A novel effective treatment for skin abscess using traditional Chinese herbal medicine: a case series

Abstract

Skin abscess is a common bacterial infection of the skin and soft tissues. Conventional treatment typically involves incision and drainage after pus formation, which may lead to prolonged healing and surgical scarring. Traditional Chinese Medicine (TCM) has extensive experience in treating infectious diseases with the potential for rapid recovery and minimal scarring; however, international literature on its efficacy remains limited. We present three cases of skin abscess successfully treated with an oral modified Xian Fang Huo Ming Yin (XFHMY) decoction based on syndrome differentiation.

Case 1

A 29-year-old male presented with a painful, swollen plaque on the left upper back persisting for over two weeks.

Case 2

A 12-year-old girl with a red, swollen mass on the left waist for more than 10 days.

Case 3

A 35-year-old male with a painful, erythematous plaque on the inner right upper arm for half a month.

After 5–7 days of TCM treatment, all abscesses resolved completely without significant scarring, and only mild hyperpigmentation or depression remained. These findings suggest that TCM, particularly modified XFHMY, may serve as an effective non-invasive alternative therapy for skin abscesses.

1. Introduction

Skin and soft tissue infections (SSTIs), including skin abscesses, represent a significant clinical challenge due to their high incidence and potential for scar formation. Although healthy individuals typically harbor commensal skin bacteria, impaired immune function or disruption of the skin barrier can lead to bacterial invasion and subsequent abscess formation [1,2]. Standard treatment involves systemic antibiotics and topical therapy in the early stages, followed by incision and drainage upon pus formation [3]. However, this approach is often associated with prolonged recovery, discomfort, and scarring.

Traditional Chinese Medicine, with a history spanning thousands of years, emphasizes internal regulation and holistic intervention. TCM has demonstrated potential in promoting abscess resolution with minimal scarring, yet reports in international literature remain scarce. Here we describe three cases of skin abscess successfully treated within one week using an orally administered modified Xian Fang Huo Ming Yin decoction, highlighting its potential as an effective, scar-sparing therapeutic option.

2. Patient information

2.1. Case 1

A 29-year-old male presented with a red, swollen, and painful plaque on the left upper back that had persisted for over two weeks. The onset occurred after intense exercise in hot and humid weather, accompanied by profuse sweating. Laboratory findings indicated leukocytosis (12.13×10⁹/L, reference range: 3.5–9.5×10⁹/L) and elevated C-reactive protein (20.36 mg/L, reference: <10 mg/L), although his body temperature was normal (36.7 °C). Despite one week of oral antibiotic treatment (unspecified), the lesion expanded to 8×8 cm² and produced purulent discharge upon palpation (Fig. 1A). The patient was otherwise healthy with no drug allergies. TCM examination showed a red tongue with a thick white coating (Fig. 1B) and a rapid pulse. The condition was diagnosed as a skin abscess with dampness-toxicity accumulation syndrome. He was prescribed a seven-day course of modified Xian Fang Huo Ming Yin (XFHMY) decoction (Table 1). Significant improvement was noted within seven days, with complete resolution and minimal scarring at one-month follow-up (Fig. 1C and D).

Fig. 1.

Clinical and tongue manifestations of Case 1 before and after Chinese herbal medicine (CHM) treatment.

(A) Pretreatment lesion showing an 8 × 8 cm² erythematous, fluctuant plaque with purulent discharge on the left upper back.

(B) Pretreatment tongue examination revealing a red tongue body with thick white coating.

(C) Posttreatment (1-month follow-up) demonstrating complete resolution of the abscess with minimal residual scarring.

(D) Posttreatment tongue showing normalization of color and coating. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Table 1.

Composition of XFHMY and modified prescriptions in three cases.

Chinese herbal medicine	XFHMY	Case 1(g)	Case 2(g)	Case 3(g)
Honeysuckle Flower	✓	15	15	15
Indian Epimeredi Herb	✓	10	6	6
Lemonfragrant Angelica Root	✓	10	10	10
Chinese Angelica	✓	15	10	10
Tangerine Peel	✓	10	10	10
Liquorice Root	✓	10	–	–
Red Paeony Root	✓	10	10	10
Thunberg Fritillary Bulb	✓	10	10	10
Mongolian Snakegourd Root	✓	10	10	10
Frankincense	✓	10	9	9
Myrrh	✓	10	–	9
Pangolin Scales	✓	–	–	–
Chinese Honeylocust Spine	✓	10	10	10
Membranous Milkvetch Root∗	ⅹ	15	–	15
Weeping Forsythiae ∗	ⅹ	–	15	15

2.2. Case 2

A 12-year-old girl presented with a painful, red, swollen mass on the left waist for over 10 days. The symptoms emerged after several days of staying up late studying. Previous treatment with oral cefuroxime and topical fusidic acid cream for seven days was ineffective. Examination revealed a 6 × 5 cm² dark red hemispherical mass (Fig. 2A). Her body temperature was 36.5 °C, and she had no significant medical history or drug allergies. TCM assessment showed a pale-red tongue with a thin, white, greasy coating and a rapid pulse. TCM syndrome differentiation guided a seven-day XFHMY regimen (Table 1) and instruct her to stop taking cefuroxime, and can continue to topical use fusidic acid. By day three, the abscess ruptured spontaneously, discharging purulent blood (Fig. 2B). After one week, the abscess resolved, leaving only localized hyperpigmentation (Fig. 2C).

Fig. 2.

Sequential clinical progression of Case 2 during CHM therapy.

(A) Baseline presentation: a 6 × 5 cm² tender, dark-red hemispherical mass on the left lumbar region.

(B) Day 3 of treatment: spontaneous rupture with purulent drainage.

(C) Day 7 of treatment: resolved inflammation with residual postinflammatory hyperpigmentation. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

2.3. Case 3

A 35-year-old male reported a painful, erythematous plaque on the inner right upper arm for half a month. The condition began after he worked outdoors in high temperatures. Despite one week of treatment with oral cefuroxime and mupirocin ointment, the lesion progressed, resulting in an 8×8 cm² lesion (Fig. 3A). His body temperature was 36.9 °C. He had no significant past medical history or drug allergies. TCM examination revealed a red tongue with a thick, white, greasy coating and a deep, slippery pulse. He was diagnosed with a skin abscess and dampness-toxicity accumulation syndrome. A five-day course of modified XFHMY was prescribed (Table 1), along with continued use of mupirocin ointment, without oral antibiotics. Follow-up via WeChat after five days showed flattening of the plaque with residual pale erythema (Fig. 3B), requiring no further intervention.

Fig. 3.

Remote follow-up of Case 3 via telemedicine.

(A) Pretreatment: an 8 × 8 cm² indurated, erythematous plaque on the right upper arm.

(B) Day 5 of treatment: flattened lesion with pale erythema (patient-provided mobile photograph).

3. Treatment and intervention

All three patients exhibited localized redness, swelling, pain, increased local skin temperature, and eventual suppuration, consistent with a diagnosis of uncomplicated skin abscess. Based on TCM principles, each case showed an acute course, raised and well-demarcated lesions, and tongue and pulse findings (white greasy coating, rapid or slippery pulse) indicative of dampness-toxicity accumulation syndrome.

Each patient was treated with a modified XFHMY decoction, a classical TCM formula for yang-stage abscesses. Due to conservation concerns, pangolin scales were omitted from the original formula. Additional herbs were tailored to each case:

Case 1

Membranous milkvetch root was added to tonify qi and promote pus discharge.

Case 2

Myrrh was excluded to avoid stomach-qi impairment in the pediatric patient. liquorice root was also excluded despite its moderating effect, weeping forsythiae was added to enhance heat-clearing and detoxification.

Case 3

Similar to Case 1, membranous milkvetch root was added, while liquorice root was omitted for the same reason as in Case 2. During the course of Traditional Chinese Medicine administration, the patient developed pus accumulation followed by spontaneous rupture of the abscess. The patient was referred to the hospital for wound management, which included disinfection with povidone-iodine solution. After gentle expression of residual pus, the lesion was dressed with sterile gauze.

Patients were instructed to decoct the herbs by bringing them to a boil followed by simmering for 30 min until approximately 200 ml of liquid remained. Each bag was decocted twice, and the resulting tea was consumed warm after morning and evening meals. The dosage for the pediatric patient was adjusted according to body weight.

4. Discussion

Skin abscesses, characterized by localized pus accumulation due to bacterial infection, typically require incision and drainage as first-line treatment [4]. While adjuvant antibiotics remain controversial for uncomplicated abscesses [5,6], guidelines strongly recommend drainage alone for immunocompetent individuals [2,4]. However, this approach often results in prolonged healing and scarring.

Other TCM interventions, such as fire needle therapy, have been reported to yield better wound healing and smaller scar size compared to incision in skin abscesses [7]. Another case series demonstrated the efficacy of fire needle therapy for small abscesses (<4 cm in diameter) [8]. However, reports on oral herbal decoctions for abscess treatment remain limited. The three cases presented here involved larger abscesses (6–8 cm), suggesting that oral XFHMY may address a clinical gap where fire needle therapy is less applicable. Moreover, recurrent abscesses are often related to constitutional factors. Oral herbal therapy aims to correct underlying imbalances, potentially reducing recurrence. For instance, in Case 1, the thick white greasy tongue coating normalized after treatment, indicating improved constitutional status.

In this report, all cases achieved healing without surgical intervention, and only mild hyperpmentation (Case 2) or depression (Case 1) were left, which conformed to the TCM theory of "promoting toxic transformation and muscle regeneration". Notably, Case 2 developed spontaneous ulceration on the third day of treatment, suggesting that XFHMY might shorten the course of disease by accelerating the "mat" of the abscess, a phenomenon consistent with the mechanism of action of traditional Chinese medicine in promoting pus formation and ulceration reported by Zhou et al. [9].

XFHMY originating from the Ming Dynasty (Fu Ren Jiao Zhu Liang Fang) is renowned as the foremost formula in Traditional Chinese Medicine for treating yang syndrome ulcers and sores. It clears heat, resolves toxicity, reduces swelling, promotes rupture of abscesses, and activates blood circulation to alleviate pain. Its composition includes 13 herbs (Table 1) and is indicated for yang-stage abscesses (red, swollen, hot, painful lesions) in their early stages before rupture. It is applicable to various SSTIs, such as inflammatory acne, furuncles, carbuncles, cellulitis, and acute mastitis, when dampness-toxicity accumulation syndrome is present [10,11]. Key diagnostic elements include acute onset, well-demarcated red and swollen lesions, elevated local skin temperature, tendency to suppurate, red tongue with white greasy coating, and rapid or slippery pulse.

Experimental studies suggest that XFHMY inhibits pro-inflammatory cytokines including IL-1, IL-6, TNF-α, and IL-17 via the JAK/STAT pathway, contributing to its anti-inflammatory effects in conditions such as rheumatoid arthritis [12,13]. Notably, TNF-α and IL-17 are central cytokines in hidradenitis suppurativa, a disease involving skin abscesses, and inhibitors of these cytokines are approved for hidradenitis suppurativa in some countries [14,15]. Thus, XFHMY may exert therapeutic effects in skin abscesses by modulating these cytokines. Furthermore, honeysuckle flower, the principal herb in XFHMY, is revered in TCM for its heat-clearing and detoxifying properties. Phytochemical studies have identified thymol derivatives in honeysuckle with significant antibacterial activity against Staphylococcus aureus, Escherichia coli, Flavobacterium, and Bacillus subtilis [16]. These findings partly elucidate the mechanism by which XFHMY treats skin abscesses.

5. Conclusion

Although data on TCM for skin abscesses remain limited, our case series demonstrates successful outcomes using syndrome differentiation and modified XFHMY. TCM may serve as a conservative, scar-minimizing alternative for uncomplicated abscesses. Further mechanistic studies and controlled clinical trials are warranted to validate the efficacy of TCM in treating skin abscesses.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. The patient understands that their name and initial will not be published and due efforts will be made to conceal their identity.

Authors contribution

Conceptualization: Lu L, Xu A, Methodology/Study design: Lu L, Song X. Investigation: Lu L, Song X. Writing - Original Draft: Lu X, Lu L Writing - Review & Editing: Lu L, Song X. Supervison: Lu L, Song X, Xu A. Funding acquisition: Lu L.

Declaration of generative AI in scientific writing

Author declares that no use of AI was taken while drafting of editing the manuscript of the article.

Funding sources

This work was supported by Hangzhou Science and Technology Special Project for Supporting the Development of Biomedicine, Pharmaceutical and Health Industries (2021WJCY160).

Conflict of interest

The authors declare that they have no conflict of interest.