"This patient presents with recurrent allergic rhinitis, sneezing with clear discharge, aversion to wind with spontaneous sweating, fatigue and loose stools — this is a pattern of Taiyang exterior deficiency and Taiyin spleen deficiency. From Shang Han Lun Article 100, this old physician clearly establishes the principle of 'treat interior deficiency first, exterior symptoms second'. The patient's 'recurrent attacks, fatigue, loose stools' indicate urgent spleen deficiency; 'sneezing, clear discharge' indicate mild exterior symptoms. Treatment should first strengthen the spleen and warm yang to secure the root (Guizhi Jia Fuzi Tang combined with Lizhong Tang modifications), then lightly diffuse lung qi to treat the branch. If one first disperses wind and clears heat, the acrid dispersion will consume qi, inevitably worsening spleen deficiency and prolonging the allergic rhinitis."

"The sneezing and watery discharge, fatigue and weakness are the branch of wind evil invading the lung; however, the chronic recurrence, fatigue with loose stools are the root of spleen-stomach weakness, earth failing to generate metal, clear yang failing to rise, and exterior defense being insecure. Using the analogy of 'a breached dike with overflowing water': when the dike is breached (spleen deficiency), water evil easily invades. Building dikes every year to prevent flooding (diffusing lung and dispelling wind) without repairing the dike to secure the root will never bring a cure. Bu Zhong Yi Qi Tang uses astragalus, ginseng, atractylodes, and licorice to supplement the center as sovereign, with cimicifuga and bupleurum to raise clear yang and secure the exterior, enabling the spleen earth to become strong so lung metal naturally becomes substantial, and clear yang rises so exterior defense naturally becomes secure — nourishing earth to flourish metal, addressing both root and branch. Therefore, strengthen the spleen, boost qi, raise yang and secure the exterior first (70%) — cimicifuga and bupleurum already contain the meaning of light diffusion, no need to add additional acrid-cold exterior-releasing herbs."

"The strongest opposing argument claims 'spleen deficiency as root, wind evil as branch,' advocating strengthening spleen and boosting qi to secure the exterior first. However, this theory neglects the pathological characteristic of pollen allergies with recurrent attacks damaging yin and consuming fluids — from the first principles of Dan Xi Xin Fa: yin is often insufficient, lung yin deficiency leads to loose interstitial spaces, allowing wind evil to penetrate deeply. Simple spleen-strengthening and qi-boosting (Bu Zhong Yi Qi Tang) can raise clear yang, but sweet-warm medicinals actually assist internal heat and are unsuitable for yin-deficient patients. The patient's chronic recurrence, clear watery discharge, aversion to wind with spontaneous sweating perfectly matches the pattern of lung defense being insecure — but the root lies in lung yin deficiency, not simple spleen deficiency. The optimal approach is treating root and branch together, with nourishing yin as primary — during acute phase, dispelling wind and opening orifices as primary, nourishing yin and moistening lung as auxiliary; during remission, nourishing yin and supplementing lung to secure the exterior as primary, dispelling wind as auxiliary. Only when lung yin is abundant will exterior defense naturally become secure, and wind-heat will have no gap to exploit, enabling complete recovery."

"From Ben Cao Gang Mu, Volume 12 — Astragalus: 'For treating nasal discharge with clear fluid, aversion to wind with spontaneous sweating, recurrent attacks, this is defense qi failing to secure. Use astragalus as sovereign, saposhnikovia as assistant, enabling defense qi to become secure and wind evil to naturally depart.' This clearly states that recurrent allergic rhinitis belongs to defense qi failing to secure, and one should secure the exterior first, yet assist with saposhnikovia — not pure supplementation. From Volume 15 — Magnolia Flower: 'Acrid, warm, non-toxic. Disperses wind-cold, opens nasal orifices. For chronic illness with deficient patients, should be combined with ginseng and astragalus, do not use acrid dispersion alone.' Magnolia flower, though essential for opening the nose, must be combined with qi-boosting medicinals for chronic deficient patients, and cannot be used alone."

"Pure lung-diffusing and wind-dispelling (Xanthium Fruit Powder, Magnolia Flower Powder) — acrid, warm, drying and intense, damaging spleen and assisting deficiency. Pure spleen-strengthening and qi-boosting (Four Gentlemen Decoction) — evil lingering in nasal orifices, sneezing difficult to stop. My formula: 70% supplementation, 30% dispersion — using Yu Ping Feng San as foundation (astragalus double saposhnikovia), adding magnolia flower and angelica dahurica to open orifices, enabling spleen health to generate lung metal, defense security to repel wind evil, nasal passage to allow evil exit."

"From Lin Zheng Zhi Nan Yi An, Volume 2, Allergic Rhinitis Section, Case 24: The patient had chronic recurrent allergic rhinitis, frequent sneezing, clear watery discharge, nasal congestion and itchy eyes, floating and weak pulse. Previous physicians used pure lung-diffusing and wind-dispelling (Xanthium Fruit Powder, Magnolia Flower Powder) — symptoms temporarily reduced but fatigue worsened, loose stools increased, recurrence frequency increased (from 3 times/year to 8 times/year). Changed to pure spleen-strengthening and qi-boosting (Bu Zhong Yi Qi Tang) — fatigue and loose stools slightly improved but sneezing did not decrease, nasal congestion worsened. Finally prescribed Yu Ping Feng San combined with Sang Ju Yin modifications (astragalus 15g, atractylodes 12g, saposhnikovia 9g, mulberry leaf 6g, chrysanthemum 6g, apricot seed 6g, licorice 3g) — 70% boosting qi and securing exterior, 30% lightly diffusing lung qi. After ten days, sneezing reduced by 80%, spirit recovered and stools regulated. Continued for over a month, follow-up for four years with only one recurrence."

"Ye comments: 'Allergic rhinitis of long duration — pure diffusion damages defense qi further, recurrence becomes more frequent; pure supplementation allows evil to linger without resolution. One must secure defense and lightly diffuse, yet clearly differentiate qi deficiency as primary, wind evil as branch — 70% securing exterior, 30% diffusing lung, enabling healthy qi to flourish so evil naturally departs. This is the principle of treating the root without forgetting the branch.'"

"From Qian Jin Yao Fang, Volume 6, Seven Orifices Diseases: 'Allergic rhinitis — lung qi disharmony, re-invasion of wind evil, spleen earth weakness, exterior defense insecure' — clearly stating allergic rhinitis is lung-spleen dual disease, lung qi disharmony as branch, spleen deficiency and exterior weakness as root. This patient's frequent sneezing and watery clear discharge are wind evil invading the lung as branch; chronic recurrence, fatigue and loose stools are all spleen deficiency and exterior weakness as root."

"This old physician maintains the lung-diffusing and spleen-strengthening sequential method — acute phase: lung-diffusing without forgetting spleen-strengthening (xanthium fruit, magnolia flower in light doses, plus atractylodes, poria, astragalus to protect spleen and boost qi); remission phase: spleen-strengthening as primary, light diffusion as auxiliary (Yu Ping Feng San plus magnolia flower). This aligns with Li Shizhen's 'astragalus double saposhnikovia' ratio and Li Dongyuan's 'nourishing earth to flourish metal' principle. However, this old physician emphasizes spleen-strengthening always runs through — acute phase adds astragalus, atractylodes, poria to protect spleen and boost qi; remission phase uses Yu Ping Feng San as foundation. This is the subtle principle of Qian Jin Yao Fang: 'When spleen is prosperous, lung metal has something to generate, and exterior defense has something to secure.'"

"Allergic rhinitis of long duration — root deficiency with branch excess, treat by stages. Acute phase: 70% diffuse lung and dispel wind, 30% strengthen spleen and boost qi, enabling evil to depart without damaging healthy qi. Remission phase: 70% strengthen spleen and boost qi, 30% lightly disperse residual evil, enabling healthy qi to recover and evil not to invade."

"Xanthium fruit is warm, acrid, drying, slightly toxic; contraindicated in chronic deficiency with loose stools; substitute with magnolia flower."

"此患者鼻鼽反复发作、喷嚏清涕、畏风自汗、疲乏便溏 —— 此乃太阳表虚、太阴脾虚之证。从《伤寒论》第100条观之，仲景明示里虚为先、表证为次之治则；患者'反复发作、疲乏、便溏'乃脾虚急证，'喷嚏、清涕'为表证缓证。治当先健脾温阳以固其本（桂枝加附子汤合理中汤加减），后轻宣肺气以治其标；若先疏风清热，辛散耗气，必致脾虚更甚、鼻鼽缠绵。此即'见肝之病，知肝传脾，当先实脾'之微旨 —— 培土实脾，则肺金有所生，卫外有所固。"

"此证喷嚏流涕、神疲乏力，乃风邪犯肺之标；然慢性反复、劳倦便溏，乃脾胃虚弱、土不生金、清阳不升、卫外不固之本。类比'堤溃水溢'：堤岸溃败（脾虚）则水邪易侵，年年筑堤防洪（宣肺祛风）而不修堤固本，终无愈期。补中益气汤以黄芪、人参、白术、甘草补中为君，升麻、柴胡升清阳而固表，使脾土健旺则肺金自实，清阳上升则卫外自固，培土荣金，标本兼顾。故当健脾益气、升阳固表为先（70%），升麻、柴胡已寓轻宣之意，无需另加辛凉解表。"

"最强反方论点主张'脾虚为本、风邪为标'，然此论忽视了花粉过敏反复发作、伤阴耗液的病理特点 —— 从《丹溪心法》第一性原理出发：阴常不足，肺阴亏虚则腠理疏松，风邪方能长驱直入。患者慢性反复、清涕如水、畏风自汗，正合肺卫不固之象，然其本在肺阴亏虚，而非单纯脾虚。最优方案是标本兼治、滋阴为主 —— 急性期以祛风通窍为主、滋阴润肺为辅，缓解期以滋阴补肺固表为主、祛风为辅，使肺阴充足则卫外自固，风热无隙可乘，方能断根。"

"《本草纲目》卷十二黄芪条：'治鼻流清涕、畏风自汗、反复发作者，此卫气不固也。当以黄芪为君，防风为佐，使卫气固而风邪自去。'明言鼻鼽反复发作属卫气不固，当以固表为先，然佐以防风，非纯补也。卷十五辛夷条：'辛，温，无毒。散风寒，通鼻窍。久病人虚者，宜配参、芪，勿单用辛散。'"

"纯宣肺祛风，辛温燥烈，便溏者脾更伤；纯健脾益气，邪恋鼻窍，喷嚏难止。当以玉屏风散为基（黄芪倍防风），加辛夷、白芷通窍，使脾健则肺有所生，卫固则风邪自却，鼻通而邪有出路。"

"《临证指南医案》卷二鼻鼽门第二十四案：患者鼻鼽慢性复发，前医纯用宣肺祛风，复发频率由年三发增至年八发；改予纯用健脾益气，喷嚏不减；最终予玉屏风散合桑菊饮加减，益气固表七分、轻宣肺气三分，十日后喷嚏减八成，随访四年仅复发一次。"

"叶按：'鼻鼽日久，纯宣则卫气愈伤、复发愈频，纯补则邪恋不解，必固卫轻透，然辨明气虚为主、风邪为标，固表七分、宣肺三分，使正旺邪自却，此治本不忘标之旨。'"

"《千金要方·卷六·七窍病》：'鼻鼽者，肺气不和，复感风邪，脾土虚弱，卫外不固' — 明确指出鼻鼽乃肺脾同病，肺气不和为标，脾虚卫弱为本。"

"老朽维持宣肺健脾序贯法 —— 急性期宣肺不忘健脾（苍耳子、辛夷轻剂，加白术、茯苓、黄芪护脾益气），缓解期健脾为主轻宣为辅（玉屏风散加辛夷）。此与李时珍'黄芪倍防风'之比例、李东垣'培土荣金'之旨相通。"

"鼻鼽日久，本虚标实，当分期论治 —— 急性期七分宣肺祛风、三分健脾益气，使邪去而不伤正；缓解期七分健脾益气、三分轻宣余邪，使正复而邪不侵。"

"苍耳子性温燥烈、有小毒，久病虚者禁用，当以辛夷代之。"