The acupuncture treatment of allergic rhinitis

Townsend Letter for Doctors and Patients, May, 2006 by Honora Lee Wolfe

Keywords: Chinese medicine, acupuncture, allergic rhinitis

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Allergic rhinitis (AR) is defined as inflammation of the nasal membranes caused by an allergen such as pollen or animal dander. It is characterized by a complex of symptoms, consisting of any combination of the following: sneezing, nasal congestion, nasal itching, and runny nose. The eyes, ears, sinuses, and throat may also be involved. In Chinese medicine, nasal congestion, nasal itching, and runny nose are considered "diseases" in their own right. Therefore, to understand the acupuncture treatment of AR, one must first understand the Chinese medical disease causes, mechanisms, patterns, and treatment principles for each of these main clinical components of AR.

Nasal Itching

Nasal itching is referred to as bi yang in Chinese. This refers to an itching sensation inside the nose that calls for relief by scratching. Its disease causes and disease mechanisms are mainly wind and heat. Itching is more severe than pain when wind is predominant, while pain is more severe if heat is predominant. In the case of nasal itching associated with AR, there is a pattern of external contraction of wind cold taking advantage of an underlying lung-spleen qi vacuity. Based on the saying, "The lungs are connected with the skin and hair and opens into the nose," when there is lung vacuity, insecurity of the defensive exterior may result. Thus, wind evils may take advantage of this vacuity to invade the body. If this wind goes upward and harasses the portals of the lungs, itching may occur in the nose. The symptoms of lung vacuity, coupled with external contraction of wind, include paroxysmal itching in the nose, frequent sneezing, spontaneous perspiration, lack of strength, a drained white facial complexion, a pale tongue with thin fur, and a floating, weak pulse. The therapeutic principles for remedying this pattern are to supplement the lungs and course wind.

The main acupuncture points chosen for these purposes are Shang Xing (GV 23) and Ying Xiang (LI 20) to dispel wind to stop itching and Zu San Li (St 36) to fortify earth (spleen) to engender metal (lung) and secure the exterior and defensive qi. The tips of the needles should be pointed transversely upward toward the bridge of the nose at Ying Xiang to a depth of 0.5 inches. The needle at Shang Xing should be inserted transversely, pointing to the back of the head along the midline to a depth of 0.5-1 inches. Zu San Li should be punctured perpendicularly to a depth of 1-1.5 inches. According to five phase theory, earth is the mother of metal, the lungs correspond to metal, and the stomach corresponds to earth. Therefore, by supplementing a point on the stomach channel, we can supplement the qi in the lungs in a manner similar to that of a mother feeding its child. Further, the defensive qi, which in this case is weak and has allowed the invasion of external wind evils, issues from the middle burner. In Chinese medicine, this means that it is a by-product of the process of digestion governed by the spleen and stomach. By supplementing the stomach qi at Zu San Li, we also supplement the defensive qi, which then secures the exterior to prevent further invasion. In addition, supplementing the stomach qi also supplements the righteous qi, which then becomes powerful enough to thrust the already contracted wind evils back out of the body.

Runny Nose

Runny nose or rhinorrhea is called bi liu ti in Chinese and refers to the discharge of excessive mucous secretions from the nose. Although runny nose can be due to several different disease causes and mechanisms in Chinese medicine, when it occurs as a symptom of allergic rhinitis, runny nose is also due to wind cold invading the lungs. If wind cold invades the body, this will fetter the exterior and lead to non-diffusion of the lungs. This is based on the sayings, "The lungs govern the skin and hair" and "The lungs open into the nose." If there is non-diffusion of the lungs, the qi mechanism will not flow freely in the nose, and thus the flow of qi and blood and fluids will be inhibited there. Hence, there is runny nose. Signs and symptoms of this pattern of runny nose include profuse, clear discharge from the nose accompanied by nasal congestion, frequent sneezing, possible fever or no fever, aversion to wind and cold, headache, cough, absence of sweating, a pale red tongue with thin, white fur, and a floating, tight pulse. In this case, the therapeutic principles are to resolve the exterior, course wind, and scatter cold.

The main acupuncture points chosen for these purposes are again Shang Xing (GV 23) and Ying Xiang (LI 20). Together, these points diffuse and unblock the portals of the nose. Moxibustion can also be used on Shang Xing since this is a wind cold pattern and the addition of heat warms the affected channels and scatters the cold. In addition, one can use Feng Men (Bl 12) and Lie Que (Lu 7). Together, these points course wind, resolve the exterior, and promote the diffusion and downbearing of the lung qi. Feng Men should be needled with the point of the needles angled inward to the spinal column at a 45 degree angle and to a depth of 0.5-1 inches. Lie Que should be needled transversely from distal to proximal upward along the medial edge of the forearm.