Experience Using the Acrid-Warm Gegen Tang to Treat Sinusitis in Mid-Summer

The patient, a woman surnamed Liu, born in 1980, originally from Shandong and now living in Nanjing, was referred to me by another patient whom I had treated for rhinitis. She reported that she had had rhinitis since high school, over ten years earlier; she had sought help through various means, and at the time it was considered sinusitis, with headaches and runny nose. Later she felt the symptoms were gone. After high school, when she went elsewhere to study, she began to have clear nasal discharge and was diagnosed with allergic rhinitis, from which she had never since recovered. The slightest cool breeze brought clear rhinorrhea and sneezing, which greatly annoyed her; she used many tissues every day.

On May 21, 2021, the patient first sought my help via WeChat video. During the inquiry she said the rhinitis was worst on waking, with clear rhinorrhea and nasal congestion, and that feeling warmer made her especially comfortable. Her mother was of an allergic constitution. For a long time, whenever she caught cold, her nose would run incessantly; in severe cases she was often woken at night by mucus blocking her airway. In winter her hands and feet were cold, and in summer she was also averse to cold. She did not sweat easily, and did not sweat even in summer. She felt her feet could never get warm. No dysmenorrhea; numbness in the arms. Stool basically normal, though she had previously had constipation. She preferred hot drinks and could not drink cold water at all. Her shoulders, neck and nape were stiff, and the back of her head was chronically uncomfortable. During the consultation, though it was midsummer, she was still wearing a woolen vest.

Based on her symptoms, I considered her a Gegen Tang presentation from the Shanghan Lun. Although she lacked the “diarrhea” symptom, she clearly showed “aversion to cold and a stiff, tight neck and back” and had been unable to sweat year-round. So even though it was midsummer, I felt I should still use the acrid-warm exterior-releasing Gegen Tang, rather than being bound by dogma such as “do not use ephedra in summer.”

Prescription: Guizhi (Cinnamon twig) 15 g, Baishao (White peony) 15 g, Gegen (Pueraria) 30 g, Sheng Mahuang (Raw Ephedra) 6 g, Zhi Gancao (Honey-fried Licorice) 10 g, Shengjiang (Fresh ginger) 7 slices, Dazao (Jujube) 7 pieces. Three doses, decocted in water, one dose daily, taken 2–3 times.

On May 24, 2021, the patient reported marked improvement after taking the above. Considering that ephedra should not be used long-term, I told her to remove the Mahuang and continue for another three doses. On May 27, she reported that after taking the formula without Mahuang, symptoms continued to improve; her previous distress had basically resolved, with only occasional, mild palpitations.

I then considered using Fuling Guizhi Baizhu Gancao Tang as follow-up, prescribing: Guizhi 30 g, Fuling (Poria) 30 g, Baizhu (Atractylodes) 15 g, Zhi Gancao 10 g. I told her to observe whether this formula worked better or the previous one.

After taking it, her stomach was slightly uncomfortable. She reported that the severe rhinitis had basically cleared, with only a bout of sneezing and nasal discharge on waking; by day she was essentially asymptomatic. I then told her to continue with the second-visit decoction for another week as consolidation.

In clinical practice I have found that what Western medicine calls sinusitis, rhinitis and allergic rhinitis are mostly sequelae of the common cold—stubborn symptoms left behind after treating the cold by modern medical means. Treating such patients with the original formulas from TCM classics such as the Shanghan Lun and Wenbing Tiaobian, as long as the formula matches the pattern, often yields immediate results.

Some TCM scholars do not treat according to TCM pattern differentiation but instead use modern biochemical knowledge to understand Chinese medicine, searching for so-called special formulas for rhinitis as a disease; their results are poorer.

This case is truly trivial, and the treatment involved no innovation; I simply followed the spirit of pattern differentiation in the Shanghan Lun and used its original formula. I believe any TCM physician who has carefully read the Shanghan Lun could achieve this effect, perhaps even better than a cautious person like me, because they might prescribe more boldly.

I have heard that some people consider Zhang Zhongjing’s level inferior to that of a modern attending physician. I believe that in treating certain diseases this may indeed be so. But one must also see that Zhang Zhongjing’s six-meridian pattern differentiation can likewise solve problems that countless chief physicians in modern hospitals cannot. Medical matters cannot be settled by an outsider’s simple assertion of who is higher or lower. Physicians long engaged in clinical practice are mostly humble, because too many patients have been disappointed by our skills—who dares blow such a trumpet as to claim to cure all diseases? We have no right to be proud; we can only draw on the strengths of all and solve patients’ problems as best we can.