A Case of Allergic Rhinitis Treated with Linggui Zhugan Tang

Patient Xue, from Pingdingshan, Henan Province, was a family member of a lung cancer patient I treat. On October 8, 2022, he sought my help for discomfort caused by allergic rhinitis.

Through remote online consultation I learned the patient had aversion to cold, nasal congestion, runny nose, nasal itching, and sneezing. Taking loratadine internally and spraying mometasone hydrochloride relieved symptoms, but as soon as he stopped, they recurred—lingering and difficult to treat. Underlying conditions: mild-to-moderate prostatic hyperplasia; triglycerides slightly high (3.7); clear urine; fair appetite; poor sleep; no thirst.

Based on the information provided, I considered the patient to have cold-type phlegm-fluid disease and decided to treat him with Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes, Licorice). Prescription: Fuling (Poria) 30 g, Guizhi (Cinnamon Twig) 15 g, Baizhu (Atractylodes) 15 g, Zhi Gancao (honey-fried Licorice) 10 g, Shengjiang (fresh Ginger) 7 slices, Dazao (Jujube) 7 pieces. Five doses, decocted in water, one dose daily.

This is the original formula from "Shanghan Lun" (Treatise on Cold Damage). In that book, the indications are: "In cold damage, after vomiting or purgation, there is upward fullness below the heart, qi surging up to the chest, dizziness on rising, and a deep, tight pulse; if sweating is promoted, the channels are stirred and the body shakes and trembles." In "Jingui Yaolue," the indications are: "Phlegm-fluid below the heart, with supporting fullness in the chest and hypochondrium, dizziness, shortness of breath, and slight fluid retention."

These passages seem not to match this patient's symptoms, but chronic rhinitis patients with aversion to cold mostly have a cold constitution and are prone to phlegm-fluid disease. When lingering and unresolving, nasal discharge dripping back becomes the "phlegm-fluid below the heart" pattern, so Fuling Guizhi Baizhu Gancao Tang may be used.

After decocting, the patient mixed the liquid with one small spoonful of Xiyangshen (American ginseng) powder and drank it as tea from a thermos cup. After five days he happily told me his symptoms had markedly improved: the nose no longer itched, sleep was much better, and nasal congestion and other symptoms had eased. I advised him to continue the same formula unchanged until fully recovered.

My daily work mainly concerns TCM treatment of malignant tumors; I generally do not treat conditions like allergic rhinitis, because I have not specialized in them and cannot guarantee results, so I modestly keep to my own field. Only occasionally, when cancer patients or their family members I have served ask for help with such issues, I try TCM pattern differentiation on their behalf; sometimes it works, sometimes not.

My personal experience is that many of Zhang Zhongjing's formulas are quite effective for allergic rhinitis and similar diseases. I commonly use Gegen Tang, Maxing Shigan Tang, Linggui Zhugan Tang, Guizhi Tang, and Guizhi Plus Gegen Tang. So long as one closely matches the patient's symptoms and grasps the main contradiction, surprisingly good results can be obtained.

Also, while reading today, I happened upon an article in the 16th issue of "Shaanxi Journal of Traditional Chinese Medicine" (1995) describing modified Banxia Baizhu Tianma Tang for sinusitis. This experiential formula treated 50 cases of sinusitis: 35 cured, 15 effective—cure rate 70%, total effective rate 100%, excellent results.

The formula is: Fabanxia (processed Pinellia) 10 g, Tianma (Gastrodia) 10 g, Cang'erzi (Xanthium) 10 g, Baizhi (Angelica dahurica) 10 g, Yanhusuo (Corydalis) 10 g, Sheng Gancao (raw Licorice) 10 g, Sheng Baizhu (raw Atractylodes) 15-30 g, Sheng Huangqi (raw Astragalus) 15-30 g, Huangqin (Scutellaria) 12 g, Yuxingcao (Houttuynia) 30 g, Chuanxiong (Ligusticum) 15 g, Lianqiao (Forsythia) 15 g, Danshen (Salvia) 15 g, Niuxi (Achyranthes) 15 g, Sheng Baishao (raw White Peony) 15 g, Xinyi (magnolia flower bud) 6 g, Huoxiang (Patchouli) 6 g. Decocted in water, one dose daily. I have not used this formula myself; I include it here merely as reprinted literature for the reference of rhinitis sufferers.

We are now entering autumn and winter, and many patients are troubled by rhinitis. I hope this article offers some help to readers bothered by rhinitis.