JOURNAL OF CHINESE MEDICINE NUMBER 66 JUNE 2001


Bai Zhu (Rhizoma Atractylodis Macrocephalae) 12 g Gan Cao (Radix Glycyrrhizae Uralensis) 4g


Modifications • Much erythema: add Da Qing Ye (Folium Daqingye) 12g. • Loose stools: remove Bai Zhu and He Shou Wu, and add Chao Bai Zhu (stir-fried Rhizoma Atractylodis Macrocephalae) 12g and Ge Gen (Radix Puerariae) 20g. • Dry stools: add Sheng Bai Zhu (Rhizoma Atractylodis Macrocephalae) 30g, Huo Ma Ren (Semen Cannabis Sativae) 20g and Rou Cong Rong (Herba Cistanches) 12g. • Much fatigue: add Dang Shen (Radix Codonopsis Pilosulae) 9g and increase the dose of Huang Qi to 30g. • Much bloating: add Chen Pi (Pericarpium Citri Reticulatae), Sha Ren (Fructus seu Semen Amomi) and Mu Xiang (Radix Saussureae seu Vladimirae).


External treatment (soak) Use 2 litres of water per bag of herbs, cooking for 20-30 minutes. As the liquid cools the patient should initially steam then soak the affected part. This should be done 10- 15 minutes twice a day during the acute attack. Each bag can be used for two soaks.


1. Standard treatment


Wang Bu Liu Xing (Semen Vaccariae Segetalis) 30g Ming Fan (Alum) 10g


Ku Shen (Radix Sophorae Flavescentis) 15g • If blisters are particularly plentiful, add Peng Sha (Borax) 10g and Mang Xiao (Mirabilitum) 10g.


2. If dryness coexists with blisters


Wang Bu Liu Xing (Semen Vaccariae Segetalis) 30g Tuo Gu Cao (Speranskia Tuberculata) 15g Ming Fan (Alum) 6g


3. In the dry phase, apply a suitable emollient ointment twice daily.


Notes


Pompholyx eczema is a satisfying disorder to treat, not only because it has simple and plain characteristics that are quite easily discernible, but also because, with attention to detail in prescribing, long term prognosis is excellent for an otherwise recalcitrant disease. All patients with pompholyx eczema should be given clear advice for the care of their hands and if necessary their feet. This involves the follow- ing points: 1. Wash hands as infrequently as possible. Ideally soap should be avoided and hands simply washed in lukewarm water. If soap is used, it should be used sparingly and soaps with perfume, tar or sulphur avoided. Hands should be dried carefully with a clean towel. 2. Shampooing, dyeing hair, applying hair lotion etc. should be done with plastic gloves or by someone else. 3. Avoid direct contact with household cleaners and


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detergents. Wear cotton or plastic gloves when doing housework. 4. Avoid exposing hands to known irritants (e.g. handling fresh fruits, vegetables, fresh meat, wool etc.). Wear warm gloves in cold weather. 5. Use plastic rather than rubber gloves (rubber can further aggravate hand dermatitis). It is best to wear white cotton gloves under the plastic gloves. Several pairs of cotton gloves should be purchased so they can be changed fre- quently. Do not wear plastic gloves for more than 20 minutes at a time. 6. Remember to follow the above instructions for 4-6 months after the hands have healed. 7. For pompholyx of the feet, attention to regular changes of cotton socks should be observed. Although internal medicines constitute the primary method


of treatment, the use of external soaks is a very useful adjunc- tive therapy during acute attacks. Itching, and vesiculation can be reduced significantly after even one soak, however several days will be needed for an acute attack to subside totally. If there is marked dryness accompanying the vesicu- lar stage, then soaks should be used sparingly or not at all, especially if the patient finds that the drying effect of the soak is too strong. In the majority of cases, 10-14 weeks of treatment are required to resolve the condition completely. To ensure com- pliance of the patient to treatment, I find it very useful to explain at the outset the commonest mode of resolution. This most often involves a continuation of the characteristic ebb- ing and flowing of the condition for several weeks as treat- ment progresses, although the severity and frequency of eruptions is often markedly reduced within 4-6 weeks of treatment. Eventually no eruptions are observed. Once satis- fied that the condition has stabilised, it is wise for the patient to continue taking the medicine on half dose for a period of 2 or 3 weeks, before weaning off completely. Looking after the hands (as explained above) for several months after clearing is important and will ensure a good long term prognosis. Most rapid results are achieved in the following types: 1. Recent onset (up to 6 months). 2. Eruptions only in spring and summer. 3. Predictable oscillation of eruptions, with distinct vesicu- lar and desquamating phases. Slowest results are seen in the following types, although perseverance with treatment almost always yields good long term results:


1. Chronic disease (over 2 years).


2. Indistinct and overlapping vesicular and dry phases. 3. Widespread eruptions reaching the dorsum of the hands, and inner aspect of the arms and face. 4. A history of eruptions with much vesiculation, that have since been replaced by chronic dry, scaly, lichenified and fissured eczema. Treatment by biomedicine is usually of only palliative


value. The mainstay of treatment is the use of the most potent topical steroid with occlusion (covered with poly-


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