Sinusitis is an infection or inflammation of the sinus cavity. It is divided into acute and chronic types, with the acute type occurring as an exacerbation of a chronic sinus condition. Acute sinusitis is of sudden onset and can last several weeks or more. Chronic sinusitis is defined by persistent nasal discharge or congestion, headache, and facial pain or pressure. Chronic sinusitis, by definition, lasts longer than three months or recurs repeatedly for periods of a month or more several times a year. In addition to the congestion or nasal discharge, these conditions can include symptoms such as nocturnal coughing and wheezing, snoring, dizziness, aching teeth, and bad breath. Fever is not usually a feature of chronic sinusitis unless complicated by a secondary infection. Nasal polyps often complicate the condition, especially when phlegm is present.


External Pathogens

The most common type of acute sinusitis is caused by a wind-heat invasion or wind-cold that transforms into heat. This disrupts the normal functioning of the Lung system, leading to congestion and blockage of the sinuses and nasal passages. If the acute infection is not properly treated, it can become chronic and linger for a long time. In some cases, excessive use of bitter, cold, or drying medications, such as antibiotics, can temporarily cool the heat and relieve symptoms, but can also leave a residue that promotes recurrent infections.


An excess of food, or an overly rich, sweet diet, in conjunction with alcohol and sedentary habits, weakens Spleen and Stomach qi, clogs the qi dynamic, and generates damp-heat. Heat and damp-heat in the middle burner can be funneled up the Stomach channel to lodge in the sinuses, where it can congeal further into phlegm-heat.

Foods that provoke phlegm are influential in chronic sinusitis, dairy in particular. The Lungs and Spleen are physiologically linked. The phlegm provoked by foods in the Spleen can cause phlegm congestion in the Lungs, with increased mucus secretions in respiratory tract mucous membranes and sinuses. Repeated antibiotic use can further complicate the picture by weakening the Spleen, allowing more phlegm to accumulate.

Emotional Factors

When stress and repressed emotions are present, they can disrupt the flow of qi in the liver. This can lead to heat buildup, which can affect the sinuses and cause swelling and congestion. This type of chronic sinusitis is often related to stress and emotions. Prolonged congestion in the sinuses creates an ideal environment for the development of intense heat, particularly when combined with stress, a heating diet, and alcohol consumption. People with this condition may experience persistent congestion and discomfort, as well as periods of increased sinus pain and purulent discharge associated with liver and gallbladder heat or fire.

Overwork, Exhaustion, Constitution

Excessive workload, worry, mental activity, irregular eating habits, and the consumption of cold and raw foods can weaken the qi of the spleen and lungs. This can lead to chronic cough or repeated upper respiratory tract infections, which can damage the qi of the lungs and impede its descent. As a result, fluids that should be processed by the kidneys can accumulate in the lungs and sinuses. Kidney deficiency is often a factor in chronic sinus conditions, and is common in older people. It can be caused by chronic illness, aging, overexertion, or be inherited. In cases where it is inherited, people may have a history of atopic conditions during childhood. In these cases, the kidney yang is not strong enough to support lung qi, maintain protective qi, or regulate body fluids. This can make the respiratory system and defenses weak, and fluids can easily accumulate in the upper body. These individuals may be particularly vulnerable to wind and environmental irritants.

Chemicals, Environmental Factors

Exposure to certain chemicals and particulate matter in air pollution and smoking can irritate the sinuses and contribute to swelling, poor drainage, and an increased risk of acute exacerbations. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can exacerbate nasal polyps and sinus congestion in some people, which can increase the risk of infection. It is important to avoid these triggers and to use caution when taking NSAIDs if you have chronic sinus issues.

Differential Diagnosis

Rhinitis is a disorder that consists of hay fever and perennial rhinitis. Both of these conditions cause sneezing, nasal itchiness, and watery nasal discharge, as well as sore and dry throat and red and itchy eyes. Sinusitis and nasal congestion may also cause similar symptoms, but typically do not include sneezing or itchiness. These conditions typically cause pain in the supraorbital and maxillary regions.


Acute patterns of sinusitis can be treated effectively with appropriate medical intervention. Chronic patterns of sinusitis, on the other hand, require persistent and ongoing treatment to resolve. People with chronic phlegm and/or heat in the sinuses are more susceptible to repeated episodes of acute sinusitis and should seek treatment promptly when they develop cold symptoms or produce colored mucus. Early treatment can lead to faster and more satisfactory results.

In some cases, nasal polyps may need to be surgically removed, depending on their size and location. Smaller polyps may be treated with Chinese medicine. After surgery, it is recommended that patients receive constitutional treatment to prevent recurrence of the polyps.

Sinus Irrigation

To relieve sinus congestion and prevent repeated infections, irrigating the sinuses with warm, salty water can be effective. In the early stages of treatment and during acute exacerbations, this should be done daily. When the condition is stable, irrigation can be done every other day or twice a week to prevent congestion and mucus buildup. Repeated nasal irrigation can help clear thick mucus and any focal infections, and can also tone the mucous membranes. This practice can also prevent allergens or viruses from taking hold in the nasal cavity. In chronic cases, several months of nasal irrigation may be needed to clear the sinuses, with ongoing rinsing as needed for maintenance.


To perform nasal irrigation, mix a quarter teaspoon of sea salt into a cup of water, or enough to mimic seawater. With the head tipped back, gently introduce the saline solution into one nostril and allow it to flow through the nasal and sinus cavities and into the throat. Spit out the solution when it reaches the throat. This procedure can be done in the shower, using a specialized neti pot or any other receptacle with a slender aperture that can fit into the nostril. Squeeze bottles or small teapots can also be used.

The key points to remember when performing nasal irrigation are:

  1. Use enough saline solution to effectively remove any mucus buildup.
  2. Allow the fluid to flow from the front of the nasal cavity to the back of the throat, thoroughly cleaning the entire passageway.

    Inhalation as Alternative

    If nasal irrigation is difficult or irritating, inhaling a volatile vapor can help open the nasal passages and assist drainage. To do this, place a towel over the head and inhale the steam from a bowl of hot water with a few drops of a suitable inhalant such as tea tree oil, eucalyptus oil, or menthol. Using a paper cone to direct the vapor to the nose can also be effective. This method can be used before nasal irrigation for those who have difficulty getting the saline solution to flow through their sinuses.