

Dr. Balfour:                         It’s the biggest… Yes, yes, yes. I think it’s really interesting to understand if somebody has hydrogen dominant SIBO, or methane dominant SIBO, or I guess hydrogen sulfide is the other one. I think I see hydrogen and methane SIBO more in my practice than hydrogen sulfide, I think. Maybe you could tell me more about that, but would that be people that have joint pains and other things that are associated with it a little bit more? I don’t know. But for the skin stuff, I see hydrogen and methane SIBO [inaudible 00:27:46].

Dr. Weitz:                            Yeah, no, hydrogen and methane are definitely more common than hydrogen sulfide, for sure.

Dr. Balfour:                         Right.

Dr. Weitz:                            We’ve only recently been able to test for hydrogen sulfide, so that test has only been available in the last year.

Dr. Balfour:                         Yeah, yeah. Yes, I’ve learned about that, too, the trio-smart.

Dr. Weitz:                            The trio-smart. Yeah. Yeah. Yeah.

Dr. Balfour:                         Yeah. I think that anything that can give us information, I find it to be valuable. Any functional medicine test… Because sometimes it just leads you to ask more questions. I might not be giving people a classical SIBO treatment protocol that they might be getting from their naturopath or functional medicine doctor or their GI doctor. But when I know what’s going on with them, it helps me understand from a Chinese medicine perspective like, “Okay, how is this manifesting? Is it just bloating? Are you getting loose stools? Is it alternating?” I’ll dig deep into asking people about their bowels and, in Chinese medicine, it is important.

People will say, “I have diarrhea.” Well, what does diarrhea mean? Is it explosive? Is it bowel smelling? Is there mucus? Is there blood? All these things actually would lead me to choosing different herbs. Or are you just getting loose stools every day? Or how many times a day is someone pooping? I mean, all these things are super important clinically, and it gets uncomfortable, that sometimes I feel, when I’m with a patient for the first time, it’s like we’re getting pretty down and dirty in that first appointment where I’m getting… I’m not letting them get by with just telling me like, “My digestive system is off,” or, “I have diarrhea.” I’m like, “Okay, let’s explore this a little more.” Got to get into the details.

Dr. Weitz:                            There’s no doubt that having detailed questions about people’s bowel movements is a personal thing. But that’s where a lot of the good stuff from functional medicine comes.

Dr. Balfour:                         Yeah. Yes. Chinese herbs, too. That’s where the good stuff comes. Yeah.

Dr. Weitz:                            Yeah, nothing like a good stool test as well.

Dr. Balfour:                         Right.

Dr. Weitz:                            Tell me about some of herbal approaches to rosacea.

Dr. Balfour:                         Again, what I’m doing is I’m using a different herb combination for somebody who has flushing rosacea versus bumps or pustules. It’s interesting if somebody does have pustules, that they have pus-filled bumps, those herbs will be different mostly than what I would use for acne. I’m choosing, in both situations, again, I would say that fire toxins might lead to pustules, but which herbs to resolve fire toxins, it’s going to be different in rosacea than it would be in acne. But again, it’s really treating the whole person and their gut, balancing out the digestion. Yeah. Rosacea, sometimes, I’ll give people herbal topical creams and things like that, and sometimes I don’t. Very often people will have tried a lot of things, and they found that-

Dr. Weitz:                            Wait. Are there any common herbal, Chinese herbal topical treatments that people can try on their own or that other functional medicine practitioners can utilize?

Dr. Balfour:                         Sure. Well, my mentor, Mazin Al-Khafaji, has a line of Chinese herbal topicals, it’s called Dermatology-M. Dermatology M. He’s got some great stuff for rosacea. There’s a colleague of mine who has a website that’s called Zi Zai Dermatology, so it’s Z-I Z-A-I Dermatology. She’s got good topicals for rosacea. They’re websites for both. Also, just hydrosols, sometimes, even a calendula hydrosol that you can get from Mountain Rose Herbs. Things like that can be good for-

Dr. Weitz:                            Maybe for those who don’t know what a hydrosol is, can you explain what a hydrosol is?

Dr. Balfour:                         A hydrosol is sort of a plant water. When they’re making essential oils from the plant, essential oils can be strong and too strong for people’s skin a lot of the times, definitely, I mean, at the very least, you want to dilute an essential oil with a carrier oil, like a plain oil, like almond oil or even olive oil, coconut oil, those are carrier oils that you could put an essential oil into. But when you have rosacea, if you have stinging and burning and redness of your skin, you don’t want to use an essential oil at all.  In that process of making essential oils, they also, I think there must be some kind of steam process that they make waters from the plant that are separated from the oil. The waters are a lot more mild and they can be tolerated. Their shelf life is maybe a year. It might vary from plant to plant. But they don’t preserve it like an alcohol or anything like that. We have patients who have really sensitive skin and they can put very little on their skin to have a plant water essentially that doesn’t have anything else. It’s gentle, but it has good healing attributes.

Dr. Weitz:                            Cool. Just give us an example maybe of a couple of hydrosols that sometimes are effective.

Dr. Balfour:                         Yeah, chamomile is a good one. Sometimes people that have a lot of allergies, if you have a lot of eczema, then that might not be the best choice, but calendula is a good one, certainly. What else? Rosemary. Rosemary hydrosol can be very calming for the skin. Those are some good choices of hydrosol. Rose water is very well-known as something that can calm your skin in rosacea, too.

Dr. Weitz:                            Right. Okay.

Dr. Balfour:                         Yeah. Again, you want to be minimal. You want to start with the minimal thing and start with the least invasive, and then maybe you can work your way up to stronger things. But when your skin’s really flaring, you want to go easy and not use a lot of active ingredients, like an essential oil would be.

Dr. Weitz:                            Do you find there’s any food triggers for rosacea?

Dr. Balfour:                         Spicy foods can be a big food trigger for rosacea. People have SIBO with rosacea a lot, and sometimes people will also have acid reflux. In that case, you want to minimize any kind of spicy foods or greasy, fatty foods, certainly, anything like that. And alcohol, alcohol is a big rosacea trigger.

Dr. Weitz:                            Okay. Do you ever use non-Chinese herbs in your practice, like probiotics?

Dr. Balfour:                         Yeah. Again, with SIBO, you have to be careful with probiotics. A lot of people that have SIBO don’t tolerate probiotics well. It used to be, I think some years ago, I would probably tell everybody to take probiotics because I thought at that time that probiotics are good to restore everybody’s good gut flora. But, again, there’s keeping up with the information that we have about dysbiosis. Now, I’m not quite so readily willing to recommend them to everybody. But yeah, knowing, getting a SIBO diagnosis when it seems like it might be indicated, it’s so valuable, so you can work with people along what they should be eating and what supplements they should be taking. But probiotics are good. Niacinamide is another, it’s a vitamin B3 derivative that I think there’s been quite recent clinical research that’s shown that niacinamide is a good supplement for some people with rosacea. When you have answers like that, that are you relatively inexpensive, and easy to take and well-tolerated, I always like supporting people with that kind of thing.

Dr. Weitz:                            Now, when you put somebody on, you do your analysis for somebody, say, with rosacea, you put them on a herbal formula. How long do you keep them on that? Do you change it? Do you alternate other herbs? Or does it depend on whether the condition changes, its appearance, et cetera?

Dr. Balfour:                         Yeah, there are certain things that don’t change quickly, like melasma, for example, or vitiligo, certain skin conditions where you don’t see a lot of fast changes. So, somebody might be on the same blend for a longer period of time to see how things can shift. But with something like rosacea or with acne as well, changes can happen relatively quickly. Chinese medicine theory is that there’s a journey of healing, and that journey might last three months, it might last four months, it might last six. Sometimes it’s longer than that, usually not for those conditions. But there are different phases of treatment.

At the beginning phase, you’re clearing redness, clearing things that are excess, you’re clearing heat, you’re quelling inflammation in that way. The end of treatment, what you’re doing is stabilizing the skin, so you’re nourishing the skin, and that prevents future flares and future breakouts. It helps over the longer term. It’s not that I might not see somebody a year later, if they have a little flare again, then we can get them back to a stability. But this idea, this concept of there being clearing and then nourishing, and in the middle, we do a bit of both. It’s called harmonizing, that’s the word that we would use. But nourishing the skin with herbs that are tonifying or moistening the skin, healing of the skin barrier. It’s a hugely important concept of Chinese medicine. I think it’s one area where Chinese medicine is a little superior to Western medicine in that way. Just the idea in that concept, because in Western medicine, like you said, with Woody Allen, there are three things you could put on people’s skin that’s flaring. Well, one of them would certainly be a steroid.

You could give somebody a steroid cream to subdue any kind of inflammation. Well, the steroid will subdue the inflammation. Sometimes that’s all you need. The body comes back into balance, it finds its own homeostasis. You put the steroid on and then they’re done. But oftentimes that’s not the case. And in Chinese medicine, if you’re going to clear inflammation, the herbs will not be as strong as the steroid, but you will clear the inflammation. Well, then you nourish the skin because you need to actually heal the skin in a different way after you’ve cleared the inflammation. Just from the concept of that, it’s pretty powerful and interesting way to look at skin healing. Chinese medicine-

Dr. Weitz:                            How do you nourish the skin and are there certain favorite skin treatments, are there certain oils or lotions you like to use for skin, just in general for skin healthiness?

Dr. Balfour:                         Definitely. Certainly, with eczema, I like to use sunflower oil, because it’s very well-tolerated. If somebody had active eczema, and anything might irritate their skin, coconut oil has been used in many traditions around the world, in India, in Chinese medicine, coconut oil has withstood the test of time, I’d say. But still, it’s not the right thing for everybody. Somebody could have an allergy to coconut oil. But something like that is well-tolerated, sunflower oil is well-tolerated. I like evening primrose oil. It has some essential fatty acids that are really good to nourish the skin, to moisten the skin. That’s one of the ideas of what I’m talking about, you might use sunflower early, because it’s well-tolerated during an inflammatory phase. Then later you might use evening primroses oil to nourish the skin a little bit more. There are herbs that you take internal that would sort of act the same way.  But to your point, if I’ve worked with somebody with a lot of acne or rosacea, and let’s say they need to stop treatment earlier than I might like, because they don’t like the taste of the herbs, or it’s getting too expensive and they can’t afford it. Then nourishing your skin with good botanical oils, it’s another way to help keep the skin stable and help lock in the good results that you’ve seen from treatment.

Dr. Weitz:                            Do you ever do acupuncture for skin conditions?

Dr. Balfour:                         I don’t do a lot of acupuncture for skin conditions. There are certain things, shingles is so painful. That’s a skin condition where I will do acupuncture just to get people out of pain and misery. Sometimes for eczema, because if they’re itching. The thing about itching a lot, it’s maddening, it can drive you crazy. In that case, acupuncture can be really helpful. But really, I mean, the other-

Dr. Weitz:                            Are there Chinese herbs that are really effective for itching?

Dr. Balfour:                         Yes. But again, it depends on a dry itch versus if someone’s got blisters on… If you have a hand eczema with a lot of blisters, that’s like [inaudible 00:42:05]. So, you’re going to use different herbs for that than if there’s dryness. Yeah. Other thing I would say is that another kind of superpower about Chinese medicine is, with herbs and acupuncture both, we’re treating sort of the mental health, the emotional aspects of skin conditions as well as the physical look of the skin. It does happen very often. I have patients who will come into my clinic and I’ve got a big box of tissues, and they start crying because their skin condition is really upsetting. Anything that affects the face and their appearance, it’s really upsetting. Or anything that causes itching, that can be upsetting in a different way. I get people often, and they’ll come in and they’ll tell me their story, and they’re very upset and they’ll be crying, and then they apologize for crying as if most people with skin conditions aren’t upset.  It’s just such a truism of treating the skin that you’re really treating people’s emotions at the same time, because so many people have an emotional component, whether it’s the trigger for their skin condition or not, maybe they’re unrelated, they just live side by side with one another. But the fact of having a skin condition can be really emotionally draining for people. Acupuncture can really help when the stress or the anger about the skin condition is just helping to propel it and keep it going or cause future flares. Chinese medicine can act on both parts of calming the emotional aspect, and then healing the skin also.

Dr. Weitz:                            Cool.

Dr. Balfour:                         Yeah.

Dr. Weitz:                            I think that’s pretty close to a wrap. Any final thoughts you want to leave our listeners and viewers with?

Dr. Balfour:                         Yeah, just that the only final thought I would say is that the one unique thing is just that we individualize the formula. If you come in and you need treatment for rosacea and your sister has rosacea, too, it might be that your formulas are totally different. I have seen that before, even with twins, where they both come in for the treatment of acne. I remember, a set of teenage twins and their two formulas were so different because everything was different about them. Yeah, it’s really about getting to the heart of what’s going on with your skin and the rest of your constitution.

Dr. Weitz:                            So, don’t take your friend’s Chinese herbal formula for your condition.

Dr. Balfour:                         I’ve had that happen, too. I had a husband and wife, and she had eczema, and he had psoriasis, and he took her eczema formula on… He knew he was taking her formula. He was like, “I ran out of my own, so I took hers. Things got worse.” I’m like, “No.”

Dr. Weitz:                            So, it really does matter, specificity makes a big difference.

Dr. Balfour:                         It does matter. Yeah.

Dr. Weitz:                            That’s great. How can folks listening get a hold of you and seek your care?

Dr. Balfour:                         The best way is through my website, which is yinyangdermatology.com. So it’s Y-I-N-Y-A-N-G-dermatology.com. Then we’re also on Instagram and Facebook and everything as yinyangderm.

Dr. Weitz:                            Great. Thank you, Dr. Balfour.

Dr. Balfour:                         Thank you. It’s great to meet you. Thanks so much for having me.



Dr. Weitz:                            You got it. Thank you for making it all the way through this episode of the Rational Wellness Podcast. If you enjoyed this podcast, please go to Apple Podcasts and give us a five star ratings and review. That way more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. So, if you’re interested, please call my office 310-395-3111, and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.


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