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Atopic dermatitis is a recurrent allergic skin disease characterized by itching, redness, swelling, and oozing on the skin all over the body or at large joints. It is a major source of distress for parents! This disease is very common in infants and young children, affecting about 3-5% of the pediatric population. About 60% of cases onset within the first year of life, and 30% onset between 1 to 5 years old. Approximately half of the affected children will also have allergic rhinitis, asthma, allergic conjunctivitis, or other allergic diseases; they are commonly known as "allergic children."

The author's son also suffered from this disease. It onset when he was 3 months old, with large patches of rosy-red rash gradually appearing all over his body, like sunset clouds (Figure 1). At that time, the author was in the early stages of medical practice and was not very familiar with this disease, and could only see it as a trial from heaven! Under the author's treatment, although the skin symptoms still recurred, their severity gradually decreased. He finally recovered after more than 3 months. Afterwards, he occasionally had minor flare-ups scattered around the large joints, which resolved quickly after TCM treatment. He has not had a recurrence since, even as he grew up. During the illness, he never took a single modern medicine pill or probiotic, nor did he apply any modern ointment.

Figure 1: The author's son's atopic dermatitis

Discoveries and Treatment Methods in Modern Medicine

Modern medicine has not yet determined its cause, only finding some clues for reference:

• Common in children: Most will gradually recover before 10-12 years old, only 5-10% persist into adulthood.
• Allergic constitution: Children whose parents have allergies have a higher probability of developing the disease.
• External triggers: Certain foods, environment, temperature, humidity, or emotional changes can easily induce or worsen it.

Since the cause of this disease is unknown in modern medicine, its main therapy can only passively control it:

• Antihistamines: Passively suppress the body's inflammatory response, does not treat the root cause. Relapses upon stopping medication, must be taken frequently. Main side effect of first-generation antihistamines: Drowsiness.
• Corticosteroids: Passively suppress the body's immune system, also does not treat the root cause. Relapses upon stopping medication. Long-term use has significant side effects. Long-term application of corticosteroid ointments can cause skin atrophy and thinning.
• Antibiotics: Used when scratching leads to redness, swelling, and bacterial infection. Also does not treat the root cause. Long-term use of antibiotics also has many adverse side effects.
• Probiotics: Some patients find them somewhat effective, most patients find them ineffective.

According to statistics, 80% of atopic dermatitis patients are dissatisfied with modern medical treatment, and 40% have sought treatment from more than 5 doctors. This shows that the therapy of modern medicine uses chemical drugs to suppress the human immune system, making it temporarily non-inflammatory and non-itchy. If a patient is lucky enough to recover, it is mainly self-recovery, not cured by modern medicine.

Recalling past medical practice, patients with this disease were frequently encountered. Besides traditional TCM thinking, the author often pondered the nature behind this disease. The author's son's experience also allowed the author to better understand the heartache of the patients' parents.

The Holistic View of Traditional Chinese Medicine (TCM)

Ancient TCM did not have the disease name "atopic dermatitis," but based on the symptoms and characteristics of this disease, many records of similar symptoms can be found in ancient TCM texts. Among them, the description of "Four Flexures Wind" is the closest to this disease. Other related records include different names.

In TCM, this disease is often classified into several patterns (Zheng):

• Wind-Heat: Meaning signs of "fire-heat" are more prominent. The affected areas are mainly characterized by redness, swelling, and itching, with little exudate. Commonly seen in the acute stage.
• Dampness-Heat Both Abundant: "Heat" means redness, swelling, itching; "Dampness" means abundant moisture, with much watery exudate visible. Also belongs to the acute stage.
• Blood Deficiency with Wind-Dryness: The patient's Qi and Blood are insufficient to nourish the skin. The affected areas are dry, rough, and scaly, leading to hyperpigmentation or lichenification over time. Mostly seen in the chronic stage.
• Spleen Deficiency with Dampness Abundance: The patient's Spleen function is low, leading to uncontrolled dampness. Redness, swelling, and heat signs on the affected areas are not obvious; the skin is mostly dull, with blisters or exudate. May be accompanied by loose stools, easy fatigue, gastrointestinal bloating, and other symptoms of "Spleen Deficiency". Mostly seen in the chronic stage.

Clinically, few patients fit exactly into the standard patterns above; most are mixed patterns of the above, or patterns not mentioned. The advantage of TCM over modern medicine lies in: truly viewing a person as a complete, interconnected organic whole. It recognizes that imbalances in the functions of the Zang-fu organs, deficiencies of Qi and Blood, excessive dampness, or excessive internal heat are all key factors in the onset of disease. Regulating the constitution means regulating these: Qi deficiency means low function, tonifying Qi can enhance function; Yin deficiency and Blood deficiency mean insufficient nourishing materials, nourishing Yin and tonifying Blood can replenish them; heavy dampness requires enhancing Spleen and Kidney function to eliminate dampness; excessive fire-heat requires clearing heat and draining fire to cool it down.

The TCM Concept of "Wind"

In TCM, "Wind" is a very special term. Many symptoms or disease names related to "itching" contain the word "wind," for example: the traditional TCM "Four Flexures Wind" refers to itching at the large joints of the limbs (the four bends). The famous formula Wind-Dispersing Powder widely used to treat skin itching or dermatitis. The common cold is sometimes also called "damaged by wind".

"Wind" means "Wind pathogen," a general term for various external causative factors that are as elusive as the wind, coming and going without a trace.

One might ask, TCM's "Blood Deficiency with Wind-Dryness" refers to dry, itchy skin caused by insufficient Qi and Blood internally. What does this have to do with the "Wind pathogen"? And why does a disease like atopic dermatitis, which seems to cause itching for no apparent reason, seem unrelated to external pathogens (Wind pathogen)?

Actually, the "Wind pathogen" resides on the skin, waiting for an opportunity to act.

Figure 2

It is estimated that there are nearly 40 trillion bacteria inside and on the human body, slightly more than the total number of human cells. These bacteria can be beneficial, harmful, or harmless, with over 90% residing in the intestines. The human skin surface hosts over a thousand species of bacteria. Bacterial distribution is not uniform; on dry arms, an area the size of a fingernail might have only a few thousand bacteria, while the same area in the armpit can have millions. The difference lies in the varying environmental conditions of different skin surfaces (e.g., humidity, pH, oil, and salt content), leading to differences in the quantity and types of bacteria present.

Under normal circumstances, these bacteria, skin surface conditions, and the immune system balance and restrain each other, resulting in healthy, disease-free skin appearance (Figure 2). But when the balance on the skin surface is disrupted, for example, if the skin's environmental conditions change, or the body's immune system becomes dysregulated, bacteria may begin to proliferate or secrete abnormal substances. The immune system starts attacking the bacteria or reacting, leading to inflammation and itching. This is the essence of what TCM calls "Wind" on the skin.

The delicate balance of skin surface microbes is closely related to many factors within the body. For example, patients with heavy dampness have poor lymphatic drainage, allowing water to easily accumulate in the skin. Lymphatic circulation is also closely related to the immune system. Heavy dampness not only reduces the metabolic efficiency of the affected area, leading to waste accumulation, but also hampers the effectiveness of immunity. Excessive moisture on the skin surface also makes it easier for microbes to multiply. Patients with Qi deficiency, Blood deficiency, or Yin deficiency have a poorer ability to nourish body tissues, and the supply of materials for immune cells is also poorer, leading to weak immunity, poor skin repair ability, and making it easier for microbes to multiply and invade.

Therefore, regulating the constitution is the most important factor in consolidating the balance of the skin's microecology. Only when the constitution improves will the immune system and skin become strong, and the disease will heal. Regulating the constitution is precisely what modern medicine lacks. If modern medical theory does not make a breakthrough in this aspect and continues to delve into the microscopic, it will never cure this disease.

Reasons for High Incidence in Children

One might ask, why does this disease mostly occur in children? The answer is: Children differ from adults in these traits:

• Children are in a period of rapid growth and development. The body often consumes large amounts of materials (TCM's "Yin") for brain and body growth. Hence, children are prone to Yin Deficiency with Fire Effulgence are easily susceptible to excessive internal heat (heatiness).
• Children's digestive tracts are tender, and teeth are still developing. Often due to insufficient chewing, indigestion, and gastrointestinal bloating, their gastrointestinal function and nutrient absorption are affected. Hence, children are prone to Spleen Deficiency and Blood Deficiency, and tend to accumulate dampness.
• Children's immune systems are developing. Most microbes are unfamiliar to it, so children's immune systems are prone to over-sensitivity and indiscriminate attacks.

Holistic Treatment in TCM

With the above understanding, we can simultaneously address the issue from both inside the body and on the skin surface to quickly and effectively cure atopic dermatitis:

• Internal: Take Chinese medicine to nourish deficiencies of Zang-fu organs, Qi, and Blood, expel excessive fire-heat and dampness, and improve constitution.
• External: Apply TCM ointments to inhibit the growth of skin surface microbes, calm overreacting immune cells, moisturize damaged skin, and promote skin repair.

Among the rich variety of traditional Chinese medicine, some have been proven to have broad-spectrum antibacterial and antifungal pharmacological effects. Some can stabilize the immune system, and some can moisturize and repair the skin. They have been proven to have almost no side effects with long-term use. As long as medicinals with suitable cold/heat properties are selected, their essences are extracted and made into a cream for application on the affected areas, combined with internal medicine to regulate the constitution, working from both inside and outside, the efficacy is certainly excellent, completely surpassing modern medicine. Curing atopic dermatitis becomes a piece of cake.

Other Precautions

• Once the skin is scratched open, it easily harbors dirt. Try to educate children to pat instead of scratch. Regularly trim and smooth the child's nails or use finger covers. Use breathable gauze to cover and protect the affected areas to avoid being scratched open.
• Sleep early and wake up early. Children should ideally go to bed by 9-10 pm. Going to bed after 11 pm is considered staying up late. The later they sleep, the more prone they are to excessive internal heat (heatiness) and lowered immunity, which can worsen dermatitis.
• Wear cotton clothes, avoid wool, nylon, and other fabrics.
• Those with very dry skin can apply Purple Cloud Ointment (Zi Yun Gao) or high-quality lotion for moisturizing.
• Turn on air conditioning in hot weather to avoid stuffiness, sweating, and dampness, which can worsen skin inflammation.
• Moderate exercise helps with allergic constitutions.
• Reduce possible life stress, guide and encourage patients to maintain an optimistic mood.
• Eat a light diet with balanced nutrition. Steaming or boiling is recommended; avoid overcooking and too many seasonings. Pay attention to and avoid foods that easily trigger allergies, which may differ for each person. Generally, avoid various dry crispy foods (e.g., biscuits, nuts, potato chips), ice cream and cold drinks, fried, grilled, or roasted foods, and foods that are too spicy, salty, or oily. Avoid factory-produced snacks and drinks containing chemical additives, colorings, and flavorings. Try to give natural, juicy snacks, such as dried fruit, soft candies, jelly, pudding, grass jelly, aiyu jelly, and chilled fruit (without ice).
• Avoid using soaps, shower gels, and laundry detergents with excessive chemical additives. Try to use natural cleansers or clean water.
• Prevent and control dust mites: Avoid carpets and tatami mats. Use mite-proof mattress encasements (full coverage), pillow covers, and duvet covers. Vacuum the mattress, duvet, and pillows weekly with a mite vacuum cleaner. 60°C hot water can kill dust mites; sun exposure is less effective. Use a dehumidifier; dust mites have difficulty surviving when humidity is <50%.
• Avoid keeping pets indoors.
• Use an air purifier to reduce PM2.5 concentration.
• If excessive scratching leads to severe redness, swelling, and inflammation, do not rule out temporarily using modern medicine for symptomatic relief.