bubble_chart Concept

Chinese medicine literature has long documented this disease. For example, the description of "yellow-water sore (impetigo)" in Jingui Yaolue is quite similar to this disease. The Song Dynasty's "Complete Book of Sores and Ulcers" discusses "heavenly blisters": "The occurrence of this sore is not limited by age... Initially, a single blister appears, gradually spreading all over the body, continuously festering." The Ming Dynasty's Waike Qixuan elaborated on the disease cause and mechanism of heavenly blisters, suggesting that the disease is caused by the invasion of the lung meridian of hand Taiyin by summer heat and dampness, leading to fire pathogens attacking the lung meridian, which then becomes latent and stagnates. Heat toxin combined with dampness damages fluids and consumes qi, injuring both qi and yin; or dampness-heat internally accumulating with spleen deficiency leading to excessive dampness; a few cases may also involve cold-dampness accumulating toxins, damaging yang and depleting qi, resulting in yang qi deficiency. However, the disease is mostly caused by dampness, heat, and toxic pathogens.

bubble_chart Modern Research

Pemphigus is a group of autoimmune blistering skin diseases characterized by intraepidermal acantholysis, with a slow course, prone to recurrence, and can be life-threatening in severe cases. Its hallmark is the appearance of flaccid blisters on normal skin or mucous membranes, with a positive Nikolsky's sign. It is generally divided into four types: vulgaris, vegetans, foliaceus, and erythematosus. Pemphigus vulgaris is the most severe and has a poorer prognosis. Typical thin-walled, flaccid blisters and bright red erosions can be seen. Skin lesions can be widespread, commonly affecting the face, chest, back, armpits, and groin, often accompanied by oral mucosal lesions and severe systemic symptoms. Pemphigus vegetans is rare, characterized by erosive lesions that tend to become vegetative, commonly affecting skin folds such as the armpits, groin, genitals, anus, and periumbilical areas, with milder systemic symptoms and generally a better prognosis. Pemphigus foliaceus is characterized by generalized or extensive erythema covered with leaf-like or thin pancake-like scales, with moistness beneath the scales and foul-smelling exudates. Oral lesions are uncommon, systemic symptoms are milder, and the prognosis is better than that of pemphigus vulgaris. Pemphigus erythematosus is more common, with rashes typically appearing on the head, mid-face, and mid-chest and back, presenting as purplish-red patches with flaccid blisters that quickly dry and form dirty, scaly lesions resembling seborrheic dermatitis or lupus erythematosus. This type is a milder form of pemphigus foliaceus and has a better prognosis.

The pathogenesis of pemphigus is not yet fully understood. It is generally considered an autoimmune disease, with patients having specific antibodies against intercellular substances of epidermal keratinocytes, mainly IgG, whose titers correlate with the severity of the disease.

[Diagnosis]

1. The presence of non-healing flaccid blisters on the skin with a positive Nikolsky's sign.
2. Both pemphigus vulgaris and pemphigus foliaceus have widespread skin lesions, often with oral involvement, and significant skin erosions that are difficult to heal. Pemphigus foliaceus shows leaf-like epidermal detachment, while pemphigus vegetans presents with hypertrophic granulation, often in skin folds. Pemphigus erythematosus lesions are usually limited to the head, face, neck, and chest and back, resembling seborrheic dermatitis.
3. Cytological examination: A smear from the base of a blister stained with Giemsa reveals acantholytic cells.
4. Histopathological examination shows acantholysis with intraepidermal clefts and blister formation.
5. Immunological tests may be necessary. Indirect immunofluorescence can detect circulating antibodies against intercellular epidermal matrix in the serum. Direct immunofluorescence of skin biopsies shows immunoglobulin deposits between epidermal cells.

bubble_chart Pattern Analysis

1. Dampness-heat Toxin Accumulation, Steaming the Tri︰The blisters rapidly develop, enlarge, and may even merge into patches, with sores appearing on the oral mucosa. Accompanied by fever, thirst, irritability, dry stools, and yellow urine. The tongue is red or deep red with a yellow, greasy coating, and the pulse is wiry and rapid or slippery and rapid. This condition is commonly seen in acute episodes, often in cases of pemphigus vulgaris, pemphigus erythematosus, or pemphigus foliaceus. Treatment involves clearing heat, resolving dampness, and removing toxins. Modified Sweet Dew Detoxicating Pill is used, including: 10g of Amomum, 10g of Patchouli, 30g of Virgate Wormwood, 15g of Talc (wrap-boiled), 10g of Akebia Stem, 15g of Lonicera, 15g of Forsythia, 50g of Gypsum (to be decocted first), 30g of Glabrous Greenbrier, 6g of Coptis Rhizome, 15g of Gardenia, 15g of Unprocessed Rehmannia Root, and 30g of Dandelion. If the tongue is deep red with scant coating, remove Amomum and Patchouli, and add 15g each of Moutan Bark and Red Peony Root. For severe constipation, add 10g of Raw Rhubarb (to be decocted later).
2. Heat Damaging Qi and Yin︰Old scars may ulcerate or scab, but new scars keep appearing, with skin erosion that is slow to heal. Accompanied by low-grade fever or tidal fever, shortness of qi, reluctance to speak, mental fatigue, lack of strength, thirst but little drinking, a red tongue with scant moisture or cracks on the surface, thin or peeling tongue coating, and a deep, thin pulse. This is commonly seen after the acute phase, in individuals with a weak constitution and deficiency of both qi and yin. Treatment involves tonifying qi, nourishing yin, clearing heat, and removing toxins. Modified Yangyin Jiedu Decoction is used, consisting of: Heterophylly Falsestarwort Root 15g, Southern Glehnia 15g, Dendrobium 15g, Scrophularia Root 15g, Ophiopogon Tuber 10g, Astragalus Root 15g, Unprocessed Rehmannia Root 20g, Moutan Bark 10g, Red Peony Root 10g, Lonicera 15g, Dandelion 30g, and Smallpox Powder 10g. For severe constipation, add Raw Rhubarb Rhizome 6g; for afternoon tidal fever or low-grade fever, add Chinese Wolfberry Root-bark 10g and Neopicrorhiza 6g.
3. Dampness Obstruction with Mild Heat︰After the blisters rupture, there is abundant fluid that spreads and forms patches, making it difficult to heal, or thick scabs may form. Accompanied by chest tightness, gastric stuffiness, poor appetite, abdominal distension and fullness, loose stools, heavy limbs, and mental fatigue, leukorrhea is often thin and white in women, and oral or tongue erosion may also occur. The tongue is pale red with a thick, white, greasy coating, and the pulse is soggy and slow. This condition is commonly seen in individuals with constitutional spleen deficiency and excessive dampness, and can occur in both the acute phase and chronic persistent phase. The treatment involves resolving dampness, clearing heat, regulating qi, and invigorating the spleen. Modified Dampness-Expelling Stomach Poria Decoction is used: Chinese Yam 30g, Coix Seed 30g, Hyacinth Bean 15g, Hypoglaucous Yam 10g, Plantain Seed 15g, Alisma 10g, White Atractylodes Rhizome 10g, Indian Bread Tuckahoe 10g, Cardamom Seed 10g, Magnolia Bark 10g, Areca Peel 15g, Glabrous Greenbrier 30g. For fever, add Skullcap Root 10g and Forsythia 15g; for oral or tongue erosion, add Unprocessed Rehmannia Root 15g, Bamboo Leaf 10g, and raw Liquorice Root 6g.