JOURNAL OF CHINESE MEDICINE NUMBER 66 JUNE 2001


not to say that erythema may not appear as the condition progresses, indeed in a proportion of cases it may be a dominant feature, but in many cases it is insignificant and therefore blood cooling herbs tend to play a small part in the construction of the formula. There are however two com- mon presentations that are encountered in practice where erythema is more likely to be observed; the first is where it appears as a background to the vesicles on the palms, soles and sides of the digits; the second is when the eczema is disseminating and moves to the dorsum of the fingers and hands. In both instances, it is imperative to incorporate ingredients that remove heat from the blood. In practice this is done not only by using ingredients such as Sheng Di Huang (Radix Rehmanniae Glutinosae), Mu Dan Pi (Cortex Moutan Radicis) and Chi Shao (Radix Paeoniae Rubrae), but most importantly by also using lighter fire-toxin resolv- ing herbs such as Jin Yin Hua (Flos Lonicerae Japonicae), Lian Qiao (Fructus Forsythiae Suspensae) and Da Qing Ye (Folium Daqingye). A common and understandable mistake that is frequently


made by those unaccustomed to treating dermatological disease, is the desire to use blood and yin nourishing ingredients for the dry phase of this disease. This should be resisted. As mentioned above, the dryness is the product of obstruction by dampness and fire-toxin, and using tonic medicines will compound the problem by as it were ‘add- ing oil to the fire’. The only exception to this rule is in chronic and refractory cases, where a long history of reoccurring attacks has led to a situation of unrelenting dryness and fissuring. In such instances a strategy of nour- ishing yin and blood, and possibly supplementing the Kidney and Liver is frequently the only pathway to a cure.


1. Liver damp-heat complicated with fire-toxin and wind This is by far the most common form, accounting for 70% or so of cases encountered in practice. Many cases, though not all, will report emotional upset as an initial trigger. Eruptions are more likely to affect the palms as opposed


Vesicles


Damp, damp-heat & fire- toxin


Bullae


As for vesicles but more extreme


to the feet, and exhibit typical manifestations of pompholyx eczema. Tongue and pulse: In many cases a red tongue body with yellow greasy coating, and a wiry pulse is seen. However it should be noted that in practice a tongue and pulse picture that betrays no association with dampness and heat of the Liver is not infrequently encountered.


Vesicles emerging


Long Dan Cao (Radix Gentianae Scabrae) 9g Huang Qin (Radix Scutellariae Baicalensis) 9g Zhi Zi (Fructus Gardeniae Jasminoidis) 9g Pu Gong Ying (Herba Taraxaci Mongolici cum Radice) 15g Zi Hua Di Ding (Herba Violae cum Radice) 15g Lian Qiao (Fructus Forsythiae Suspensae) 12g Bai Xian Pi (Cortex Dictamni Dasycarpi Radicis) 12g Bai Ji Li (Fructus Tribuli Terrestris) 15g Ze Xie (Rhizoma Alismatis Plantago-aquaticae) 9g Chi Fu Ling (Sclerotium Poriae Cocos Rubrae) 12g Che Qian Zi (Semen Plantaginis) 9g Gan Cao (Radix Glycyrrhizae Uralensis) 4g


Modifications • Erythema: add Da Qing Ye (Folium Daqingye) 12g, Mu Dan Pi (Cortex Moutan Radicis) 9g. • Yellow pustules: add Ye Ju Hua (Flos Chrysanthemi Indici) 12g, increase the dose of Zi Hua Di Ding and Pu Gong Ying and use external soak (see below). • Much exudation: add Ma Chi Xian (Herba Portulacae Oleraceae) 12-15g and Fu Ling Pi (Cortex Poriae Cocos) 12g. • If the condition is particularly virulent, with many vesi- cles, or bullae, add Huang Lian (Rhizoma Coptidis) 9g, Jin Yin Hua (Flos Lonicerae Japonicae) 12g, Hu Zhang (Radix et Rhizoma Polygoni Cuspidati) 12g and Long Kui (Sola- num Nigrum) 9g. • Intense itching: add Fang Feng (Radix Ledebouriellae Sesloidis) 9g and Ku Shen (Radix Sophorae Flavescentis) 9g and use external soak (see below).


Crusting, weeping & erosion


Damp-heat not yet resolved


Erythema Hot blood/fire-toxin Dryness and fissures


1.Damp-heat still lingering


2. Deficiency of blood & yin


The more intense and concentrated, the more


the dampness will be accompanied by heat,


and fire-toxin.


Erythema surrounding a vesicle is an indication of


heat in the blood with fire-toxin.


Use fire-toxin resolving herbs from all depths.


As for vesicles, although fire-toxin resolving herbs


are usually needed in larger numbers.


Drain dampness and heat from the Liver or Spleen


depending on condition.


Erythema as a background to the


vesicles, or as a


consequence of spread to the dorsum.


Use lighter fire-toxin resolving and blood


cooling ingredients.


Use lighter fire-toxin and wind scattering herbs.


Draining damp medicines should be


reduced, but not stopped. In chronic cases nourishing medicines should be employed.


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