Multiple Abscess
Multiple Abscess
Multiple Abscess
The alias disease: Multiple Abscess
Their location: Systemic
Attendance sections: Boils and Sores
It refers to multiple abscess occurring in the deep areas of the muscles. It is believed in Chinese medicine that this disease is usually caused by stagnation of qi and blood due to obstruction of the meridians and collaterals, resulted from circulation of pathogenic toxins in the blood vessels because of insufficiency of the anti-pathogenic ability.Its clinical feature is diffuse tumefaction and pain in the infected areas initially, with normal skin color. It happens frequently in the areas with thick muscles of the four limbs and body trunk. Very often, it has not been cured in one area and appears in another area again. Because of the different causative factors, there are different names. For instance, multiple abscess occurring in summer and autumn is called multiple abscess of summer dampness. Multiple abscess caused by furuncle and boil is termed multiple abscess of residual toxins.Multiple abscess caused by retention of postpartum lochia or traumatic injury is called multiple abscess of stagnant blood. Multiple abscess happening in the iliac fossa is called multiple abscess of the iliac fossa. It is similar to pyemia in Western medicine, abscess in the deep position of the muscles and abscess of the lilac fossa.
Diagnostic Essentials
It frequently occurs in the lumbus, hip, posterior aspect of the thigh and iliac fossa.
First of all, muscular pain and diffuse swelling with normal skin color and slightly warm sensation by pressure happen in one area or several areas in the proximal part of the four limbs or body trunk. In about 2 3 days, tumefaction and burning pain become obvious, with palpable mass. Progressively, the tumefaction enlarges and pain is aggravated. In about 2 weeks, the skin in the center of the tumefaction becomes slightly red and warm and feels soft in the center. After rupture, the discharged pus is yellow, white, tenacious and thick, or mixed with blood clots. In another 2 weeks, after the tumefaction diminishes and pain stops, the wound is healed.
If high fever still lingers after the wound is healed or is accompanied bv muscular nain in other areas or palpable mass, mostly it is a secondary infection.
Multiple abscess of the iliac fossa only occurs in one aspect of the iliac fossa. Initially, the infected thigh feels spasmodic and uncomfortable, with difficult walking. After 2 - 3 days, when local pain is aggravated, the thigh shrinks upwards and adducts slightly and is unable to extend straightly. But, the knee joint is still able to extend and flex. If the infected limb is stretched forcefully, it is able to cause serious pain, causing the abdomen protruded forward and the spine curved like a bow. Mter about 7 -10 days, a mass in a long form and hard nature can be palpated with a tenderness in the lilac fossa. It takes about one month for suppuration.Because the position is comparatively deep, the fluctuating sensation is not obvious. Mter it is cured, the infected thigh is still difficult to flex and extend. Only after practice for 1 - 2 months, can the normal function be restored.
This disease is accompanied by obvious general symptoms. The total count of peripheral leukocyte and neutrophil ratio are obviously enhanced. Bacteria growth can be noticed in blood bacteria culture. Ultrasonic examination is helpful for diagnosis of multiple abscess in the deep position.
Treatment Based on Syndrome Differentiation
Syndrome of Attack and Migration of Residual Toxins
Main Symptoms A history of boils, sores, carbuncles and furuncles existed before infection, manifested by obvious tumefaction and pain, progressive red color and burning pain, yellow, tenacious and thick pus discharged after rupture, easy healing of the wound, accompanied by fever, dry mouth, aching sensation in the body and bone, reddened tongue, yellowish coating, full and rapid pulse.
Therapeutic Methods Clear away heat, dissolve toxins, diminish tumefaction and disperse accumulation.
Formula Modified "Huanglian Jie Du Decoction" plus "Xijiao (substituted by Shuiniujiao) Dihuang Decoction" with Huanglian (Rhizoma Coptidis) 3 g, Huangqin ( Radix Scuteltariae ) 10 g, Shanzhizi ( Fructus Gardeniae ) 15g, Shuiniujiao ( Cornu Bubati ) (Decoct first) 30 g, raw Dihuang ( Radix Rehmanniae ) 20 g, Mudanpi (Cortex Moutan Radicis ) 10 g, Chishaoyao ( Radix Paeoniae Rubra ) 12 g, Tianhuafen (Radix Trichosanthis) 15 g, and raw Gancao (Radix Glycyrrhizae ) 5 g.
Modification For high fever and thirst, add raw Shigao (Gypsum Pibrosum ) (Decoct first) 20 g and Zhimu (Rhizoma Anemarrhenae) 12 g. For constipation and brown urine, add raw Dahuang (Radix et Rhizoma Rhei) (Decoct later) 10 g and Cheqianzi (Pericarpium Citri Reticulatae) (Decoct in pack) 15 g. For hard tumefaction with difficult rupture or hesitant pus discharge after rupture, add Zaojiaoci (Spina Gleditsiae) 12 g and processed Chuanshanjia (Squama Manitis) 10 g.
Mixed Obstruction of Summer Dampness Syndrome
Main Symptoms It often happens in summer and autumn, manifested by soft tumefaction in the infected area, no change of skin color, aching and distending pain,mild development, yellow and white pus, accompanied by slight fever, stuffy chest, abdominal fullness, aching sensation in the bones and joints, or white mass in the body, reddened tongue, white and greasy coating, slippery and rapid pulse.
Therapeutic MethodsClear away summer heat,dissolve toxins, dissipate dampness and diminish tumefaction.
FormulaModified "Qing Shu Decoction" plus "Wu Shen Decoction" with Jinyinhua (Flos Lonicerae ) 6 g, Lianqiao ( Fructus Forsythiae ) 12 g, Danzhuye ( Herba Lophatheri) 15 g, Tianhuafen (Radix Trichosanthis ) 12 g, Cheqianzi (Semen Ptantaginis) (Decoct in pack) 15g, Pugongying (Herba Taraxaci) 20g, Zihuadiding (Herba Violae) 15 g, Zexie (RhizomaAlismatis) 10 g, and "Liu Yi Powder" (decoct in pack) 15 g.
Modification Forexcessiveheattoxins,add Shanzhizi ( Fructus Gardeniae ) 12 g and Xiakucao ( Spica Prunellae) 15 g. For high fever and thirst, add raw Shigao (Gypsum Fibrosum) (Decoct first) 20 g and Lugen (Rhizoma Phragmitis) 15 g. For stuffy chest, nausea and vomiting, add Huoxiang (Herba Agastachis) 10 g and Peilan (Herba Eupatorii) 10 g. For suppuration with difficult rupture, add Zaojiaoci (Spina Gteditsiae) 12 g and processed Chuanshanjia (Squama Manitis) 10g.
Blood Retention and Stagnancy Syndrome
Main SymptomsIf caused by retention of postpartum lochia, it mostly occurs on the lower abdomen and medial aspect of the thigh. If caused by injury of tendons and meridians due to fatigue, it often occurs on the medial aspect of the four limbs. If induced by traumatic injury, it often occurs in the injured areas. It is manifested by diffuse tumefaction and pain in the local area, with slightly red skin color or blue purple skin color, and blood clots mixed in the discharged pus after rupture. The general symptoms are mild comparatively, and high fever can present in suppuration. There are ecchymosis and petechia on the tongue, and hesitant pulse.
Therapeutic MethodsHarmonizeYing-Nutrient System, activate blood, expel stagnation and dredge collaterals.
Formula Modified "Huo Xue San Yu Decoction" plus "Wu Shen Decoction" with Danggui (Radix Angelicae Sinensis ) 8 g, Chishaoyao ( Radix Paeoniae Rubra ) 10 g, Taoren (Semen Persicae) 6 g, prepared Dahuang (Radix et Rhizoma Rhei ) 8 g, Chuanxiong (Rhizoma Ligustici Chuanxiong ) 4 g, Mudanpi ( Cortex Moutan Radicis) 10 g, Cheqianzi (Semen Plantaginis) (Decoct in pack) 12 g, Jinyinhua ( Flos Lonicerae ) 6 g, Niuxi ( Radix Achyranthis Bidentatae ) 10 g, and Gancao (Radix Glycyrrhizae ) 5 g.
Modification Forexcessiveheattoxin,add Huangbai (Cortex Phellodendri ) 10 g and Shanzhizi (Fructus Gardeniae) 12 g. For obvious damp heat, add raw Yiyiren (Semen Coicis ) 15 g and Zelan (Herba Lycopi) 10 g. For retention of postpartum lochia, add Yimucao (Herba Leonuri ) 15 g and prepared Xiangfu (Rhizoma Cyperi) 10 g
Other Therapies
Application Method
For the tumefaction without mass in the initial stage, it is advisable to use "Jin Huang Ointment" and "Yu Lu Ointment" for external application. For the tumefaction with obvious mass, it is advisable to mix "Tai Yi Plaster" with "Hong Ling Pellet" for external application. After rupture, it is advisable to use "Ba Er Pellet" to promote pus discharge and expel the decay and cover the wound with "Hong You Ointment". Mter pus is discharged completely, it is advisable to mix with "Sheng Ji Powder" and cover the wound with "Sheng Ji Ointment" for promoting granulation and healing the wound.
Incision Method
It is advisable to make an incision to discharge pus after pus is formed.
Bamboo-Tube Rolling Method
It is mainly used for those with motor impairment after cure of multiple abscess in the iliac fossa, for proper practice of flexing and extending function of the lower limbs. After the bamboo tubes are placed next to the bedside from the big size to small size by turns, the patient is asked to step on the bamboo tubes for a rolling movement, twice or three times a day and 20 - 30 minutes each time.
Cautions
Multiple abscess is an acute suppurative disease occurring in the deep position of the muscles and is mostly secondary to other infection and is easy to recur after cure. Therefore, for either primary disease or after cure of multiple abscess, careful attention should be given in order to prevent recurrence. For multiple abscess of the iliac fossa, it is necessary to pay attention to functional practice after it is cured, to obtain an early recovery without any sequela.
There are some measures that you can take to prevent boils from forming. The regular use of antibacterial soaps can help to prevent bacteria from building up on the skin. This can reduce the chance for the hair follicles to become infected and prevent the formation of boils. In some situations, your health-care practitioner may recommend special cleansers such as pHisoderm to even further reduce the bacteria on the skin. When the hair follicles on the back of the arms or around the thighs are continually inflamed, regular use of an abrasive brush (loofah brush) in the shower can be used break up oil plugs and build up around hair follicles.
Pilonidal cysts can be prevented by avoiding continued direct pressure or irritation of the buttock area when a local hair follicle becomes inflamed. At that point, regular soap and hot water cleaning and drying can be helpful.
For acne and hidradenitis suppurativa (see above), antibiotics may be required on a long-term basis to prevent recurrent abscess formation. As mentioned above, surgical resection of sweat glands in the involved skin may be necessary. Other medications, such as isotretinoin (Accutane), can be used for cystic acne and have been helpful in some patients with hidradenitis suppurativa. Recurrences are common in patients with hidradenitis suppurativa.
Finally, surgery may occasionally be needed, especially in pilonidal cysts that recur, but also for hidradenitis suppurativa. For pilonidal cysts, surgically removing the outer shell of the cyst is important to clear the boil. The procedure is typically performed in the operating room. For hidradenitis suppurativa, extensive involvement can require plastics surgical repair.
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