Case by: Jason Blalack
A six-year or old girl came in with chronic eczema located symmetrically around the elbows, back of the knees, on the legs, and on the upper back. The areas were dry, itchy, had mild erosion and lichenification, only mild erythema in areas, and had scabs and scratch marks. She had a history of persistent runny nose, felt hot, restless sleep, talking in her sleep, allergies (e.g. cats, pollen, possible food intolerances), and would easily get sinus and ear infections since the age of four. Her pulse was fast and slippery and her tongue body was red with red prickles and a slightly thicker coat.
Diagnosis: This was wind predominate chronic childhood atopic eczema due to damp collecting, transforming to heat, with an underlying Spleen qi deficiency.
Prescription:
- fú líng pí (Poriae Cutis)6
- bái xiān pí (Dictamni Cortex)9
- bái zhú (Atractylodis macrocephalae Rhizoma)9
- yì yǐ rén (Coicis Semen)12
- gǔ yá (Setariae (Oryzae) Fructus germinatus)6
- mài yá (Hordei Fructus germinatus)6
- fáng fēng (Saposhnikoviae Radix)9
- chán tuì (Cicadae Periostracum)6
- cì jí lí (Tribuli Fructus)9
- gān cǎo (Glycyrrhizae Radix)6
1 bag over 7 days.
Visit #2 – Eczema looked slightly better and there was less itching. Her sinus problems had been eliminated. Although she still felt hot her sleep was better, meaning it was less restless and not waking up as much. The tongue coat was also slightly less thick.
The previous formula was given plus sāng yè (Mori Folium) 9 and xī xiān cǎo (Siegesbeckia) 6.
Visit #3 – Itching was reduced. She also caught a very mild cold which left very quickly (much quicker than in the past and did not go into the usual sinus infection). The overall body temperature was less hot, and sleep was good. The previous formula was given again.
Visit #4 – There was less itching, no new breakouts for weeks, upper back was completely clear, sinuses were clear, no problem with cats, temperature had normalized, sleep was good. The tongue body was less red with a thin slightly thicker white coat.
Working towards a more maintenance formula, the previous prescription was given minus fáng fēng (Saposhnikoviae Radix) and xī xiān cǎo (Siegesbeckia) with the addition of bái biǎn dòu (Lablab Semen album) 9 and chì xiǎo dòu (Phaseoli Semen) 9, with the reduction of bái xiān pí (Dictamni Cortex) 6.
Visit #5 – Symptoms remain improved; however the tongue coat was still thick. I added zhì bàn xià (Pinelliae Rhizoma preparatum) and chén pí (Citri reticulatae Pericarpium), used châo bái zhú (dry-fried Atractylodis macrocephalae Rhizoma) and châo yì yî rén (dry-fried Coicis Semen) and removed sāng yè (Mori Folium) and gǔ yá (Setariae (Oryzae) Fructus germinatus).
Commentary: I do not find anything overly strange or exciting about my approach for this case. It is a straightforward approach I often take for skin conditions especially when itching is a predominant sign. That is, at the beginning I focus on reducing the symptoms and fundamental pathodynamic, then as the symptoms reduce, I slowly modify the formula to address more of the root problem. As long as the symptoms stay at bay, I will, for example, remove all stop itching type herbs such as chán tuì (Cicadae Periostracum), fáng fēng (Saposhnikoviae Radix), cì jí lí (Tribuli Fructus), bái xiān pí (Dictamni Cortex) etc. and focus more on the internal cause, e.g. strengthening the Spleen and eliminating dampness and any heat that remains.
However, the one thing interesting about this case is that the skin presentation (dry, itchy, no vesicles, pustules, or oozing) which might suggest a blood deficiency type, was treated through a damp and heat pattern. This choice was made due to a proper differentiation of pattern identification, and not fixating on one single element. This formula is based on one of Zhao Bing-Nan’s core eczema formulas; fú líng pí (Poriae Cutis), bái xiān pí (Dictamni Cortex), bái zhú (Atractylodis macrocephalae Rhizoma), and yì yǐ rén (Coicis Semen).
Location: Boulder, Colorado: Case of childhood eczema treated with Chinese medicine