by Eric Brand

Definition
Bi Yuan is often simply translated as sinusitis. It is an old disease category that dates back to the Nei Jing, and it is still one of the most prominent headings in modern Chinese medical disease classification. Some sources emphasize congestion while most sources emphasize profuse nasal discharge. It is differentiated from a variety of other diseases that affect the nose, primarily bi zhi or bi sai (both of which are translated as nasal congestion), as well as bi qiu (sniveling nose).

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Pattern Differentiation
The Chinese literature has a general consensus on the patterns commonly seen in bi yuan, though there is some variety in patterns listed in different prominent texts. For example, the acupuncture treatment reference text Zhen Jiu Zhi Liao Xue1, divides deep source nasal congestion into five categories: depressed heat in the lung channel, depressed heat in the gallbladder, damp-heat in the spleen and stomach, lung qi vacuity cold, and spleen qi vacuity. The “5th edition” ENT textbook2 also discusses deep source nasal congestion at length; this text lacks the pattern of “depressed heat in the lung channel” and instead references the pattern “wind-heat invading the lung.” Similarly, some internal medicine texts describe the lung vacuity cold pattern as a lung-kidney yang vacuity pattern. The Practical Dictionary discusses a pattern of wind-cold deep-source nasal congestion.

As a historical disease category, deep-source nasal congestion was also a reference point for relatively severe patterns associated with persistent bloody discharge with a foul and fishy smell, accompanied by dizziness or emaciation; such conditions typically prompt investigation into the possibility of cancer in the modern day.

DEPRESSED HEAT IN THE LUNG CHANNEL
This is marked by profuse nasal mucus or sticky white or sticky yellow mucus, periodic nasal congestion, reduced sense of smell, headache, heat effusion and aversion to cold, cough with profuse phlegm, a red tongue with a thin white coat, and a floating, rapid pulse.
Treatment Method: Course wind and diffuse the lung, clear heat and free the orifice of the nose.

Acupuncture Therapy: Emphasize treatment of the du mai, hand yang ming, foot yang ming, and hand tai yin channels. Select points such as: GV 23 (shang xing), yin tang, LI 20 (ying xiang), LI 4 (he gu), GB 20 (feng chi), BL 12 (feng men), LU 7 (lie que).

Raw Medicinal Therapy:
Cang Er Zi San (苍耳子散 Xanthium Powder) [modified]
cang er zi (苍耳子 xanthium, Xanthii Fructus)
xin yi (辛夷 magnolia flower, Magnoliae Flos)
bo he (薄荷 mint, Menthae Herba)
bai zhi (白芷 Dahurian angelica, Angelicae Dahuricae Radix)
Plus:
huang qin (黄芩 scutellaria, Scutellariae Radix)
ju hua (菊花 chrysanthemum, Chrysanthemi Flos)
lian qiao (连翘 forsythia, Forsythiae Fructus)
ge gen (葛根 pueraria, Puerariae Radix)

Granule Strategies
Base formula:
Cang Er Zi San (Xanthium Powder) 8 g
Huang Qin (Scutellariae Radix) 1 g

Wind-heat predominant:
Add Sang Ju Yin 4 g
Depressed heat predominant:
Add Sang Bai Pi 1.5 g, Ju Hua 1 g, and Zhi Mu 1.5 g
In general, depressed heat in the lung channel manifesting in deep-source nasal congestion is also commonly treated with the base formula Xin Yi Qing Fei San. This formula is widely available in granule form in Taiwan, but it is rarely seen on the US market.

DEPRESSED HEAT IN THE GALLBLADDER
The symptoms of this pattern are yellow, sticky, pus-like nasal mucus. The mucus is profuse and foul-smelling; there is nasal congestion and reduced sense of smell, as well as headache, dry throat, dizziness, tinnitus, or deafness. The tongue is red with a yellow coat, and the pulse is wiry and rapid.
Treatment Method: Clear and drain the liver and gallbladder, free the orifice of the nose.

Acupuncture Therapy: Emphasize treatment of the foot shao yang, du mai, hand yang ming, and foot shao yin channels. Select points such as GV 23 (shang xing), yin tang, LI 20 (ying xiang), LR 3 (tai chong), GB 34 (yang ling quan), and KI 6 (zhao hai).

Raw Medicinal Therapy:
Long Dan Xie Gan Tang (龙胆泻肝汤 Gentian Liver-Draining Decoction) [modified]
long dan (龙胆 gentian, Gentianae Radix)
huang qin (黄芩 scutellaria, Scutellariae Radix)
chai hu (柴胡 bupleurum, Bupleuri Radix)
zhi zi (栀子 gardenia, Gardeniae Fructus)
ze xie (泽泻 alisma, Alismatis Rhizoma)
che qian zi (车前子 plantago seed, Plantaginis Semen)
mu tong (木通akebia, Akebiae Caulis)
dang gui (当归 Chinese angelica, Angelicae Sinensis Radix)
sheng di huang (生地黄rehmannia, Rehmanniae Radix)
gan cao (甘草 licorice, Glycyrrhizae Radix)

For severe nasal congestion, add:
cang er zi (苍耳子 xanthium, Xanthii Fructus)
bai zhi (白芷 Dahurian angelica, Angelicae Dahuricae Radix)
e bu shi cao (鹅不食草 centipeda, Centipedae Herba)
If there is exuberant liver-gallbladder fire with severe headache, constipation, reddish urine, rashness, impatience, and irascibility, consider using a modification of the formula dang gui long hui wan (Chinese Angelica, Gentian, and Aloe Pill), which drains fire from the liver and gallbladder.

Granule Strategies
Base formula:
Long Dan Xie Gan Tang 8 g
Cang Er Zi San 4 g

If constipation is present, add ground lu hui 1 g, or unprocessed da huang as a granule, 0.3–1g.

DAMP-HEAT IN THE SPLEEN CHANNEL
This pattern is marked by profuse yellow turbid nasal mucus with a foul odor, along with relatively severe nasal congestion and reduced sense of smell. There may also be headache, fatigued and cumbersome limbs, poor appetite, distention and fullness in the stomach duct and abdomen, and yellow urination. The tongue is red with a greasy yellow coat, and the pulse is slippery and rapid or soggy. This pattern is often associated with dietary irregularities.

Treatment Method: Disinhibit dampness and drain heat, dispel phlegm and transform turbidity.

Acupuncture Therapy: Emphasize the ren mai, du mai, hand yang ming, foot tai yin, and foot yang ming channels. Select points such as: GV 23 (shang xing), yin tang, LI 20 (ying xiang), CV 12 (zhong wan), BL 20 (pi shu), SP 4 (gong sun), SP 9 (yin ling quan), and ST 40 (feng long). Use even supplementing and draining stimulation for all points except SP-4 and ST-40, which should be drained.

Raw Medicinal Therapy:
Huang Qin Hua Shi Tang (黄芩滑石汤 Scutellaria and Talcum Decoction)
huang qin (黄芩 scutellaria, Scutellariae Radix)
hua shi (滑石 talcum, Talcum)
mu tong (木通akebia, Akebiae Caulis)
fu ling (茯苓 poria, Poria)
zhu ling (猪苓 polyporus, Polyporus)
da fu pi (大腹皮 areca husk, Arecae Pericarpium)
bai dou kou (白豆蔻 cardamom, Amomi Fructus Rotundus)
If there are severe heat signs, add:
huang lian (黄连 coptis, Coptidis Rhizoma)
da huang (大黄 rhubarb, Rhei Radix et Rhizoma)
shi gao (石膏 gypsum, Gypsum Fibrosum)
For severe nasal congestion, add:
bai zhi (白芷 Dahurian angelica, Angelicae Dahuricae Radix)
xin yi (辛夷 magnolia flower, Magnoliae Flos)
bo he (薄荷 mint, Menthae Herba)

Granule Strategies
Base formula:
Xie Huang San 8 g
Cang Er Zi San 4 g
Huang Qin 1 g
Pei Lan 1 g

LUNG QI VACUITY COLD
This is marked by profuse sticky white nasal mucus with no foul odor, reduced sense of smell, and either mild or severe nasal congestion. All these symptoms are worse with cold. There may be headache, cloudy head, spontaneous sweating and aversion to wind, shortness of breath, low voice, and cough with thin phlegm. The tongue is pale with a white coat, and the pulse is moderate or weak.

Treatment Method: Supplement the lung and boost qi, course and dissipate wind-cold.

Acupuncture Therapy: Emphasize the du mai, hand yang ming, foot tai yang, hand tai yin, and foot shao yang channels. Select points such as: GV 23 (shang xing) (-), yin tang (-), LI 20 (ying xiang) (-), BL 13 (fei shu) (+), LU 9 (tai yuan) (+), and KI 3 (tai xi) (+).

Raw Medicinal Therapy:
Wen Fei Zhi Liu Dan (温肺止流丹 Lung-Warming Nose-Drying Elixir)
xi xin (细辛 asarum, Asari Herba)
jing jie (荆芥 schizonepeta, Schizonepetae Herba)
ren shen (人参 ginseng, Ginseng Radix)
gan cao (甘草 licorice, Glycyrrhizae Radix)
he zi (诃子 chebule, Chebulae Fructus)
jie geng (桔梗 platycodon, Platycodonis Radix)
yu nao shi (鱼脑石 otolith, Pseudosciaenae Otolithum)
Plus:
xin yi (辛夷 magnolia flower, Magnoliae Flos)
bai zhi (白芷 Dahurian angelica, Angelicae Dahuricae Radix)
cang er zi (苍耳子 xanthium, Xanthii Fructus)
For cold pain of the forehead, add:
chuan xiong (川芎 chuanxiong, Chuanxiong Rhizoma)
gao ben (藁本 Chinese lovage, Ligustici Rhizoma)
For tendency to easily catch common colds, add:
huang qi (黄芪 astragalus, Astragali Radix)
bai zhu (白朮 white atractylodes, Atractylodis Macrocephalae Rhizoma)
fang feng (防风 saposhnikovia, Saposhnikoviae Radix)

Granule Strategies
Base formula:
Cang Er Zi San 4 g
Ren Shen Ge Jie San 5 g
Xi Xin 0.2 g
For those with a tendency to easily catch common colds, add Yu Ping Feng San 3 g.

SPLEEN QI VACUITY
This is marked by profuse sticky white or yellow nasal mucus with no foul odor, relatively severe nasal congestion, and reduced sense of smell. There may be headache, dizziness, fatigued limbs and lack of strength, low food intake and abdominal distention, sloppy stool, somber white facial complexion or withered yellow facial complexion. The tongue is pale with a white coat, and the pulse is moderate or weak.

Treatment Method: Fortify the spleen and boost qi, clear and transform damp-turbidity.

Acupuncture Therapy: Emphasize the foot yang ming, du mai, ren mai, and foot tai yin channels. Select points such as: GV 20 (bai hui), yin tang (-), LI 20 (ying xiang) (-), BL 20 (pi shu) (+), CV 12 (zhong wan) (+), SP 6 (san yin jiao) (+), and ST 36 (zu san li) (+).

Raw Medicinal Therapy:
Shen Ling Bai Zhu San (参苓白朮散 Ginseng, Poria, and White Atractylodes Powder) [modified]
dang shen (党参 codonopsis, Codonopsis Radix)
bai zhu (白朮 white atractylodes, Atractylodis Macrocephalae Rhizoma)
gan cao (甘草 licorice, Glycyrrhizae Radix)
shan yao (山药 dioscorea, Dioscoreae Rhizoma)
lian zi (莲子 lotus fruit/seed, Nelumbinis Semen)
bian dou (扁豆 lablab, Lablab Semen Album)
fu ling (茯苓 poria, Poria)
yi yi ren (薏苡仁 coix, Coicis Semen)
sha ren (砂仁 amomum, Amomi Fructus)
jie geng (桔梗 platycodon, Platycodonis Radix)
Plus:
huang qi (黄耆 astragalus, Astragali Radix)
ze xie (泽泻 alisma, Alismatis Rhizoma)
For severe nasal congestion, add
xin yi (辛夷 magnolia flower, Magnoliae Flos)
bai zhi (白芷 Dahurian angelica, Angelicae Dahuricae Radix)

Granule Strategies
Base formula:
Shen Ling Bai Zhu San or Bu Zhong Yi Qi Tang 10 g
Cang Er Zi San 4 g

Auxiliary Treatments
Auxiliary treatments include auricular acupuncture, intradermal needling, point injection, and plasters. Point injection uses B vitamins injected into LI 4 (he gu) and LI 20 (ying xiang), once every other day, using one point per time. Other sources recommend injecting a solution of yu xing cao (Houttuyniae Herba) into the point BL 13 (fei shu) once every other day. Plasters use raw fu zi (Aconiti Radix Lateralis Praeparata), which is ground to a powder and mixed with scallion juice to make a paste. 35 grams of paste is applied to the point KI 1 (yong quan), once per day. Auricular acupuncture focuses on the inner nose, forehead, tip of the nose, and lung. Intradermal needles are applied to the back of the neck, the nose, and LI 20 (ying xiang), LI 4 (he gu), GB 20 (feng chi), and BL 13 (fei shu).

1) Zhen Jiu Zhi Liao Xue (Acupuncture and Moxibustion Therapy), Shi
Xue-Min, ed. People's Medical Publishing House. Beijing, 2001.

2) Zhong Yi Er Bi Hou Ke Xue (Chinese Medical ENT). Shanghai
Technology Press. Shanghai, 1984.