Senile pruritus mainly manifests skin irritation without primary skin rash. Its pathogenesis lies in generation of wind due to blood deficiency or stagnation of six exogenous factors in skin. General pruritus and localized itching are both common.

Syndrome differentiation and treatment

External attack by wind and cold

It manifests general pruritus without definite site and dry skin covered with squamae which mostly occur in winter or after attack by wind and cold, and of which pruritus is relieved by warmth, or concurrent aversion to cold and wind, whitish and thin fur, floating and tense or floating and slow pulse. It is advisable to eliminate wind, dispel cold and check itching. The prescription used is the modified Wind-Dispelling Powder. In the case of wet scratch and oozing of water due to scratching, add Cangzhu (Rhizoma Atractylodis ), Zexie ( Rhizoma Alismatis ) and Baixianpi (Cortex Dictamni Radicis ); in the case of spontaneous sweating due to exterior syndrome of deficiency, add Huangqi (Radix Astragali seu Hedysari) and Baizhu ( Rhizoma Atractytodis Macrocephalae ) .

Excessive wind due to blood heat

It manifests itching, red skin with calor aggravated by warmth, drinking and eating pungent food, relieved by cold, or concurrent fever and aversion to wind, vexation, dry mouth, yellowish and thin fur, red tongue, floating and slippery or taut and rapid pulse. It is advisable to eliminate wind, clear away heat, cool blood and check itching. The prescription used is the modified Pruritus-Checking and Wind-Dispelling Decoction which is composed of Shengdihuang ( Radix Rehmanniae ), Danggui ( Radix Angelicae Sinensis ), Mudanpi ( Cortex Moutan Radicis), Huangqin (Radix Scutellariae), Lianqiao ( Fructus Forsythiae), Baijili (Fructus Tribuli ), Jingjie (Herba Schizonepetae), Fangfeng (Radix Ledebouriellae), Bohe Herba Menthae), Longgu ( Os Draconis) and Gancao (Radix Glycyrrhizae). In the case of severe heat, add Zicao (Radix Arnebiae seu Lithospermi ) and Shanzhi (Radix Pittospori); in the case of constipation, add Dahuang (Radix et Rhizoma Rhei) and Mangxiao (Natrii Sulfas ).

Dyness of blood due to yin deficiency

It manifests susceptibility to onset in autumn and winter, dry skin covered with squamae, wide-spread scratches, severe nocturnal itching, thickened skin in the scratched area, or concurrent palpitation, insomnia, red or reddish tongue, taut and thready pulse. It is advisable to nourish yin and blood, moisten dryness and check itching. The prescription used is the modified Yangxue Runfu Decoction (Blood-Nourishing and Skin-Moistening Decoction). In the case of purple skin scratches and deep purple tongue, add Sumu (Lignum Sappan), Taoren (Semen Persicae) and Zaojiaoci (Spina Gleditsiae); in the case of itching worsened by emotional changes, add Tianma ( Rhizoma Gastrodiae ), Gouteng ( Ramulus Uncariae cure Uncis ), Longgu ( Os Draconis ) and Mull ( Choncha Ostreae ) .

Downward flow of dampness and heat

It manifests pruritus mostly occurring around the anus and pudenda suddenly, secondary skin rash, pustulae, oozing of water and pain after scratching, concurrent foul leukorrhea with yellowish colour, red tongue with yellowish and greasy fur, taut, slippery and rapid pulse. It is advisable to clear away heat, promote diuresis, expel wind and check itching. The prescription used is Longdan Xiegan Decoction (Decoction of Gentiana for Purging the Liver Fire) with additional Mull (Concha Ostreae ), Huangbai ( Cortex Phellodenclri), Baijili (Fructus Tribuli) and Baixianpi ( Cortex Dictamni Radicis ). In the case of pruritus vulvae and fishy leukorrhea, add Tufuling ( Rhizoma Smilacis Glabrae ) and Shechuangzi (Fructus Cnidii); in the case of anal pruritus, add Kushen (Radix Sophorae Flavescentis ) and Difuzi ( Fructus Kochiae ); in the case of scrotal pruritus, add Chantui (Periostracure Cicadae).