Urticaria is an allergic skin disease with skin wheals as the main manifestation. The main clinical signs are the appearance of wheals over the skin with sudden onset and rapid disappearance, leaving no trace after recovery. There is a sensation of severe itching and burning heat on the affected part. Urticaria can recur frequently and each episode can last for a long time. In TCM this disease is called wandering wind evil.

Main Points of Diagnosis:

1.The wheals appear suddenly. Most of them are red and only a few are pale. Their shapes vary, but they all have a clear border. They may occur throughout the body or may be restricted to the face, neck or limbs. They may arise one after another and recur frequently. After recovery there will be no trace remaining.

2. There is significant itching and a burning sensation.

3. Dermatological test is positive. The wheal may be caused by mechanical stimulation.

4. In case of occurrence in the respiratory tract or on the mucous membranes of the digestive system, some relevant symptoms will develop.

5. The attack can be produced by exposure to cold or heat, or due to psychological disturbance and intake of protein food, etc.

Differentiation and Treatment of Common Syndromes   

1.Internal Treatment

a) Wind-Heat

Main Symptoms and Signs: There is severe pruritus, a burning sensation and red wheals on the affected part. The tongue is red with thin yellow fur and the pulse is floating and rapid. Dermatological test is positive.

Therapeutic Principle: Dispel wind and clear heat

Formula: Decoction of Expelling Pathogenic Wind and Clearing Pathogenci Heat

dittany  
spirodela
dried/fresh rehmannia 
red peony
honeysuckle
cicada molting
arctium
chrysanthemum
mint
moutan bark
forsythia
sophora root
licorice root

The above herbs are to be decocted in water for oral administration.

b) Wind-Cold

Signs and Symptoms: There is a sensation of severe itching, the appearance of pale skin wheals, aversion to wind and cold, and a positive dermatographic test. The tongue is pale with thin white fur and the pulse is floating and tight.

Therapeutic Principle: Expel Wind and Disperse Cold

Formula: 

schizonepeta 
ledebouriella
cinnamon twig
dahurican angelica
Chinese angelica
ligusticum root
salvia root
licorice root

The above herbs are to be decocted in water for oral administration.

c) Blood Deficiency

Main Signs and Symptoms: The patient has wheals which recur frequently. This pattern easily becomes chronic. It attacks when the patient is caught by cold. Usually, the patient is very weak. The tongue is pale with thin white fur and the pulse is thready.

Therapeutic Principle: Supplement qi, consolidate the surface, and nourish the blood to expel wind.

Formula: Varied Jade Wind-Screen Powder 

huang qi  (astragalus)
bai zhu (white atractylodes)
fang feng  (ledebouriella)
dang gui (Chinese angelica)
bai shao yao (white peony)
ligusticum root  (chuan xiong)
sheng di huang (dried/fresh rehmannia root)
he shou wu (flowery knotweed)
jing jie (schizonepeta)
ci ji li (tribulus)
gan cao (licorice)

The above herbs are to be decocted in water for oral administration.


2. External Treatment

Powder for arresting itching:

jing jie (schizonepeta)
hua shi  (talcum)
bing pian (borneol)

The above herbs are to be ground into a fine powder, wrapped with a piece of cloth, and then rubbed on the affected (i.e. itching) part.

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