Eczema (濕疹)
Eczema or “wetness-heat of skin” is also called in TCM “acute eczema” which indicates that the illness has spread all over the body showing erosions and exudation. This term was seen early in the book “Jin Guai Yao Lue” (金匱要略). It was ascertained that the pathogenic origin was “wind heat residing in the heart and revealing through the skin.” According to the different sites of the lesions and the different stages of development of the disease, there are numerous terms, for example, wet tinea, dry tinea, noxious wetness boil, scrotal eczema etc. It is acknowledged generally that generalized eczema or generalized pruritus with exudation following hepatitis, tumors and neurosis, or yellowish exudation after scratching, all belong to this category (in fact, the latter two kinds are recognized as the result of hepatophilic virus infection).
For centuries, physicians accepted that “acute eczema” was chiefly due to deficiency of gi and blood, insufficient defense of the exterior, disharmony of visceral organs, attack of wind, wetness and heat evils on the exterior and correlations of the external and internal pathologic changes. The internal causes were weakness of spleen and stomache, uncontrolled passion and internal generation of hepatic wind. The external causes included intake of large amounts of sea food and acrid eating or attack of wind wetness evil on the skin.
In the Han dynasty, Zhang ZhongJing (張仲景) established the therapeutic principle of clinical treatment which was “facilitation of the expulsion of wetness” (利濕). According to the analysis of the pathogenesis of “acute eczema”, it is divided into the following forms: wetness overcome by wind, wetness overcome by heat, heat overcome by wetness, weakness of blood and dryness of wind, retention of wetness heat, transformation of wetness heat to toxin. It is not difficult to discover that this classification has some internal relation with the present TCM classification of “chronic hepatitis”. The above forms reveal the pathologic changes of the human body response during different stages of the disease process of chronic hepatitis. The symptoms, signs and pulse picture are different in the above mentioned forms, and their details can not be described here because of limited space. In fact, patients with these forms of eczema, if, according to syndrome differentiation, treated under the TCM principle of “facilitating expulsion of wetness for treatment of liver” would anticipate effective therapeutic results.
Introduction of cases
| Case 4
Chan (code number 314), male, age 1 year. His grandmother and grandfather both had chronic hepatitis and were treated and clinically cured in our clinic with TCM drugs. The infant has his first visit on March 1997 and his complaint was presented by his mother saying that he had skin disease since ten more days after birth. The illness was diagnosed by dermatologist as infantile eczema (小兒濕疹), but repeated treatment yielded no apparent improvement. Physical examination revealed an undernourished child with poor development and generalized eczema. On the face and skin over articulations like axilla, wrist and ankles, there were dermal erosions, flush and multiple eruptions. The abdomen was soft, the liver enlarged to 1.5 cm. It was diagnosed as chronic hepatitis with TCM classification of “wetness-heat vaporization form” (wetness-heat of skin). TCM drugs were not taken because the parents did not accept the drug feeding. Four months later, the skin lesions were not yet controlled in spite of treatment by specialists and WM physicians. The child was bad in temper, cried at night and showed abdominal distention. Diarrhea occurred 4-6 times a day and he could only take soybean milk. The eruptions spread all over the body and were flushing, dry and in some areas the skin showed erosions, exudation, fissures and desquamation. The liver was still enlarged to 1.5 cm and TCM therapy was requested by his family members. After taking TCM drugs for 8 days, the liver returned to normal. His dermal erosions and pruritus decreased and the lesions on the face and limbs improved. After 4 weeks of TCM treatment, the skin lesions were cured clinically and TCM therapy was stopped. Eight months later, he was hospitalized because of tonsillitis (扁桃腺) with fever and relapse of dermal lesions. He had his return visit after abatement of fever and discharge from the hospital. The patient was still lean with flush of the cheeks; macular eruptions were seen on the left side of face. The hepatomegaly was 3 cm, and it was the first relapse. After 4 days of TCM treatment, the flush at the left cheek disappeared and the eruptions subsided. The liver retracted to 1.5 cm. Another 4 days of TCM therapy liver caused return of the liver to normal. No skin eruptions were seen. Systemic TCM therapy continued for 4 weeks and was then stopped. The child’s father had a return visit on January 1999 and told that his child’s skin was intact and there was no relapse of eczema.
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| Case 5
Chan (code number 359) male age 21 months. His first visited the clinic on October 1996 accompanied by his mother who said that her son suffered from generalized reddish eruptions which caused itching, desquamation and poor sleeping. He was repeatedly attacked by common cold, cough and fever. Physical examination revealed a thin child, malnourished and underdeveloped. The skin showing generalized dryness, desquamation and scratching marks, especially over the head, face and limbs. The skin of the limbs had an ichthyosis-form appearance, associated with desquamations. The skin over both elbows and interior side of wrists had localized flush, erosion and exudation. The abdomen was soft and the liver enlarged to 1.5 cm. The diagnosis was chronic hepatitis with TCM classification of “liver stagnation and lung dryness form”, “wetness-heat vaporization form”, complicated with infantile eczema. After taking 13 parcels of TCM drugs, the dermal condition gradually improved. Liver dullness returned to normal. Return visits were made after two months and half a year, still showing a normal liver. The skin was still somewhat dry, but did not show eruptions, itching or desquamation.
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By WONG Kwok Hung
published on 23rd October 2001
(translated by Professor ZHENG Hua En in 2003)