To investigate the clinical efficacy of electroacupuncture at Zusanli（ST36）combined with Danggui Yinzi in patients with chronic eczema of the blood-deficiency and wind-dryness pattern，and to explore its effects on the neuro-immune-skin barrier crosstalk.

This prospective，randomized controlled trial enrolled 60 patients diagnosed with chronic eczema of the blood-deficiency and wind-dryness pattern at the outpatient Department of Traditional Chinese Medicine，Affiliated Hospital of Yangzhou University，from September 2023 to December 2024. Participants were randomized（1∶1）to an observation group（electroacupuncture at ST36 plus Danggui Yinzi）or a control group（electroacupuncture at ST36 alone）for an 8-week intervention. The primary outcome was the Eczema Area and Severity Index（EASI）. Secondary outcomes included nocturnal pruritus assessed by the Visual Analogue Scale（VAS），Traditional Chinese Medicine（TCM）syndrome score，serum interleukin（IL）-31 and IL-4 levels，and filaggrin（FLG）expression as a marker of skin barrier function. Neuro-immune-related biomarkers were quantified using ELISA，qRT-PCR，and immunohistochemistry，including substance P（SP），nerve growth factor（NGF），and FLG mRNA. Statistical analyses were performed using mixed-effects models，analysis of covariance（ANCOVA），and correlation analyses.

After 8 weeks，the EASI score in the observation group decreased to 4.2±1.5，significantly lower than that in the control group（7.8±2.1，P<0.001）. The VAS score decreased by 63%，and serum IL-31 and IL-4 levels decreased by 57.3% and 44.6%，respectively（all P<0.001），with superior improvements compared with the control group. The relative expression of FLG increased by 2.15-fold（95% CI［1.42，3.72］）in the observation group，and FLG upregulation was negatively correlated with SP reduction（r=-0.67，P<0.001）. Electroacupuncture at ST36 combined with Danggui Yinzi may alleviate eczema symptoms through synergistic actions of “suppressing neurogenic itch，modulating Th2-driven inflammation，and promoting barrier repair.”

Electroacupuncture at Zusanli（ST36）combined with Danggui Yinzi effectively improves clinical symptoms in patients with chronic eczema of the blood-deficiency and wind-dryness pattern by reducing pruritus，lowering inflammatory burden，and enhancing skin barrier function. The underlying mechanisms may involve inhibition of the TRPV1/SP/IL-31 axis，regulation of Th2 inflammation，and FLG-mediated barrier restoration，providing modern biomedical evidence for combined acupuncture-herbal therapy in eczema.