NEURODERMATITIS

Clinical Manifestations
  • Lichen simplex chronicus (neurodermatitis) is a chronic
    inflammatory skin disease characterized by paroxysms
    of pruritis and the development of lichenoid changes
    of the skin. The disease occurs from repeated scratching
    or rubbing, either as a habit or in response to stress.
    There is no underlying dermatological disorder.
    In TCM, lichen simplex chronicus is also known as Niu
    Pi Xuan (ox hide tinea) or She Ling Chuang (collar sore).
  • This condition tends to occur on the nape of the
    neck, the wrists, the elbows, the ankles, and the anogenital
    region. It may also spread to the limbs, the areas around the eyes and the sacro-coccygeal region.
  • It is more common in adults and is unrelated to season.
  • Lesions generally manifest as single or multiple irregular or polygonal-shaped plaques with intermingled slightly elevated red papules. The skin in the affected area is rough with deepened skin creases (lichenification).
  • In chronic cases, the lichenified areas become brown (due to hemosiderin deposition) and are covered by fine dry scales.
  • There is severe pruritis, which is worse during the night.
  • The disease tends be chronic with repeated attacks.
  • Differential diagnosis:
    Chronic eczema:
    This condition often evolves from recurring acute or subacute eczema. Characteristic lesions manifest as dry, rough, thickened, and scaling skin, deepening and widening of the cleavage lines of the skin, and hyperpigmentation or hypopigmentation. Itching may be moderate or intense; repeated scratching or rubbing of
    the skin often results in obvious lichenification. Although more usual in easily reached areas, chronic eczema tends to be more widespread than lichen simplex chronicus.
    Lichen planus:
    Eruptions usually involve the flexor surfaces of the wrists and forearms, and the lower legs around and above the ankles. Lesions manifest as intensely pruritic 2-10 mm flat-topped dull red shiny papules. The surface of the lesions exhibits a lacy white pattern of lines (Wickham’s striae). Lesions that persist, most frequently on the shins, may develop into confluent hypertrophic
    plaques that can resemble the lesions of lichen simplex chronicus, with a coarse surface covered by scales. Mucous membranes are involved in 40-60% of lichen planus cases.
Treatment Principle
Herb Formulas
  • Neurodermatitis #2
  • Xiao Feng Hua Yu Tang
  • Neurodermatitis #3
  • Combined Internal and External treatment: Neurodermatitis #1 + Neurodermatitis Wash #1
  • Topical:
    Pi Fu Ruan Gao
    Zhi Yang Ding

    For circumscribed lesions with severe itching:
    Bai Bu Ding (Stemona Root Tincture) apply twice a day
    Ban Mao Cu Jin Ji (Mylabris Vinegar Steep Preparation) apply twice a day
    Qing Liang Gao (Cool Clearing Paste) apply twice a day
    Di Tai Cha Ji
    Shi Cu Hu Ji
    For lesions in the nape of the neck and the anogenital region: Steep Zi Cao in Xiang You (Oleum Sesame Seminis) in a ratio of 1:2 for 15 days. The oil is then filtered and used externally on lesions three to six times a day. After one month of treatment, paroxysmal itching should be relieved and plaques and lichenification should be reduced. After two to two and half months of treatment, the skin in the affected area should returned to normal and itching should disappear. The medication.
    For thin lesions: Huang Lian Ruan Gao (Coptis Ointment) apply twice a day
    For thickened lesions:
    Hei Dou Liu You Ruan Gao apply twice a day
    Mix 15g Mylabris Ban Mao with 100 ml alcohol. After one week, strain the mixture and apply to the lesion with a cotton ball. Blisters will form. Then use a sterilized needle to puncture the blisters. Clean and dress the lesions. Several days later, a scar will form and the lesion will heal.
    Ba Dou You Gao
    Jin Yu Gao
    For disseminated lesions: Cang Wu Cuo Yao (Xanthium and Clamshell Massage Preparation)
    Fumigation Method: Neurodermatitis Fumigation Formula #1
Points
  • LI-4, LI-11, SP-6, SP-10, Ashi points on the lesion sites (transverse insertion around the edges of the lesions)
  • DU-14, DU-15, DU-16, GB-20i, LI-4, LI-11, PC-6, SP-10, ST-36, UB-10, UB-40
  • DU-14, GB-20, LI-4, LI-11, SP-10, ST-36, UB-36, UB-40
  • DU-14, GB-20, LI-4, LI-11, SP-6, SP-10
  • Insert four or five needles into the healthy skin surrounding the lesions. Insert the needles toward the center of the lesions. Tap the lesions with a dermal needle a few times. Remove the needles and apply cups to the lesions. Remove the cups after 30 minutes. In addition needle LI-4, PC-6, SP-6, SP-10, ST-36. Treat once every other day for ten treatments. When the itching and lichenification have disappeared, discontinue the dermal needling and cupping.
  • Direct moxibustion: Ahshi points at the site of the lesions.
    Moxa cones: Place five to seven moxa cones around the Ahshi points relatively equidistant from each other and burn.
    Moxa sticks: Hold an ignited moxa stick over the areas of the lesions, adjusting the temperature according to the patient’s tolerance level.
  • Indirect moxibustion with moxa cones: Ahshi points at the site of the lesions. Position a slice of fresh ginger or garlic over each of the Ashi points. Place the moxa cones on top of the slices and burn three to five cones at each point. Treat once a day. A course consists of ten treatment sessions.
  • Encirclement Needling: Ashi points at the site of the lesions. Insert 1 cun filiform needles obliquely above, below and to the left and right of the Ashi points (four needles in total). Retain for 30 minutes after obtaining Qi. Treat once every other day. A course consists of five treatment sessions. This method is used for localized lichen simplex chronicus (neurodermatitis).
  • Encirclement Needling with electroacupuncture:Ahshi points at the site of the lesions. Insert 1 cun filiform needles obliquely above, below and to the left and right of the Ashi points with their tips all directed toward the center of the lesions (four needles in total). Adjust the frequency according to the patient’s tolerance level. Retain the needles for 15-30 minutes. Treat once a day or every
    other day. A course consists of ten treatment sessions.
  • Cutaneous Needling:
    1. Tap the lesions with a seven star needle the apply cups.
    2. Tap the lesions with a seven-star needle After routine disinfection of the affected area, tap heavily but slowly from the peripheral area of the lesions to the center until the skin reddens
    and there is slight bleeding. Remove the blood with a cotton ball, ignite a pure moxa stick and circle the area about 2cm above the lesions for 10-15 minutes. Treat once every other day for 10 sessions.
  • Ear:
    1. Lung, Shenmen, Adrenal, Liver, Subcortex
    2. Bleed the posterior auricular vein
  • Scalp Acupuncture:
    1. Needle the upper three-fourths of the sensory line bilaterally
    2. Needle the area corresponding to the site of the lesions
Clinical Manifestations
  • Clusters of red, flat pimples
  • Severe itching
  • T: Pale
  • C: Yellowish or Thin and white
  • P: Floating and rapid
Treatment Principle
  • Clear Heat from the Blood
  • Expel Wind
  • Stop itching
Herb Formulas
Points

Clinical Manifestations
  • Dry cough with little or no sputum
  • Sputum is difficult to expectorate
  • Maybe hemoptysis
  • Cough may cause chest pain
  • Dry or sore throat
  • Hoarse voice
  • Dry lips and mouth
  • Thirst
  • Dryness in nose
  • Epistaxis
  • Chills and fever
  • Headache
  • Anhidrosis
  • Dry skin and hair
  • Constipation
  • T: Red tip
  • C: Thin, yellow and dry
  • P: Superficial, maybe rapid
Treatment Principle
  • Cleanse the Lungs
  • Moisten Dryness
Herb Formulas
  • Qing Zao Jiu Fei Tang
  • If symptoms persist for a long time: Yang Yin Qing Fei Tang
  • Topical: Soak 10g Mylabris Ban Mao in 20ml Dimethyl Sulfoxide (DMSO) for 24 hours in a glass jar with a lid. Add 200ml of 75% alcohol and steep for 3-5 days in warm weather or 7-10 days in cold weather. Decant the liquid is a sterile amber glass jar with a lid and discard the dregs. Apply the tincture to a small area of the affected skin with sterile gauze. Wait 24 hours. if there are no untoward symptoms such as flaring of the symptoms, apply to the other areas once or twice daily. Because of the toxicity of Ban Mao, long-term application is discouraged. Use for 5-7 days then rest 2-3 days before resuming application. Do not apply to broken or eroded skin.
Points
Clinical Manifestations
  • This chronic pattern responds poorly to treatment
  • The lesions manifest as thickened, infiltrative, lichenified
    plaques resembling the skin on the neck of an ox
  • Local itching is intense
  • T: Red or crimson
  • C: Little
  • P: Deep and rough
Treatment Principle
  • Arrest Wind
  • Transform Dampness
  • Clear Heat
  • Alleviate itching
Herb Formulas
Points
Clinical Manifestations
  • Thick (lichenified), dry lesions
  • Some scaling
  • Severe itching, worse at night: Red
  • C: Yellow and Greasy
  • P: Soft and rapid
Treatment Principle
  • Expel Wind
  • Clear Heat
  • Transform Dampness
Herb Formulas
Points
Clinical Manifestations
  • Generalized body aches and pains
  • Irritability
  • Heavy sensation in the shoulder and back
  • Discomfort or a constricted sensation in the area of the chest and diaphragm
  • Multiple sores, carbuncles furuncles or abscesses
  • Redness
  • Itching
  • Persistent swelling
  • Chest pain
  • Fever
  • Thirst
  • Aching and painful extremities
  • Aching and painful joints
  • Unbearable swelling and pain of the lower extremities
  • Shoulder stiffness
  • T: Normal
  • C: Greasy and slightly yellow
  • P: Wiry and rapid or Soft and moderate or Soft, superficial and slow or Slippery and rapid or Deep and tight
Treatment Principle
  • Resolve Dampness
  • Clear Heat
  • Disperse Wind
  • Stop pain
  • Activate the Blood
  • Tonify Qi and Blood
Herb Formulas
Points
Clinical Manifestations
  • Aversion to Wind and Cold
  • Spontaneous sweat
  • Recurrent colds
  • Shiny, pale complexion
  • Increased susceptibility to external invasion
  • T: Pale or pink
  • C: White
  • P: Floating, Deficient and soft
Treatment Principle
  • Tonify Qi
  • Stabilize the exterior
  • Stop sweat
Herb Formulas
Points
Clinical Manifestations
  • At the initial stage, the lesions manifest as slightly elevated
    flat-topped red papules, which quickly become confluent
    to form red plaques with well-defined borders.
  • The skin becomes rough
  • Deepened skin creases appear
  • A thin layer of fine dry scales covers the plaques
  • Severe itching and excoriation lead to bloody crusts
  • Restlessness
  • Dry mouth
  • Thirst
  • Insomnia
  • T: Red
  • C: Thin and yellow
  • P: Wiry and slippery or Slippery and rapid
Treatment Principle
  • Clear Heat
  • Cool the Blood
  • Disperse Wind
  • Alleviate itching
Herb Formulas
Points
Clinical Manifestations
  • Chronic lichenoid lesions with thick, dry, dark flaky skin
  • Scaling
  • Scratch marks or
  • Bloody scabs
  • Anemia
  • Itching which is worse at night
  • Swelling
  • Abscesses
  • Ulceration
  • T: Pale or Pink
  • C: Thin and white
  • P: Thready, floating and rapid or Thin and wiry or Deep and thready
Treatment Principle
  • Nourish the Blood
  • Moisten Dryness
  • Clear Heat
  • Dispel Wind
  • Relieve itching
Herb Formulas
  • Dang Gui Yin Zi  modified
  • Chinese Patent Medicines:
    Qing Jiu Wan
    Run Fu Wan
Points
Clinical Manifestations
  • Chronic, continuous uterine bleeding
  • A pale complexion
  • Stabbing pain in the abdomen
  • Alternating chills and fever
  • Irregular menstruation with profuse bleeding
  • Abdominal pain
  • Fever
  • Thirst
  • Itchy skin
  • Heat in the upper body with Cold in the lower body
  • Irritability and restlessness despite fatigue and exhaustion
  • Mood swings
  • A sallow complexion
  • Emaciation
  • T: Dry with a red tip
  • C: Thin white
  • P: Deep and rapid
Treatment Principle
  • Drain Fire
  • Resolve toxicity
  • Tonify the Blood
  • Stop bleeding
  • Warm the menses
  • Cool the Blood
Herb Formulas
Points
Clinical Manifestations
  • Lesions, which may be multiple, manifest as pale red or
    grayish-white thick dry plaques with a rough surface covered
    by dry scales
  • The skin is lichenified
  • There is severe itching, which is worse during the night and disturbs sleep
  • This is a chronic condition with lesions that resist treatment or recur after remission
  • Chronic itching
  • T: Red
  • C: Scant coating
  • P: Deficient and thready
Treatment Principle
  • Nourish Yin
  • Moisten the skin
  • Extinguish Wind
  • Alleviate itching
Herb Formulas
Points
Clinical Manifestations
  • Neurodermatitis
  • Itching
  • Pale complexion Pale lips
  • Blurred or failing vision
  • Spots before eyes
  • Dizziness
  • Dry eyes
  • Pale nail beds
  • Irritability
  • Frightens easily
  • Insomnia with much dreaming
  • Tinnitus
  • Numbness of limbs
  • Tremor, spasms or involuntary movements (chorea)
  • Involuntary shaking of head
  • Light menses or amenorrhea
  • Late menses
  • Tic or tremor of hands and feet
  • Maybe trismus
  • T: Pale
  • C: Little
  • P: Thready and wiry
Treatment Principle
  • Nourish the Blood
  • Subdue Wind
Herb Formulas
Points
Clinical Manifestations
  • Thick (lichenified), dry lesions
  • Some scaling
  • Severe itching, worse at night
  • T: Red
  • C: Thin
  • P: Thready
Treatment Principle
  • Nourish the Blood
  • Moisten the skin
  • Extinguish Wind
  • Stop itching
Herb Formulas
Points
Clinical Manifestations
  • Pain in low back and knees
  • Aches and pains in the bones and sinews
  • Weakness or atrophy of lower extremities
  • Scanty yellow urine
  • Red, hot, swollen and painful feet or knees
  • Edema in lower legs
  • Leukorrhea (thick, yellow, foul-smelling)
  • Sores on lower extremities due to Damp
  • Redness, swelling and pain of the knees with burning sensations
  • Oliguria
  • Eczema
  • T: Normal
  • C: Yellow and greasy
  • P: Soft and and rapid
Treatment Principle
  • Eliminate Heat and Dampness
Herb Formulas
Points
Clinical Manifestations
  • Abdominal distention
  • Dry, scaly skin
  • Tightness
  • A mass-like appearance
  • Softness on palpation
  • Absence of thirst
  • Maybe an aversion to drinks
  • Tenderness and soreness of the lower abdomen
  • Lower abdominal cramps
  • No fever
  • Condition fails to improve
  • A right-sided abdominal swelling that is soft when touched and not very painful
  • Cold extremities
  • A gray or pale complexion
  • T: Pale
  • C: Thin and white
  • P: Rapid or Rapid, empty and weak
Treatment Principle
  • Expel pus
  • Reduce abscess
  • Reduce swelling
  • Warm Yang
  • Disperse Phlegm
Herb Formulas
Points