Allergic rhinitis, also known as allergic rhinitis, is a relatively common and frequently occurring nasal disorder in clinical practice. This condition is similar to “nasal congestion” in Traditional Chinese Medicine. It is an abnormal reaction characterized primarily by lesions of the nasal mucosa, resulting from the body’s increased sensitivity to certain allergens. Clinically, this condition is classified into two types: perennial and seasonal (also known as hay fever or pollen allergy). Seasonal allergic rhinitis is particularly common, with many people experiencing symptoms during the flowering seasons of various plants.
I. Etiology and Pathogenesis of Allergic Rhinitis
This condition is associated with the following factors:
Genetic Factors: These may be inherited from one or both parents, though maternal inheritance is more common.
Allergens: The patient’s nasal mucosa becomes sensitized upon exposure to allergens, such as inhaled pollen, dust, and fungi; ingested cow’s milk, fish, shrimp, and eggs; or contact with cosmetics, animal fur, alcohol, and certain medications.
Climate: Changes in climate can also trigger this condition, including physical factors such as cold, heat, humidity, and even sunlight.
Infections: Infections can trigger episodes or exacerbate symptoms, particularly in patients with concomitant asthma.
According to Traditional Chinese Medicine, this condition is fundamentally rooted in the Kidney, with the Lung and Spleen being the primary sites of manifestation; it can be either congenital or acquired. Due to deficiency of lung qi, the defensive yang is unstable, and the skin pores become loose; wind and cold pathogens take advantage of this vulnerability to invade the nasal passages. As the body’s defensive and pathogenic forces clash, lung qi cannot circulate and regulate properly, causing body fluids to stagnate and the nasal passages to become obstructed, resulting in frequent sneezing and profuse clear nasal discharge. The abundance of lung qi depends on the distribution of spleen qi; when spleen qi is deficient, lung qi becomes deficient. Since the root of qi lies in the kidneys, kidney deficiency impairs the ability to contain and absorb, causing qi to fail to return to its source and instead dissipate upward, resulting in persistent symptoms. When kidney water overpowers earth, the spleen fails to transform body fluids, and qi cannot retain fluids, leading to a continuous flow of clear nasal discharge.
II. Clinical Manifestations in Patients with Allergic Rhinitis
The typical symptoms of this condition include sudden nasal itching, frequent sneezing, and profuse clear nasal discharge, sometimes accompanied by tearing and nasal congestion. It is characterized by a rapid onset and quick resolution, but may recur frequently; generally, it is not accompanied by systemic symptoms such as chills or fever. During an episode, the nasal mucosa is edematous, pale, or purplish-gray—most notably in the inferior turbinates—and the nasal cavity contains copious watery secretions; during remission, the nasal mucosa may appear completely normal. In chronic cases with severe reactions, the nasal mucosa may exhibit polypoid changes or develop polyps, leading to severe nasal congestion that impairs breathing.
III. Treatment of Allergic Rhinitis
Traditional Chinese Medicine (TCM) Differential Diagnosis and Treatment: The primary symptoms of this condition include a sudden onset, initially characterized by nasal itching, a sour and distended sensation, followed by frequent sneezing, nasal congestion, and a profuse flow of thin, clear nasal discharge. The sense of smell may be temporarily diminished, and symptoms such as headache, tinnitus, or hearing impairment may also be present.
If the syndrome is attributed to lung qi deficiency, it may be accompanied by fatigue, reluctance to speak, shortness of breath, weak breathing, and a soft voice. Alternatively, due to deficiency of lung-wei qi and instability of the skin and muscles, patients may frequently experience spontaneous sweating, a pale complexion, a pale tongue with a thin white coating, and a weak pulse. For cases primarily characterized by deficiency of lung qi with cold, the treatment principle should focus on warming and tonifying the lungs while dispelling wind and dispersing cold. The formula “Wen Fei Zhi Liu Dan” with appropriate modifications may be selected, or “Yu Ping San” combined with “Cang’erzi San” with appropriate modifications may be used.
If accompanied by kidney yang deficiency, symptoms may include soreness and weakness in the lower back and knees, nocturnal emissions, and premature ejaculation; in women, leukorrhea may occur, along with aversion to cold, frequent urination at night, a pale and tender tongue, a white and moist coating, and a deep and fine pulse. Treatment should focus on warming and strengthening kidney yang, as well as consolidating the kidneys to anchor qi; the formula “Jin Gui Shen Qi Wan” with appropriate modifications may be selected.
If accompanied by spleen deficiency, the spleen’s failure to properly receive and transport nutrients leads to the retention of dampness and turbidity internally, resulting in insufficient generation of qi, blood, and essence, and inadequate nourishment of the body. This may manifest as poor appetite, abdominal distension, a sensation of heaviness and fullness, and loose stools; the tongue appears pale with tooth marks on the edges, a thin white coating, and a soft, slow pulse. The treatment principle should be to strengthen the spleen, tonify qi, raise the pure, and transform dampness. The Bu Zhong Yi Qi Tang formula, with appropriate modifications, or the Bi Yu Tang formula may be selected for treatment. To be effective, the formula must be adjusted according to the patient’s specific condition and the physician’s clinical experience.
Antihistamines should be used to reduce nasal mucosal secretions, such as chlorpheniramine.
Topical Herbal Treatment
(1) Grind the herb into a fine powder and blow a small amount into the nose 2–3 times daily;
(2) Grind an appropriate amount of dried ginger into a fine powder, mix with honey, and apply to the nasal cavity 3 times daily.
Acupuncture Treatment
(1) Acupuncture: The primary acupoints may include Yingxiang, Fengchi, and Hejiao. Supplementary acupoints such as Feishu, Shenshu, and Pishu may be selected and rotated with each session. Treatment is administered once daily, with 10 sessions constituting one course of treatment; electroacupuncture or electrical pulse stimulation of acupoints may also be used.
(2) Moxibustion: Select points such as Baihui (GV20), Shangxing (GV10), Shenzhu (GV14), Shenque (CV8), Qihai (CV6), Mingmen (GV4), Zhongwan (CV12), Quchi (LI11), Zusanli (ST36), Sanyinjiao (SP6), and Yongquan (KI1). Perform moxibustion on 3–4 points per session for 20 minutes, once daily; a course of treatment consists of 7–10 sessions.
Auricular Acupuncture or Auricular Acupoint Pressure: Acupoints such as Neibi, E, and Fei may be selected for treatment.
Massage: This method is somewhat effective for nasal congestion, runny nose, and frequent sneezing. The procedure involves first rubbing the thenar pads of both hands together until they become warm. Then, use the warm thenar pads to massage both sides of the nose, moving along the bridge of the nose to the Yingxiang acupoint, rubbing back and forth until a sensation of warmth is felt in the area. Next, push from the Zanzhu acupoint toward the temples on both sides until the area feels warm. Perform this 2–3 times daily. Alternatively, use the middle fingers of both hands to rub up and down along both sides of the nasal bridge 20–30 times. Nasal massage helps unblock facial meridians, promotes the smooth flow of qi and blood, and expels pathogenic factors, thereby facilitating the resolution of symptoms.
IV. Prevention of Allergic Rhinitis
Identify allergens (such as certain types of pollen, odors, or medications) and take effective measures to avoid inhaling them.
The author once encountered a patient who had a rather rare potted plant at home. Every year when it bloomed, the patient would experience an allergic rhinitis episode accompanied by mild asthma; the symptoms would not subside until the flower had wilted. It was later determined that this plant was the cause of the condition; once the patient moved away from it, the symptoms never recurred.
Engage in regular exercise to strengthen the body’s resistance to disease and avoid exposure to cold.
Taking traditional Chinese medicines that tonify the lungs, spleen, and kidneys to regulate immune function is an important measure for preventing this condition.
Those with kidney yang deficiency should avoid excessive sexual activity.
Some patients are sensitive to seafood and should therefore avoid consuming it.