Three 2021 TCM Cases of Treating Rhinitis Patients

For a long time I have focused on TCM anticancer research and generally do not treat diseases other than tumors, but by chance I do treat a few patients with other illnesses. This year I treated four rhinitis patients; three had fair results, and one gave no feedback after taking the medicine. The formulas I used for the three effective patients were all different, because the reasons these three patients developed rhinitis were also different. Today I have gathered their cases for everyone's reference.

It should be noted that I never met these three patients in person; my diagnosis was mainly through detailed online video consultation, rather than the traditional TCM four examinations, so none of these cases includes the patient's pulse.

Case One: Patient Liu, a "Ge Gen Tang pattern" patient.

Liu, female, born 1980, primary-school teacher; first video consultation on May 21, 2021.

A classmate of this patient had once come to me for treatment, so on the classmate's referral she also came to me for her rhinitis. The patient had had sinusitis for over ten years, especially severe every morning on waking, with a blocked nose; she said she felt much more comfortable when warm. Her mother was allergic. When the patient caught cold, her nose ran incessantly; in severe cases she would wake at night with mucus in her nose. In winter her hands and feet were ice-cold, and even in summer she felt cold. She did not sweat easily, sweating little even in summer; on the day of consultation she was still wearing a woolen vest. She felt her feet could not get warm. No dysmenorrhea, but arm numbness. Stools basically normal, though she had had constipation before. She liked hot drinks and could not drink cold water at all. Her shoulders and neck were stiff, and the back of her head felt uncomfortable.

The patient's symptoms closely resembled the Ge Gen Tang pattern in the Taiyang-disease chapter of the Shanghan Lun: aversion to cold, no sweating, and a stiff, tight neck and back. So although it was already summer in May, there was no need to be bound by old admonitions such as "do not use Ma Huang and Gui Zhi in spring and summer"; I could directly prescribe the acrid-warm surface-releasing Ge Gen Tang.

I therefore prescribed the original Ge Gen Tang formula: Gui Zhi (Cinnamon Twig) 15 g, Bai Shao (White Peony) 15 g, Ge Gen (Kudzu Root) 30 g, Ma Huang (Ephedra) 6 g, Zhi Gan Cao (Honey-fried Licorice) 10 g, fresh Sheng Jiang (Ginger) 7 slices, Da Zao (Jujube) 7 pieces; 3 doses, decocted in water, one dose daily, taken morning and evening.

One point should be noted: although I do not shy away from using Ge Gen Tang in summer, I did not use the Ma Huang at the proportion in the original formula but reduced it. Mainly out of concern that summer temperatures are high and a large Ma Huang dose could easily cause trouble, I was a bit more cautious.

After three doses the patient reported a very clear improvement in symptoms, but with palpitations and shortness of breath; she asked whether she should change the formula. I considered that using Ma Huang for a longer time in summer was, after all, not ideal, so I told her to remove the Ma Huang and take three more doses. After taking three more doses of Gui Zhi Jia Ge Gen Tang (i.e., Ge Gen Tang minus Ma Huang), she reported that symptoms still improved, though more slowly than before, and she still did not sweat. She asked whether I should adjust the prescription. I thought it over and decided to switch to Fu Ling Gui Zhu Gan Cao Tang for consolidation: Gui Zhi 30 g, Fu Ling 30 g, Bai Zhu 15 g, Zhi Gan Cao 10 g. Again I told her to take three doses at a time, decocted in water; if effective, take three more doses.

After six doses of Fu Ling Gui Zhu Gan Cao Tang, the patient told me that her rhinitis was basically cured, with almost no symptoms by day and much better at night than before, but that her stomach felt slightly uncomfortable after taking it. I therefore asked her to compare retrospectively the effects of Fu Ling Gui Zhu Gan Cao Tang and Gui Zhi Jia Ge Gen Tang to see which was better; she answered that Gui Zhi Jia Ge Gen Tang. So I had her continue with a few more doses of Gui Zhi Jia Ge Gen Tang for consolidation, stopping once symptoms disappeared.

Case Two: Patient Cheng, a "Ma Xing Shi Gan Tang pattern" patient.

Cheng, male, 53, from Hangzhou, Zhejiang; first online consultation on June 24, 2021.

The patient's chief complaint was severe rhinitis with chronic purulent bloody discharge for many years and difficult breathing; his recent condition was terrible and unbearable. On March 26, 2021, because of nosebleed, he had a spiral CT plain scan of the nasopharynx at the Fuyang District First People's Hospital in Hangzhou. Findings: hypertrophy of the left inferior turbinate with small patchy low-density shadows; high-density shadows in both maxillary and ethmoid sinuses; nothing abnormal otherwise. Diagnosed as bilateral maxillary and ethmoid sinusitis with left inferior turbinate hypertrophy. Western anti-inflammatory treatment for over a month had shown no improvement, and the patient hoped I would write a TCM prescription.

Through inquiry I learned the patient had smoked for years, with a dry mouth and thirst, drinking a large amount normally, yellow urine, and formed stools. He also frequently had mouth ulcers; after reading my articles earlier he had supplemented vitamins on the advice of one of my articles, and the ulcers had now improved. His complexion was dull yellow without luster; his tongue was red, moist, without coating, with teeth marks on the edges.

Based on the patient's detailed condition, I judged him to be a "Ma Xing Shi Gan Tang pattern" of exuberant lung heat. The Shanghan Lun records that Ma Xing Shi Gan Tang treats "no marked fever on the body, sweating and panting"; generally such conditions are chronic lesions caused by respiratory inflammation, without fever, with thirst, panting, and yellow urine.

I therefore prescribed modified Ma Xing Shi Gan Tang: Zhi Ma Huang (Honey-fried Ephedra) 6 g, raw Shi Gao (Gypsum) 30 g (decocted first for half an hour), Xing Ren (Apricot Kernel) 6 g, Zhi Gan Cao 6 g, and Bai Mao Gen (Imperata Root) 30 g. Three doses, decocted in water, taken morning and evening.

The first four herbs in this prescription are Ma Xing Shi Gan Tang. Why did I add Bai Mao Gen? Because this patient not only had a runny nose but also nosebleeds; Bai Mao Gen both clears lung heat and stops nosebleeds, so I added it, and at 30 g.

After three doses the patient told me he was about 90% better: the purulent blood was gone and his nasal cavity felt clear. He asked whether he should take three more doses to consolidate; I agreed.

Case Three: Patient Han, a "Chai Ge Jie Ji Tang plus E Bu Shi Cao pattern" patient.

Han, male, architectural designer, 39, from Tianjin; first online consultation on August 26, 2021.

The patient had had allergic rhinitis for 15 years, flaring up every year after the Start of Autumn. His family had asked me in June 2021 to write a prescription, but his rhinitis was not acting up then, so I suggested prescribing based on his specific symptoms after the Start of Autumn.

This patient had a clear watery nasal discharge, severe nasal obstruction, sneezing, head distending pain, dry itchy eyes, an irritable temper, difficulty falling asleep, and frequent waking at night due to breathing obstruction, after which he could not get back to sleep. Treated for years at a local hospital, he relied on Lianma nose drops and menthol nose drops to ease symptoms. He sometimes took Chinese medicine or saw an acupuncturist, but with unsatisfactory results. Because of business entertainment he often drank alcohol; his gut was easily irritated and he often had diarrhea for various reasons; his stools were usually unformed, slimy, and hard to flush. He feared heat, had a red tongue tip, a bitter mouth, and high uric acid.

I judged the patient's symptoms to be a "Chai Ge Jie Ji Tang" pattern. Chai Ge Jie Ji Tang presents with gradually lessening aversion to cold, increasing body heat, headache without sweating, eye pain and dry nose, irritability and insomnia, dry throat and deafness, and orbital pain. I therefore decided to use Chai Ge Jie Ji Tang.

Prescription: Chai Hu (Bupleurum) 12 g, Ge Gen 9 g, Gan Cao 3 g, Huang Qin (Scutellaria) 9 g, Qiang Huo (Notopterygium) 6 g, Bai Zhi (Angelica Dahurica) 6 g, Bai Shao 6 g, Jie Geng (Platycodon) 6 g, raw Shi Gao 12 g (decocted first for half an hour). Three doses, decocted in water, taken morning and evening.

After three doses the patient reported that his rhinitis symptoms had eased, but his eyes itched terribly. I therefore had him add E Bu Shi Cao (Centipeda) 10 g, Gu Jing Cao (Eriocaulon) 10 g, and Mu Zei (Equisetum) 10 g to the above, and take three more doses. E Bu Shi Cao is a common herb for allergic rhinitis; Gu Jing Cao and Mu Zei are common herbs for eye diseases.

After three more doses the patient said his symptoms had improved very markedly; he no longer needed nasal sprays, but his stomach felt a little off. During this period he had also drunk alcohol twice for work. Considering that E Bu Shi Cao is irritating, I told him to reduce it to 6 g and continue for five more doses.

Five days after the adjusted prescription, the patient's various symptoms had basically disappeared, and his years-long rhinitis seemed cured. His family asked for follow-up advice. The TCM principle is "stop once the disease is addressed" (i.e., stop medicine once cured), so I told him to stop and observe. I told him that if it recurred, taking the final formula would work again.

Although rhinitis is a minor ailment that cannot be compared with diseases like cancer, patients who have it still suffer greatly, especially those with years-long refractory cases. All three of these patients had long disease courses and had already tried many methods without effect.

I worked entirely according to the TCM "formula-pattern school" approach, closely focusing on "formula-pattern" (in plain terms, the indication for a formula). None of these patients could have their pulse taken, so there was no reliance on pulse diagnosis; I could instead focus purely on analyzing the patients' "formula-pattern."

The "formula-pattern" is objective—a diagnostic basis anyone can learn and master, uninfluenced by anyone's subjective consciousness, and having nothing to do with the esoteric yin-yang and five phases. Pulse diagnosis is subjective: for the same patient, different doctors feel different pulses, making it hard to use as a basis for clinical diagnosis. Professor Jiang Chunhua once secured national funding to carry out pulse-diagnosis research in Shanghai. To this end he specially assembled a group of Shanghai's most famous veteran TCM physicians to take pulses on different patients and write down their findings; agreement among them was under 15% (see Jiang Chunhua's TCM and Science). This shows that the accuracy of pulse diagnosis is very low; relying on it to treat disease easily misleads the doctor and delays the patient. But social prejudice is hard to change; most people's understanding of TCM still rests on the idea that TCM diagnoses by taking the pulse.

I therefore endorse Professor Hu Xishu's saying: "The formula-pattern is the highest level of pattern differentiation." If TCM is to improve its efficacy in treating disease, it must work on the objective "formula-pattern." The "formula-pattern" (formula indications) and "medication-pattern" (drug indications) are the hardest to remember and the easiest to forget; I study and review formulas and herbs every day, taking this as the key to guiding clinical treatment. Compared with TCM's yin-yang and five-phases theory, formula-pattern and medication-pattern are dry and dull, hard to learn and remember, so many people prefer to be lazy and are unwilling to chew this hard bone, which leads to poor TCM clinical results.

I am publishing my complete process of diagnosing and treating disease in the hope that the few young apprentices learning TCM from me, when grown and practicing clinically, will follow the "formula-pattern school" path of valuing objective bases for using formulas and herbs, rather than empty mystification.