bubble_chart Concept

Skin erythema, referred to as "erythema". Any red changes on the skin that are round, oval, or irregular in shape, lying flat on the skin and not raised to the touch, can be called erythema.

This condition, according to disease cause and mechanism of disease, can be divided into two major categories: "yang macula" and "yin macula". Ye Tian-shi also separately established the term "deficiency macula". Initially presenting as this condition, if it later transforms into purplish macula, it can be managed as "skin purplish macula". Warm febrile disease with macula is discussed separately and does not fall within the scope of this condition.

bubble_chart Pattern Analysis

1. Yin Deficiency︰It belongs to the category of "deficiency macules," characterized by bright red, makeup-like spots in the shape of coins or butterflies, symmetrically distributed on the cheeks, zygomatic areas, both sides of the nose, ears, mouth, lips, scalp, back of hands, etc. Accompanied by vexing heat in the chest, palms, and soles; dry throat and mouth; dizziness, tinnitus, blurred vision, hair loss; afternoon tidal fever; sore waist and weak legs; insomnia, night sweats; joint aching pain; dry stools; yellow urine; a red tongue with scant coating and no moisture; and a pulse manifestation of thin, rapid, and weak. Although also classified as "yin macules," it is mostly caused by innate deficiency, the five minds transforming into fire, which consumes and scorches nutrient-blood, leading to disharmony in the yin collaterals, or prolonged exposure to intense sunlight, allowing heat toxin to penetrate inward, blazing and scorching nutrient-blood, stasis obstructing the Jingmai, and manifesting externally as macules. The characteristic feature is the presence of bright red patches on the face. Additionally, there are signs of restlessness and vexation, vexing heat in the chest, palms, and soles; flushed cheeks; blurred vision and hair loss; dizziness and tinnitus; a red tongue with scant coating; and a thin, rapid pulse—all indicative of yin deficiency with effulgent fire. Treatment should focus on nourishing yin and reducing fire, supplemented by invigorating the blood to unblock collaterals. The recommended formula is a modified Zhi Bai Rehmannia Decoction.
2. Spleen Failing to Control Blood︰It belongs to the category of "yin macula." Commonly seen are pale red spots ranging from pinhead to elm coin size appearing on both lower legs, with a prolonged and recurrent course. Accompanied by a {|###|}pale complexion{|###|}, {|###|}mental fatigue and lack of strength{|###|}, poor appetite, {|###|}abdominal distension and fullness{|###|}, loose stools, edema of the lower limbs, or epistaxis, {|###|}bloody stool{|###|}, women may experience {|###|}menorrhagia and metrostaxis{|###|}, {|###|}tongue texture pale{|###|}, thin white coating, and a soggy, thin, weak pulse. It is often caused by dietary irregularities, exposure to cold or heat, {|###|}overstrain{|###|}, excessive contemplation, or improper post-illness recuperation, leading to {|###|}spleen qi injury{|###|}, loss of control, and blood failing to follow {|###|}meridian tropism{|###|}, resulting in external leakage forming macules. Clinically, manifestations may include a {|###|}lusterless complexion{|###|}, {|###|}shortness of breath{|###|}, fatigue, {|###|}loose stools or lienteric diarrhea{|###|}, abdominal distension, and anorexia—symptoms of {|###|}spleen deficiency{|###|} and failure of clear yang to ascend. There may also be epistaxis, {|###|}bloody stool{|###|}, and women may experience {|###|}menorrhagia and metrostaxis{|###|}—symptoms of the spleen failing to control blood. The key diagnostic features are pale red macules and a {|###|}pale tongue texture{|###|}. Treatment should focus on {|###|}tonifying the spleen and replenishing qi{|###|}, guiding blood back to {|###|}meridian tropism{|###|}. The recommended formula is Returning to Spleen Decoction.
3. Blood-heat Wind-dryness︰It belongs to the category of "yang macula," with an acute onset, commonly seen on the extensor sides of elbows and knees, scalp, and trunk. Initially, red or bright red spots appear, which may gradually expand into patches covered with silvery-white scales that peel off layer by layer, bleeding upon removal. It is often accompanied by itching, irritability, dry mouth, constipation, dark urine, a red tongue with yellow coating, and a wiry, slippery, rapid pulse. The condition may arise from emotional distress, dietary irregularities, excessive consumption of pungent or wind-inducing foods, or external factors such as wind and dryness-heat invading the skin. Combined internal and external pathogens lead to heat congestion in the blood vessels, resulting in bright red spots or patches. Key diagnostic features include sudden onset, dotted red patches covered with silvery-white scales that bleed when peeled. Treatment should focus on cooling blood, clearing heat, removing toxins, and relieving itching. The recommended prescription is Glabrous Greenbrier Decoction.
4. Exterior Binding of Wind Pathogen︰It belongs to the category of "yang macula." It often occurs in spring and autumn. Initially appearing on the chest, back, upper limbs, or abdomen, it starts with a single "mother macule" and gradually multiplies, with fine white scales like bran in the center. After several days, sudden onset of numerous rose-red patches of varying sizes may appear symmetrically from the neck to the knees, possibly accompanied by itching. It is often associated with irritability, thirst, a quick temper, dry stools, yellow urine, a wiry and rapid pulse, and a red tongue with thin yellow coating. The condition is mostly caused by inherent internal accumulation of blood heat and external contraction of wind pathogens. When internal and external pathogens combine, red macules appear. The key diagnostic points are: the red macules initially appear on the chest, back, or forearms and gradually spread, potentially extending from the neck to the knees. The macules are rose-red in color, covered with fine bran-like white scales, and are the size of a fingernail, round or oval in shape. The center may appear light yellowish-brown with fine wrinkles, and the long axis of the lesions often aligns with the skin texture. Treatment involves cooling the blood, dispersing wind, clearing heat, and relieving itching. The recommended formula is the Blood-Cooling Wind-Dispersing Powder.
5. Wind-heat Damaging the Nutrient Aspect︰It belongs to the category of "yang macula." Its main clinical manifestations include: dark red or bright red macules, often occurring in spring and autumn, appearing mostly on the face and the back of the hands and feet as bean-sized erythema with a central depression and raised edges resembling a dike, sometimes with blisters in the center, resembling a cat's eye. Initial symptoms may include fever, headache, dry mouth, sore throat, dry stools, yellow urine, a red tongue with thin yellow coating, and a wiry, slippery, rapid pulse. It is often caused by internal blood heat with dampness accumulation, compounded by exposure to wind-heat pathogens, leading to nutrient-defense disharmony, pale stagnation, and stagnation in the skin. Alternatively, it may be triggered by dietary deficiencies or the consumption of contraindicated foods. The clinical characteristics are: initial external contraction of wind-heat, soon followed by the appearance of nearly round, bright red macules the size of soybeans to broad beans on the face or the back of the hands and feet, with slightly raised edges resembling a dike and a slightly depressed center, sometimes with blisters. New and old erythema may overlap, accompanied by pain or mild itching. Treatment should focus on clearing heat, dispelling wind, activating blood circulation, and resolving macules. The recommended formula is Cimicifuga Rhizome Detoxification Decoction.
6. Dampness-heat Stagnation︰It falls under the category of "yang macula." It commonly occurs on the front of the lower leg and occasionally on the thighs and upper arms. The lesions are bright red in color, accompanied by plum-pit-sized hard nodules, with a burning pain that worsens upon touch. There is swelling of the legs and feet, making walking difficult, a sticky sensation in the mouth, abdominal distension and fullness, anorexia, unsmooth bowel movements, dark urine, and in women, yellow and foul-smelling leukorrhea. The tongue coating is yellow and greasy, and the pulse is slippery, rapid, and forceful. Individuals with an inherent accumulation of dampness may develop heat if the dampness stagnates for a long time. When dampness-heat pours downward, it congeals and obstructs the blood vessels and meridians, leading to blood stasis that manifests as macules. This condition can arise from living in damp and low-lying areas, sitting or lying on damp ground, exposure to humid conditions after rain, or improper diet that injures the spleen and stomach, resulting in internal dampness. When dampness accumulates and generates heat that flows downward, it manifests as bright red patches. These are accompanied by plum-pit-sized hard nodules that are tender and painful to the touch, with a subjective sensation of burning heat. Swelling of the legs and feet may occur, and in severe cases, movement may be restricted. The treatment should focus on invigorating the blood to unblock the collaterals, and the recommended formula is the Tongluo Huoxue Decoction.

The key diagnostic method is erythema, which can be seen in various symptoms and signs. If it fades upon pressure, it is often related to heat in the blood aspect. If it appears on the head and face, it is often associated with wind and fire. If it occurs on the lower limbs, it is often associated with dampness. If it is itchy, it is often associated with wind. If accompanied by scaling, it is often related to dryness. If the erythema is red and moist, the condition is usually mild and easy to treat. If the erythema is purplish-red, blackish-red, or dark red with a glossy appearance, the pathogenic factors have penetrated deeply, making the condition difficult to treat.

bubble_chart Documentation

1. Jingui Yaolue-Lily Bulb Erosion of Throat, Anus and Genitalia Yin and Yang Toxin: "The disease caused by yang toxin, the face is red and mottled like brocade patterns, sore throat, spitting pus and blood. It can be treated in five days, but not in seven days, Cimicifuga and Turtle Carapace Decoction is the main treatment."
2. Zhubing Yuanhou Lun-Round Tinea (tinea circinata) Syndrome: "The appearance of round tinea (tinea circinata) is a raised circular pattern, red around the edges, and also itchy and painful."
3. Zhubing Yuanhou Lun．Volume 31: "The face and body skin and flesh turn red, different from the flesh color, or as big as a hand, or as big as a coin, and also not itchy or painful, called red blemish. This is also caused by wind evil fighting in the skin, and the disharmony of blood and qi."
4. Waike Lili．Volume 7: "One person suffered from mottles, the color was red and purple, burning pain fever, likes cold, pulse deep and solid, with Saposhnikovia Sage-Inspired Powder one dose immediately receded, and then with Jingfang Baidu Drink added with Scutellaria and Coptis four doses and recovered."