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A Case Study on the TCM Treatment of

Chronic Hypertrophic Rhinitis

 

By Dr. Zheng-cheng Yang

Chen Yue Qin TCM Clinic, Taiwan

 

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Chronic hypertrophic rhinitis is an illness that affects many people and greatly impacts their lives. Severely obstructed nasal passages can lead to dizziness, heavy headedness, mental listlessness, fatigue, inability to con­centrate, poor sleep and diminished memory. Those with post-nasal drip may develop cough (with phlegm).

 

In Traditional Chinese Medicine, rhinitis falls into the categories of nasal congestion 鼻窒 (bí zhì) or 鼻齆 (bí wèng). Within the Su Wen, the chapter Wu Chang Zheng Da Lun says: “During the time of Great Summer heat, there is coughing, sneez­ing, bleeding from the nose, and nasal obstruction.” It also says: “Lying on one side will open the upper nostril while the lower one will be obstruct­ed.” In the chapter Xuan Ji Yuan Bing Shi, it says: “bí zhì means nasal obstruction lying on one side will open the upper nostril while the lower one will stay obstructed.” These passages describe the primary symptoms of this condition.

 

 

Clinical Presentation

This condition is most common in young men. It is neither seasonal nor regional in nature however; the symptoms tend to become more noticeable after the sufferer is exposed to cold or damp weather. Primary symptoms include continu­ous bilateral obstruction or obstruction that alternates between the nasal passages, nasal congestion that can be heard, and scant, thick nasal discharge. Patients who have these symptoms for extended periods with no resolution may develop a diminished sense of smell.

 

Rhinitis can usually be divided into two stages:

1.           Thickening Phase: The mucous membrane ap­pears dusky-red and becomes thickened, especially in the lower nasal concha, and its surface is flat and smooth. When pressure is applied with a probe, the mucous membrane shows edema-like pitting that doesn’t recover immediately, and there is diminished response to vaso-constricting pharmaceuticals.

2.           Hyperplastic Phase: The mu­cous membrane appears grayish-white with an un­even surface. Mulberry-shaped protuberances can be seen at the fore-end of the nasal concha, which are hard to the touch. There is no edema-like pitting in the membrane, yet the response to vaso-constrictors is also diminished.

 

Nasa Cavity

 

Key Points of Differentiation

        Chronic hypertrophic rhinitis is often a develop­ment of chronic simple rhinitis. Simple rhinitis oc­curs intermittently and symptoms include alternating obstruction of the nasal passages, thickened secretions, a smooth glossy mucous membrane, and a positive response to vaso-constrictors. Nasal obstruction associ­ated with chronic hypertrophic rhinitis is much more severe than in simple rhinitis and most commonly both nostrils are obstructed continuously. Symptoms common to both conditions are a diminished sense of smell and thickened nasal secretions. Symptoms such as a heavy head, headache, inability to concentrate, and snoring are also common.

From the TCM perspective, these two illnesses are most directly due to localized Qi and blood stasis.

 

Etiology & Pathomechanism

According to TCM, chronic hypertrophic rhinitis has five causative factors:

 

 

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