Encrusted skin

Also snake body; snake scales; toad skin. Dry rough scaly hardened skin. It usually observed in emaciated patients with abdominal fullness and inability to eat.

Patterns

Blood vacuity and wind-dryness (血虚风燥 xuè xū fēng zào): The skin gradually turns gray, dry, rough, and scaly like the skin of a snake, lizard, or even crocodile. The scales are dense, dirty looking or gray white, and elevated at the edges. The scales are separated by white furrows that create a reticular appearance. Blood vacuity wind-dryness encrusted skin is most pronounced on the extensor side of the limbsbut can cover the whole body, although it rarely invades the face. It may be temporarily relieved in summer and worsens in winter. Occasionally there is itching and the skin may split at the joints, causing soreness. It is associated with dry mouth and pharynx, reduced sweating, pale tongue with little liquid and with white fur, and a forceless fine sunken pulse. This form of encrusted skin traditionally called snake body, snake scales, and snake skin.

Medicinal therapy: Nourish the blood and moisten the skin; enrich yīn and engender liquid. Use Blood-Nourishing Skin-Moistening Beverage (养血润肤饮 yǎng xuè rùn fū yǐn).

Blood heat and wind-dryness (血热风燥 xuè rè fēng zào): This form of encrusted skin starts with dry hard papules the size of millet seeds, transpierced by fine hairs, prickly to the touch, and gradually coalescing. It usually occurs on the extensor side of the elbows and kneesand can spread over the whole body. The skin is dry and sloughs, and there is keratosis and splitting of the palms and soles, thickening of the nails, and mild itching. The tongue is red and the pulse is fine and rapid.

Medicinal therapy: Clear heat and cool the blood; disperse wind and moisten dryness. Use Blood-Cooling Dryness-Moistening Beverage (凉血润燥饮 liáng xuè rùn zào yǐn).

Damp-heat obstructing the network vessels (湿热阻络 shī rè zǔ luò): This form of encrusted skin usually occurs on the nape and neck, behind the ears, forehead and face, and around the noseand can spread to down the limbs and the medial line of the chest and back. Sometimes there is a clear hemilateral distribution. It is severe in summer and mild in winter, and associated with itching. It starts with hard follicular papules that are prickly to the touch, without any change in skin color. As it advances, there appear oily gray-brown scabs, which darken over the years and coalesce to take on a warty appearance. There is often malodor. The tongue is red with stasis speckles with a slimy yellow fur. The pulse is slippery and rapid.

Medicinal therapy: Clear heat and eliminate dampness; quicken the blood and free the network vessels. Use Dampness-Eliminating Stomach-Calming Poria Five Decoction (除湿胃苓汤 chú shī wèi líng tāng), swallowing Rhubarb and Ground Beetle Pill (大黄蟅虫丸 dà huáng zhè chóng wán) with it.

Nondistribution of fluids (津液不布 jīn yè bù bù): The skin is generally rough. Dense cornifying follicular papules appear on the nape, trunk, elbows, and knees, giving the appearance of toad skin that is hard and prickly to the touch. This form of encrusted skin is often associated with dry eyes and clouded, flowery vision. Around hair follicles on the abdomen, lumbus, and buttocks are brown cornified plates, attached at their center and raised at the edges. The condition is more severe in winter than in summer. The tongue is pale with little liquid. The pulse is sunken, fine, and forceless.

Medicinal therapy: Assist the spleen and nourish the stomach; nourish the blood and moisten dryness. Use Supplemented Atractylodes Paste (加味苍朮膏 jiā wèi cāng zhú gāo).

Etymology

Chin 肌 jī, flesh; 肤 fū, skin; 甲 jiǎ, armor, scales, fingernail or toenail; 错 cuò, crossed, uneven, irregular, wrong. In Essential Prescriptions of the Golden Cabinet (金匮要略 jīn guì yào lüè), the term took the form of 甲错, in which 甲 has been interpreted as denoting the skin, although its primary uses (shell, nail) indicates something hard.