Seattle Institute of Oriental Medicine

Translations: Dermatology

Two Cases of Skin Disease

Case 1: Male, 44 years old, worker, admitted to the hospital May 29, 1990.

The patient's body had nodular red macules and uncomfortable itching for more than three years. In 1987, the beginning of the disease, the entire body was itching, which gradually formed nodules that were not uniformed in size. The nodules joined together becoming big, flat, red macules. Traditional Chinese Medicine and Western medicine treatments had been unsuccessful for this patient, causing suffering which was difficult to talk about.

Upon the first examination, the patient's complexion was red, physical body was sturdy, voice was clear, the entire body's skin had nodular red macules with dull-red and hard nodules. The large nodules were like yellow beans and the small ones like millet-grain, which oozed fluid with no pus. The chest and shoulders and the four limbs had obvious scratch marks, itching was worse when exacerbated by heat, difficulty sleeping, mouth was dry with bitter taste, food intake was normal, urine and stool were not unusual. The tongue body was dull-red, the fur was yellow, greasy, and the pulse was wiry. These symptoms belong to heat toxin, blood stasis rash. Treatment is to clear heat, cool blood, resolve toxins, stop itching, quicken the blood, and dispel stasis. Prescription: pu gong ying (herba Taraxaci Mongolici cum Radice), jin yin hua (flos Lonicerae Japonicae), sheng di huang (radix Rehmanniae Glutinosae), tu fu ling (rhizoma Smilacis Glabrae) each 30 grams, chi shao (radix Paeoniae Rubrae) 15 grams, tao ren (Semen Persicae), hong hua (flos Carthami Tinctorii), dan shen (radix Salviae Miltitorrhizae), di fu zi (fructus Kochiae Scopariae), bai xian pi (cortex Dictamni Dasycarpi), gan cao (radix Glycyrrhizae Uralensis) 10 grams each. Take decocted with water, one bag per day. Separately, use yin hua, pu gong ying, she chuang zi (fructus Cnidii Monnieri), zao xiu (rhizoma Paridis) 50 grams each. Decoct with water and externally wash one time each day. Simultaneously, take imidazole (a Western pharmaceutical), vitamin B-1, vitamin E, and an antihistamine.

June 1, second visit: After taking the herbs, it was obvious the patient took a turn for the better. The skin itching was alleviated, the nodular erythema had retreated. While taking the above formula internally, the patient also applied 20 bags of the external wash. The patient was advised to avoid smoking and alcohol in addition to acrid, hot, rich, greasy food and drinks.

The disease had day by day gradually taken a turn for the better. The entire body's skin color tended towards normal, the nodules overall had dispersed and retreated, itching had clearly alleviated, with no more oozing of fluids. The two lower limbs rash speckles were dormant, the tongue appeared pale and thin, the fur was thin and yellow. At this point, the treatment plan was to boost the qi, nourish blood, clear heat, resolve toxins, in order to regulate the treatment. The patient stopped taking western pharmaceuticals. Altogether, the treatment was 35 days and the disease resolved. The following days, the patient did not have a relapse.

Case 2: Male, 71 years old, first examination October 2, 1989. All over patient's body the skin had nodules with uncomfortable itching for more than 1 year. At first there was skin itching that gradually became nodules on the skin. The patient used a lot of medicinals that treated both internally and externally with no effect.

There were nodules on the head, face, mostly chest, abdomen, and four limbs of the entire body. The color was dull-red, shaped like large and small yellow beans. There were scratch marks, weeping, with no pustular drops and raised skin. The skin itself was rough and lacked luster. The itching did not stop, and when the patient used soap wash, the itching was severe. The patient did not sleep at night, the mouth was not bitter, appetite was okay, stools were dry and bound. The tongue was pale, coat was thin, white, and the pulse was wiry, and fine. This pattern is blood vacuity, wind dryness, along with stasis type of skin rash. Treatment is to nourish blood, dispel wind, stop itching, quicken blood, and dispel stasis. Formula is Tao Hong Si Wu Tong with additional ingredients to treat. Prescription: tao ren (Semen Persicae), hong hua (flos Carthami Tinctorii), dang gui (radix Angelicae Sinensis), chuan xiong (radix Ligustici Chuanxiong), bai shao (radix Paeoniae Lactiflorae), di fu zi (fructus Kochiae Scopariae), she chuang zi (fructus Cnidii Monnieri), bai xian pi (cortex Dictamni Dasycarpi), jing jie (herba seu flos Schizonepetae) each 10 grams, shou wu (caulis Polygoni Multiflori) 30 grams, xuan shen (radix Scrophulariae) 15 grams. Prepare 3 packs, take 1 pack per day. Take decocted with water. Use separately pu gong ying (herba Taraxaci Mongolici cum Radice), jin yin hua (flos Lonicerae Japonicae), she chuang zi (fructus Cnidii Monnieri) each 50 grams, she tui (Serpentis Exuviae), 15 grams. Decoct with water, wash head and body one time each day. Avoid smoking, alcohol, and acrid, hot, dry, rich, sweet, greasy food and drinks.

After taking the herbs the patient's itching alleviated, the nodules dispersed and retreated, the weeping stopped and formed scabs. The herbs targeted this disease. The patient followed the previous formula both internally and the external wash, for a half month. The nodules dispersed and retreated, the itching stopped, and the disease was resolved. Follow-up appointments each year revealed no relapse.

Author's Notes: The patient's condition in these two cases both manifest as nodules on the entire body, with red macules as the primary symptoms. Treatment is to commonly use western medicine anti-inflammatories, anti-itching medications, antibiotics, and steroids. However, this disease over time has no recovery. In Case 1, normally the diet is irregular and the patient craves acrid, hot, dry, rich, sweet, greasy food and drinks, which engenders phlegm and transforms to heat. Over time, this accumulation turns into a heat toxin internally, qi stagnation, blood stasis, blood-level heat, depression in the flesh and skin. So there were skin nodules that became macules of a dull-red color, and itching exacerbated by heat. Therefore, the differential diagnosis is heat toxin blood stasis. The treatment is to clear heat, cool the blood, resolve toxins, and stop itching. Case 2 was caused by old age, qi and blood vacuity, blood exhausted, insufficient qi and blood movement that cannot nourish the flesh and skin. This creates wind and dryness depression in the flesh and skin, causing nodules to form. Over time the nodules do not disperse, causing skin dryness and itching. Use Tao Hong Si Wu Tong to treat, adding herbs to support the Right qi, secure the root, and dispel Evil. This approach has proven considerably effective.

Inger Johnson
Medical Chinese
SUM 2005

Two Cases on Skin Disease
New Journal of Traditional Chinese Medicine, 1994, Vol. 26, Issue 5, page 47.