Volume 4, Number 2 | Summer 2009

Kampo Dermatology – Clinical Studies
Treatment of Atopic Dermatitis with Kampo – Puberty andAdulthood (6)Fumino Ninomiya
Aoki Clinic
A major characteristic of atopic dermatitis isthat varied symptoms appear during puberty andadulthood and they cover the entire body. The
parts that are rubbed such as the underarms andinside elbows become lichenified (the skin becomethickandhard)andintractable.

Sweat

accumulation in the parts that are rubbed is alsoa major factor.

The skin surface consists of a variety ofstructural shapes and typically often develops
erythroderma. For erythroderma, medicines thatclear heat and induce water drainage, and resolve
blood stasis are mainly used appropriately, as
well as gorinsan, shofusan, or keishibukuryogan.
To remove intense inflammation, strong heatclearing medicines are used. In atopic dermatitis,
however, there are many cases of spleen-stomach
deficiency with internal cold. So, an excessive useof heat clearing medicines should be avoided.
Making adequate adjustments is important. It isimportanttofocus

on

heat

clearingprescriptions.
If facial redness is intense and skin irritation
extends to the whole body, shishihakuhito,

orengedokuto,
keishikaogito,andbyakkokaninjinto are used. Byakkokaninjinto isused to target hot flashes, sweating, and thirst.
If there is erythema, papules, and lichens on theunseiin,keigairengyoto, saikoseikanto, and saikokeishito

wholebody,and shin’iseihaito are used.
If there are erythema, edemas, and moistening,the medications such as eppikajutsuto, choreito,

inchinkoto, goreisan, and shofusan are used.
These medicines should be used for a shortperiod to manage the symptoms.
If the lower body has intense inflammation, theprescriptions

suchasryutanshakanto

andsaiseijinkigan are used.
If there is an infection, medications such ashainosankyuto or jumihaidokuto are used.
If there is the presence of upper body sweatingwith a weak constitution, medications such as

Treatment of secondary aspects and prescriptions

also

body, the medications such as sammotsuogonto

medications

suchasare used.
For erythema on the upper part of the upper

keishikaogito and boiogito are used.
If there is dry skin dermatitis on the wholebody,medicines

toenrichyinsuchasbakumondoto, tokito, and jiinkokato (even fortreating a secondary aspect of the disease) areused.
Some cases may need to combine medicines
inducing water draining. A typical medicine todissipate water damp is goreisan, which can beapplied to individuals of any generation. ForHyperhydrosis and edemas, boiogito is used.

choreito, which has actions of nourishing yin anddraining water is used for heat symptoms.

Inchingoreisan is used for conditions witherythema – erythema is the symptom for thismedicine. ryokeijutsukanto is used for conditions
with moist eczema dermatitis due to the reversed
flow of fluids.
Treatment of the root/primary aspects and its
prescriptions
The basics to treat the root during puberty andadulthood are to improve the patient’s constitution
by supplementing deficiencies with the use of
medications mainly for tonifying qi, and yin.
Forthesyndrome

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)ofgastrointenstinal
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Volume 4, Number 2 | Summer 2009

weaknessandacquired

spleendeficiency,

medications such as rikkunshito, shikunshito,ninjinto,andheiisan

areused.

Forkidney-deficiency lacking kidney essence as aresult of acquired internal weakness, medications
such as hachimijiogan, rokumigan, and shimbuto
are used. For liver depression and qi stagnation
Before treatment

with which stresses are greatly connected,
medications such as shigyakusan, saikokeishito,

Before treatment

saikokeishikankyoto,saikokaryukotsuboreito,
yokukansan, and kamishoyosan are used. For
blood deficiency, shomitsuto is a typicalformulation (Table 2).
Atopic dermatitis has great influences ofcharacteristics of each season, which will bereported in a separate literature.
Case 1: Female of 31 years old with atopic
dermatitis and neurosis.
Present conditions: 159cm, 51kg
Whole body erythema. Psychoneurosis, SDS(psychological test) 65 scores. Difficulty
falling asleep, intensely irritable, worrisome,poor appetite, loss of nerve. The entire body
felt cold. Stiff shoulders (+). The patient was
helping with the housework.
Tongue condition: Moist with white furs.
Treatment and course:

yokukansankachimpihange
5.0g
andsammotsuogonto 5.0g were administered for sixweeks.
After a while, the skin inflammation improved
and a cure was attained.
Appetite came, and the patient became able toenjoy meals, and felt refreshed. Irritabilityresolved. She could get a conversation with herfamily members to start moving. She spent every
day with fun and became hopeful about the future.
The overall QOL improved.

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6 weeks after treatment
6 weeks after treatment

Case 2: Male of 20 years old with atopic
dermatitis and whole body chronic exudative
dermatitis
Present conditions: Atopic dermatitis developed
at the age zero. In mid-course, it was in remission,
but when he entered the university and started
living alone, it became gradually worse.
Past medical history: Allergic rhinitis. His father
had allergic rhinitis.
Present conditions: 172cm, 63kg
There was whole body erythema. Moist crusts
and lichens co-existed with exudative dermatitis
associatedwitha
secondaryinfection.
Constipation (+), cold legs (+), abdominal pain (+),
frequency of urination 5 times, water intake 3-5
lit./day. In everyday life, the patient ate
in-between snacks, mostly sweets. She did nottake breakfast and mostly dined out. She ate very
few vegetables and fish.
Abdominal condition: Palpitations above theumbilicus, tenderness beside the umbilicus, andThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 4, Number 2 | Summer 2009

lower abdominal resistance.
Treatment and course
May 9. (1) choreito 7.5g, gorinsan 7.5g, andRoxithromycin 100mg 2 tablets wereadministered for 14 days.
(2) Procedures: Black light radiation. Patchesof shiunko, Bacitracin mixed ointment, andpioctanine Salbe were applied.

Before treatment

Before treatment(3) For the face wash, soap must be used. It wasexplained that soft cottons are the safest forthe skin.
(4) Since stress was getting worse, instructions
were given for training the autonomic nerves.
With the three-day visits to the hospital, thesymptoms were nearly recovered and theconditions seem to become better.

After treatment

After treatment

May 21. The secondary infection was cured.
Erythema decreased.
(a) choreito 7.5g and hainosankyuto 7.5g
were administered for 28 days.
(b) Procedures were same as those of May 9.
June 13. Erythema further decreased and thepigment deposited. Itching (+), which wasintense on the face, chest, neck and upper body.
shin’iseihaito 5.0g, keigairengyoto 5.0g,choreito 5.0g, and Ebastine 10mg one tablet
were administered for 14 days.
[Lifestyle guidance](1) The patient was told to get up early in themorning and eat breakfast. Explanations
were given about food materials and how toeffectively intake them. Go to bed at 23:00.
Get enough sleep.
(2) How to apply ointments after taking a bath
was explained. The effective method of taking
a bath to disperse cold in the legs was also
explained.

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