Erysipelas

Erysipelas is an acute contagious infectious skin disease characterized by sudden onset of chills, fever, local redness and swelling which may take place on any site of the body and rapidly extend.

Etiology and Pathogenesis

Erysipelas is mostly due to accumulated damp heat in the spleen and stomach flowing downward to the leg ; or due to obstruction of qi and blood in meridians caused by pathogenic wind and toxic heat. Therefore the pathogenic heat infects the blood, and then the skin and muscles. Or it is due to invasion of toxin into the wound in the skin. The erysipelas arising in face and head is mostly evoked by wind heat, that in the hypochondriac, lumbar and hip regions is usually caused by liver fire, that on the leg by damp heat, and in new - born babies by internal heat.

Differentiation

Main manifestations: Rapid onset of a well demarcated patch of redness, hotness and burning pain, rapidly extending in size ; change in color of the patch from bright red to dull red in several days and then healing with desquamation. If accompanied by chills, fever, acute headache, red tongue proper with thin yellow coating, and superficial rapid pulse, it is a wind heat syndrome. If accompanied by fever, irritability, thirst, stuffy sensation in the chest, poor appetite, constipation, dark urine, yellow sticky tongue coating, soft and rapid pulse, it is a damp heat syndrome. High fever, vomiting, delirium and convulsion indicate invasion of the pathogenic factors into the interior of the body.

Analysis: Erysipelas is caused by invasion of exogenous wind heat or damp heat from the stomach and intestines into the blood, skin and muscles. Therefore the affected skin is red and painful. If it is caused by exogenous wind heat stagnating in the skin and muscles, there are chills and fever. If it is caused by damp heat in the stomach and intestines, there are high fever, thirst, stuffy sensation in the chest, poor appetite, constipation and dark urine. When the pathogenic factor penetrates into the pericardium, delirium and convulsion occur.

Treatment

Method: Points of the Yangming Meridian are selected as the principal points. The reducing method is applied to eliminate heat and relieve toxin, or prick the points to bleed.

Prescription: [LI11 - LI4 - MH3 - BL40 - SP10], Ashi points.

Supplementary points:

Wind heat: GB20.
Damp heat: ST36, SP9.
Fever: DU14.
Pathogenic toxin attacking the interior: Twelve Jing-Well points (LI11, LR1, MH9, TH1, HT9, SI1), MH8.
Constipation: TH6.

Explanation: LI11 and LI4 disperse wind heat from the Yangming Meridians. Reducing SP10 and bloodletting of BL40, LI11 and ashi points are to clear offbeat from the blood, i. e. eliminating the accumulated heat by reducing method. The reducing method used to ST36 and SP9 is to dispel damp heat. Pricking the twelve jing-well points to cause bleeding and reducing MH8 are to expel heat from the skin and heart. Reducing DU14 and GB20 remove the pathogenic heat and relieve exterior symptoms. TH6 is used for constipation by removing heat.

Remarks

Strict sterilization is necessary to avoid infection. If ulcer occurs due to mixed infection, or if there is septicemia or pyemia, comprehensive treatment should be applied.