Ji Liangchen's Case: a Severe Urticaria
Jiang ××, female, age 44.
Main complaint. Splitting headache; both eyes red and swollen; lips red and body swollen; whole body covered in red eruptions, itching beyond bearing; no thirst; no stool in three days; urine yellow and short; whole body burning hot; tongue coat white and greasy, both sides yellow and thick, body of tongue pale; pulse wiry, slippery, and rapid. Body temperature 39.3 °C. With a history of bronchitis, three days ago she found a folk recipe — banxia, qingpi, and duck eggs steamed together — and took it. After going out and meeting wind, the disease broke out. Diagnosed at a hospital as severe urticaria; given anti-allergics, steroids, zixue dan and the like — patterns did not yield, fever did not fall, swelling spread, itching unbearable.
Pattern-discernment. Damp-heat banked within; heart-spleen pent-up heat; gathered in the couli; struck by wind-evil — forming a red-color yinzhen (urticaria).
Treatment principle. Clear damp-heat; harmonize blood and dispel wind.
Formula.
Chixiaodou (crushed) 30 g · yiyiren 30 g · whole danggui 9 g · large lianqiao 30 g · xiangbaizhi 9 g · huangqin slips 15 g · light zhuru 15 g · southern bohe (added late) 9 g
Note. The formula is Chixiaodou Danggui San combined with Mahuang Lianqiao Chixiaodou Tang, with modifications. Chixiaodou, raw yiyiren, light zhuru clear heat and drain damp; lianqiao, huangqin clear heat and resolve toxin, cool the heart and drain the intestine. Because the tongue is pale, whole danggui added to nourish and quicken blood, dispel stasis and generate new. Aromatic baizhi — excellent for headache, also reduces swelling and stops itching. Bohe (pungent-cool) disperses wind-heat, lets evil release from the surface. With one dose patterns greatly eased; with the second dose, fever and itching gone, swelling-and-pain wholly cleared — as if two persons. She left the hospital cured.
Yinzhen — also yinsha — popularly fengzhenkuai (wind-rash mass), urticaria — a common allergic disease. The evil mostly arises from damp-heat banked within, heart-spleen pent-up heat, gathered in the couli, struck by wind-evil, ying-wei disharmony. In this case the patient had latent damp-phlegm cough; from mistaken use of a folk-recipe she developed allergy; damp-evil turned to heat; the surface closed by wind; evil could not vent outward, heat could not move downward — no road out. So above, splitting headache; outside, red eruption and itch; below, urine yellow and short, and three days of no stool, high fever unyielding, itching-and-swelling — the disease severe.
So with the method clear the inner, drive away the outer — a formula treating both — two doses brought fever down, swelling gone, itching wholly cleared. If chest tightness also appeared, that would signal qi-mechanism not venting — evil-obstruction; add light chantui (cicada slough); but if rash is light and chest is clear, do not use chantui — using it adds rash. My clinical experience.
Why large lianqiao at 30 g? "All pain and itching and sores belong to the heart." With whole-body swelling, unceasing itching, body burning, urine yellow-short, rapid pulse — clearly heart-channel pent heat striking with wind-damp evil. Heavy use of heart-entering lianqiao — light, vent-scatter, clear heat, resolve toxin — combined with chixiaodou for clearing heat and toxin and draining damp, plus baizhi and bohe for surface wind-dispersal — strikes the heart of the matter; two doses brought cure.