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Allergic rhinitis is a very common condition. Its local cause is an excessive immune response of the nasal mucosa to specific allergens. Common symptoms include nasal congestion, runny nose (rhinorrhea), sneezing, and nasal itchiness. Sometimes it affects surrounding tissues, causing itchy eyes, itchy throat, and itchiness inside the ears. Severe nasal congestion can easily lead to hypoxia and dizziness, and it is sometimes easily mistaken for a common cold or eye allergies.

• Approximately 10% to 30% of the global population suffers from allergic rhinitis, reaching up to 40% in some regions. Its global prevalence has been continuously rising over the past few decades, especially in developed countries.
• The proportion of female patients is slightly higher than that of male patients, particularly in relation to hormonal fluctuations (such as menstrual cycles, pregnancy).
• It is more common in children and adolescents, significantly impacting academic performance and quality of life. Symptoms may lessen for some patients as they age. According to statistics from institutions like the Taiwan Asthma Health Education Association, the prevalence of allergic rhinitis in Taiwan is about 20% to 30%, and among elementary school children, it's approximately 30% to 50%, even higher in some areas.

The severity of symptoms is not necessarily proportional to the objective concentration of allergens and is also related to the sensitivity of the individual's immune system.

Allergic rhinitis is usually not a sign of a serious disease, but it can affect quality of life, sleep, and work efficiency in the long term.

Discoveries in Modern Medicine

Allergic rhinitis is primarily caused by the immune system's overreaction to certain environmental allergens, leading to the release of inflammatory mediators (such as histamine). Common pathogenic factors are as follows:

• Inhalant Allergens: Dust mites, cockroaches, pet dander, mold spores, pollen (seasonal). After these particles are inhaled into the nasal cavity, they stimulate the immune system to launch an attack.
• Air Pollution: Such as PM2.5, secondhand smoke, chemical volatile substances, which can damage the nasal mucosal barrier and exacerbate allergic reactions.
• Changes in Temperature and Humidity: Climate changes, large temperature differences, cold air, dry or overly humid environments can easily irritate the nasal mucosa.
• Genetic Predisposition: Individuals with a family history of allergic diseases (such as asthma, atopic dermatitis, allergic rhinitis) have a significantly higher risk of developing the condition.
• Food Allergies: A small number of patients' rhinitis symptoms may be related to specific foods (such as seafood, nuts, dairy products).
• Structural Problems: Such as deviated nasal septum, turbinate hypertrophy, which may make symptoms more pronounced.
• High stress, lack of sleep, and improper diet can easily worsen symptoms.
• The "Hygiene Hypothesis" suggests that overly clean environments in modern society reduce children's early exposure to microbes, leading to an imbalance in the immune system and making them more prone to developing allergic diseases.

Modern Medical Treatment

For mild to moderate allergic rhinitis, the following measures are usually effective in improving symptoms:

• Avoiding Allergens: Using anti-mite bedding, maintaining indoor humidity at 50%-60%, using air purifiers, avoiding contact with pets.
• Nasal Irrigation with Saline: Can clear allergens and mucus from the nasal cavity, relieving symptoms.
• Regular Exercise: Helps improve autonomic nervous system regulation and blood circulation in the nasal mucosa.
• Stress Management and Adequate Sleep: Can stabilize the immune system.

The following types of auxiliary medications can relieve symptoms:

• Antihistamines: Block the action of histamine, providing quick relief from sneezing, runny nose, and nasal itchiness. Available in oral and nasal spray forms.
• Nasal Corticosteroid Sprays: Locally suppress nasal inflammation. They are first-line treatment for moderate to severe persistent rhinitis and require continuous use for several days to weeks for significant effect.
• Decongestants: Quickly constrict blood vessels to relieve nasal congestion, but not suitable for long-term use as they may cause rhinitis medicamentosa.
• Mast Cell Stabilizers: Work preventively and need to be used before exposure to allergens; effect is relatively weak.

These medications primarily address the symptoms, and symptoms often recur after discontinuation.

If the above methods are ineffective, or when combined with other issues, the following treatments are considered:

• Immunotherapy (Desensitization Therapy): Gradually exposes the body to微量 amounts of allergens to induce immune tolerance. It is a therapy that may modify the allergic constitution, but the treatment course lasts for several years.
• Surgical Treatment: For patients with combined severe nasal structural abnormalities, such as inferior turbinate reduction, septomeatoplasty, to improve airflow.

The Systemic View of Traditional Chinese Medicine (TCM)

TCM believes the key to this disease lies in "Insufficient Healthy Qi, invasion of external pathogens." The Lungs govern Qi and open into the nose; the Spleen is the source of Qi and Blood production, nourishing Lung Qi; the Kidneys are the root of Qi, receiving and anchoring Qi. If the Lungs, Spleen, and Kidneys are weak, it leads to insecure defense, making the nasal orifice susceptible to invasion by external pathogens like wind-cold. Clinically, TCM formulates treatment plans by identifying the corresponding "Pattern (Zheng)," which is an analysis of the systemic pathological model of the disease. Here are several common patterns:

• Lung Qi Deficiency and Cold: Insufficient Lung Qi fails to effectively defend against external pathogens, allowing wind-cold to take advantage of the deficiency. Symptoms include intense nasal itchiness with continuous sneezing, clear runny nose, nasal congestion, aversion to wind and cold. Treatment focuses on warming the Lungs, dispersing cold, boosting Qi, and securing the exterior.
• Spleen Qi Weakness: Spleen deficiency fails to transform and transport the essence of food and water upwards to the Lungs, leading to Lung Qi deficiency as well, and internal retention of dampness. Symptoms include nasal congestion and runny nose, fatigue and lack of strength, poor appetite, soft stools. Treatment focuses on boosting Qi, strengthening the Spleen, resolving dampness, and unblocking the orifices.
• Kidney Yang Deficiency: Kidney Yang is the root of the body's Yang Qi. Kidney Yang deficiency fails to warm the Lungs and Spleen, leading to malnourishment of the nasal orifice. Symptoms include nasal congestion with clear discharge, aversion to cold and cold limbs, soreness and weakness of the lower back and knees, with symptoms worsening in the early morning or in cold conditions. Treatment focuses on warming and supplementing Kidney Yang, securing the Kidneys, and receiving Qi.
• Latent Heat in the Lung Channel: Some patients, due to constitution or excessive consumption of pungent and spicy foods, lead to accumulated heat in the Lungs. When affected by wind pathogens, it forms a pattern of external cold wrapping internal fire. Symptoms include nasal itchiness and sneezing, sticky or yellowish nasal discharge, dry mouth. Treatment focuses on clearing and dispersing Lung Heat, dispersing wind, and unblocking the orifices.

Clinically, these patterns often intermingle, such as the most common "Lung-Spleen Qi Deficiency" pattern, or the "Lung-Spleen-Kidney All Deficient" pattern resulting from prolonged illness affecting the Kidneys.

Acupuncture Treatment

Acupuncture is one of the characteristic therapies in TCM for treating allergic rhinitis. Its core concept lies in "dredging the meridians, harmonizing Qi and Blood, and supporting the healthy Qi to eliminate pathogens." TCM believes that the proper function of the nasal orifice is closely related to the smooth flow of Qi and Blood in multiple meridians within the body, especially the Hand Yangming Large Intestine Meridian, Foot Yangming Stomach Meridian, and the Governor Vessel.

During treatment, the TCM practitioner will select acupoints on different parts of the body for stimulation based on the patient's constitution and pattern. In addition to local points like Yingxiang (LI20) and Yintang (EX-HN3), distal limb points are more commonly combined, for example:

• Hegu (LI4) (hand), Zusanli (ST36) (leg): These two points are key points for regulating Qi and Blood, capable of enhancing overall resistance. They belong to the category of "treating the root."
• Lieque (LU7) (arm): Belongs to the Lung Meridian, can disperse Lung Qi and unblock the nasal orifice.

Through the combination of distal and local points, acupuncture can effectively regulate the imbalanced functions of the Zang-Fu organs, suppress excessive inflammatory reactions, thereby alleviating rhinitis symptoms.

In addition to traditional body acupuncture, the following methods are also commonly used in clinical practice:

• Moxibustion: For patients with a "Deficiency-Cold" constitution (usually feel cold, clear and thin nasal discharge like water), an ignited moxa stick is used to apply warmth over specific acupoints (such as Yintang (EX-HN3), Zusanli (ST36)). The warming effect of mugwort can effectively warm and unblock the meridians, dispel cold pathogens, and improve rhinitis symptoms caused by cold.
• Electroacupuncture: After inserting needles into the acupoints, an electroacupuncture device is connected to deliver a micro-current. This provides continuous and stable stimulation to the points, enhancing the effects of dredging and regulation.

Acupuncture treatment is usually recommended as a course, several times per week, lasting for several weeks. Its advantage lies in its ability to significantly and quickly relieve acute episodes of nasal congestion and runny nose. Long-term, regular treatment helps reduce the frequency and severity of attacks, fundamentally adjusting the allergic constitution.

TCM External Treatments

Clinically, patients with severe nasal congestion due to turbinate hypertrophy are often seen. The turbinates are structures protruding inside the nasal cavity; their function is to increase the contact area between the nasal cavity and air, allowing inhaled air to be filtered, warmed, and humidified by the nasal mucosa before entering the trachea and lungs. If long-term allergies cause repeated inflammation of the turbinates, leading to hypertrophy, edema, and even fibrosis, eventually blocking the entire nasal cavity, patients must breathe through their mouths, prone to hypoxia, dizziness, and poor concentration.

TCM external treatment involves applying Chinese medicinal sprays inside the nasal cavity to shrink the turbinates and clear the nasal orifice, which addresses the symptoms. It primarily targets patients with excessive turbinate hypertrophy, very severe nasal congestion, and poor response to internal medication. If surgery is not considered, trying TCM external treatment is an option.

This type of TCM external spray is made from medicinals with effects such as dispersing and unblocking orifices, reducing swelling and relieving pain, and softening hard masses and dissipating nodules. Sprayed into the nasal cavity, it can quickly penetrate the mucosa, promote local Qi and Blood circulation, eliminate congestion and edema of the nasal mucosa, dissolve fibrotic tissue, causing the swollen turbinates to shrink and relieving nasal congestion.

However, this type of spray primarily addresses the symptoms, helping to relieve severe nasal congestion. It does not address the root problems of the imbalance of Qi, Blood, Yin, and Yang within the body or the weakness of the Lung, Spleen, and Kidney Zang-Fu organs. It can be combined with internal Chinese medicinals, acupuncture, and other treatments to achieve long-term stability and improvement.

Acupressure

Massage the following acupoints. Press each point for 3-5 minutes until a sore, numb, or distended sensation is felt. This helps to disperse and unblock the nasal orifice and tonify the Lungs and Spleen.

• Yingxiang (LI20): Beside the midpoint of the lateral border of the nasal ala, in the nasolabial groove. Key point for directly benefiting and unblocking the nasal orifice.
• Yintang (EX-HN3): Midpoint between the eyebrows. Calms the spirit, awakens the brain, unblocks the nose, and opens the orifices.
• Hegu (LI4): On the back of the hand, between the 1st and 2nd metacarpal bones, at the midpoint of the radial side of the 2nd metacarpal bone. Yuan-Source point of the Hand Yangming Large Intestine Meridian. "For face and mouth, Hegu is used." It can regulate and smooth Qi and Blood in the head and face.
• Zusanli (ST36): 3 cun below the outer knee eye (Dubi ST35), one finger-breadth lateral to the tibia. Important point for strengthening and health preservation. Can strengthen the Spleen and benefit Qi, supplement Earth to generate Metal, and enhance immunity.
• Fengchi (GB20): On the nape, below the occipital bone, in the depression between the sternocleidomastoid muscle and the trapezius muscle. Important point for expelling wind, can resist the invasion of external pathogens.

Perform once in the morning and once in the evening daily. Persistence is key to seeing results.

Health Preservation and Wellness

• Avoid Wind and Cold:
  • Pay attention to keeping warm, especially the neck, head, and face. You can wear a mask in the morning to block cold air.
  • Avoid frequently moving between places with large temperature differences. In summer, the air conditioning temperature should not be set too low.
• Dietary Regulation:
  • Avoid icy drinks, cold beverages, and cold-nature foods (e.g., watermelon, dragon fruit) to prevent damaging Spleen and Stomach Yang Qi.
  • Consume moderate amounts of foods that warm and tonify the Lungs and Spleen, such as Chinese yam, Poria, pumpkin, ginger, red dates.
  • Those with Lung Heat should avoid pungent, spicy, grilled, and fried foods.
• Regular Exercise: Moderate aerobic exercise like brisk walking, jogging, and swimming can promote circulation, improve lung function, and stabilize the immune system.
• Acupoint Application (Sanfu Tie): During specific solar terms, apply warm medicinal patches to acupoints on the back to stimulate meridian Qi, warm Yang Qi, and prevent allergic attacks.

Summary

TCM views allergic rhinitis as a systemic issue of immune dysregulation, not just a problem of the nasal cavity itself. It is closely related to congenital constitution, postnatal care, emotional stress, and the external environment. Treatment starts by regulating the functions of Zang-Fu organs like the Lungs, Spleen, and Kidneys. Through the combination of Chinese medicinals, acupuncture, acupoint application, and health preservation practices, the aim is to support the body's Healthy Qi, balance the immune response, and fundamentally lower the allergic threshold of the nasal mucosa, achieving long-term stable results where even exposure to allergens does not easily trigger an attack.