Dermatology & Skin Disorders TCM | Dr. Li Bin (TCM Dermatology) | CMCS Shanghai

About Dr. Li Bin

Dr. Li Bin is Chief Dermatologist at Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai — one of China's foremost centres for integrative dermatological care and a national reference institution for the TCM management of eczema, psoriasis, urticaria, and acne. He is recognised for his precision in TCM pattern differentiation in skin disorders, his expertise in customised herbal prescription and external herbal therapy, and his success with cases resistant to conventional treatment — particularly chronic eczema with corticosteroid dependence and impaired skin barrier function. Dr. Li's clinical philosophy holds that chronic eczema is not a skin disease in isolation but a systemic disorder of Damp-Heat accumulation in the skin and blood, driven by constitutional imbalance and perpetuated by the skin barrier dysfunction that recurrent corticosteroid use both treats and worsens. His department at Yueyang Hospital has established one of Shanghai's most comprehensive integrative dermatology programmes, combining classical herbal prescription, herbal fumigation-washing therapy, acupuncture, and structured skin care guidance into a unified care pathway for patients with chronic and treatment-refractory inflammatory skin disorders.

Case Overview

Ms. Sarah Mitchell (pseudonym), a 38-year-old British office worker based in Shanghai, presented with a five-year history of chronic eczema — generalised pruritus with erythematous papules, papulovesicles, and plaques predominantly on the extensor surfaces of the limbs and trunk — significantly worsened over the preceding three months with expanded lesion distribution, intensified nocturnal pruritus, and severely disrupted sleep. Multiple courses of antihistamines and topical corticosteroids had produced temporary relief with recurrence on cessation; corticosteroid dependence and skin barrier impairment were suspected. Allergy testing demonstrated mild sensitisation to house dust mite and pollen. TCM diagnosis identified Damp Sore — Damp-Heat Accumulating in the Skin. Dr. Li Bin designed an integrative programme combining optimised Western pharmacotherapy (olopatadine, compound glycyrrhizin, tacrolimus ointment with structured corticosteroid tapering) with classical herbal prescription (Longdan Xiegan Tang combined with Bixie Shenshi Tang, modified), herbal fumigation-washing therapy, and acupuncture. At one month, pruritus had essentially resolved and lesions had largely cleared. Six-month follow-up confirmed no recurrence.

Patient Background

• Name / Nationality: Ms. Sarah Mitchell (pseudonym) — British; 38-year-old office worker based in Shanghai
• Age / Sex: 38-year-old female
• Chief Complaint: Recurrent generalised pruritus and skin rash for over five years, significantly worsened for three months
• History of present illness: Insidious onset of generalised pruritus five years prior, predominantly on extensor limb surfaces and trunk; scratching producing scattered erythematous papules and papulovesicles, partially confluent with exudate; diagnosed as chronic eczema at multiple hospitals; antihistamines and topical corticosteroids providing temporary relief with recurrence on cessation. Over the preceding three months: lesion distribution expanded; pruritus intensified, worst at night; sleep severely disrupted; quality of life markedly impaired
• Past medical history: No food or drug allergies; no other chronic disease; no surgery or trauma
• TCM four examinations:
  • Inspection: Sallow, dusky complexion; agitated affect; generalised scattered and confluent dark-red papules and papulovesicles, partially forming plaques; rough surface with excoriations, haemorrhagic crusts, and scales; predominantly extensor limb surfaces and trunk; red tongue; yellow greasy coating
  • Auscultation/olfaction: Normal respiration; no abnormal odour
  • Inquiry: Intolerable generalised pruritus; worsened by heat and spicy food; dry and bitter mouth; dry hard stools; dark yellow urine
  • Palpation: Slippery, rapid, forceful pulse (滑数有力脉)

Diagnostic Workup

Dermatological Examination

• Generalised scattered and confluent dark-red papules and papulovesicles; partially forming ill-defined plaques; rough surface with excoriations, haemorrhagic crusts, and scales; predominantly extensor limb surfaces and trunk

Laboratory Investigations

• Full blood count, liver function, and renal function all within normal limits
• Allergen panel: mild sensitisation to house dust mite and pollen — no severe specific allergen identified

Dr. Li's pre-treatment assessment: The clinical picture is straightforward — chronic eczema with a five-year history, now in a flare that has not responded to the usual antihistamine and topical corticosteroid approach. But the more important issue is the corticosteroid dependence. This patient has been applying topical corticosteroids intermittently for five years. The skin barrier is compromised — the stratum corneum is thinned, the transepidermal water loss is increased, and the skin is more permeable to irritants and allergens than it should be. Every time she stops the corticosteroid, the barrier dysfunction allows the inflammatory cycle to restart. We cannot simply prescribe more corticosteroid — we need to taper it carefully while simultaneously repairing the barrier with tacrolimus and emollients, and addressing the underlying Damp-Heat pattern with the herbal formula and external therapy. The tongue is red with a yellow greasy coating — that is Damp-Heat, established and significant. The pulse is slippery and rapid — Damp-Heat in the blood. The treatment principle is to clear the Heat, drain the Dampness, and cool the Blood — while the Western therapy manages the inflammatory cascade and repairs the barrier.

TCM Diagnosis and Integrative Treatment Strategy

The TCM diagnosis established by Dr. Li Bin was Damp Sore — Damp-Heat Accumulating in the Skin (湿疮·湿热蕴肤证). The corresponding Western diagnosis was chronic eczema.

The treatment principle was: clear Heat and drain Dampness; resolve toxin and disperse accumulation; dispel Wind and arrest pruritus (清热利湿，解毒散结，祛风止痒).

Herbal prescription — Longdan Xiegan Tang combined with Bixie Shenshi Tang, modified: Longdancao 10g, Huangqin 12g, Zhizi 10g, Zexie 12g, Mutong 9g, Cheqianzi 15g (wrapped), Danggui 12g, Shengdihuang 15g, Chaihu 10g, Gancao 6g, Bixie 15g, Yiyiren 30g, Fuling 15g, Huashi 15g (wrapped), Baixianpi 15g, Difuzi 15g. One decoction daily, taken warm in two divided doses. Rationale: Longdan Xiegan Tang clears Liver-Gallbladder Damp-Heat and cools the Blood — the primary formula for Damp-Heat skin disorders with red tongue, yellow greasy coating, and slippery rapid pulse; Bixie Shenshi Tang drains Dampness through the lower jiao and resolves the Damp accumulation in the skin; Baixianpi and Difuzi are classical anti-pruritic herbs that dispel Wind-Damp from the skin surface.

Herbal fumigation-washing therapy: Decoction prepared from Kushen, Huangbai, Shechuangzi, Difuzi, Baixianpi, Jinyinhua, and Lianqiao. Drug solution poured into basin; when temperature appropriate, patient seated above basin with towel used to gently wash affected areas; 20–30 minutes per session, once daily. Rationale: direct topical application of Heat-clearing, Dampness-draining, and anti-pruritic herbs to the affected skin — producing local anti-inflammatory and antipruritic effects that complement the systemic herbal prescription.

Acupuncture: Primary points: Quchi (LI 11), Xuehai (SP 10), Zusanli (ST 36), Sanyinjiao (SP 6), Yinlingquan (SP 9). Supplementary points by symptom: severe pruritus — Fengshi (GB 31) and Geshu (BL 17); erythematous lesions — Dazhui (GV 14) and Hegu (LI 4); marked exudate — Shuifen (CV 9) and Yinjiao (CV 7). Reducing method after arrival of Qi; 30-minute retention; daily treatment six days per week.

Western pharmacotherapy: Antihistamine: olopatadine hydrochloride 5 mg twice daily for pruritus relief. Immune modulator: compound glycyrrhizin tablets 50 mg three times daily for anti-inflammatory and immune-regulatory effect. Topical therapy: structured corticosteroid taper — gradual reduction in frequency and potency to avoid rebound; tacrolimus ointment (non-steroidal immunomodulator) twice daily alternating with urea-vitamin E cream 3–4 times daily to reduce skin inflammation and repair barrier function.

Lifestyle guidance: Diet: strict avoidance of spicy, greasy, and stimulating foods (chilli, Sichuan pepper, fried foods) and known trigger foods (shellfish, beef, lamb); increased fresh vegetables and fruit; maintenance of regular bowel habit. Skin care: no scratching; gentle cleansing; loose, soft, breathable cotton clothing; lukewarm (not hot) bathing; immediate post-bath moisturiser application to support barrier repair. Emotional regulation: avoidance of anxiety and emotional stress, which exacerbate Damp-Heat and worsen pruritus through neuroimmune pathways.

Treatment Course and Outcomes

At Two Weeks

• Pruritus significantly reduced; nocturnal sleep quality improved
• Lesion erythema faded; exudate reduced; scattered papules and papulovesicles beginning to resolve
• Full blood count on repeat: all indices within normal limits

At One Month

• Pruritus essentially resolved; majority of lesions cleared — only residual post-inflammatory hyperpigmentation remaining
• Consolidation treatment continued; Western medication doses progressively reduced; herbal formula adjusted according to evolving pattern

Six-Month Follow-Up

• No recurrence of eczema; skin condition good; quality of life significantly improved; patient highly satisfied with treatment outcome

Dr. Li's clinical reflection: The key decision in this case was the corticosteroid taper. If we had simply stopped the topical corticosteroid and replaced it with the herbal formula, the barrier dysfunction would have produced an immediate rebound flare that would have undermined the patient's confidence in the treatment. By tapering the corticosteroid gradually while introducing tacrolimus to maintain anti-inflammatory cover and the herbal fumigation-washing to address the Damp-Heat topically, we gave the barrier time to repair itself under the protection of the tacrolimus and the emollient, while the systemic herbal formula addressed the constitutional Damp-Heat pattern that was driving the inflammation from within. The fumigation-washing is not a cosmetic intervention — Kushen, Huangbai, and Shechuangzi have well-documented antibacterial, anti-inflammatory, and antipruritic pharmacological activities. Applied directly to the affected skin daily, they produce a local therapeutic effect that the oral formula cannot achieve alone. The combination of systemic and topical TCM therapy, carefully coordinated with the Western taper, is what produced the durable remission.

Expert Commentary — Dr. Li Bin

1. Corticosteroid Dependence in Chronic Eczema: The TCM Perspective on Barrier Repair

Topical corticosteroid dependence is one of the most clinically challenging problems in chronic eczema management. Corticosteroids are highly effective anti-inflammatory agents, but prolonged use produces a well-documented cycle of dependence: the corticosteroid suppresses the inflammatory response and temporarily restores barrier function; cessation allows the barrier dysfunction to re-emerge, triggering a rebound inflammatory response that is often more severe than the original; the patient reapplies the corticosteroid to control the rebound, reinforcing the dependence. In TCM, this cycle is understood as a failure to address the root pattern — the Damp-Heat accumulation in the skin and blood that drives the inflammation — while repeatedly suppressing the branch manifestation with a cooling, drying intervention that, over time, depletes the Yin and Blood that nourish the skin. The integrative approach to corticosteroid dependence requires simultaneous management of three processes: gradual corticosteroid tapering to avoid rebound; barrier repair with non-steroidal topical agents (tacrolimus, emollients); and constitutional treatment of the underlying Damp-Heat pattern with herbal prescription and external therapy. None of these three processes is sufficient alone — the taper without barrier repair produces rebound; the barrier repair without constitutional treatment produces recurrence; the constitutional treatment without the taper produces inadequate short-term control that undermines patient adherence.

2. Herbal Fumigation-Washing Therapy: Pharmacological Mechanisms of Topical TCM in Eczema

Herbal fumigation-washing therapy (熏洗疗法) is one of the oldest external treatment modalities in TCM dermatology, and one of the most extensively studied in modern pharmacological research. The herbal combination used in this case — Kushen, Huangbai, Shechuangzi, Difuzi, Baixianpi, Jinyinhua, and Lianqiao — represents a classical anti-Damp-Heat, anti-pruritic external formula whose individual components have well-characterised pharmacological activities. Kushen (Sophora flavescens) contains matrine and oxymatrine, which have demonstrated anti-inflammatory effects through inhibition of NF-κB signalling, reduction of IL-4 and IL-13 production, and inhibition of mast cell degranulation — directly addressing the Th2-skewed immune response that drives atopic eczema. Huangbai (Phellodendron amurense) contains berberine, which has antibacterial activity against Staphylococcus aureus — the pathogen most commonly associated with eczema flares through skin colonisation and superantigen production. Shechuangzi (Cnidium monnieri) contains osthole, which has antihistaminic and anti-inflammatory properties. The warm temperature of the fumigation-washing solution enhances skin permeability, facilitating penetration of the active compounds into the dermis. Daily application produces a sustained local anti-inflammatory and antipruritic effect that complements the systemic action of the oral herbal formula and the barrier-repairing effect of the tacrolimus and emollient.

3. The Neuroimmune Dimension of Chronic Eczema: Why Emotional Regulation Is a Medical Intervention

The relationship between psychological stress and eczema exacerbation is one of the most consistently reported findings in dermatological research, and one of the most consistently undertreated in clinical practice. Psychological stress activates the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, producing cortisol and catecholamine release that dysregulates the Th1/Th2 immune balance toward Th2 dominance — the same immune skewing that drives atopic eczema. Stress also directly activates cutaneous mast cells and sensory nerve fibres through substance P and nerve growth factor, producing neurogenic inflammation and pruritus that are independent of the adaptive immune response. In TCM, emotional dysregulation — particularly anxiety and frustration — produces Liver Qi stagnation that transforms into Heat, which combines with the existing Damp-Heat pattern to intensify the skin inflammation. The lifestyle guidance to avoid emotional stress and maintain emotional equanimity is not a soft recommendation — it is a targeted intervention against a documented neuroimmune mechanism that perpetuates the eczema cycle. In this patient, the nocturnal pruritus — which is characteristically worsened by the autonomic shift toward parasympathetic dominance during sleep — was one of the first symptoms to improve, reflecting the combined effect of the antihistamine, the Damp-Heat-clearing herbal formula, and the reduction in stress-driven neurogenic inflammation as the patient's sleep quality began to restore itself.

How CMCS Shanghai Coordinated This Case

CMCS Shanghai supported Ms. Mitchell from initial consultation through six-month follow-up, including: priority appointment coordination with Dr. Li Bin at Yueyang Hospital with bilingual review of all prior dermatology records and treatment history; bilingual interpretation throughout all TCM four-examination consultations, pattern differentiation discussions, and integrative treatment planning sessions; coordination of allergen panel, full blood count, and liver and renal function testing with bilingual results communication and clinical summary for the patient's dermatologist in the UK; bilingual pharmacy support for herbal decoction preparation, fumigation-washing preparation instructions, and concurrent topical medication schedule; bilingual skin care and dietary guidance with written instructions provided in English; monthly symptom and skin condition monitoring with bilingual progress summaries communicated to the patient's GP overseas; and six-month follow-up comprehensive dermatological summary provided to the patient's overseas medical team.

For international patients with chronic eczema, psoriasis, urticaria, acne, or other inflammatory skin disorders resistant to conventional treatment, Dr. Li Bin's team at Yueyang Hospital offers a clinically rigorous, evidence-informed integrative approach — combining classical herbal prescription, external herbal therapy, acupuncture, and structured skin care to achieve durable remission without corticosteroid dependence. CMCS ensures that expertise is accessible: in the patient's language, with overseas physicians informed at every step, from the first integrative consultation through long-term follow-up.

This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.