Itching of skin – wind originated pruritus
(皮膚搔癢症 – 風瘙癢)
Itching of the skin without eruptions is called “wind originated pruritus” in traditional Chinese medicine. “Wind” means that the itching is caused by wind evil, which wonders without a defined location. “Pruritus” means that the objective itching sensation comes from skin and it requires scratching. The term “wind originated pruritus” was first seen in the book “Zhu Bing Yuan Hou Lun” or “General Treatise on the Etiology and Symptomology of Diseases” (in Chinese 《諸病源侯論》); the establishment of the theory of the disease was seen in Chiu and Han dynasties and described in detail in Shui and Tong dynasties and its treatment was specified in Ming and Chin dynasties.
For thousand of years, TCM recognized that when the toxic evil invaded the body, “The evil resided in the muscle, causing weakness of the muscle and skin ….. defensive power of the body struggles with the evil. If yang wins, hotness results; if yin wins, coldness results; coldness leads to weakness of the superficies and weakness causes the coming in and out of the evil and therefore the skin in pruritic. Hotness produces pruritus and coldness produces pain”.
Therefore, the formation of “wind originated pruritus” is due to disharmony of blood and qi, lowering of the external defence and wind coming from internal production or external invasion. So, pruritus cutis as well as symptoms of itching due to diabetes, jaundice, neurosis, tumor and visceral diseases without primary dermal lesions, all belong to this category.
Modern medicine has proved that pruritus cutis often appears in “liver disease”, regardless of the occurrence of jaundice, especially in the early stage of chronic hepatitis and cirrhosis of liver. Commonly, it is considered that “liver disease” causes metabolic disturbance which induces stimulation of dermal nerve endings by bile salts. If the course of disease is prolonged, the skin may be rough, hypertrophic, desquamating, pigmented and showing changes of lichenification due to long term scratching.
The classification of the pathogenesis of wind originated pruritus is as follows: the forms are
- blood deficiency and wind dryness,
- blood heat and wind abundance,
- blood stasis with production of wind,
- wind coldness residing at the exterior,
- wind wetness enclosed in skin,
- prolonged retention of wind evil.
These forms are internally related to the TCM classification of “chronic hepatitis”. It is usually considered that red skin lesions, increase of pruritus following heat, voiding of small amount of reddish urine in one tie, reddish color of tongue and rapid pulse belong to blood heat with production of wind. If the skin lesion is lighter in color and the patient has increase of pruritus after coldness, voiding of a large amount of clear urine in one time, lighter color of tongue and wiry or tense pulse, the condition belongs to exterior residence of cold evil. If there is increase of pruritus after tiredness, mental fatigue, paleness of face, lighter color of tongue and small pulse, the condition belongs to blood deficiency with production of wind which changes into dryness.
According to the viewpoint of traditional Chinese medicine, pruritus originates from the heart, and the liver holds blood, the spleen regulates blood, so that “liver disease” can lead to blood deficiency, blood heat, blood dryness, blood stasis and all of them can produce wind and cause pruritus. If treatment aims at the cure of liver and clearance of wetness and then, basing of the TCM theory of “treat the blood first before treating the wind symptom, the wind symptom subsides when the blood circulates” (in Chinese “治風先治血，血行風自滅”), one may treat under the principle of blood regulation, wind expulsion and wetness clearance to drive away evil and stop pruritus and the result would surely be more effective and practical.
Introduction of cases
| Case 16
Chan (code number 2582), male, age 47 years. His first visit was in July 2001. He complained that he had a large area burn and amputation of both legs with installation of artificial limbs following an industrial accident and had been temporarily diagnosed as fatty liver. Liver function test was normal. He felt frequently itching of skin with occasional exacerbation as to require scratching to the extent of bleeding and pain. He also had multiple acne, repeated abdominal distention, frequent feeling of hunger, defecation right after meal, tenesmus, wetness-heat of stools, burning sensation of anus, blood tinged toilet paper after bowels and wine addiction. Physical examination: multiple burn scars over face, neck and upper extremities, installation of artificial legs, abdomen full and distended, hepatomegaly of 4.5 cm, percussion tenderness over hepatic region. Tentative diagnosis was chronic hepatitis with TCM classification of wetness-heat vaporization (including stomache, intestines, skin, lower-jiao) and blockage of channels and blood stasis forms. After taking 3 parcels of TCM drugs, the liver was normal. He felt no pain in the anus and hematochezia ceased; he passed stools twice a day, being small in amount. The urine was yellowish and acne was seen over the face. TCM therapy continued and pruritus of skin gradually subsided, but during the course of treatment, there were repeated attacks of globus hystericus associated with abdominal distention, diarrhea, burning sensation of anus, blood tinged toilet paper and exopathic symptoms. Clinical cure was obtained after 43 parcels of TCM drugs and then medication was stopped. Two months later, a return visit revealed relapse of pruritus after taking bamboo shoots and scratching caused occasional urticarial red macules. Physical examination did not show hepatomegaly and the illness was cured following treatment with 8 parcels of TCM drugs.
|
| Case 17
Lui (code number 765) female, age 30 years. Her first visit was in April, 1999. Her husband was a type B hepatitis virus carrier, was treated but with no effectiveness. She had blood examination and was negative for antibodies and antigen but she received hepatitis B preventive injections. She complained at the first visit of repeated skin itching without eruptions and later she had repeated common cold, sorethroat, profuse nasal discharge, dreamful sleeping and insomnia for twenty more days. Headache was frequent and the urine yellowish, the stools being of wetness-heat character. Physical examination revealed an enlarged tongue with teeth prints, hypochondrial anomaly, percussion tenderness over hepatic region and hepatomegaly of 4.5 cm. After taking 3 parcels of TCM drugs, the liver returned to normal. During the course of TCM therapy, she experienced abdominal pain, diarrhea, loose stools thrice a day, still somnolent and dreamful. Another 3 parcels of TCM drugs were taken and the pruritus lessened, her throat dry, sleeping dreamful and the yellowish color of urine was lighter. After taking 5 parcels of TCM drugs, the clinical symptoms disappeared but during treatment she had migraine, tinnitus, mild vertigo, pruritus of skin and her menstrual flow decrease in amount and blood clots were less. A course of 6 weeks TCM therapy was given and follow-up was arranged after clinical cure. |
By WONG Kwok Hung
published on 8th January 2002
(translated by Professor ZHENG Hua En in 2003)