This article introduces the etiology, pathology, diagnosis, and treatment of itchy and dry skin in terms of Traditional Chinese Medicine (TCM).
Acupuncture is a TCM modality in which filiform needles are inserted to certain points on the body based on meridian theory, in order to treat diseases. Modern researches indicate that the therapeutic effects acupuncture lies in its impacts on various systems. One prevailing explanation is that acupuncture functions through the Neuro-Endocrine-Immune network.
Etiology of Dry Skin
Generally speaking, there are two categories of etiologies causing this condition, i.e., external evils and internal dysfunctions. The external evils indicate factors from the environment. TCM established its theory based on observations to the nature, so the external evils are named as wind evil, dampness evil or heat evil, etc. For example, people who suffer from a wind evil attack will manifest symptoms similar to the characteristics of wind. Wind is known to be changeable. Wind symptoms thus include itchiness all over the body without a fixed location, symptoms attack on and off.
Internal dysfunction indicates internal factors leading to organ dysfunction. For instance, dietary irregularities can impact digestion and cause food allergy-like symptoms. Moreover, emotional disturbance is another important factor contributing to skin issues, which has been revealed by modern research. Neurodermatitis and vitiligo are proved to be closely related to stressful life events.[1,2]
From the aspect of the external evils, wind, dampness, and heat directly attack the skin, which is the first barrier of the body, and causes skin issues like itchiness, dryness, blisters, and lesions.
From the aspect of the internal dysfunction, in TCM, the TCM organ spleen (not to be confused with the Western anatomical spleen) is considered to be a digestive organ responsible for food digestion and water metabolism. Dietary irregularities lead to spleen deficiency, which causes water accumulation and phlegm formation. The phlegm and dampness is the direct factor to skin itchiness, while the emotional disturbance causes liver qi stagnation and further compromises spleen. In regard to blood deficiency, failure to nourish the skin results in skin dysfunction.
In term of diagnosis, TCM focuses on pattern rather than disease identification. No matter the etiologies or manifestations, as long as they are diagnosed with the same pattern, the same treatment principle is applied. But sometimes TCM practitioners also take western medicine diagnosis into consideration.
Pattern identification based on the symptom of the patients:
- Wind pattern: Severe itchiness without a fixed location, dry skin, symptoms attack on the off, aversion to wind, headache, stuffy nose, dry throat.
- Dampness pattern: Severe itchiness at a fixed location, swelling, blister, chronic and persistent attack, heaviness in the head, fatigue.
- Heat pattern: Severe itchiness with a burning sensation, reddish and painful skin, headache, nasal congestion with yellow mucus, thirsty, fever, constipation.
- Dietary irregularities: Chronic itchiness, swelling, blister, poor appetite, abdominal bloating, sticky stool
- Emotional disturbance: Chronic itchiness, headache, irritable, hypochondriac distension, poor appetite.
- Blood deficiency: Chronic itchiness, dry and peeling skin, pale complexion, poor appetite, cold in the hands and feet, light period (female).
Acupuncture treatment for itching
Acupuncture therapies are customized to the underlying cause of each person’s itch. Acupuncture should be performed at least 3 times a week for the first 2 weeks. A treatment course is 10 sessions. 2 or 3 courses may be needed.
Points selection: Local points: points around the impacted skin area.
Points based on pattern identification:
Wind pattern: LU7, GB 20, BL12, SJ5.
Dampness pattern: SP9, ST40, SP6, SJ6.
Heat pattern: LU10, DU14, ST44, LI11.
Dietary irregularities: RN 12, ST36, LV3, SP3
Emotional disturbance: LV3, LI4, PC6, LV2
Blood deficiency: SP10, BL17, SP3, ST36
In addition, whatever the etiology or pattern the patient has, TCM attaches great importance to emotion regulation. Skin issues are intractable and annoying which leads to anxiety and frustration, while the anxiety and frustration worsen the symptoms. To break the vicious cycle, treatment must pay attention to calm down patients’ spirits. Therefore, we use groups of soothing points, including DU20, DU24, Sishencong, and PC6.
Topical use. After sterilization, tap the local sites with the head of the needle till the color of the skin becomes slightly red.
Not recommended for skin dryness.
Figure 1. Plum Blossom Needles. Credit: Magnolia Natural Medicine
Methods: After sterilization, paste magnetic beads on the auricular points with medical tapes. Keep the beads on the ear for 3-5 day, ask the patient to press them 3-5 times (2-3 min per time) every day. Remove it immediately upon any abnormal sensation. This therapy can provide long-lasting stimulation.
Points commonly selected: Spirit gate (Shenmen), Wind Stream (Fengxi), Lung, Spleen, Liver.
Figure 2. Auricular acupuncture. Credit: "MDNG members receive free acupuncture tr" (CC BY-ND 2.0) by Maryland National Guard
For severe and acute itchiness, bloodletting therapy is suggested.
Methods: After sterilization, puncture the points with syringe needles for 2-3 times. Squeeze 5-10 drops of blood. Cupping can be applied for more bleeding. Band-Aid must be applied on the puncture site after treatment. Avoid shower 48 hours.
Points commonly used: Ear tip, DU14, BL17
Not recommended for skin dryness.