bubble_chart Concept

Skin pustules refer to small blisters on the surface of the skin that contain pus and are raised and swollen. The pustules appear yellow or milky white; some start as pustules initially, while others develop from vesicles. They may occur singly and sporadically or spread all over the body. Deep pustules have thick walls, while superficial ones have thin walls. After rupture, the pus overflows and dries, forming scabs.

This condition is referred to as "pustular sores" in Zhubing Yuanhou Lun, described as "occurring on the skin, with blistering heads and white pus." By the Ming Dynasty, Waike Zhengzong provided a clear record of "pustules." Waike Qixuan mentions "spring pustules" and "autumn pustules," indicating that this condition has seasonal prevalence. Subsequent medical texts only briefly mention it in the context of diseases, lacking detailed and systematic descriptions.

bubble_chart Pattern Analysis

1. Toxic-heat Invasion︰The pustules are bean-shaped, with thin yellowish walls and surrounded by erythema. Upon rupture, they discharge thick pus that easily dries, forming thick yellow crusts. They often exhibit characteristics of contact infection. In severe cases, systemic symptoms such as high fever, headache, dry throat, thirst with a desire for cold drinks, severe constipation, scanty dark urine, red tongue with yellow and dry coating, and slippery-rapid pulse may occur. This condition is caused by the invasion of toxic-heat pathogens into the skin, with pustules accompanied by a series of toxic-heat symptoms (e.g., high fever, headache, thirst for cold drinks, severe constipation, scanty dark urine, red tongue with yellow and dry coating, slippery-rapid pulse). The lesions initially manifest as pustules, whereas dampness-heat congealing often begins as vesicles that later transform into pustules or present as a mixture of vesicles and pustules clustered together. The pustules themselves also differ: those caused by toxic-heat invasion are typically the size of a Mung Bean or soybean, with thin yellowish walls and prominent surrounding erythema. The exudate from these pustules can often spread and induce new pustules elsewhere. The treatment should focus on clearing heat and removing toxin, commonly using modified Five-Marvel Decoction and Coptis Detoxification Decoction. For external application, use祛湿散 (Qushi San) mixed with Sesame Oil to dress the affected area, aiming to resolve dampness and remove toxin.
2. Dampness Toxin Congealing︰Initially appearing as blisters, they rapidly transform into pustules, or blisters and pustules may appear simultaneously, clustered together. The blister walls are thin and milky white, rupturing to form erosions with a mixture of watery and purulent discharge, creating thin scabs. Accompanied by mild fever, dry mouth without thirst, a red tongue with thin yellow coating or slight greasiness at the root, and a rapid or slippery rapid pulse. This is caused by the congealing of dampness toxin that invades the skin, accompanied by dampness signs (such as dry mouth without thirst, greasy tongue coating, and soggy pulse). The progression of the two also differs, often manifesting as millet-sized blisters with thin walls, frequently occurring on large areas of erythematous skin. After rupture, they often form extensive erosions with persistent exudation, lingering and slow to dry. The treatment principle primarily focuses on removing toxin, but...
3. Dampness-heat︰The pustules are superficial, small as foxtail millet grains, appearing in batches and recurring repeatedly. The pus is light yellow, drying to form crusts. If the blister walls are thick and not easily ruptured, a sense of distending pain may be felt. This condition is commonly seen in individuals with inherent obesity and excessive sweating, often accompanied by warm skin, a red tongue with yellow or greasy coating, and a soggy pulse. It is mostly caused by accumulated heat in the lung meridian and dampness in the spleen meridian, where the two yin qi and yang qi meet and become trapped in the skin. It is frequently observed in those with inherent obesity and profuse sweating, with warm skin. Treatment should focus on fortifying the spleen, dispelling dampness, and clearing heat, often using the Qingpi Chushi Decoction.
4. Heat Stagnation in the Nutrient-Blood Level︰The pustules are superficial, about the size of rice grains, and appear on erythematous patches. The pus is mixed with blood, giving it a slightly pinkish hue. When dried, they easily form crusts of pus and blood. Generally, there are no obvious systemic symptoms. The tongue is red or dark red with scant coating, and the pulse is wiry and choppy. This condition is commonly seen in individuals with excessive yang-heat constitution, caused by indulging in spicy, fragrant, dry, or pungent foods, leading to external congestion of blood-heat, disharmony of the collaterals, and stagnation of nutrient-blood heat in the muscles and interstices, resulting in pustules. In terms of pattern differentiation, the patient typically has a constitution prone to heat, often presenting with constipation and a dry mouth with a preference for cold drinks. Treatment should focus on invigorating blood and clearing heat to release the flesh, often using modified Xianli Huoming Decoction.

The condition of pustules is mostly caused by the invasion of external pathogens. Clinically, the first two symptoms and signs are the most common. Although the treatment primarily focuses on removing toxins, it is essential to always pay attention to protecting the stomach qi. Linzheng Zhinan Yi'an. The book "Sore and Ulcer" states, "Although most ulcer diseases manifest on the surface, the root of the illness lies within... Generally, using bitter and cold herbs to attack and expel, known as clearing heat and removing toxins, actually harms the stomach and damages life. Once the stomach qi is compromised, various complications will arise." The latter two symptoms and signs are caused by the dysfunction of qi and blood in the internal zang-fu organs. The treatment should focus on regulating the zang-fu organs and promoting the smooth movement of qi.