Ji Yunning(賈苑凝), Ci Lingling (蔡玲玲), Zhng Xiojing (張小靜), Sun Song(孫凇), Jing Xioyun(姜曉媛), Liu Hunwei(劉歡葦), nd Li Yunwen(李元文)＊

Cases analysis of Professor Li Yuanwen in treating eczema

Jia Yuanning(賈苑凝)a, Cai Lingling (蔡玲玲)a, Zhang Xiaojing (張小靜)b, Sun Song(孫凇)a, Jiang Xiaoyuan(姜曉媛)a, Liu Huanwei(劉歡葦)c, and Li Yuanwen(李元文)a＊

a:Dongfang Hospital, the Second Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100000, China

b:General Hospital of Ningxia Medical University，Ningxia province,Yinchuan 750000, China

c:Henan University of Chinese Medicine, He’nan province , Zhengzhou 450000, China)

Funding:The Beijing municipal commission of science and technology “10 kinds of diseases and 10 kinds of medicines”subject (number: Z131100002513013) ; The Beijing municipal administration of traditional Chinese medicine “TCM external treatment” project (number: WZF2012-03) ; Project from Human Resources Dept of Dongfang Hospital “Dongfang Famous Doctors”

Professor Li Yuan-wen is a tutor of doctoral candidates of Beijing university of Chinese medicine. He has combined traditional Chinese and modern medicine in treating skin diseases for more than 30 years in clinical his clinical practice, scientif i c research and education. He has rich experience in treating all kinds of complex skin diseases and holds a unique opinion. We summarize some of his clinical experience in the treatment of eczema.

Eczema; Experience; Li Yuanwen; TCM Dermatology

THEORETICAL CHARACTERISTICS

Professor Li combines skin lesions with differentiation of TCM syndromes in treating patients, on which he considers comprehensively. Holism concept of TCM holds that the human body is an organic whole which is closely related to the environment. People is one part of the nature, that is corresponding to the heaven and earth respectively, so there is close relationship between human body and the external environment. Just because of this, Pro Li believes that in the treatment of eczema, we should attach importance to the diagnosis and treatment of patients, meanwhile, we should give consideration to the season, the disease history, the inducing factors, the patients' living environment and other related various factors, because comprehensive consideration is the basis of an accurate diagnosis and proper treatment.

In the preface of Orthodox Manual of External Medicine written by Chen Shigong in the Ming Dynasty, it is recorded that“if you r body is suf f ering from a disease inside, Youman have no symptom on your skin, however if you have any skin lesions, then your body is certainly suf f ering from a disease inside. If you don’t know this principle, you will Youman have no” We should realize that skin lesions is one part of holism, and holism is the sum of every part. Dif f erentiation of TCM syndromes of eczema is divided into the overall dialectical differentiation and skin dialectical dif f erentiation, although there is a close relationship between them, the former is the precondition of the latter.

TCM four diagnostic methods include inspection, auscultation, olfaction and pulse-taking. A diagnosis should be made based on a comprehensive analysis of data gained by using four diagnostic methods. In those four methods, Professor Li pays special attention to the change of the tongue.

Cao Bingzhang's Tongue Dif f erentiation Guide holds that the tongue could tell us the actual situation of the fi ve internal organs, the tongue coating can tell us disease location of exopathogens, the color and lustre of the tongue can indicate the evil heat, the thickness of the tongue coating can ref l ect the the weight of the moisture, the fat of the tongue can show strength of the vital qi.

Pro Li attaches great importance to combining skin lesions with dif f erentiation of TCM syndromes. Attention should be given to the redness, swelling, heat, pain of the local lesion, which ref l ects the state of hot and humid, toxic heat, blood deficiency and blood stasis respectively on the basis of the dialectic of holism. If the dialectic thinking of the skin lesions is not consistent with holism, further analysis should be made carefully to fi nd out the intrinsic relationship between the holism and local skin disease, which means to perceive the inward essence through the outward manifestation.

TYPICAL CASES

Chief complaints: Ms. Liu, a thirty-two-year-old woman with rashes on face and neck accompanied by itching for 5 years and aggravating 1 week, came into the clinic.

Present History: The patient had been suf f ering from erythra accompanied by itching all over the body for 5 years with no directcause. After scratching, the erythra expanded rapidly with plenty of exudation. She was diagnosed as eczema in other hospitals . And was given the oral decoction of Chinese medicine and Qingshi Zhiyang ointment (former name: GanShiQingDai Ointment)1-9for external use. The symptoms can be controlled and the erythra vanished gradually. But it became even severer when the patient was tired and seasons alter.

One week ago, there were erythra on her face and neck again, accompanied by plenty of exudation and heavy itching, which even influenced her sleep during night. She used the ointment by herself and got no ef f ect, so she came into the clinic. She was diagnosed as eczema with the symptoms of erythra on face and neck, intense itching, fatigue and burnout, fi dget and thirsty, good appetite, bad sleep, dry stool and oliguria with deep-colored urine.

Physical examination showed that there were large inf i ltrating red plaques on her face and neck, with red papulae and blisters which were of the size of rice to muny bean that widely distributed over the face and neck. There were a large number of exudation, ulceration, scratch and escharosis. There was red tongue, thin yellow tongue fur with water slippery tongue and teeth marks on sides and wiry rapid pulse.

Diagnosis of Modern Medicine: eczema.

Diagnosis of TCM: JinYinChuang. TCM Syndrome: excessive dampness-heat syndrome.

Treatment: replenishing qi to invigorate the spleen, removing pathogenic heat from blood.

Recipe: Shenghuangqi (Membranous Milkvetch Root) 20g, Shigao (Gypsum) 30g, Zhuye (Foliabambosae) 10g, Mudanpi (CortexMoutan) 10g, Shenggancao (Glycyrrhizauralensis) 10g, Shengdihuang (RadixRehmanniae) 10g, Chishao (RadixPaeoniae) 15g, Quanshen (Bistort) 15g, Zhuling (PolyporuSumbellatus) 15g, Baiwei (RadixCynanchiAtrati) 10g, Qinghao (Artemisia AnnuaL) 15g, Chaihu (Radix Bupeuri) 10g, Wumei (Dark Plum) 10g, Ganjiang (RhizomaZingiberis) 6g, Fangfeng (Radix Sileris) 10g, Dongguapi (EpicarpiumBenincasae) 15g, Danggui (Angelica) 10g, Maidong (OphiopogonJaponicus) 10g. 14 doses, water decoction, one dose per day.

The second visit: after a week of traditional Chinese medicine treatment，the itching had been alleviated significantly and she slept well (the sleep quality has been increased). The skin swelling had basically been dissipated, and the exudation were obviously decreased, the color of rashes faded and the scratch on her skin reduced obviously. She felt thirsty lightly, and the urine and stool were better than before. There were red tongue with teeth marks and less moss, rapid pulse. Recipe: adding Shashen (AdenophoraStricta) 10g, Xuanshen (Radix Scrophulariae) 10g in the last recipe. Continue to take it for another 2 weeks.

The third visit: There were no new erythra on her face and neck. The color of the original rashes faded, and the itching was relieved significantly. The same formula was used for another 2 weeks.

COMMENTS AND DISCUSSION

This typical case is about the acute breakout of chronic eczema. It manifests large areas of erythema infiltration on the skin where there are extensive red papules and blisters, of which the size is between rice and mung beans. There is much exudation, ulceration, scratches and scabs. The tongue is red and the coating is thin, yellow, and slippery with tooth marks on the edge. The pulse is wiry and rapid. Although it is acute, the symptom would become worse when the patient get tired. Thus the patient may not be cured simply through eliminating pathogenic heat from the blood but should be given medicine that would tonify Qi to eliminate pathogen and strengthen vital Qi. The patient should be cured with the method of tonifying Qi and nourishing Yin and invigorating spleen to remove dampness properly in addition to medicine that eliminate s pathogenic heat from the blood. Shenghuangqi (Membranous Milkvetch Root) can recuperate Middle-Qi as well as eliminating pathogen and strengthening vital qi. Shigao (Gypsum Filrosum), Zhuye (bamboo leaves), Maidong (Radix Ophiopogonis) can clear ref i ned substance without harming the immune system. It clears away heat and nourishes Yin, and it also extinguishes the heart-f i re and eliminates worries. Mudanpi (Cortex Mutan), Dihuang (Radix Rehmannia), Chishao (Radix Paeoniae Rubra) and Quanshen (Rhizoma Bistortae) could cool the blood. Danggui (Radix Angelicae) is also beneficial to the blood. It nourishes and simulates the circulation of the blood. Zhu ling (Polyporus) and Dongguapi (Exocarpium Benincasae) could tonify the spleen and increase secretion of urine to relive edema. Baiwei（Radix Cynanchi Atrati）and Qinghao (Herba Artmisiae Annuae) could clear heat in a def i ciency condition. Wumei (Fructus Mume) could encourage production of body fluids by acor in flavor. Combining it with Chaihu (Radix Bupleuri), it could not only sooth and nourish liver but also enrich blood and astringeYin. Ganjiang (Rhizoma Zingiberis) conducts Chinese medicine upwards. Fangfeng (Radix Saposhnikon’ae) could dispel wind and dredge meridians to alleviate itching. This is consistent with an important treating principle of TCM: treating acute symptoms first for emergency cases. The prescription complies with the method of taking away firewood from under cauldron and the simultaneous treatment of the symptoms and root cause. Pro. Li teaches us to add Huangqi (Membranous Milkvetch Root) for tired patients. And he also emphasizes the progresses of TCM pharmacology research. Modern pharmacologic researches prove that Zhuling (Polyporus) can build up the body and improve immune functions. Wumei (Fructus Mume) has the function of desensitization. The reason may be that non-specific stimuli generates more free antibodies that neutralize allergens in the body. The effective anti-inflammatory component of Chaihu (Radix Bupleuri) is saponin10. From all of the above analysis, Pro.Li emphasizes the integral and the dialectical thinking of the four methods of diagnosis before discussing the treatment of skin diseases. By combining the diagnosis with his treatment experience based on the relations between qi and blood, main and collateral channels, pathogenesis and internal organs, he proves that this dialectical treatment could provide inspirations on the clinical treatment of eczema.

REFERENCES

1 Miaoliang Zhang, Bilian Yang, Lingling Cai, et al. Experience of clinical application of cordierite antipruritic ointment.Clinical Journal of Chinese Medicine, 2016,8(33):145-147.

2 Xueyan Chen, Yuanwen Li, et al. Clinical observation of Qingshi Zhiyang ointment in treating neurodermatitis. Clinical Journal of Chinese Medicine,2016,8(27):103-105.

3 JIANG Jing, LI Yuan-wen, et al. Effects on the Bcl-2 and Bax protein expression Changes of lymphocytes and keratinocyte cells from subacute eczema lesions in Rats intervened by Ganshi Qingdai Cream.Global Traditional Chinese Medicine,2015,8(06):697-701.

4 SUN Zhanxue, ZHAO Lijuan, et al. Effects of Ganshi Qingdai Cream intervening Lesions of subacute eczema model in rats.Global Traditional Chinese Medicine, 2013,6(03):162-164.

5 SUN Zhan-xue, ZHANG Feng-chuan, LI Yuan-wen. Ef f ects on apoptosis of keratinocyte cells and lymphocytes from eczema model lesions in rats intervened by GanShiQingDai Cream.Chinese Journal of Clinicians(Electronic Edition),2013,7(3):1146-1150.

6 JIANG Ying-juan, LI Yuan-wen, et al. Treating 82 neurodermatitis patients in TCM syndrome of liver Stagnation transforming into fire by QingGanYiFu decoction combining with GanShiQingDai Cream. Journal of Traditional Chinese Mediciine,2011,52(24):2136-2137.

7 SUN Zhan-xue, LI Yuan-wen, et al. Clinical observation on ef f ects of GanShi QingDai Ointment on 66 patients with neurodermatitis. China Journal of Traditionnal Chinese Medicine and Pharmacy,2010,25(11):1849-1851.

8 LI Nan, ZHANG Feng-chuan, LI Yuan-wen.The clinical observation on the ef f ects of QingDai ointments on patients with dermatitis and eczema. Global Traditional Chinese Medicine,2009,2(04):280-281.

9 CAI Ling-ling, LI Yuan-wen, ZHANG Feng-chuan, et al.Clinical research of GanShi QingDai Ointment in treating neurodermatitis. Global Traditional Chinese Medicine,2013,6(2):95-99.

10 GUO Yu-cheng, ZHAO Yu-tang, LI Xiu-fen. Anti-allergic effect pharmacodynamics research of GuoMin Decoction. Journal of ChengDe Medical College,2008,25(4):387-389.

（Accepted: November 29, 2016）

Email: yuan-wen@sohu.com