Case Studies

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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

“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

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

• 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

• 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

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

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.

Eric’s Treatment

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

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;

“Case Studies” is not intended to replace the advice of your
health- care provider.

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