Eczema (atopic dermatitis) — Wokingham, Berkshire

1. Overview

Atopic eczema (atopic dermatitis) is a chronic relapsing inflammatory skin condition affecting approximately 15–20% of children and 1–3% of adults worldwide, making it the most prevalent inflammatory skin disease globally. It is characterised by intensely itchy, dry, inflamed skin and follows a relapsing and remitting course, with flares alternating with periods of partial or complete remission. Atopic eczema is frequently associated with asthma, allergic rhinitis and food allergies as part of the “atopic march.”

Conventional treatment consists primarily of topical corticosteroids and emollients, with topical calcineurin inhibitors, systemic immunosuppressants (ciclosporin, methotrexate, azathioprine) and, more recently, biologics (dupilumab) used for moderate-to-severe disease. While effective, topical corticosteroids carry risks of skin atrophy, adrenal suppression and rebound on withdrawal; systemic agents have significant side-effect profiles; and many patients and parents seek a more natural approach. Chinese herbal medicine has a well-established evidence base for atopic dermatitis, with a 2023 systematic review and a 2022 meta-analysis of high-quality RCTs confirming its effectiveness for improving recovery rate and reducing recurrence compared to conventional treatment and placebo.

Important note on treatment timeline: Chinese herbal medicine works by gradually modulating immune dysregulation (the Th2-skewed immune response underlying eczema), clearing the internal pathological factors (Damp-Heat, Wind-Heat or Blood Dryness) and strengthening the Spleen and Lung that govern skin health in TCM. Unlike topical corticosteroids, which suppress inflammation immediately but do not address the root cause, herbal treatment produces progressive improvement. Most patients notice meaningful change within four to six weeks; significant clearance typically develops over two to three months of consistent daily treatment. Because herbs address the underlying cause, the improvement tends to be sustained with lower relapse rates.

2. Symptoms

Intense itching (pruritus) — the cardinal and most distressing symptom; itch in atopic dermatitis is chronic, often worse at night and at extremes of temperature, and drives the itch-scratch cycle that perpetuates and worsens skin damage; itch severity is the primary driver of impaired sleep and reduced quality of life
Dry skin — transepidermal water loss is significantly elevated in atopic dermatitis even in non-lesional skin; the resulting chronic dryness impairs the skin barrier, allows penetration of allergens and irritants and promotes sensitisation; dry skin worsens itch and is central to the pathophysiology of atopic dermatitis
Erythematous patches and papules — in active disease, areas of inflamed, red, papular skin develop in characteristic distribution patterns; in infants, the face and extensor surfaces of the limbs are most commonly affected; in older children and adults, eczema typically affects the flexural areas (antecubital and popliteal fossae, wrists, neck)
Weeping, crusting and secondary infection — in acute flares, the skin may weep serous fluid and crust over; scratching breaks the skin barrier and introduces Staphylococcus aureus — found in abundance on the skin of most atopic dermatitis patients — leading to secondary bacterial infection that dramatically worsens inflammation and itch; eczema herpeticum (widespread herpes simplex superinfection) is a serious complication
Lichenification — chronic scratching produces thickening, leathering and hyperpigmentation of the skin (lichenification); this is the skin’s response to repeated trauma and represents a Blood Stasis component in TCM terms
Sleep disturbance and psychological impact — nocturnal itch profoundly disrupts sleep in both children and adults; sleep deprivation worsens mood, cognitive function and immune regulation, perpetuating the eczema; depression and anxiety are significantly more prevalent in atopic dermatitis patients than in the general population

3. Causes

Skin barrier dysfunction — the most important pathogenic mechanism; mutations in the filaggrin gene (FLG) — present in approximately 30% of atopic dermatitis patients in Western populations — impair the structural integrity of the skin barrier; a defective barrier allows transepidermal water loss (causing dryness), penetration of environmental allergens, irritants and microorganisms (causing sensitisation and inflammation) and colonisation by Staphylococcus aureus (which drives inflammation through superantigen production and IL-13 and IL-31 stimulation)
Th2-skewed immune dysregulation — atopic dermatitis involves a predominantly Th2-type immune response; Th2 cytokines (IL-4, IL-13, IL-31) suppress filaggrin and loricrin production (further impairing the barrier), drive IgE production (the antibody underlying allergic sensitisation) and promote eosinophilic inflammation; dupilumab, the leading biologic for severe eczema, works by blocking IL-4 and IL-13 signalling; in chronic lesions, a Th1 component also contributes
Environmental triggers — common triggers that provoke or worsen eczema flares include house dust mites, pet dander, pollen, mould, certain foods (cow’s milk, eggs, peanuts, wheat in children), synthetic fabrics, soap, detergent and bubble bath; temperature extremes (heat and cold), sweating, psychological stress and illness also reliably provoke flares in susceptible individuals
Skin microbiome dysbiosis — the skin microbiome in atopic dermatitis is characterised by reduced diversity and overgrowth of Staphylococcus aureus, which produces toxins that directly activate T cells, drive inflammation and impair barrier repair; restoring microbiome diversity is an emerging treatment target
Genetic predisposition — atopic dermatitis has a strong genetic component; concordance in identical twins is 70–80%; multiple susceptibility loci beyond FLG have been identified, including genes regulating IL-4R signalling, skin barrier proteins and immune regulation

4. Eczema in Chinese medicine

In traditional Chinese medicine, eczema and atopic dermatitis are grouped under the classical skin condition known as “Shi Zhen” (Damp rash) or “Si Wan Feng” (four-bend Wind, referring to its flexural predilection). TCM understands eczema as arising from internal pathological factors that express themselves through the skin via the Lung (which governs the skin and body hair), the Spleen (which governs the transformation of fluids and whose weakness generates Dampness) and the Blood. The main TCM patterns are:

Wind-Heat with Damp in the skin — the predominant pattern in acute eczema flares; Wind and Heat invade the skin and surface channels, combining with internally generated Dampness to produce intensely itchy, red, weeping or vesicular lesions; Heat dries and irritates the skin; Dampness produces vesicles, weeping and crusting; the rapid migratory quality of itch reflects the Wind component; this pattern correlates closely with the Th2-driven, histamine-mediated acute phase of atopic dermatitis; treatment disperses Wind, clears Heat, resolves Dampness and relieves itch
Spleen Damp-Heat — the pattern underlying chronic, weeping eczema, particularly in patients with a constitutionally weak Spleen; the Spleen’s failure to transform and transport fluids generates Dampness, which combines with Heat (from diet, stress or constitutional tendency) and overflows to the skin; characterised by chronic, weeping, oozing lesions with yellow or clear discharge, heavy limbs, poor appetite, loose stools and a greasy yellow tongue coating; treatment strengthens the Spleen, clears Damp-Heat and resolves Dampness from the skin
Blood Dryness with Wind — the pattern in chronic, dry, lichenified eczema; long-standing Damp-Heat depletes Blood and Yin, leaving the skin without adequate nourishment and moisture; the Wind (either residual from the acute phase or generated by the Blood deficiency itself) drives persistent intense itch; characterised by dry, thickened, lichenified, hyperpigmented skin, reduced weeping and chronic itch; this is the pattern most often seen in older children and adults with longstanding atopic dermatitis; treatment nourishes Blood and Yin, moistens the skin, extinguishes Wind and relieves itch
Lung Qi and Wei Qi deficiency — the constitutional vulnerability pattern underlying recurrent eczema; the Lung governs the skin and its defensive Wei Qi; when Lung Qi is deficient, the skin is poorly defended against external pathogens (Wind, Damp, Heat, allergens) and is unable to maintain its barrier integrity; this aligns directly with the filaggrin deficiency and impaired skin barrier of atopic dermatitis; treatment strengthens Lung Qi and Wei Qi using herbs such as Huang Qi (Astragalus), Bai Zhu and Fang Feng (the three herbs of Yu Ping Feng San), alongside specific skin-treating herbs

5. Chinese herbal medicine for eczema

Chinese herbal medicine is the most effective TCM treatment for atopic eczema and should be considered the primary approach. Herbs work by modulating the underlying immune dysregulation (shifting the Th2-skewed response towards more balanced Th1/Th2 activity), improving skin barrier function, reducing Damp-Heat or nourishing Blood Dryness, and strengthening the Lung and Spleen to address the constitutional root of the condition. Daily herbal treatment taken consistently produces progressive improvement over two to three months.

The evidence base is well established. A 2023 systematic review and meta-analysis by Jia et al., published in the Journal of Dermatological Treatment, included 17 RCTs with 1,624 patients and found Chinese herbal medicine was associated with a significantly higher overall recovery rate (RR 1.15, 95% CI: 1.05–1.26) and a substantially decreased recurrence rate (OR 0.19, 95% CI: 0.07–0.55) compared to control. A meta-analysis by Cai et al. (2022), published in Frontiers in Pharmacology, evaluated 8 high-quality RCTs with 662 patients and found CHM produced significantly higher EASI-90 response rates (RR 3.72) and improvements in SCORAD, body surface area, VAS itch and sleep scores compared to placebo. A systematic review and meta-analysis by Wang et al. (2023), published in the Journal of Ethnopharmacology, pooled 20 RCTs on topical Chinese herbal medicine and confirmed significant improvement in symptom scores from baseline compared to active control or placebo.

Herbal formulae are individually tailored to the TCM pattern:

Xiao Feng San modifications (Eliminate Wind Powder) — the most widely used classical formula for acute and subacute eczema with Wind-Heat and Damp pattern; disperses Wind, clears Damp-Heat, cools Blood and nourishes Blood and Yin to prevent the drying herbs from further depleting Blood; principal herbs include Jing Jie, Fang Feng, Chan Tui, Cang Zhu, Ku Shen, Shi Gao, Sheng Di Huang and Dang Gui; highly effective for the intensely itchy, weeping, acutely flaring eczema of Wind-Damp-Heat
Chu Shi Wei Ling Tang modifications (Remove Dampness and Calm the Stomach) — for Spleen Damp-Heat eczema with prominent weeping and discharge; strengthens the Spleen, clears Damp-Heat and dries Dampness; uses Cang Zhu, Bai Zhu, Hou Po, Chen Pi, Fu Ling, Ze Xie, Yi Yi Ren, Huang Bai and Zhi Zi to drain Dampness via the intestines and urine
Si Wu Xiao Feng Yin modifications (Four Substance Drink to Eliminate Wind) — for Blood Dryness with Wind eczema; nourishes Blood and Yin, moistens the skin and extinguishes Wind; uses Shu Di Huang, Dang Gui, Bai Shao, Chuan Xiong, He Shou Wu, Bai Xian Pi, Di Fu Zi, Chan Tui and Fang Feng; effective for dry, lichenified, hyperpigmented chronic eczema in adults
Yu Ping Feng San modifications (Jade Windscreen Powder) — incorporated as a constitutional strengthening formula to address Lung Qi and Wei Qi deficiency underlying recurrent eczema; strengthens the immune defence and skin barrier; particularly relevant for patients with concurrent allergic rhinitis or recurrent respiratory infections alongside eczema

Herbs are prescribed as pharmaceutical-grade granules from Sun Ten (Taiwan), dissolved in warm water and taken daily. An online Chinese herbal consultation is available for patients who cannot attend in person.

6. Acupuncture for eczema

Acupuncture is used alongside Chinese herbal medicine for eczema, with particularly strong benefit for:

Relieving itch — acupuncture at Blood-cooling and Wind-expelling points (LI11, SP10, BL17, BL40, SP6) provides rapid itch relief through peripheral and central antipruritic mechanisms; LI11 (Quchi) has the strongest evidence for itch reduction in eczema and is a core treatment point
Modulating immune function — acupuncture regulates Th1/Th2 immune balance and reduces IgE-mediated allergic sensitisation; this directly addresses the immune dysregulation underlying atopic dermatitis and supports the immunomodulatory action of Chinese herbal medicine
Reducing stress-triggered flares — psychological stress is a major trigger for eczema flares; acupuncture calms the sympathetic nervous system, reduces cortisol and directly addresses the Liver Qi stagnation and Heart Heat that, in TCM terms, worsens skin inflammation; regular acupuncture reduces the frequency and severity of stress-triggered flares
Improving sleep — nocturnal itch severely disrupts sleep in eczema patients; acupuncture at Heart-calming and Shen-settling points (HT7, PC6, SP6, AN Mian) alongside itch-relieving treatment improves sleep quality and reduces the sleep deprivation that perpetuates eczema

7. Treatment timeline

Weeks 1–3 — initial reduction in itch intensity; the first symptom to improve is usually itch, which often decreases noticeably within two to three weeks of daily herbal treatment; sleep quality begins to improve as nocturnal itch reduces
Weeks 3–6 — reduction in acute flare frequency; erythema begins to subside in active areas; weeping reduces; new flare triggers may become less intense in their response; the skin begins to feel less reactive
Weeks 6–12 (months 2–3) — progressive skin clearance; chronic lesions thin and lichenification softens; dry skin areas improve with combined herbal treatment and emollients; most patients achieve significant clearance within two to three months; this represents genuine resolution of the underlying Damp-Heat or Blood Dryness rather than surface suppression
Maintenance — after clearance, a reduced maintenance dose of herbs sustains remission, addresses seasonal flares (particularly in autumn and spring) and strengthens the Lung Qi and Spleen constitution to reduce long-term vulnerability; this preventive approach reduces the need for topical steroids and the risk of rebound on their withdrawal

8. Self-care tips

Emollients throughout the day — regular, frequent application of an unperfumed emollient moisturiser is the cornerstone of conventional eczema self-care and complements herbal treatment directly; moisturisers restore the impaired skin barrier, reduce transepidermal water loss, reduce itch and reduce the frequency of flares; apply immediately after bathing (within three minutes) while the skin is still slightly damp to seal in moisture
Identify and avoid triggers — keeping an eczema diary to track which exposures (foods, fabrics, environments, emotional states) precede flares helps identify individual triggers; common triggers include house dust mites (use mite-proof bedding covers), certain foods (particularly in children), biological washing powders, synthetic fabrics and nickel in jewellery; reduction of trigger exposure reduces flare frequency alongside herbal treatment
Avoid scratching where possible — scratching damages the skin barrier, drives the itch-scratch cycle and introduces Staphylococcus aureus; keep fingernails short; use cool compresses to relieve acute itch; acupuncture is highly effective for controlling refractory itch without scratching
Damp-reducing diet — in TCM, foods that generate Dampness or Heat worsen the Damp-Heat pattern underlying eczema; reduce dairy products, refined sugar, processed foods, excessive wheat and alcohol; favour cooked vegetables, lean proteins, sweet potato, mung beans (which have a specific Damp-resolving action in Chinese food therapy) and green tea; see Chinese food therapy for detailed guidance
Manage stress — psychological stress is one of the most consistently reported eczema triggers; it activates the HPA axis, raises cortisol and drives the Th2 immune response that worsens atopic inflammation; regular exercise, adequate sleep (difficult but important), mindfulness practice and acupuncture all reduce stress-triggered flares; addressing underlying anxiety or depression is often as clinically important as treating the skin directly
Tepid baths, not hot — hot water strips natural skin oils, worsens dryness and can trigger itch; bath or shower in tepid water for no more than 10–15 minutes; use a soap substitute rather than soap or bubble bath; pat (do not rub) the skin dry and apply emollient immediately

9. Treatment at my clinic

I treat eczema at my clinic in Wokingham, Berkshire, primarily through Chinese herbal medicine tailored to the specific TCM pattern — Wind-Damp-Heat, Spleen Damp-Heat or Blood Dryness with Wind — alongside Lung and Spleen strengthening to address the constitutional root. Acupuncture is used alongside for itch relief, immune modulation and sleep improvement. Chinese herbal medicine is the primary treatment because it works systemically, addressing the internal immune and Damp-Heat pathology that drives eczema rather than suppressing its surface expression with steroids. Consistent daily treatment over two to three months produces meaningful, sustained improvement with lower relapse rates. Related conditions commonly co-treated include psoriasis, allergic rhinitis and hay fever, insomnia and anxiety.

Visit the prices page for treatment costs or book an online Chinese herbal consultation if you cannot attend in person.

10. Frequently asked questions

Can Chinese herbal medicine help eczema?

Yes. A 2023 systematic review of 17 RCTs with 1,624 patients found Chinese herbal medicine significantly improved overall recovery rate (RR 1.15) and substantially reduced recurrence rate (OR 0.19) compared to control. A 2022 meta-analysis of 8 high-quality RCTs found CHM produced significantly higher EASI-90 skin clearance rates and improved itch and sleep scores compared to placebo. Herbs address the underlying immune dysregulation and Damp-Heat pathology rather than suppressing the surface.

How long does Chinese herbal treatment take for eczema?

Itch usually reduces noticeably within two to three weeks. Meaningful skin clearance typically develops over two to three months of daily treatment. This reflects the depth at which herbs work — correcting the underlying Damp-Heat, Blood Dryness or immune dysregulation — rather than suppressing inflammation at the surface. The resulting improvement is more sustained, with lower relapse rates compared to topical corticosteroids.

Is Chinese herbal medicine safe for children with eczema?

Yes — Chinese herbal medicine has been used for children with eczema for centuries and is well tolerated. Multiple RCTs have included paediatric patients. Formulae are adjusted for children’s age and constitution. Herbs are prescribed as pharmaceutical-grade granules from Sun Ten (Taiwan), dissolved in warm water and taken as a drink. The granule form is more acceptable to children than raw herb decoctions. Always consult a qualified herbalist registered with the Register of Chinese Herbal Medicine (RCHM).

What is the TCM understanding of eczema?

In TCM, eczema arises from internal pathological factors — Wind-Heat, Damp-Heat (particularly from Spleen weakness), or Blood Dryness — that overflow to the skin via the Lung, which governs the skin and body hair. The constitutional vulnerability is rooted in Lung Qi and Spleen deficiency, which impairs the skin barrier and generates Dampness respectively. Treatment therefore addresses both the acute skin pattern and the constitutional root.