Da Huang Mu Dan Tang & Yi Yi Fu Zi Bai Jiang San Pattern to treat Eczema

Ms. Lu, 70 years old

1st consultation on November 7th, 2013.11.7

The patient suffered from eczema on both her legs and back for over 3 years. She went to a specialized hospital, where she saw a dermatologist and was given Chinese medicine for a year with no obvious effect.
 
 
Symptoms:: dry mouth, no bitter taste, dry stools, which were not formed if she would eat vegetables, pale red and flake-shaped eczema on her right sole instep and ankle, the skin was thick, coarse and broken without pus with an unbearable itch. Her tongue was pale red with a white coating, her pulse was wiry and thready.

 

Six Syndrome: Yang ming Tai yin concurrent syndrome

Formula pattern: Da Huang Mu Dan & Yi Yi Fu Zi Bai Jiang San without Gua plus Chi Dou Dang Gui Tang pattern

Sheng Yi Ren 30g Bai Jiang Cao 30g Chuan Fu Zi 6g
Da Huang 6g Chi Xiao Dou 15g Dang Gui 10g
Dan Pi 10g Tao Ren 10g Bai Shao 10g

 

2nd consultation on January 16th, 2014: Her right ankle and sole instep eczema were itching severely, dry mouth, slight sweating, fatigue, good appetite, occasional cough, dry stools, calf spasms at night, pale red tongue with white coating, thready and wiry pulse.

 

Six Syndrome: Tai yang Yang ming Tai yin concurrent syndrome

Formula pattern: Gui Zhi jia Jing Fang Bai Ji Li & Chi Dou Dang Gui Yi Yi Bai Jiang Tang pattern

Gui Zhi 10g Bai Shao 10g Zhi Gan Cao 6g
Jing Jie 10g Fang Feng 10g Bai Ji Li 15g
Chi Xiao Dou 15g Dang Gui 10g Sheng Yi Ren 30g
Bai Jiang Cao 15g Sheng Jiang 15g Da Zao 4 pcs

The patient was repeatedly urged not to scratch her skin!

 

3rd consultation on February 26th, 2014: Her cough subsided, her dry mouth improved, she still felt fatigued, there was occasional pain in her right thumb, mild sweating, her eczema was only apparent on the instep, her tongue coating was white and her pulse was thready and wiry.

 

Six Syndrome: Tai yang Yang ming Tai yin concurrent syndrome

Formula pattern: Yi Yi Bai Jiang San Plus Chi Dou Dang Gui San jia Jie Geng Jing Fang Tang pattern

Sheng Yi Ren 30g Bai Jiang Cao 30g Chi Xiao Dou 15g
Dang Gui 10g Jie Geng 10g Zhi Gan Cao 6g
Jing Jie 10g Fang Feng 10g

 

4th consultation on March 24th, 2014: Her mouth was only slightly dry, the scabs on her instep have decreased significantly, the itching subsided greatly, her appetite and sleep were normal, her tongue coating was white, moist and peeling in the center, her pulse was thready and wiry.

 

Six syndrome: Yang ming Tai yin concurrent syndrome

Formula pattern: Yi Yi Fu Zi Bai Jiang San Plus Chi Xiao Dou Dang Gui Tang pattern

Sheng Yi Ren 30g Bai Jiang Cao 30g Chuan Fu Zi 6g
Chi Xiao Dou 15g Chi Xiao Dou 15g Dang Gui 10g

 

Result: After taking 14 packs of the medicine, her eczema resolved and there was only visible hyperpigmentation left.

 

Analysis: This case was a chronic pattern, seen by many specialists without any results, which caused the patient to lose confidence when in essence the problem stemmed from improper prescription. This disease presents on the skin however according to Jing Fang differentiation it was diagnosed as a Yang ming Tai yin concurrent syndrome mainly, treated by Da Huang Mu Dan Tang Plus Yi Yi Fu Zi Bai Jiang Tang.

 

Da Huang Mu Dan Tang was recorded in line 4 of the 《 Jin Gui Yao Lue· On Incised Wounds, Welling-Abscess, Intestinal Welling-Abscess and Wet Spreading Sores Disorders 》:

 

“ [In case of] Intestinal abscesses, if there is distention and glomus in the lower abdomen, as painful as lin [syndrome] when palpated, regular urination, frequent hot sensations, spontaneous sweating and repeated aversion to cold with a slow and tight pulse, incomplete pus, purgation method is suitable, and the stools would contain blood; If the pulse is surging and rapid, pus has already formed and purgation is inappropriate. Da Huang Mu Dan Pi Tang governs.”

 

《金匮要略·疮痈肠痈浸淫病》第4条:肠痈者,少腹肿痞,按之即痛如淋,小便自调,时时发热,自汗出,复恶寒,其脉迟紧者,脓未成,可下之,当有血;脉洪数者,脓已成,不可下也。大黄牡丹皮汤主之。

 

This formula can treat internal excessive heat with festering pus, and even though the disease presented on the skin, the symptoms indicated a Yang ming internal excess with dampness stasis, which is indicative of this formula pattern. Since there was stagnated dampness with severe heat, Yi Yi Fu Zi Bai Jiang San was added. Sheng yi ren and Bai Jiang Cao can expel internal rheum and clear heat and Fu Zi is added to increase the mechanism of transforming phlegm and rheum.

 

By the 2nd consultation the pattern worsened as evident by the severe itching as well as cough due to an external pattern, which is why after the exterior was resolved the disease showed great improvement. By the 4th consultation the itching subsided entirely, suggesting there was only the interior syndrome left. As the treatment matched the pattern, recovery was bound to come quickly.