Part 2: Itch, Itch, Scratch, Scratch: 3 Allergy Cases

(Note: This entry is a continuation of the previous entry. Best to read in order for full effect!)

What compelled each patient to seek out Chinese medicine care was the very insufferable and at times incapacitating symptom of itchy skin, or pruritis. As someone with a history of hay fever since a child, complete with ceaseless itchy eyes and nose, I can empathize completely. According to traditional Chinese medicine, the symptom of itchy skin is generally thought to be caused by ‘wind’. Traditional Chinese medicine categorizes external pathogenic agents into wind, heat, cold, damp, and dryness. Each one of these agents has a particular nature and acts in specific ways in the body. As Nigel Wiseman states in Fundamentals of Chinese Medicine, the nature of wind as a pathogenic agent in the body is similar to our understanding of “the meteorological phenomenon from which the name is derived: it comes and goes quickly, moves swiftly, blows intermittently.” Itchy skin travels around the body, appears and disappears, intensifies and calms down without warning.

In the three cases outlined in the previous entry, we see that there are, in fact, a multitude of contributing factors—environmental, emotional, physical, genetic, and lifestyle-related—that coalesce to cause the chief complaint of itchy skin. Many of my patients tell me, for example, that they have had allergy tests or they have eliminated certain foods or that it doesn’t run in the family, but they still do not know what one thing is causing these symptoms. What I have found is that there is no one thing but rather it is the combination of multiple factors over time that has led to their hypersensitivity.

We cannot ignore the global changes that challenge our immune systems on a daily basis—especially for those of us who live in urban or industrial areas. Air, water, and food pollutants are becoming more potent and the global temperature is rising at an alarming rate. Together these conditions create a toxic environment that sets the stage for bacterial and viral epidemics and infections. In Case 1, the patient’s prolonged exposure to direct environmental pollutants at his workplace may have overwhelmed an otherwise healthy constitution.

In addition to the mounting strength of environmental stressors and pollutants, our demanding lifestyles also wears us down and prevents us from eating regular, home-cooked meals, getting adequate sleep and ample downtime. All three patients are professionals with very demanding jobs that often require long workdays.

Other lifestyle stressors also include overindulgence in certain recreational activities. Although the patient from Case 2 exercises regularly, she has a ten-year history of smoking, social drinking and coffee intake. Over time, these habits create heat in her system. Rather than be released properly from the bowels, urethra and through the pores, the heat is trapped inside.

Our emotional health is also a contributing factor to the health of our skin. The patient in Case 2 experienced emotional ‘stagnation’ due to unfulfilled desires and feeling ‘stuck’ or frustrated in her life. These feelings are not simply metaphors for what is physically and energetically occurring in the body but actually prevents the free circulation of qi and blood in her body. This impeded circulation further traps the mounting heat in her system. Her cold hands and feet, yet warm torso is indicative of this impeded circulation. Poor circulation and trapped heat only need small triggers like increased physical activity to cause skin outbreaks on her torso.

The patient in Case 3 presents differently from the other two in that there is a good deal of qi deficiency, or overall weakness, of her physical functioning. This may be due to her genetic make-up or from long-term weakness stemming from her childhood. This patient has a childhood history of eczema, asthma, and seasonal allergies—all signs of immune, respiratory and digestive compromise. The patient’s difficulty in warming up, reduced appetite and low energy are indicative of her body’s hypo-functioning. In this case, part of her treatment plan includes building up her internal strength so that the body can begin to self-regulate and become less susceptible to external pathogens.

Thus, in all three cases we see examples of external pathological agents mixing with existing internal imbalances. Each case is unique but each presents with the same symptom of itchy skin. In all three cases, I used a modification of the formula Xiao Feng San, or Eliminate Wind Powder. This formula combines wind dispersing, heat clearing, dampness eliminating and blood cooling medicinals. With skin disharmonies, it is often important to treat the blood because the quality of the blood and smooth circulation of blood is important to healthy skin. The blood must be nutrient rich so it can nourish the skin and tissues. And the blood must be able to reach and circulate to the outer layers of skin. Hence, blood cooling herbs reduce toxicity in the blood. Other herbs are also added to improve the quality of the blood and to invigorate its movement.

This formula was amended to suit the specific needs of each patient. In Case 1, strong toxicity reducing herbs were added to the formula to combat the invading external pathogens. In Case 2, general constitutional heat clearing, qi moving and spirit calming herbs were added to address the other presenting disharmonies that contributed to the itchy skin. And in Case 3, qi supplementing herbs were added to strengthen her core energy so that the body slowly learned to heal itself.

Hence, we see that treating the symptom of itchy skin is not enough. Each person’s presentation, constitution and health history is unique and require custom-tailored care. As a Chinese medicine practitioner, I must uncover the overall disharmony in the whole person and strategically find ways to best relieve the presenting itchiness, treat the root cause of the imbalance, and strengthen and nurture the body so that it can continue to stay strong and healthy.