Research in Theory and Basic Sciences理論與基礎研究〕
The Eczemas: TCM Etiology, Classification and Acupuncture & Herbal Treatments

溼疹的中醫病因、臨床分型及其針灸中藥治

By Yiwen Su, O.M.D., L.Ac., Prof. of Northwest Institute of Acupuncture & Oriental Medicine

701 N. 34th St., Suite 300, Seattle, WA 98103  U. S. A.

美國蘇毅文


[ABSTRACT ] The TCM etiology and common differential patterns of various eczemas were discussed in conjunction with a brief review in western perspectives. Calming the Heart Shen as one of the TCM treatment principles for all patterns was put forward according to the Yellow Emperor’s Inner Classics. Treatment of Acupuncture and Herbal Medicine was provided according to the clinical experience of the author.

 

     THE ECZEMAS, “Shi Zhen” in Chinese, are caused by endogenous or exogenous factors, characterized by papules, vesicles and exudation in acute stage and thickening & lichenification in chronic stages. Itching is almost always significant.

     In western medicine, the terms eczemas and dermatitis are now used synonymously,[1]therefore, the exogenous eczemas include contact dermatitis either due to skin irritation or allergies. The endogenous eczemas include atopic dermatitis, neurodermatitis, stasis dermatitis, etc.

     Clinically, the eczemas are classified into acute or chronic eczemas.[1]

     The following features describe the acute eczemas:

     a) Redness & swelling, usually with ill-defined margins

     b) Papules, vesicles and more rarely large blisters

     c) Exudation & cracking

     d) Scaling

The features of chronic eczemas are described as follows:

     a) May show all above, though usually less vesicular & exudative

     b) Thickening, lichenification, and dry leathery thickening with increased skin markings is secondary to rubbing & scratching (most often in atopic eczema)

     c) Fissures & scratch marks

     d) Pigmentation changes

     In Traditional Chinese Medicine (TCM) the eczemas were commonly referred to as “Shi Chuang” (Damp Skin Sores) , however, there were other names documented according to the different locations of skin lesions, e. g. “ Si Wan Feng” (Four Bends Wind), “RuTouFeng” (Breast Nipples Wind), “XuanErChuan” (Around Ears Skin Sores). Some were also named according to the features of the skin lesions, e. g. “Niu Pi Xuan” (Cow Skin Lesion) which refers to lichenification in chronic eczemas as neurodermatitis, etc.

     In my experience, the TCM etiology and common clinical patterns may be summarized as follows.

     Wind-Damp-Heat pattern and Blood Heat pattern in acute stage and Damp-Heat pattern and Blood Deficiency in chronic stage. In all cases a factor that is present is disturbed Heart Shen. This was clearly stated in Yellow Emperor’s Inner Classics as “All painful or itching skin sores are part of the Heart Disturbances”. [2]

     Therefore, the treatment principles for the eczemas are to dispel wind, remove dampness, clear heat, and cool the blood in acute stage. The treatment principles in the chronic stage are to nourish Yin& Blood, grasp wind, and calm the Heart Shen in all cases.

     The acupuncture and herbal treatment are designed thereafter.

[Acute Stage]

     (1) Wind-Damp-Heat pattern

Acu-points

     DU14, LI11, SP9, HT7, SP10, LI4, Ba Xie, Ba Feng.

     b) Herbs

¨Shi Chuang No.1: Cang Zhu 9g, Huang Bai 12g, BeiXie 12g, Ku Shen 12g, Jing Jie 9g, Chan Tui 6g, Hua Shi 15g, Chen Pi 6g, Fu Shen 15g, LianQiao 12g, SuanZaoRen 12g, Gan Cao 3g.

    (2) Blood Heat

Acu-points

    SP10, Bai Cong Wo, UB15, UB18, LV5, LI11.

    b) Herbs

¨Shi Chuang No.2: Sheng Di 12g, Shi Gao 15g, Zhi Mu 9g, Huang Bai 12g, Dan Pi 12g, Chi Shao 12g, Zi Cao 9g, Zhu Ye 9g, LianQiao 12g, Di Long 9g, Gan Cao 3g.

   [Chronic Stage]

   (1) Damp-Heat

a) Acu-points

Four doors (ST25, CV6, CV12), Bai Cong Wo, LI4, LI11, SP9.

    b) Herbs

¨Shi Chuang No. 3: Cang Zhu 9g, Huang Bai 9g, Yi YiRen 12g, ChuanNiu Xi 9g, Bai Xian Pi 15g, Dang Gui 6g, Jing Jie 6g, Fang Feng 6g, Wu Shao She 10g, Fu Shen 12g, Chen Pi 9g.

     (2) Blood Deficiency with Wind & Dryness

    a) Acu-points

    GB20, UB12, LI11, SP10, SP6, ST36, moxa on Tian Ying points.

    b) Herbs

¨Shi Chuang No. 4: Shu Di 15g, Dang Gui 9g, He Shou Wu 18g, JiXueTeng 12g, BaiJi Li 12g, Bai Xian Pi 18g, Bai Shao 9g, Di Long 9g, SuanZaoRen 15g, ZhiGan Cao 6g.

    (3) LV Yin and Blood Deficiency

    a) Acu-points

    UB18, SP6, HT7, LV2, KD3, LV5, LV8.

    b. Herbs

¨Shi Chuang No. 5: Bai Shao 12g, Gou Qi Zi 12g, Nu Zhen Zi 12g, He Shou Wu 18g,Yu Jin 12g, Xiang Fu 9g, Bai Xian Pi 15g, SuanZaoRen 18g, Long Gu 12g, Mu Li 12g.

    Topical Therapy:

    For acute stage, use topical wash with the same formulas as internal treatment.

    For chronic stage, use modified Qing Dai San oil. (Qing Dai, Shi Gao, Hua Shi, Huang Bai, Huang Lian, Di Yu).

     References:

    1. CRW. Edwards, et al: Davidson’s Principles and Practice of Medicine. (Seventeenth edition), Churchill Livingstone, Edinburgh, UK. 1995, p944-945

    2. Yellow Emperor’s Inner Classics, Simple Questions, Chapter 74.

     About the Author

     Dr. Yiwen Su, O.M.D., L.Ac. began his eight years of full-time TCM training in 1980 at Chengdu University of TCM, where he later served as a senior physician and instructor. Dr. Su also has specialty clinical training in Dermatology and General Surgery at the Provincial Hospital of Sichuan Province, P. R. China. He has lectured and practiced in Germany and Israel. In the U. S., Dr. Su was an instructor and clinical supervisor at Emperor’s College in California. Dr. Su is currently a faculty member of Northwest Institute of Acupuncture and Oriental Medicine, Seattle, WA. Beside of teaching, he has his private practice at NIAOM.

 

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