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Case by: Jason Blalack

A six-year or old girl came in with chronic eczema located symmetrically around the elbows, back of the knees, on the legs, and on the upper back. The areas were dry, itchy, had mild erosion and lichenification, only mild erythema in areas, and had scabs and scratch marks. She had a history of persistent runny nose, felt hot, restless sleep, talking in her sleep, allergies (e.g. cats, pollen, possible food intolerances), and would easily get sinus and ear infections since the age of four. Her pulse was fast and slippery and her tongue body was red with red prickles and a slightly thicker coat.

Diagnosis: This was wind predominate chronic childhood atopic eczema due to damp collecting, transforming to heat, with an underlying Spleen qi deficiency.

Prescription:

  • fú líng pí­ (Poriae Cutis)6
  • bái xiān pí­ (Dictamni Cortex)9
  • bái zhú (Atractylodis macrocephalae Rhizoma)9
  • yì yǐ rén (Coicis Semen)12
  • gǔ yá (Setariae (Oryzae) Fructus germinatus)6
  • mài yá (Hordei Fructus germinatus)6
  • fáng fēng (Saposhnikoviae Radix)9
  • chán tuì (Cicadae Periostracum)6
  • cì jí lí (Tribuli Fructus)9
  • gān cǎo (Glycyrrhizae Radix)6

1 bag over 7 days.

Visit #2 – Eczema looked slightly better and there was less itching. Her sinus problems had been eliminated. Although she still felt hot her sleep was better, meaning it was less restless and not waking up as much. The tongue coat was also slightly less thick.

The previous formula was given plus sāng yè (Mori Folium) 9 and xī xiān cǎo (Siegesbeckia) 6.

Visit #3 – Itching was reduced. She also caught a very mild cold which left very quickly (much quicker than in the past and did not go into the usual sinus infection). The overall body temperature was less hot, and sleep was good. The previous formula was given again.

Visit #4 – There was less itching, no new breakouts for weeks, upper back was completely clear, sinuses were clear, no problem with cats, temperature had normalized, sleep was good. The tongue body was less red with a thin slightly thicker white coat.

Working towards a more maintenance formula, the previous prescription was given minus fáng fēng (Saposhnikoviae Radix) and xī xiān cǎo (Siegesbeckia) with the addition of bái biǎn dòu (Lablab Semen album) 9 and chì xiǎo dòu (Phaseoli Semen) 9, with the reduction of bái xiān pí­ (Dictamni Cortex) 6.

Visit #5 – Symptoms remain improved; however the tongue coat was still thick. I added zhì bàn xià  (Pinelliae Rhizoma preparatum) and chén pí­ (Citri reticulatae Pericarpium), used châo bái zhú (dry-fried Atractylodis macrocephalae Rhizoma) and châo yì yî rén (dry-fried Coicis Semen) and removed sāng yè (Mori Folium) and gǔ yá (Setariae (Oryzae) Fructus germinatus).

Commentary: I do not find anything overly strange or exciting about my approach for this case. It is a straightforward approach I often take for skin conditions especially when itching is a predominant sign. That is, at the beginning I focus on reducing the symptoms and fundamental pathodynamic, then as the symptoms reduce, I slowly modify the formula to address more of the root problem. As long as the symptoms stay at bay, I will, for example, remove all stop itching type herbs such as chán tuì (Cicadae Periostracum), fáng fēng (Saposhnikoviae Radix), cì jí lí (Tribuli Fructus), bái xiān pí ­ (Dictamni Cortex) etc. and focus more on the internal cause, e.g. strengthening the Spleen and eliminating dampness and any heat that remains.

However, the one thing interesting about this case is that the skin presentation (dry, itchy, no vesicles, pustules, or oozing) which might suggest a blood deficiency type, was treated through a damp and heat pattern. This choice was made due to a proper differentiation of pattern identification, and not fixating on one single element. This formula is based on one of Zhao Bing-Nan’s core eczema formulas; fú líng pí (Poriae Cutis), bái xiān pí­ (Dictamni Cortex), bái zhú (Atractylodis macrocephalae Rhizoma), and yì yǐ rén (Coicis Semen).

Location: Boulder, Colorado: Case of childhood eczema treated with Chinese medicine

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Showing 6 comments
  • Michael Tierra
    Reply

    Thanks for making this available Jason. I have a couple of questions.

    1. How was this presumably tea administered? What dose and did the child have any resistance to taking it? I assume that the child takes the tea every day. How long did the child have this problem before she was treated by you and finally did she ever undergo any other treatment (s), TCM, conventional Western and had she ever responded to any of those.

    2. Never prescribing one bag for 7 days — how is this actually done. Are the herbs cooked once ore recooked.

    3. I must say I’ve had a difficult time with certain skin. Childhood eczema can be absolutely miserable and I’ve only encountered one vivid caseover 25 years ago, long before I felt that I had a grasp on TCM pattern diagnosis. It was the daughter of a girlfriend and the dynamics didn’t allow me much leeway to administer effective treatment other than palliative measures.

    Having said all of the above I’ve struggled achieving a satisfactory resolution with most serious adult psoriasis cases. From everyone that I’ve asked, books i’ve read — it hasn’t appeared that this condition is very amenable to treatment. Do you find this to be true in your practice?

  • Sharon Weizenbaum
    Reply

    Hi Jason,

    I am not clear as to the Spleen Qi deficiency part of your diagnosis. What led you to this conclusion? What was your reasoning for including Mai Ya and Gu Ya?

    Thanks

    Sharon

    • Jason Blalack
      Reply

      Hi Michael & Sharon,

      Here are some answers.

      1. The herbs are cooked once and the liquid is stored in the fridge. The patient takes the full amount over seven day’s time, two doses a day. You are right, at first, many kids (and adults) have resistance to herbs; however the practitioner’s attitude as well as quick results usually keeps people drinking them. One can also flavor them accordingly.

      2. The patient had this problem since infancy and I’m fairly certain that she has done numerous courses of antibiotics and steroids, both of which have short-term results.

      3. Skin conditions are of course difficult. But certainly the more energy I put into studying them the better results I get. Many times one can never cure the condition and only provide relief. I also agree that psoriasis is difficult.

      4. (Sharon) Underlying Spleen qi deficiency is evidenced by frequent colds, ongoing rhinitis, (unofficial) food sensitivities, and most importantly chronic damp manifesting as eczema. She also had a sallow yellow complexion and deficient appearance, which I did not mention. There is a saying, “In eczema”when damp is more serious than heat – it is important to treat the Spleen” there is also, regulating the Spleen, improving its transportation function, and transforming dampness is the basic method for the treatment of eczema.

      Therefore we can deduce that the Spleen must have some deficiency; due to the protective qi issues and quite simply, the chronic dampness must be coming from somewhere.

      gu ya and mai ya are an herbal pair where one is ascending and one descending. They were used to harmonize, tonify, and lightly regulate the ascending and descending function of the Spleen and Stomach. It is also my idea that together they are especially beneficial for kids in reducing food allergies / sensitivities (by repairing the Spleen’s function). One additional reason is that children often get food stagnation because they are often just deficient the Spleen’s movement and transportation function.

      Hope that helps… do others have different ideas? How would others address such a problem?

  • mei
    Reply

    hi Jason
    Just wondering of the gu ya, mai ya combo, which herb is ascending and which is descending? I use it a lot but has always thought it had to do with the fact that both treats food stagnation and gu ya has a slight tonifying effect.

    Interesting case
    Cheers
    Mei

    • Jason Blalack
      Reply

      Hi Mei,

      Mai Ya enters the Spleen and ascends, Gu Ya enters the Stomach and descends. Together they harmonize the Spleen and Stomach, unhindering the transportation and transformation functions (Wang Zhengfu). Of course they also both treat food stagnation.

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