Journal of Acuherb in Medicine


Allergic Rhinitis

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Allergic Rhinitis

 

Allergic rhinitis or hay fever is a disorder characterized by acute attacks of nasal itching, congestion, watery nasal discharge, and sneezing. The episodes occur frequently with short intervals, or remission periods, between attacks. Attacks commonly occur in the morning and at night. Affected individuals are completely normal between episodes. The disorder is due to a hypersensitivity reaction to certain substances that affect the mucous membranes of the nose and associated glands. The disease presents in both seasonal and perennial forms.

In the traditional Chinese medicine (TCM) classic Huang Di Nei Ning (The Yellow Emperor’s Medicine Classic), a similarly described disease is referred to as “bi-qiu”, or “qiu-ti”. “Bi-qiu” means profuse watery nasal discharge; “qiu-ti” means sneezing and profuse watery nasal discharge.

From the TCM viewpoint, the nose has both respiratory and olfactory (smell) functions. It works closely with the lungs,kidneysspleen, and meridians. The lungs open into the nose and nasal function is mainly dependent on the action of the lung energy, qi. The free movement of the lung qi keeps the nasal passages clear and maintains an accurate sense of smell. The governing meridian (Du Mai), a channel system of the midline controlled by the kidneys, passes through the nose. The kidneys thus communicate with the nose. The spleen is the primary organ of digestion and its main function is to transform food into essence (jing) . This is then transported to the lungs and heart where it is used to create qi and blood. Normal spleen function therefore facilitates proper functioning of the lungs; when the spleen is impaired, phlegm-related disorders may develop. 

Causes

Qi deficiency (internal factors)
A deficiency inherited at birth, chronic illness, over-exertion, improper diet, or emotional disturbances can damage the organs. Under-functioning of organs and an irregular flow of blood and qi make the body susceptible to illness. In allergic rhinitis, the lungs, spleen, and kidneys are the main organs which are involved.

1. Deficiency of lung qi 
The lungs and nose belong to same system: the lungs control the nose and the nose is the surface orifice of the lungs. Improper function of the lungs will affect the nose. The process also impairs theprotective qi and enables the exogenous evils to invade the nose more easily. The result will be frequent episodes of nasal problems, such as obstruction, watery discharge, and sneezing.
2. Dysfunction of stomach and spleen 
When this occurs a decline in the formation of qi and blood results and the nose will lose its supply of nutrients. This causes a disorder of the nasal mucosa (mucous membranes) and nasal obstruction, watery discharge, and sneezing result. The sense of smell is also affected.
3. Deficiency of kidney qi 
When the kidneys fail to assist the lungs in using qi sent down to them from the lung and to regulate the fluid balance in the body, the circulation of qi and water become affected. Impairment of kidney function will result in inadequate kidney essence (jing) to maintain the functions of the nose. Symptoms will be seen such as a pale, swollen nasal mucosa, frequent episodes of nasal itching, sneezing, and watery discharge.

Invasion of exogenous evils (external factors)
Located in the center of the face, the nose from a TCM viewpoint is sited in the most yang part of the body. Exogenous yang evils, such as wind evil, can attack it easily. This invasion is usually accompanied by other evils such as the coldness, heat, or dampness evil. As the nose is the external opening of the lungs and helps the lungs to control the protective qi, when exogenous evils attack the qi, nasal disorders commonly occur. 
Furthermore, when the body constitution is weak, such as when there is a deficiency of lung qi, or the protective qi is not strong enough, exogenous evils can attack the nose simultaneously and nasal disorders result. TCM considers acute or recent attacks of rhinitis or hay fever to be mainly the result of external factors, whereas chronic or frequent relapses are mainly due to internal factors. 

Symptoms

Chinese practitioners will collect the information they need to make a diagnosis through the process of consultation, assessing systemic symptoms, and then determining the disharmony pattern that fits the individual. The following are the usual types of disharmony patterns for allergic rhinitis: 

1. Deficiency of lung qi, invasion by wind and coldness evils
 

Individuals present with nasal itching, sneezing, congestion, and a watery discharge. Symptoms are usually triggered by being exposed to wind or a cold temperature in the morning. Systemic symptoms include pallor, shortness of breath, ease of sweating on exertion, and aversion to cold.

2. Lung and spleen deficiency,dampness accumulation in the nose
 

Individuals usually present with symptoms such as sneezing with watery discharge and moderately severe nasal obstruction. These can be accompanied by heaviness in the forehead or a pounding pain between the eyebrows. Other symptoms include a loss of sense of smell, fatigue, shortness of breath, aversion to cold, a heavy sensation in the limbs, abdominal fullness, a poor appetite, and diarrhea.

3. Depletion in kidney yang, lungs lose promoting and warmth support from the kidneys
 

Individuals suffer from nasal obstruction, sneezing with watery discharge, severe aversion to cold, and coldness in the limbs. The symptoms are usually triggered by a cold temperature. Other symptoms include dizziness, ringing in the ears, frequent nocturnal urination, impotence and premature ejaculation, and a hot sensation in the palms and soles of the feet.

4. Spleen deficiency, stagnation of phlegm evil
 

Individuals present with a more severe nasal obstruction, copious watery discharge, and discomfort from nasal itching. They may also experience heaviness in the head, weakness of the limbs, fullness and discomfort in the chest and gastric regions. They may produce copious white sticky sputum, and have a poor appetite, and diarrhea.

5. Invasion of wind and heat evils in the lungs
  Typical presentations of this type of disharmony pattern include frequent episodes of sneezing, nasal itching, and complete obstruction of the nasal orifices by a heavy discharge. When stimulated by foreign evils or heat evil, a copious watery discharge will develop. Periodic relapse and remission will occur. There will be general symptoms like fever, aversion to cold, headache, and sweating.

Diagnosis

Based on the four examination technique, TCM practitioners make a diagnosis according to clinical symptoms and further characterize the disorder by the disharmony patterns displayed by each individual. At various stages of disease, different disharmony patterns are present and individuals with the same disease will be treated differently depending on the type of disharmony pattern they have. 

In allergic rhinitis, the procedures used in TCM to differentiate between disharmony patterns can be explained as follows:

1. Deficiency of lung qi, invasion by wind and coldness evils
  Due to a constitutional weakness, the individual is susceptible to influenza or other illnesses. In terms of TCM, this usually means that the individual does not have strong protective qi and this enables the wind evil and coldness evils to invade the nose easily. On examination, the nasal mucosa is pale and swollen, with a slight watery discharge. The tongue is pale and covered by white fur. The pulse is weak and feeble.
2. Lung and spleen deficiency, dampness accumulation in the nose
  When the lungs and spleen are deficient or under-functioning, an imbalance of body-fluid metabolism and dampness evil ccumulation results. Dampness evils flow through the meridians and accumulate in the nose to produce a swollen, pale nasal mucosa and excessive secretions. On examination, the nasal mucosa is clearly swollen and polyps (small growths) or similar changes may be seen. The tongue appears bulky, pink and furrowed, and is covered by white greasy fur. The pulse is weak and hesitant.
3. Depletion in kidney yang, lungs lose promoting and warmth support from the kidneys
  In TCM, the kidney yang is considered to be the fundamental source of promotion and provision of warmth to the body. Depletion of kidney yang usually occurs after long-term or severe damage of organs. It leads to under-functioning of the organs, interrupted flow of qi and blood, and also affects the functioning of the lung and the nose. On examination, the tongue is pink and covered with moist white fur. The pulse is weak and thready.
4. Spleen deficiency, stagnation of phlegm evil
  TCM practitioners believe that the spleen and stomach are very vulnerable to an improper diet, invasion by exogenous evils, or the effects of other organ deficiencies. A deficiency or under-functioning of the spleen leads to a decline in qi and blood or acquired essence (jing)production. The consequence of this is that the body is malnourished and phlegm evil will accumulate. The effect on the nose is to cause it to lose its supply of nutrients and for the nasal mucosa to develop related syndromes. On examination, the tongue is pale and covered by white greasy fur. The pulse is slippery.
5. Invasion of wind and heat evils in the lungs
  When exogenous evils, like wind and heat, attack the protective qi, a nasal disorder usually presents as part of the lung-wei syndrome. On examination, the nasal mucosa is swollen, there is congestion, and some watery discharge, or the discharge may be slightly sticky and thick. The tongue is red and covered with thin fur that may be yellow. The pulse is floating and rapid.

Treatment

Internal Therapy

  Deficiency of lung qi, invasion by wind and coldness evils


Therapeutic aim:To warm up the lungs and aid the protective qi, eliminate wind evil and ventilate the nasal passages.

Prescription:
 

huang qi milk vetch root
bai zhi large head atractylodes root
fang feng divaricate saposhnikovia root
bai zhi dahvrain angelica root
xin yi blond magnolia flower
cang er zi Siberian cocklebur fruit
shi chang pu grassleaf sweet flag rhizome
wu wi zi Chinese magnolia vine fruit
da zao Chinese date
xi xin Manchurian wild ginger
jiu gan cao liquorice root (processed with honey)

 

  Lung and spleen deficiency, dampness accumulation in the nose


Therapeutic aim:
 To invigorate the spleen and replenish qi, clear up dampness evil and ventilate the nasal passages.

Prescription: 

huang qi milk vetch root
bai zhi large head atractylodes root
chen pi dried tangerine peel
xin yi blond magnolia flower
dang shen pilose asiabell root
chai hu Chinese tororwax root
gui zhi cassia twig
bai shao white peony root
xi xin Manchurian wild ginger
ma huang ephedra
wu wi zi Chinese magnolia vine fruit
jiu gan cao liquorice root (processed with honey)

 

  Depletion in kidney yang, lungs lose promoting and warmth support from the kidneys

Therapeutic aim: To warm up the kidneys and invigorate yang, benefit the lungs and stop discharge. 

Prescription: 

shu di huang processed rehmannia root
shu fu zi common monkshood daughter root (processed)
gui zhi cassia twig
shan yao common yam root
ze xie oriental water plantain root
shan zhu yu Asiatic cornelian cherry fruit
fu ling Indian bread
huang qi milk vetch root
bai zhi large head atractylodes root
fang feng divaricate saposhnikovia root
xin yi blond magnolia flower
jiu gan cao liquorice root (processed with honey)

 

  Spleen deficiency and stagnation of phlegm evil

Therapeutic aim: To reinforce the spleen, clear up dampness evil and ventilate the nasal passages.

Prescription:

dang shen pilose asiabell root
bai zhi large head atractylodes root
fu ling Indian bread
chen pi dried tangerine peel
fa ban xia pinellia tuber (processed with radix glycyrrhizae and lime)
jiu gan cao liquorice root (processed with honey)
xin yi blond magnolia flower
cang er zi Siberian cocklebur fruit
bai zhi dahvrain angelica root
zi wan tatarian aster root
shan yao common yam root

 

  Invasion of wind and heat evils in the lungs

Therapeutic aim: To expel the heat and phlegm evils, ventilate the nasal passages and stop discharge.

Prescription: 

huang qin baical skullcap root
zhi zi cape jasmine fruit
zhi mu common anemarrhena rhizome
sang bai pi white mulberry root-bark
dong gua ren Chinese waxgourd seed
xin yi blond magnolia flower
cang er zi Siberian cocklebur fruit
bai zhi dahvrain angelica root
jie geng platycodon root
feng fang honeycomb
gan cao liquorice root

External Therapy

  Bi-yun powder insufflated into the nose:
e bu shi cao small centipeda herb
chung xiong Szechwan lovage rhizome
xin yi blond magnolia flower
xi xin Manchurian wild ginger
qing dai natural indigo

 

  Eardust of yellow croaker tampon inserted into the nose:
yu nao shi powder eardust of yellow croaker
bing pian borneol
xin yi blond magnolia flower
xi xin Manchurian wild ginger

Acupuncture
The use of acupuncture at the distal and proximal points, or along the meridians, helps to regulate the meridians and qi movement, facilitate the flow of lung qi and ventilate the nose.

Major acupuncture points: ying-xiang, shang-xing, he-liao, feng-chi and feng-fu..
Minor acupuncture points: bai-hui, yang-bai, cuan-zhu, pi-shu, shen-shu and zu-san-li. 

Massage
Massage of the lumbar and sacral regions of the spine, especially massage of the acupuncture points ying-heung, shen-shu and ming-men, help to strength the yin and yang of the body and are commonly applied in nasal diseases.

Prevention

Living environment

Attention should be paid to climatic changes. In the winter and autumn especially, it is important to avoid staying in environments with extreme temperature changes. Suitable clothes should be worn to prevent the invasion of exogenous evils.
Exposure to stimulants should be avoided. These include irritant substances such as odor or dust. The living environment (home) should be cleaned regularly. Dry, sunny places should be chosen to live in whenever possible.
   
Moderate and regular exercise will help strengthen the body’s resistance.
   
 
Dietary management
From a TCM perspective, foods and drugs come from the same source, so foods can have similar properties and functions to those of drugs. Foods and drugs are classified into four characteristics and five tastes. The four characteristics refer to the healing nature of Chinese herbs. These properties are cold, hot, warm and cool. The five tastes are acrid, sweet, sour, bitter and salty.

During attacks of allergic rhinitis certain foods should be eaten more frequently. These include foods that are acrid tasting, foods that promote warmth and sweating, and foods that facilitate the lung’s dissemination functions. These foods help to eliminate the exogenous evils. Such foods include spring onions, ginger, or cilantro (fresh coriander).
   
   
In general, excessive consumption of cold, greasy, and spicy foods should be avoided. Known sea-food or other foods that trigger the disorder should likewise not be eaten.
   
   
Foods which will tonify, eg, Chinese date, walnut, Chinese yam, dried mushrooms and mutton should be eaten. These foods help to invigorate the qi, cure deficiency, tonify the spleen, build up the body’s resistance.
   
   


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