TTraditional Chinese Medical students spend a significant portion of their practical clinic courses hanging around in the herb room. Back in the day there were 4-5 students shadowing a teacher. With every patient we would first all crowd into one of the small treatment rooms. After the teacher gathered information and placed needles, we all hustled back the herb room. There the teacher laid out the salient findings and made a diagnosis. The most likely western medical diagnosis was discussed as well. The excitement was palpable when there was an eczema patient. This difficult condition responds well to Traditional Chinese Medicine (TCM). Tapping on the table for attention, Dr. Sharon would gesture to the student closest to the patent medicine shelves.
“Get the Xiao Feng San, we will need it!”
She called through her Beijing opera smile. For a severe case students assembled the formula from bulk raw herbs which the patient cooked at home. Sometimes a patient was instructed to drink the formula and apply it externally to the lesions.
Translated Xiao Feng San is “Eliminate Wind Powder.” The formula first appears in a 1617 CE book called Orthodox Lineage of External Medicine. Xiao Feng San’s purpose then (and now) was the treatment of weepy, itchy, red lesions that cover a large part of the body. TCM calls this is a “wind rash”. It is caused when wind accompanied by damp and/or heat invades the body. Due to pre-existing damp-heat, the invasion is trapped, like Vikings getting stuck in a bog. Bogs are hard to drain, no matter where they are. In the body excess damp and heat transform into a toxin which, with the wind, surfaces creating the "wind rash". This type of rash is medically defined as eczema, psoriasis, contact dermatitis, hives, and even diaper rash. Xiao Feng San treats all these, and eczema is its specialty. Other conditions this formula can be used to treat are athlete’s foot, neurological rash, Poison Ivy/Oak, tinea infection, Schonlien-Henoch purpura, and drug rash.(1)
Eczema AKA atopic dermatitis is an inflammation of the skin resulting from contact with a specific irritant. Often, however, eczema occurs without contact. It is most common in children starting in babyhood and disappearing in adulthood. The exact cause of eczema is unknown. The current thinking links it to an overactive immune response. Substances that cause allergies like dust, mold, pets and some foods can set off eczema. Other contact triggers are soap, detergents, and disinfectants. Infections, stress, sweating, heat and humidity, and hormonal changes can also set off this condition. In the acute phase, there are skin blisters which weep and ooze serum. The chronic phase is dry, thick and scaly. Itching is the fiend of either phase. In children, the itching can be so severe that they will scratch until the skin bleeds. Eczema can affect the pigmentation of darker skin causing the affected area to be lighter or darker. Patients should rough for tight fitting clothing. Wool is especially irritating.
Eczema and psoriasis share many triggers and are close cousins. The differences are good to know for small talk at parties. Eczema appears early in life and is very itchy. Psoriasis makes its first appearance between 15 and 35. It is not very itchy but can be stinging or burning. Eczema appears where the body bends, knees, elbows, neck. Psoriasis can show up on the face, scalp, lower back, palms, and soles of feet. The lesions differ from those of eczema, being thick inflamed raised areas with silvery scales. Psoriasis is linked to other health conditions; diabetes, heart disease, or depression. Eczema is only skin deep.
Let’s have a cup of tea and look at a study.
71 subjects from Taiwan ranged in age from 8 to 23 years old. All had severe, refractory atopic dermatitis, the fancy name for eczema. All subjects had a poor response to the usual eczema medications, topical steroids, and oral antihistamines. Treatment with Xiao Feng San showed a significant improvement in total lesion scores compared to the placebo group; 80% vs 14%. Other symptom scores showed the most improvement for the Xiao Feng San group. Patients were checked four weeks after the conclusion of the treatment. The lesion score for the herbal treatment group remained significantly better than that of the placebo group.
Some patients reported the formula tasted terrible, but no actual adverse symptoms were reported. Despite the significant improvement in symptoms and lesions, lab results were unaffected. Total serum immunoglobulin E level, eosinophil counts, or interleukin 5, interleukin 13, and eosinophil cationic protein levels all remained the same. The authors concluded that Xiao Feng San might be an alternative choice of therapy for severe eczema. They suggested more scientific evaluation was needed to determine the mechanism of action. They noted as well that palatability needed to be considered before widespread use was accepted.(2) Lucky for us that this helpful formula is available in a pill (pian or wan) and capsule (san) form.
Lab results may not shed light on the mechanism of Xiao Feng San, but TCM is quite clear as to its actions. In TCM terms the skin speaks clearly as regards the “evils” involved in this condition. Redness is heat, weeping is dampness, itching is wind. Eczema is the chronic version of this mix of evils. The evils or pathogens have become trapped in the layers of the body. It requires a multi pronged herbal strategy. The main herbs, Jing Jie, Fang Feng, Nui Bang Zi, and Chun Tui disperse wind to ditch the itch. The heat and damp create a dangerous swampy, bog and are treated together with three herbs. Cang Zhu, Mu Tong, and Ku Shen drain the swamp. Ku Shen also eliminates parasites. Two more herbs chime in to clear heat. Shi Gao and Zhi Mu take on and take out deep heat. Lastly, the blood is cooled, nourished, and invigorated with Sheng Di Huang, Dang Gui, and Hei Zhi Ma. This last strategy aids the main herbs which extinguish the wind by adhering to a TCM treatment principle. “To treat the Wind, first treat the blood. When the blood moves the wind will naturally be distinguished.” In addition to wind these last three herbs also treat constipation.(1) Although constipation may not be the root cause, it can certainly exacerbate symptoms. When toxins cannot leave through the bowels they are reabsorbed. The skin, also a detox organ, does its best to take over the job of expelling them.
Fun facts about dogs and cats. In young children dogs protect against eczema, cats do not. Children who tested positive for dog allergies were less likely to develop eczema by the age of 4 if they lived with a dog before age
1. Children with dog allergies who did not live with a dog were 4 times more likely to develop eczema. Children with cat allergies living in a cat household were 13 times more likely to develop eczema than those living in a cat free home. Rest assured children who were not allergic to cats were not at an increased risk for eczema living with a cat. The data used was gathered from 636 children enrolled in the Cincinnati Childhood Allergy & Air Pollution Study. This long-term study examines the effects of environmental particulates on childhood respiratory health and allergy development. Children enrolled are considered at high risk for developing allergies because their parents have allergies. The researchers focused on several potential risk factors for developing eczema. The children were tested for 17 separate allergies on a yearly basis from ages 1 through 4 years, and the parents completed yearly surveys.(3) The option of dog and cat households was not explored.
When taking Xiao Feng San it is advised to not consume alcohol, coffee, spicy foods. and seafood. Avoid smoking as it may interfere with the actions of the herbs in this formula.
Xiao Feng San is primarily dispersing formula so it should not be used weaker patients. Do not use with marked Qi or Blood deficiency. There are many types of Qi in the body. The Qi deficiency referred to here is a whole body Qi. Symptoms include weak voice, spontaneous sweating, no appetite, loose stools, and fatigue. The symptoms of Blood deficiency are sallow complexion, pale lips, dizziness, poor memory, numbness, blurred vision, fatigue and insomnia.(1)(4)
Serving size: Consume according to label directions or instructions from your knowledgeable healthcare practitioner.
Disclaimer: Use herbs wisely. If you have questions or special considerations, work with your practitioner. If symptoms worsen or you have concerns, contact a knowledgeable practitioner. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.
References
1 Bensky, Scheid, Ellis, Barolet Formulas and Strategies. Portable 2nd edition. Eastland Press Inc. 2015
2 Lin, Joann H., Cheng, H.M., Chiang, L.C., Jan, Y.M., Chen, G.W., Li, T.C. “The Efficacy and Safety of a Chinese Herbal Product (Xiao-Feng-San) for the Treatment of Refractory Atopic Dermatitis: A Randomized, Double-Blind, Placebo-Controlled Trial.” International Archives of Allergy and Immunology, 2011,155-2:141–148
3 Tolly G. Epstein et al, Opposing Effects of Cat and Dog Ownership and Allergic Sensitization on Eczema in an Atopic Birth Cohort, The Journal of Pediatrics, DOI: 10.1016/j.jpeds.2010.07.026
4 Maciocia, G, The Foundations of Chinese Medicine, Churchill Livingstone, 1989
