PRURIGO NODULAR: UMA PERSPETIVA INTEGRATIVA COM A MEDICINA TRADICIONAL CHINESA
PRURIGO NODULAR: UNA PERSPECTIVA INTEGRADORA CON LA MEDICINA TRADICIONAL CHINA
REGISTRO DOI: 10.69849/revistaft/cs10202508262003
Vanessa Valente Chong1
Fahad Kabeer2
Carlos Aurélio da Silva Pereira3
David Rodrigues Rio4
Dilma Barros Cordeiro5
Sílvia Bernardes Pacheco Marques6
Abstract
Nodular prurigo, as a dermatological pathology that is difficult to treat clinically, raises pertinent questions and invites reflection on the limits of conventional medicine and the need for more integrative therapeutic approaches. This article proposes a reflection on the contribution of Traditional Chinese Medicine (TCM) in understanding and addressing nodular prurigo, not just as a physical pathology, but as a manifestation of internal, physical and emotional imbalances (Maciocia, 2015). The choice of topic is justified by the growing demand for therapies that consider the subject holistically, in a context of valuing complementary and integrative medicines (WHO, 2013).
The main aim of this article is to discuss how TCM principles – such as Qi imbalance, Liver stagnation and Blood heat – offer a functional approach to the treatment of chronic nodular pruritus. The methodology is based on a bibliographical analysis of an interpretative nature, based on classic and contemporary sources (Kaptchuk, 2000; Unschuld, 2003), exploring possible interfaces with the paradigm of conventional medicine.
The reflection is based on the idea that illness, in TCM, is both a bodily and energetic expression, with the skin being a mirror of internal states. With this, an expanded model for reading illness is proposed, which integrates knowledge and recognizes the complexity of the human being.
The conclusion is that TCM offers a relevant epistemological contribution, opening up possibilities for more person-centered care that is attuned to the multiple dimensions of the chronic illness experience.
Keywords: Prurigo Nodularis; Integrative Perspective; Traditional Chinese Medicine; Conventional Medicine.
Resumo
O prurigo nodular, enquanto patologia dermatológica de difícil tratamento clínico, levanta questões pertinentes e convida à reflexão sobre os limites da medicina convencional, e a necessidade de abordagens terapêuticas mais integrativas. Este artigo propõe uma reflexão sobre a contribuição da Medicina Tradicional Chinesa (MTC) na compreensão e abordagem do prurigo nodular, não apenas como patologia física, mas como manifestação de desequilíbrios internos, físicos e emocionais (Maciocia, 2015). A escolha do tema justifica-se pela crescente procura de terapias que considerem o sujeito de forma holística, num contexto de valorização das medicinas complementares e integrativas (WHO, 2013).
O objetivo central deste artigo é discutir como os princípios da MTC como o desequilíbrio do Qi, a estagnação do Fígado e o calor no Sangue oferecem uma abordagem funcional ao tratamento do prurido crónico nodular. A metodologia assenta numa análise bibliográfica de natureza interpretativa, com base em fontes clássicas e contemporâneas (Kaptchuk, 2000; Unschuld, 2003), explorando interfaces possíveis com o paradigma da medicina convencional.
A reflexão desenvolve-se a partir da ideia de que a doença, na MTC, é simultaneamente expressão corporal e energética, sendo a pele um espelho dos estados internos. Com isso, propõe-se um modelo ampliado de leitura do adoecer, que integra saberes e reconhece a complexidade do ser humano.
Conclui-se que a MTC oferece um contributo epistemológico relevante, abrindo possibilidades para um cuidado mais centrado na pessoa e sintonizado com as múltiplas dimensões da experiência de doença crónica.
Palavras-chave: Prurigo Nodularis; Perspetiva Integrativa; Medicina Tradicional Chinesa; Medicina Convencional.
Resumen
El prurigo nodular, como patología dermatológica difícil de tratar clínicamente, plantea cuestiones pertinentes y invitas a reflexionar sobre los límites de la medicina convencional y la necesidad de enfoques terapéuticos más integradores. Este artículo propone una reflexión sobre la contribución de la medicina tradicional china (MTC) a la comprensión y el tratamiento del prurigo nodular, no solo como una patología física, sino como una manifestación de desequilibrios internos, físicos y emocionales (Maciocia, 2015). La elección del tema se justifica por la creciente demanda de terapias que consideren al sujeto de manera holística, en un contexto de valoración de las medicinas complementarias e integradoras (OMS, 2013).
El objetivo principal de este artículo es discutir cómo los principios de la MTC como el desequilibrio del Qi, el estancamiento del hígado y el calor de la sangre ofrecen un enfoque funcional para el tratamiento del prurito nodular crónico. La metodología se basa en un análisis bibliográfico de carácter interpretativo, basado en fuentes clásicas y contemporáneas (Kaptchuk, 2000; Unschuld, 2003), que explora posibles interfaces con el paradigma de la medicina convencional.
La reflexión se basa en la idea de que, en la medicina tradicional china, la enfermedad es una expresión tanto corporal como energética, y la piel es un espejo de los estados internos. Con esto, se propone un modelo ampliado para interpretar la enfermedad, que integra conocimientos y reconoce la complejidad del ser humano.
La conclusión es que la medicina tradicional china ofrece una contribución epistemológica relevante, que abre posibilidades para una atención más centrada en la persona y en sintonía con las múltiples dimensiones de la experiencia de la enfermedad crónica.
Palabras clave: Prurigo nodular; perspectiva integradora; medicina tradicional china; medicina convencional.
1. Introduction
Prurigo nodularis (PN) is a chronic skin disorder marked by intensely pruritic, often excoriated nodules that disrupt sleep, mood, and day-to-day functioning. Its multifactorial origins and frequent refractoriness to therapy make it a persistent clinical challenge in dermatology (Ständer et al., 2020).
Biomedically, PN is susteined by a self-perpetuating itch–scratch cycle with contributions from immune, neural, and psychosocial drivers. Standard treatments topical or intralesional corticosteroids, immunomodulators, antihistamines, phototherapy, and newer biologics such as dupilumab can help, yet a substantial proportion of patients remain symptomatic, especially when psychosomatic dimensions are prominent (Ständer et al., 2020; Weisshaar & Szepietowski, 2016).
Traditional Chinese Medicine (TCM) is often considered in this context because it combines reported clinical effects with a framework that views health as an interplay of body, mind, and environment (Kaptchuk, 2000). In TCM, cutaneous disease is interpreted as an external sign of internal imbalance, offering an interpretive lens that extends beyond purely organic explanations. This paper explores how TCM fundamentals might enrich the understanding of PN by articulating physiological, emotional, and energetic dimensions together.
2. Definition and Clinical Features
PN is a chronic pruritic dermatosis defined by multiple hyperkeratotic, dome-shaped nodules often porcelain-white and frequently larger than one centimeter arising on a background of thickened skin and dermal fibrosis driven by the itch–scratch cycle.
Clinically, patients report relentless itch accompanied by burning, stinging, and pain, with marked effects on appearance, daily functioning, and sleep. PN is also linked to higher rates of mental health comorbidity and substantial reductions in quality of life (Wong & Yen, 2022).
3. Epidemiology and Risk Factors
PN is uncommon but increasingly recognized. Global prevalence estimates remain limited, yet population-based analyses point to a higher burden among women, and frequent xerosis cutis. Two broad clinical phenotypes are often distinguished: early-onset atopic PN and late-onset non-atopic backgrounds and include metabolic disease alongside diverse dermatologic and psychological comorbidities.
Chronic pruritus the cardinal symptom commonly accompanies systemic, dermatologic, neurologic, and psychiatric disorders, and may also present without a clearly identifiable cause. The morbidity burden is substantial: impaired sleep, psychological distress, increased healthcare use, and disruptions to work and social life.
These patterns reinforce the need for integrative approaches aligned with patient-specific drivers.
4. Pathophysiology
PN entails immune dysregulation, neurocutaneous changes, and pruriceptive amplification. Inflammatory cytokines, proteases, and alterations in opioid signaling contribute to a self-reinforcing itch scratch cycle. Comorbidities neurological disease, malignancy, chronic kidney disease, endocrine and psychiatric disorders, allergic and immunologic conditions, infections, and iatrogenic/factitious dermatitis can intersect with onset or persistence (Shao et al., 2023).
Proposed cascades include tetrahydrobiopterin-mediated induction of cathepsin S, activation of protease-activated receptor-2 (PAR‑2), and keratinocyte release of pro–TNF‑α via the p38 MAPK pathway, with downstream NF‑κB activation that amplifies cutaneous inflammation (Shao et al., 2023).
Clinically, persistent scratching damages the barrier, predisposes to secondary infection, and sustains neurogenic inflammation. Peripheral nerve fibers are repeatedly activated, prompting cytokine release and upregulation of nerve growth factor, which promotes sensitization and sprouting of cutaneous nerves; dermal nerve proliferation likely contributes to nodule formation and refractory itch (Shao et al., 2023).
5. Traditional Chinese Medicine Overview
TCM is a long-standing medical system, organized around the dynamic balance of yin and yang and the Five Phases, with illness seen as disruption of systemic harmony. Classical texts including the Nan Jing, Ling Shu, Su Wen, Shang Han Lun, and Jin Gui Yao Lue laid theoretical and practical foundations for diagnosis and treatment.
In clinical work, TCM views health as the interplay of body, mind, and spirit (Wu & Dong, 2021). Practitioners integrate the Four Examinations: inspection, listening/smelling, inquiry, and palpation with the Eight Principles and syndrome differentiation, supported by pulse and tongue assessment, to formulate individualized strategies.
6. Historical Context
TCM rests on its own epistemic framework, grounded in qi (vital energy), yin–yang dynamics, and the Five Phases (wu xing). These lenses conceive the human as an interconnected, adaptive system. In contrast to the reductionist models, TCM emphasizes balance across physical, emotional, environmental, and spiritual dimensions (Maciocia, 2015).
Within this framework, PN mapped onto categories such as feng chún chuāng (itching skin lesions), niú pí xuǎn (nodular dermatosis), and patterns of “persistent wind in the skin.” Pattern identification often implicates the Liver, Spleen, alongside pathogenic Wind, Dampness, Heat, and Blood Stasis (xuè yù).
7. Core Principles: Skin and Itch in TCM
The skin is governed by the Lung and functions as the body’s outer line of defense; surface changes reflect internal states. Pruritic skin disorders are commonly attributed to patterns such as Heat in the Blood, invasion of external Wind, Liver qi constraint, and Yin deficiency which can drive itching, inflammation, and nodule formation (Flaws & Finney, 2001).
Treatment targets the root: acupuncture and moxibustion combined with tailored herbal formulas, diet, and lifestyle shifts to re-harmonize qi and organ systems, strengthen defense, and reduce itch propensity (Chen, 2017). PN is often interpreted as lingering or “toxic” Heat entangled with emotional constraint, surfacing as persistent pruritus and nodules.
8. Chronic Pruritus and PN: The Conventional Medical View.
From a Western perspective, PN comprises hypertrophic, intensely pruritic nodules sustained by a self-perpetuating itch–scratch cycle with immune, neural, and psychosocial drivers (Ständer et al., 2020).
Management includes corticosteroids, immunomodulators, antihistamines, phototherapy, and, biologics such as dupilumab, yet many patients remain symptomatic, particulary when psychosomatic dimensions are salient (Ständer et al., 2020; Weisshaar & Szepietowski, 2016).
9. Morphological aspects
PN typically presents with multiple firm, hyperkeratotic nodules on the arms, legs, and trunk. Lesions often symmetrical and most evident on extensor surfaces.
Clinical recognition relies on distribution, lesion morphology, and history of chronic itch and scratching.
10. Etiology and Pathogenesis according to TCM
PN is viewed as the result of long-standing internal disharmony wherein pathogenic Wind, Dampness, and Heat disrupt the movement of qi and xue. Common constellations include qi and Blood stagnation, Damp-Heat accumulation, and Yin deficiency with Empty Heat imbalances that surface as pruritic nodules as the body attempts to seeks to vent internal pathogens.
Blood and Yin deficiency permit endogenous Wind and pathogenic Fire to stir in the skin, driving relentless itch and nodule formation (Zhou et al., 2019; Chen, 2017). Emotional strain constrains Liver qi, which can transform into Internal Heat; rising Liver Fire then consumes Yin and agitates Internal Wind, manifesting as persistent pruritus (Liu, 2019). Spleen deficiency fosters Dampness and Phlegm. Phlegm that obstructs the channels and deepen inflammation (Zhang, 2021).
11. Diagnostic Framework for Prurigo Nodularis in TCM
Diagnosis follows through syndrome differentiation (bian zheng), using the Four Examinations. While PN, anchors the biomedical context, treatment is guided by the underlying pattern of disharmony rather than the disease alone. Common patterns include:
a) Wind-Heat in the skin;
b) Wind-Dryness with Blood Deficiency;
c) Liver qi stagnation with Heat;
d) Spleen deficiency with Damp Accumulation;
e) Blood and Yin deficiency with Empty Heat;
f) Phlegm and Blood stasis.
These patterns may coexist or shift over time, requiring phased, individualized care (Wang, 2018).
12 Differentiation of Syndromes
Because PN’s drivers are heterogeneous, a universally effective therapy is elusive. In TCM terms, disease evolution reflects internal Heat, Toxin, and Stasis disrupting cutaneous function, often compounded by external Wind, Heat, and Dryness. Syndrome differentiation is dynamic and anchored in the patient’s constitution and stage, with pulse and tongue findings tracking shifts between excess and deficiency, and among Wind, Damp, Heat, Dryness, and Blood Stasis tendencies (Wong & Yen, 2022).
13. Pulse Diagnosis
Pulse diagnosis offers a nuanced window into systemic function, describing qualities of shape, strength, amplitude, density, and rate, helping to inform diagnosis, treatment, and prognosis (Wang et al., 2022; Wu & Dong, 2021). Assessment is performed at the radial artery on both wrists across three depths: superficial, middle, and deep at the classical cun, guan, and chi positions.
In PN, commonly observed pulse qualities include floating, wiry, thin, slippery, and occasionally rapid or irregular, depending on the dominant pattern (e.g., Wind–Heat, Damp-Heat, Blood/Yin deficiency).
14. Tongue Diagnosis
Tongue inspection assesses shape and color, alongside coating color, thickness, texture, and moisture. It provides visible markers of the overall state of qi in the Zang–fu organs.
Standardized photography enales computer- assisted analysis of color, texture, geometry, and fissures (Xie et al., 2022). A nine-feature schema commonly includes tongue shape, body color, coating color, coating thickness, coating texture, prickles, tooth-marking, sublingual vessel appearance, and ecchymosis, with adjudication by a senior expert when assessors disagree (Chen et al., 2022).
15. Chinese Herbal Medicine in the Treatment of Prurigo Nodularis
Herbal prescriptions are selected according to the patient’s pattern and adjusted as the presentation evolves.
a) Liver Qi Stagnation with Heat – Long Dan Xie Gan Tang (Zhou, 2020).
b) Damp-Heat in the Channels – Er Miao San or San Ren Tang (Li, 2018).
c) Blood and Yin Deficiency with Empty Heat – Zhi Bai Di Huang Wan (Wang, 2016).
d) Spleen Deficiency with Phlegm-Damp – Shen Ling Bai Zhu San (Chen, 2017).
e) Phlegm and Blood Stasis Obstructing the Channels – Er Chen Tang with Tao Hong Si Wu Tang (Scheid & Bensky, 2009).
Formulas are frequently modified adding or subtracting herbs to target pruritus, clear toxin, move Blood, or protect Yin so that treatment remains closely aligned with the patient’s changing pattern and clinical course.
16. Acupuncture and moxibustion in PN
Acupuncture is used to disperse Wind and Heat, move qi and Blood, and tonifies deficiency. It is often paired with moxibustion to modulate immune activity, and calm itch. Point selection combines local and distal sites to pattern (Liu, 2019).
Commonly used points: LI11 (Quchi), SP10 (Xuehai), BL17 (Geshu), LI4 (Hegu), ST36 (Zusanli), LR3 (Taichong) (Zhang, 2020).
Pattern-based point selection
- Liver Qi Stagnation with Heat – LR3, GB34, LI4, LI11, SP10 (Wang, 2017).
- Damp-Heat in the Channels – SP9, ST44, LI11, BL40, SP10 (Liu, 2019).
- Blood and Yin Deficiency with Empty Heat – KI3, SP6, BL23, PC7, LR8 (Chen, 2016).
- Spleen Deficiency with Phlegm-Damp – ST36, SP9, BL20, CV12, ST40 (Tang, 2015).
Moxibustion is especially helpful for Spleen–Kidney Yang deficiency or chronic presentations with internal Cold. Indirect or direct moxa (Artemisia vulgaris) is commonly applied at:
- CV4 (Guanyuan), CV6 (Qihai), ST36 (Zusanli), BL23 (Shenshu) (Li, 2021).
Heat-sensitive moxibustion at DU4 (Mingmen) has been reported to modulate immune responses and improve microcirculation, current evidence remains remains preliminary and heterogeneous, warranting larger, well-controlled trials (Li et al., 2022).
17. Safety and Adverse Events
Safety monitoring is essential. Expected adverse events include localized burns or irritation from moxibustion, dizziness or vasovagal reactions with acupuncture, and rare allergic or gastrointestinal effects from herbs. Potential herb–drug interactions should be reviewed (e.g., formulas containing Phellodendron or Sophora may interact with certain medications). Contraindications and cautions include pregnancy, bleeding disorders or anticoagulant use (for techniques involving bleeding or strong moving herbs), uncontrolled infection, and poor wound healing.
18. Integrative Evidence and Research Gaps
Evidence specific to PN remains limited compared with other dermatoses such as psoriasis or urticaria; extrapolation should be explicit and cautious. Priorities for PN-focused research include randomized trials with pruritus intensity (e.g., VAS/NRS) as the primary endpoint; patient-reported outcomes (DLQI, HADS) as secondary endpoints; transparent intervention reporting (TIDieR/STRICTOM); standardized moxibustion dose and point protocols; and adequate follow-up to assess durability and relapse.
19. Dietary Therapy
In TCM, diet and lifestyle habits are considered essential components of the treatment of any chronic condition. PN is understood as the result of persistent internal imbalances and therefore requires a continuous and personalized approach that includes diet and the management of emotions and lifestyle.
In general, it is advisable to adopt a diet that promotes the strengthening of the spleen and stomach, avoiding factors that generate heat or humidity. Natural, fresh, and easily digestible foods should be favored.
Recommended foods:
a. Lightly cooked whole grains (brown rice, barley).
b. Sweet and neutral-tasting vegetables (pumpkin, carrots, turnips, broccoli).
c. Fruits that are not very sweet and not acidic (pears, cooked apples, prunes).
d. Light proteins such as white fish, tofu, and legumes.
e. Mild teas with purifying properties such as chrysanthemum or mint tea. (Zhou, 2018).
Foods to avoid:
a. Spicy, fried, fatty, and processed foods.
b. Coffee, alcohol, soft drinks, and refined sugar.
c. Excessive seafood and red meat, especially in Heat or Damp-Heat patterns. (Chen, 2017).
In patterns with Heat and intense itching, foods with properties that “cool the Blood” and eliminate toxins can be included, such as cucumber, watermelon, mung beans (lu dou), and green tea (in moderation).
In cases of Yin deficiency and dry skin, nutritious and moisturizing foods such as lotus seeds, black sesame seeds, boiled egg whites, and light soups are recommended.
20. External treatments and others
a) Moist compress or washing with herbal decoction herbs such as Purslane (Ma Chi Xian), Sophora Flavescens (Ku Shen) or Phellodendron (Huang Bai) can be used, applied directly to the area to be treated to eliminate Heat, dry Dampness, relieve itching, and promote healing of lesions. (Bensky, Clavey; 2004).
b) Use of the Fire Needle Acupuncture technique – the nodules can be punctured 2-3 times in order to warm and activate the meridians, activate blood flow, and remove stasis. (Tong; Zhang; Chen – Observations on the Efficacy of Fire Needling plus Moxibustion in Treating Prurigo Nodularis, Shanghai Journal of Acupuncture and Moxibustion; (12): 1090-1092, 2016).
c) Bloodletting with cupping therapy – perform bloodletting around the nodules or at the Shu points on the back, followed by cupping to drain the heat and remove blood stasis. (Filshie, White, Cummins; 2016).
21. Lifestyle and Emotions
Emotional management is particularly important in cases of PN, since stress, anger, and frustration directly affect the Liver and Heart, aggravating itching.
Recommendations:
a. Practice moderate exercises such as Qi Gong, Tai Chi, or daily walks to promote the free flow of Qi and relax the mind.
b. Relaxation techniques such as meditation, abdominal breathing, and guided visualization.
c. Avoid excessive anxiety and stress, as they significantly aggravate this condition.
d. Maintain regular sleep and meal times, respecting the body’s rhythms.
e. Avoid scratching the lesions or washing with hot water to prevent secondary infections; apply cold compresses with chamomile or calendula infusions as an alternative (Liu, 2020).
f. Wear loose, lightweight cotton clothing to avoid friction and irritation.
g. The patient’s involvement in the recovery process is essential. Cultivating a calm, patient, and confident attitude promotes therapeutic success and reduces the incidence of recurrence.
22. Combining TCM with Western Medicine
The combination of Traditional Chinese Medicine (TCM) with Western medicine has shown promise in the treatment of various dermatological conditions, such as psoriasis and chronic urticaria. Established therapeutic interventions for psoriasis often include topical corticosteroids, vitamin D derivatives, calcineurin inhibitors, systemic phototherapy, acitretin, cyclosporine A, immunosuppressants, and biological agents.
However, these treatments are often associated with safety concerns and substantial costs. TCM, by contrast, offers a long history of clinical use and is supported by systematic reviews indicating its effectiveness. It acts by modulating inflammatory pathways, including the interleukin (IL) network and the IL-23/IL-17 axis.
The Jueyin prescription, composed of seven herbal constituents, was demonstrated to be both safe and effective in patients with early-stage psoriasis. In chronic urticaria, the pathological mechanism remains unclear; the condition is generally considered a manifestation of allergic reactions causing localized capillary congestion and inflammation.
TCM approaches include treatments addressing exogenous wind evils, disharmony of camp and health, diet, and emotional factors leading to liver-yang transforming wind and blood deficiency generating wind.
Guizhi Decoction and Xiaofeng powder are frequently used to clear heat, dispel wind, and nourish blood. A meta-analysis of 17 trials involving 617 patients found that TCM combined with acupuncture achieved higher effective rates than Western medicine alone. Guizhi Decoction may confer greater benefit than Xiaofeng powder, although more research is needed. When combined with acupuncture, the total effective rate surpassed that of loratadine or cetirizine, but was not significantly different from mizolastine, suggesting mizolastine might be preferable if Western medicine is included.
Symptom improvement was also documented. Understanding how to integrate TCM into Western medical practice requires clinical skill to determine the appropriate context for herbal interventions. The “disease-pattern combination” methodology assists in selecting drug-herb combinations that achieve mutual enhancement.
Concepts such as “whole food herbal medicine” underscore the need to control herb dosage and consider cost-effectiveness. A stepwise approach enables medical doctors to gain proficiency in TCM, facilitating its incorporation into patient care (Sun et al., 2020).
Table 1- Clinical Summary: PN Patterns and treatments
| Pattern (TCM) | Key Symptoms | Tongue/Pulse | Core Points | Base Formula | Notes (Moxa/Diet) |
| Liver qi stagnation with Heat | Intense itch; red nodules; irritability; worsens with stress/spicy foods | Tongue red with red edges; pulse wiry, slightly rapid | LR3, GB34, LI4, LI11, SP10 | Long Dan Xie Gan Tang | Avoid alcohol/spicy; consider DU4 moxa only if Yang-deficient elsewhere |
| Damp-Heat in channels | Erythema, oozing or swelling; heavy sensation | Tongue red with yellow coat; pulse slippery, rapid | SP9, ST44, LI11, BL40, SP10 | Er Miao San / San Ren Tang | Light diet; avoid greasy/sweet foods |
| Blood & Yin deficiency with Empty Heat | Dry skin; chronic itch; insomnia; night sweats | Tongue red, scant coat; pulse thin, rapid | KI3, SP6, BL23, PC7, LR8 | Zhi Bai Di Huang Wan | Gentle warming moxa if cold signs; nourish Yin |
| Spleen deficiency with Phlegm‑Damp | Heaviness; fatigue; thicker nodules | Tongue pale with greasy coat; pulse slippery or soft | ST36, SP9, BL20, CV12, ST40 | Shen Ling Bai Zhu San | Dietary regulation; reduce damp‑producing foods |
| Phlegm with Blood stasis | Firm, long‑standing nodules; dark discoloration | Tongue dark/purple; pulse choppy or wiry | Local ashi + SP10, BL17, LI4 | Er Chen Tang + Tao Hong Si Wu Tang | Add moving/herbs cautiously with anticoagulants |
23. Challenges and Considerations
The integration of TCM with Western medicine in managing PN necessitates attention to several challenges. A key consideration is the cultural and linguistic diversity among patients, which can hinder effective communication and understanding of TCM treatments (Wong & Yen, 2022).
Educating both clinicians and patients about TCM principles and practices is essential to bridge this gap. Limited high-quality clinical trials evaluating TCM interventions for PN pose another significant barrier. Most existing studies have small sample sizes and lack rigorous study designs, thereby restricting the capacity to draw definitive conclusions about efficacy and safety (Wu & Dong, 2021).
There is a pressing need for well-designed, large-scale randomized controlled trials to establish evidence-based guidelines for TCM in PN management (Sun et al., 2020). Ethical concerns, including informed consent and patient autonomy, must be addressed carefully, particularly when considering interventions such as acupuncture, moxibustion, and herbal medicines that may carry risks or cultural stigmas.
Documenting adverse effects systematically and ensuring open, transparent patient-practitioner communication are essential components of ethical care. Overcoming these challenges is critical for the successful implementation of an integrative approach combining TCM and Western medicine, ultimately enhancing therapeutic options and outcomes for patients with PN.
24. Bridges and tensions between knowledge: TCM and Conventional Medicine
The articulation between TCM and Western medicine is still marked by epistemological gaps. While conventional medicine requires measurable empirical evidence, TCM operates with concepts that escape classical analytical logic, such as the movement of Qi or the harmonization of the Zang-Fu organs.
However, there is a growing number of studies seeking to establish functional correspondences between both approaches, such as the influence of acupuncture on neuroimmune modulation (Huang et al., 2019) or the anti-inflammatory effect of classical formulas such as Xiao Feng San (Zhou et al., 2021).
Despite structural differences, there is room for convergence. Both recognize the role of the mind in chronic disease and the importance of treatments that consider subjective well-being. The challenge lies in avoiding reductionism, respecting the theoretical foundations of each tradition, and paving the way for more integrated clinical practices.
25. Discussion
This article allows us to understand PN not only as an isolated dermatological manifestation, but as the somatic expression of complex physiological and emotional imbalances. Traditional Chinese Medicine, by conceptualizing the skin as an extension of the Lung and a vehicle for expressing internal states, offers an interpretive model that goes beyond the mechanistic view of Western dermatology (Maciocia, 2015).
From this perspective, persistent itching can be seen as a sign of Heat in the Blood, resulting from repressed frustration, prolonged anxiety, or Stagnation of Liver Qi, often unidentified in conventional medical diagnoses.
This approach does not deny the existence of neurophysiological changes recognized by Western medicine, but proposes a complementary reading, allowing not only to broaden the diagnosis, but also to diversify therapeutic strategies.
While conventional medicine contributes objective diagnostic tools and validated pharmacological therapies, its approach tends to focus on the symptom (itching, lesion, inflammation) and isolated pathology, TCM seeks the underlying energy pattern. This interpretation not only enriches the understanding of the clinical picture, but also reorients the therapeutic approach: instead of merely suppressing symptoms, it seeks to rebalance the organism as a whole.
The integration of the two paradigms could promote a more sensitive approach to the complexity of human experience, especially in chronic and multifactorial diseases. However, the growing interest in integrative practices and preliminary data on the clinical efficacy of acupuncture, herbal medicine, and other TCM practices in relieving chronic itching and inflammation, as well as improving quality of life (Huang et al., 2019; Zhou et al., 2021), indicate a fertile field for interdisciplinary collaboration.
Thus, this article advocates a model of care that values the diversity of knowledge and the wholeness of the person, overcoming the dichotomies between body and mind, science and tradition.
26. Conclusion
The reflection developed here points to the relevance of integrating the fundamentals of Traditional Chinese Medicine into the understanding and approach to prurigo nodularis. Far from offering a single or definitive solution, TCM offers a broader view of the disease process, which values the totality of the subject, including the energetic, emotional, and environmental dimensions, valuing the subjective and relational dimensions of the disease, and proposing a symbolic reading that complements conventional analysis.
The functional model of TCM allows us to identify patterns of imbalance that remain invisible to conventional logic, thus broadening our understanding of human suffering. This approach is particularly relevant in chronic and multifactorial pathologies, such as prurigo nodularis, where conventional treatments often fail to provide sustained relief.
Although it is not intended to replace the advances of conventional medicine, it is recognized that this integration can enrich care, especially in complex and refractory cases. To this end, it is necessary to build epistemological bridges that are capable of respecting the specificities of each tradition without resorting to reductionism.
A truly person-centered medicine requires openness to dialogue between paradigms and the appreciation of plurality of knowledge. In this sense, TCM represents not only a set of therapeutic techniques, but also a worldview that can contribute significantly to rethinking healthcare in times of increasing clinical and existential complexity.
It can therefore be concluded that an integrative and epistemologically respectful approach between TCM and conventional medicine can contribute to a more humane, person-centered medicine that is sensitive to the complexity of chronic disease. Future research should explore mixed research methodologies capable of capturing both the clinical effects and the subjective transformations generated by these practices.
References
Bensky D., Clavey S., Stöger E. Chinese Herbal Medicine Materia Medica, Eastland Press, 2004.
Chen, X. Princípios Dietéticos para Doenças de Pele. Xangai: Shanghai University Press, 2017.
Chen, J., Yang, J., Qin, Y., et. all. (2022). Tongue features of patients with granulomatous lobular mastitis.
DermNet NZ. Nodular Prurigo https://dermnetnz.org/topics/nodular-prurigo
Deng, W., Fu, M., & Huang, J. (2024). Mechanism of pruritus ani lotion combined with Huajiao-Gancao-Bingpian oil for pruritus ani treatment based on network pharmacology and molecular dynamics.
Flaws, B., & Finney, C. The Dermatology Handbook: Practical Diagnosis and Treatment with Chinese Medicine. Blue Poppy Press, 2001.
Filshie J., White A., Cummins M. Medical Acupuncture – A western scientific approach, Elsevier, 2016.
Huang, Y., Wang, X., & Li, J. Effects of acupuncture on pruritus: A systematic review. Journal of Integrative Medicine, 17(5), 326–335, 2019.
Kaptchuk, T. J. The Web That Has No Weaver: Understanding Chinese Medicine. McGraw-Hill, 2020.
Maciocia, G. The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs, 2nd ed. Churchill Livingstone, 2015.
Maria Leis, P., Fleming, C.W., Lynde, C. Prurigo Nodularis: Review and Emerging Treatments. Skin Therapy Letter. 2021.
Lee, S. R., Kim, S., Park, C. E., et. all., (2019). Effect of Korean medicine as add-on therapy to phototherapy for psoriasis: Two case reports.
Li, H. Fitoterapia Chinesa Clínica: Guia para Prática Médica. Nanjing: Nanjing University Press, 2018.
Li, J. Diagnóstico Diferencial em Dermatologia Tradicional Chinesa. Pequim: China Medical Science Press, 2020.
Li, J. Moxabustão Clínica e suas Aplicações. Pequim: People’s Health Publishing House, 2021.
Liu, Y. Acupuntura Clínica para Dermatologia. Xangai: Shanghai Science and Technology Press, 2019.
Liu, Y. Psicossomática na Medicina Tradicional Chinesa. Nanjing: Jiangsu Traditional Medicine Press, 2020.
Lu, Z., Zhou, Q., Chai, S., et. all., (2022). Efficacy and safety of Chinese medicine combined with acupuncture in the treatment of chronic urticaria: A meta-analysis.
Tang, M. Fundamentos de Acupuntura Interna. Pequim: Traditional Medicine Publishing Group, 2025.
Tang, M. Patologias Digestivas na MTC. Pequim: People’s Medical Publishing, 2016.
Tong, D., Zhang Y., Chen, C. Observations on the Efficacy of Fire Needling plus Moxibustion in Treating Prurigo Nodularis, Shanghai Journal of Acupuncture and Moxibustion; (12): 1090-1092, 2016.
Shao, Y., Wang, D., Zhu, Y., Xiao, et. all., (2023). Molecular mechanisms of pruritus in prurigo nodularis.
Sun, X., Zhou, X., Wei, Y., et. all., (2020). Our Choice: study protocol for a randomized controlled trial for optimal implementation of psoriasis treatment by the integration of Chinese and western medicine.
Ständer, S., Zeidler, C., & Szepietowski, J. C. Prurigo nodularis: Diagnostic and therapeutic aspects. Journal of the European Academy of Dermatology and Venereology, 34(2), 223–231, 2020.
Unschuld, P. U. Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. University of California Press, 2023.
Wang, D. Guias Clínicos de Fórmulas Tradicionais Chinesas. Pequim: Zhongyi Keji Chubanshe, 2016.
Wang, D. Protocolos de Acupuntura Baseados em Padrões. Pequim: People’s Health Publishing House, 2017.
Wang, D. Dermatologia Chinesa: Etiologia e Tratamento. Xangai: East Medicine Press, 2018.
Wang, Y., Lu, H., & Hu, Z. (2022). High Frequency Ultrasound-Based Evaluation of Clinical Effect of Ephedra-Forsythia-Red Bean Decoction Addition and Subtraction Treatment of Psoriasis Vulgaris.
Weisshaar, E., & Szepietowski, J. C. Pathogenesis and management of chronic prurigo. Expert Review of Clinical Immunology, 12(8), 903–915, 2016.
Wong, L. S. & Yen, Y. T. (2022). Chronic Nodular Prurigo: An Update on the Pathogenesis and Treatment.
World Health Organization (WHO). WHO Traditional Medicine Strategy: 2014–2023. WHO Press, 2013.
Wu, D. & Dong, G. (2021). A Case of Prurigo Nodularis Treating by Acupuncture.
Zhang, L. Atlas Terapêutico de Pontos de Acupuntura. Pequim: Medical Illustration Press, 2020.
Wu, D. & Dong, G. (2021). A Case of Prurigo Nodularis Treating by Acupuncture.
Deng, W., Fu, M., & Huang, J. (2024). Mechanism of pruritus ani lotion combined with Huajiao-Gancao-Bingpian oil for pruritus ani treatment based on network pharmacology and molecular dynamics.
Wu, D. & Dong, G. (2021). A Case of Prurigo Nodularis Treating by Acupuncture.
Xie, J., Jing, C., Zhang, Z., Xu, J., Duan, Y., & Xu, D. (2022). Digital tongue image analyses for health assessment.
Zhang, L. Manual Clínico de Ervas Chinesas para Doenças de Pele. Cantão: Guangdong TCM University Press, 2021.
Zhou, F. Nutrição e Dietética na Medicina Chinesa. Xangai: Oriental Medicine Press, 2018.
Zhou, F. Farmacologia das Fórmulas Chinesas Tradicionais. Pequim: Beijing University of Chinese Medicine Press, 2020.
Zhao, Y. Fisiopatologia em Medicina Chinesa Tradicional. Pequim: China Press of Traditional Chinese Medicine, 2017.
Zhou, Y., Zhang, Y., & Li, X. Xiao Feng San for chronic urticaria: A meta-analysis of randomized controlled trials. Chinese Journal of Integrative Medicine, 27(4), 293–299, 2021.
Zhou, X. (2013). P03.04. How to Integrate Traditional Chinese Medicine Into a Western Medical Clinical Practice.
1Master student of TCM, Acupuncture and Moxibustion, at Jiangxi University of Traditional Chinese Medicine, Postgraduate degree in Traditional Chinese Medicine Geriatric Rehabilitation; Degree in Naturopathic Medicine (Nº0300104); Degree in Acupuncture (Nº0500216); Institution: Jiangxi University of Traditional Chinese Medicine China; Affiliation: Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine (China); Email: vanessa.chong06@gmail.com
2Master degree in TCM Dermatology. Institution: Jiangxi University of Traditional Chinese Medicine, China. Email: 1412950373@qq.com
3Postgraduate degree in Traditional Chinese Medicine. Institution: Atlântico Business School, Escola Superior de Negócios Atlântico. Email: aureliotrainer@gmail.com
4Postgraduate degree in Traditional Chinese Medicine. Institution: UMC – Universidade de Medicina Chinesa. Email: davidninrio@gmail.com
5Degree in Traditional Chinese Medicine. Institution: IMT- Instituto de Medicina Tradicional. Email: dilma.barros@gmail.com
6Postgraduate degree in Traditional Chinese Medicine Geriatric Rehabilitation. Institution: Chinarte. Email: silviabpmarques@gmail.com