rhinology ophthalmology and ent/notes/2. rhin… · •whitish nasal discharge: deficiency of the...

Rhinology

1. Lung

The lung opens into the nose. Naturally, the lung is closely related to the nose.

Invasion of the lung by exogenous pathogenic factors, heat in the lung meridian, or deficiency and cold of the lung qi may all give rise to such diseases as nasal obstruction, profuse nasal discharge and nasal polyp.

The nose relationships with Zang Fu

2. Stomach

The stomach meridian of foot-yangming passes beside the nose, and this meridian is the meridian of profuse blood and sufficient qi.

Therefore, if there exists heat in the stomach, it will rise to invade the nose along the course of stomach meridian of foot-yangming, resulting in fire-heat syndromes of the nasal region such as nasal bleeding, nasal furuncle and swelling.

3. Spleen

Physiologically, the spleen raises lucid yang and lowers the turbidity.

If this function fails, three possible situations may occur: if the spleen qi fails to keep blood circulating within blood vessels, nasal bleeding will appear; if there exists turbid dampness in the nose, profuse nasal discharge will occur; if phlegm and dampness accumulate, nasal polyp will be generated.

4. Gallbladder

The gallbladder meridian of foot-shaoyang distributes tortuously at the rear of the head.

Accordingly, TCM believes if heat affects the brain, it will give rise to yellow, profuse and turbid nasal discharge.

When the gallbladder transfers its heat to the brain, it will cause Bi yuan (rhinorrhea with turbid discharge). The patient suffering from Biyuan has running nose. Biyuan is similar to acute nasal sinusitis and chronic nasal sinusitis in western medicine.

5. Kidney

The kidney controls water metabolism and the five kinds of fluids.

Nasal discharge belongs to one of the five kinds of fluids.

yin deficiency of the kidney may see dry nasal cavity, even atrophy of mucosa, mostly seen in atrophic rhinitis;

yang deficiency of the kidney may see profuse thin nasal discharge, mostly seen in allergic rhinitis (anaphylactic rhinitis).

6. Heart

The heart controls mental activities. Therefore the Clinically, olfactory hallucination幻觉, or nervous anosmia may be cured by treating the heart meridian.

The heart controls blood circulation. Clinically, hypertrophic rhinitis may be cured by acting upon the heart meridian and promoting blood circulation to remove blood stasis.

The Relation with the Meridians

The meridians circulating in and around the nose are

Stomach Meridian of Foot-Yangming,

Large Intestine Meridian of Hand-Yangming,

Small Intestine Meridian of Hand-Tai yang,

Bladder Meridian of Foot-Taiyang,

Ren Meridian and

Du Meridian.

Differentiation of Symptoms and Signs

The common symptoms and signs diseases are

1. Nasal obstruction:

Mostly it is caused by unsmooth flow of Qi and blood in the nose.

2. Nasal discharge

Nasal discharge

In acute diseases: clear and watery: wind and cold

In chronic diseases: Qi deficiency in the lung and spleen or

Yang deficiency in the kidney.

Nasal discharge- colour

Whitish nasal discharge: deficiency of the lung Qi which fails to protect the surface, deficiency of the spleen in the transportation which causes ascension of turbid dampness.

Yellowish turbid nasal discharge is mostly caused by the mixture of heat in Zangfu organs with external pathogenic evils. Nasal discharge with blood is usually caused by the pathogenic dryness.

Yellowish and greenish thick nasal discharge is mostly due to deficiency and injury in the lung and spleen, and Yin deficiency in the lung and kidney, which causes flare-up of deficiency fire, resulting in accumulation of evils and heat-toxins.

Common Rhinologic Diseases

Acute Rhinitis

Acute rhinitis is a very common acute infectious inflammation happening in nasal mucosa.

In Chinese medicine, it is called "Shang Feng Bi Sai-Nasal Obstruction by Common Cold“.

Etiology and Pathogenesis

Wind, the causative factor of hundred diseases, often brings cold and heat to invade the lung system, attack the orifice of the nose, causing dysfunctions of the lung in clarifying and descending abilities, as well as nasal obstruction.

Acute Rhinitis

Clinical Manifestations

1. Nasal obstruction, obstructive nasal sound.

2. Watery nasal discharge, sneeze, constitutional discomfort.

3. About 7 to 10 days duration.

4. Congestion and swelling in mucosa of the nasal cavity, watery secretion in the nose.

Type and Treatment

(I) Wind-cold type

Symptoms and Signs: Nasal obstruction, watery nasal discharge, sneeze, slight congestion and severe swelling in nasal mucosa, buzzy sound in speaking,

accompanied by headache, aversion to cold, constitutional discomfort, slight red tongue, thin and white tongue coating, superficial and tense pulse.

Therapeutic Method, Expelling wind, dispersing cold and opening the orifice.

Treatment

1) Acupuncture:

LI 4 ,

Lu7 , GB 20 ,

Yin tang, Taiyang, LI20, Shang Ying Xiang.

The acupoints are punctured with strong stimulation and with the needles retained for 10 to 15 minutes.

Type and Treatment

(2) Wind-heat type

Symptoms and Signs: Nasal obstruction, tickling sensation in the nose, whitish tenacious or yellowish thick nasal discharge, redness and swelling in the nasal mucosa,

accompanied by fever, aversion to wind, headache, sore throat, thirst, red tongue, thin and yellow tongue coating, superficial and rapid pulse.

Therapeutic Method: Expelling wind and clarifying heat for opening the orifice .

Treatment

Acupuncture:

Yin tang, Taiyang, LI20

LI 4 ,

DU14, LU7, LI 11， GB 20 ,

The acupoints are punctured with strong stimulation and with the needles retained for 10 to 15 minutes.

Chronic Rhinitis

It refers to the condition in which pathogenic factor in nasal mucosa lingers and is unable to be expelled for a long time.

Etiology and Pathogenesis

It is related to Qi deficiency of the lung and spleen which fails to protect the body from being attacked by pathogenic factors, and which leaves the evils and toxins to linger in the body, resulting in accumulation of the evils in meridians and collaterals, stagnation of Qi and blood as well as nasal obstruction.

Chronic Rhinitis

Clinical Manifestations

1. Intermittent, alternative or continuous nasal obstruction.

2. Swelling or hypertrophy of nasal mucosa, which is as big as mulberry fruit and in dark-red colour, especially in inferior nasal concha.

3. Mucous excretion in nasal cavity, difficult to be blown out.

Type and Treatment

( 1) Qi deficiency of the lung and spleen, with lingering evils in the nose

Symptoms and Signs, Alternative or intermittent nasal obstruction aggravated by cold, scanty white nasal discharge,

accompanied by cough, thin sputum, poor appetite, loose stool, pale tongue, thin and white tongue coating, slow and feeble pulse.

Therapeutic Method, Nourishing the lung and spleen. Removing the evils and opening the orifice.

Treatment

(1) Acupuncture:

LI 20 , Yintang , DU 23 , BL 2

LI 4

ST36,UB13,UB20

The acupoints are punctured with the needles retained for 20 minutes, and one treatment is given every other day.

(2) Moxibustion: The acupoints are DU 26 . LI 20 , DU 16 , BL 13 , BL 20 , and ST 36 .

Type and Treatment

(2) Lingering evils, stagnation of Qi and blood stasis

Symptoms and Signs: Serious and continuous nasal obstruction. obstructive nasal sound,

accompanied by heavy sensation in the head, discomfort, dry throat, dark-red or purple tongue, thin and white tongue coating, and wiry and thready or hesitant pulse.

Therapeutic Method: Adjusting and harmonizing Qi and blood for removing stagnation and dispersing stasis.

Treatment

(1) Acupuncture:

LI 20 , Yintang , DU 23 , BL 2

LI 4, LV3,

SP10, UB17

The acupoints are punctured with the needles retained for 20 minutes, and one treatment is given every other day.

(2) Moxibustion: The acupoints are DU 26 . LI 20 , DU 16.

Allergic Rhinitis

It refers to allergic reaction of nasal mucosa stimulated by wind and cold evils (allergen) , clinically characterized by tickling sensation in the nose, sneeze, watery nasal discharge, sudden onset and disappearance.

Etiology and Pathogenesis

It is related to invasion of allergic evils which cause dysfunction of the lung in descending and dispersing abilities, and dysfunction of the kidney and Spleen in governing and accepting abilities, resulting in internal production of turbid dampness, accumulation of body fluid, lingering nasal discharge.

Clinical Manifestations

1. Tickling sensation in the nose, accompanied by tickling sensation in the eyes and throat, nasal obstruction.

2. Frequent sneeze, often over ten continuous sneezes one Time.

3. Nasal discharge, profuse watery secretion.

4. Rapid onset and disappearance. Reoccurance.

5. Slight red tongue, thin and white tongue coating, thready and feeble pulse.

6. Pale facial complexion, lassitude, shortness of breath, reluctance of speaking, or poor appetite, loose stool, aversion to cold, cold sensation in limbs, soreness in low back, frequent nocturnal urination.

Type and Treatment

1. Syndrome of wind and cold invading the lung

Main symptoms and signs: Short duration of onset, paroxysmal nasal itch and sneezing, clear and thin nasal discharge, nasal obstruction, or with cough, expectoration of sputum with whitish colour and aversion to wind, whitish nasal mucosa with edema, little reddish tongue with whitish thin fur, floating and tense pulse.

Therapeutic methods: Dispelling wind and descending the lung qi, expelling cold and removing obstruction of the orifice.

Treatment

(1) Acupuncture:

LI 20 , Yin Tang, Du23

GB 20 , LI 4, LU7.

Each time 2 to 3 acupoints are punctured, and the treatment is given once a day.

Type and Treatment

2. Syndrome of internal accumulation of heat in the lung

Main symptoms and signs: Repeated onset of nasal itch, sneezing, clear nasal discharge with scanty amount, nasal obstruction, dryness of the nasal cavity during the intermittent stage, thirst with inclination to drink, reddish complexion, reddish nasal mucosa with swelling, reddish tongue with whitish or yellowish fur as well as rapid pulse.

Therapeutic methods: Clearing away heat and descending the lung qi.

Treatment

(1) Acupuncture:

LI 20 , Yin Tang, Du23

LI 4 ,

LI11, LU5

Each time 2 to 3 acupoints are punctured, and the treatment is given once a day.

Type and Treatment

3. Syndrome of qi deficiency of the lung and spleen

Main symptoms and signs: Long duration of attack, repeated onset of nasal itch and sneezing, clear and profuse nasal discharge and nasal obstruction which occur or worsen after fatigue, or cough, expectoration, anorexia, loose stool, fatigue of limbs, little red tongue with whitish and thin or whitish and greasy fur, thready and weak pulse.

Therapeutic methods: Tonifying the lung and spleen, sending up yang to consolidate defensive qi.

Treatment (1) Acupuncture:

LI 20 , Yin Tang, Du23

LI 4 ,

BL 13 , BL 20, BL 23 .

Each time 2 to 3 acupoints are punctured, and the treatment is given once a day.

(2) Moxibustion: The acupoints are RN 6 and ST 36 .

Moxa-stick is applied above the selected acupoints till local skin feels warm.

Type and Treatment

4. Syndrome of yang deficiency of the kidney

Main symptoms and signs: Long duration of onset, paroxysmal nasal itch and sneezing, clear nasal discharge, nasal obstruction, anosmia,

aversion to cold, cold limbs, loose stool, frequent and profuse nocturnal urine, pale tongue with whitish fur, deep and thready pulse.

Therapeutic methods: Warming and strengthening the kidney yang, consolidating defensive qi and removing obstruction of the orifice.

Treatment

(1) Acupuncture:

LI 20 , Yin Tang, Du23

LI 4 ,

BL 13 , BL 23 .

Each time 2 to 3 acupoints are punctured, and the treatment is given once a day.

(2) Moxibustion: The acupoints are DU 23 , DU 4 , RN 6 and ST 36 .

Each time 2 to 3 acupoints are selected and one or two treatments are given a day.

Acute Sinusitis

It is a commonly-encountered acute inflammation in the mucosa of the nasal sinuses.

In Chinese medicine, it is called "Bi Yuan --Sinusitis".

Etiology and Pathogenesis

It is related to the pathogenic factors which invade and attack the human body and mix with the heat in the lung, spleen and gallbladder, ascending to the orifice of the nose, steaming and burning the muscular membrane of the nasal sinuses.

Clinical Manifestations

1. Decrease of smelling ability in the attack of nasal obstruction.

2. Profuse and purulent nasal discharge, at the initial time yellow and white thick nasal discharge, and then yellow, turbid and tenacious nasal discharge with stinking odour and difficulty to blow off.

3. There is painful sensation from the sinuses. Splitting headache or distension and discomfort in the head. Headache varies with the condition of sick sinuses, mostly appearing in the superficial skull in sinusitis of the anterior group of sinuses or in deep location in sinusitis of posterior group of sinuses. sinusitis of posterior group of sinuses.

Type and Treatment

( 1 ) Wind-heat

Symptoms and Signs, Nasal obstruction, profuse yellow and tenacious nasal discharge, hyposmia, pain in the forehead or temples,

fever, aversion to cold, slight red tongue, thin and yellow tongue coating, superficial and rapid pulse.

Therapeutic Method: Expelling wind and clarifying heat

Treatment

Acupuncture:

LI 20 ,Yintang , Taiyang ,

LI 4 ,

LU7, DU14, GB 20

Each time 2 to 3 acupoints are punctured and manipulated with strong stimulation, and the treatment is given once a day.

Type and Treatment

(2) Heat accumulation in the gallbladder

Symptoms and Signs: Nasal obstruction, yellow, tenacious and purulent nasal discharge, hyposmia, spliting headache, fever, bitter taste in the mouth, dry throat, blurring of vision, red tongue, yellow tongue coating, wiry and rapid pulse.

Therapeutic Method: Clarifying heat from the gallbladder for removing dampness and opening the orifice.

Treatment

Acupuncture:

LI 20 ,Yintang , Taiyang ,

LI 4 , GB 20 ,

GB34, GB43

Each time 2 to 3 acupoints are punctured and manipulated with strong stimulation, and the treatment is given once a day.

Type and Treatment

(3) Damp-heat in spleen meridian

Symptoms and Signs: Trickling yellow and turbid nasal discharge in a large volume, severe nasal obstruction. Anosmia, headache, heaviness on head,

distending sensation in abdomen, red tongue, yellow and greasy tongue coating, Slippery and rapid pulse.

Therapeutic Method, tonify the spleen and reducing heat for removing dampness and turbidity.

Treatment

(I) Acupuncture:

LI 20 ,Yintang , Taiyang ,

LI 4 , GB 20 ,

LI 11 and ST 36

Each time 2 to 3 acupoints are punctured and manipulated with strong stimulation, and the treatment is given once a day.

Chronic Sinusitis

It often develops from acute sinusitis, clinically characterized by lingering turbid nasal discharge.

It belongs to the category of "Bi Yuan --Sinusitis" in Chinese medicine.

Etiology and Pathogenesis

It is related to deficiency of the lung and spleen which fail to protect the surface and fail to expel pathogenic evils, resulting in unsmooth flow of Qi and blood in the nose, and dysfunction in fluid transportation and transformation, which in turn causes accumulation of pathogenic damp and turbidity in the nose, and hence decay as well as suppuration.

Clinical Manifestations

1. A large volume of lingering, sticking and white nasal discharge without smelly odour, decrease of smelling ability, severity of nasal obstruction, nasal obstruction relieved after blowing the nose and aggravated by exposure to wind and cold.

2. Pale tongue, thin and white tongue coating, soft and slow and feeble pulse.

3. Accompanied by dizziness, distending sensation in the head shortness of breath, lassitude, low voice, reluctance in speaking.

Type and Treatment

1. Syndrome of lung qi deficiency with cold

Main symptans and signs: Nasal discharge is whitish and greasy. Nasal obstruction is severe or mild, with hyposmia. Nasal obstruction and discharge worsen when the nose is stimulated by cold, etc.

The general symptoms include dizziness, cold body and limbs, short breath, fatigue and cough with sputum. The tongue is pale with whitish thin fur and the pulse is thready and weak.

Therapeutic methods: Warming and invigorating the lung qi, dispelling wind and dispersing cold.

Treatment

(1) Acupuncture

main acupoints :LI 20 , LI 4 , DU 23, DU 20

additional acupoints: BL 2 , Yintang , BL 7 ,GB 20 UB13,UB20

The treatment is given once a day. The main acupoints must be used in every treatment and the additional acupoints are chosen alternatively. All the acupoints are manipulated by tonifying technique, and with the needles retained for 10 to 15 minutes. Seven to ten days treatments are as one course.

(2) Moxibustion: It is supposed to DU 21 , LI 20 and DU 23

ST36, UB13

Type and Treatment 2. Syndrome of qi deficiency of the spleen

Main symptoms and signs: Nasal discharge is whitish, greasy and profuse, but free from foul odour. Nasal obstruction is severer with hyposmia.

The general symptoms include fatigue of limbs, poor appetite, abdominal distension, loose stool and sallow complexion.

The tongue is pale with whitish thin fur and the pulse is slow and weak.

Therapeutic methods: Strengthening the spleen and invigorating qi, removing dampness.

Treatment

(1) Acupuncture

main acupoints :LI 20 , LI 4 , DU 23 DU 20

additional acupoints: BL 2 , Yintang , BL 7 ,GB 20 UB13, UB20, ST36, Ren6

The treatment is given once a day. The main acupoints must be used in every treatment and the additional acupoints are chosen alternatively. All the acupoints are manipulated by tonifying technique, and with the needles retained for 10 to 15 minutes. Seven to ten days' treatments are as one course.

(2) Moxibustion: It is supposed to DU 21 , LI 20 and DU 23

ST36, SP6, SP9