Traditional Chinese Medicine Approach to Eczema

Summary

Traditional Chinese Medicine (TCM) understands eczema through the interaction between the body and the environment. An underlying weakness in the body’s vital energy, called Qi, can allow external pathogenic factors to attack – causing itchiness, inflammation, and dry, red skin.^[1] The most common pathogenic factors causing eczema are combinations of wind, heat, and dampness.^[2]

The imbalance is determined by evaluating the entire person, including skin symptoms and appearance, as well as digestion, sleeping, and overall wellbeing. When wind and heat are predominant, the eczema appears as dry, cracked, and reddened skin. When damp heat is more pronounced, the eczema appears with crusting and blisters. The lack of Qi is indicated by poor appetite and pale skin.

Symptoms and Causes

Symptoms

Eczema, also known as atopic dermatitis, is a common, chronic condition of the skin that affects many children and adults.^[3] In western medicine, eczema is understood as the genetically predisposed combination of a defective skin barrier and an increased inflammatory response. Interestingly, we see how TCM and Western Medicine (WM) mirror each other in the understanding of eczema through the individual’s skin interacting with the environment.

Eczema is characterized by chronically dry, itchy, and scaly skin. When scratched and irritated, the skin can become red, itchy, and swollen with oozing and weeping. The skin of the cheeks, wrists, inner elbows, and knees are most commonly affected in babies and young children. In older children and adults, the skin of the neck, inner elbows, and the backside of the knees are more commonly affected. Eczema tends to be worse in childhood with improvement in adolescence and adult years. However, in some cases eczema can persist into adulthood.

Imbalances

Atopic dermatitis is a complex condition that develops as a result of the interaction between various internal and external factors. In Chinese, eczema is known as shi zhen (damp eruption), feng shi chuang (wind-damp sore), and jin yin chuang (wet spreading sore). Chinese medicine classification of eczema accounts for the morphology (appearance of the eczema lesion), phase of eruption (acute, subacute, chronic), as well as based on the body site of lesions.^[4] Additionally, body symptoms such as digestion, pain, headache, and sleep play a role in TCM diagnosis.

In TCM, the etiology of eczema generally falls into an interaction of factors from three primary categories:^[4]

External factors

• Wind
• Dampness
• Heat
• Dry

Internal factors

• Heart
• Spleen
• Kidney

Dietary irregularities

• Over consumption of greasy, rich, or spicy foods

Treatment Philosophy

Treatment approach varies depending on the predominating pattern diagnosis. Often, a combination of oral and topical herbal formulas, acupuncture, and diet and lifestyle recommendations will be prescribed.

Chinese Herbs

The use of Chinese herbs is growing in popularity around the world as people look for natural therapies to treat this condition and reduce their dependence on steroids.^[2] A large study in Taiwan looking at children taking Chinese herbal medicine showed an overall reduction in the use of steroids.^[5]

In Chinese medicine, wind, dampness, and heat are all common factors in the development of eczema. If the eczema is predominantly heat, then herbs that reduce heat will be the focus of the formula. If the eczema is predominantly dampness, then herbs that drain and dry dampness will be the focus of the formula. Together, the herbs combine to address the symptoms as well as the underlying imbalance causing the eczema.

One commonly used formula shown to be effective to treat eczema is Xiao Feng San (clear wind powder).^[6,7] This formula treats eczema caused by wind, dampness, and heat. Many of the herbs in the formula have shown anti-inflammatory and antibacterial effects.^[2] For example, ku shen (sophora root) is widely known for reducing inflammation, itch, and growth of Staphylococcus aureus.^[8,9] Jing jie (schizonepeta bud or stem) and fang feng (ledebouriella root) are a classic combination to reduce itching and dispel wind.^[10] While some standard formula use dang gui (Chinese angelica root) for eczema, this herb should be avoided in acute cases as it may exacerbate the damp factors.

Commonly used base formula for eczema: Xiao Feng San (Clear Wind Powder)

Indications: Weepy, itchy, red skin lesions. Wind rash due to wind-heat or wind-dampness that interacts with preexisting damp-heat.^[12]

*Modifications to formulas should be made to account for the individual’s current presentation.

If the eczema is more heat and heat toxicity predominant, then additional herbs to remove the heat may be added such as jin yin hua (honeysuckle). Honeysuckle has been shown to have anti-inflammatory and immunoregulatory properties.^[13] It is often traditionally combined with lian qiao (forsythia fruit), which is known for anti-allergic and antibacterial properties.^[14,15]

If damp heat is more predominant, herbs such as huang qin (skullcap root), huang lian (coptis rhizome), or huang bai (phellodenron bark) may be added. These herbs are known as the three yellows for their color and are well known for their antibiotic and anti-inflammatory effects.^[16] When damp heat and toxicity is severe, they may be used as the formula huang lian jie du tang (coptis formula to reduce toxicity). This formula has shown anti-allergic and anti-inflammatory effects.^[16,17]

For acute eczema, to clear heat and eliminate dampness, modifications of bi xie shen shi tang (dioscorea decoction to leach out dampness) or er miao wan (two marvel powder) should be considered.^[18]

For chronic eczema, to nourish the blood, dispel wind, and stop itching, modifications of si wu tang (four substances decoction) with xiao feng san, or di huang yin (rehmannia decoction) should be considered.^[18]

Acupuncture

Those with eczema commonly look for therapies to help reduce itch, pain, and discomfort associated with the condition. 

Acupuncture has been shown to reduce itching in those with eczema.^[19] According to TCM, this is because acupuncture helps to reduce wind, dampness, and heat which are common causes of itch in eczema.^[4] 

*Additional points should be added according to the patient’s pattern and presentation.

Physiologically, acupuncture works in several ways to reduce itch. A previous study showed that acupuncture reduces itching by changing the itch response in the brain.^[20] Acupuncture may also reduce itch by reducing activation of basophils, a white blood cell involved in the inflammatory responses in eczema.^[21]

Acupressure is the massage and application of pressure at acupuncture points. Acupressure is great because it is something that can be done at home. Acupressure has also shown potential in reducing itching. One small study showed that self-administered acupressure at the acupuncture point Qu Che (LI 11) reduced itching.^[22] Stimulation of LI 11 has also been shown to reduce scratching in animal studies.^[21]

One of the challenges with eczema is that it can lead to fatigue and loss of sleep.^[23] One of the great things about acupuncture is its ability to allow patients to feel relaxed with improved wellness, regardless of the reason for the visit.^[24] In addition, acupuncture is well known to reduce anxiety, improve sleep, and give patients more energy.^[25]

On top of all the benefits of acupuncture for eczema, acupuncture is a very safe therapy and most often people leave the therapy feeling refreshed and relaxed.^[26] People often fall asleep during the treatment.

Other TCM Therapies

Cupping is a commonly used therapy in Traditional Chinese Medicine that can benefit patients with a wide array of conditions, especially when those conditions are due to excess heat. In Chinese Medicine, heat is a very common cause of eczema.

While some small reports and traditional sources suggest that wet cupping may be effective for eczema, the skin of those afflicted with eczema can be very sensitive.^[27,28] The pressure of the cupping may aggravate the skin and is best to be avoided, particularly in severe cases. There is one published case study of an eczema flare after cupping.^[29]

Diet and Lifestyle

Specific dietary and lifestyle modifications for each patient may vary depending on their history and presentation. However, most patients will benefit from the following recommendations:^[1]

• Avoid washing with hot water
• Avoid using soap while bathing
• Limit or remove consumption of hot and spicy foods, alcohol, and seafood
• Limit scratching to reduce the possibility of secondary infections

Conclusion

Chinese herbal medicines (CHM) may work through a variety of mechanisms, including suppressing the release of pro-inflammatory cytokines and chemokines.^[30] In the treatment of moderate to severe atopic dermatitis, CHM has been shown to improve erythematic intensity, pruritus and itching frequency, transepidermal water loss, expression of AD-mediated chemokines, as well as improvements on the Scoring Atopic Dermatitis Index, Children’s Dermatology Life Quality Index, and Dermatology Life Quality Index.^[31] For children with atopic eczema, use of Chinese herbal medicine may improve health-related quality of life.^[32]