Urticaria - Yin Zhen
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Definition
Recurrent, transient, cutaneous swelling and erythema due to fluid transfer from vasculature to the dermis. This condition is common and varies from minor but inconvenient cutaneous lesions to the severe life-threatening angio-oedema affecting the laryngeal area.
Causes and Pathological Mechanisms
- Wind, Damp Heat and Qi and Blood Deficiency are the main causes
- Wind: “wind is the chief of all diseases”, movable and changeable, combining with cold to become Wind Cold and with Heat to become Wind Heat. Wind Cold and Wind Heat invade and hang about in the skin and Cou Li (interstitial space) and urticarial weals will appear.
- Damp Heat: pre-heaven deficiencies (intolerance), too much rich, greasy, meaty and seafood (fish, prawn, crab and other shellfish, egg etc – protein food), worms (parasites) – stomach and intestine disharmony and damp-heat accumulation. Damp Heat stuffing and obstructing the skin and Cou Li and urticarial weals will appear.
- Qi Deficiency – with Wei Qi deficiency and loose defence, wind evil takes advantage and invade.
- Blood Deficiency (Constitution or long-term illnesses) leads to Wind stirring up internally.
- Internal injuries with seven Emotions or disharmony in Chong Ren. Deficient ying blood fails to nourish the Liver and Kidney – dry Wind hanging about in the skin.
Patterns
- Symptoms: Red urticarial weals occur when it is hot and better when it is cold (summer>winter), hot feeling in weals,
- Tongue: Red tongue with thin yellow coating
- Pulse: Floating and Rapid
- Treatment strategy: Dispel wind and clear heat
- Formula: Sang Ju Yin or Yin Qiao San or Xiao Feng San
- Modifications: For Blood Heat add Chi Shao, Mu Dan Pi and Huai Hua
- Acupoints:
- Symptoms: Light pink or white urticarial weals occur when it is cold and windy and better when it is warm (winter>summer)
- Tongue: thin white tongue coating
- Pulse: Floating and Moderate or Tight
- Treatment strategy: Dispel wind and cold and harmonise ying-wei
- Formula: Jing Fang Bai Du San or Gui Zhi Tang
- Acupoints:
Stomach Damp Heat and intestine Damp Heat
- Symptoms: Urticarial weals occur after eating some certain food, with pains in epigastrium and abdomen, tiredness, poor appetite, constipation or diarrhoea, nausea and vomiting
- Tongue: Red tongue with yellow and greasy coating
- Pulse: Slippery and Rapid
- Treatment strategy: Relieve the interior and the exterior simultaneously and clear away dampness and heat
- Formula: Fang Feng Tong Sheng San and Chan Sha and Yin Chen
- Acupoints:
Symptoms: Urticarial weals appear and disappear repetitively over months or even years, mostly occur or get worse when tired, lack of shen and energy
- Tongue: pale tongue with thin white coating
- Pulse: Deep, Soggy and Thready
- Treatment strategy: Tonify qi and blood, consolidate the exterior (wei) and tonify blood to stop wind
- Formula: To tonify qi and blood use Ba Zhen Tang, to consolidate the exterior (wei qi) use Yu Ping Feng San, to tonify blood and stop wind use Dang Gui Yin Zi
- Acupoints:
Chong Ren disharmony
- Symptoms: Urticarial weals appear and disappear cyclically. They appear a few days before menstruation and disappear when menstruation finishes, and the same happens in the next cycle, mostly with irregular menstruation period pain.
- Tongue:
- Pulse:
- Treatment strategy: harmonises Chong-Ren.
- Formula: Si Wu Tang and Er Xian Tang (Xian Mao, Xian Ling Pi, Zhi Mu, Huang Bai, Dang Gui and Ba Ji)
- Modifications: For liver qi stagnation with heat or fire use Dan Zhi Xiao Yao San
- Acupoints:
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