TCM Acupuncture and Massage

Chapter 72 Diseases of the ENT (2)
2. Chronic hypertrophic rhinitis comes from chronic simple rhinitis, which is caused by long-term chronic inflammation and blood stasis, which lead to hyperplasia of nasal mucosa and turbinates.Irreversible chronic inflammation of mucosa and submucosal tissues.At this time, the mucous membrane thickens, the tissue elasticity decreases, and the nasal ventilation capacity is poor, thus endangering the physiological function of the nose.

(1) Etiology and pathogenesis

①Local factors: During the development process, the nasal septum grows curved, or the nasal septum is curved due to acquired impact, and other reasons are often combined with compensatory chronic hypertrophic rhinitis.

②Systemic factors: chronic diseases, vitamin deficiency, excessive smoking and alcohol, etc. can affect nasal mucosal vasomotor and cause obstacles; long-term use of reserpine and antihypertensive drugs can also cause nasal vasodilation and rhinitis symptoms.

③Environmental factors: The nasal mucosa is stimulated and damaged by physical and chemical factors, which can cause chronic rhinitis.Environments with sharp changes in temperature and humidity, such as steelmaking, freezing, baking and melting, are also more likely to occur.

(2) Clinical manifestations

① Severe nasal congestion, mostly persistent, often mouth breathing, and often decreased sense of smell.

② thick nasal mucus, mostly mucus or purulent.Cough and phlegm due to runny nose and irritation of the throat.

③When the hypertrophic middle turbinate presses the nasal septum, it can cause compression or inflammation of the preethmoid nerve branched from the ophthalmic branch of the trigeminal nerve, resulting in irregular frontal pain that radiates to the bridge of the nose and orbit, called preethmoid neuralgia.

(3) Treatment principles For those with mild symptoms, you can exercise more or use drugs to control them; for those with severe symptoms, you may need surgery to correct the excessively curved nasal septum and excessively thick turbinate.

([-]) Atrophic rhinitis

Atrophic rhinitis is a slowly developing nasal atrophic inflammation characterized by atrophy of nasal mucosa, periosteum and bone.It usually starts at puberty and is more common in women than men.

1. The etiology and pathogenesis are still unclear, and there are many theories, which can be classified into two categories:

(1) Primary: It is a local manifestation of systemic diseases, which may be related to the lack of lipids and fat-soluble vitamins, nutritional disorders, lack or imbalance of trace elements, genetic factors, collagen diseases, endocrine disorders, immune dysfunction, etc. related.

(2) Secondary: caused by local factors, such as nasal mucosa trauma or excessive surgical resection, some special infectious diseases, chronic hypertrophic rhinitis, chronic suppurative sinusitis, extreme deviation of nasal septum, dust or harmful gas Long-term stimulation, etc.

2. Clinical manifestations
(1) Dryness in the nose and nasopharynx: This is due to the atrophy of the glands in the nasal mucosa and the decrease in secretions.

(2) Nasal congestion: Nasal congestion can be caused by pus scab blocking the nasal cavity, or because the nerves of the nasal mucosa are insensitive, even if the pus scab is removed, the passage of air is difficult to detect, and it is mistaken for nasal congestion.

(3) Nasal secretions: often in the form of massive or tube-shaped pus scabs, which are not easy to blow out. When the dry scabs are blown out vigorously, there will be a small amount of nosebleeds.

(4) Olfactory disturbance: the sense of smell often decreases or disappears.This is caused by atrophy of the mucous membrane in the olfactory area or obstruction by dry scabs.

(5) Stinking breath: due to the growth of bacteria under the pus scab, the protein in the pus scab is corrupted and decomposed, resulting in a foul smell, which is called stinky nose syndrome.

(6) Headache and dizziness: Due to the atrophy of the turbinate, the lack of temperature regulation and heat preservation in the nasal cavity, the stimulation of nasal mucosa by inhaling cold air, and the stimulation of pus scab can all cause headache and dizziness.

3. Treatment The principle of treatment is to clean the nasal cavity, remove pus scab, moisten the mucous membrane, prohibit vasoconstrictors, and strengthen systemic treatment.Systemic and local comprehensive therapy should be used, and the symptoms can be improved.

(1) Clean the nasal cavity: rinse the nasal cavity with warm normal saline or ordinary warm saline.

(2) Nasal medication: lubricating nasal drops are commonly used, which can promote congestion and swelling of the nasal mucosa, increase blood circulation, and reduce dryness and odor in the nose.

(3) Vitamin therapy: Multivitamin combination can protect mucosal epithelium, promote tissue cell metabolism, and enhance resistance to infection.

(4) Surgical therapy: It can be tried for those who have not been treated for a long time.The purpose is to narrow the nasal cavity, reduce the amount of air inhalation, reduce water evaporation, reduce the formation of pus scab, and stimulate the nasal mucosa to increase congestion and secretion, and improve symptoms.

([-]) Dry rhinitis

The occurrence of dry rhinitis is closely related to climate and occupational factors.It is caused by long-term stimulation of the nasal mucosa, resulting in atrophy of mucous glands and decreased secretion, and the mucosa may even have superficial erosion due to dryness.

1. Etiology and pathology It is generally believed that it is caused by long-term stimulation by external physical or chemical substances.The reduction or disappearance of goblet cells in the nasal mucosa caused the dryness of the nasal mucosa, but the nasal mucosa and turbinates did not atrophy, and the nasal secretions also had no odor.

2. Clinical manifestations include dry nose, decreased nasal secretions, itching, burning sensation, and often induce patients to pick their nose, causing a small amount of epistaxis, and the sense of smell generally does not decrease.Anterior rhinoscopy showed that the nasal mucosa was dark red, the surface was dry and dull, and there were filamentous secretions in the nasal passages.The mucous membrane in the anterior lower area of ​​the nasal septum is often eroded, and small pieces of thin scabs may adhere to it, and often bleed when removed.No atrophy of the turbinates should be differentiated from atrophic rhinitis.

3. Treatment
(1) Remove the cause of the disease.Improve environmental conditions such as dust reduction, cooling, and ventilation, and strengthen personal protection, such as wearing a mask and washing the nasal cavity.

(2) Oily nasal drops can be used locally, such as compound peppermint oil, liquid paraffin or nasal ointment.Care should be taken not to use vasoconstrictors.Cod liver oil pills and B vitamins can also be taken orally.

([-]) Allergic rhinitis

Also known as allergic rhinitis, it is caused by the high sensitivity of the nasal mucosa to certain components in the inhaled air.Its symptoms are very similar to those of a cold, but it can occur many times a day, and it is completely normal when it does not occur.The onset of allergic rhinitis is sometimes closely related to the season.

1. Etiology and pathogenesis The body reacts excessively to the air inhaled, food eaten or foreign objects in contact with the skin, and allergic diseases occur. 2. Clinical manifestations (1) Sneezing: There are often several sneezing episodes every day, often exacerbated by spreading or at night.Each episode can range from a few to as many as dozens.

(2) Nasal discharge: There is often a large amount of clear water-like nasal mucus.

(3) Nasal congestion: varying degrees, intermittent or persistent.

(4) Nasal itching: Most patients feel itching inside the nose and sometimes outside the nose, soft palate, face, external auditory canal, etc. Seasonal rhinitis is most obvious with itchy eyes.

(5) Hyposmia or disappearance: mostly temporary, but also persistent.

3. Treatment
(1) Avoid contact with allergens.

(2) Drug therapy: Depending on the situation, antihistamines, steroid hormones and other drugs can be used.

(3) Immunotherapy: also known as specific desensitization or desensitization therapy.

(4) Other therapies: It can reduce the sensitivity of the nasal mucosa or reduce the excitability of the parasympathetic nerve.

4. The most fundamental preventive measure to prevent allergic rhinitis is to understand allergens and try to avoid them.When the symptoms mainly occur outdoors, outdoor activities should be limited as much as possible, especially contact with flowers and plants or rotten leaves, as well as catkins and fruit hairs on the paulownia. You can wear a mask when you go out, or you can go to the beach with fewer allergens.When symptoms mainly occur indoors, attention should be paid to controlling the occurrence of indoor mold and mildew, thoroughly killing cockroaches and other pests, and keeping pets away.

([-]) Drug-induced rhinitis

It is a chronic poisoning reaction of the nasal mucosa caused by long-term use of nasal mucosal vasoconstrictors such as Biyanjing and ephedrine nasal drops due to improper or excessive nasal drug use.The main manifestation is that after long-term nasal administration, nasal obstruction is not sensitive to the treatment of nasal drops.Some other drugs can also cause nasal congestion when used, also known as drug-induced rhinitis, such as phentolamine, etc., but as long as the drug is stopped, the nasal congestion symptoms will usually be relieved by itself in about half an hour.

1. Treatment
First of all, the vasoconstrictor nasal drops should be stopped for at least two weeks, then the primary cause should be treated and the original drug should be replaced with other drugs. 2. To prevent the occurrence of drug-induced rhinitis, the main thing is to rationally use vasoconstrictor nasal drops.When a disease causes nasal congestion, pay attention to the treatment of the primary cause of the nasal congestion, fundamentally solve the problem of nasal congestion, thus avoiding the use of nasal drops.When it must be used, pay attention to the dosage and frequency of medication, avoid long-term use, long-term addiction, and cause drug-induced rhinitis.

([-]) Acute sinusitis
Acute suppurative inflammation of the sinus mucosa.In severe cases, the bone wall may be involved, and even complications of adjacent organs and tissues may be caused.According to the composition of the sinuses, it can be divided into maxillary sinusitis, ethmoid sinusitis, frontal sinusitis and sphenoid sinusitis.

1. Etiology and pathogenesis
(1) Secondary to cold.

(2) Spread of infection in adjacent lesions: root abscess, tonsillitis and chronic inflammation of pharyngeal lymphoid tissue can all cause sinusitis.

(3), direct factors: after swimming, sewage directly enters the sinuses through the nasal cavity or trauma causes bacteria to directly invade and infect and inflame.

(4) Systemic factors: Excessive fatigue, malnutrition, excessive smoking and alcohol, especially patients with chronic diseases such as diabetes, tuberculosis, chronic nephritis, etc., have poor systemic resistance and are prone to sinusitis.

2. Clinical symptoms The headaches caused by it have certain characteristics: the onset is often rapid, accompanied by fever, the headache site is relatively deep, and it is mostly indistinct pain.The headache is aggravated when bowing the head, shaking the head, coughing or exerting force, and the headache is relieved when lying down.Headaches have a fixed place and time.

(1) Acute frontal sinusitis: regular headache, starting early every day, gradually aggravating, the worst at noon, gradually reducing in the afternoon, and disappearing completely at night, the same attack the next day, with obvious tenderness in the upper part of the inner upper corner of the eye socket.

(2) Acute ethmoid sinusitis: pain between the eyebrows, tenderness in the inner canthus of the affected side, and redness and swelling in the inner canthus or upper eyelid when the inflammation is severe.

(3) Acute sphenoid sinusitis: Generally, it rarely occurs alone. It often causes pain on the top of the head and the back of the occiput, and can radiate to the neck and behind the eyeballs.

(4) Acute maxillary sinusitis: the headache is mild in the morning and severe in the afternoon, and the cheeks may be swollen.

3. Treatment is based on the principle of eradicating the cause, anti-inflammation and detumescence, smooth drainage and prevention of complications.

(1) Systemic therapy is the same as that for acute rhinitis.

(2) Local treatment: can improve sinus drainage, local hot compress, infrared or ultrashort wave physiotherapy, maxillary sinus puncture irrigation.

(3) Etiological treatment: After the acute inflammation subsides, the cause should be found out and eliminated.

4. Prevention
(1) For the whole body, have a regular diet and daily life, quit smoking and drinking, pay attention to oral hygiene, exercise physical fitness, use cold water to scrub and bathe, and do not wear wet clothes, shoes and socks.

Because the back is cold and the feet are cold, it is easy to cause a cold.Locally, keep the ambient air moist, avoid dry nose, and do not use nasal medicine easily.

(2) Clear the infection of adjacent lesions, such as chronic tonsillitis, chronic pharyngitis, dental caries, etc.

(3) Correction of nasal deformities or lesions.

(4) Avoid diving and choking when swimming.

(5) Prevention of sudden changes in air pressure: it is not advisable to take an airplane.

([-]) Chronic sinusitis
It is caused by repeated attacks due to weak constitution, failure to regulate after acute sinusitis.The number of cases accounted for 13.02% of newly diagnosed patients in the Department of Otorhinolaryngology.

1. Etiology and pathogenesis
(1) Systemic reasons: fatigue, cold, malnutrition, allergic constitution, excessive smoking and alcohol, systemic diseases that weaken the body's resistance.

(2) When suffering from acute rhinitis, the infection spreads to the sinuses.

(3) Nasal cavity disease hinders sinus ventilation and drainage.

(4) Chronic tonsillitis can block the nasal cavity and easily induce sinusitis.

(5) Nasal stuffing is used for too long during nasal cavity surgery or treatment of epistaxis.

(6) Sinus trauma, fracture or foreign body remains.Due to the above reasons, bacteria invade the sinuses, destroy the tissue, and cause acute or chronic inflammation.

2. Clinical manifestations
Thick nose, runny nose, nasal congestion, headache and other symptoms.Pathological examination
Look into the visible nasal cavity to have purulent nasal mucus, nasal pyometra, nasal discharge and other phenomena, and severe cases are combined with the existence of nasal polyps.

3. Treatment
Treat with antibiotics and nasal irrigation for one to three months; if ineffective, endoscopic sinus surgery must be used to remove the lesion.If the symptoms are severe in winter or at night, it is recommended to use a warm and wet towel to gently cover the nose, which can also relieve allergic symptoms.

[-]. Point massage

([-]) Acupuncture therapy

1. Select acupoints Yingxiang, Bitong, Cuanzhu, Yintang, Baihui, Fengchi, Feishu, Lieque, Hegu.

2. Positioning
Yingxiang - next to the midpoint of the outer edge of the alar nose, in the nasolabial fold.

Bitong—the junction of the alar cartilage and the turbinate, near the upper end of the nasolabial fold.

Cuanzhu—face, in the brow depression.

Yintang - the forehead, the midpoint of the two brows.

Baihui - the top of the head, at the midpoint of the line connecting the two ear tips.

Fengchi - the nape, under the occipital bone, the depression between the sternocleidomastoid muscle and the upper end of the trapezius muscle.

Feishu—on the back, below the spinous process of the third thoracic vertebra, 3 cun laterally.

Lie Que—Cross the mouth of a tiger with both hands, and the tip of the index finger reaches the place.

Hegu—the radial edge of the midpoint of the second metacarpal.

([-]) Self-massage method:

1. Rub Yingxiang, use the index fingers of both hands to rub on the Yingxiang acupoints in the nasolabial folds on both sides, until the nose feels hot.

2. Push the face separately, use the fingers of both hands to push from the Yintang point along the forehead, the upper and lower eye sockets to the temple, and also operate on Renzhong and Chengping, for a total of 5 minutes.

3. Take the wind pool and neck, first use the thumbs of both hands to hold the two wind pools, and then use the five fingers of one hand to hold the neck, depending on the degree of local soreness, the operation lasts for 3 minutes. 4. Acupuncture, press the above-mentioned acupoints, with the degree of soreness, 1 minute per acupoint.

5. Clasp the Feishu acupoint with fingers, put five fingers together, and tap the parts near the Feishu acupoint on both sides, taking local soreness as the degree.

(End of this chapter)