Urticaria (Hives) is defined as a kind of skin rash notable for pale red, itchy bumps caused by allergic reactions to internal and external agents. The word ‘urticaria’ is derived from the Latin word urtica, which means ‘nettle’, which is a tooth-leaved plant covered with hairs that secrete a stinging fluid that immediately affects the skin.
TCM Understanding of Urticaria
According to TCM, the following factors may be involved in urticaria:
sensitive to substances, food, drugs, biological products, infections, intestinal parasites, etc.
external weather changes, such as wind, cold, etc.
Urticaria is a disease at the body surface, but it is always a manifestation of the internal organs. In TCM, it is said that “Viscera inside the body must manifest themselves externally”. “有诸内，必形诸外” “Viscera” refers to the internal organs inside a human body. Disharmony within the internal organs will be reflected externally.
In TCM, Urticaria is also known as Feng Mo or Feng Tuan (wind rash). It occurs in 2 forms: acute and chronic. Acute urticaria is generally attributed to an external invasion of Wind-Heat or Wind-Cold induced by Lung and/or Spleen Qi imbalance. When the Lung Qi is deficient, the invasion occurs through the skin or respiratory tract after exposure to pollens or irritants. When the Spleen Qi is affected, there is an accumulation of Damp-Heat, which then manifests in the skin after exposure to triggers such as shellfish. Hence, diet is important in the management of urticaria as well. Chronic urticaria is usually attributed to an internal stirring of Wind and Heat, in association with Blood deficiency.
TCM treatments aim to restore the internal balance so that it is internally balanced with external environment. A combination of both Acupuncture and Chinese herbal medicine is usually given to help manage the symptoms and to prevent acute onsets in the case of chronic urticaria.
Urticaria Case Study
Here is an example of a case study:
Female, age 40+
Date of visit: 25 Feb 2019
She first started having hives outbreaks since June 2018. She was in the process of moving to a new home during Aug 2018. She was prescribed antihistamines by a doctor and was taking them for 2 months. However, whenever she took the western medicine, she would feel drowsy and the condition persisted, hence, she stopped taking the western medicine. She was referred by a friend and came to visit on 25 Feb 2019.
Skin Scratch test (positive), recurrent outbreaks of hives (itchy red bumps) in the lower back and thighs regions, prone to feeling cold easily, dry lips, darkish coloration of tongue and thick white coating, stringy pulse
After eating sweet or savory foods or after bathing at night 8-9pm
Lack of rest and stress during the shifting to a new home could have caused her immune system to be weakened. A possible trigger factor could be a change in environment when moving to a new temporary place (her sister’s place) to stay while the new home was undergoing renovations. She has a weak digestive system and hence the thick coating on the tongue, indicating dampness and toxins accumulated in the body were not cleared out quickly enough. There was underlying stress as well which caused Qi (vital energy) and blood stagnation.
Acupuncture was done and a week of Chinese herbal medicine was prescribed. Points such as Xue Hai, Zu San Li, He Gu, Tai Chong were chosen to help promote Qi and blood circulation, disperse wind and boost the digestive system. Chinese Herbal medicine consists of modified *Xiaofeng powder with the aim to dispel wind, eliminate dampness, clear heat and promote Qi and blood circulation. Second Visit: 6 Mar 2019
After a week of Chinese herbal medicine, she complained of having ulcers. She still had a few episodes of hives (still itchy) on her thigh regions but the frequency had reduced. Her tongue was darkish in color and the thick white coating in the tongue has reduced a little but with a tint of yellow coloring (damp-heat).
Acupuncture was done and a week of Chinese herbal medicine was prescribed. Modification of Chinese Herbal medicine: modified Xiaofeng powder and addition of Yin Qiao San to further disperse wind-heat and relieves toxicity.
A week later, the patient feedback that she was feeling fine and no more onsets of hives. Subsequently, in May and June, she continued with acupuncture treatment and taking 3 weeks of Chinese herbal medicine each time. The objective of once-a-month TCM treatment sessions was to help strengthen her immune system, thus preventing future episodes of hives and for regular maintenance.
*Points to note: The medicine formulas listed in the case study were prescribed according to the patient’s body constitution and the patterns of disharmony which she presented (TCM Syndrome Differentiation). Do not purchase such formulas on your own. It is advisable to seek consultation from a registered TCM practitioner to manage your condition holistically.
Physician Poh Yu Min 傅瑜敏, is a TCM practitioner at