Cutaneous pruritus refers to a subjective symptom where the skin feels itchy and there is a desire to scratch, but there are no primary skin lesions. As mentioned in Waike Zhengzhi Quanshu, Volume 4: "Generalized cutaneous pruritus, without sores or scabies, and the itching does not stop with scratching."

This condition is referred to as "pruritus due to wind (cutaneous pruritus)" or "wind-heat sore (pityriasis rosea)" in the "Zhu Bing Yuan Hou Lun"; Waike Zhengzhi Quanshu calls it "itching wind"; and "Youke Quanshu" refers to it as "generalized itching". If the cutaneous pruritus is limited to one area, such as the scrotum, vulva, anus, etc., or if there are primary skin lesions like papules or blisters before the pruritus, these cases are not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Blood Heat︰It mostly occurs in young and middle-aged adults, presenting as cutaneous pruritus with linear scratch marks, worse in summer or when exposed to heat and relieved by cold. Accompanied by dry mouth, dysphoria, a wiry and rapid or slippery and rapid pulse, a deep red tongue or red tongue tip, and thin yellow coating. It is often caused by emotional distress or excessive consumption of pungent and fried foods, leading to blood heat generating wind and resulting in cutaneous pruritus. Young adults with vigorous blood and qi are more prone to this condition, and scratching leaves numerous blood marks. In summer, when yang qi is at its peak, external heat combines with internal heat, exacerbating the cutaneous pruritus, which is relieved by cold. Therefore, the key to this syndrome lies in blood heat, and treatment should focus on cooling blood and clearing heat to dispel wind and relieve itching. The recommended formula is the Itch-Relieving and Wind-Extinguishing Decoction. The condition is primarily due to blood heat, with internal factors being the main cause.
2. Blood Deficiency︰It is commonly seen in the elderly, with symptoms worsening in autumn and winter and alleviating in spring and summer. Clinical manifestations include dry skin covered with scratch marks, lichenification in frequently scratched areas, skin scaling resembling bran, or widespread blood scabs. Accompanied by a dull complexion, palpitations and insomnia, dizziness, and blurred vision, the pulse is wiry and thin, and the tongue is pale with a clean coating. It often occurs in the elderly due to dual deficiency of qi and blood, where blood fails to nourish the skin, leading to blood deficiency and wind-dryness, resulting in dry, scaly skin like bran. Persistent scratching leads to widespread blood scabs and scratch marks. Over time, the skin develops lichenification. Treatment should focus on nourishing blood and moistening dryness, dispelling wind to relieve itching, with the recommended formula being the Nourishing Blood and Moistening Skin Decoction. Since blood deficiency is the root cause and internal wind is the contributing factor, replenishing qi and blood will naturally eliminate internal wind and resolve cutaneous pruritus.
3. Wind-dampness︰Cutaneous pruritus, with blisters, papules, exudation, or erosions after scratching, is more common in young adults, especially during summer and autumn. The pulse is slippery and rapid, and the tongue coating is white and greasy or thin, yellow, and greasy. It is often caused by excessive consumption of rich, sweet, fatty, spicy, or fried foods, leading to internal dampness accumulation, which is then aggravated by exposure to wind, resulting in the mutual contention of wind and dampness. Wind predominance causes itching, leading to incessant scratching, while dampness predominance results in blisters, papules, exudation, or erosions. Treatment should focus on dispersing wind, eliminating dampness, and relieving itching. The recommended formula is Quan Chong Fang. Additionally, conditions like dampness-heat jaundice can also cause generalized itching. For all cases of cutaneous pruritus, avoid washing with hot water or soap. For cutaneous pruritus, topical application of Sophora wine or San Shi edema can be used; for dry and itchy skin, moisturizing ointments are suitable.
4. Wind Excess︰It often occurs in spring, with generalized cutaneous pruritus, itching without a fixed location, and prolonged unhealed condition. The skin may become thickened and lichenified, resembling the hide of an ox. The pulse manifestation is wiry and thin, with a red tongue and thin yellow coating. Due to the looseness of the skin's striae and interstices, external wind pathogens invade, stagnate over time, transform into heat, and permeate the skin, causing itching. Spring is the season dominated by wind and wood, hence it is prone to frequent occurrence. Its characteristics include itching without a fixed location, incessant scratching, thickened and lichenified skin, or resembling the hide of an ox. Treatment should focus on expelling wind and clearing heat, eliminating toxins to stop itching, with the prescription Black-Tail Snake Wind-Expelling Decoction. In summary, both are yang patterns, mostly caused by wind pathogens as an external factor. For those with blood heat, clearing heat and cooling blood should be applied; for those with excessive wind, expelling wind and dispelling pathogens is appropriate.
5. External Contractionwind-cold︰It often occurs in winter, with cutaneous pruritus appearing on exposed areas such as the head, face, chest, neck, and hands. Symptoms worsen with cold and alleviate with warmth or sweating. The tongue is pale with a white coating, and the pulse manifestation is floating and slow or floating and tight. Although it belongs to a yin pattern, it is mostly caused by insufficient yang qi in the body, which fails to resist external cold, combined with exposure to wind-cold pathogens. Therefore, this condition is commonly seen in winter, affecting exposed areas like the head, neck, and hands. When warmth or sweating occurs, the wind-cold temporarily dissipates, leading to relief of cutaneous pruritus. In summary, although both belong to a yin pattern, external factors are the primary cause, hence the prevalence in exposed areas. Treatment should focus on dispelling wind and dispersing cold, with the prescription of Cinnamon Twig and Ephedra Half and Half Decoction.

bubble_chart Documentation

1. "Zhubing Yuanhou Lun: Pruritus due to Wind (Cutaneous Pruritus)": "This is caused by wandering wind in the skin, which causes body pain when encountering cold and cutaneous pruritus when encountering heat."
2. "Zhubing Yuanhou Lun: Wind Moving Through the Body Like Insects": "When a person is deficient, wind evil invades the nutritive and defensive levels, overflowing between the skin, combining with deficiency heat, thus wandering throughout the body, resembling the movement of insects."
3. "Zhubing Yuanhou Lun: Wind-Heat Sore (Pityriasis Rosea)": "When pathogenic qi lodges in the muscles, it causes the muscles to become deficient, the vital qi disperses, and the skin is further attacked by cold, leading to external eruptions, closure of the striae and interstices, and excessive hair growth. The evil and defensive qi struggle with each other; when yang prevails, there is heat, and when yin prevails, there is cold. Cold leads to exterior deficiency, and deficiency allows pathogenic qi to come and go, thus causing itching of the flesh. All types of itching are aggravated by heat and cause pain when encountering cold."