Treatment of Urticaria with Traditional Chinese Medicine (TCM): Differentiation of Syndromes and Internal-External RegulationTCM considers urticaria to be closely related to spleen and stomach deficiency and internal accumulation of damp-heat. Therefore, regulating the spleen and stomach and dispelling wind and cold are crucial in its treatment
Treatment of Urticaria with Traditional Chinese Medicine (TCM): Differentiation of Syndromes and Internal-External Regulation
TCM considers urticaria to be closely related to spleen and stomach deficiency and internal accumulation of damp-heat. Therefore, regulating the spleen and stomach and dispelling wind and cold are crucial in its treatment. While identifying and removing the underlying cause is the first step, symptomatic treatment is usually employed when the cause remains unclear. This article details the treatment of three common TCM patterns of urticaria and their corresponding therapies.
I. Wind-Heat Invasion Syndrome
Symptoms: Bright red wheals, intense burning and itching, worsening with heat; accompanied by fever, chills, and sore throat; red tongue with a thin white or yellow coating; rapid and floating pulse.
Syndrome Differentiation: This pattern is caused by wind-heat pathogens invading the skin. The wind-heat pathogens stagnate in the skin, failing to dissipate, leading to bright red, burning wheals that worsen with heat; intense itching is due to the prevalence of wind; fever and chills result from disharmony of Ying and Wei Qi; sore throat is due to wind-heat obstructing the lung meridian; the red tongue, thin yellow or white coating, and rapid floating pulse all indicate wind-heat invasion.
Treatment Principle: Clear wind-heat.
Prescription: Modified Xiao Feng San. Xiao Feng San is a commonly used TCM formula for wind-heat type urticaria, effective in clearing wind-heat, detoxifying, and relieving itching. Adjustments can be made based on the patient's condition:
- For severe heat: Add Huang Qin (Scutellaria baicalensis) and Zhi Zi (Gardenia jasminoides) to clear heat and drain fire.
- For severe itching: Add Chan Tui (Cicada slough) and Di Fu Zi (Kochia scoparia) to relieve itching.
- For concomitant lung heat: Add Xing Ren (Apricot kernel) and Yu Xing Cao (Houttuynia cordata) to clear lung heat and resolve phlegm.
II. Wind-Cold Binding Syndrome
Symptoms: Pale wheals, worsening with wind-cold, alleviating with warmth, no thirst; pale tongue with a white coating; floating and tight pulse.
Syndrome Differentiation: This pattern is caused by wind-cold pathogens invading the skin. Pale wheals suggest cold pathogens; wind pathogens cause skin itching; wind-cold invasion leads to disharmony of Ying and Wei Qi, resulting in pale wheals and itchy skin; the cold nature of the pathogen causes alleviation with warmth and worsening with cold; lack of thirst indicates that body fluids are not impaired; a pale tongue with white coating and a floating and tight pulse all indicate wind-cold binding.
Treatment Principle: Disperse wind-cold.
Prescription: Modified Gui Zhi Tang. Gui Zhi Tang, with its ability to warm and regulate the meridians and dispel wind-cold, can be adjusted based on individual patient needs:
- For severe cold: Add Fu Zi (Aconite root) and Gan Jiang (Dry ginger) to warm and dispel cold.
- For severe itching: Add Jing Jie (Schizonepeta tenuifolia) and Fang Feng (Saposhnikovia divaricata) to disperse wind and relieve itching.
III. Blood Deficiency and Wind-Dryness Syndrome
Symptoms: Recurrent wheals persisting for a long time, worsening in the afternoon or at night; accompanied by irritability, dry mouth, and hot palms and soles; red tongue with little coating, thin and deep pulse.
Syndrome Differentiation: This pattern is due to long-standing blood deficiency, leading to skin malnutrition and dryness, generating wind. Prolonged blood deficiency leads to poor skin nourishment and dryness, causing dryness to generate wind; wind pathogens attacking the skin cause recurrent and persistent wheals; due to the common source of body fluids and blood, blood deficiency leads to yin deficiency and internal heat, resulting in irritability, dry mouth, and hot palms and soles; internal heat disturbing the yin causes worsening of symptoms in the afternoon or at night; a red tongue with little coating and a thin and deep pulse all indicate blood deficiency, fluid injury, and internal heat.
Treatment Principle: Nourish blood, dispel wind, and moisten dryness.
Prescription: Modified Dang Gui Yin Zi. Dang Gui Yin Zi, known for nourishing blood, moistening dryness, dispelling wind, and relieving itching, is a commonly used formula for blood deficiency and wind-dryness type urticaria. Adjustments can be made based on the patient's condition:
- For significant blood deficiency: Add Shu Di Huang (Rehmannia glutinosa) and Bai Shao (Paeonia lactiflora) to replenish blood.
- For severe dryness-heat: Add Sheng Di Huang (Fresh Rehmannia glutinosa) and Mai Dong (Ophiopogon japonicus) to nourish yin and clear heat.
- For severe itching: Add Bai Ji Li (Tribulus terrestris) and Sheng Di Yu (Polygonum aviculare) to relieve itching.
Daily Management Recommendations
In addition to TCM syndrome differentiation treatment, daily management is crucial. Maintain a clean and cool living environment to avoid damp-heat; eat a light diet and avoid spicy and irritating foods; ensure adequate sleep and avoid overwork; maintain a positive mood and avoid excessive stress. These measures can help alleviate urticaria symptoms and promote recovery.
Conclusion
Treatment of urticaria requires syndrome differentiation for optimal results. The information provided is for reference only. Specific treatment plans should be determined by a qualified TCM practitioner based on the patient's individual condition. Avoid self-medication to prevent delaying treatment. I hope this information helps you better understand TCM treatment for urticaria. I am Dr. Zhai Xiaoxiang, TCM physician, guarding your skin health.
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