Dermatological Implications of Coining: An Eastern Medicine Cultural Practice.

A 36-year-old Chinese man with no significant medical history presented to his clinician's office for follow-up of results from recent blood work. Upon entering the room, the patient was wearing a mask. After reviewing his lipid panel, he mentioned that he had been "fighting a cold." He reported 3 days of cough with chest tightness and mild shortness of breath. He denied fever. The patient was using an overthe- counter cough medicine but reported no chronic medication use. On initial inspection, the patient had a vivid purple eruption on his arms. The patient denied pain or itching. After the patient lifted his shirt, the full extent of the discoloration was seen configured in a symmetric fashion over the anterior torso and abdomen (Figure 1). The eruption was purple-red in color and distributed in a linear pattern over the anterior chest contouring the outline of the underlying ribs. Additional vertically arrayed areas of erythematous skin consisting of microecchymoses were appreciated on the anterior abdomen. These appeared to follow an intentional pattern. No other petechiae, palpable purpura, or isolated ecchymoses were seen. When questioned further, our patient readily admitted that he had participated in a common traditional Chinese treatment consisting of "scraping bruises" to relieve his bronchitis.