Pyogenic Infections of the Skin - Chuang Yang
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Definition
Chuang Yang (Sore Ulcer) is the general term for pyogenic infections of the skin in TCM. These infections include:
- Carbuncles (Yong)
- Gangrene (Ju)
- Furuncle/boil (Jie)
- Rooted furuncle (Ding)
- Shank ulcer (Lian Chuang)
- Bed sores (Ru Chuang)
- Scrofula (Luo Li)
- Flowing phlegm (Liu Tan)
- Subcutaneous nodules (He)
- Flowing or multiple abscess (Liu Zhu)
Causes and Pathological Mechanisms
The causes for Chuang Yang are quite complex and include:
- The six Exogenous Evils,
- Extraordinary poisons/Toxin
- External injuries
- Seven Emotions
- Improper Diet
- Sexual activities
The six climatic evils are Wind, Cold, Summer Heat, Dampness, Dryness and Heat (Fire) can all cause external diseases. Heat–toxin (or fire–toxin) is the commonest cause of external diseases because wind, cold, summer-heat, dampness and dryness can transform into heat and generate fire. Yi Zong Jin Jian (The Golden Mirror of Medicine) stated that: “Carbuncles and gangrenes are all caused by fire-toxins”.
Seasonal factors include Spring – wind: mumps; Summer – heat and dampness: summer furuncles or boils (shu jie) and multiple abscess (shu shi liu zhu) and Winter – cold: frostbites or cold sores.
Other factors include extraordinary poisons/toxins. Constitution hypersensitivity – toxins: plants, certain materials or chemicals, insect and animal bites and stings – poisons: snake, bees and wasps, dogs, cats and other domestic animals. External injuries, seven Emotions, sexual activity and diet.
The local pathological response can include; Qi and Blood Stagnation; disharmony between Ying Qi and Wei Qi and blockages in the Jingluo.
Patterns
Jie (Furuncle)
- Symptoms: Fever, tiredness, headache, redness, swelling, hot feeling and pain. At first, pustule or cone-like poroma (small hard nodule of infection) in the opening of the hair follicle followed by bigger nodule, more pain with a “pus head” in the middle and wave motions around it in 2-3 days.
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Yong (Carbuncle)
- Symptoms: Fever, rigor, headache and loss of appetite. Firstly: red, swollen, hot and painful lump with miliary pus heads on top (2-3 days). Secondly, bigger lump with severe pain, more pus heads like a beehive (3-4 days). Thirdly, skin between pus heads necrotic and suppurating to become a ulcerative wound with pus often 3-4 inches in diameter (1-2 weeks).
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Dan Du (Erysipelas)
- Symptoms: High fever and headache. Followed by red and burning patches on the skin which is slightly higher than the normal skin around it with a well defined border. Burning pain and sometimes with blisters.
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Acute Phlegmon
- Symptoms: Fever, rigor, headache and tiredness. Dull red, swelling, hot and painful patch, darker in the middle and with ill defined border hardness, evident tenderness and pitting edema. In severe cases they will have widespread necrosis in subcutaneous tissue and the formation of abscess.
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Hong Si Ding (Acute Lymphangiitis)
- Symptoms: Fever, rigor, headache, tiredness and loss of appetite. A red line spreads along the medial side of the forearm or the inner side of the shin towards to proximal end. Local tenderness, swollen and painful lymph nodes.
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Lian Chuang (Shank Ulcer)
- Symptoms: Necrotic tissue, pus and foul smell for the wound and discolour, malnutrition or eczema of adjacent skin. Chronic ulcer in the lower 1/3 inner or outer sides of the leg, about 3 cuns above the medial and lateral malleoli.
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Ru Chuang (Bed Sore)
- Symptoms: Ulcer in places of pressure and friction (spine, sacrum, great trochanter, iliac spine and calcaneus.
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References
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