Integrative View of Atopic Dermatitis (Eczema) PART II: The TCM Basics

[This article was originally written for Acupuncture Today January, 2012, Vol. 13, Issue 01. Although this is intended as a more
concise summary for practitioners to reference, the list of tips at the end are for both practitioners to be aware of as well as
directly useful for those who suffer from eczema.]

With regard to Traditional Chinese Medicine (TCM), there are many possible TCM patterns that
correspond to the western diagnosis of atopic dermatitis (eczema). In chronic cases, a rather complex
overlapping of multiple syndromes can be present. Practitioners should differentiate based on the
presentation of lesions and patient history, and not just adhere to the list of TCM patterns I cover here.
Treatment should definitely include internal herbal medicine as atopic eczema definitely has underlying
imbalances that cannot be effectively treated just using topical substances; though topical herbs can be
quite helpful to ease symptoms such as itching, oozing, flaking and redness. Diet improvements must
also be considered for each patient.
In both infants and children, the most common TCM pattern for AD/eczema is Damp Heat. For internal
herbal treatment, it is important to determine which pathogenic factor is more predominant: Damp or
Heat. More exudate or weepy/oozing lesions indicate more Damp. When Heat predominates, there may
be more redness but there will also be more itching and dryness. Chubbier babies who tend to sweat more
tend to be more prone to a Damp condition. Their eczema will likely have more exudate and lesions will
form yellow crusts when they dry. Thinner or weaker babies have a tendency to develop the drier type of
eczema where Heat is more predominant (some sources differentiate this from Damp Heat and call it
Fetal Heat). In this type, the lesions will not be very weepy and there will be more dry, flaky crusts that
look like white or gray bran-like scales on top of the lesions. There might be cracking (fissuring) of the
skin or even bloody scabs if scratching is intense. In infants who are dependent on formula or in children
who have a poor diet (lots of sugary foods, milk and dairy products, fatty or greasy foods), there will also
be underlying Deficiency of Spleen and Stomach. The TCM pattern of Damp Heat accounts for most
cases of acute eczema regardless of the age of the patient. Both Damp Heat and Deficiency of Spleen and
Stomach are a possibility in subacute stages of eczema.
The TCM pattern of Heat in the Blood is also a possibility during the childhood phase of AD/eczema as
well as the adolescent/adult phase. Though some Damp Heat may also be present, this pattern presents as
the drier type of eczema, with more redness and more intense itching than when there is only Damp Heat.
Heart Heat is typically the underlying source of the Heat in the Blood. Heat in the Blood pattern can
occur in the acute or subacute stages of eczema.
Most chronic stages of AD/eczema are seen in the adolescent/adult phase. The skin may exhibit
lichenification: it is thicker, drier, rougher, and may have scaling. Itching can be intense, especially at
night which can lead to insomnia. These cases are most often (but not always) diagnosed in TCM as
Blood Dryness Due to Damaged Yin with Accumulation of Dampness. This develops over a long period
of time from Damp Heat. The Heat damages Yin. When the Damp accumulates in the skin and oozes
out, this exudation also damages Yin. This all eventually leads to dryness. At first, the patients tongue
may be puffy and moist with scalloped sides (signs of Dampness) but the moisture will decrease over
time, cracks may form in the center and a red tip or sides may begin to develop (signs of dryness and Yin
deficiency). There may also be Blood Stasis which is indicated if the lesions remain hyperpigmented
after healing. This condition can be quite complicated to diagnose and to treat. We must first Eliminate
Dampness but caution must be used so as not to exacerbate the Blood Dryness and the developing Yin
Deficiency. Next treat the source of the Dampness (usually Spleen Qi Deficiency) and then also Nourish
& Move Blood and Nourish Yin. It is sometimes necessary to both Eliminate Dampness and Nourish
Blood and Yin at the same time.

In addition to addressing the patterns described above, most eczema presentations are also accompanied
by Fire Toxins and Wind. Herbal formulas for AD/eczema should also include herbs to Resolve Toxins
(to treat the over-proliferation of staph bacteria that so often is present in the lesions) and to Dispel Wind
(to address the itching). While many cases of AD/eczema can benefit from herbal treatment combined
with acupuncture, in cases with lesions over most of the body or cases with significant erythema (redness
and inflammation), it sometimes may be best to avoid acupuncture since placement of the needles can
sometimes aggravate symptoms locally, especially on the delicate skin of the face.
Tips to Improve AD/Eczema: (print out for your patients)
FOR KIDS, TEENS and ADULTS:

Steer clear of common food allergens (a frequent trigger for atopic eczema): eggs, milk, peanuts,
soybeans (including tofu), fish (esp. shellfish and shrimp), and wheat (or other gluten-containing
foods like oats, barley and rye). You may want to research food allergies to get more information
or seek the help of a health care practitioner to help you determine which foods you may be
allergic to.
Avoid foods that are fatty, spicy or fried. Dont overindulge in sweets. Dont eat too much fish
or seafood, esp. shrimp. Dont consume too much dairy either (including milk, cheese, yogurt).
From the TCM perspective, excess consumption of any or all of these foods weaken the energy of
the Spleen and encourage the development of energetic Dampness and Damp-Heat, a common
underlying cause of eczema.
Although eating too much fish seems to worsen eczema, increasing intake of fish oil (for the
essential fatty acids) seems to help. Try cod liver oil 3-4 grams daily for one month then cut back
to 1 to 2 grams daily. Flax seed oil is also an option: 1 tsp, 3 times per day (great as salad
dressing if you dislike to swallow it alone).
Take good quality probiotics (healthy bacteria for your gut) between meals. They are a very
important factor in keeping the immune system healthy. Available at health food stores, usually
kept refrigerated.
If you also have airborne/respiratory allergies (dust mites, mold, seasonal pollens, animal dander,
etc.) avoid those allergens as best you can. Also stay away from people with colds/flu. If you
have any type of immune response it can trigger a flare-up of your eczema.
Fluctuations in hormones can trigger eczema, so if you have irregular periods or thyroid issues,
keep them well managed.
Avoid over-washing your hands or over-bathing. Keeping your skin clean is important, but overcleansing can strip your skin of moisture and actually make your eczema worse.
While eating oats may trigger eczema if you are allergic to gluten, bathing with oats can really
reduce itching. Try adding 2 cups of rolled oats (oatmeal) to your bath. Soaps and lotions
containing oats are good, too.
Avoid glycerin soaps or lotions high in glycerin if you live in a really dry climate. Glycerin is a
humectant and is said to attract moisture to the skin. This is great if the climate you are in is
humid but if the air is drier than your skin, a humectant will leach water from your skin into the
air. Not helpful if you want to keep your skin from drying out.
Apply moisturizer immediately after bathing.
Avoid contact with wool: clothing, coats, socks, blankets, upholstery.
Avoid extreme temperatures for air as well as water that contacts your skin. Wash with
lukewarm water, avoid really hot and humid climates, stay covered-up in very cold, windy or dry
conditions.
Stay happy! Emotional stress and upset can exacerbate your skin problems, esp. eczema. Deal
with your stress in healthier ways than stuffing emotions or letting minor annoyances stress you

out. Try acupuncture, yoga or other form of regular exercise. Walking each day will help more
than you may think (take your dog with you
If you have herpes simplex infection, get it under control.
Apply only high quality skin care products to your face and body. Cheap cosmetics and lotions
often contain harsh or even dangerous ingredients. Products with high alcohol content will also
irritate skin.
Ointments and lotions formulated specifically for skin with eczema can be helpful to reduce
itching and soothe skin.

FOR BABIES:

Keep their nails trimmed short (to break the cycle of itch-scratch-secondary infection of lesions).
Keep the skin creases and folds of chubby flesh clean (legs, buttocks, groin, arms, armpits, neck).
Avoid contact with wool blankets/clothing.
If mom is breast feeding, mom should avoid foods that are fatty, overly sweet, spicy or fried.
Dont overindulge in fish or seafood, esp. shrimp. Dont consume too much dairy either
(including milk, cheese, yogurt). From the TCM perspective, these foods encourage the
development of energetic Dampness and Damp-Heat.
Dont feed your infant/toddler the above foods. Also avoid common allergens: eggs, milk,
peanuts, soybeans, wheat and fish (already mentioned above).
Keep baby clean, but dont over-bathe them as too much washing can cause dehydration of skin
and worsen the condition.
Ointments and lotions formulated specifically for skin with eczema can be helpful to reduce
itching and soothe skin.
Mittens (or socks) on their hands at night can reduce scratching in their sleep.

If there is enough interest, I will also write a Part III in which I share specific herbal formulas for
treatment.

Author Bio:
Diana Hermann is a licensed acupuncturist and NCCAOM board certified in Chinese herbology. She is
owner of Zi Zai Dermatology (herbal skin care products) and maintains a private practice in Fort Collins,
Colorado. She also writes a blog to help educate both patients and practitioners of TCM about skin care.

Websites:
www.ZiZaiDermatology.com (skin care products hand crafted with Chinese herbs)
www.ZiZaiDermatology.wordpress.com (blog about skin care from the TCM perspective)
www.AcupunctureoftheRockies.com (private practice in Fort Collins, CO)

Email: [email protected]

Phone:
(970) 416-9600 Office of Acupuncture of the Rockies
(970) 484-2223 Office of Zi Zai Dermatology