A Closer Look At Allergies

Translated by Lauren Leung, LAc.

Allergies are common in the lives of many Americans. Although it is not considered as a major illness, it does disrupt many people's daily activities. In this article, I will use a traditional Chinese medicine (TCM) approach in explaining the cause of allergies and its treatment protocols.

Common Allergic Symptoms

To better understand allergies, we need to take a closer look at common symptoms, which include:

1. stuffy nose, runny nose, sneezing, or headache
2. itchy skin, or swollen, red skin
3. itchy eyes, or swollen eyes
4. difficulty in breathing, coughing, or shortness of breath

All of the above symptoms are similar to those of catching a cold in TCM. In TCM, catching a cold means an exterior attack to the body. The exterior is related to the lungs because the lungs:

• control breathing - causing difficulty in breathing, coughing, or shortness of breath
• govern the skin - causing itchy skin, or swollen red skin
• open in the nose - causing stuffy nose, runny nose, sneezing
• are related closely to protective chi - causing itchy eyes or swollen eyes. This is a sign that protective chi is battling with pathogenic chi in the eye area. This battle takes place in the eye because protective chi is more prevalent in areas that need the most protection against toxins or invading pathogens, such as in the eyes, skin, and wall of the large intestine. Furthermore, the eyes are the starting point where protective chi comes out to the body's exterior in the morning and circulates 25 cycles around the body during daytime before it enters into the interior of the body at night.

Etiology

On average, 20 percentof allergies in California are caused by wind invasion; 80 percent are due to lingering of pathogenic chi within the body. The main reason for the lingering is because the body's zheng chi (immune system) is weak, deficient and unable to fight off the pathogens, thus allowing it to invade the body and stay there. To take a closer look at this interaction, it is important to understand its physiology. Look at the picture below.

* nutritive chi is also known as ying qi; protective chi is also known as wei qi

Nutritive chi (blood) travels inside the blood vessels. Once the blood vessels are full of blood and expand, tissue fluids will disperse outward. Within the tissue fluids are white blood cells, which are also penetrating outward. These white blood cells are known as protective chi in TCM. Nutritive chi inside the blood vessels must be full in supply in order to give rise to protective chi. Once protective chi is sufficient in supply, it will push the pathogens on the body's exterior out by form of perspiration. This process is known as chi's transformation function, whereby chi is transformed into fluids (i.e., protective chi is transformed into perspiration [fluids]).

Counteractively, if nutritive chi is low in supply, it cannot form enough protective chi to protect the exterior body (the skin), and thus will allow pathogens to invade. In short, allergies are a result of protective chi's deficiency (see picture below).

Common causes for protective chi to become too thin include:

1. Lack of food intake - nutritive chi is formed from food. Decreased levels of food consumption yield decreased levels of nutritive chi, which yields a thin layer of protective chi that is prone to invasion. Allergic symptoms arising due to lack of food intake may include itchy skin, itchy eyes, aversion to cold, or being easily prone to catch a cold (all due to lack of nutritive and protective chi). In more severe cases, these people may catch a cold and will not sneeze or perspire, because zheng chi is too deficient and the pathogenic chi has invaded interiorly.


2. Eating too much cold and raw foods - this makes the stomach cold and unable to correctly digest food, yielding to the decreased levels of nutritive and protective chi. Eating cold foods in the morning especially hampers the digestive system because the time between 5 am and 11 am is when energy circulates through the large intestine, stomach and spleen. Intake of cold foods during this time will inhibit these organs from re-energizing because the coldness freezes up their movements and will hamper chi from coming out of the organs.


3. Cold stomach - protective chi cannot come out to the exterior of the body because its majority may be lost through diarrhea.

Herbal Prescription

Which herbal prescription should be used for a fever, headache, stuffy nose and aversion to cold?

1. gui zhi tang
2. sang ju yin
3. bai hu tang
4. yin qiao san

According to TCM physiology, when food enters the body, the spleen and stomach digest the food. It then ascends the essence up to the heart and lungs, and descends the turbid downward and eventually out the body as feces. The heart receives the nutritive chi while the lungs receive protective chi and send it throughout the body, with nutritive chi inside the vessels and protective chi outside the vessels. However, nutritive chi needs to be full inside the vessels to give rise to a thick layer of protective chi for protection against pathogens.

A fever represents that pathogenic chi and zheng chi are battling on the surface of the body. Aversion to cold indicates that the root cause is coldness, not heat. Incorrect use of cold herbs can lead to the lingering of pathogenic chi into the body's interior. The use of cold herbs will sedate zheng chi, withdrawing the body's defense inward and allowing the pathogenic chi to move inside. The fever will then subside because the body's zheng chi has lost the battle and retreated inward, and there no longer exists a battle on the exterior. Once inside the body, the pathogenic chi can move into the lungs and cause coughing. From then on, whenever the patient catches a cold, he or she will start coughing. This is due to the lingering of pathogenic chi inside the lungs.

Bai hu tang, sang ju yin and yin qiao san are all cold or cool formulas to clear heat. Bai hu tang clears heat by pushing fluids out of the vessels, turning the vessels into a vacuum suction for pathogens. Yin qiao san's cool herbs will decrease the stomach temperature and, in turn, decrease the temperature from the lungs to the skin, which can lead to chest congestion.

Gui zhi tang, on the other hand, is a warm formula, helping to tonify the body in order to get rid of pathogenic chi. Gui zhi tang regulates nutritive and protective chi by replenishing nutritive chi to a full enough supply for it to give rise to enough protective chi. Once protective chi is full in supply, then it can push the pathogenic chi out the body by perspiration. Gui zhi tang's effect can be compared as filling up a half-empty cup to flush out the pathogens (see picture below).

Most allergies occur because of lingering pathogens inside the body. This could be due to lack of food consumption or incorrect use of cool/cold herbs, including use of antibiotics or anti-inflammatory drugs (which are cold in nature). Incorrect use of cold herbs, antibiotics or anti-inflammatory drugs suppresses the pathogen inside the body by the following path: fever › stuffy nose › sore throat › coughing › chest congestion.

Case History (Note: Letters in italics are analysis of the case)

A 39-year-old female has skin allergies in the face and neck. Once the wind blows or the sun shines on her skin, it will itch and turn red. Her history is as follows:

1. Since she gave birth to her child over one year ago, both her arms' medial side (hand shaoyin) became itchy. The patient has tried using aloe gel, but it makes the skin even itchier. Then she went to see both her family physician and a dermatologist, and was prescribed a cool-natured paste for external use on the skin. The paste was ineffective and triggered the itchy red spots to spread to her chest area (shaoyang area). Afterward, she was transferred to an allergy specialist doctor, who gave her an injection (which was also ineffective) and was later prescribed steroids. The steroids stopped the itchy red spots from spreading on her skin, but did not get rid of the problem. (Application of aloe gel makes the skin itchier because aloe is cold by nature. Cold herbs makes zheng chi weaker.)


2. Later the patient went to see a TCM doctor, but her skin problems had already spread to her frontal thigh (yangming area) and lower leg. The TCM doctor diagnosed the problem to be urticaria and prescribed herbs. After 10 days of taking the herbal decoction, the patient's symptoms disappeared; however, both her upper arms' medial sides turned into a blackish color. (Pathogenic chi is suppressed in protective chi's territory, causing the blackish color.)


3. Later, because the patient went back to Taiwan, the change in weather caused her skin allergies to develop again. This time it started on the face, spreading from the shaoyang area to the yangming area. The patient returned to the TCM doctor and was treated with both acupuncture and herbs. The symptoms disappeared in two weeks. (Extreme hot temperatures in Taiwan caused the pathogens to get pushed from the interior towards the exterior into the facial region.)


4. Three months afterwards, the patient was traveling in an area with lots of sunshine, and her allergies redeveloped in the face. She went to the TCM doctor again and after treatment, the symptoms went away again. However, this time her skin became very sensitive and allergic. Oftentimes, it would itch and turn red for no reason. (The sunshine gave her body more yang chi [boosts zheng chi] to fight pathogenic chi, thus the symptoms reappeared.)


5. Recently, the patient's face and neck developed an allergic reaction to wind, causing her skin to become dry, hot, and itchy. Again, she went to the TCM doctor for treatment, and the symptoms disappeared. However, her skin became even more sensitive to the extent that she could not tolerate anything touching her face, not even a hug from her baby.

Interrogation:

1. The above symptoms are worse at night than during the day. Sometimes, it starts getting worse in the afternoon. (Indication of yin pathogen. Both yin and yang are deficient.)
   
2. She does not often sneeze, but has a strong aversion against cold. (Protective chi is deficient. Pathogens have already invaded the interior because do not often sneeze.)
   
3. She eats very little (a habit she started after childbirth because she wanted to lose weight). (Zheng chi is deficient.)
   
4. When her skin allergies were prevalent, her menstrual cycle would come early, with a large quantity of bright red blood. She also had blood clots. However, under normal conditions without the allergies, her menstrual cycle drips for an average of eight days. (With the skin allergies, zheng chi and pathogenic chi are battling, causing heat to push blood out, thus the early menstruation. Under normal conditions, zheng chi is deficient and cannot grasp blood, thus the dripping.)
   
5. The taste of the herbal decoctions prescribed by the TCM doctor was acrid and cool. Each time the symptoms disappeared after taking the herbs, her skin would become dry and peel off. (Cool/cold herbs suppresses pathogens inward. In addition, the cool herbs make the layer of protective chi thinner, disabling its ability to carry zheng chi to the skin for nourishment, thus the dry skin.)

Tongue:

Tongue body: light red with crack in the center
Tongue coating: slight coat

Diagnosis:

Nutritive and protective chi deficiency; lingering of pathogenic chi

Herbal Prescription:

The herbal formula is a modification of gui zhi tang. Its function is to open the passageway from the spleen and stomach to the exterior. It is necessary to eat rice gruel after the decoction to provide sufficient energy for perspiration.

After taking the herbal decoction, the patient will not get better immediately. Instead, previous symptoms may reappear in reverse order. This is because the herbs tonify zheng chi (nutritive and protective chi) allowing enough strength for zheng chi to battle with pathogenic chi and forcing the pathogens out toward the exterior. For example, if the patient had a cough with pathogens in the lungs, then the symptoms could recur in the following order: cough › sore throat › stuffy nose/runny nose › fever › perspiration. Perspiration will bring the pathogen out of the body.

In normal cases, the decoction will cause a slight perspiration. However, if the pores did not open after taking the prescribed decoction, the patient was told that the skin would become itchier. Thus, two bags of ma huang tang were additionally prescribed to open the pores. After a week of taking the herbal prescriptions, the patient's pores did not open and her skin became itchier. She was then told to take the two bags of ma huang tang. After achieving perspiration, she no longer had allergies on her skin and the symptoms did not recur.