Urticaria

From: Dermatology and Venereal Disease of Traditional Chinese Medicine. Pages 238 - 242 (Selected Sections)

Translated By Will Campbell

Urticaria is a commonly seen allergic skin disease where the skin and blood are reactive. It is commonly called ‘wind papule lump' (a literal translation from the Chinese). This condition is characterized by fresh red or pale whitish wheals which can hide and then reappear. It is also called ‘concealed rash'.

Causes and Dynamic of the Condition

The Su Wen says, "When wind evil settles in the flesh, the flesh becomes vacuous and it's qi is dispersed. Cold can become active with the skin and spreads into the interstices. When the fine hairs are open so that the evil wind moves chaotically, then there is itching." The Zhe Bing Yuan Hou Lun says, "...when a person's yang qi is vacuous on the exterior, then there is much sweating. When sweat comes out, wind can attack. When wind qi together with hot qi are active within the flesh, this generates pustules." This means that when a person's right qi is vacuous and weak, then wind-cold and wind-heat evil can enter the skin and cause this condition. In addition, wind can result from eating an excessive amount of highly aromatic foods, seafood, and other foods such as tropical fruit and alcohol and/or having constitutional accumulated heat. In both cases, heat generates this wind. Wind can also be generated from qi & blood vacuity. Blood vacuity conditions include damage to the seven emotions, unregulated chong and ren, or qi and blood vacuity and weakness. Qi vacuity can easily result in pathological changes leading to this condition.

1. Exterior Wind Evil

When a person's exterior is not consolidated, it is easy for wind evil to invade and attack. Wind is the beginning of all kinds of conditions, but most typically it is related to invasion of cold or hot evil qi. If a person's yang qi is not sufficient, then it is easy for them to contract wind-cold evil leading to an exterior wind-cold pattern. If the yin qi is not sufficient, then it is easy for them to contract wind-heat evil leading to an exterior wind-heat pattern.

2. Stomach Intestine Damp Heat

Eating an excessive amount of highly aromatic foods, seafood, and other foods such as tropical fruit and alcohol or having intestinal parasites can negatively impact the spleen and stomach's ability to transform and transport. The result is damp heat mixed with stagnation and dry fire which stirs wind. "When the middle jiao gets the clears qi, it changes to red and becomes blood." Damp-heat-wind evil in the spleen and stomach follows the movement of qi and blood out to the flesh. This wind-damp-heat evil gets into the flesh and interstices where it fights with the qi and blood. In addition, internally generated stomach and intestinal damp heat can cause the stomach-intestinal qi mechanism to become depressed and stagnant. This leads to the abdomen becoming distended and painful, the bowels becoming sloppy or bound, and other related symptoms.

3. Unregulated Emotions

The liver governs coursing and discharging and governs the emotions. If there is an excessive amount of worry, thinking or repressed anger, the liver cannot course, the qi mechanism will become depressed and bound, and the depressed qi will transform into fire and generate wind. The movement of qi and blood in the skin will not flow easily and will internally generate wind-heat evil which will become depressed in the flesh and interstices. As the qi and blood contend with this wind-heat evil, wheals and itching will result. In addition, since all of the five zang support an emotion, excessive emotional activity will consume the essence and blood of the five zang resulting in vacuity wind and internal dryness. This vacuity wind acting within the skin will cause this condition.

4. Unregulated Chong and Ren

When the pre-heaven essence is not sufficient, there are various post heaven conditions giving rise to liver and kidney debility. This means that pre-heaven essence insufficiency, as well as many causes relating to post-heaven, can give rise to weakness of liver-kidney. Then, as a result of the weaknesses, the other things occur which eventually leads to chong-ren irregularity. When the relationship between liver blood and kidney essence is disturbed, the chong and ren will become unregulated. With kidney essence debility, the right qi will not be sufficient to ward of external evil. When the essence and blood are deficient, internal heat will be generated, the skin will lose it's nourishment, the ying and wei will lose their harmony and this condition will result.

5. Deficiency of Qi and Blood

When the qi is deficient, the exterior is not consolidated so that wind-cold and wind-heat can easily invade. When the blood is deficient, dry heat wind evil is internally generated and the skin loses its nourishment. Internal and external evil qi depressing and stagnating the skin and interstices and fighting with the qi and blood result in this condition.

In summary, the keys to this condition are 1) a weak constitution and an exterior which is not consolidated, 2) invasion and attack of wind-cold or wind-heat evil, 3) stomach and intestinal damp heat transforming into dryness and stirring wind, 4) unregulated emotions, 5) unregulated chong and ren, 6) deficiency of qi and blood, 7) internally generated vacuity heat wind evil. All of these can contend with the qi and blood within the skin and interstices, resulting in wheals and itching.

Diagnosis

IV. Symptom Differentiation by Type

1. Wind heat type: Red colored wheals which become more intense with heat and less with cold and are worse in the summer and better in the winter. Lesions primarily occur in upper half of the body and feel hot to the touch. Lesions are diffuse and superficial and there is a feeling of vexation heat and itching. There can also be fever, thirst, stool is dry and bound, urine is dark and scanty, throat is red, swollen and painful. Pulse is floating and rapid, tongue coat is thin yellow.

2. Wind cold type: White colored wheals which become more intense with cold or a draft and can slowly resolve with warmth. Worse in the winter and better in the summer. Lesions primarily occur in exposed areas. They are not red or hot. They are comparatively tight and solid and itching is relatively severe. Dislike of cold drinks and preference for warm drinks. No thirst. Urine clear and long. Pulse is floating and moderate or floating and tight. Tongue body is fat and the coat is thin white.

3. Stomach Intestine damp heat type: This type is mostly caused by eating fish or meat or having intestinal parasites. The wheals are red colored and large and there is vexation itching. Appearance of the wheals is accompanied by abdominal pain with either dry bound stools or diarrhea. In extreme cases, there is nausea and vomiting. There can also be exhaustion and lack of appetite. Pulse is slippery and rapid. Tongue is red with a yellow, greasy coat.

4. Liver qi depressed and bound type: Appearance of the wheals and the itching relates to emotional restraint and depression, or increases in intensity with stress. They are accompanied by vexation and agitation, easy anger, chest oppression, rib-side distention, reduced appetite, bitter taste, poor sleep. Pulse is wiry, thin and rapid. Tongue is red with a thin yellow coat.

5. Unregulated chong and ren type: Patient constitutionally has irregular menses. Wheals typically appear a number of days before the start of the menses and frequently disappear after the menses is finished, but comes back at the time of the next menses. Wheals can also result from overwork or excess sexual activity. Pulse is thin or deep and rough. Tongue is slightly purple with a thin coat.

6. Qi & Blood vacuity and weakness type: Wheals continuously recur for several months or several years without resolving. Overwork will cause them to break out with increased intensity. It can be accompanied by weariness and lack of strength, head ache and cloudy vision. Pulse is soggy and thin or deep and thin. Tongue is pale with a thin coat. This pattern is vacuity of both qi and blood. If qi vacuity is predominant so that the exterior in not consolidated, wind and cold can exacerbate the primary symptoms and make it easier for them to recur. There can also be lack of strength and limpness of the limbs. If there is a tendency towards blood vacuity, then symptoms can be accompanied by a withered yellow or pale complexion, heart vexation and poor sleep. Reappearance of wheals is relatively intense in the afternoon or evening.

Treatment

I. Internal Treatment

1. Treatment Differentiated by Pattern

(1) Wind heat type: Treatment should course the wind, clear heat and harmonize the qi and blood. The formula to be used is Xiao Feng San modified with the following commonly used herbs: Niu Bang Zi, Bo He, Chan Tui, Fang Feng, Chi Shao, Sheng Di, Sheng Shi Gao, Huang Qin, Ku Shen, Mu Tong, Gan Zao.

(2) Wind cold type: Treatment should extinguish wind, dissipate cold, and harmonize the ying and wei. The formula to be used is Gui Zhi Tang modified with the following commonly used herbs: Gui Zhi, Ma Huang, Bai Shao, Gan Zao, Sheng Jiang, Tong Cao, Wei Ling Xian, Ze Lan, Bai Xian Pi, Chen Pi, Can Sha.

(3) Stomach Intestine Damp Heat type: Treatment should course wind, clear heat, open the bowels and move stagnation. The formula to be used is Fang Feng Tong Sheng San Tang modified with the following commonly used herbs: Fang Feng, Bo He, Jing Jie, Hou Po, Sheng Da Huang, Zhi Qiao, Huang Qin, Dang Gui, Yin Chen, Jiu Xiang Chong, Gan Cao.

(4) Liver Qi Depressed and Bound type: Treatment should course liver, resolve depression, clear heat, extinguish wind. The formula to be used Xiao Yao San modified with the following commonly used herbs: Dang Gui, Bai Shao, Chai Hu, Huang Qin, Bo He, Fang Feng, Wu Wei Zi, Wu Mei, Sheng Di, Dan Pi, Zhi Zi.

(5) Unregulated Chong and Ren type: Treatment should regulate and contain the Chong and Ren, augment and boost the liver and kidney. The formula to be used is Si Wu Tang combined with Er XianTang modified with the following commonly used herbs: Dang Gui, Chuan Xiong, Bai Shao, Shu Di, Xian Ling Pi, Xian Mao, Rou Cong Rong, Tu Si Zi, Dan Shen, Yi Mu Coa, Wu Shao She, He Shou Wu.

(6) Qi & Blood Vacuity and Weakness type: Treatment should nourish both qi and blood, expel wind and open the collaterals. The formula to be used is Ba Zhen Tang modified with the following commonly used herbs: Dang Gui, Chuan Xiong, Shu Di, Bai Shao, Tai Zi Shen, Chao Bai Zhu, Fu Ling, Gan Cao, He Shou Wu, Shi Ji Li, Dang Shen, Fang Feng.
If there is qi vacuity with the exterior not being consolidated, treatment should supplement the qi and consolidate the exterior. The formula to be used is Mu Li San with Yu Ping Feng San modified with the following commonly used herbs: Mu Li, Sheng Huang Qi, Fu Xiao Mai, Ma Huang Gen, Fang Feng, Chao Bai Zhu, Di Gu, Wu Shao She, He Shou Wu, Chuan Xiong, Huo Ma Ren, Shi Ji Li, Shu Di, Fang Feng, Bai Xian Pi, Jiang Can, Shan Yu Rou.

2. Commonly Used Patents

(1) Fang Feng Tong Sheng Wan, 6g 3 times/day
(2) Yu Ping Feng Wan, 6g 3 times/day
(3) Xiao Yao Wan, 9g 3 times/day
(4) Gui Pi Wan, 9g 3 times/day
(5) Wu Ji Bai Feng Wan, 1 pill 2 times/day

II. External Treatment

1. Externally Used Herbs

(1) Steam Wash: Lu Lu Tong 60g, Can Sha 60g, Hou Po 30g, Xi Xian Cao 30 g. Decoct in water and steam wash.
(2) Powder application: Bai Bu 20g and Ming Fen soaked in 100 ml alcohol (50%) for 15 days. Put on the wheals to deal with the itching 3-4 times/day.

3. Acupuncture Treatment and Method

(1) Wind Cold type: Primary Points - Du 14, LI 4, UB 12. Supporting Points - GB 20, Sp 10, Sp 6. Draining Method with strong needle stimulation
(2) Wind Heat type: Primary Points - Du 14, UB 17, LI 11. Supporting Points - LI 4, Lu 11, So 6. Strong needle stimulation
(3) Stomach Intestine Damp Heat type: Primary Points - St 36, St 25, PC 6, UB 25. Supporting Points - Ren 12, Ren 8. Draining Method with strong needle stimulation
(4) Unregulated Chong Ren type: Primary Points - UB 18, Lv 14, Sp 6, UB 17. Supporting Points - LI 11, GB 31, Ren 4. Even Method
(5) Qi & Blood Both Vacuous type: Primary Points - UB 20, Sp 6, Ren 6. Supporting Points - St 36, UB 12, Ren 8. Even Method.