Chronic urticaria is a common, stubborn and difficult to treat disease. The reason why it is stubborn and difficult to treat lies in its complex etiology and pathogenesis, the difficulty in identifying evidence, and the difficulty in using medication to cut through the pathogenesis. Through years of clinical research, we believe that the reason for the difficulty or inaccuracy of identification lies in the conventionalization of ideas and the simplicity of methods, and it is certainly not easy to solve very complex problems with simple, conventional ideas and methods. In recent years, we have used our own regrouped and summarized evidence and treatment scheme to treat chronic urticaria, and have achieved good near-term and long-term results. [1-3] As long as we expand our thinking and objectively understand the complex evidence of the disease, chronic urticaria can be treated with good results. 1, firm beliefs Chinese medicine treatment of chronic urticaria obvious advantages In summary, chronic urticaria is a disease caused by abnormal immune function, and the human immune system is very large, complex and fine, a variety of reasons lead to long-term immune sensitization of the body, the outside world was very unusual substances can become allergens that trigger allergic reactions, which is the pathogenesis of chronic urticaria brief. At present, the main drugs of Western medicine are antihistamine and other inflammatory mediators, which only act on the end of the allergic reaction, and therefore take the drug to stop or reduce the dough, and stop the drug to recur. Some experts also want to regulate immunity from the deeper level, taking oral thymidine and transfer factor to improve cellular immunity, and hormones and immunosuppressive agents such as tretinoin, etc. The former has no definite efficacy, while the latter still belongs to forced inhibition, and the problem of recurrence is still a problem. The understanding and treatment of disease in TCM is different from that in Western medicine, as TCM has a macroscopic understanding of human beings and disease. The treatment is to “observe the location of yin and yang and regulate it, in order to calm the period.” With the holistic concept, evidence-based treatment and cause-specific treatment, Chinese herbal medicines with yin and yang properties are used and prescribed according to a certain combination theory, which makes Chinese medicine treatment not only effective but also free of side effects and low recurrence rate. Ling Shu? Nine needles twelve original” said: “Now the five organs of the disease, such as Utah thorn also, Utah dirt also, Utah knot also, Utah closed also. Although the prick is long, can still be pulled out; Although the dirt is long, can still be snow; Although the knot is long, can still be solved; Although the closed is long, can still be decided. Or say that the long illness is not desirable, is not its words.” [4] It is clearly stated that all diseases can be cured, and “those who say that they are incurable have not obtained their art.” According to our clinical experience, chronic urticaria can achieve good results or even long-term remission as long as you follow the theories and methods of Chinese medicine, are good at catching traces of the disease, and are diligent in thinking. 2, stubborn and difficult to treat = complex contradictions in the disease mechanism Undoubtedly, chronic urticaria is stubborn and difficult to treat, and the reason why it is difficult to treat is that the complexity of its etiology and pathogenesis exceeds the extent to which most doctors can solve it with conventional thinking. This leads us to regard complex diseases as uncomplicated and make it difficult to use medication with precision. To summarize, there are many factors that make the use of medicine impractical, about the following: first, the individual’s basic skills in Chinese medicine is not solid, not able to recognize; second, the attitude of treatment is not serious, sloppy and perfunctory; third, the influence of the textbook, because the textbook for the convenience of teaching, the Chinese medical evidence given are common, not common is not listed, or the evidence given in the textbook does not represent the objective evidence of complex diseases, need to be rewritten; fourth, the evidence given in the textbook. Fourth, the lack of enterprising spirit, that what others can not cure, I also difficult to cure, follow the wave. Personally, I think that as long as the evidence is objectively identified, and the evidence is used as the medicine, and we do not stick to textbooks and books, we will achieve good results. For example, we have newly classified the TCM symptoms of chronic urticaria into three main symptoms: “wind-damp heat in the skin”, “blood-deficiency and wind-loving”, and “disharmony between the Ying and the Wei”, each of which has two main symptoms respectively Each main evidence has two concurrent evidence [1-2], which is very different from the textbook, forming a new evidence and treatment system that is objective and operable, and some patients will be prescribed medicine based on clinical manifestations, which is easy to promote and has significant efficacy. According to our clinical observation, the pathogenesis of chronic urticaria is very complex, often mixed with deficiency and reality, cold and heat, surface and internal disease, and disorders of the internal organs. For deficiency, cold and heat, which is more or less, also need to be carefully screened. In fact, some cases with long duration and ineffective treatment, the first consultation is often clueless, the four clinics have little information related to the identification of evidence, or even no evidence to identify, but after several follow-up consultations, as long as careful, can gradually identify the disease mechanism. 3.Expand your mind and explore the screening from multiple angles Because of the high degree of complexity of the etiology of chronic urticaria, we need to get rid of conventional thinking and never be preconceived. It is necessary to think from multiple perspectives according to the traditional Chinese medicine thinking method. For example, the triggers for the onset or exacerbation of the wind mass (heat, cold, food, emotions, time of day, weather, exertion, etc.), the season of onset, the possible causes, the patient’s physical attributes, personality traits, and all the contents of the “Ten Questions Song”, in addition to very careful pulse examination and tongue examination, can generally lead to a more correct conclusion of the diagnosis. For the identification and treatment of very stubborn cases, I often compare it to “wiping the dirty glass”, the beginning is vague and unclear, and a follow-up consultation is like wiping once with a rag. In retrospect, perhaps your first identification and prescription is wrong, but as long as you take each follow-up consultation of the patient seriously, each time there are new discoveries, new understanding, and finally see the “true face of the mountain”. The more successful cases you accumulate, the more experience you will have and the more confident you will be in your treatment. Cite a case: Zou, male, 16 years old, 2009-1-1 initial diagnosis. The main complaint: the whole body out of the wind mass, itching for more than six months. Current medical history: six months ago, the whole body out of the wind, ranging in size, itchy, taking Western medicine can not be controlled, now the wind group daily out, itchy, with poor, yellow face not Hua, loose stool, once a day, allergic rhinitis, tongue tip red, moss thin yellow greasy, pulse right sinking weak, left can. Diagnosis: chronic urticaria. Differentiation: wind-damp-heat in the skin, with deficiency of Wei Qi. Treatment: Benefit Qi and consolidate the surface, remove wind and dampness and clear heat. The formula is based on Sanjiu herbal free decoction granules: raw Astragalus 10g×2 packs, Fucus 10g×1 packet, Cicada 6g×2 packs, Fructus 10g×2 packs, Scutellaria 10g×2 packs, Gardenia 10g×2 packs, Bai Xian Pi 10g×2 packs, Dioscorea 10g×2 packs, Red Peony 10g×2 packs, Licorice 3g×1 packet. 10 packs, taken with water. Beifen (Cetirizine) syrup 10ml, taken daily at bedtime. After taking the above plus or minus for 1 month, the wind masses started to decrease and even disappeared for a time, but then they came out again, loose stools, wind masses often came out at night, red tongue, thin white fur, weak pulse. Considering that his Wei-Yang is weak and accompanied by internal heat and spleen deficiency, we changed the formula to benefit Qi and warm Yang, clear heat and remove wind, remove dampness and strengthen the spleen. Prescription: Astragalus membranaceus 10g×2 packs, Radix et Rhizoma Polygonati 3g×2 packs, Cinnamomum cassia 6g×2 packs, Fructus Anemarrhena 10g×2 packs, Gardenia jasminoides 10g×2 packs, Scutellaria baicalensis 10g×2 packs, Dangpi 10g×2 packs, Bai Xian Pi 10g×2 packs, Radix et Rhizoma Dioscorea 10g×2 packs, Glycyrrhiza glabra 3g×1 packs, Yun Ling 10g×2 packs, Sha Ren 3g×2 packs. 10 packs, taken with water. Beifen (Cetirizine) syrup was reduced to 5ml and taken every night before bedtime. The above prescription was reduced and taken for more than 2 months, the wind mass gradually reduced to stop, the rhinitis was also healed, and the cetirizine syrup was also gradually stopped, the Chinese medicine prescription reduced the bitter cold products, and increased the medicine to nourish the qi and strengthen the spleen, another month was taken, and the medicine was cured and stopped. This case was initially diagnosed with signs of qi deficiency and wind-damp-heat in the skin, without signs of yang deficiency such as fear of cold, and was only given agents to benefit qi and fix the surface, and to remove wind and heat and dampness, which was effective, but the good times did not last. Later, considering that the supplementation of qi should not be, and long-term loose stools, yellow face, and allergic rhinitis, when warming the yang to fix the surface and remove dampness and wind, the condition was steadily reduced after the medicine until it was cured. Reviewing this case, the actual initial diagnosis should have warmed Yang and benefited Qi, but it was not used because the symptoms and signs of Yang deficiency were not obvious and the tongue was red. Had he been more experienced, he could have been cured early and shortened the course of treatment. Through long-term clinical practice, I personally know that for intractable diseases like chronic urticaria, one should never treat things as they are, which is a major taboo of treatment. For example, when you encounter herpes zoster, you cannot immediately think of gentian diarrhea liver soup; when you see acne, you can immediately prescribe loquat and lung clearing drink. This is something that must be corrected. Another example is that when you encounter a patient with chronic urticaria with a yellowish tongue, you cannot just clear damp-heat based on the tongue, but also look carefully at the tongue, tongue, pulse, questioning, looking at the face, shape, etc., to figure out where damp-heat comes from and where it is located (in the surface and in the interior), and also to figure out the position of damp-heat in the pathogenesis, whether it is primary or secondary, whether it is due to diet, or whether it is generated internally due to deficiency, or whether it is an external sensation of damp-heat evil, to clarify the The source of damp-heat and its position in the pathogenesis, the treatment, prescriptions and medicines will be more relevant, the treatment will be better and more lasting. It has been clinically found that in many cases, damp-heat is often accompanied by yang deficiency, which at first glance seems to be the opposite and may be considered difficult to understand by the novice TCM student. In fact, for intractable diseases such as chronic urticaria, there are many cases where damp-heat and yang deficiency coexist, and the two are contradictory, but it is this contradiction that objectively reflects the intricacies of the disease. From a clinical point of view, damp heat and yang deficiency coexist in a variety of situations, one, damp heat and yang deficiency there is a causal relationship, that is, yang deficiency can not warm water and damp, depression for a long time into heat; second, the body of yang deficiency, too much spicy and fatty products in the short term; third, the body of damp heat, the doctor excessive use of bitter cold medicine to damage its yang; fourth, the body of yang deficiency, feeling external damp heat, and so on. Only when these specific circumstances are clear, the use of drugs can be targeted to achieve good results. Can not be regardless of red and white, see damp heat on the clearing of heat and damp, that can only take effect for a while, and difficult to cure the disease. 5, when the treatment is in trouble to find the cause of the treatment of Chinese medicine evidence-based treatment of chronic urticaria most of the results are good, but because the cause of the disease is very complex pathogenesis, but also often encounter a few very difficult cases. These are mainly patients with a long course of the disease, and multiple treatments are ineffective. Some patients have been treated in all major hospitals, with all kinds of western medicine, and in many places by Chinese medicine practitioners, but to no avail. Despite this, you may still feel confused because there is no abnormality in the tongue, pulse, diet, sleep, stool, etc. It seems that there is no evidence to identify and cannot explain the pathogenesis of the wind mass. This was the case with a female patient I met. She was very anxious for treatment and spared no time and money. After careful inquiry, no obvious abnormalities were found, and after meditating, I felt that her high-pitched voice, fast speech and outgoing personality were the places to cut into. She was prescribed Chai Hu, Long Bone and Oyster Soup with addition and subtraction, which was taken continuously for several months, and the persistent disease was gradually healed. In some patients, the treatment was effective, but the relief was to a certain extent, and then the improvement did not continue and stagnated. Even for several months in a row, the patient is anxious and the doctor is confused. When this happens, it is important to calm down and carefully check the tongue and pulse and medical history to see if there is something wrong with the diagnosis, if the medicine is not very appropriate, or if the prescription needs to be kept for another period. Some patients have difficulties in treatment because of an unhealthy lifestyle, and this requires full communication between the doctor and the patient and collaborative treatment to cure the disease. Others have deficiencies in identification, such as Yang deficiency without tonifying Yang, or liver depression without draining the liver. For patients with weak constitution, they should be frequently asked and encouraged to persist in exercise to strengthen their constitution, which is beneficial for disease recovery.