ECZEMA

Eczema and Asthma Part 1 - Eczema.

Jimi Windmills

Introduction

It has been a while since I posted so I thought I would post a two part short article I wrote a little while back. In these two brief articles I discuss two conditions that often present simultaneously in patients, Eczema and Asthma (particularly in children).

Aetiology and Pathogenesis

In Chinese Medicine, eczema is traditionally known as seeping sap sores. It is an inflammatory response that occurs superficially on the skin. It typically presents with red skin, papules and vesicles, weeping and crusting. In more chronic cases it can eventually lead to scaling, pigmentation change, and lichenification (Crawford 1988: 18).

There are both internal and external causative factors. External Wind, and internal Heat and Damp. A person generates internal Heat, primarily by regular consumption of hot, pungent food. This causes a disruption to the spleen which leads to the accumulation of Damp, and a deficiency of Wei Qi. Wind invades while the Wei Qi is low, and having penetrated, accumulates at the skin level with the Damp and Heat to cause Eczema (Crawford 1988: 18). In the deficient pattern of eczema, Blood is consumed by a chronic heat in the intestines, causing a deficiency of Blood. This Blood deficiency leads to a rising internal Wind. The Wind and the dryness from the Blood deficiency, fail to nourish the skin, resulting in dry skin and eczema (Crawford 1988: 18).

Yan and Zhu agree that there are two predominant patterns of eczema (Yan and Zhu 2005: 89). Both agree on the acute pattern involving Wind Dampness and Heat, Yan and Zhu call it “Fulminant wind, dampness & heat” (2005: 89), while Crawford in her article titled The Acupuncture Treatment of Skin Diseases calls this pattern “Damp-Heat complicated with EPF Wind” (1998: 18). While their pattern identification is similar, their treatment principles differ, and point prescriptions utterly divergent. First we will examine the excess condition.

Excess Pattern Eczema - Wind, Dampness and Heat.

This pattern is characterised by a red rash with exudate and itching, and the expression of the pattern can change depending on which pathogenic factor predominates (Yan and Zhu 2005: 89). Crawford adds the following differentiating features; erythema, vesicles, erosion, oozing, crust, bitter taste and stickiness in the mouth, scanty deep yellow urine, constipation, a red tongue with sticky yellow coating, and a soft, rolling or rapid pulse (1998: 18-19). Yan and Zhu point out that in excess patterns of eczema, one of the three external influences will often predominate;

• Wind dominates – Most likely to affect the upper body, or widely spread with minimal exudate.
• Heat dominates – Affected area will be bright red and may have many pustules.
• Damp dominates – There will be raised blisters with excess exudate. This may be accompanied by heaviness in the chest and difficult inhalation (Yan and Zhu 2005: 89).

The treatment principle for this pattern, according to Yan and Zhu, is to expel the wind, clear the heat, and resolve the dampness (2005: 89). Crawford tells us to clear Damp-heat and relieve itching (1998: 18). It is interesting to note that while Yan and Zhu have included GB31 in their point prescription, they neglected to include 'stopping the itch' in their treatment principle. Crawford on the other hand overlooks wind clearing, from her principle and core prescription¹. Yan and Zhu and Crawford pick quite different points, with only LI11 being a common component of their core prescriptions. To treat this condition Yan and Zhu have the primary point prescription of Du14, LI11 ST36, SP6, and GB31 (Yan and Zhu 2005: 89). To this they add auxiliary points: LI4 for prevalent wind; SP6² and Ren12 for prevalent damp; LV1 prick and bleed for prevalent heat; LV5 and Ren3 for damp affecting the scrotum (Yan and Zhu 2005: 89). Needle using a sedating technique, once a day, with 20-30min needled retention (Yan and Zhu 2005: 89).

Crawford prescribes LI11, SJ5, BL25, and SP9 with a reducing method, and recommends Du14, if there is concomitant fever, and HE7 if there is itch. Crawford also suggests surround needling with electro-stimulation (Crawford 1998: 19).

Deficiency Pattern Eczema – Yin/Blood Xu, Wind and Dryness.

This is chronic eczema that tends to reoccur. The skin is dry, thick and itchy. The itch is generally worse at night. The patient is often skinny, with a fine, soggy pulse, and a pale tongue (Yan and Zhu 2005: 89). To these differentiating features Crawford adds that the affected area may have a change of pigmentation, may ooze when scratched, and that there may be some desquamation of the skin. The tongue has a white coat, and the pulse will be thready, rapid, or rolling and rapid (1998: 19).

Yan and Zhu and Crawford’s patterns for the deficient pattern of eczema are different in their emphasis. Yan and Zhu call their deficient pattern “Yin vacuity, dry blood & fulminant wind” (2005: 90), while Crawford calls it “Deficiency of Xue complicated with Dryness of Wind” (1998: 19). While at first it may seem a superficial difference, it actually changes the way they develop their treatment principle and point prescriptions. While both Yan and Zhu and Crawford admit elements of Yin/Blood deficiency, Dryness and Wind, the critical difference is the origin of the Wind. It is obvious that Yan and Zhu are treating the Wind as an external pathogen, since their principle to dispel the Wind, is matched in their prescription with the point BL12 Fengmen the Wind Gate typically used to expel external Wind (2005: 90). Crawford on the other hand, acknowledging the chronic aspect of the condition, asserts through her principle and prescription, that the Wind is born of the Blood deficiency. Her principle to nourish Xue and eliminate Wind, is matched with more appropriate points for this pattern; BL17, SP10, ST36, and SP6 (1998: 19), All of which serve to build the Blood, eliminating the Wind.

Yin vacuity, dry blood, and fulminant Wind (Yan and Zhu 2005: 89).

The treatment for this pattern is to expel the Wind, nourish the Blood, and moisten the Dryness. The point prescription given by Yan and Zhu is; LI11, SP10, BL17, BL12, with modifications of HT7 for vexation (disturbed Shen from the itch), and GB31 to relieve the itch. They suggest a tonifying needle technique (Yan and Zhu 2005: 89).

Yan and Zhu also recommend moxa to treat this type of deficient pattern eczema. Moxa is to be applied at LI11, SP10, and over the centre and periphery of the affected area. In addition to these points they also moxa DU14, LI4, SP6, ST36 and any place that is itchy (2005: 89). Yan and Zhu also suggest ear points Spirit Gate, Heart, Lungs, Liver, Spleen, and any tender ear points, and using a dermal hammer over the affected area, and parallel to the spine³, until there is a little bleeding (2005: 89).

Deficiency of Xue complicated with Dryness of Wind (Crawford 1998: 19).

As mentioned above, Crawford pays more attention to the chronic, deficient nature of the condition, recognising that the Dryness of Wind is a result of a long-standing Blood deficiency. Crawford prescribes BL17, SP10, ST36, SP6, and if there is pronounced itching, PC7. Dermal hammer is suggested to break up the thickened skin, with cups applied once there is blood seeping out. Another option to treat locally is moxa cones burned directly on area of thickened skin, between 1-7 cones, each burned down a little further as tolerance to the heat develops (1998: 19). Like Yan and Zhu, Crawford also suggests ear points for deficient patients. The auricular points Shenmen, Subcortex, Adrenal, Heart, Diaphragm, and points relating to the anatomical location of the eczema. Use only 3 or 4 of these points each treatment, retaining needles for 20 minutes. Use ear seeds unilaterally in particularly chronic cases.

Conclusion

In this analysis of the treatment of eczema with acupuncture and moxibustion, I first outlined the aetiology and pathogenesis of the disease, and described the patterns of eczema. I compared these descriptions and treatments from the set text to a journal article, with particular attention given to inspection as a diagnostic method. I also noted as a comparison, the differences between treating internal and external diseases, in particular the confusion that can arise around mis-diagnosing the source of pathogenic wind.

1  Crawford includes Du14 in her additional points, to be added in the case of fever. However if included in the core set of points, could effectively expel the wind.

2  Yan and Zhu name San Yin Jiao with no point number in their text. I believe this is an error, as they previously list Yin Ling Quan (SP9) as an auxiliary point in this treatment, and go on to list SP6 (which is already in the primary prescription) as a point for prevalent damp. I have left their prescription intact with this note to point out that it should indeed be Yin Ling Quan (SP9), in conjunction with Ren12 for prevalent damp.

3  I presume they mean to dermal hammer the Bladder channel of the back.

Bibliography

Crawford, M 1998, 'The Acupuncture Treatment of Skin Diseases By Dr Gu Yue Hua', Journal of Chinese Medicine, No. 26.

Maciocia, G 1994, The Practise of Chinese Medicine, Churchill Livingstone, New York.

Scott, J and Barlow, T 1999, Acupuncture in the Treatment of Children, Eastland Press, Seattle.

Wen, BL, Liu, BY, Peng, J, Wang, XF, Xiang, XX, Liu, XF, Hu, JQ, Lu, F, He, LY, Zhu, WZ, Fang, YG, Wang, Y 2012, 'Clinical Research of Acupoint Application for "Treatment of Winterdisease in Summer" Used to Prevent and Treat Bronchial Asthma in Children', Journal of Traditional Chinese Medicine, Vol. 32 No. 1 pp. 31-39. Viewed 29 October 2012 http://www.sciencedirect.com.ezproxy.endeavour.edu.au:2048/science/article/pii/S0254627212600284.

Yan, CL, and Zhu YL 2005, The Treatment of External Diseases with Acupuncture and Moxibustion, Blue Poppy Press, Boulder.

Zhang, ZD, Deng, YQ, Zhang, Y, Han, Y, Lin, L, Chao, EX 2010, 'TCM Differential Treatment of Cough Variant Asthma', Journal of Traditional Chinese Medicine, Vol. 30, No. 1 pp. 60-63.