Erysipelas is an acute cutaneous and subcutaneous inflammatory disease. It is a serious condition. If not treated properly and adequately, it can have potentially serious consequences. (Today it is known to be caused by hemolytic Streptococci invading the subcutaneous tissues, especially reticular lymphatic vessels.)
Etiology, Pathology and Clinical Manifestation
Erysipelas results when exogenous Fire attacks the body, generating Heat in the Blood Level and gelling in the superficies. A common precipitating event is trauma that causes contusion or breaks the skin.
The condition tends to develop abruptly. Shaking chills, fever and headache usually precede or accompany the appearance of the skin lesion. The skin develops a well-demarcated patch of inflammation that is fire-red and slightly raised. Pressing of the affected skin reduces the redness, which returns promptly upon release. There may be vesicles or bullas, and burning pain often accompanies them. These vesicles or bullas generally do not suppurate. The regional lymphatic nodes may become swollen and tender.
When treated properly and adequately, the skin becomes dark red and will eventually slough, leaving normal skin underneath.
Erysipelas on the head is the most serious. If erysipelas on a lower limb recurs repeatedly it may eventually lead to elephantiasis.
Herbal Treatment
Internal Treatment
Erysipelas due to Wind-Heat-Fire
Erysipelas due to Wind-Heat-Fire most commonly affects the head, face and neck.
Main Symptoms. In addition to the skin lesion of erysipelas there are shaking chills and fever, constipation and thirst with desire to drink. In severe cases, the eyelids may be swollen and difficult to open. The regional lymph nodes are swollen and tender. The tongue is red, with thin yellow coating. The pulse is slippery and rapid.
Therapeutic Principle. Eliminate Heat, detoxify poisons, dispel Wind and reduce swelling.
Treatment. Pu Ji Xiao Du Yin (All-Purpose Detoxification Drink). It has the following composition: huangqin (Scutellaria) 15 g, xuanshen (Scrophularia) 15 g, banlangen (Isatis) 15 g, huanglian (Coptis) 10 g, lianqiao (Forsythia) 10 g, chenpi (Citrus tangerina) 10 g, mabo (Calvatia lilacina) 10 g, niubangzi (Arctium) 10 g, bohe (Mentha) 10 g, baijiangcan (Bombyx) 10 g, chaihu (Bupleurum) 10 g, jiegeng (Platycodon) 10 g, shengma (Cimicifuga) 6 g, and gancao (Glycyrrhiza) 6g.
For constipation, add raw dahuang (Rheum palmatum) 10 g, decocted last.
For thirst and much drinking, add tianhuafen (Trichosanthes) 10 g.
If there is sore throat as well, add shengdihuang (Rehmannia) 10 g and mudanpi (Paeonia suffruticosa) 10 g.
Erysipelas due to Gelled Fire in Liver Meridian
Erysipelas due to Fire gelling in the Liver Meridian most commonly affects the trunk of the body.
Main Symptoms. The lesion is typical of erysipelas and it tends to extend peripherally. The tongue is red, with thin yellow coating. The pulse is taut and rapid.
Therapeutic Principle. Cool the liver, purge Fire and eliminate Dampness.
Treatment. Longdan Xie Gan Tang (Liver-Clearing Gentiana Decoction), with increased amounts if necessary.
Erysipelas due to Dampness-Heat-Fire
This most commonly affects the lower limbs.
Main Symptoms. The typical erysipelas lesion tends to spread peripherally. The regional lymph nodes are swollen and tender. There may be anorexia and thirst. The tongue is red, with yellow and greasy coating. The pulse is slippery and rapid.
Therapeutic Principle. Eliminate Dampness, cool Heat and detoxify poisons.
Treatment. Wu Shen Tang (Five-Deity Decoction) combined with Beixie Shen Shi Tang (Dioscorea Dampness-Eliminating Decoction). The combined composition is as follows: jinyinhua (Lonicera) 15 g, chishaoyao (Paeonia lactiflora) 15 g, zihua- diding (Viola) 15 g, niuxi (Achyranthes) 15 g, bixie (Dioscorea septemloba) 10 g, fuling (Porla) 10 g, cheqianzi (Plantago) 10 g, huangbai (Phellodendron) 10 g, mu-danpi (Paeonia suffruticosa) 10 g, zexie (Alisma) 10 g, huashi (talcum) 10 g, tongcao (Tetrapanax papyriferus) 2 g, and yiyiren (Coix) 15 g. Note: cheqianzi is decocted wrapped in cloth.
If Heat poisons are especially strong, add huangqin (Scutellaria) 6 g and zhizi (Gardenia) 12 g.
For anorexia, add huoxiang (Agastache) 10 g and peilan (Eupatorium) 10 g.
Erysipelas due to Heat Poisons at Nutritive Level
Main Symptoms. The lesion of erysipelas is large, and is accompanied by high fever, agitation, nausea, vomiting, mental confusion and delirium. The tongue is crimson-red, and the pulse threadlike and rapid.
Therapeutic Principle. Cool the blood, detoxify poisons, clear Heat and open the orifices.
Treatment. Modified Qing Wen Bai Du Yin (Drink for Clearing Pestilential Disease and Detoxification). The modified composition is as follows: shuiniujiao (Bubalus bubalis) 10 g, shigao (gypsum) 20 g, shengdihuang (Rehmannia) 20 g, lianqiao (Forsythia) 15 g, huanglian (Coptis) 10 g, huangqin (Scutellaria) 10 g, zhizi (Gardenia) 10 g, zhimu (Anemarrhena) 10 g, chishaoyao (Paeonia lactiflora) 10 g, xuanshen (Scrophularia) 10 g, mudanpi (Paeonia suffruticosa) 10 g, zhuye (Phyllostachys nigra) 10 g, and gancao (Glycyrrhiza) 6g. Note: shuiniujiao is added as a fine powder to the finished decoction.
For mental confusion and delirium, it is appropriate to add An Gong Niuhuang Wan (Gallstone Palace-Calming Pill) or Zi Xue Dan (Purple-Snow Pill), one pill twice daily.
Topical Treatment
At early stages, apply a paste of any of the following herbs to the lesion. Four herbs are suitable: xianrenzhang (Opuntia dillenii), bajiaogen (Musa basjoo), machixian (Portulaca oleracea) and wild juhua (Chrysanthemum). Mash the herb into a paste.
For elephantiasis resulting from recurrent erysipelas, treat with dasuan (Allium sativum) as follows. Place a large handful of the garlic in half a pot of boiled water. Let the vapor fumigate the gauze-covered limb, then wash it when the soup has cooled sufficiently. Do this nightly for 20-30 min.
Acupuncture Treatment
Body Acupuncture. For erysipelas due to Wind-Heat-Fire, select the acupoints Hegu (LI-4), Quchi (LI-11), Fengmen (BL-12) and Weizhong (BL-40).
For erysipelas due to gelled Fire in the Liver Meridian, select the acupoints Waiguan (SJ-5), Taichong (LR-3) and Weizhong (BL-40).
For erysipelas due to Dampness-Heat-Fire, select the acupoints Xuehai (SP-10), Sanyinjiao (SP-6), Neiting (ST-44), Yinlingquan (SP-9), Fenglong (ST-40) and Jiexi (ST-41).
For erysipelas due to Heat poisons in the Nutritive Level, select the acupoints Dazhui (DU-14), Shaochong (HT-9) and Quze (PC-3).
Ear Acupuncture. Select the acupoints Adrenal, Shenmen, Subcortex and Occiput.
Case Study
The patient was a 47-year old man with recurrent erysipelas on the left lower leg for 10 years. Each recurrence occurred following the common cold or excessive exertion or walking. Each time, his left lower leg abruptly developed inflammation with a burning pain. He also had chills and fever, the temperature reaching 40°C (104°F). Each time he received an injection of antibiotics, with good response. The intervals between recurrences were 6 months at first, but decreased recently to 1 month. At the time of consultation, the lesion had been present for 6 days. This time it was precipitated by excessive walking.
His temperature was 39° C. He had a large area of inflammation on the left lower leg. It was tender to the touch. The left inguinal lymph nodes also were swollen and tender. His tongue was red, with yellow coating, and his pulse was slippery and rapid.
Diagnosis. Erysipelas of the leg due to Dampness-Heat-Fire.
Therapeutic Principle. Eliminate Dampness and Heat, cool the blood and detoxify poisons.
Treatment and Course. The prescribed formula had the following composition: mudanpi (Paeonia suffruticosa) 4.5 g, chishaoyao (Paeonia lactiflora) 4.5 g, huangqin (Scutellaria) 4.5 g, rendongteng (Lonicera japonica) 9g, fuling (Poria) 9 g, yiyiren (Coix) 9 g, zexie (Alisma) 9 g, beimu (Fritillaria) 9 g, Er Miao Wan (Dual Wonderful Pill) 9g, and Liu Yi San (Six-One Powder) 9g. Note: Er Miao Wan and Liu Yi San are decocted wrapped separately.
The composition of Er Miao Wan is as follows: cangzhu (Atractylodes) and huangbai (Phellodendron) in equal amounts.
The composition of Liu Yi San is as follows: six parts of huashi (talcum) and one part of gancao (Glycyrrhiza).
The patient returned in 4 days. After three daily doses of the prescribed herbs, the inflammation showed moderate improvement. The formula was continued for two more daily doses, with further improvement. Treatment was then changed to 9 g of Er Miao Wan by mouth daily for 15 days. The lesion cleared completely. At the 18-month follow-up there was no further recurrence.
