The Skin in Health and Disease

Dr Swami Karmananda Saraswati, MB, BS (Syd.)

The skin which covers the human body is a most unique and complex living structure. Its outermost cell layers are dead, and are continually flaking from the body, yet it is through them that the aura of vitality and good health is reflected to the world like a mirror. Similarly, it is only our skin which upholds the engrossing illusion of our existence as individuals separate from one another. Consciousness is one and universal. Individual mind is an illusion upheld solely by our perception of physical separation. My skin is the barrier which I believe is the end of me and your skin is the same for you. Physiologically speaking, that barrier is nothing more than a few layers of flaking, already dead epithelial cells.

The skin is an organ

In considering the skin in health and disease, the first point is to realise that the skin is a distinct body organ. An organ is defined as a group of cells clustered together in order to fulfil a specific physiological function. Just as the heart is an organ which pumps blood, and the kidneys are organs which filter and eliminate metabolic wastes from the bloodstream, so is the skin an organ, the largest of the body, and surely one of the most important.

Secondly, the health of the skin cannot be considered in isolation from the rest of the body. Skin health is intimately related to the diet, the state of the digestive processes, and of the liver and bloodstream. This is seen in leucoderma, which is not essentially a skin disease at all, but is primarily a liver and pituitary disorder with visible skin manifestations.

Correction of skin disorders is impossible while the liver and bowels are clogged up with a backlog of dietary and metabolic waste products.

Equally, the restoration of skin health through yoga therapy is often directed primarily at influencing the digestive and circulatory functions. This is because skin eruptions so commonly reflect a more widespread eliminative, circulatory or metabolic problem, which must first be corrected if skin health is to be restored. It is not sufficient to merely suppress skin diseases with drugs and creams which give only temporary relief but no lasting cure.

A medical classification of skin diseases

1. Hypersensitivity or allergy to drugs, chemicals, etc.
   This type of skin eruption is very common today when people are being prescribed powerful drugs for common ailments which are often better managed without them. The number and severity of side effects of modern drugs is something not well publicised, but every doctor is well aware that the skin, liver, kidneys and digestive system are very commonly injured as a side effect of drug therapy. Such diseases are termed iatrogenic ones - produced as a side effect of drug therapy for another symptom, and they present a major problem for doctors today. Treatment of an iatrogenic skin rash is to discontinue the offending drug and then purify the body of drug residues through a program of fasting, asanas, pranayamas and shatkriyas.
2. Psychosomatic skin disease
   The skin is an extremely sensitive mirror of the mind, and skin diseases, rashes and itches often manifest in tense, anxious and sensitive persons. An itch is often a way of expressing the mental tensions arising from interpersonal conflicts. It is recognised in statements such as: 'What's biting you?' or 'He really gets under my skin.' Dermatologists term these rashes neurodermatitis and observe that they come and go in response to altering psychic, emotional and personal stresses in life in some temperaments. An itch is a very peculiar manifestation. At first no rash is visible, but it is generated by self-destructive scratching of the skin. Scratching can become a total mental obsession and the rash soon deteriorates. However, both the rash and the itch are forgotten, at least momentarily, when a new object of awareness appears on the scene, for example a new acquaintance or a cup of tea.
   Antar mouna, witnessing the itching sensation without resorting to the unconscious scratching response, is the fundamental step in management of neurodermatitis. Once the scratching is resisted, the rash soon disappears. Asanas, pranayama and yoga nidra are effective adjuncts for relief of underlying mental and emotional tensions. The hatha yoga kriyas - neti, kunjal and shankhaprakshalana are prescribed to clean the digestive system and purify the nadis (psychic nerve passages) in which painful blockage and obstruction to pranic flow is occurring.
3. Contact dermatitis
   Many chemical agents cause irritations and eruptions, particularly with prolonged exposure. This is especially so with cosmetics, body lotions, underarm deodorants, hair sprays, insect repellents, dishwashing liquids and industrial chemicals. When the offending agent is determined and its use discontinued, the rash also disappears.
4. Skin infections
   Medical scientists attribute skin infections to various micro-organisms, including viruses, bacteria and fungi which live and multiply upon the skin surface. Although certain viruses and bacteria grow upon normal healthy skin as part of its natural flora, when the body metabolism becomes unbalanced, the level of vitality drops or wastes accumulate throughout the system; pathogenic (disease-producing) organisms, which find these conditions more favourable, begin to multiply rapidly and skin infections result. Such a bacterial overgrowth is recognised as the indication to begin drug therapy, either topically (applied to the skin surface) or systematically (administered orally or by injection), to selectively destroy that population. A wide variety of specific drugs are used, including antibiotics for bacterial skin infections, steroid creams for fungal overgrowths, and grizeofulvin, an anti-fungal agent taken orally.
   These provide rapid symptomatic relief. However, skin infections commonly recur after drug therapy, because the fundamental cause has not been recognised and the underlying imbalance remains uncorrected.

Classification of skin infections

• (a) Viral infections
  'Shingles' is a very painful skin condition in which vesicles appear in bands on the skin surface. It is due to infection by herpes zoster virus at the site of origin of the cutaneous nerve roots in the region of the spinal axis, due to deficiency or blockage in the flow of prana occurring in association with the cutaneous nerve plexus.
  The most common site of origin is the thora-columbar nerve roots, which are associated with anahata chakra. As a result, a painful band-like rash appears on the ribcage or chest wall.
  'Cold sores', due to infection by herpes simplex virus are another example. These weeping sores may appear around the lips and nose during and after a cold, 'flu or other respiratory infections. They subsequently disappear soon after the body overcomes the primary infection. They will almost inevitably reappear when another cold manifests. Cold sores go on appearing and reappearing where the body's levels of resistance and vitality are reduced. This troublesome tendency can be overcome by practice of hatha yoga, surya namaskar and pranayama.
• (b) Bacterial infections:
  These include boils, impetigo and cellulitis, and are characterised by the production of pus. This thick, yellow-white liquid waste consists of the body's own martyred white blood cells. These bacterial infections signify inactivity of the skin, bad blood from putrefaction in the system and constipation. Such infections are the result of improper diet. They show that the body is full of toxic waste matter and is in a low state of resistance.
  Bacterial infections are best allowed to run their course, but the entire intestines should be washed by shankhaprakshalana, to remove constipation and ensure effective elimination via the bowels. Sometimes, in extreme conditions, boils may signify internal mental or emotional conflict and confusion which has thrown the immune defence system into a state of self-rejection and disorder.
• (c) Fungal infections:
  These manifest as a moist itching rash, usually in the wet, moist and sweaty areas of the body - especially between the toes and in the genital regions. Fungus gains access to the skin's layers when conditions are favourable due to an excess of acidity in the body. Acidity is one of the waste products of cell metabolism and recurrent fungal infections reflect an underlying elimination problem. They are best managed by internal purification through shankhaprakshalana which will remove excess acidic wastes.
  Topical steroid creams, which only serve to suppress the symptom, are of limited value. Fungal rashes are notoriously difficult to permanently eradicate by conventional therapy alone. They go on recurring for as long as the underlying acidic conditions remain uncorrected. They are worsened by synthetic underwear and socks. Like all skin eruptions they are best left dry and open to the atmosphere rather than covered up with bandages and dressings.
• (d) Scabies:
  This is an infestation by small mites which burrow within the skin and lay their eggs there, causing intense itching, especially in the wrists, arms and finger webs. The remedy is bathing of the whole body in benzol benzoate oil, followed by boiling of all clothing and bedding. Working up a sweat several times in the day also helps to eliminate the parasite.
• (e) Psoriasis:
  This unsightly recurrent skin disorder is the cutaneous manifestation of a more deep set psycho-physiological disturbance. An improper, devitalized diet high in carbohydrates, and faulty utilisation of fats and excess cholesterol in the skin and blood are also contributing factors.
  No lasting cure for psoriasis has yet been found in medical science, but yogic practices frequently enable an earnest individual to realise and evolve beyond the root cause of this disease. Amaroli should be practised in conjunction with other sadhanas, including inverted asanas and leg exercises if the legs are affected. Expose the affected areas to direct sunlight for some time each day, and bathe them in salty ocean water as often as possible.
• (f) Skin cancer:
  This usually occurs on the face or forearms of fair skinned persons following many years of exposure to direct sunlight in a tropical country. The skin should be shielded by a suitable lotion before exposure and a wide brimmed hat should be worn. The practice of amaroli (massage with 3 to 7 day old urine) in conjunction with dietary modification and pranayama frequently proves successful in its management.

General yogic program for skin health

Refer to 'Asana Pranayama Mudra Bandha' for full description of the practices.

Specific modifications in individual cases may be necessary under skilled guidance.

1. Surya namaskara to the point of total body sweating, while facing the newly rising sun. The sweat should be allowed to dry on the body while resting in shavasana.
2. Pranayama: Bhastrika and nadi shodhana should be practised each morning. Antar and bahir kumbhaka and maha bandha (jalandhara, uddiyana, moola) may be integrated into the pranayama practice.
3. Shatkriyas: Neti, kunjal and laghoo shankhaprakshalana should be performed; daily. Poorna shankhaprakshalana should be undertaken in an ashram environment once at the commencement of therapy.
4. Yoga nidra
5. Diet: A light vegetarian diet, rich in alkaline foods (juices, fruits and vegetables). Oil, sweets, refined, fried and spicy foods should be avoided and salt and dairy foods restricted. At commencement of treatment, a raw food diet should be followed for at least 5 days. Then, for a month, either the lunch or evening meal can be missed.

Further recommendations

1. Cold bath and skin rub each morning.
2. Sparing use of soap and cosmetics.
3. Skin rashes should be kept dry as far as possible and open to the atmosphere. The area should be washed free of debris once a day with a mild, non-abrasive soap, and dried carefully.
4. Avoid constipation and keep digestive system clean.
5. Drink plenty of water.