Kalin Huddleston

Spring/Summer 2005

Journal of Sichuan of Traditional Chinese Medicine; Vol. 19(No. 10) 2001, pg 57.


 

Puritis main symptom is severe itching with wheal shaped papules and small nodes. At this time it is unknown what causes this disease. It is often though it is related to reactions to diet, insect bites, or allergies to medicine. Other possible causes are poor health, having an infection, genetics, small intestine function is obstructed, or endocrine or nervous systems are not regulated. In Chinese medicine this disease is in the wind itch category. The main pathogenic causes are wind heat, blood heat, and blood stasis. This disease can be over a wide area of the body like the arms, legs, trunk, and face. The course of this disease can last longer than one month and be complicated with other symptoms, as well as it can be very overwhelming for the patient. External applications of medications seem to be limited in the way they can help this disease. The formula Zi Yin Dan Yin has been used internally to treat puritis for many years. Below are the results of 35 cases that have been treated with this formula for puritis.

Clinical Data

In this study there were 35 cases all of which were outpatients. The criteria for this research were the patients were to have a diagnosis of puritis and not have liver, gallbladder, or kidney disease. They also could not have an endocrine or metabolic disease or a lymph/blood systemic disease. Among the cases 26 were female and 9 were male. The patients were between 17 to 41 years old with an average age of 36 years old. The clinical manifestations for this study that the patients needed to have were a sudden and severe itching with round, flat topped papules that were millet to mung bean sized. Between the papules there are red wheals. The color is either dull red or pale white. The papules have a scattered distribution and are found on the arms, legs, trunk, and face. Since the itching is severe it is common to see scratch marks and scabs as well as secondary infections. The patients who have a history of puritis for over 1 year may have hyperpigmentation or shallow scars.

Treatment formula

Zi yin dan yin: zi cao, fang feng, bai xian pi, di fu zi each 12 grams; yin chai hu, dan pi each 15 grams; jing jie 10 grams; chong tui, gan cao each 6 grams.

Each day decoct 1 pack of herbs in water and take 3 times a day warm for 5 days. This is one course of treatment.

Modifications:

Yin deficiency with effulgent fire – huang bai and zhi mu

Secondary infection or turns in to eczema – add ku shen and mu tong

Insomnia – zhen zhu mu and yuan zhi

Stomach/intestine function imbalance – su geng and chen pi

Curative affect observations

Curative affect criteria: 1) cure: itching completely gone and the papules, wheals, and small nodes gradually dissipate; 2) improvement: itching is less obvious and the papules, wheals, and small nodes are reduced; 3) no affect: itching, papules, wheals, and small nodes have no obvious change.

Results: 1) cure: 26 cases; 2) improvement: 7 cases; 3) no affect: 2 cases. The cure efficacy was 74.3% and the total efficacy was 94.3%.

Typical Disease Case

This patient is a 39 year old female. Her puritis began 3 years ago and she now has a relapse that appeared on her face, trunk, arms, and legs with severe itching. With the itching she had papules, wheals, and nodes. She tried many different external applications on her own as well as internally taking western medications. With all of these treatments there was no obvious affect. The course of the first outbreak lasted about 1 month where it gradually began to lessen. After this she has been having relapses 1 to 2 times a year. At this time she has had the outbreak for 2 days and it is like the first occurrence. Upon examining her she has red wheals on her face. On her arms, legs, and trunk she has papules, wheals, and nodes that are red or dark red. She also has obvious scratch marks, scabs, and diffuse patches of hyperpigmentation. Along with here skin condition she has heart vexation and poor sleep with lots of dreams. Her tongue body tends toward thin and a little red, while the fur is thin and slightly yellow. Her pulse is wiry and rapid.

Chinese medicine diagnosis: Wind itching. The symptoms belong to wind heat and blood heat accumulating in the flesh and it is not able to come out. The treatment should clear heat, dispel wind, cool the blood, quicken the blood, and stop itching. The formula that was used was: zi cao, fang feng, bai xian pi, di fu zi each 12 grams; yin chai hu, dan pi each 15 grams; jing jie 10 grams; zhen zhu mu 20 grams; chong tui, gan cao each 6 grams. She took 3 packs of the above formula and her itching pretty much disappeared. The wheals on her face and trunk dissipated. The papules and nodes on her arms, legs, and trunk were less obvious. Her vexation and poor sleep with many dreams improved. After 5 days she stopped taking the herbs and her skin condition was basically fully recovered. All that remained were scratch marks and hyperpigmentation.

Knowledge from experience

In Chinese medicine puritis belongs to the wind itching category. The main symptoms are sudden and severe itching of the skin. After scratching there may be scratch marks, scabs, it turns into eczema, lichenification, the skin thickening, or hyperpigmentation. This disease is most commonly seen in women and the course of the disease doesn’t typically last longer than 3 months but it can have relapses. In Chinese Medicine it is best to treat the skin by protecting the skin and curing the disease. This disease is talked about a lot in the classics like the Nei Jing, Su Wen, and Zhi Zhen Yao Da Lun. They say that “all painful itchy sores belong to the heart.” The Zhu Ding Yuan Hou Lun says “When there is exterior vacuity and interior repletion, heat toxin can fill the interior and rashes erupt. The main symptom of puritis is itching but it may begin with dry skin. The main pathogenic factors for this disease are blood and wind heat that is depressed and fumigates the flesh. The symptoms that are seen are itching, papules, wheals, and nodes. This disease is found in the blood aspect so the treatment must clear heat, cool blood, dispel wind and stop itching. After the patient has had this disease it can lead to qi and blood stasis or the blood heat can make stasis, so you should quicken the blood and transform stasis.

In the formula zi cao, yin chai hu, and dan pi can clear the heat in the blood aspect. Zi cao can especially treat blood heat that leads to macular rashes. It can cool the blood, move the blood, resolve toxin and transform stasis that causes the rashes. The 3 herbs combined blood the blood, clear heat, transform stasis, resolve toxin and outthrust the rashes very well. All of the herbs open the interstices and outthrust and resolve the wind evil. Bai xian pi and di fu zi stop itching. Gan can resolves toxin and harmonizes all the herbs. Combined all the herbs cool the blood, clear stasis, soothe the wind, clear heat, resolves toxin, outthrust the rash and stop itching. This treatment for itching has been proven to have a good curative effect