Translation by Shirliey Fung

Summer 2005

Medical Chinese

Traditional Chinese Medicine External Diseases

Higher Medical Teaching Materials

Chinese Medicine Surgical Department

Shanghai Science and Technology Press

Main writer: Gu Bo Kang

6.11 Eczema

Eczema is one of multiple types of skin damage, with many forms. Overall, eczema patients present with symptoms such as itching, erosion, weeping, and scabbing. In general, eczema can be divided into three types: acute, sub-acute, and chronic. This disease has many distinguishing characteristics: many forms of lesions, symmetrical distribution, self-sensation of itching, reoccurrence, and easy development into chronic stage, etc.  Men, women, elders, and youth all can development this disease. Moreover, the majority of cases are those with congenital, naturally endowed sensitivities. There is not a clear seasonal aspect, however it often occurs in winter and fall. Acute cases present extensively, all over the body; chronic cases frequently present in some set region of the body; sub-acute cases are somewhere in between the previous two kinds. Traditional Chinese Medical literature distinguishes according to the area where the disease occurs and the distinguishing characteristics of the disease’s nature. Each of these has a different name. It is called, “jin yin chuang” (excessively soaked sores) when it excessively soaks the entire body and oozes fluid. According to the Various Disease Source Discussion (Zhu Bing Yuan Hou Lun), Chinese doctors say that, “jin yin chuang is the wind and heat in the heart, presenting in the flesh and skin. At onset, the sores are extremely small. First there is itching, then pain, and then the sores form.” The produced fluid soaks the flesh, excessively soaking and saturating so that it is all over. That which presents mainly as a macule rash is called, “xue feng chuang” (blood wind sores) or “su chuang” (millet sores). According to the Medical Ancestor Golden Lessons (Yi Zong Jin Jian), Chinese doctors say that, “sores develop all over the body, its shape is like millet, itching is without degree. When the sores are scratched open, moist and greasy fluid excessively soaks out and hardens.” That which occurs in the region of the ear is called, “xuan er chuang” (behind the ear sores); that which occurs on the hand is called, “wo chuang” (burrow sores); that which occurs on the breast nipple is called, “ru tou feng” (nipple wind); that which occurs on the naval is called “qi chuang” (naval sores); that which occurs on the scrotal region is called “sheng nang feng” (kidney scrotum wind); that which occurs on the crooks of the lower limbs is called “si wan feng” (four crooks wind); etc.

Cause and Pathology of Disease

            Eczema is a result of a congenital inability to endure wind, damp, and heat obstructing the flesh and skin. Acute type occurs mainly because of wind and damp. Sub-acute type occurs mainly because of deficient spleen not transporting leading to stuck damp-evil. Chronic type occurs because of long-term damage to the blood, blood deficiency generating wind and dryness causing the skin to lose its moisture. Varicose veins on the shank are often because qi and blood not moving causing damp and heat to accumulate and block.

Pattern Differentiation

1. This disease has many types and many appearances of skin rashes (many formations of injury). Acute types often present simultaneously with red flushing, macule rashes, vesicles, pustules, exudation, and scabs. Chronic types often present with damage such as scaling and lichenification. Damaged skin has the tendency to fuse with the exudate. In accordance with the special characteristics of the course of the disease and the skin damage, the disease can be characterized into three types: acute, sub-acute, and chronic, as below:

(1)   Acute ezcema: The disease arises more quickly. It is often symmetrical. It can occur on any part of the body, and can simultaneously appear extensively over the entire body. However, it most often occurs on the forehead, eyelid, cheeks, ear region, mouth corners, elbow hollows, knee hollows, hands, shanks, external genitalia, and anal region, etc. It presents with skin flushing, swelling, itching, areas of different sizes, and unclear borders. Afterwards, on the flushed skin or its surrounding area, there appears papules, plaques, and vesicles which group or closely gather together to form a plaque. Often because of scratching, vesicles are popped, causing erosion, exudation, and scabbing. In the end, the top of the scab drops off, revealing shiny red colored skin. Simultaneously, there is a small amount of flaking until full recovery is reached. Patient experiences a sensation of itching—light cases have minute itching, serious cases are unable to bear it. Can be intermittent or come strongly and recede rapidly. Itching often increases at night, affecting sleep. Patients that have acute eczema with extensive skin damage can also present with fever. Most present with constipation and short, dark urine. The tongue has a greasy yellow coat. The pulse is slippery and rapid. The course of the disease is two to three weeks. For patients with extensive skin damage, it often takes four to six weeks for complete recovery. After recovery, there is a tendency towards reoccurrence. It often occurs because of a diet containing the five pungeants and fermented foods.

(2)   Sub-acute eczema: Mostly occurs from extended acute eczema. The red swelling and vesicles of acute eczema are lessened. So too is the exudation, however the patient still presents with red macules, papules, and flaking. In general, it does not affect the entire body, but there are symptoms of chest oppression, slow-wittedness, watery stool, a greasy tongue coat, and a slippery pulse.

(3)   Chronic eczema: Mostly presents after many occurrences of acute and sub-acute. With repeated occurrences, the disease becomes chronic. The main proof is the increasing thickness of the patient’s skin. Upon touch it is comparatively stiff and dull red or brown in color. Its surface is rough and crude. Skin lines are particularly noticeable or the skin becomes lichenified. It is often accompanied with a small amount of scratch marks, blood blisters, scaling, and deepening of pigmentation. In between, there is erosion and exudation. Itching is severe, particularly at night or when the patient is anxious or stressed. If it occurs on the palmar aspect or joint area, it is easy to have chapping, which causes pain. The course of the disease is very long, it can last for several months up to several years. It is often accompanied by signs and symptoms such as a muddled head, sore lower back and soft limbs, a thin tongue coat, a immersed and thin pulse, etc. 

2.                  Eczema has the inclination to easily occur in certain specific areas. Often seen areas are:

(1)   Head: Patients with eczema on the head often experience erosion, exudation, and thick, yellow scabbing. At times it gathers the hair into a ball. Afterwards, it causes trichomadesis. These cases often present with light red macule patches that have an outer layer of thin scaling.

(2)   Ear region: Occurs easily in the ear burrow, in the folds behind the ear, and on the area in front of the ear. Damage includes flushing, erosion, exudation, scabbing, and cracking. In some cases, the area behind the ear cracks open, as if cut by a knife. There is itching, but no pain. It often occurs symmetrically.

(3)   Breast area: Mainly occurs in women. It presents with moistness, erosion, exudation, with a top layer of scaling, or with congealed yellow scabbed areas. At times there is chapping pain.

(4)   Naval area: Skin damage presents as fresh red or dull red macule patches. There may or may not be exudation and scabbing. The boundary is distinct and does not affect the normal skin in the surrounding area. There is often a bad odor and continuous infection.

(5)   Genital area: Skin damage presents as light red macule patches. On the surface, there is erosion, scabbing, and exudate that moistens the patient’s pants. In the long-term, the skin becomes coarse and thick. There is hyper or hypo pigmentation. Itching is severe, and becomes worse at night. In patients where it occurs in the anal region, there is occasional radiating type chapping.

(6)   Hand area: There are many forms. On the back of the hand, it forms in coin shapes. Skin damage presents as flushing, erosion, exudation, and scabbing. On the edge of the palm, it is not distinct. Skin becomes thick and coarse. In the winter and fall, there is chapping pain. The disease course is long.

(7)   Shank region: Often accompanied by varicose veins. This is frequently seen in patients who hold jobs that demand long periods of sitting or standing. Skin damage primarily presents on the skin of the outer and inner sides of the lower third of the leg. It presents with dull red macules that have a moist surface, erosion, exudation or dryness, scabbing, and flaking. It can be localized or spread all over. It is often accompanied by ulcers of the shank. Later, skin becomes thick. The pigmentation is calmed. In the middle of the lesion, the pigmentation is receded. The eczema can be followed by vitiligo.

Coin-shaped eczema is one of the particular types of eczema. It receives its name from the coin-shaped lesions that form on the skin. It often occurs on the sides of the four limbs. It comes from small papular rashes or papules gathering together to form a coin-sized macule plaque or a ring-shaped lesion. Exudation is relatively copious. It often becomes sub-acute or chronic. It often occurs severely in the winter and is not easily treated.