In TCM, there is no overarching disease category for allergies as we understand them in the west. Rather, the clinical manifestations relating to allergies are essentially seen as an imbalance in the body’s energies (qi).
Understanding allergies
Allergies involve an excessive immune response to normally harmless substances such as pollen, dust mites, pet hair, mould and certain food and drugs. Hayfever (allergic rhinitis) is perhaps the best known of these conditions, with around 49% of people in the UK reporting symptoms in a 2020 study. Other allergies include skin allergies, asthma and food allergies. As a disease category, they are the most common chronic disease in Europe and, globally, appear to be on the rise (1).
Traditional Chinese Medicine (TCM) has a long history of treating allergic conditions and seeks to both provide symptomatic relief and correct underlying causative factors.
How do allergies work in TCM?
In 1911, Austrian scientist, Clemens von Pirquet, named this heightened immune response ‘allergy’; allos being Greek for ‘altered’ and ergeai meaning‘energy’ (2). As it happens, this is an apt description of the TCM perspective of allergies. In TCM, there is no overarching disease category for allergies as we understand them in the west. Rather, the clinical manifestations relating to allergies are essentially seen as an imbalance in the body’s energies (qi).
Perhaps the most prominent TCM allergy pattern is that of deficient defensive qi (wei qi). Circulating beneath the skin, our defensive qi forms our immunity to the external environment. It originates from a combination of Kidney qi (constitutional energy), Lung qi (energy from respiration) and Spleen qi (digestive energy). If any of these pivotal energies are weak, our wei qi is compromised and fails to provide the exterior defence needed to repel external pathogens (allergens) (3).
Allergens typically fall in to the category of external wind; the external pathogen which enters the body most readily (often combined with another factor eg. wind cold), is at its most prevalent in Spring and, like the wind itself, is moving and changeable in nature, often appearing with speed. Acute hives (urticaria) – an allergic skin reaction – illustrate this concept pointedly both in their nature – the sudden eruption of raised, itchy welts – and TCM name; ‘feng zhen’ (‘wind rash’) (4).
At the most superficial level, wei qi deficiency can result in such skin allergies. Here, weakened wei qi allows penetration of the skin by ‘toxins’ and the resultant battle between our qi and the pathogenic factor generates heat and dampness which accumulates in the skin in the form of lesions (4).
Going a little deeper, allergic rhinitis results when external pathogens penetrate the mucous membranes of the nose and throat and lodge, causing irritation and inflammation and disrupting the proper flow of lung qi in the nose causing sneezing (3).
Further still, weak wei qi allows wind to enter the lungs causing inflammation, the constriction of airways and disruption of the descending function of the lungs resulting in cough and wheeze, i.e. allergic asthma.
Food allergies arise from a weakness in our digestive energy, governed in TCM primarily by our Spleen and Stomach functions and fired by our Kidney qi.
In addition to deficiencies, allergies often occur against a backdrop of pre-existing excess in the body, making these conditions both more likely and severe. These ‘internal excesses’ are what TCM describes as pathogenic factors. Wind, heat, dampness, phlegm and dryness often feature in allergic conditions. These can be external or internal in origin, determine the symptom expression of the allergy, stem from a variety of sources to create an intolerant constitution and hypersensitivities which are then triggered by ordinarily harmless substances. Retained heat in the body, for example, may be likened to chronic low-grade inflammation stemming from the Th2-dominant immune milieu common to atopic individuals. (5)
Understanding the root
Constitution
There is often a family history of allergies in individual allergy sufferers. This fits with the TCM view that our inherited constitution (ie. Kidney qi) greatly impacts the likelihood of experiencing allergies.
Lung qi deficiency
This can be due to many factors including aninherited constitutional weakness of the Lungs, previous respiratory illness, a sedentary lifestyle, over-exercising, poor posture leading to shallow breathing, smoking, air pollution, stress and unresolved grief.
Spleen qi deficiency
Spleen qi is weakened in particular by stress, over-thinking, poor eating habits (ie. eating on the run/ at the desk) and by a damp diet; one that features excessive dairy, cold, raw, greasy, sweetened foods, alcohol, antibiotics and (for some) wheat. Children have underdeveloped digestive energy and are, therefore, especially sensitive to damp diets and prone to the development of dampness and allergies.
Signs and symptoms
Allergic rhinitis
Typical symptoms of allergic rhinitis – blocked nose, nasal discharge, sneezing – will be accompanied by the following patterns:
Wind: Acute rhinitis with cold (nasal discharge will be thin and clear) or heat (thick, yellow/green discharge, red itchy eyes, thirst). Responds well to treatment.
Kidney qi deficiency: Chronic rhinitis. As it is often a constitutional deficiency, is typically present from childhood. Symptoms worse following sex and when overworked as these deplete Kidney qi. Accompanying symptoms may include typical Kidney deficiency symptoms such as weak and sore knees and lower back, low libido and premature aging and/ or signs of Kidney yin deficiency (eg. nightsweats, dry mouth at night, red tongue) or yang deficiency (eg. cold lower back, profuse, clear urination, pale tongue). Treatment of this pattern will require time and dedication as Kidney qi is our core energy and not easily replenished.
Lung qi deficiency: Recurrent episodes of hayfever, frequent colds, shortness of breath, possible accompanying asthma.
Lung and Spleen qi deficiency with Phlegm: Recurrent hayfever with copious mucus, foggy head, fatigue, poor appetite, loose stools, swollen tongue with teeth marks (3).
Skin allergies
Allergic skin reactions such as eczema (atopic dermatitis), contact dermatitis and urticaria (hives) can cause itching, burning, redness, bumps and swelling. Generally speaking, in TCM the level of heat present relates to the level of inflammation and redness, dampness to swelling and oozing, wind to itching and dryness to dryness and scaling (4).
Food allergies
The characteristic symptoms of food allergy flare-ups – itchy mouth, hives, swollen face, mouth and throat, difficulty swallowing, wheezing or shortness of breath, dizziness, nausea or vomiting, abdominal pain or diarrhoea, hay fever-like symptoms and possible anaphylaxis (severe allergic reaction and medical emergency) – may be accompanied by the following pre-existing patterns:
Spleen qi deficiency: Frequent loose stools,poor appetite, fatigue. This pattern is particularly common in children.
Spleen yang deficiency: As per Spleen qi deficiency with cold signs, eg. cold intolerance, lower abdomen that is cold to the touch, abdominal pain alleviated by warmth, nausea or vomiting better for warm foods, undigested food in stools. (6)
Herbal solutions
TCM formulae used in the treatment of allergies are many and varied, depending on the condition, presenting symptoms and underlying imbalance. However, some commonly used herbs and formulas include:
Allergic rhinitis
huang qi (Astragalus membranaceus, Astragalus root): adaptogen, diuretic, anhydrotic (stops sweating), antiviral, antioxidant. Animportant immune-booster and Lung tonic, huang qi fortifies qi and defensive qi and enhances digestion, thereby addressing the primary underlying causes of allergic rhinitis. Along with xin yin hua and cang er zi, these are the three most common herbs found in TCM formulae for hayfever (7,8).
xin yi hua (Magnolia liliflora, Magnolia flower): diaphoretic, decongestant, expectorant, aromatic stimulant. A primary herb for unblocking the nasal passages in all varieties of patterns, xin yi hua also ‘releases the exterior’ making it appropriate for externally-contracted wind conditions (7,9). May also be used as a nasal rinse (3).
cang er zi (Xanthium sibiricum, Xanthium fruit): analgesic, anti-inflammatory, antibacterial, stimulant. Slightly toxic and drying, cang er zi shares the functions of xin yi hua but also dries dampness and, therefore, nasal discharge and alleviates sinus headache (7,9).
Yu Ping Feng San (Jade Windscreen Powder): huang qi (Astragalus membranaceus, Astragalus root), bai zhu (Atractylodes macrocephala, white Atractylodes), fang feng (Ledebouriella divaricata, Siler). Creating a ‘screen’ against the wind, as the title suggests, this is a popular formula to tonify defensive qi. Bai zhu strengthens digestion, thus, defensive qi and fang feng (‘guard against wind’), releases the exterior. It is ideally used as a preventative formula against allergic rhinitis to build up the Lungs and immunity. In the case of perennial rhinitis, it may be used in between episodes and for seasonal allergic rhinitis, it is best taken over a period of several months in the lead up to allergy season. When taken for symptomatic relief, it is often combined with Cang Er Zi San (Xanthium Powder)(cang er zi, xin yi hua, bai zhi (Apiaceae dahurica, Angelica root), bo he (Mentha haplocalyx, Mint)). (7,10)
Skin allergies
Common TCM treatment strategies for skin allergies involve clearing damp, heat and wind with herbs such as jin yin hua (Lonicera japonica, Honeysuckle), fang feng (Ledebouriella divaricata, Siler) and ku shen (Sophora flavescens, Sophora root). Chronic conditions may also require the nourishing of Blood and dryness with herbs such as dang gui (Angelica sinensis, Chinese angelica root).
External application of herbs is also an important component of TCM dermatology. San Huang Xi Ji (Three Yellow Wash) – a wash applied twice daily until symptoms subside – is a popular formula for contact dermatitis, containing the three huangs; da huang (Rheum palmatum, Rhubarb), huang bai (Phellodendron amurense, Phellodendron) and huang qin (Scutellaria baicalensis, Scutellaria root). (4)
Food allergies
Wu Mei Wan (Mume Pill), a TCM formula traditionally used to treat intestinal parasites, chronic diarrhea and dysenteric disorders, is the basis of FAHF-2 (Food Allergy Herbal Formula – 2), a novel TCM formula involved in a number of promising clinical trials, some of which approved by the US FDA. FAHF-2 utilises the internal-warming properties of Wu Mei Wan (minus two of the toxic herbs) and combines this with the immunomodulatory, anti-inflammatory and anti-allergy properties of addition, ling zhi (Ganoderma Lucidum, Reishi mushroom) (11). It “has been shown to be highly effective in providing long-term protection against peanut-induced anaphylaxis, with a high safety margin” (12).
Holistic solutions
- Acupuncture: Acupuncture is an important adjunctive treatment to TCM for the treatment of allergies for its immunomodulatory, anti-inflammatory and analgesic properties (13,14).
- Strengthen the Lungs: For tips on optimising lung health see Respiratory health: A Traditional Chinese Medicine perspective, Respiratory health: An Ayurvedic perspective and Keeping your lungs healthy
- Strengthen the Spleen: Adopt healthy eating habits including relaxing while eating and eating slowly and adopting a diet low in damp-forming foods.
- Incorporate relaxation techniques in to your everyday life
- Skin allergies: During an outbreak avoid damp or ‘heating’ foods (eg. spicy foods, lamb, shellfish, duck, alcohol, chocolate, caffeine) (4).
- Hayfever: Daily nasal flushing with warm salty water clears and strengthens the mucous membranes of the nose and sinuses. Powdered gan jiang (dried ginger) mixed with honey and applied to the nasal cavity may also be beneficial in cases from Lung qi deficiency (3).
References
- Allergy UK https://www.allergyuk.org/about-allergy/statistics-and-figures/
- Dwyer J. The Body At War: How Our Immune System Works. 2nd ed. London: J M Dent; 1993.
- Maclean W, Lyttleton J. Clinical Handbook of Internal Medicine: The Treatment of Disease with Traditional Chinese Medicine. Vol 1. Sydney: University of Western Sydney; 1998.
- De-Hui S et al. Manual of Dermatology in Chinese Medicine. Seattle: Eastland Press; 1995.
- Powell M. Medicinal Mushrooms: A Clinical Guide. Eastbourne: Mycology Press; 2010.
- Maclean W, Lyttleton J. Clinical Handbook of Internal Medicine: The Treatment of Disease with Traditional Chinese Medicine. Vol 2. Sydney: University of Western Sydney; 2002.
- Tierra L. Healing with the Herbs of Life. New York: Crossing Press; 2003.
- Li D et al. ‘Mechanisms of traditional Chinese medicines in the treatment of allergic rhinitis using a network biology approach’. Journal of Traditional Chinese Medical Sciences. January 2021; 8(1). doi.org/10.1016/j.jtcms.2016.11.007.
- Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica. 2nd ed. Washington: Eastland Press; 1993.
- Barolet R, Bensky D. Chinese Herbal Medicine: Formulas and Strategies. Washington: Eastland Press Inc.; 1990.
- Tasaka K et al. ‘Anti-allergic constituents in the culture medium of Ganoderma lucidum’. Agents Actions. April 1988; 23(3-4):153-6. doi: 10.1007/BF02142526.
- Wang J, Li X-M. ‘Chinese Herbal Therapy for the Treatment of Food Allergy’. Curr Allergy Asthma Rep. August 2012; 12(4): 332–338. doi: 10.1007/s11882-012-0265-4.
- Pesheva E. ‘Quieting the Storm’. The Harvard Gazette. August 2020. https://news.harvard.edu/gazette/story/2020/08/study-reveals-acupuncture-affects-disease-course/
- British Acupuncture Council. ‘Allergic Rhinitis’. https://acupuncture.org.uk/about-acupuncture/_fact-sheets/allergic-rhinitis/
