The TCM Treatment Modality of Intranasal Drug Administration

The Old Book of Tang, Biographies of Artists and Technicians records: "Xu Yinzong was a native of Yixing, Changzhou. He first served the Chen dynasty as a military aide to the Prince of Xincai. At that time the Empress Dowager Liu suffered from wind and could not speak; famous physicians all treated her without success, and her pulse became increasingly deep and locked. Yinzong said: 'Medicine cannot be given by mouth; one should fumigate her with the steam of a decoction, letting the medicine enter the skin and coursing through the network vessels, whereupon she will recover.' He then brewed several hu of Huangqi Fangfeng Tang (Astragalus-Saposhnikovia Decoction) and placed it beneath the bed; the steam rose like smoke, and that very night she could speak. For this he was promptly promoted to Administrator of Yixing."

The New Book of Tang, Biography of Xu Yinzong also records this event: "The Queen Mother suffered from wind and could not speak; her pulse was deep and hard to gauge, and the physicians declared their methods exhausted. Yinzong said: 'Liquid medicine cannot be administered.' He then boiled several hu of Huangqi (Astragalus) and Fangfeng (Saposhnikovia), placed the decoction beneath the bed, and fanned the vapor over her; that evening she spoke."

This is perhaps the earliest record in Chinese literature of treating illness through intranasal TCM administration. The passage above tells the story of the Tang physician Xu Yinzong treating a stroke in the Queen Mother of the Prince of Xincai. The Queen Mother had suddenly suffered a stroke: her jaw was locked, she was unconscious and unable to speak, and her condition was grave. Many physicians were called, but none could help.

After Xu Yinzong saw her, he reasoned that she could not take medicine by mouth, so another approach had to be found. He hit on the idea of brewing the Chinese herbs Huangqi and Fangfeng and placing the pot beneath the Queen Mother's bed. The medicinal steam filled the room like smoke; though she could not speak, she could still breathe. Inhaling the vapor took effect, and that very night she regained consciousness and could speak.

This intranasal treatment modality must already have been in limited circulation in the Tang dynasty. Sun Simiao, a famous Tang contemporary of Xu Yinzong later honored as the "King of Medicine," also recorded several intranasal treatments in his work Qianjin Fang (Thousand Golden Remedies). The Qianjin Fang contains three passages describing this therapy.

"Spread cooked mugwort thinly onto paper four cun wide; then sprinkle sulfur powder over the mugwort, making sure it is evenly spread. Take a stalk of reed the length of the paper and roll ten such rolls. First burn the roll, remove the reed, and draw the smoke as it issues from the hole; swallow it until vomiting occurs, then stop. The next morning fumigate again as before, once or twice daily, and recovery will naturally follow. The patient may eat thin rice porridge; everything else is forbidden."

"One liang of Xunhuang (arsenic sulfide), ground fine. Wax paper and the Xunhuang are combined, mixed evenly, and rolled as before; fumigate as before, once or twice daily, stopping at vomiting. After seven days of convalescence, nourish with mutton broth."

Take a rotten blue cloth four cun wide, lay mugwort on it, lay Qingfan (green vitriol) powder on the mugwort, lay a little Xunhuang powder on the vitriol, then a little salt, then a few fermented-soybean flakes; roll it tightly, light it, put it in a dry jar, cover the mouth with paper pierced with a small hole, draw in the smoke and swallow it slowly, stopping at vomiting. If the chest feels stuffy, pause; when the smoke ends, stop. Use once or twice daily; three rolls are not needed before recovery. Avoid greasy food for twenty-one days.

Xu Yinzong was born in 536 CE and died in 626 CE, aged 90. Sun Simiao's exact birth and death years are unknown; he was born around 541–581 and died in 682, living past a hundred. The two were essentially contemporaries, and both used or recorded intranasal administration. One can imagine that in the Tang this method already had some currency.

My most vivid impression of intranasal administration comes from my father. He learned a folk treatment for acute throat diseases from our local people, and it is very effective. He squeezes juice from fresh Sedum lineare (Fojia Cao) and drops it into the nose to treat sore, swollen throat. The effect is excellent: throat pain and swelling generally ease within half an hour.

I used to wonder why local folk here gave medicine through the nose. At one point I guessed it was because the local Fojia Cao is so bitter (it really is bitter—I have tasted it myself). But on deeper reflection I arrived at another reason. Patients with acute tonsillitis or acute pharyngitis have throats so swollen and painful that even water cannot pass, so the only route left is through the nose.

Whether famous physicians like Xu Yinzong and Sun Simiao or ordinary folk back in my hometown, they were all remarkably resourceful. Before modern intravenous infusion existed, they devised many ingenious ways to deliver medicine into the body when drugs could not be taken by mouth. Clearly, intranasal administration was widespread among the people and has a long history.

I have written about the Song-style fumigation-inhalation therapy, a special treatment worked out by a contemporary Chinese physician, Dr. Song Shiqi (deceased many years ago). The Song method places several specially processed, refined, and purified Chinese herbs in a sealed metal container, sublimating them by high heat into fine medicinal particles that the patient inhales through the mouth and nose into the lungs. From the pulmonary capillaries they enter the pulmonary venous blood, reach the heart, and then spread through the body to take effect.

Dr. Song Shiqi also published a monograph, Song's Fumigation-Inhalation Therapy, describing his method. He used this special therapy mainly to treat cancer, stroke sequelae, and Parkinson's disease, with some efficacy. In his lifetime Dr. Song was vice president of a hospital in Xingtai, Hebei. His novel therapy was reported by the Guangming Daily in 1988 and drew wide attention. But because he used highly toxic drugs such as arsenic, safety concerns aroused great controversy, which eventually led Dr. Song and a newspaper to face off in court over defamation of reputation.

I once wrote an article titled "The Anti-Cancer Principle of TCM Fumigation-Inhalation Therapy" describing Dr. Song's method in detail. Surprisingly, that article caught the attention of Dr. Song's family, and later his nephew contacted me.

The nephew now works at the Anguo Chinese medicinal materials market in Hebei. He told me that Dr. Song's fumigation-inhalation therapy was passed to his two sons-in-law, but the elder son-in-law, Dr. Cang, has also passed away, and the younger son-in-law is elderly and retired. So this fumigation-inhalation therapy is now basically no longer practiced.

My most recent encounter with intranasal administration was on Zhihu, where a patient's family member shared how a medicinal pillow had cured his wife's severe insomnia and mental disturbance. He shared the formula for that calming, sleep-promoting pillow.

Formula: Yejiao Teng (夜交藤, Polygonum multiflorum vine) 350 g (coarse granules); Suanzaoren (酸枣仁, sour jujube seed) 250 g (coarse granules); Hehuanhua (合欢花, albizia flower) 150 g (coarse granules); Yuanzhi (远志, Polygala) 120 g (coarse granules); Juemingzi (决明子, cassia seed) 80 g; Xiakucao (夏枯草, Prunella) 30 g (cut into short sections); xunyicao (lavender) 30 g; Tanxiangmu (檀香木, sandalwood) 10 g (coarse granules).

Anyone trained in Chinese medicine can see at a glance the effect of this formula. Hehuanhua and Yejiao Teng are TCM's most classic pair for calming the spirit and promoting sleep. The Hehuan Anshen Tang for insomnia and dreaminess in the Yichun Yiyi, and the "Yangxue Jieyu Tang" for postpartum depression in the Fuke Yuchi, both rely mainly on this herb pair.

Suanzaoren and Yuanzhi are also the most commonly used calming, sleep-promoting herbs; Juemingzi and Xiakucao lower blood pressure, among other effects. Lavender and sandalwood are aromatic herbs that also calm the spirit and promote sleep; adding these two makes the pillow's scent more agreeable.

So as soon as I saw this formula I judged it effective. I immediately made several such medicinal pillows for family and friends, though I mixed the herbs with buckwheat husks. Some of my relatives and friends suffered from insomnia and were the first to try them; after use they basically all reported good calming and sleep-promoting effects.

This set me thinking: what on earth is the treatment mechanism? I tried it myself. Since I have no insomnia problem—basically going to bed early and rising early, sleeping six or seven hours a night plus about an hour's noon rest at school, with ample daily sleep—this medicinal pillow did not affect me much. But it let me experience firsthand how such medicine enters the body.

The faint herbal fragrance from the pillow wafted around my head all night. Small medicinal molecules can certainly enter the nose by molecular diffusion and be inhaled into the body, so this is also a form of intranasal administration. Because the molecules enter the nasal cavity only by diffusion, the amount of active ingredient entering the body is tiny. But administered continuously through the nose all night, it maintains a sustained effect, so this method is actually longer-acting than oral sleeping pills.

The nasal cavity is rich in capillaries and lymphatic capillaries, favoring rapid drug absorption. Modern medicine already uses intranasal delivery in vaccination and certain specific treatments—for example, nasal influenza vaccines. Western medicine also uses intranasal administration for other conditions—for example, intranasal scopolamine for depression, and research is exploring peptide drugs such as insulin and oxytocin for Alzheimer's disease.

Intranasal administration has certain advantages in treating neurological and immune-system diseases and deserves deeper study. If we could develop safe and effective intranasal drugs for cancer, neurological diseases, and immune diseases, we could relieve the suffering of many patients. But in using any treatment or drug, patient safety must be given full consideration.