Sinusitis – A Common Complaint

May 23, 2024

Acute and Chronic Sinusitis? 

Acute and chronic sinusitis are inflammatory conditions affecting the paranasal sinuses, commonly caused by viral infections, bacterial infections, or allergies. Acute sinusitis typically lasts less than four weeks and is often triggered by a viral infection like the common cold. Symptoms include facial pain, congestion, thick nasal discharge, and sometimes fever. Chronic sinusitis, on the other hand, persists for 12 weeks or longer and may be caused by recurrent acute sinusitis, nasal polyps, or anatomical abnormalities. Its symptoms are like acute sinusitis but are typically milder and last longer, significantly impacting an individual’s quality of life. 

How many people are affected by sinusitis?  

Worldwide, sinusitis affects millions of people annually. According to the World Health Organization (WHO), it’s estimated that over 10% of adults worldwide suffer from chronic sinusitis, with rates varying by region and socioeconomic factors. Acute sinusitis is even more prevalent, with a significant portion of the population experiencing episodes at least once a year.  

In the United States alone, 30 million (almost 9%) adults are diagnosed with sinusitis yearly. These statistics underscore sinusitis’s substantial burden on global healthcare systems. Thus, effective management and treatment strategies are essential to alleviate symptoms and improve patients’ well-being.  

Reasons for increased prevalence of sinus conditions  

As for all respiratory system infections, external irritants such as smoke, drugs, chemicals, dust, dirt, or internal influences such as dietary components or lifestyle factors may be responsible. As sinus cavities are part of the first line of defence, they could signify a malfunction or immune system disruption.  

Immune system dysfunction is due to internal causes such as nutritional deficiencies, stress, lack of sleep, and perhaps the absence of breast milk in early childhood, which is an essential developmental factor – not only in view of a robust immune system.  

It is also possible that a lack of physical exercise to clean mucous or circulate air through the cavities might be a reason why more people suffer from sinus congestion and inflammatory conditions. All these factors might contribute to an epidemic of sinus conditions.  

Treatment of sinusitis using Western medicine  

Treating acute and chronic sinusitis in Western medicine typically involves a combination of medications, nasal irrigation, and sometimes surgery for chronic cases that do not respond to other treatments. 

For acute sinusitis, treatment often starts with over-the-counter pain relievers such as ibuprofen or acetaminophen to alleviate discomfort and reduce fever. Nasal decongestants, either in oral or nasal spray form, can help relieve congestion by shrinking swollen nasal passages. Additionally, nasal saline irrigation with a “Neti pot” or nasal saline spray can help flush out mucus and alleviate symptoms. 

In cases of bacterial sinusitis or severe symptoms, antibiotics may be prescribed by a healthcare provider to target the underlying infection. However, antibiotics are not always necessary, as acute sinusitis is often caused by viral infections, which do not respond to antibiotics. 

For chronic sinusitis, treatment may involve longer courses of antibiotics, corticosteroid nasal sprays to reduce inflammation, and possibly allergy medications if allergies contribute to symptoms. In cases where medical therapies fail to provide relief or if there are structural issues such as nasal polyps or a deviated septum, surgery may be recommended. Endoscopic sinus surgery aims to improve sinus drainage and remove blockages, helping to alleviate symptoms and reduce the frequency of sinus infections. However, our patients do not always want to opt for these treatments.  

The treatment of sinusitis with Chinese herbal medicine  

Luckily, in Traditional Chinese Medicine (TCM), sinusitis treatment embodies a nuanced approach grounded in harmonising bodily energies and rectifying respiratory imbalances. As Chinese medicine herbalists, we tailor formulations according to the individual’s symptomatology, constitutional predispositions, and underlying energetic disharmonies. This refined approach is an excellent advantage in the treatment of stubborn sinusitis.  

American Dragon suggests 27 seven different patterns of sinusitis. The patterns towards the bottom of this list are more constitutional and potentially require more attention after an acute infection or have greater importance during the chronic phase of sinusitis. 

Acute sinusitis warrants herbal regimens to dispel pathogenic heat and resolve dampness, common culprits in TCM pathogenesis. Potent herbs like Cang Er Zi or Xin Yi Hua are prominent in unblocking nasal passages and mitigating congestion. Concurrently, herbs such as Bo He, Lian Qiao or Ge Gen are adept at dispelling wind-heat, while Jie Geng aids in expectorating phlegm. Additionally, I often add Shi Chang Pu to clear the orifices.  

I think it’s important to treat acute infections with the consideration of the following patterns:  

Acute  

Pattern  Formula(s)  Note(s)  
Wind attacks the lungs 

 

They are both wind-dispelling formulas that target the nose and head.  

 

 

 

 

 

 

These formulas stabilising the exterior must be modified to the presenting signs and symptoms.  

 

My number one formula for acute sinusitis is Ge Gen Tang, which I modify according to symptoms. For more eye symptoms, I use Ju Hua and Jue Ming Zi, and for the nose, I use Shi Chang Pu or Bo He.  

Wind cold attacks the lungs  

 

Wind cold attacks the lungs with mild dryness  
Wind cold attacks the lungs with interior yang deficiency  

 

Taiyang patterns transform into Yangming pattern  
Wind-cold invasions with internal heat  
Wind cold attacks the lungs with nutritive and Wei qi deficiency 
Wind cold dampness  
Wind heat attacks the lungs  

Chronic sinusitis necessitates a comprehensive strategy addressing underlying deficiencies or excesses within the individual’s constitution. Herbal prescriptions are often formulated to fortify the immune system and equip the body against recurrent infections. Herbs like Huang Qi, Ren Shen, and Dang Shen are typical. Simultaneously, agents like Huang Qin or Huang Lian are employed to quell inflammation and heat. At the same time, Bai Zhu, Cang Zhu or Zhi Gan Cao are used to tonify the spleen and alleviate underlying dampness. 

Chronic patterns  

Lung qi deficiency  For chronic sinusitis, I often add a few herbs to target the symptoms, such as blocked sinuses (Ban Xia, Fu Ling and Shi Chang Pu).  

 

Once the “exterior” signs have disappeared, I will focus on tonifying the lung, spleen, and kidney.  

Lung Yin deficiency  
Lung heat  
Lung and spleen qi deficiency  
Lung and stomach stagnant heat  

 In the practice of TCM, treatment protocols are best tailored to the individual’s presentation, with herbal formulas iteratively refined in response to treatment progress and evolving symptomatology. Integrating herbal interventions, acupuncture modalities, and dietary adjustments emphasises the comprehensive therapeutic approach to sinusitis within the TCM framework. The treatment of chronic sinusitis can be complex, especially when the patient was repeatedly treated with antibiotics before finding their way onto your treatment table.  

References :

http://www.itmonline.org/arts/sinusayu.htm 

https://www.americandragon.com/conditions/Sinusitis.html 

Brigitte Linder
Brigitte Linder was born in Zurich and has lived near Melbourne on the south coast of Australia since 2008. She operated Safflower – Chinese Herbs Expertly Dispensed until mid-2023. Safflower is an herbal dispensary business operating under the banner of the Therapeutic Goods Administration (TGA). It was issued a GMP licence. Acuneeds acquired the company in January 2024 and intended to offer all services to practitioners in Australia and New Zealand.Brigitte completed a master's degree in 2023 with NICM Health Research (Western Sydney University). Her thesis involved creating a case report guideline for Chinese herbal medicine. In 2019, she published her first book and has since mentored TCM graduates to better transition to full-fledged practitioners. She has been consulting patients for 20 years and enjoys working with children and patients with complex conditions. She is a diplomat of the Institute of Classics in East Asian Medicine (ICEAM) and prescribes Eastern Han-era herbal formulas, namely Shang Han Lun and Jin Gui Yao Lue. Brigitte has always been interested in uniting a strong, cohesive TCM community. She continues to invest time and effort to ensure practitioners and the profession receive support and recognition.
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