SUN TEN Quarterly Newsletter Winter 2009: Case Study - TCM Treatment of Atopic Dermatitis

Case Study: TCM Treatment of Atopic Dermatitis

Author: Dr. Te-Feng Tsai


A 15 year-old male has a history of atopic dermatitis and allergic rhnitis, and was under control by taking Western medication. His atopic dermatitis relapsed one year ago, and had no significant improvement by using antihistamine and steroid, severe itchiness worsened when the weather is hot. His pattern differentiation is wind and heat abundance. The treatment principle is to purge fire, expel wind to relieve itchiness, and the prescribed formulas are Coptis & Scute Combination (Huang Lian Jie Du Tang) and Dang Gui & Arctium Formula (Xiao Feng San). After three months of treatment, symptoms have improved. Later the itchiness is worsen again, and there is no improvement when previous treatment is applied. After careful diagnosis, the itchiness might be related to nervousness. Therefore, calming herbs are added to the previous formula, and a satisfying result is reached.


Atopic dermatitis, also called atopic eczema, is a chronic allergic disease of skin. Patients often have family histories of allergies, and frequently accompanies by asthma, hay fever, or allergic rhinitis. Most patients first occurred during infancy, childhood or puberty, and are not contagious. Long term skin itching and scratching not only thickens the skin, causes papules; but also affects sleeping quality. Patients often are unaware of the scratching during sleep, and injure the skin, and even cause wound infections. These symptoms usually subside after puberty, but some may persist throughout adulthood.

The Clinical Characteristics of Atopic Dermatitis includes

1. Serious skin itchiness

2. Typical skin lesion at specific region. (Eczematous dermatitis or lichen dermatitis)

  • For infant and babies, mostly occur at facial, neck,extensor and flexor side of extremities.
  • For children, mostly occur at hollow part of the elbow, popliteal fossa, and neck. If the symptoms worsen, skin lesion may occur all over the whole body.
  • For adolescents and adults, mostly occur at flexor side of joints.

3. Chronically continuous or recurrent attacks. (Usually over 6 months.)

4. Individual or family member have history of atopic constitution (including asthma, allergic rhinitis, hay fever, or atopic dermatitis.)


If patient's symptom matches 3 or more of the above criteria, it can be diagnosed as atopic dermatitis. Because of recurrence frequency, the skin is often in a chronic inflammatory state, lesions have dry, scaling, darkening, and wrinkling appearances. In acute stage, there are oozing from the wounds and patients' emotions are greatly affected, this aggravates the conditions even more.


There is no specific term for this disease in Chinese medicine, but similar terms named after different clinical stages or region of lesions exist. For example, during infancy, it is called tai-lian-chuang (胎斂瘡), or naixian (奶癬), during puberty and adulthood, it is called jin-yin-chuang (浸淫瘡), or si-wan-feng (四彎風). The disease often caused by insufficient innate or allergen contact. Although symptoms are in the exterior, but they are actually from the inflammation inside the body. It is the viscera and bowels causing the skin to itch, that is the internal and external dampness stagnated and transformed into heat, and their mutual contention reside at the skin. Therefore this disease is associated with lung, spleen, andkidney meridians.


Three Clinical Patterns of Atopic Dermatitis


1. Dampness-Heat Pattern:

Mostly in acute stage, skin lesions are erythematous and swelling, sometimes erosion or oozing, accompanied by vexation, thirst, hard stool, difficult urination, reddish urine, yellow and slimy tongue fur, string-like and slippery rapid pulse.


Main treatment is to dispel dampness and clear heat by using Dang Gui & Arctium Formula (Xiao Feng San)Jia Jian.


2. Spleen Deficiency and Dampness Predominating Pattern:

Often has longer clinical course, skin lesions have exudates or vesicles, hypertrophic or infiltrating, accompanied by fatigue, gastric stuffiness or pain, slimy sensation in the mouth and torpid intake, bland taste in the mouth but not thirsty, abdominal pain and soft stool, pale tongue, white slimy or slippery tongue fur, soggy and weak pulse or moderate and weak pulse.


Main treatment is to tonify the spleen and dispel dampness by using Dampness-Eliminating Stomach-CalmingPoria Five Formula (Wei Ling Tang) Jia Jian.


3. Blood Deficiency and Wind-Dryness Pattern:

Often seen in chronic cases, and usually recurrent, skin lesions are often dry and dark, thickened and lichenified, scratch scars or scaling, and accompanied by fine pulse, and pale red tongue.


Main treatment is to nourish blood and moisten dryness by using Dang Gui & Tribulus Combination (Dang Gui Yin Zi) or Four-Agent Dang Gui & Arctium Formula (Si Wu Xiao Feng San) Jia Jian. Besides the above patterns, clinical observations found patients'emotions can cause itchiness and lead to repeatedly scratching, and causing wound infections. When under stress causing stagnant Qi and transformed into fire, worsened dampness-heat symptoms, and aggravated scratching. Therefore, patients' emotions should be considered by adding herbs with calming effect during the treatment.


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