Introduction: Learning from Mr. Zhao Bingnan about the four syndromes of urticaria and the empirical formulas for diagnosis and treatment.

Urticaria can be classified into four types.

Wind-heat

Commonly seen in acute urticaria

Flat, wheal-like rashes appear on the whole body or exposed areas, slightly raised above the skin surface, red or pink in color, with intense itching, accompanied by symptoms such as headache, fever, restlessness, thirst, dry stools, and dark urine. The tongue is red with thin white or white greasy coating, and the pulse is slippery and rapid.

Treatment should aim to release the exterior with pungent-cool herbs, disperse wind, and relieve itching.

Prescription 1: Schizonepeta Spike 6g, Saposhnikovia Root 6g, Honeysuckle Flower 12g, Great Burdock Achene 9g, Tree Peony Bark 6g, Common Duckweed 6g, Rehmannia Root 9g, Peppermint 4.5g, Baical Skullcap Root 9g, Cicada Slough 3g, Raw Licorice Root 6g

Prescription 2: Mulberry Leaf 9g, Chrysanthemum Flower 9g, Apricot Kernel Paste 4.5g, Forsythia Fruit 9g, Honeysuckle Flower 12g, Peppermint 4.5g, Licorice Root 9g, Tree Peony Bark 9g, Saposhnikovia Root 9g

Wind-Cold

Commonly seen in chronic urticaria

Generalized pinkish-white or pink wheal-like flat papules all over the body, accompanied by itching, which worsens upon exposure to wind or cold. May also present with fever, chills, absence of sweating, body aches, and absence of thirst. Tongue coating is white, and the pulse is floating and tight.

The treatment principle is to disperse warmth and release the exterior, dispel wind, and relieve itching.

Prescription: Ephedra 3g, Apricot Kernel 4.5g, Dried Ginger Peel 3g, Saposhnikovia Root 6g, Duckweed 4.5g, Cortex Dictamni 15g, Schizonepeta Spike 6g, Cicada Slough 4.5g, Tangerine Peel 9g, Moutan Bark 9g, Raw Licorice Root 6g

Stagnant Heat Affected by Wind

Wheals and rashes persist continuously, recurring repeatedly; the rash patches may be pale or red, intensely itchy causing insomnia, accompanied by epigastric fullness and stuffiness, poor appetite, chest tightness, belching of foul odor and acid regurgitation, gastric discomfort with nausea or abdominal pain, dry and constipated stools, dark urine. The tongue coating is white and thick or greasy, and the pulse is deep and choppy.

The treatment principle should aim to resolve both the exterior and interior.

Prescription: Fangfeng (Saposhnikovia root) 9g, Jinyinhua (Honeysuckle flower) 15g, Difuzi (Broom cypress fruit) 18g, Jiesui (Schizonepeta spike) 9g, Dahuang (Rhubarb) 4.5g, Houpo (Magnolia bark) 9g, Fuling (Poria) 9g, Chishao (Red peony root) 9g, Gancao (Licorice root) 9g

Blood Deficiency with Wind Attack

The rash recurs frequently, often worsening in the afternoon or at night, and improving in the morning or late night. Accompanied by symptoms such as dizziness, heaviness in the head, soreness in the lower back, physical fatigue, insomnia, and excessive dreaming. The tongue is pale or reddish, clean without coating; the pulse is deep, thin, and slow.

The treatment principle is to replenish qi and nourish blood, and to disperse wind pathogens.

Prescription: Rehmannia root 30g, Chinese angelica 15g, red peony root 18g, white peony root 18g, fleeceflower root 15g, astragalus root 15g, saposhnikovia root 9g, schizonepeta spike 9g, tribulus fruit 15g, ephedra 9g

Among the above four types, the wind-heat type is more acute than the wind-cold type. The treatment principle focuses on dispelling pathogenic wind, using pungent and dispersing herbs to promote outward diffusion. This approach yields better results for cases where external pathogens have not deeply invaded and healthy qi is not deficient, while the wind-cold type and deficiency type show poorer therapeutic efficacy.

For chronic patients, even after being cured and with no new skin eruptions appearing recently, to reduce recurrence, it is advisable to continue taking medication for a period after cure or take pills for a longer duration to achieve the goal of minimizing relapse.

During treatment or after recovery, dietary restrictions must also be observed. It is essential to avoid stimulating foods such as fish, shrimp, chili peppers, and alcohol.

Case Examples

Case 1:

Zhang, male, 40 years old. Initial consultation on June 9, 1973.

Generalized red wheals accompanied by fever for 4 days.

Four days ago, after physical labor, there was profuse sweating. Upon going outdoors to cool off, exposure to cold led to the sudden appearance of red wheals on the lower limbs, followed by the buttocks and waist. Starting yesterday, chills and fever developed, with a body temperature around 38°C. Large patches of similar wheals appeared on the upper limbs, chest, and back. Over the past four days, the wheals have come and gone but have never completely subsided. The head, face, and upper limbs also feel swollen and red.

Initially, the wheals were pale in color and raised above the skin surface. Subsequently, the swelling slightly subsided, leaving behind erythema. The itching sensation was particularly pronounced, affecting appetite and sleep. The stool was dry.

In 1969, there was a similar episode, which later led to septic arthritis due to joint pain, and no other medications were taken before the illness.

Examination: Body temperature 38°C, no significant abnormalities found on internal medicine examination.

Scattered red wheals are present throughout the body, with newly emerged rashes raised above the skin surface and older rashes leaving behind erythema. The rashes form large, irregular patches, widely distributed on the head, face, trunk, and limbs, with evident scratch marks due to significant pruritus. There is noticeable swelling on the head, face, and upper limbs.

The tongue coating is thin and white, and the pulse is wiry, slippery, and slightly rapid. The diagnosis is acute urticaria. The pattern belongs to internal accumulation of heat with wind-cold constraining the exterior, manifesting as hidden rashes. The treatment principle is to dispel wind, clear heat, and unblock the interior.

Prescription: Schizonepeta (Jingjie) 9g, Saposhnikovia Root (Fangfeng) 9g, Scutellaria Baicalensis (Huangqin) 9g, Gardenia Fruit (Zhizi) 9g, Dictamnus Dasycarpus Bark (Baixianpi) 30g, Kochia Scoparia Fruit (Difuzi) 30g, Sophora Flavescens Root (Kushen) 15g, Tribulus Terrestris Fruit (Cijili) 30g, Plantago Seed (Cheqianzi) (wrapped) 30g, Alisma Rhizome (Zexie) 15g, Rhubarb (Dahuang) 9g, Trichosanthes Fruit (Quangualou) 30g.

On June 11, after taking 2 doses of the above prescription, the body temperature returned to normal, and most of the systemic rash had subsided, but there were still newly emerging small patches of wheals, and the swelling had resolved.

Continuing with the previous prescription, removing Rheum officinale, and taking 3 more doses. On June 12, the rash completely subsided, but there were still scattered newly emerging small wheals at night, with all other aspects normal. Subsequently, 3 more doses were taken to consolidate the therapeutic effect, and no recurrence was observed during follow-up.

Case 2:

Li, female, 41 years old. Initial consultation on February 10, 1971.

For over 10 years, red bumps have continuously appeared all over the body, with intense itching. They occur mainly on the trunk and limbs, coming and going, and are more severe every morning and evening, especially after going to bed on winter nights. They also persist without interruption in summer, and previous treatments have been ineffective.

Examination: Scattered, irregularly shaped, large flat raised patches the size of a fingernail or a copper coin are present on the limbs, pale red in color. The tongue is pale with a white coating, and the pulse is deep and moderate. Diagnosed as chronic urticaria.

The syndrome is attributed to pre-existing damp accumulation combined with external contraction of wind-cold pathogens transforming into heat, resulting in a complex interplay of wind, cold, dampness, and heat that lingers and manifests in the skin. Treatment should aim to harmonize yin and yang qi, while also clearing heat, dispersing cold, expelling wind, and removing dampness.

Prescription: Cortex Acanthopanacis 9g, Cortex Mori 9g, Cortex Lycii 9g, Cortex Moutan 9g, Cortex Zingiberis 9g, Pericarpium Citri Reticulatae 9g, Testa Dolichoris 9g, Cortex Poriae 9g, Cortex Dictamni 9g, Pericarpium Arecae 9g, Radix Angelicae Sinensis 9g, Herba Spirodelae 9g

Second Visit (February 17): After taking the above prescription for 7 doses, the rash significantly decreased, with only a few remaining after going out in the morning, and it basically did not appear at night.

Third Visit (February 26): After continuing with another 4 doses, the rash completely disappeared. After taking an additional 3 doses, clinical cure was achieved.