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Erysipelas

The alias disease: Erysipelas

Their location: Systemic

Attendance sections: Boils and Sores

It refers to an acute cutaneous and subcutaneous inflammation caused by hemolytic streptococcus and is often secondary to traumatic injury, lesion and infective focus of the skin and mucous membrane. It is believed in Chinese medicine that its occurring on the head and face is often related to pathogenic wind, heat and fire and that happening in the lower part of the body is usually related to accumulation of dampness and heat. Before lesion of the local skin appears, there are often such symptoms as aversion to cold, fever, headache, lassitude and poor appetite, and progressive edema with fresh red skin and clear margin. If it occurs in the loose parts of eyelid, lips and ear lobes, swelling in red color is more obvious, with burning pain. It can be accompanied by local lymphadenectasis. The total count of peripheral leukocyte and neutrophil ratio are obviously enhanced. It often occurs on the face, calf, forearm, hand and foot, which occurs on the head and face is called “Head erysipelas” and which occurs in the lower limb is called “leg erysipelas” in Chinese medicine.

Diagnostic Essentials

Before onset, there is mostly a history of traumatic injury, lesion or infective focus in the skin and mucous membrane of the hand, foot, ear, and nose.

Before onset, there are general symptoms of aversion to cold, fever and headache.

Tumefaction in fresh red color, with burning pain and clear margin is present in the skin of the infected area. Usually, there is no suppuration and necrosis occurs very seldom, but accompanied by local lymphadenectasis. The total count of peripheral leukocyte and neutrophil ratio are obviously enhanced.

Treatment Baaed on Syndrome Differentiation

Wind-Heat-Toxin Accumulation Syndrome

Main Symptoms  It frequently occurs on the head and face, manifested by aversion to cold, obvious fever, aching pain in the joints, superficial tumefaction with red color and burning pain in the local area, reddened tongue, thin coating, superficial and rapid pulse.

Therapeutic Methods  Disperse wind, clear away heat and dissolve toxins.

Formula  Modified “Pu Ji Xiao Du Drink” with Niubangzi ( Fructus Arctii ) 10g, Bohe ( Herba Menthae ) (decoct later) 3 g, Jiangcan ( Bombyx Batryticatus ) 12 g, Shengma ( Rhizoma Cimicifugae ) 8 g, Chaihu (Radix Bupleuri ) 6 g, Huangqin ( Radix Scutellariae ) 10 g, Lianqiao ( Fructus Forsythiae ) 15 g, Xuanshen ( Radix Scrophulariae ) 12 g, Jinyinhua ( Fiox Lonicerae) 6 g, and raw Gancao (Radix glycyrrhizae) 3 g.

Modification  For severe aversion to cold and fever, add Jingjie (Herba Schizonepetae) 10 g and Fangfeng (Radix Ledebouriellae) 10 g. For excessive tumefaction, add Chishaoyao (Radix Paeoniae Rubra ) 12 g and Mudanpi (Cortex Moutan Radicis) 10 g.

Syndromes of Invasion of Heat-Toxin into Blood

Main Symptoms  Severe general symptoms, accompanied by chills, fever, headache, aching sensation in the bone, constipation and scanty urine, red skin, burning sensation, serious pain, crimson tongue, thin and yellowish coating, thready and rapid pulse.

Therapeutic Methods  Clear away heat, cool blood and dissolve toxins.

Formula Added “Xijiao (Substituted by Shuiniujiao) Dihuang Decoction” with Shuiniujiao ( Cornu Bubali ) (Decoct first) 30 g, raw Dihuang (Radix Rehmanniae) 20 g, Mudanpi ( Cortex Moutan Radicis ) 10 g, Chishaoyao ( Radix Paeoniae Rubra ) 15 g, Zicao ( Radix Arnebiae seu Lithospermi ) 30 g, Shanzhizi ( Fructus Gardeniae ) 15 g, Zihuadiding ( Herba Violae ) 30 g, Xuanshen (Radix Scrophulariae) 15 g, and raw Gancao (Radix Glycyrrhizae ) 6 g.

Modification For lingering constipation after taking herbal medicine, add prepared Dahuang (Radix et Rhizoma Rhei) 6 g and Mangxiao (Natrii Sulfas) (Take after infused in water) 10 g. For restlessness and brown urine, add Danzhuye (Herba Lophatheri) 12 g and Lugen (Rhizoma Phragmitis) 15 g. For lingering high fever, add raw Shigao (Gypsum Fibrosum) (I)ecoct first) 20 g and Tianhuafen (Radix Trichosanthis ) 15 g.

Damp-Heat Retention Syndrome

Main Symptoms It frequently happens in the lower limbs, manifested by severe local tumefaction, with slightly red color, and repeated seizure, accompanied by stuffy chest, fullness in the epigastric region, poor appetite, loose stool, brown urine, reddened tongue, thin and yellow and greasy coating, soft and rapid pulse.

Therapeutic Methods Clear away heat, remove dampness and dissolve toxins.

Formula Modified “Bixie Shen Shi Decoction” with Bixie (Rhizoma Dioscoreae Septemlobae) 12 g, raw Yiyiren ( Semen Coicis ) 30 g, Huangbai ( Cortex Phellodendri) 15 g, Chifuling (Poria) 12 g, Zexie (Rhizoma Alismatis ) 10 g, Cheqiancao ( Herba Plantaginis ) 30 g, Huzhang ( Rhizoma Polygoni Cuspidati ) 15 g, Niuxi (Radix Achyranthis Bidentatae) 12 g, and “Bi Yu San” (decoct in pack) 15 g.

Modification  For excessive heat toxins, add Huangqin (Radix Scutellariae ) 6 g and Shanzhizi (Fructus Gardeniae) 12 g. For epigastric fullness and poor appetite, add Huoxiang (Herba Agastachis) 10 g and Peilan (Herba Eupatorii) l0 g. For severe swelling limbs with concave by pressure, add Cangzhu (Rhizoma Atractylodis ) 8 g and Baizhu (Rhizoma Atractylodis Macrocephalae) 12 g.

Other Therapies

Method of Wet Dressings

It is advisable to add Mingfan (Alumen) 15 g and Wubeizi (Galla Chinensis) 12 g into the dregs of the second decoction of the oral formula, and decoct and condense herbal juice for local cold wet dressing, half a hour each time and 4 – 5 times a day.

Application Method

It is advisable to choose either “Jin Huang Powder”or “Yu Lu Powder” or “Qing Fu Powder” to be mixed with”Jin Yin Hua Distillate” or herbal juice for oral administration after it is cooled down for external application of the infected area, with the herbal dressing changed once or twice a day.

Stone-Needle Method

For recurrent erysipelas in the lower limbs, with severe tumefaction, itching and pain, it is advisable to prick with a three-edged needle for bleeding therapy.

Cautions

This disease is mostly secondary to traumatic injury and infection of the skin and mucous membrane. Therefore, active treatment of the primary disease can reduce occurrence of this disease. For the patient with erysipelas in the lower limbs, it is requested to raise the infected limb and to have a good rest for alleviating pain. For severe condition, it is advisable to use proper antibiotics in combination.

Maintain healthy skin by avoiding dry skin and preventing cuts and scrapes. This may reduce the risk for the development of erysipelas.

As detoxification diets may not stimulate the liver, lungs or the kidneys enough, herbal detoxification supplementation is often added. Not only do herbs provide vitamins, minerals and enzymes-essential for good nutrition, they are also useful in helping certain organs when different herbs are combined. Different herbal combinations aid different organs and they could be found in most organic food stores.

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