bubble_chart Concept

The skin condition rubella manifests as raised papules on the skin, often clustered together and merging into patches. Because this condition frequently appears suddenly or disappears quickly without leaving any trace, it is commonly referred to as "wind bumps."

This condition, Suwen-Sishici Nicong Lun refers to as "urticaria"; Zhubing Yuanhou Lun categorizes it into "white rash and red rash," and introduces the term "㿔"; by the Tang dynasty, Qianjin Yaofang first names it "rubella." In the Song dynasty, Sanyin Jiyi Bingzheng Fanglun further distinguishes urticaria into "white as membrane, red as blood wind."

Chinese medicine believes that this disease is closely related to the invasion of wind evil: wind is the leader of all diseases, it moves quickly and changes frequently, wind cannot harm alone, but easily combines with cold or heat, lodging in the skin, then causing rubella. A weak constitution, or illness leading to insufficient qi and blood, blood deficiency can generate wind; or wind evil taking advantage of weakness to invade, lodging in the skin and causing rashes; internal damage from seven emotions, imbalance of Chong and Ren, insufficient nutrient-blood, poor nourishment of liver and kidney, generating wind and dryness, blocking the skin, can also cause rashes; congenital deficiency, intolerance to rich and fatty foods, leading to gastrointestinal disharmony, accumulation of dampness and heat, stagnation in the skin, is also a common pathological mechanism.

If the rash is bright red like painted cinnabar, it is called scarlatina, which is discussed separately in another section.

bubble_chart Modern Research

Urticaria is a common skin disease primarily characterized by wheals, mostly related to allergic reactions. Pathogenetically, it can be divided into two types:

1. Allergic type: Acute urticaria occurs within seconds after an antigen enters the body, belonging to type I allergic reaction, with IgE as the antibody. Urticaria caused by blood transfusion is a type II allergic reaction, where IgG and IgM react with antigens on the red blood cell membrane, activating complement and causing mast cells to release mediators such as histamine. Serum sickness and urticarial vasculitis are related to type III allergic reactions, where antigen-antibody complexes activate complement, forming anaphylatoxins and releasing chemotactic factors, attracting neutrophils to release lysosomal enzymes. Some cases of cold urticaria also involve type IV allergic reactions.
2. Non-allergic type: Certain drugs, foods, chemicals, enzymes, and tissue injuries can directly cause mast cells to release mediators such as histamine, leading to urticaria.

Additionally, genetics play an important role in the occurrence of this disease.

Due to the above factors, temporary inflammatory hyperemia and significant fluid leakage occur in the skin mucosal blood vessels, causing localized edematous damage to the skin. Its clinical features include rapid onset and resolution, accompanied by intense cutaneous pruritus, and may include fever, abdominal pain, diarrhea, or other systemic symptoms. When occurring in the throat, it can cause laryngeal edema and respiratory distress, even asphyxia, and should be promptly managed. Depending on the course and clinical manifestations, it can be classified into acute urticaria, chronic urticaria, angioedema, and papular urticaria.

〔Diagnosis〕

Based on the rapid onset and resolution of wheals, urticaria is easily diagnosed.

bubble_chart Pattern Analysis

1. Wind-heat from External Contraction︰The rash appears pink, coalescing into patches and rapidly spreading over the body, with a local burning sensation that worsens with heat and alleviates with cold. It may also be accompanied by a pattern of common cold due to wind and heat, a red tongue with thin yellow coating, and a floating, rapid pulse. If wind-heat is accompanied by dampness, the rash resembles bean sprouts, surrounded by red halos, with small blisters between the papules and occasionally large blisters. Itching is severe, and scratching may lead to the oozing of serous fluid. This condition arises from wind-heat pathogens stagnating in the muscles and congesting the skin, manifesting as red or pink rashes that can quickly spread across the body, worsening with heat and improving with cold. Treatment should focus on dispersing wind and clearing heat, using the Wind-Dispersing and Heat-Clearing Decoction. If wind-heat is accompanied by dampness with small blisters among the papules, the Wind-Dispersing and Dampness-Overcoming Decoction may be used.
2. External Contractionwind-cold︰The rash appears pinkish-white or porcelain-white, varying in size, sometimes merging into patches, often more pronounced on exposed areas of the body. Symptoms worsen with cold and alleviate with warmth, possibly accompanied by a pattern of common cold due to wind-cold, white tongue coating, and floating-tight pulse. This is caused by wind-cold pathogens obstructing the striae and interstice, preventing outward dispersion. The key distinguishing features are: pinkish-white or porcelain-white coloration, more evident on exposed skin areas, improving with heat and worsening with cold. Treatment should focus on dispersing wind and dissipating cold, using Cinnamon Twig Ephedra Half and Half Decoction. If aversion to wind, spontaneous sweating, and floating-slow pulse indicate an exterior deficiency pattern, the approach should be replenishing qi and consolidating the exterior while dispersing wind, using the Solidify Defense and Expel Wind Decoction.
3. Blood Heat︰Suddenly, a rash appears with bright red color, scattered initially and rapidly merging into patches, accompanied by severe itching, or preceded by a burning and pricking sensation on the skin. Scratching leads to the emergence of red or purplish-red linear wheals. The tongue is red with scant coating, and the pulse is rapid. This is often caused by {|###|}five minds transforming into fire{|###|}, which generates wind due to blood-heat and damages the blood vessels; or it may result from internal use of certain medications, leading to {|###|}dermatitis medicamentosa{|###|} that spreads and causes blood-heat to congest the skin. The {|###|}papules{|###|} are bright red or appear as red linear rashes after scratching, and can occur all over the body. Treatment should focus on {|###|}clearing heat and cooling blood{|###|}, dispersing wind, and relieving itching. The recommended formula is Wind-Dispersing Powder with modifications.
4. Blood Stasis︰The rash appears dark red, often in patches, commonly found on areas prone to pressure such as the buttocks and waistline. It is accompanied by a dull complexion, slightly purplish-red lips, ecchymosis on the tongue, and a choppy pulse. This condition often arises when wind pathogens fail to disperse and stagnate over time, obstructing nutrient-blood and causing blood stasis and meridian stagnation. Key diagnostic features include a dark red rash forming patches, primarily occurring on pressure-prone areas of the body. Treatment should focus on invigorating blood to unblock collaterals, dispelling wind, and relieving itching. Recommended formulas include the Invigorating Blood and Dispelling Wind Decoction or the Unblocking Meridians and Expelling Stasis Decoction.
5. Gastrointestinal Heat Accumulation︰The rash is red and itchy, resembling the size of foxtail millet grains, or forming patches that connect like clouds. The onset is sudden, accompanied by chest and epigastric discomfort, abdominal distension and fullness, constipation, scanty and dark urine, a red tongue texture with thick yellow coating, and a slippery, rapid, and forceful pulse. It is often caused by dietary irregularities or consumption of foods like fish and shrimp, leading to accumulated heat in the stomach and intestines. The heat cannot be discharged internally or dispersed externally, stagnating in the skin's striae and interstice, thus triggering the rash. Symptoms include red, patchy wheals accompanied by signs of accumulated heat in the stomach and intestines. Treatment should focus on relaxing bowels and discharging heat, dispersing wind and releasing the external. The commonly used formula is Saposhnikovia Sage-Inspired Powder.
6. Deficiency of Both Qi and Blood︰The rash appears pale in color, comes and goes intermittently, persists for a long time, and recurs repeatedly. It may worsen after exertion, accompanied by a pale complexion, palpitations, shortness of breath, mental fatigue, lack of strength, poor appetite, a pale tongue texture, and a deep, thin, weak pulse. This condition is commonly seen in patients with spleen-stomach weakness, often caused by insufficient qi and blood, compounded by exposure to wind pathogens that stagnate in the striae and interstices, preventing outward dispersion. The onset is slow, the rash patches are pale, the condition lingers without healing, and symptoms worsen after exertion, accompanied by signs of dual deficiency of qi and blood. Treatment should focus on nourishing blood and dispelling wind, replenishing qi and consolidating the exterior. Modified Angelica Decoction is often used for this purpose.
7. Imbalance of the Chong and Ren Channels︰The rash is closely related to the menstrual cycle and pregnancy, often worsening before and during menstruation and alleviating after menstruation. It is frequently accompanied by a red tongue with yellow coating and a wiry, rapid pulse. This type is often associated with endocrine disorders. Treatment focuses on regulating the thoroughfare vessel and conception vessel. Modified Peach Kernel, Carthamus, and Four-Ingredient Decoction combined with Curculigo and Epimedium Decoction is used. Ingredients include Peach Kernel, Carthamus, and Chuanxiong (10g each), Prepared Rehmannia Root, Peony Root, and Chinese Angelica (20g each), Common Curculigo Rhizome and Epimedium Herb (15g each). For cases with kidney deficiency, add Morinda, Dodder Seed, and Cibot Rhizome (10g each). For cases with qi stagnation, add Cyperus, Curcuma Root, Aucklandia Root, and Dried Tangerine Peel. For severe itching, add Cimicifuga Rhizome, Xanthium, Belvedere Fruit, Schizonepeta, and Saposhnikovia Root.

Traditional Chinese medicine believes that skin rubella often originates from "wind". Those caused by external wind have a sudden onset, while those caused by internal wind have a slower onset. However, there is also a distinction between deficiency and excess in clinical practice. Those with a strong constitution are mostly excess pattern and are easy to treat, while those with a weak constitution are mostly deficiency pattern and are difficult to cure. Therefore, in clinical practice, it should be differentiated based on pulse diagnosis and constitution.

Angioneurotic edema: the treatment based on pattern identification is the same as acute urticaria. Papular urticaria: refer to the treatment based on pattern identification of acute and chronic urticaria.

bubble_chart Documentation

1. Zhubing Yuanhou Lun: "When a person's yang qi is deficient externally, there will be profuse sweating. If sweating occurs in the wind, wind qi will attack the muscles, combining with heat qi, leading to the formation of rashes resembling sesame or beans. In severe cases, they gradually enlarge and can turn into sores when scratched." "When a person's skin is deficient, it is easily invaded by wind evil, resulting in urticaria." "When pathogenic qi invades the skin and encounters wind-cold, it leads to wind epidemic urticaria."
2. Waike Dacheng-Urticaria: "Urticaria manifests as small raised spots on the skin, accompanied by chills, fever, and itching all over the body. As stated in the classics, sweating during labor and exposure to wind can lead to stagnation, resulting in heat rashes. Mild heat causes a red color, while severe heat causes a black color. It is caused by phlegm-heat in the lungs, and treatment should focus on clearing the lungs, eliminating phlegm, and releasing the exterior, such as with Xiaodu Yinzi; for cases that can be purged, Major Bupleurum Decoction is used; for deficiency cases, Middle-Tonifying Qi-Replenishing Decoction is used, or it can be treated with modified Notopterygium Powder."
3. Yizong Jinjian-Waike Xinfa nodular swellings (tumefactions): "This condition is commonly known as ghost rice bumps. It is caused by sweating and exposure to wind, or sleeping in the cold, as wind evil often affects those with exterior deficiency. Initially, the skin becomes itchy, followed by the appearance of flat bumps resembling bean pods, which accumulate into patches."