Urticaria (Hives) is an inflammatory reaction of the skin and mucous membrane characterized by local wheals and redness.

The TCM names of urticaria include, wind rash (feng zhen), wind itch concealed rash (feng sao yin zhen), and wind rash lumps (feng zhen kuai)

Signs and Symptoms

Pale or red wheals appear suddenly on the skin and are caused by vascular dilatation and edema, with an itching or burning sensation. The lesions may remain small (1-5mm) or enlarge to as much as 10cm or more across. Crops of skin lesions come and go, with a lesion remaining in one site for several hours, and then disappearing within 24 hours.

Acute urticaria is self-limiting and typically subsides in several days to 2 weeks. Chronic urticaria recurrently attacks for more than 6 weeks.

Traditional Chinese Medicine Etiology

Wind is the main pathogen in urticaria.

• Wind-cold or wind-heat invades the body, which results in a disharmony between nutritive and defensive qi

• Damp-heat accumulates in the stomach and intestines, due to an irregular diet or intestinal parasites.

• A congenital defect with qi and blood deficiency results in wind and defensive qi deficiency.

• Mental irritation, disharmony of the Chong and Ren, or liver and kidney deficiency can not nourish skin, generating wind and dryness.

Differentiation and Treatment

1. Wind-cold

White colored wheals appear and they are aggravated by cold and wind and alleviated by warmth, and occur most frequently in the winter. There is no thirst and the tongue is pale with a thin white coating, and the pulse is floating.

Treatment principle: Disperse wind and cold, harmonize nutritive Qi and defensive Qi

Formula: Modified Gui Zhi Tang

Gui Zhi - 12g, Bai Shao - 15g, Da Zao - 10g, Zi Su - 12g, Fang Feng - 12g, Jing Jie - 12g, Xing Ren - 12g, and Sheng Jiang - 3pieces.

Acupuncture: Du14, LI11, LR2, ST36, SP10, and SP6

2. Wind-heat

Red colored wheals appear and are aggravated by heat and alleviated by cold. The temperature of the lesions is higher than that of the normal skin, and the lesions occur most frequently in the summer. There is also restlessness and thirst. The tongue is red with a thin yellow coating, and the pulse is floating and rapid.

Treatment principle: Disperse wind, clear heat, and stop itching

Formula: Modified Yin Qiao San

Jin Yin Hua - 15g, Lian Qiao - 12g, Dan Zhu Ye - 10g, Yu Xing Cao - 20g, Niu Bang Zi - 12g, Bo He - 6g, Jing Jie - 10g, Chan Tui - 6g, Lu Gen - 15g, and Gan Cao - 6g

Acupuncture: Du14, GB20, DU20, UB40, LI4, and LI11

3. Damp-heat in stomach and intestine

Red colored wheals appear with an irregular diet, accompanied with abdominal pain, nausea, vomiting, and dry or loose stools. The tongue is red with a yellow and greasy coating and the pulse is slippery or rapid. Some cases have intestinal parasites

Treatment principle: Clear intestines and transform dampness, disperse wind and stop itching

Formula: Modified Yin Chen Hao Tang

Yin Chen - 20g, Jin Yin Hua - 15g, Lian Qiao - 12g, Zi Su - 9g, Zhi Shi - 10g, Zhi Zi - 9g, Shan Zha - 12g, and Gan Cao - 6g

• If intestinal parasites, add Wu Mei - 20g and Bin Lang - 15g

• If dry stool or constipation, add Da Huang - 9g

• If diarrhea, add Ge Gen - 20g, Huang Qin - 12g, and Huang Lian - 9g

Acupuncture: UB20, LI11, ST36, UB25, and REN12

4. Toxic heat

Large red wheals appear suddenly and may spread all over the body, or merge together like map. Accompanying symptoms include, extreme itching, high fever and chills, thirst with a desire for cold water, red face and eyes, restlessness, constipation, and dark urine. The tongue is red with a yellow or dry yellow coating, and the pulse is rapid.

Treatment principle: Clear Ying and cool blood, remove toxic materials and stop itching

Formula: Modified Shui Niu Jiao Tang

Shui Niu Jiao - 30g, Sheng Di Huang - 20g, Yu Xing Cao - 20g, Zi Cao - 10g, Chan Tui - 6g, Huang Qin - 12g, Dan Pi - 12g, Xuan Shen - 15g, Shi Gao - 20g, Chi Shao - 10g, and Gan Cao - 6g

Acupuncture: PC3, SP10, Du14, SJ10, LI11, UB40, and GB39

5. Defensive Qi deficiency

Wheals appear after sweating. Wheals are small and don’t merge together. There is itching, aversion to wind, and spontaneous sweating. The tongue is pale red with a thin white coating, and the pulse is deep and weak.

Treatment principle: Strengthen spleen, tonify Qi and consolidate defensive Qi to disperse wind

Formula: modified Yu Ping Feng San

Huang Qi - 30g, Fang Feng - 15g, Bai Zhu - 15g, Mu Li - 20g, Bai Shao - 15g, Fu Ling - 15g, Shu Di Huang - 15g, Shan Zhu Yu - 12g, Zhi Gan Cao – 6g, Bai Jiang Can - 12g, and Wu Wei Zi - 12g

Acupuncture: ST36, SP10, LI11, SJ4, and SP6

6. Qi and blood deficiency

Pale red wheals appear recurrently for several months or years. Skin lesions are worse after overworking. There is dizziness, listlessness, and insomnia. The face is pale, the tongue is pale with a thin white coating, and the pulse is thin and weak.

Treatment principle: Tonify Qi and nourish blood

Formula: modified Ba Zhen Tang

Dang Shen - 15g, Bai Zhu - 10g, Fu Ling - 12g, Dang Gui - 10g, Shu Di Huang - 15g, Sheng Di Huang - 15g, Bai Shao - 12g, Chai Hu - 10g, E Jiao - 15g, and Zhi Gan Cao - 6g

Acupuncture: ST36, SP6, SP10, UB20, UB17, and LI11

7. Disharmony between the Chong and Ren

Pale red wheals appear mainly on the lower abdomen, low back and thighs. Skin lesions occur several days before the onset of menses, disappear after menses, and recur with the next cycle. The periods are painful and/or irregular. The tongue is normal or pale with a thin white or scanty coating, and the pulse is fine and wiry.

Treatment principle: Regulate the Chong and Ren meridians

Formula: Si Wu Tang with Er Xian Tang

Dang Gui - 12g, Chuan Xiong - 6g, Xian Mao - 6g, Yin Yang Huo - 6g, Tu Si Zi - 15g, Nu Zhen Zi – 15g, Mo Han Lian - 15g, Dan Shen - 15g, Niu Xi - 10g, Yi Mu Cao - 10g, and Dan Pi - 10g

Acupuncture: KI3, LI4, UB24, Ren4, Ren6, SP6, and SP10

8. Yin deficiency with empty heat

Dark red wheals attack recurrently for several months or years. Skin lesions are worse in the afternoon and during the night, and are accompanied by restlessness, palpitations, night sweats, irritability, and dry mouth. The tongue is red with a scanty coating and the pulse is fine and rapid.

Treatment principle: Nourish yin, clear heat, cool blood and disperse wind

Formula: Modified Zhi Bai Ba Wei Wan

Shan Zhu Yu - 12g, Fu Ling - 12g, Shan Yao - 15g, Ze Xie - 10g, Dan Pi - 10g, Sheng Di Huang - 15g, Shu Di Huang - 15g, Zhi Mu - 10g, Huang Bai - 10g, Wu Wei Zi - 10g, Mu Li - 15g, Zi Su - 10g, and Fang Feng - 10g

Acupuncture: SP6, SP10, LI4, LI11, LU9, and HT9

9. Blood stasis

Dark red or purple wheals appear in areas where there is pressure, such as under the belt and watch band. The complexion is dark, with purple lips and there is thirst with no desire to drink water. The tongue is purple, possibly with purple spots and the pulse is thin and choppy.

Treatment principle: Promote flow of Qi, invigorate blood, and unblock the channels

Formula: Tao Hong Si Wu Tang
Tao Ren - 10g, Hong Hua - 9g, Dang Gui - 12g, Chi Shao - 9g, Chuan Xiong - 9g, Di Long - 10g, Jing Jie - 10g, Fang Feng - 10g, Niu Xi - 12g, Wu Yao - 10g, and Qing Pi - 10g

Acupuncture: UB17, UB40, LR2, LR3, LI4, SP6, and SP10

External treatment

Decoct and use as a steam and wash, once each day: