JOURNAL OF CHINESE MEDICINE NUMBER 66 JUNE 2001


thene). It is necessary to use potent steroids because weaker ones don’t penetrate the thick epidermis of the palms and soles sufficiently. The steroids that many patients end up relying upon for long periods have a very observable detri- mental effect on the skin, thinning it and predisposing to further attacks. With infection, antibiotics are prescribed. In recalcitrant cases, internal steroids may be used, usually for short courses, and occasionally as a maintenance dose. Other treatment may include UV light and immunosup- pressive therapy such as cyclosporin.


Case Examples:


Case 1. Women, age 33 Initially developed pompholyx eczema 18 months prior to her first visit, following emotional upheaval when she split up from her partner of several years. The eruptions were intense from the outset, both hands being affected. After several months of near constant activity, the eczema spread to the dorsum of the hands. She describes the eczema as a burning hot sensation, with intolerable itching. At it’s peak (several times a month) she was unable to sleep because of the constant itching. Soon after the onset she visited her GP, who prescribed Dermovate (the most potent of topical steroids). Twice daily applications initially helped, but after several months, she found that not only the skin of her palms became very delicate, tearing and fissuring at the slightest trauma, but increasingly the steroids became less effective. This was further complicated by reoccurring infection, manifesting as pustules with yellow exudation. The infections were controlled by regular courses of antibiotics. Eventually, in desperation she discontinued all treatment. Tongue: Thin yellow slippery coating Pulse : Thready and wiry On examining it was clear that the eczema was fiercely


active. There was, numerous small vesicles, yellow crusting indicating recent exudation, on a background of intense erythema. The dorsum of her hands were also affected. This is a typical case of stagnant heat generated by a constrained liver leading to liver and gall bladder damp heat and fire toxin.


1.


Pu Gong Ying 20 Zi Hua Di Ding 15 Ye Ju Hua 12 Ma Chi Xian 12 Huang Qin 9 Huang Lian 6 Bai Xian Pi 12 Bai Ji Li 15


Long Dan Cao 9 Yin Chen Hao 9 Ze Xie 9


Che Qian Zi 12


Mu Dan Pi 9 Da Qing Ye 12 Mu Tong 9 Gan Cao 6


External


Wang Bu Liu Xing 30 Ming Fan 10 Huang Bo 15 Ku Shen 15


The above constituted the basis of her treatment for the first 7 week. Soon after starting she found that the intensity of the itch, and the development of pustules were significantly reduced. The external soak was very soothing, and signifi- cantly reduced the itching and heat sensation of the palms. It also had the effect of drying any developing vesicles and pustules. After 3 weeks of twice daily use, external treat- ment was no longer required.


2.


Jin Yin Hua 12 Lian Qiao 12 Da Qing Ye 12 Ye Ju Hua 12


Sheng Di Huang 15 Mu Dan Pi 9 Zhi Zi 9


Huang Qin 9 Bai Ji Li 15 Fu Ling 12 Ze Xie 9 Gan Cao 6


On week 7, the prescription was changed significantly to take into account the changed circumstance. She no longer suffered with any pustuler eruptions, and the vesicles were markedly reduced, not only in quantity, but in frequency of appearance. The eczema was significantly drier, with a propensity for fissuring. It is worth studying the above two formulas with care,


since they are characteristic of the formulas that are often employed for managing pompholyx eczema in its various stages. The emphasis of the first formula was on strongly resolv- ing fire-toxin, draining damp heat, subduing itch and to a lesser degree cooling blood. Pu gong ying, Zi Hua Di Ding, Ye Ju Hua, and Ma Chi


Xian all strongly resolve fire toxin on the deep level, that is clearly required for such intensely active eczema. Ma Chi Xian is particularly suitable for weeping eczema. Huang Qin, Huang Lian, Long Dan Cao, Yin Chen Hao strongly drain damp heat from the Liver and the skin. The fire toxin resolving and damp heat draining medi-


cines are always primary in treating the initial active phase of pompholyx eczema.


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