Eczema

Eczema is not one pattern. In TCM the same diagnosis can arise from several different internal imbalances, and the aim is to identify which one is driving the skin at that moment rather than to treat the label. The five patterns described here separate an acute, hot, weeping picture from a chronic, dry, deficient one, and they can overlap: a person may carry a dry underlying pattern with a hot acute flare on top. Each pattern has its own rationale, its own tongue and pulse, and its own herbal and acupuncture strategy, which is why what helps one person's eczema can aggravate another. The self-check above is a way into that differentiation, not a diagnosis; a practitioner confirms it from the history, the skin, the tongue and the pulse.

Avoid in pregnancy   Caution in pregnancy

Avoid in pregnancy   Caution in pregnancy

Avoid in pregnancy   Caution in pregnancy

Avoid in pregnancy   Caution in pregnancy

Avoid in pregnancy   Caution in pregnancy

• Across the patterns the advice converges: limit greasy, fried and spicy food, alcohol, dairy and refined sugar, since these are the foods the framework regards as generating dampness and heat. Individual triggers vary, and a food-and-symptom diary is more useful than a universal list.
• For the dry chronic pattern, add moistening foods such as pear, black sesame, tofu and congee, and keep meals warm and cooked. For the acute weeping pattern, cooling foods such as mung beans, cucumber and watermelon can be used while greasy, fried and spicy food, alcohol, dairy and refined sugar are reduced. Regular meal times and not overeating support the Spleen, which is central to managing eczema.

Avoid in pregnancy   Caution in pregnancy

How the tradition treats eczema, with the herbs, formulas and points used for it.

Principles

• Treat the root and the branch together: clear the acute skin picture while addressing the internal imbalance that keeps producing it.
• In the acute, weeping stage, clear heat and drain dampness; in the chronic, dry stage, nourish Blood and Yin and settle Wind.
• Respect the stage. What helps an oozing, hot rash can aggravate dry, fragile skin, and vice versa.
• Support the Spleen throughout - the classical literature stresses that dampness will recur if digestion is not addressed.
• The acute weeping stage is treated as excess and requires clearing Heat and draining Dampness; the chronic dry stage is treated as deficiency and requires nourishing Blood and Yin. Most plans do both in proportion, addressing the branch during a flare and the root between flares.

Herbs used

Formulas

• Long Dan Xie Gan Tang - Formulas Long Dan Xie Gan Tang - Clears heat and drains dampness from the Liver and Gallbladder - the hot, weeping, angry picture.
• Shen Ling Bai Zhu San - Strengthens the Spleen and drains dampness - the duller, fatigue-linked pattern.
• Dang Gui Yin Zi - Nourishes Blood and dispels Wind - the dry, thickened, night-itch pattern.
• Xiao Feng San - Xiao Feng San - Dispels Wind, clears heat and addresses dampness - used across itchy, spreading rashes.
• Liu Wei Di Huang Wan - Nourishes Liver and Kidney Yin - the depleted, dry, chronic picture.

Acupoints

• LI-11 (Quchi) - Clears heat and cools the Blood; a first-line point for hot, itchy skin.
• SP-10 (Xuehai) - Cools the Blood and is used for heat in the skin - the 'sea of blood'.
• SP-9 (Yinlingquan) - Drains dampness, for oozing and swelling.
• ST-36 (Zusanli) - Strengthens the Spleen and Stomach, supporting the root of dampness.
• SP-6 (Sanyinjiao) - Nourishes Yin and Blood; also drains dampness.Avoid in pregnancy
• BL-20 (Pishu) - The Spleen's back-shu point, used to support digestion.
• LI-4 (Hegu) - Dispels Wind and relieves itch on the surface.Avoid in pregnancy
• DU-14 (Dazhui) - DU-14 (Dazhui) - Clears heat and releases the exterior.
• KI-3 (Taixi) - Nourishes Kidney Yin in the depleted picture.
• BL-23 (Shenshu) - The Kidney's back-shu point, supporting constitutional reserves.
• BL-18 (Ganshu) - The Liver's back-shu point, supporting the Blood-storing function.

What to expect

• A typical plan combines regular acupuncture with a daily herbal formula, taken as a decoction or concentrated powder.
• In the first weeks the aim is symptom control - less oozing, less redness, less itch.
• Chronic, dry eczema is expected to improve more slowly, with visible skin change over two to three months.
• Consistency matters more than intensity; the classical literature stresses that improvement is lost when treatment is stopped early.
• Expect fluctuations rather than a straight line: dietary slips and stress can cause short flares, and the trend over several weeks matters more than any single day. Once the skin is stable, many people move to a maintenance diet and occasional acupuncture to sustain the result.

• Do not stop prescribed topical or systemic treatment abruptly; stopping corticosteroids abruptly can trigger a flare.
• Long-term use of internal herbal formulas should be supervised, with liver function checked where indicated - several herbs used in chronic skin formulas carry that caution on their own pages.
• Children, pregnancy and breastfeeding require practitioner review before internal herbs.
• Open, broken skin should not be treated with strong topical applications without advice.

• TCM is described as complementary to conventional care: emollients and mild topical corticosteroids can be used alongside herbs and acupuncture. Where oral immunosuppressants or biologics are being taken, the combination should be discussed with the prescribing doctor rather than changed unilaterally.
• Topical moisturisers and mild corticosteroids can be used alongside herbs and acupuncture. If oral immunosuppressants such as ciclosporin, methotrexate or prednisone, or biologic drugs, are being taken, tell both the TCM practitioner and the prescribing doctor, because some herbs may interact with them or affect liver function. Prescribed medication should never be stopped suddenly, and a full medication list should be brought to the consultation.

During pregnancy Blood and Yin are directed towards nourishing the fetus, so Blood deficiency patterns can become more prominent, and the skin may turn drier and itchier, especially in the later months. Treatment leans towards gentle nourishment rather than strong cooling or moving methods.

Very bitter and cold herbs such as Long Dan Cao and Ku Shen are avoided in pregnancy, as is Dang Gui, and milder alternatives may be used instead. External washes with Huang Bai and Ku Shen are traditionally used, with limited trial evidence; a practitioner should be consulted, especially in pregnancy.

Acupuncture is often preferred to internal herbs. Points traditionally avoided in pregnancy, including Hegu (LI-4) and Sanyinjiao (SP-6), must not be used, and a licensed practitioner will choose safe points such as Quchi (LI-11) and Xuehai (SP-10) to relieve itching. Any treatment during pregnancy should be arranged with a practitioner experienced in obstetric care.

Bitter and cold herbs such as Long Dan Cao and Huang Qin can pass into breast milk and may cause loose stools or digestive upset in a nursing infant. For acute, weeping eczema in a breastfeeding mother, a bland diet, external herbal washes and acupuncture are the safer first line rather than strong internal decoctions.

If internal herbs are needed, a practitioner will choose mild, neutral herbs that support the Spleen and drain Dampness without coldness, such as Fu Ling and Bai Zhu. Nourishing formulas such as Dang Gui Yin Zi can be used with caution, since they do not usually affect milk supply or infant digestion.

Acupuncture is a drug-free option with no risk to the baby and can effectively reduce itching and inflammation. Dietary changes such as avoiding greasy, spicy and dairy-rich food often make a significant difference and support both mother and baby.

In children eczema is most often linked to an immature Spleen and a tendency to accumulate Dampness from food stagnation. A diet high in sweets, dairy and greasy snacks easily overwhelms the child's digestion, producing internal Damp-Heat that erupts on the skin, and the acute stage often shows as red, weepy patches on the cheeks and in the flexures, matching Wind-Heat or Damp-Heat.

Herbal doses are reduced according to age and weight, typically a quarter to a half of an adult dose. Xiao Feng San is a classic choice for acute, itchy, red eczema in children, modified to avoid overly cold herbs, while chronic dry eczema may respond better to a gentle Spleen-strengthening approach such as Shen Ling Bai Zhu San than to heavy blood-nourishing formulas.

Paediatric tui na is used as a complement, with limited trial evidence, and should not replace medical assessment in a child; techniques that strengthen the Spleen meridian and clear Damp-Heat can be taught to parents. Because children describe symptoms poorly, a practitioner relies heavily on tongue inspection, the appearance of the rash, and observation of sleep and stool patterns.

In older adults eczema tends to be chronic, dry and intensely itchy, reflecting a decline in Kidney and Liver Yin and Blood. The skin becomes thin, scaly and lichenified and the itch often worsens at night, and the pattern is usually Blood deficiency with External Wind or Kidney and Liver Yin deficiency rather than the Damp, oozing picture seen in younger people.

Treatment prioritises nourishing Yin and Blood, with formulas such as Dang Gui Yin Zi or Liu Wei Di Huang Wan. Doses are generally lower, about two-thirds of a standard adult dose, to protect digestion, and treatment takes longer because the body's regenerative capacity slows with age.

Polypharmacy is a real concern, since many older patients take medication for blood pressure, diabetes or other conditions, so a full review for herb-drug interactions is essential. Acupuncture is often better tolerated than herbs and can relieve itch and improve sleep without adding to the medication burden.

Urgent-sign guidance is based on standard sources: NHS anaphylaxis, NHS cellulitis, NHS Stevens-Johnson syndrome, NHS melanoma.

• Long Dan Cao

Itching itself is given a name in this framework: Wind. Wind is described as coming from outside (weather, irritants) or arising inside (from Blood deficiency or from heat), and it explains why itch moves, fluctuates and worsens at night. In the acute phase, Wind-Heat is said to strike the surface; in long-standing eczema, dampness and heat are said to have consumed the Blood and Yin that nourish the skin, leaving it dry and undernourished - and that emptiness allows internal Wind to stir.

This is why one Western diagnosis can correspond to several patterns. A person with weepy red patches after spicy food is read as Damp-Heat; another with dull, less oozing patches and fatigue as Spleen Deficiency with Dampness; another with dry, lichenified skin that flares in winter as Blood Deficiency with External Wind. Each calls for a different herbal and acupuncture strategy - and what suits one may aggravate another.

In older patients and long-standing cases the Liver and Kidney are also considered, since they are said to store Blood and fundamental Yin. As those reserves run low, the skin loses its moisture and the dryness deepens.

What follows from this is that two people with the same diagnosis may need opposite treatment: one cleared and cooled, the other nourished and moistened. The classical literature presents this as the practical value of pattern differentiation, and it is also the reason it cautions against applying a single eczema formula to every case.

How it connects

Eczema and digestive discomfort often travel together because the Spleen is the root of Dampness in TCM. When poor diet, stress or overwork weakens the Spleen, it fails to transform and transport fluids, and the resulting internal Dampness can overflow into the skin as eczema while also causing bloating, fullness and loose stools, so treating the Spleen often improves both skin and gut. Anxiety frequently coexists as well, and not only as a reaction to visible lesions: it is often a shared pattern of Liver Qi stagnation, where stagnant Liver Qi generates Heat and Wind that flare the skin while chronic itching knots the Qi further. Herbs and acupuncture that smooth the Liver and calm the Shen often relieve both the mood and the skin.

What a practitioner looks for

• Stage and appearance: acute, weepy, red and hot skin points to an excess picture such as Damp-Heat or Wind-Heat; chronic, dry, scaly, thickened skin points to deficiency, usually of Blood or Yin.
• Distribution and behaviour: where the rash sits and whether it moves, and whether it worsens with heat, humidity, wind, night-time or stress.
• Associated signs: digestion, stools, appetite, thirst, sleep, energy, and whether the person feels hot or cold.
• Tongue and pulse: the tongue's colour, shape and coating and the pulse's quality are used to confirm which pattern predominates.
• Triggers and history: diet, occupation, irritants, previous treatments and how the skin has behaved over time.

In practice the practitioner first separates excess from deficiency: bright red, swollen, weeping skin with a thick yellow greasy tongue coating and a slippery rapid pulse reads as Damp-Heat invading the Spleen, while duller, less oozing patches with fatigue, loose stools, a pale swollen tongue with a white greasy coating and a soft slow pulse read as Spleen deficiency with Dampness, often following a long bout of Damp-Heat that has weakened the Spleen.

Dry, flaky, lichenified skin that itches worse at night, with a pale tongue carrying a thin white coat and a thin pulse, is the usual picture of Blood deficiency with External Wind, where long-standing Damp-Heat has consumed Blood and Yin. Wind-Heat is less common, appearing as a sudden crop of red papules with a burning sensation after an external trigger, with a red tongue tip, a thin yellow coating and a floating rapid pulse.

In older people with chronic dry eczema the root may be Kidney and Liver Yin deficiency, with dry rough skin, a sore lower back, dizziness, tinnitus, a red tongue with little or no coating and a thin rapid pulse, which moves the emphasis from clearing Dampness towards nourishing Yin.