Annual subscribers now receive The Modern Nèi JīngFREESubscribe Annually·Clinical Education Tool — This platform provides educational resources for TCM practitioners and students. It does not issue medical certificates, prescriptions, or clinical diagnoses.
Also known as: Chronic sinusitis, Chronic rhinosinusitis, CRS, Chronic rhinosinusitis with nasal polyps, CRSwNP, Chronic rhinosinusitis without nasal polyps, CRSsNP, Chronic sinonasal inflammation, Recurrent sinonasal disease
Chronic rhinosinusitis is persistent inflammation of the nasal and paranasal sinus mucosa, generally defined by compatible symptoms lasting at least 12 weeks together with objective evidence of sinonasal inflammation. Typical symptoms include nasal obstruction or congestion, anterior or posterior nasal discharge, reduction or loss of smell, and facial pressure or discomfort. It is commonly classified as disease with nasal polyps (CRSwNP) or without polyps (CRSsNP), although modern classification increasingly recognises distinct inflammatory endotypes. Associated conditions include asthma, allergic rhinitis, aspirin-exacerbated respiratory disease, immunodeficiency, dental disease, structural obstruction and selected fungal disorders. Diagnosis should not rest on facial pain alone and may require nasal examination, endoscopy or CT imaging. First-line medical management commonly includes regular saline nasal irrigation and intranasal corticosteroid therapy; antibiotics are not routinely indicated for uncomplicated chronic inflammatory disease unless bacterial infection is specifically suspected. Persistent or severe disease may need ENT assessment, additional pharmacological management, biologic therapy in selected severe nasal-polyp disease, or endoscopic sinus surgery [1][2][3][4][5]. In Chinese medicine, chronic rhinosinusitis overlaps with Bí Yuān 鼻渊, Bí Zhì 鼻窒 and Bí Sāi 鼻塞, involving the Lung, Spleen and channels of the face. Common mechanisms include lingering Wind-Heat obstructing the nasal passages, Damp-Heat accumulating in the sinus region, Phlegm-Damp obstruction with Spleen Qi deficiency, Lung Qi deficiency with impaired dispersing and descending, Qi and Blood stasis obstructing the nasal collaterals, and constitutional Lung-Spleen deficiency with recurrent disease. Pattern differentiation must be integrated with examination for polyps, infection, allergic disease, dental pathology, asthma and structural obstruction. Acupuncture is adjunctive and does not replace intranasal corticosteroids, saline irrigation, appropriate antimicrobial treatment, ENT assessment or surgery when medically indicated [1][2][6].
Plain-English one-pager you can print or hand to a patient. Free, no sign-in needed.
Generate an AI TCM diagnosis for Chronic Sinusitis (Chronic Rhinosinusitis)
Runs this Western diagnosis through the Medi-Chi engine and returns a pattern differentiation with a full point prescription and a herbal formula, tailored to the patient details you enter next.
Points with location, depth and cautions
Formula with pinyin, 中文 and dosages
Or run it as:
Free accounts get a limited number of AI diagnoses each month; herb and point reference pages stay free either way. Output is clinical decision support, not a prescription — you stay the treating practitioner.
For patients — plain-English summary
Tap to collapse
Chronic rhinosinusitis is long-lasting inflammation inside the nose and sinuses. Common symptoms are a blocked nose, nasal or postnasal discharge, reduced sense of smell and facial pressure. Treatment usually starts with saline nasal rinses and a prescribed corticosteroid nasal spray. Some people with nasal polyps or stubborn disease need specialist ENT care or surgery. Acupuncture may be used alongside conventional care for some symptoms, but it does not replace medical treatment or investigation.
When to get medical help straight away
Swelling or redness around an eye
Reduced or double vision
Pain or difficulty moving an eye
Severe headache with confusion or neurological symptoms
Neck stiffness with severe illness
Rapidly increasing facial swelling
Seizure
Signs of severe systemic infection
Things you can do at home
Rinse with saline using sterile, distilled or previously boiled and cooled water — never straight from the tap.
Use your corticosteroid nasal spray every day as prescribed, with the right technique.
Steer clear of cigarette smoke, vaping and workplace dust or fumes.
Don't keep using over-the-counter decongestant sprays for more than a few days — they can make congestion worse.
Get your hay fever and asthma looked after, since they often drive sinus symptoms.
Keep your GP and ENT specialist in the loop, and get urgent care straight away for any of the warning signs above.
•Emergency: Swelling or redness around the eye with rapidly worsening symptoms. Arrange emergency medical assessment for possible orbital, intracranial or severe infectious complications; do not delay escalation for acupuncture or herbal treatment.[,,]
•Emergency: Reduced vision, double vision or loss of visual acuity. Arrange emergency medical assessment for possible orbital, intracranial or severe infectious complications; do not delay escalation for acupuncture or herbal treatment.[,,]
•Emergency: Painful or restricted eye movements. Arrange emergency medical assessment for possible orbital, intracranial or severe infectious complications; do not delay escalation for acupuncture or herbal treatment.[,,]
•Emergency: Protrusion of the eye. Arrange emergency medical assessment for possible orbital, intracranial or severe infectious complications; do not delay escalation for acupuncture or herbal treatment.[,,]
•Emergency: Severe frontal headache with neurological symptoms. Arrange emergency medical assessment for possible orbital, intracranial or severe infectious complications; do not delay escalation for acupuncture or herbal treatment.[,,]
•Emergency: Altered consciousness. Arrange emergency medical assessment for possible orbital, intracranial or severe infectious complications; do not delay escalation for acupuncture or herbal treatment.[,,]
•Emergency: New focal neurological deficit. Arrange emergency medical assessment for possible orbital, intracranial or severe infectious complications; do not delay escalation for acupuncture or herbal treatment.[,,]
•Emergency: Seizure. Arrange emergency medical assessment for possible orbital, intracranial or severe infectious complications; do not delay escalation for acupuncture or herbal treatment.[,,]
•Emergency: Neck stiffness with severe headache or systemic illness. Arrange emergency medical assessment for possible orbital, intracranial or severe infectious complications; do not delay escalation for acupuncture or herbal treatment.[,,]
•Emergency: Rapidly progressive facial swelling with systemic deterioration. Arrange emergency medical assessment for possible orbital, intracranial or severe infectious complications; do not delay escalation for acupuncture or herbal treatment.[,,]
•Emergency: Signs of sepsis. Arrange emergency medical assessment for possible orbital, intracranial or severe infectious complications; do not delay escalation for acupuncture or herbal treatment.[,,]
•Urgent: Unilateral persistent nasal obstruction. Arrange urgent medical or ENT assessment to exclude invasive infection, malignancy, complicated dental disease or other significant pathology.[,,]
•Urgent: Unilateral blood-stained or foul-smelling nasal discharge. Arrange urgent medical or ENT assessment to exclude invasive infection, malignancy, complicated dental disease or other significant pathology.[,,]
•Urgent: Repeated unexplained nosebleeds. Arrange urgent medical or ENT assessment to exclude invasive infection, malignancy, complicated dental disease or other significant pathology.[,,]
•Urgent: New facial numbness. Arrange urgent medical or ENT assessment to exclude invasive infection, malignancy, complicated dental disease or other significant pathology.[,,]
•Urgent: Persistent unilateral facial swelling. Arrange urgent medical or ENT assessment to exclude invasive infection, malignancy, complicated dental disease or other significant pathology.[,,]
•Urgent: New cranial nerve abnormality. Arrange urgent medical or ENT assessment to exclude invasive infection, malignancy, complicated dental disease or other significant pathology.[,,]
•Urgent: Severe or rapidly progressive facial pain. Arrange urgent medical or ENT assessment to exclude invasive infection, malignancy, complicated dental disease or other significant pathology.[,,]
•Urgent: Persistent high fever. Arrange urgent medical or ENT assessment to exclude invasive infection, malignancy, complicated dental disease or other significant pathology.[,,]
•Urgent: Marked deterioration in an immunocompromised patient. Arrange urgent medical or ENT assessment to exclude invasive infection, malignancy, complicated dental disease or other significant pathology.[,,]
•Urgent: Severe headache substantially different from the patient's usual symptoms. Arrange urgent medical or ENT assessment to exclude invasive infection, malignancy, complicated dental disease or other significant pathology.[,,]
•Urgent: Dental infection with facial swelling or spreading symptoms. Arrange urgent medical or ENT assessment to exclude invasive infection, malignancy, complicated dental disease or other significant pathology.[,,]
•Urgent: Black or necrotic nasal tissue, particularly in an immunocompromised or poorly controlled diabetic patient. Arrange urgent medical or ENT assessment to exclude invasive infection, malignancy, complicated dental disease or other significant pathology.[,,]
•Prompt investigation: Symptoms persisting despite appropriate medical therapy. Coordinate GP, ENT, allergy, respiratory, dental or immunology assessment according to the clinical presentation.[,,]
•Prompt investigation: Persistent loss of smell. Coordinate GP, ENT, allergy, respiratory, dental or immunology assessment according to the clinical presentation.[,,]
•Prompt investigation: Suspected nasal polyps. Coordinate GP, ENT, allergy, respiratory, dental or immunology assessment according to the clinical presentation.[,,]
•Prompt investigation: Recurrent exacerbations significantly affecting quality of life. Coordinate GP, ENT, allergy, respiratory, dental or immunology assessment according to the clinical presentation.[,,]
•Prompt investigation: Coexisting poorly controlled asthma. Coordinate GP, ENT, allergy, respiratory, dental or immunology assessment according to the clinical presentation.[,,]
•Prompt investigation: Possible aspirin-exacerbated respiratory disease. Coordinate GP, ENT, allergy, respiratory, dental or immunology assessment according to the clinical presentation.[,,]
•Prompt investigation: Suspected allergic fungal rhinosinusitis. Coordinate GP, ENT, allergy, respiratory, dental or immunology assessment according to the clinical presentation.[,,]
•Prompt investigation: Possible immunodeficiency. Coordinate GP, ENT, allergy, respiratory, dental or immunology assessment according to the clinical presentation.[,,]
•Prompt investigation: Persistent unilateral symptoms. Coordinate GP, ENT, allergy, respiratory, dental or immunology assessment according to the clinical presentation.[,,]
•Prompt investigation: Recurrent disease following previous sinus surgery. Coordinate GP, ENT, allergy, respiratory, dental or immunology assessment according to the clinical presentation.[,,]
•Prompt investigation: Suspected odontogenic sinusitis. Coordinate GP, ENT, allergy, respiratory, dental or immunology assessment according to the clinical presentation.[,,]
•Prompt investigation: Significant structural nasal obstruction. Coordinate GP, ENT, allergy, respiratory, dental or immunology assessment according to the clinical presentation.[,,]
TCM Pattern Differentiation
Showing 1 of 6
Example pattern
Lingering Wind-Heat Obstructing the Nasal Passages
Tongue
Slightly red, particularly at the tip or sides, with a thin yellow or white-yellow coating.
Pulse
Floating and slightly rapid, or floating and wiry (Fú Shuò / Fú Xián 浮数／浮弦).
Signs
•Persistent or recurrent nasal congestion
•Yellow or slightly thick nasal discharge
•Reduced sense of smell
•Mild frontal or facial pressure
•Dry or irritated throat
•Intermittent headache
•Symptoms aggravated following respiratory infections
•Mild thirst
•Occasional sneezing
•Sense of residual Heat in the upper respiratory tract
Treatment principle
Disperse lingering Wind, clear Heat and restore Lung diffusion to open the nasal passages and reduce congestion.
•Use regular saline nasal irrigation when clinically appropriate, with sterile, distilled or previously boiled and cooled water — never untreated tap water.
•Clean irrigation devices according to the manufacturer's instructions and use an appropriate saline concentration.
•Stop irrigation and seek advice if it causes significant pain, persistent ear symptoms or bleeding.
•Use prescribed intranasal corticosteroid therapy consistently and with correct spray technique.
•Follow ENT or medical recommendations for nasal polyps and persistent disease.
•Avoid tobacco smoke, vaping and inhaled irritants, including workplace dust, smoke and chemical exposure.
•Manage coexisting allergic rhinitis and asthma appropriately and reduce exposure to identified allergens where practical.
•Address mould or damp environmental exposure and avoid excessive fragrances or irritant aerosols indoors.
•Maintain adequate hydration.
•Seek dental assessment when odontogenic sinusitis is suspected.
•Avoid prolonged unsupervised use of topical nasal decongestants because rebound congestion may occur.
•Do not self-start leftover antibiotics for chronic symptoms.
•Monitor changes in nasal obstruction, smell, discharge and facial symptoms, and seek review for persistent unilateral symptoms, recurrent bleeding or a substantial change in symptom pattern.
•Do not use acupuncture in place of emergency assessment for orbital or neurological symptoms — complicated sinus infection can spread to orbital or intracranial structures.
•Do not needle deeply or in a superior direction around the orbit; risk of ocular, vascular and other tissue injury.
•Do not needle through acutely infected facial skin because of the risk of spreading infection.
•Do not use herbal medicine as a substitute for indicated antibiotics; coordinate with medical care.
•Do not recommend routine antibiotics for chronic rhinosinusitis without evidence of bacterial infection — unnecessary use causes adverse effects and antimicrobial resistance, and antibiotic decisions belong within medical assessment.
•Do not advise stopping prescribed intranasal corticosteroids because acupuncture has commenced; medicine changes must be discussed with the prescribing clinician.
•Do not use strong Blood-moving herbs around planned sinus surgery because of perioperative bleeding risk; review herbal products with the surgeon before surgery.
•Do not use restricted or high-risk herbal ingredients — exclude Má Huáng, Fù Zǐ, Xì Xīn and Aristolochia species from Medi-Chi recommendations.
•Do not claim that acupuncture cures chronic rhinosinusitis or permanently removes nasal polyps; describe acupuncture as adjunctive care without guarantees of outcome [6].
•Initial: review previous nasal endoscopy, CT imaging and ENT diagnoses where available, and clarify whether nasal polyps are present.
•Initial: assess allergic rhinitis, asthma and aspirin or NSAID sensitivity.
•Initial: review smoking, vaping and occupational exposures.
•Initial: ask about dental disease or procedures associated with unilateral maxillary symptoms.
•Initial: reconcile intranasal corticosteroids, saline irrigation, antibiotics, antihistamines and other treatments.
•Initial: screen for unilateral bleeding, visual symptoms, neurological symptoms, fever and facial swelling.
•Ongoing: track nasal obstruction, discharge and smell function at each review.
•Ongoing: record the frequency and severity of exacerbations.
•Ongoing: monitor treatment adherence and nasal spray technique.
•Ongoing: screen for new unilateral or red-flag features at every visit.
•Ongoing: review changes in asthma or allergic disease control.
•Ongoing: assess treatment tolerance and local bruising after facial acupuncture.
•Ongoing: coordinate ENT review when symptoms persist despite an appropriate management trial.
•Ongoing: reassess the diagnosis when facial pain persists without characteristic sinonasal symptoms or objective evidence of sinus disease.
•Outcome measures: Sino-Nasal Outcome Test-22 (SNOT-22), visual analogue scale for overall sinonasal symptom severity, nasal obstruction severity, patient-reported smell function, exacerbation frequency, rescue medicine use, sleep disturbance, and the Patient-Specific Functional Scale where appropriate.
Frequently Asked Questions
What counts as chronic rhinosinusitis?+
Compatible sinonasal symptoms — nasal obstruction, nasal or postnasal discharge, reduced smell, facial pressure — lasting at least 12 weeks with objective evidence of sinonasal inflammation on examination, endoscopy or CT. Facial pain alone is not enough to make the diagnosis [1][2].
Can acupuncture replace a corticosteroid nasal spray?+
No. Saline irrigation and intranasal corticosteroids remain first-line medical management. Acupuncture may be used adjunctively for symptom support, and patients should not stop prescribed sprays because they have started acupuncture [1][2][6].
Which TCM patterns are most common in chronic sinusitis?+
Lingering Wind-Heat, Damp-Heat in the sinus region, Spleen Qi deficiency with Phlegm-Damp, Lung Qi deficiency, Qi and Blood stasis in the nasal collaterals, and combined Lung-Spleen Qi deficiency. Chronic cases usually mix excess and deficiency mechanisms.
When should a patient be referred urgently?+
Immediately for orbital swelling, visual change, painful eye movement, severe headache with neurological signs, neck stiffness or sepsis. Urgently for unilateral obstruction, blood-stained or foul discharge, repeated epistaxis, facial numbness, or necrotic nasal tissue in an immunocompromised or diabetic patient [1][2].
Is facial needling safe around the sinuses?+
With conservative depth and angle, yes. Never needle deeply or superiorly near the orbit, avoid infected skin, warn about bruising, and take extra care with anticoagulant therapy.
Australian Health Practitioner Regulation Agency · 2026
Advertising and claims obligations for registered Australian practitioners.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.
