“I get itchy welts and a while later they are somewhere else.”
Hives that move
Lesions that come and go on their own during exam season, with allergy testing already done and negative.
- Patient
- Woman, 24
- Occupation
- Final-year student
- Medication
- An antihistamine on the worst days.
- Allergies
- Negative skin-prick tests two months ago.
- History
- No childhood eczema
- Habits
- Exam season. Sleeps five hours.
1 · The consultation
You have 18 minutes. Each question or examination costs 2. Choose carefully what to ask.
Questions
Examination
2 · The tongue
3 · The pulse
Describe the pulse on each axis.
4 · The pattern
5 · Differential diagnosis
You're torn between two patterns. Which is it?
Which finding decides it?
6 · Case twist
Before finishing“«I breathe perfectly and my face and tongue have never swollen. The worst is the night-time itching, which stops me studying.»”
Mark the warning signs present:
What do you do?
7 · The treatment
Principle
Strategy
Points (choose 4)
Case solved
Reasoned solution
Pattern: Wind-Heat in the skin. Supporting signs: Welts that appear and vanish within hours, They move around, Red and hot, worse with warmth, Red tongue tip, Floating, rapid pulse.
The deciding clue: Appear and vanish within hours: Each welt lasts under a day and leaves no mark. What moves like that is Wind..
Safety: Urticaria with a clear airway, no angioedema and lesions that resolve on their own: treat by dispersing Wind and cooling the skin.
Treatment: Dispel Wind, Clear Heat from the skin; Disperse and cool. Points: LI11, SP10, GB31, LI4.
More patients are waiting in the app, with voice, a real timer and a history of your decisions.
See the solution without playing
Pattern: Wind-Heat in the skin. Supporting signs: Welts that appear and vanish within hours, They move around, Red and hot, worse with warmth, Red tongue tip, Floating, rapid pulse.
The deciding clue: Appear and vanish within hours: Each welt lasts under a day and leaves no mark. What moves like that is Wind..
Safety: Urticaria with a clear airway, no angioedema and lesions that resolve on their own: treat by dispersing Wind and cooling the skin.
Treatment: Dispel Wind, Clear Heat from the skin; Disperse and cool. Points: LI11, SP10, GB31, LI4.
Teaching case. Fictional patient for study purposes. If you have real symptoms, consult a healthcare professional.
