bubble_chart Concept

Eczema falls under the category of "tinea sores" in Chinese medicine. Depending on its clinical manifestations and the location of the disease, it is also referred to as "damp tinea," "damp sores," "cubital and popliteal eczema," "ear-rotating wind," "yellow-water sore (impetigo)," "scrotal wind pattern," "umbilical sore," and so on. Chinese medicine believes that its pathogenesis is due to emotional disturbances leading to internal heart fire and blood heat, or exposure to wind-dampness pathogenic heat, where pathogenic qi becomes obstructed in the skin, or due to improper diet and dysfunction of the spleen in transportation, leading to internal dampness that stagnates and transforms into heat, combining dampness-heat and manifesting on the skin. This disease is commonly seen in infants and young children, often caused by "the mother consuming pungent foods, the father eating grilled or fried foods, passing heat to the child, or fetal blood heat, and exposure to wind after birth," resulting in inherited heat, inherited toxins, and blood heat exposed to wind.

bubble_chart Modern Research

Eczema is a common disease with unclear causes, which can be triggered by various factors and is considered an allergic disease. In some specialized texts, it is also referred to as specific dermatitis, atopic dermatitis, or hereditary allergic dermatitis. The clinical manifestations are diverse. The inflammatory conditions can be divided into:

1. Acute: erythema, papules, blisters, swelling, exudation, erosion, crusting, etc.;
2. Chronic: the skin appears brownish-red, with infiltration, thickening, rhagades, scales, or lichenification, desquamative plaques, etc.;
3. and subacute types.

The skin lesions are often symmetrically distributed, characterized by intense itching, a chronic sexually transmitted disease course, recurrent episodes, and difficulty in treatment. Factors that may cause various types of eczema include:

1. Constitutional factors: related to genetic predisposition, patients have a tendency to produce IgE, are more sensitive to internal and external disease-causing agents than the average person, and are prone to other IgE-related allergic diseases, or have a family history of such conditions.
2. Psychological and neurological factors: excessive mental stimulation and fatigue can exacerbate eczema symptoms, especially chronic lichen resolving dampness and nummular eczema. Dysfunction of the autonomic nervous system and cold extremities are often causes of hand eczema.
3. Focal infections: bacterial, fungal, and viral infections can cause eczema-like changes in the skin; dental infections, or sinusitis, tonsillitis, cholecystitis, and bladder inflammation can also be triggers for chronic eczema.
4. Digestive system dysfunction: gastrointestinal disorders can lead to abnormal absorption of membrane secretions, allowing foreign protein allergens to enter the body and trigger eczema, while also causing deficiencies in vitamins B and C, which can easily lead to eczema.
5. Circulatory disorders: the most common include varicose veins in the lower limbs and swollen foot wind wilting, hemorrhoids, etc., which can easily cause lower limb eczema and perianal eczema.
6. Endocrine and metabolic disorders: some people's menstruation eczema or progesterone autoimmune allergic eczema, and eczema-like rashes in diabetic patients, indicate that endocrine and metabolic diseases are also one of the disease-causing factors of eczema.

The above six aspects are the main factors that induce eczema. Additionally, currently identified direct allergens include various protein foods, Mongolian snakegourd root, skin and hair, bacteria, etc.

[Diagnosis]

1. Two of the following three necessary conditions must be met:
   1. Cutaneous pruritus.
   2. Typical lichenification in characteristic locations.
      1. Adult flexural lesions.
      2. Infant facial and extensor lesions.
   3. Tendency towards chronicity or chronic recurrence.
2. And two or more of the following major manifestations:
   1. Personal or family history of atopy (asthma, allergic rhinitis, or atopic dermatitis).
   2. Immediate reaction to skin tests.
   3. Presence of white dermographism and/or delayed pallor with cholinergic agents.
   4. Anterior subcapsular white internal visual obstruction.
3. Or four or more of the following manifestations:
   1. Xerosis or ichthyosis.
   2. Pityriasis alba.
   3. Keratosis pilaris.
   4. Hyperkeratosis of palmar lines.
   5. Dennie's lines.
   6. Elevated serum IgE.
   7. Conical corneal membrane.
   8. Tendency for recurrent skin infections.
   9. Effective response to topical steroids.
   10. Eosinophilia.
   11. Prone to urticaria.
   12. Allergic reactions to drugs, especially penicillin.

bubble_chart Pattern Analysis

1. Wind-heat Syndrome of External Contraction︰The onset is acute, primarily presenting with red papules that are widespread over the body, accompanied by unbearable cutaneous pruritus, scratching-induced bleeding, and minimal exudation. The tongue is red with thin white or thin yellow coating, and the pulse is wiry and slightly rapid. This pattern is seen in acute papular eczema and some cases of subacute eczema. Treatment involves dispersing wind, cooling blood, clearing heat, and dispelling dampness. Modified Wind-Dispersing Powder is used, consisting of Schizonepeta, Saposhnikovia Root, Great Burdock Achene, and Cicada Slough (15g each), Atractylodes Rhizome, Sophora, Anemarrhena, Black Sesame, Unprocessed Rehmannia Root, and Akebia Stem (10g each), Chinese Angelica and Gypsum (20g each), and Liquorice Root (5g). For cases with pronounced wind-heat, marked by thirst and fever, add Lonicera and Forsythia. If dampness-heat is predominant, with symptoms such as heavy body, lack of strength, anorexia, and yellow greasy tongue coating, add belvedere fruit, Plantain Seed, Gardenia, and Purslane Herb. For severe heat in the blood aspect, manifested by bright red rashes, vexing heat in the chest, palms, and soles, and a red or crimson tongue, add Red Peony Root, Moutan Bark, and Arnebia.
2. Dampness-heat︰The onset is acute, with bright red rashes, intense cutaneous pruritus, significant exudation, and in severe cases, blister formation, yellow crusts, or erosion. The stool is dry, and the urine is yellow or reddish. The tongue is red with a yellow or yellow greasy coating, and the pulse is slippery and rapid. This pattern corresponds to acute eczema or the acute stage of chronic eczema. The treatment principle is to clear heat and drain dampness, dispel wind, and relieve itching. Modified Simiao Powder is used, consisting of 15g each of Phellodendron Bark, Atractylodes Rhizome, and Achyranthes Root, 30g of Coix Seed, and 10g each of Belvedere Fruit, Plantain Seed, Gardenia, and Puncturevine Caltrop Fruit. For cases with predominant blood heat, add Arnebia, Moutan Bark, and Red Peony Root. For cases with intense heat, add Honeysuckle, Forsythia, Saposhnikovia Root, Schizonepeta, and Purslane Herb.
3. Spleen Deficiency︰The skin lesions are dull and not red, with minimal and clear exudation; there may be yellow scaling or primarily infiltrated patches. The complexion is dull, with poor appetite, loose stools, or abdominal distension and fullness. The tongue is pale with a thin white or white greasy coating, and the pulse is slow-slippery or soggy. This pattern corresponds to some cases of subacute eczema. Strengthen the spleen to resolve dampness and dispel wind to relieve itching. Modified Seven-Ingredient White Atractylodes Powder is used. For severe loose stools, abdominal distension and fullness, or excessive exudation, add 15g of Atractylodes Rhizome and 10g of Villous Amomum Fruit. For abdominal distension, fullness, nausea, and vomiting, add 10g each of Pinellia, Dried Tangerine Peel, and Fresh Ginger Rhizome. For a thick greasy tongue coating and poor appetite, add 10g each of Fortune Eupatorium Leaf and Cultivated Purple Perilla Leaf.
4. Blood Deficiencywind-dryness︰Over time, the skin lesions become infiltrated, thickened, and chronic, accompanied by pigmentation, intermittent flare-ups, scaling, and minimal exudation with dryness. Symptoms may include dry mouth and throat, irritability, dizziness, insomnia, dry stools, a red tongue with scant coating, and a thready, rapid pulse. The treatment aims to nourish blood and yin, relieve itching, and dispel wind. Angelica Decoction is used, consisting of Chinese Angelica, Peony Root, and Sichuan Lovage Rhizome (20g each), Unprocessed Rehmannia Root, Puncturevine Caltrop Fruit, Saposhnikovia Root, Schizonepeta, and Fleeceflower (10g each), Astragalus Root (15g), and Liquorice Root (5g). For cases with vexing heat in the chest, palms, and soles, night sweats, soreness and weakness in the lower back and knees, indicating kidney yin deficiency, add Barbary Wolfberry Fruit and Prepared Rehmannia Root (20g each). If dryness-heat is not prominent, reduce the dosage of Sichuan Lovage Rhizome and Fleeceflower.