Pediatric erysipelas refers to a condition where the skin turns red, resembling the color of cinnabar, and is commonly seen in infants and young children.

Ancient records provide detailed descriptions of erysipelas. For example, Luxin Jing documents sixteen types of erysipelas; Zhubing Yuanhou Lun records thirty types; Shengji Zonglu lists twenty-five types, along with infantile wandering swelling and redness with pain, totaling over thirty types. Today, terms such as "erysipelas," "wandering erysipelas," and "chiyoufeng" are commonly used.

Additionally, newborns may exhibit redness due to the shedding of vernix caseosa and exposure to the external environment, but without any symptoms. Also, newborns may show localized redness due to their delicate skin being affected by external pathogens, yet they nurse normally and remain in good spirits. This is referred to as "fetal redness" and is not considered within the scope of this condition.

bubble_chart Pattern Analysis

1. Evil Toxin in the Exterior︰Initially, aversion to cold with fever, eye discharge in both eyes, frequent convulsions and crying, followed by red and swollen skin resembling cloud patches, as red as cinnabar, with a glossy sheen, localized skin stiffness, burning pain, and migratory symptoms; floating and purple finger venules. Progressing from mild to severe, it often manifests as mild aversion to cold with severe fever, localized skin redness and swelling that spreads rapidly, resembling cloud patches, as red as cinnabar, with stiff skin and migratory symptoms; or excessive eye discharge, or frequent convulsions and crying. If pathogenic heat is intense, the toxins penetrate inward, injuring the nutrient yin. At this stage, symptoms gradually worsen: the initially bright red skin turns purplish-red, the stiffness and swelling intensify, the area becomes scorching hot and unbearably painful, resisting touch. In severe cases, toxins may form pus, leading to ulceration and discharge of watery fluid, accompanied by persistent high fever, restlessness and frequent crying, parched lips and dry mouth, chest and abdominal distension and fullness, unconsciousness, generalized convulsions, purple and stagnant finger venules, and a deep-red tongue texture.

   Treatment principle: In the early stage, when the pathogen is still in the exterior, the erysipelas area is small, and the fever is not high, the method should focus on clearing heat and removing toxins. The representative formula is Universal Relief Decoction for Eliminating Toxin. If the pathogen has transmitted inward, with a large erysipelas area and severe redness and swelling, the method should focus on clearing the nutrient level to remove toxins, cooling blood, and clearing heat. The representative formula is Rhinoceros Horn Toxin-Removing Drink. For more severe cases, Plague-Clear Toxin-Vanquishing Decoction may be used. If unconsciousness and convulsions are present, add Purple Snow Bolus or Angong Wan. Regardless of the severity, As Wish Golden Yellow Powder can be applied topically in appropriate amounts, mixed with water decocted from Dyers Woad, to the affected area.

2. Pathogenic Toxin Invading the Interior︰High fever persists, dysphoria with frequent crying, dry lips and mouth, chest and abdominal distension and fullness, and in severe cases, unconsciousness, rapid breathing with flaring nostrils, and fixed staring eyes; the skin appears purplish-red, swelling is pronounced, the affected area is scorching hot, and the pain is unbearable, eventually leading to toxin accumulation and suppuration, ulceration with discharge resembling river water, purple and stagnant finger venules, and a crimson red tongue texture. $The pathogenic toxin is either in the exterior or has penetrated the interior! The cause of erysipelas mostly stems from latent fetal toxic fire in infants or postnatal skin injuries, coupled with improper care, allowing invasion by external wind and pathogenic toxins. Wind toxins erupt in the striae and interstices, while heat toxins contend in the blood aspect, steaming and evaporating at the muscular surface, thus triggering the disease. The key points for differentiation are: in the early stage of erysipelas, when the pathogenic toxin is still in the exterior, symptoms progress from mild to severe, often manifesting as mild aversion to cold with pronounced fever, local skin redness and swelling that rapidly spreads outward, resembling cloud-like patches or cinnabar-red stains, stiff skin, and migratory symptoms; or excessive eye discharge, or convulsions with frequent crying. If pathogenic heat is exuberant and the toxin penetrates the interior, injuring the nutritive yin, symptoms gradually worsen—the skin turns from bright red to purplish-red, stiffness and swelling intensify, the affected area becomes scorching hot with unbearable pain and tenderness, and in severe cases, toxin accumulation leads to suppuration and ulceration with discharge resembling river water, accompanied by persistent high fever, dysphoria with frequent crying, dry lips and mouth, chest and abdominal distension and fullness, unconsciousness, generalized convulsions, purple and stagnant finger venules, and a crimson red tongue texture.

   Treatment principles: In the early stage when the pathogen is still in the exterior and the erysipelas area is small with mild fever, the method should focus on clearing heat and removing toxins, represented by the formula Universal Relief Decoction for Eliminating Toxin; if the pathogen has transmitted to the interior with extensive erysipelas and severe redness and swelling, the method should prioritize clearing the nutritive level to remove toxins, cooling blood, and clearing heat, represented by the Rhinoceros Horn Toxin-Removing Decoction, or in more severe cases, Plague-Clear Toxin-Vanquishing Decoction; for cases with unconsciousness and convulsions, add Purple Snow Bolus or Angong Pills; regardless of disease severity, As Wish Golden Yellow Powder can be applied topically to the affected area, mixed with water decocted from Dyers Woad.

bubble_chart Documentation

1. Zhubing Yuanhou Lun．erysipelas: "Dan refers to a sudden redness and inflammation on the human body, resembling the appearance of being painted with cinnabar, hence it is called Dan. It may occur on the hands and feet or on the abdomen, as large as a palm, all caused by wind-heat and evil toxins, and in severe cases, it may resemble a carbuncle. If not treated promptly, the pain becomes unbearable, and over time, it may rot and discharge several liters of pus and blood. If it occurs between the joints and spreads to the limbs, the toxin entering the intestines can be fatal, and it is most dangerous for children."
2. 《Pediatrics Zhengzhi Zhunsheng．sore and ulcer》: "Erysipelas in children is caused by extreme heat toxin, which clashes with blood and is carried by wind, hence the redness, swelling, and spreading all over the body, also known as red wandering wind. If it enters the kidneys or abdomen, it can be fatal. Generally, although there are many types of erysipelas, the root cause is the same."