Allergic rhinitis (AR) is described as a chronic, IgE-mediated inflammatory disorder with a multifactorial pathogenesis. Key pathophysiologic components highlighted in the review include Th2 cell polarization, impairment of the mucosal epithelial barrier, dysbiosis of the microbiota, and neuro-immune interactions. The authors emphasize that these interconnected mechanisms contribute to symptom generation and persistence, and that effective therapies may need to target multiple pathways simultaneously.
In traditional Chinese medicine (TCM) AR is classified under the term “bi qiu,” with pathogenesis attributed to dysfunction of the lung, spleen, and kidney and to invasion by external pathogenic factors. The review notes longstanding clinical use of Chinese herbal formulas—Yupingfeng San (Jade Wind Screen Powder) is given as an example documented in classic texts—and frames TCM as a holistic approach that can address multiple elements of AR pathogenesis concurrently.
The authors performed a comprehensive literature search across PubMed, Web of Science, EMBASE, Cochrane Library, Wanfang Database, and China National Knowledge Infrastructure (CNKI). Search terms combined clinical and mechanistic keywords such as "allergic rhinitis," "pathogenesis," "traditional Chinese medicine," and "active components of Chinese medicine."
Inclusion criteria were: original clinical studies, observational studies, randomized controlled trials (RCTs), and meta-analyses relevant to AR and TCM; articles published primarily in 2020–2025, with earlier seminal work included for foundational mechanisms. Exclusion criteria included abstracts, non–peer-reviewed material, low-quality studies lacking appropriate controls, and studies irrelevant to AR. Plant names were validated against The World Flora Online to ensure taxonomic accuracy, and a PRISMA flowchart is reported as included in supplementary materials.
Preclinical data reviewed indicate multiple molecular and cellular targets through which TCM and individual herbal components may influence AR pathophysiology. Mechanisms discussed include regulation of transcription factors such as NF-κB and GATA3, which are central to inflammatory and Th2-driven responses. Restoration of epithelial barrier integrity is noted, with increases in tight junction proteins including ZO-1 and occludin identified in experimental models.
The review also summarizes evidence that certain TCM interventions can modulate the gut microbiota and increase production of short-chain fatty acids (SCFAs), metabolites implicated in immune regulation. These microbiota-mediated effects are presented as a potential route by which TCM exerts systemic immunomodulatory influence that could impact nasal mucosal immunity.
The authors caution that the bulk of these mechanistic insights arises from animal and in vitro studies, limiting direct extrapolation to human clinical outcomes.
Clinical studies cited in the review provide preliminary evidence for the safety and symptomatic benefit of TCM therapies, both as monotherapy and when combined with Western medicines. A randomized controlled trial (n = 60) is highlighted in which nasal lavage with Glycyrrhizae Radix et Rhizoma (licorice) significantly improved SNOT-22 scores (reported change from 27.9 ± 15.5 to 13.2 ± 9.6, p < 0.001) and reduced nasal airway resistance (p < 0.001), with effects described as superior to corticosteroid or saline lavage in that study.
Beyond this RCT, the review notes multiple smaller clinical reports and observational studies, but underscores that overall clinical evidence remains preliminary. Safety profiles reported are generally favorable in the included studies, but the authors emphasize the need for higher-quality trials with rigorous controls, standardized herbal preparations, and clinically relevant endpoints.
The review explicitly identifies key limitations: most mechanistic data are derived from preclinical models rather than human tissues or trials, heterogeneity exists in herbal formulations and dosing, and many clinical studies are small or single-center. The authors call attention to the translational gap between promising mechanistic findings and definitive clinical proof of efficacy and safety in large, well-controlled human trials.
The authors conclude that TCM shows preclinical potential to address AR’s multifactorial etiology through holistic, multi-target regulatory mechanisms. However, they recommend that future research prioritize large-scale, multi-center randomized trials and the application of advanced biotechnological methods to standardize herbal products, elucidate mechanisms in humans, and facilitate global acceptance. The review positions TCM as a complementary strategy with potential to overcome limitations of conventional treatments, while acknowledging that stronger clinical validation is required before broad adoption.
Conflict of interest: the authors declared no competing interests.