In late June, I received a request for help from a middle school classmate regarding his wife, Zhou Zhou. Since giving birth two years ago, she had been suffering from recurrent urticaria. Despite seeing dermatologists and trying various antiallergic medications, including daily rupatadine fumarate, she still experienced persistent itching. Coupled with the demands of caring for her child, she had barely slept well in two years.

Initial Consultation: Understanding the Symptoms

Due to the distance, we communicated through an online consultation. Zhou Zhou explained that her symptoms began after her postpartum confinement. Although she felt she had a good recovery period, she struggled to sleep soundly, frequently waking up to tend to her baby. I suspected that her condition might be related to long-term depletion of yin and blood, leading to blood deficiency and the generation of wind, which could cause urticaria.

Zhou Zhou described her urticaria as constant, with itching occurring at all times, leaving her exhausted. She also noted increased skin sensitivity, a yellowish complexion, and difficulty sweating. Her appetite was good, but her bowel movements were infrequent.

First Treatment: Conservative Approach

Since I couldn’t assess her pulse online, the appearance of her tongue became crucial. Her tongue showed signs of cold-dampness with internal heat. Given the persistent nature of her symptoms, I prescribed a modified formula of Mahuang Guizhi Each-Half Decoction, substituting Mosla for Ephedra due to the hot summer weather in Jiangsu. The initial prescription included:

Mosla 6g
Cinnamon Twig 6g
Raw Licorice 6g
Fresh Ginger 3 slices
Jujube 5 pcs
Apricot Kernel 6g
White Peony Root 6g
Tribulus Fruit 10g
Gypsum 10g
Angelica 6g
Coix Seed 12g
Atractylodes 6g
Codonopsis 10g
Poria 10g
White Atractylodes 10g

Second Consultation: Discontinuing Western Medicine

Zhou Zhou hesitated about continuing Western medicine, which had not effectively controlled her urticaria. I advised her to stop the Western medications and focus solely on Chinese herbal treatment. After three doses, she reported a tolerable itching episode, and her tongue appeared less coated, indicating improvement. I then added blood-nourishing herbs to her regimen.

Ongoing Management: Adjusting the Prescription

After six doses, Zhou Zhou noted that while the intensity of the itching had decreased, the frequency remained high. This prompted me to re-examine the pathogenesis. A re-examination of her tongue revealed a grayish-purple hue, and she admitted to not sweating much, likely due to spending most of her time in air conditioning. I suddenly realized: Ah, so that's the problem! This lack of sweating prevented the expulsion of pathogenic factors trapped in her skin. I decided to reintroduce Ephedra into her treatment.

Final Stages: Focusing on Recovery

After taking the new prescription, Zhou Zhou reported a significant reduction in the frequency of outbreaks. As her menstrual cycle approached, I advised her to stop the medication temporarily. Although her urticaria improved, her skin remained sensitive. Following the principle of stopping treatment when the condition improves, I shifted her focus to nourishing qi and blood with Yu Ping Feng San.

The end: A Successful Outcome

After finishing the medication this time, Zhou Zhou said the urticaria had completely stopped recurring, though her skin was still a bit sensitive. Her sleep was still affected by the child, easily waking up in the middle of the night, but overall she was sleeping more deeply than before. Feeling that the surface symptoms had basically been resolved, I asked Zhou Zhou to buy Gui Pi Wan, a Chinese patent medicine, to continue nourishing the blood of the heart and spleen. By August 4, after about two and a half months and approximately 20 doses of Chinese herbal medicine, Zhou Zhou informed me that her urticaria had completely resolved. I recommended she continue taking a small amount of pill-formed herbal medicine(Gui Pi Wan) to consolidate her recovery.

Zhou zhou’s feedback with translation

Afterword:

This case highlights the complexities of treating skin conditions, which often involve significant individual variation. While setbacks are common, the process of treatment can enhance diagnostic skills. Like Zhou Zhou's case, although blood deficiency was the root cause, if the surface symptoms weren't treated well, it was like there was a layer of paper preventing access to the deeper issues. Looking back at the whole process of adjusting the prescription, actually only a few herbs were really changed, but the effect was completely different. I can't help but marvel again at the subtlety of TCM thinking and prescription!

Disclaimer

The medical case presented is based on a real patient encounter from Dr. Michelle Zhang's practice. The Chinese herbal medicines and prescriptions are specific to this case.

If you have similar symptoms, please consult a qualified Traditional Chinese Medicine (TCM) practitioner for proper diagnosis and treatment.

Important Notice:

-Do not self-diagnose or self-medicate based on this information.

-Each patient’s condition is unique and requires individual assessment by a licensed healthcare provider.

By reading this, you acknowledge the importance of seeking professional medical advice for any health concerns.

Urticaria That Prevented a Mother from Sleeping Well for 2 Years