Chronic urticaria is a recurrent, stubborn and intractable allergic skin disease with complex etiology and pathogenesis. In recent years, we have conducted a detailed clinical study of the disease from the perspective of Chinese medicine evidence-based treatment, and achieved good long-term results. The experience of Chinese medicine evidence-based treatment is summarized as follows: 1. Chinese medicine evidence-based, highlighting the advantages of treatment In recent years, a lot of evidence shows that chronic urticaria is a skin disease mainly caused by the involvement of autoimmune factors, different from the pathogenesis of acute urticaria, the presence of autoantibodies against high-affinity IgE receptors, histamine releasing activity or anti-IgE autoantibodies in the serum of patients, its activation of mast cells, basophils de The pathways of granulation are also significantly more numerous than those previously recognized and there are many unknown factors involved. The close relationship between chronic urticaria and autoimmune thyroiditis also suggests the involvement of autoimmune mechanisms in the pathogenesis of some chronic urticaria. There is no better treatment for this disease and antihistamines are not effective in some patients with chronic urticaria. Chronic urticaria belongs to the category of “addiction rash” in Chinese medicine. Objectively speaking, the disease is caused by a combination of internal and external factors, with internal causes being more important than external ones. In this regard, the “Inner Classic” has a clear discussion: “wind and rain, cold and heat, not deficiency, the evil can not hurt people alone.” For the adjustment of many aspects of the internal disorders or disorders (mainly immunity, etc.), the effect of Western medicine is poor because it is difficult to achieve comprehensive regulation due to the single action of Western medicine. In contrast, Chinese medicine has obvious advantages in this regard, through diagnosis and treatment, deficiency, then tonic, solid, then diarrhea, chaos, and the use of natural Chinese herbal medicine multi-target, multi-level effect, to achieve the adjustment of yin and yang, qi and blood, to remove disease-causing factors (six perversions), so that the balance of yin and yang, qi and blood reconciliation, then external factors can not work through internal factors, the disease will be long-term relief or healing. 2, the evidence is summarized, from the clinical urticaria of Chinese medicine identification typing higher Chinese medicine colleges and universities in the new century planning textbook “Chinese medicine external medicine addiction rash” is divided into four types, namely wind-cold bundle surface evidence, wind-heat offending evidence, gastrointestinal damp-heat evidence, blood deficiency wind-dry evidence, can not yet summarize the complex evidence of chronic urticaria, is not conducive to clinical application. For the identification of chronic urticaria, we are not bound by the textbook, and we completely follow the identification method of Chinese medicine to identify and then summarize the evidence, forming a total of three main types of evidence and six part-time evidence, which is highly operable. (1) Wind-damp-heat-embedded skin syndrome Main symptoms: It is common in young and strong people, with recurrent wind masses, itching, red tongue, yellow greasy coating, and slippery pulse. Basic prescription: Fucus, Cicadelle, Bupleurum, Scutellaria, Gardenia, Motherwort, Thicket, White moss bark, Radix et Rhizoma, Tongcao, etc. With deficiency of the lung guard: more frequent in middle age and above, accompanied by weakness, easy to catch cold, thin or fat body, palpitations when moving, and weak or deficient pulse. It is advisable to add raw astragalus to the basic formula. With weakness of Wei-Yang: wind masses occurring at night, fear of cold, more colds in general, thin and weak body, unpleasant complexion, pale tongue and weak pulse. It is appropriate to remove the basic formula of cicada molasses and fucus, and add raw astragalus, saposhnikovia and cinnamon branch. (2) Blood deficiency and wind-lust evidence Main evidence: mostly in women above middle age. Clinical manifestations include wind masses, itching, yellowish-white face, low menstrual flow, palpitations and weakness, dizziness and forgetfulness, little sleep and dreaminess. The tongue is pale, with thin white coating and weak pulse. Basic prescription: Jing Fang Si Wu Tang. Insufficiency of Wei-Yang: fear of cold, lack of warmth in the hands and feet, easily catching cold, often with clear nasal discharge, or easily developing frostbite in winter, with a dull complexion. The basic formula should be supplemented with Radix Astragali, Radix Aconiti and Radix Cinnamomi. With lung health deficiency: easy to catch cold, often with clear nasal discharge, palpitations and sweating when moving. The basic formula should be supplemented with Radix Astragali, Atractylodes Macrocephala, Radix Glycyrrhiza Uralensis, Radix Ginger and Jujube. (3) The evidence of disharmony of Ying and Wei is mainly seen in young and strong people, with recurrent attacks of wind masses that do not heal for a long time, with no obvious discomfort other than wind masses and itching. The tongue and pulse are as usual. Basic prescription: Gui Zhi Tang plus Bai Moss Peel and Di Shi Zi. For those with blood deficiency, add Radix Angelicae Sinensis; for those with qi deficiency, add Radix Astragali; for those with internal heat, add Gardenia, etc. The above types of evidence originate from clinical practice and are obviously different from the textbook, but the treatment according to this identification is mostly effective. The main difference with the textbook and the current Chinese medicine dermatology community general identification is reflected in the important role of “wet” and “deficiency” in the formation of chronic urticaria process. If the dampness is sticky, the wind and the dampness together, it will be difficult for the wind evil to go away; if the deficiency is not able to overcome the evil, the wind evil stays. In many cases, “dampness” and “deficiency” often cause the disease at the same time, resulting in very complex clinical manifestations, and the identification of evidence is also very important. Dampness” and “deficiency” are actually the main cause of “wind” evil staying for a long time, that is, if there is no “dampness” and “deficiency That is to say, without the existence of “wet” and “deficiency”, “wind” either has nothing to cling to or is promptly dispelled by the righteousness. Here “deficiency” has four layers of meaning: Wei Qi deficiency, blood deficiency, Wei Yang deficiency, Qi and Yin deficiency, can also be considered to have a different degree and level of “deficiency”, such as Wei Yang deficiency is heavier than Wei Qi deficiency. The existence of these “deficiencies” is a manifestation of the deficiency of the body’s vital energy, and is also the root cause of the retention of wind and evil. It should also be pointed out that, in the identification of Chinese medicine, not all the symptoms or signs of a certain type of chronic urticaria should be present, but a few of the main symptoms or signs can be seen, it is not necessary to have all of them, it is not common to see those who have all of them clinically. Through years of clinical observation, it has been found that most chronic urticaria patients have a certain pattern in the healing process, that is, their symptoms evolve in stages from the beginning of treatment to the end of treatment. Usually, the following two symptoms are common at the time of first consultation: (1) the lung guard is not solid with damp-heat and blood deficiency, the tongue is red or slightly red, and the tongue coating is yellow and greasy; after a period of treatment, as the disease decreases, the tongue turns light red or light white, and the disease will be further reduced after timely adjustment of treatment and prescriptions according to the change of symptoms, otherwise it will stagnate, and eventually the method of warming the Yang, benefiting the Qi and replenishing the Blood will be used in a few cases. The root of the etiology of chronic urticaria is mostly Yang deficiency and blood deficiency, while the beginning of the disease only shows Qi deficiency or both dampness and heat, and the essence of Yang deficiency gradually appears only after the “Qi” is restored and the dampness and heat is cleared by replenishing Qi. It is worth mentioning that clinical treatment cannot go beyond Qi deficiency and Damp-Heat to warm Yang directly, but can only be done step by step to relieve the disease until it is completely cured. (2) Wind-damp-heat contained in the skin evidence, there are about two kinds of regression of this symptom: first, through treatment, wind-damp-heat is removed, the disease is cured; second, through treatment, wind-damp-heat is less removed, but there is a deficiency of Wei-Qi (lung Wei is not solid) evidence, and must be in the draining of wind-damp-heat clearing at the same time with the use of beneficial Qi solid surface drugs, in order to complete the work. It is difficult to elaborate on all the variations of the symptoms. However, “mixed deficiency and reality” gradually turns into pure deficiency, or “first reality and then deficiency” is a major feature or pattern of this disease, which is worth further exploration. 4, Chinese and Western medicine together, to improve the patient’s compliance Most of the patients who come to the clinic have been treated in many hospitals and do not have much confidence in the treatment, but just hold the mentality of trying. If they use Chinese medicine alone at this time, some patients may lose confidence and give up treatment or change doctors because of the slow onset of effect. Therefore, the combination of Chinese and Western medicine can significantly improve the efficacy and “stabilize” the patient, and then gradually withdraw the Western medicine after the Chinese medicine takes effect, and the Chinese medicine continues to be taken until the disease is cured. The duration of treatment is about 2 months to 1 year. If you can’t get the patient’s trust, you often give up halfway and give up your previous work. Patients with this disease should not be boasted without basis, otherwise the results are counterproductive. In the course of treatment, timely adjustment of prescriptions and medicines, and encouragement of patients on the basis of the curative effect already achieved, are important guarantees for the eventual achievement of good results. 5, consolidate the effect, the key to healing clinical experience, when after a long period of treatment, the patient’s wind mass completely subsided and has not reappeared for several days, indicating that the disease has achieved substantial results, only one step away from a complete cure. At this time, attention should be paid to consolidate the existing efficacy, encourage or tell the patient to adhere to treatment for more than 1 month, so as not to stop the drug too early and cause the disease to recur. The author has a lesson in this regard, a patient through more than two months of treatment, the wind mass has not come out for many days, very happy, think they have been cured, self-medication and did not in the follow-up, but also take the initiative to introduce other patients to treatment. However, the good times did not last long, and the disease recurred after February, and the wind masses started again, so he had no choice but to receive treatment again, and the effect was slower than the first time. Therefore, it is necessary to consolidate the treatment for a period of time after the basic cure, so as to avoid recurrence and increase the difficulty of treatment and prolong the course of treatment. 6.Clinical observation We use Chinese medicine to identify the evidence and take oral Chinese medicine soup as the main treatment, and add antihistamine and hormone for short-term use if the skin lesion is serious, and observe the long-term efficacy for 3 months to 1 year after stopping the medicine. The total effective rate (cured + apparent effect) of the recent treatment was 61.81%; the long-term effect of cured patients: the long-term remission rate was 86.67%. The medium-term remission rate was 6.67%, and the relapse rate was 6.67%. It can be seen that the combination of Chinese and Western medicine in the treatment of chronic urticaria can significantly improve the efficacy, and Chinese medicine evidence-based treatment can achieve good long-term efficacy. The highlight of our observation is the long-term efficacy. After searching domestic and international data, there is no report of long-term efficacy observation of chronic urticaria for more than 3 months. In this group, 86.67% of the patients who were cured and could be followed up achieved long-term remission, and the longest case had not recurred for 2.5 years. At present, except for one case of relapse (relapse after 2 months of self-medication discontinuation without following the doctor’s advice and thinking that it was cured, and then re-treatment), all other patients have not seen any signs of relapse, and their physical condition has generally improved after treatment, and other existing diseases have also improved or disappeared to varying degrees.