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.