The approach to the diagnosis and treatment of Allergic Rhinitis presents similar problems to that of Asthma. From the Chinese Medicine Theory, it is 'Bi Yuan' which means 'Nose Pool', it has been diagnosed and healed for long time.
[Allergic Rhinitis in Western Medicine]
Nasal congestion, a water nasal discharge and sneezing. In a few cases it affects the eyes and the conjuctively may become red and itchy. In 20% of cases there is also Asthma in conjunction with sinusitis.
Allergic Rhinitis is due to an antigen-antibody reaction in the nasal mucosa, it the antigens responsible are only particles then, it is called seasonal Allergic Rhinitis (hay fever). If the allergies are dust, house-dust mites, faecal matter, fungal spores, dogs and cats, the most allergenic substances are protein from their skin, urine and such as cigarette, petrol fumes and perfumes.
Allergenic Rhinitis, develops as a result of the interaction between the inhaled allergen and adjacent molecules of IgE antibodies, these adhere to the surface of the mast cells which, line the nasal epidelium with the first exposure, to the offending allergen. After the first exposure, the mast cells are 'primed' i.e. high levels of IgE anti bodies adhere to their surface, with subgent exposure to allergens, the IgE anti bodies provoke an 'Explosion'. In the mast cells with the massive release of histamine. Histamine itself causes an increase in permeability of the epidelium allowing allergens to reach IgE primed mast cells, sneezing result from over stimulation of the different nerve endings and starts within minutes of the allergens entering the nose, this is followed by a greatly increased nasal secretion and eventually nasal blockage about 15-20 minutes after contact with the allergen. This pathological process is similat to that of Asthma, the main difference being that histamine plays a more important role in the development of Allergenic Rhinitis of Asthma. In fact, anti hestamines are effective for Allergenic Rhinitis but, on of little value for Asthma. A higher number of mast cells are present in the nasal mucosa of individuals with Allergenic Rhinitis and they probably increase as allergen stimulation continues, this accounts for the increasing responsiveness of the nose to lower amounts of allergens. The grossly swollen muscosa in Allergic Rhinitis may obstruct of drainage from the sinuses causing, sinusitis in half the patients. Thus, infection of the paranasal sinuses is a frequent complication and consequence of allergic rhinitis. This is an important point to remember when discussing the differences between allergic rhinitis in 'Bi Yuan' some individuals may also lose the sense of taste and smell.
The Western Treatment of Allergenic Rhinitis relies mostly on the use of antihistamine agents, these work by preventing histamine from reaching its site of action, i.e. the H1 receptors and hence they are called H1 receptor blockers. Side-effects include sedation, dizziness, fatigue, insomnia, nervousness, gastro-intestinal disturbances. Failure to respond to antihistimines is due to the fact that active substances other than histamines are released in allergenic states. Steroids by nasal inhalation are also used for allergic rhinitis; these do not seem to have the same general systemic effects of oral steroids.
[the Chinese Theory of 'Bi Yuan']
The main clinical manifestations usually mentioned in connection with a 'Bi Yuan' are a purulent nasal discharge with a foul smell, a stuffed nose, a runny nose, headache and, sneezing.
[aetiology and pathology]
'Bi Yuan' is due to repeated invasions of Wind-Cold in the lung channel which are not treated properly. After some time, Cold turns into heat, the Lung cannot disperse and descend Qi and local stagnation of Qi and blood develops in the nose. All these factors lead to nasal discharge. The gallbladder channel carries Heat upwards to the brain and, as the Governing vessel also flows into the brain and the nose, this therefore, causes a purulent yellow nasal discharge. In Chinese Medicine, this condition was infact also called 'brain flooding' or 'brain discharge'. Thus two channels and organs are involved: Lungs and Gallbladder. After several years, the Spleen will usually become involved and a Spleen deficiency leading to Dampness further aggrevates the condition. The manifestation of this condition consists of symptoms of Wind-Cold or Wind-Heat. The root of the condition is a deficiency of the Lung in dispersing and descending Qi and, in some cases, Gallbladder Heat. The treatment is variously aimed at expelling Wind-Cold or Wind-Heat. Clearing Gallbladder Heat or clearing Spleen-Heat according to the pattern involved.
The main patterns encountered is 'Bi Yuan' are:
1. Lung invaded by Wind-Cold
2. Lung invaded by Wind-Heat
3. Lung and Gallbladder Heat
Symptoms from the above list 1 to 5 described :
1. Lung invaded by Wind-Cold : Stuffed nose, runny nose with clear mucus, slight headache, sneezing
2. Lung invaded by Wind-Heat : Stuffed nose, runny nose with thick-yellow discharge, itchy nose and throat, redness and swelling around the nose, itchy eyes.
3. Liver and Gallbladder Heat : Dry nose, runny nose with yellow-sticky-purulent and foul-smelling discharge. Diminished sense of smell, bitter taste, dry throat, headache.
4. Lung-Heat : Stuffed nose, runny nose with yellow foul-smelling discharge which may contain blood, dry mouth, feeling of heat.
5. Spleen-Heat : Stuffed nose, runny nose with yellow foul-smelling discharge, diminished sense of smell. Feeling heaviness of the heart, headache, bitter and sticky taste.
Differences between Allergic Rhinitis and Bi Yuan :
The use of the theory of Bi Yuan to treat Allergic Rhinitis presents several problems.
1. The theory of Bi Yuan presents no clear explanation of the allergic nature of Rhinitis and no explanation of its aetiology.
2. Some of the Patterns described in Bi Yuan are not Allergic Rhinitis but, sinusitis. In fact all of them, except for lung invaded by Wind-Cold include, runny nose with a yellow, sticky, purulent and foul smelling discharge. This is clearly a symptom of sinusitis, not Rhinitis, as it is the infection of the sinuses, not Rhinitis, that produces the yellow and purulent discharge.
[A new theory of allergic Rhinitis]
Allergic Rhinitis is due to an over-activity of the immune system to certain allergens. Like Asthma, this is due, from the Traditional Chinese Medicine point of view, to a deficiency of the Lung and Kidney's Defensive-Qi systems, combined with retention of chronic Wind in the Nose.
The deficiency of Lung and Kidney's Defensive-Qi system is either hereditary of due to problems during the pregnancy or child birth. The aetiological factors are exactly the same as for Asthma. Repeated invasion of Wind which are not treated properly, combined with pre-existing systems lead to the retention of what could be described as chronic Wind in the nose, similiar to what happens in Asthma when Wind is retained in the chest.
Allergic Rhinitis is therefore characterized by two factors: a deficiency of Lung and Kidney's defensive-Qi systems and retention of Wind in the nose. As mentioned for Asthma, a deficiency of the Kidney's Defensive-Qi system involves only this particular aspect of it's function and not others. One would not therefore expect to see symptoms such as tinnitus, dizziness, night sweating, weak back and legs, etc. Even more than Asthma, aAllergic Rhinitis is due to Kidney deficiency. This is so because, in Allergic Rhinitis, the Kidney is not only the root of the disease but, also in the manifestations via the governing vessel, the governing vessel emerges from between the Kidneys and flows up to the spine to the top of the head and then down to the nose. For this reason the Kidneys are responsible not only for breathing, due to their function of grasping Qi but, also sneezing. The symptoms and signs of Allergic Rhinitis are those of Wind-Cold as the nasal discharge is always white and watery. This indicates a deficiency of Defensive Qi which, is spread by the Lungs but, has it's root in the Kidneys. Although some books do refer to a Kidney Deficiency as the Root of Allergic Rhinitis, the Kidneys are responsible not only for the root of this disease(because of the Kidney's Defensive Qi System) but, also for the Manifestation through their direct connection with the defensive-Qi and sneezing. Allergic Rhinitis often starts early childhood but, it may also start later in life, with a progressive decline of Kidney-Qi connected to the beginning of sexual activity. In fact, in women over 40 suffering from Allergic Rhinitis there is often a direct connection between sexual activity and an attack of Rhinitis. Although rhinitis is obviously a much less severe disease than Asthma, when compared with it, it indicates a more muscus and therefore runny nose.
As for the manifestation, the main pathogenic factors is Wind invading the Lung channel in the nose. However, this is due only to repeated invasion of Wind, as in the theory of Bi Yuan but, primarily to the inherent deficiency of the Kidney's Defensive-Qi system and Governing vessel in the nose which 'mimic's' symptoms of invasion of Wind-Cold, Sneezing itself is also directly due to the Kidneys and not necessarily to Wind.
As for treatment, it is important to distinguish seasonal from perinnial Rhinitis. In seasonal Rhinitis, on should apply different principles of treatment according to the season. In perennial Rhinitis, the principle of treatment is irrespective of the season.
[Treatment of the Manifestation]
Sneezing, profuse runny nose with white-watery discharge, pale complexion, stuffed nose, slight headache, no thirst.
Expel Wind-Cold and restore the dispersing and descending of Lung Qi
Point : Ub12, Ub13, Lu7, Li20, Yinxiang, Bitong, Du20, Sangxiong, Gb20
Tech : reducing or even method cupping b is applicable on ub12, Ub13
1. XIAO QING LONG TANG
2. CANG ER ZI SAN
3. MA HUANG TANG
4. GUI AI TANG
Sneezing, runny nose with white and watery discharge, itchy throat, itchy-red eyes, slight thirst
Expel Wind, clear Heat, restore the dispersing and descending of Lung Qi
Point : Ub12, Ub13, Li4, Li11, Li20, Yngxiang, Bitong, Yintang
Tech : reducing or even method, cupping is applicable on ub12, Ub13
1. Sang Ju Yin
2. Chai Ge Jie Ji Tang
3. Deficiency of lung and Kidney's defensive-Qi systems and the Governing vessel
Tonify the Lung and Kidney's Defensive-Qi systems, strengthen the Governing vessel, consolidate the exterior and expel Wind.
Ub13, Du12, Rn12, St36, Lu7, Lu9 with reinforcing method, to tonify the Lung's defensive qi system.
Li4, Li20, Bitong, Du23 with even method to expel Wind from nose
1. YU PING FENG SAN
2. SHEN SU SAN
1. LiX + LuX , CX + CX : electro acupuncture
Tech : after UbXX + UbXX : Moxa, electro acupuncture
2. UbXX, UbXX, RnX, RnX, RnXX, RnXX
LiX + LuX , CX + CX : electro acupuncture
Tech : first treatment weak stimulation gradually more strong stimulation