A 35-year-old woman with a one-year history of severe, recurrent hives triggered by a COVID-19 infection was successfully managed using a combination of Wind-dispersing herbal decoctions, acupuncture, and autohemotherapy.

Case ID: CHC-0058

Case Summary

This case describes a 35-year-old woman who suffered from persistent, severe hives (urticaria) for over a year following a COVID-19 infection. Dependent on antihistamines (Loratadine) that only provided temporary two-day relief, she presented with bright red, burning, and intensely itchy wheals across her trunk. The original report documented a conventional diagnosis of chronic urticaria complicating a COVID-19 infection and a TCM assessment of Hidden Rash (Yin Zhen) driven by a Wind-Heat Epidemic Toxin Exterior Syndrome. She was managed through a highly integrative approach combining modified Xiaofeng San and Yu Ping Feng San herbal decoctions with acupuncture and autohemotherapy (injecting her own venous blood into acupoints) to clear the trapped toxicity and rebuild her immune system.

Patient Presentation

• Patient: 35-year-old female (Surname: Wu).
• Main Complaint: Recurrent, systemic pruritic (itchy) wheals for over 1 year following a COVID-19 infection.
• History: The patient sought initial consultation on December 2, 2023. More than a year prior, after contracting COVID-19, she began experiencing recurrent outbreaks of systemic hives. The wheals were primarily located on her trunk, bright red in color, and accompanied by a burning sensation and severe itching. She did not experience chills or fever. During flare-ups, she relied on Loratadine tablets, which controlled the symptoms, but the hives would inevitably return two days later. Her appetite, sleep, and bowel/urinary functions were normal.

Examination and Diagnosis

• Conventional Diagnosis: Chronic urticaria complicating COVID-19 infection.
• TCM Tongue and Pulse: The tongue was red with a thin, white coating. The pulse was floating and rapid (脉浮数).

TCM Assessment

The original practitioner interpreted the presentation as Hidden Rash driven by Wind-Heat Epidemic Toxin Exterior Syndrome (隐疹 – 风热疫毒表证).

According to the holistic principles of yin and yang Chinese Medicine an acute viral infection like COVID-19 can severely deplete the body’s Defensive (Wei) Qi. Because her exterior defense was left empty and un-secured, a Wind-Heat epidemic pathogen became deeply trapped in her muscle and skin layers.

This trapped pathogen disrupted the harmonious interaction between her Defensive (Wei) and Nutritive (Ying) Qi, erupting physically as the bright red, burning hives. The red tongue and floating-rapid pulse provided objective textbook confirmation of an active Wind-Heat pathogen locked in the exterior layers of the body.

Treatment Approach

The primary treatment principle was to disperse Wind and clear Heat, resolve toxicity and stop itching (疏风清热，解毒止痒). The strategy utilized a phased approach: aggressively clearing the trapped wind and heat from the skin first, then transitioning to deeply tonifying her immune system to prevent recurrence, supported by specialized acupoint injection therapy.

Interventions and Herbal Formulas

• Initial Visit (December 2, 2023):
  • Acupuncture: Applied with a reducing (泻法) technique to clear heat. Points included Baihui (GV20), Fengchi (GB20), Dazhui (GV14), Quchi (LI11), Hegu (LI4), Zusanli (ST36), Xuehai (SP10), and Sanyinjiao (SP6).
  • Herbal Formula: A 16-herb decoction acting as a modified Xiaofeng San (Eliminate Wind Powder).
    • Dispersing Wind to Stop Itch: Jing Jie (10g), Fang Feng (10g), Niu Bang Zi (10g), and Chan Tui (Cicada Slough, 8g) opened the pores to vent the trapped wind-toxin out of the skin.
    • Clearing Heat and Dampness: Cang Zhu (10g), Ku Shen (6g), Mu Tong (10g), Zhi Mu (10g), Shi Gao (Gypsum, 20g), and Dan Pi (10g) strongly purged the inflammatory heat, cooled the fire, and drained the dampness.
    • Nourishing Blood: Dang Gui (10g), Sheng Di (20g), Hu Ma Ren (Black Sesame, 10g), and Chi Shao (10g) nourished and cooled the blood based on the TCM principle that “to treat wind, one must first treat the blood; once blood circulates, wind naturally dissipates.” Ji Li (Tribulus, 12g) stopped itching, and Gan Cao (5g) harmonized. (3 doses prescribed).
• Second Visit (December 7, 2023):
  • The hive outbreaks decreased, and the itching was reduced.
  • Autohemotherapy Added: The practitioner continued acupuncture but added autohemotherapy (自血疗法). The patient’s own venous blood was drawn and immediately injected into alternating acupoints (Xuehai, Quchi, Hegu, Zusanli) to powerfully stimulate her immune response.
  • Herbal Formula: Cang Zhu, Dan Pi, and Chi Shao were removed from the initial formula. (5 doses prescribed).
• Third Visit (December 15, 2023):
  • The patient was significantly improved, with only occasional, very mild flare-ups.
  • Herbal Formula Shift: With the pathogenic heat largely cleared, the strategy shifted to boosting Qi, securing the exterior, and nourishing blood. A heavily modified Yu Ping Feng San (Jade Windscreen Powder) was prescribed: Huang Qi (20g), Fang Feng (10g), Bai Zhu (15g), Dang Gui (10g), Gui Zhi (10g), Bai Shao (10g), Shu Di (10g), Chuan Xiong (5g), Da Zao (10g), Zhi Gan Cao (8g), Ren Shen (12g), Xin Hui Chen Pi (5g), and Tu Fu Ling (15g). (5 doses prescribed).

Follow-Up

• The patient was advised to maintain a light diet and avoid high-protein, seafood, and stimulating foods.
• A one-year follow-up confirmed that the patient experienced absolutely no recurrence of the hives, indicating her immune system was fully restored.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the aggressive, multi-modal restoration of a virus-damaged immune system. Post-viral urticaria is notoriously stubborn because the virus fundamentally damages the body’s defensive boundary (Wei Qi), allowing otherwise harmless environmental triggers to constantly cause inflammation.

Instead of just indefinitely suppressing the histamine response with Loratadine, Professor Zhao utilized a classic two-step TCM eradication. First, he aggressively “vented” the trapped inflammation using Xiaofeng San. Second, once the inflammation was gone, he “sealed the doors” using the immune-boosting Yu Ping Feng San. Crucially, the integration of autohemotherapy—injecting the patient’s own blood into immune-modulating acupoints like Zusanli (ST36) and Xuehai (SP10)—acted essentially as an autologous vaccine, forcibly “rebooting” her immune tolerance and achieving a permanent cure.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine / Traditional Chinese Medicine Bureau of Guangdong Province Original title: 【以案说医】招仕富：新冠病毒感染并发荨麻疹治疗验案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: 2024-09-05 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation