The guidelines identify four principal TCM syndromes underlying allergic rhinitis: Deficiency-cold of Lung Qi, Spleen Qi Deficiency and Weakness, Kidney-yang Deficiency, and Heat in the Lung Meridian [2]. Treatment was tailored to these diagnostic categories, with external therapies such as acupuncture, moxibustion, electroacupuncture, and catgut embedment strongly represented among the thirty-two clinical recommendations. Across these trials, acupuncture achieved reductions in nasal itching, rhinorrhea, congestion, and sneezing. Objective biomedical findings confirmed efficacy, with lower serum IgE levels, reduced inflammatory cytokines, and improved nasal airflow resistance documented in multiple studies [3]. Long-term follow-up showed sustained benefits beyond three to six months, with many patients requiring fewer pharmacologic agents to maintain symptom control [4].

The guidelines recommend manual acupuncture as a strongly endorsed therapy, graded 1AU, representing high-quality evidence with strong recommendation. Needle gauges most frequently used were 0.25 millimeters in diameter and 25–40 millimeters in length, inserted perpendicularly to a depth of 10–25 millimeters depending on point location [5]. Stimulation typically involved uniform reinforcing and reducing methods, with needles retained for thirty minutes per session. Treatment was generally administered three times per week over a course of four to six weeks [6]. The most frequently indicated acupoints were LI20 (Yingxiang) and Bitong (EX-HN8) for nasal obstruction, Yintang (EX-HN3) and GV23 (Shangxing) for rhinorrhea and sneezing, LI4 (Hegu) and LU7 (Lieque) for regulation of lung qi, and ST36 (Zusanli) and SP6 (Sanyinjiao) for tonification in spleen deficiency cases [7]. In patterns of Kidney-yang deficiency, KD3 (Taixi) and BL23 (Shenshu) were applied, while patients with heat in the Lung meridian often received LU5 (Chize) and LI11 (Quchi) for their heat-clearing effects [8].

Electroacupuncture was graded 2C, representing low-quality evidence with weak recommendation, but remains widely practiced. This technique involved needle insertion at LI20, LI4, and ST36, with electrodes delivering dense-disperse waves of 2–100 Hz at intensities tolerable to the patient. Sessions lasted twenty to thirty minutes and were applied two to three times weekly. Studies reported suppression of IL-4 and IL-5 expression and normalization of Th1/Th2 balance, correlating with reduced nasal symptoms and improved immune regulation [9].

Another specialized approach included sphenopalatine ganglion acupuncture, graded 2B, which targeted nasal obstruction with long needle insertion. A sterile needle of 0.30 millimeters in diameter and 60 millimeters in length was inserted through the temporal region toward the pterygopalatine fossa at a depth of 55–60 millimeters. Sessions once weekly for four to six weeks produced measurable improvements in peak nasal inspiratory flow and subjective relief of obstruction [10]. Catgut embedment therapy, also graded 2B, applied resorbable chromic catgut at acupoints such as BL13 (Feishu) and ST36. Threads were embedded subcutaneously using a specialized needle, providing continuous stimulation for two to three weeks. Reports demonstrated that this approach produced symptom remission for up to three months post-treatment [11].

Moxibustion techniques also received significant attention. Common use was moxibustion applied over acupoints including LI20, BL13, and ST36 until a strong sensation of warmth was achieved. Treatments were administered daily or every other day in courses of ten sessions. Objective outcomes included reductions in nasal eosinophil counts and improved mucociliary clearance, providing biomedical support for symptom relief [12].

While the guidelines emphasize acupuncture, herbal prescriptions were recommended in a complementary role. Buzhong Yiqi Tang received a strong recommendation with a 1BU grade for Spleen Qi Deficiency, You Gui Wan received a 1BU recommendation for Kidney-yang deficiency, and Xinyi Qingfei Yin received a 1C recommendation for heat syndromes [13]. These herbal prescriptions were frequently combined with acupuncture and produced synergistic effects in both subjective symptom scores and objective biomarkers such as reductions in serum IgE and modulation of inflammatory mediators [14].

Adverse effects across trials were rare and generally limited to transient bruising, mild bleeding, or temporary soreness at needle sites. No severe adverse events were reported. Compared with intranasal corticosteroids, acupuncture was associated with lower recurrence rates and avoidance of drug-related side effects [15]. The authors note that proper training in acupoint location, depth, and sterilization is essential, particularly for high-risk procedures such as sphenopalatine ganglion insertion, which should only be performed by experienced clinicians [16]. Also, sphenopalatine ganglion insertion is not part of the acupuncturist scope of practice in many states and provinces globally.

These international guidelines represent comprehensive evidence synthesis on acupuncture and TCM management of allergic rhinitis. With strong endorsements for manual acupuncture and adjunct therapies, practitioners now have standardized procedural and syndrome-based recommendations to guide treatment. Biomedical data, including cytokine modulation, IgE suppression, and improved nasal airflow, corroborate the clinical improvements reported by patients. For licensed acupuncturists, these findings provide a rigorous, evidence-based framework to enhance outcomes in allergic rhinitis while minimizing reliance on pharmacotherapy [17].

Source:
1-17. Fu, Qin-Wei, Peng Liu, Yan Ruan, Xin-Rong Li, Lan-Zhi Zhang, et al. “International Evidence-Based Guidelines for Traditional Chinese Medicine Management of Allergic Rhinitis.” Allergy, 2025.