Allergic Rhinitis & Chinese Medicine
The clinical symptoms of allergic rhinitis include paroxysmal attacks of sneezing, runny nose, nasal congestion, anosmia, and itching in the eyes and back of the throat caused by exposure to airborne allergens such as pollen and animal dander. Often such attacks are seasonally recurrent due to the patient being allergic to specific types of pollen released at specific times of the year. The common name of such seasonally recurrent types of allergic rhinitis is hayfever, while pollinosis is its technical Western medical moniker. Chinese doctors have recognized allergic rhinitis as a specific disease for many centuries. It is called bi qiu in Chinese medicine or “sniveling nose,” and there are effective preventive and remedial treatments for hayfever within Chinese medicine. However, to understand how these work, one must understand the Chinese medical view of the pathogenesis and pathophysiology of this condition.
Chinese medical disease causes & mechanisms
Because ancient Chinese doctors did not have microscopes, they referred to all unseen airborne pathogens as species of evil wind. They knew that some special something was in the air that provoked attacks of upper respiratory symptoms, but they could not see the offending substance, just as one cannot see the wind though one can feel its effects. Chinese doctors also knew that some diseases are seasonal. These are referred to as seasonal diseases in Chinese medicine and are associated with seasonal contraction of evil wind. If external wind evils enter the body where they are not supposed to be, they hinder and obstruct the free flow of qi. Chinese doctors knew that most externally invading or contracted wind evils enter the upper part of the body, typically first attacking the lungs. However, according to the Nei Jing (Inner Classic), the 2,500 year old “bible” of Chinese medicine, if the righteous or healthy qi of the body is full, evils cannot enter. In particular, it is the defensive qi which guards the e xterior of the body against invasion from external wind evils.
Therefore, it is axiomatic that everyone with allergic rhinitis does have a defensive qi vacuity according to Chinese medicine, at least at the time of the attack. Further, because the defensive qi issues from the middle burner and is made from the finest essence of water and grains (i.e., food and drink), a defensive qi vacuity is mainly due to a spleen vacuity. It is the spleen which upbears the finest essence of water and grains to the lungs to be transformed into the qi. According to five phase theory, the spleen is the mother of the lungs and, although the lungs govern the qi of the entire body, they especially govern the defensive qi. Therefore, spleen vacuity in those with allergic rhinitis leads to lung and defensive qi vacuity. “When the spleen and stomach are vacuous and weak, the qi of the upper burner is insufficient.”  In Chinese medicine, the causes of spleen vacuity are inherent weakness due to immaturity, faulty diet, such as overeating, uncooked chilled foods, sugars and sweets, and oily, fatty foods, too much thinking, worry, and anxiety, overtaxation and fatigue, too little physical exercise, contraction or internal engenderment of dampness, damp heat, and/or summer heat, chronic disease, aging, and iatrogenesis due to overuse of “bitter, cold” medicinal (which includes antibiotics).
Not only is the spleen the root of the engenderment and transformation of the defensive qi, the spleen is also the main viscus in the movement and transformation of water fluids in the body. If, for any reason, the spleen is vacuous and weak, it may fail to properly move and transform water fluids which, instead, stop, collect, and transform into damp evils. Once produced, these damp evils further damage the spleen since, “The spleen is averse to dampness.” However, these damp evils may also obstruct the free flow of qi and, therefore, either lead to or aggravate liver depression qi stagnation. Since the qi moves the fluids throughout the body, qi stagnation may lead to or aggravate dampness, while dampness may lead to or aggravate qi stagnation. Further, if damp evils linger, they may be transformed into phlegm. If the qi accumulates and counterflows upward, this phlegm may rise up and lodge in the lungs. Thus it is said in Chinese medicine, “The spleen is the root of phlegm engenderment; the lungs are where phlegm is stored.” Because one of the main symptoms of allergic rhinitis is a congested, runny nose with clear white, watery mucus, the overwhelming majority of hayfever sufferers do have phlegm rheum according to Chinese medicine. (Phlegm rheum means this clear, wet, watery discharge.) However, because this phlegm rheum is not always apparent, it is spoken of as being deep-lying or hidden during normal times.
Putting all this together, we can say that most sufferers of allergic rhinitis manifest the following Chinese medical patterns: spleen-lung vacuity giving rise to a defensive qi insecurity complicated by deep-lying phlegm rheum and liver depression qi stagnation. Because the spleen and kidneys are mutually rooted and spleen disease eventually reaches the kidneys, many hayfever sufferers also have a kidney vacuity as well. This is especially so in the young whose kidneys are inherently immature and in the elderly whose kidneys have become vacuous and weak due to age. Thus many Chinese doctors identify the three main viscera in allergic rhinitis as the lungs, spleen, and kidneys. 
However, this still leaves the question of why some people always experience allergic rhinitis each fall, and this question has been addressed in Li Dong-yuan’s Pi Wei Lun (Treatise on the Spleen & Stomach). Li was one of the so-called four great masters of medicine of the Jin-Yuan dynasties, and the Pi Wei Lun was his great masterpiece. According to Li, autumnal allergic rhinitis is due to summerheat damaging the spleen as well as faulty diet–also damaging the spleen. “In summer, the original qi [i.e., the spleen qi] is damaged by intense heat.”  In the summer, in response to this heat and also because of the ripening of seasonal fruits, many people consume too many uncooked and chilled foods and drinks as well as too many sweets. Because the sweet flavor “gathers” in the spleen and also engenders dampness, eating too many sweets damages the spleen and also engenders dampness and phlegm. Therefore, some people are more spleen vacuous in the late summer and fall than at other times in the year and also ha ve more deep-lying phlegm rheum. If external wind evils take advantage of this vacuity and enter, they hinder and obstruct the function of the lungs which is to downbear and depurate. This means the lungs downbear fluids, sending them downwards to the kidneys and bladder for eventual excretion. If the lungs do not downbear and depurate, then fluids congest, ascend, and eventually spill over. Because the lung qi cannot descend, it counterflows upward instead. If there is liver depression, the tendency of the lung qi to counterflow upward is even greater. Thus there is sneezing, nasal congestion, and runny nose of clear white nasal mucus. The anosmia indicates loss of function of the lungs, since smell is a function of the lungs, while the itching indicates the presence of external evils.
According to the theories of Li Dong-yuan, autumnal allergic rhinitis may be prevented by first regulating the diet, avoiding overconsumption of uncooked, chilled foods and drinks, sugars and sweets, and oily, fatty foods, and, secondly, by taking Chinese herbs prophylactically which supplement the spleen, upbear the clear, and secure the defensive, dry dampness and clear any lingering summerheat. The formula that Li suggests for these purposes is called Huang Qi Ren Shen Tang (Astragalus & Ginseng Decoction). It consists of Radix Astragali Membranacei (Huang Qi), Radix Panacis Ginseng (Ren Shen), Fructus Schisandrae Chinensis (Wu Wei Zi), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Rhizoma Atractylodis (Cang Zhu), Tuber Ophiopogonis Japonici (Mai Men Dong), Radix Angelicae Sinensis (Dang Gui), Cortex Phellodendri (Huang Bai), Pericarpium Citri Reticulatae (Chen Pi), Rhizoma Cimicifugae (Sheng Ma), Massa Medica Fermentata (Shen Qu), and mix-fried Radix Glycyrrhizae (Gan Cao). Within this formula, Huang Qi, Ren Shen, Bai Zhu, Cang Zhu, and Gan Cao all fortify the spleen and boost the qi. In addition, Bai Zhu and Gang Zhu powerfully transform and dry dampness. Wu Wei Zi supplements the lungs and kidneys and secures the defensive qi. Sheng Ma uphears the clear and rectifies the qi. Chen Pi downbears the turbid and transforms phlegm and dampness. Mai Men Dong and Dang Gui enrich yin and nourish the blood respectively, thus preventing the acrid, warm Bai Zhu, Cang Zhu, and Chen Pi from damaging righteous or healthy fluids. Shen Qu transforms food and abducts stagnation. If there is spleen vacuity, there is the likelihood of food stagnation, since it is the spleen which is the root of the dispersion and transformation of food, and Huang Bai clear any lingering dampness and heat or summerheat. It is my experience that, when this formula or its modifications are administered 6-8 weeks prior to the usual onset of autumnal hayfever and when combined with proper diet, it can prevent or lessen the severity of allergic rhi nitis attacks.
As for the treatment of acute paroxysmal allergic rhinitis itself, the treatment principles are to supplement the spleen, lungs, and possibly the kidneys at the same time as securing the defensive, expelling wind evils, and warmly transforming phlegm rheum. One formula that does just that is Bi Qiu Tang (Sniveling Nose Decoction) created by Dr. Zhang Wei-zi at the Guangxi College of Chinese Medicine which consists of: Radix Codonopsitis Pilosulae (Dang Shen), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Ledebouriellae Divaricatae (Fang Feng), Herba Asari Cum Radice (Xi Xin), Herba Seu Flos Schizonepetae Tenuifoline (Jing Jie), Radix Dioscoreae Oppositae (Shan Yao), Semen Coicis Lachryma-jobi (Yi Yi Ren), Periostracum Cicadae (Chan Tui), Radix Platycodi Grandiflori (Jie Geng), Radix Astragali Membranacei (Huang Qi), Fructus Terminaliae Chebulae (He Zi), Flos Magnoliae (Xin Yi Hua), Herba Menthac Haplocalycis (Bo He), Rhizoma Alismatis (Ze Xie), and Fructus Schisandrae Chinensis (Wu Wei Zi). Within this formula, Dang Shen, Huang Qi, Bai Zhu, and Shan Yao supplement the lungs, spleen, and kidneys. He Zi and Wu Wei Zi secure the lungs and specifically stop runny nose. Fang Feng and Jing Jie dispel wind evils from the exterior. Xi Xin, Bo He, and Xin Yi Hua free the flow of the nose, thus relieving nasal congestion. Chan Tui dispels wind and stops itching, while Jie Geng guides the other medicinals to the lungs and also transforms phlegm. Yi Yi Ren and Ze Xie seep dampness via urination and, therefore, help Bai Zhu eliminate dampness.
As seen above, the treatment of allergic rhinitis in Chinese medicine is divided into two phases: 1) the preventive phase and 2) the remedial phase. In the preventive phases, the emphasis is on treating the roots of this disease — vacuity of the lungs, spleen, and kidneys and the existence of deep-lying phlegm rheum. In the active remedial phase, one should also equally expel wind evils as well as address the main symptoms of runny nose, nasal congestion, sneezing, and itching of the throat and/or eyes. While the treatment of individual patients may differ somewhat based on individually idiosyncratic Chinese medical patterns, the majority of allergic rhinitis sufferers do share the same basic disease mechanisms.
(1.) Li Dong-yuan, Pi Wei Lun (Treatise on the Spleen & Stomach), translated by Yang Shou-zhong & Li Jian-yong, Blue Poppy Press, Boulder, CO. 1993, p. 85
(2.) For instance, see Zhu Yu-qin’s “The Lungs, Spleen & Kidneys Must be Responsible for Allergic Rhinitis,” He Nan Zhong Yi (Henan Chinese Medicine), #6, 2000. p. 16
(3.) Li Dong-yuan. op. cit.., p. 85
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