Dermatology - (Second Edition)

Author: Li Yuwen, Zhang Fengchuan / Country: Mainland China
Publisher:
Publishing Date: 2006-06-01
Features:
8. Wan Chunfa's Diagnostic and Treatment Experience
Wan Family believes that erysipelas is named after the affected skin appearing red like painted lacquer and can occur in any part of the body, but is more common in the lower limbs and face. In the Qing Dynasty, Gao Jinting discussed the causes and locations of sores and ulcers, stating: "The conditions of the sore department, those in the upper part, all belong to wind-heat and wind-rheum, as wind tends upward; those in the lower part, all belong to damp-fire and damp-heat, as water tends downward; those in the middle part, mostly belong to qi stagnation and fire stagnation, as qi and fire both arise in the middle." Gao Jinting's "upper wind, lower damp, middle qi and fire" approach to identifying causes based on anatomical locations highly summarizes the general pathogenic principles of surgical diseases. The Wan Family applied this perspective to the treatment of erysipelas.
Treatment for the upper part based on wind:
If it occurs in the head and face, the skin appears flushed red, like floating clouds, with heat and pain, headache and bone aching, rapid spread, affecting the eyelids, causing eyelid swelling like peaches, extending to the top of the head, swelling like a drum, chills and fever, thirst and dry throat, short and dark urine, constipation, yellow greasy tongue coating, red tongue, and a pulse. The condition is classified as wind-heat invading the high peak, and treatment should disperse wind, clear heat, and detoxify. The formula used is modified Pujisi Decoction combined with Niubang Jieji Decoction. Medications include:
- Radix Araliae 10g
- Mentha 3g
- Bupleurum 6g
- Radix Isatidis 15g
- Coptis 3g
- Scutellaria 6g
- Flos Lonicerae 15g
- Forsythia 10g
- Radix Paeoniae Rubra 10g
- Radix Moutan 10g
- Decoction, taken twice daily.
Treatment for the lower part based on dampness:
If it occurs in the lower limbs, the legs swell red and form patches, with a shiny surface, wandering and spreading, with occasional blisters on the skin, ulcers, and pain. Swelling under the groin and spine, difficulty in walking, chills and fever, yellow greasy tongue coating, and a pulse. The condition is classified as damp-heat descending, accumulating in the blood, and transforming into fire-toxin. Treatment should activate blood circulation, resolve stasis, clear heat, and drain dampness. The formula is modified Wushen Decoction:
- Angelica Sinensis 10g
- Radix Paeoniae Rubra 10g
- Radix Achyranthis Bidentatae 10g
- Lindera 15g
- Persicae Semen 10g
- Phellodendron 10g
- Poria 10g
- Red Bean 15g
- Flos Lonicerae 15g
- Licorice 6g
- Decoction, taken twice daily.
Treatment for the middle part based on fire:
If it occurs in the flanks and waist, the swelling appears red, wandering without a fixed location, causing burning pain, chills and fever, thirst and dryness, yellow and dark urine, constipation, yellow greasy tongue coating, red tongue, and a pulse. The condition is classified as liver fire combined with damp-heat from the spleen meridian accumulating in the skin. Treatment should clear the liver, drain heat, drain dampness, and detoxify. The formula is modified Chaihu Qinggan Decoction:
- Bupleurum 3g
- Radix Moutan 10g
- Gardeniae Fructus 10g
- Scutellaria 6g
- Flos Lonicerae 15g
- Forsythia 10g
- Ligusticum 3g
- Radix Gentianae 6g
- Radix Rehmanniae 15g
- Radix Araliae 10g
- Decoction, taken twice daily.
From the Suwen·Taiyang Yangming Lun Piān: "Those injured by wind first affect the upper part." Wind tends upward, is agile, and changes frequently. Erysipelas occurring in the head and face, appearing red like painted lacquer and like floating clouds, is called an affliction of the yang pathogen, with heat in the qi phase. Wind follows the qi, wandering without a fixed place. When treating, dispersing wind, clearing heat, and detoxifying often yields significant results.
From the Suwen·Taiyang Yangming Lun Piān: "Those injured by dampness first affect the lower part." Dampness is sticky and persistent, and damp pathogens often cause lingering and difficult-to-heal conditions. Therefore, after the acute symptoms of lower limb erysipelas subside, a few may still have localized swelling, or chronic erysipelas in the lower limbs may frequently recur due to fatigue and friction. The reactive hyperplasia of lymphatic endothelial cells in the affected area causes obstruction of the capillaries, leading to lymphedema, which may develop into "big foot wind" over time. Activating blood circulation and draining water can be effective.
Lower limb erysipelas is often triggered by tinea pedis or leg ulcers. Therefore, while treating erysipelas, it is important to actively treat the underlying conditions like tinea pedis. This is crucial for preventing recurrence. When it occurs in the flanks and waist, it is due to the liver being affected by pathogens, with liver fire raging and wind-heat spreading to the spleen. In treatment, Bupleurum and Radix Araliae are used to expel pathogens and reach the surface to prevent the spread of erysipelas. Combined with anti-inflammatory and antibacterial medications like Gardeniae Fructus, Scutellaria, Flos Lonicerae, and Radix Gentianae, inflammation can be controlled early and recovery achieved.
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