bubble_chart Concept

Miliaria alba refers to white, blister-like eruptions on the surface of the skin, resembling water blisters, with a white and translucent appearance. When ruptured, a clear and thin fluid is released. It is commonly seen on the neck, chest, and abdomen, and less frequently on the limbs.

This condition was first mentioned in Wenre Lun, and later discussed in the works of many warm disease scholars, such as Linzheng Zhinan Yi'an and Wenre Jingwei. Because miliaria alba contains a fluid that is crystal-clear and shiny, it is also called "miliaria crystalline"; if the eruptions are dry and white, with empty shells and no fluid, it is referred to as "dried miliaria."

bubble_chart Pattern Analysis

1. Dampness-heat︰The fever is persistent but not pronounced, lingering with sweating that fails to relieve it. The complexion appears dull or with a grimy look, and the expression is indifferent. There is distension and fullness in the chest and abdomen, poor appetite with nausea, dry mouth, and thirst without the desire to drink. Miliaria alba may be seen on the chest and abdomen, appearing lustrous, plump, and distinct in granules, with clear, slightly yellow fluid oozing out when scratched. The tongue coating is yellow and greasy, and the pulse is soft and rapid. This is due to dampness-heat obstructing the qi aspect, where dampness is retained by heat and heat is trapped within dampness, leading to persistent fever unrelieved by sweating, thus giving rise to miliaria alba—white, crystalline, plump, lustrous, and distinct in granules, with clear serous fluid oozing when scratched, hence called miliaria crystalline.
2. Injury of Both Qi and Body Fluid︰Persistent fever, dry mouth and tongue, fatigue and timidity, palpitation, dysphoria, confusion, rapid breathing, flaring of nostrils, wriggling of limbs, or even spasm and convulsion, miliaria alba appearing dull white, indistinct granules, empty shells without fluid, red tongue with little moisture, yellow tongue coating, thin and rapid weak pulse. Due to prolonged fever, depletion of qi and damage to fluid, healthy qi failing to overcome pathogenic factors, inward invasion of toxic pathogens, and exhaustion of body fluids, miliaria alba develops, differing from cases dominated by dampness-heat. Furthermore, observation of the color and morphology of miliaria alba: dull white color, pale as dry bones, shriveled and indistinct granules, empty shells without fluid, hence termed dried miliaria.

The formation of miliaria alba is primarily due to the lingering of dampness-heat evil in the qi aspect, which becomes entangled and unresolved, steaming the skin and leading to its development. It is commonly seen in warm diseases, such as dampness warm disease, latent summerheat, and summerheat warmth with dampness. The appearance of miliaria alba in warm diseases indicates that the illness is located in the qi aspect and is characterized by dampness-heat. By observing the form of miliaria alba, one can further discern the state of exuberance and debilitation of pathogenic qi or healthy qi. If the miliaria alba is glossy and bright, with plump granules, and after expelling the pathogen from the exterior, the fever decreases and the spirit becomes clear, it is a good sign of sufficient qi and fluid, with healthy qi overcoming pathogenic qi. However, if the miliaria alba appears withered, with empty shells and no fluid, and after manifestation, the body heat does not decrease but instead leads to unconsciousness, it is a critical condition of damage to both qi and fluid, where healthy qi fails to expel the pathogenic qi, and the evil toxin invades inward.

bubble_chart Documentation

1. Chongding Tongsu Shanghan Lun Introduction by He Lian-chen: "Warm and heat-induced rashes are often seen in the syndromes of dampness-warm disease and latent summerheat during summer and autumn, and occasionally in the syndromes of wind-warmth combined with dampness during spring and winter. Initially, it is caused by dampness stagnating in the skin and incomplete sweating, mostly appearing white like crystal. It is advisable to gently vent lung qi and open and discharge the defense aspect, with Reed Rhizome being the most stable and effective. If prolonged and damaging to qi and fluids, appearing white like dry bones, it is mostly ominous. Urgently use sweet and moistening fluids to nourish qi and fluids, such as Ophiopogon Tuber Decoction, Dryness-Clearing Lung-Rescuing Decoction and the like, to save a slim chance. Avoid bitter, drying, and warming methods that consume qi and fluids and hasten death. The characteristics of the rash are as follows: white in color with fine spots, shaped like chestnuts, slightly itchy to the touch, with a little water when scratched, resembling a crystalline lens and appearing bright and moist is auspicious. The rash appears when the heat is strong and hides when the heat is mild, with no fixed schedule, sometimes recurring three to five times in a row. If dry and white like dry bones, it is very ominous, with a pulse that is faint or thin and rapid, spirit fatigue, qi timidity, and sticky sweat spontaneously appearing."