Posted in May 2010
The Acupuncture Treatment of Allergic Rhinitis
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 itchingis 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 open 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 her 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 byproduct 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 evilsback out of the body.
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 nondiffusion 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 nondiffusion 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° 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.
Nasal congestion is referred to as bi se in Chinese and is characterized by a feeling of difficulty breathing through the nose due to obstruction. Its disease causes and mechanisms also include wind cold external contraction and qi vacuity of the lungs and spleen. If wind cold invades the body, it will fetter the exterior and lead to nondiffusion of lung qi. As it is said, "The lungs open into the portal of the nose." With nondiffusion of the lung qi, wind cold may congest in the nose, causing blockage in the network vessels there, and give rise to nasal congestion. Simultaneously, qi vacuity may arise from chronic disease, taxation, overthinking, or dietary irregularity. Because "The lungs open into the nose," the free flow of air through the nose relies on harmonious lung qi. If the lung qi becomes vacuous, insecurity of defensive yang will exist, making the body susceptible to the invasion of external evils. When such external evils invade the body, the depuration of the lungs will be impaired and the invading evils may stagnate in the nose, leading to congestion there. Spleen qi is responsible for the upbearing of the clear qi and the downbearing of the turbid. If the spleen qi becomes vacuous, the clear qi cannot be upborne, while the turbid is not downborne. If the turbid stagnates in the nose and blocks the network vessels there, nasal congestion will occur. Once again, the signs and symptoms of wind cold are acute nasal congestion, accompanied by runny nose with clear mucous; sneezing; possible or no fever; aversion to cold; thin, white tongue fur; and a floating or floating, tight pulse. The therapeutic principles are to course wind, scatter cold, and free the flow of the portals of the nose.
In terms of acupuncture, yet again we have the important combination of Shang Xing (GV 23) and Ying Xiang (LI 20) to course wind and free the flow of the portals of the nose. Then Lie Que (Lu 7) can be combined with He Gu (LI 4) to further course wind and scatter cold, diffuse the lungs, and resolve the exterior. He Gu should be needled perpendicularly to a depth of 0.5–1.5 inches, depending on the size of the patient’s hand.
As we have seen above, Chinese doctors believe that everyone affected by all AR suffers from an external contraction of wind cold at the time of the attack, plus an underlying lung-spleen qi vacuity. However, Chinese doctors also believe that everyone with allergic rhinitis also suffers from deep-lying or hidden phlegm rheum. Hidden phlegm means phlegm that is ordinarily not seen. Nevertheless, given the right circumstances, this phlegm may become manifest, as in runny nose. Rheum is a particularly colorless, thin, watery kind of phlegm, exactly the kind of phlegm one sees in uncomplicated AR. It is said in Chinese medicine, "The spleen is the root of phlegm engenderment; the lungs are [merely] the place where phlegm is stored." This means that spleen qi vacuity is the root of the creation of phlegm in the body. The spleen governs the movement and transformation of water fluids in the body. If fluids collect, they transform into damp evils; and, if dampness endures, it congeals into phlegm. Therefore, to deal with the presence of hidden phlegm rheum in the lungs, one should also fortify the spleen and transform phlegm.
In terms of acupuncture, this can be done by needling the combination of Zhong Wan (CV 12) and Feng Long (St 40), especially when we have already needled Zu San Li. Zhong Wan is needled perpendicularly to a depth of 0.5–1 inches, while Feng Long is needled perpendicularly to a depth of 1–1.5 inches. Zhong Wan controls the qi of the entire middle burner, including that of the spleen. Therefore, needling Zhong Wan can supplement the spleen qi. Although Feng Long is on the stomach channel, the spleen and stomach channels form a unit wherein the spleen is yin to the stomach’s yang. By needling points on the stomach channel, we can send yang qi to the spleen to help supplement and fortify it. Feng Long is the network point on the stomach channel that specifically leads the qi to the spleen channel.
The kidneys are the former heaven root, the spleen is the latter heaven root, and former and latter heavens are mutually rooted and interdependent. Further, the lungs, spleen, and kidneys together are the three viscera that control the movement and transformation of water fluids in the body, and we have seen that phlegm is nothing other than a pathological accumulation of congealed fluids. We have already addressed the regulation and rectification of the lungs and spleen with the points suggested above. However, in some cases, such as pediatric allergic rhinitis, we should also supplement the kidneys and invigorate yang.
This can be done with moxa on Shen Shu (Bl 23), Ming Men (GV 4), and Guan Yuan (CV 4) with a moxa roll in that order. Shen Shu is the back transport point that flows directly to the kidneys, and Ming Men connects to the gate of life and the life-gate/ministerial fire. Guan Yuan connects with the source qi in the lower burner which is governed by the kidneys. Thus, moxaing these three points warms the kidneys, which helps move and transport water fluids on the one hand and support and bolster the spleen qi on the other.
Schedule of Treatment
The above treatment should be given once or even twice per day during acute allergic episodes. As the symptoms subside (which should be within 24 hours of the first treatment, if not immediately), treatments can then be tapered off to once or twice a week during allergy season as prevention. In addition, patients should generally be counseled to reduce or eliminate sugars and sweets; dairy products, such as milk, yogurt, cheese, and ice cream; and chilled drinks, especially with meals. In Chinese medicine, all these are believed to damage the spleen and create excessive phlegm fluids.
Honora Lee Wolfe, DiplAc, LicAc, FNAAOM
Honora Lee Wolfe, founding director at the Boulder College of Massage Therapy from 1976 to 1980, and went on to study Tui na massage at the Shanghai College of TCM. A licensed acupuncturist since 1988, Ms. Wolfe has taught at national and regional acupuncture colleges and conferences in North America and Europe and is the author or coauthor of several books, including, most recently, Western Physical Exam Skills for Practitioners of Asian Medicine.
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