JOURNAL OF CHINESE MEDICINE NUMBER 66 JUNE 2001


Case 2. Woman, age 35 She has suffered from excessive sweating from the palms since late teens. Six years prior to her visit to the Skin clinic, during a hot summer she developed her first bout of pom- pholyx eczema. Initially it was fairly mild, and cleared of it’s own accord by the start of autumn, but as the years went by, she developed more intense eruptions of eczema earlier in the season, that tended to last longer into autumn before finally clearing. Four years after the first attack, the eczema settled in, so that she had continual eruptions irrespective of the season. At this stage she visited her GP, who pre- scribed Betonvate. When that proved ineffective she was prescribed Dermovate, which subdued the eczema some- what, although benefits were short lived and increasingly less effective. At the same time as the eczema became more severe, and perennial, she became increasingly prone to bouts of foul smelling diarrhoea, punctuated by loose bow- els and bloated sensation of the abdomen on eating. She also complained of loose of appetite. Tongue: Thin yellow slippery (hua) coating. Pulse : Slippery (hua)


The diagnosis was of accumulation of damp heat in the spleen, and as consequence, an aggregation and gathering of fire toxin in the skin.


1.


Bai Jiang Cao 12 Ma Chi Xian 12 Zi Hua Di Ding 15 Ye Ju Hua 12 Huang Qin 9 Huang Lian 6 Bai Xian Pi 12 Bai Ji Li 15 Bi Xie 12


Chi Fu ling 12 Sheng Yi Ren 15 Che Qian Zi 12 Mu Tong 9 Gan Cao 9


External:


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


After 3 weeks of the above formula, the intensity of erup- tions subsided, although she continued to suffer with foul smelling diarrhoea and loose stools. Chuan Xin Lian 9g was added. The external soak was also discontinued by week 4. By week 5, her bowels regulated, both in frequency and consistency of stools. Chuan xin lian was replaced with Ge gen 30g , with the rest of the formula in essence remaining unchanged until week 9.


By week 9 the skin of her palms was dry but otherwise


free of active eruptions of eczema. The majority of the time she opened her bowels once a day, with normal well formed stools. Her appetite showed some improvement. The formal was changed to the following:


2.


Cang Zhu 12 Bai Zhu 12


Sheng Yi Ren 15 Bi Xie 9 Fu Ling 12 Huang Lian 6 Ge Gen 20 Dang Shen 9 Chen Pi 9 Gan Cao 6


Although the eczema is confined to the hands, the lack of association with an emotional trigger, and the development of digestive problems strongly implies that a treatment based on draining damp heat from the spleen is indicated. The initial formula reflects this. A few points could be made here. Bai Jiang Cao along with Ma Chi Xian form the primary ingredients. Not only are they able to drain damp heat from the skin and bowels, they strongly resolve fire toxin from the skin. Pu Gong Ying is not included, due to its strong action of moving the bowels. Instead Zi Hua Di Ding and YeJu Hua are used to potentiate the action of the leading ingredients. Taken together they drain damp heat and act as heavy or deep fire toxin resolving medicine. Huan qin and huang lian drain damp and heat from the middle jiao. This action is aided by Bi Xie that separates the pure from impure. This action of Bi Xie combines well with Yi Yi Ren, and the two are particularly useful in situations where the spleen is obstructed by dampness, leading to overflowing of damp and heat onto the skin. Chi Fu Ling, Che Qian Zi and Mu Tong complete the formula, by emphasising yet another conduit where by removal of dampness is achieved. Chuan Xin Lian is an extremely bitter medicine and best avoided unless the circumstances demand it. Its action of draining damp heat from the intestines is very powerful, and can be used for the widest range of such patterns. This action coupled with it’s substantial effect on resolving fire toxin from the skin makes it ideal if progress is slow, or as in this case diarrhoea persists despite treatment. Once the majority of the damp heat was drained, and the


bowel function improved, Chuan Xin Lian is replaced by a large dose of Ge Gen. Ge Gen is ideal in situations where the picture of a necessarily weakened Spleen is complicated by damp and heat. Ge Gen is equally adept at treating diar- rhoea from both these origins. By week 9 the damp heat and fire toxin were removed to the extent that they no longer manifested on the skin. In order to achieve a good long term prognosis, it is wise to continue


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