A blocked nose every change of season: how seasonal moxibustion is used for rhinitis

History and prior work-up

Paroxysmal nasal itching, sneezing in bursts, profuse clear watery discharge, and nasal obstruction for 5 years, worse at the spring and autumn season changes. Symptoms were worst on waking each morning, with itchy eyes and mildly reduced smell; no asthma. Allergy testing showed dust mite (+++) and pollen (+).

Antihistamines and intranasal corticosteroids had been used — effective but quick to relapse. No desensitization therapy.

Examination and pattern differentiation

The main pattern is lung qi deficiency with cold, combined with lung-spleen qi deficiency. Worsening with cold and on waking points to deficiency-cold; fatigue and poor appetite point to spleen deficiency. Classical Chinese ENT medicine divides nasal allergy (bi qiu) into four patterns — lung qi deficiency with cold, spleen qi weakness, kidney yang insufficiency, and latent heat in the lung channel — and in this case lung qi deficiency with cold is the guiding pattern.

• Nasal mucosa pale and swollen; lusterless complexion; aversion to wind with spontaneous sweating; worse on exposure to cold.
• Tongue pale with a thin white coat; pulse fine and weak; prone to catching colds; average appetite, stool tending to looseness.

Treatment pathway

• External treatment first: Yingxiang (LI20), Yintang (EX-HN3), Shangxing (GV23), Fengchi (GB20), Hegu (LI4), Lieque (LU7), Zusanli (ST36), Feishu (BL13), Pishu (BL20), Shenshu (BL23), Dazhui (GV14). During flare-ups, acupuncture is the mainstay; in remission, moxibustion and acupoint application (during the hottest and coldest periods, sanfu and sanjiu) take over, forming a seasonal treatment plan. Twice weekly, with concentrated courses at the season changes.
• Herbal decoction as support: for lung qi deficiency with cold, Wenfei Zhiliu Pill; for spleen qi weakness, Buzhong Yiqi Decoction. In remission, Yupingfeng Powder may be added to consolidate the exterior. Dosage is set at the in-person consultation.
• Classical and modern references: Wenfei Zhiliu Pill appears in the Bian Zheng Lu; the modern physician Gan Zuwang treated nasal allergy through the lung, spleen, and kidney, with emphasis on boosting qi to consolidate the exterior and warming the lung to disperse cold.
• Concurrent management: avoid known allergens (dust mites, pollen), saline nasal rinsing, humidity control at home; patients with asthma must carry a rescue inhaler.

Re-evaluation

Follow-up and advice

Care for allergic rhinitis runs on a seasonal cycle, and seasonal moxibustion must be continued through its courses (sanfu and sanjiu) — we do not promise a permanent cure. Sudden worsening with wheezing or difficulty breathing should be managed as an acute asthma attack.