Acute Naso-Sinusitis

Naso-sinusitis, or simply sinusitis, is nonspecific inflammation of the mucous membrane of the sinuses. The typical symptoms of acute sinusitis include fever, headache, nasal congestion and viscid or purulent nasal discharge.

I Etiology, Pathology and Clinical Manifestation

Three mechanisms lead to the development of acute naso-sinusitis. Invasion of the lung and the Lung Meridian by exogenous Wind and Heat leads to failure of the lung’s functions of dispersion and depuration, allowing Heat evil to scorch the nasal sinuses. Accumulated Heat in the lung may transmit to the liver and the gallbladder, whence Heat rises and scorches the nasal sinuses. If turbid Dampness accumulates in the spleen and the stomach, it may transform into endogenous Heat, which can then rise and scorch the nasal sinuses.

Preceding the development of acute sinusitis there is often symptoms of upper respiratory infection or choking on water while swimming. Nasal congestion may be intermittent or steady, often with a diminished sense of smell. As sinusitis develops the nasal discharge becomes viscid or purulent. Headache tends to be mainly in the region of the affected sinus and often shows a typical time course – mild in the morning, severe at noon and gradually subsiding in the afternoon. Tapping over the sinuses may elicit tenderness and may reproduce the headache. X-ray examination shows cloudiness or fluid in the normally clear and air-filled sinuses.

II Herbal Treatment

1 Wind-Heat in Lung Meridian

Main Symptoms. Nasal congestion, viscid or purulent discharge, inflamed mucous membrane, fever, wind-aversion and headache. The tongue is red, with thin yellow coating. The pulse is floating and rapid.

Therapeutic Principle. Dispel Wind, cool Heat, soothe the lung and open the orifices.

Treatment. Modified Cangerzi San (Xanthium Powder). The modified composition is as follows: cangerzi (Xanthium sibiricum) 9 g, lianqiao (Forsythia) 9g, xinyi (Magnolia liliflora) 3 g, jingjie (Schizonepeta) 9 g, dandouchi (Glycine max) 9 g, niubangzi (Arctium) 9 g, zhuye (Phyllostachys nigra) 9 g, bohe (Mentha) 9g, baizhi (Angelica dahurica) 12 g, jinyinhua (Lonicera) 12 g, lugen (Phragmites) 18g, jiegeng (Platycodon) 6 g, and gancao (Glycyrrhiza) 6 g. Note: xinyi is added last.

2 Strong Heat in Gallbladder

Main Symptoms. Nasal blockage with foul-smelling viscid purulent discharge.

Associated symptoms include severe headache, fever, wind-aversion, a bitter taste, dry throat, agitation and dizziness. The tongue is red, with yellow coating. The pulse is taut and rapid.

Therapeutic Principle. Purge gallbladder Heat, eliminate turbidity and open orifices.

Treatment. Modified Longdan Xie Gan Tang (Liver-Clearing Gentiana Decoction).

The modified composition is as follows: longdancao (Gentiana) 9 g, huangqin (Scutellaria) 9 g, chaihu (Bupleurum) 9 g, danggui (Angelica) 9 g, zexie (Alisma) 9 g, zhizi (Gardenia) 15 g, shengdihuang (Rehmannia) 15 g, cheqianzi (Plantago) 15 g, gancao (Glycyrrhiza) 6 g, and chuanmutong (Akebia quinata) 6g. Note: cheqianzi is decocted wrapped in gauze.

3 Dampness-Heat in Spleen and Stomach

Main Symptoms. Persistent nasal blockage with copious yellow viscid discharge.

Markedly inflamed and swollen nasal mucous membrane. There may be headache, fever, headache as though squeezed, epigastric distention, anorexia and dark urine.

The tongue is red, with greasy yellow coating. The pulse is slippery and rapid.

Therapeutic Principle. Cool Heat, eliminate Dampness, clear turbidity and open orifices.

Treatment. Gan Lu Xiao Du Dan (Sweet Dew Detoxification Pill). It has the following composition: huashi (talcum) 30 g, yinchenhao (Artemisia) 9 g, huangqin (Scutellaria) 9 g, shichangpu (Acorus) 9 g, shegan (Belamcanda) 9 g, bohe (Mentha) 9 g, baidoukou (Amomum cardamomum) 9 g, huoxiang (Agastache) 9 g, lianqiao (Forsythia) 15 g, and chuanmutong (Akebia quinata) 6g.

For especially prominent headache, modify the composition in accordance with the location of the headache. Vertex: add gaoben (Ligusticum sinense) 9g. Brow: add baizhi (Angelica dahurica) 8 g. Occiput: add gegen (Pueraria) 30 g. Temple: add chaihu (Bupleurum) 9 g and manjingzi (Vitex trifolia) 9 g. Cheeks: add baizhi (Angelica dahurica) 9g.

If nasal discharge is particularly copious, add yuxingcao (Houttuynia) 9 g, beimu (Fritillaria) 9 g and cangerzi (Xanthium sibiricum) 9g.

For marked nasal blockage, add mudanpi (Paeonia suffruticosa) 9 g, chishaoyao (Paeonia) 9 g and xixin (Asarum) 3g.

III Acupuncture Treatment

Body Acupuncture.
For Wind-Heat in the Lung Meridian, select the acupoints Chize (LU-5), Hegu (LI-4), Yingxiang (LI-20), Yintang (EX-HN-3) and Fengchi (GB-20).

For strong Heat in the gallbladder, select the acupoints Fengchi (GB-20), Xiaxi (GB-43), Shangyinxiang (EX-HN-8), Shangxing (DU-23) and Yintang (EX-HN-3).

For Dampness-Heat in the spleen and stomach, select the acupoints Hegu (LI-4), Zusanli (ST-36), Sanyinjiao (SP-6), Yingxiang (LI-20), Shangxing (DU-23) and Lieque (LU-7).

Ear Acupuncture. Select the acupoints Internal Nose, Forehead, Lung, Adrenal and Tragic Apex.

IV Case Study

The patient was a 24-year old man with nasal congestion and discharge for 10 days.

He had caught a cold about a month earlier, which resolved as expected. For the past 10 days he had nasal congestion with thick discharge and loss of smell. He had pain at the root of his nose that was aggravated by eye movement. He also had frontal headache that was severe on arising in the morning but resolved by evening. When severe the headache was accompanied by dizziness and nausea. His temperature was 38:1ıC (100:6ıF). His tongue coating was white, and his pulse floating and rapid.

Diagnosis. Acute sinusitis due to exogenous Wind-Heat.

Therapeutic Principle. Dispel Wind, cool Heat and open orifices with aromatic herbs.

Treatment and Course. Modified Cangerzi San (Xanthium Powder). The modified composition is as follows: cangerzi (Xanthium sibiricum) 9 g, xinyi (Magnolia liliflora) 6 g, juhua (Chrysanthemum) 9 g, bohe (Mentha) 6 g, lianqiao (Forsythia) 9 g, shengdihuang (Rehmannia) 9 g, baishaoyao (Paeonia) 9 g, baizhi (Angelica dahurica) 9 g, jinyinhua (Lonicera) 18 g, gancao (Glycyrrhiza) 5 g, fangfeng (Saposhnikovia) 9 g, qianghuo (Notopterygium) 9 g, huangqin (Scutellaria) 9g, and danggui (Angelica) 9 g. Note: xinyi is added last.

After one dose all symptoms improved significantly. After another dose nasal congestion and pain resolved completely and his sense of smell returned to normal. Follow-up assessment in 9months showed no recurrence.

(Source: Zhu Kairong, Selected CM Case Records in EENT)