“Unveiling the Gut–Skin Dialogue: How Dysbiosis Fuels Chronic Itch”
- caulocare
- Jun 13
- 5 min read
By Dr. Phumlarp Caulo| Caulo Care, Forest Hill, New York| June 13, 2025
Have you ever felt your heart race the moment an itch begins, unable to stay still until you scratch it, only to find that the fleeting relief disappears almost as soon as it comes, leaving behind a stubborn mark that refuses to fade? What if the real cause of that itch reaches far beyond the surface of your skin, hinting at deeper imbalances within your body? In this post, we will decode the origins of pruritus, exploring how the interplay of Qi, blood, and internal nutrition can manifest as that relentless urge to scratch, drawing on both the pioneering work of Ferdinand von Hebra and the insights of Traditional Chinese Medicine (TCM) alongside modern medical science.
Ferdinand von Hebra: Pioneer of Scientific Dermatology
Long before dermatology became recognized as a distinct medical specialty, Ferdinand von Hebra (1816–1880) laid its scientific foundation. Born on 7 September 1816 in Brünn (now Brno, Czech Republic), Hebra pursued his premedical studies in Graz before earning his medical degree from the University of Vienna in 1841. Under the mentorship of Joseph Škoda and inspired by the pathologist Karl von Rokitansky at Vienna General Hospital’s “Rash Room,” Hebra merged careful clinical observation with pathological investigation and detailed medical illustration—ushering dermatology into the era of science.
Key Innovations
Histopathology of the Skin. Hebra was the first to apply microscopic examination of skin biopsies to classify and distinguish dermatologic diseases.
Morphologic Classification introduced a clear system for describing lesions—macules, papules, vesicles, and more—enabling precise communication among physicians.
Etiologic ProofIn his landmark 1844 work on scabies, Hebra definitively demonstrated that the condition was caused by mites, refuting the prevailing humoral theories.
Major Works
Atlas der Hautkrankheiten (1856–1876): A richly illustrated compendium of over 100 plates, reprinted in ten editions.
Lehrbuch der Hautkrankheiten (1878–1881): Completed by his student Moritz Kaposi, this textbook became the standard teaching reference in dermatology.
The Vienna School of Dermatology Vienna General Hospital, Hebra founded what became known as the “New Vienna School of Dermatology.” His clinical methods and curricula served as models for emerging dermatology departments across Europe and North America, and he mentored luminaries such as Moritz Kaposi, Heinrich Auspitz, and Isidor Neumann. Even after his death, Hebra’s clinic remained the “Mecca” of dermatology in the nineteenth century, and his name endures in various eponyms—“Hebra’s disease,” among them.
I Traditional Chinese Medicine Perspective
“The Spleen is the General, the Large Intestine its Army, and the Skin the Battlefield.”
Zang–Fu Correspondence
Spleen (脾) governs the transformation and transportation of nutrients.
The Large Intestine (大肠) is responsible for excretion.
The skin is nourished by Spleen Qi and Blood; deficiency in these organs leads to dryness, flaking, and itching.
Primary Pathomechanisms
Damp–Heat in the lower burner ascends to the Yang Biao (superficial level), provoking red, hot, swollen, and pruritic eruptions akin to urticaria.
Blood–Damp Stasis in the Large Intestine manifests as indurated, lichenified plaques, characteristic of chronic eczema or lichen simplex chronicus.
Qi Deficiency yields poor absorption, resulting in sagging, xerotic skin, and delayed wound healing.
Transmission Mechanisms
Impaired Transportation & Transformation A weakened Spleen allows Dampness to accumulate in the Intestine, creating lipid stagnation that “clouds” cutaneous vessels, leading to eruptions.
Blood & Qi Deficiency Insufficient Blood fails to nourish the skin, producing dryness; Qi deficiency further slows microcirculation, causing pallor and atrophic changes.
Pattern Differentiation Examples
Damp–Heat in Large Intestine: Abdominal pain, loose stools, with hot, itchy rashes.
Spleen Qi Deficiency with Wind: Bloating, borborygmus, dry scaly skin prone to itching.
Therapeutic Protocols
Eliminate Damp–Heat
Herbal Formula: Cang Zhu (Rhizoma Atractylodis) + Dang Gui (Radix Angelicae Sinensis) + Gan Jiang (Rhizoma Zingiberis)
Acupoints: ST25 (Tianshu), SP9 (Yinlingquan)
Tonify Spleen & Ascend Qi
Herbal Formula: Shen Ling Bai Zhu San (including Bai Zhu, Fu Ling, Shan Yao)
Acupoints: SP6 (Sanyinjiao), ST36 (Zusanli)
Invigorate Blood & Resolve Stasis
Herbal Formula: Xue Fu Zhu Yu Tang
Focus: Disperse Blood stasis and alleviate chronic plaques.
Case Study (TCM)
Patient A: Chronic urticaria with concurrent diarrhea for two months.
Diagnosis: Damp–Heat in the Large Intestine.
Treatment: Cang Zhu 9 g, Dang Gui 6 g, Gan Jiang 3 g daily for two weeks; three sessions of acupuncture at ST25.
Outcome: 70 % resolution of pruritic lesions; marked improvement in bowel habits.
II. Modern Medicine Perspective
“The Gut–Skin Axis”
Structural Framework
Intestinal Barrier: Tight junctions, mucus layer, secretory IgA.
Cutaneous Barrier: Stratum corneum, lipid matrix.
Immune Crosstalk: Lipopolysaccharide (LPS) triggers TLR4 on immune cells, eliciting TNF-α and IL-6 release.
Metabolite Signaling: Short-chain fatty acids (acetate, propionate, butyrate) produced by microbial fermentation bind GPR43 on keratinocytes to dampen inflammation.
Dysbiosis & Leaky Gut
Dysbiosis: Altered Firmicutes/Bacteroidetes ratio increases pathogen-associated molecular patterns (PAMPs).
Leaky Gut: Elevated zonulin disrupts tight junctions, allowing LPS translocation and systemic inflammation that can exacerbate cutaneous immune responses.
Dermatologic Conditions Linked to the Gut
Atopic Dermatitis (AD): Gut dysbiosis skews immunity toward Th2, raising IL-4 and IL-13, downregulating filaggrin and weakening the barrier.
Acne Vulgaris: High-glycemic diets provoke gut inflammation and IGF-1–mediated sebaceous hyperactivity leading to comedones.
Psoriasis: Overgrowth of Prevotella triggers Th17 cells and IL-17–driven keratinocyte proliferation.
Interventional Strategies
Nutritional Therapy: Increase dietary fiber (whole grains, fruits, vegetables) and omega-3 fatty acids (e.g., salmon) to reduce systemic and cutaneous inflammation.
Probiotics & Prebiotics: Strains such as Lactobacillus rhamnosus GG and Bifidobacterium longum help restore microbial balance and mitigate symptoms of AD.
Pharmacologic & Topical Agents: Topical corticosteroids or calcineurin inhibitors, and—for refractory cases—biologics such as anti-IL-17 antibodies.
Case Study (Modern Medicine)
Patient B: Chronic atopic dermatitis with irritable bowel syndrome–like symptoms.
Findings: Decreased Bacteroides, increased Proteobacteria on microbiome analysis.
Intervention: Probiotic cocktail (L. rhamnosus GG, 1 × 10⁹ CFU daily for eight weeks) and a low-FODMAP diet.
Outcome: Eczema Area and Severity Index reduced by 40 % within six weeks.
When we appreciate that itch is not merely a cutaneous reflex but a signal of internal disharmony, skin health must begin with balancing the digestive system, Qi, and blood, all while clearing excess Damp-Heat. Only when these foundational processes are harmonized will the superficial reminder of an itch gradually fade, allowing the skin to become supple and the body to achieve true equilibrium.
— Dr. Phumlarp Caulo
Dr. Phumlarp Caulo LAc,MsAc,OM,DAHM,Pre-RN
Integrative Medicine Practitioner, bridging Eastern and Western Wisdom.
“Rooted in ancient wisdom, guided by modern science
On this page, we look back at history so you can move forward with health.
I believe in Mother of the Earth, the timeless healer of body and soul.”
This information is only educational and should not be construed as medical advice.
Everything must be balanced, and the suggestions may not apply to you.
A specialist doctor should be consulted for any medical advice or diagnosis.
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Dr. Phumlarp Caulo LA,c, MAc. OM, DAHM
Doctor of Acupuncture/Chinese Medicine
Caulo Care Acupuncture
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