Clinical Experience in Treating Autumnal Allergic Rhinitis in Northern China

Yü Nü Jian is an empirical formula created by Zhang Jingyue during the Ming Dynasty. Its composition is as follows: raw gypsum (Sheng Shi Gao) 3 to 5 qian, prepared rehmannia (Shu Di) 3 to 5 qian or 1 liang, ophiopogon (Mai Dong) 2 qian, anemarrhena (Zhi Mu) and achyranthes (Niu Xi) 1.5 qian each. It is decocted in one and a half cups of water until reduced to seven-tenths, and taken warm or cold.

Zhang Jingyue pointed out that Yü Nü Jian “treats syndromes of water deficiency and fire hyperactivity, with all six pulse positions floating, surging, slippery, and large; insufficiency of Shaoyin and excess of Yangming; vexation-heat, dry mouth and thirst, headache, toothache, and hemorrhage.” He also noted the contraindication: “If there is loose stool or diarrhea, it is not appropriate.” From this passage, we can see that the symptoms treated by this formula include “vexation-heat, dry mouth and thirst, headache, toothache, and hemorrhage.” Zhang Jingyue also specified its contraindication: “If there is loose stool or diarrhea, it is not appropriate.”

In this formula, raw gypsum and anemarrhena have the effects of clearing heat and reducing fire. They are important components of Bai Hu Tang (White Tiger Decoction) and represent a classic herb pair for treating Yangming interior heat syndrome. According to traditional TCM theory, prepared rehmannia and ophiopogon belong to the category of herbs that nourish yin and reduce fire; they can treat syndromes of yin fluid depletion and hyperactive internal heat. Achyranthes has the effects of invigorating blood and promoting diuresis; in TCM, it guides fire downward, allowing pathogenic heat to be discharged through urination. When used together, the primary therapeutic actions of the herbs in this formula are to clear and drain dryness-fire and to nourish yin and reduce fever. Any condition whose pathogenesis aligns with this can be treated with it.

During the Qing Dynasty, the renowned warm disease scholar Wu Jutong modified this formula into “Jia Jian Yü Nü Jian” (Modified Jade Lady Decoction) in his Wen Bing Tiao Bian (Systematic Differentiation of Warm Diseases). He substituted raw rehmannia (Sheng Di) for prepared rehmannia, removed achyranthes, and added scrophularia (Xuan Shen) to treat warm disease syndromes with blazing heat in both the qi and blood levels. This greatly expanded the scope of application for this formula. It is evident that with slight modifications, the indications for this formula become remarkably broad.

Recently, a patient with allergic rhinitis from Tianjin experienced a recurrence of rhinitis after the onset of autumn, presenting with symptoms such as itchy eyes, nasal congestion, sneezing, and nasal dryness. The patient reported a subjective sensation of body heat and sensitivity to cold air. The Western medicine diagnosis was allergic rhinitis, with severe exacerbations occurring annually from September to October. Because this patient’s family had sought my treatment for various illnesses over many years, upon the onset of symptoms, his wife asked me to devise a TCM treatment plan.

My immediate thought was Yü Nü Jian. This patient presented with key symptoms such as nasal dryness and body heat, which, from a TCM perspective, indicate hyperactive fire in the upper jiao. As it was autumn, the air was dry, and body fluids were also deficient. Fluid deficiency with fire hyperactivity is precisely the indication for Yü Nü Jian.

The prescription was as follows: raw gypsum (Sheng Shi Gao) 15 g, prepared rehmannia (Shu Di) 30 g, ophiopogon (Mai Dong) 6 g, anemarrhena (Zhi Mu) 5 g, achyranthes (Niu Xi) 5 g, and reed rhizome (Lu Gen) 30 g. Three doses were prescribed, to be decocted in water at one dose per day. The raw gypsum was to be decocted first for half an hour before adding the remaining herbs. The decoction was prepared twice and divided into two to three servings. I added reed rhizome to enhance the formula’s ability to clear lung heat.

After taking just one dose, the patient’s symptoms were significantly alleviated, and the sneezing had stopped.

This is not my first time using Yü Nü Jian to treat autumnal allergic rhinitis in northern China. Previously, I successfully treated multiple northern patients with autumnal exacerbations of allergic rhinitis using this formula. These patients were located in Beijing, Tianjin, Shijiazhuang, Jinan, and other areas. In northern China during autumn, the pathogenic heat has not yet dissipated, and the air is dry; this makes it suitable for treatment with formulas that simultaneously nourish yin and clear heat to reduce fire. Whether this formula is effective for southern patients remains unknown to me; currently, virtually all patients seeking my treatment for this type of allergic rhinitis are from northern regions.

According to knowledge acquired from immunology courses, most patients with allergic rhinitis exhibit Type I hypersensitivity, which is strongly associated with genetic factors and is considered a congenital condition. Such diseases are typically incurable; however, this formula can alleviate symptoms during acute episodes, enabling patients to live essentially normal lives without being significantly affected by rhinitis.

There are two primary clinical indicators for using this formula: first, dryness of the upper respiratory tract (mouth, pharynx, and nose); second, the patient’s subjective sensation of dryness-heat or tidal fever. Following Professor Yin Huihe’s principle of “grasping the chief symptoms,” as long as these two chief symptoms are identified, this formula can be applied. As for accompanying symptoms, they need not be specifically addressed; most will resolve spontaneously with treatment.

Furthermore, although I advocate the strategy of using large, multi-targeted formulas for treating refractory diseases, for easily manageable conditions such as this, I rarely employ large formulas. In most cases, I rely on small formulas and syndrome differentiation for treatment.