Monthly Archives: December 2011

The Art of the Bath, Chinese Herbs, and Transdermal Celebrations

The bath.

A container, a liquid. A human (or other animal) to bathe in this liquid.

Macaques bathing in hot spring, courtesy fungur.blogspot.com

More Relaxing Monkeys! Soooo relaxed. Courtesy fungur.blogspot.com

 

The power of the bath has been celebrated by myths, enjoyed by many cultures, immortalized in film, and sadly overlooked by many citizens of the modern world.

Here we have Cleopatra bathing in a huge tub of milk:

Milk baths may be beautifying, but other ingredients can be more practical for stress relief and muscle relaxing. For example, my neck and shoulders easily become solid pieces of gristle due to old athletic injuries. I find myself rolling my neck at odd times, not to stretch but rather to test whether or not I could indeed roll my neck at all.

ENTER: AWESOME CHINESE HERBAL BATH.

Of course. The boiling of herbs for half an hour, the addition of this herbal decoction to a hot hot bath, and the complete immersion and foot massage during the bath itself, with sea salts. Hmmm. The cold shower afterward and subsequent ginger tea before going to sleep. These things were all at my fingertips and I had yet to incorporate them into a routine.

Thank you, Awesome Chinese Herb Bath, for I am now revitalized, warm, and ready to face an entire Portland winter. The seemingly mundane event of taking a relaxing bath (satirized in this Onion article) sparked a runaway mental forest fire of herbal bath ideas for my clients who have more severe types of stress and pain. I began to offer herbal bath and herbal soak options which can help relieve pain, reduce inflammation, relax ligaments, and heal injuries. Success! A way to really extend the treatment effect, while giving patients the tools to treat themselves in a preventive way. Hooray for preventive medicine that is actually fun.

I’d like to think that I’m doing my part to promote a bath culture in the US. One day we may approach the sophistication of the Taiwanese, South Korean, or Thai cultures in regard to hot springs/foot baths/saunas/generally excellent water-based external herbal therapy. The following video illustrates the importance of the hot spring in Taiwan: you will notice that several people are sitting by the side of a busy road, at night, soaking their feet in something resembling a ditch by the road but which is actually a piping-hot rejuvenating hot spring. THAT is dedication.

So… what actually happens when one bathes? Why is it relaxing? What happens to the skin and blood vessels? What kinds of molecules traverse the dermis?

Some may be reminded of the ability for certain controlled substances to pass the epidermal barrier, such as nicotine or LSD. The band Ween has illustrated this effect with their song “Transdermal Celebration.”

Taking a bath in a Chinese herbal tea has not created that particular effect yet (to my knowledge), but sometimes one forgets how it feels to be relaxed and can consequently feel a little tipsy when the tense muscles let go. Because the skin functions as a protective barrier, we might expect that only a select few substances can penetrate its defenses, and we may have been lead to believe this in popular culture. Yet this barrier is awfully porous, for better or for worse. Skin penetration is a complex topic which the pharmaceutical industry has spent many hours and dollars investigating, primarily as it applies to adhesive patches. Lynn Margetts and Richard Sawyer report in their 2007 article Transdermal drug delivery: principles and opioid therapy published by the Oxford Journal’s Continuing Education in Anesthesia, Critical Care, and Pain (1):

The application of medications to the skin to ease ailments is a practice that has been utilized by humankind over the millennia and has included the application of poultices, gels, ointments, creams, and pastes. These applications were primarily intended for a local topical effect. The use of adhesive skin patches to deliver drugs systemically is a relatively new phenomenon.1

The first adhesive transdermal delivery system (TDDS) patch was approved by the Food and Drug Administration in 1979 (scopolamine patch for motion sickness). Nitroglycerine patches were approved in 1981. This method of delivery became widely recognized when nicotine patches for smoking cessation were introduced in 1991.

TDDS offer pharmacological advantages over the oral route and improved patient acceptability and compliance. As such, they have been an important area of pharmaceutical research and development over the last few decades.

Here is a kind of site-map for the investigation of skin penetration (ok, snicker):

From the Wright State University Boonshoft School of Medicine's Department of Pharmacology and Toxicology

Not pretty. All kinds of things can penetrate the epidermis, and many factors can influence skin permeability. Continuing to quote from Margetts and Sawyer:

Skin structure

The skin is the largest organ in the body; it protects against the influx of toxins and the efflux of water and is largely impermeable to the penetration of foreign molecules. Human skin consists of three main layers: the epidermis, dermis, and hypodermis (Fig. 1). The epidermis, in particular the stratum corneum, acts as the major barrier to drug absorption. The stratum corneum contains only 20% of water and is a highly lipophilic membrane; it is 10–20 µm thick depending on its state of hydration. The thickness of the epidermis varies from 0.06 mm on eyelids to 0.8 mm on the soles of the feet.

Fig. 1 Cross-section of the skin

An applied drug must traverse these structural layers, encountering several lipophilic and hydrophilic domains on the way to the dermis where absorption into the systemic circulation is rapid due to the large capillary bed. Removing the stratum corneum speeds the diffusion of small water-soluble molecules into the systemic circulation by up to 1000 times.2 Alternatively, hydrophilic compounds can reach the dermis via shunt pathways such as hair follicles, sweat glands, nerve endings, and blood and lymph vessels. These routes contribute minimally to steady-state drug flux. The dermis is the thickest layer of the skin (3–5 mm) and possesses hair follicles, sweat glands, nerve endings, and blood and lymph vessels. It acts as the systemic absorption site for drugs.

There are variations between individuals in the rate at which drugs are absorbed via the skin due to factors such as thickness of the stratum corneum, skin hydration, underlying skin diseases or injuries, ethnic differences, and body temperature.

So apparently, compounds which dissolve in water can traverse the epidermis to reach the dermis in many ways, and their potency is slightly unpredictable! The hot bath may not be the most efficient transdermal delivery system, but for the purpose of administering low doses of herb-derived compounds it can be highly effective. In a hot bath, the sweat glands and hair follicles open and relax, allowing for greater absorption of chemical compounds. The increased blood flow due to the higher temperature creates increased capillary permeability as well. Basically, in the hot bath, the epidermal sentries fall asleep and start drooling, while multitudes of herb-derived compounds ride into town on water molecules. Yeehaw!

So ask your acupuncturist about setting up a nice herbal tea which can be used in the bath. This is a cheap, satisfying, effective way to reduce muscle tension and pain from chronic musculoskeletal complaints.

You can make one at home by using rosemary and lavender, with some ginger thrown in. Take a half cup each of rosemary leaves and lavender flowers, add two inches of thinly sliced ginger, and boil for 20 minutes. Strain and add to a hot bath (careful not to burn yourself!), then add a half cup of apple cider vinegar or cooking wine to the bath. Soak for half an hour. You can even make a cup of green tea and hold the tea bag over each eye for added de-stressing of the eyes and head. If you’re really ambitious, after the bath take a quick cold shower and then bundle up. This is both invigorating and relaxing, so appropriate for morning or evening.

Have fun and let me know what you come up with!

Note: It is important to use non-toxic herbs for a bath tea, due to the large surface area exposed and the inability to regulate dosages in a predictable way. Pregnant women should use extreme caution when taking herbal baths, and always consult a health care provider before trying this therapy. And of course don’t use an herbal bath if you have open wounds, swollen traumatic injury, or any sensitive blood pressure condition.

If you don’t feel like throwing yourself into the tub, there is the option of creating an abbreviated and focused “bath” of the afflicted body part. One of the most common ways to administer potent external herbs is via the steam compress. Andrew Ellis, the founder of the excellent Spring Wind line of external plasters and compresses, provides clear directions for using his external herbal products. Andrew Ellis has written a succinct document titled Treatment of the Three Stages of Sinew Damage Employing External Applications (2). (snip:)

Successful treatment of trauma requires an understanding of its pathology. After initial trauma the local blood vessels dilate, blood flow to the region increases and fluids are exuded into the inflammatory focus. The result is the swelling, rubor and pain associated with inflammation. The principal of treatment at this point is to move blood, clear heat, dissipate swelling and relieve pain. Acupuncture and application of soft plasters or liniments form the basis of treatment. Soaks, steams and compresses are avoided because they aggravate inflammation by dilating blood vessels and encouraging hyperemia.

After a few days the circulatory system begins to clear away damaged tissues and swelling and pain decrease. At this point the local area begins to turn deep-red and purple indicating stasis of blood and qi. The treatment principle at this juncture is to soothe the sinews, dissipate stasis and quicken blood. Massage (above and below the traumatized location), liniments, steams, soaks, acupuncture and soft plasters are primary treatment.

When pain and swelling have subsided and what remains is the nagging pain of an enduring injury or pain that is exacerbated by damp or cold, the principle of treatment is to move qi, quicken collaterals, disperse cold, dispel damp, dissipate stasis and relax sinews.

Acupuncture and moxabustion are useful in treatment of this stage of traumatic damage as are massage (including the traumatized location and employing massage salves or liniments), steams, soaks, hot compresses and the application of hard plasters.

Steam-Soaks
Place an herb pack in four cups of water and bring to a boil. Lower the heat and simmer for 25 minutes. Immediately put the water (with herb bag still immersed) in an appropriately sized basin and hold the affected limb over the steaming liquid. When the decoction cools enough to allow the patient to bath the affected limb, the traumatized region should be totally immersed. Total soak-steam time should be 20-25 minutes. This procedure should be performed two times a day.
Adding two tablespoons of rice wine to the water at the beginning of the process will enhance the effect of the steam-soak. The liquid can be re-heated and used for three to four days.
• For large areas or for multiple injuries the above doses can be doubled.
• The herb bags can be used as hot compresses at the end of the soaking process.

Steam-soaks as a Compress
Many areas, such as the shoulder, knee, hip and back, are difficult to soak. In such cases, cook an herb pack in two cups of water. Bring to a boil and simmer 25 minutes. Remove the bag and as soon as it cools enough to apply place it on the affected spot. Put a hot-pack or a hot water bottle over the compress to keep it hot and leave on for 20-25 minutes. Adding two tablespoons of rice wine to the water at the beginning of the process will enhance the effect.

It is important to cover the region that has been treated with the soak or compress. In most cases a soft plaster or plaster will be applied after a steam soak thus fulfilling this requirement. If however, no dressing is to be applied the patient must otherwise cover the traumatized region and protect it from wind and cold.

Contraindications and Cautions
Steam-soaks should not be used to treat areas that are still swollen. Care must be taken to avoid scalding. Ideally, the soak water or compress should be as hot as the patient can tolerate but not so hot that it burns the skin

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A couple bath-related videos for your enjoyment:

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References:

1. Margetts, Lyn & Sawyer, Richard (2007). Transdermal drug delivery: principles and opioid therapy. Continuing Education in Anaesthesia, Critical Care, and Pain. 7 (5): 171-176. Retrieved from: http://ceaccp.oxfordjournals.org/content/7/5/171.full

2. Ellis, Andrew. Treatment of the Three Stages of Sinew Damage Employing External Applications. Spring Wind Herbs, Inc. Retrieved from: http://www.lhasaoms.com/email/SW_TraumaDoc1.pdf