Eczema (Atopic Dermatitis) - Traditional Chinese MedicineTraditional Chinese Medicine Summary

Traditional Chinese Medicine

TCM Summary

Eczema, also known as atopic dermatitis, is a common, chronic condition of the skin that affects many children and adults.[1] In western medicine, eczema is understood as the genetically predisposed combination of a defective skin barrier and an increased inflammatory response. Imbalances of heat, wind, and Qi explain eczema according to traditional Chinese medical philosophy.

Treatment Philosophy

Eczema is a chronic condition with no permanent cure. Regardless of whether a western or an alternative medical approach is implemented, it requires constant attention and care. The typical treatment for eczema has two goals:

  • To improve the skin barrier.
  • Reduce inflammation in the skin.

Traditional Chinese Medicine therapy first aims to remove the pathogen and then to strengthen the body's energy. Traditional Chinese Medicine uses personalized diagnosis and therapy to address the specific imbalance each patient is experiencing.  Traditional Chinese Medicine therapy may include herbal medicines, acupuncture and topical moisturizers.

Symptoms and Causes

Eczema is characterized by chronically dry, itchy and scaly skin. When scratched and irritated the skin can become red, itchy, and swollen with oozing and weeping. The skin of the cheeks, wrists, inner elbows and knees are most commonly affected in babies and young children. In older children and adults, the skin of the neck, inner elbows and the backside of the knees are affected more commonly. Eczema tends to be worse in childhood with improvement in adolescence and adult years. However, in some cases eczema can persist into adulthood.

Chinese Herbs

Chinese herbs are given in multi-herb formulas, most often in dehydrated powders or raw herbs that are cooked into strong teas or decoctions. Research has shown a link between Chinese herbal medicine and a reduction in the need for corticosteroid use in children.[10]

 

Oral herbs

The herbal ingredients of therapeutic formulas are customized to each patient to address the specific imbalances causing eczema. Xiao Feng San (Clear Wind Formula) is a commonly used formula for reducing eczema caused by wind, heat and dampness. [3] This contains herbs with antibiotic and anti-inflammatory properties.[11]

If damp heat and toxicity are the causes of eczema, the herbal formula Huang Lian Jie Du Tang (Copitis formula to clear toxins) is often used.[3]  This formula contains Huang lian (Coptis chinensis), a powerful herb that has shown antibiotic effects against Staphylococcus aureus, a bacteria known to colonize skin with eczema.[12,13] Ku shen (Sophora flavescens) is another herb that dries dampness. Studies have shown that it reduces inflammation, itch, and inhibits the growth of S. aureus.[3]

 

Topical herbs

Herbs are also used topically.  Sometimes they are applied straight to the skin as a moist compresses or they may be mixed with a moisturizer. Common combinations of herbs are Huangbai (Cortex phellodendri), Zicao (Radix arnebiae), and Diyu (Radix sanguisorbae).[14] For redness, papules, and erosion the single herb Qing Dai (Indigo powder) can be mixed with moisturizer as a topical soothing balm. [15]

Acupuncture

Acupuncture is very commonly used for eczema to stop itching and promote overall wellness. The physiologic mechanisms that acupuncture employs to reduce pain may be effective for stopping itch.[16]

Diet and Lifestyle

Lifestyle

  • Stress reduction: Circulation and flow of Qi, our body’s energy, is imperative for a healthy life. Stress inhibits the flow of Qi leading to stagnation that can cause the buildup of heat within the body. Recent studies have shown the relationship between stress and inflammation in people with atopic dermatitis (eczema).[17]
  1. Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol.2014;134(6):1527-1534; PMID: 24166134 Link to research.
  2. Yihou X. Dermatology in Traditional Chinese Medicine. United Kingdom: Donica Publishing Ltd; 2004.
  3. Chen HY, Lin YH, Hu S, et al. Identifying chinese herbal medicine network for eczema: implications from a nationwide prescription database. Evid Based Complement Alternat Med.2015;2015:347164; PMID: 25685167 Link to research.
  4. Brown SJ, McLean WH. Eczema genetics: current state of knowledge and future goals. J Invest Dermatol.2009;129(3):543-552; PMID: 19209157 Link to research.
  5. Cabanillas B, Novak N. Atopic dermatitis and filaggrin. Curr Opin Immunol.2016;42:1-8; PMID: 27206013 Link to research.
  6. Palmer CN, Irvine AD, Terron-Kwiatkowski A, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet.2006;38(4):441-446; PMID: 16550169 Link to research.
  7. Akiyama M. FLG mutations in ichthyosis vulgaris and atopic eczema: spectrum of mutations and population genetics. Br J Dermatol.2010;162(3):472-477; PMID: 19958351 Link to research.
  8. Cork MJ, Danby SG, Vasilopoulos Y, et al. Epidermal barrier dysfunction in atopic dermatitis. J Invest Dermatol.2009;129(8):1892-1908; PMID: 19494826 Link to research.
  9. Silverberg JI, Hanifin J, Simpson EL. Climatic factors are associated with childhood eczema prevalence in the United States. J Invest Dermatol.2013;133(7):1752-1759; PMID: 23334343 Link to research.
  10. Chen HY, Lin YH, Wu JC, et al. Use of traditional Chinese medicine reduces exposure to corticosteroid among atopic dermatitis children: a 1-year follow-up cohort study. J Ethnopharmacol.2015;159:189-196; PMID: 25449448 Link to research.
  11. Cheng HM, Chiang LC, Jan YM, et al. The efficacy and safety of a Chinese herbal product (Xiao-Feng-San) for the treatment of refractory atopic dermatitis: a randomized, double-blind, placebo-controlled trial. Int Arch Allergy Immunol.2011;155(2):141-148; PMID: 21196758 Link to research.
  12. Kong HH, Oh J, Deming C, et al. Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Genome Res.2012;22(5):850-859; PMID: 22310478 Link to research.
  13. Muluye RA, Bian Y, Alemu PN. Anti-inflammatory and Antimicrobial Effects of Heat-Clearing Chinese Herbs: A Current Review. J Tradit Complement Med.2014;4(2):93-98; PMID: 24860732 Link to research.
  14. Chen D, Lu C-j, Kurtz A. Eczema & atopic dermatitis. The Clinical practice of Chinese medicine. Beijing: People's Medical Pub. House,; 2007.
  15. Xu Y. Dermatology in Traditional Chinese Medicine. United Kingdom: Donica Publishing Ltd; 2004.
  16. Pfab F, Huss-Marp J, Gatti A, et al. Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema - a blinded, randomized, placebo-controlled, crossover trial. Allergy.2010;65(7):903-910; PMID: 20002660 Link to research.
  17. Peters EM, Michenko A, Kupfer J, et al. Mental stress in atopic dermatitis--neuronal plasticity and the cholinergic system are affected in atopic dermatitis and in response to acute experimental mental stress in a randomized controlled pilot study. PLoS One.2014;9(12):e113552; PMID: 25464511 Link to research.