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Sinus
Infections
by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)
Aetiology
In the Ayurvedic approach to sinusitis, exposure to an infective agent
such as pathogenic bacteria is just one factor in the development of the
illness. Of far greater significance is the build up of excess doshas
in the body, due to incorrect diet and lifestyle. Once excess doshas have
built up and become prevalent due to repeated errors in daily regimen,
they are readily carried by vata upwards to the head, where they lodge
in any weak spot, creating acute illness. Unfortunately, due to today’s
polluted environment, the integrity of the mucus membranes of the nasal
sinuses is under constant attack. Thus weakened, the sinuses are particularly
vulnerable to invasion by provoked doshas. It is the unwholesome situation
created by a combination of weakened sinuses, accumulation of doshas
and build-up of ama or toxins in the body that provides a fertile
ground for the multiplication of pathogens.
Sinusitis, as an inflammatory condition, always involves some component of pitta, the fiery humour. However, provocation of either vata or kapha within the sinuses can give rise to pitta irritation of the mucous membranes. Sinus infections thus can be regarded as either vata, pitta or kapha in nature, each type having specific causative factors and symptoms.
Causes of
vata-type Sinus Infection
According to the Charak Samhita, factors which tend to provoke
vata in the sinuses and head include suppression of natural urges,
sleeping by day, staying awake at night, loud or excessive talking, excessive
sexual intercourse, fasting, and consumption of too much salad and other
raw foods. Charak notes that emotional factors play a significant role
in the development of vata type sinusitis, particularly too much
weeping; suppression of tears; grief, fear and anxiety. Head injury causing
fracture of the sinus passages can predispose to vata type sinusitis,
while Charak specifically mentions environmental causes, namely exposure
to smoke or dust. Nowadays, environmental factors play an even greater
role in creating a predisposition to sinus infections. All particulate
air pollution, including soot, industrial pollution, dust from synthetic
carpets and forced-air indoor heating, as well as air-conditioning, play
a major role in provoking the vata dosha in the head and sinuses.
Causes of
pitta-type Sinus Infections
The factors listed by Charak as giving rise to pitta-predominant
sinus infections include excessive intake of spicy foods, salt, sour fruits,
vinegar and alcohol, excess exposure to the sun, and overly warm indoor
environments. Anger is the main emotional factor underlying any episode
of pitta sinusitis. In modern times, environmental pollution
plays a key role in creating a predisposition to pitta type sinusitis,
for the pitta in the sinuses is greatly provoked by inhalation
of fumes and toxins. In the outdoor environment, car exhaust, herbicides,
pesticides, and factory fumes are significant provoking factors. Unfortunately,
most indoor environments today offer even more opportunity to irritate
pitta in the sinuses. Formaldehyde, paint fumes, carpet glues,
epoxy resins, asbestos, drain cleaner, household cleaners, detergents,
and chlorine bleaches are just some of the toxins to which we and our
children are consistently exposed, and which ongoingly irritate the sinus
passages. Furthermore, pitta type sinus infections are an occupational
hazard for many, including house painters, carpet fitters and artists
who work in oil. Another significant cause of both vata and pitta
sinusitis is cocaine snorting.
Causes of
kapha-Type Sinus Infections
kapha-type sinus infections are a classic disease of the “couch
potato” type. Sedentary habits, excess sleep, and a diet high in
oily, sweet and heavy foods, are the main provoking factors mentioned
by Charak. Denial and “stuffing” of emotional pain can manifest
as stuffy sinuses, while molds, damp, fog and smog also serve to provoke
kapha in the sinus passages.
Symptoms of
vata-type Sinus Infections
In vata-type sinus infections, the sinuses are dry, painful and
sensitive. Nasal discharge is scanty and may be brownish in color. Pain
is extreme, particularly in the temporal region, the forehead and between
the eyebrows, while the patient may complain of pain in the ears and dizziness.
At times the pain may be so severe that the affected person feels as if
the head is breaking apart and the eyes are falling out. A patient in
this condition is extremely restless, nervous, and hypersensitive, pacing
back and forth or writhing on the bed. The neck and shoulder muscles are
stiff and sore, while the condition may be accompanied or preceded by
generalized vata symptoms such as constipation. Application of
hot rocks or warm castor oil packs provide a measure of relief.
Symptoms of
pitta-type Sinus Infections
pitta-type sinusitis is accompanied by fever—in some cases,
such as acute frontal sinusitis, by very high fever with delirium. The
sinuses throb and the facial bones are tender to the touch. Nasal discharge
is yellow, orange or green, and may be streaked with blood. The head burns,
and the eyes burn and there is a throbbing headache, while thirst and
sweat accompany the fever. The patient is irritable, angry, critical and
demanding. Application of cold packs provides a measure of relief from
the burning head pain.
Symptoms of
kapha-type Sinus Infections
In the case of kapha-type sinusitis, the sinuses and nose are
so stuffy that the patient breathes through the mouth. Nasal discharge
is copious, thick, white and sticky. There is dull pain in the head, numbness
and a feeling of heaviness. The head feels cold, while the patient also
complains of drowsiness, lack of appetite and general lassitude.
Diagnosis
of Sinusitis
In the presence of the above-mentioned symptoms, it is fairly easy to
diagnose vata, pitta, or kapha type sinusitis,
while a sinus infection involving a combination of two doshas
will show a mixture of symptoms. What is of key importance in the diagnosis
of any sinus infection is to determine which of the three doshas
is the root of the condition. Is the patient’s kapha-type
sinusitis, for instance, part of a generalized kapha provocation,
or has the kapha disorder in the head arisen as a result of overall
vata provocation? It is extremely important to answer the question
in order to employ the correct treatment strategy.
In the case of vata-type sinusitis, this typically results from generalized vata disturbance, although other, more complex situations are possible, since either pitta or kapha may be blocking the vata in the sinuses. With pitta-type sinusitis, the condition may result from pitta provocation, or from generalized vata provocation which has pushed pitta into the head, or from an overall kapha condition, displacing and blocking pitta in the head. And while kapha sinusitis can and frequently does manifest as a symptom of kapha provocation, there are also very many vata provoked individuals who experience kapha-type sinusitis, as a result of vata pushing kapha to the head. Correct diagnosis of this situation is essential, for typically, kapha sinusitis would be treated by bitter, pungent and astringent herbs and foods—the very tastes that provoke vata. If generalized vata disturbance is the underlying cause of the kapha sinusitis, treatment aimed solely at pacifying kapha will serve only to worsen the condition.
Thus, the particular type of sinus infection may be diagnosed from the symptoms and from examination of the temporal pulse, but the overall doshic balance must also be assessed carefully, by taking a detailed history and performing a thorough examination of the tongue, face, nails, and above all, the radial pulse—nadi vignan, or pulse diagnosis. Assessment of the vikruti pulse, showing the current state of balance or imbalance of the doshas, will clearly reveal, for example, general vata provocation accompanying kapha type sinus infection. Careful history taking and use of the questions, “When were you completely well?” and “What was the first symptom you experienced?” will perhaps show a history of constipation, restlessness, fear and insomnia—all vata symptoms preceding the onset of kapha sinusitis.
Treatment
The treatment protocol for any sinus infection involves the following:
1. Management of fever
2. Use of neti or nasal cleansing
3. Use of Nasya or nasal medication
4. Herbs
5. Diet
6. Cleansing or purificatory measures
7. Lifestyle adjustments to prevent further episodes
Management
of fever
Acute sinusitis, like any acute condition, should be treated according
to the classic guidelines for fever. If this is not done, either the sinusitis
will become chronic or other, more severe conditions will arise. Of the
utmost importance in the management of fever is fasting. The patient should
abstain from solid food for the duration of the fever, until the temperature
returns to normal and keen appetite arises. The vata person can
fast on warm tea made from fresh ginger or from ajwan (Sanskrit, ajamoda,
Lat. apium graveolens), which calms vata and relieves
stuffy sinuses. The pitta person can fast on cool or lukewarm
teas made from coriander, sandalwood, rose or fresh ginger, all of which
are anti-infective and anti-febrile. The kapha person can fast
on tea of dry ginger.
Once keen appetite returns, the first meal should consist of a soup or gruel such as rice gruel, barley gruel, squash soup or mung bean gruel, cooked with digestive spices such as ginger, black pepper, cumin, coriander, fennel, turmeric, cinnamon, cardamom, and bay. This preparation helps restore digestive fire. That evening, bitter and pungent herbs such as Mahasudarshan, a combination of about forty different herbs, and Trikatu, a combination of three pungents, dry ginger, black pepper and piper longum should be taken. These bitter and pungent herbs help to restore digestive fire and remove toxins. Next day, well-cooked and easily digestible foods should be taken, such as kitcheri, a preparation made from basmati rice and mung dal, and the specific herbal regimen for the sinus infection should be instituted.
Jala Neti
– Salt Water Nasal Cleansing
The use of jala neti or salt water nasal cleansing is essential
in both the treatment and prevention of sinus infection. This involves
washing the nasal passages with salt water which is poured into the nostril
and exits out the other nostril or through the mouth. The water used for
the purpose should be pure, free of chlorine, while the salt should be
either pure sea salt, or better still, rock salt from Utah. Classically,
a brass vessel with a long spout is used, although an indoor plant watering
can with a spout makes an excellent substitute. This procedure cleans
the passages, enabling the sinuses to drain freely, an essential aspect
of treatment.
Like any other part of the body, the nose, after being washed with lukewarm water of the same salinity as tears, must be carefully dried. This is effected by vigorous breathing exercises and forward bending yoga poses which allow any excess water to drain from the sinuses.
The other form of neti is sutra neti, using a string stiffened and lubricated with beeswax, which is passed in through the nose and out through the mouth. Sutra neti, which helps to maintain the passages in a free condition, so that the sinuses can drain, is of great use both in the prevention of sinusitis and in the treatment of chronic, allergic or non-infective sinusitis. However, SUTRA NETI SHOULD NEVER BE USED IN ACUTE SINUS INFECTIONS, since it has the potential to spread the infection further.
Nasya
– Nasal medication
Since sinusitis is a localized infection, localized treatment in the form
of nasal drops is particularly helpful. One patient, who came to see me
complaining of a severe sinus infection, had recently been treated by
an antibiotic so strong that, once she took it, her hair fell out. Even
so, due to the poor blood supply of the sinuses, which ensures that only
small doses of antibiotic reach the sinuses, her infection was just temporarily
relieved. After being treated with Nasya, she recovered in a
few days. Her only regret was that she did not learn about the value of
Ayurvedic treatment until after her hair fell out.
Nasyas may be of two kinds, water-decoction or oil-based. An excellent decoction Nasya for sinusitis is ginger-rose-jaggery, consisting of a decoction of equal parts fresh ginger, rose petals and jaggery, a product made from boiled-down sugar can juice and readily available in Indian grocery stores. This preparation is tridoshically balanced, the coolness of the rose balancing the heat of the ginger. It is tremendously effective in clearing the head.
Oil Nasyas
may be prepared using a sesame oil base and may include anti-infective
oils such as eucalyptus, rose and tulasi (sacred basil—ocimum
sanctum). For both vata and kapha type sinusitis,
vacha oil Nasya (acorus calamus) is extremely helpful,
as it is decongestant and reduces both vata and kapha.
For pitta type sinusitis, the best Nasya is ghee medicated
with Brahmi (herpestis monniera).
All Nasyas should be administered in fish pose, with the head
tilted backwards. According to Ayurvedic teachings, the correct does is
five drops per nostril, one drop for each of the Five Elements.
Oral use of
botanicals
In oral, that is, systemic, use of botanicals for sinusitis, it is of
the utmost importance, as described above, to consider not only the type
of sinus infection that is present, but also the overall doshic balance
in terms of both vikruti, or current imbalance, or prakruti,
or constitution. Those herbs should be selected and combined which will
treat both the sinus infection and the general vikruti, while
not ignoring prakruti—for example, very hot herbs are generally
avoided in pitta prakruti, even if vata or
kapha are the main provocations.
Marich
(Black Pepper, piper nigrum)
Marich is pungent in taste, heating in energy, pungent in post-digestive
effect. It pacifies vata and kapha, but provokes pitta.
Its name, marich, is one of the names of the sun, for it is believed to
absorb and concentrate solar energy. Its active principle is piperin.
It has decongestant action and can be used in both vata and kapha
type sinus infections, one pinch orally mixed in honey, two or three times
daily.
Tvak
(Cinnamon, cinnamomum zeylonicum)
Cinnamon is pungent, sweet and astringent in taste, heating in energy
and sweet in post-digestive effect. It pacifies vata and kapha
and may provoke pitta. Diaphoretic, expectorant, decongestant
and analgesic in action, it is helpful in the treatment of vata
and kapha type sinusitis. It should be taken only in pinch-sized
amounts and is best combined with other herbs.
Vacha
(acorus calamus)
Pungent and bitter in taste, heating in energy, pungent in post-digestive
effect, vacha calms vata and kapha, but may provoke
pitta. In sinusitis, it may be administered systemically, in
a balanced yoga or formula with other herbs, topically, as a paste applied
externally to the sinuses, or nasally, either as a snuff or in the form
of vacha oil Nasya. By all these routes of administration, it
will clear and heal the sinuses.
Chitrak
(plumbago rosea)
Pungent in taste, heating in energy, pungent in post-digestive effect,
chitrak is generally tridoshic, although if used in excess it will provoke
pitta. Chitrak is generally useful in all fevers and respiratory
tract infections, and should form part of a balanced yoga (formula) for
the treatment of sinus infections.
Tulasi
(ocimum sanctum)
One of the most sacred and revered plants in India, tulasi is bitter in
taste, heating in energy, pungent in post-digestive effect. It pacifies
vata and kapha, but provokes pitta. In effect,
it is antibacterial, antiviral, antiseptic, antipyretic and diaphoretic.
It is the herb of choice for all vata and kapha type
fevers and respiratory tract infections, including acute sinusitis, but
should not be used in pitta sinusitis. Above all, it is the perfect
herb for the situation of vata pushing kapha to the
head, with kapha-type sinusitis, for it both removes the kapha
from the nasal passages and balances vata in its seat, the colon.
Tulasi is best taken as a tea or infusion, with honey.
Rose
Rose is bitter, pungent, astringent and sweet in taste, cooling in energy,
and sweet in post-digestive effect. In pitta-type sinusitis,
it serves to lower fever, reduce pitta and soothe the inflamed
sinuses. Rose can also be used to balance a formula to make the overall
effect more suitable for pitta.
Sitopaladi
Churna
This is a formula consisting of rock candy, bamboo manna, pippali (piper
longum), cardamom and cinnamon. It may be taken in does of 1-4 gm,
2-4 times daily, and is a balanced formula, extremely valuable in all
types of sinusitis, although it is most effective as an anti-kapha
remedy.
Abrak Bhashma
Abrak is a preparation made from mica ash, and is a valuable anti-infective
agent, useful in all types of sinus infections. It should be used in very
small quantities, combined with other herbs to form a balanced yoga.
Diet
Selection of the proper diet is important in the prevention of and treatment
of sinus conditions. In vata-type sinusitis, a diet of warm,
moist, oily, soupy food should be taken, and raw, dry and bitter foods
avoided. In pitta sinus infections, it is necessary to reduce
the intake of spicy, sour and salty foods. For kapha-type sinusitis,
a light, dry, warming diet is needed, strictly avoiding all dairy products
except ghee and goat milk.
Lifestyle
adjustments
Lifestyle adjustments both facilitate the treatment of sinus infections
and prevent them recurring or becoming chronic. Habits which tend to provoke
vata in the sinuses, such as smoking or snorting cocaine should
be stopped. Attention must be paid to indoor air quality, reducing as
far as possible the uses of chemicals in the home and office. In certain
cases, there may need to be an adjustment in the person’s occupation.
For example, one patient of mine has switched from painting in oils to
watercolor. Underlying emotional factors should also be addressed, particularly
when the patient has a history of recurrent sinus infections. Positive
habits such as a proper exercise program should be encouraged while a
pranayama practice is extremely valuable in maintaining the balance of
vital airs (prana) in the head.
Cleansings
Cleansing practices other than jala neti and Nasya cannot
be used during the acute stage of a sinus infection, but can be applied
either after the condition is resolved, or after it has persisted for
more than three weeks. The value of cleansing practices is to reduce the
excess doshas and to restore the doshas to their seats,
thus preventing recurrence, chronicity or the onset of other, more serious
conditions. In the case of vata sinusitis, or of vata
pushing the other doshas into the head, the most important cleansing
is snehan svedan—that is, oiling the whole body with sesame
oil and then sweating. Basti or Ayurvedic enema should also be
employed to calm the upward movement of vata. Oil enema can be
done, using a few ounces of warm sesame oil, to calm the vata
in the colon. This can be followed by a decoction enema, using two tablespoons
of dashmoola (a combination of ten roots including castor root)
to one and a half pints of pure water, simmering this without reducing,
for twenty minutes.
Pitta-type sinusitis is an indication that pitta should be reduced by virechan (purgation). The most simple and gradual method of purgation is to take an infusion of one-half teaspoon of amlaki (emblica officinalis) daily at bedtime. Amlaki can be prepared as either a cold infusion or hot infusion; however, it may be easier to digest when drunk as a warm tea than as a cold infusion.
For kapha-type sinusitis, vaman, or emesis, is a key therapy. The excess kledak kapha which accumulates in the stomach—the main seat of kapha— is what overflows into tarpak kapha, the kapha of the head, leading to stuffy sinuses. Hence, to get to the root of the problem, it is essential to pacify the kapha in the stomach, and to remove excess doshas from the seat of kapha. The Ayurvedic method of vaman typically involves ingestion of about a quart of liquorice tea, after which the uvula is immediately stimulated until vomiting occurs. The yogic method is slightly different, salt water (normal saline) beings used instead of liquorice tea. Saline is used to cleanse the stomach, in exact proportion of one and a half teaspoons of salt per quart of pure water. Concentrated salt solution, despite its emetic effect, is not used for this practice, since it would have a dehydrating effect. Vaman is also effective in clearing the sinuses in situations where vata is pushing kapha to the head. However, in this circumstance, emesis should be employed only with great caution, since this practice has a potential to promote vata.
Conclusion
Like all conditions of the head, sinus infections are less easy to diagnose
and treat then might appear at first glance. This is because of the tendency
of vata to move upwards, carrying other doshas to the
head. Thus, the provocation occurring within the head and sinuses is by
no means always the same as that affecting the rest of the body. Chronic
or recurrent sinus infections may result from a failure to treat the underlying
doshic imbalance. In particular, great caution is needed when using extremely
bitter anti-infective herbs, such as goldenseal (hydrastis canadensis).
If pitta and kapha are the main doshic imbalances, these
herbs will be very effective, but if an underlying vata imbalance
is giving rise to a pitta or kapha type of sinus infection,
excess use of bitter herbs will greatly exacerbate the condition.
Similarly, the use of antibiotics for pitta-type sinusitis is
very much a double-edged sword, since most antibiotics are pitta
provoking. By aggravating the underlying cause, antibiotics, although
effective in the short run, may tend to create recurrent pitta-type
conditions.
Alakananda Devi
(Alakananda Ma)
is director of Alandi Ayurvedic Clinic in Boulder, Colorado, and principal
teacher of Alandi School of Ayurveda, a traditional ayurvedic school and
apprenticeship program. She can be reached at 303-786-7437 or by email
at:
info@alandiashram.org.