变应性鼻炎的辨证分型及中医治疗新进展

New Progress in Syndrome Differentiation and Traditional Chinese Medicine Treatment of Allergic Rhinitis

摘要: 变应性鼻炎是以鼻塞、打喷嚏、流清涕、嗅觉减退为主要特征的鼻腔炎症性疾病。全球发病率达10%~30%，病程迁延可引发鼻窦炎、中耳炎及睡眠呼吸障碍，严重影响患者生活质量。西医治疗以鼻用糖皮质激素、抗组胺药及鼻腔冲洗为主，但存在耐药性显著、黏膜萎缩及复发率高等问题。近年研究发现，西医常规治疗后3个月复发率可达38.6%，局限性较大。中医基于“鼻渊”、“鼽嚏”理论，提出“肺脾肾三脏失调，外邪侵袭”理论。临床实践显示，中药复方联合针灸治疗总有效率较高，且复发率较西医降低。作用机制研究证实，中医药通过调节Th1/Th2平衡、抑制NF-κB通路活化等多靶点发挥疗效。特色疗法如穴位贴敷可改善鼻黏膜微循环，鼻腔熏蒸直接作用于病灶，较单纯西药治疗总有效率提高。本文系统综述该病的中医病因病机，探讨中西医结合治疗策略，为临床提供参考。

Abstract: Allergic rhinitis is an inflammatory disease of the nasal cavity characterized primarily by nasal congestion, sneezing, clear nasal discharge, and hyposmia. With a global incidence rate of 10%~30%, its prolonged course may lead to sinusitis, otitis media, and sleep-disordered breathing, significantly impairing patients’ quality of life. Western medical treatments primarily involve intranasal glucocorticoids, antihistamines, and nasal irrigation, yet face challenges including notable drug tolerance, mucosal atrophy, and high recurrence rates. Recent studies reveal a 38.6% recurrence rate within three months post conventional Western treatment, indicating substantial limitations. Traditional Chinese Medicine (TCM), grounded in the theories of “Bi Yuan” (nasal sinusitis) and “Qiu Ti” (sneezing and runny nose), proposes the pathogenesis as “dysfunction of the lung, spleen, and kidney systems coupled with invasion of external pathogens.” Clinical evidence demonstrates that TCM herbal formulations combined with acupuncture achieve higher overall efficacy rates and lower recurrence compared to Western medicine alone. Mechanistic studies confirm that TCM exerts multi-target therapeutic effects through regulating Th1/Th2 balance and inhibiting NF-κB pathway activation. Specialized TCM therapies such as acupoint application improve nasal mucosal microcirculation, while nasal fumigation directly targets lesions, achieving superior overall efficacy to Western monotherapy. This review systematically examines TCM etiology and pathogenesis of this condition, explores integrated Chinese-Western therapeutic strategies, and provides clinical insights.