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1 1 Eczema (Shi Zhen, 湿疹 ) Eczema/ 湿疹 pic 1

2 [Introduction] dermal inflammation: polymorphous serious itching symmetrical chronic / recurrence effusing tendency delayed allergic reaction int factors ext factors genetic food medications parasites bacteria pollens animal furs cold/heat/sunlight indigestion endocrine disturbance emotions local infection TCM Damp boil Damp toxic boil Ear boil Hand boils Nipple boils acute wind damp heat acute attack 2

3 wind/damp/heat skin --- rash int damp food damp SP blood heat damp heat skin --- rash chronic: blood def wind dryness [Diagnostic essentials] acute attack location (rashes): any parts of the body face behind ear dorsum of hand breast scrotum medial aspect of elbow legs foot shape/form (rash) erythema (hong ban) papules (qui zhen) papular vesicle (qui pao zhen) 3

4 blisters effusion erosion crust when in complication with infection: pustules (nong pao) pustular crust purulent effusion indistinctive border unbearable itching outcome: tends to recur become chronic sub acute small papules scale crust + slight infiltration slight effusion unbearable itching chronic acute sub acute chronic ( acute) infiltration (qin run) thickness dryness coarseness scales lichenoid change (tai xian yang bian) 4

5 pigmentation scratched marks bloody crusts rhagades (jun lie) (in joints of hand and foot) unbearable itching [Treatment] Syndrome differentiation A. Acute and sub-acute eczema 1) wind heat 2) wind damp 3) damp heat (heat>damp) 4) damp heat (damp=heat) 5) damp heat (damp>heat) 6) LV stg + damp 7) SP damp + ST heat B. Chronic eczema 1) SP def+damp 2) damp + blood stasis 3) SP def + blood dryness 4) yin def + damp 5) yin def/blood dryness + qi stg/blood stasis 6) wind+ blood dryness 7) LV+KI def 8) SP insufficiency + damp Other treatment 1) patent herbs 2) acupuncture 3) topical treatment

6 Syndrome differentiation A. Acute and sub-acute eczema 1) wind heat (in skin) Manifestation: rapid onset, red patch of skin/ papules (whole body), itching; t r, c-normal, p rapid, wiry Treatment principle: clear wind heat + cool blood Formula: modified shu feng qing re yin Herbs: Ci ji li 10, jing jie 10, chan gui 10, niu bang zi 10, jin yin hua 10, huang qin 10, zhi zi 10, sheng di huang 10, dan shen 10, chi shao 10 If severe itching: gou teng, quan xie If severe damp: yin chen, tu fu ling 2) wind damp M: T: disperse wind damp F: modified xiao feng san Jin jie 10, ku shen 8, zhi mu10, cang zhu 6, qiang huo 8, chan tui 10, fang feng 10, niu bang zi 10, sheng di huang 10, fu ling 10, sheng shi gao 10, dang gui 6, If in face/ears: cang er zi If in lower part: di fu zi 3) damp heat (heat>damp) M: T: clear heat, drain dampness, cool blood F: modified qing re li shi tang Long d c 6, huang qin 10, bai mao gen 10, sheng di huang 10, da qing ye 15, che qian zi 10, sheng shi gao 10, hua shi 10, gan cao 10 4) damp heat (damp=heat) (skip) 5) damp heat (damp>heat) M: slow onset, ----; poor appetite T: invigorate SP, drain damp, + clear heat F: m chu shi zhi yang tang Fu ling 15, bai zhu 10, huang qin 10, zhi zi 6, ze xie 6 Yin chen hao 6, zhi ke/qiao 6, sheng di huang 12, zhu ye 6 6

7 Gan cao 10 If: severe itching bai xian pi, ci ji li (bai ji li) 6) LV stg + damp TP: clear LV (heat?), resolve damp f: m dan zhi xiao yao san (jiao wei xiao yao san) xiao yao san + mu dan pi, zhi zi + huang qin, sheng di huang, lian qiao, dang shen if: severe itchy gou teng, bai ji li ; insomnia long gu, ci shi 7) SP damp + ST heat Manifestations: eczema (face, four limbs; red, papules, blister); Treatment p: clear/purge SP heat Formula: modified xie huang san huo xiang, pei nan, fu ling pi 12g zhi zi, gan cao, huang qin, chai hu 6g shi gao 20 fang feng, (chao) bai shao, mai men dong, mu dan pi, hu zhong, yin chen hao 10g if itching + gou teng, bai ji li B. Chronic eczema 1) SP def + damp M: itching, shedding, thickness of skin, pigment, papular vesicle (pale red), oozing Poor appetite, fullness of abd, loose stool, T: pale, swollen (teeth marks); C: white thick greasy/wet T: invigorate sp, resovle damp, nourish blood, moisten skin F: modified jian pi chu shi tang Bai zhu, Fu ling, zhu ling, yi yi ren, cang zhu, zhi qiao, huo po, Bai shao, che qian cao, ze xie, dong guo pi, Ku shen, ma chi xian/han, Dang gui, dan shen, chi shao If itching severe, bai xian pi, di fu zi 7

8 2) damp + blood stasis M: purple patches/erosion in legs, skin thickness, lichenoid change Lasting for decades, T: slightly dark/ purple ; C: thin white or scanty; P: deep, choppy TP: remove b stasis, drain damp F: modified tao ren (he) cheng qi tang Tao ren, zhi shi, chai hu, gui zhi 6 Qing pi, chi shao, bai shao, dang gui, (jiu/alcohol)da huang 10g (han) fang ji, ze xie, dan shen 12 chi xiao dou 12 if itching severely: + bai xian pi, di fu zi; if pain: chuan lian zi, yan hu suo 3) SP def + blood dryness M: chronic, skin (thick, coarse), itching, marks of scratching, pigmentation; Pale tongue, white coating T: tonify sp, dry damp, nourish blood, moisten skin F: modified jian pi run fu tang Fu ling, chang zhu, bai zhu, dang gui, dan shen 10; Ji xue teng 15, Chi shao, bai shao 20 Sheng di huang 15 Chen pi 6 If itching: ku shen, bai xian pi If qi def: huang qi, dang shen 4) yin def + damp (less) M: Low fever, thirst, irritability, feverish in five centers, scanty u, worsening in afternoon T: nourish yin, resolve damp F: modified zi yin sheng jin tang Sheng di huang 15 30, bai shao, dang gui, yu zhu, mu dan pi 10g Fu ling pi, ze xie, di gu pi 12, ku shen, can tui, chai hu, huang qin, chuang xiong 6 If severe itching: di fu zi, bai ji li 5) yin def/blood dryness + qi stg/blood stasis M: coarse/thick skin, dilated veins? (purple), itching, merged skin rashes (red), shedding, some red papules (vesicles), 8

9 Feverish sensation in five centers, afternoon fever, dry mouth (no drinking), dry stool, red/pale tongue, scanty coating, rapid thin p or deep rapid p T: nourish yin, moisten dry, nourish blood, move blood, moisten skin F: modified zi yin run zao tang Sheng di huang, shu di huang 20 Dan shen, he shou wu, bai xian pi, ze xie, ku shen 15 Tian men dong, mai men dong, nu zhen zi, han lian cao (mo han lian), xuan shen, dang gui, chi shao, bao shao 12g Tao ren, hong hua 6 If itching: long gu, mu li 6) wind+ blood dryness M: skin (pigmentation, thickness,), severe itching, TP: nourish blood, moisten, disperse wind F: modified si wu xiao feng san Shu d h 12, dang g 10, bai shao 10, qin jiu/jiao, fang feng, chan tui 10, sheng d h 12, If itching exemly severe, + gou geng, bai ji li if insomnia + long gu, zhen zhu mu -- Other treatment 1) patent herbs fang feng tong shen san 2) acupuncture seven star needle 3) topical treatment a) your own decoction: early stage: ku shen, huang bai, di fu zi, jing jie decoction if: oozing: huang bai, di yu, ye ju hua b) san huang xi ji: three huang c) qing dai gao: dry type d) 5% - 10% liu huang yuan gao Empirical/simple formulas: - acute: lu gan shi fen / powder 90g, zhu sha 30g, hua shi fen/powder 500g, 9

10 bing pian 30g, sesame oil - acute + chronic: ke zi (he zi) 100g (pound) + water 1500 ml 500ml + 500ml vinegar, - mang xiao g, + water - wu zhu yu 50g, 1500 ml scrotum - ku shen 50, huang bai 50, she chuang zi 30, jiao mu (shu jiao, chuan jiao, hua jiao) 20 [self care] no hot water, no soap no scratching no spicy food, chicken, duck, beef, mutton, fish, seafood [summary] 10

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