Dermatitis is an acute inflammatory disease caused by B hemolytic streptococcus invading the skin or lymphatic vessels in the subcutaneous tissues and surrounding soft tissues, most commonly in the lower legs and feet, followed by the cheeks, and a few in the trunk. It is named after the sudden reddening of the skin, such as the redness of the skin and the redness of the patches. Western medicine treatment principle is early, effective, adequate use of antibiotics to relieve systemic symptoms, control the spread of inflammation and prevent recurrence, but the clinical efficacy is not very satisfactory. The author applied a combination of internal and external treatment to lower extremity dermatophytosis in clinical practice, and the efficacy is remarkable. Complaint: redness, swelling and pain on the dorsum of the right foot for three days. Three days ago, the right dorsum of the foot suddenly appeared red, swollen and painful, accompanied by chills and fever (T 38.8 ℃), 12 million units of penicillin was administered daily, but the condition was not controlled. The dorsum of the right foot was red, swollen and painful, with a red complexion like a pelvis, with clear borders, covering an area of about 7 cm×4 cm, discolored by pressure, burning and painful by palpation, with a dark red tongue, thin yellow moss and a stringent pulse. Diagnosis: dorsal dandruff of the right foot. The evidence belongs to damp-heat injection. Treatment: Clearing heat, resolving dampness and detoxification, invigorating blood and promoting circulation. Treatment: 1. Internal treatment with Si Miao Yong An Tang plus flavor. The formula is as follows: Radix et Rhizoma Ginseng, Radix Angelicae Sinensis, Radix et Rhizoma Paeoniae, Radix Achyranthes Bidentatae, Radix Scutellariae, Fructus Atractylodis, Poria, Rhizoma Safflower, Radix et Rhizoma Dioscorea, Radix et Rhizoma Glycyrrhiza Uralensis, 6 g. Decoction in water, one payment per day. 2. External treatment: The affected area of the right foot is disinfected with iodine volt, and the trigeminal needle is pecked lightly and quickly to pierce the affected area with 5-8 needles, about 2-3 mm. Needle site has a little blood seepage, wait a moment, iodine volts again after disinfection, the affected area is applied externally plus flavor Jinhuang San ointment (thickness of about 4-5L), and then a sterile bandage fixed. The next day, the swelling and pain of the right dorsum of the foot was obviously reduced, and the patient was cured after applying the ointment of Jinhuang San to the affected area after tapping with a trigeminal needle again. Case 2 Tang, male, 72 years old, visited the clinic on September 10, 2010. His left calf and dorsum of the foot had been red, swollen and painful for more than half a month. More than half a month ago, due to foot infection, the left calf and dorsum of the foot began to appear red, swollen and hot pain, accompanied by fever, and was hospitalized in a hospital with “left lower extremity dermatitis”, treated with daily intravenous “ceftriaxone sodium”, external application of ichthyolite ointment and local physiotherapy. He was hospitalized for more than half a month, but the redness, swelling and pain in the left calf and dorsum of the foot did not diminish, and the fever did not subside, so he was referred to a Chinese medicine doctor for treatment. The left calf, ankle and dorsum of the foot are red and swollen with clear borders, bright surface, no fingers when pressed, burning skin temperature, pain when pressed, dark red tongue, yellow greasy moss, sunken pulse. Diagnosis: left lower extremity dermatitis. The diagnosis is damp-heat injection, stagnation of the veins and channels, and deficiency of evil. The treatment is to resolve dampness and detoxification, remove blood stasis, promote blood circulation, and reduce swelling. Treatment method: 1. Internal treatment method, formula Honeysuckle, Astragalus, Astragalus, Prunus, Job’s tear, 30 grams each, Zingiber officinale, Dandelion, 20 grams each, Phellodendron, Atractylodes, Comfrey, Dampness, Radix Paeoniae, Zedoary, Atractylodes, Poria, 10 grams each, Mouton, Glycyrrhiza, 6 grams each. 2. External treatment method: After percussion with a trigeminal needle, apply a cream of Jinhuang San to the affected area of the left lower extremity, and fix it with a sterile bandage, and after 2 consecutive percussions (once a day), continue to apply a cream of Jinhuang San to the affected area. (Percussion method is the same as case 1, the number of percussion needles is 10-20.) Three days after the combination of internal and external treatment, the redness, swelling and pain of the lower extremity were obviously reduced, and the symptoms of the affected extremity were basically eliminated after ten days, which was then cured by regulating qi and blood with the addition and subtraction of tonifying Zhong Yi Qi Tang. The clinical features of both case 1 and case 2 are acute lower extremity dermatosis, characterized by rapid onset and obvious symptoms, with damp-heat injection and stagnation of veins and channels as the main pathogenesis, but the two cases are different. Case 1 was a middle-aged male who had just fallen ill, and the four diagnoses were combined to identify damp-heat downward injection. The formula used Si Miao Yong An Tang Plus, in which four herbs, namely Xuan Shen, Jin Yin Hua, Angelica Sinensis and Gan Cao, nourished Yin and cleared heat and activated blood to detoxify the toxin, while Scutellaria Baicalensis, Huang Bai and Niubizi cleared heat and dampness to induce the downward movement of the herbs, and Red Flower and Di Long activated blood to open the channels, so that the toxin and blood were cleared and the swelling and pain were relieved. Case 2 is an elderly male, the onset of more than half a month, after antibiotic treatment is not effective, the poisonous evil filled for many days, has been depleted of Qi and blood, coupled with the lower extremity swelling is very, the four consultations together, identified as damp-heat poisonous evil stasis blocking the lower extremity, Qi stagnation and blood stasis, so the formula with astragalus, atractylodes, prunus ginseng to strengthen the spleen and benefit the Qi, contain the poison out, in order to prevent the poisonous evil within the meaning, poring, zedoary water to reduce swelling, swelling subsided pain. The two cases used the same external treatment method, i.e., three-pronged needle percussion on the skin of the lesion and external application of Chinese medicine. The skin of the lesion can be percussed with a three-pronged needle to unblock the local congestion of qi and blood, so that the heat and toxicity of the evil with the blood exudation and drainage, so that the meridian qi can be regulated, the function of the internal organs can be adjusted, and then achieve the purpose of reducing inflammation, swelling and pain. It can not only improve local blood circulation, but also reduce inflammatory exudation, promote the absorption of inflammation, and prevent the spread of inflammation. The combination of internal herbal medicine, trigeminal acupuncture and external herbal medicine is clinically effective and worthy of reference. Case 3 Wang, male, 58 years old, presented to the clinic on July 22, 2009. Complaint: Swelling and sinking pain in the right calf for more than one year. In June 2008, there was no obvious cause for the redness, swelling and pain in the right calf, and the swelling started from the inner and outer ankle to the calf gradually, and in September of the same year, the swelling, pain and swelling in the right calf were most obvious, which affected walking when serious, without varicose veins in the lower limbs, and the ultrasound of the lower limbs indicated no deep vein thrombosis and venous valve insufficiency. He had been hospitalized in the local hospital for “phlebitis”, but the treatment was generally effective. Over the past year, the swelling and pain in the right lower leg was mild and severe, with recurrent attacks. On examination: slight swelling of the right lower limb from below the knee joint to the inner and outer ankle, with widespread uniform swelling, dark red complexion, slightly higher skin temperature than the left side, tough texture, obvious tenderness, red descending tongue, white greasy moss, sunken and astringent pulse. Diagnosis: chronic dampness in the right lower extremity. The evidence belongs to damp-heat poisonous evil accumulating in the lower extremity, with heavy stasis of blood. Treatment is to invigorate blood circulation, resolve blood stasis, and relieve pain. Treatment: 1. Internal prescription: 30g each of honeysuckle, danshen, henbane and fu ling, 10g each of angelica, Chuanxiong, red peony, tannin, banshee, shanjia and atractylodes. Decoction with water, one payment per day. At the same time, 100 mg of Calendula officinalis, 15-20 days for a course of treatment. 2, Chinese herbal fumigation sweat right lower limb affected area. Radix Salviae Miltiorrhiza, Radix et Rhizoma Gastrodiae 30g each Radix Angelicae Sinensis, Rhizoma Chuanxiong, Radix Paeoniae Alba, Radix et Rhizoma Yuanhu, Radix Wei Lingxian 15g each Safflower, Radix Angelicae Sinensis, Radix et Rhizoma Dahuricae Sinensis, Radix et Rhizoma Wujia Pi, Radix et Rhizoma Haitongpi 10g each Mangosteen 30g (later). The above drugs together as coarse powder, wrapped with gauze (can be divided into packets), water decoction, take the heat to first fumigate and then wash and saturate the affected area, twice a day for 30-60 minutes each time. 20 days later, the skin color of the affected area was basically normal, the pain disappeared, and the symptoms of swelling of the lower limbs were significantly relieved. In this case, chronic dampness and stasis in the lower extremities, with a long and lingering course of the disease, the Chinese herbal medicine was taken internally, and at the same time, calendula officinalis was administered quietly to enhance the efficacy of blood circulation, dispel blood stasis and relieve pain. In the fumigation formula, Radix Angelicae Sinensis, Rhizoma Ligustici Chuanxiong, Radix Paeoniae Alba, Radix Rehmanniae Sinensis and Radix Wei Lingxian clear heat and cool the blood, activate blood circulation, disperse blood stasis and relieve pain, while Radix Argyi is hard, salty and cold, pungent, dispersing and bitter, which is not guarded. The basic pathogenesis of Dan Poison is the interweaving of heat and dampness, which enters the blood and “does not leak out, and develops on the skin”, so the general treatment principle of Dan Poison is to clear heat and cool the blood to detoxify. In accordance with the Qing? The treatment of lower extremity dermatophagoides should be accompanied by the method of activating the blood and moistening the ligaments to relieve pain while clearing the heat and cooling the blood to detoxify. If the duration of the disease is long and the condition is recurrent, the Qi and blood should be depleted, so that the products that benefit the Qi and nourish the blood should be added as appropriate to protect the Qi of the spleen and stomach, so that the bitter cold products do not hurt the Qi and blood. In conclusion, in the treatment process, we should always adhere to the principle of Chinese medicine in treating the symptoms, and on this basis, we should consider the patient’s age, physique, duration of illness, new illness, long illness and other factors, add and subtract medicines according to the symptoms, and treat them in a coordinated manner, giving full play to the advantages of internal and external treatment of Chinese medicine, and combining internal and external treatment to improve clinical efficacy.