Cinnamon and Rhubarb Soup for Urticaria

Yesterday, I came across a WeChat post from my classmate Ding Hongchang, where he shared a case of using Guizhi plus Dahuang Decoction (Cinnamon and Rhubarb Soup) to treat an acute flare-up of urticaria. One dose produced a remarkable result. Naturally curious, I decided to investigate further.

From the photo he posted, the patient’s urticaria lesions were reddish in color, suggesting a mild heat presentation. Over the years, my own results in treating urticaria have been less than satisfactory. I’ve always felt that Chinese herbal medicine was not as effective as acupuncture for this condition — probably because I haven’t yet found the right approach.

According to the Shanghan Lun (Treatise on Cold Damage), the formula for Guizhi plus Dahuang Decoction is as follows:

Guizhi (Cinnamon twig) 3 liang, peeled
Dahuang (Rhubarb) 2 liang
Shaoyao (Peony root) 6 liang
Shengjiang (Fresh ginger) 3 liang
Gancao (Licorice root) 2 liang, honey-fried
Dazao (Jujube) 12 pieces, split open

These six ingredients are decocted in 7 sheng of water down to 3 sheng. The dregs are removed and 1 sheng is taken warm, three times daily.

The original text states (Lines 279–280): “When a Taiyang pattern has been mistakenly purged, causing abdominal fullness and intermittent pain, this belongs to Taiyang — Guizhi plus Shaoyao Decoction governs. When there is pronounced, hard pain, Guizhi plus Dahuang Decoction governs.”

“In Taiyang disease, when the pulse is weak and the patient has ongoing loose stools, if Dahuang and Shaoyao are indicated, they should be reduced in dosage. Because the patient’s stomach qi is weak and easily disrupted.”

Analyzing the original text, this formula was designed for exterior patterns that have been erroneously driven inward, typically presenting with abdominal pain. The patient’s overall constitution tends toward deficiency, showing signs of insufficiency in upright qi.

Urticaria, on the other hand, is typically attributed to wind pathogens lodged in the exterior, or in the Yangming level. There is also the contemporary theory of “wind arising from blood deficiency.” In any case, wind is always central to the pathology. Since wind is involved, using Guizhi Decoction as a base makes theoretical sense, and an approach using acrid, dispersing herbs to release the exterior should be viable.

Yet over the years, I’ve used quite a lot of such prescriptions without being able to control the condition — sometimes even making it worse. Why is that?

Perhaps the key is the addition of Dahuang (Rhubarb). After all, Rhubarb has the power to purge and sweep away everything. The Lung governs the skin and hair, and is paired with the Large Intestine. Maybe Rhubarb, by unblocking the Large Intestine, also unblocks the Lung qi — and the wind pathogen simply follows it out.

But then again, I’ve used Fangfeng Tongsheng Wan (Wind-Dispel and Penetrating Efficacy Pill) plenty of times too… and it still didn’t work…

So I still don’t fully understand the precise treatment strategy for urticaria. Perhaps the cases I’ve encountered clinically are all of the recalcitrant variety, where conventional methods simply don’t work.

In any case, the use of Guizhi plus Dahuang Decoction for urticaria is certainly an experience worth noting. Going forward, when I encounter patients affected by wind pathogens who also exhibit organ qi stagnation, I’ll try this formula. If it proves effective, I’ll compile the case for the record.

昨日看同学丁红昌的朋友圈，发现他用桂枝加大黄汤治疗荨麻疹急性发作，一剂显效，十分好奇，随查证之。

根据配图显示，此人荨麻疹颜色发红，应该是略有热象，我这些年治疗荨麻疹效果一直不是特别好，总感觉中药效果不如针灸，估计是不得法。

根据伤寒论，桂枝加大黄汤：

桂枝三两 去皮      大黄二两      芍药六两      生姜三两      甘草二两（炙）      大枣十二枚（擘）

上六味，以水七升，煮取三升，去滓，温服一升，日三服。

本太阳病，医反下之，因尔腹满时痛者，属太阳也，桂枝加芍药汤主之；大实痛者，桂枝加大黄汤主之。（279）

太阴为病，脉弱，其人续自便利，设当行大黄、芍药者，宜减之。以其人胃气弱，易动故也。（280）

看原文分析应该是用于表证误入里的，多有腹痛之症状，人的整体可能较为虚弱，呈正气不足之象。

而荨麻疹多为风邪在表，或在阳明，目前又有血虚生风之说，总之离不开风，离不开风的话用桂枝汤也是可以的，用些辛散解表治法应该可行，可是这么多年我用了不少却也难以控制，有时反而加重，这又是为什么呢？

原因可能是加了大黄，毕竟大黄有涤荡一切之力，而肺又主皮毛，又与大肠相表里，也许大黄通了肺气，风邪就跟着去了，可是，我也没少用防风通圣丸啊。。。。。照样不管用。。。。。。

所以我仍然不是很明白荨麻疹的具体治疗思路，也许我临床上见到的都是疑难型的荨麻疹，常规方法都不好使。。。。。

总之，桂枝加大黄汤在荨麻疹的运用上确实是一个值得注意的经验，今后如若看到感受风邪，又有腑气不通者，就试一试这个方子，若有效果，再整理医案。