bubble_chart Concept

Nasal discharge refers to the secretion flowing out from the nostrils. Based on the nature of the nasal discharge, it can be clinically categorized into several types, including "clear discharge," "white sticky discharge," "sticky purulent discharge," "yellow purulent discharge," "purulent bloody discharge," and "foul-smelling discharge."

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰The nasal discharge is thin and copious, with nasal congestion and frequent sneezing, accompanied by fever and chills, headache, cough, and absence of sweating. The tongue texture is pale red with thin white coating, and the pulse is floating and tight. This indicates an external contraction of wind-cold, with clear and thin nasal discharge, combined with an exterior cold pattern. The treatment should focus on releasing the exterior with pungent-warm herbs, dispersing wind, and dissipating cold. The recommended formula is Fistular Onion Stalk, Fermented Soybean Decoction with modifications.
2. Wind-heat External Contraction︰The nasal discharge is yellow, thick, and copious, and in severe cases, there is redness, swelling, and pain around the nostrils, accompanied by nasal congestion. Additional symptoms include headache, fever, aversion to wind, cough, sweating, a red tongue with white coating, and a floating, rapid pulse. This is due to external contraction of wind-heat, with yellow, thick, and copious nasal discharge, presenting as an exterior heat pattern (headache, fever, aversion to wind, cough, sweating, red tongue with white coating, floating and rapid pulse). By carefully examining the color and nature of the nasal discharge as well as the accompanying symptoms, the two conditions can be easily distinguished. Treatment should focus on releasing the exterior with pungent-cool herbs, dispersing wind and clearing heat, and relieving stuffy orifices. The recommended formula is Cocklebur Fruit Powder with modifications.
3. Dampness-heat︰The nasal discharge is yellow, turbid, and copious, sometimes even flowing backward, with a foul odor. Nasal congestion is severe, accompanied by a diminished sense of smell, heavy-headedness, epigastric stuffiness, anorexia, a bitter and sticky taste in the mouth, aversion to drinking water, dark yellow urine, a red tongue with yellow and greasy coating, and a slippery-rapid or soggy-rapid pulse. This condition arises from dampness-heat pathogens impairing the spleen and stomach, disrupting their transformative functions, leading to the accumulation and obstruction of dampness-heat in the nasal passages, which scorches and erodes the mucous membranes. Consequently, the nasal discharge appears deep yellow or greenish-yellow, thick and purulent in texture, copious, and foul-smelling. Associated symptoms include heavy-headedness, epigastric stuffiness, anorexia, a bitter and sticky taste in the mouth, aversion to drinking water, dark yellow urine, a red tongue with yellow and greasy coating, and a slippery-rapid or soggy-rapid pulse—all indicative of dampness-heat obstruction. Treatment should focus on clearing heat and draining dampness to relieve nasal obstruction. For cases where dampness predominates over heat, the approach emphasizes draining dampness while also clearing heat, using Modified Powder of Four Ingredients with Poria. For cases where heat predominates over dampness, the primary focus is on clearing heat while also draining dampness, employing Skullcap and Talc Decoction.
4. Dryness-heat︰The nasal discharge is yellow, sticky, and scanty, mixed with blood or purulent and bloody. The nasal cavity is dry, painful, and obstructed, accompanied by headache, distension and oppression in the chest and epigastrium, dry throat, bitter taste in the mouth, thirst with a preference for cold drinks, dry stool, yellow urine, a red tongue with yellow coating, and a thin, rapid pulse. This is due to the upward disturbance of the nasal orifice by dryness-heat pathogens, which scorch the body fluids, resulting in scanty yellow sticky nasal discharge, dryness, and pain in the nasal cavity. When dryness-heat damages the collaterals, the nasal discharge may contain blood or appear purulent and bloody. Additional signs of dryness-heat impairing fluids include headache, chest oppression, bitter taste in the mouth, dry throat, thirst with a preference for cold drinks, dry stool, yellow urine, a red tongue with yellow coating, and a thin, rapid pulse. Therefore, the distinction between dampness-heat and dryness-heat is not difficult to make. Treatment should focus on clearing dryness and draining fire. For cases with pronounced heat, use Diaphragm-Cooling Powder to clear and drain; for cases with severe dryness, use Dryness-Clearing Lung-Rescuing Decoction to clear and moisten.
5. Qi Deficiency︰The nasal discharge is clear and thin like water, and over time it becomes white and sticky, lingering persistently, or alternates between clear and yellow, or is light yellow with a foul odor. There is nasal congestion, which is triggered by exposure to cold or certain allergens, accompanied by shortness of breath, reluctance to speak, fatigue, lack of strength, or epigastric stuffiness, anorexia, loose stools, a pale and swollen tongue with a thin white coating, and a slow, weak pulse. The deficiency lies in qi, caused by qi deficiency failing to control, resulting in copious nasal discharge along with signs of qi deficiency. Alternatively, it may be due to lung qi deficiency, where the defensive exterior is unstable, leading to frequent common colds, clear and watery nasal discharge that recurs repeatedly, accompanied by shortness of breath, reluctance to speak, and fatigue, lack of strength. Treatment should aim to tonify the lung and secure the exterior, using Jade Screen Powder combined with Cocklebur Fruit Powder. Or, it may be due to deficiency of both the lung and spleen, with white and sticky nasal discharge that lingers persistently, or alternates between clear and yellow, accompanied by shortness of breath, reluctance to speak, fatigue, lack of strength, epigastric stuffiness, anorexia, loose stools, a pale and swollen tongue, and a slow, weak pulse—signs of lung-spleen qi deficiency. Treatment should aim to tonify the lung, tonifying the spleen and replenishing qi, using Middle-Tonifying Qi-Replenishing Decoction. If accompanied by dampness-heat, it becomes a deficiency/excess complex condition, with yellow, foul-smelling nasal discharge resembling pus. In this case, the above formula should be modified by adding herbs to expel dampness and open the orifices.
6. Kidney Deficiency︰The nasal discharge is thin and scanty, increasing with exposure to cold, or alternating between clear and yellow, persisting for a long time without healing. The nostrils are blocked, and the sense of smell is diminished. It is accompanied by soreness in the lower back and weakness in the knees, fear of cold, cold limbs, a pale tongue with white coating, and a deep, thin, and weak pulse. The deficiency lies in the kidney. It is due to kidney deficiency leading to insufficient fluids and insecurity of kidney qi, hence the scanty nasal discharge, along with symptoms of kidney deficiency. Alternatively, the clear nasal discharge may be scanty, increasing with exposure to cold, or alternating between white and yellow, scanty and persisting for a long time without healing, inevitably accompanied by soreness and weakness in the lower back and knees, fear of cold, cold limbs, and other symptoms of kidney deficiency. The treatment should focus on tonifying the kidney and clearing the lungs. The recommended formulas are True Warrior Decoction or Kidney Qi Pill combined with Cocklebur Fruit Powder.

The symptom of nasal discharge in clinical practice focuses on differentiating between external and internal, cold and heat, deficiency and excess. Generally, headache, fever, and aversion to wind indicate an external cold; clear and thin white discharge often suggests cold; yellow and sticky discharge usually indicates heat; yellow, purulent, and foul-smelling discharge points to dampness-heat; scanty discharge with blood is associated with dryness-heat; qi deficiency is characterized by shortness of breath, lack of strength, anorexia, and loose stools; kidney deficiency is marked by soreness and weakness in the lower back and knees, fear of cold, and cold limbs. In summary, by analyzing the color, texture, quantity, odor of the nasal discharge, and accompanying symptoms, one can clearly distinguish the condition.

bubble_chart Documentation

1. "Zheng Zhi Yao Jue": "Clear nasal discharge is caused by brain cold and lung cold."