MEDICAL ACUPUNCTURE

Volume 19, Number 1, 2007

© Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2006.508

Acupuncture for Chronic Urticaria: Case Report

W. Watere, MD

ABSTRACT

A 41-year-old woman was referred with chronic urticaria. Allergy test results (with prick test and food aller-
gens, perfumes, and antibiotics), including laboratory findings and hormonal test results, were normal. She was
treated with steroids and antihistamines orally. Without those drugs, the patient’s urticaria recurred. She took
these drugs daily for 2 years but did not want to continue. The patient received 3 acupuncture treatment ses-
sions. The interval between the first, second, and third sessions was 8 weeks. At the end of the first sessions,
her urticaria disappeared completely. At the end of the third sessions (i.e., 28 weeks after the first treatment),
her urticaria was still in complete remission. Steroids and antihistamines were discontinued at the end of the
first sessions.

Key Words: Chronic Urticaria, Steroids, Antihistamines, Acupuncture, Wind and Cold Syndrome (Yin Hyperactivity),
Yang Insufficiency

INTRODUCTION netic tendency, stress, psychological factors, and idiopathic

U RTICARIA, ALSO CALLED NETTLE-RASH, hives, or wheals,
simply means itching with rash. The clinical presenta-
tion of urticaria is usually acute or acute-on-chronic or re-
curring. The patient may present with usually sudden, acute
skin eruption with swelling, redness, intense itching sensa-
tion, burning, and anxiety. At times, the eruptions and itch-
ing may lead to work disturbances, sleeplessness, restless-
ness, and edginess. These eruptions can remain on the body
for variable periods, anywhere from a few seconds to even
hours. They have a tendency to disappear and reappear. They
tend to disappear without leaving behind any trace.1,2
The urticaria eruptions may be irregularly shaped, red cir-
cular, or like vertical striae. They may appear as single or
multiple eruptions, occasional or many appearing at once,
or appearing and disappearing in random order. In Tradi-
tional Chinese Medicine (TCM), urticaria is called “hidden
measles.”1
The etiologies of urticaria are unknown. The most com-
mon factors known to induce urticaria include food aller-
gens, environmental allergens, drugs, systemic disease, ge-
cause. Chronic urticaria is a challenging problem for mod-
ern (Western) medicine because on most occasions, the ex-
act cause remains unknown.2 It is marked by repeated
attacks, lasts months or years, and needs long-term treat-
ment.2,3
According to TCM, urticaria is caused by a collection of
pathogenic Wind in the superficial layer of the muscles, or
accumulation of Heat in the stomach and intestines that is
not removed from inside and outside and settles in the pores
of the skin.3
CASE REPORT
A 41-year-old woman (1.6 m [53"], 60 kg [133 lb]) pre-
sented with chronic urticaria since 2002. Multiple skin erup-
tions with red circular form were discovered in all parts of
her body, except her head and face. She reported that she
could not conduct normal daily activities and her quality of
life had suffered. She was depressed, anxious, and fatigued.
Furthermore, she stated that she suffered from sleeplessness

TCM Center, Elisabeth Hospital, Recklinghausen, Germany.

49
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due to the intense itching sensation, and was often excited
and aggressive within her family.
The patient had cold hands, feet, and aversion to cold.
About 20 years earlier, she had undergone an appendectomy.
She reported no nicotine or alcohol usage. Her whole tongue-
surface was covered with a thick white coat (“snow-tongue”).
Physical examination results were normal except for multi-
ple urticaria eruptions as described above, and cold hands
and feet. Blood pressure was 120/80 mm Hg; pulse regular
at 84/min (according to TCM: deep and weak pulse, 8).
In the previous 2.5 years, the patient had consulted 3 der-
matologists, ambulance treatment, a gynecologist, and an
otolaryngologist (whose findings were normal). Laboratory
findings, including allergy test (with skin allergens/prick test
and food allergens, perfumes, and antibiotics), as well as
hormonal testing, were normal. She was treated with steroids
and antihistamines orally. Without those drugs, her urticaria
recurred. For two years, she had taken those drugs and
did not wish to continue. Therefore, she consulted us for
acupuncture treatment.
METHODS
TCM: Diagnosis, Treatment, and Treatment
Principles
The TCM diagnosis included Wind-Cold Syndrome (Yin
Hyperactivity), Yang Insufficiency.4,5 Treatment included
acupuncture, and treatment principles included eliminating
Wind and Cold, strengthening the Yang-Qi, calming mind
and spirit,4,6–9 and stopping the itching sensation.10
Selected Acupuncture Points1,3,4,6–8,10
Points selected included: GB 20 (Fengchi), GV 14
(Dazhui), GV 20 (Baihui), LI 4 (Hegu), LI 11 (Quchi, HT 7
(Shenmen), ST 36 (Zusanli), SP 10 (Suehai), Ex-LE3 (Ex-
trapoint-Lower Extremity 3/Baichongwo (means Nest of 100
Parasites/Insects). Its location is 1 cun cranial of SP 10 (Xue-
hai/Ocean of Blood). Its function is to stop severe itching from
neurodermitis, urticaria, etc. This point (Ex-LE 3), in combi-
nation with SP 10 (Xuehai) and GV 20 (Baihui/Meeting of
100 Meridians), is very effective to halt itching.
Treatment
The patient gave written informed consent for treatment.
She was treated in a room with infrared light for warmth,
especially necessary for Wind-Cold Syndrome. She was re-
laxed as she listened to Chinese instrumental (Yin-Yang)
music. Thus, the patient’s comfortable treatment room may
have strengthened the effects of acupuncture.
Needle type used was Hwato 0.25 x 40 mm; single-use,
sterile needle (Suzhou Medical Appliance Factory, Suzhou,
China). The needles remained in place for 30 minutes each
WATERE
session; an insertion depth of 0.5-1.5 cun (depending on
location of the needle) was used. Acupoints (except for
GV 14 and GV 20) were needled bilaterally.
The patient received 3 sessions of acupuncture treat-
ments; each treatment was performed twice weekly. The first
session consisted of 16 treatments, the second and third ses-
sions each consisted of 12 sessions (Table 1).
The interval between the first and second sessions was 8
weeks, and between the second and third sessions was also
8 weeks.
These 3 treatment sessions were necessary because
chronic urticaria needs long-term management.
RESULTS
Significant improvement of symptoms was noted after
the sixth visit of the first treatment sessions; multiple ur-
ticaria skin eruptions decreased. At the end of the first
treatment, the patient’s skin eruptions disappeared com-
pletely. She had no itching sensation anymore, but she still
had white coating of her tongue. She began gradually to do
her usual daily activities, and steroids and antihistamines
were discontinued.
Eight weeks later, the patient began her second session
of treatments. She was still free from urticaria eruptions and
the itching sensation. Her tongue was still covered by a white
coat, but was thinner than before (during the first treatment
period). This indicated the Yin was still hyperactive, but its
hyperactivity decreased. She stated that her sleep was nor-
mal. At the end of the second sessions, urticaria eruptions
and severe itching sensation were still in complete remis-
sion. She reported that her actions within her family were
normal again, she felt calmer and could better perform her
daily activities.
The third sessions began 8 weeks later. Thus, 14 weeks
after the first sessions were completed, the patient’s urticaria
was still in complete remission. At the end of the third ses-
sions, she reported that she was able (again) to perform her
normal daily activities and that her quality of life was ex-
cellent. She described feeling powerful both in body and
mind, and she was happy. The white coat on her tongue had
normalized, and the symptoms described above disappeared
completely.
At the end of 3 acupuncture treatment sessions (28 weeks
after the first treatment), the patient’s chronic urticaria was
still in complete remission.
TABLE 1. NUMBER AND FREQUENCY OF TREATMENTS
Treatment Sessions Frequency per week
1 16 2
2 12 2
3 12 2
ACUPUNCTURE FOR CHRONIC URTICARIA
DISCUSSION
The rationale for points chosen are:
• GB 20 and LI 4 eliminate Wind and Cold
• GV 20 and ST 36 raise the sunken Yang
• GV 20 and HT 7 calm mind and spirit
• LE 3 and SP 10 stop itching
• ST 36 and SP 6, the crossing of 3 Foot-Yin Meridians,
strengthen Yang, harmonize immunity
• GV 14, LI 11, and SP 10 harmonize immunity.
Recurrences of chronic urticaria are frequent; therefore,
the patient received three acupuncture treatments with in-
tervals as described above.
CONCLUSIONS
In this particular anecdotal case, excellent results appear
to have been achieved with acupuncture. This may encour-
age a large trial to determine whether acupuncture may be
a helpful modality in the treatment of urticaria.
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2. Shah R. Life Force Centre. Mumbai, India. http://www.
urticaria.com. Accessed June 19, 2005.
51
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Address correspondence and reprint requests to:
W. Watere, MD, PhD
TCM-Center, Elisabeth Hospital
Röntgen Strasse 10
45661 Recklinghausen
Germany
E-mail: watere@t-online.de