Clinical Cases of Allergic Rhinitis Treated with Traditional Chinese Medicine

Clinical Cases of Allergic Rhinitis Treated with Traditional Chinese Medicine

Allergic rhinitis frequently occurs during the spring and autumn seasons, and the author often encounters patients seeking treatment for this condition. Although rhinitis appears to be a single disease, careful inquiry reveals that symptoms vary among patients. Following the principle of syndrome differentiation and treatment in Traditional Chinese Medicine (TCM), patients with different clinical presentations should not be treated with the same formula. Only when symptoms match the indications of a formula can immediate efficacy be achieved; otherwise, treatment will be futile. This article presents two clinical cases of rhinitis for readers' reference.

Case 1: A Male Pediatric Patient from Tianjin

This pediatric patient is the son of a case previously reported in the author's article "Treatment of Autumn Allergic Rhinitis in Northern China with Modified Yu Nu Jian." He is a school-aged child.

The mother reported the following symptoms: sneezing, lacrimation, and nasal congestion upon waking in the morning; severe nasal congestion at night with mouth breathing; frequent awakening around 4 a.m. due to suffocation, followed by difficulty returning to sleep; constipation; and aversion to heat. Saline nasal irrigation at home had yielded unsatisfactory results.

Based on the above symptoms, this case belongs to the category of warm diseases (febrile diseases) in TCM, specifically lung heat syndrome, with the lung heat extending to the large intestine, thereby causing constipation. According to TCM theory, the lung and the large intestine are externally-internally related; therefore, this patient is suitable for Ma Huang Xing Ren Shi Gan Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction), a representative formula for clearing lung heat. Since the heat also involves the large intestine meridian, herbs that moisten the intestines, relieve constipation, and clear interior heat were added.

The prescribed formula was as follows: Zhi Ma Huang (honey-fried ephedra) 3 g, Xing Ren (apricot seed) 3 g, Zhi Gan Cao (honey-fried licorice) 3 g, Sheng Shi Gao (raw gypsum) 15 g (decocted first), and Huo Ma Ren (hemp seed) 15 g.

The first four herbs constitute the original Ma Huang Xing Ren Shi Gan Tang formula, with Huo Ma Ren added to moisten the intestines and relieve constipation. After one dose, the patient's symptoms were essentially resolved. Following the TCM principle of discontinuing treatment when seventy to eighty percent of the pathogenic factors have been eliminated and allowing the body's immune system to manage the remainder, treatment was terminated.

Of course, the parents may choose to continue the medication. However, according to therapeutic principles, once the primary symptoms have resolved, discontinuation should be encouraged to allow the body's self-recovery, which is beneficial for enhancing immune function.

Case 2: A Middle-Aged Female Teacher of the Author

This teacher, who is of similar age to the author, taught the author's pathology laboratory course. During the previous semester, the author frequently heard theoretical course instructors mention that a colleague in her office had suffered from allergic rhinitis for many years without achieving a cure. The author was somewhat surprised, as rhinitis is not typically considered intractable; it was puzzling that it had stymied medical school faculty. The author thought that if she sought TCM treatment, better outcomes might be achieved than with Western medicine.

Persistent intention eventually bears fruit. Last Thursday, through an introduction by a theoretical course instructor, this teacher consulted the author, reporting that her allergic rhinitis had flared this autumn with persistent nasal itching, ocular itching, continuous sneezing, dryness of the mouth, nose, and throat, and profuse sweating. Symptoms were worse in the morning or after wind exposure. Her tears were viscous; she had no sputum, but her sleep was unaffected. Bowel movements and urination were normal; although her mouth was dry, she did not drink excessively.

She has had rhinitis for many years, with the most severe exacerbations occurring each autumn, and has never undergone allergen testing. According to Western medical diagnosis, she has concurrent conjunctivitis and allergic rhinitis and requires daily use of ophthalmic drops for conjunctivitis and antihistamines to alleviate symptoms and maintain basic daily functioning.

In TCM terms, the above symptoms correspond to wind-heat syndrome. The condition may have initially been wind-cold, but over a prolonged period, wind-cold transformed into heat, resulting in wind-heat syndrome. The appropriate treatment principle is to release the exterior with acrid-cool herbs; the author therefore chose Gou Teng Bo He Cha (Uncaria and Mint Tea).

The prescribed formula was as follows: Bo He Ye (mint leaves) 3-5 pieces and Gou Teng (uncaria) 3 stems, steeped in boiling water and consumed as a tea. The tea should be replaced when the flavor becomes weak; it may be changed multiple times per day.

The teacher began this regimen last Friday. On the first day, ocular itching improved markedly, allowing her to discontinue the eye drops; nasal symptoms also lessened. Since the formula was effective, it was continued without modification. Given the chronic course, rapid resolution is unlikely, and she is currently continuing treatment with Gou Teng Bo He Cha.

For minor conditions that are readily amenable to treatment, small TCM formulas applied according to syndrome differentiation often yield excellent results, but they demand meticulous inquiry skills from the practitioner. The clearer the patient's chief complaint and the more detailed the inquiry, the more precisely the appropriate formula can be identified. Once the optimal formula is found, Chinese herbal medicine frequently produces therapeutic effects much more rapidly than Western pharmaceuticals.

Why can these two formulas treat rhinitis? The author has only recently begun studying Western pharmacology and lacks sufficient expertise to explain the mechanisms using modern pharmacological knowledge; therefore, the therapeutic rationale is presented here solely from the perspective of TCM syndrome differentiation and treatment.