Urticaria - Wind-Cold Pattern

Dr. Li Wei, DACM

Urticaria · Wind-Cold Pattern

Updated: June 23, 2026

Reviewed by: Dr. Li Wei, DACM

Reading Time: 7 min

Body Area: Skin

Pattern Overview

Wind-Cold is a common pattern in urticaria, characterized by cold-induced mast cell degranulation, wheals triggered by cold exposure, intense itching, and winter exacerbation. The core pathogenesis is invasion of Wind-Cold pathogens into the exterior, causing cold-induced mast cell degranulation, histamine release, and wheal formation.

Key Symptoms and Differentiation Points

| Differentiation Dimension | Manifestations |

| :— | :— |

| Primary Symptoms | Pale wheals, intense itching, triggered by cold exposure, winter exacerbation |

| Associated Symptoms | Chills, no sweating, nasal congestion, white or pale wheals |

| Tongue and Pulse | Pale red tongue with thin white coating, floating and tense pulse |

| Pathogenesis | Wind-Cold pathogens binding the exterior |

| Etiology | Cold exposure, winter season, constitutional Wind-Cold, cold urticaria |

Acupuncture Point Prescription

| Point | Location | Function |

| :— | :— | :— |

| Fengchi (GB20) | Depression below the occipital bone, between the sternocleidomastoid and trapezius | Disperses Wind and releases the exterior |

| Hegu (LI4) | Dorsum of the hand, between the 1st and 2nd metacarpals | Disperses Wind and releases the exterior |

| Lieque (LU7) | Above the wrist, on the radial side, in the depression between the tendons | Diffuses the Lung and disperses Wind-Cold |

| Quchi (LI11) | Lateral end of the elbow crease | Disperses Wind and stops itching |

| Xuehai (SP10) | On the medial thigh, 2 cun above the patella | Cools Blood and stops itching |

Clinical Recommendation: Filament needle, reducing method; moxibustion may be added to disperse Cold.

Herbal Formula

Base Formula: Gui Zhi Ma Huang Ge Ban Tang (桂枝麻黄各半汤) or Jing Fang Bai Du San (荆防败毒散)

Composition:

Cinnamon Twig (Gui Zhi), Ephedra (Ma Huang), Schizonepeta (Jing Jie), Saposhnikovia (Fang Feng), Notopterygium (Qiang Huo), White Peony (Bai Shao), Ginger (Sheng Jiang), Licorice (Gan Cao)

Action: Disperses Wind-Cold, releases the exterior, and stops itching.

Modifications

| Associated Symptoms | Additions/Subtractions |

| :— | :— |

| Intense itching | Add Bai Xian Pi, Ku Shen to stop itching |

| No sweating | Add Ma Huang, Gui Zhi to release the exterior |

| Chills | Add Fu Zi, Xi Xin to warm and disperse Cold |

| Pale wheals | Add Gui Zhi, Sheng Jiang to warm the meridians |

Western Mechanism Reference

Cold-induced mast cell degranulation and histamine release, with cold urticaria and TRPA1 channel activation. Wind-Cold corresponds to cold urticaria, where cold exposure activates TRPA1 channels inducing mast cell degranulation and histamine release.

References

  1. Dermatology of TCM - Urticaria with Wind-Cold.

  2. Zang-Fu Pattern Differentiation: Wind-Cold Binding the Exterior → Clearing Pathway.

  3. WHO. (2023). Skin health. World Health Organization.

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