Dr. Liu Jingqi[1], July 20, 1982

Ms. Sun, age 45 had an aversion to cold and fever and all over her body she developed large round patches of wind rash.  She had had this for over 20 days.  Before the illness, she had been out sweating in the rain and after one day she developed the rash.  Every day she had 5-6 episodes with itching and heart vexation.  She had a calcium injection and oral chlor-trimeton and vitamin C all with no effect.  Her facial complexion was sallow and the skin scratch test was positive and her whole body had round patches though it was most profuse on her chest and thorax area.  Her tongue was pale with thin moss and her pulse was wiry.  This was a presentation of Wind Cold tied up on the exterior though it was inappropriate to drain.  The treatment principle was to use pungent warm to penetrate through to the exterior, dredge wind and stop itching.  I gave her 6 packages of the following formula:

Discussion: According to reports, this formula treats contraction of wind cold with itching, a cold and heat illness or a cold that lasts without resolution in which the evil is light with itching.  For this it is quite effective.

Translated by: Sharon Weizenbaum

NOTE: For further reading on this case and formula, please see Sharon’s introduction, Guizhi mahuang ge ban tang & guizhi er mahuang yi tang

Original Chinese: 五、风隐疹(荨麻疹)
刘景棋医案：孙某某，女，45岁，1982年7月20日初诊。恶寒发热，全身起大片风团已二十余日。发病前曾汗出冒雨，过一日后即发现全身起大片风团，每日发作五六次，痒甚，心烦。曾注射钙剂，口服扑尔敏、维生素丙等无效。面色苍白，皮肤划痕试验阳性全身敲在大片风团，胸部较多。舌淡苔白，脉弦。辨证：风寒束表不得宣泄。治则：辛温透表，疏风止痒。处方：桂枝5克，白芍3克，生姜3克，炙甘草3克，麻黄3克，大枣4个，炒杏仁3克。 服6剂，临床治愈，随访三个月末复发。
(《经方验肘987；13)
按语：据报道，本方治疗感受风寒所致荨麻疹，有寒热表证或日久不愈，邪微而痒者，有良效。

[1] From 经方验, experience with classical formulas, 1987, page 13

Gui Zhi Ma Huang Ge Ban Tang

Gui Zhi (1 liang + 16 zhu) 4 grams
Sheng Jiang (1 liang) 3 grams
Bai Shao (1 liang) 3 grams
Zhi Gan Cao (1 liang) 3 grams
Ma Huang (1 liang) 3 grams
Da Zao 4 dates
Xing Ren (24 pieces) 3 grams

Gui Zhi Er Ma Huang Yi Tang

Gui Zhi (2 liang + 17 zhu) 4 grams
Sheng Jiang (1 liang +6 zhu) 3 grams
Bai Shao (1 liang + 6 zhu) 3 grams
Zhi Gan Cao (1 liang +2 zhu) 3 grams
Ma Huang (6 zhu) 1 grams
Da Zao 5 dates
Xing Ren (6 pieces) 2 grams

Original clauses from the Shan Han Lun

1.Tai Yang disease, for 8 or 9 days, malaria like symptoms, fever and aversion to cold, more fever, less cold, the person does not vomit, urine and stool are normal, episodes occurring 2-3 times each day.  2. Where the pulse is slightly moderate, there will be imminent recovery. 3. Where the pulse is faint with aversion to cold, this is deficiency of both Yin and Yang and one should not further promote sweating, purging or vomiting, 4. Where the complexion is like that of a hot color, there has been no imminent recovery.  This is because the patient cannot raise a mild sweat, the body will be itchy and Gui Zhi Ma Huang Ge Ban Tang is appropriate. (clause 23)”

Having taken Gui Zhi Tang, there is copious sweat; if the pulse is flooding and big, give Gui Zhi Tang as before.  If the disease resembles malaria, occurring again during the day, sweating will resolve it, Gui Zhi Er Ma Huang Yi Tang will resolve it. (clause 25)”

Explanation of Formulas:

Although there are symptoms of illness in this presentation, the cold and heat manifest together and these episodes occur two to three times a day and there is no vomiting.  This means that the illness has not entered the Shao Yang.  Although the heat is more than the cold, there is still clear urine and normal bowels.  This means that the illness has not entered the Yang Ming.  Since there is not a Yang Ming or a Shao Yang pattern, there has been no transmutation.  This means that the illness is still at the Tai Yang and that it has become mild and chronic.  The correct Qi attempts to push the evil out by sweating but the sweating is not effective to resolve the evil.  The result is that the illness becomes chronic and yet one cannot create a big sweat.  Gui Zhi Ma Huang Ge Ban Tang is appropriate because it will create a light sweat.

Gui Zhi Er Ma Huang Yi Tang is similar to the above formula in that it is also for a mild condition.  In order to resolve the muscles, the ingredients only slightly promote sweating.

Clinically, this illness presentation is most often seen in young people and elderly people as well as those who are weakened with chronic illness.  There is no discussion as to whether this is cold damage or wind strike.  What is important is only that this is chronic without resolution, that the presentation is relatively light, and that there is cold and heat like malaria.  For this, one can use the above two formulas.

Case examples:

1. A light presentation with stasis on the exterior
2. Unresolved stasis on the exterior
3. Urticaria
4. Unpleasant Body Oder