变应性鼻炎的中西医结合治疗现状

The Current Status of Traditional Chinese and Western Medicine Treatment for Allergic Rhinitis

摘要: 变应性鼻炎，中医也称为鼻鼽，是机体接触变应原后，产生主要由IgE介导的以炎性介质释放，并有多种免疫活性细胞和细胞因子共同参与的鼻粘膜慢性非感染性炎症。临床上常出现喷嚏、清水样涕、鼻塞、鼻痒等症状，中医对鼻鼽以整体观念辨证论治，对病因病机总结提出寒、热、虚、痰等，古今各医家对鼻鼽也有各自独到的见解，在分型上，中医将其归纳为肺经郁热、肺气虚寒、脾虚湿困和肾阳不足四种证型，针对四种证型施以清宣肺气、温肺散寒、益气健脾、温补肾阳，同时加以通利鼻窍治法，除了中药方剂，体针、鼻内针、艾灸、穴位贴敷等在鼻鼽的治疗过程中均有明显疗效。西医上对变应性鼻炎的发病机制进行了更深入的研究发现，在IgE介导的I型变态反应过程中，多种炎性细胞(T细胞、B细胞、ILC2、DCs、嗜酸性粒细胞、嗜碱性粒细胞、肥大细胞等)及细胞因子(Th2型细胞因子IL-4，IL-5，IL-9，IL-13和上皮源性细胞因子IL-25，IL-31，IL-33，TSLP等)构成复杂的网络相互作用，共同促进变应性鼻炎的发生与发展。所以在治疗上采取药物治疗，通过作用于变应性黏膜炎症的某个分子靶点，阻断变应原引起的免疫炎性疾病的发生，故能有效地控制症状，除此之外，变应原特异性免疫治疗、外科手术干预也是常见治疗方法。在临床上，中西医结合的治疗，不仅更加直观地了解疾病产生的过程，还可以选择更加健康、创伤更小的治疗，进一步指导临床。

Abstract: Allergic rhinitis, also known as nasal allergy in traditional Chinese medicine, is a chronic non infectious inflammation of the nasal mucosa that occurs when the body comes into contact with allergens, mainly mediated by IgE and released as inflammatory mediators, with the participation of various immune active cells and cytokines. In clinical practice, symptoms such as sneezing, watery nasal discharge, nasal congestion, and nasal itching often occur. Traditional Chinese medicine (TCM) treats nasal congestion based on a holistic approach, summarizing the causes and pathogenesis of symptoms such as cold, heat, deficiency, and phlegm. Throughout history, various medical experts have had their own unique insights on nasal congestion. In terms of classification, TCM categorizes it into four types: lung meridian stagnation and heat, lung qi deficiency and cold, spleen deficiency and dampness, and kidney yang deficiency. For these four types of symptoms, TCM applies methods such as clearing and promoting lung qi, warming the lungs and dispersing cold, supplementing qi and spleen, and warming and tonifying kidney yang. At the same time, TCM also applies the method of promoting and benefiting the nasal cavity. In addition to traditional Chinese medicine prescriptions, TCM also uses body acupuncture, intranasal acupuncture, moxibustion, acupoint application, etc. Significant therapeutic effects were observed during the treatment of nasal polyps. A more in-depth study on the pathogenesis of allergic rhinitis in Western medicine has found that in the IgE mediated type I allergic reaction process, multiple inflammatory cells (T cells, B cells, ILC2, DCs, eosinophils, basophils, mast cells, etc.) and cytokines (Th2 cytokines IL-4, IL-5, IL-9, IL-13 and epithelial derived cytokines IL-25, IL-31, IL-33, TSLP, etc.) form a complex network interaction, jointly promoting the occurrence and development of allergic rhinitis. Therefore, drug therapy is adopted in treatment, which acts on a molecular target of allergic mucosal inflammation to block the occurrence of immune inflammatory diseases caused by allergens, effectively controlling symptoms. In addition, allergen-specific immunotherapy and surgical intervention are also common treatment methods. In clinical practice, the combination of traditional Chinese and Western medicine not only provides a more intuitive understanding of the process of disease occurrence, but also allows for the selection of healthier and less traumatic treatments, further guiding clinical practice.