The approach to the diagnosis and treatment of allergic rhinitis presents similar problems to that of asthma. Since "allergic rhinitis" is a disease defined according to Western medicine, we need to establish which symptom it might correspond to in the Chinese medical literature. Most books, both Chinese and English-language ones, correlate allergic rhinitis to the Chinese symptom of "Bi Yuan" which literally means "nose-pool". We need first to ascertain whether there is such a correspondence and whether the theory of "Bi Yuan" may be used to differentiate and diagnose allergic rhinitis. As for asthma, we shall therefore discuss the following items:
– Allergic rhinitis in Western medicine
– The theory of Bi Yuan in Chinese medicine
– Differences between allergic rhinitis and Bi Yuan
– A new theory of allergic rhinitis in Chinese medicine.
The Chinese Theory of "Bi Yuan"
The main clinical manifestations usually mentioned in connection with 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 Gall-Bladder 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 in fact also called "brain flooding" or "brain discharge".
Thus two channels and organs are involved: Lungs and Gall-Bladder. After several years, the Spleen will usually also become involved and a Spleen deficiency leading to Dampness further aggravates 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, Gall-Bladder Heat.
The treatment is variously aimed at expelling Wind-Cold, clearing Gall-Bladder Heat or clearing Spleen-Heat according to the pattern involved.
The main patterns encountered in Bi Yuan are:
– Lung invaded by Wind-Cold
– Lung invaded by Wind-Heat
– Liver and Gall-Bladder Heat
– Lung-Heat
– Spleen-Heat.
Lung Invaded by Wind-Cold
Stuffed nose, runny nose with clear mucus, slight headache, sneezing.
Lung Invaded by Wind-Heat
Sneezing, stuffed nose, runny nose with thick-yellow discharge, itchy nose and throat, redness and swelling around the nose, itchy eyes.
Liver and Gall-Bladder Heat
Dry nose, runny nose with yellow-sticky-purulent and foul-smelling discharge, diminished sense of smell, bitter taste, dry throat, headache.
Lung-Heat
Stuffed nose, runny nose with yellow foul-smelling discharge which may contain blood, dry mouth, feeling of heat.
Spleen-Heat
Stuffed nose, runny nose with yellow foul-smelling discharge, diminished sense of smell, feeling of heaviness of the head, 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 very 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-reactivity of the immune system to certain allergens. Like asthma, this is due, from the Chinese point of view, to a deficiency of the Lung and Kidney's Defensive-Qi systems, combined with retention of chronic Wind in the nose.
Aetiology
The deficiency of Lung and Kidney's Defensive-Qi systems is either hereditary or due to problems during the pregnancy or childbirth. The aetiological factors are exactly the same as for asthma (see Chapter 5).
Repeated invasions of Wind which are not treated properly, combined with a pre-existing deficiency of Lung and Kidney's Defensive-Qi systems, lead to the retention of what could be described as chronic Wind in the nose, similar to what happens in asthma when Wind is retained in the chest.
Pathology
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 its function and not others. One would not expect therefore to see symptoms such as tinnitus, dizziness, night-sweating, weak back and legs, etc. Even more than asthma, allergic rhinitis is due to a Kidney deficiency. This is so because, in allergic rhinitis, the Kidneys are involved not only in the Root of the disease, but also in the Manifestation via the Governing Vessel. The Governing Vessel emerges from between the Kidneys and flows up the spine to the top of the head and then
down to the nose and lips. It is therefore the channel connection between the Kidneys and the nose. For this reason the Kidneys are responsible not only for breathing, due to their function of grasping Qi, but also sneezing.
Thus the hyper-reactivity of the immune response of allergic rhinitis is due to a deficiency of the Kidney's Defensive-Qi system and Governing Vessel. With regard to the role of the Governing Vessel in allergic rhinitis, it is interesting that many of the herbs which Li Shi Zhen connected with this vessel are expelling-Wind herbs which act on the nose. These herbs are Fang Feng Radix Ledebouriellae sesloidis, Cang Er Zi Fructus Xanthii, Jing Jie Herba seu Flos Schizonepetae tenuifoliae, Qiang Huo Radix et Rhizoma Notopterygii, Xi Xin Herba Asari cum radice and Gao Ben Rhizoma et Radix Ligustici sinensis.2(142)
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 its root in the Kidneys.3(143) Thus, 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 deficiency 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 in early childhood but it may also start later in life, with a progressive decline of Kidney-Qi or perhaps with a decline of Kidney-Qi connected to the beginning of sexual activity. In fact, in men over 40 suffering from allergic rhinitis there is often a direct connection between sexual activity and an attack of rhinitis. Thus, although rhinitis is obviously a much less severe disease than asthma, when compared with it, it indicates a more severe deficiency of the Kidneys.
As for the difference between seasonal and perennial allergic rhinitis (hay fever), the latter simply occurs when there is a more severe Kidney deficiency.
Obviously, in patients aged 50 or over the pathology will be complicated by other factors, the most common of which is a Spleen deficiency which produces more mucus and therefore a runny nose.
As for the Manifestation, the main pathogenic factor is Wind invading the Lung channel in the nose. However, this is due not only to repeated invasions 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 "mimics" symptoms of invasion of Wind-Cold. Sneezing itself is also directly due to the Kidneys and not necessarily to Wind.
Treatment
As for treatment, it is important to distinguish seasonal from perennial rhinitis. In seasonal rhinitis we should apply different principles of treatment according to the season. In perennial rhinitis, the principle of treatment is irrespective of the season.
The discussion of the treatment will therefore be structured in the following way:
SEASONAL ALLERGIC RHINITIS
Treatment of the Manifestation
Wind-Cold
Wind-Heat
Treatment of the Root
Deficiency of Lung and Kidney's Defensive-Qi systems and the Governing Vessel
PERENNIAL ALLERGIC RHINITIS
Deficiency of Lung and Kidney's Defensive-Qi systems and the Governing
Vessel.
Seasonal Allergic Rhinitis
In seasonal rhinitis one must adapt the treatment according to the season. During the pollen season, attention is directed at treating the Manifestation, i.e. expelling Wind-Cold or Wind-Heat. Outside the summer season, attention is directed at treating the Root, i.e. tonifying the Lung and Kidney's Defensive-Qi systems and strengthening the Governing Vessel.
Treatment of the Manifestation
Wind-Cold
Clinical Manifestations
Sneezing, profuse runny nose with white-watery discharge, pale complexion, stuffed nose, slight
headache, no thirst.
Treatment Principle
Expel Wind-Cold and restore the dispersing and descending of Lung-Qi.
Wind-Heat
Clinical Manifestations
Sneezing, runny nose with white and watery discharge, itchy throat, itchy-red eyes, slight thirst.
Treatment Principle
Expel Wind, clear Heat, restore the dispersing and descending of Lung-Qi.
Treatment of the Root
In seasonal rhinitis, attention should be directed at treating the Root of the disease at any time outside the pollen season. The best time to do it is actually towards the end of the summer and beginning of Autumn, i.e. August, September and October.
In treating the Root, the aim is to tonify the Lung and Kidney's Defensive-Qi systems and strengthen the Governing Vessel. As the rhinitis is seasonal, there is no need to treat the Manifestation.
Deficiency of Lung and Kidney's Defensive-Qi Systems and the Governing Vessel
Clinical Manifestations
Pale complexion, weak back, propensity to catching colds, Pale tongue, Weak-Deep pulse.
Treatment Principle
Tonify the Lung and Kidney's Defensive-Qi systems and strengthen the Governing Vessel.