Rhinitis

Rhinitis is a disorder that involves episodes of nasal congestion, inflammation of the nasal mucosa, watery nasal discharge, sneezing, and irritation of the conjunctiva, throat, and ala nasi. The nasal mucosa becomes hypersensitive and over-reactive to allergens such as pollen, grasses, dust mites, animal dander, fungal spores, and certain foods.

Causes

Allergic Type

The three main causes of allergies are constitutional instability of protective qi, lingering heat pathogen in the qi level, and constant creation of internal heat due to organ system dysfunction. These causes can lead to irritation and inflammation of the mucous membranes, resulting in allergy symptoms. The appropriate treatment approach depends on the specific cause, with the guiding principles being to treat the Lungs during acute episodes, vent the pathogen and restore damaged qi for lingering heat pathogen, and harmonize the Liver and Spleen and remove the source of heat for constant internal heat.

External Pathogens

There are several ways that external pathogens can cause rhinitis, the most common being the invasion of wind-cold or wind-heat that blocks the descent and diffusion of Lung qi. If this invasion is not properly treated, the pathogen can become trapped, causing a lingering pathogen in the qi level. This lingering pathogen can then irritate and dry the moist lining of the Lung organ system, making it hypersensitive to other inhaled stimuli. In some cases, exposure to environmental irritants can initiate a state that mimics a qi level pathogen, leading to chronic nasal congestion or a runny nose. The chronic itching and sneezing of rhinitis is caused by the persistent presence of external wind in the mucous membranes of the nose. This presentation of wind can remain in the nose for an extended period if protective qi is unable to expel it.

Constitutional Factors

A tendency to develop rhinitis can be inherited, and is characterized by deficiency of Lung and Kidney qi. This inherited weakness can lead to wind becoming embedded in the superficial tissues of the Lung organ system, causing a persistent low level response from the normal qi and hypersensitivity to stimuli such as dust and pollens. People with this inherited tendency may also experience wheezing and eczema. Kidney deficiency can also be acquired later in life due to factors such as age, habits, and other illnesses. In these cases, failure of the Kidneys to support Lung qi and the natural fluid cycle between them can lead to protective qi deficiency and enable a lingering pathogen to gain a foothold in the qi level. These mechanisms can lead to the development of rhinitis in middle-aged or older people with evidence of Kidney deficiency.

Emotional Factors

The factors that contribute to Liver qi constraint or heat/fire, such as stress, emotional repression, anger, and interference with natural cycles, can influence the Lung organ system through the reverse controlling cycle. In the context of rhinitis, the most important factor is heat generated by constraint, and its influence on the Spleen. This heat can dry out and irritate the nasal mucous membranes, while a weakened Spleen produces dampness and phlegm. A common feature of all varieties of Liver qi constraint type rhinitis is the provocation of nasal symptoms by emotional turmoil and stress.

Overwork, Exhaustion, Rumination

Overwork, exhaustion, excessive worry or mental activity, and sedentary habits can all deplete Lung and Spleen qi. This depletion can be caused by repeated upper respiratory tract infections, especially if they are treated with antibiotics that also weaken the Spleen. Poor posture, shallow breathing, lack of exercise, or excessive physical exertion can also compromise Lung qi. If Spleen qi is deficient, it cannot support Lung qi through the generating cycle.

Chronically weak Lungs can fail to send the appropriate amount of fluid to the Kidneys, leading to congestion in the nasal mucous membranes. Prolonged weakness of Lungs, Spleen, and Kidney yang qi can also disrupt fluid metabolism, causing pathological fluids to accumulate in the Lungs and block the descent of Lung qi.

Kidney function also plays a role in respiration. Kidney qi helps to anchor Lung qi during the respiratory cycle, and if Kidney qi is weak, the anchoring function is impaired and inspired qi can float upward. Kidney yin deficiency, which can be caused by persistent overwork, lack of sleep, or burning the candle at both ends, can generate heat that scorches and dries Lung yin.

Environment and Habits

A dry or desiccating environment, such as air-conditioned, dehumidified, or hermetically sealed buildings, can dry out the mucous membranes of the Lungs and damage Lung fluids and yin. On the other hand, a humid or damp environment can contribute to the accumulation of dampness and phlegm through direct exposure and by compromising Spleen function. Exposure to airborne irritants, such as pollens and other allergens, air pollution, volatile chemicals, perfumes, and fumes, can also contribute to acute and persistent rhinitis. Smoking any substance can damage the Lungs, with tobacco and marijuana being particularly toxic and hot. Habitual use of these substances can dry out and irritate the delicate, moist linings of the Lungs, leading to fluid and yin damage.

Diet

Irregular dietary habits or excessive consumption of cold, raw, or sweet foods weaken the Spleen and encourage the generation of phlegm, which in turn migrates and accumulates in the Lungs (the 'storehouse of phlegm'). Overeating stresses the digestive system, leading to inefficient digestion and buildup of phlegm and dampness, which can be expressed through the mucous membranes of the nasal passages. A diet rich in cheese and dairy, sugar and carbohydrates, meat, fatty foods, and alcohol directly introduces phlegm and heat in the body.

Treatment

There are three phases to consider when treating rhinitis:

1. During acute episodes with severe symptoms, treatment is aimed at managing symptoms without addressing the underlying constitutional pattern.
2. With moderate yet persistent symptoms, treatment focuses on managing symptoms by dispersing pathogens and addressing the constitutional pattern.
3. During remission from symptoms or before the allergy season begins, treatment focuses exclusively on correcting the underlying constitutional pattern.

The general rule of thumb is to "treat the Lungs during acute episodes and treat the Kidneys in between episodes." When symptoms are acute, herbal treatment and acupuncture may need to be administered multiple times a day, and treatment should continue between episodes to build up the constitution. This is particularly important in the months leading up to the allergy season. In cases of Kidney deficiency, there may be little in the way of typical Kidney symptoms, but the inferred Kidney yang deficiency will always be addressed with the addition of Kidney tonic herbs.