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Eczema is the
most common inflammatory skin disease. It is characterized
by redness, swelling, vesicles, weeping, crusting, scaling
and itching. In Chinese medicine, it is known as Shi Zhen
(damp eruptions). In western medicine, the terms
“dermatitis” and “eczema” are interchangeably used. There
are three stages of eczema: acute, subacute and chronic.
Each represents a stage in the evolution of a dynamic
inflammatory process. Clinically, eczema may start at any
stage and evolve into another. The acute lesions are bright
red and swollen plaques with papules, vesicles or blisters;
these lesions are filled with serous fluid and there is
exudation and crusting and they are intensely itchy. Acute
lesions are often confused with contact dermatitis. Chronic
lesions are red, scaly, thickened, dry and sometimes
fissured, and they resemble lichen simplex chronicus and
tinea manus. Subacute lesions are in the intermediate stage
between the acute and chronic stages.
Etiology and
Pathology in TCM
Eczema can be
caused by both internal and external factors, and damp heat
is the main cause of eczema. Constitutional weakness and the
dysfunction of transformation and transportation of the
spleen result in damp heat accumulating on the skin. The
acute stage is due to the dysfunction of the heart. The
subacute and chronic stages are due to the spleen and liver.
Damp-heat is
the main pathogenesis in the acute stage. When the disease
transforms to the chronic stage, accumulation of damp heat
combined with yin blood deficiency and stasis are the main
pathological changes.
Pattern
Identification and Treatment
Acute and
subacute eczema
1. Damp heat,
with more heat
Main Symptoms:
Sudden onset, skin lesions may spread over the whole body,
flushed and burning sensation, discharge of suppurative
fluid, lingering pruritus, accompanied by feverish sensation
in the body, vexation, thirst, dry stools, scanty and dark
urine, red tongue, yellowish or yellow-greasy coating, and
slippery or rapid pulse.
Treatment
Principle: Clear away heat and remove dampness.
Formula: Long
Dan Xie Gan Tang
Long Dan Cao
15g, Zhi Zi 10g, Huang Qin 10g, Sheng Di Huang 10g, Che Qian
Zi 10g, Ze Xie 10g, Huang Bai 10g, Cang Zhu 10g, Fu Ling
10g, Liu Yi Powder (decoct in gauze wrapper)10g.
Modification:
For severe
pruritus: add Ku Shen 20g, Bai Xuan Pi 15g
For pustules
with discharge of yellow fluid: add Pu Gong Ying 20g, Jin
Yin Hua 12g
2. Damp heat
accumulation, with even dampness and heat
Main Symptoms:
Sudden onset, bright red erythema, rashes, weeping with
fishy smell, erosion, yellow crust, accompanied by dry
stools, scanty and dark urine, red tongue, yellowish or
yellow-greasy coating, and slippery or rapid pulse.
Treatment
Principle: Clear away heat and remove dampness.
Formula:
Modified Dao Chi San and Huang Lian Jie Du Tang
Mu Tong 12g,
Sheng Di Huang 15g, Chi Shao 10g, Zhu Ye 12g, Huang Qin 10g,
Huang Lian 10g, Zhi Zi 10g, Huang Bai 10g, Gan Cao 10g, Ku
Shen 20g
3. Damp heat
accumulation, with more dampness than heat
Main Symptoms:
Rashes, papulovesicles, small vesicles, slightly red
erythema, erosion with much weeping after scratching,
accompanied by poor appetite, lassitude, soft or loose
stools, clear copious urine, pale red tongue, white and/or
greasy coating, and slippery pulse.
Treatment
Principle: Dry dampness and clear heat
Formula: Chu
Shi Zhi Yang Tang
Fu Ling Pi 12g,
Bai Zhu12g, Zhi Ke10g, Huang Qin12g, Zhi Zi 10g, Sheng Di
Huang 15g, Zhu Ye 12g, Deng Xin Cao 6g, Sheng Gan Cao 6g, Ku
Shen 20g, Bai Xian Pi 15g
4. Liver qi
stagnation with dampness
Main Symptoms:
Skin lesions located along liver meridian (e.g., the nipple,
scrotum, vulva, etc.), erythematous eruptions,
papulovesicles, small amount of discharge, yellow crust,
itching, accompanied by a bitter taste, dry throat,
dizziness, irritability, restlessness, dark urine, red
tongue, thin yellow or dry tongue coating, and a wiry and
rapid pulse.
Treatment
Principle: Soothe liver and remove dampness
Formula:
Modified Dan Zhi Xiao Yao San
Dan Pi 12 g,
Zhi Zi 12g, Chai Hu 10g, Huang Qin 12g, Dang Gui 10g, Chi
Shao 12g, Sheng Di 15g, Fu Ling 12g, Lian Qiao 12g, Sheng
Gan Cao 6g, Bai Zhu 12g
5. Damp heat
accumulation in the spleen and stomach
Main Symptoms:
Damp heat and turbid evil attack the five sense organs and
the skin lesions locate around the mouth, eyes, nose, scalp,
and behind the ears. Erythematous eruptions, papulovesicles,
vesicles, weeping, erosion, yellow crust, itching,
accompanied by thirst, bitter taste, bad breath, dark urine,
red tongue, yellow tongue coating, and rapid pulse.
Treatment
Principle: Clear spleen and purge fire
Formula:
Modified Xie Huang San
Huo Xiang 12g,
Pei Lan 10g, Fu Ling 12 g, Huang Qin 12g, Zhi Zi 10g, Shi
Gao 15g, Chai Hu 9g, Sheng Gan Cao 6g, Ku Shen 20g
Chronic Eczema
1. Spleen
deficiency with dampness
Main Symptoms:
Long-lasting itchy patches with scales or thickened skin,
hyperpigmentation, eruptions with small vesicles, slight
erosion and crusting, accompanied with abdominal distention,
poor appetite, loose stools, pale and puffy tongue with
tooth marks, white thick greasy coating, and weak pulse.
Treatment
Principle: Strengthen spleen and dry dampness
Formula:
Modified Chu Shi Wei Ling Tang
Cang Zhu 15g,
Chen Pi 12g, Bai Zhu 15g, Hou Po 12g, Zhu Ling 15g, Fu Ling
Pi 12g, Yi Yi Ren 15g, Yin Chen Hao 12g, Che Qian Cao 12g,
Da Fu Pi 15g, Dong Gua Pi 15g, Sheng Gan Cao 6g, Ku Shen 20g
2. Accumulation
of dampness and stasis
Main Symptoms:
Swelling in one or both lower legs, leg pain, thickened skin
with grey or dark color, lichenoid skin, intensely itchy,
painful sores, dark red tongue, thin white coating, and deep
and hesitate pulse.
Treatment
principle: Remove stasis and dry dampness
Formula: Zhu Yu
Tang
Tao Ren 15g,
Hong Hua 12g, Dang Gui 9g, Chi Shao 12g, Fang Ji 12g, Qing
Pi 12g, Su Mu 12g, Zhi Shi 12g, Dan Shen 15g, Chi Xiao Dou
12g, Ze Xie 12g, Niu Xi 10g, Sheng Gan Cao 6g, Di Fu Zi 15g
3. Spleen
deficiency and blood dryness
Extremely itchy
patches with scales, thickened skin with scratch lines,
hyperpigmentation, pale tongue, white coating, and fine and
weak pulse.
Treatment
Principle: Strengthen spleen and moisten skin
Formula: Jian
Pi Run Fu Tang
Fu Ling 12g,
Cang Zhu 12g, Bai Zhu 12g, Dang Gui 9g, Chuan Xiong 9g, Dan
Shen 15g, Chi Shao 12g, Bai Shao 12g, Sheng Di 15g, Di Fu Zi
12g, Chen Pi 10g, Sheng Gan Cao 6g
4. Yin
deficiency with dampness
Main Symptoms:
Long-lasting itchy patches with small vesicles, red
eruptions around the edge of patches, erosion and oozing,
crust, easily flares-up, skin lesions spread out all over
the body, accompanied with thirs, five palm heat, dark and
scanty urine, red tongue, scanty or no coat, and fine and
rapid pulse.
Treatment
Principle: Nourish yin and dry dampness
Formula: Zi Yin
Chu Shi Tang
Sheng Di 15g,
Bai Shao 12g, Dang Gui 9g, Yu Zhu 12g, Dan Pi 10g, Fu Ling
12g, Zhe Bei 12g, Ze Xie 12g, Di Gu Pi 15g, Ku Shen 10g,
Huang Qin 12g, Sheng Gan Cao 6g
External
Treatment
Acute eczema
Wet Dressing
Formula: Ku Shen 20g , Huang Bai 15g, Long Dan Cao 15g, Di
Fu Zi 15g, Di Yu 15g
Chronic eczema
Moisturizers:
to seal water in the skin, reduce fissuring, scaling and
itching.
Acupuncture
Treatment
LI 4, LI 11, SP
6, SP 9, ST 36, ST 40, SP 10, HT 7
Extreme
itching: add GB 31, HT 8
Blood
deficiency: add BL 17
Auricular
Acupuncture
Lung, Heart, Spleen, Adrenal, Shenmen |
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