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Introduction
Chinese medicine is a philosophical system of medicine
which has developed in China continuously for at least the last 2,500 years. It
differs in many ways from western medicine in philosophy, diagnosis of disease
and treatment, and it often looks at illnesses and conditions in a radically
different way. The most obvious difference to both patients and practitioners
alike is the way in which Chinese medicine looks at the whole patient and their
environment and does not focus on the disease or a particular part of the body.
It is no surprise to Chinese medicine practitioners that diet, work, stress and
various emotional factors can not only make a condition worse, but in fact be
central to the disease starting in the first place.
What causes illness or disease?
In Chinese medicine the underlying theory is that the body
should be in a perfect state of balance, physically and emotionally and with
regard to the outside world. If this balance is achieved then the body is in a
state of health and well-being appropriate to the natural age of a person. When
disease is present it is because of influences either external or internal or
indeed coming from the environment itself which upsets the balance and causes
illness.
1. Outside influences
Traditionally in China these have been described as
"Climate" factors eg. wind, cold, dampness, heat, dryness. For a Chinese person
therefore if you stay outside in a cold wind you will literally catch a cold!
2. Internal Influences
These are described in terms of emotions Joy, anger, worry,
sorrow, fear. Again, to a Chinese person it is no surprise that diseases can
begin or get worse in stressful situation, for example divorce or the death of a
loved one.
3. The influence of diet and work
In Chinese medicine everything has to be in balance,
including work and diet. Too much work can lead to exhaustion of the body and
weakening of resistance to disease. Too little work on the contrary can lead to
stagnation and laziness in the same way an athlete would lose fitness if he
stopped training. Diet is very important to the practitioner of Chinese medicine
and imbalance of types and quantities of food can lead to problems. A good
practitioner of Chinese medicine will always enquire about diet and will have
recommendations on what to eat to maintain health, or even to combat diseases.
The Organs Meridians and Qi
In Chinese terms the essential substance for life is called
Qi (pronounced Chee). It is used to explain the difference between living things
and non living, for example the difference between a live person and a dead one
is the presence or absence of Qi given that in all other respects they are
alike. It also explains why, say the atoms of carbon in a human are "alive" and
those in a piece of wood are not. The function of the organs in the human body
are to maintain the necessary Qi in the body by obtaining it from food and air
and it is the meridians through which it circulates to all parts of the body to
nourish it. The meridians were described by ancient Chinese physicians to
explain the circulation of Qi and are related to each internal organ. They are
theoretical in concept and do not have an identifiable anatomical structure. It
is interesting how there are similarities in western medicine, for example pain
from the heart is often felt down the arm in a heart attack. In Chinese medicine
the heart meridian runs from the centre of the chest down the arm in the same
route.
How Does this relate to Eczema?
In Chinese terms Eczema is brought about by the influence
of 3 main factors. Wind, heat, damp. These may be external, as has been
described above, or arise inside the body caused by problems with the function
of important organs in the body. Eczema may be of sudden onset, it may be
long-standing (chronic) or it may be in between (subacute). Eczema of sudden
onset would show a red itchy skin and if dampness were involved the weepy
exudate familiar to sufferers would be present. Long standing eczema has the
coarse hard thick red or dark brown crusts which can last for months or even
years and be very itchy.
Diagnosis and treatment
After asking questions about the eczema and the way it came
about, the function of the internal organs of the body and the internal and
external influences described above, the Chinese medical practitioner will
examine the patient's tongue and pulse. From the colour and texture of the
tongue and the nature of the pulse the type of disease patter or "syndrome"
affecting the patient can be deduced. The doctor can then decide what treatment
to prescribe.
What treatments are available?
In the treatment of eczema more than one treatment is
likely to be recommended.
1. Acupuncture
The insertion of fine silver needles through the skin at
specific points on the body to regulate the function of internal organs and the
flow of the natural energy in the meridians. Some of the organs have a specific
influence on the skin and points pertaining to these organs will be chosen.
2. Herbal Remedies
Over many hundreds of years Chinese doctors have developed
combinations of ingredients derived mainly from plants which have been found to
remedy disease in the body in more than one way. Commonly herbs are prescribed
to improve the function of internal organs, to drive away disease causing
influence, eg cold and to maximise the ability of the body to resist illness and
cure itself. These herbs are traditionally made up in to a drink by boiling, but
as this is not always acceptable to the western palate, modern centres of
Chinese practice have developed capsules, similar in appearance to western
medicines, which can be swallowed or in the case of children broken open and put
in drinks or sprinkled on food.
3. Skin preparations
These are produced from herbs and made into lotions, creams
and ointments for external application. Some practitioners prescribe wet
bandages for the exudative type of eczema.
Case study
A 33 year old man presented with eczema of about 15 years
duration. It affected his hands and arms and also the trunk, especially the
lower back. He said it really began after a trip to the seaside on a very hot
day when he was sunburned and exposed to wind. He also said nobody had asked
that before! He had been divorced 2 years before the consultation and during
that time he had a relapse of his eczema. He had recently quit a job which had
involved dressing up in protective clothing because the heat and humidity
aggravated his eczema. His tongue and pulse examination confirmed that he was
affected by heat and wind. This had caused dryness in Chinese terms,
particularly to the blood. He was treated with 4 sessions of acupuncture, and
given 2 types of herbal remedy by night, and a herbal lotion to use on the
hands. In addition he was given advice about diet, and on the advice of the
Practitioner was able to give up smoking.
Analysis
This patient had been under the care of a skin specialist
at his local hospital, and had been admitted to hospital once when exceptionally
bad. His treatment was steroid cream and on occasion steroids by mouth. This
certainly helped the condition, but never completely cured it. The patient was
becoming worried about the amount of medication he was having. After a few weeks
treatment he noticed the hands were nearly back to normal and his back had
stopped itching. He still got rashes when he became hot and wore gloves. He
managed to get a job in a deep freeze depot!
Summary
In Chinese terms this patient had been suffering the
effects of wind and heat which had brought about long term damage to the
internal organ function and manifested itself on the skin. The underlying cause
had been identified and treated, but relapses still occur when exposed to heat.
In a long term case such as this, the treatment would have to be maintained for
a lengthy period to maintain progress. The alterations to the patients diet and
lifestyle must also play a large part in the cure.
Eczema is an inflammation of the skin which may cause dryness, flakiness,
heat, and probably most importantly, itching. Dermatitis is a term
which is sometimes connected, in people's minds, with exposure to chemicals.
It really only means inflammation of the skin, and could be used
interchangeably with eczema, as it often is by doctors.
Eczema can be caused by a number of different factors, and may result in
just a small patch of skin being affected, but can affect skin anywhere on
the body.
Whatever causes your eczema, it leads to itching and redness, and may make
the skin dry and flaky. Sometimes, itchy blisters form. When these burst, or
when scratching damages the skin, the surface may be left moist and crusty.
Often, in the commonest form of eczema (atopic eczema), the problem is
worst in the folds of the skin where your limbs bend.
The itch is intense, and makes you want to scratch. You should avoid this
if you possibly can, as scratching only makes the symptoms worse. People say
that if you have to do anything, gentle rubbing, with the flat of your
hands, is better than scratching.
Whatever the cause of your eczema, the skin becomes more sensitive, and
you may well notice that you are more easily upset by cosmetics, soaps,
detergents, etc.
Many things cause eczema. The commonest is a general allergic over
sensitivity (atopy). This sort of eczema is known as atopic
eczema, and it is linked with
asthma and
hayfever. That is, these conditions often run together in a family.
The other possible causes include:
- Infantile eczema which often affects young babies.
This may lead to a patch below their chins, which gets wettest from
dribbling, and may be associated with cradle cap.
- Contact with substances which irritate the skin chemically.
This is caused by direct contact between the skin and the substance, which
might be such things as detergents, soaps, diesel or engine oils, strong
chemicals, cleaners etc.
- Contact with substances which the body has become allergic to.
Commonly this involves nickel, rubbers etc. If a woman was sensitive to
nickel in the past it would cause a reaction where the bra hooks and
suspenders came near her skin, as these typically contained nickel.
Plastics have helped to overcome this risk, but jewellery and watches are
still a common cause. Suddenly people need to spend a bit more on their
presents to you!
- Varicose veins can lead to a form of eczema affecting
the lower legs. This is known as varicose or gravitational eczema. As well
as treatment of the skin, it is important to improve the blood circulation
in the legs, and for most people this includes wearing support stockings
and staying active on your feet. Your doctor will discuss the options.
Your doctor will usually come to the diagnosis from examining you. If in
doubt, or if he or she feels that you need further tests, then you may be
referred to a skin specialist (dermatologist).
Further tests may include blood tests, patch tests (where little patches
of different substances are stuck to your skin for a few days, to see if you
react to any of them) and other allergy tests.
There is essentially no cure for eczema. It involves a
sensitivity of the skin that you are likely to have to some degree from now
on. There are, however, a number of approaches which help to minimise your
symptoms.
- The mainstay of treatment is moisturising the skin.
For this we use creams, ointments and shower and bath oils which help to
replenish the skin's natural protective oils.
You should discuss these with your doctor, nurse or pharmacist. Washing
tends to dry out the skin and make eczema worse. It helps to use an
emollient cream as a substitute for soap, and you can apply it liberally
at other times during the day. The special bath oils and shower gels also
leave a coating of oils on the skin. Some of the creams and oils contain
an antiseptic, as it has been found that eczema often flares up as a
result of a germ infecting the skin.
- Your doctor may prescribe a cream or ointment containing a
steroid (topical steroid). These are very effective at reducing
inflammation and itch. Your doctor will want you to use this sparingly,
and only while the eczema is bad. There are different strengths of steroid
applications, and the tendency is to use the lowest strength that the skin
requires at the time, in order to minimise the risk of possible side
effects of using steroids.
- In moderate to severe atopic eczema, where topical steroid treatment
has not worked, your doctor may prescribe a new type of treatment to be
applied to the skin (topical treatment). The preparations are made from a
type of drug known as immunomodulators (calcineurin
inhibitors, eg tacrolimus and pimecrolimus) that are used, when taken
internally, for such things as preventing rejection of transplanted
organs. They are strong drugs, but given as an ointment they do not affect
your general immunity, and the main possible side effect is a burning
sensation. They are certainly effective on atopic eczema and, used under
the supervision of your doctor, may make a difference where the previous
treatments were not doing enough. In England and Wales there are
guidelines on their usage from the National Institute of Clinical
Excellence.
-
Antihistamines taken by mouth may be helpful in reducing the
itch. Your doctor will advise.
- If the skin becomes obviously infected, which is more likely as its
normal protective surface has been damaged, your doctor will prescribe
antibiotics.
- There are a number of older fashioned remedies which
are still effective and may be suggested by your doctor or specialist. For
example tars, menthol.
- Evening primrose oil supplements are used for eczema,
and are a safe treatment, but have not consistently proved to be effective
in research trials. It would appear that the evidence may not support them
being any more effective than capsules or medicine containing no active
ingredient (placebo).
- If the skin is not responding well, your doctor will probably ask a
skin specialist (dermatologist) to see you. There are a
number of options that the specialist may use. These may include:
- Bandages and wet wraps.
- Drugs to suppress the immune system of the body as a whole. These
are only used in severe cases, and include Cyclosporin, a drug otherwise
mainly used to stop rejection in patients receiving transplants.
- Phototherapy. Ultra-violet light treatment (UVB and PUVA) can be
used in the treatment of atopic eczema. Ultra-violet therapy potentially
increases the risks of skin cancer, so it is only used in severe cases.
- Naturally, if your eczema is a result of a specific allergy or
sensitivity, then it is wise to avoid the thing which causes it
if you can.
- Use the cream or ointment which your doctor recommends on a regular
basis, and as a soap substitute, to keep the skin supple and to
prevent drying.
- Avoid scratching when you itch. If you can not stop
yourself, then gently rubbing, with the flat of your hand, is less likely
to do damage.
- Avoid exposure to chemicals and strong detergents. It
is usually better to avoid using biological agents altogether. Use
protective gloves when you use such things in the house or at work.
- If you have been found to be allergic to a specific substance,
avoid contact with it, if this is feasible.
- Use your treatments according to the instructions
from your doctor and the pharmacist.
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