Getting to the Root of Eczema - Article

Effective eczema treatment side-lined with loss of patient choice

Charles Buck - Sept 2020

Chinese medicine (CM) was almost unknown in the UK in 1989 when doctors at London’s Great Ormond Street Hospital published trials on over 1000 eczema patients of a ten-herb brew called Zemaphyte.

Best practice in CM tailors treatment to each individual - a process that requires a long specialist training. The dermatologists did not have this, so a fixed formula was used and the results published in the British Medical Journal. These trials showed that over 70% of patients benefited. Standard care for eczema is often unsatisfactory, so there was excitement from patients and from the medical world.

Stumbling across this treatment, and knowing nothing of the sophistication of China’s medical tradition, the medics imagined that one herb must be giving the effect, the rest must be hokum. A single substance in there might be identified and marketed as a drug - in the medical mind a drug is by definition a single chemical. To find out what that chemical was the Zemaphyte formula was sent for analysis.

Meanwhile, patients found out. Thousands flocked to the handful of Chinese herb clinicians practising at the time. I was prescribing 3-5 tons of CHMs annually for eczema and for other skin problems - and getting results. Unfortunately, the ongoing lack of state regulation also allowed untrained pretenders to step in to meet the demand.

Genuine CHM physicians relied on arduous training that teaches how to examine each case individually and skilfully match the treatment to the person.

Angry, red and inflamed skin needs more herbs to clear heat, rashy-itchy patches needs herbs for wind, if there is pus then herbs for fire-toxins are included. Skin that is weepy and worse in the elbows and knees needs more herbs for dampness, and if the skin is dry and cracked then herbs to moisten the skin or improve blood micro-circulation are given.

A mix of all these things is often best and the practitioner’s expertise is about getting the balance right. As treatment progresses things change and so the prescription is altered, the doses tapered off and eventually stopped. Many then remain clear for months or years, some only reappear decades later.

The medical world found this glimpse into a parallel medical universe all a bit strange. Used to seeing things simply as our scientific medicine versus those unscientific folk remedies, in CM they had stumbled across something far more sophisticated than they expected. Ironically, it was in standard dermatology that things were simple - there is an inflammatory state called eczema that you hit with steroid creams. There is no reason to consider the wider clinical picture as was routine for Chinese clinicians.

For patients this new kid on the block meant there was now a viable choice, something from a deeply rooted culture and something with evidence of effectiveness.

The scientists studying the research formula reported back saying they’d been unable to identify the active ingredient, it really was a package of substances working together to correct all the things that go wrong in eczema. Some herbs had antihistamine effects, some were anti-inflammatory, some cleared trapped fluids, some helped skin repair and local microcirculation.

Where the herb tradition taught that eczema consisted of various mixes of wind, dampness, heat, fire toxicity, poor skin nutrition. Pharmacology said it was allergy, exudate, inflammation, secondary infection and impaired microcirculation.

You say tomato - I say tou mei dou…!

The formula really was a coherent strategy that made sense in terms of China’s traditional theories as well as from the viewpoint of modern pharmacology. But the doctors were disappointed; patenting a new treatment requires finding a single novel chemical entity.

No matter how beneficial for patients, with intellectual property rules as they are the treatment could not get a medicines license. So it was shelved.

The CHM people, however, were still going strong!

Now the media reporting changed and stories appeared telling people that CHM was risky. They pointed to the 1% of the trial patients who had briefly raised liver enzymes, something that is normal in the population anyway.

Then, serious adverse events were reported from a slimming clinic in Belgium where doctors with zero training in CHM injected homemade drug cocktails, adding in a Chinese herb they had mis-identified.

A tragic incident certainly, but one that should properly be classified as misadventure or worse, as malpractice.

CHM clinicians were also accused of cheating by using steroids treatments.

A few dubious clinics had mistakenly imported an over-the-counter (OTC) cortisone cream available in pharmacies in China - no mention of herbs on the packaging whatsoever. Similar creams are also available OTC from UK Chemists shops. What was presented as a health fraud was an error made by some low-grade UK clinic - people who were unable to read the packaging of the product.

In this way doctors and patients were persuaded that Chinese medicine was risky and disreputable. The real CM professionals, those with degree training and an ethical outlook, had an excellent safety record and did not use dubious products.

Media narratives said the Government should “clamp down” on unregulated practice. In truth, acupuncturists and CM clinicians have lobbied government for decades to put statutory controls in place to stop untrained people from practising and have been repeatedly refused – even when a 2-year formal parliamentary investigation recommended regulation.

The losers in all the medical politics are the patients who are led away from a viable, safe and evidence-based healthcare choice, not only for eczema but many other conditions poorly served by modern medicine.

Charles Buck is a practitioner, author and educator of Chinese medicine with four decades experience based in Chester UK