Skin that itches and flares

The Chinese surgical literature — 外科 wài kē, the medicine of what shows on the outside — has always sorted skin by what it does rather than by what it is called. A sore that weeps is a damp sore, 湿疮. One that itches and moves from place to place has wind in it, 风, because wind is the tradition’s word for anything that arrives suddenly and will not stay still. One that is red and hot has heat. Most of what people write to us about has all three at once, in changing proportions, which is exactly what the old descriptions say.

The Neijing is older and blunter. In its list of the mechanisms of illness it assigns all pain, itching and sores to the heart — which sounds strange until you remember that the heart in this tradition governs blood and the spirit, and that nobody with a flaring itch sleeps well or thinks clearly. Fifteen centuries later the Waike Zhengzong is still working inside that sentence.

The third idea, and the one that matters most for skin that has been going on for years, comes later: 血虚风燥 xuè xū fēng zào, thin blood with wind and dryness. When the skin has flared and dried and flared for long enough, the tradition stops looking at the flare and starts looking at what is underneath it — skin that is rough, thickened, grey-brown and dry between episodes, in a person who is often also pale, sleeps lightly and feels the cold. That is described as a lack of the moistening substance rather than an excess of anything, and it changes what the kitchen is asked to do.

Eczema — or atopic dermatitis, the longer form of the same word — is what a clinician where you live will most likely have called this, and it is a good word for what it names: a recognisable way skin behaves. It is not a word we use in a reading, for the same reason the pattern pages give. The tradition has nothing that maps onto it one to one. It has three or four descriptions that between them cover most of what the word covers, and the interesting question is which of them is in front this month.

There is one more thing to say about the word, and it is a boundary rather than a translation. Much of what carries it is in children, and we do not write readings for anyone under eighteen, without exception. A page can describe how the tradition reads a weeping itch; it cannot and will not do that for a child. If the skin you are worried about is your child’s, please take them to someone who can see it.

Three pictures, and they layer.

The same person can carry the third picture as the ground and the first as what sits on top of it in a bad month. A reading’s job is to say which is which, because the foods that quiet a hot wet flare and the foods that moisten dry thin skin are close to opposites.

The tradition has a word, 发物 fā wù, for foods that provoke — that bring out what was sitting quietly. The list is old and partly regional, but the core of it is remarkably consistent across the books: shellfish, lamb and goose, alcohol, chilli and the warming spices, and anything fried. In a flare, those are set aside first, before anything is added.

• Heat makes wind and damp worse. Cooler baths, cotton rather than wool, and a bedroom that is not overheated do more than most people expect.
• Sweat left on the skin is damp. Rinse it off in tepid water, then oil while the skin is still slightly wet — the tradition’s version of moisturising is oil onto damp skin, not lotion onto dry.
• Scratching at night is where most of the damage is done, and the itch is worst then because that is when the surface is meant to be closing. Cut the nails, cool the room, and use the point below with the out-breath.
• For the dry, thin picture the rules invert: it wants warmth, oil and rest, and the cooling foods that quiet a flare make dry skin drier.

What the kitchen is asked to do depends on the picture, so the list below is sorted that way rather than as one list.

• In a wet, hot flare: job’s tears 薏苡仁, which the Bencao Gangmu files under overcoming damp and which is cooked as a bland congee; poria 茯苓 in the same pot for the spleen; chrysanthemum or mulberry leaf as a cool tea for the wind and heat. Nothing warming and pungent — the ginger and cinnamon wait.
• Between flares, damp and slow: the same congee, with tangerine peel 陈皮 added to get the middle moving, and a hard look at dairy, sugar and cold drinks, which the tradition reads as damp-forming.
• Dry and thin: the opposite kitchen. Jujube and goji simmered in the congee, sesame oil, and the cooling teas set aside. This is the picture people get wrong most often, by following advice written for a flare.

None of this is applied to the skin, and none of it is a promise. It is what a physician in our clinic would put in the congee for a person with this picture, written down.

The point classically paired with the surface of the body is in the web of the hand: Hegu, Large Intestine 4, 合谷, the Joining Valley. The tradition assigns the large intestine channel to the skin and the surface, and Hegu is its source point; the old line gives it the face, and the itch that is worst on the face and neck is the one it is most often paired with. Its entry shows two ways of finding it on your own hand. It is avoided in pregnancy.

Held with a clamp of thumb and finger for a minute on each side when the night itch begins, breathing out on the pressure, it gives the hands something to do that is not scratching. That is the honest scope of the claim.

Afterwards, the three pictures still describe the skin accurately, and the congee is still there. A reading is written for the months between flares; it is not what you reach for during one that has changed character.