Chronic Naso-Sinusitis

Chronic naso-sinusitis, or simply chronic sinusitis, results mostly from repeated episodes of acute naso-sinusitis. Its typical feature is persistent turbid nasal discharge. Chronic sinusitis often affects several sinuses simultaneously.

I Etiology, Pathology and Clinical Manifestation

The causes of chronic sinusitis are the same as those causing acute sinusitis. The basic pathology is insufficiency of the lung and the spleen, so that the exterior and the Defensive Level are infirm. Evil Qi can therefore persist and cause impedance of Qi and blood movement in the nasal region. Failure of fluid movement, due to spleen and lung dysfunction, permits exogenous pathogenic evil and turbidity to accumulate in the sinuses. Putrefaction ensues. The resulting pus may overflow the sinuses and drain into the nasal cavity.

Chronic sinusitis persists for weeks or months. Typically, the persistent nasal discharge is white viscid or yellow purulent. Nasal blockage is intermittent and reduced by clearing the nasal passage. Exposure to Wind or Cold often aggravates chronic sinusitis. The mucous membrane of the nasal passage is inflamed, and purulent exudate may be seen where the affected sinuses drain into the nasal cavity.

Patients with chronic sinusitis often have dizziness and feel distending pressure. The symptoms may be sufficiently severe as to slow the mental processes, induce shortness of breath, reluctance to talk and a weak voice.

The tongue is usually pale, with thin white coating. The pulse tends to be even but soft and forceless. X-ray examination typically shows cloudiness or fluid in the affected sinuses and thickening of the nasal mucous membrane.

II Herbal Treatment

1 Internal Treatment

Therapeutic Principle. Warm and restore lung-Qi and dispel Wind and Cold.

Treatment. Wen Fei Tang (Lung-Warming Decoction). It has the following composition: huangqi (Astragalus) 18 g, shengma (Cimicifuga) 6 g, gegen (Pueraria) 15 g, qianghuo (Notopterygium) 9 g, fangfeng (Saposhnikovia) 12 g, charred mahuang (Ephedra) 3 g, dingxiang (Syzygium) 6 g, gancao (Glycyrrhiza) 6 g, and congbai (Allium fistolosum) 3 sections. The decoction is split into two portions, one portion to be taken in the morning and one portion in the evening.

For headache and dizziness, add baizhi (Angelica dahurica) 15 g and chuanxiong (Ligusticum) 9g.

If nasal blockage is particularly severe, add xinyi (Magnolia liliflora) 9 g and cangerzi (Xanthium sibiricum) 12g.

For exacerbation by exogenous pathogenic evil making the discharge more viscid and yellow, add juhua (Chrysanthemum) 15 g, huangqin (Scutellaria) 12 g and jiegeng (Platycodon) 12g.

If Spleen-Qi is especially deficient, use modified Shen Ling BaizhuWan (Panax-Poria- Atractylodes Pill) instead.

Two other prepared formulas are useful: Tong Yi Li FeiWan, one pill three times daily; and Huo Dan Wan, 6 g three times daily.

2 Topical Treatment

Three herbal preparations are suitable for topical treatment.

Di Bi Ling (Efficacious Nose Drops) may be instilled in the nose three to four times daily.

Yunaoshi Wan (Fish Otolith Powder) may be insufflated into the nose two to three times daily.

The third preparation has the following composition: ebushicao (Centipeda minima) 9 g, wulianmei (Cayratia japonica) 9 g and huangqin (Scutellaria) 9g.

After decoction, concentrate the solution, let stand and after cooling use the clear supernatant as nose-drop, three to four times daily.

A specialist may wish to irrigate the sinuses.

III Acupuncture Treatment

Select the acupoints Yingxiang (LI-20), Hegu (LI-4), Shangxing (DU-23) and Baihui (DU-20). Apply the reinforcing method and leave the needle in place for 10–15 min. Treat daily, 7–10 days making a course. In addition, select for reserve treatment the acupoints Cuanzhu (BL-2), Yintang (EX-HN-3), Tongtian (BL-7), Fengchi (GB-20) and Zusanli (ST-36). The reserve acupoints are used by rotation.

Moxibustion may be applied to the acupoints Xinhui (GV-22), Qianding (DU-21), Yingxiang (LI-20) and Shangxing (DU-23). Leave in place until the patient feels local warmth and the local skin shows erythema.

IV Case Study

The patient was a 19-year old woman who had had headache and nasal block and discharge for 2 years. The discharge was purulent initially, but gradually became thin and clear. At another hospital she was diagnosed to have chronic naso-sinusitis and was treated variously with formulas, herbs and sinus irrigation, without benefit.

In addition, she had cold limbs, spontaneous sweating, fatigue and lack of strength. Her tongue was pale, with thin white coating. Her pulse was threadlike and depletive.

Diagnosis. Chronic naso-sinusitis due to lung insufficiency.

Therapeutic Principle. Warm the lung, augment lung-Qi and open orifices.

Treatment and Course. Modified Wen Fei Zhi Liu Dan (Lung-Warming Discharge-Stopping Pill). It has the following composition: dangshen (Codonopsis) 25 g, xixin (Asarum) 5 g, hezi (Terminalia chebula) 10 g, jingjie (Schizonepeta) 10g, qianghuo (Notopterygium) 6 g, cangerzi (Xanthium sibiricum) 19 g, shichangpu (Acorus) 10 g, huangqi (Astragalus) 15 g, fangfeng (Saposhnikovia) 10 g, fuling (Poria) 15 g, and gancao (Glycyrrhiza) 5 g. (Note: According to the Guidance of Hong Kong Chinese Medicine Council dosage of xixin should not be over 3 g in a prescription.)

She took the herbal decoction daily for over a month and responded well. All symptoms resolved and the sinusitis cleared.

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