A 49-year-old man with a six-month history of severe nasal congestion and loss of smell (anosmia) was successfully managed using an integrative approach of Qi-tonifying herbs and targeted acupuncture.

Case ID: CHC-0057

Case Summary

This case describes a 49-year-old man who presented with a half-year history of persistent nasal congestion and a complete inability to smell both fragrant and foul odors. He had grown dependent on ephedrine-based nasal drops for temporary relief. The original report documented a conventional diagnosis of rhinitis and a TCM assessment of Nasal Pool (Bi Yuan) driven by Spleen and Lung Qi deficiency. He was managed through a dual approach combining a modified Liu Junzi Tang and Yu Ping Feng San herbal decoction with a specialized “Nasal Three Needles” acupuncture protocol to rebuild his underlying immunity and unblock the sensory orifices.

Patient Presentation

• Patient: 49-year-old male (Surname: Li).
• Main Complaint: Nasal congestion and decreased sense of smell for half a year.
• History: The patient sought his initial consultation on July 6, 2023. Six months prior, he developed nasal congestion and subsequently lost his sense of smell, unable to detect either pleasant or foul odors. He had previously taken Biyuan Tongqiao Granules (a common over-the-counter TCM remedy for sinusitis) without any effect. He frequently had to use Furacilin/Ephedrine nasal drops just to temporarily relieve the congestion so he could breathe.
• Associated Symptoms: He had cool hands and feet, but no aversion to cold or fever. His appetite and spirit were fair, and his bowel and urinary functions were normal.

Examination and Diagnosis

• Conventional Diagnosis: Rhinitis.
• TCM Tongue and Pulse: The tongue body was pale and tender (舌质淡嫩) with a thin, white coating. The pulse was weak (脉虚弱).

TCM Assessment

The original practitioner interpreted the presentation as Nasal Pool driven by Spleen and Lung Qi Deficiency (鼻渊 – 脾肺气虚证).

According to the holistic principles of yin and yang Chinese Medicine the Lungs open into the nose, and the Spleen is the mother of the Lungs (in the Five Elements framework). In this patient, an initial invasion of an external pathogen damaged his Lung and Spleen Qi. Because the Qi was deficient, the clear, ascending Yang energy could not rise to nourish the head, and the turbid Yin could not descend.

This resulted in the turbid dampness physically blocking the “clear orifices” of the nose, causing chronic congestion and the loss of smell. His cool extremities, pale/tender tongue, and weak pulse were textbook objective confirmations of this systemic Qi and Yang deficiency. This explains why the previous Biyuan Tongqiao granules failed: they focus on clearing heat and toxins, whereas this patient’s root problem was deep Qi deficiency and cold.

Treatment Approach

The primary treatment principle was to tonify the Spleen and benefit the Lungs, dispel wind and expel toxicity, and warm and unblock the nasal passages (补脾益肺，祛风排毒，温通鼻窍). The strategy utilized the “cultivating earth to generate metal” (培土生金) method—building the digestive system (Spleen/Earth) to naturally strengthen the respiratory system (Lungs/Metal)—combined with localized acupuncture to immediately clear the nasal blockage.

Interventions and Herbal Formulas

• Acupuncture Therapy:
  • Utilized the “Nasal Three Needles” (迎香 Yingxiang LI20, 上迎香 Shangyingxiang EX-HN8, 印堂 Yintang EX-HN3, and 攒竹 Cuanzhu BL2) along with Fengchi (GB20), Shuigou (GV26), Shangxing (GV23 – with added moxibustion), Feishu (BL13), Pishu (BL20), and Zusanli (ST36).
  • A reinforcing (tonifying) needle technique was applied to boost Qi.
• Initial Herbal Formula (July 6, 2023): A 15-herb decoction combining the core frameworks of Liu Junzi Tang (Six-Gentleman Decoction) and Yu Ping Feng San (Jade Windscreen Powder).
  • Tonifying Spleen and Lungs: Ren Shen (Ginseng, 10g), Huang Qi (Astragalus, 20g), Bai Zhu (15g), Fu Ling (15g), and Shan Yao (Chinese Yam, 15g) formed a massive Qi-tonifying core to strongly rebuild the Spleen and Lungs.
  • Regulating Qi and Dampness: Ban Xia (Pinellia, 12g), Chen Pi (Tangerine Peel, 8g), and Hou Po (Magnolia Bark, 10g) dried dampness and directed turbid Qi downward.
  • Unblocking Nasal Passages: Cang Er Zi (Xanthium, 10g), Fang Feng (Saposhnikovia, 10g), and Xin Yi Hua (Magnolia Flower, 10g, decocted wrapped) are the classic trio for warming the nasal passages and scattering wind to immediately restore smell.
  • Warming Yang and Astringing: Gui Zhi (Cinnamon Twig, 10g) warmed Yang and scattered cold, while Wu Wei Zi (Schisandra, 10g) gently astringed the Lung Qi. Jie Geng (Platycodon, 10g) guided the medicine up to the chest and head, and Zhi Gan Cao (10g) harmonized the formula.
  • Administration: 5 doses, water decocted, taken warm morning and evening.

Follow-Up

• Second Visit (July 13, 2023): After 5 days of herbs and acupuncture, the patient’s condition significantly improved. The nasal congestion was reduced, and he could now smell pungent/stimulating odors. The tongue remained pale and the pulse weak. The exact same treatment plan (5 more herbal doses and acupuncture sessions) was continued.
• Third Visit (July 20, 2023): The nasal congestion was completely gone. The patient could now smell general odors, though his olfaction was still slightly diminished. The practitioner removed the surface-releasing nasal herbs (Cang Er Zi, Fang Feng, Xin Yi Hua) and adjusted the Chen Pi to high-quality Xin Hui Chen Pi (5g) to strictly focus on consolidating the Spleen and Lung Qi to prevent relapse.
• Outcome: A one-year follow-up confirmed that the patient had completely recovered with no recurrence of the rhinitis or anosmia.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is successfully identifying deficiency as the root cause of chronic sinus congestion. Often, chronic rhinitis is mistakenly treated purely as an “infection” or “inflammation” using heavy, cold, clearing herbs.

Because this patient’s root was actually Spleen and Lung Qi deficiency (he lacked the physical energy to push the fluids out of his head), standard formulas failed, and he became reliant on chemical nasal drops. Professor Zhao successfully cured the condition by heavily tonifying the body’s internal energy (Ren Shen, Huang Qi, Bai Zhu) and combining it with warm, opening herbs (Gui Zhi, Xin Yi Hua) and moxibustion. Once the body’s central Yang energy was restored, the nasal passages naturally cleared and stayed clear.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine Original title: 【以案说医】招仕富：中医治疗鼻炎案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: September 6, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation