Clinical Experience in Treating Eczema from the Perspective of Chinese Medicine

: Eczema is a type of inflammatory skin disease with severe exudation and lichenification caused by various reasons. It is a common condition in dermatology, with complex causes and various manifestations of skin lesions, often prone to recurrent episodes. Traditional Chinese Medicine (TCM) discusses the etiology and pathological mechanisms of eczema from the perspectives of wind, dampness, and heat evils. In clinical treatment, TCM focuses on the involvement of the spleen deficiency and dysregulation, and the internal generation of damp-heat during the development of eczema. However, the close relationship between the heart, blood vessels, mental state, and the occurrence of eczema is often overlooked in clinical practice. The idea of treating eczema from the perspective of the heart and spleen can be traced back to the ancient text "Yellow Emperor's Inner Canon - Supreme Truth and Main Principles," which states: "All pains, itching, and sores belong to the heart" and "All dampness, swelling, and fullness belong to the spleen." This article analyzes the clinical significance of the heart and spleen in the treatment of eczema from the perspective of TCM's theory of zang-fu organs.


Introduction
Eczema refers to a typical inflammatory skin disease affecting the epidermis and superficial dermis, caused by various internal and external factors.It is characterized by erythema, papules, infiltration, and exudation of the epidermis, and in severe cases, dry and thickened skin, roughness, scales, pigmentation, cracking, and various skin lesions [1] .The exact etiology of eczema is still not well understood, but it is associated with immunological dysfunctions such as endocrine and metabolic changes, nutritional disorders, chronic infections, cancers, as well as genetic and acquired impairment of the skin barrier function [2] .In modern medicine, the main preventive and treatment methods for eczema include oral antihistamines, intravenous calcium, sodium thiosulfate, vitamin C, and topical corticosteroid ointments.Although they have certain effects, they come with limitations as long-term use of corticosteroids may cause local skin atrophy and pigmentation [3] .Traditional Chinese Medicine (TCM) often uses terms like "wet sores" and "soaking and stagnation sores" to describe eczema.TCM treatment methods have a history of thousands of years and involve various approaches such as internal medicine, external applications, acupuncture, and dietary management according to the different stages of eczema.TCM treatments have relatively minor side effects, high patient compliance, and lower recurrence rates [4] .

The Relationship between the Heart and Eczema
In the book "Yellow Emperor's Inner Canon -Supreme Truth and Main Principles," it is described that "all pains, itching, and sores belong to the heart," indicating the significant role of the heart in "itching and sores."In the chapter "Symptoms and Manifestations of Soaking and Stagnation Sores" in the book "Differentiation and Treatment of Various Diseases," it is stated that "soaking and stagnation sores occur because of wind-heat in the heart, manifesting on the skin."This explains that the occurrence of eczema is caused by internal heart-fire and external wind pathogen.In "The Collected Record of Holy Benevolence," it is described as "if wind-heat accumulates in the heart meridian, it will lead to restlessness of the spirit, vigorous qi and blood circulation, and manifestations on the skin as soaking and stagnation sores."In the book "The Classics of Surgical Medicine -Theories on Pain, Itching, and Numbness of Clear Sores," it states, "all pains, itching, and sores are attributed to heart-fire... if it is close, it causes pain; if it is mild, it causes itching" [5] .
The heart governs the blood vessels.The movement of Qi in the heart transports blood, filling the vessels and continuously circulating.The circulation of blood nourishes the body's tissues and organs, maintaining their basic physiological functions.If the heart's function in governing the blood vessels declines or if there is excessive heat in the heart, it can lead to an accumulation of excessive heat in the blood, causing damage to the blood vessels and sweat glands, resulting in skin ulcers and exudation.
The heart governs the mind.This is related to the occurrence of skin itching in eczema.Itching is the main manifestation of eczema, and these sensations of itching and severe pain are perceived by the spiritual aspect of the heart."The heart is the major organ among the five Zang organs and six Fu organs, and it is the residence of the spirit."It is the primary source of human mental activity, responsible for both internal and external sensory movements [6] .
The heart belongs to fire.Fire is characterized by a rising and hot nature, belonging to the yang and heat of the body.When the heart meridian is affected by excessive heat, it can cause blockages in the flow of Qi and blood, leading to itching and pain.This pathogenic heat cannot be expelled externally.
Skin diseases manifest externally but are related to the internal organs.The excessive heat in the heart is one of the main causes of eczema, and the lack of nourishment to the heart-mind is also a major cause of the itching manifestation in eczema.The dysfunction of the heart is closely associated with the onset of the disease.

The Influence of the Spleen on Eczema
According to the "Collection of Insights in Sores and Ulcers": "The formation of damp and toxic sores is due to deficiency of spleen and stomach, where dampness and heat accumulate and cause numbness in the muscles [7] ."Spleen and stomach deficiency of dampness and heat is acquired through inherent weakness, improper diet, or excessive consumption of spicy and stimulating foods, leading to spleen and stomach dampness impairment.This impairs the spleen's ability to transport and transform, causing the internal generation of dampness pathogen.When there is heat and dampness interweaving in the body, it manifests as damp sores on the skin1.The skin lesions are red, swollen, and accompanied by incessant itching.In the diagnosis and treatment of eczema, it is important to consider strengthening the spleen and eliminating dampness in order to restore skin health [8] .
In the book "Essential Principles of Surgery in the Golden Mirror of Medicine," it states: "Immersion sores appear initially like moths, with constant itching and spreading.Itching causes yellowish fluid to ooze, resulting in extensive immersion.This condition is caused by the influence of heart fire, spleen dampness, and pathogenic wind."In summary, there is a significant connection between the heart and spleen in physiology and diseases.The heart and spleen have a mother-child relationship.The spleen's transformation and transportation rely on the warmth provided by the heart yang.Additionally, the heart governs the blood vessels, sending warm qi from the spleen and stomach to the heart and lungs, facilitating blood circulation.At the same time, the heart and spleen mutually influence each other during the onset of diseases.

Treating from a perspective of the spleen
In the treatment of dampness-related conditions, the focus is primarily on addressing spleen dampness.The main symptom often observed in these cases is the presence of excessive exudation without clear boundaries of the affected lesions.
1) Damp-heat internal accumulation syndrome is commonly seen during the acute phase of eczema.The main symptoms include fresh, red erythema, papules, pustules, and exudation.The central part of the skin lesions is more severe, often exhibiting a symmetrical distribution.Patients may also experience restlessness, thirst, low-grade fever, a red tongue with thin white or yellow coating, and a wiry and slippery pulse [9] .The treatment approach often focuses on clearing heat, cooling blood, and relieving itchiness.Prescriptions such as Longdan Xiegan Decoction are commonly used with modifications.Zhu Renkang also referred to this condition as "blood-heat internal dampness" or "heart fire-spleen dampness syndrome."He emphasized the importance of promoting urination in the diagnosis, as it plays a significant role in eliminating dampness pathogen [10] .Due to the combination of dampness and heat, although the symptoms may not be abrupt, they are often challenging to treat and prone to recurrence.Therefore, it is advisable to avoid excessive use of strong cold herbs, as they may further impair the vital functions of the spleen and stomach, leading to further stagnation of dampness and blockage of heat, making it more difficult to achieve complete recovery.
2) The clinical features of the syndrome of spleen deficiency and excessive dampness include a slow onset of the condition, dull and pale skin color, milder skin lesions compared to the acute phase, recurrent episodes, and a lingering course of the disease.Patients often experience poor appetite, distention in the abdomen, pale or withered complexion, fatigue, weakness, and loose stools.The tongue appears pale, swollen, and with a greasy coating, while the pulse is slippery or soggy.The treatment approach involves invigorating the spleen, warming the middle, and relieving itchiness [11] .The prescription used often includes Huashi Decoction with modifications.The treatment strategy should aim at strengthening the foundation of the body by nourishing the acquired constitution first, and then addressing the dampness pathogen.

Treating from a perspective of the heart
In terms of treatment, priority should be given to treating the inner heat.It is often caused by contact with aggressive and dry substances, the stimulation from spicy food, or a long-lasting depression that transforms into fire.The main symptoms are fresh red patches and rashes.Clinically, symmetrical skin lesions can be observed, with a significant amount of intense redness, a burning sensation upon touch, accompanied by a bitter taste and constipation, along with a red tongue with a yellow coating, and a rapid and wiry pulse.This condition should be treated by clearing the nutrient vessels and cooling the blood while not forgetting to disperse heat and transform qi.The modified formula, Piyantang, which is based on the theory of defending and circulating qi and nourishing blood, should be used.When dealing with this disease, it is important to avoid using spicy and warm dispersing wind herbs such as Jingfang, as they may worsen the condition if wrongly used.

Emphasizing the underlying deficiency.
In terms of treatment, the focus should be on addressing the underlying deficiency in this condition, which is commonly seen in chronic, subacute, and other types of eczema.If acute eczema persists and does not improve, the condition becomes prolonged and difficult to treat.In such cases, it is necessary to give equal emphasis to addressing the root cause while nourishing and promoting permeation [12] .Based on the characteristic differentiation of subacute and chronic eczema, Dr. Zhu developed a self-formulated nourishing yin and eliminating dampness decoction in his clinical experience compilation, Zhurenkang Clinical Experience Collection [13] .For those with pronounced itching, Bai Xianpi (White fresh root bark) or Zhu Jingpi (Sophora flower bud bark) is used.This method effectively eliminates dampness without harming yin, and nourishes yin without exacerbating the retention of damp evil [14] .

Medical Case
Mr. Wang, a 49-year-old male, came for his initial consultation on September 27, 2021.Two years ago, he developed widespread erythematous papules and had significant nocturnal itching, which persisted and did not improve without medication.Three weeks ago, his symptoms worsened after consuming seafood, leading to intense itching and disrupted sleep.He received intravenous administration of compound glycyrrhizin injections, calcium gluconate, and other treatments at a hospital, which provided relief for the itching but did not completely eliminate the skin rash.Subsequently, no proactive measures were taken.Two weeks ago, the patient experienced irritability, fatigue, poor appetite, and difficulty falling asleep.He received oral administration of traditional Chinese medicine for dispelling wind and alleviating itching, including total scorpion, saponin thorns, and saposhnikoviae radix.After taking three doses, the itching intensified, and there was no significant reduction in the skin rash, which remained bright red with decreased urine output.Present symptoms include widespread erythematous papules throughout the body, with more lesions on the upper half.The skin lesions are rough and thick, with evident scratch marks, blood-filled vesicles, portions of lesions merging together, erosion and exudation, erythema and swelling, bitter taste and dry mouth, intense itching, restless sleep, and constipation.The tongue appears red in color with a yellow and greasy coating, and the pulse is slippery and rapid [15] .
Second visit: (October 4, 2021) The skin lesions have become thinner, with reduced exudation and less itching.There has been improvement in difficulty falling asleep, appetite has improved, and the stools are slightly dry.The tongue appears bluish-red, with a yellow and greasy coating, and the pulse is flooding and rapid.Based on the original prescription, Rehmannia glutinosa and Akebia trifoliata are removed, and 10g of tangerine peel (Chenpi) and 15g of coix seed (Yiyiren) are added.Third visit: (October 11, 2021) No new skin eruptions are present, and the skin lesions are dry without exudation.The tongue appears pale with a yellow coating, and the pulse is slow.Treatment principle: Nourish the blood, moisturize the skin, and clear residual heat.The prescription includes 10g of Angelica sinensis, 10g of coix seed (Yiyiren), 6g of Coptidis Rhizoma (Huanglian), 10g of Semen Phaseoli (Biandou), 10g of Ophiopogon japonicus (Maidong), 10g of Plumbago zeylanica (Bai Xianpi), 10g of Ligusticum chuanxiong (Chuanxiong).Apply Sanhuang ointment externally to the affected area.
Fourth visit: (October 15, 2021) The skin lesions are dry without crusts, and there is relief from itching.Topical application of anti-itch cream was effective.The patient was followed up for half a month and achieved complete recovery.
Comments: There are multiple forms of skin lesions and the condition is complex.Accurate diagnosis yields significant results, while misdiagnosis can lead to prolonged treatment and even induce erythroderma with a propensity for recurrence.The patient's eczema did not heal two years ago, but due to long-standing damp-heat retention depleting yin and blood, it resulted in blood deficiency with wind and dryness.Therefore, the treatment should focus on nourishing the blood and eliminating dampness, but it should not solely rely on nourishing blood and nourishing yin remedies [16] .Additionally, dampness is a yin pathogen and is prone to combine with heat internally, leading to serious aggravation if mistreated by dispersing the exterior pathogen.Therefore, it should be cleared and resolved.
Patient, female, 83 years old, first visit on February 21, 2022.The patient developed bilateral upper limb erythema and papules five months ago without a clear cause.The patient was previously diagnosed with "eczema" at a local public hospital and was treated with oral "loratadine" and other therapies, but no clear improvement was observed.Seeking further systemic diagnosis and treatment, the patient came to the hospital.Current symptoms include disseminated erythematous papules, exudation, and scabs on both upper limbs, redness and scaling of the trunk, severe itching (especially at night), accompanied by lower abdominal distension, loose stools, decreased appetite, easy fatigue, normal bowel movements, and normal sleep.Tongue examination revealed a pale and swollen tongue with tooth marks, greasy coating, and a slow pulse.
During the second consultation, the patient complained of significant relief in itching and a slight reduction in abdominal distention.The patient had a good appetite and could sleep at night.Bowel movements were formed, and urination was normal.Tongue examination showed a pale red tongue with a thin white coating, and the pulse was weak.During the third consultation, the symptoms were as follows: the skin appeared normal, with basic recovery.Huangqi and jujube were removed from the prescription and replaced with 9g of tangerine peel.After continuing the treatment for one week, the patient was cured.
Commentary: The patient has damp-heat impregnation of the skin.Huangqi and baishao in the prescription assist in enhancing the qi-replenishing effect of Huangqi.Dafupi promotes the movement of qi within the skin, promoting diuresis and reducing inflammation.Difu zi is effective in dispelling wind and relieving pain.Meiguihua invigorates the spleen and harmonizes the stomach.Jiaoshenqu and maiya strengthen the spleen and harmonize the stomach [17] .With the addition of a small amount of huanglian, the prescription does not overly dry the body, effectively exerting the functions of strengthening the spleen, resolving dampness, dispelling wind, and relieving pain.

Daily Care
Food should be consumed in moderation, avoiding excessive eating and drinking.It is advisable to eat plenty of fresh and tender vegetables and fruits, while reducing the consumption of spicy and stimulating foods.Engaging in moderate exercise can enhance the body's ability to resist diseases, such as practicing Tai Chi, taking walks, or engaging in dance.It is important to remember not to scratch the affected skin lesions and to avoid washing with hot water or using irritating detergents [18] .
As the disease progresses, it is important to communicate more with the patient, establish the courage to fight against the pain, and actively pursue treatment.

Conclusions
Although eczema manifests on the skin, its root cause lies in the heart and spleen.The function of the heart and spleen is closely related to this condition.By adopting the approach of invigorating the spleen, resolving dampness, clearing heat, and cooling the blood, we prioritize the patient's well-being and unleash their own immune function.Modern pharmacological research has shown that spleen-invigorating herbal medicines can enhance immune function and regulate and suppress immune overactivation.