BIRMINGHAM CENTRE FOR CHINESE MEDICINE

245 Alcester Road South, Kings Heath, Birmingham B14 6DT

Tel: 0121-441 2757

CASE HISTORIES - ECZEMA

Chinese herbal medicine is very good in the treatment of inflammatory skin conditions, notably eczema. In deciding on treatment the practitioner will note: the age of the patient and pattern of onset; family history; colour of the rash; amount of itching; severity and distribution of the eczema; degree of dryness/weeping; presence of blistering or pus; degree of subjective heat and thirst; bowel pattern; quality of sleep; relationship to mental and emotional changes; the tongue presentation and the nature of the pulse.

From this information the practitioner can identify the main pathogenic factors involved. In the case of eczema one will typically find, in different degrees and combinations, the presence of Heat, Wind, Dampness, and Fire-Toxin. In general Heat is shown by red lesions, subjective heat, unusual thirst and sleep disruption, together with a red tongue body and a rapid pulse. The main indications of Wind are itching, and symptoms that are very changeable. Eroded or weeping or 'puffy' lesions indicate Dampness, while pustular or easily infected areas show the presence of Fire-Toxin. In inflammatory skin conditions Dryness is usually secondary to Heat. The treatment principle will in one way or another include 'clearing Heat', but there are several strategies for doing this, determined by the detail of the individual presentation and in particular by the degree of Dampness present.

CASE

The patient was a woman of 29. She had suffered from eczema since infancy. She had been treated at the Centre some years before, when her eczema had been particularly severe. She had been unable to manage it successfully with steroid creams. She had responded very well to the previous course of treatment and had been in remission for two years. She was now experiencing a flare-up, with a similar presentation: a diffuse and intensely itchy red rash affecting the whole body. In the past there had been eruptions of blistering in certain areas and on occasion there were pustular lesions. Generally the skin was very dry, and it did not weep. She felt very hot and when the eczema was especially bad she became shivery. It was worse at night. Her tongue was red with a redder tip. The eczema tended to get worse with psychological stress and the current flare-might have been due to a recent change of job and house move.

The diagnosis involves deciding on the relative weight of pathogenic factors. In this case we find severe Heat in the Blood together with Wind, with minor manifestations of Dampness (which in association with Heat becomes Damp-Heat) and Fire-Toxin. The episodes of shivering are in the present scenario a sign of severe Heat, with loss of heat from the surface, an example of what is known in Chinese medicine as 'True Heat-False Cold'.

The patient responded very well to treatment which included herbs that (a) Cool the Blood (Sheng Di Huang [Radix Rehmanniae Glutinosae], Mu Dan Pi [Cortex Moutan Radicis], Chi Shao Yao [Radix Paeoniae Rubrae] Hong Zi Cao [Radix Arnebiae seu Lithospermi]) (b) clear Heat from the Qi level (Dan Zhu Ye [Herba Lophatheri]) (c) scatter Wind (Bai Ji Li [Fructus Tribuli], Fang Feng [Radix Ledebouriellae]) (d) clear Heat and dry out Dampness (Huang Qin [Radix Scutelleriae]) (e) 'drain' Heat and Damp through a diuretic action (Ze Xie [Rhizoma Alismatis],). (f) resolve Fire-Toxin (Bai xian pi [Cortex Dictamni], Jin Yin Hua [Flos Lonicerae Japonicae]).

The treatment continued for about three months. Such a length of treatment for atopic eczema is normal, though it varies greatly depending on circumstances. Less than one month or more than six months would however be unusual. It should be noted that the type of formula used here would not be appropriate for a different presentation. If for example there had been a lot of weeping, this would call for a different balance of methods, focussing more on the Damp-Heat or Fire-Toxin elements or both. The ability to fine-tune a formula in order to match the specific features of the individual patient and to take into account a number of possible refinements is one of the great strengths of Chinese herbal medicine.