59 :Hepatophilic virus disease – TCM classification as “Wetness-heat vaporization form” Common symptoms (11) : Wetness-heat of skin (8)

•          Wind−wetness-heat syndrome: The lesions are usually patches of conglomerate papules, the skin hypertrophic, partly erythematous, moist, erosive and with scabs; the abdomen is distended, the appetite poor, the urine reddish yellow, the tongue red with yellow or yellowish greasy coating, the pulse taut and rapid.
•           Blood heat causing endogenous wind:  The lesions first appear as erythematous papules which rapidly conglomerate into red patches, the surface striae coarse or coated with small amount of thin scale like cover.  Associated symptoms are uneasiness, and dryness of mouth.  The tongue proper is red, the coating thin, yellowish, the pulse slippery and rapid or taut and rapid.
•          Wetness-heat of spleen channel: The skin over the face and ear shows mild erosion with not much exudation but itching.  The skin over sacrococcygeal region (尾骶部) is coarse, hypertrophic and pruritic.  The tongue is pale, its coating white and greasy; the pulse slippery.
•          Accumulation of endogenous evil: The lesion has many fissures and appears hypertrophic.  The coarseness of skin is similar to that of cow, causing intense itching.  The lesion is dry and locates symmetrically.  The disease runs a prolonged course and is difficult to be cure.  The lesions usually appear on the neck, the four limb articulations and the sacrococcygeal region.  The tongue is pale, the coating white and the pulse taut.
•          Deficiency of blood and liver hyperfunction: The skin is rough and hypertrophic.  There is dryness and desquamation and the striae give a mat like appearance.  Usually, there are scratching marks and scabs.  The patient is anxious and uneasy.  The eruptions aggravate and relapse frequently when the patient is in low spirits.  The tongue is pale with white coating; the pulse taut and slender.

  In summary, if the skin is coarse, hard and very itching and also dry and desquamating, usually it is due to wind evil.  If the lesion is hypertrophic and itching and also moist with scabs and relapsing frequently, it is usually due to wetness evil.  If the patient encounters sentimental frustration and mental depression, the liver qi may change to fire.  If there is dryness of mouth with a desire to drink water and there is also restlessness, it may be due to fire in the heart.  The abundance of fire in the heart, liver and lung, may be associated with dermal wetness-heat symptoms.   In this case, the administration of TCM drugs to soothe the liver and relieve stagnation, to clear away heat and eliminate excessive humidity, to coal blood and drive out wind and to nourish blood and liver, may often result in clinical cure.  This is evidence from another aspect, demonstrating that the cause in the production of various skin lesions in dermal wetness-heat is in fact related to hepatophilic virus infection.

Wong (code number 2646), male, aged 74.

His first visit was on September 2001 and the complaint was abnormal liver function and psoriasis for 10 more years.  For a long time, there were irregular erythematous patches over the outer surface of the thighs and pretibial region of both limbs and at the dorsal surface of the feet.  There were also symmetrical skin lesions which were pigmented, brownish, hypertrophic and desquamating.

Physical examination: tongue enlarged with multiple fissures, the coating sparse and yellowish white; hepatomegaly of 1.5 cm.  In both lower extremities conglomerate telangieclases (集族性毛細血管擴張) could be seen.  The diagnosis was chronic hepatitis with TCM classification of “liver stagnation and lung dryness form”, “wetness-heat vaporization form”, associated with psoriasis and bronchiectasis (支氣管擴張).

After taking 3 parcels of TCM drugs, the liver returned to normal.  There was blood tinged yellowish sputum in the morning and the tongue coating was thick and geographic.  The mental status was good and fatigue abated.  Edema of the lower extremities was (+).  He continued to take the TCM drugs for a week and the dermal pruitus subsided, the skin lesions did not progress; the tongue coating disappeared with regression of the fissures, and the abdominal distention decreased.

He continued the TCM treatment and the blood tinged purulent sputum showed a lighter color.  The erythematous patches over the limbs as well as the eruptions gradually subsided.  Four weeks later, the sputum showed only tiny red particles and the coughing decreased; but the eruptions appeared occasionally.  Six weeks afterwards, blood tinged sputum was inconspicuous and the skin itching stopped but occasionally there was transient erythema.  The tongue was apparently clean and edema of the lower limbs disappeared.  A total number of 46 parcels of TCM drugs were taken after which the medication was stopped for observation.

Wong (code number 2396) female, age 34 years.

She first visited the clinic on March 2001 with the chief complaint of repeated sorethroat, abundant clots in menstruation and pruritus of skin at the internal side of both ankles.  She had a history of rheumatic arthritis and had hyperthyroidism but did not receive treatment.

Physical examination: puffy appearance, upper eye lids edematous, mild exophthalmos (輕度眼突), abdomen soft and distended, hepatomegaly of 1.5 cm, (+) edema of lower extremities, at internal side of both ankles symmetrical localized skin lesions, showing erythema, hypertrophy, lichenification, fissures, desquamation and scratch marks.  The diagnosis was chronic hepatitis, presenting the symptoms of first, second, fourth and sixth forms of TCM classification, associated with thyroid hyperfunction (內分泌失調甲亢) and neurodermatitis.

After 3 parcels of TCM drugs, the liver was normal but there was still abdominal cramps and diarrhea.  There were still clots in the menstrual blood which was somewhat larger in amount; the lesions in the lower extremities improved and the dermal pruritus in front of the ankle decreased.  During the TCM therapy, there were frequent abdominal cramps and diarrhea.  Acne appeared for a time.  The menses following were normal; edema of the lower extremities disappeared. Finally, there was no more pruritus, the skin lesions subsided leaving some pigmentation.  The total course of treatment was 8 weeks, at the end of which clinical cure was obtained and the patient was followed up.