Scarlatina refers to a condition characterized by a bright red rash resembling cinnabar.

In addition to the systemic scarlatina, this condition is accompanied by swollen and ulcerated throat, hence it was also referred to by predecessors as "scarlatina," "scarlatina," "scarlatina," and "scarlatina rash."

According to Jingui Yaolue, there is a disease called yang toxin, whose symptoms are quite similar to scarlatina. The earliest record of scarlatina can be found in Ye Tian-shi's "Medical Cases of Scarlatina," which states: "There is a condition called scarlatina, which can occur in winter and spring, affecting people of all ages, spreading like a pestilence. When it occurs, it causes high fever, extreme thirst, a dense red rash on the skin resembling brocade patterns, and painful, swollen, and ulcerated throat..." Later, in "The Correct Understanding of Scarlatina," it is mentioned: "The small, scattered particles are called sha, appearing as red halos like dust and sand... The larger, cloud-like patches are called dan, sometimes hidden beneath the skin." Before the Qing dynasty, sha and rash were not distinguished. This article only discusses "scarlatina," while "rash" will be addressed in a separate section.

bubble_chart Pattern Analysis

1. Epidemic Toxin Invading the Lung and Stomach︰Initially, there is aversion to cold and fever, or mild heat, headache, red throat with obstruction, or cough and vomiting. Later, high fever with restlessness and thirst, swollen and painful throat that is red or even ulcerated, faint scarlet rashes on the neck, chest, and back muscles, thin white or thin yellow tongue coating, red tongue texture, and floating rapid pulse. This is mostly caused by exposure to pestilential pathogens that invade the lung and stomach through the mouth, nose, skin, and hair. The throat serves as the gateway to the lung and stomach. When the lung and stomach are affected by pathogens, stagnation transforms into fire, leading to intense internal heat. Hence, symptoms such as aversion to cold, fever, headache, vomiting, red and swollen painful throat, or even ulceration, faint scarlatina, yellow tongue coating, and red tongue appear. The key diagnostic points are: exhibiting some exterior pattern, swollen and painful throat, or even ulceration, faint scarlatina. Treatment should focus on dispersing and releasing, using methods to release the flesh and dispel pathogens outward, which aligns with the Neijing principle of "fire stagnation expelling pathogens from the exterior." Prescriptions may include Lonicera and Forsythia Powder or the flesh-releasing rash-outthrusting decoction. For severe throat swelling and pain, Qingyan Decoction or the Jade Key throat-blowing remedy can be used.
2. Epidemic Toxin Scorching Qi and Nutrient Phases︰High fever with sweating, unresolved, red and swollen throat with ulceration, scarlatina spreading all over the body, presenting as speckled crimson patches, dysphoria and thirst, or thirst without desire to drink, or even unconsciousness with delirious speech, or convulsions, red tongue with yellow coating, or deep red and dry tongue, or a tongue with prickly projections resembling Chinese wax myrtle bark, rapid or surging and rapid pulse. At this stage, the exterior pathogen has already resolved, while the epidemic toxin transforms into fire and enters the interior, with heat toxin attacking the throat, manifesting as high fever with irritability and thirst, red and swollen throat with ulceration, and a red tongue with yellow coating. Treatment should focus on clearing the qi aspect to drain heat, using Diaphragm-Cooling Powder; for throat swelling, pain, and ulceration, external application of Xilei Powder can be used to remove decay and promote regeneration. If qi heat is exuberant, with high fever, irritability, thirst, and profuse sweating, or if nutrient-blood heat is intense with densely distributed scarlatina, a deep red and dry tongue, or prickly red projections on the tongue, urgent cooling of the nutrient aspect and clearing qi heat is required, along with clearing heat and cooling blood. Recommended formulas include the Cool the Nutrient and Clear Qi Aspect Decoction or Rhinoceros Horn and Rehmannia Decoction. If there is constipation due to dryness accumulation, Rhubarb Rhizoma and Mirabilite can be added for purgation. If the toxin attacks the heart, leading to unconsciousness, Taiping Huimin Heji JufangSupreme Treasured Pill or Peaceful Palace Bovine Bezoar Pill can be used to clear heat and promote resuscitation.
3. Injury of Lung and Stomach Yin with Residual Heat︰The high fever has subsided, or there is only low-grade fever in the afternoon. Swelling and ulceration of the throat have lessened, appetite is poor, and scarlet fever is gradually receding with skin desquamation. After the scarlet fever has healed, the skin peels off like bran all over the body. The tongue is red or deep red and dry, with little or no coating, and the pulse is thin and rapid. These are signs of yin deficiency with heat. The clinical characteristics include the high fever having subsided, or only low-grade fever in the afternoon, reduced swelling and ulceration of the throat, and the gradual retreat of scarlet fever with skin peeling. Although the severe symptoms have diminished, residual heat remains, and the yin fluids are depleted, manifesting as afternoon low-grade fever, a red and dry tongue, a thin and rapid pulse, and other signs of yin deficiency with internal heat. Treatment should focus on nourishing yin with sweet and cold herbs and clearing residual heat, using the Qing Yan Yang Ying Tang (Throat-Clearing and Nourishing Decoction).

bubble_chart Documentation

1. 《Scarlatina Positive》: "Scarlatina is a condition caused by the seasonal epidemic pestilence and the evil heat of wind-warmth, which flares up and steams, causing trouble. Once triggered, the heat is like a wildfire."
2. Yishacao: "The poison of scarlatina can be triggered by exposure, pestilence, or the stagnant steam and fog. When a person's healthy qi is deficient, inhaling the poison through the mouth and nose causes the exposure. If there is scarlatina in the family, inhaling the poison from the sick person causes pestilence. The prognosis: look at the throat, the throat ulcer should be shallow rather than deep; observe the spirit, the spirit should be clear rather than confused; feel the pulse, the pulse should be floating, rapid, and spirited, not sinking, thin, and weak; examine the rash, the rash should be distinct and slowly expel the pathogen through the exterior, not red like paper and suddenly appearing faintly." 《Discussion on Mild Epidemic Throat》: "It originates from the triple energizer ministerial fire, with the lung and stomach meridians as the battlefield, and inhaling the pestilence qi as the main culprit."