Professional Documents
Culture Documents
long period in the interstices (cou li), it causes dis- • Shi Gao ‡ (Gypsum Fibrosum) and Fu Ling Pi (Cortex
harmony in the channels and vessels. When move- Poriae Cocos) clear Heat from the Qi level and
ment in the channels and vessels is impaired, the reduce fever.
disease will become chronic. • Di Fu Zi (Fructus Kochiae Scopariae), Bai Xian Pi
• Friction caused by clothing and scratching may also (Cortex Dictamni Dasycarpi Radicis) and Ku Shen
aggravate the disease, causing lichenification. (Radix Sophorae Flavescentis) alleviate itching,
relieve Toxicity and dissipate Wind.
Pattern identification and treatment BLOOD-DRYNESS DUE TO YIN
INTERNAL TREATMENT DEFICIENCY
Lesions, which may be multiple, manifest as pale red or
EXUBERANT WIND DUE TO BLOOD- grayish-white thick dry plaques with a rough surface cov-
HEAT ered by dry scales. The skin is lichenified. There is severe
At the initial stage, lesions manifest as slightly elevated itching, which is worse during the night and disturbs
flat-topped red papules, which quickly become con- sleep. This is a chronic condition with lesions that resist
fluent to form red plaques with well-defined borders. treatment or recur after remission. The tongue body is
The skin becomes rough, deepened skin creases appear red with a scant coating; the pulse is deficient and thready.
and a thin layer of fine dry scales covers the plaques. Treatment principle
Severe itching and excoriation lead to bloody crusts. Nourish Yin, moisten the skin, extinguish Wind, and
Accompanying symptoms and signs include restlessness, alleviate itching.
dry mouth, thirst, and poor sleep. The tongue body is
red with a thin yellow coating; the pulse is wiry and slip- Prescription
pery or slippery and rapid. SI WU RUN FU TANG JIA JIAN
Four Agents Decoction for Moistening the Skin, with
Treatment principle modifications
Clear Heat and cool the Blood, disperse Wind and alle-
viate itching. Dang Gui (Radix Angelicae Sinensis) 10g
Hei Zhi Ma (Semen Sesami Indici) 10g
Prescription Qin Jiao (Radix Gentianae Macrophyllae) 10g
XIAO FENG SAN JIA JIAN Chao Bai Shao (Radix Paeoniae Lactiflorae, stir-fried) 12g
Powder for Dispersing Wind, with modifications Gan Di Huang (Radix Rehmanniae Glutinosae Exsiccata) 12g
Jing Jie (Herba Schizonepetae Tenuifoliae) 6g He Shou Wu (Radix Polygoni Multiflori) 12g
Fang Feng (Radix Ledebouriellae Divaricatae) 6g Gou Teng (Ramulus Uncariae cum Uncis) 12g
Ku Shen (Radix Sophorae Flavescentis) 6g Dai Zhe Shi ‡ (Haematitum) 15g, decocted for 30 minutes
Chao Niu Bang Zi (Fructus Arctii Lappae, stir-fried) 10g before adding the other ingredients
Sheng Di Huang (Radix Rehmanniae Glutinosae) 10g Zhen Zhu Mu ‡ (Concha Margaritifera) 15g
Dan Shen (Radix Salviae Miltiorrhizae) 10g Nan Sha Shen (Radix Adenophorae) 15g
Chao Mu Dan Pi (Cortex Moutan Radicis, stir-fried) 10g Suan Zao Ren (Semen Ziziphi Spinosae) 6g
Shi Gao ‡ (Gypsum Fibrosum) 12g, decocted for 30 min- Shan Yao (Radix Dioscoreae Oppositae) 30g
utes before adding the other ingredients Explanation
Fu Ling Pi (Cortex Poriae Cocos) 12g • Dang Gui (Radix Angelicae Sinensis), Chao Bai Shao
Di Fu Zi (Fructus Kochiae Scopariae) 12g (Radix Paeoniae Lactiflorae, stir-fried), Gan Di Huang
Bai Xian Pi (Cortex Dictamni Dasycarpi Radicis) 12g (Radix Rehmanniae Glutinosae Exsiccata), and He
Explanation Shou Wu (Radix Polygoni Multiflori) nourish the
• Jing Jie (Herba Schizonepetae Tenuifoliae), Fang Feng Blood and moisten Dryness.
(Radix Ledebouriellae Divaricatae) and Chao Niu • Hei Zhi Ma (Semen Sesami Indici), Nan Sha Shen
Bang Zi (Fructus Arctii Lappae, stir-fried) dissipate (Radix Adenophorae) and Shan Yao (Radix Dio-
Wind and alleviate itching. scoreae Oppositae) enrich Yin and moisten Dryness.
• Sheng Di Huang (Radix Rehmanniae Glutinosae), Dan • Gou Teng (Ramulus Uncariae cum Uncis) and Qin Jiao
Shen (Radix Salviae Miltiorrhizae) and Chao Mu Dan (Radix Gentianae Macrophyllae) extinguish Wind
Pi (Cortex Moutan Radicis, stir-fried) cool and and alleviate itching.
invigorate the Blood, moisten the skin and reduce • Dai Zhe Shi ‡ (Haematitum), Zhen Zhu Mu ‡ (Concha
erythema. Margaritifera) and Suan Zao Ren (Semen Ziziphi
136 DERMATOLOGY IN TRADITIONAL CHINESE MEDICINE
Spinosae) calm the Liver, extinguish Wind and quiet 2. For gastrointestinal dysfunction, add Chao Zhi Ke
the Spirit to strengthen the effect in alleviating (Fructus Citri Aurantii, stir-fried), Bai Zhu (Rhizoma
itching. Atractylodis Macrocephalae) and Chen Pi (Pericar-
pium Citri Reticulatae).
ACCUMULATION OF WIND-DAMP 3. For menstrual irregularities, add Yi Mu Cao (Herba
In this chronic pattern which responds poorly to treat- Leonuri Heterophylli), Wu Yao (Radix Linderae
ment, lesions manifest as thickened, infiltrative, licheni- Strychnifoliae), Zhi Xiang Fu (Rhizoma Cyperi
fied plaques resembling the skin on the neck of an ox Rotundi, processed), and Yue Ji Hua (Flos et Fructus
(hence one of the names for this condition in Chinese – Rosae Chinensis).
niu pi xuan, or oxhide tinea). Local itching is intense. The 4. For thickened skin with deep crease lines, add Chi Shi
tongue body is red or crimson with a scant coating. The Zhi ‡ (Halloysitum Rubrum), Jiu Zhi Da Huang (Radix
pulse is deep and rough. et Rhizoma Rhei, processed with alcohol), Tao Ren
Treatment principle (Semen Persicae), Cang Zhu (Rhizoma Atractylodis),
Arrest Wind, transform Dampness, clear Heat, and alle- and Chuan Shan Jia* (Squama Manitis Pentadactylae).
viate itching. 5. For predominance of Wind-Heat, add Fu Ping
(Herba Lemnae seu Spirodelae) and Chan Tui ‡ (Peri-
Prescription ostracum Cicadae).
WU SHE QU FENG TANG JIA JIAN 6. For predominance of Cold-Damp, add Yi Yi Ren
Black-Tail Snake Decoction for Expelling Wind, with (Semen Coicis Lachryma-jobi), Wei Ling Xian (Radix
modifications Clematidis) and Ma Huang* (Herba Ephedrae).
Wu Shao She ‡ (Zaocys Dhumnades) 10g 7. For predominance of Wind Toxins, add Cang Er Zi
Jing Jie (Herba Schizonepetae Tenuifoliae) 10g (Fructus Xanthii Sibirici), Quan Xie ‡ (Buthus Mar-
Huang Qin (Radix Scutellariae Baicalensis) 10g tensi) or Gou Teng (Ramulus Uncariae cum Uncis),
Qiang Huo (Rhizoma et Radix Notopterygii) 10g and Wu Shao She ‡ (Zaocys Dhumnades).
Fang Feng (Radix Ledebouriellae Divaricatae) 12g 8. For insomnia, add Bai Zi Ren (Semen Biotae Orien-
Lian Qiao (Fructus Forsythiae Suspensae) 12g talis), Yuan Zhi (Radix Polygalae Tenuifoliae) and Hu
Jin Yin Hua (Flos Lonicerae) 12g Po ‡ (Succinum).
Chan Tui ‡ (Periostracum Cicadae) 6g
Gan Cao (Radix Glycyrrhizae) 6g EXTERNAL TREATMENT
Ku Shen (Radix Sophorae Flavescentis) 4.5g • For circumscribed lesions with severe itching, apply
Xu Chang Qing (Radix Cynanchi Paniculati) 30g Bai Bu Ding (Stemona Root Tincture), Ban Mao Cu Jin
Chi Xiao Dou (Semen Phaseoli Calcarati) 30g Ji (Mylabris Vinegar Steep Preparation) or Qing Liang
Gao (Cool Clearing Paste) twice a day.
Explanation
• For thin lesions, apply Huang Lian Ruan Gao (Coptis
• Wu Shao She ‡ (Zaocys Dhumnades), Jing Jie (Herba
Ointment) twice a day.
Schizonepetae Tenuifoliae), Qiang Huo (Rhizoma et
Radix Notopterygii), Fang Feng (Radix Ledebouriellae • For thickened lesions, apply Hei Dou Liu You Ruan Gao
Divaricatae), Chan Tui ‡ (Periostracum Cicadae), Ku (Black Soybean and Vaseline® Ointment) twice a day.
Shen (Radix Sophorae Flavescentis), and Xu Chang • For disseminated lesions, apply Cang Wu Cuo Yao
Qing (Radix Cynanchi Paniculati) dissipate Wind and (Xanthium and Clamshell Massage Preparation); see
dispel Dampness, and arrest Wind to alleviate itching. Appendix 5 for details.
• Huang Qin (Radix Scutellariae Baicalensis), Lian Qiao • Zhao Bingnan suggested the following fumigation
(Fructus Forsythiae Suspensae), Jin Yin Hua (Flos method:
Lonicerae), Gan Cao (Radix Glycyrrhizae), and Chi Prescription ingredients
Xiao Dou (Semen Phaseoli Calcarati) clear Heat and
Cang Zhu (Rhizoma Atractylodis) 9g
relieve Toxicity, invigorate the Blood and reduce
Ku Shen (Radix Sophorae Flavescentis) 9g
eruptions.
Huang Bai (Cortex Phellodendri) 9g
General modifications Fang Feng (Radix Ledebouriellae Divaricatae) 9g
1. For tension, irritability or sudden outbursts of anger, Da Feng Zi (Semen Hydnocarpi) 30g
add Mu Li ‡ (Concha Ostreae), Long Gu ‡ (Os Draco- Bai Xian Pi (Cortex Dictamni Dasycarpi Radicis) 30g
nis), He Huan Pi (Cortex Albizziae Julibrissin), Wu Song Xiang (Resina Pini) 12g
Wei Zi (Fructus Schisandrae Chinensis), and Ye Jiao He Shi (Fructus Carpesii) 12g
Teng (Caulis Polygoni Multiflori). Wu Bei Zi ‡ (Galla Rhois Chinensis) 15g
LICHEN SIMPLEX CHRONICUS (NEURODERMATITIS) 137
Grind the ingredients into a powder and roll up in a top of the slices and burn three to five cones at each
piece of thick paper. Light the roll and fume the point. Treat once a day. A course consists of ten treat-
affected areas for 15-30 minutes, once or twice a day. ment sessions.
The heat produced by the burning roll should be
adjusted according to the patient’s tolerance level. ENCIRCLEMENT NEEDLING
Points: Ashi points (the site of the lesions).
ACUPUNCTURE Technique: Insert 1 cun filiform needles obliquely
Empirical points above, below and to the left and right of the Ashi points
Main points: LI-11 Quchi and SP-10 Xuehai. (four needles in total). Retain for 30 minutes after
Auxiliary points: LI-4 Hegu, SP-6 Sanyinjiao and Ashi obtaining Qi. Treat once every other day. A course con-
points (lesion sites). sists of five treatment sessions.
Technique: Apply the even method. Retain the needles Indications: This method is used for localized lichen
for 30 minutes after obtaining Qi. Treat once a day. A simplex chronicus (neurodermatitis).
course consists of ten treatment sessions.
Indications: This method is used for localized lichen ENCIRCLEMENT NEEDLING WITH
simplex chronicus (neurodermatitis). ELECTRO-ACUPUNCTURE
Selection of points on the affected channels Points: Ashi points (the site of the lesions).
Points: GB-20 Fengchi, BL-10 Tianzhu, GV-16 Fengfu, Technique: Insert 1 cun filiform needles obliquely
GV-15 Yamen, GV-14 Dazhui, LI-11 Quchi, PC-6 above, below and to the left and right of the Ashi points
Neiguan, LI-4 Hegu, BL-40 Weizhong, ST-36 Zusanli, with their tips all directed toward the center of the
and SP-10 Xuehai. lesions (four needles in total). Adjust the frequency
Technique: Select five or six of the points and apply according to the patient’s tolerance level. Retain the
the reducing method. Retain the needles for 30 minutes needles for 15-30 minutes. Treat once a day or every
after obtaining Qi. Treat once a day. A course consists other day. A course consists of ten treatment sessions.
of ten treatment sessions.
Indications: This method is used for disseminated Clinical notes
lichen simplex chronicus (neurodermatitis).
Explanation • Combining internal and external treatments is rec-
• LI-11 Quchi, LI-4 Hegu, GV-14 Dazhui, GV-16 ommended for best results. Internal medications
should be prescribed according to syndrome differ-
Fengfu, GB-20 Fengchi, and BL-10 Tianzhu dissi-
entiation. External medications should differ
pate Wind and alleviate itching.
according to whether the lesions are localized or
• SP-10 Xuehai, SP-6 Sanyinjiao and ST-36 Zusanli disseminated. Acupuncture and moxibustion have a
nourish the Blood and moisten Dryness. good effect in quieting the Spirit and alleviating
• GV-15 Yamen, PC-6 Neiguan and BL-10 Xuehai itching.
quiet the Spirit and settle the Mind. • Where the condition is caused by emotional factors,
• BL-40 Weizhong drains Heat and relieves Toxicity. treatment should focus more on nourishing the Blood
and quieting the Spirit, or on settling fright and quiet-
MOXIBUSTION ing the Spirit. For recurrent dry and scaly skin, the
Direct moxibustion treatment principle should focus more on invigorating
Points: Ashi points (the site of the lesions). the Blood and transforming Blood stasis.
Technique • To consolidate the improvement, continue with
• Moxa cones: Place five to seven moxa cones around internal treatment for one or two months even when
the Ashi points relatively equidistant from each other the lesions are resolving and itching has subsided,
and burn. otherwise relapse is possible.
• Moxa sticks: Hold an ignited moxa stick over the area
of the lesions, adjusting the temperature according
to the patient’s tolerance level.
Advice for the patient
Indirect moxibustion with moxa cones • Emotional factors play an important part in the eti-
Points: Ashi points (the site of the lesions). ology of this disease, and so avoiding mental stress is
Technique: Position a slice of fresh ginger or garlic essential; patients may have to be prepared to alter
over each of the Ashi points. Place the moxa cones on their lifestyle to achieve this.
138 DERMATOLOGY IN TRADITIONAL CHINESE MEDICINE
• Physical abrasions can trigger the condition, and so Preparation for Relieving Toxicity)vii was applied to the
avoiding mechanical and physical irritants is impor- affected areas twice a day.
tant. Second visit
• Dietary factors can aggravate any skin condition, After seven bags of the decoction, itching was reduced and
hence spicy food and overindulgence in coffee, the patient was less irritable. The prescription was modified
strong tea or alcohol should be avoided. by removing Long Dan Cao (Radix Gentianae Scabrae), Zhi Zi
(Fructus Gardeniae Jasminoidis) and Gou Teng (Ramulus
Uncariae cum Uncis) and adding Quan Xie ‡ (Buthus Martensi)
Case histories 6g, Zao Jiao Ci (Spina Gleditsiae Sinensis) 6g, Xu Chang Qing
(Radix Cynanchi Paniculati) 15g, and Bai Ji Li (Fructus Tribuli
Case 1 Terrestris) 30g.
Patient External treatment
Female, aged 42. Tao Ye Xi Ji (Paper Mulberry Leaf Wash Preparation) was
Clinical manifestations prescribed to wash the affected areas for 15 minutes once a
day.
The patient had experienced itchiness on the nape of the
neck for six months. The itching, which was severe at night, Outcome
had gradually spread to the bilateral antecubital and popliteal After 14 bags of the modified decoction, itching had stopped
fossae and the leg. The skin had become rough and thickened. and the lesions had resolved.
Accompanying symptoms and signs included irritability and
irascibility, restless sleep, a bitter taste in the mouth, dry Discussion
throat, and menstrual irregularities. Zhang Zhili considers that emotional and mental factors are a
Examination revealed thickened, scaly, dark red, hyperpig- major cause of this disease among women in modern society.
mented plaques on the nape of the neck, the antecubital and Generalized itching and dark red skin lesions arise because of
popliteal fossae and the extensor aspect of the leg with emotional problems and Depression binding Liver Qi. If
obvious ridges and without clear margins. Rubbing and these factors are complicated by external contraction of
scratch marks were evident. The tongue body was red at the pathogenic Wind, enduring Depression transforms into Fire,
margins and tip with a slightly yellow coating; the pulse was which attacks the skin and flesh to cause the condition.
wiry and slippery. Irritability, irascibility, a bitter taste in the mouth, and a dry
throat are caused by Liver-Fire flaming upward and menstrual
Pattern identification irregularities result from impairment of the Liver’s dredging
Constrained Liver Qi combined with external contraction of and drainage function and inhibition of the functional activi-
pathogenic Wind leading to enduring Depression transform- ties of Qi.
ing into Fire. Chai Hu (Radix Bupleuri) and Zhi Ke (Fructus Citri Aurantii)
Treatment principle soothe the Liver and regulate Qi; Long Dan Cao (Radix Genti-
Soothe the Liver and regulate Qi, clear Heat and dissipate anae Scabrae) and Zhi Zi (Fructus Gardeniae Jasminoidis)
Wind. clear and drain Liver-Fire; Sheng Di Huang (Radix Rehmanniae
Glutinosae) and Mu Dan Pi (Cortex Moutan Radicis) cool the
Prescription ingredients Blood and clear Heat; Dang Gui (Radix Angelicae Sinensis),
Chai Hu (Radix Bupleuri) 10g Chi Shao (Radix Paeoniae Rubra), Bai Shao (Radix Paeoniae
Zhi Ke (Fructus Citri Aurantii) 10g Lactiflorae), Ye Jiao Teng (Caulis Polygoni Multiflori), and Gou
Long Dan Cao (Radix Gentianae Scabrae) 10g Teng (Ramulus Uncariae cum Uncis) nourish and invigorate
Zhi Zi (Fructus Gardeniae Jasminoidis) 10g the Blood and extinguish Wind to alleviate itching; and Fang
Sheng Di Huang (Radix Rehmanniae Glutinosae) 15g Feng (Radix Ledebouriellae Divaricatae) dissipates Wind to
Mu Dan Pi (Cortex Moutan Radicis) 10g alleviate itching.
Chi Shao (Radix Paeoniae Rubra) 10g After repressing Liver-Fire, Dang Gui (Radix Angelicae
Bai Shao (Radix Paeoniae Lactiflorae) 10g Sinensis), Sheng Di Huang (Radix Rehmanniae Glutinosae), Chi
Dang Gui (Radix Angelicae Sinensis) 10g Shao (Radix Paeoniae Rubra), Bai Shao (Radix Paeoniae Lacti-
Ye Jiao Teng (Caulis Polygoni Multiflori) 30g florae), and Mu Dan Pi (Cortex Moutan Radicis) nourish the
Gou Teng (Ramulus Uncariae cum Uncis) 10g Blood and emolliate the Liver to treat the Root. The combi-
Fang Feng (Radix Ledebouriellae Divaricatae) 10g nation of Quan Xie ‡ (Buthus Martensi), Xu Chang Qing (Radix
Cynanchi Paniculati), Bai Ji Li (Fructus Tribuli Terrestris), and
One bag a day was used to prepare a decoction, taken twice a day.
Zao Jiao Ci (Spina Gleditsiae Sinensis) nourishes the Blood
External treatment and expels Wind to alleviate itching while dispelling any
Xiong Huang Jie Du San Ding Ji (Realgar Powder Tincture residual Wind in the Blood. 47
vii In those countries where the use of Xiong Huang (Realgar) is not permitted, Bai Bu Ding (Stemona Tincture) can be substituted.
LICHEN SIMPLEX CHRONICUS (NEURODERMATITIS) 139
Internal treatment prescription used externally on lesions three to six times a day. After
Dang Gui (Radix Angelicae Sinensis) 10g one month of treatment, paroxysmal itching was
Chi Shao (Radix Paeoniae Rubra) 10g relieved and plaques and lichenification were reduced.
Chuan Xiong (Rhizoma Ligustici Chuanxiong) 10g After two to two and half months of treatment, the
Niu Xi (Radix Achyranthis Bidentatae) 10g skin in the affected area returned to normal and itching
Sheng Di Huang (Radix Rehmanniae Glutinosae) 30g disappeared. The medication proved effective for
Shu Di Huang (Radix Rehmanniae Glutinosae Conquita) 30g lesions in the nape of the neck and the anogenital
Dan Shen (Radix Salviae Miltiorrhizae) 30g region. No recurrence was reported in follow-up visits
Yi Yi Ren (Semen Coicis Lachryma-jobi) 30g between six months and four years. 53
Bai Xian Pi (Cortex Dictamni Dasycarpi Radicis) 15g
COMBINED TCM AND WESTERN
One bag a day was used to prepare a decoction, taken MEDICINE TREATMENT
twice a day. A course of treatment lasted ten days. Chen combined TCM and Western medicine in the
External treatment prescription treatment of lichen simplex chronicus. 54
Lu Lu Tong (Fructus Liquidambaris) 30g TCM prescription ingredients
Xiang Fu (Rhizoma Cyperi Rotundi) 30g Jing Jie (Herba Schizonepetae Tenuifoliae) 9g
Wu Zhu Yu (Fructus Evodiae Rutaecarpae) 15g Fang Feng (Radix Ledebouriellae Divaricatae) 9g
Mu Zei (Herba Equiseti Hiemalis) 10g Zhi Zi (Fructus Gardeniae Jasminoidis) 6g
A decoction of these ingredients was used to steam and Ku Shen (Radix Sophorae Flavescentis) 6g
wash the affected area. Results were seen after two Dang Gui (Radix Angelicae Sinensis) 9g
courses. Mu Dan Pi (Cortex Moutan Radicis) 9g
Ci Shi ‡ (Magnetitum) 15g
EXTERNAL TREATMENT Mu Li ‡ (Concha Ostreae) 15g
Gan Cao (Radix Glycyrrhizae) 3g
1. Zhang prescribed external application of Di Tai Cha
Ji (Anti-Lichen Rub Preparation). 52 One bag a day was used to prepare a decoction, taken
twice a day.
Prescription ingredients
Western medicine
Ma Qian Zi* (Semen Nux-Vomicae) 3g
Sheng Cao Wu* (Radix Aconiti Kusnezoffii Cruda) 3g Beclometasone dipropionate ointment was applied
Wu Bei Zi ‡ (Galla Rhois Chinensis) 3g externally.viii Results were seen between 10 and 20 days.
Xi Xin* (Herba cum Radice Asari) 3g Recurrence affected 10 percent of patients after treat-
Huang Bai (Cortex Phellodendri) 6g ment was ended.
Ban Xia (Rhizoma Pinelliae Ternatae) 6g SEVEN-STAR NEEDLING COMBINED WITH
Tian Nan Xing (Rhizoma Arisaematis) 6g
MOXIBUSTION
The ingredients were ground into a fine powder and Ma reported on treatment of the condition with a
soaked in 30 percent Cresol and Soap Solution 150ml, seven-star needle, preferring it to the encirclement need-
95 percent alcohol 50ml and castor oil 20ml for five ling method. After routine disinfection of the affected
days. The medication was then applied externally area, he tapped heavily but slowly from the peripheral
directly on the lesions with gauze or cotton buds, three area of the lesions to the center until the skin reddened
to four times a day for seven days. and there was slight bleeding. He removed the blood
with a cotton ball, ignited a pure moxa stick and circled
2. Wang steeped Zi Cao (Radix Arnebiae seu the area about 2cm above the lesions for 10-15 minutes.
Lithospermi) in Xiang You (Oleum Sesami Seminis) in a Treatment was given once every other day. Results were
ratio of 1:2 for 15 days. The oil was then filtered and seen after 10 sessions. 55
viii This medicine is a prescription drug and can only be prescribed by registered doctors.
This chapter covers disorders of the hair and mucocu- Chapter 4, pyogenic paronychia (whitlow) in Chapter
taneous diseases of the mouth. Disorders of the nails 10, tinea unguium (ringworm of the nail) in Chapter 11,
are discussed in the relevant chapters – psoriasis in and hangnail in Chapter 17.
Alopecia areata
斑秃
A hair follicle is defined as an invagination of the epi- • The disease is characterized by the sudden appear-
dermis containing a hair, with the density of hair folli- ance of one or several clearly defined round or oval
cles being greatest on the head. The hair grows from patches of hair loss, generally 1-4 cm in size.
germinative cells in the hair bulb in the dermis; the • In severe cases, there may be loss of eyebrow,
number and type of melanocytes associated with these moustache, beard, axillary, or genital hair. A few
cells are responsible for the color of the hair. The cycle patients lose all the hair on the scalp (alopecia tota-
of each follicle is independent of its neighbors and lis); complete baldness of the head and body is
passes through three phases – a growth phase (anagen), known as alopecia universalis.
lasting for three to five years, a short conversion phase • The skin is smooth and white or may have short
(catagen), and a resting phase (telogen), lasting for up to stubs of hair at the margins of lesions (so-called
three months, after which the hair is shed. One possible “exclamation mark hairs”, about 4mm in length and
cause of alopecia areata has been suggested as prema- tapering toward the scalp). Inflammation and scaling
ture termination of the anagen phase. are absent.
Alopecia areata is sudden-onset patchy hair loss in one
• Hair loss may be accompanied by fine pitting of the
or more circumscribed round or oval areas, primarily on
nails.
the scalp. The condition appears to have an immunologic
basis, occurring in association with autoimmune and • New hair growth is usually the same color and tex-
atopic disorders. Although the exact pathogenesis has yet ture as existing hair, but may be fine and white, par-
to be definitively identified, the disease is often associated ticularly in older patients.
with emotional factors and endocrine dysfunction. • The outcome is variable. A first episode usually
Alopecia areata usually appears as patchy baldness, but results in regrowth within a few months. Further
occasionally causes all hair to be lost. Although total episodes often result in more extensive patches of
baldness is often permanent, regrowth is possible in hair loss, with slower regrowth.
cases with limited involvement.
In TCM, alopecia areata is known as gui ti tou (ghost- Differential diagnosis
shaved hair) or you feng (glossy scalp Wind).
Tinea capitis
Clinical manifestations This condition occurs most frequently in prepubertal
children. Alopecia areata should be differentiated from
• The highest incidence of alopecia occurs among the the “gray patch ringworm” pattern, which is character-
young and middle-aged. ized by round or irregular scaly lesions of grayish-white
540 DERMATOLOGY IN TRADITIONAL CHINESE MEDICINE
patches. The hair is dry and brittle and usually breaks for new Blood to irrigate and nourish the hair root,
off 3-4 mm above the skin surface with white sheaths thus leading to rapid hair loss over a large area.
left at the root of the affected hairs. Although hair loss • Qi and Blood Deficiency due to prolonged illness, or
may occur in persistent conditions, the disease normally debilitation of the Chong and Ren vessels mean that
disappears spontaneously during adolescence. the hair is no longer nourished properly, resulting in
Other conditions dry hair or thinning and lusterless hair, and eventu-
Alopecia can also be caused by habitual hair-pulling ally to hair loss.
(trichotillomania) or traction from tight hair rollers or • Internal damage due to the emotions, such as disap-
pulling the hair tightly into a bun or pony-tail. These pointment or excessive thought and preoccupation,
causes need to be eliminated from the diagnosis. can injure the Heart and Spleen, impairing the trans-
formation and transportation function of the Spleen
and leading to loss of the source for transforming
Etiology and pathology and generating Qi and Blood. This manifests in the
exterior as gray hair and hair loss and in the interior
• Alopecia areata can result from Excess or Deficiency as Deficiency-Heat due to restlessness and overstrain.
patterns: • When Lung Qi is abundant, it promotes the diffu-
• Excess patterns are caused by excessive intake of sion and distribution of Body Fluids and Blood to
spicy, hot or fried food or by a depressed mental nourish the Zang-Fu organs internally and moisten
state transforming into Fire, thus consuming Yin and enrich the skin, flesh, hair, and orifices exter-
and Blood and generating Wind due to Blood- nally. Damage to the Lungs can lead to various hair
Heat. Another Excess pattern is caused by Blood disorders, including thinning hair, dry or gray hair, or
stasis in the hair orifices, depriving the hair root of hair loss.
nourishment by Yin and Blood. Both patterns • The Kidneys store the Essence of the Zang-Fu
manifest as unexpected hair loss. organs. If the Essence is Deficient, the Kidneys can-
• Deficiency patterns include Qi and Blood not transform and generate Yin and Blood, causing
Deficiency and Liver and Kidney Deficiency. depletion of the source for generating hair. This
Depletion of Blood and damage to Yin results in results in hair loss or premature graying of hair.
lack of transformation and generation of Qi and • Excessive sexual activity drains the Kidney Essence,
Blood. The hair root is empty and the hair has no damaging the Liver and Kidneys. Yang Qi is also dis-
source of growth, leading to large areas of hair charged with the sperm. Apart from hair loss, this
loss. also causes cold in the glans penis, dizziness and
• Overindulgence in spicy, greasy or fried foods, or a blurred vision.
depressed mental state transforming into Fire, or • Congenital Deficiency of Kidney Qi is also respon-
plentiful Qi and Blood in young people, or Liver- sible for late growth of hair, thin hair, or lusterless
Wood transforming into Fire can consume Yin and dry yellowing hair.
Blood or cause Blood-Heat to transform into inter-
nal Wind. Wind-Heat then follows Qi upward to the Pattern identification and treatment
vertex, preventing the hair root from being nour-
ished by Yin and Blood. Sudden loss of hair, yellow INTERNAL TREATMENT
discoloration of the hair or premature graying can
then result. BLOOD-HEAT GENERATING WIND
• Overeating of sweet and fatty food tends to damage This pattern manifests as sudden hair loss, rapidly
the Spleen and Stomach, leading to internal accu- evolving into large round or oval bare patches with
mulation of Damp-Heat. If this Damp-Heat steams occasional itching. A few patients may experience loss of
upward to the vertex along the channels and attacks hair in the eyebrows, moustache and beard. In some
the hair root, the hair will thin or fall out. cases, accompanying symptoms and signs include a sen-
• Looseness of the pores in the scalp allows external sation of heat in the scalp, irritability, irascibility, and
Wind to attack, thus making the hair root less secure restlessness. The tongue body is red with a scant coat-
and depriving it of proper nourishment, resulting in ing; the pulse is thready and rapid.
patches of hair loss. Treatment principle
• Blood stasis in the hair orifices (follicles) obstructs the Cool the Blood and extinguish Wind, nourish Yin and
movement of Qi in the channels, making it difficult protect the hair.
ALOPECIA AREATA 541
Prescription Prescription
SI WU TANG HE LIU WEI DI HUANG WAN JIA TONG QIAO HUO XUE TANG JIA JIAN
JIAN Decoction for Freeing the Orifices and Invigorating the
Four Agents Decoction Combined With Six-Ingredient Blood, with modifications
Rehmannia Pill, with modifications
Dang Gui Wei (Extremitas Radicis Angelicae Sinensis) 12g
Sheng Di Huang (Radix Rehmanniae Glutinosae) 15g Chi Shao (Radix Paeoniae Rubra) 12g
Nü Zhen Zi (Fructus Ligustri Lucidi) 15g Sheng Di Huang (Radix Rehmanniae Glutinosae) 12g
Sang Shen (Fructus Mori Albae) 15g Chuan Xiong (Rhizoma Ligustici Chuanxiong) 10g
Chao Mu Dan Pi (Cortex Moutan Radicis, stir-fried) 10g Gan Cao (Radix Glycyrrhizae) 10g
Chi Shao (Radix Paeoniae Rubra) 10g Tao Ren (Semen Persicae) 10g
Bai Shao (Radix Paeoniae Lactiflorae) 10g Hong Hua (Flos Carthami Tinctorii) 10g
Shan Zhu Yu (Fructus Corni Officinalis) 10g Suan Zao Ren (Semen Ziziphi Spinosae) 10g
Xuan Shen (Radix Scrophulariae Ningpoensis) 12g Ju Hua (Flos Chrysanthemi Morifolii) 10g
Hei Zhi Ma (Semen Sesami Indici) 12g Sang Ye (Folium Mori Albae) 10g
Tu Si Zi (Semen Cuscutae) 12g Bai Zhi (Radix Angelicae Dahuricae) 6g
Fu Shen (Sclerotium Poriae Cocos cum Ligno Hospite) 18g Man Jing Zi (Fructus Viticis) 6g
Dang Gui (Radix Angelicae Sinensis) 18g Yuan Zhi (Radix Polygalae) 6g
Ce Bai Ye (Cacumen Biotae Orientalis) 18g Explanation
Dai Zhe Shi ‡ (Haematitum) 18g
• Dang Gui Wei (Extremitas Radicis Angelicae Sinen-
Explanation sis), Chi Shao (Radix Paeoniae Rubra), Chuan Xiong
• Sheng Di Huang (Radix Rehmanniae Glutinosae), Nü (Rhizoma Ligustici Chuanxiong), Tao Ren (Semen
Zhen Zi (Fructus Ligustri Lucidi), Sang Shen (Fructus Persicae), Hong Hua (Flos Carthami Tinctorii), Bai
Mori Albae), Xuan Shen (Radix Scrophulariae Ning- Zhi (Radix Angelicae Dahuricae), Man Jing Zi (Fruc-
poensis), and Hei Zhi Ma (Semen Sesami Indici) tus Viticis), and Yuan Zhi (Radix Polygalae) free the
nourish Yin and protect the hair, clear Heat and cool orifices and invigorate the Blood to increase local
the Blood. blood circulation.
• Tu Si Zi (Semen Cuscutae) and Shan Zhu Yu (Fructus • Ju Hua (Flos Chrysanthemi Morifolii), Sang Ye
Corni Officinalis) enrich the Liver and supplement (Folium Mori Albae) and Gan Cao (Radix Glycyrrhi-
the Kidneys. zae) dredge Wind and clear Heat.
• Dai Zhe Shi ‡ (Haematitum) and Fu Shen (Sclerotium • Sheng Di Huang (Radix Rehmanniae Glutinosae) and
Poriae Cocos cum Ligno Hospite) extinguish Wind Suan Zao Ren (Semen Ziziphi Spinosae) nourish Yin
and quiet the Spirit. and quiet the Spirit.
• Dang Gui (Radix Angelicae Sinensis), Ce Bai Ye
QI AND BLOOD DEFICIENCY
(Cacumen Biotae Orientalis), Chi Shao (Radix Pae-
This pattern generally occurs in patients with a weak
oniae Rubra), Chao Mu Dan Pi (Cortex Moutan Radi-
constitution, or after a prolonged illness or postpartum.
cis, stir-fried), and Bai Shao (Radix Paeoniae
Hair loss gradually becomes increasingly serious with
Lactiflorae) nourish and invigorate the Blood,
bald patches growing in size and number, especially in
because the hair can only grow when the Blood is
areas that may be rubbed frequently such as the
abundant.
occiput. The scalp is shiny and soft; short stubs of hair
BLOOD STASIS IN THE HAIR FOLLICLES scattered unevenly over the affected area may fall off
Headache or a stabbing pain in the scalp precedes alo- on rubbing. Accompanying symptoms and signs
pecia, which manifests initially as sudden patches of hair include pale lips, palpitations, shortness of breath, weak
loss and may persist to develop into complete baldness. voice, dizziness, sleepiness, and lassitude. The tongue
Accompanying symptoms and signs include frequent body is pale red with a thin white coating; the pulse is
nightmares, difficulty in getting to sleep, restlessness thready and weak.
with a feverish sensation, and grinding of the teeth. The Treatment principle
tongue body is dark red or has stasis marks and a scant Augment Qi and supplement the Blood.
coating; the pulse is deep and rough.
Prescription
Treatment principle BA ZHEN TANG JIA JIAN
Free the orifices and invigorate the Blood. Eight Treasure Decoction, with modifications
542 DERMATOLOGY IN TRADITIONAL CHINESE MEDICINE
(Radix Scrophulariae Ningpoensis), Jiu Dang Gui (Radix Ban Mao Ding (Cinnamon Twig and Mylabris Tincture)
Angelicae Sinensis, processed with wine), Jiu Chuan or Dong Chong Xia Cao Jiu (Cordyceps Wine) to the
Xiong (Rhizoma Ligustici Chuanxiong, processed with affected area.
wine), Sheng Di Huang (Radix Rehmanniae Glutinosae),
Shu Di Huang (Radix Rehmanniae Glutinosae Con- ACUPUNCTURE
quita), and Dang Shen (Radix Codonopsitis Pilosulae)
augment Qi and nourish the Blood to generate hair. Selection of points according to pattern
• Sang Shen (Fructus Mori Albae), Gou Qi Zi (Fructus identification
Lycii), Tu Si Zi (Semen Cuscutae), and Bu Gu Zhi • For Blood-Heat patterns, select GB-20 Fengchi,
(Fructus Psoraleae Corylifoliae) enrich and supple- SP-10 Xuehai and ST-36 Zusanli.
ment the Liver and Kidneys. • For Blood stasis patterns, select LR-3 Taichong,
• Zhi He Shou Wu (Radix Polygoni Multiflori Praepa- PC-6 Neiguan joined to TB-5 Waiguan, SP-6
rata) and Hei Zhi Ma (Semen Sesami Indici) generate Sanyinjiao, and BL-17 Geshu.
and blacken the hair. • For Blood Deficiency patterns, select BL-18 Ganshu,
BL-23 Shenshu and ST-36 Zusanli.
General modifications • For Liver and Kidney insufficiency patterns, select
1. For palpitations and insomnia, add Wu Wei Zi BL-23 Shenshu, BL-18 Ganshu, KI-3 Taixi, SP-10
(Fructus Schisandrae), Bai He (Bulbus Lilii), Mai Men Xuehai, and SP-6 Sanyinjiao.
Dong (Radix Ophiopogonis Japonici), Bai Zi Ren
(Semen Biotae Orientalis), and Lian Zi (Semen Selection of points on the affected channels
Nelumbinis Nuciferae). Main points: ST-36 Zusanli and SP-6 Sanyinjiao.
2. For emotional depression and self-pity, add He Huan Auxiliary points: ST-8 Touwei, GB-41 Zulinqi, GB-43
Pi (Cortex Albizziae Julibrissin), He Huan Hua (Flos Xiaxi, BL-60 Kunlun, LR-3 Taichong, and KI-3 Taixi.
Albizziae Julibrissin), Yu Jin (Radix Curcumae), and Selection of adjacent points
Xiang Fu (Rhizoma Cyperi Rotundi). Main points: GV-20 Baihui, GV-23 Shangxing and
3. For reduced appetite and abdominal distension, add GV-19 Houding.
Chao Gu Ya (Fructus Setariae Italicae Germinatus, Auxiliary points
stir-fried), Ji Nei Jin ‡ (Endothelium Corneum Gige-
• For severe itching, add GB-20 Fengchi and GV-14
riae Galli), Mei Gui Hua (Flos Rosae Rugosae), Hou
Dazhui.
Po Hua (Flos Magnoliae Officinalis), and Fo Shou
(Fructus Citri Sarcodactylis). • For insomnia, add EX-HN-1 Sishencong i and HT-7
4. For prevalence of Wind-Heat with sudden and Shenmen.
severe alopecia, add Tian Ma* (Rhizoma Gastrodiae • For hair loss on the temples, add ST-8 Touwei and
Elatae), Bai Fu Zi (Rhizoma Typhonii Gigantei) and GB-8 Shuaigu.
Chong Wei Zi (Semen Leonuri Heterophylli). • For poor appetite, add CV-12 Zhongwan and ST-36
Zusanli.
PATENT HERBAL MEDICINES • For hair loss on the eyebrows, join EX-HN-4 Yuyaoii
• For Qi and Blood Deficiency, take Sheng Fa Wan to TB-23 Sizhukong.
(Generating Hair Pill), one 9g honeyed pill, three
times a day. Empirical points
Main points: Fanglao (1 cun posterior to GV-20 Bai-
• For Blood-Heat generating Wind, take Ce Bai Wan
hui) and Jiannao (0.5 cun inferior to GB-20 Fengchi).
(Biota Pill), one 9g honeyed pill, twice a day.
Auxiliary points
• For insufficiency of the Liver and Kidneys, take Yi
• For severe itching, add GV-14 Dazhui.
Ma Er Zhi Wan (Black Sesame Double Supreme Pill)
6g twice a day; or Yi Shen Rong Fa Wan (Pill for • For greasy hair, add GV-23 Shangxing.
Boosting the Kidneys and Nourishing the Hair) 10g • For hair loss on the temples, add ST-8 Touwei.
with water before meals, two or three times a day.
Technique
EXTERNAL TREATMENT Apply the reducing method for Excess patterns and the
Apply Sheng Fa Ding (Generating Hair Tincture), Gui Zhi reinforcing method for Deficiency patterns. Retain the
i M-HN-1 according to the system employed by the Shanghai College of Traditional Chinese Medicine.
ii M-HN-6 according to the system employed by the Shanghai College of Traditional Chinese Medicine.
544 DERMATOLOGY IN TRADITIONAL CHINESE MEDICINE
needles for 30 minutes after obtaining Qi; during this • For severe itching, add GB-20 Fengchi and GV-16
period, manipulate the needles three to five times. Treat Fengfu.
once every two days. A course consists of ten treatment • For insomnia, add Anmian (located at the midpoint
sessions. between SJ-17 Yifeng and GB-20 Fengchi).iii
Explanation • For Kidney Deficiency, add KI-3 Taixi and BL-23
• ST-36 Zusanli, SP-6 Sanyinjiao and CV-12 Zhongwan Shenshu.
fortify the Spleen, augment Qi and nourish the Blood. Selection of points along the affected channels
• BL-60 Kunlun and KI-3 Taixi nourish and supple- Points: Ashi points (hair loss sites), GB-20 Fengchi, LU-9
ment the Liver and Kidneys. Taiyuan, PC-6 Neiguan, neck, sacrum, and lumbar region.
• ST-8 Touwei, GB-41 Zulinqi, GB-43 Xiaxi, and LR-3
Taichong dissipate Wind, move Qi and free the net- Local points
work vessels. Points: Ashi points (hair loss sites).
• GB-20 Fengchi and GV-14 Dazhui dispel Wind and
Technique
alleviate itching.
Apply medium stimulation with the hand. Treat for ten
• EX-HN-1 Sishencong and HT-7 Shenmen clear Heat minutes, once every two days. A course consists of
from the Heart and drain Fire. fourteen treatment sessions.
EAR ACUPUNCTURE POINT LASER THERAPY
Points: Lung, Kidney, Ear-Shenmen, Sympathetic Points: Ashi points (hair loss sites).
Nerve, Endocrine, and Spleen. Technique: Apply a helium-neon laser to the Ashi
Technique: Retain the needles for 30 minutes; during points for 10 minutes in each treatment session. If there
this period, manipulate the needles five or six times. are several patches, treat each for five minutes. Treat
Treat once every two days. A course consists of ten once a day. Interrupt the treatment for one day after six
treatment sessions. treatment sessions before continuing. A course consists
of thirty treatment sessions.
SCALP ACUPUNCTURE
Points: Upper three-fifths of the Motor and Sensory Areas.
Technique: Insert the needles quickly under the skin Clinical notes
and rotate lightly and quickly for three to five minutes.
Retain the needles for 30 minutes. Treat once a day. A • Although there are many treatments for alopecia
course consists of ten treatment sessions. areata, the disease is rather slow to respond. It is
therefore important to bear in mind the classical
PRICKING TO BLEED METHOD adage of keeping a prescription relatively unchanged
Point: BL-40 Weizhong. if it is reasonable, thus allowing it a certain time to
Technique: After routine sterilization of the point, work. Treatment will not be effective unless pattern
prick with a three-edged needle to cause slight bleeding. identification is correct.
Treat once every five days. A course consists of five • Offer reassurance to patients to stop them worrying
treatment sessions. about the condition and increase their confidence in
Indication: Excess patterns such as Blood stasis in the the treatment.
hair follicles. • Treatment can be accompanied by dietary therapy.
Walnuts, sesame seeds and seafood are all beneficial
PLUM-BLOSSOM NEEDLING to regeneration of the hair follicles.
Selection of points according to disease • Alopecia areata may resolve spontaneously. However,
differentiation total baldness is usually very difficult to treat.
Main points: Ashi points (hair loss sites).
Auxiliary points Advice for the patient
• For hair loss on the temples, add ST-8 Touwei.
• For hair loss at the vertex, add GV-20 Baihui, GV-19 • Eat a wide variety of foods.
Houding and CV-21 Qianding. • Look after the hair properly; do not wash it with
iii M-HN-54 according to the system employed by the Shanghai College of Traditional Chinese Medicine.
ALOPECIA AREATA 545
strongly alkaline soap or shampoo. Avoid using elec- • for poor appetite and diarrhea, Hou Po (Cortex Magnoliae
tric hair dryers or dyeing the hair. Officinalis) 10g and Bai Bian Dou (Semen Dolichoris
Lablab) 10g were added.
externally by application of Zhi Zhu Hua You (Yellow tongue body, and a wiry pulse.
Azalea Flower Oil) and other materia medica for mois-
Treatment principle
tening Dryness and cooling the Blood.
Dredge the Liver and supplement the Kidneys.
“If hair loss is due to Blood Deficiency and invasion
of Wind, treat by supplementing the Blood and dissi- Prescription ingredients
pating Wind; for premature graying of the hair, treat by Shan Zhu Yu (Fructus Corni Officinalis) 6g
nourishing the Blood and dispelling Wind. Chuan Xiong (Rhizoma Ligustici Chuanxiong) 6g
“Materia medica for replenishing and supplementing Gan Cao (Radix Glycyrrhizae) 6g
the Liver and Kidneys should be combined with others Bai Shao (Radix Paeoniae Lactiflorae) 15g
for bearing Yang upward and dissipating Wind; materia Dang Gui (Radix Angelicae Sinensis) 10g
medica for nourishing the Blood can be combined with Sheng Di Huang (Radix Rehmanniae Glutinosae) 10g
others for freeing Yang Qi.” Dang Shen (Radix Codonopsitis Pilosulae) 10g
Bai Zhu (Rhizoma Atractylodis Macrocephalae) 10g
Modern clinical experience Fu Ling (Sclerotium Poriae Cocos) 10g
Nü Zhen Zi (Fructus Ligustri Lucidi) 10g
TREATMENT BASED ON PATTERN Chai Hu (Radix Bupleuri) 10g
IDENTIFICATION Han Lian Cao (Herba Ecliptae Prostratae) 10g
He Shou Wu (Radix Polygoni Multiflori) 20g
1. Pei identified three patterns for this disease. 2
One bag a day was used to prepare a decoction, taken
• Qi Deficiency of the Spleen and Stomach twice a day. A course of treatment consisted of 20 bags.
Accompanying symptoms and signs Results were seen after two to three courses.
Emaciation, a sallow yellow facial complexion, poor • Damage to Qi and Yin
appetite, lassitude, a pale and swollen tongue body, and a
deep and thready pulse. Accompanying symptoms and signs
A dark facial complexion, lassitude, dry mouth,
Treatment principle Deficiency-type irritability, a pale tongue body, and a
Supplement the Middle Burner and augment Qi. deep and thready pulse in a prolonged illness.
Prescription ingredients Treatment principle
Dang Shen (Radix Codonopsitis Pilosulae) 10g Augment Qi and nourish Yin.
Bai Zhu (Rhizoma Atractylodis Macrocephalae) 10g
Fu Ling (Sclerotium Poriae Cocos) 10g Prescription ingredients
He Shou Wu (Radix Polygoni Multiflori) 10g Bu Gu Zhi (Fructus Psoraleae Corylifoliae) 100g
Dang Gui (Radix Angelicae Sinensis) 10g He Shou Wu (Radix Polygoni Multiflori) 100g
Nü Zhen Zi (Fructus Ligustri Lucidi) 10g Dan Shen (Radix Salviae Miltiorrhizae) 100g
Han Lian Cao (Herba Ecliptae Prostratae) 10g Chi Shao (Radix Paeoniae Rubra) 70g
Gan Cao (Radix Glycyrrhizae) 6g Sheng Di Huang (Radix Rehmanniae Glutinosae) 70g
Chen Pi (Pericarpium Citri Reticulatae) 6g Shu Di Huang (Radix Rehmanniae Glutinosae Conquita) 70g
Huang Qi (Radix Astragali seu Hedysari) 20g Han Lian Cao (Herba Ecliptae Prostratae) 70g
Mu Xiang* (Radix Aucklandiae Lappae) 3g Dang Shen (Radix Codonopsitis Pilosulae) 70g
Cao Dou Kou (Semen Alpiniae Katsumadai) 3g Dang Gui (Radix Angelicae Sinensis) 70g
Sheng Di Huang (Radix Rehmanniae Glutinosae) 12g Mai Men Dong (Radix Ophiopogonis Japonici) 70g
Gou Qi Zi (Fructus Lycii) 12g Wu Wei Zi (Fructus Schisandrae) 70g
One bag a day was used to prepare a decoction, taken Bai Xian Pi (Cortex Dictamni Dasycarpi Radicis) 70g
twice a day. A course of treatment consisted of 20 bags. Mu Gua (Fructus Chaenomelis) 70g
Results were seen after two to three courses. Nü Zhen Zi (Fructus Ligustri Lucidi) 70g
Qiang Huo (Rhizoma et Radix Notopterygii) 70g
• Liver Depression and Kidney Deficiency
These ingredients were ground into a powder and mixed
Accompanying symptoms and signs with honey to make 9g pills (approximately 120 pills).
Dizziness, aching in the lower back, weak legs, a bitter One pill was taken with boiled water twice a day, one in
taste in the mouth, a sensation of fullness in the chest the morning and one in the evening. A course of treat-
and hypochondrium, irritability and restlessness, a red ment lasted for three months.
ALOPECIA AREATA 547
All patients were given a decoction of Ce Bai Ye (Cacumen Hu Tao Ren (Semen Juglandis Regiae) 12g
Biotae Orientalis) 60g and Sheng Jiang (Rhizoma Zingiberis Huang Jing (Rhizoma Polygonati) 12g
Officinalis Recens) 3g to be used to wash the affected areas Tu Si Zi (Semen Cuscutae) 12g
once a day, with each bag being used for two days. Qiang Huo (Rhizoma et Radix Notopterygii) 10g
Chen Pi (Pericarpium Citri Reticulatae) 10g
2. Li considered that alopecia was pathologically related Di Gu Pi (Cortex Lycii Radicis) 10g
to dysfunction of the Liver, Spleen and Kidneys. He Gan Cao (Radix Glycyrrhizae) 3g
employed three principles to treat alopecia areata For all prescriptions, one bag a day was used to prepare a
(including alopecia totalis and alopecia universalis). 3 decoction, taken twice a day. Results were seen at the earli-
• Augment Qi and nourish the Blood est after 16 days and at the latest after six months. The best
responses were achieved with alopecia areata and alopecia
Prescription totalis; results for alopecia universalis were not as good.
SHENG FA YIN
Generating Hair Beverage 3. Hu identified four patterns. 4
Huang Qi (Radix Astragali seu Hedysari) 20g • Yin Deficiency of the Liver and Kidneys, treated
Dang Gui (Radix Angelicae Sinensis) 15g with Zuo Gui Yin (Restoring the Left [Kidney Yin]
Bai Zhu (Rhizoma Atractylodis Macrocephalae) 15g Beverage) and Er Zhi Wan (Double Supreme Pill),
Huang Jing (Rhizoma Polygonati) 12g with the addition of Zhi He Shou Wu (Radix Polygoni
Sang Shen (Fructus Mori Albae) 12g Multiflori Praeparata) 30g, Zi He Che ‡ (Placenta Hom-
Fu Shen (Sclerotium Poriae Cocos cum Ligno Hospite) 12g inis) 30g and E Jiao ‡ (Gelatinum Corii Asini) 30g.
Mu Gua (Fructus Chaenomelis) 12g • Blood-Dryness due to exuberant Wind, treated
Tian Ma* (Rhizoma Gastrodiae Elatae) 10g with Tian Ma Gou Teng Yin (Gastrodia and Uncaria
Yuan Zhi (Radix Polygalae) 10g Beverage) with the addition of Sheng Di Huang
Da Zao (Fructus Ziziphi Jujubae) 15g (Radix Rehmanniae Glutinosae) 10g, Xuan Shen
Gan Cao (Radix Glycyrrhizae) 6g (Radix Scrophulariae Ningpoensis) 10g and Dai Zhe
Shi ‡ (Haematitum) 15g.
• Dredge the Liver and transform Blood stasis
• Yin-Cold congealing due to Kidney Yang Defi-
Prescription ciency, treated with Jin Kui Shen Qi Wan (Kidney Qi
TAO HONG XIAO YAO SAN JIA JIAN Pill from the Golden Cabinet), or Yang He Tang Jia
Peach Kernel and Safflower Free Wanderer Powder, Ma Huang Fu Zi Xi Xin Tang (Harmonious Yang
with modifications Decoction Plus Ephedra, Asarum and Prepared
Ji Xue Teng (Caulis Spatholobi) 30g Aconite Decoction). If Cold congealing was due to
Dang Gui (Radix Angelicae Sinensis) 12g Spleen Yang Deficiency, the pattern was treated with
Chi Shao (Radix Paeoniae Rubra) 12g Gui Zhi Ren Shen Tang He Ma Huang Fu Zi Xi Xin
Han Lian Cao (Herba Ecliptae Prostratae) 12g Tang (Cinnamon Twig and Ginseng Decoction
Tao Ren (Semen Persicae) 12g Combined With Ephedra, Asarum and Prepared
Chai Hu (Radix Bupleuri) 10g Aconite Decoction).
Yu Jin (Radix Curcumae) 10g • Blood stasis obstructing the channels and net-
Hong Hua (Flos Carthami Tinctorii) 10g work vessels, treated by freeing the network vessels
Qing Pi (Pericarpium Citri Reticulatae Viride) 6g and invigorating the Blood.
Chen Pi (Pericarpium Citri Reticulatae) 6g Prescription ingredients
Chuan Xiong (Rhizoma Ligustici Chuanxiong) 6g
Yi Mu Cao (Herba Leonuri Heterophylli) 10g
• Enrich the Kidneys and nourish Yin Chi Shao (Radix Paeoniae Rubra) 10g
Tao Ren (Semen Persicae) 10g
Prescription
Chuan Xiong (Rhizoma Ligustici Chuanxiong) 10g
FU FANG SHOU WU TANG
Hong Hua (Flos Carthami Tinctorii) 6g
Compound Fleeceflower Decoction
Di Gu Pi (Cortex Lycii Radicis) 15g
Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata) 15g Tu Bie Chong ‡ (Eupolyphaga seu Steleophaga) 6g
Shu Di Huang (Radix Rehmanniae Glutinosae Conquita) 12g Bai Zhi (Radix Angelicae Dahuricae) 10g
Shan Yao (Radix Dioscoreae Oppositae) 12g Qian Cao Gen (Radix Rubiae Cordifoliae) 10g
Gou Qi Zi (Fructus Lycii) 12g Sheng Di Huang (Radix Rehmanniae Glutinosae) 15g
Du Zhong (Cortex Eucommiae Ulmoidis) 12g Cong Bai (Bulbus Allii Fistulosi) 6g
548 DERMATOLOGY IN TRADITIONAL CHINESE MEDICINE
SPECIAL PRESCRIPTIONS and restlessness and yellow urine were also given Long Dan
Xie Gan Wan (Chinese Gentian Pill for Draining the Liver).
1. Ma reported on his own formulation of a basic pre-
scription plus modifications. 5 External treatment
SHENG FA DING
Prescription
Generating Hair Tincture
SHOU WU SHENG FA YIN
Fleeceflower Root Beverage for Generating Hair Ren Shen (Radix Ginseng) 20g
He Shou Wu (Radix Polygoni Multiflori) 30g
He Shou Wu (Radix Polygoni Multiflori) 15g
Gu Sui Bu (Rhizoma Drynariae) 30g
Shan Zhu Yu (Fructus Corni Officinalis) 15g
Bu Gu Zhi (Fructus Psoraleae Corylifoliae) 10g
Gou Qi Zi (Fructus Lycii) 15g
Tu Si Zi (Semen Cuscutae) 15g The ingredients were steeped in wine for one month
Shu Di Huang (Radix Rehmanniae Glutinosae Conquita) 18g and then applied to the affected area two or three times
Hei Zhi Ma (Semen Sesami Indici) 30g a day. Results were seen at the earliest after 14 days and
Bai Shao (Radix Paeoniae Lactiflorae) 30g at the latest after six months.
Dang Gui (Radix Angelicae Sinensis) 12g
Chuan Xiong (Rhizoma Ligustici Chuanxiong) 10g COMBINATION OF INTERNAL AND
Qiang Huo (Rhizoma et Radix Notopterygii) 6g EXTERNAL TREATMENT
Gong combined internal and external treatment. 7
Modifications
1. For Blood-Heat, Sheng Di Huang (Radix Rehmanniae Internal prescription
Glutinosae) 15g and Mu Dan Pi (Cortex Moutan SHENG FA YIN
Radicis) 12g were added. Generating Hair Beverage
2. For Liver Depression, Yu Jin (Radix Curcumae) 15g and
Dang Gui (Radix Angelicae Sinensis) 12g
Xiang Fu (Rhizoma Cyperi Rotundi) 12g were added.
Zhi Shou Wu (Radix Polygoni Multiflori Praeparata) 12g
3. For Kidney Deficiency, Lu Jiao Jiao‡ (Gelatinum
Sang Shen (Fructus Mori Albae) 12g
Cornu Cervi) 15g, melted in the prepared decoction,
Nü Zhen Zi (Fructus Ligustri Lucidi) 12g
and Sang Shen (Fructus Mori Albae) 15g were added.
Han Lian Cao (Herba Ecliptae Prostratae) 12g
4. For insomnia, He Huan Hua (Flos Albizziae Julibris-
Yu Jin (Radix Curcumae) 12g
sin) 15g and Ye Jiao Teng (Caulis Polygoni Multiflori)
Zhi Ke (Fructus Citri Aurantii) 12g
30g were added.
Huang Qi (Radix Astragali seu Hedysari) 15g
One bag a day was used to prepare a decoction, taken Dan Shen (Radix Salviae Miltiorrhizae) 15g
twice a day. Initial results were seen after one month. Yuan Zhi (Radix Polygalae) 9g
Si Gua Luo (Fasciculus Vascularis Luffae) 9g
2. Liu employed the treatment principle of freeing the Sheng Ma (Rhizoma Cimicifugae) 6g
orifices and invigorating the Blood to treat alopecia areata.6
One bag a day was used to prepare a decoction, taken
Prescription twice a day.
SHENG FA LING
Efficacious Remedy for Generating Hair External prescription
SHENG FA DING
Dang Gui (Radix Angelicae Sinensis) 30g Generating Hair Tincture
Chi Shao (Radix Paeoniae Rubra) 30g
Chuan Xiong (Rhizoma Ligustici Chuanxiong) 30g He Shou Wu (Radix Polygoni Multiflori) 200g
Tao Ren (Semen Persicae) 20g Bu Gu Zhi (Fructus Psoraleae Corylifoliae) 200g
Hong Hua (Flos Carthami Tinctorii) 20g Gan Jiang (Rhizoma Zingiberis Officinalis) 100g
He Shou Wu (Radix Polygoni Multiflori) 60g Hong Hua (Flos Carthami Tinctorii) 100g
Hei Da Dou (Semen Glycines Atrum) 30g Chuan Xiong (Rhizoma Ligustici Chuanxiong) 100g
Huang Qi (Radix Astragali seu Hedysari) 30g Rou Gui (Cortex Cinnamomi Cassiae) 100g
Shi Chang Pu (Rhizoma Acori Graminei) 20g She Chuang Zi (Fructus Cnidii Monnieri) 100g
The ingredients were decocted in one liter of water until The ingredients were cut up and crushed, then soaked for
500ml of liquid was left. This liquid was stored in a bottle, ten days in 3000ml of a 75 percent alcohol solution. The
with 70ml being taken twice a day. Patients with pro- liquid was filtered off for application to the affected area
nounced Liver-Fire symptoms accompanied by irritability twice a day. Results were seen after two months.