Treatment for a Common Problem: Chronic Sinusitis

By Misha Cohen, OMD, LAc

The American Academy of Otolaryngology-Head and Neck Surgery describes chronic sinusitis as "a prolonged sinus infection; one that usually lasts for more than three months ... when you breathe in through your nose, the sinuses (which are air-filled) act like a filter, which creates mucus. If your sinus pathways do not properly drain, your sinuses can become 'diseased.' This can result in difficulty breathing through your nose, facial pain, and blockage of the sinuses among other symptoms. A sinusitis condition can interfere with one's lifestyle because of the constant pain and discomfort ... generally, a sinusitis condition will last more than 10 days and could also cause a discharge of thick yellow/green mucus, nasal congestion, and facial pain/pressure. There is no known 'cure' for chronic sinusitis. The right treatment can help resolve a current infection, but there are no guarantees that the infection won't return."

When a client complains of sinus discharge; post-nasal drip; headache; hearing problems; ear infection; a sinus cold; or sinus allergies that won't go away (or that come and go), we think of sinusitis. Often it's not apparently acute, but over time, it really puts a burden on the immune system - especially in immunocompromised people - and if left untreated, it can lead to serious infection requiring strong antibiotics.

There are four main treatments a Western doctor prescribes:

1. Oral antibiotics are one of the most prescribed treatments for chronic sinusitis. Doctors prescribe a number of antibiotics that are taken on a daily basis for usually two to three weeks.
2. Nebulized antibiotics are a way of treating infections topically. The client breathes the nebulized antibiotics in through the nose to get directly to the source of the problem. This treatment usually lasts two to three weeks.
3. Intravenous (IV) antibiotics are used in select cases. IV antibiotic therapy generally lasts four to six weeks.
4. Sinus surgery is generally a last line of defense for medical doctors. The purpose is to relieve the chronic sinusitis condition. Most surgeries are endoscopic procedures. The surgery is generally accomplished in one to three hours. It can take several weeks for a full recovery.²

Complementary and alternative medicine (CAM) offers treatment approaches to sinusitis in both early and late stages. In early stages without severe infection, we often use treatment as an alternative to Western therapies. In later stages, we often combine therapies in a complementary manner.

Chinese medicine practitioners often use acupuncture, Chinese or Western herbs, sinus washes/steams, and massage as basic treatment. I personally find acupuncture to work wonders immediately for clearing the sinuses and relieving pain. Nutrition, including diet and nutritional supplements, are also a major part of the treatment plan.

Chinese Differential Diagnosis

The following diagnoses are found in chronic and acute sinusitis:

• Lung/Spleen dampness;
• Lung heat;
• Lung/Spleen damp heat;
• Large Intestine channel disturbance;
• Deficient Lung; or
• Qi stagnation.

Acupuncture Treatment

The following acupuncture points are often used for chronic sinusitis:

• To open the sinuses: LI 4; LI 20; bitong; St 1/2/3; Du 22/23/24; UB 2; GB 20; GB 14.
• General point for nasal congestion: bitong.
• For blocked ears: TB 17. You may add GB 2, SI 19 or TB 21 with deep insertion for blocked ears.

These points are chosen based on differential diagnosis:

• Liver-Gallbladder constitutional types with heat rising: GB 2.
• Digestion problems: SI 19.
• Problems with water metabolism, common cold symptoms: TB 21.
• Digestion problems related to postnasal drip: Ren 12.
• Phlegm obstruction: St 40.
• With common cold symptoms: LI 4; Lu 7; TB 5; GB 20.
• Sores in nose: St 44.
• Heat, infection: LI 4, St 44.
• Needle locally for local discomfort: points such as GB 14; St 2; LI 20 and tai yang.

Apply white flower oil under the patient's nose during treatment (not too much for sensitive skin). Acupuncture treatments should be considered at least twice a week for acute or difficult situations.

Nasal Wash

A nasal irrigating bulb or glass nasal douche can be performed in several ways. I recommend the following techniques: Use a mild salt-water solution in a glass nasal douche to gently clean sinus passages. Use sea salt or kosher salt. Do not use commercial salt with chemicals that keep it flowing! Use spring water that is not chlorinated; filtered water; or boil tap water to destroy the chlorine. Warm water feels much more comforting than cold water; too warm is painful. Use ½ to 1 teaspoon salt in 1 cup water. Work up to 2 teaspoons of salt per cup. Warm water may also be used alone.

Using a glass nasal douche (available at some pharmacies), gently pour several drops into each nostril and tilt the head. Let the solution run into the sinuses or down the throat. If the solution stays in the sinuses, spit it out of the mouth with any phlegm that may be in the solution. Repeat 3-5 times each side. Be careful not to force the solution into the sinuses with too much pressure, especially if the client has a cold and stuffy nose. With ear congestion, be very gentle and use small amounts of water to begin.*

The areas with damaged tissue may feel a sharp sensation, which only lasts a few seconds. In time, this discomfort will subside as the tissues heal. The benefits are worth the temporary sensation. The sinuses will begin to drain, and as old build-ups begin to work loose, phlegm of various colors and consistencies will be discharged. There may be some blood in the phlegm initially as well.

Herbs

1. Chinese patent or pill formulas for sinus congestion are found over the counter in health food stores and Chinese herb stores. I always recommend using GMP (good manufacturing practices) labeled formulas for safety reasons and to be sure there are no harmful pharmaceuticals or toxins in the pills. For example, in our clinics, we use often use pe min kan wan with green or black tea.
   
   
2. Cooked bulk herb formulas: A qualified, trained herbal practitioner may prescribe cooked herbs. The client should drink the herbal decoction hot/warm and steam the sinuses with the herbs before drinking them. The client can also place essential oils below the nose and steam the sinuses with herbs. The practitioner should provide specific instructions for individualized formulas and treatments.
   
   A typical herb formula we use for relieving dampness, stopping a cough and opening the sinuses includes xing ren; jie geng; zi wan; chen pi; lu gen; ma huang; gan cao; xin yi hua; cang er zi; and bai ji li. Of course, variations are made according to the differential diagnoses and symptoms:
   
   • With heat, add ban lan gen; da qing ye; ju hua; huang qin; jin yin hua.
   • With pain, add bai zhi.
   • With Spleen damp, add fu ling.
   • With dryness, add tian hua fen.
   • With headache, add chuan xiong.
   • For qi stagnation, add chai hu, xiang fu.
   
   
3. Steaming Herbs: Throughout the day, clients may vaporize eucalyptus, rosemary and/or thyme in fresh herb form or as essentials oils. According to the late Tom Sinclair, LAc,³ thyme is the strongest antibacterial antisinusitis herb. Red thyme is considered to have the strongest effect.

Add herbal essential oils to hot water (in a portable mug or in a simmering kettle), a vaporizer, essential oil atomizer, candlestick oil evaporator, or in a sink. Cover the client's head with a towel tent and instruct him or her to close the eyes and breathe in. The solution also may be applied to a washcloth covering the face. In addition, oils can be applied below the sinuses and breathe in steam. One can use white flower oil quite effectively in this case.

Massage

Acupressure can be performed on the sensitive spots on the forehead; hairline; cheeks; nose; ears; palate; and LI 4. The points mentioned above also may be used for sinus massage. Reflexology massage on the fingers and toes is beneficial. For blocked ears, massage behind the ears with white flower oil. I recommend clients perform self-massage to the facial area.

Conclusion

If done consistently for two to three months, using the above treatments in the clinic along with home self-care can have profound healing effects on chronic sinus infections; allergies; asthma; chronic coughs; or post-nasal drip.

* Note: Patients with ear infections should not do the sinus cleanse until the infection has cleared.

References

1. From www.chronicsinusitis.com.
2. www.chronicsinusitis.com/treatments.html.
3. Thomas Sinclair, Director Immune Enhancement Project 1993-1998, personal communication.

Acupuncture for Sinusitis - Treatment Protocols