"My nose is like this every year — I wake up and sneeze non-stop." A question that comes up often is this one. Malaysia has no four seasons, but air-conditioning, haze and the rainy months are all still here, so the nose is a year-round topic.

The answer first. TCM theory treats the nose as the lung's gateway: the World Health Organization's TCM terminology standard says "The nose is the opening of the lung", and "The lung dislikes cold" — "Lung qi is easily damaged by exogenous pathogenic cold". [WHO-2022]

So the theory's direction is three things: no cold draught on the nose and mouth, a warm drink first thing in the morning, and sleep at a fixed time (all the theory's direction).

As for "how do I wash the bedding?", "which mask for haze?" and "is this rhinitis or a cold?", Western patient-information pages and Malaysia's Ministry of Health give a yardstick to hold it against. This article puts the two side by side, in 6 points.

I. How TCM theory sees the "nose"

In TCM theory, the "lung" is not quite the anatomical organ; it is the name of a set of functions. The World Health Organization's TCM terminology standard defines the entries that touch the nose this way:

• Lung system: "A functional system composed of the lung, large intestine, skin, body hair, nose and lung meridian." [WHO-2022]
• The lung opens into the nose: "The nose is the opening of the lung." [WHO-2022]
• The fluid of the lung is nasal discharge: "Nasal discharge is associated with the lung." [WHO-2022]
• The lung dislikes cold: "The lung is intolerant of cold and connected with the skin and body hair. Lung qi is easily damaged by exogenous pathogenic cold." [WHO-2022]

The theory adds one more line: wind "is the spearhead of exogenous pathogenic factors and liable to associate itself with cold, dampness, dryness and heat". [WHO-2022] That is why TCM tends to describe recurring sneezing and clear discharge in the language of "wind-cold" — the theory's language, not a diagnosis of you.

In daily life, the theory's direction is a handful of habit-level things:

① No cold draught straight at the nose and mouth — the aircon vent, the fan, the wind on a motorbike.

② A warm drink first thing in the morning, before heading out.

③ Warm the nose and neck on waking — a thin scarf is the theory's direction.

④ Sleep at a fixed time, avoid late nights, and keep the bedroom clean. The Hong Kong Department of Health's Chinese Medicine Regulatory Office lists sleeping at fixed times and avoiding late nights and lying in, and attending to the hygiene of living quarters, among its principles. [CMRO-养生]

These are directions, not a prescription; which of them matters for you is a question for after the consultation.

II. A yardstick first: what Western pages say about allergic rhinitis

Theory gives direction; Western patient-information pages give definitions and practice. The following is taken from the UK National Health Service (NHS) and Singapore's MOH HealthHub public pages.

① What allergic rhinitis is. Allergic rhinitis is a Western medical diagnosis. The NHS says it "is where your nose gets irritated by something you're allergic to, such as pollen, causing sneezing and other symptoms"; common allergies include pollen, house dust mites, animal dander and mould. [NHS-鼻敏感]

The NHS also states that allergic rhinitis "is different from non-allergic rhinitis, which is caused by things like having a cold, very hot or cold temperatures and humidity". [NHS-鼻敏感] So "it blocks the moment I walk into an air-conditioned room" has a place in Western medicine too.

② Rhinitis or a cold. The NHS says the symptoms of allergic rhinitis "are similar to a cold" but usually happen "within minutes of coming into contact with something you're allergic to" [NHS-鼻敏感]; cold symptoms "come on gradually over 2 to 3 days" and "You should begin to feel better in about 1 to 2 weeks". [NHS-感冒]

HealthHub adds three points: in allergic rhinitis the mucus and tears "will be clear", while for colds "mucus may be thicker, and appear greenish or yellowish"; "Allergic rhinitis does not cause fever or muscle ache"; and it "rarely causes sore throat". [SG-鼻敏感]

③ Reducing allergens at home. The NHS advice is: "use synthetic bedding and covers, and wash bedding regularly at 60C and above"; "dust with a damp cloth and use a vacuum with a HEPA filter". [NHS-鼻敏感]

The same page says: "keep your home dry and well-ventilated, and deal with any damp and condensation"; "do not allow pets in bedrooms". [NHS-鼻敏感]

HealthHub's list is more specific: "Encase mattresses, pillows and bolsters with House Dust Mite (HDM)-proof covers"; "Wash bedding with hot water (55-60 °C) frequently"; "Remove rugs or carpets, and minimise items on the bed (e.g. stuffed toys, cushions)". [SG-鼻敏感]

④ How to rinse the nose. The NHS method: "Boil a pint of water, then leave it to cool"; "Mix 1 teaspoon of salt and 1 teaspoon of bicarbonate of soda into the water"; wash your hands. [NHS-鼻敏感]

Then, over a sink, pour a small amount into a cupped palm and "Sniff the water into 1 nostril at a time", breathing through your mouth and letting the water run back into the sink; "up to 3 times a day (making a new solution each time)". [NHS-鼻敏感] A pint is around 570ml. [NHS-鼻窦炎]

⑤ Pharmacy medicines, and who asks a pharmacist first. The NHS says "You can often treat allergic rhinitis without seeing a GP"; a pharmacist can advise on antihistamines, decongestant nasal sprays or drops, steroid nasal sprays, and salt water sprays or solutions. [NHS-鼻敏感]

Two class-level cautions. Decongestant nasal sprays "should not be used for longer than 5 days as this can make a blocked nose worse" [NHS-鼻敏感]; HealthHub calls this "a rebound blocked nose". [SG-鼻敏感] Why the cap exists is in section III.

For the type of antihistamine that makes you feel sleepy, the NHS says "do not drive or use machinery after taking these antihistamines". [NHS-抗组织胺]

If you use a spray or medication your doctor prescribed, say so, and never stop your medication on your own. For Chinese herbs alongside Western medication, see Can Chinese herbs be taken with Western medicine.

III. How it happens: two accounts

Section II gave the yardstick. This section answers a different question: why the nose does this, and which step each of the three pharmacy classes, and each of the things you do at home, is aimed at.

The Western account and the TCM theory's account sit side by side, each with its source, and neither is a translation of the other.

① The Western account: an allergic reaction and histamine. The NHS allergic rhinitis page says only this much: allergic rhinitis "is caused by an allergic reaction". [NHS-鼻敏感] HealthHub says a little more: it "results from an over reaction of the immune system to particles which they are allergic to". [SG-鼻敏感]

The histamine step is on the NHS antihistamines page. The NHS says: "Histamine is normally released when your body detects something harmful, such as an infection. It causes blood vessels to expand and the skin to swell, which helps protect the body." [NHS-抗组织胺]

The same page goes on: "in people with allergies, the body mistakes something harmless – such as pollen, animal hair or house dust – for a threat and produces histamine. The histamine causes an allergic reaction with unpleasant symptoms including itchy, watering eyes, a running or blocked nose, sneezing and skin rashes." [NHS-抗组织胺]

That is where the NHS page stops; it does not spell out every step after histamine, and this article stops there too.

② Three classes, three steps. Put the three classes from section II back on that chain and it is clear why they are not the same thing:

• Antihistamines: the NHS says they "block the effects of a substance called histamine"; that is why the NHS writes that taken before contact with the allergen they "help stop this happening", and taken afterwards they "can reduce the severity of symptoms". [NHS-抗组织胺] How to use them is a question for the pharmacist.
• Decongestant nasal sprays: the NHS says they "work by reducing the swelling of the blood vessels in your nose, which helps to open the airways" [NHS-减充血剂] — aimed at the "blocked" step, not at the allergic reaction itself.
• Steroid nasal sprays: HealthHub says they "help to relieve inflammation and swelling in the nose caused by the allergens". [SG-鼻敏感]

③ Why decongestant sprays have a 5-day cap. The NHS decongestants page states: nasal sprays and drops "should not be used for more than 5 days at a time because using them for too long can make your stuffiness worse". [NHS-减充血剂]

HealthHub calls this "a rebound blocked nose" — "constant blocked nose caused by an overuse of nasal decongestants". [SG-鼻敏感]

The NHS non-allergic rhinitis page goes further and lists "using decongestant nasal sprays for longer than it says on the packet" itself among the causes of non-allergic rhinitis. [NHS-非过敏性鼻炎]

On the NHS's own wording, a spray used to unblock the nose can become, past its limit, a source of another kind of blocked nose.

As for why the rebound happens, none of these pages says, and this article does not fill that in. The same NHS page also says: "Do not use more than one medicine to treat a blocked nose at the same time", including "using nasal sprays together or combining them with tablets or capsules for congestion". [NHS-减充血剂]

A spray or medicine your doctor prescribed is used as the doctor directed — never stop your medication on your own.

④ Why bedding at 60C. The NHS gives the temperature and no reason: synthetic bedding, washed regularly "at 60C and above". [NHS-鼻敏感]

HealthHub gives the purpose: "Wash bedding with hot water (55-60 °C) frequently to remove dust mites"; encase mattresses, pillows and bolsters in dust-mite-proof covers. [SG-鼻敏感]

Remove rugs or carpets and minimise items on the bed because they "may collect dust"; vacuum and mop frequently "to get rid of the dust mites and insect droppings". [SG-鼻敏感]

So these measures all aim at the same step — less contact with the allergen, the start of the chain in ①. As for why the number is 60, neither page explains; this article follows the pages and gives only the temperature and the purpose.

⑤ The TCM theory's account: a "surface". The theory has no histamine layer; it uses a different model — the body has a "surface", and the lung is in charge of it. The World Health Organization's standard defines the relevant entries this way:

• The lung governs the skin and body hair: "The lung warms and nourishes the skin and body hair, regulates the opening and closing of the sweat pores and safeguards the surface of the body." [WHO-2022]
• The lung governs upward and outward diffusion: "the upward and outward diffusion of lung qi". [WHO-2022]
• Wei-defensive qi: "Opposite to the Ying-nutrient qi. It travels outside the vessels and is transformed from the nutrients of water and food." [WHO-2022] A second entry, Wei-defence circulates outside the vessels: "Wei-defence is yang and resolute in nature. It travels outside the vessels." [WHO-2022]
• Wind floats and ascends: "Wind is characterized by upward flowing. It easily affects the head, face, surface of the body and yang meridians." [WHO-2022] Wind opens and disperses: "Wind loosens the interspace between skin/muscle fibers and opens the skin pores, resulting in sweating and aversion to wind." [WHO-2022]
• Pathogenic factors attacking orifices: "Pathological states caused by pathogenic factors invading the mouth, nose, ears and eyes." [WHO-2022]

Read together with section I's "The lung opens into the nose" and "The lung dislikes cold", this is the theory's barrier model.

The lung diffuses qi outward to the surface, the surface is kept by the "Wei", and the nose is an opening in that surface; wind-cold coming in through the surface and the nose meets this layer first.

That last paragraph is this article's reading of the definitions above, not the standard's own sentence — the standard defines each entry separately and has no single line that joins them.

The two accounts describe the same kind of experience, and neither is a translation of the other: the NHS speaks of an immune reaction, histamine and blood vessels; the theory speaks of qi, the surface and the orifices.

"Wei-defensive qi" is not another name for the immune system, and histamine is not the laboratory version of "wind-cold".

How either account applies to you is a question for after the consultation, not for this section.

IV. One table: five situations, what the theory says, the usual practice, when to see a doctor first

In the table, "see a doctor" means a Klinik Kesihatan or clinic visit; the "call 999 now" situations do not wait for a clinic.

The "what TCM theory says" column is how the theory explains it, not a judgement about you.

V. See a doctor first in these situations

• You have asthma, or have been diagnosed with it. Asthma needs medical diagnosis and treatment, with a clear medication and emergency plan. Follow your doctor's treatment, and never stop an inhaler or controller medication on your own. — Asthma getting worse too is on the NHS list of reasons to see a GP [NHS-鼻敏感]
• Difficulty breathing, wheezing, speaking in short phrases, or blue lips. Call 999 now, or go to the nearest emergency department.
• Persistent one-sided blockage, or repeated nosebleeds. These need medical investigation. — Regular nosebleeds: see a doctor [NHS-鼻血]; sinusitis symptoms on one side of the face only: the NHS says a GP may refer you to an ENT specialist [NHS-鼻窦炎]
• Blood-streaked discharge, facial pain, a marked loss of smell, or persistent fever alongside it. See a doctor first. — Facial pain and swelling with feeling very unwell, or painkillers not helping: seek care the same day [NHS-鼻窦炎]; sense of smell not back in a few weeks [NHS-嗅觉], or a high temperature for more than 3 days [NHS-感冒]: see a doctor
• Recurrence that disrupts sleep, school or work. Worth a proper medical assessment rather than managing it yourself indefinitely. — The NHS lists symptoms affecting your sleep and everyday life as a reason to see a GP [NHS-鼻敏感]
• No firm diagnosis yet. Establish what it is first, then talk about TCM care. — Not being sure what is causing your symptoms is on the NHS list too [NHS-鼻敏感]

"Seek care the same day" means a same-day visit to a Klinik Kesihatan or clinic.

⚠️ A safety note: TCM and Western medicine complement each other; it is not a choice between them. If you are under medical treatment, TCM care is a layer added on top — not a layer swapped in. A nosebleed lasting longer than 10 to 15 minutes or bleeding that seems excessive [NHS-鼻血] means call 999 now, or go to the nearest hospital emergency department.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

VI. What an online consultation does, and what needs an in-person visit or a doctor

With the theory and the yardstick covered, the last thing is how "my kind of nose" is handled inside a consultation.

① The five directions a practitioner asks about. The pattern — time of day, time of year, which places; what it does — sneezing, clear discharge, blockage, itching in the nose or eyes, and which troubles you most.

What sets it off — air-conditioning, dust, haze, pets; whether cough, skin problems or disturbed sleep come with it; and the sprays, medicines and supplements you already use.

The practitioner also asks whether you have seen a doctor, whether you have had allergy testing, and which sprays you have used. What has already been ruled out is information too.

② Why the tongue. The World Health Organization's terminology standard defines tongue diagnosis as "A diagnostic method to inspect the patient's tongue body and tongue coating". [WHO-2022] An online consultation works from the tongue photo you take. Lighting, timing, angle and the common mistakes are in how to take a useful tongue photo.

③ What cannot be done online, the practitioner will say. Looking inside the nasal passages and listening with a stethoscope cannot be done online; investigations — allergy testing, nasal endoscopy — are a doctor's. If the practitioner thinks a Western medical check should come first, they say so.

④ Three possible directions: acupuncture, Chinese herbs, and lifestyle adjustments. The herbs may be concentrated granule powder or a decoction; the lifestyle side means the kind of habits in sections I and IV.

The goal is to manage a recurring condition, not to "root it out" — there is no promise of a cure here. Which, and whether, is decided after the consultation, and the practitioner's written instructions take precedence.

⑤ Reminders by situation, not by constitution:

• On long-term medication: tell the practitioner everything you take; if you already take other medicines, the NHS says speak to a pharmacist or GP before taking antihistamines [NHS-抗组织胺]; a nosebleed while taking a medicine that helps prevent blood clots is on the NHS list of reasons to see a GP. [NHS-鼻血] Never stop your medication on your own.
• Pregnant, trying, or breastfeeding: for antihistamines in pregnancy or while breastfeeding, the NHS says speak to a pharmacist or GP first [NHS-抗组织胺]; the MOH states "N95 mask is not suitable for pregnant women and children". [MOH-口罩] Whether herbs or acupuncture suit you, ask the practitioner first.
• Under 12: the NHS states "decongestants should not be used by children under 6" [NHS-鼻敏感], and that "Children aged 6 to 11 should take them for no longer than 5 days" — ask a pharmacist first [NHS-减充血剂]; for an antihistamine for a young child, speak to a pharmacist or GP first [NHS-抗组织胺]; an N95 mask is not suitable for children. [MOH-口罩] For a child's nose, see a paediatrician first.
• Older adults: the NHS says older people should speak to a pharmacist or GP before taking antihistamines [NHS-抗组织胺]; the MOH counts older people among the high-risk group in haze. [MOH-烟霾]
• Before surgery, or a chronic condition under regular review: tell your doctor the herbs, herbal teas and supplements you take, and let the doctor judge.

What to prepare beforehand is in what to prepare before an online consultation.

Fitting it into life in Malaysia

• Air-conditioning at the office and in the car: the theory's direction is the vent away from your face and a thin jacket within reach; the NHS lists very hot or cold temperatures and humidity among causes of non-allergic rhinitis. [NHS-鼻敏感] Driving in haze, the MOH's advice is aircon on recirculation and windows closed. [MOH-烟霾]
• Haze season, check APIMS first: the DOE's five bands are 0 to 50 Good, 51 to 100 Moderate, 101 to 200 Unhealthy, 201 to 300 Very Unhealthy, Above 300 Hazardous; the reading is a 24-hour running average. [DOE-API]
• Masks on haze days: the MOH's practice is that at 101 to 200 the high-risk group wears a mask outdoors, at 201 to 300 everyone does, and people with health problems see a doctor; drink plenty of water and wash your face often. [MOH-烟霾] For the mask, a respirator such as an N95; "The use of the surgical mask will not prevent one from inhaling the small airborne particles". [MOH-口罩]
• Commuting by motorbike: wind straight at the nose and mouth is a thing the theory minds — visor down and neck covered is the theory's direction. If you have taken the type of antihistamine that makes you feel sleepy, do not ride or drive. [NHS-抗组织胺]
• Fabric sofas, carpets, soft toys: HealthHub's advice is "Remove rugs or carpets, and minimise items on the bed". [SG-鼻敏感] No need to throw everything out; start with the bedroom.
• Sunning the bedding: there is sun every day here and sunning is a habit; the sourced measure is the wash temperature — the NHS says 60C and above [NHS-鼻敏感], HealthHub says 55-60 °C. [SG-鼻敏感] The theory's "hygiene of living quarters" lands here. [CMRO-养生]
• Changes after moving or going back to your hometown: whether a different environment made a difference is often a useful single sentence at the consultation.
• Sprays and antihistamines from the pharmacy (Guardian, Watsons): the NHS says allergic rhinitis can often be handled by asking a pharmacist first; decongestant sprays no longer than 5 days. [NHS-鼻敏感] Say what you bought and for how long you used it.
• Herbal-tea-shop teas, direct-sales supplements: mention them all at the consultation; the practitioner looks at them together.
• Overtime season, exam season: late nights are an early thing the theory asks about — sleeping at a fixed time and avoiding late nights is the wording of that set of principles. [CMRO-养生]
• Keep two weeks of notes: which day, what time, where you were. Two weeks of notes beats recall — see what to prepare before an online consultation.

Frequently asked

Why do I sneeze the moment I wake up? TCM theory holds that the nose is the opening of the lung and the lung dislikes cold [WHO-2022]; the early morning is cool, and wind-cold enters easily through the nose — the theory's language, not a diagnosis of you. On the Western side, the NHS lists house dust mites among common allergies, with symptoms usually "within minutes" of contact [NHS-鼻敏感]; the first item on HealthHub's list is dust-mite-proof covers for mattresses and pillows, and washing bedding "with hot water (55-60 °C)". [SG-鼻敏感] Symptoms getting worse or affecting your sleep: see a doctor. [NHS-鼻敏感]

What about air-conditioned rooms? The theory's direction is the vent away from your face, a thin jacket, a warm drink on the desk; the entry behind it is "The lung dislikes cold" [WHO-2022] — the theory holds that a cold draught on the nose and mouth chills lung qi first. On the Western side, the NHS states that very hot or cold temperatures and humidity can cause non-allergic rhinitis, which is a different thing from allergic rhinitis [NHS-鼻敏感]; telling the two apart is the doctor's job. Not sure what is causing it: see a doctor. [NHS-鼻敏感]

Which mask on a haze day? The MOH's position: "The use of the surgical mask will not prevent one from inhaling the small airborne particles. Therefore the recommended protection is the use of the respirator"; "The N95 respirator may be used as protection during the haze"; it "is effective only if used correctly", and "is not suitable for pregnant women and children". [MOH-口罩] When to wear one goes by the API: at 101 to 200 the high-risk group wears a mask outdoors, at 201 to 300 everyone does, and people with health problems see a doctor. [MOH-烟霾] Difficulty breathing or wheezing means call 999 now, or go to the nearest hospital emergency department.

Does rinsing the nose help? The NHS lists "salt water nasal sprays or solutions to rinse out the inside of your nose" among what a pharmacist can advise, and gives the method: "Boil a pint of water, then leave it to cool", add 1 teaspoon of salt and 1 teaspoon of bicarbonate of soda, sniff into 1 nostril at a time, "up to 3 times a day (making a new solution each time)". [NHS-鼻敏感] The point is "boiled, cooled, fresh each time" — never tap water as it comes. It is a general measure, not a substitute for a diagnosis; if treatments from a pharmacist are not working, see a doctor. [NHS-鼻敏感]

How do I tell allergic rhinitis from a cold? The NHS says the symptoms are similar, but allergic rhinitis usually happens "within minutes of coming into contact with something you're allergic to" [NHS-鼻敏感]; cold symptoms "come on gradually over 2 to 3 days" and you "should begin to feel better in about 1 to 2 weeks". [NHS-感冒] HealthHub's three points: in allergic rhinitis the mucus is clear, while a cold's "may be thicker, and appear greenish or yellowish"; "Allergic rhinitis does not cause fever or muscle ache"; it "rarely causes sore throat". [SG-鼻敏感] A high temperature for more than 3 days: see a doctor. [NHS-感冒]

What does TCM look at for allergic rhinitis? The whole picture around the recurrence: when it happens, what it tracks with, how the rest of the body is, plus tongue diagnosis — "A diagnostic method to inspect the patient's tongue body and tongue coating" [WHO-2022], done online from your photo. The practitioner uses the theory's language — lung, wind-cold, nasal discharge — and does not make the Western diagnosis of "allergic rhinitis" or replace it. The goal is to manage the recurrence, not to "root it out"; whether acupuncture, herbs or lifestyle adjustments is decided after the consultation.

In closing

✅ Worth remembering:

1. TCM theory treats the nose as the lung's opening: "The nose is the opening of the lung"; "The lung dislikes cold". [WHO-2022]
2. The theory's direction is no cold draught on the nose and mouth, a warm drink in the morning, warm the nose and neck, and sleep at a fixed time.
3. The Western account: an allergic reaction produces histamine [NHS-抗组织胺]; antihistamines block histamine [NHS-抗组织胺], decongestant sprays shrink swollen blood vessels and, overused, can make the blocked nose worse [NHS-减充血剂]. The theory's account is a "surface": the lung governs the skin and body hair, Wei-defensive qi [WHO-2022]. Neither translates the other.
4. The Western yardstick: wash bedding at 60C and above [NHS-鼻敏感], dust-mite-proof covers [SG-鼻敏感]; over-the-counter decongestant sprays no longer than 5 days. [NHS-鼻敏感]
5. Haze: at API 201 to 300 everyone wears a mask outdoors [MOH-烟霾], and the MOH states that respirators work better than surgical masks [MOH-口罩]. One-sided blockage, repeated nosebleeds, blood-streaked discharge, loss of smell: see a doctor first. A nosebleed lasting longer than 10 to 15 minutes or bleeding that seems excessive [NHS-鼻血], or difficulty breathing: call 999 now, or go to the nearest hospital emergency department.
6. An online consultation asks five directions and looks at your tongue photo; allergy testing and nasal endoscopy are a doctor's.

❌ Do not:

1. Go looking for remedies before there is a firm diagnosis.
2. Stop a prescribed spray or medication because you have started TCM care — never stop your medication on your own.
3. Weigh up TCM options during difficulty breathing or wheezing — call 999 now, or go to the nearest hospital emergency department.

👉 If you are not sure where to even start describing a nose problem that keeps coming back, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you.

Reviewed by Ms. Koo Shuang, a TCM practitioner registered with Malaysia's Traditional and Complementary Medicine Council under the T&CM Act 2016, practising in gastroenterology, dermatology, respiratory and women's health.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

「医师，我这个鼻子每年都这样，早上起来打喷嚏打不停。」不少读者常问这句话。大马没有四季，但冷气房、烟霾和雨季一样存在，鼻子的问题也就全年都在。

先给答案。 中医理论把鼻子看作肺的门户：世界卫生组织的中医术语标准写的是「鼻是肺的开窍」，而「肺恶寒」——肺气容易被外来的寒邪所伤。[WHO-2022]

所以这套理论给的方向是三件事：别让冷风直吹口鼻、晨起先喝温的，以及定时睡眠（都是理论的方向）。

至于「床单要怎么洗」「烟霾天戴什么口罩」「这是鼻敏感还是感冒」，西医的病人资讯页和大马卫生部给了可以对照的尺。这篇把两边放在一起，整理成 6 个重点。

一、中医理论怎么看「鼻子」

在中医理论里，「肺」不完全等于解剖学上的器官，而是一组功能的名字。世界卫生组织的中医术语标准把和鼻子有关的几条这样定义：

• 肺系：由肺、大肠、皮肤、体毛、鼻和肺经组成的功能系统。[WHO-2022]
• 肺开窍于鼻：鼻是肺的开窍。[WHO-2022]
• 肺在液为涕：鼻涕与肺相关。[WHO-2022]
• 肺恶寒：肺不耐寒，与皮肤、体毛相连；肺气容易被外来的寒邪所伤。[WHO-2022]

理论还有一句：风是「百病之长」，容易与寒、湿、燥、热相合。[WHO-2022] 所以中医常用「风寒」这一类的语言，来描述反覆的喷嚏和清涕——这是理论的语言，不是给您的诊断。

落到生活上，这套理论的方向是几件习惯层面的事：

① 别让冷风直吹口鼻——冷气出风口、风扇、摩托车上的风。

② 晨起先喝一杯温的，再出门。

③ 起床时先让鼻子和颈部暖起来——围一条薄围巾，是理论的方向。

④ 定时睡眠，避免熬夜，并注意居室卫生。香港卫生署中医药规管办公室的养生原则写的是「定时睡眠，避免熬夜和久卧」，以及「须注意居室卫生」。[CMRO-养生]

这些是方向，不是处方；哪一项对您有意义，是问诊后的事。

二、先有一把尺：鼻敏感的西医说法

理论讲方向，西医的病人资讯页讲定义和做法。以下取自英国国民保健署（NHS）和新加坡卫生部 HealthHub 的公开页面。

① 鼻敏感是什么。 过敏性鼻炎（鼻敏感）是西医的诊断。NHS 的说法是：鼻子被您过敏的东西刺激，引起打喷嚏等症状；常见的过敏原包括花粉、尘螨、动物皮屑、霉菌。[NHS-鼻敏感]

NHS 也写明，过敏性鼻炎和非过敏性鼻炎不同——后者由感冒、过高或过低的温度、湿度之类引起。[NHS-鼻敏感] 所以「一进冷气房就塞」，在西医里也有它的位置。

② 鼻敏感和感冒怎么分。 NHS 的说法是，鼻敏感的症状和感冒相似，但通常在接触过敏原后几分钟内出现 [NHS-鼻敏感]；感冒的症状则在 2 到 3 天里逐渐出现，大约 1 到 2 周会开始好转。[NHS-感冒]

HealthHub 补了三点：鼻敏感的鼻涕和眼泪是清的，感冒的鼻涕可能较稠、偏绿或偏黄；鼻敏感不引起发烧或肌肉酸痛；鼻敏感很少引起喉咙痛。[SG-鼻敏感]

③ 家里怎么减少过敏原。 NHS 的建议是：用合成纤维的寝具和套子，并定期以 60°C 或以上清洗寝具；用湿布抹尘，用带 HEPA 滤网的吸尘机。[NHS-鼻敏感]

同一页还说：保持家里干燥通风，处理潮湿和冷凝；不让宠物进卧室。[NHS-鼻敏感]

HealthHub 的清单更具体：床褥、枕头和长枕用防尘螨套；寝具经常以 55 到 60°C 的热水清洗；移走地毯，减少床上的物品，例如毛绒玩具、抱枕。[SG-鼻敏感]

④ 洗鼻子怎么做。 NHS 的做法是：烧开一品脱水，放凉；加入 1 茶匙盐和 1 茶匙小苏打；洗手。[NHS-鼻敏感]

然后在洗手盆上，用手掌盛一点溶液，一次一个鼻孔吸入，用口呼吸，让水流回洗手盆；每天最多 3 次，每次新配。[NHS-鼻敏感] 一品脱约 570 毫升。[NHS-鼻窦炎]

⑤ 药剂行的药，谁先问药剂师。 NHS 的说法是，鼻敏感通常不用看医生就能处理；药剂师可以建议抗组织胺、减充血喷鼻剂、类固醇喷鼻剂和盐水喷雾。[NHS-鼻敏感]

两个类别层面的提醒。减充血喷鼻剂不宜连续使用超过 5 天，否则可能让鼻塞更严重 [NHS-鼻敏感]；HealthHub 把这叫作「反弹性鼻塞」。[SG-鼻敏感] 为什么有这个上限，见第三节。

会令人昏昏欲睡的那一类抗组织胺，服用后不要驾驶或操作机器。[NHS-抗组织胺]

正在使用医生开的药或喷剂的，请如实说明，切勿自行停药。中药与西药同用的问题，另见：中药和西药可以一起吃吗。

三、它是怎么发生的：两套说法

第二节给了尺。这一节回答另一个问题：鼻子为什么会这样，药剂行的三类药和家里的那几件事，各自对着哪一步。

西医的说法和中医理论的说法并排放，各自写明出处，不互译。

① 西医的说法：过敏反应与组织胺。 NHS 的鼻敏感页只写一句：过敏性鼻炎由过敏反应引起。[NHS-鼻敏感] HealthHub 多说一点：它是免疫系统对所过敏的颗粒反应过度的结果。[SG-鼻敏感]

组织胺那一步，写在 NHS 的抗组织胺页。NHS 的说法是：身体察觉到有害的东西，例如感染，通常会释放组织胺；组织胺使血管扩张、皮肤肿胀，这是身体的保护反应。[NHS-抗组织胺]

同一页接着说：有过敏的人，身体把无害的东西——花粉、动物毛发、屋尘——误当成威胁而产生组织胺；由此引起的过敏反应包括眼睛痒而流泪、流鼻涕或鼻塞、打喷嚏和皮疹。[NHS-抗组织胺]

NHS 的页面到这里为止，没有再写组织胺之后的每一步；这篇也停在这里。

② 三类药各对着哪一步。 把第二节的三类药放回这条线上，就看得出它们为什么不是一回事：

• 抗组织胺：NHS 说它阻断组织胺的作用；也因此 NHS 写，在接触过敏原之前服用是「帮助防止」，之后服用是「减轻严重程度」。[NHS-抗组织胺] 怎么用，问药剂师。
• 减充血喷鼻剂：NHS 说它的作用是减少鼻内血管的肿胀，让气道通畅 [NHS-减充血剂]——对的是「塞」这一步，不是过敏反应本身。
• 类固醇喷鼻剂：HealthHub 说它缓解的是过敏原引起的鼻内发炎与肿胀。[SG-鼻敏感]

③ 为什么减充血喷鼻剂有 5 天的上限。 NHS 的减充血剂页写明：喷剂和滴剂一次不宜使用超过 5 天，因为用太久反而可能让鼻塞更严重。[NHS-减充血剂]

HealthHub 把这叫作「反弹性鼻塞」——因过度使用鼻用减充血剂而造成的持续鼻塞。[SG-鼻敏感]

NHS 的非过敏性鼻炎页，更把「使用减充血喷鼻剂的时间超过包装所写」本身列为非过敏性鼻炎的原因之一。[NHS-非过敏性鼻炎]

按 NHS 的写法，用来通鼻的喷剂用过了头，可能成为另一种鼻塞的来源。

至于反弹为什么会发生，这几页都没有写；这篇不替它补。NHS 同一页还说：不要同时用超过一种通鼻的药，包括两种喷剂同用，或喷剂加口服药。[NHS-减充血剂]

医生开的喷剂或药物，按医生的指示使用，切勿自行停药。

④ 床单为什么要 60°C。 NHS 给的是温度，没有写原因：合成纤维寝具，定期 60°C 或以上清洗。[NHS-鼻敏感]

HealthHub 写了目的：以 55 到 60°C 热水经常清洗寝具，是为了除去尘螨；床褥、枕头、长枕用防尘螨套。[SG-鼻敏感]

移走地毯、减少床上的物品，因为它们可能积尘；经常吸尘和拖地，是为了清除屋里的尘螨和昆虫排泄物。[SG-鼻敏感]

所以这几件事对着的是同一步——减少接触过敏原，也就是①那条线的起点。至于 60°C 这个数字为什么是 60，两页都没有解释；这篇照页面的写法，只给温度和目的。

⑤ 中医理论的说法：一道「表」。 理论没有组织胺这一层；它用的是另一套模型——身体有一层「表」，由肺管着。世界卫生组织的标准把相关的几条这样定义：

• 肺主皮毛：肺温养皮肤与体毛，调节汗孔的开合，并护卫体表。[WHO-2022]
• 肺主宣发：肺气向上、向外的布散。[WHO-2022]
• 卫气：与营气相对；行于脉外，由水谷的营养所化。[WHO-2022] 另有一条卫行脉外：卫气属阳，性质刚悍，行于脉外。[WHO-2022]
• 风性轻扬：风的特性是向上飘动，容易侵犯头面、体表和阳经。[WHO-2022] 风性开泄：风使皮肉之间的间隙疏松、汗孔张开，因而出汗、怕风。[WHO-2022]
• 邪害空窍：致病因素侵犯口、鼻、耳、目所造成的病理状态。[WHO-2022]

把这几条和第一节的「肺开窍于鼻」「肺恶寒」放在一起读，就是理论的屏障模型。

肺把气向外布散到体表，体表由「卫」守着，鼻是这层表上的开口；风寒从体表和鼻窍进来，先碰到的是这一层。

上面这一段是本文对这几条定义的整理，不是标准的原句——标准把每一条分开定义，没有一句话把它们串起来。

两套说法讲的是同一类经验，不是互译：NHS 讲的是免疫反应、组织胺与血管，理论讲的是气、表与窍。

「卫气」不是免疫系统的另一个名字，组织胺也不是「风寒」的化验室版本。

哪一套说法在您身上怎么用，是看诊后的事，不在这一段里。

四、一张表看懂：五种情况，理论怎么说、一般怎么做、什么时候先看医生

表里「看医生」指 Klinik Kesihatan 或诊所的门诊；「立刻拨打 999」的情况，不等门诊。

「中医理论的说法」一栏是理论怎么解释，不是给您的判断。

五、这些情况请先看西医

• 有气喘，或曾被诊断过气喘：气喘需要西医的诊断与治疗，并有明确的用药与急救安排。请以西医的治疗为主，切勿自行停用喷剂或控制药物。——气喘也在加重，NHS 列为应看医生 [NHS-鼻敏感]
• 呼吸困难、喘鸣、说话时断句、嘴唇发紫：请立刻拨打 999，或前往最近的急诊部。
• 单侧持续鼻塞，或反覆流鼻血：需要西医检查确认原因。——反覆流鼻血，看医生 [NHS-鼻血]；鼻窦炎的症状只在脸的一侧，NHS 说医生可能转介耳鼻喉专科 [NHS-鼻窦炎]
• 鼻涕带血、脸部疼痛、嗅觉明显减退，或伴随持续发烧：请先就医。——脸部疼痛肿胀且很不舒服，或止痛药没有帮助，当天求医 [NHS-鼻窦炎]；嗅觉几周内没恢复 [NHS-嗅觉]、高烧超过 3 天 [NHS-感冒]，看医生
• 反覆发作影响睡眠、上课或工作：值得让医生正式评估一次，而不是长期自行处理。——NHS 把影响睡眠和日常生活列为应看医生的情况 [NHS-鼻敏感]
• 还没有明确诊断：先看西医确认是什么，再谈调理。——不确定是什么引起的，NHS 也列为应看医生的情况 [NHS-鼻敏感]

「当天求医」指 Klinik Kesihatan 或诊所的当天门诊。

⚠️ 安全提醒：中医与西医是互相补位的关系，不是二选一。若您正在西医治疗中，中医调理是加上去的一层，不是拿来替换的那一层。流鼻血超过 10 到 15 分钟或出血量大 [NHS-鼻血]，请立刻拨打 999，或前往最近的医院急诊部。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

六、线上问诊会做什么，什么需要亲诊或看医生

理论和尺都讲完了，最后一件事是：「我这种鼻子」在问诊里是怎么被处理的。

① 医师会问的五个方向。 发作的规律——一天里、一年里、在什么地方；具体的表现——喷嚏、清涕、鼻塞、鼻痒、眼睛痒，哪一项最困扰。

诱发的情境——冷气、灰尘、烟霾、宠物；有没有伴随咳嗽、皮肤问题、睡眠受影响；您已经在用的喷剂、药物、保健品。

另外还会问：看过西医没有、做过过敏原检测没有、用过什么喷剂。已经排除过的可能性，同样是重要的资讯。

② 为什么要看舌头。 世界卫生组织的术语标准把舌诊定义为「观察病人舌体和舌苔的诊法」。[WHO-2022] 线上问诊看的是您拍的舌头照片，拍法见：舌头照片怎么拍。

③ 线上做不到的，医师会说。 需要看鼻腔内部、需要听诊的部分，线上做不到；需要检查的——过敏原检测、鼻内视镜——是医生的事。医师若认为应该先做西医检查，会直接说。

④ 可能采用的方向有三个：针灸、中药，以及生活调整。 中药可能是浓缩中药粉或水煎药；生活调整指第一节和第四节那类习惯。

目标是管理反覆发作的情况，不是「断根」——这里没有「治好」的承诺。用哪一种、要不要用，看诊后才决定，以医师的书面指示为准。

⑤ 按情况的提醒——不是按体质：

• 正在长期服药：所有药都告诉医师；已经在服其他药的，NHS 建议用抗组织胺前先问药剂师或医生 [NHS-抗组织胺]；正在服用抗凝血药而流鼻血，NHS 列为应看医生的情况。[NHS-鼻血] 切勿自行停药。
• 孕期、备孕或哺乳：孕期或哺乳期用抗组织胺，NHS 建议先问药剂师或医生 [NHS-抗组织胺]；卫生部写明 N95 口罩不适合孕妇。[MOH-口罩] 中药与针灸是否适合，先问医师。
• 12 岁以下：NHS 写明减充血剂 6 岁以下不宜使用 [NHS-鼻敏感]，6 至 11 岁使用不超过 5 天，请先问药剂师 [NHS-减充血剂]；给幼儿选抗组织胺，先问药剂师或医生 [NHS-抗组织胺]；N95 口罩不适合儿童。[MOH-口罩] 孩子的鼻子，先看儿科医生。
• 乐龄人士：NHS 建议乐龄人士用抗组织胺前先问药剂师或医生 [NHS-抗组织胺]；卫生部把乐龄人士列入烟霾高风险群体。[MOH-烟霾]
• 准备手术、慢性病定期复诊中：把您在吃的中药、凉茶、保健品告诉医生，由医生判断。

问诊前的准备，见：线上问诊前该准备什么。

大马生活里怎么安排

• 办公室与车里的冷气：理论的方向是出风口不对着脸、备一件薄外套；NHS 把过高或过低的温度和湿度列为非过敏性鼻炎的原因之一。[NHS-鼻敏感] 烟霾天开车，卫生部建议开内循环、关上车窗。[MOH-烟霾]
• 烟霾季节，先看 APIMS：DOE 的五档是 0 至 50 良好、51 至 100 中等、101 至 200 不健康、201 至 300 非常不健康、300 以上危险；读数是 24 小时滑动平均。[DOE-API]
• 烟霾天的口罩：卫生部的做法是 101 至 200 高风险群体外出戴口罩，201 至 300 所有人外出戴，有健康问题的人看医生；多喝水、常洗脸。[MOH-烟霾] 口罩选呼吸器，例如 N95；外科口罩挡不住细颗粒。[MOH-口罩]
• 摩托车通勤：风直吹口鼻是理论很在意的一件事——面罩放下、颈部围起来是理论的方向。服了会令人昏昏欲睡的那一类抗组织胺，不要骑车或驾驶。[NHS-抗组织胺]
• 布沙发、地毯、毛绒玩具：HealthHub 的建议是移走地毯，减少床上的物品。[SG-鼻敏感] 不必全部丢掉；先从卧室开始。
• 晒被单：大马太阳天天有，晒是习惯；有来源的做法是清洗温度——NHS 说 60°C 或以上 [NHS-鼻敏感]，HealthHub 说 55 到 60°C。[SG-鼻敏感] 理论说的「居室卫生」，落在这里。[CMRO-养生]
• 回乡或搬家后的变化：换了环境之后有没有不一样，这一句话看诊时常常很有用。
• 药剂行（Guardian、Watsons）的喷剂和抗组织胺：NHS 说鼻敏感通常先问药剂师就能处理；减充血喷鼻剂不超过 5 天。[NHS-鼻敏感] 买了什么、用了多久，看诊时一并说明。
• 凉茶铺的茶、直销的保健品：看诊时都说出来，医师会一并看。
• 加班季、考试季：熬夜是理论会先问的事——「定时睡眠，避免熬夜」是这套养生原则的原话。[CMRO-养生]
• 记录两周的发作情形：哪一天、什么时段、当时在哪里。两周的记录比回忆准确。做法可参考：线上问诊前该准备什么。

常见问题

早上一起床就打喷嚏是为什么？ 中医理论认为鼻是肺的开窍、肺恶寒 [WHO-2022]，清晨气温低，风寒容易从鼻窍而入——这是理论的语言，不是给您的诊断。西医这边，NHS 把尘螨列为常见过敏原，症状通常在接触后几分钟内出现 [NHS-鼻敏感]；HealthHub 清单的第一条是床褥、枕头用防尘螨套，寝具以 55 到 60°C 热水清洗。[SG-鼻敏感] 症状加重或影响睡眠，看医生。[NHS-鼻敏感]

冷气房怎么办？ 理论的方向是出风口不对着脸、备一件薄外套、办公桌上放温饮；依据是「肺恶寒」这一条 [WHO-2022]——理论认为冷风直吹口鼻，肺气先受寒。西医那边，NHS 写明过高或过低的温度和湿度可引起非过敏性鼻炎，和过敏性鼻炎是两回事 [NHS-鼻敏感]；两者怎么分，由医生判断。不确定是什么引起的，看医生。[NHS-鼻敏感]

烟霾天要戴什么口罩？ 卫生部的说法是：外科口罩挡不住烟霾里的细颗粒，建议用呼吸器，例如 N95；N95 要正确佩戴才有效，不适合孕妇和儿童。[MOH-口罩] 什么时候戴，看 API：101 至 200 高风险群体外出戴，201 至 300 所有人外出戴，有健康问题的人看医生。[MOH-烟霾] 呼吸困难、喘鸣，请立刻拨打 999，或前往最近的医院急诊部。

洗鼻子有用吗？ NHS 把盐水喷雾或盐水冲洗列为药剂师可以建议的做法之一，做法是：烧开一品脱水、放凉，加 1 茶匙盐和 1 茶匙小苏打，一次一个鼻孔吸入，每天最多 3 次，每次新配。[NHS-鼻敏感] 重点在「烧开、放凉、每次新配」——不用生水。它是一般做法，不取代诊断；药剂师的药没有帮助，看医生。[NHS-鼻敏感]

鼻敏感和感冒怎么分？ NHS 的说法是：两者症状相似，鼻敏感通常在接触过敏原后几分钟内出现 [NHS-鼻敏感]；感冒在 2 到 3 天里逐渐出现，大约 1 到 2 周开始好转。[NHS-感冒] HealthHub 的三点：鼻敏感的鼻涕是清的，感冒的可能较稠、偏绿或偏黄；鼻敏感不引起发烧或肌肉酸痛；很少引起喉咙痛。[SG-鼻敏感] 高烧超过 3 天，看医生。[NHS-感冒]

中医看鼻敏感看什么？ 看的是反覆发作这件事的整体情况：什么时候发、和什么有关、身体其他方面如何，加上舌诊——「观察病人舌体和舌苔的诊法」[WHO-2022]，线上看的是照片。医师用的是理论的语言——肺、风寒、涕——不做「过敏性鼻炎」这个西医诊断，也不取代它。目标是管理反覆发作，不是「断根」；针灸、中药还是生活调整，看诊后才决定。

结语

✅ 记住这几点：

1. 中医理论把鼻子看作肺的开窍：鼻是肺的开窍，肺恶寒。[WHO-2022]
2. 理论的方向是冷风不直吹口鼻、晨起温饮、暖鼻颈，以及定时睡眠。
3. 西医的说法：过敏反应产生组织胺 [NHS-抗组织胺]；抗组织胺挡组织胺 [NHS-抗组织胺]，减充血喷鼻剂消血管肿胀，用过头反而可能更塞 [NHS-减充血剂]。理论的说法是一道「表」：肺主皮毛、卫气 [WHO-2022]。两边不互译。
4. 西医的尺：寝具 60°C 以上清洗 [NHS-鼻敏感]、防尘螨套 [SG-鼻敏感]；减充血喷鼻剂（非处方）不超过 5 天。[NHS-鼻敏感]
5. 烟霾：API 201 至 300 所有人外出戴口罩 [MOH-烟霾]，卫生部写明呼吸器优于外科口罩 [MOH-口罩]。单侧鼻塞、反覆流鼻血、鼻涕带血、嗅觉减退——先看西医。流鼻血超过 10 到 15 分钟或出血量大 [NHS-鼻血]、呼吸困难——请立刻拨打 999，或前往最近的医院急诊部。
6. 线上问诊问五个方向、看舌头照片；过敏原检测和鼻内视镜是医生的事。

❌ 不要这样做：

1. 不要在还没有明确诊断时就先自行找调理方式。
2. 不要因为开始中医调理就自行停掉医生开的喷剂或药物——切勿自行停药。
3. 不要在出现呼吸困难或喘鸣时还在考虑调理——请立刻拨打 999，或前往最近的医院急诊部。

👉 如果您不确定「我这种反覆发作的鼻子情况，该从哪里说起」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估。

本文由 邱双 医师 撰稿审阅。邱双 医师依 2016 年 T&CM 法令于马来西亚传统与辅助医药理事会注册执业，专长为肠胃科、皮肤科、呼吸科与妇科。

无论身在何处，与持证中医师对坐。

汉方现代中医