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  Acne Vulgaris
  

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By: Lueder Jachens, M.D.
(Original title: Akne vulgaris. Der Merkurstab 1996; 49:19-23. English by A. R. Meuss, FIL, MTA.)

On one hand, the skin delimits the organism from its environment; on the other, it is permeable to both ponderable and imponderable principles, e.g. in the sphere of the senses. The skin is a complete barrier for form-giving, structuring forces that arise from the nerves inside the organism and reach the skin as sunlight from outside, for instance. Sense organs that are partly created out of those qualities exist in areas of the body surface where sensory qualities are able to overcome this barrier. These are the only sites where imponderables such as light, sound, odors enter into the organism.

The blood is the main vehicle for the flow of substance reaching the periphery from the microcosm of the internal organs. In the skin, the flow generally changes direction. Having come from the inside it is turned back to move inward again. This happens mainly in the capillary loops of the papillae, the rhythmic up and down of which, in the gearing of dermis and epidermis, reminds of wave forms left in the sand when the sea has receded from a beach. Part of the flow of matter continues in the original (centrifugal) direction, however, passing through the barrier as sebum, sweat or material desquamating from the highly-differentiated comified layer. Rudolf Steiner suggested that the basis for human self-experience lies in the flow of matter coming up against resistance and changing direction in secretory organs.(1) Astral body activity lives in excretions in quite general terms. Secretion to the inside, e.g. of hormones, must be distinguished from eliminations to the outside. The astral body is the energy system that maintains a healthy balance between the two.(2)

These basic features of the skin help us to understand the pathogenesis of acne. Increased sebum production, with the sebum composition changed, reflects an increase and change in the flow of matter to the periphery. It is not fully "cooked," with sebaceous follicles densely populated with microorganisms as a result. The I organization which is active in warmth processes has not entirely taken hold of the substance so that foreign bacterial life is able to thrive on it. The centrifugal process pushing outwards from inside combines with a comification disorder at the sebaceous ducts, which are blocked with plugs of keratinous material. Hardening tendencies of the form principles originating in the nerves are clearly coming into play. Blackheads and follicles filled to bursting develop, with bacterial lipases breaking down the sebum into fatty acids that cause irritation and inflammation - a digestive process in the wrong site. Rudolf Steiner refers to this pathological continuation of digestive principles "in the direction of the head" - evident to us in the inflammatory process involving papule and pustule - as one-sided activity of the lower ethers (chemical and life ether). This causes "softening of the brain/' in this case dissolution of the sebaceous follicle in the skin, an organ that is part of the upper human being.(3)

A characteristic feature of acne vulgaris is that it is located mainly in the face. A shift of digestive activity "in the direction of the head" is apparent in two ways: 1) because the skin, an organ belonging essentially to the human being of nerves and senses, is involved and 2) because the skin of the head is affected. This part of the body surface is most important for social contact, hence the often considerable suffering of young persons. We can understand this if we consider acne vulgaris in the light of the study of man: looking into the mirror, the young person, whose inner life is still maturing, is shown that the metabolic aspect of the process is temporarily not functioning properly.

Looking at the process in relation to the whole human being, it is important to realize that acne generally occurs during puberty. (A third of all young people suffers from some form of acne.) Organic brain development reaches its conclusion towards the end of the first 7-year period. The milk teeth are lost, and powers that previously served the organism become free for thinking as a conscious activity. The child is ready to go to school.

A second level of maturity is reached by the end of the second 7-year period. Organically the young person becomes sexually mature, and in the inner life he or she is now mature for the earth, with a new self-perception. On one hand, the astral body is given new tasks in the organic sphere, e.g. to organize the subtle interplay between developing and breaking down of the uterine mucosa. On the other hand, the whole environment is seen with new eyes; new interest in the world awakens. The process is in stages and will obviously get into "ferment" at times.

Signs of inadequate intervention of astral body and I organization in the metabolism may be menstrual irregularities in young women, constipation, acrocyanosis, and offensive sweats. If one decides to meet the situation with metal therapy, Ferrum offers general assistance with incarnation and helps the organism to be "breathed through." Mercury may help to stimulate metabolism and especially glandular function. External applications of Cuprum may serve to increase mobility, e.g. letting the blood, the vehicle for warmth, flow right down into the feet.

Rudolf Steiner and Ita Wegman referred to the way skin inflammations may engage the upper aspects of the human being too much so that they are no longer sufficiently able to perform their functions in the organs of the microcosm. They gave the example of effects on the liver and digestion. Silica makes internal organs sensitive to one another. Medicinal use of it releases the higher aspects of the human being from their involvement in the skin so that they may be more active in the inner organism.(5) The organ involved in the disorder also needs to be treated, in the present case the liver. Gallbladder, pancreas, spleen and kidneys are other organs where sluggishness may develop so that activity has to be encouraged.

If skin inflammations go hand in hand with daytime tiredness and increased dreams at night, this may be because the higher aspects are not properly "settled" in the physical body. Phosphorus treatment may help in this case.(6) Phosphorus also encourages I organization activity to counteract "excessive etheric and astral activity."(7)

Sulfur is helpful for disorders of protein metabolism; it makes protein, a physical substance, more inclined to accept intervention from the ether body.(8) Great care is, however, indicated in giving Sulfur to fair-haired people. Fair hair indicates a powerful sulfur process, black hair a powerful iron process.(8) Aggravation from Sulfur is more likely in fair-haired women; blond men tolerate it better, e.g. as Sulfur selenosum.

Dietary advice in acne cases bases on the role sugar plays as vehicle for the I organization in the blood. If I-activity in the metabolism is weakened, refined sugars and fine flour make this weakness evident by causing an aggravation of the skin condition.(9) Proteins are most open to ether forces. Their degradation and synthesis are ultimately determined by the I organization, and we relieve the latter by reducing the intake of meat, cold meats and cheese.(10) Whole milk is best avoided, with soured milk products taken instead. Lactic acid-forming bacteria predigest cow's milk, as it were, and this relieves the strain on weakened digestive powers. Fat is mainly the vehicle for heat; excessive fat intake causes "parasitic heat foci" in the organism and a tendency to inflammation.(11) A low-fat diet is therefore recommended for acne.

Raw food may also prove therapeutic, especially when beginning medical treatment of severe acne. It supports the structuring activity of silica at the periphery, healing the deformation caused by inflammation.(12)

An interesting observation that has been frequently made is that young people of asthenic habit tend to develop acne on the chest and back. This may be due to the enhanced nerve impulse of asthenic subjects not being exhausted in pathologic skin changes in the facial region but extending to the upper trunk. Aggravation from stress also points to a one-sided nerve process. The forehead is often affected in grammar school pupils who have to do much intellectual work, whereas perioral efflorescences may suggest that the causes are predominantly metabolic.

If acne persists beyond the early twenties, this may be a sign of constitutional weaknesses persisting from puberty. This shows the potential offered by acne treatment taking account of the whole constitution and providing genuine prevention of more serious conditions. Oral contraceptives, often taken even in puberty, impose foreign functional principles on the pelvic processes in young women. The astral body cannot come fully into its own in establishing an individual menstrual cycle. Acne will, of course, often improve because the peripheral hormonal situation in the sebaceous gland changes, with sebum production reduced. The acne will, however, return when the hormones are discontinued. Several years of oral contraception may cause a type of acne to develop which is partly due to hormonal effects on liver metabolism.

Acne patients have different constitutions, with a marked polarity that points to different requirements:
hysteria -  neurasthenia
estrogen type - gestagen type
Rubens type - Cranach type
adiposity, pyknic habit - asthenic habit
tendency to migraine - tendency to atopy(13)

With an hysterical constitution and the rounded forms we know from Rubens paintings, one sees juicy pustules and superficial papules. With neurasthenics, tending to be undernourished, young women with the figure of a young boy (see Cranach paintings) and asthenic young men, deep-reaching nodules, often persisting for weeks, are common. In all cases, whatever the constitution and shape and form of efflorescences, the Wala Acne Series may be used as a basic treatment. The main active principle is Nasturtium.(14)

In conclusion, let me stress that in spite of the many different background situations seen in individual cases is a true pyoderma, i.e. an inflammatory, "warm" disease. Croatian dermatologists have established that older people who have had acne in their youth are less likely to develop basaliomas and spinaliomas, epidermal skin cancers that count among the "cold" diseases.

A beginning has been made with relating details of a dermatological syndrome to the images of the human organism Rudolf Steiner was able to present out of the science of the spirit. The intention has been to encourage colleagues to tind a way to individual treatment. Rudolf Steiner made it clear that a syndrome has to be carefully studied when he said: "Never do imaginations arise more easily than if one studies pathological states in the human being."(3)

References
1 Steiner R. An Occult Physiology (GA 128), lecture of 24 March 1911. Tr. E. Frommer. London: Rudolf Steiner Press 1983.
2 Steiner R, Wegman I. Fundamentals of Therapy (GA 27), chapter 12. Tr. E. Frommer, J. Josephson. London: Rudolf Steiner Press 1983.
3 Steiner R. The Spiritual-Scientific Aspect of Therapy (GA 313), lecture of 12 April 1921. Tr. R. Mansell. Long Beach CA: Rudolf Steiner Research Foundation 1990.
4 Steiner, R. Anthroposophie als Kosmosophie Teil n (GA 208). Not translated.
5 Steiner R, Wegman I. Fundamentals, chapter 12.
6 Steiner R. Spiritual Science and Medicine (GA 312), lecture of 25 March 1920. Tr. not known. London: Rudolf Steiner Press 1975.
7 Steiner R, Wegman I. Fundamentals, chapter 13.
8 Steiner R. Curative Education. 30 June 1924. Tr. M. Adams. London: Rudolf Steiner Press 1981.
9 Steiner R, Wegman I. Fundamentals, chapter 8.
10 Ibid, chapter 9.
11 Ibid, chapter 10.
12 Steiner R. Spiritual Science and Medicine, lecture of 30 March 1920.
13 Weber G. Akne, Rosacea, Alopezie durch Kontrazeptiva und hepatische Insuffizienz - ihre Therapie. Deutsches Aerzteblatt 1976; 34:2159-64.
14 Mandera R, Meyer U. Portrait of a Medicinal Plant. Tropaeolum majus L. - Nasturtium. Journal of Anthroposophical Medicine. 1995; 12(4): 60-67.





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