The Donguibogam description of pathogenic qi and heat tangling in the stomach and surfacing on the skin closely parallels modern concepts of immune system malfunction and inflammatory reactions. Urticaria, particularly the chronic form, is not merely a transient reaction to an allergen. It is a complex manifestation of an immune system that has lost its regulatory balance.
Numerous mast cells reside beneath the skin. When these immune cells are excessively stimulated by internal or external triggers, they release substantial amounts of histamine. Histamine dilates blood vessels and increases vascular permeability, resulting in localized red swelling and nerve irritation that provokes severe pruritus. While acute urticaria typically represents an immediate reaction to specific foods, medications, or environmental exposures, chronic urticaria that persists or recurs for six weeks or longer involves far more intricate mechanisms.
In many instances of chronic urticaria, an identifiable allergen cannot be found. Instead, the condition may stem from autoimmune processes or internal triggers such as chronic stress, hormonal shifts, and gastrointestinal dysfunction. Stress stimulates the hypothalamic-pituitary-adrenal axis, elevating cortisol levels and inducing hyperactivation of the sympathetic nerve, which destabilizes immune regulation. These neuroendocrine-immune interactions heighten cutaneous hypersensitivity reactions. The concept of heat in Donguibogam aligns with this state of heightened internal inflammation and accelerated metabolism.
Recent scientific interest also highlights the gut-skin axis. Dysbiosis in the intestinal microbiome, including leaky gut syndrome, can stimulate systemic inflammatory responses that emerge as skin symptoms. Chronic urticaria must therefore be understood not as a standalone skin disorder, but as a consequence of interconnected dysfunctions across immune balance, stress regulation, and digestive health. Long-term management requires identifying these underlying causes to restore systemic equilibrium.
