TCM and Dermatitis
Dermatitis
By Dr. Hong-Yen Hsu
The surface of the skin can become inflamed in response to exposure to many factors. This inflammation is broadly called dermatitis, and to each of its many forms, doctors have assigned specific names which reflect its very complicated etiologies. Some kinds are due to allergies, others are caused by fungi or bacteria, and still others by contact with toxic substances which cause acute dermatitis in exposed areas.
Modern medicine treats the above conditions with antipruritics, tranquilizers, and adrenocortical steroids internally as well as externally. If pruritus is severe, antihistaminics may also be used, but none of these forms of treatment are capable of effecting radical cures.
The most common symptoms of dermatitis are urticaria, eczema and pruritus. Herbal treatment for dermatitis depends upon the lesion's color, dampness or dryness, presence or absence of pus, powdery appearance and scab formation. Physique, dryness in the mouth and constipation comprise the physical conformation of the patient and also influence the choice of herbal formulas.
Symptoms and Formulas
(1) For acute eczema, urticaria, contact dermatitis (swelling and reddening in the lesion), Bupleurum & Schizonepeta Combination is usually recommended.
(2) For lesions with exudative secretions and round scabs that become aggravated in the summer, pruritus which is quite severe, and thirst in patients of average physique, Tangkuei & Arctium Formula is recommended.
(3) For eczema and lesions which are dry and red in color, scorching sensations, severe pruritus, and a powdery appearance upon scratching (found in sunlight allergic dermatitis), Tang-kuei & Gardenia Combination is usually recommended. If the pruritus is judged unusually severe, add forsythia
(4) For lesions with a powdery appearance that are very dry and coarse but not swollen, Tang-kuei and Tribulus Combination is commonly recommended.
Formulas and Applications
Atopic dermatitis cannot be cured with a short course of treatment, but require months or years of continuous therapy with appropriate formulas.
(1) Forsythia & Lonicera Formula: this is the most commonly used formula. It was first used for treating eczema on the head of young children. Symptoms include discharges from the scalp of purulent secretions, filthy scabs with a fetid odor, and a severe pruritus which prompts scratching to the point of bleeding. It is commonly seen on the head, face, neck, armpits and pudendum, where the lesions are red, bloody, vesicular, eroded, and scabby. The formula can also be used for adults if they have a good physique, and for whom the use of purgatives is also occasionally recommended.
(2) Bupleurum & Schizonepeta Combination: this formula is recommended for patients of average physique, and in whom the dermatitis is of a dry type with a suppurative tendency. The effectiveness of the formula is lessened if there are profuse exudative secretions which form scabs.
(3) Tangkuei & Arctium Formula: this is an alternative formula for patients with a generally good physique whose lesions are reddened, swollen, highly exudative, itch severely and form scabs. It tends to be especially effective for cases characterized by secretions which are abundant and purulent, and produce nummular scabbing. Generally, most such patients complain of thirst, pruritus that becomes more severe at night, feverish sensations at the site of the lesion, and aggravation of the lesions in the summer. Clinically, if Tangkuei & Arctium Formula fails, Tang-kuei & Gardenia Combination can be used, and vice versa.
(4) Tang-kuei & Gardenia Combination: this formula is indicated for patients of average physique who have eruptions which appear to be primarily papular eczema, are dry natured, have a withering and drying tendency, of a redcolor, are hot, itch constantly, and produce exfoliation and a powdery appearance when scratched. This form of dermatitis does not produce exudative secretions, although scratching may leave some bleeding signs. Lesions are mostly on the face, neck and nape, and become aggravated in the winter. The formula is more effective for patients who show symptoms of neuritis. However, it should not be used if there is a reduced appetite or diarrheal predisposition.
(5) Bupleurum & Rehmannia Combination and Schizonepeta & Forsythia Combination: the symptoms appropriate to these formulas are similar to those of Tang-kuei & Gardenia Combination, but are more chronic. Usually the lesion is of the dry type, quite pruritic and exfoliative. To accommodate the constitution, Bupleurum & Rehmannia Combination is recommended for young children and Schizonepeta & Forsythia Combination for the elderly. For most patients, the mucous membranes show an allergic reaction.