Allergic rhinitis (AR) is a hypersensitivity disorder characterized by symptoms such as sneezing, nasal congestion, nasal itching, and rhinorrhea. These common clinical manifestations of allergic rhinitis are often accompanied by itchy eyes, conjunctival hyperemia, coughing, and sputum production. The characteristic triad of allergic rhinitis includes allergic crease, allergic salute, and allergic shiners. Common allergens and triggering factors include pollen, dust mites, animal dander, smoke, food, and temperature changes. This condition is mediated by immunoglobulin E (IgE) and induces allergic inflammation in the nasal mucosa through T-helper 2 (Th2) cells. The imbalance between Th1 and Th2 immunity has long been recognized as a classical pathogenic mechanism of allergic rhinitis.
The allergic reaction can be divided into two phases: the early phase and the late phase. The early phase occurs within 5–10 minutes after initial exposure to an allergen. The allergen stimulates plasma cells to produce IgE antibodies, which bind to receptors on the surface of mast cells, leading to mast cell degranulation and the release of histamines, leukotrienes, and prostaglandins. This results in inflammation of the nasal mucosa, manifesting as nasal congestion and rhinorrhea. In the late phase, cytokines such as IL-4 and IL-3 promote the infiltration of eosinophils, basophils, and lymphocytes into the nasal mucosa, prolonging the inflammatory response and leading to persistent nasal congestion.
First-line treatments in Western medicine include intranasal corticosteroids (e.g., mometasone furoate), oral or intranasal antihistamines (e.g., cetirizine), and oral leukotriene receptor antagonists (e.g., montelukast).
In Traditional Chinese Medicine (TCM), allergic rhinitis falls under the category of “Bi Qiu” . The primary clinical manifestations include sudden and recurrent sneezing, nasal itching, and clear nasal discharge. The etiology involves both internal and external factors. Internal factors include organ deficiencies, insufficiency of vital Qi, and weakness of the body’s defense system, primarily involving the lungs, spleen, and kidneys. External factors include exposure to wind-cold pathogens, excessive heat, and climatic changes.
According to the Twelfth Five-Year Plan Textbook of TCM Otolaryngology, allergic rhinitis can be classified into four syndromes:
1. Lung Qi Deficiency with Cold – Treatment: Warming the lungs, tonifying Qi, dispelling wind, and dispersing cold. Representative prescription: Modified Xiao Qing Long Tang.
2. Lung Heat Accumulation – Treatment: Clearing and ventilating lung Qi, unblocking nasal passages. Representative prescription: Modified Xin Yi Qing Fei Yin.
3. Spleen Qi Deficiency – Treatment: Strengthening the spleen, tonifying Qi, uplifting Yang, and unblocking nasal passages. Representative prescription: Modified Bu Zhong Yi Qi Tang.
4. Kidney Yang Deficiency – Treatment: Warming and tonifying kidney Yang, consolidating the kidneys, and promoting Qi intake. Representative prescription: Modified Jin Gui Shen Qi Wan.
Common external TCM therapies for allergic rhinitis include pediatric tuina, acupuncture, moxibustion, acupoint application therapy, auricular acupressure, herbal nasal drops and powders, and herbal nasal rinses. Clinical studies suggest that integrative treatment combining Western medicine (e.g., antihistamines) with acupuncture, herbal medicine, and pediatric tuina can improve symptoms, enhance patients’ quality of life, and reduce recurrence rates. One clinical study compared integrated therapy (pediatric tuina combined with cetirizine) with western medicine alone in treating pediatric allergic rhinitis. The results showed that the integrated approach was more effective in alleviating symptoms and preventing recurrence.
A meta-analysis also indicated that herbal medicine was as effective as antihistamines and corticosteroid sprays, with integrated therapy yielding better outcomes than Western medicine alone. This suggests that herbal medicine may enhance the efficacy of Western treatments. Furthermore, an animal study investigated the effects and mechanisms of a modified Yu Ping Feng San nasal spray in mice. Results showed that the herbal spray and mometasone furoate spray both effectively alleviated nasal symptoms. The modified Yu Ping Feng San reduced IgE production and modulated the IFN-γ/IL-4 ratio, affecting the Th1/Th2 balance and reducing inflammation, producing effects similar to those of Western medicine.
Despite these promising findings, the clinical studies mentioned have limitations, such as the absence of placebo-controlled or comparative studies and the lack of long-term follow-up evaluations. Additionally, the meta-analysis focused only on integrative treatment, making it difficult to determine the standalone efficacy of herbal medicine. Whether TCM alone can fully replace Western medicine remains unclear. Overall, more comprehensive research is needed on integrative treatment for allergic rhinitis, particularly regarding its long-term efficacy and safety.

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