bubble_chart Concept

A blister refers to a blister that occurs on the surface of the skin. It can be as small as a needle tip or as large as a chess piece, appearing either singly or in clusters; the blister wall can be thin or thick and raised, containing clear or turbid fluid.

Blisters are one of the common symptoms in dermatology. Due to the different types of skin diseases, the manifestations of blisters also vary. Chinese medicine differentiates syndromes based on the location, color, and nature of the fluid inside the blister, and believes that its disease cause is closely related to dampness.

bubble_chart Pattern Analysis

1. Wind-dampness Stagnation in the Skin︰The blisters are as small as needle tips, resembling foxtail millet grains, clear and raised, scattered or clustered in patches, often occurring in areas with heavy sweating, and may be accompanied by wheals. Most cases involve itching, with no systemic symptoms. The tongue texture is normal, with scant coating, and the pulse is floating and rapid. These symptoms are more common in spring, summer, and autumn when the weather is warm, the striae and interstices are loose, and wind-dampness easily invades the skin, stagnating and leading to blisters appearing unpredictably. The blisters are slightly red, with minimal exudate upon rupture, and often occur in areas prone to sweating. Skin redness may be observed, sometimes accompanied by wheals and varying degrees of itching. When cold-dampness congeals, the skin initially appears pale, then turns reddish-purple, or may develop bluish-purple lumps, with noticeable numbness, itching, swelling, and pain upon exposure to heat. For treatment, wind-dampness-induced blisters should be addressed by dispelling wind and eliminating dampness, supplemented with heat-clearing. The recommended formula is the Wind-Dispelling and Dampness-Overcoming Decoction with modifications.
2. Cold-dampness Stagnation︰The blisters appear white with a reddish-purple periphery, often occurring on dark red or bluish-purple swellings. Upon rupture, they exude clear, thin fluid and may also form erosions or ulcers, which are slow to heal. They commonly appear on the hands, feet, cheeks, auricles, and other areas, with the local skin feeling cold. Exposure to heat may cause a burning sensation and unbearable itching or pain. The tongue texture is pale with a white coating, and the pulse is deep and slow. These symptoms often occur in winter, especially during severe cold, when cold pathogens invade the skin, obstructing the flow of qi and blood in the meridians. Dampness and cold pathogens clash and stagnate in the skin, leading to blister formation. Clinical characteristics include: frequent occurrence on the hands, feet, cheeks, and auricles; white blisters that easily erode or ulcerate upon rupture and are difficult to heal. Treatment involves warming and resolving cold and dampness, supplemented by promoting meridian circulation and activating blood flow. Prescriptions include Angelica Cold-Extremities Decoction or modified Cinnamon Twig and Chinese Angelica Decoction.
3. Dampness-heat︰The blisters vary in size, appearing red, glossy, and plump, with surrounding erythema. Upon rupture, they exude greasy fluid, forming moist, eroded surfaces or dry crusts due to {|###|}dryness accumulation{|###|}. Blisters often occur on erythematous patches, either at the center or edges, and severe cases may present with {|###|}fever{|###|} and general malaise. The {|###|}tongue texture{|###|} is red with a yellow, greasy coating, and the pulse is soggy or slippery-rapid. The condition typically arises from excessive spleen dampness and heart fire, or exposure to dampness, leading to conflict and accumulation in the skin. The onset is acute, with heat manifestations; small, tense, glossy blisters surrounded by erythema are common, forming crusts quickly after rupture. Treatment prioritizes symptom relief or addresses both root and branch, with the primary method being {|###|}draining dampness{|###|} and clearing heat. The recommended formula is Gentian Liver-Draining Decoction, modified as needed.
4. Water-dampness External Effusion︰The blisters are as large as chess pieces or even eggs, and may grow even larger. Initially, the blister fluid is clear but later becomes turbid or bloody. The blister walls are thin, loose, and prone to rupture, leaving shallow, pale sores. Accompanying symptoms include a pale complexion, fatigue, anorexia, and loose stools. The tongue appears pale and swollen with a thick, greasy coating, and the pulse is soggy and slow. This condition arises from spleen-stomach weakness, leading to impaired transportation and transformation, causing body fluids to accumulate as dampness, which gradually manifests on the skin. Hence, the onset is slow, presenting with dampness symptoms but no obvious signs of heat. The clinical features include large blisters with thin, loose walls that rupture easily, without redness around the blisters, slow healing of sores after rupture, and delayed scabbing. Blisters often appear on normal skin. Treatment focuses on addressing the root cause, with the primary approach being to regulate the stomach, strengthen the spleen, and eliminate dampness. The recommended formula is Dampness-Expelling Stomach Poria Decoction with modifications.
5. Toxin Invasion by Parasites︰The blisters are as small as mustard seeds or as large as soybeans, with clear boundaries and slight elevation. The blister fluid is initially clear but becomes turbid over time. They appear sporadically and gradually spread into clusters, often causing intense itching that leads to scratching, which can cause the blisters to merge or even become red, swollen, and painful. The clinical characteristics are small, clustered blisters, with their location varying by condition (appearing between fingers or toes, in the groin, or at insect bite sites), often accompanied by severe itching. Chinese medicine excels in topical treatments, such as Realgar ointment or Stemona root tincture for external application, which are effective in killing parasites, relieving itching, and drying dampness.

Among the various types of blisters mentioned above, blisters caused by external dampness belong to a deficiency pattern, with the primary treatment method being to strengthen the spleen and eliminate dampness. The other four types of blisters are associated with an excess pattern or a mixed deficiency and excess syndrome, primarily caused by external dampness combined with other pathogenic qi or by toxic pathogens invading the skin. The main treatment approach is to dispel dampness, and based on clinical manifestations, the cause is identified, and treatment is tailored accordingly through pattern identification.

bubble_chart Documentation

1. Youyou Jicheng．"Chickenpox Ludan Syndrome Treatment": "After a child is born, within a hundred days or more than half a year, suddenly the eyelids become red and swollen, the face turns dark green, the child is restless and cries at night, and the face is as red as rouge. This is due to latent heat inside, expelling pathogen from exterior to the outside. Initially, the face is covered like chickenpox, the feet are slightly red but not strong, appearing and disappearing without regularity, then it spreads to the neck, red like scarlatina, known as Ludan, and should be treated with Sanjie Powder to disperse it."