-IBIS-1.5.0-
tx
cutaneous system
urticaria
psychospiritual approaches

metaphors and correlations

• In a study of 37 Urticaria patients, two multidimensional personality tests (FPI and FAF) were administered. Those tested appeared to be less communicative, more inhibited and compliant, and less dominant and aggressive. They did not show signs of socially accepted expression of negative emotion or socially desirable signs of assertiveness. The following traits were not noted to a significant extent: depression, irritability, sociability, emotional stability, composure. A high rate of coincidence with other psychosomatic disorders such as chronic gastritis (51%), frequent headache (44%), migraine (15%), and duodenal ulcers (14%) was noted. (Locke, 1983, p. 137)
• Patients all found it difficult to express anger (common to many psychosomatic conditions). Particular feature to urticaria is failure to recognize hostile feelings to any significant extent, even though they felt trapped, hurt, frustrated, and helpless. (Locke, 1986, p. 79)
• Study showed that in most cases the patients had been intensely annoyed just before the urticaria eruption, but had not expressed it, and had greatly resented their own annoyance. All of this is connected with their infantile personality structure. (Locke, 1986, p. 80)
• Compulsive scratching; a descriptive model: Limited repertoire of social skills in these patients does not provide them with a strategy to master negative emotions. The resulting diffuse tension is temporarily reduced by scratching; this reinforces the tendency to perceive itching. The immediate relief of tension that follows scratching is followed by feelings of dissatisfaction or guilt associated with scratching, which further increases the tension. (Locke, 1986, p. 153)
• The emotional catharsis which a patient may experience through the relationship with an understanding and sympathetic practitioner can be an important factor in recover from a chronic recurrent pruritus of 'obscure origin.' (Locke, 1986, p. 168)
• Emotional conflict is of singular importance in the evolution of pruritus and psychotherapy is a major factor in successful treatment. (Locke, 1986, p. 169)
• Pruritus and scratching may be looked upon as a substitute for the sexual act or masturbation. The patient utilizes chronic dermatitis and scratching to discharge tension associated with psychological conflicts. The skin becomes 'eroticized' as an 'organ of expression' (Dunbar) of hostile, masochistic, and exhibitionistic trends. Repressed genital sexuality has been displaced to the skin with scratching occasionally representing a masturbatory equivalent. (Locke, 1986, p. 154, 170)
• Scratching is an expression of self-directed aggressiveness as a source of simultaneous pleasure and pain; it expresses at the same time a feeling of guilt and of a tendency toward self-inflicted punishment. (Locke, 1986, p. 170)
• Desires that go against the grain; unsatisfied; remorse; itching to get out or get away. (Hay, 1984, p. 171)
• Skin problems represent anxiety, fear, being threatened; old, buried stuff. (Hay, 1984, p. 183)

Chinese psychophysiology:
Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); controls the muscles; has an intimate relationship with the genitals and Lower Warmer; expresses itself in the nervous system; and reflects emotional harmony and movement.
» Healthy expressions are kindness, spontaneity, and ease of movement.
» Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Xue Xu (Blood Deficiency) predisposes to Xue (Blood) Heat. Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions such as Liver Wind.
» Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216)
» Liver Shi (Excess)
signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc.
» Liver Wind derives from Liver Yin Xu (Deficiency) and/or Liver Xue Xu (Blood Deficiency) and their subsequent inability to embrace the Yang, and can manifest as joint stiffness, dizziness, tremor, paralysis, convulsions, rashes, itching, and neurological problems. Wind can also be internalized after exposure to inclement, especially windy, weather and any concomitant influences of Damp, Cold, and/or Heat.

Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality.
»
Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy.
»
The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.

Small Intestine ~ Xiao Chang receives and transforms food by separating the Clear (Pure) from the Turbid (Impure), with the Clear becoming bodily fluids and the Turbid becoming urine - this function also operates on the emotional, mental, and spiritual levels; regulates quality of Xue (Blood); is responsible for digestion and nutrient absorption; with the Heart, is responsible for sweating; and opens into the tongue.
» Healthy expressions are love, joy, and the ability to discriminate; and, as the Princely Fire, warmth, vitality, and excitement.
» The Small Intestine is affected by sadness which grips a person and destroys the mental clarity and capacity of sound judgment for which this organ is responsible. (Maciocia, p. 273) Weakness, dysfunction, and illness are associated with cruelty, hate, indiscretion, and impatience.
» Small Intestine Shi (Excess) signs include happiness, joviality, scarlet complexion (Seem, p. 29); congested abdomen; pain at temples and sides of neck; flaccidity of muscles and joints in the arms, especially the elbows; and reddish urine.

Stomach ~ Wei is the Sea of Nourishment and origin of all fluids; transforms and digests food so that the Spleen can separate the distilled food essences; with the Spleen, is the root of post-natal Qi; and as Earth, relates to the ability to assimilate, stabilize, and feel centered and balanced.
»
Healthy expressions are fairness, openness, and nurturance.
» Weakness, dysfunction, and illness associated with worry, anxiety, and overthinking.
»
Stomach Shi (Excess) signs include nightmares; acne; skin eruptions; excess stomach acid (Seem, p. 28); heat in the abdominal area; overactive digestive system causing hunger and thirst; dark yellow urine; gluttony; halitosis; swollen gums; red dry lips; pains and cramps in legs. Stomach Heat Excess often originated in Stomach Yin Xu (Deficiency).

Large Intestine ~ Da Chang absorbs water; governs transformation and conveyance of waste from food to form stool; is paired with the Lung and relates to strength and sustainability as the Yang aspect of Metal.
»
Weakness, dysfunction, and illness associated with sadness, grief, and worry. Worry depletes the Lung Qi which fails to descend and assist the Large Intestine in its functions.
» Healthy expressions are righteousness and courage.
» Large Intestine Xu (Deficiency)
signs include skin eruptions; itching; cold; difficulty warming up (Seem, p. 29); shivering; rumbling in the bowels; and diarrhea.
» Large Intestine Shi (Excess) signs include dry mouth; parched lips; hot body (Seem, p. 29); warmth and swelling along the course of the channel; distended abdomen; dizziness; constipation; and yellow-orange urine.

Lung ~ Fei is the home of the Po (Corporeal Soul); governs the Qi; facilitates the immune function by assisting the dispersal of the Wei (Protective) Qi; regulates the rhythm of respiration, the pulse, and all bodily processes; relates to strength and sustainability; moves and adjusts fluid metabolism; opens at the nose; extends through the skin, controls the pores, and manifests through the body hair.
» Healthy expressions are righteousness and courage.
»
Weakness, dysfunction, and illness associated with excessive grief, sadness, worry, and depression.
» Lung Xu (Deficiency)
signs include cold shoulder and back; changing complexion; and inability to sleep (Seem, p. 28); shortness of breath; changes in urine color; rumbling in the bowels with loose bowel movements; pallor; malar flush; chills; sniffles; sneezing; light cough; and sensitivity to cold. Chronic Lung Yin Xu (Deficiency) increases susceptibility to rising Heat and acute Shi (Excess) conditions such as Phlegm, Wind, Heat and Cold.


therapies

behavior modification:
• Compulsive scratching: Suggested treatment techniques include aversive conditioning, relaxation, reinforcement for not scratching, and training in social skills. (Locke, 1986, p. 153)
• Aversive conditioning, reciprocal inhibition, habit reversal, and progressive relaxation provide effective means of treating compulsive scratching in neurodermatitis. (Locke, 1986, p. 164)
• Self-modification program: patient can maximize the self-directed modification since they design, maintain and terminate their own treatment. One 20-day contingency program reduced scratching to zero, and eliminated itching. 18 month follow-up revealed two brief recurrences, quickly Suppressed by re-institution of the program. (Locke, 1986, p. 166)
• Training parents to use operant guidance techniques: Withhold all reinforcement associated with the child's scratching herself, but reinforce other, desirable behavior. As the scratching decreased, the mother was instructed in appropriate techniques for thinning out the reinforcement schedule. (Locke, 1986, p. 167)
• Compulsive scratching: Suggested treatment techniques include aversive conditioning, relaxation, reinforcement for not scratching, and training in social skills. (Locke, 1986, p. 153)
• Intervention: Pediatric treatment for injurious scratching using a combination of time-out for scratching and tangible reinforcement for reductions in the number of body sores. (Locke, 1986, p. 203)
• Intervention: Pediatric behavioral treatment, centering on reinforcing desirable
behavior and noncritical communication. (Locke, 1986, p. 205)

affirmation:
• I am at peace just where I am. I accept my good, knowing all my needs and desires will be fulfilled. (Hay, 1984, p. 171)
• (Skin) I lovingly protect myself with thoughts of joy and peace. The past is forgiven and forgotten. I am free in this moment. (Hay, 1984, p. 183)

theotherapy:
(skin problems) Dionysus, Heracles, Orestes, Pelops (Lemesurier, p. 115)

hypnotherapy:
• Hypnosis was started in the form of simple suggestion. Varying degree of hypnotic trance were obtained, and during the hypnotic state the suggestion was given that the skin condition would resolve and return to normal and the irritation, if present, would disappear. In most of the conditions treated pruritus was a marked feature, and it was certainly found that the anti-pruritic effect of simple hypnosis was often very striking. It was also apparent that the doctor-patient rapport was considerably enhanced. Patients became more willing to speak. (Locke, 1986, p. 188)
• Hypnosis followed by use of posthypnotic suggestions: use of fingertip application whenever feeling or noticing the beginning of a rash. Return for hypnotherapeutic reinforcement sessions 3-4 times a year. (Locke, 1986, p. 155)
• Erickson's pseudo-orientation in times technique was used to consolidate and extend partial therapeutic gains resulting in complete remission of a neurodermatitis case. (Locke, 1986, p. 163)
• Hypnosis and autogenic training supplement each other in an excellent manner. The hypnosis will comparatively quickly render the patient symptom-free, while the autologous training has a weaker hypnotic effect but requires no assistance once practiced. After instructions, the patient may unaided control his disease which gives self-confidence that greatly contributes to recovery. (Locke, 1986, p. 168)

psychotherapy:
• Whatever happens to the skin corresponds to an inner process. The diverse functions of the skin (protection, contact, expression, excretion, respiration, temperature regulation, sexuality, etc.) are associated with a common theme that alternates between the two poles of separation and contact. Something is bursting through our limits, or trying to armor an inner sensitivity. A physical itch shows that something is 'biting' or 'bugging' us on a psychological level, some inner fire or powerful emotion wants to express. Questions to ask in the event of skin problems:
» What is it that is getting under my skin? What is trying to burst through barriers?
» How easy/difficult is it to make contact with other people? Do I desire intimacy?
» Have I condemned myself to solitary confinement? What is useful about this?
(Dethlefsen, p. 162, 170)

process paradigm: (experientially oriented)
• What is the symptom preventing me from doing? What is the symptom making me do? (see process interview: cutaneous system)

related materia medica listings:
the shadow and physical symptoms
skin metaphors and correlations
converting a signal to a symptom
behavior modification techniques
affirmations: guidelines and precautions
theotherapy
hypnotherapy
process paradigm


footnotes

Reprinted from The Foundations of Chinese Medicine, Maciocia, Giovanni, 1989, by permission of the publisher Churchill Livingstone, a division of Elsevier Limited.