Advances in treatment of allergic rhinitis with Chinese and Western Medicine

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Allergic rhinitis (Allergic rhinitis AR) also known as allergic rhinitis, nasal mucosa is a chronic inflammation caused by susceptible indiv


Allergic rhinitis (Allergic rhinitis AR) also known as allergic rhinitis, nasal mucosa is a chronic inflammation caused by susceptible individuals exposed to allergens, is the motherland medicine "biqiu" category. Clinically, sneezing, nasal itching, stuffy nose, watery nasal discharge as the main feature, the incidence and mechanism of organism specific disorders. Epidemiological studies reported that the average incidence of allergic rhinitis in the world is between 10% and 20%, and some countries are as high as 40%. The research shows that the incidence of allergic rhinitis is increasing in the past 30 years. The trend is particularly significant in western developed countries. Allergic rhinitis because of its high incidence, which is closely related with bronchial asthma, sinusitis, nasal polyps and conjunctivitis and other diseases, patients with learning and work efficiency, resulting in a decline in the quality of life, and increased social and individual economic burden. In 2001, according to the relevant experts in the field of the development of the WHO, allergic rhinitis and its impact on asthma (Allergic rhinitis and impact on asthma, ARIA), a global reference file. In this paper, "a respiratory tract, a disease", emphasizing the relationship between allergic rhinitis and asthma in etiology, pathology, immunology and treatment. Therefore, allergic rhinitis has become a global health problem to be solved urgently.

At present, there are many methods for treating allergic rhinitis. No matter what kind of treatment, avoid contact allergens can be the first step, the allergen has been clear, should try to avoid contact with. As for the pollen allergy, reduce out in the pollen season; the animal dander, feather allergy to avoid contact with the animal, birds, etc.. Western medicine treatment of allergic rhinitis mainly consists of three parts, namely, drug therapy, immunotherapy and surgical treatment. The new progress of Chinese and Western medicine treatment of allergic rhinitis is summarized as follows.

1 western medicine treatment

1.1 drug therapy

The treatment of allergic rhinitis can effectively control the symptoms, in recent years, the variety of such drugs increased, but also more secure and effective, thus highlighting the importance of drug treatment. Drugs for the treatment of allergic rhinitis in addition to drugs commonly used antihistamines, corticosteroids, decongestants, anticholinergic drugs and mast cell stabilizers, including the development of new leukotriene receptor antagonist and anti IgE antibody [1]. Although the drug can effectively control the symptoms, but can not achieve the purpose of radical [2]. The clinical application of different drugs should be based on different types of symptoms and the use of different methods, and recommend the use of drugs and the use of alternating.

1.1.1 antihistamine medications include oral and intranasal application, its mechanism is a competitive antagonist of histamine H1 receptor nerves and blood vessels, relieve nasal itching, sneezing, runny nose and other symptoms, and the onset of [3] in 1 hours. First generation antihistamines easily through the blood-brain barrier, it has obvious sedative effect, also has anti cholinergic effects, manifested as dry mouth, blurred vision, urinary retention; second generation antihistamines can overcome this disadvantage, and found that in addition to histamine H1 receptor, also has other anti allergy effect. For example, loratadine (Loratadine) and cetirizine (Cetirizine) can inhibit cell adhesion molecule (intercellular adhesion, molecule, ICAM) role, known in type I allergic diseases due to the release of cytokines and histamine production, leading to increased expression of ICAM; the application of loratadine and cetirizine can the degree of closure of adhesion molecules, reduce allergic inflammation to. The study found that in recent years, there are some two generation antihistamines such as terfenadine and astemizole (Terfenadine) (Astemizole) [4] rare cardiac toxicity may occur, serious. Since the beginning of 1990, have been reported in terfenadine and astemizole, caused by prolonged QT interval of ECG torsades de pointes ventricular tachycardia, and even death cases, attracted widespread attention of scholars. Impaired liver function or concomitant administration of cytochrome P450 was associated with cardiac toxicity. The above mentioned and dangerous drugs and ketoconazole, itraconazole and erythromycin interaction, such a severe reaction in the patients with serious drug overdose. The mechanism of the occurrence of these drugs can block and cardiac repolarization related potassium channel, pharmacology study found that the molecular structure of terfenadine and astemizole are lipophilic nitrogen substituent, may be related to cardiac toxicity. But, like cetirizine, fexofenadine, loratadine (Fexofenadine) (Desloratadine), mizolastine (Mizolastine) in recent years, these high security anti histamine drug development, clinical curative effect is superior to [5][6], it is called the third generation antihistamines [7].

1.1.2 corticosteroids can reduce vascular permeability, survival and inhibiting the activation of inflammatory cells, inhibiting production of inflammatory mediators and cytokines, thereby inhibiting the inflammatory process at multiple levels through a variety of ways. Oral medication is more suitable for acute and severe disease and patients with nasal polyps, can choose prednisone (Predinsone) 30-40mg / D, in the morning fasting a medication for 7d or symptom control gradually after reduction, almost all patients are effective, but should avoid long-term medication, otherwise it will cause systemic side effects. Preparation of a nasal submucosal injection of long-acting corticosteroid injection or slow release can maintain the curative effect for several weeks, for hay fever, in season 1, injected 2 times; continuous application of perennial allergic rhinitis patients not. Injection of nasal mucosa may cause retinal artery embolism, leading to blindness, so the injection should be used in small molecule drugs, the diameter should be less than 6 m, and the injection speed can not be too fast, the pressure can not be too large.

Intranasal corticosteroids are the first choice for the treatment. The drug is absorbed by the nasal mucosa, and is rarely used in the oropharynx, and is rapidly inactivated in the liver without causing side effects of the inhibition of the adrenal cortex. The recent development of a new generation of intranasal corticosteroids such as beclomethasone spray (Beclomethasone), Buderson (Budesonide), fluorine Kathan (Fluticasone), Momison (Mometasone), the local availability is high, safety, less side effects of systemic and local [8], has a good effect on nasal itching, sneezing, runny nose and a stuffy nose. Compared with oral or topical antihistamines, intranasal corticosteroids are effective in relieving symptoms and have become the first-line treatment for allergic rhinitis [8][9][10]. However, some people think that the specific effect of antihistamines on the H1 receptor, and a new generation of antihistamines can also effectively relieve nasal congestion, should be used as a first-line drug [3][11]. The topical application of corticosteroids in nasal cavity is less common than [12], which is mainly caused by dryness of nasal cavity and nasal bleeding. It is reported that very few drugs can cause endogenous glucocorticoid secretion to reduce [13].

1.1.3 is used to relieve the symptoms of nasal obstruction, and it is applied in the nasal cavity. The principle of action is to combine the alpha adrenergic receptor of the blood vessel wall of nasal mucosa to relieve the swelling of nasal mucosa. Commonly used drugs for ephedrine (Ephedrine) and oxymetazoline (Oxymetazloine). In principle, the use of the drug is no more than 7d. Because some antihistamines can not relieve nasal congestion, it is often used in combination with anti diarrhea drugs.

The principle of 1.1.4 anticholinergic drugs is to inhibit the secretion of excessive cholinergic nerve, can reduce nasal secretions, but not for nasal itching and sneezing, so alone with a drug can not achieve good results. Commonly used drugs for ipratropium bromide (Ipratropium neomide), etc.. There were no local adverse reactions such as vascular rebound and nasal mucosa damage, and no systemic adverse reactions were observed.

1.1.5 mast cell stabilizer has the effect of stabilizing mast cells, preventing mast cell degranulation and release medium. Disodium (Nitto Clou) and Nedocromil (sodium hyaluronate). The clinical data confirmed on nasal itching and sneezing and runny nose nasal treatment is better than; but only for patients with mild to severe symptoms, the curative effect is better than topical nasal steroid drugs. Because this kind of drug has no effect on the release of the media, it should be in advance before the onset of medication to prevent the main role. Partial use of sodium hyaluronate, not absorbed by the system, no cross reaction, safe and effective [14].

1.1.6 leukotriene receptor antagonist and its mechanism is the antagonist of leukotriene receptor, is a representative drug montelukast (Montelukast). The clinical research shows that three ene receptor antagonist on allergic rhinitis and asthma therapy is safe and effective; but better than antihistamines, topical corticosteroids than the combined effect is poor; not compared with the single use of either drug and antihistamines. Now most of the literature does not advocate for the replacement of other allergic rhinitis drugs [15][16], but for those who are more serious symptoms are a useful supplement to standard therapy [17].

1.1.7 anti IgE antibody drug is Omar monoclonal antibody (Omalizumab). The research shows that the formation of a Omar monoclonal anti immunoglobulin E (IgE) umbrella, for blocking a variety of allergens invasion. Obama is the first monoclonal antibody drug monoclonal antibody based on a new generation of IgE, which acts on the antibody can trigger allergic reactions. [18] can be combined with the free IgE in the blood by subcutaneous injection to prevent the adhesion of IgE and mast cells, thus controlling the generation of allergy. Severe symptoms of Omar antibody could attenuate the allergic rhinitis, reduce the use of antihistamines, as a useful supplement to the existing [19] drugs for the treatment of allergic airway disease in.

1.2 immunotherapy

With the further research on pathogenesis of allergic rhinitis and immune treatment mechanism and found only in improving symptoms of antihistamine drugs, immunotherapy based on the change of immune response in patients with allergic rhinitis and achieve the purpose of clinical cure; in this sense, immunotherapy in the treatment of allergic rhinitis status can not be ignore.

Progress in the mechanism of 1.2.1 immunotherapy

In 1970s the common understanding of the pathogenesis of allergic rhinitis, allergic rhinitis is type I allergic reaction mediated by IgE, the specific antigen into atopic individuals, produced specific IgE antibody attached to mast cells and basophilic cell surface, the body in a sensitized state; when the same antigen enter again when combined with the specific IgE, the mast cell degranulation and histamine, prostaglandins, leukotrienes and other inflammatory mediators, increase telangiectasia, permeability, glandular secretion, eosinophil infiltration. With the deepening of research, people found that some patients in the immediate reaction after about 8 ~ 24h symptoms recurred, the formation of the late phase reaction, the late phase response by activation of eosinophils and CD4+T cells regulate [20].

In recent years the starting link and the intermediate links in the pathogenesis of allergic rhinitis and a new understanding that antigen-presenting cells (Antigen, presenting cell, APC) and CD4+T cells, T helper cells (Th cells) and related cytokine production in the occurrence of allergic rhinitis development plays a key role. Cytokines can be used as an immune medium [21] display a variety of immune activity. Cytokines can be divided into two types, namely Th1 type cytokines and Th2 type cytokines. Th1 type cytokine production with interleukin (Interleukin, IL) -2 (Interferon, IFN), interferon gamma and tumor necrosis factor (Tumor necrosis, factor, TNF) - beta, mainly involved in the cellular immune response, Th2 type cytokines IL-3, IL-4, IL-5 products, IL-10, IL-13 etc., mainly involved in humoral immunity reaction. The present study has confirmed the occurrence of allergic rhinitis is a specific antigen atopic individuals, the differentiation of Th cells by Th1 shift, response bias, Th2 reaction, Th1 reaction into Th2>.

Therefore, the purpose of immunotherapy is to regulate the differentiation of Th cells, so that the reaction of Th1 and Th2 can be restored to a normal state of equilibrium. Since IFN- and IL-4 are the representative cytokines of Th1 cells and type Th2 cells, the changes of these two cytokines in immune therapy have been studied in recent years. Many studies have confirmed after immunotherapy of IFN- gamma did not change significantly while IL-4 decreased, and the levels of IL-4 and immune therapy time is negatively related to [22], was also confirmed after immunotherapy by IFN- increased significantly and no change in IL-4 [23]. Studies show that the immune treatment of allergen extracts after injection, subcutaneous tissue antigen stimulated cells can produce IL-12 mediated Th1 reaction [24]. It has been found that the IL-12 of patients with respiratory allergic disease was significantly reduced by [25] before immunization, and the level of IL-12 in patients after successful immunotherapy was significantly increased, and the number of cells expressing IL-12 was also increased. In recent years, Th2 type cytokine product IL-5 has been paid more and more attention because of its close relationship with eosinophils in allergic inflammation. Through the comparative study on [26] in perennial allergic rhinitis of nonatopic individuals and received immunotherapy, see the synthesis level of perennial allergic rhinitis group IL-5 treatment increased significantly, and the level of IFN- significantly reduced the synthesis of gamma.

Improvement of 1.2.2 vaccine

Traditional vaccines have a severe allergic reaction induced by may, one [27] study of 386 patients with perennial allergic rhinitis, the incidence and risk factors of severe allergic reactions in 5 years received 22722 house dust mite extract after injection, the systemic allergic reaction rate is 6.22%. In the early years there were reports of individual deaths during the injection, and even the allergen skin test caused death. For the diagnosis and treatment of allergen extracts containing allergenic and non allergenic substances, so it is difficult to diagnosis standard, only when sensing allergen source cannot determine the exact molecular allergen. Therefore, it is impossible to treat each patient according to the actual allergen panorama.

In recent years, the research on allergen vaccine has been improved. Some researchers [28] through the DNA recombination technology, take the allergen DNA as the template, can obtain the recombinant allergen, and then prepare a variety of recombinant allergen vaccine for immunotherapy. The recombinant allergen low allergen activity and antigenicity significantly so, differentiation of Th cell can be adjusted, so that Th1 and Th2 react to restore the normal state of balance, which is safe and effective immune therapy, shorten the course of [29].

Some scholars have proposed peptide immunotherapy [30]: allergen specific immunotherapy is often dose dependent, but because of the presence of allergic reactions, so that the amount of allergen treatment can not reach enough doses. T cell epitope peptide (epitope peptides) is a kind of short, linear amino acid sequence, which is presented to T cells by antigen presenting cells (APC). It can be recognized by T cells, but not with allergen specific IgE, and thus does not produce an allergic reaction, but retains the ability to completely regulate T cell responses during immunotherapy. Clinical trials have shown that peptide immunotherapy is safe and effective. However, an antigen T cell epitope peptide is not sufficient to protect all patients.

In recent years, the study of DNA vaccine [31] has found that the plasmid DNA (pDNA) encoding some kind of antigen or allergen can be injected into muscle or subcutaneous, which can be absorbed and synthesized by APC. Experimental results show that pDNA can induce strong Th1 reaction, which can make APC cells produce and secrete IFN-, IL-12 and IL-18, which can cause Th to differentiate into Th1. To pDNA after the mice were inoculated with ovalbumin to ova, that can inhibit the infiltration of eosinophils, reduce IgE antibody titers. Although it has been proved that pDNA vaccine has a potential application prospect, it is a long time to clone all the target genes, to find the suitable vector and to establish the controllable regulatory motif.

Study on 1.2.3 immunotherapy

Subcutaneous injection of immunotherapy has the potential to induce severe allergic reactions, and subcutaneous injection has some pain, a longer course of treatment, limiting the use of immunotherapy. Over the years, people continue to strengthen the study of immunotherapy, so that it is more safe and effective, easy to use, to avoid the pain of injection therapy and possible adverse reactions. Since the beginning of 1920, there is research on the oral route, but due to the researchers in the method of administration, dose accumulation and difference between the original types should be handed in many aspects, so that people on the way to the effect and mode of action into question.

In the author for sublingual administration of [32], they will be coated with soluble pollen allergen material made of sublingual tablets containing clothes, that has satisfactory clinical efficacy, but the mechanism of the way immune therapy is unclear. The results showed that the lymphocyte proliferation response was significantly decreased after sublingual immunotherapy, which was attributed to the induction of immune tolerance. There are some points of view that allergen molecules can enter the lymph nodes through the sublingual mucosa, and then drainage to the lymph nodes, the release of IL-12, stimulate the Th cells to Th1 cell activity, and finally produce desensitization. Once this mechanism is clear, people will spend more energy to choose a better target, or the use of bioadhesive agents, penetration enhancers and local adjuvant to enhance the efficacy of sublingual immunotherapy. Some researchers believe that at this stage of subcutaneous immunization applicable to patients with severe allergic rhinitis and bronchial Gao Min emotional, and sublingual immunity for minor symptoms [33]. In addition, allergen nasal local desensitization has been tried for many years, said to be satisfied with the efficacy. However, due to the limitations of dose control and the types of allergens, and may induce severe reactions and other factors are still widely carried out.

1.3 surgical treatment

For surgical treatment of only a small number of carefully selected patients with invalid on drugs and immune therapy, treatment methods including nasal septum and inferior turbinate hypertrophy of partial resection, the purpose is to change the anatomical abnormalities, reduce the reactivity of [34][35] plant nerve nasal mucosa. Endoscopic vidian nerve and anterior ethmoidal nerve transection or cautery, and microwave, RF, plasma treatment of nasal mucosa, many clinical reports of [36][37], through long-term observation, the effect is still not sure, even if only is the improvement of symptoms, but did not solve the problem of "allergy". Symptoms often in 2 years and the possibility of recurrence, and may lead to dry eye and even corneal ulcers and other serious sequelae, it should not be used as the preferred method [38].

2 Chinese medicine treatment

Allergic rhinitis in traditional Chinese medicine called "biqiu", or mainly due to sniveling and sneezing, lung qi, Wei table is not solid, cou justified osteoporosis, cold and make the nose, take advantage of a weak point, evil is to wrestle, not through regulating qi, body fluid stop together, nasal congestion, sneezing, runny to. "Treatment tips" said: "t-ching, brain lung cold caused by cold." Qi full, depends on the distribution of temper. Deficiency of spleen qi and deficiency of lung qi. But the root of Qi in the kidney, kidney deficiency is not taken, gas is not easy to Yang Guiyuan, dissipation, pathogenic wind to pathogenic invasion. In the "Q - five vision theory" said: "the five disease...... The kidney is less, sneezing." Therefore, the disease is manifested in the lung, but its pathological changes have some relationship with the spleen and kidney. Gan Zuwang [39] considers the pathogenesis of this disease in the lung heat, lung fire: General nasal disease, most of the new disease is cold, illness is hot. So long as the product can be more than a bit, the heat in lung. "Dongyibaojian" as saying: "by fire for disease." Chinese medicine treatment of allergic rhinitis allergic patients starting from the adjustment, there were Tongzhi effect, has been the concern of the medical profession.

2.1 syndrome differentiation treatment

From the whole, the dialectical treatment, adjust the balance of yin and Yang of the human body organs, so as to achieve the purpose of disease prevention and treatment. Most doctors think that this disease is the cold evil outside attack, lung spleen and kidney deficiency caused by syndrome differentiation according to the specific. Huang Yiqian [40] of the disease will be divided into three types: deficiency of lung heat type: tonifying lung, Fufeng cold. Prescription: Astragalus, Atractylodes, angelica, Radix Saposhnikoviae, cocklebur, Magnolia, silkworm, Schisandra, chrysanthemum, licorice. Lung qi deficiency type: spleen dampness, nourishing lung. Prescription: Astragalus, licorice, ginseng, Atractylodes, angelica, angelica, Rhizoma Gastrodiae, Schisandra chinensis, Fructus Xanthii, Fructus mume. Two types of lung and kidney deficiency: tonifying kidney and warming yang. Prescription: Astragalus, Atractylodes, Radix Saposhnikoviae, radix rehmanniae, antler glue, angelica, asarum, dogwood, Xanthium, eucommia. The disease will be summarized as Gan Zuwang [41]: empirical: cold attacking the lung, lung deficiency syndrome: thermovoltaic; Wei Qi lost solid, no fire in Yuanyang. The treatment of cold attacking the lung with harmonic Qi, warming lung Quxie method, commonly used with Guizhi Decoction; application of Qingre heat lung V desensitization, and Qingre Tuomin Decoction; Qi Wei Qi solid loss solid card application method, get Yuping Feng powder as the main body, they may take shenlingbaizhusan in some flavor to supplement its taste too little; Yuanyang fire permits to take kidney warming Yang, commonly used have Fugui decoction or eight youguiyin.

Some scholars put forward some new ideas on the basis of a large number of clinical practice. Wu Chengshan [42] proposed biqiu in etiology and pathogenesis, syndrome characteristics and phlegm disease were similar, attributed to generalized phlegm, phlegm and in accordance with the theory of governance. According to "disease with phlegm, when warming drugs" principle, selection of Lizhongtang, Qi Xiao Qinglong Decoction occasions. Li Fancheng [43] confirmed by experiments that cold affect the microcirculation of patients, that the pathogenesis of the disease is caused by lung and kidney cold phlegm. There are doctors in this disease and hepatobiliary germinal gas shortage, selection of Longdan Xiegan Decoction in treating. Shao Jianmin [44] thinks that the pathogenesis of this disease is lung cold, kidney disease, long unhealed often due to cold and orifices network barrier, cause blood stasis symptoms, particularly emphasizing the importance of blood stasis in the disease process.

2.2 basic addition and subtraction treatment

This is the doctor according to the clinical practice, the basic addition and subtraction to treat this disease with a prescription for.

2.2.1 Yuping wind scattered the disease as the virtual standard of evidence, and lung, spleen and kidney three dirty close correlation. Dan Xi Yuping Feng powder composed of Astragalus, Atractylodes, wind. Fang Yi lung, Huangqi solid muscle, Baizhu Jianpi Fuzheng, Astragalus Gubiao help antiperspirant, wind dispelling wind evil, the three drugs have yiqigubiao, rousing power, the spleen and kidney strong muscle, table full of evils is not easy to invade. EVA to [45] with Yuping Feng San Jiawei (Huang Qi, Atractylodes, parsnip, Xanthium, cicada, Tribulus terrestris, polygonatum, licorice, coix seed, lily) for the treatment of allergic rhinitis with Hismanal control had significant difference. Li Ming [46] of Yuping Feng San Jiawei (Huang Qi, windproof, white atractylodes rhizome, Schizonepeta, Platycodon, angelica, Fructus Mume, Schisandra chinensis, asarum, Xanthium, licorice) in treatment of this disease the total effective rate was 94%.

2.2.2 small Qinglong Decoction according to the disease pathogenesis, symptom characteristics and phlegm disease similar theory, in accordance with the treatment of phlegm. The treatment of the disease, when using the table of cold dispelling, Wenfei Huayin, nobumichi nose method. The simple solution is not to drink water table, simply drink outside evil indissoluble, only table of cold dispelling, Wen Xuan lung drink, nose and use, can make the evils to declare, stop drinking to Juan, nasal patency. Small Qinglong Decoction of ephedra, jiebiao Guizhi cold, Radix Paeoniae Alba with Guizhi reconcile camp Wei; ginger, Asarum in Wenfei Huayin, outside of Xinsan cold, Schisandra temperature and prevent the lung qi and lung qi, dissipation, pinellia juanyin Jiangzhuo, licorice to reconcile various drugs, with peony sour and sweet, slow Ma, Guangxi and Xinsan too. Pan Feng Jun [47] with small Qinglong Decoction (ephedra, Ramulus Cinnamomi, Radix Paeoniae Alba, Rhizoma Zingiberis, asarum, Schisandra, pinellia, licorice, Xanthium, angelica, Xin Yi) for the treatment of allergic rhinitis with up to 93% efficiency. Zhang Duan and [48] with small Qinglong Decoction in the treatment of allergic rhinitis, and the curative effect with Latin difference.

2.2.3 Guizhi Decoction allergic rhinitis attack disease mainly in the treatment of lung, mainly from Xin from temperature. Guizhi Decoction is a cold treatment table Xuzheng reconcile camp Wei agent, played a role of local regulation of overall treatment. Zhou Haiping [49] with Guizhi Decoction (Ramulus Cinnamomi, Radix Paeoniae Alba, ginger, jujube, licorice) for the treatment of allergic rhinitis, curative effect.

The other side also includes basic BUZHONGYIQITANG, cangerzisan etc..

2.3 Chinese patent medicine and prescription treatment

Chinese medicine treatment of allergic rhinitis and prescription, is the most widely used Xinqin granule, and various other units developed by Min ling oral liquid, such as the nose section, Bi Kemin, min Decoction Bimin Tablet etc..

Xinqin granule is sugar free type granule by asarum, scutellaria root, white atractylodes rhizome, Schizonepeta, windproof, angelica, astragalus, Guizhi, Xanthium, Shichangpu and other Chinese medicinal herbs extract processed. Asarum fragrant Tongqiao prescription, baicalin of extreme heat, two herbs, Qingre Huazhuo Tongqiao, analgesic, as monarch drug. Schizonepeta, angelica fragrant Tongqiao, dispelling wind and relieving pain, Ramulus Cinnamomi and Fructus Xanthii, Shichangpu Essien Tongqiao dispelling wind and relieving pain, channeling, brain permeable turbidity, as adjuvant drug. Huangqi and Baizhu Jianpi Yiqi, anti wind guide Huangqi table and no evil resist evil, love the disadvantages of the three drugs have a Yuping fan of Italy, can Yiqi Gubiao and dispelling wind from evil. The drug combination can heat Tongqiao, dispelling wind and relieving pain, and scattered and more, completed without delay, so that the cold or heat evil to Dakwah, nasal patency, control the symptoms of allergic rhinitis and drug regulation of humoral immune function, prevent the recurrence of the disease. Wang Dehui [50] such as the use of Xinqin granule in treating allergic rhinitis had a total effective rate of 89.29% was significantly higher than the control group qianbaibiyanpian the efficiency of 26.67%. Diao Yuhua [51] with Xinqin granule in treating allergic rhinitis and astemizole group had significant difference.

The prescription for most of the doctors clinical experience summary, which contains Chinese medicine syndrome differentiation, disease differentiation thought. At the same time, it has the features of simplicity, efficiency and low cost. On the basis of deep research, some drugs are suitable for popularization and application. As for [52] Gan Zuwang frequently encountered clinical stubborn allergic rhinitis with its own soup (cut sensitive madder, comfrey, Eclipta alba, Herba sign grass, windproof, bupleurum, Radix Cynanchi paniculati, earthworm, ebony, etc.) as treatment, addition and subtraction with the disease, the effect is very good.

2.4 acupuncture combined with acupuncture and medicine

Clinical studies have shown that acupuncture treatment of allergic rhinitis is reliable, no side effects, easy to operate, is worth a clinical treatment. Acupuncture or acupuncture combined with the following methods:

The use of 2.4.1 acupuncture acupoints according to syndrome differentiation, the most commonly used acupuncture points Hegu, Lieque, Quchi, Zusanli, yingxiang. [53] take Lanqing zanzhu, li20, Hegu, Quchi, Xuehai, Sanyinjiao, yellow phlegm plus Taichong; spleen deficiency and spleen Yu, kidney and Shenshu, Zusanli; the cuanzhu and Yingxiang mutual penetration. Treatment of 150 cases, the total effective rate was 97, 3%. Zhang Shuting [54] the main acupoints: Zusanli, Yingxiang, Lung Qi selected Taiyuan; spleen deficiency of spleen xuanjiang Sanyinjiao selection; selection LI4; kidney yang deficiency with Taixi, stars, and moxibustion baihui. With the exception of reinforcing method Zusanli, the rest are reinforcing reducing.

2.4.2 acupoint injection or sticking western medicine for the treatment of allergic rhinitis in local anesthetics or glucocorticoid nasal injection, the method of rapid onset, but can cause complications of visual impairment, and the maintenance time is short. According to the etiology and pathogenesis of allergic rhinitis and the theory of meridians and collaterals, acupoint injection or sticking method is adopted, which has the advantages of quick effect, high curative effect, simple and easy operation, no adverse reaction, and is easy to be accepted by patients. There are common points Yingxiang, Feishu, Quchi, Shenshu, injection of drugs for the local anesthetic, corticosteroids, medicine etc.. Xu Wenkang [55] the use of dexamethasone and lidocaine injection Yingxiang acupoint in treating allergic rhinitis, the total effective rate was 89.6%, significantly higher than the control group oral astemizoli. Find full Hunan [56] with Huangqi injection, oral liquid, vitamin B12 acetate is phlogistic 96% recent efficacy of triamcinolon Shenshu acupoint injection in the treatment of allergic rhinitis, the long-term curative effect is better than 88.9%, Xinqin granule, and cetirizine group.

In addition, there are acupoint embedding, auricular therapy, moxibustion, acupoint therapy etc.. Overall, results of the research and application of various methods of acupuncture treatment, provide new ideas and methods for further study and treatment of allergic rhinitis.

2.5 modern mechanism of TCM Treatment

Chinese medicine treatment of allergic rhinitis for the control of symptoms, prevention of recurrence and even cure disease provides a good idea and method. At present, many scholars at home and abroad have devoted themselves to the study of the mechanism of allergic rhinitis in traditional Chinese medicine, and to study the mechanism of traditional Chinese medicine on this disease.

Study on the mechanism of Chinese traditional medicine of 2.5.1 including the study of single herb and prescription. Wang Zhongren [57] introduces the current research situation of anti allergic rhinitis of jujube, ephedra, Scutellaria, Xin Yi, licorice, Astragalus and other traditional Chinese medicine, the mechanism of Chinese herbs on allergic rhinitis are discussed from different aspects. Tang Youwei [58] compiled the research on the treatment of allergic rhinitis in Japanese kampo. Study of Xiaoqinglong Decoction and found: the small Qinglong Decoction containing crude drug, asarum, and ephedra Guizhi has inhibitory effect on chemical free medium, can inhibit mast cell and basophil histamine release; inhibitory effect of Xiaoqinglong Decoction on histamine, serotonin and acetylcholine were 5-, but does not affect the central histamine H1 receptor, thus basically no other antihistamines and sedative effects of anti allergy drug has. The inhibition of nasal secretion by Xiao Qinglong Decoction is an anticholinergic action in the nasal gland, which inhibits the secretion of Ca2+ in the nasal gland before stimulation. The small Qinglong Decoction of Ephedra ephedrine has similar effect, improve the nasal congestion by nasal mucosa vasoconstriction. In May four arachidonic acid cascade effect on Lipoxygenase system, involved in the metabolism of leukotrienes.

The study on the mechanism of 2.5.2 acupuncture and moxibustion mainly results from the imbalance of immune system, and acupuncture can affect many aspects of it. The new [59] Lai study showed that acupuncture can affect the patients with total IgE and specific IgE direct effect on the antigen antibody reaction step, acupuncture has significant effect on patients with basophils, mast cell degranulation and histamine release process. Day moxibustion therapy can affect the immune status of patients by regulating the activation of T lymphocytes. Tan Jingshu [60] treatment of allergic rhinitis by acupoint application, found that the number of T cells (Ts cells) was significantly increased after treatment, and the level of serum IgE was decreased.

3 section

Allergic rhinitis is a global disease, with the improvement of economic level, the development of industrialization, the incidence rate increased further; and the increase of incidence of sinusitis, otitis media and bronchial asthma, therefore it has received extensive attention. The western medicine for the treatment of allergic rhinitis, whether drug therapy, immune therapy, or surgery, has made great progress, but still can not cure the disease fundamentally, but also bring certain economic burden to patients; this will give Chinese medicine to study the disease provides a a good chance. Now Chinese medicine or traditional Chinese and Western medicine treatment of allergic rhinitis has some advantages, but there are also some problems to be solved. Although, made some achievements in clinic, but the experimental research is far behind the clinical confirmed clinical experience is always in the subordinate status; the local symptoms in patients with allergic rhinitis significantly, some patients had no obvious symptoms, often unlicensed discernable, dialectical law research needs further; not specification for clinical diagnosis and treatment standards, is not conducive to the development and promotion of scientific research methods. Facing these problems, there are a lot of work needed, the first is combined with clinical, standardized research of syndrome differentiation and treatment law; secondly, with the rapid development of molecular biology and genetic engineering, it is necessary to combine modern medicine, research on the mechanism of Chinese medicine treatment of this disease, resulting in clinical efforts to achieve better control of symptoms. Prolong the remission stage, reduce the economic burden of the patients, so as to cure the disease.

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