My Experience Treating Autumn Allergic Rhinitis in the North with Modified Yunü Jian

Yunü Jian (Jade Women Decoction) is an empirical formula of the Ming-dynasty physician Zhang Jingyue. It consists of raw Shigao (gypsum) three to five qian; Shudihuang (prepared rehmannia) three to five qian, or one liang; Maidong two qian; Zhimu and Niuxi, each one and a half qian. With one and a half cups of water, decoct to seven-tenths; take warm or cold.

Zhang Jingyue noted that Yunü Jian "treats water deficiency with fire exuberance, with floating, surging, slippery, and large pulses on all positions, insufficiency of the shaoyin, excess of yangming, vexing heat and dry thirst, headache and toothache, and bleeding patterns. If the stool is loose and watery, it is not suitable." In this passage we can see that the formula treats symptoms such as "vexing heat and dry thirst, headache and toothache, and bleeding patterns," and Zhang Jingyue also gives its contraindication: "if the stool is loose and watery, it is not suitable."

In this formula, raw Shigao and Zhimu clear heat and drain fire; they are important components of Baihu Tang and a classic pair for treating yangming interior-heat patterns. Shudihuang and Maidong, according to traditional TCM theory, nourish yin and descend fire and can treat patterns of depleted yin fluids with exuberant internal heat. Niuxi invigorates blood and promotes diuresis and can conduct fire downward, letting the fire-heat pathogen exit through the urine. Used together, these medicinals mainly clear and drain dry fire, nourish yin, and reduce fever; any disease mechanism of this nature can be treated.

The Qing-dynasty warm-disease master Wu Jutong, in his Wenbing Tiaobian, adapted this formula into "modified Yunü Jian" (changing prepared rehmannia to raw, removing Niuxi, and adding Xuanshen) to treat warm-disease patterns of both qi and blood flaring, greatly expanding the formula's range. We can see that with slight adaptation, this formula's indications become very broad.

Recently, an allergic-rhinitis patient from Tianjin had a relapse after autumn began, with itchy eyes, nasal congestion, sneezing, and dry nose. The patient felt warm and was sensitive to cold air. Western diagnosis was allergic rhinitis, with severe episodes every September to October. Because the patient's family has come to me for treatment of various illnesses over the years, after the relapse his wife asked me to devise a TCM treatment plan.

The first formula that came to mind was Yunü Jian. This patient had the key symptoms of dry nose and a feeling of heat, which in TCM means exuberant fire in the upper burner. It was autumn, the air was dry, and the fluids were also depleted. Fluid depletion with exuberant fire is exactly Yunü Jian's indication.

So I prescribed: raw Shigao 15 g; Shudihuang 30 g; Maidong 6 g; Zhimu 5 g; Niuxi 5 g; Lugen (Phragmitis Rhizoma) 30 g. Three doses, decocted in water, one dose daily; decoct the raw Shigao first for half an hour, decoct the formula twice total, and take in 2–3 divided doses. I added Lugen to strengthen the formula's power to clear lung heat.

After one dose, the patient's symptoms eased markedly and the sneezing had stopped.

This is not the first time I have used Yunü Jian for autumn allergic rhinitis in the North; I have had several previous northern patients with autumn allergic rhinitis, all treated successfully with this formula. These patients are distributed across Beijing, Tianjin, Shijiazhuang, and Jinan. In the autumn North, the heat has not yet dispersed and the air is dry, so a formula that combines yin-nourishing with heat-clearing and fire-draining is suitable. Whether this formula works for southern patients, I do not yet know; the patients who come to me for this kind of allergic rhinitis are basically all northerners.

According to what we learned in immunology class, allergic-rhinitis patients mostly have type I hypersensitivity, which is strongly related to genetic factors and is a congenital condition. Such diseases usually cannot be cured, but this formula can relieve the symptoms when they flare, so that the patient can live basically normally, untroubled by rhinitis.

This formula has two main medication indicators: first, dryness of the upper respiratory tract (mouth, throat, and nose); second, the patient's own feeling of heat or tidal heat. Following Professor Yin Huihe's idea of "grasping the main symptom," as long as these two main symptoms are present, this formula can be used. As for the accompanying symptoms, they need not be treated; most will resolve on their own as the medication works.

In addition, although I advocate treating refractory diseases with the large, multi-component, multi-target approach, for easily treated diseases I rarely use large composite formulas; most often I apply small formulas with pattern differentiation.