A 38-year-old woman with a six-month history of recurrent, burning facial hives (urticaria) triggered by allergies and the menstrual cycle was successfully managed using a Qi-benefiting, Blood-nourishing, and Wind-venting herbal strategy.

Case ID: CHC-0087

Case Summary

This case describes a 38-year-old woman who presented with a six-month history of severe, recurrent facial erythema (red plaques), burning swelling, and intense itching, which primarily affected her cheeks and forehead and worsened around her menstrual period. Medical testing revealed allergies to milk and smog. The original report documented a conventional diagnosis of Urticaria and a TCM assessment of Yin Zhen (Hidden Rash/Hives) driven by Liver Blood Deficiency causing Blood Heat and Internal Wind. She was managed by Professor Hu Shiping using a highly comprehensive formula—a combination of Jing Fang Si Wu Tang, Guo Min Jian (Allergy Decoction), and Sheng Jiang San—to nourish her blood, clear Yangming channel heat, and vent the wind from her skin, resulting in a complete and lasting recovery within one month.

Patient Presentation

• Patient: 38-year-old female (Surname: Hu).
• Main Complaint: Recurrent red plaques, burning, and itching on the face for half a year.
• History: The patient sought consultation on August 26, 2020. Over the past six months, her face had repeatedly broken out in red plaques accompanied by burning, red swelling, and distinct itching. The rash was concentrated primarily on the cheeks and forehead, and the symptoms predictably worsened right before and during her menstrual period.
• Associated Symptoms: Her appetite, sleep, urination, and bowel movements were all normal.
• Allergies: An allergen test indicated she was allergic to milk and smog (haze).

Examination and Diagnosis

• Conventional Diagnosis: Urticaria (Hives).
• TCM Tongue and Pulse: The tongue body was dark with a red tip, and there were distinct teeth marks (齿痕) along the edges. The coating was thin and white. The pulse was fine and slippery (脉细滑).

TCM Assessment

The original practitioner interpreted the presentation as Hidden Rash (Yin Zhen) driven by Liver Blood Deficiency generating Blood Heat and Wind (瘾疹 – 肝血亏虚，血热生风).

According to the holistic principles of Chinese Medicine, while hives appear on the surface of the skin due to an attack of Wind, Dampness, and Heat, the root of the disease lies in an underlying deficiency of Qi and Blood. In this patient, a deficiency of Liver blood caused internal heat to generate. Because the blood was deficient, it could not nourish the vessels, leading to “Blood Deficiency Generating Wind” (血虚生风).

This internal wind combined with external wind-heat and rose to the head, becoming trapped in the skin and causing the intense itching and red plaques. The fact that her symptoms worsened with her menstrual cycle (a time of blood loss) further confirmed the root cause of Blood Deficiency. Her dark tongue with teeth marks indicated underlying Spleen Qi deficiency and mild stasis, while the red tip and slippery pulse pointed to active heat and dampness.

Treatment Approach

The primary treatment principle was to benefit Qi and tonify Blood, clear heat and disperse wind (益气补血，清热疏风). The strategy was to deploy a complex, multi-targeted formula that simultaneously rebuilt the body’s internal blood reservoir while aggressively venting the trapped wind-heat out through the skin’s surface.

Interventions and Herbal Formulas

• Initial Herbal Formula (August 26, 2020): A 16-herb decoction combining the core concepts of Jing Fang Si Wu Tang, Guo Min Jian (Allergy Decoction), and Sheng Jiang San (Ascending and Descending Powder).
  • Scattering Wind and Venting the Rash: Jing Jie (Schizonepeta, 15g), Fang Feng (Saposhnikovia, 15g), and Bai Ji Li (Tribulus, 30g) scatter wind and vent rashes, drawing the trapped wind out from the superficial layers. Jiang Can (Silkworm, 15g) and Chan Tui (Cicada Slough, 10g) disperse wind-heat and unblock the skin’s micro-collaterals.
  • Treating Wind by Treating Blood (Cooling & Nourishing): Yin Chai Hu (Stellaria, 30g), Chi Shao (Red Peony, 15g), and Mu Dan Pi (Moutan, 15g) clear heat and cool the blood.
  • Astringing and Preserving Yin: Because wind and heat severely deplete the body’s fluids, Bai Shao (White Peony, 30g), Wu Wei Zi (Schisandra, 15g), and Wu Mei (Mume, 30g) use their sour and astringent properties to gather and nourish Yin and fluids. (Note: Yin Chai Hu, Fang Feng, Wu Mei, and Wu Wei Zi together form the famous modern “Allergy Decoction”).
  • Clearing Damp-Heat and Unblocking Yangming: Huang Bo (15g) and Tu Fu Ling (30g) clear heat, dispel dampness, and resolve toxicity. Da Huang (Rhubarb, 10g) is specifically used here to directly flush heat out of the Yangming meridian (which governs the forehead and cheeks where the rash is worst) and to move central blood stasis.
  • Boosting Qi and Securing the Exterior: Huang Qi (Astragalus, 30g) and Gan Cao (5g) boost the Qi to generate blood and secure the body’s defensive boundary against future wind attacks.
  • Administration: 14 doses, water decocted, taken warm after breakfast and dinner.
• Second Visit (September 9, 2020): After taking 14 doses, the patient reported a significant improvement in the facial red swelling, burning, and itching. Her appetite and sleep were good, her urination was normal, and her stools were soft (twice a day). The pulse remained fine and slippery, and the tongue remained dark with a thin white coating.
  • Outcome: Because the initial formula was highly effective, the practitioner prescribed 14 more doses of the exact same formula. Subsequent follow-ups confirmed that the patient’s chronic urticaria never recurred. She was advised to maintain regular exercise, a balanced diet, and a consistent sleep schedule.

Why This Case Is Interesting (Clinical Reasoning)

This case beautifully highlights Professor Hu Shiping’s highly nuanced approach to dermatology, specifically his heavy use of Huang Qi (Astragalus) and Da Huang (Rhubarb) for facial rashes.

First, the use of Da Huang in a patient without severe constipation is a targeted meridian strategy. The patient’s worst rashes were on her forehead and cheeks—areas governed by the Yangming (Stomach/Large Intestine) meridian. By adding Da Huang, Professor Hu “directly folded” (直折) the Yangming heat downward, clearing the facial congestion while also dissolving middle-Jiao blood stasis.

Second, the heavy use of Huang Qi (30g) in a wind-heat rash serves three brilliant purposes:

1. Generating Blood: The patient was blood deficient. Because “Qi is the commander of Blood,” heavy Qi tonification creates new blood. “When the blood flows, the wind extinguishes itself.”
2. Drying Dampness: Dampness originates in the Spleen; Huang Qi strengthens the Spleen to cut off the source of dampness.
3. The “Broad Sweating Method” (广汗法): Huang Qi secures the exterior and normalizes the opening and closing of the pores. When the pores function properly, the body can naturally sweat out the trapped wind and dampness without damaging the underlying Righteous Qi.

By simultaneously venting wind, cooling blood, astringing fluids, and unblocking the bowels, this formula perfectly balanced Yin and Yang, ascending and descending, achieving a rapid cure for a stubborn allergic condition.

Source Original source: Shenzhen Hospital of Beijing University of Chinese Medicine (Longgang) / Traditional Chinese Medicine Bureau of Guangdong Province Original title: 【以案说医】胡世平：瘾疹血虚风热化，治本尤需健中州 Practitioner: Professor Hu Shiping (胡世平) Publication date: August 02, 2024 Original language: Chinese