Editor's Note: This study was completed by a group at the teaching clinic at Farmingdale State College, run by the New York College of Traditional Chinese Medicine (NYCTCM). For a complete list of authors and their biographies please see the end of this article.
Eczema affects approximately 3.5 percent of the global population1 and is one of the most common skin complaints seen by dermatologists.
Symptoms of Eczema
Sufferers of eczema report a chronic condition of red, dry, and itchy skin that is often found near the joint creases of the body, such as the elbows; between the fingers; and behind the knees (although it can appear anywhere).2
These lesions can itch, weep, and crust over, and are easily susceptible to fungal and bacterial infections. Conventional medicine treats eczema with moisturisers and topical steroid creams and lifestle changes.3
However, the negative side effects of long term use of topical steroid creams are well documented — sometimes causing topical steroid addiction, which can increase symptoms, and stimulate a need for stronger steroid creams to achieve the same therapeutic effects as before.4
Traction has been gained by the TCM community in the treatment of skin conditions such as eczema, with good effects in managing the symptoms, especially in reducing the itch.5,6 In particular, the combination of Eastern nutrition coupled with acupuncture treatments provide a well rounded treatment module that patients find helpful.
For the purpose of confidentiality, the patient discussed here will be referred to as JA.
Case Study of JA
JA, a 59 year old female, came to the clinic with the complaint of itching skin. Rashes were present on her skin on 50 percent of her face, 75 percent of her hands, and on the anterior aspect of her lower leg. She reported the rashes to be itchy, red, and dry, and she often found that she had scratched herself bloody in the middle of the night due to the itch.
JA was diagnosed with eczema when she was 20 years old. At that same time she had her first severe asthma attack. She reported that she's also allergic to many different foods, resulting in the breakout of hives and swelling, and an increase in the severity of her rashes and her itching. Seasonal allergies also cause her asthma and rashes to flare up but she reported she is otherwise energetic and comfortable.
JA came to the teaching clinic at Farmingdale State College, run by the New York College of Traditional Chinese Medicine (NYCTCM) to begin acupuncture treatments for her eczema. She now receives treatment twice a week.
She signed the informed consent to be treated by in-training student interns who were under the supervision of a licensed acupuncturist in the state of New York.
Diagnosis Made By Western Medicine
JA was diagnosed with eczema by her dermatologist, and asthma by her pulmonologist when she was 20 years old. When JA came to the clinic she was on Singulair (10 mg) and Proventil (inhaler, as needed) to control her asthma. JA reported using her inhaler upwards to five times a day during bad allergy seasons.
Assessment by TCM
The diagnostic methods used by TCM require not only the main complaint as reported by the patient, but an overall assessment of the patient's condition and their constitution in order to reach a diagnostic conclusion.
Therefore, the assessment includes inquiry of present and past medical history; current reported symptoms; observations; palpation; and inspection of pulse and tongue.
JA reported that she is often thirsty and drinks a lot of water to compensate. The patient's body constitution is thin, and her skin and hair were dry. Red, itchy rashes were present on her face, hands, and legs. She complainted of feeling stressed often, and presented with a red tongue with almost no coating and deep center cracks. Her pulse was wiry and rapid on both sides.
According to TCM diagnostic methods, her symptom of eczema are caused by blood heat due to liver qi stagnation. Long term qi stagnation can cause heat, and the heat rises to the skin as the only way for it to escape, thus manifesting itself in the form of rashes.
The Five Element Theory states this long term stagnation of the liver has led it to attack the lung (Wood insulting Metal), which is responsible for both breathing disorders and skin disorders.
Treatment Principle
According to her diagnosis and overall condition, we established a treatment principle based on resolving the stagnant Qi, smoothing the flow of blood and qi in the body, and clearing the heat in the blood.
Aside from using acupuncture based on the "Nei Jing" theory and the "Master Tung" theory diet changes were recommended based on Eastern nutrition. The method of bleeding was also used to reduce the heat in the blood.
The goal of the treatment was to reduce the symptoms of eczema and to increase the length of the time before the symptoms flared up. Cooperation with her nutritional and dietary changes were also paramount in treating the symptoms of her eczema.
Special note was also taken to reduce her asthma symptoms due to the fact that a reduction in her inhaler use also saw a reduction in her eczema symptoms.
Editor's Note: The second part of this article will appear in next month's issue and will resume with the acupuncture points and the case study results.
References
- Hay RJ, Johns NE, Williams, HC, et al. "The Global Burden of Skin Disease in 2010: An Analysis of the Prevalence and Impact of Skin Conditions.". The Journal of investigative dermatology, 2014;134(6): 1527–34.
- Tollefson MM, Bruckner AL, et al. "Atopic dermatitis: skin-directed management." Pediatrics, 2014;134 (6):e1735–44.
- McAleer MA, Flohr C, Irvine AD. "Management of difficult and severe eczema in childhood". The BMJ, 2012;345: e4770.
- Nnoruka E, Daramola O, Ike, S. "Misuse and abuse of topical steroids: implications." Expert Review of Dermatology, 2007;2(1):31–40.
- Pfab F, Huss-Marp J, Gatti A, et al. "Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema – a blinded, randomized, placebo-controlled, crossover trial." Allergy, 2010; 65(7): 903–910.
- Ozawa M, Tsuchiyama K, Gomi R, et al. "Neuroselective transcutaneous electric stimulation reveals body area-specific differences in itch perception. J Am Acad Dermatol, 2006; 55: 996–1002.
Joseph G. Montalto earned his bachelor's degree in biology from Molloy College and his master's degree in physical therapy from Touro College. He owns a physical therapy practice in N.Y. and is board certified in orthopedics.
Dr. Bin Xu received his bachelor's and master's in medicine from the Harbin Medical University, his diploma of acupuncture and TCM from the University of Heilongjiang, and his PhD in medical science from Kanazawa Medical University in Japan. He worked as a physician in China from 1990 to 1993, and since 1993 has been employed as a research scientist in N.Y.
Dr. Yemeng Chen graduated from Shanghai University of Traditional Chinese Medicine in 1985. After that, he worked as an instructor in Shanghai Medical University and practiced as a physician in the affiliated Huashan Hospital, becoming the director of the acupuncture department in 1989. Dr. Chen has more than 30 research papers published in various medical journals in different countries and has also published 10 acupuncture books, including two large-scale reference works. He is currently president of New York College of Traditional Chinese Medicine.
Audrey Krapf is the director at the Health and Wellness Center at Farmingdale State College in N.Y. She is recipient of the NYSCHA Susan Shearer Award for leadership, commitment and enthusiasm in college health.
Kevin Murphy is the director of the Health and Wellness Center at Farmingdale State College. Prior to this appointment, Kevin served as assistant director of the Health and Wellness Center. Mr. Murphy worked as a Level 1 trauma nurse prior to his career in college health. Kevin received an AAS in nursing from Suffolk Community College, A BSN in Nursing from Western Governors University, and a MSN in Nursing Management and Leadership from Western Governors University. Kevin is a lifelong resident of Long Island, and currently lives in West Islip along with his wife and two children. Kevin is focused on providing cost effective, evidence based care to the students of Farmingdale State College in order to allow them to peruse their educational endeavors.
Josephine Fan began her studies under the tutelage of her grandfather. She decided to pursue the academic credentials and licensing requirements to become a N.Y. state licensed acupuncturist. She completed her educational requirements and passed the NCCAOM tests in 2016, and is currently awaiting approval for her application.