June 29, 2011

Two Cases of Wind Rash (Urticaria)

The following are two translated cases by Matt Branham of Eugene, Oregon.


Wind hidden rash (urticaria) Case #1

Dr. Liu Jun Shi case: patient Wu, male 57 yrs old, outpatient service #43115, came for a visit on 6/27/1983.  The whole body was covered with rash which periodically got better and then returned over the past ten years, the whole body itched making life hard to bear.  The rash was worse on the upper body, there was fear of cold, ordinarily when he encountered cold the whole body would break out.   He had tried many treatments, which gave temporary relief, but the effectiveness of the treatments were lacking. Whenever he encountered cold the rash would flare up again.  The tongue body had teeth-marks, and both pulses were slippery and moderate.  This pattern belongs to constitutional yang deficiency.  In addition there is wind evil, so one must warm yang and disperse cold, Wu Tou Chi Shi Zhi Wan with modifications is the treatment.
 Zhi chuan wu, cao wu 3g each, gui zhi 3g, bai shao9g, xi xin 3g, gan jiang 9g, bai zhi 4g, chuan jiao 9g, gan cao 9g, chi shi zhi 30g, decoct and take 3 packets.

Second visit was on 6/30/86.  The urticaria had greatly decreased, the itching and pain were also alleviated.  He was asked to continue taking the original 3 packets.    
Third visit on 7/5/86.  Urticaria had completely receded, and on follow up with the patient regularly after two years there was no recurrence.

Beijing Journal of Traditional Chinese Medicine

Editors comments: When yin cold flourishes internally, yang qi becomes weak, thus the exterior cannot defend against wind evil, leading to wind rash.  Other treatments failed to dispel cold, therefore yang qi had difficulty in recovering; they did not warm yang, and wind did not go, therefore, over a long period of time he wasn’t healing.   Wu Tou Chi Shi Zhi Wan was used to warm yang and dispel cold, only then can one get to the root of the problem, therefore remedying chronic illness in a relatively short amount of time.

Addendum: This formula by Zhang Zhong Jing is an example of his use of wu tou and fu zi at the same time.   Wu tou and fu zi belong to the same category, but their functions are slightly different: Wu tou is good at lifting out sunken and chronic cold.  It also can scatter and disperse wind and cold from the channels.   Fu zi is good at treating organ level cold damp, and is able to warm and transform cold damp.  Due to the fact that this pattern was a yin cold evil, as well as affecting the interior and exterior, zang fu, channels and collaterals as well as the core and surface, Zhang Zhong Jing used both wu tou and fu zi to rouse yang and disperse cold evil.
Chen Ming, Zhang Ji Sheng, Wang, Jin Gui Ming Yi, Beijing University Press 2003




Wind hidden rash (Urticaria) Case #2

Dr. Li Mao Xing's case: patient Zhang, male, age 34. Two years ago the patient caught a wind cold and his whole body broke out in rash with severe itching.  When he scratches, the rash gets worse.  He has tried cyproheptadine hydrochloride and vitamin c treatments which brought about some relief, but still he had frequent recurrence and a cure had not been served.  A week ago, after eating seafood there was a recurrence of the rash, and on 11/15/91 he came in to my office for an interview. 
Examination: his whole body was covered with rash of unequal size, the form of the rash was not uniform, bright red in color and bumpy, the rash color faded with pressure, and itched intensely.  It was also accompanied by low grade fever, headache, thirst, constipation, turbid urine, red tongue, yellow coat, and wiry rapid pulse.  The pattern belongs to excess heat held internally, externally contracted evil, and the issuing of heat toxin to the exterior.  Treatment used Fang Feng Tong Sheng Tang modified.
  Herbs used: fang feng, jing jie, chuan xiong, shan zhi zi, huang qin, da huang(cooked later) all 10g, ma huang, bo he 6g, gan cao 8g, shi gao, ku shen, 15g, mang xiao 12g (decoct separatly) bai xian pi 30g. Take one packet per day water decocted.  After taking 8 packets, the rash, for the most part disappeared, the itching was controlled, but his bowel movements increased in number.  The next step in the prescription removes mang xiao, and decreases da huang, with the addition of jin yin hua 20g, in order to increase the heat clearing, toxicity resolving functions.  After 6 packets the skin rash had disappeared, and the itching was completely resolved.   The illness had been completely resolved and after one year follow up there was no recurrence. 

Zhejiang Journal of Traditional Chinese Medicine

Editors comments: Urticaria is commonly called wind rash; Chinese doctors call it hidden rash.  There are several treatment methods, with the principle methods being; coursing wind, clearing heat, resolving toxicity and alleviating itching.  This case belongs to excess heat in the interior, affected by externally contracted evil, causing both interior and exterior excess syndrome.  Therefore, Fang Feng Tong Sheng Tang was used as it, resolves the exterior and unblocks the interior, courses wind, clears heat and resolves toxicity.  The formula with the addition of ku shen and bai xian pi to clear heat, disinhibit dampness and stop itching, and jin yin hua to resolve toxicity and eliminate fire was used.  The whole formula clears and penetrates both the interior and exterior, thereby disinhibiting dampness and eliminating heat and dispelling toxins.
Chen Ming, Zhang Ji Sheng, Wang, Wen Bing Ming Fang, Beijing University Press 2003

A quote from the Wen Re Lun that Chip Chace had mentioned in our class on warm disease got me thinking about the effectiveness of Jing Fang formulas for the treatment of rashes.  The quote goes something like this, “You can ride your horse and enjoy the landscape when treating shang han (cold damage), but things can change when you look over your shoulder in treating rashes.”  Both of these cases treated urticaria, or skin rashes, from a different perspective.   The first case involved a formula from the Jin Gui Yao Lue while the second used a formula from the Wen Bing tradition.  As rashes of this nature can occur through many etiologies using appropriate pattern identification will lead to the desired outcome.  In case 1, exposure to cold caused the rash to flare.  This patient had weak wei qi due to a constitutional yang deficiency, the appropriate treatment was thus to warm yang to secure the exterior.  Chi Shi Zhi is sweet and warm thus augmenting the qi, its astringent nature was also well suited to aid in securing the exterior.  In case 2, initially the patient developed rash from exposure to wind cold, later after eating seafood the rash recurred this time with marked heat signs.   The wind cold evil was never released from the exterior.  After eating bad seafood the patient experienced a toxic reaction to the food that brought a recurrence of the skin rash.  The skin is ruled by the lungs, the lungs are interiorly related to the large intestine, when the patient presented with heat signs and constipation a purging method was appropriate.  Here the Dr. was consistent with Wen Bing thinking to add exterior resolving herbs so as to vent some of the pathogen up and out to the wei level while also purging the interior heat through the bowels.   While both of these traditions use their formulas in a particular way, they both employ basic pattern identification to reach their conclusions.  To me the unification of these systems comes in the effective use of the Eight Parameters.  These archetypal structures are the hallmark of a phenomenological world view espoused by the ancients and of great value to modern day people.

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