Clinical Experience Introduction of the Treatment of Binaural Skin Cellulitis with The Combination of Da Chai Hu Tang and Long Dan Xie Gan Tang

Cellulitis refers to an extensive, diffuse and suppurative inflammation of skin and subcutaneous tissue, which caused by staphylococcus aureus, hemolytic streptococcus or saprophytic bacteria. Professor Ji Yunxi used combined Da Chai Hu Tang and Long Dan Xie Gan Tang to treat one case of skin cellulitis on both auricles. The case was reported as follows.

First Visit: Feb 1st 2018.

Mr. Qiu, 69ys, his both auricles were red, swollen, hot and painful. After hormone treatment, the symptoms were relieved. However, it was recurred shortly; both ears were swollen, painful and high fever. Thus patient was hospitalized immediately. After treated with corticosteroids and daptomycin for a few days, the inflammation was improved and discharged. Five days later, the above symptoms reoccurred, and admitted got corticosteroids and daptomycin for the second time. Three days after second discharge, his symptoms happened again. So he turned to Dr. Ji asked for Chinese medicine help.

His both ears were red, swollen, hot and painful, and the right ear was severer than the left one. He has poor sleep and full of dream for over 2 years, took sleep pill for over 2 months and cholecystectomy for 3 months, and he easily lost temper; dry stool, constipation, defecated once every 3-5 days, normal appetite, no dryness or bitter taste in the mouth, no mouth ulcer, no chest fullness and palpitation. The tongue is red, the coat is yellow, thick and greasy, and the pulse is deep and slippery.

Western medicine diagnosis: skin cellulitis. TCM diagnosis: Ear carbuncle (yong). The treatment principle is to clear heat and toxin, resolve dampness and promote bowel movement. Modified Da Chai Hu Tang and Long Dan Xiegan Tang were prescribed.

chai hu 15g, xiang fu 10g, haung qin 15g, jiang ban xia 10g, chen pi 6g, da huang 10g, yu jin 10g, zhi shi 10g, long dan cao 6g, jin qian cao 15g, che qian zhi 15g, dang gui 15g, sheng di 10g, jiao shan zhi 10g, gan cao10g, niu xi 15g (The formulae is for three days, decocted in water and take twice a day)

Second visit on Feb 5th2018: After taking the above decoction, the symptoms improved obviously. Redness and swollen of the right ear subsided, the redness and heat of the left ear faded, and swollen slightly reduced. The tongue was dark red, the coat was thin, and the pulse was deep and slippery. Doc. Ji modified the original prescription by reducing Da Huang to 5g. As the Spring Festival approaching, Dr. Ji prescribed formulae for another seven days, and meanwhile instructed the patient to follow up promptly anytime if he is not feeling well.

Third visit: Feb 28th. 2018: After taking the last seven doses of medicine, patient basically recovered (as shown in Figure 2). The pulse was slippery and soft, the tongue was light red, the coat was thin and white. The patient had itchy skin and poor sleep, difficult to fall asleep and dreaminess, no mouth ulcer, toothache or stomach distention, but has sour waist, leg weakness and easy to feel fatigue. Gui Zhi method was proposed to finalize the treatment.

Gui zhi 10g, sheng long gu 30g, sheng mu li 30g, fu ling 15g, wu wei zi 6g, shi chang pu 10g, duan ci shi 30g, yuan zhi 10g, he huan pi 10g, zhi gan cao 6g, bai xian pi 10g, she chuang zi 10g, dang gui 15g, bai zi ren 10g, yang chun sha 10g, huo ma ren 10g (seven days decoction, twice a day)

Notes: "Ear cellulitis" belongs to the category of "ear carbuncle (Yong)" in traditional Chinese medicine, which caused by heat, toxin and blood stasis. ‘Ear is the gathering place of the ancestral meridians.’ Hand Shao Yang Sanjiao Meridian, Hand Tai Yang Small Intestine Meridian, Foot Shao Yang Gallbladder Meridian and Foot Tai Yang Bladder Meridian all follow the ear and are closely related to the ear.

In the book of “Treatise on Cold Damage Diseases, 264)”, it said“Shaoyang disease with wind affection, the ears can’t hear anything.’ Which means the disease evil invades Shaoyang, causes foot Shaoyang meridian is inhibited, Shaoyang’s ministerial fire goes upward, and pathogentic qi invades the ear.

Foot Shaoyang Gallbladder Meridian belongs to the gallbladder and connects the liver. Foot Shaoyang Gallbladder Meridian and Foot Jueyin Liver Meridian stands in interior-exterior relationship. Yang rising and Yin descending mutual cause and effect, if Shaoyang rises inversely, will interfere Jueyin flow downward. Therefore, the patient became irritable, his ears were red, swollen, hot and painful, and the coat is yellow, thick and greasy. All of the symptoms were caused by damp and heat accumulation of liver and gallbladder meridian.

Constipation is due to dryness in Hand Yangming meridian. Furthermore, the nature of foot Jue Yin is Yin, while the function is Yang. Evil heat impairs yin, causes lack of energy to promote bowel movement, and the outlet of evil Qi is blocked.

Since the disease is in Shaoyang, it should be prohibited to use dredging method, however the symptoms also shows it has Yangming Fu organs fullness, so promoting bower movement is recommended.

It is a coexist disease of Shao yang and Yang ming. The excessive fire of liver and gallbladder caused obstruction of San Jiao; it corresponds to the circulation routes of meridians. Therefore, Da Chai Hu Tang was proposed to relieve Shaoyang and Yangming, combined with Long Dan Xiegan Tang to clear the liver, benefit the gallbladder and nourish liver blood.

In these formulae, Xiao Chai Hu Tang harmonizes Shaoyang, relieve reverse evil heat of Shaoyang, together with Da Huang and Zhi Shi to unblock Yang Ming. Excessive fire of liver and gallbladder disturbs ears and eyes and consumes Yin blood. Carbuncle toxin is heat toxin; herbs that are used to clearing heat toxin are cold nature and bitter taste, and consume yin blood fatherly. Therefore, it is necessary to add some herbs that nourishing Yin blood while clearing heat and detoxification. So Long Dan Xie Gan proposed. The combination of the two formulae not only relieved the evil qi of Shaoyang and Yangming by Da chaihu Tang, Longdan Xiegan Tang drainage liver heat and toxin, also benefit healthy qi. At the same time, Xiang fu, Yu jin were to clear heat and remove depression, and Jin Qian Cao and Niu Xi were to reduce fire, so as to create a route to get rid of evil heat. The formulae corresponds with the disease and syndrome, so it worked effective and efficiently. After recovered from the severe illness, patient's healthy qi was impaired, so Dr.Ji used Gui Zhi method to restore genuine Qi, rebuild the balance of Yin and Yang.