Hi David, You described rosacea tonight as a bacterial infection, which blew my mind (you also said you didn't think it was related to the liver a few weeks ago, which also blew my mind). Can you elaborate on what rosacea actually is? Apologies for this question running all over the place but I know someone whose face both flushes BEET red with even the mildest embarrassment, frustration, heat (both external temperature and eating spicy foods), and physical exertion. I'm thinking this might be liver fire rising's "red head." In addition to the flushing, she also has redness in the cheeks (mostly) but also in the space between the eyebrows, the sides of the nose, and parts of the chin. She used to have it on the forehead too (with what dermatologists called "chicken skin" (little bumps) but that has mostly gone away). The blotchiness/rosacea(?) fluctuates day-to-day (she thought depending on what she eats), and was told by a top dermatologist in Philadelphia that "some people just have capillaries that are closer to the top of the skin than others and so you can see the redness." If this is bacterial, can someone sustain a bacterial infection for years and years (which is how long she's had the blotchy face) (and the flushing, if they are at all related)? Any advice you can provide is MOST appreciated. She finds the flushing most annoying ("people know my emotions before I do/how I feel is written all over my face") and she's been trying to get to the bottom of what's causing the rosacea forever. THANK YOU!

It is not one condition sometimes it can have a bacterial cause, many times it is idiopathic (no known cause), women get it more than men, it can run in families, allergies to skin mites can also be a cause, excess sun and smoking can be contributing factors. Western liver herbs are useful for treating many skin issues, although with Rosacea I use Gotu Kola and Sarsaparilla as a base treatment and if I can determine other underlying issues including from a TCM perspective Liver fire rising (this is the TCM liver, not the anatomical liver), I will treat that as well. It does not sound bacterial in this case at all, but certainly could be “liver fire rising”. Sadly the Dermatologist may be correct in her case, especially if she has fair skin. Still herbs may be worth trying .