What Can You Do About Chronic Itch? Integrative Western and Traditional Chinese Medicine Approaches to Finding the Real Cause (Part 2)

Q: What questions do physicians commonly ask patients with chronic itching?

A: During a consultation, physicians commonly ask the following:

1. Are you getting enough sleep?
2. Are your bowel movements regular?
3. Do you exercise regularly, especially activities that make you sweat?
4. Are you feeling relaxed, and do you have healthy ways to manage stress?
5. Have you noticed any factors that worsen or relieve the itching?

Q: How does TCM treat itching caused by poor sleep?

A: Treatment is tailored to the individual’s symptoms.

For patients with insufficient sleep, TCM practitioners may use calming herbs and minerals such as dragon bone (Long Gu), oyster shell (Mu Li), and mother-of-pearl (Zhen Zhu Mu). These substances are rich in calcium and are traditionally believed to help calm the nervous system.

If stress is a contributing factor, herbs such as Albizia bark (He Huan Pi) and Uncaria (Gou Teng) may be used to calm the mind and soothe the liver.

Daily intake of milk, yogurt, and black soybeans may also help improve sleep quality by providing calcium and magnesium.

Q: Is constipation related to itchy skin?

A: Constipation and skin conditions appear to be closely connected.

From a TCM perspective, patients with constipation may be treated with rhubarb root (Da Huang) to promote bowel movements and clear internal heat. Individuals with dry mouth and thirst may also benefit from gypsum (Shi Gao), while those with edema may be prescribed Yu Li Ren.

Research from Taiwan’s National Health Insurance Database found that individuals with constipation had a 2.31-fold higher risk of atopic dermatitis compared with those without constipation.

A Japanese study found that children who experienced constipation at age one had a 1.18-fold higher risk of developing atopic dermatitis by age three.

Another Taiwanese study showed that babies born to mothers who experienced constipation during pregnancy had a 1.26-fold higher risk of developing atopic dermatitis.

For individuals who stay up late regularly, foods such as mulberries and mung beans may help promote bowel regularity and clear internal heat.

Q: Can a lack of exercise make itching worse?

A: Individuals who spend most of their time in air-conditioned environments and rarely exercise may be treated in TCM with herbs that help release pathogens from the body’s surface, including:

• Ephedra (Ma Huang)
• Cinnamon twig (Gui Zhi)
• Schizonepeta (Jing Jie)
• Saposhnikovia root (Fang Feng)
• Duckweed (Fu Ping)

Duckweed is traditionally used to promote sweating, relieve itching, facilitate rash eruption, and reduce edema.

Duckweed powder can even be used as a plant-based alternative to whey protein made from milk or soybeans, making it suitable for vegetarians.

However, herbal therapy should be combined with regular exercise that induces sweating. Gentle stimulation of the lung meridian and bladder meridian may also be beneficial.

Q: Can stress make itching worse?

A: Absolutely. Stress is a well-recognized trigger for itching.

In TCM, treatment often focuses on soothing the liver and calming internal wind. Commonly used remedies include:

• Tribulus fruit (Bai Ji Li)
• Chai Hu Qing Gan Yin

Green tea and magnesium-rich foods may also be beneficial, including:

• Seaweed
• Turmeric
• Pumpkin seeds
• Sesame seeds
• Sunflower seeds
• Nuts

Individuals with nut allergies should avoid nuts.

Paying attention to situations that trigger itching can help physicians identify underlying causes and assist patients in avoiding aggravating factors.

Q: How should people with chronic itch care for themselves on a daily basis?

A: Many patients struggle with chronic itch for years and undergo repeated medical evaluations without finding a definitive cause. Therefore, a stepwise management strategy is recommended. Even when the underlying cause remains unclear, lifestyle modifications may significantly improve symptoms.

1. Learn relaxation techniques such as diaphragmatic breathing, prayer, or meditation.
2. Maintain a cool indoor environment, particularly at night.
3. Wear breathable cotton clothing to minimize skin irritation from sweat.
4. Avoid potential allergens and irritants, including dry environments, excessive cleansing, spicy foods, and alcohol.

Additional recommendations include:

• Taking warm baths for no more than 20 minutes.
• Using non-alkaline, fragrance-free cleansers.
• Applying moisturizers immediately after bathing to maintain skin hydration.

Q: What is the proper way to decoct Chinese herbal medicine?

A:

General Guidelines for Herbal Decoction
(Clay pots, ceramic cookware, or stainless steel pots are preferred. Avoid iron or aluminum cookware.)

1. Soak the herbs for 20 minutes before cooking to allow water absorption and facilitate extraction of active compounds.
2. First decoction:
   • Add 1,000 mL of water.
   • Bring to a boil over high heat for 5 minutes.
   • Simmer over low heat for 40–50 minutes.
   • Reduce to approximately 200 mL.
3. Second decoction:
   • Add 800 mL of water.
   • Bring to a boil over high heat for 5 minutes.
   • Simmer over low heat for 40–50 minutes.
   • Reduce to approximately 200 mL.
4. Combine both decoctions and divide into two doses, taken morning and evening.