From New Journal of Traditional Chinese Medicine

October 28, 1996 Vol 28, No 10, p. 45

By Liu Min

Chronic Anal Eczema is a commonly seen anal skin disease.  My (author’s) strategy of using She Xie Tang with a Stop Itching Ointment has cured 98 cases to a satisfactory level.  See results reported below:

1.  Clinical Data

In the study group of 98 cases at the outpatient clinic, there were 52 males, 46 females.  Age range was 23-78 years; length of disease course was from 7 monthes to 25 years.  The study group illness was diagnosed on the basis of consultation and determined to be Chronic Anal Eczema.   Clinical  Pattern:  acute or systemic anal eczema that is prolonged and does not heal.  Skin is damaged by mild swelling and inflammation; the skin around the anus becomes thicker and roughened; there is lichenification; elasticity weakens or perhaps is lost altogether.  Accompanied by fissures and cracks, a brownish or grayish-white color, the line between damaged and undamaged skin is indistinct, there is severe itching, a relatively long disease course that recurs again and again.

2.  Treatment Methods:

2.1  She Xie Tang is made up of wushaoshe, dangshen, baishao, danshen 15g each; fuling, baijili 30g; danggui, honghua, sheng gancao, 10g each; quanxie, wugong 2 pieces.

With simultaneous Spleen and Stomach Deficiency with Cold, add huangqi, cangzhu, baizhu, shichangpu (powdered); for simultaneous Heat Toxin with Flourishing Damp, add shan zhizi, longdancao, mian yinchen; for simultaneous Blood Heat add zhimu, biejia, danpi.

2.2  Stop Itching Ointment consists of Zinc Oxide 12g, Baking Soda, Borneal 6g each, zhenzhu (powdered) 1g, huangdan, bohebing 3g each, phenol or carbolic acid 2ml, pikangshuang 40g, Vaseline 250g.  Use the preceding herbs to make a salve or ointment.

2.3  Usage/Dosage:  Use every day, 1 pack of SheXieTang decocted in water, divided evenly.  Take first dose in the morning and the second in the evening.

To the dregs, add shechuangzi, difuzi 30g, cover and cook.  Yield should be approximately 500 ml.  Every evening before bed, use for a wash.  Defacate afterwards and before going to sleep, apply the Stop Itching Ointment on affected area.  Course of treatment lasts about 2 weeks.  In general, it may take 2-3 courses of treatment.

3.  Standards of Treatment and Treatment Results

3.1  Treatment Standards: 

Clincially cured: aware that itching symptoms relieved, anal skin is smooth, followup ½ year later shows no recurrence.

Clear Effect:  aware that severe itching has resolved, anal skin basically smooth, followup ½ year later shows still some relapses, but disease is basically mild.

Improvement:  aware that itching is milder, anal skin shows some obvious improvement.

No Effect:  Symptoms are as before and there is no change in condition.

3.2  Treatment Outcome

Among the study group, Clincially Cured: 45 cases, Clear Effect: 29 cases, Some Improvement: 22 cases, No Effect: 2 cases.  Effective rate is 98%.  The minimum course of treatment was 1 course, maximum was 3 courses.

4.  Typical Case

73 year old woman, examined June 23, 1993.

Chief Complaint: anal itching recurring over 12 year period, accompanied by heart vexation, easy to anger, sleep not peaceful, sloppy stool, cloudy white urine, dry mouth.  In the past has had several diagnoses of  Anal Eczema and has used Chinese herbs as well as various Western medicines.  Skin is relatively thin and fragile due to use of  Western medicines (steroids).  While on the medicines, skin improves for 5-6 days and afterwards, relapses. 

Visual Exam:  Skin surrounding anus is rough and thick and grayish-white in color, there is a small amount of thick, sticky seepage with a fishy odor, the skin surface shows excoriation marks and bloody scabs, accompanied by peeling scales.  The tongue is red on the sides with a thick white coat.  Pulse is string like and slippery. 

Western Diagnosis: Chronic Anal Eczema. 

TCM differentiates into Spleen Deficiency Liver Depression, Blood Deficiency Wind Dryness.  Treatment is to strengthen the Spleen, course the Liver, nourish Blood, eliminate Damp and dispel Wind.  Use SheXie Tang with these modifications:  Longchi, mian yinchen 30g each, chuanbixie 15g.  Take 1 pack per day decocted and taken orally.  Also use the dregs modified with shechuanzi, difuzi 30g each.  Cook again and use approximately 500 ml as a steaming sitz bath every day before  bed.  Twice each day apply Stop Itching Ointment.  Treated with 1 course and afterwards, the anal itching was relieved.  Exam showed that the skin around the anus was smooth.  Followup visits over 2 years showed no relapses.

5.  Experience

Many treatments for Chronic Anal Eczema of both the acute and systemic types are not suitable or thorough and therefore the evil toxins are retained for a long time.  Yin and Blood are impaired and consumed, blood deficiency engenders Wind which then engenders Dryness.  Wind Dryness becomes depressed and bound, and the skin layer is adversely affected.

Perhaps a cause is indigestion from parasites harassing.  Food and drink damage the Spleen and the Spleen loses strength.  Damp Heat causes blockage and possibly during recovery from an External Wind Evil, there is an attack on the skin.

Many diseases involve the Spleen and Liver as the 2 Zang are inextricably linked.  Over the longterm, if the disease is not dealt with, it is easy for both (Spleen & Liver) to become exhausted.  Therefore, the primary treatment is to strenghten the Spleen and course the Liver, nourish Blood, dispel Wind, and eliminate Damp.  Secondly, quicken the Blood.  SheXie Tang contains dangshen and baizhu to streanthen the Spleen, clear Damp, and restore the Spleen and Stomach transportation and transformation functions to unblock the Qi Mechanism  and stop the Damp Heat from collecting internally.  Baijia and baishao course and drain the Liver Qi, nourish the Blood, harmonize Yin, dispel Wind, and stop  itching.  Sheng di and danggui nourish Blood and moisten skin.  Wushe, quanxie and wugong trackdown Wind evil and stop persistent itching.  Additions like honghua, mudan quicken and nourish the Blood and course and free blood vessels.  Sheng gancao clears Heat and resolves toxins.  All are regulating and harmonizing herbs. 

 In combination, these herbs in varying amounts will be successful in strengthening the Spleen, eliminating Damp, coursing the Liver, extinguishing Wind , and regulating and harmonizing Qi and Blood.  Again, decoct the herbs to make a steaming sitz bath, therefore allowing the most effectiveness as the herbs go directly to the disease.  Meanwhile,  external application to the affected area of the Stop Itching Ointment to dispel rot, engender flesh, moisten skin and stop itch will help speed recovery.

In modern days, the causes of Anal Eczema are not well understood, but here is a list of some relevant factors:  localized allergy, localized infection (maybe hemorrhoids, anal fissures, anal prolapse, or other anal illness, etc).  These factors may all play a role in the onset of the disease.  Further considerations are  anxious spirit, insomnia, and depression as causative factors.  Irregular diet, colitis, intestinal parasitical disease, as well as endocrine disorder can give rise to Anal Eczema. It is therefore important to treat the basic disease condition while actively seeking out the underlying cause of the disease and vigorously treating it as well.  During the duration of the treatment as well as after recovery, it is important to regulate the emotions,  as well as avoid eating spicy or over-stimulating food which could influence the treatment effect and lead to a relapse.