Atopic Dermatitis
Overview
Atopic dermatitis is a chronic, relapsing, intensely itchy inflammatory skin disease, often beginning in infancy and associated with a personal or family history of allergy, asthma, or allergic rhinitis. It features dry skin and eczematous lesions, classically in the body folds. Chinese medicine attributes it mostly to fetal latent heat, spleen deficiency with internal dampness, and heart-fire hyperactivity in the acute phase, and to blood deficiency with wind-dryness in the chronic phase.
TCM disease & pathogenesis
In TCM this is 'four-bends wind' (si wan feng, affecting elbow and knee creases), also called infantile milk ringworm or spreading sore; the Golden Mirror of Medicine (Yi Zong Jin Jian, 1742) notes it 'arises in the bends of the legs … monthly, shaped like wind-lichen, caused by wind pathogen entering the interstices,' highlighting its flexural distribution and chronic relapse. The lesion is in the skin but rooted in the spleen, lung, and heart. The basis is an innate constitutional insufficiency with inherited fetal heat/toxin; faulty feeding then impairs spleen-stomach transformation so internal dampness forms, stagnates into heat, and damp-heat floods the skin with oozing red papules and intense itching. Over time it consumes yin-blood; blood deficiency with wind-dryness leaves the skin malnourished—dry, thickened, lichenified. Flare-ups are usually damp-heat while remission shows spleen deficiency and blood dryness; treatment fortifies spleen and drains dampness, clears heat and cools blood in flares, and in chronic phases nourishes blood, moistens dryness, and extinguishes wind to stop itching.
Pattern differentiation (clinical patterns)
Heart-Fire with Spleen Deficiency and Dampness
Red skin with papules and vesicles, excoriations and weeping, incessant itching, fretfulness, poor appetite and loose stools, red tongue tip with thin yellow coating, rapid pulse.
Clear heart-fire and guide out redness; fortify the spleen and drain dampness.
Blood Deficiency with Wind-Dryness (Chronic)
Dry thickened lichenified skin with scaling and fissures, itching worse at night, prolonged course, pale tongue with thin coating, fine weak pulse.
Nourish blood and moisten the skin; expel wind and stop itching.
Connections
Daily care & prevention
Use fragrance-free emollients generously and frequently; bathe briefly with lukewarm water and mild cleanser; avoid known food and environmental triggers, overheating, sweating, and rough fabrics; keep nails short. Massage Quchi (LI11), Zusanli (ST36), Sanyinjiao (SP6), and Xuehai (SP10). Long-term or widespread cases and infants should be managed by a dermatologist.
When to seek medical care
Seek urgent care for infected, weeping lesions with pus crusts and fever, widespread redness or skin shedding, facial/eye involvement, or an infant who is feeding poorly, dehydrated, or very lethargic.