It all started with a little itch between my toes,” Eric told me. “The next thing I knew, some of my big toenail started turning yellow, and yesterday I stubbed it badly and that really hurt.” Eric and I were sitting in a treatment room in my clinic and he was showing me his foot. It looked clean and well-scrubbed, but the telltale signs of Tinea unguium (nail fungus) were unmis- takable. Part of the nail was yellowish-brown, thickened, distorted and grooved. Eric moved it back and forth to demonstrate.
“I tried an over-the-counter cream that was supposed to help, but after two months, I really haven’t seen any changes,” he said. “My doctor prescribed a stronger cream, but still nothing. She told me about an oral medication that is effective about 50 to 60 percent of the time, but I didn’t like the sound of the possible side effects.”
Eric’s problem was a fairly familiar scenario in my clinic over the years. Some people are known to be more susceptible to fungal infections than others, due to genetic predisposition. This makes treating the infections especially difficult for some patients. Athlete’s foot also is caused by a fungal infection from another similar fungus, and the two are often associated so that untreated athlete’s foot can increase the risk of toenail fungus.
Tough to Treat
Nail fungus is not easy to treat because the fungus gets under the tough nail, and topical applications of medicated creams or oils can’t penetrate. I’ve had patients who had their nail removed and then treated with an antifungal preparation until the nail grew back. This was sometimes effective, but the nail can become reinfected, and who wants to have their nail removed? Sounds like a really nasty stubbed toe could happen without the nail’s protection.
In Chinese medicine, we always try to look at the whole individual, not just their individual symptoms. As I reviewed Eric’s tongue and pulse signs, a clear pattern emerged. His red tongue with a yellow coating meant excess heat pathogen. This is thought to increase the risk of any kind of infection. Some signs of Spleen qi deficiency also were present. This meant his immune function might not be optimal. With toenail fungus, one needs all the help possible, from the inside and outside.
Fabulous Foot Hygiene
First of all, Eric and I talked about foot hygiene. Here is a list of the basics.
• Keep the foot dry — avoid putting on shoes right after a bath before the foot is dried completely. A foot powder sometimes helps for prevention. Put 1/2 cup of light cosmetic clay into the blender and add 1/2 teaspoon tea tree oil, or a combination of tea tree, thyme oil or oregano oil, and a little cedar oil or other favorite scent. Blend until well-mixed. Apply a small amount and rub in well between the toes and all over the feet.
• Make sure to trim infected nails after you trim healthy ones. Keeping the nails trimmed and filed will reduce the risk of infection and the risk of infected nails catching on things that might pull it away from the nail bed — a really painful experience.
• Avoid bare feet in public showers, or any wet places where fungus might grow. Wear sandals that slip on and off easily. Treat the top of the sandal with a little tea tree oil, blended with thyme or oregano oil. This will help keep fungus away from your foot.
• Avoid plastic shoes and synthetic socks that might promote dampness between the toes and on the bottoms of your feet. Cotton and wool both wick moisture away, and allow better air flow.
• Quickly treat any signs of athlete’s foot — peeling skin or cracking between the toes or bottom of the feet, before it migrates to your nails.
Fighting the Fungus
Nail fungus can be treated in stages. First, an all-natural treatment with antifungal essential oils for two to four months, applied twice daily with an over-the-counter urea cream (see “Understanding Urea” on Page 17). This should work for mild to moderate infections. If that doesn’t work, the most effective treatment is applying a blend of tea tree oil (and/or oregano oil) to an over-the-counter or prescription topical preparation. Taking oral antifungal agents should be a last resort because of potential side effects, such as liver toxicity. Application of a local agent is a lot less risky because less gets into the body.
One 1999 study with a butenafine prescription cream plus tea tree oil resulted in an 80 percent cure rate in 60 patients after 16 weeks, compared with no cures in the placebo group. No relapses occurred. This is an excellent outcome. On the other hand, oral medications are often only about 60 percent effective with toenail fungus. With the prescription cream/tea tree treatment, the nail may or may not come off, and one has to trim away the tip of the nail if it detaches. Sometimes only the fungus-infected nail will degrade and can be trimmed away.
If the entire nail is deeply infected, it is likely that the only topical cure will be removing the nail with a 40 percent urea preparation applied for five to 10 days, and then treating the nail bed with an olive oil, tea tree and oregano oil blend with added butenafine. Your doctor can help with this treatment. An allantoin cream can help speed nail regeneration. Several brands are available online or at your local health-food store. Even though it sounds somewhat radical, this treatment is still a safer option than the next step, which is oral medications with their toxic side effects.
Healing from the Inside Out
Eric’s infection looked treatable and had not spread to the entire nail. He was set on getting rid of the fungus and although he didn’t want to use an oral antifungal, he did want to try an over-the-counter antifungal cream combined with tea tree and oregano oils.
He also agreed to take an herbal formula for relieving the pathogenic heat, a prescription that included yellow dock root, dandelion root, gentian root and Oregon grape root. A tea from this combination would have been very bitter, so I gave him concentrated extract powders in capsules, about 11/2 grams of the extract, twice daily. For patients with very sluggish bowels, tending toward constipation with signs of heat, I usually add cascara sagrada, a useful herb to eliminate heat, hydrate the bowels and increase regularity.
To strengthen his immune response against the fungus, I gave him an extract of shiitake mushroom. Shiitake is nontoxic and unlikely to cause an allergic reaction or infection from taking it orally, which makes it a safe and effective way to help boost the immune response to clear the infection. Eric began by taking 2 capsules, twice daily, of a water-based extract powder of shiitake.
Diet-wise, Eric agreed to reduce his simple carbohydrate intake, and cut back on red meat and stimulating drinks, like sodas and coffee. All these warming foods and drinks tend to increase the risk of fungal infections.
Here is the treatment procedure Eric used. For mild infections, this process should be effective. Blend about 1/2 teaspoon of a 50-50 combination of oregano and tea tree oils with 4 ounces of 20 percent urea cream and apply to the nail twice daily. Cover the nail with a bandage for the first week, and leave it open to the air after that. Completely clearing the infection might take two to four months, so be prepared.
While tea tree has proven effects against toenail fungus, oregano is even more powerful. Discontinue the treatment if you experience any local irritation more than a little redness and itching. Some people do experience irritation with tea tree or oregano oils. In that case, try diluting the oils 50-50 with olive oil. Any irritation should go away soon after discontinuing the treatment.
Eric came into the clinic after four weeks, and the nail looked quite a bit better but still had signs of infection. Another five weeks had mostly cleared the nail, and when I saw him three weeks later he was still applying the cream once a day. I had to admire his persistence. Eric told me that he had used a little of the cream between his toes when he had beginning signs of athlete’s foot, and that seemed to clear it after a few days.
Christopher Hobbs’ case studies are gleaned from his 30 years of studying and practicing herbalism. Hobbs, a fourth-generation botanist and herbalist, is the creator of the correspondence course Foundations of Herbalism; www.FoundationsOfHerbalism.com.
“Case Studies” is not intended to replace the advice of your health- care provider.