Hives TCM

Reviewed by Tony Tang Yuqi, TCM Physician (Singapore-registered)

Urticaria — hives, 荨麻疹 (Xun Ma Zhen), also called 风疹块 (Feng Zhen Kuai) — causes itchy, raised welts that appear and fade, sometimes with swelling of the lips or eyelids. Tangs Clinical TCM (唐氏中医) in Singapore treats chronic and recurring hives with herbal formulas prescribed by pattern differentiation, and adjusts the prescription at every review.

What Is Urticaria?

Hives appear when mast cells in the skin release histamine and other chemicals, causing itchy welts (wheals) and sometimes deeper swelling (angioedema). Individual welts usually fade within 24 hours, but new ones can keep appearing.

Acute and chronic hives

• Acute urticaria lasts less than six weeks and is often linked to an infection, a food, a medicine or an insect bite.
• Chronic urticaria returns on most days for more than six weeks, and can last months or years. In chronic spontaneous urticaria there is often no identifiable external trigger. In chronic inducible urticaria, hives are set off by a physical stimulus such as scratching or pressure (dermatographism), cold, heat, sweating or sunlight.

Common signs

• Raised welts that are red, pink or skin-coloured
• Intense itching
• Welts that change shape, move, and come and go
• Swelling of the eyelids, lips or cheeks (angioedema)
• Flares after heat, cold, pressure, exercise or stress

Common triggers

• Viral and other infections
• Foods such as shellfish, nuts or milk
• Medicines such as aspirin, other NSAIDs, or penicillin
• Insect bites
• Pressure or friction on the skin
• Cold air or water
• Heat, sweating and exercise
• Sunlight
• Stress

Chronic hives do not always mean you are allergic to something. In many people with chronic spontaneous urticaria, no external allergen is found.

Hives in Singapore’s Climate

Many people in Singapore move several times a day between tropical heat and cold air-conditioning. For some, heat and sweating set off hives; for others, cold air or cold water does. In TCM terms, this repeated heat–cold contrast — together with iced drinks — often produces a pattern described as “heat outside, cold inside”, which shapes how we prescribe.

How TCM Understands Hives

In TCM, hives belong to the category of “wind” conditions, because the welts come and go quickly and move around the body. Acute hives are often described as wind-heat or wind-cold affecting the skin. Chronic, recurring hives are more often linked to weakness underneath — deficiency of Qi or blood, a weakened defensive layer (Wei Qi), or accumulated dampness from a weakened Spleen — so that the skin reacts easily to heat, cold, food or stress.

Because these patterns overlap and change, we do not match one formula to one diagnosis. The same condition can be treated differently in different people, and different conditions that share an underlying pattern may be treated with the same formula — the classical principle of “same disease, different treatments; different diseases, same treatment.”

How We Treat Chronic Hives at Tangs Clinical TCM

Oral formulas prescribed by pattern

We do not have a separate range of formulas for hives. Our oral formulas are experience-based prescriptions developed in our clinic, and the range names reflect where each formula was first developed, not the only condition it is used for. For hives, your physician chooses formulas from any of our ranges according to your constitution and pattern at each visit.

Supporting the defensive layer, not suppressing it

Our oral formulas do not use bitter-cold herbs, which in TCM theory can weaken the Spleen. Chronic hives often involve weakness of the body’s defensive layer; protecting the Spleen and Stomach and harmonising Ying and Wei (nutritive and defensive qi) are central to our approach, which aligns with the Orthodox School of External Medicine (Zhengzong Pai) of the Ming-dynasty physician Chen Shigong.

Two or three formulas, ranked by weight

When a presentation is complex — for example, hives together with eczema — we may prescribe two or three formulas together. As in a classical prescription, where herbs take chief, deputy and assistant/envoy roles, combined formulas are ranked by weight into principal, supporting and assisting formulas.

Reviewed and adjusted at every visit

At each review, your physician reassesses your skin and general health and adjusts the formulas and doses. Your prescription changes as your condition changes, rather than staying the same from start to finish.

Case Records and Further Reading

Each case record describes one patient; it is not a prediction of how anyone else will respond.

• Chronic hives for 20 years, with eczema for 18 years — case record
• Erythema multiforme or urticarial vasculitis? — case discussion
• Acute vs chronic hives from a TCM perspective
• Foods to avoid for hives, eczema and psoriasis

Individual responses to treatment vary.

Diet and Daily Care

Diet is discussed at every consultation and adjusted to your pattern. General guidance we often give:

• Keep a simple diary of flares, foods, medicines, heat, cold and stress, and bring it to your consultation.
• Limit alcohol, spicy and deep-fried foods, and any food you have noticed sets off your hives.
• Avoid iced drinks and cold foods, which in TCM terms weaken the Spleen.
• Avoid sitting directly in cold air-conditioning airflow, and cool down gradually after heat or exercise.
• Wear loose, soft cotton clothing, and avoid tight straps and belts if pressure sets off welts.
• For itch, a cool (not ice-cold) compress can help — but avoid it if cold triggers your hives.

What to Expect

1. Contact us

Message us on WhatsApp or call the clinic. We will share information on fees and what to prepare. Photos of your hives during a flare are helpful, as welts may have faded by the time of your visit.

2. First consultation

Your physician reviews your skin, flare pattern, triggers, history, current medication and general health, and prescribes based on your pattern.

3. Regular reviews

At each follow-up, your skin and general health are reassessed and your prescription is adjusted.

If you are using other medication

Please do not stop or change any prescribed medication without speaking to your doctor. Individual responses to treatment vary.

Book a Consultation

WhatsApp +65 8870 0555 | Call +65 6333 4066