Sinusitis

Western Diagnosis Inflammation in paranasal sinuses d/t viral, bacterial, fungal infections or allergic reactions

Etiology 1) Acute -Preceded by viral URI -Strep, pneum, staph, hemo

2) Chronic -25% d/t dental infections

Signs & Symptoms -Tender/swollen over sinuses -Frontal pain & H/A -Facial pain, H/A, toothache -Erythematous, edematous nasal mucosa -Mucopurulent discharge -Decreased transillumination

Tests/Labs Culture & sensitivity of discharge X-rays: sinuses & apices of teeth (R/O periapical abscess) CT Scan: extent/degree of infection

Treatment

IBIS:

Definition:
An inflammation or infection in the paranasal sinuses.

Etiology:
The most common inciting agent of sinusitis is a viral URI, although bacteria, fungi, and allergic reactions may also be responsible. Any factor that creates edema of the nasal tissues resulting in obstruction and the lack of proper drainage of the area will often lead to sinus infection. As the obstruction continues, oxygen is resorbed back into the blood vessels, causing a painful relative negative pressure that draws transudate from the mucous membranes. The transudate is an excellent medium for bacteria, especially streptococcus, pneumococcus, Hemophilus influenza, and staphylococcus, which are the bacteria most implicated in acute sinusitis. The bacterial overgrowth leads to an influx of serum and leukocytes to fight the infection, setting up a painful positive pressure.

Chronic sinusitis is often associated with an allergic individual, and dental infections account for 25% of chronic maxillary sinusitis. Swimming and diving, and injury to the area (especially fractures to the ethmoid or frontal sinuses) are other precipitating factors.

With chronic sinusitis that seems to go away after an antibiotic then returns, consider candidiasis (Easley) or focal infection (Matsumoto).

Somatic Therapies:
• sinus exercises

Nutrition:
eating principles: » acute: • eat as little as possible • increase fluids: diluted vegetable juices, broths, herbal teas • increase foods rich in Vitamins C and A • fruit and vegetable juice fasts • low sugar » chronic: • elimination/rotation diet, rotation diet, rotation diet expanded

therapeutic foods: • increase foods rich in Manganese: buckwheat, nuts, beans, peas and blueberries • increase pungent foods and Lung foods • increase foods rich in Silicon (Jensen, pp. 29-30) • garlic, onions, citrus

fresh juices: • carrot and spinach (Jensen, p. 50) • carrot, beet, cucumber (Jensen, p. 50) • celery and grapefruit with pinch of cream of tartar (Jensen, p. 50) • cucumber, radish, and green pepper (Jensen, p. 50) • watercress and apple with 1/4 tsp cream of tartar (Jensen, p. 50) • coconut milk and carrot (Jensen, p. 50) • lemon juice with a little horseradish (Jensen, p. 52) • mixture of cayenne powder in a cup of water (Jensen, p. 52)

specific foods: • horseradish, ginger, green onions, magnolia flowers, bananas, garlic, black mushrooms, chrysanthemum flowers, apricot kernels

specific remedies: • tea from magnolia flowers, basil, ginger and green onions, three times daily for 1 wk (Ni, p. 115) • combine magnolia flowers and eggs, cook together and eat (Ni, p. 115) • tea from mulberry leaves and chrysanthemums, then cook rice porridge in the tea and add apricot kernels (Ni, p. 115) • nasal lavage with salt water • boil tea of mint, basil and ginger. While boiling the tea, inhale the steam through the nose, three times daily for 2 months. (Ni, p. 115)

avoid: • food intolerances • all dairy products, all catarrh-forming food: tomatoes, oranges, sugar, sweets; coffee, caffeine, processed and refined foods, heavy protein foods, fats, meats, vinegars, shellfish

Botanicals
• Anemone pulsatilla (toxic): yellow or greenish creamy discharge (NCNM Botanicals) • Atropa belladonna (toxic): throbbing, congestive (Harper-Shove, p. 38) • Euphrasia spp.: (British Herbal Pharmacopoeia, p. 89) • Hydrastis canadensis: not in acute inflammation, profuse tenacious yellowish or greenish yellow mucus/pus (Felter, p. 417) • Ligusticum porterii: chronic sinusitis, congestion (NCNM Botanicals) • Quercus alba: relaxation of mucous membranes with discharge, chronic mucous discharge (Felter and Lloyd, p. 1618) • Salvia officinalis (oil): apply externally over sinuses (NCNM Botanicals) • Sambucus nigra: chronic nasal catarrh with deafness (British Herbal Pharmacopoeia, p. 187) • Sticta pulmonaria: sneezing, coryza and conjunctival hyperemia or inflammation (Felter, p. 655) • Usnea barbata: inhibits gram-positive bacteria (NCNM Botanicals) • Verbascum thapsus: demulcent (Priest and Priest, p. 95)

Chinese Formulae
• Pueraria Nasal C.: Rhinitis and nasal suppuration, including sinus headache (Hsu, 1980, p. 37; Dharmananda, 1986, p. 208) • Xanthium F. (Cang Er San); Bi Yan Pian (patent): Heat (Xanthium: Hsu, 1980, p. 196; Yeung, p. 52; Bensky and Barolet, p. 51; Bi Yan Pian: Zhu, p. 53) • Xin Yi San: Wind-Cold (Yeung, p. 266; Bensky and Barolet, p. 51) • Blue Earth Dragon (patent) (Dharmananda, 1990, p. 60) • Jade Screen (patent) (Dharmananda, 1992, p. 102) • Ma Huang and Asarum C. (Ma Huang Fu Zi Xi Xin Tang): Wind-Cold with Kidney Yang Xu (Deficiency): Sinus congestion with watery mucus (Hsu, 1980, p. 72; Yeung, p. 155; Dharmananda, 1986, p. 126; Bensky and Barolet, p. 55) • Bi Min Gan Wan/Pe Min Kan Wan (patent): nasal allergies (Zhu, p. 55; Bao L, et al. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 1997 Feb;17(2):70-72.) • Schizonepeta and Siler F. (Jin Fang Bai Du San): Wind-Cold Damp: severe nasal/sinus congestion (Hsu, 1980, p. 609; Yeung, p. 140; Bensky and Barolet, p. 54) • Cnidium and Tea F. (Chuang Xiong Cha Tiao San): Wind: Headache (Hsu, 1980, p. 40; Yeung, p. 57; Dharmananda, 1986, p. 341; Bensky and Barolet, p. 49) • Pueraria and Magnolia C.: Wind-Cold with sinus congestion (Hsu, 1980, p. 50; Dharmananda, 1986, p. 207) • Superior Sore Throat Powder Spray (patent): topically (Fratkin, p. 91, Zhu, p. 158)

Acupuncture
after assessing the person and palpating, consider these patterns: external cause: Wind and Cold entering the Lung through the skin that remains "latent" and is eventually transformed into Heat internal cause: Raging Fire of the Gall Bladder having its source in the Fire of the Liver

» therapeutic note: • A chronic, often subclinical, infection in the sinuses, along with irritation in the oropharyngeal mucous membranes, is often the source of, or at least a contributor to, a general pattern of glandular/lymphatic exhaustion and a plethora of symptoms. This area is a common site of primary focal infection from which secondary infections derive. Palpation at reflex sites in the areas of TW-16 ("East Wind") and LI-10.5 as well as local sites above and below the eyes will confirm this hypothesis. Abdominal palpation will usually reveal other tender and/or painful spots that should be released with subsequent needling of the points on the arm, neck and face. If tender and/or painful points are found, consider needling Lu-7 and the reactive points in the areas of "LI-10.5", "St-2.5", yu yao, east wind/TW-16, and "St-43". Sinus irrigation with saline solution can greatly enhance the therapeutic efficacy of treatment - see the materia medica item:"patient handout: sinus wash". (Matsumoto)

» illustrative combinations: • "yu yao", "St-2.5", "east wind", "LI-10.5", Lu-7, and "St-43", with other points sensitive to palpation, for sinusitis and glandular/lymphatic exhaustion, esp. with a primary focal infection in the sinuses and oropharyngeal mucous membranes ; also Lu-7 -> Lu-8 with threading along superior border of the clavicle to release scalene muscles (Matsumoto) • LI-20, UB-2 and UB-7 for chronic sinusitis; also consider Lu-7 and LI-4 for Heat in the Lung; and/or add GB-20 and Lv-2 for Heat in the Gall Bladder (Shanghai, p. 690-691; Lee and Cheung, p. 353) • GB-20, SI-11, GV-23, LI-20, LI-10, LI-4, UB-17, GV-23, UB-4 and UB-12 for sinusitis (Lee and Cheung, p. 354) • Kd-8 and Lv-8; GV-26, St-7, St-1, St-3, GB-14, UB-2 and GV-28; UB-64, St-45 and St-40; SI-1 and SI-18; Kd-3 and UB-62; LI-11 and LI-17; LI-20 and GV-23; UB-12 and GB-20 for sinusitis (Mann, p. 141-142) • GV-20, LI-4 and LI-20 for chronic sinusitis (Shanghai, p. 690) • GV-23, UB-4, yin tang, UB-12 and LI-4 for chronic sinusitis (Shanghai, p. 690) • GV-23 and GV-16 for chronic sinusitis; if ineffective, also consider: LI-19, GB-20, GV-26, bai lao and UB-12 (Shanghai, p. 690) • LI-11, Lu-7, LI-4, Lu-10, LI-20, yin tang and St-44 for chronic maxillary sinusitis with nasal discharge due to Heat in the Lung (Jirui and Wang, p. 217) • bi tong, UB-2 and Lu-7 for nasosinusitis (Shanghai, p. 213) • LI-20 -> bi tong, St-2, UB-2, yu yao, yin tang, bi yan (-): clear nasal obstruction, drain sinuses, alleviate sinus headache (Finkelstein) • TW-16 and/or "east wind" (-): palpate lateral aspects of neck for ashi (tender) points (Matsumoto) • LI-4 and Lu-7; GB-1, UB-2 and LI-20; GB-20, GV-14, GV-16, GV-20 and GV-28; PC-8 and SI-2; St-3 and St-45; TW-17, GB-15 and GB-19 for nasal catarrh (Mann, p. 141-142) • PC-6 and PC-7; GV-16, GV-12 and GV-24A; TW-5 and Kd-10 for rhinorrhea associated with tension (Mann, p. 142) • GB-20, GV-23 and LI-20 (can also add: LI-4 and GB-40 for purulent rhinorrhea due to Wind and Heat (Mann, p. 141) • Sp-4 and Lu-9; UB-3, UB-4 and UB-1; UB-56 and UB-60; UB-17 and St-12; LI-20, LI-19, GV-25, GV-16 and UB-10 for anosmia (Mann, p. 142) • bi tong, GV-23, yin tang and LI-4 for chronic rhinitis (Shanghai, p. 155) • Lu-7 and LI-20 for sneezing, nasal obstruction, runny nose and loss of smell

Homeopathy
• Arsenicum album: thin, watery, burning and excoriating discharge; sneezes without relief; burning thirst for sips of warm drinks; anxious and restless; chilly • Kali bichromicum: pressure and fullness sensation at the root of the nose; stitching pains, ulcerated septum; thick, foul ropey discharge which is difficult to get out; loss of smell, violent sneezing with no discharge; thirsty • Lycopodium: approximately kali-b.; crusty, sore, plugs up, grey discharge, obstruction < night; usually right-sided • Mercurius solubilis: swelling of nasal bones; caries with greenish ulceration, nosebleeds; nostrils are raw and ulcerated; easy and profuse sweat which does not relieve, thirsty • Natrum carbonicum: constant coryza which is foul smelling; patient hawks much mucus from the back of the throat; < slightest draught, < sun; oversensitive, especially to music • Natrum muriaticum: violent, fluid coryza which lasts from 1-3 days then nose stops up and breathing becomes difficult; discharge is like egg whites; loss of smell • Nux vomica: stuffed up, esp. at night; stuffiness on going outside or after exposure to cold; irritable, angry, easily chilled • Phosphorus: after presence of polyps; catarrh with blood; oversensitive to smell • Pulsatilla: pressing pain at root of nose, bland, yellow-green discharges; patient chilly, thirstless and desires to be outside; weepy > consolation; very sensitive • Sepia: thick greenish discharge, thick plugs of mucus; chronic catarrh, esp. post nasal which must be hawked through mouth, > motion < cold air • Silicea: itching at point of nose; frontal and maxillary pains; hard, dry crusts which bleed when loosened; nasal obstruction with loss of smell; very sensitive and chilly

Subtle Support
• La (Gardner, p. 103, 109)

• notes: A#, B, C, D#, E, G, G#

• chords: diminished 8th, C Major, D# Major, G# Major (Gimbel, p. 116)

Mind/Body
• Results from early childhood message "Don't cry"; failure to cry may result in sinusitis in later years. (Harrison, p. 24) • Theory: if we cry when we are sad, the physiological response is tears from the eyes and nose. When we have finished, the mucous membranes in the nose and sinuses return to normal. If the sadness is not expressed by crying, the mucous membranes remain chronically inflamed. (Harrison, p. 137) • Irritation to one person, someone close. (Hay, 1988, p. 63) • Inflammation: fear; inflamed thinking; seeing red; anger and frustration about conditions in one's life. (Hay, 1984, p. 170-1) • Grief, loss, and sadness. (Epstein, p. 188)

• Lung ~ Fei is the home of the Po (Corporeal Soul); governs the Qi; facilitates the immune function by assisting the dispersal of the Wei (Protective) Qi; regulates the rhythm of respiration, the pulse, and all bodily processes; relates to strength and sustainability; moves and adjusts fluid metabolism; includes the throat; and opens at the nose. » Healthy expressions are righteousness and courage. » Weakness, dysfunction, and illness are associated with excessive grief, sadness, worry, and depression. Worry depletes the Lung Qi. » Lung Xu (Deficiency) signs include cold shoulder and back; changing complexion; and inability to sleep (Seem, p. 28); shortness of breath; changes in urine color; rumbling in the bowels with loose bowel movements; pallor; malar flush; chills; sniffles; sneezing; light cough; and sensitivity to cold. Chronic Lung Yin Xu (Deficiency) increases susceptibility to acute Shi (Excess) conditions such as Phlegm, Wind, Heat and Cold. » Lung Shi (Excess) signs include panting; yawning; sneezing (Seem, p. 28); pain in the upper back, shoulder, and chest; colds with stuffed nose; hoarseness; wheezing respiration; frequent urination with small amounts; heavy chest; reduced lung capacity; coughing; and nasal discharge.
 * Chinese psychophysiology:**

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; maintains smooth flow of Qi and Xue (Blood); and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Fire Blazing. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of sinusitis, irritability, bitter taste, headaches, etc.

• Gall Bladder ~ Dan is the source of courage and initiative, and is responsible for decision-making as the bodily Minister of Justice; controls circulation of the nourishing and protecting energies [Ying Qi and Wei (Protective) Qi]; and opens into the eyes. Its channel purifies Yang energy in the body. » Healthy expressions are kindness, decisiveness, control, and spirit of initiative. » Gall Bladder Shi (Excess) signs include tiredness; sighing; irritability; bitter taste in the mouth in the morning; pain in all joints; edematous knees and legs (Seem, p. 29); tinnitus; lateral headache; heaviness in head and stomach; muscular spasms; and limbs slightly cold. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder. » Anger, frustration, and resentment can cause Liver Qi Stagnation which, in turn, can produce Heat which affects the Gall Bladder.

• Spleen ~ Pi governs digestion; transforms food into Qi and Xue (Blood); governs the Xue (Blood); governs the Xue (Blood); ;resolves Dampness and Phlegm; maintains upbearing; and relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen. This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and Cold foods will also deplete the Spleen.

Integrative Therapies
Sinusitis is an inflammation of the sinuses due to viral and bacterial infections or allergic reactions. The forehead or cheeks may be tender and swollen. Common symptoms are frontal headaches, pain behind and between the eyes, or a "splitting" headache. There may be fatigue, fever, chills, and loss of smell. A yellow or greenish discharge is common. If a fever of 102 degrees Fahrenheit or more persists for more than 2 days or if there is constant, bloody discharge or numbness, see your physician.

The most common predisposing factor in sudden onset sinusitis is the common cold. In long-term sinusitis, an allergic background is commonly present, and in many cases, there is an underlying dental infection. If in doubt, see your dentist.

AS GENERAL MEASURES: 1. Rest until your symptoms improve. Bed rest is better. 2. Drink at least 10 cups of fluids per day, preferably water, diluted vegetable juices, soups, and herb teas. 3. Avoid simple sugars, such as candy and pastries.

A PROPER DIET FOR SINUSITIS WILL INCLUDE THE FOLLOWING: • Stop all milk and milk products – They aggravate the problem by producing more mucus. • Another consideration is food allergies. Certain foods seem to be more likely to cause sinusitis. Eliminating these foods from the diet is a good way to determine if one or several of them are responsible. The main problem foods are dairy products (including milk, cheese, ice cream), eggs, wheat, corn, and sugar. After eliminating all of those foods from the diet, and the symptoms have gone away, one food at a time can be reintroduced to see if the symptoms reoccur. A new food would be introduced each week. If you need more information, you may want to refer to the article on Food sensitivities.

THE FOLLOWING SUPPLEMENTS ARE USED FOR SINUSITIS, AND CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: 1. Vitamin C – 500 milligrams every 2 hours for the first 48 hours. After this, reduce to 1,000 milligrams 3 times a day. 2. Bioflavonoids – 1,000 milligrams per day. 3. Vitamin A – 25,000 Units per day. 4. Beta-carotene – 100,000 Units twice per day. Pregnant women (or women who may become pregnant) should not take more than 15,000 Units of either vitamin A or Beta-carotene a day. 5. Zinc lozenges – 1 lozenge containing approximately 20 to 25 milligrams of Zinc every 2 hours. After one week, reduce the dosage to 3 times a day. Zinc gluconate and zinc gluconate-glycine are the forms which have demonstrated the greatest effectiveness in studies.

HERBS FOR SINUSITIS: • Golden Seal is the most effective herb for acute bacterial sinus infections. You can take it in 3 forms. 1. Capsules – 2 capsules, 4 times a day. 2. A tincture, which is a liquid herbal extract – 1 teaspoon, 3 to 4 times a day. 3. Dried root – 1 to 2 teaspoons per cup of boiling water. Simmer 5 minutes. Steep 15 minutes. Drink 1 cup, 4 times a day.

Caution: Pregnant women should not take Golden Seal.

• Echinacea – used in the same dosage as Golden Seal. These can be taken together. • Ephedra – 1 teaspoon of herb per cup of boiling water or 1 capsule 3 to 4 times a day. Do not use in cases of high blood pressure or insomnia.

LOCAL APPLICATIONS FOR SINUSITIS: 1. Steam inhalation – breathe over a pot of steaming hot water, and drape a towel over your head to prevent steam loss. A quarter teaspoon of Eucalyptus or Bitter Orange oil can be added for a soothing sensation. If you are not using a commercial steam inhaler, be very careful not to burn yourself.

2. Nasal washes are very effective. Use either cooled Golden Seal tea or salt water (mix 1/2 teaspoon of salt per cup of water). Tilt your head back and introduce the solution into one nostril at a time with an eye dropper or a squeeze bottle. Spit out through the mouth. Repeat this a few times.

3. Local water therapy – Place a hot, moist towel over the sinus area for five minutes. Then place a cold, moist towel over the sinuses for 1 minute. Repeat this cycle 3 times. This can be done 3 to 4 times a day. Remember to always start with hot and end with cold.

HOMEOPATHY: From the following homeopathic medicines choose the one that best matches your symptoms. Dissolve 3 pellets under the tongue. • Kali bic 12c: Use it for a yellow or greenish discharge that is thick or stringy. There may be lots of sneezing and loss of smell. Use 3 times a day. • Hepar sulph 12c: For sinusitis that is painful to touch and worse from cold air. Use 3 times a day. • Silica 30c: For chronic, long-term sinusitis. Use once a day for 1 week.

Note: A wide range of homeopathic medicines can be helpful for individuals with chronic or recurrent sinusitis. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.

=
================================================================================================================== Dietary Recommendations Eat lightly. Food complements: drink fresh grapefruit, orange, mandarin and horseradish juice in the morning, on an empty stomach.

Orthomolecular Treatment
-Bromelin

Basic Gemmotherapeutic Treatment
Ribes Nigrum Carpinus Betulus