Abstract: Urticaria due to blood stasis syndrome is commonly found on skin areas subjected to pressure from belts, straps, socks, and watch bands. The lesions are relatively fixed, often occurring at night, with a dark red color, accompanied by symptoms of blood stasis such as purple lips, a dark purple tongue, nodules in the sublingual veins, and a thin, rough pulse. Common treatments include Tongjing Zhuyu Decoction and Xuefu Zhuyu Decoction.
1. 【Basic Knowledge】
1. Main qualitative symptoms of wind evil: aversion to wind, itchy throat, itchy skin, migratory pain, facial swelling, body convulsions, trembling limbs, tongue tremors, dizziness, crooked mouth and eyes, hemiplegia, sudden fainting, and a floating, slow or wiry pulse.
2. Main qualitative symptoms of qi stagnation: pain, fullness, distension, engorged sublingual veins, and symptom relief after activity. The characteristics of qi stagnation pain are that it varies in intensity, often presenting as a cramping pain, with distension being more prominent than pain.
3. Main qualitative symptoms of blood stasis: purple tongue, purple lips, and purplish spots on the tongue. Engorged, twisted, and nodular sublingual veins. Women may experience dark purple menstrual blood with clots. Skin is dry. The characteristics of blood stasis pain are stabbing pain, fixed location, and worsening at night.
4. The famous physician of the Yuan Dynasty, Du Sijing, said: “Symptoms worsen during the day, and are quiet at night, indicating a qi level disease without blood involvement; symptoms worsen at night and are quiet during the day, indicating a blood level disease without qi involvement.” This means that daytime symptom exacerbation is due to qi level changes, while nighttime exacerbation indicates blood level changes. Qi level changes can include qi heat, qi stagnation, and qi deficiency; nighttime exacerbation indicates blood level changes, which can include blood heat, blood stasis, and blood deficiency.
2. 【Xuefu Zhuyu Decoction】
1. Formula Song:
Xuefu Danggui Shengdi Tao, Honghua Zhike Xikong Rao. Chaihu Chisha Gancao, Xuehua Xiaxing Bu Zuo Lao.
2. Composition
Danggui 9g, Shengdi Huang 9g, Taoren 12g, Honghua 9g, Zhike 6g, Niuxi 9g, Chuanxiong 4.5g, Chaihu 3g, Chisha 6g, Jiegeng 4.5g, Gancao 6g.
3. Function:
Activates blood, resolves stasis, promotes qi, and alleviates pain.
4. Indications:
Blood stasis syndrome in the chest. Symptoms include chest pain, headache, persistent pain like a needle prick, prolonged hiccups, choking on water, dry retching, internal heat and restlessness, palpitations, insomnia with vivid dreams, irritability, tidal fever in the evening, dark lips, dark circles under the eyes, dark red tongue, or tongue with purplish spots, and a rough or tight pulse.
5. Analysis:
In the formula, Taoren breaks blood stasis, and Honghua activates blood and dispels stasis, serving as the monarch herbs. Chisha and Chuanxiong assist the monarch herbs in activating blood and dispelling stasis; Niuxi activates blood and opens the meridians, guiding blood downward, serving as minister herbs. Shengdi and Danggui nourish blood and benefit yin, clear heat, and activate blood; Jiegeng and Zhike work together to regulate qi and open the chest; Chaihu soothes the liver and relieves depression, working with Jiegeng and Zhike to regulate qi stagnation, allowing qi to flow and blood to move, serving as assistant herbs. Jiegeng can also carry the medicine upward, serving as a messenger herb; Gancao harmonizes the other herbs, also serving as a messenger herb. The combination of these herbs promotes blood activation, stasis resolution, and qi movement, thus alleviating all symptoms, making it an excellent formula for treating blood stasis syndrome in the chest.
3. 【Etiology and Pathogenesis】
1. Although the causes of urticaria are numerous and complex, they ultimately trace back to one word: “wind.” Wind can be classified as internal wind and external wind. The “Medical Canon of the Golden Mirror” states: “This condition is commonly known as ghost rice bumps. It arises from sweating and exposure to wind, or sleeping in the cool air, with wind evil often affecting those with a weak exterior. Initially, the skin itches, followed by the appearance of bumps resembling bean petals, accumulating in patches. If itching is severe during the day, it is advisable to take Qin Jiao Niubang Decoction; if itching is worse at night, take Danggui Drink.” Wind is the leader of all diseases, adept at movement and change. When wind evil invades the skin, it collides with qi and blood, obstructing their flow, leading to the appearance of wind bumps.
2. Urticaria, known in TCM as Yinzhen. The “Principles of Diagnosis and Treatment” states: “Wind urticaria arises from evil qi lodging in the skin, which, when combined with wind and cold, results in urticaria. If it is red rash, it is due to cold dampness invading the muscles, with wind heat forming red rashes, worsening with heat and improving with cold. Wind heat invasion damages the nutritive blood.” This means that urticaria occurs when there is evil qi in the skin, combined with wind and cold invasion, leading to the condition. Red rashes occur when damp evil invades the muscles, combining with wind heat to form red rashes, worsening with heat and improving with cold. Wind heat invasion consumes the nutritive blood.
3. The pathogenesis of urticaria due to Xuefu Zhuyu Decoction is that blood stasis obstructs the meridians, leading to insufficient qi and blood supply to the skin, resulting in skin deficiency, allowing wind evil to invade the skin and cause urticaria.
4. 【Case Examples】
1. Case:
A 50-year-old male reported that four years ago, without any obvious trigger, he developed several itchy, edematous wheals on his limbs. He was treated for “acute urticaria” at a local hospital and recovered after one week. However, subsequently, the wheals recurred with seasonal and emotional changes, and he sought treatment from various sources without satisfactory results. Current examination: wheals on the distal limbs and sides of the trunk appear and disappear intermittently, with severe itching, more frequent at night, aversion to wind, irritability, poor sleep, dry lips with no desire to drink, normal appetite, and regular bowel movements. Purple lips, dark red tongue, purplish spots on the tongue edges, thin white coating, and a deep, rough pulse.
2. Analysis:
The wheals are itchy and appear intermittently, reflecting the nature of wind as “changeable” in the symptoms of wheals. Therefore, the cause of wheals is due to wind evil, not as stated in the “Inner Canon” that “all sores and itching pain belong to the heart.” Why does the skin have wind evil? A detailed analysis is as follows:
(1) As Du Sijing said: “Symptoms worsen at night and are quiet during the day, indicating blood level disease without qi involvement,” thus the wheals are more frequent at night, indicating blood level changes. Additionally, the purple lips and purplish spots on the tongue edges indicate blood stasis, confirming it as a blood stasis syndrome. Blood stasis obstructs the meridians, leading to insufficient qi and blood supply to the skin, resulting in skin deficiency, allowing wind evil to invade and cause wheals. How does blood stasis occur? The patient’s irritability and wheals changing with emotions indicate liver depression; liver depression leads to qi stagnation, and qi stagnation leads to blood stasis. To treat blood stasis caused by qi stagnation, Xuefu Zhuyu Decoction is modified. Since there are no symptoms of chest tightness or chest pain indicating qi stagnation in the chest, but rather prominent irritability indicating liver depression, the chest-opening and qi-regulating herbs Jiegeng and Zhike are removed and replaced with Xiangfu to enhance liver soothing and depression-relieving effects. Additionally, Di Long is added to clear liver heat, extinguish liver wind, and open the meridians, along with Myrrh and Wulingzhi to enhance blood-activating and stasis-resolving effects. This series of treatments is aimed at “calming the interior.”
(2) The wheals are edematous, indicating that the skin has not only wind evil but also damp evil. Therefore, Fangfeng, Qin Jiao, Qianghuo, and Difuzi are used to expel external wind and dampness from the skin. This treatment is aimed at “expelling the external.”
3. Diagnosis:
Urticaria is classified as qi stagnation and blood stasis, with external wind and dampness syndrome.
4. Prescription:
Danggui 12g, Shengdi 12g, Taoren 10g, Honghua 12g, Niuxi 12g, Chuanxiong 10g, Chaihu 9g, Chisha 12g, Zhi Gancao 6g, Xiangfu 12g, Myrrh 9g, Wulingzhi 9g, Di Long 9g, Qin Jiao 9g, Qianghuo 9g, Fangfeng 12g, Difuzi 12g.
5. Usage:
7 doses, decocted in water, take one dose each time, twice daily.
6. Effect:
After taking the medicine, symptoms were alleviated. The formula was continued for 14 doses, and symptoms basically disappeared. Due to significant reduction in qi stagnation and blood stasis, Myrrh, Wulingzhi, and Chaihu were removed. Shudihuang 12g was added to prevent wind dryness from harming yin, and after taking 7 more doses, the effect was consolidated.
5. 【Summary】
1. The syndrome of urticaria varies from person to person, from place to place, and from time to time, with countless syndromes. Differentiating syndromes can treat all urticaria! Grasping the concept of “wind” ensures the direction of differentiation is correct. Expelling the external and calming the interior ensures the treatment approach is correct.
2. When implementing the “dual approach of internal and external,” the properties of both ends must be oppositional in yin and yang, such as: internal being yin and external being yang. The internal and external properties are oppositional in yin and yang, thus both calming the interior and expelling the external is the dual approach of internal and external. Similarly, left rising is yang, and right descending is yin; the properties of left rising and right descending are oppositional in yin and yang, thus both regulating left rising and treating right descending is the dual approach of internal and external. Why must the treatment adhere to the dual approach of internal and external? This is because only by adhering to the dual approach can yin and yang be quickly balanced.
3. If blood stasis is caused by qi deficiency, use Bu Yang Huan Wu Decoction; if blood stasis is caused by blood deficiency, use Taohong Siwu Decoction; if blood stasis is caused by yang deficiency, use Shaofu Zhuyu Decoction; if blood stasis is caused by yin deficiency, use Huoxue Runzao Shengjin Decoction.
Introduction of TCM Practitioners:
(Zeng Yiwen, Xiao Chunhong)
Xiao Chunhong: A native of Jilin, a true “master of TCM” without the title! Passionate about TCM, dedicated to its transmission, with countless fans. Proficient in various TCM theories, integrating them into clinical treatment, he has created a unique diagnostic method combining theory, law, formula, and medicine, greatly improving the speed and effectiveness of TCM diagnosis. His mentor praised him as “a clinical encyclopedia of TCM; a rare TCM talent in fifty years, destined to be recorded in the history of TCM celebrities!”
Zeng Yiwen: A native of Hunan, a true “hardcore TCM practitioner.” After three years of graduation, he became a key member of the Dinghu District People’s Hospital due to TCM, earning the respect of many as a young “old TCM doctor.” For 30 years in clinical practice, he has consistently adhered to pure TCM treatment for various common, frequently occurring, and difficult diseases, winning the favor of numerous patients both within and outside the province!Xiao Chunhong and Zeng Yiwen met online due to their mutual passion for TCM. Since 2021, they have collaborated online for consultations, treating various difficult and complicated diseases, alleviating the suffering of many patients, showcasing the miraculous effects of TCM, and creating a new form of TCM diagnosis and treatment. Together, they inherit TCM, selflessly, without regret, tirelessly, and joyfully! It is said: “Xiao from the North; Zeng from the South, despite being from opposite ends, they can happily collaborate to treat and save people through TCM! What a wonder!”
Appendix:
Dr. Zeng Yiwen’s consultation address and schedule:
Zhaoqing Medical College Affiliated Hospital: Every Monday and Friday morning
Zhaoqing Dinghu TCM Clinic (Jianneng TCM Clinic): Every Tuesday and Thursday evening, Sunday morning.
Saturday morning: Foshan Gushengtang Address: No. 12, North Nanhai Avenue, Nanhai District, Foshan City, Guangdong Province
Saturday afternoon: Guangzhou Gushengtang Address: No. 29, Zhongshan Second Road, Yuexiu District
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Original | Xiao Chunhong
Reviewed|Xiao Chunhong Zeng Yiwen
Edited|Xu Yuanhuai