Two Recent Case Reports of Allergic Rhinitis Treated

Allergic rhinitis is common every spring and autumn, and patients around me come to me for treatment from time to time. Rhinitis may seem like the same disease, but careful history-taking shows that different patients' symptoms are not identical. According to the TCM principle of treatment based on pattern differentiation, patients with different clinical symptoms should not be treated with the same formula. Only when the symptoms match the formula's indications can one achieve immediate results; otherwise the effort is wasted. This article introduces the formulas used for two rhinitis patients, for readers' reference.

Case 1: A male child patient in Tianjin

This child is the son of the patient in my earlier article "Treating Northern Autumn Allergic Rhinitis with Modified Yunu Jian"; he is a school-age child.

His mother reported the following symptoms: sneezing, tearing, and nasal congestion after waking in the morning; severe nasal congestion at night, breathing through the mouth; easily waking around 4 a.m. from breathlessness and then finding it hard to fall back asleep; constipation; and a fear of heat. Rinsing the nose with saline at home had not worked well.

Analyzing these symptoms, this child falls under the TCM category of warm disease (lung-heat pattern), and the lung heat has already affected the large intestine, hence the constipation. TCM holds that the lung and large intestine are exterior-interiorly related, so this child is suited to Mahuang Xingren Shigao Gancao Tang, the representative TCM formula for exuberant lung heat; because the heat has reached the large-intestine channel, herbs that moisten the intestines, unblock the bowels, and drain interior heat must be added.

I therefore prescribed: Zhi Mahuang 3g, Xingren 3g, Zhi Gancao 3g, Sheng Shigao 15g (decoct first), Huomaren 15g.

The first four herbs are the original Mahuang Xingren Shigao Gancao Tang; the added Huomaren moistens the intestines and unblocks the bowels. After one dose, essentially all the above symptoms resolved. Following the TCM principle that once the disease is seven or eight parts gone, treatment should stop and the body's own immunity should handle the rest, I ended the treatment.

Of course, the parents may have the child continue taking the medicine later. But in principle, once the main symptoms are gone, one should encourage stopping the drug and let the body recover on its own; this is good for strengthening the immune system.

Case 2: A middle-aged female teacher of mine

This teacher teaches my pathology lab class and is about my age. Last semester I often heard the theory-course teachers mention that a colleague in their office had suffered from allergic rhinitis for years and could not shake it. At the time I was a bit surprised; rhinitis should not be that intractable, so why could it defeat a medical-school teacher? I thought that if she came to me for TCM treatment, I might achieve better results than Western medicine.

If you keep a thought in mind, a response will come. Last Thursday, introduced by the theory-course teacher, she came to me. She told me her rhinitis had flared this autumn: itchy nose all day, itchy eyes, incessant sneezing, dry mouth, nose, and throat, profuse sweating, worse on waking or after exposure to wind, sticky tears, no phlegm, but sleep unaffected. Urination and defecation were normal; although her mouth was dry, she did not drink much.

This teacher has had rhinitis for years, worst every autumn, and has never had allergen testing. By Western diagnosis, she has conjunctivitis and allergic rhinitis flaring together; she needs eye drops for conjunctivitis and antihistamines every day just to relieve symptoms and maintain a basically normal life.

These symptoms, in TCM, belong to the wind-heat pattern. It may have begun as wind-cold, but over the years the cold transformed into heat, yielding a wind-heat pattern. Treatment should use the acrid-cool exterior-releasing method; I decided to treat her with Gouteng-Bohe tea.

I prescribed: 3–5 slices of Bohe (mint), 3 sprigs of Gouteng (uncaria), steeped in boiling water as a tea; when the flavor fades, replace it, several times a day.

My teacher started last Friday. On the first day the eye itching improved markedly and she could stop the eye drops; the nasal symptoms also eased. Since the formula was effective, I did not change it, and she continued. Because her course is long and hard to cure quickly, she is currently still being treated with the Gouteng-Bohe tea.

These easily treated minor ailments respond very well when treated with small, well-matched TCM formulas, but they test the doctor's history-taking skill. The clearer the patient's chief complaint and the more detailed the doctor's inquiry, the better the formula can be matched. Once the right formula is found, Chinese medicine often produces results much faster than Western drugs.

Why can these two formulas treat rhinitis? I have only just begun studying Western pharmacology and am too inexperienced to explain it with modern pharmacology; I can only explain the therapeutic principle through TCM pattern differentiation.