| Background and objectivesEczema is a common chronic allergic inflammatory dermatological disease. The pathology of eczema is complex, involving a series of internal and external factors which induce inflammation of epidermis and superficial dermis. The main characteristic of eczema is severe itching, polymorphous skin lesions, symmetrical distribution and has exudation tendency. In recent years, Hong Kong, China and the developed countries the prevalence of eczema increased year by year, the disease is widespread worldwide attention. However, since the pathogenic factors of eczema are complex, includes both internal and external factors, clinical treatment is very difficult. Commonly used medicine, such as glucocorticoids and anti-histamine drugs has adverse effects like drug dependence, relapse and withdrawal symptoms. Thus, it is an important medical and social problem waiting to be solved. There is an urgent need for safe and effective treatment to improve the clinical efficacy.Literature studyThe literature study is carried out by reviewing articles of recent fundamental research and clinical research of eczema.Eczema is a chronic allergic inflammatory dermatological disease with clinical symptoms like severe itching, polymorphous skin lesions, symmetrical distribution, exudation tendency and chronic process. Histopathological feature is edema between epidermal cells, with varying degrees of acanthosis and superficial perivascular infiltration of lymphoid cells. The morphology of skin lesion is the main criteria for diagnosis of eczema. In 2002 the National Science and Technology Terminology Committee published "Dermatology Term" recognized eczema as the "Atopic Dermatitis". It falls in the categories of Shi-chuang, Si-wan-feng, Nai-xuan, Wan-xuan, etc of Chinese Medicine. Epidemiological studies suggest that the incidence of eczema is increasing in the world, exploring effective treatment is an urgent need to address the problem.In the theory of traditional Chinese Medicine, the pathology and etiology of eczema is due to the invasion of external pathological factors under the condition of congenital insufficient or due to dysfunction of spleen organ, or insufficiency of blood and detention of wet and heat pathogen, resulting in a syndrome of blood deficiency and wind-dryness. The target organs affected includes liver and spleen organ. Dysfunction of the spleen, liver, kidneys and heart associated with depletion of blood and invasion wet pathogens is main cause of disease.According to the principles of TCM syndrome differentiation, there are six main syndromes of eczema. Syndrome of down flow of Hot and Damp and syndrome of blood deficiency and wind-dryness are most common syndromes. Modern medical research suggests that the etiology and pathology of eczema are very complex. It is a series of allergic reaction caused by complex internal and external factors. Main etiology includes genetic factor, environmental factors, infection factors, dietary factors and drug factors. It's is believed the pathology of eczema is closely related to immune system. Typeâ… and typeâ…£allergic reactions are the main pathological mechanism happened in eczema. Immune functions and immune regulatory functions are suppressed in eczema patients, factors like cytokines, T lymphocytes, natural killer cells and EOS are involved. Studies also proved that the cellular immunity and humoral immunity both contribute to the pathogenesis of eczema. The result of studies provides a theoretical basis for treating eczema by regulating immune mechanisms with the application of acupuncture. The categorization of eczema is based on disease process, skin lesion and body symptoms. Eczema is divided into acute, sub-acute and chronic eczema. It is also classified by locations of skin lesions. Commonly diagnosis includes ear eczema, breast eczema, eczema umbilical fossa, scrotum eczema, eczema vulva, anus eczema, hand eczema and leg eczema, ect.By choosing appropriate acu-points and means like needling and moxibustion, acupuncture and regulate the imbalanced yin and yang, dredging the blocked meridians and reinforcing the immune system. According to the theory of acupuncture, it is a capable treatment for treating chronic eczema. On the other hand, modern study also proved acupuncture has bi-directional regulatory function on immune system, can promote the specific and non-specific immunity of human beings.Based on the theory of acupuncture and meridian, scholars apply acupuncture, massage, blood pricking therapy, moxibustion and other methods for treating eczema. The treatment of Chinese medicine mainly based on etiology and pathogenesis of eczema, which targets on wind, wet and hot pathogens. They have the function of reinforcing spleen function, expelling wind and anti-itching, nourishing blood and moisturizing skin. Most frequently used acu-points in the studies are Quchi(LI11) and Xuehai(SP10), followed by Sanyinjiao (SP6), Yinlingquan (SP9), Hegu (LI4), Dazhui (DU14) and Zusanli (ST36). The combination of acu-points fulfills the therapeutic principle mentioned above.In traditional Chinese medicine treatment, oral, topical application of herbal medicine is used. The principle of application of herbal medicine is mainly based on the differentiation system of Chinese Medicine. Most researches get satisfactory result. In addition, prescription medicine Dang Gui Ying Zi is widely used to treatment chronic pruritic skin diseases, it is proved effective and pharmacological research also suggest it has regulatory function for immune system. It has the function of nourishing blood and invigorates skin, dispelling wind pathogens and anti-inching function. Based on the same treatment for different diseases principle in traditional Chinese medicine, the prescription medicine is widely used for treating chronic urticaria, pruritus, chronic eczema, atopic dermatitis and neurodermatitis and proved effective in various studies.Western medicine commonly uses topical application of glucocorticoid drugs, followed by calcineurin inhibitor drugs for the treatment of eczema, System drugs like anti-histamine drugs, anti-microbial drugs, glucocorticoid drugs and immune regulating agents are also used. Recent research main stress on reducing side effects of current drugs, and improve the efficacy of drugs. Therefore, many researchers used glucocorticoid drugs amalgamate with other drugs such as water salicylic acid, anti-microbial drugs and anti-histamine drugs used to try and reduce the drug dose and application period to improve efficacy and reduce adverse reactions. Safe use and application of immunomodulatory agents such as MTX and other drugs such as Avi A, glycyrrhizin, non-steroidal anti-inflammatory analgesic drugs are also under investigation. Another approach like combining physical methods such as microwave irradiation, long-wave ultraviolet light therapy, far infrared spectral radiation has achieved some results. But adverse drug effect is still a common problem.Diagnostic criteria used in recruiting cases for research is mainly based on "Clinical Dermatology" edited by Zhaobian. Evaluation of efficacy of treatment is mostly using subjective methods, and the improved EASI scoring system modified by Zhaobian can be used for evaluating the efficacy of research.Clinical Study and ResultThe study is designed in randomized control trial method.76 cases are dived into two groups, the experimental group (41 cases) and the control group (36 cases). The experimental group applies "Acupuncture+Prescription medicine Dang Gui Yin Zi, while the control group uses prescription medicine Dang Gui Yin Zi only. Acu-points choosed included Hegu, Quchi, Xuehai, Sanyinjiao, Zusanli, Shenmen, Taibai, Taichong, Guanyuan. The last also use Warm-needling method. The efficacy is evaluated by EASI, the severity of itchiness and the Dermatology Life Quality Index (DLQI).Referred to the result of EASI, both groups show positive results. However, the experimental has higher efficacy than the control group. The rate of highly efficacy of the experimental group is 68.29% while that of the control group is only 28.75%. The total efficacy rate of the experimental group is 85.37% while that of the control group is only 45.71%. Both groups also decrease in the severity of itchiness and DQLI. All the results are authenticated by statistic methods.The efficacy of the result is achieved by appropriate choose of acupoints amalgamates with the application of effective prescription Chinese herbal medicine "Dang Gui Ying Zi". Both treatment methods fulfill both traditional principle of Chinese Medicine and result of modern research in immunology and eczema pathology.Although linearly relationship are shown in the three assessment systems of eczema, adopting three system ensures that changes in objective clinical symptoms, subjective feeling of itchiness and quality of life can all be evaluated.Conclusion:Integrating the therapeutic effect of acupuncture and herbal medicine is effective on treating chronic eczema, and is worth further investigation and promotion.
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