From the perspective of modern medicine, pruritus ani stems from diverse factors. While it may look like ordinary dermatitis, it often involves a combination of infections such as fungi or parasites, structural conditions like hemorrhoids, perianal hygiene issues, dietary triggers like coffee, chocolate, and spicy foods, medication side effects, or psychological factors such as stress and anxiety.
The concept of damp-heat in Donguibogam corresponds closely in modern medicine to chronic perianal inflammation, eczema, and erythema and edema caused by skin irritation. When moisture builds up and ventilation is poor, bacteria and fungi proliferate readily, damaging the skin barrier and initiating an immune response that causes pruritus. Likewise, spleen-stomach damp-heat aligns with high dietary intakes of refined sugars, fats, and harsh spices. These dietary habits contribute to gut dysbiosis and increase intestinal mucosal permeability, elevating pro-inflammatory cytokines. These inflammatory mediators can circulate through the bloodstream or irritate the perianal region directly, aggravating the itch.
Liver wind and chronic stress exert direct effects on the autonomic nervous system and immune system. Prolonged stress drives sustained secretion of the stress hormone cortisol, which weakens skin barrier function and leaves the tissue susceptible to external irritants. The immune response can also become hypersensitive, intensifying pruritus even from minor contact. Neurologically, the activity of itch-inducing neuropeptides such as substance P rises, while inflammatory mediators including histamine stimulate nerve endings to provoke the sensation of scratching. The tendency for pruritus to peak at night reflects natural biological rhythms: cortisol levels decrease later in the day while skin temperature rises, prompting increased histamine release. Modern medicine thus reflects the insights of Donguibogam through detailed biological mechanisms, confirming that addressing whole-body health, diet, and stress management remains essential for managing anal pruritus.
