A 64-year-old woman with a refractory, itchy rash and concurrent urinary pain following corticosteroid withdrawal was managed using a combined internal and external damp-heat clearing strategy.

Case ID: CHC-0026

Case Summary

This case describes a 64-year-old woman who presented with a one-month history of a sudden, systemic rash with intense itching, accompanied by painful and urgent urination. The original report documented a conventional diagnosis of eczema and a TCM assessment of Damp Sores driven by Damp-Heat accumulation and Wind pathogen invasion. The patient was managed through a dual therapeutic approach, utilizing an internal decoction to clear systemic heat and an external herbal wash to directly soothe the skin lesions.

Patient Presentation

• Patient: 64-year-old female.
• Main Complaint: Systemic skin rash with severe itching, along with painful, urgent, and frequent urination.
• History: The patient, who had a habitual preference for spicy foods, experienced a sudden onset of a systemic, itchy rash one month prior to the consultation on July 10, 2022. She initially received conventional Western medical treatment (including promethazine, dexamethasone, and loratadine) which temporarily improved the symptoms. However, the rash and itching severely relapsed upon discontinuation of the medications. She also reported concurrent lower urinary tract symptoms, including pain and urgency. Her appetite and bowel movements were normal.

Examination and Diagnosis

• Conventional Diagnosis: Eczema.
• TCM Tongue and Pulse: The tongue was red with a yellow, greasy coating. The pulse was stringy (弦).

TCM Assessment

The original practitioner interpreted the presentation as Damp Sores driven by internal Damp-Heat and external Wind invasion (湿疮 – 湿热内蕴，风邪外袭).

Within the framework of yin and yang Chinese Medicine, a long-term dietary preference for heavy, spicy foods generates internal damp-heat that disrupts the body’s internal balance. The original report noted that this trapped damp-heat pushed outward into the skin and muscles, creating the inflammatory rash. Simultaneously, an external “Wind” pathogen invaded the superficial layers, acting as the highly mobile trigger for the relentless itching.

Crucially, because dampness is heavy and naturally sinks, the systemic damp-heat also poured downward into the lower jiao (pelvic region). This downward accumulation obstructed the bladder’s function, directly causing her concurrent symptoms of painful, frequent, and urgent urination. The red tongue and yellow greasy coating provided clear objective evidence of this excess pathogenic heat and dampness.

Treatment Approach

The primary treatment principle was to clear heat, resolve dampness, dispel wind, and stop itching (清热利湿，祛风止痒). The strategy required a synchronized internal and external approach to flush the systemic damp-heat out of the body while immediately calming the localized skin inflammation.

Herbal Formulas and Modifications

• Internal Formula (July 10, 2022): A concise, 7-herb daily decoction aimed at clearing wind and regulating the digestive system.
  • Dispersing Wind and Clearing Heat: Chai Hu (10g) and Huang Qin (10g) were used to clear the internal heat and disperse the wind pathogen.
  • Strengthening Spleen and Moving Qi: Bai Zhu (15g) and Zhi Shi (10g) fortified the Spleen and promoted Qi circulation, addressing the root source of the dampness by improving the body’s natural fluid metabolism.
  • Stopping Itching: Fang Feng (15g) and Di Gu Pi (15g) were specifically utilized to clear wind from the exterior and stop the severe itching. Gan Cao (10g) harmonized the herbs.
• External Formula (Topical Wash): A localized herbal bath designed to invigorate circulation at the skin level.
  • Jiu Chuan Xiong (20g), Chi Shao (15g), Ji Xue Teng (30g), Ai Ye (30g), and Rou Gui (30g) were boiled in water to create a topical wash. This combination aggressively invigorated blood, dispelled wind, and opened the skin’s collaterals, providing direct relief to the weeping, itchy lesions.

Follow-Up

• July 20, 2022 (Second Visit): After ten days of combined treatment, the source reported a significant clinical improvement. The patient’s skin lesions had dried and astringed, with the affected area shrinking by half. The severe itching was markedly reduced. Furthermore, her urinary pain, urgency, and frequency had completely resolved, and her urination returned to normal. Her tongue shifted to pale red with a thin yellow coating, and her pulse became slippery. The practitioner discontinued the internal decoction and instructed her to continue only the external wash to consolidate the healing process.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the holistic diagnostic connection between a dermatological condition and a urinary condition. In standard conventional care, a systemic rash and painful urination might be treated as two separate issues by different specialists.

However, the original practitioner recognized that both sets of symptoms shared the exact same root cause: Damp-Heat. The damp-heat flared upward and outward to cause the eczema, while simultaneously sinking downward to cause the urinary pain. By utilizing an internal formula that cleared the systemic heat and dried the dampness, the practitioner effectively “turned off the faucet” of the pathology. This approach successfully resolved both the skin lesions and the urinary tract symptoms simultaneously, demonstrating the effectiveness of TCM in managing inflammatory rebounds following corticosteroid withdrawal.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Beijing University of Chinese Medicine Shenzhen Hospital (Longgang) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: [【以案说医】王进东：风邪湿热交相侵，病机直取疗效明]
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 16, 2024
• Original language: Chinese
• Source link: [View original page]
• ChineseHerb.org version: English translation and editorial adaptation