Chronic urticaria is a common disease in dermatology.
Chronic urticaria is a common disease in dermatology, known as “addiction rash” in Chinese medicine, and the long-term efficacy of Western medicine is poor, while Chinese medicine has obvious advantages. However, because of the complexity of the Chinese medical diagnosis, not only different schools, but also a wide range of evidence types, which is not easy to grasp, so there is no standardized evidence criteria. The following is a review of the literature on the etiology of chronic urticaria in the past ten years, for the reference of our colleagues.
1. Etiological identification
(1) Wind and urticaria evidence Wind is the main qi of spring, and urticaria caused by wind is usually occurring during climate change, according to Guo Tianzhang et al [1], the disease most often occurs in spring and winter. The wind evil is present on the surface of the muscles and closed in the meridians and channels, and stays in the skin, resulting in disharmony between the Ying and the Wei, plus the wind is the longest of all diseases, its nature is light, and it is good at moving and changing several times.
(2) The wind-heat fight evidence The Treatise on the Origin of the Diseases, clouded: “If the red square is caused by cool dampness folded in the heat of the muscle, the heat knotted into the red square, the heat of the day will be intense, and the cold will be extinguished.” According to Song Yeqiang [2], this disease is mostly caused by the endowment of intolerance, feeling the wind-heat or wind-cold evil into the heat, or eating spicy, fish and other things that produce wind and heat, and wind-heat is an important cause of the disease; if the positive energy is lost over time, the evil energy can become wind-heat and deficiency. The clinical symptoms include windy skin, bright red, itchy, aggravated by heat and relieved by cold, accompanied by heart trouble, chest tightness, abdominal pain, dry stool, yellow urine and other symptoms, red tongue, yellow moss, string or floating pulse; deficiency may have tiredness and fatigue, dizziness and insomnia, red tongue with tooth marks, white or yellow-white moss and deficient pulse.
(3) Wind-cold surface deficiency evidence Surgical Heart Method Essentials” cloud: “This evidence is commonly known as ghost rice pimple, by sweating out of the wind, or lying in the cold dew, wind evil more in the table deficiency of people.” This evidence is mostly seen in chronic cold urticaria. Liu Guijun et al.3] believe that the disease is initially caused by the external attack of wind and cold and the disharmony of Ying and Wei, and over time, it appears as a result of surface deficiency. The clinical symptoms are pale and slightly red, with the exposed areas such as the head and face, hands and feet being the most important, more so when exposed to wind and cold, and slowing down when exposed to heat, with a light tongue, thin white fur, and a floating and tight or sinking pulse.
(4) Wind-damp-heat contains skin evidence Wind-damp evil invades the skin, stagnating between the muscle couples and veins, which can lead to Yang Qi depression, Ying and Wei disharmony; it can also be transmitted internally into the interior, so that wet trapped in the middle Jiao, and over time, heat, wind-damp-heat three evils in the skin couples and become this disease. According to Liu Aimin [4], this disease occurs in young and strong people, with wind masses of different sizes and itchy, and when western medicine is taken, the wind masses do not come out, and when they stop, they recur soon and are prolonged. Clinical symptoms include red and itchy wind masses, yellow and greasy tongue coating, or red and greasy tongue coating, and slippery or smooth pulse.
(5) Cold and dampness in the blocking evidence Cold and dampness are both yin evil, which is the disease, most likely to damage the Wei Yang, block the qi, depression and closure of the muscle couples, so that the veins and veins of evil Qi agglomeration. If the two are combined with the wind evil causing the disease, it can make the disease mechanism more complicated. Zhang Xiaojie [5] considered this evidence as an indispensable type of chronic urticaria after statistical analysis. The clinical symptoms are head heaviness like a wrap, body heaviness and weakness, intense itching, white colored wind masses, generalized evil and mucousy mouth, or pain in the stomach and epigastrium, relieved by warmth; accompanied by a small amount of nausea, white face, white or greasy tongue coating, and smooth or moist pulse.
2.Certification of qi and blood
(1) Qi deficiency and lack of external consolidation Shen Ming et al [6] believed that this disease is mostly due to Qi deficiency and lack of external consolidation, resulting in the invasion of wind and evil in the skin. As the saying goes, “If the righteousness exists within, evil cannot dry up. This disease is mostly caused by deficiency of Qi and blood due to prolonged illness or weakness, resulting in the lack of solidity of the external guard and the invasion of wind and evil. The clinical symptoms include light color of the wind mass, aggravated in the morning or in the presence of wind, drowsiness of the limbs, lack of color, light tongue with teeth marks on the side, thin white moss, and weak pulse.
(2) Stagnation of Qi and blood (Su Wen? Paralysis” says: “The disease is long-standing and deep, the movement of Ying and Wei is astringent, and the meridians are sparse at times, so it does not work”, and “The Medical Lin Correction” also says that “the long-standing disease is blood stasis. It is also said in “Blood Evidence” that “the congestion of phlegm and water is caused by stasis of blood”, which clarifies the truth that stasis of blood causes phlegm and water to be a problem. The internal stasis affects the function of internal organs, restricts the production of qi, blood and fluids, disrupts the elevation of qi and fluid in Sanjiao, and disrupts the metabolism of water and fluids; externally, it blocks the blood channels, makes the skin lose nourishment, loosens the couples, and makes the external guard not solid, so that the disease is prone to external evil, which makes it difficult to cure.
According to Chinese medicine, “qi is the master of blood, and qi can produce blood and move blood”, so qi stagnation can lead to blood stasis, and qi deficiency can also lead to stasis. Wu Caixia et al [7] found that most patients with this disease have an impatient temperament, a pale white or dark red tongue, or obvious petechiae with petechiae, thin white moss or little moss, teeth marks at the edges, and a thin or thin string pulse. It is believed that qi stagnation and blood stasis or qi deficiency and blood stasis have a very important role in the occurrence of this disease, and the legislation of activating blood and resolving blood stasis can often be effective in treatment. Sun Guangyu [8] believed that the disease is prolonged and caused by “stasis”, and from the physiological and pathological perspectives, he clarified that the pathogenesis of chronic urticaria is characterized by obvious microcirculatory disorders, which is consistent with “stasis” in Chinese medicine, so its main pathogenesis is The main pathogenesis of chronic urticaria is that blood stasis obstructs the ligaments, and the skin loses nourishment, resulting in deficiency and damage as a result of blood stasis. The clinical symptoms include dark red or purplish red skin lesions, aggravated at night, with relatively fixed locations, mostly in the distal parts and pressure areas, accompanied by dull complexion, dizziness, boredom, dry mouth without desire to drink, numbness in the limbs, dull tongue or petechiae, white or little coating, and stringent or astringent pulse.
(3) Qi and blood deficiency According to traditional Chinese medicine, Qi and blood are mutually exclusive, and Qi deficiency can lead to blood deficiency, while blood deficiency can also lead to Qi deficiency. Fan Ruiqiang et al [9] believed that this disease is caused by repeated attacks of the rash, which do not heal after a long time, and the loss of qi and blood, coupled with the external attack of wind and evil, so that the internal cannot be drained and the external cannot be penetrated, and it is depressed between the skin couples, and the evil and the positive fight. Long-term disease is mostly deficiency evidence and is more common in the deficiency of both qi and blood. Wang Xili et al [10] believed that the reason why the disease is lingering and difficult to heal is the weakness of qi and blood is the key, one is the deficiency of qi, the guard outside is not solid, the wind evil takes advantage of the deficiency and enters, so often after exertion or sweating the wind aggravates, accompanied by weakness and sweating, etc.; the second is the deficiency of blood, the camp and guard lose harmony, the camp yin can not be guarded inside, the guard qi is leaked outside, the couples are not dense, the wind evil takes advantage of the deficiency and attacks outside, so the rash mostly starts in the afternoon or at night, can be accompanied by dry eyes, hand and foot fever, dry skin The rash may be accompanied by dry eyes, hot hands and feet, dry skin, etc. Clinically, Qi deficiency and Blood deficiency affect each other and often coexist. The symptoms include weakness, insomnia, sleeplessness, fatigue, weakness, pale face, small rash with light color, fat tongue, light texture, tooth marks, and weak pulse.
3.Evidence of internal organs
(1) Lung Spleen Qi deficiency, Ying and Wei disharmony According to Liu Fengnian et al [11], the root cause of recurrent urticaria is deficiency of proper qi. “The lung is the master of the surface of the body, and if the lung is deficient, the external guard is not consolidated, and evil enters through the deficiency; “the spleen is the essence of the latter day”, and if the spleen is deficient, the water and grain cannot be transported and transformed, and dampness is generated internally. The spleen is the essence of the postnatal period. The spleen and stomach are the source of biochemistry of qi and blood. A deficiency in the spleen results in a lack of source of biochemistry of qi and blood, a deficiency in positive qi, and a mismatch between the Ying and Wei, so that the external evil cannot be removed quickly from the skin, resulting in persistent urticaria over time. Cai Xi [12] also believed that this disease is mostly caused by the weakness of the spleen and stomach and insufficient biochemistry of qi and blood, and that the loss of moistening of the five organs and six bones of the body is the key to the disease becoming chronic, so the identification should start from the spleen and lungs. The symptoms of lung and spleen deficiency are often accompanied by weakness, shortness of breath, bad wind, easy to catch a cold, dullness, stool, etc. The tongue is light white and greasy, and the pulse is slow.
(2) Insufficient liver and kidney, the deficiency of wind within the movement of Chinese medicine that the liver collects blood, the kidney collects essence, essence and blood of the same origin, a loss of both, a glory and honor. If the addiction rash is prolonged, or the qi is depleted and the yin and blood are injured, or the treatment is inappropriate, too pungent to disperse the wind and clear heat and dampness, thus depleting the yin and blood and damaging the liver and kidney, clinical evidence should be clearly identified. Chen Dacan et al [13] believe that although skin diseases are mostly external manifestations of skin lesions, there are always internal causes and changes in Qi and blood of the internal organs, especially in persistent skin diseases, which are closely related to the internal organs, and mostly damage the liver and kidneys, clinical diagnosis, if we can start with the liver and kidneys, taking into account the whole body, and properly use the kidney method in treatment, often make the disease healed. The rash is sudden in onset and sudden disappearance, pale red in color, with positive skin scratching sign, accompanied by headache, dizziness, irritability, red tongue with little coating and deficient string pulse.
(3) Damp-heat in the stomach and intestines, fumigating the skin According to Luo Chongqian et al [14], in addition to the intolerance of the nature of the disease and the external exposure to the evil of wind-cold and wind-heat, there is also a dysfunction of the spleen and stomach in transporting and transforming the disease, which results in the internal growth of damp-heat and fumigation of the skin, which should not be ignored in clinical practice. The rash is recurrent, with pain in the epigastrium, refusal to press, restlessness, inability to eat, fatigue, loose stools, or constipation, fever, red tongue, yellowish greasy coating, and slippery pulse.
(4) Deficiency of spleen and kidney and weakness of guard yang Zhang Xiaojie [15] concluded from the analysis that the identification of this disease should not ignore the physical factors, especially the yang deficiency constitution, which is mostly dominated by spleen and kidney yang deficiency, often combined with qi deficiency, blood stasis, and yin-cold constitution. The clinical manifestations of this disease are: prolonged illness, light-colored wind mass, appearing mostly in the evening, cold and warm, cold extremities, obscure face, lack of energy, easy to get frostbite in winter, clear and long urine, thin stool at times; light and fat tongue, white moist coating, sunken and weak pulse or sunken and weak.
4. Identification of the six meridians
Zhang Xuelin [16] identified chronic urticaria into the following six types according to the six meridians of Typhoid Fever: rash due to superficial solidity in the Sun, rash due to dryness and heat in the Yangming, rash due to unfavorable pivot in the Shaoyang, rash due to dampness in the Taiyin, rash due to deficiency fire in the Shaoyin, and rash due to a mixture of cold and heat in the Jueyin, and gave Xinjia Gui Zhi Tang, Bai Hu plus Ginseng Tang, Xiao Chai Hu Tang combined with Dan Gardenia Free and Easy San, Yin Chen Jie Fu Tang, Huang Lian Agaricus Tang, and Wu Mei Tang respectively. The treatment was effective with the addition and subtraction of Xinjia Gui Zhi Tang, Bai Hu plus Ren Shen Tang, Xiao Chai Hu Tang combined with Dan Gardenia Yi Yao San, Yin Chen Zu Fu Tang, Huang Lian A Gao Tang and Wu Mei Tang.
5. Conclusion
Chronic urticaria is a common clinical allergic skin disease. Its multiple causes and complex pathogenesis make clinical diagnosis and treatment more difficult, and there are often multiple symptoms at the same time. The current literature is mostly limited to the observation of efficacy; the literature on the study of simple symptoms is very limited; and the samples of clinical data are small, and many lack of control and in-depth studies, and the research methods of evidence-based medicine characterized by the application of “multicenter, large sample and blind method” have not been fully utilized. In this paper, we summarize the common types of symptoms under the above four identification methods, and the most widely used in clinical practice are the identification of qi and blood and the identification of internal organs. We should be more flexible in clinical application, and be careful to check where the yin and yang are and adjust them, not to stick to one, in order to achieve satisfactory results.