Effectively Treating Allergy and Common Cold/Flu with TCM
Effectively Treating Allergy and
Common Cold/Flu with TCM
by Tina Chen, L.Ac.
Edited by Kabba Anand, L.Ac. and Britta Becker, L.Ac.
Published October 3, 2019
In school we learn that there are herbal formulas for wind-cold, wind-heat, Lung cold, and Lung heat. In the classroom the differences between each category are clear, however, in practice, when symptoms and patterns are more complex, accurate diagnosis can be challenging. In order to prescribe herbal formulas effectively when symptoms are mixed, and the clinical findings may not be consistent with patterns described in textbooks, the key symptom and pattern need to be determined.
In order to help you effectively treat allergy and common cold/flu with TCM, I will share my experience, in the hope that you will gain additional insight and skill in addressing these patterns.
OVERVIEW
First, let’s discuss western medicine and how they address allergy/common cold/flu. According to Dr. Chien Fu Liao, a new speaker for eLotus, if you read the fine print, you will know that western meds can only ALLEVIATE the symptoms. By alleviating the symptoms, patients suffer less but the condition does not necessarily resolve. Symptoms of cough, sneezing and runny nose, etc. are the body's natural way of expelling pathogens. By suppressing symptoms, the patient may feel better temporarily, but in fact the treatment has trapped the pathogens inside rather than expelling them.
TCM has a more specific and effective approach in treating allergy/common cold/flu. In TCM we use exterior releasing diaphoretic herbs that expel pathogenic factors through perspiration; as well as antibiotic, antiviral, warming and tonic herbs when appropriate, recognizing that each person has an unique constitution, as well as their own reactions/responses to the same bacteria/virus or allergen.
Before describing the different types of colds, here are some special instructions for taking herbs and how to select the right formulas.
Allergies (hay fever) should be treated just like a cold - depending on the differential diagnosis. Symptoms usually overlap those of wind-cold. From a TCM perspective, in the case of an allergy, we are dealing with an external pathogen which has not yet been expelled. The result is that the immune system is weakened to the point that it reacts more and more “allergically” over time.
SPECIAL NOTE ON TAKING HERBS
I use herbal extract powders in my clinic, using the Fang Jia Fang Method, as my teachers are from Taiwan. If you are not familiar with the method of adding formulas, Dr. Chen explains it here. Dr. John Chen: Method of Adding Herbal Formulas . Even if you generally use raw herbs and customize formulas, you may still find this information useful. Here is a video on how to mix the formulas. Preparing Custom Formulas with Extract Powders
For exterior conditions, I generally ask the patient to take herbs every 4 hours, and on average, 15-20 grams a day for a 150 pound adult. A higher dose is recommended because colds often develop and change rapidly and can become more severe very quickly. If the dosage is not high enough, it may be ineffective in bringing the situation under control. It is like chasing a runaway car: you must first speed up to catch up to it, then slow down. Once the symptoms have begun responding, you can reduce the total dosage to 12g, 10g, or even down to 6g. I generally prescribe herbs for only 2 days at a time, since the conditions may shift quickly. The initial chief complaint may have changed after a few days of herbal medicine.
SPECIAL NOTE ON SELECTING THE RIGHT FOMULA(S)
As I mentioned before, when you look at formula explanations in a textbook, there are lists of symptoms associated with each formula. When I started practicing I thought that all those symptoms MUST be present before prescribing a formula. However, in the clinic NOBODY shows up with all those symptoms all at once. The textbook is painting a picture of what the patient might look like so that you might recognize a similar pattern when you see it. However, you don’t need to see ALL those symptoms in order to prescribe that particular formula. You just need to discern the key symptom in order to determine if the formula is suitable. Many of the symptoms listed in the books are secondary symptoms, and MAY NOT be significant diagnostically. In the sections below, I will underline the KEY DIAGNOSTIC SYMPTOMS to assist in selecting the most appropriate formula.
WIND-COLD
99% the time, in the beginning stages of a cold/flu or allergy attack, you are dealing with a wind-cold invasion. This is the stage where a patient feels cold, needs to put on a jacket or is sneezing. They will dislike going out, as any draft of wind will exacerbate symptoms. A Wind-cold stage usually lasts 2-3 days. If the patient’s constitution is strong, they may remain in this stage for 3-5 days before the disease progresses further. The key symptom indicating it is an initial wind stage is: aversion to wind. The key symptoms indicating that the condition is cold are: chills, sneezing, runny nose with clear or white discharge.
Below is a list of formulas to use depending on which wind-cold symptoms are most predominant.
Herbal Prescription
Main formula for Wind-Cold: Xiao Qing Long Tang (Minor Bluegreen Dragon Decoction). This formula should be at least 50% of the entire composition. It can be 100% if the main complaints are sneezing, clear or white runny nose. If other symptoms are also present, you can add other formulas.
- Add Gui Zhi Tang (Cinnamon Twig Decoction) if chills or aversion to cold are the main symptoms.
- Add Ge Gen Tang (Kudzu Decoction) if neck tightness is severe.
- Add Chuan Xiong Cha Tiao San (Ligusticum Chuanxiong Powder to be Taken with Green Tea) if headache is severe.
- Add Qiang Huo Sheng Shi Tang (Notopterygium Decoction to Overcome Dampness) for bodyaches. This formula is a MUST use for viral infections.
- Add Xin Yi San (Magnolia Flower Powder) for nasal blockage.
SPECIAL NOTE AND CLINICAL PEARLS:
If the patient has no access to herbs, the best thing to do is to cook some ginger (20 slices) with 1.5 cup of water. Bring it to a boil for 2 minutes. Then add 1-2 spoons of brown sugar. Drink this while it’s hot to induce sweating. Do this at least twice a day.
If you are dealing with a baby or child who cannot take herbs, you can also boil some Ai Ye (Folium Artemisiae Argyi) and/or ginger and pour it into the tub and take a hot bathwater to induce sweating. Adults can do this as well in addition to ingesting the herbs. Be sure not to do this repeatedly, as it will induce too much sweating, and lead to deficiency.
Most allergy patients or patients who frequently re-catch colds can use the above formulas in the initial stage. Patients may think they have allergies, but in fact they are catching a cold again. It may be difficult to differentiate colds from allergy since the symptoms are very similar. The KEY differentiating symptom is the itchiness of the eyes and nose or throat. Allergy patients usually experience itching while patients with colds won’t.
In the beginning stage of a cold/flu/allergy, many practitioners like to use some heat clearing herbs. While it’s true that some heat clearing herbs should be used if there is an infection, however, a common clinical error is to use too many cold herbs too quickly. The consequence is that instead of expelling the pathogen, the pathogen becomes trapped in the body and the cold symptoms of runny nose, sneezing, etc worsen from cold herbs administered during a wind-cold condition. Heat clearing herbs are appropriate in the next stage of the common cold/flu development, which is the Wind-Cold/Wind-Heat: The In-Between Stage
WIND-COLD/WIND-HEAT: THE IN-BETWEEN STAGE (BUT NOT SHAOYANG)
During this stage, patient is battling the wind-cold unsuccessfully and the pathogen is moving inward turning into wind-heat. At this time, you will see BOTH wind cold and wind heat signs and it may become difficult to differentiate which the patient has.
Most of us have been taught that there is either wind heat or wind cold, but have not been introduced to the concept of a transition period (except for shaoyang syndrome). But shaoyang syndrome is not what I am talking about here. Years into my practice it finally dawned on me that this IN-BETWEEN STAGE is a stage when patients have BOTH wind cold and wind heat and their symptoms reflect that: yellow nasal discharge or phlegm in the morning but white or clear nasal rest of the day, feeling of irritability or heat but still experiencing chills or aversion to cold/wind, anad/or a little bit of sore throat.
In summary, the illness is beginning to become full blown wind heat, but there is lingering wind and cold that needs to be expelled.
At this time, you need to prescribe BOTH wind cold expelling and wind heat clearing herbs together. The percentage of which formula you assign to your prescription will determine the effectiveness. If you see more wind cold symptoms (chills, aversion to wind/cold, clear, white nasal discharge or phlegm), then more than 60% of your prescription should consist of wind cold dispelling formulas listed above. If you see more heat symptoms (sore throat, heat sensation, yellow nasal discharge or phlegm), then 60% or more of your formula should be for wind-heat such as the ones listed below.
Herbal Prescription
Here in this stage you can either use Da Qing Long Tang (Major Bluegreen Dragon Decoction) or combine formulas from the wind-cold and wind-heat releasing list.
WIND-HEAT
Wind-heat is the next stage. Depending on the strength of the invading pathogen, the process of wind cold turning into wind heat can take 5-7 days (this is usually the case when the pathogen is not too virulent or the patient has strong constitution). However, sometimes an exterior attack can turn into wind-heat during the course of one day. The key symptom of wind-heat is sore throat. Tickling in the throat may be due an allergy but if it turns into pain, wind-heat involved. There may be other supporting symptoms to confirm your diagnosis such as yellow phlegm or nasal discharge, fever or heat sensation, or irritability. But again, they don’t all have to be present for you to prescribe a wind-heat clearing formula.
Below is a list of formulas presented in order of their heat clearing strength. So if your patient is in the initial stages of wind-heat, don’t use any of the formulas towards the bottom of this list. Overuse or overdose of cold formulas may stagnate the pathogen, trap it inside and make it harder to treat.
Herbal Prescription
Mild Wind-Heat Clearing Formulas
Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction) – for more cough
Cang Er Zi San (Xanthium Powder) – for more yellow nasal discharge
Moderate Wind-Heat Clearing Formulas
Yin Qiao San (Honeysuckle and Forsythia Powder)
There really isn’t a strong wind-heat clearing formula. When there is that much heat, then most likely the condition has moved into the Lungs and is Lung heat already. You need to select formulas to clear Lung heat.
SHAOYANG SYNDROME
Clinical manifestations in the textbook for shaoyang syndrome include: alternating chills and fever, hypochondriac distension and pain, poor appetite, bitter taste in the mouth, irritability, nausea.
To be honest, I have never seen all of these symptoms present at the same time. The key uses of Xiao Chai Hu Tang (Minor Bupleurum Decoction) are the following:
Alternating chills and heat sensation. This can manifest as cold at night but daytime heat, or vice versa. Or if the head is hot and the body is cold. Or if they feel chills but irritability inside.
Another great use of Xiao Chai Hu Tang (Minor Bupleurum Decoction) is for kids with high fever or, fever that will reduce with Tylenol but goes back up again after the effect wears off. This formula along with soaking Ai Ye (Folium Artemisiae Argyi) in a hot bath is excellent to bring the fever down.
Lastly, I like using this formula for mixed conditions. By this I mean that the patient may be suffering from a mixture of cold and heat condition such as cold limbs, hot body or vice versa; hot upper body and cold lower body or vice versa, cold during the day, hot during the night, vice versa. Also, it’s very effective to add to Wu Mei Wan (Mume Pill) to treat parasites or any alternating temperature issues in the body. This doesn’t have to be a common cold condition.
LUNG HEAT
When the pathogen has moved inside and manifest as Lung heat, there is no longer any exterior wind. Therefore, the patient will not have any more sneezing, aversion to cold/wind. Instead, you will see symptoms like fever, chest pain, cough, more severe sore throat. You will see fewer nasal symptoms but more lung symptoms.
Herbal Prescription
Ma Huang Xing Ren Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) – standard and MUST use formula for Lung heat
Pu Ji Xiao Du Yin (Universal Benefit Decoction to Eliminate Toxin) – more for severe sore throat. Also, this is a MUST use for viral infections with or without sore throat and ear pain.
Bai Hu Tang (White Tiger Decoction) – if Lung heat as affected the Stomach causing Stomach heat.
OTHER CONSIDERATIONS
Qi Deficiency:
Add tonic formulas, but no more than 40% of the entire formula. The majority of the formula should still be exterior releasing. Don’t use too much Huang Qi (Radix Astragali). Although it tonifies wei (defensive) qi, it somehow traps the pathogen inside.
Dryness: Usually this is towards the tail end of a cold where there are some lingering cough or sticky phlegm that is hard to expectorate. The following formulas can be used.
For dry cough with phlegm, add Qing Fei Tang (Clear the Lung Decoction) or Bei Mu Gua Lou San (Fritillaria and Trichosanthes Fruit Powder).
For dry cough or yin deficiency without phlegm, add Mai Men Dong Tang (Ophiopogonis Decoction) or Bai He Gu Jin Tang (Lily Bulb Decoction to Preserve the Metal) or Qing Zao Jiu Fei Tang (Eliminate Dryness and Rescue the Lung Decoction).
Cough in General
Here are two cough formulas to use in case you can’t really decide on a diagnosis.
Dun Sou San (Long-Bout Cough Powder)
Qing Fei Tang (Clear the Lung Decoction)
Phlegm:
Qing Qi Hua Tan Wan (Clear the Qi and Transform Phlegm Pill) – for yellow phlegm in the Lungs
Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) – better for white, clear or post nasal drip.
Stomach Heat:
Often times Lung heat will transfer directly to yangming fire without entering the shaoyang stage. So for patients who show stomach heat of thirst, heat sensation in the mouth, canker sores/stomatitis or foul breath, add Gan Lu Yin (Sweet Dew Decoction) or Bai Hu Tang (White Tiger Decoction).
REVIEW OF SYMPTOMS AND SUMMARY OF SYMPTOMS THAT CLEARLY POINT TO WIND-COLD VS WIND-HEAT
In review, textbook formula explanations will include a long list of symptoms in the hope of painting a picture of a patient’s presentation. However, you don’t need to see ALL the symptoms listed in order to prescribe that particular formula. Instead, make an accurate diagnosis by focusing on a few KEY symptoms and then use the most appropriate formula effectively. Below is a summary of the most important symptoms that can help you decide on a diagnosis.
Wind-Cold: Aversion to cold/wind, chills, white or clear nasal discharge/phlegm
Wind-Heat: Sore throat, fever, yellow nasal discharge/phlegm
Symptoms that are confusing and don’t clearly differentiate between wind-heat or wind-cold, can be either: cough, headache, body-ache, sneezing, runny nose.
DIET : Diet is also important for your patient’s rapid recovery. Proper diet will accelerate and enhance the effects of the herbal prescription.
AVOID
Foods that turn condition into heat:
Spicy food, fried food, alcohol, meat (particularly lamb), junk food or chips, crackers
Foods that worsen wind conditions:
seafood, mango, duck, durian
Foods that produce phlegm and increase nasal discharge:
Dairy, sugar
EAT THESE
Brown rice and millet porridge/congee. This is rice cooked until it’s soft like oatmeal. Alternatively, you can soak brown rice in water, then blend it in a blender and then cook it. Stir often. The finished product will look like glue. Rice and millet in this form tonifies the Spleen and gives the body energy to fight the cold. Also, it warms up the body and will help induce sweating to expel the exterior pathogen.
Vegetable – Vegetables
Chicken soup and lots of water – This is what my grandma practiced.
Lots of sleep – Sleep is essential to recovery. Just like cell phones need to be recharged, so does your body. People often say work hard, play hard, but never rest hard. Resting is so important to regain balance in life.
*Formulas mentioned in this article can be found in the textbook that I wrote with Dr. John Chen, Chinese Herbal Formulas and Applications. For sample pages, see aompress.com. To purchase, visit www.evherbs.com
About Tina Chen, L.Ac.
Tina Chen is respected herbology expert holding a Masters of Oriental Medicine degree in Chinese Medicine and is a California Acupuncture Board Licensed Acupuncturist with extensive training and practice in pulse diagnosis and Chinese herbal medicine. She graduated from South Baylo University of Oriental Medicine, the University of California, Irvine, and pursued extensive post-graduate training in China at Anhui Hospital in Anhui, First Tianjin Hospital in Tianjin, and Guananmen Hospital in Beijing.
Tina is a Licensed Acupuncturist, also certified in Traditional Chinese Medicine by the World Health Organization, with specialties in herbology, gynecology, and internal medicine. She co-authored textbooks in Chinese herbology — Chinese Medical Herbology and Pharmacology in 2003 and its companion volume Chinese Herbal Formulas and Applications in 2008. In 1995, Tina became an apprentice of Dr. Jimmy Chang, and is a leading practitioner of Dr. Chang’s Pulsynergy method. Currently, she works at Evergreen Herbs and Jian Tai Clinic.
