Acute Eczema Managed by a Three-Tiered “Heaven, Earth, and Humanity” Strategy: A Chinese Medicine Case

A 53-year-old man with a sudden, acute outbreak of itchy lower abdominal eczema was rapidly and completely cured using a highly sophisticated herbal strategy that treated the skin across three physiological dimensions: superficial wind (Heaven), central blood and Qi (Humanity), and deep dampness (Earth).

Case ID: CHC-0088

Case Summary

This case describes a 53-year-old man who presented with a sudden, three-day outbreak of an itchy, maculopapular rash on both sides of his lower abdomen. The original report documented a conventional diagnosis of acute eczema and a TCM assessment of Wet Sores (Shi Chuang) driven by Wind Pathogens Attacking the Exterior and Damp-Heat Accumulating Interiorly. He was managed by Professor Hu Shiping using a masterful composite formula drawing from Er Miao San, Liu Yi San, Sheng Jiang San, and Jing Fang Si Wu Tang. By conceptualizing the skin into three layers (Heaven, Humanity, and Earth) and simultaneously deploying sweating, draining, and unblocking methods, the practitioner completely resolved the patient’s acute eczema in just seven days.

Patient Presentation

• Patient: 53-year-old male (Surname: Si).
• Main Complaint: Maculopapular rash on both sides of the lower abdomen for 3 days.
• History: The patient sought consultation on August 15, 2022. Three days prior, without any obvious trigger, a symmetrical maculopapular rash appeared on both sides of his lower abdomen. The rash was highly pruritic (itchy) and easily broke open and wept fluid after scratching. He had attempted to self-treat by applying a topical over-the-counter ointment (“Wuji Gao”), but the symptoms persisted.
• Associated Symptoms: He experienced a slight distending pain and discomfort in the skin. His sleep was light, and he suffered from early awakening (waking at 5:00 AM and finding it difficult to fall back asleep). His urination and bowel movements were normal.

Examination and Diagnosis

• Conventional Diagnosis: Eczema.
• TCM Tongue and Pulse: The tongue body was dark red with a thick, white, and slightly yellow coating. The pulse was slippery (脉滑).

TCM Assessment

The original practitioner interpreted the presentation as Wet Sores (Shi Chuang) driven by Wind Pathogens Attacking the Exterior and Damp-Heat Accumulating Interiorly (湿疮 – 风邪外袭，湿热内蕴).

According to the holistic principles of Chinese Medicine, the sudden onset of an itchy rash in the upper/surface layers of the skin is the hallmark of an external Wind attack. However, the fact that the rash easily broke and wept fluid upon scratching, combined with the dark red tongue, thick white-yellow coating, and slippery pulse, indicated that his deeper, internal environment was heavily burdened with Damp-Heat.

When external Wind collides with internal Damp-Heat, the pathogens become trapped in the skin and flesh. The trapped wind causes the severe itching, the trapped dampness causes the weeping fluid, and the trapped heat/Qi stagnation causes the localized distending pain and sleep disturbance.

Treatment Approach

The primary treatment principle was to clear and drain damp-heat, dispel wind and stop itching (清利湿热，祛风止痒). Professor Hu Shiping approached this by treating the exterior and interior simultaneously (表里同治，上下同调), applying a complex synthesis of four classic formulas to address every layer of the pathology.

Interventions and Herbal Formulas

• Initial Herbal Formula (August 15, 2022): A 16-herb decoction modifying Er Miao San (Two-Marvel Powder), Liu Yi San (Six-to-One Powder), Sheng Jiang San (Ascending and Descending Powder), and Jing Fang Si Wu Tang (Schizonepeta and Saposhnikovia Four-Substance Decoction).
  • Dispelling Wind and Stopping Itch: Jing Jie (Schizonepeta, 15g), Fang Feng (Saposhnikovia, 15g), and Ji Li (Tribulus, 30g) scatter external wind to rapidly relieve the itching. Wu Mei (Mume, 20g) combined with these wind herbs produces a strong anti-allergic effect.
  • Nourishing Blood to Extinguish Wind: Following the tenet “to treat wind, first treat blood,” Jiu Chuan Xiong (Wine-prepared Ligusticum, 15g), Chi Shao (Red Peony, 20g), Bai Shao (White Peony, 20g), and Da Huang (Rhubarb, 10g) nourish and invigorate the blood.
  • Clearing Heat and Drying Dampness: Cang Zhu (Atractylodes, 15g) and Huang Bo (Phellodendron, 15g) form Er Miao San to strongly dry dampness and clear heat.
  • Draining Dampness and Harmonizing: Hua Shi (Talc, 30g – decocted in a bag) and Gan Cao (Licorice, 5g) form Liu Yi San (in a 6:1 ratio). They clear heat without aiding dampness and drain water without damaging Yin. Da Huang and Chan Tui (Cicada Slough, 10g) recreate the ascending/descending dynamic of Sheng Jiang San. Tu Fu Ling (Smilax, 30g) clears deep damp-toxicity.
  • Moving Qi and Stopping Pain: Zhi Shi (Immature Bitter Orange, 15g) and Mu Xiang (Aucklandia, 15g – added later) move Qi to stop the distending skin pain.
  • Administration: 7 doses, water decocted, taken warm after breakfast and dinner.

Follow-Up

• Outcome: Following the administration of just 7 doses, the main symptoms were completely resolved. The rash, itching, and skin pain vanished, and his sleep normalized. The treatment was considered highly effective, achieving a rapid cure.

Why This Case Is Interesting (Clinical Reasoning)

The defining feature of this case is Professor Hu Shiping’s brilliant application of the “Three Powers” (Heaven, Earth, and Humanity – 天地人) philosophy to conceptualize and treat dermatological diseases.

Rather than viewing the skin as a single, flat organ, Professor Hu treats it as a three-dimensional ecosystem requiring three distinct therapeutic vectors simultaneously:

1. The Heaven Layer (Superficial): Wind and dampness attack the upper and outer body. “To treat the upper Jiao is like a mist; if it is not light, it will not lift.” He uses light, lifting herbs like Jing Jie, Chan Tui, Fang Feng, and Ji Li to vent the superficial wind through mild sweating, instantly stopping the itch.
2. The Earth Layer (Deep): Dampness is heavy and naturally sinks to the lower body and deep muscles. “To treat the lower Jiao is like a weight; if it is not heavy, it will not sink.” He uses heavy, draining herbs like Da Huang, Tu Fu Ling, Hua Shi, and Huang Bo to scour out the deep, hidden damp-heat through the bowels and urine.
3. The Humanity Layer (The Pivot): The middle Jiao (Spleen, Stomach, Liver) is the central axis. If it is blocked, the skin loses its nourishment. He uses Chuan Xiong, Cang Zhu, Chi Shao, Bai Shao, Mu Xiang, and Zhi Shi to actively circulate Qi and Blood in the center. Because “when the blood flows, the wind extinguishes itself,” this central regulation permanently removes the pathological environment.

By perfectly orchestrating these three layers—light herbs for the “Heaven” exterior, heavy herbs for the “Earth” interior, and moving herbs for the “Humanity” center—the practitioner rapidly harmonized the patient’s internal micro-environment, curing the acute eczema in just one week.

Source Original source: Shenzhen Hospital of Beijing University of Chinese Medicine (Longgang) / Traditional Chinese Medicine Bureau of Guangdong Province Original title: 【以案说医】胡世平：荆防升降二四六，表里通调湿疹效 Practitioner: Professor Hu Shiping (胡世平) Publication date: August 02, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation