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AN EPIDEMIC OF SINUS DISORDERS

NATURAL TREATMENT WITH AYURVEDIC METHODS

Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

There seems to be an “epidemic” of sinus problems in America. Each year, hundreds of thousands undergo surgery to clear sinuses that are so severely blocked, often as the result of infections resistant to drug treatment, that there seems to be no other way out. Millions take antibiotics and other prescription drugs to clear, or attempt to clear, repetitive infections and/or to alleviate the intense congestion caused by irritants and allergies. Prescription decongestant drugs, such as the widely-used Seldane, have been shown to be potentially dangerous when mixed with certain antibiotics. There are tens of millions who purchase over-the-counter (OTC) remedies for their symptoms; some of the OTC drugs, such as those based on pseudoephedrine, can induce insomnia, while others, such as those based on common antihistamines, induce drowsiness.

Several possible causes for these sinus problems can be suggested. Direct irritation of the sinuses might be blamed on cigarette smoking, a practice undertaken by 48 million Americans. Sinus irritation also arises from those who have used, or continue to use cocaine by inhalation of the powder (many millions of people in the past twenty-five years). There are those who work daily, or at least frequently, in dusty, dirty, or polluted areas, not just in inner cities, but on some farms, in mines, and in rural factories that refine natural resources. Abnormalities of the immune system, leading to allergy and/or reduced ability to fight sinus infections, may arise from early curtailment of, or the failure to provide any, breast feeding of infants. Immune dysfunction can also be the result of exposure to powerful chemicals and drugs, common nutritional deficiencies, and from irregular habits associated with eating and sleeping. A further contributing factor to sinus problems may be lack of vigorous physical activity: such activity dilates the sinuses and stimulates the circulation of air and cleansing mucus through the sinuses. All of these might be considered life-style and environmental factors that are characteristic of conditions for most people in the U.S. during the second half of the 20th century. Thus, it is not surprising to find the appearance of widespread nagging sinus disorders.

There are three problems with the current remedies—such as drugs and surgery—that are most commonly applied to treating the disorder. First, they fail to correct the behaviors that contribute to the sinus problems, or even show direction towards behavioral modifications, so the disorder recurs. Second, they do not improve the body’s own mechanisms for rectifying such disorders; rather, they temporarily force a change that gives symptomatic relief. Third, for some people there are side-effects of drugs and complications from surgery.

One avenue towards a possible solution is to rely on traditional medicine: a continually evolving approach to healthy life that can be traced back to ancient times, but which illuminates current options for natural health care. Here is an example.

INDIA AND AYURVEDIC MEDICINE

India is the ancient source of our own language, the source of great art, and the widespread Buddhist religion. From India we have gained the popular yoga exercises, much of the West’s approach to vegetarian diet, the strategy of non-violent revolutionary change inspired by Ghandi, and the natural medical approach known as Ayurveda.

In ancient times, the knowledge of wise living was set down in a group of teachings (vedas: collections of knowledge and wisdom), including the one that is the source of traditional medicine in India—Ayurveda (ayur, meaning to know. Ayurveda is knowing the great wisdom, and, thereby, having a long, healthy life; it is often translated into English as the “science of life”). Today, more than 2,500 years after the earliest records of this medical system were produced, it is a popular means of health care in India and, increasingly, throughout the world (1).

Within the system of Ayurveda there is a rich heritage of herbal knowledge (2). This knowledge, when applied with the sophisticated system of diagnostics and therapeutics, can be a powerful tool towards relieving many of the ills that affect us today. As importantly, these effective methods can be a guiding light towards understanding a healthful lifestyle.

AYURVEDIC UNDERSTANDING OF SINUS DISORDERS

From the point of view of trained Ayurvedic physicians, many of the sinus problems experienced today have their root in the digestive system, especially the stomach and upper small intestine, which directly receives partially-digested food from the stomach. That is to say, the nasal irritants, the immune system disturbances, and other contributors to sinus problems that we can identify, are producing frequent symptoms—some of them quite serious—because of an underlying digestive disorder in many instances.

This digestive problem is described more specifically as a weakness in the digestive fire; in Ayurvedic terminology (3), the problem is manda agni: dampened ability to transform and metabolize. Agni is one of the five elements (bhutas) that combine to form the physical realm and the human body: agni is the fire element. Within the body there are many metabolic processes, or agni, and the one that is particularly of concern here is called the jathar agni, or the metabolic processes of the stomach and upper small intestine. From the modern scientific viewpoint, one might describe the hydrochloric acid and other digestive substances in the stomach, as well as the enzymes fed into the jejunum (upper small intestine) by the pancreas, as the essential components of digestive capability. The insufficient activity of these digestive fluids corresponds, roughly, to manda agni.

Why is this a problem in relation to the sinuses? Because the food is not as quickly and as thoroughly digested as it should be, leading to production of byproducts that affect the sinuses. According to the traditional understanding, ingested food becomes divided into two portions: one is pure (aharaprasada) and is the one that is used to nourish the body, while the other is the refuse (mala), that which remains after the pure portion is drawn off. The result of inadequate digestive fire is that some of the substances that should be separated and removed from the food end up accumulating. This material, called ama, is unusable for normal physiological processes. These substances contribute to an increase in phlegm.

In the Ayurvedic system of diagnosis and classification of imbalances, phlegm is the substance associated with one of three transporting systems, or humors, called doshas: kapha, pitta, and vata (see: Basics of Ayurvedic physiology). Kapha is the transporting system for certain fluids (other than blood), collectively called phlegm. These fluids are critical to maintaining health. The normal mucus lining all of the membranes of the body is protective, lubricating, and cleansing. It could be said that because of the weakened agni of the digestive system, kapha has an overabundance of fluid, including some fluid that is of undesirable nature. An overabundance is an imbalance and is unhealthy: the body needs to get rid of it, but the secretion mechanisms for ridding excess can eventually be overwhelmed.

The fluid has several potential sites for accumulation. The reason that it accumulates in the sinuses for some people (but elsewhere for others) is because there is a disturbance there. That disturbance could be the irritation from ragweed pollen, cigarette smoke, or other compounds; it could be from the lack of normal movement of air and mucus due to inadequate exercise; it could be because of the effect of emotions on the respiratory system. Such causes are the immediate disease-inducing factors, known to Ayurvedic physicians as nidanas.

Kapha is described as the dosha of phlegm, which is a combination of the water and earth elements (water contributes the fluid quality, earth the murkiness and thickness). The accumulation of phlegm in the sinus area disturbs another of the three transporting systems: vata. Vata is the dosha of air. The lungs and sinuses are directly involved in transport of air, and they regulate the prahna vata (air vata); there are other aspects of vata that affect the body and are regulated elsewhere. The prahna vata becomes agitated by the obstruction of phlegm, as it is unable to maintain smooth flow (it is said to be vitiated). When there is a disturbance, the smooth flow is transformed into an agitated flow, like the wind. Vata is derived from the air and ether elements (air is the substance, and ether is the space through which the air flows to yield its fundamental characteristic: movement).

The third transporting system, or dosha, is called pitta, and this is the transporter of metabolic nutrients and the energy of metabolism. One aspect of pitta, called pachak pitta, corresponds to digestive fire. Pitta is described as the dosha of fire. In many cases of sinus problems, there is a weakness or deficiency in pitta (as it manifests in the agni of digestion), an excess in kapha (as it manifests in mucus), and a disturbance of vata (as it manifests in the breath). Thus, all three doshas are imbalanced and contribute to the sinus disorder that is experienced.

Over time, if the accumulation of phlegm and disruption of air flow continues, it distorts the entire tissue structure of the face. Muscles become tense, nerves become pinched, and even the bone structure becomes compressed: one experiences tightness and pain. From the viewpoint of Ayurveda, this is because the disturbance of the doshas has led to a distress of the dhatus: the structural components of the body. There are seven dhatus recognized by traditional practitioners, including the mamsa dhatu (muscle), the majja dhatu (nerves), and the ashti dhatu (bone). It is suggested that the distortion of facial structures by chronic sinus problems, in addition to maintaining the sinus congestion, can lead to weakening of vision, premature greying of hair, and wrinkling of the skin.

MASSAGE THERAPY

An important step in remedying the chronic sinus disorder is external oeliation, or, more simply, oil massage (4). This massage will soften the structures (dhatus) that have been distorted by the imbalanced transporters (doshas). Head massage (champi) is considered very important in the Ayurvedic system and it is used to prevent kapha from accumulating in the head (among other things, used for common cold, sinusitis, and headaches). For sinus disorders, the massage is carried out by applying a medicated oil.

Oils in general, and sesame oil in particular, have the ability to calm the agitated vata dosha. That is because the qualities of this oil counter the qualities of vata. In fact, oil massage is sometimes called snehana, which means to apply oil to control vata. Vata is described as having the qualities (among others) of lightness, coldness, irregularity, and dryness. By contrast, the sesame oil is heavy, warming, smooth, and, of course, oily; thus, it counteracts the excessive impact of vata characteristics when the vata is disturbed. Facial massage with oil alleviates the accumulation of kapha and calms the vata.

Medicated oil, such as narayan oil or mahanarayan oil, enhances the influence of the massage. The herbs in mahanarayan oil (of which there are about 50) and narayan oil (which has a smaller number of the herbs) are selected to help soften the obstructions (distortions of the dhatus) that occur from long-term dosha imbalances. The main ingredient of the narayan oils is shatavari (Asparagus racemosus). The oil is also used topically to treat rheumatism, stiff neck, hemiplegia, and various nervous system disorders. Mahanarayan oil is selected for the massage treatment when the sinus blockage is extreme; narayan oil is otherwise selected.

For maximum effectiveness, the oil is applied warm (which is more comfortable, more fluid, and more able to transport the herb ingredients into the skin than cold oil) to specific points on the face that are the key areas of circulation. These points, called marma points, have been described in the early Ayurvedic literature. They are much like the acupuncture points of Chinese traditional medicine, and, in fact, one can massage both the Indian marma points and Chinese acupoints with good effect.

Marma points are juncture points (4, 5), rather than points along meridians as found in Chinese medicine. There are a total of 107 critical marma points on the body, divided into five groups: muscle (11 points), vessels (41 points), ligaments (27 points), bones (8 points), and vulnerable joints (20 points). There are 11 points on each leg and each arm (total of 44), 12 in the region of the chest and abdomen, 14 on the back, and 37 in the region of the neck and head. These points are valuable treatment sites, and, according to traditional understanding, if the junctures are physically damaged it can have significant negative health impact—in some cases, causing death. As has occurred with Chinese acupuncture points, the basic set has been expanded by some practitioners; some, such as Frank Ross (6), have advocated a complete combining and integration of the Chinese and Ayurvedic points.

A few drops of oil are sufficient to provide herb extractives and lubrication for the massage. After the facial points (about a dozen or so) are massaged, the oil is spread across the entire face in broad strokes. The massaging of the marma points and the whole face stimulates the body to eliminate accumulations. It helps the dhatus—the structures which hold onto substance—to release. It calms and regulates the vata. For an illustrated guide to the basic facial massage, see Johari’s recent publication on Ayurvedic massage (4).

To enhance the action of this massage, the person being treated is kept comfortable by placing a hot water bottle under the neck, on the abdomen (over the intestines), and on the feet. The heat has a relaxing effect and promotes circulation. Further, after applying the oil each time—a process that is repeated three times—a heated towel is placed on the face, helping the blood vessels and pores to expand and accept the herb ingredients.

NASYA: NASAL INHALATION OF HERBS

After two applications of the oil to the marma points and to the face as a whole, a few drops (typically 5) of medicated oil is placed in each nostril (the person being treated inhales the oil). This portion of the treatment is known as nasya. The hot water bottle under the neck assists the person in comfortably extending the neck so that the nose points up and back, allowing the oils to flow towards the sinuses. For the treatment of sinus congestion, a typical medicated oil is calamus and ginger extract in sesame oil. This oil strongly opens the congested tissues of the sinuses and breaks up the phlegm (in the event that a person has a feverish condition, cooling coconut oil is sometimes used to replace sesame oil; when the oils are not available, calamus powder can be inhaled as a snuff). Following this, there is the third application of oil to the face, and then the excess oil on the skin can be removed by a warm, moistened towel.

The nasal passages can also be massaged on a daily basis by the individual suffering from sinus problems. For this method, Dr. Lad (7) says “Dip the clean little finger into the appropriate oil and insert into each nostril as deeply as possible [he cautions about both sharp fingernails and forceful insertion]. The nasal passage is then lubricated through this gentle massage. Nasal massage helps to relax the deeper tissues and can be done every day or any time one is under stress....By this means, the emotions that are blocked in the respiratory tract are released” For stressful situations, when the sinuses are not overly congested, one can use brahmi oil (which is made from gotu kola or bacopa in sesame oil base) or clarified butter (ghee).

Softening the dhatus, cleansing the overflowing kapha (see below), and calming the vata, are the principles of treatment for the symptoms of sinus problems. The treatment, which generally requires having two oils (one for facial massage and one for use in the nose) and a minimum of accessory equipment (hot water bottles, warm towels, dropper), takes about 25 minutes, and it can be self-administered if necessary. Additionally, small amounts of the medicated nasya oil can be inhaled again at intervals of several hours to give further relief.

INGESTING HERBS, REGULATING DIET

A key to ultimately eliminating the problem of sinus congestion is to invigorate the jathar agni. To accomplish this, one can swallow small amounts of herb combinations in the form of simple powder (which can be encapsulated or tableted for convenient administration). The most common treatment for dampened digestive fire is the powder known as Hingushtaka, a spicy blend of asafoetida (Ferula asafoetida), ginger, black and long peppers, and other herbs. A modification of this formula, called Shivakashar Panchana, is made by adding haritaki (Terminalia chebula) and a small amount of sodium bicarbonate, and is selected when there is evidence of obvious lung weakness, such as asthma and bronchitis, when rales are heard through a stethoscope. Either formula will treat indigestion, gas, bloating, and accumulation of ama, the unusable substance that arises when food is not fully digested. For those who are sensitive to spicy herbs (such as persons with ulcers), an alternative formula can be used, such as the combination of licorice and turmeric. Licorice pacifies the overexcited fire (pitta vitiation), while turmeric smoothes and promotes the essential digestive fire (agni). The combination of these two herbs is used to treat hyperacidity, excessive appetite, irritation and inflammation of the stomach and esophagus.

The total treatment for the sinus problem is to increase the digestive fire, penetrate the areas of blockage, and eliminate the accumulation by regulating the doshas and modifying the dhatus. To retain the benefits of this treatment, one should be careful in eating habits to avoid weakening the digestive fire. According to Ayurvedic principles, one should avoid chilled foods and foods that are classified as having a cold nature, as these will further reduce the digestive fire while contributing to the vata imbalance. One should also minimize phlegm-increasing foods: milk products and fatty meats, such as pork and lamb, are examples. These foods can exacerbate the kapha accumulation in the head. And, of course, one should be careful to avoid irritating the sinuses with smoke, chemicals, or dust.

In this article, one of the most common patterns for development of sinus disorders has been presented, with the basic types of therapy to be applied, using specific examples of massage oils, nasya ingredients, and herb/diet suggestions. For an individual, one must check to see that this pattern is an appropriate depiction, or else adjust the treatment details correspondingly to the results of the analysis. Dr. Vinod Verma (1) presents some alternative approaches for sinusitis, such as jel neti, the yogic method of sinus cleansing by pouring water or milk into the nostrils, and the inhalation of highly aromatic mixtures (e.g., eucalyptus, menthol, camphor, lavender, anise). As one becomes familiar with the basic concepts of Ayurveda, health problems due to imbalances in the body can be detected before they become severe and can be treated easily through herbs, diet, and lifestyle modifications, rather than pursuing an endless course of drugs and surgery.

ACKNOWLEDGMENT

The treatment method for sinus disorders described in this article, and much of the explanation for its functions, is based on information provided by Kim McCarthy, a massage therapist specializing in Ayurvedic medicine; McCarthy practices and teaches in Portland, Oregon. I wish to thank Husaini Ali, of Universal Medicaments, and Dr. K.S. Kundley, of the Poddar Ayurvedic Hospital, for providing suggestions about the treatment methods, materials used, and Ayurvedic principles, some of them outlined elsewhere (3).

REFERENCES

1. Verma V, Ayurveda: A Way of Life, 1995 Samuel Weiser Press, York Beach, ME.

2. Nadkarni KM, Indian Materia Medica, 1908 (revised and enlarged 1954), Bombay Popular Prakashan, Bombay.

3. Dharmananda S, Basic principles of Ayurvedic physiology, 1997 START Group Manuscripts, Portland, OR.

4. Johari H, Ayurvedic Massage, 1996 Healing Arts Press, Rochester, VT.

5. Kutambiah P, Ancient Indian Medicine, 1962 (revised 1969) Orient Longman, Bombay.

6. Ross F, Lost Secrets of Indian Acupuncture, 1994 Lotus Press, Twin Lakes, WI.

7. Lad V, Ayurveda: The Science of Self-Healing, 1984 Lotus Press, Twin Lakes, WI.

February 1997