July 12, 2010

Zhu Ren-Kang- Collection of clinical experience in dermatology (朱仁康-临床经验集-皮肤外科)

Eczema-Case #2
Tian, male, 24 years old presented on March 13, 1967.

Chief complaint: Patient has suffered with a pruritic erythematous papular eruption covering his whole body for the last month.

Disease history: Last month the patient initially noticed small red papular eruptions over his limbs and torso that when scratched exuded fluid. Currently the eruptions are generalized over the entire body being more severe over the upper arms and thighs. Several decoctions have been taken as well as injections of sodium hyposulfide all to no avail.

Inspection: Scattered over the entire body were small millet-grain like red papules with exudate, more obvious on the limbs. The papules were quite diffused and symmetrical.
Pulse was moderate and the tongue was normal with a clean coating.

Chinese medical diagnosis:
Millet sore (粟疮)

Western medical diagnosis: Generalized eczema

Pattern: Interior spleen vacuity with enduring accumulation transforming to heat, transmutation and steaming of damp-heat coupled with external wind.

Treatment principle:
Disinhibit dampness and clear heat.

Formula: 4 packages of Long Dan Xie Gan Tang with additions and subtractions were prescribed.

Second Visit (March 17): Patient reported that the condition was basically the same as before with no improvement. The itchiness was still present and his sleep was disturbed. Tongue body was now red with a thin white coat, and his pulse was wiry and thin.
The treatment principle was changed to cool the blood, clear heat, disperse wind and alleviate itching.

Formula:
Sheng Di 30g
Dan Shen 9g
Chi Shao 9g
Jing Jie 9g
Ren Dong Teng 12g
Ku Shen 9g
Di Fu Zi 9g
Bai Xian Pi 9g
Er Miao Wan 9g
Liu Yi San 9g
4 Packages were administered.

Third visit (March 21): After taking the above formula, the itchiness had decreased considerably and the skin was gradually clearing up. The above formula was repeated with the additions of;
Qian Cao 9g
Chan Yi 6g
Cang Er Zi 9g
5 packages were administered.

Fourth visit (March 26): After taking the above formula, a major portion of his skin had returned to normal and no new lesions were observed. The itchiness was still present in the evenings.
9g of Chi Ling was added to the previous formula and after taking 5 packages the patients’ condition was resolved.

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