An Overview of Sinusitis

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An Overview of Sinusitis

Sinusitis is an inflammatory process in the paranasal sinuses that can be due to viral, bacterial or fungal infections, allergic reactions or seasonal energetic changes. It is classified as acute or chronic depending on the duration of the infection. There are four pairs of sinuses -- the ethmoidal, frontal, maxillary, and sphenoidal. The frontal and maxillary sinuses are more prone to infection and inflammation.

Acute sinusitis is usually precipitated by an inadequate immune system response to seasonal energetic changes or acute viral respiratory tract infection but can also be caused by streptococci, pneumococci, Hemophilus influenzae, or staphylococci. Exacerbations of chronic sinusitis may be caused by a gram-negative rod or anaerobic microorganisms.

When infected, the nasal mucous membranes become red and distended; yellow or green purulent rhinorrhea may be present. Swollen nasal mucous membranes obstruct the paranasal sinus, resulting in pressure that is painful. Undrained mucus and pus from the mucous membrane can fill the sinus, and become a medium for bacteria. Symptoms of chronic sinus infection resemble those of acute sinus infection, except that the chronic form causes continuous mucus-and pus-filled discharge.

Symptoms of sinusitis can include an overall ill feeling, sore throat, and slight fever -- temperature of 99ø to 99.5ø F (37.2ø to 37.5ø C) -- frontal headache, facial pain, occasional cough, and a feeling of heaviness of the head. There is often local tenderness over the maxillary and frontal sinuses. Pain from the sphenoid sinus is often referred to the frontal or occipital area. Lethargy may be present as well as fever and chills, suggesting an immune response to the infection beyond the sinuses. Excessive consumption of foods that are greasy or high on the glycemic index contribute to the problem by increasing the systemic dampness and heat, overtaxing the spleen's function.

In Oriental medicine, inflammation is described as excessive Minister Fire. King Fire governs the normal body temperature, while Minister Fire works through the Sanjiao organ (nervous system). King Fire is a function of the blood that supplies the necessary components to the site of inflammation.

Five-elementally, the immune system is associated with the spleen and lung pulses; any inflammatory response will show up in the function of these two organs. Allergies will show a strong movement in the spleen/lung connection; flu will show more heat contributed from the Sanjiao movement; and the common cold will also include strong heat movement in the wood element, indicating heat in the muscles.

One of the most important factors in fighting inflammation is the wei qi support from the immune system. While lowering inflammation is rather easy, maintaining control of the situation is up to the immune system. The stronger the immune system, the better the response to inflammation and pain.

The Minister Fire also includes wei qi, the defense energy shield -- in Western terms, immune system response. When this shield holds strongly against a pathogen, no perverse influence can be distributed to any other organ. However, as soon as it cannot adequately respond to a perverse energy movement, Minister Fire fluctuates causing tension and imbalance with King Fire, the blood component and heart. The pathogenic energy from the Minister Fire to King Fire manifests largely as blood flow changes: fever, swelling (histamine reaction), infection, and a faster heart beat. Pain is due to opposition between foreign components and the immune system.

Acupuncture for Sinusitis

We can divide sinusitis cases into different types: the first two cases are related to the most common sinus problem; the others show symptoms which might indicate sinusitis, cause sinusitis, or be caused by chronic sinusitis. This perspective offers a wider definition of sinusitis; one that is marked by some degree of inflammation in the sinus areas even when excessive mucus or pus not present.

The pulses will show a variety of movement in the lung position -- a strong floating or flooding movement carrying a great deal of dampness (phlegm-heat), to a thinner pulse showing more dryness and tension (wind-cold). If the cun position is faster or more floating than the other, or has rushing qualities, it indicates there is heat in the lung or the pericardium, and that heat is holding and building there. This will usually indicate mucus in the bronchial area, difficult breathing, dryness of nose and sinus. In chronic cases the pulse may not show strong contrast if the condition has become isolated from the regular meridian flow.

If the pulse moves past the right cun position toward the thumb, then there is definitely blockage in the sinus area. If the movement comes into the lung and stops or diminishes before reaching the end of the cun, upper jiao points, especially Lu.1 (Zhongfu), are blocked.

Sinus patients with a constantly runny nose

In this case, check if the secretion is greater upon waking. If so, it indicates the main problem is in the upper sinus. When the patient is in a lying position the upper sinus gets filled up; when they wake, it clears, causing a sudden draining of mucus.

A second consideration in chronic cases with clear discharge is muscular tension in the neck and shoulders. Strong muscular tension not only blocks the meridian movement through the neck, but also impedes lymphatic and blood circulation, creating poor drainage of the sinuses and face. Consequently, mucus builds up and can become infected. This often happens in cases when patients with chronic discharge have recurrent bouts of infection because their healing process is slow and incomplete. Treatment should include opening neck and shoulder acupuncture points.

Sinus patients with no secretion from the nose

If the nose is totally dry, it may be caused by a blockage inside the nasal cavity, or from long-term dryness or mild heat. The patient cannot breathe through the nose and breathes through the mouth instead. But there is still some low level inflammation inside.

Headaches

If a patient's head feels heavy and they have a headache that becomes more severe when the head is lowered, it is a sign of sinusitis.

Smelling

If a patient can breathe through the nose but cannot discriminate odors it could indicate mild sinusitis.

Nervous condition

If a patient lacks concentration, has no patience, or cannot pay attention, it might be caused by sinusitis.

Neuritis around the sinus

If neuritis causes sinusitis, defects of vision can occur, especially blurry vision if the inflammation spreads into other meridians toward the eyes.

Middle ear infection

If middle ear infection is severe, it can cause sinusitis through the connection between the ear and the sinus.

Chronic sinusitis

If sinusitis has been present for a long time it can cause bronchitis or chronic inflammation in the throat or the esophagus.

Digestive Problems

If sinusitis has been present for a long time it can cause a digestive problem by the constant mucus secretion dripping down the throat.

Sinusitis caused by an allergy

When checking a sinusitis case for allergies, the first pulse to check is the lung. You will notice mucus production (wind and dampness coming from the spleen toward the lung). You may also notice that the energy flow is slower, which means that each energy movement is slower then the breathing; clinically you would notice less than four pulse beats per respiration. This condition can include by sinusitis.

Treatment Strategies

The treatment of sinusitis often uses local points or addresses symptoms. The reason is because the human body can always breath through the nose or mouth, and the disorder does not necessarily have to affect the lung itself. The process is divided into two cases: localized sinusitis and sinusitis with lung involvement; in which case you have to work on the organ itself, for example, when asthma, bronchitis, and allergies are also part of the condition. Even when sinusitis is involved with the eyes, nose, etc., it is still treated as a local problem. Sinusitis is primarily involved with the meridians innervating the nose -- Dumai, Renmai, and Yangming. Secondarily, we can support with Shaoyang and Taiyang.

L.I.4 (Hegu) is recommended since it widens the nasal cavity, and helps drain the mucus. Other points to consider are Lv.3 (Taichong) and L.I.4 (Hegu), G.B.21 (Jianjing) and U.B.40 (Weizhong). T.W. 17 (Yifeng) is very effective in opening up the sinus by helping relax the nervous tension in the face and jaw. G.V.20 (Baihui) and all the points from G.V. 16 through G.V.24 can be used to open up the sinus because they open up the Governing and the Conception vessels.

If you are opening the sinuses with L.I.4 (Hegu), stick the needle in the upward direction, 1/2" deep and twist it hard, so that there is a strong deqi sensation.

1. To open the local points and to relieve blockage and inflammation

L.I.20 (Yingxiang)

Bitong (Extra)

Yintang (Extra 1)

Start the procedure from L.I.20 (Yingxiang); do bird-pecking for about five minutes. Then go to Bitong and repeat the process. Then do bird-pecking on Yintang. If you need stronger stimulation, take a thin needle, needle Yintang and thread it to the root of the nose. We add L.I.4. (Hegu) to this formula.

2. Insert the needle with strong sedation skill on the following points:

G.V.16 (Fengfu)

G.V.23 (Shangxing)

G.V.20 (Baihui)

3. Yintang (Extra 1)

L.I.20 (Yingxiang)

U.B.10 (Tianzhu)

G.B.20 (Fengchi)

Insert at Yintang all the way down to the root of the nose. Insert deeper on U.B.10 and G.B.20, and perform strong sedation on these two points.

4. For mild sinus problems, sedate these points:

G.V.20 (Baihui)

G.V.23 (Shangxing)

G.V.16 (Fengfu)

G.B.20 (Fengchi)

G.V.26 (Renzhong)

L.I.20 (Yingxiang)

L.I.19 (Heliao)

L.I.4 (Hegu)

St.36 (Zusanli)

This formula opens up the meridian flow through the head along the Governing Vessel while L.I.4 (Hegu) and St.36 (Zusanli) bring heat down out of the face.

5. Do bird-pecking on the following points:

L.I.2 (Erjian)

G.B.20 (Fengchi)

G.B.12 (Wangu)

Other points to consider

- L.I. 11 (Quchi) if the infection has spread and become systemic.

- Lu.7 (Lieque) if the pain on the head or face is asymmetrical, needle the opposite side.

- Lu.5 (Chizi) stimulates the descending action of the lung.

- G.B.34 (Yanglingquan) sedates heat in the muscles and along the meridian.

- Huatojiaji points from T1 through T12 can be needled with a light bird-pecking style briefly (about four or five quick pecks per point, from top to bottom) if systemic or muscular heat is strong in conditions associated with cold and flu.

Herbal Formulas

1. Xanthium Sinusitis Formula (Gang Er Bi Dou Yah Fang) Fructus Xanthii

9.0 Radix Scutellariae baicalensis 9.0 Semen Plantaginis
9.0 Radix Puerariae

9.0 Herba Taraxaci mongolici cum radice 6.0 Radix Platycodi grandif lord 6.0 Radix Angelicae dahuricae
3.0 Radix Glycyrrhizue uralensis 3.0
Clear damp-heat in the nose and sinuses and clear Stomach channel heat; restore the descending action of lung-qi; drain dampness via urination. If there is Stomach-Fire with constipation or dry stools add Rhizema Rhei.

2. Xanthium Form (Cang Er Zi San) Radix Angelica dahuricae
10.0 Flos Magnoliae

5.0 Bulbus Allii Fislosi
3.0 Fructus Xanthii

2.5 Camelliae Fm.

2.0 Herba Menthae

0.5

Disperse wind-cold, drain nasal discharge in rhinorrhea, nasal suppuration, and chronic clear nasal discharge.

3. Magnolia Flower and Gypsum (Xin Yi Qing Fei Yin) Folium Eriobotryae
3.0 Rhizoma Anamarrhenae
3.0 Bulbus Lilii

3.0 Fructus Gardenia
3.0 Radix Ophiopogonis
3.0 Gypsum fibrosum

3.0 Radix Scutellariae baicalensis 3.0 Flos Magnoliae

2.0 Rhizoma Cimicifugae
1.0
Clear sinusitis, dispel lung heat and increases qi circulation to clear nasal congestion, nasal empyema, and rhinitis.

4. Hua T'o Sinusitis Formula Radix Rehmanniae praeparata
3.0 Radix Ophiopogonis
3.0 Rhizoma Atractylodis
3.0 Radix Puerariae

2.0 Radix Scutellariae
2.0 Gypsum fibrosum

2.0 Rhizoma Cimicifugae
2.0 Radix Angelicae dahuricae
2.0 Radix Platycodi grandiflori
2.0 Radix Bupleuri

2.0 Radix Paeoniae rubra
2.0 Rhizoma seu Radix Notopterygii 2.0 Radix Glycyrrhizae
1.0
Sinusitis caused by Yang ming channel disorders, pain in eyes, dry nose.

Oriental Medicine.

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By James Ramholz

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