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Chi You Dan (Red Roaming Erysipelas)

The *Huangdi Neijing* (Yellow Emperor's Inner Canon), in its discussions on the Five Movements and Six Qi, states that erysipelas all belongs to Fire.
The classics state: "When Shaoyang (Lesser Yang) governs the year, if the guest pathogen prevails, it causes red rashes to erupt externally, as well as erysipelas." This refers to such cases.
*Tai Ping Sheng Hui Fang* (Comprehensive Essential Formulas for the Universal Benevolent Sages) says: "Regarding all types of erysipelas, the human body suddenly turns red like cinnabar, hence it is called erysipelas." It may erupt on the hands and feet, or on the abdomen, sized like a palm. All are caused by wind-heat and malignant toxins; severe cases also belong to the category of carbuncles (Ju). If not treated urgently, the pain will be unbearable; over time, it will ulcerate and discharge several sheng (a unit of volume) of pus and blood. If it erupts between the joints, it causes toxic swelling of the four limbs; if the toxin enters the abdomen, it leads to death. Infants contracting this disease face the most critical situation.
Dai Fu'an said: "The color and shape of erysipelas vary, and so do the sensations of itching and pain. Generally, it arises from blood heat and muscle deficiency, with qi pathogens clashing and causing eruption. Red ones are common; because they are red, they are called 'Dan' (Cinnabar/Red). There are also white eruptions, called Leng Mo (Cold Erysipelas)." This disease often occurs due to loose muscle texture being invaded by wind pathogens. Wind-heat causes redness; wind-cold causes whiteness. Nowadays, people only call red ones 'Dan' and white ones 'Mo'. Ancient formulas also named them Yin Zhen (Urticaria/Hives). This not only distinguishes cold from heat but also encompasses the four climatic factors (Wind, Cold, Summer-Heat, Dampness). Recent medical theories call white ones 'Po Mo' and red ones 'Xue Feng' (Blood Wind).
Zhu Danxi said: "Erysipelas caused by internal injury results from extremely deficient Stomach Qi, with the whole body feeling like fire roaming externally. It is suitable to use tonification to descend the fire."
Liu Juanzi in *Gui Yi Fang* (Ghost Remnant Formulas) said: "Dan is a malignant toxic sore. Those with five colors and no pain are erysipelas; those that itch are Wind Dan."
Chen Shigong said: "Chi You Dan (Red Roaming Erysipelas), also known as Huo Dan (Fire Erysipelas), is caused by reckless movement of Heart Fire, with wind-heat of the San Jiao (Triple Burner) taking advantage of the weakness, thus erupting on the surface of the skin. There are dry and wet types, differing in red and white colors. The dry type is red in color, shaped like cloud patches, with wind-grain-like papules rising on top, accompanied by itching and fever. This belongs to the fire of the Heart and Liver meridians. Treatment should cool the Heart and drain the Liver, using Hua Ban Jie Du Tang (Spot-Transforming Detoxification Decoction) as the main formula. The wet type is mostly yellowish-white, varying in size, weeping fluid, ulcerating, and painful. This belongs to damp-heat of the Spleen and Lung meridians. One should clear the Lungs and drain the Spleen, using Chu Shi Wei Ling Tang (Dampness-Removing Wei Ling Decoction) as the main formula. If it grows on the waist and hypochondrium, it is reckless Liver Fire, also known as Chan Yao Dan (Waist-Coiling Erysipelas), treated mainly with Chai Hu Qing Gan Tang (Bupleurum Liver-Clearing Decoction). In severe cases, urgently use fine magnetic tips to prick the blood, and apply slices of lean pork to the affected area." (From *Wai Ke Zheng Zong*)
Xu Xueshi said: "Fei Zao Dan (Flying Stove Erysipelas) starts with red swelling and brightness from the top of the head. (Suitable to mix scallion white natural juice with Baidi powder and apply.) Ji Zao Dan (Auspicious Stove Erysipelas) is wind-heat of the Bladder Meridian, starting from the head towards the back of the neck with red swelling. (Suitable to mix Xiaodou and Zijingpi powder, using egg white or wine to apply.) Gui Huo Dan (Ghost Fire Erysipelas) is wind-heat of the Hand-Yangming meridians, starting with red swelling on the face. (Suitable to mix Mi Zhi Bo San with honey or egg white and Fulonggan powder to apply.) Tian Huo Dan (Heavenly Fire Erysipelas) is heat-toxin of the Kidney Meridian and wind-heat of the Bladder, starting with red swelling on the spine. (Suitable to melt 1-2 year old sheep fat, mix with Qianghuo powder and apply.) Tian Zao Dan (Heavenly Stove Erysipelas) presents with red swelling and slight yellowing on both arms, or one arm. This is wind-heat of the Hand-Yangming meridian. (Suitable to burn willow branches to ash, mix with water to apply, or apply Chonghe Gao.) Shui Ji Dan (Water-Splashed Erysipelas) presents with virtual swelling, redness, and heat on both hypochondriums. This is wind-heat of the Foot-Shaoyang Gallbladder Meridian. (Suitable to burn feces of a pregnant sow to ash, mix with wax water to apply.) Hu Chui Dan (Hu Blown Erysipelas) starts with yellow swelling above the navel. This is heat and dampness in the Ren Mai (Conception Vessel). (Suitable to mix Binglang powder with vinegar to apply, or Chonghe Gao with wine.) Ye Huo Dan (Wild Fire Erysipelas) starts with red swelling on both legs like burning fire. This is wind-heat in the Foot-Yangming Meridian. (Suitable to mix Ruxiang powder with sheep fat, or crush Huodan Cao and mix with vinegar, or mix Baiji powder with water to apply.) Yan Huo Dan (Smoke-Fire Erysipelas) starts with red swelling and pain on the dorsum of both feet. This is wind-heat of the Foot-Taiyang, Foot-Yangming, and Foot-Shaoyang meridians. Some start from the sole of the foot, indicating excessive heat in the Foot-Shaoyin Kidney Meridian. (Suitable to mix Xiangyou with soil from under pig troughs, or Mi Zhi Bo San to apply.) Hu Lou Dan (Hu Leaking Erysipelas) starts from the genitalia, presenting as yellow or red swelling. This is deficient fire of the Foot-Jueyin Liver Meridian erupting externally. (Suitable to mix Yangyou with Wulou Tu, or Zhi Bo San with vinegar to apply.)"
It is further stated: "These are all caused by toxins received in the womb. If not treated within three days, the toxin attacks the intestines and stomach, leading to certain death."
It is further stated: "For any infant under 100 days old who develops erysipelas, regardless of the type, death is inevitable."
Dou Hanqing said: "How to treat You Dan (Roaming Erysipelas) erupting on the head? One must lay the infant on a bed, place one or two bricks under the heels to weigh down and drive the toxic vapor downwards to the head, then prick with magnetic tips to allow toxic vapor and blood to exit from the top of the head. If held upright by the nurse during pricking, the toxic vapor will flow downwards, blocking the throat, making survival difficult. Recently, I have observed colleagues performing pricking incorrectly, harming many children. Therefore, I do not shy away from triviality and reiterate this point."
It is further stated: "Whenever erysipelas enters the abdomen, causing fullness, distension, protruding umbilicus, and a body hot as burning charcoal, death ensues."
It is further stated: "For Nei Dan (Internal Erysipelas), if swelling extends from below the ribs to below the waist, and redness spreads to the waist, death occurs."
Shen Douyuan said: "Nei Dan refers to redness like applied vermilion, visible within the flesh, hence the name. It feels board-like with slight swelling. If it erupts at points such as Yuanxi and Jinmen, on either right or left, it belongs to the Shaoyang Gallbladder Meridian and is treatable within one to two days. If it involves the waist and umbilicus turning blue-purple with severe pain, or if urination and defecation are blocked, it is untreatable and death is certain." (From *Qi Xuan Wei Zhi*)
It is further stated: "Jia Dou Dan (Bean-Clasping Erysipelas) is red, like vermilion painted on the skin. It is caused by heat-toxin accumulating with evil blood, combined with Mingmen (Gate of Life) ministerial fire erupting. It often occurs alongside smallpox. If it floats thinly like rosy clouds, it is easy to treat; if thick and purple, it is difficult to cure. One should follow the seasons: in summer heat, use Tongsheng San (Universal Salvation Powder) or similar acrid-cool agents to resolve it; in severe cold, use Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) or similar acrid-warm agents. Once smallpox erupts, this timing is appropriate. Neglect in care can lead to wind-heat causing blood boiling, or cold causing blood stagnation. External application methods can also be used."
It is further stated: "Erysipelas spreading from the abdomen to the four limbs indicates survival; entering the abdomen from the four limbs indicates no hope of rescue."
Dou Hanqing said: "For Chi Dan (Red Erysipelas), urgently use magnetic tips to remove purple blood. Prick from bottom to top so toxic blood flows upward; do not prick against the flow. Urgently apply Ruxiang powder mixed with egg white to the pricked area, and frequently apply juice from Banana Root."
It is further stated: "There is another type called Lan Pi Huo Dan (Rotting Skin Fire Erysipelas). Mix lotus pod shells, flour, Fulonggan, and Huangbai powder evenly and sprinkle dry."
Li Dongyuan said: "Erysipelas refers to the human body suddenly turning red like applied cinnabar, hence the name. Secularly called 'Chi Liu' (Red Tumor), or caused by touching wounds, causing surrounding redness, called 'Chuang Liu' (Sore Tumor). All diseases of erysipelas wander不定 (without fixed location), resembling cloud vapor. For infants, it is most taboo within 100 days, called 'Tai Liu' (Fetal Tumor). Because their Qi and Blood are tender and weak, and Zang-Fu organs are soft and fragile, they cannot withstand the knife-needle, hence the taboo."
Feng Luzhan said: "Chi Zi Dan Liu (Red-Purple Erysipelas Tumor) all erupt from internally depressed Heart Fire, red like cinnabar, hence called Dan. Heat-toxin lodges in the skin, clashes with Qi and Blood, and is ridden by wind. Yin stagnates in Yang, causing erysipelas. Extreme heat generates wind, wandering the body in moments. Deficient heat causes itching; excess heat causes pain. Spreading from abdomen to limbs is easy to treat; returning from limbs to abdomen is difficult. Although books mention five colors and ten types of Dan, it all stems from blood heat belonging to the Heart. Heart fire blazes internally, guest wind strikes externally. When wind prevails, trees shake; thus, it wanders very fast. Named 'Dan' because the Heart corresponds to Fire and the color is red. Red color indicates life; white indicates Qi deficiency with phlegm; purple indicates盛 (excess) toxin; green-blue like moss indicates death. Red is named Chi You Dan, indicating deep infection of heat-toxin. Its appearance is red swelling, patchy like rouge, erupting on hands, feet, head, face, chest, or back, causing irritability, chest oppression, abdominal distension, heat like fire, unbearable pain, wandering the body, flowing rapidly. Must treat urgently; if it enters abdomen and Kidneys, it is incurable. White is named Bai You Feng (White Roaming Wind), a mild syndrome of wind-dampness. Symptoms include flowing lumps with itching, high fever with aversion to cold, nasal congestion, brain stuffiness, cough, and vomiting. Treatment: Red type uses cooling and detoxification; severe cases prick out evil blood and apply medicine. White type uses only dispersing and draining dampness. Huo Zhuo Chuang (Fire-Burning Sore) is congenital heat-toxin. Fire travels through hollow orifices, appearing as red spots like tinea on mouth, nose, eyes, ears, scrotum, and anus, gradually becoming red blisters, breaking after a day, leaving red skinless areas like scalds, with extreme pain, restlessness, and potential total body rot within 1-2 days. If fontanelle swells with Qi, or Yin-Du swells brightly, it is untreatable. Also, all erysipelas entering Zang organs, with protruding umbilicus discharging plasma, purple-floating cheeks, choking refusing milk, clenched fists, cessation of urination/defecation, blood spots on chest/back, black sores on tongue, purple-swelling of heart/chest, are all untreatable. However, infants have delicate Zang-Fu organs. For all erysipelas, one must first take internal detoxifying herbs before external application. Toxins enter easily but exit hard; injury to muscles is minor harm, injury to Zang-Fu is rapid and severe harm." (From *You Ke Jin Zhen Jin Nang*)
Chen Shigong said: "Infant Chi You Dan receives toxins before birth and manifests after birth. While in the womb, nourishment relies on father's essence and mother's blood. If parents cannot restrain desires, rampant lust-fire inevitably invades the fetus. After birth, hot baths, drying clothes with heat/smoke, touch off internal toxins. Before eruption, there is fever, crying, and convulsions, followed by red swelling, brightness, and heat, wandering instantly without fixed location. Starting from forehead is named Tian Zao Dan. Treat with Shengma Gegen Tang, taken by both mother and child. Others start on abdomen/back. Abdomen/back spreading to limbs is mild; limbs spreading to chest/back is severe. Total principle is to prick out evil blood. After pricking, first apply slices of lean pork for about an hour, then apply Jinhuang San mixed with juice crushed from water banana root. If toxic vapor enters interior, causing hard abdominal distension and refusal to nurse, administer Xuexue San (Purple Snow Powder). After three days, if body cools completely, flesh at pricked site becomes soft and active, voice clear, abdomen soft, and nursing normal, it is a favorable sign (Shun); otherwise, it is unfavorable (Ni)." (From *Wai Ke Zheng Zong*)
Qian Qinglun said: "Tian Huo Dan starts with red spot scars on the back. (Powdered Sangbaipi mixed with sheep fat to apply.) Shui Ji Dan starts with virtual swelling on both hypochondriums. (Powdered raw iron filings mixed with pig manure to apply.) Chan Yao Dan has a red bud on the waist with red veins on both sides; if it coils to the navel, death ensues. (Thick gold ink mixed with Xionghuang powder to apply.) Leng Dan (Cold Dan) appears as white pigment. (Boil a pinch of Jiangpi [Ginger Peel] in water to wash.) Re Dan (Hot Dan) appears as red pigment. (Boil Zibeifuping [Mint/Floating Duckweed] in water to wash.) Dan Liu (Erysipelas Tumor) sometimes grows under the chin like a cherry, protruding, red, and shiny. (Grind mutton brain with Puxiao [Mirabilite] until paste-like, apply to lesion for immediate effect.) Dan Zhen (Erysipelas Rash) presents as red dots all over the body like sprinkled vermilion. (Use Fangji 1.5 liang, Puxiao, Xijiao, Huangqin, Huangqi, Shengma each 1 qian, add Zhuli [Bamboo Sap], decoct and drink for cure.) Huo Dan (Fire Erysipelas) presents with red swelling all over the body. (Equal parts Danggui, Chishao, Gancao, Dahuang. Take 3 qian per dose, half cup water, decoct to 3-4 fen, take after meals, also effective.) Huo Dan erupting on ankles. (Crush Yuntaicai [Rapeseed Greens] and apply, disappears immediately.) Chi You Feng Dan (Red Roaming Wind Erysipelas) suddenly swells and itches, flowing to more than one place. This condition is extremely urgent; delayed rescue leads to death. (Equal parts Xionghuang and Wubeizi powdered, mixed with vinegar to apply. Or Wu Mingyi powder mixed with scallion juice for immediate disappearance. Or rust water applied for disappearance. Or fresh lotus leaves crushed with a little salt applied for disappearance.)"