Experience Treating Chronic Rhinitis in Children as Lung Heat

Recently Beijing's weather turned abruptly, and with air pollution there are many rhinitis sufferers—especially children. In my observation, roughly 20% of children have rhinitis of varying degrees.

Pediatric rhinitis is mostly triggered by repeated colds treated incompletely. As to its disease mechanism, the great majority belong to lung heat. A child having a prolonged runny nose after a cold is a common occurrence that rarely draws parents' attention. But this pediatric rhinitis is precisely the source of many chronic respiratory diseases—and even nasopharyngeal carcinoma and lung cancer—and must not be neglected.

Children often do not know hot from cold and dress themselves carelessly; parents, projecting their own experience, force them to put on more clothes. But children are naturally lively, move a lot, and sweat easily. Dressing them too much often causes heat to congest in the lungs. Hence children catch colds easily, and their colds are often due to internal fire plus wind-cold. "No fire, no wind-cold": pediatric colds are mostly heat-type colds. Pediatric rhinitis also mostly arises from lung heat generating fire, with yellow nasal discharge, a rapid and forceful pulse, and a red tongue or slight yellow coating.

I have treated pediatric chronic rhinitis as lung heat with good results. The base formula is the classical Mahixinggan Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction).

Mahuang (Ephedra) 6g, Xingren (Apricot kernel) 10g, Zhigancao (Honey-fried licorice) 6g, Sheng Shigao (Raw gypsum) 24g.

Mahixinggan Tang comes from the Shanghan Lun. The original text contains two passages: "After sweating, one may not again give Guizhi Tang; if there is sweating and wheezing without a strong exterior heat, Mahuang Xingren Gancao Shigao Tang may be given," and "After purging, one may not again give Guizhi Tang; if there is sweating and wheezing without a strong exterior heat, Mahuang Xingren Gancao Shigao Tang may be given."

The indication for Mahixinggan Tang is that the exterior pattern has resolved, heat congests in the lungs, and lung qi is bound and congested: the patient is short of breath and wheezing, with no fever and no aversion to cold, and no Yangming interior pattern. In Mahixinggan Tang, ephedra is used in a small dose and gypsum in a large dose, so ephedra's action of dispersing the lungs and stopping wheezing is brought out while its sweating, exterior-releasing action is held in check; apricot kernel disperses the lungs and downbears qi; licorice paired with gypsum anticipates vacuity, meaning there is supplementation within the clearing.

Clinically, the use of this formula is not limited to "sweating and wheezing without strong exterior heat." It works well in treating various conditions arising from exuberant lung heat without an exterior pattern. The key to differentiation is whether the patient has exuberant lung heat; as long as it is exuberant lung heat, whether the condition is what we today call asthma, rhinitis, chronic pneumonia, or even some lung cancers, one may boldly prescribe it. The effect is very marked.

Exuberant lung heat often comes with other accompanying symptoms; one may then add or subtract the formula above to clear and drain lung heat while addressing the other symptoms. For example, sore throat is a common accompanying sign, and one may add shegan (Belamcanda), chantui (Cicada slough), and mabó (Calvatia) to handle it. Some patients even show irritability, vexing heat, and insomnia; then one may combine this formula with Zhizi Chi Tang, adding zhizi (Gardenia) 6–10g and danchizi (Fermented soybean) 10g, with very marked results.

Western treatment of pediatric rhinitis takes a long time—at least a week to improve—and is expensive, sometimes even requiring nasal irrigation, a painful process. But with Chinese pattern differentiation, treating exuberant lung heat with the corresponding formula, recovery often takes only two or three days.

Untreated pediatric rhinitis easily triggers a series of sequelae such as nasopharyngitis, chronic bronchitis, asthma, and sleep disorders. Snoring and similar symptoms in normal people are mostly caused by untreated pediatric rhinitis.

Pediatric rhinitis is mostly an excess pattern of lung heat; it must not be treated as a vacuity pattern, nor should cold and cool herbs be used early, which would bind and congest lung qi and give rise to other troubles. One should use lung-dispersing and heat-clearing together so that the lung's function of governing respiration recovers; then, without treating the discharge, the discharge stops of itself. If one treats the runny nose by attacking the runny nose, there is no effect at all.

Originally written November 2013.