Article Hayfever Chinese Medicine by mikeholy


									                                        Article #1
                               Hayfever & Chinese Medicine
                     by Bob Flaws, Dipl. Ac. & C.H., Lic. Ac., FNAAOM, FRCHM

Keywords: Chinese medicine, Chinese herbal                specific protein (e.g., a specific pollen grain) is
medicine, allergic rhinitis, hayfever                     inhaled into the nose, it can bind to the IgE on
                                                          the mast cells, leading to immediate and delayed
Western medicine & hayfever                               release of a number of mediators.

The technical name for hayfever is allergic               The mediators that are immediately released
rhinitis. Rhinitis is defined as inflammation of          include histamine, tryptase, chymase, kinins, and
the nasal membranes and is characterized by a             heparin. The mast cells quickly synthesize other
symptom complex that consists of any                      mediators, including leukotrienes and
combination of the following: sneezing, nasal             prostaglandin D2. These mediators, via various
congestion, nasal itching, and rhinorrhea. The            interactions, ultimately lead to the symptoms of
eyes, ears, sinuses, and throat can also be               rhinorrhea (i.e., nasal congestion, sneezing,
involved. Allergic rhinitis is the most common            itching, redness, tearing, swelling, ear pressure,
cause of rhinitis. It is an extremely common              and postnasal drip). Mucous glands are
condition, affecting approximately 20% of the             stimulated, leading to increased secretions.
American population or 40 million men, women,             Vascular permeability is increased, leading to
and children. While allergic rhinitis is not a            plasma exudation. Vasodilation occurs, leading
life_threatening condition, complications can             to congestion and pressure. Sensory nerves are
occur and the condition can significantly impair          stimulated, leading to sneezing and itching. All
quality of life. The total direct and indirect cost       of these events can occur in minutes. Hence, this
of allergic rhinitis has recently been estimated at       reaction is called the early or immediate phase
$5.3 billion per year in the U.S.                         of the reaction.

Pathophysiology:                                          Over 4_8 hours, these mediators, through a
                                                          complex interplay of events, lead to the
Allergic rhinitis involves inflammation of the            recruitment of other inflammatory cells to the
mucous membranes of the nose, eyes, eustachian            mucosa, such as neutrophils, eosinophils,
tubes, middle ear, sinuses, and pharynx. The              lymphocytes, and macrophages. This results in
nose invariably is involved, and the other organs         continued inflammation, termed the late_phase
are affected in certain individuals. Inflammation         response. The symptoms of the late_phase
of the mucous membranes is characterized by a             response are similar to those of the early phase
complex interaction of inflammatory mediators             but less sneezing and itching and more
but ultimately is triggered by an                         congestion and mucus production tend to occur.
immunoglobulin E (IgE)–mediated response to               The late phase may persist for hours or days.
an extrinsic protein. The tendency to develop             Systemic effects, including fatigue, sleepiness,
allergic, or IgE_mediated, reactions to extrinsic         and malaise, can occur from the inflammatory
allergens (proteins capable of causing an allergic        response. These symptoms often contribute to
reaction) has a genetic component. In                     impaired quality of life. Symptoms such as
susceptible individuals, exposure to certain              fatigue, drowsiness (due to the disease or to
foreign proteins leads to allergic sensitization,         medications), and malaise can lead to impaired
which is characterized by the production of               work and school performance, missed school or
specific IgE directed against these proteins. This        work days, and traffic accidents.
specific IgE coats the surface of mast cells
which are present in the nasal mucosa. When the
Complications:                                            Aberg and by the Australian National Health
                                                          Survey in 1989. By the turn of the 20th century,
A number of complications which can lead to               hayfever associations were being formed with
increased morbidity or even mortality can occur           thousands of members. More recently, hayfever
secondary to allergic rhinitis. These include             prevalence has continued to increase in line with
otitis media, eustachian tube dysfunction, acute          that seen for asthma.
sinusitis, and chronic sinusitis. Allergic rhinitis
can also be associated with a number of                   Types of allergens:
comorbid conditions, including asthma, atopic
dermatitis, and nasal polyps. Evidence now                Seasonal allergic rhinitis is commonly caused by
suggests that uncontrolled allergic rhinitis can          allergy to seasonal pollens and outdoor molds.
actually worsen the inflammation associated               Tree pollens, which vary by geographic location,
with asthma or atopic dermatitis.                         are typically present in high counts during the
                                                          spring, although
Epidemiology:                                             some species produce their pollens in the fall.
                                                          Common tree families associated with allergic
Allergic rhinitis occurs in persons of all races.         rhinitis include
Prevalence of allergic rhinitis seems to vary             birch, oak, maple, cedar, olive, and elm. Grass
among different populations and cultures, which           pollens also vary by geographic location. Most
may be due to genetic differences, geographic             of the common grass species are associated with
factors or environmental differences, or other            allergic rhinitis, including Kentucky bluegrass,
population_based factors. In childhood, allergic          orchard, redtop, timothy, vernal, meadow
rhinitis is more common in boys than in girls,            fescue, Bermuda, and perennial rye. A number
but in adulthood, the prevalence is                       of these grasses are cross_reactive, meaning that
approximately equal between men and women.                they have similar antigenic structures (i.e.,
Onset of allergic rhinitis is common in                   proteins recognized by specific IgE in allergic
childhood, adolescence, and early adult years,            sensitization). Consequently, a person who is
with a mean age of onset 8_11 years, but allergic         allergic to one species is also likely to be
rhinitis may occur in persons of any age. In 80%          sensitive to a number of other species. The grass
of cases, allergic rhinitis develops by age 20            pollens are most prominent from the late spring
years. The prevalence of allergic rhinitis has            through the fall but can be present year_round in
been reported to be as high as 40% in children,           warmer climates. Weed pollens also vary
subsequently decreasing with age. In the                  geographically. Many of the weeds, such as
geriatric population, rhinitis is less commonly           short ragweed, which is a common cause of
allergic in nature.                                       allergic rhinitis in much of the United States, are
                                                          most prominent in the late summer and fall.
Hayfever appears to be a recently developed               Other weed pollens are present year_round,
disease. Researchers in the late 1980s could find         particularly in warmer climates. Common weeds
no systematic reference to it earlier than the 16th       associated with allergic rhinitis include short
century, and until the 1830s, the only form               ragweed, western ragweed, pigweed, sage,
recognized was the “rose cold” or “rose fever.”           mugwort, yellowdock, sheep sorrel, English
By 1860, an anonymous writer cited by Salter              plantain, lamb's quarters, and Russian thistle.
commented on “...the more general and more
severe development of hay_fever which appears             Indoor and outdoor molds can also be allergens
to have recently occurred.” In a similar vein,            resulting in allergic rhinitis. Atmospheric
Blackley wrote in 1873 that “hay_fever                    conditions can affect the growth and dispersion
has...been considerably on the increase,” was             of a number of molds. Therefore, their airborne
most common among the educated and upper                  prevalence may vary depending on climate and
classes, and was uncommon among farm                      season. For example, Alternaria and
workers _ a pattern matching that found by                Cladosporium are particularly prevalent in the
                                  Article 1– Hayfever & Chinese Medicine

dry and windy conditions of the Great Plains             usually exposed. Sporadic allergic rhinitis can
states where they grow on grasses and grains.            also be due to pollens, molds, or indoor
Their dispersion often peaks on sunny                    allergens to which a person is not usually
afternoons. They are virtually absent when snow          exposed. While allergy to specific foods can
is on the ground in winter, and they peak in the         cause rhinitis, an individual affected by food
summer months and early fall. Aspergillus and            allergy also usually has some combination of
Penicillium can be found both outdoors and               gastrointestinal, skin, and lung involvement. In
indoors (particularly in humid households), with         this situation, the history findings usually
variable growth depending on the season or               suggest an association with a particular food.
climate. Their spores can also be dispersed in           Watery rhinorrhea occurring shortly after
dry conditions.                                          eating may be vasomotor (and not allergic) in
                                                         nature, mediated via the vagus nerve. (This often
Perennial allergic rhinitis is typically caused by       is called gustatory rhinitis.)
allergens within the home but can also be caused
by outdoor allergens that are present                    Occupational allergic rhinitis, which is caused
year_round. In warmer climates, grass pollens            by exposure to allergens in the workplace, can
can be present throughout the year. In some              be sporadic, seasonal, or perennial. People who
climates, individuals may be symptomatic due to          work near animals (e.g., veterinarians,
trees and grasses in the warmer months and               laboratory researchers, farm workers) might
molds and weeds in the winter. In the United             have episodic symptoms when exposed to
States, two major house dust mite species are            certain animals, daily symptoms while at the
associated with allergic rhinitis. These are             workplace, or even continual symptoms (which
Dermatophagoides farinae and                             can persist in the evenings and weekends with
Dermatophagoides pteronyssinus. These mites              severe sensitivity due to persistent late_phase
feed on organic material in households,                  inflammation). Some workers who may have
particularly the skin that is shed from humans           seasonal symptoms include farmers, agricultural
and pets. They can be found in carpets,                  workers (exposure to pollens, animals, mold
upholstered furniture, pillows, mattresses,              spores, and grains), and other outdoor workers.
comforters, and stuffed toys. While they thrive          Other significant occupational allergens that
in warmer temperatures and high humidity, they           may cause allergic rhinitis include wood dust,
can be found year_round in many households.              latex (due to inhalation of powder from gloves),
On the other hand, dust mites are rare in arid           acid anhydrides, glues, and psyllium (e.g.,
climates. Allergy to indoor pets is a common             nursing home workers who administer it as
cause of perennial allergic rhinitis. Cat and dog        medication).
allergies are encountered most commonly in
allergy practice, although allergy has been              Western medical diagnosis & treatment:
reported to occur with most of the furry animals
and birds that are kept as indoor pets. While            The Western medical diagnosis of allergic
cockroach allergy is most frequently considered          rhinitis is based on the patient’s history, their
a cause of asthma, particularly in the inner city,       presenting signs and symptoms, and allergy skin
it can also cause perennial allergic rhinitis in         tests (immediate hypersensitivity testing).
infested households. Rodent infestation may also         Sensitivity to virtually all of the allergens that
be associated with allergic sensitization.               cause allergic rhinitis can be determined with
                                                         skin testing. Total serum IgE is a measurement
Sporadic allergic rhinitis, intermittent brief           of the total level of IgE in the blood (regardless
episodes of allergic rhinitis, is caused by              of specificity). While patients with allergic
intermittent exposure to an allergen. Often, this        rhinitis are more likely to have an elevated total
is due to pets or animals to which a person is not       IgE level than the normal population, this test is
                                    Article 1– Hayfever & Chinese Medicine

neither sensitive nor specific for allergic rhinitis.       demonstrated to be as high as 80_90% for
As many as 50% of patients with allergic rhinitis           certain allergens. However, this is a long_term
have normal levels of total IgE, while 20% of               process. Noticeable improvement is often not
nonaffected individuals can have elevated total             observed for 6_12 months, and, if helpful,
IgE levels. Therefore, this test is generally not           therapy should be continued for 3_5 years.
used alone to establish the diagnosis of allergic           Further, immunotherapy is not without risk
rhinitis, but the results can be helpful in some            because severe systemic allergic reactions can
cases when combined with other factors. As                  sometimes occur. Therefore, it is not for
with the total serum IgE, an elevated eosinophil            everyone.
count supports the diagnosis of allergic rhinitis,
but it is neither sensitive nor specific for the            Chinese medicine & hayfever
diagnosis. However, the results of this test can
also sometimes be helpful when combined with                According to Chinese medical theory, everyone
other factors.                                              who suffers from allergic rhinitis has has a
                                                            defensive qi insecurity. In Chinese medicine, the
The Western medical management of allergic                  defensive qi protects the surface of the body
rhinitis consists of three categories of treatment,         from attack and invasion by various types of
1) environmental control measures and allergen              pathogens. When the defensive qi is sufficient,
avoidance, 2) pharmacological management, and               pathogens cannot enter the body to cause
3) immunotherapy. Environmental control                     disease. Therefore, the Nei Jing (Inner Classic),
measures and allergen avoidance involve both                the “bible” of Chinese medicine states, “If evil
the avoidance of known allergens (substances to             enter, the righteous must be deficient.” Unseen
which the patient has IgE_mediated                          airborne pathogens, such as pollen, molds,
hypersensitivity) and avoidance of nonspecific              dander, etc., are called wind evils. (Like wind,
or irritant triggers. Most cases of allergic rhinitis       they are invisible but their effect can be felt.) In
respond to pharmacotherapy. Patients with                   any group of people exposed to such wind evils,
intermittent symptoms are often treated                     only a percentage develop symptoms of disease.
adequately with oral antihistamines,                        These are the people whose defensive qi was
decongestants, or both as needed. Regular use of            deficient and insecure and, therefore, allowed
an intranasal steroid spray may be more                     the wind evils to penetrate. Wind evils typically
appropriate for patients with chronic symptoms.             enter the upper body through the mouth and
Daily use of an antihistamine, decongestant, or             nose. The nose is the orifice of the lungs, and
both can be considered either instead of or in              wind evils that enter the nose tend to lodge in
addition to nasal steroids. The newer,                      the lungs. When such wind evils lodge in the
second_generation (i.e., non-sedating)                      lungs, they prevent the lung qi or energy from
antihistamines are usually preferable to avoid              carrying out its normal physiological functions.
sedation and other adverse effects associated               The functions of the lung qi are to descend and
with the older, first_generation antihistamines.            downbear fluids in the body. Therefore, if wind
Ocular antihistamine drops (for eye symptoms),              evils, such as allergens, inhibit the lung qi from
intranasal antihistamine sprays,                            descending and downbearing fluids, these fluids
intranasal cromolyn, intranasal anticholinergic             may back up within the lungs, eventually to
sprays, and short courses of oral corticosteroids           spillover from the orifice of the nose in the form
(reserved for severe, acute episodes only) may              of mucous.
also provide relief. Immunotherapy (or
desensitization) consists of subcutaneous                   This tendency toward runny nose is complicated
high_dose allergy shots given with a                        by another given within Chinese medicine in
hypodermic needle for reducing symptoms and                 terms of allergic rhinitis. Everyone with allergic
the need for medication. Success rates have been            rhinitis has what is called deep-lying or hidden
                                  Article 1– Hayfever & Chinese Medicine

phlegm in their lungs. Hidden phlegm means               know, the amount of sweets, fats, and oils in the
that the phlegm is not apparent normally but             human diet have radically increased in the last
only becomes apparent when provoked by                   150 years. This is change in diet exactly
certain disease mechanisms. In Chinese                   parallels the rise in hayfever in the developed
medicine, there is a well-known statement of             nations of the world. To exacerbate matters,
fact: “The spleen is the root of phlegm                  excessive or inappropriate use of antibiotics can
engenderment; the lungs are the place where              also damage the Chinese idea of the spleen.
phlegm is stored.” This saying is further based          Similarly, overwork and too much stress can
on the fact that it is the Chinese concept of the        contribute to a general decrease in qi (including
spleen that is primarily responsible for the             defensive qi), while too little physical exercise
movement and transformation of water fluids in           may contribute to the accumulation of phlegm
the body. If, for any reason, the spleen becomes         and dampness. Here we have a picture of
vacuous and weak, it may fail to move and                modern life in the West. Therefore, it makes
transform water fluids. These water fluids               perfect sense in terms of Chinese medicine that
collect and transform into damp evils (i.e.,             hayfever and other related allergies seem to be
pathological dampness). If dampness lingers and          on the rise in the West.
endures, it may further congeal into phlegm.
Thus phlegm is then typically stored in the lungs        What can Chinese medicine do about this?
even though it is “produced” in the spleen. To
tie things together, the Chinese concept of the          In Chinese medicine, the treatment principles for
spleen is also responsible for the creation of the       eliminating allergic rhinitis are to 1) fortify the
defensive qi. This means that people with a              spleen and boost the qi, 2) dispel wind and
vacuous, weak spleen tends to have both a lot of         eliminate evils, and 3) transform phlegm and dry
phlegm dampness and a deficiency of defensive            dampness. These principles deal with the root
qi. Further, it is a statement in fact that              and branches of allergic rhinitis. Spleen qi
children’s spleens are inherently immature and           vacuity weakness is the root of this condition,
that their qi is weak and insufficient. This helps       while a defensive qi vacuity and deep-lying
explain why the prime incidence of allergic              phlegm are its branches. Within Chinese
rhinitis comes in the late childhood years and           medicine, there are many well-know herbs
early adolescence. It also helps explain why             which can accomplish these various aims. For
some people “outgrow” their allergies. As the            instance, Huang Qi (Radix Astragali
person’s spleen qi becomes stronger, their               Membranacei), Dang Shen (Radix Codonopsitis
defensive qi likewise becomes more secure and            Pilosulae), Bai Zhu (Rhizoma Atractylodis
they produce less phlegm and dampness.                   Macrocephalae), Fu Ling (Sclerotium Poriae
                                                         Cocos), Shan Yao (Radix Dioscoreae
This theory also helps to explain why hayfever           Oppositae), Wu Wei Zi (Fructus Schisandrae
is a relatively recent phenomenon in human               Chinensis), and Yi Yi Ren (Semen Coicis
medical history. According to Chinese medical            Lachryma-jobi) can fortify the spleen and boost
theory, because the spleen is the main organ in          the qi, while BaI Zhu (Rhizoma Atractylodis
charge of digestion, it is very greatly influenced       Macrocephalae), Cang Zhu (Rhizoma
by diet. In particular, the spleen is averse to          Atractylodis), Fu Ling (Sclerotium Poriae
dampness. This means that external or                    Cocos), Ze Xie (Rhizoma Alismatis), Jie Geng
environmental dampness may cause damage to               (Radix Platycodi Grandiflori), Ban Xia
spleen. However, dampness can also be                    (Rhizoma Pinelliae Ternatae), Qian Hu (Radix
internally engendered. Based on Chinese dietary          Peucedani), Gan Jiang (dry Rhizoma Zingiberis
theory, certain foods tend to engender fluids            Officinalis), Sheng Jiang (uncooked Rhizoma
more than other foods. Such foods tend to be             Zingiberis Officinalis), Chen Pi (Pericarpium
sweeter and also oilier. As most people today            Citri Reticulatae) can transform phlegm and
                                    Article 1– Hayfever & Chinese Medicine

eliminate dampness. Chinese herbs which can                above three classes of Chinese herbs. Within it,
dispel wind and eliminate evils include Jing Jie           Dang Shen, Huang Qi, Yi Yi Ren, Bai Zhu, and
Sui (Herba Seu Flos Schizonepetae Tenuifoliae),            Shan Yao supplement the lungs, spleen, and
Fang Feng (Radix Ledebouriellae Divaricatae),              kidneys, the three viscera which govern water
Chan Tui (Periostracum Cicadae), Xin Yi Hua                metabolism in the body. He Zi (Fructus
(Flos Magnoliae Lileflorae), Cang Er Zi                    Terminaliae Chebulae) and Wu Wei Zi secure the
(Fructus Xanthii Sibirici), and Bo He (Herba               lungs and specifically stop runny nose. Fang
Menthae Haplocalycis).                                     Feng and Jing Jie Sui relatively gently dispel
                                                           wind evils from the exterior while not damaging
When Chinese doctors use these kinds of                    the defensive qi. Xin Yi Hua and Bo He open the
medicinals to treat allergic rhinitis, they combine        orifices and free the flow of the nose, thus
them into multi-ingredient formulas. Such                  relieving nasal congestion. Chan Tui dispels
formulas can be further divided into two types:            wind and stops itching. Jie Geng guides the
formulas to prevent seasonal allergic rhinitis and         other medicinals to the lungs and also transforms
formulas to remedially treat during a paroxysmal           phlegm. Gan Jiang warms the lungs and
attack. For instance, Modified Astragalus &                transforms phlegm. The combination of Yi Yi
Ginseng is a Chinese herbal formula originally             Ren and Ze Xie seeps dampness via urination
created almost 1,000 years ago by the great                and, therefore, helps Bai Zhu eliminate
Chinese medical doctor Li Dong-yuan. When                  dampness. Gan Cao (Radix Glycyrrhizae
taken 4-6 weeks before the onset of seasonal               Uralensis) harmonizes all the other medicinals in
allergic rhinitis, it can help eliminate or decrease       the formula at the same time as helping fortify
such attacks. Within this formula, Huang Qi,               the spleen and supplement the qi. From the
Dang Shen, Bai Zhu, Cang Zhu, Wu Wei Zi, and               Western pharmacological point of view,
Da Zao (Fructus Zizyphi Jujubae ) fortify the              AllerEase regulates the immune system and is
spleen and boost the qi. Bai Zhu, Cang Zhu, Ban            antihistaminic, mucolytic, and decongestant.
Xia, Chen Pi, and Sheng Jiang transform
phlegm and eliminate dampness. In addition,                Research outcomes:
Huang Qi, Wu Wei Zi, Shan Zhu Yu, and Wu
Mei (Fructus Pruni Mume) specifically                      In China, 33 patients with wind cold allergic
supplement and secure the defensive qi, while              rhinitis and an underlying lung-spleen vacuity
Fang Feng gently out-thrusts any lingering wind            were given a single course of treatment with this
evils. Dang Gui (Radix Angelicae Sinensis),                formula and then followed for six months. In six
Chai Hu (Radix Bupleuri), Sheng Ma (Rhizoma                cases, their symptoms disappeared and did not
Cimicifugae), Huang Bai (Cortex Phellodendri),             recur for the full six months of the study. In 23
and Gan Cao (Radix Glycyrrhizae Uralensis)                 cases, their symptoms recurred after more than
help to harmonize the formula and insure that it           three months but less than six months. However,
regulates the immune system as a whole at the              repeat treatment was able to eliminate their
same time as being specifically antihistaminic             symptoms. Only four cases got no effect. Thus
and muycolytic. For instance, while this formula           the total effectiveness of this formula was
is decongestant and mucolytic, the inclusion of            87.8%.
Mai Men Dong and Dang Gui helps insure that
this formula will not cause dry mouth and                  Proper diet & lifestyle:
excessive thirst like many Western
decongestants.                                             As stated above, the rise in incidence in hayfever
                                                           is due to a combination of changed diet, too
AllerEase is a Chinese herbal formula which is             much stress and fatigue, and too little physical
specifically for the remedial treatment of acute           exercise. While Chinese herbs can go a long way
allergic rhinitis. It also contains a number of the        to redressing these disease-causing agents, the
                                   Article 1– Hayfever & Chinese Medicine

best therapeutic effects are achieved by a
combination of Chinese herbs and right diet and
lifestyle. Right diet typically means eliminating
or drastically reducing sugar and sweets,
including fruit juices, cutting out or seriously
cutting back on refined carbohydrates, eating
less dairy products, such as milk, yogurt, and
cheese, and consuming less fermented foods,
such as bread, cheese, vinegar, and alcohol. All
these foods very powerfully engender fluids in
the body and, therefore, have the potential, when
overeaten, of damaging the Chinese concept of
the spleen. Right lifestyle means getting plenty
of rest and avoiding unnecessary stress
coordinated with sufficient physical exercise.
Not only will such a diet and lifestyle help
eliminate allergic rhinitis, it will also help
reduce weight, lower cholesterol, and prevent
heart disease and diabetes with all of their many

Modified Astragalus & Ginseng and AllerEase
are available for sale in North American through
Imperial Secrets Herbs of Boulder, CO.

About Bob Flaws

Bob Flaws is one of the world’s premier
practitioners of and authorities on Chinese
medicine. Author and translator of almost 100
books and hundreds of articles, Bob trained at
the Shanghai College of Chinese Medicine and
has been in practice for 26 years. He regularly
lectures throughout the world to both students
and practitioners and is a contributing editor for
The Townsend Letter for Doctors & Patients..


To top