Allergic rhinitis returning every spring
F, 27 years old. A 27-year-old woman with bouts of sneezing, watery nasal discharge and itching of the nose and eyes every spring since adolescence, with two months of continuous symptoms a year.
The patient
- Age and sex
- 27 years · F
- Chief complaint
- A 27-year-old woman with bouts of sneezing, watery nasal discharge and itching of the nose and eyes every spring since adolescence, with two months of continuous symptoms a year.
- Tongue
- Pale body with slight teeth marks and a thin, white, somewhat moist coating.
- Pulse
- Weak and slightly floating pulse, especially in the right Cun (寸) position.
Symptoms
- Bouts of ten or fifteen sneezes, especially on getting up
- Clear, copious, watery nasal discharge
- Itching of the nose, palate and eyes, with watering
- Congestion that alternates sides and worsens outdoors
- Spontaneous sweating with little effort and aversion to draughts
- Background tiredness through the symptomatic season
Warning signs to rule out
- Nasal obstruction always on the same side, repeated nosebleeds or one-sided facial pain. → ENT referral. Allergic rhinitis alternates sides; fixed obstruction requires looking at the structure.
- Wheezing, chest tightness or breathlessness during attacks. → Medical assessment: rhinitis and asthma share ground, and asthma needs its own treatment and its own rescue plan.
- Fever with purulent discharge lasting more than ten days, or improving and then worsening again. → Medical assessment for possible superimposed bacterial sinusitis.
Case resolution
Think through the pattern first, then expand the resolution
- Pattern
- Lung Qi Deficiency with insufficient Wei Qi and repeated Wind invasion
- Meridians involved
- Lung, Large Intestine, Spleen
- Pathogenic factors
- Wei Qi vacuity, External Wind, Cold-Damp
The Lung governs the nose and controls the Wei Qi, the defensive layer circulating under the skin. When that Qi is scarce, Wind enters again and again through the same door: hence the bouts of sneezing, the itching and the watery discharge, the reaction of a body expelling what it failed to keep out. Spontaneous sweating and aversion to draughts confirm the exterior is not consolidated. The key to this case is that the crisis is treated in spring, but the pattern is corrected in autumn.
Differential diagnosis
Shares: Sneezing, itching and nasal congestion.
Sets it apart: Wind-Heat gives thick yellowish discharge, red burning eyes, thirst and red tongue edges. Here the discharge is watery and the tongue pale: tonifying and warming is right in this case and counterproductive in the other.
Shares: Copious watery discharge, cold aversion and tiredness.
Sets it apart: When the root is the Kidney, symptoms occur year-round and worsen in winter, with a cold lower back, nocturia and a deep Chi (尺) pulse. Here the picture is seasonal and the pulse weak at Cun (寸): the axis is the Lung.
Shares: Persistent nasal congestion and head heaviness.
Sets it apart: Phlegm gives thick, sticky discharge, constant rather than alternating congestion, tenderness over the sinuses and a greasy coating. Here there is no sinus pain and the discharge is watery.
Treatment
Principle: During attacks, dispel Wind and open the nose. Out of season, tonify Lung and Spleen Qi and consolidate the Wei Qi.
| Point | Role | Technique |
|---|---|---|
| LI20 | Yingxiang: the local point of the nose, with immediate effect on obstruction. | Oblique upward 0.3-0.5 cun, without going deep. |
| EX-HN3 | Yintang: it calms the itching and clears the forehead, useful mid-sneezing bout. | Transverse downward 0.3-0.5 cun. |
| LU7 | Lung Luo and command point of the head: it releases the exterior and treats the nose from a distance. | Transverse toward the elbow 0.3-0.5 cun. |
| BL13 | Lung Back-Shu: the background point of the consolidation season, with moxa. | Oblique toward the spine 0.5 cun with moxa. Never deep perpendicular. |
| ST36 | Reinforces the Spleen so it produces the Qi the Lung distributes over the exterior. | Perpendicular 1-1.5 cun, tonifying with moxa. |
| GV14 | Meeting of the Yang channels: it reinforces defence at the upper back, where Wind enters. | Oblique upward 0.5 cun or ten minutes of moxa. |
Formula: Yu Ping Feng San. The formula for consolidating Wei Qi, for the symptom-free season. In full crisis with watery discharge and cold, Xiao Qing Long Tang resolves the episode far better.
- Frequency
- Two sessions weekly during the crisis and one weekly for eight weeks from late summer. The first year's aim is not disappearance but a shorter, milder season than the previous one.
Home care
- Saline nasal rinse on waking and on returning home.
- Cover the upper back and nape when going out on windy days.
- Moxa on BL13 and ST36 twice a week from September through spring.
- Shower and change of clothes on getting home during peak pollen days.
Progress
- Session 1 · April, mid-season Bouts of fifteen sneezes in the morning, a nose running all day and irritated eyes. Three weeks like this. LI20, Yintang and LU7 with reducing technique, plus saline rinses at home. No tonification yet: the external factor is active. Bouts drop from fifteen to five sneezes and the nose runs only in the morning.
- Session 6 · June, end of season Symptoms subside as the pollen season ends. Spontaneous sweating and draught aversion persist. It is explained that relief ends here and the real treatment begins, with an appointment set for September. The patient understands the plan and returns in autumn, the part almost nobody completes.
- Session 8 · September, out of season Asymptomatic, but with a pale tongue, a weak Cun (寸) pulse and sweating with little effort. The scheme changes completely: BL13 and ST36 with moxa, GV14, and Yu Ping Feng San for eight weeks. Spontaneous sweating disappears within a month and she gets through winter with a single cold.
- Session 16 · the following April The season starts three weeks later and with isolated sneezes instead of bouts. Four reinforcement sessions during the season and the autumn cycle is repeated. She cuts the season from two months to three weeks and keeps the antihistamine for peak days only.
- Discharge
- Treatment ends at the end of the second spring, not the first: the result is measured by comparing seasons, and one is not enough to know whether the terrain has changed.
- Watch for relapses
- Autumns when the consolidation cycle is skipped. The first sign that Wei Qi is low again is sweating with little effort, months before the first sneeze.
Health notice. Educational and study content. It describes concepts of Traditional Chinese Medicine and does not replace diagnosis or treatment by a healthcare professional. Needling, medicinal herbs and invasive techniques must be applied by trained professionals. Safety guide.
