Mr. Han, 38 years old

1st consultation on May 20th, 2014

The patient suffered from eczema for 5 years. His symptoms included itching, loose stools 3-5 times a day, abdominal distention, belching and acid regurgitation, dry mouth, fatigue, insomnia with a history of gout. His tongue coating was slightly greasy and his pulse was deep, thready and wiry.

Six syndrome: Jue yin Tai yin concurrent syndrome

Formula pattern: Gan Cao Xie Xin Jia Chi Xiao Dou Dang Gui Yi Ren Chen Pi Tang pattern

2nd consultation on May 5th, 2014: The sores and itching subsided drastically, he passed formed stools 1-2 times a day and the belching resolved. However, he still suffered from dry mouth, blisters on his lips and epistaxis about 3 times/week. His sleep improved and was only mildly disturbed as he would wake up easily, with occasional prickling pain in his liver area. His tongue coating was white and greasy at the root, his pulse was thready and wiry. He was prescribed the same formula with the addition of Sheng Di Tan 15g and Bai Jiang Cao 15g. The nose bleeding demonstrated there is some heat above affecting the upper and Sheng Di Tan is added to cool and nourish the blood and stop the bleeding. The Bai Jiang Cao is often characterized as a Yang Ming medicinal since it is cool in nature and expels internal rheum which transformed to heat. Since there is a greasy coating on the tongue and some heat above Bai jiang Cao was added.

3rd consultation on June 3rd, 2014: The sores continued to decrease, the itching had not changed in severity, he passed stools once a day, experienced no more epistaxis, the dry mouth and insomnia improved greatly, there was no more abdominal distention or belching, his tongue coating was white and greasy at the root and his pulse was thready, wiry and slippery.

At this point the syndrome had changed. The heat above was not obvious anymore since the insomnia, the mouth sores, bleeding nose and dry mouth all had improved. Now the symptoms of itching was the most prevalent and had not changed in severity. In this case the syndrome had changed to an exterior syndrome of Tai yang. However there was the greasy tongue coating demonstrating there was still the internal rheum of the Tai yin syndrome and there were some heat signs remaining such as the dry mouth and insomnia pointing to the Yang Ming syndrome.

Six syndrome: Tai yang Tai yin Yang ming concurrent syndrome

Formula pattern: Gui Zhi Jia Jing Fang Ji Li Chi Xiao Dou Dang Gui Yi Ren Sheng Di Tan Tang pattern

Analysis: The formula Gui Zhi Jia Jing Fang Tang was prescribed very often by Prof. Hu and Dr. Feng where there is a Tai yang presentation of both a Ma Huang Tang and Gui Zhi Tang formula pattern presentation at the same time. When the itching is very severe or persistent, Bai Ji li is often added to this formula to treat the itching by releasing the exterior.

Chi Xiao Dou Dang Gui San is often added to a syndrome presenting with blood stasis and phlegm retention intermingling causing blood heat or blood and phlegm stasis. This is a case of chronic severe eczema that is stubborn and has not responded to previous treatment for 5 years. Adding this formula targets the blood stasis and phlegm retention, expels blood stagnation and drains phlegm.

 
4th consultation on June 10th, 2014: The eczema on both arms reduced but was still itching, sleep was not fully resolved, the dry mouth improved, he passed formed stools once a day, sweating profusely, his tongue coating was white and greasy at the root and the pulse was thready. He was prescribed 7 further packs of the same formula without Sheng Di Tan and with the addition of Di Fu Zi 15g and Bai Jiang Cao 15g.

5th consultation on June 17th, 2014: His itching resolved and there was no recurrence of the rash.

Note: Chronic eczema can undergo many transformations, manifesting in the skin, or reflect either interior or half-exterior half-interior syndromes, often with concurrent syndrome presentations. This patient suffered from eczema for 5 years, presenting with a Jue yin Tai yin concurrent syndrome and a Gan Cao Xie Xin Jia Chi Xiao Dou Dang Gui Yi Ren Chen Pi Tang pattern. However the internal rheum had transformed into heat and so Sheng Yi Ren was added in the beginning to drain the internal rheum transformed into heat. However on the second consultation the heat was more prevalent and Sheng Di Tan and Bai Jiang Cao were added the treat the blood heat and internal rheum transforming to heat. Continually changing the formula according to the presentation of syndrome differentiation will bring quick results in clinic.