Volume 4, Number 4 | Winter 2009

Japanese Acupuncture - Current Research
Sinusitis – Nasal Congestion/Effect of Acupuncture
Stimulation on Nasal Secretion –Takeshi Kusumi
University of Human Arts and Sciences

1. Nosediseaseandtreatment
withacupuncture
Acupuncture treatment in the field ofotorhinolaryngology in Japan started when thenews was reported in 1974 that acupuncture
anesthesia was used in China for ahearing-impaired individual. Since then, theacupuncture anesthesia has been practiced inJapan based on the Chinese methods.
Acupuncture treatment of sinusitis is also basedon the one of their methods. The acupuncture of
the time was performed not for the purpose oftreatment but was handled as acupuncture
anesthesia for the surgery of sinusitis. Various
books about acupuncture treatment forotorhinolaryngological diseases have been
written by a well-known clinical practitioner inJapan, introducing acupuncture treatment forsuch as hearing loss, buzzing in the ear,dizziness, rhinitis, heaviness of the head,neuralgia, and nerve paralysis. The contents ofthe books, however, are not based on medical
rationales and only provide the general
information of diseases and acupuncture points
used for the treatment of respective diseases. Bycontrast, what the university hospital needed
was the information of scientifically groundedacupunctured effects. Earlier studies on
acupuncture treatment of sinusitis were lack ofscientific reasoning and did not serve as usefulreferences.
This report is not written from the standpointof how to “cure” sinusitis. The purpose is to givean account of nose diseases, especially theconnection of nose diseases with the autonomic
nervous system on the basis of the relationshipbetween nose symptoms and acupuncture2

stimulation. Therefore, this report will not be
useful for the therapists who expect or seek
information about treatment of certain diseases.
So I hope this report will be utilized not only for
acupuncture treatment of sinusitis but as a guidefor supportive or preventive measures of sinusitis
treatment with reference to the relationshipbetween autonomic nerve symptoms of the nasal
mucous membranes ad acupuncture stimulation.
2. General information of chronic sinusitis
There are few reports published on
acupuncture treatment of chronic sinusitis. Thismay be due to a wide gap between themechanisms of acupuncture efficacy, causes andpathological conditions. So, firstly a brief
explanation of sinusitis will be given.
Chronic sinusitis is caused by individual’sconstitution, allergies, bacterial and viral
infections. If appropriate procedures were nottaken in the acute phase, it may lead to chronicproblems. The symptoms differ depending on thecombination of affected paranasal cavities.
However, subjective symptoms commonly seen
include rhinorrhea (nasal discharge), nasal
congestion, headache/feeling of top heaviness,and decreased mental function. Furthermore,nasal obstruction and inflammation of the nasal
mucous membranes may cause anosmia, areduced sense of smell. The type of nasal
discharge in chronic sinusitis is mucous andpurulent, which is different from the watersoluble thin type in allergic rhinitis. In the case ofsinusitis, the nasal discharge more often gives thesensation of dropping downward through theposterior nasal aperture as posterior nasal drop
rather than through the anterior nasal aperture.
In modern medicine, there are two types ofsinusitis treatment – conservative treatment inwhich antibiotics and/or antiphlogistics are used,and operative treatment1)2).
It is difficult to treat sinusitis presenting these

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 4, Number 4 | Winter 2009

conditions with acupuncture and such sinusitis isoften handled as a disease to which acupuncture
is not applicable. Even so, it cannot be said that
acupuncture treatment is completely helpless.
This report is not intended to provide the way ofhandling chronic sinusitis for a radical cure but isintended to provide the way of thinking aboutacupuncture treatment based on the relationshipbetween the nasal mucous membranes andautonomic nerves for the people who complain ofsinusitis.

A nasal discharge is secreted from the nasal
glands in the nasal mucosa. The secretion of nasal
discharge occurs when parasympathetic nerves
become hyperactive. We have also verified thisphenomenon by our clinical study using
autonomic drugs and autonomic blockingdrugs5)6).
Symptoms relating to the nasal mucosa
include those caused by the involvement of theautonomic nerves and those developed by theinvolvement of the sensory nerves innervating

3. Typical nasal symptoms
Sneezing, nasal congestion, and nasal
discharge
areknown
as
three
major
characteristics of nasal allergy. These symptoms
are also typical conditions that are associatedwith other nasal disorders1)2).
Nasal congestion is caused by nasal septum
deviations, nasal polyps, nasal tumors, or otherstructural anomalies of the nose. If there is nostructural anomaly, swollen mucus membranes in
the nose is often the cause. The swelling of thenasal mucous membrane is due to the structure ofabundant blood vessels in the nasal mucous
membranes and the degree of the swelling isaffected by the activities of cervical sympathetic
nerves that innervate the blood vessels in thenasal mucous membrane. If the activities of thecervical sympathetic nerves are enhanced, theblood vessels of the nasal mucous membranes
contract and the nasal congestion improve. The
connection of the blood vessels of the nasal
mucous membranes to cervical sympathetic
nerves has been elucidated from the anatomicaland physiological viewpoint, and the connection
has also been verified from clinical effects of astellate ganglion block3)4), stellate ganglion
stimulation, and adrenaline nasal spray5)6). The
blood vessels of the nasal mucous membranes areinfluenced only by sympathetic nerves but
parasympathetic nerves have no action on the
blood vessels of the nasal mucous membranes.

the nasal mucosa. Sneezing happens by the
involvement of the sensory nerves. Nasal allergicsneezing

happenedby

allergen-induced

simulation is triggered by the stimulation of thesensory nerves distributed over the nasal mucosa.
4. Nerve innervations of the nose
The nasal mucous membranes function by thesensory nerves responsible for processing sensory
information such as smell and pain and theautonomic nerves innervating the blood vessels ofthe nasal mucosa and nasal glands. This section
presents

anoverview

ofautonomic

nerve

innervations (Figure 1).

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Figure 13

Volume 4, Number 4 | Winter 2009

The blood vessels of the nasal mucosa receive

nasal mucosa) needs 15 minutes. The influence ofcontrol of the cervical sympathetic nerves. As

acupuncture stimulation given in this way on theshown in the Figure, preganglionic fibers coming

nasal mucosa is characteristically more effectivefrom the upper thoracic spinal cords form

compared to that in the recumbent position.

synapses,andthenpass

throughthepterygopalatine ganglion to control the blood

6.

vessels of the nasal mucous membranes. The

acupuncture stimulation

control is ipsilateral, and vascular contraction

1) Influence on nasal congestionand dilation occur depending on the control

Relationship between nasal symptoms andNasal

congestion

improvesbyactivity status. As with other peripheral vessels,

electro-acupuncture stimulation to one hand.

this function is not subject to parasympathetic

However, the degrees of the improvement arenerve control.

subjective, so assessing improvements is difficult.

The nasal glands are innervated by the greater
petrosal nerve responsible for parasympathetic
functions of the facial nerve. After the greater
petrosal nerve has formed synapses in thepterygopalatine

ganglion,

thepostganglionicfibers innervate the nasal glands. The control isalso ipsilateral. When activities increase, nasal
discharge is secreted. Nasal discharge is notaffected by sympathetic activities.
The autonomic nerves innervating the nasal
mucosa do not have dual and antagonistic control
characteristic of autonomic nerves.

Therefore, we used a rhinomanometer to measure
the nasal airway resistance to objectively assessthe degrees of nasal congestion.
The nasal airway resistance decreased withinone

minutewith

theThe acupuncture points to apply stimulationelectro-acupuncture stimulation to one hand,showing an improvement in nasal congestion8).
Electro-acupuncture

stimulation

inserted in these acupuncture points

at the same time. This result indicates that
acupuncture stimulation to one hand worked onsides, resulting in an improvement in the nasal
congestion of the opposite side (Figure 2).

7).

The

stimulation conditions are for 15 minutes with 1
Hz with the stimulation intensity that causesslight muscle contractions and with which
patients do not subjectively feel painful. The
similartothatofacupuncture anesthesia except for the points thatsimulation is given to one hand while sitting andthat acupuncture anesthesia needs longer hoursof stimulation whereas acupuncture stimulation
for nasal symptoms (autonomic nerves in the4

thewell as contralateral nose to the stimulated handcurrents are applied to the needles as electrodes

islowerednasal airway resistance of the ipsilateral nose as

are hegu and neiguan on one hand. Electric

methodofthe blood vessels of the nasal mucosa on both

5. Methods of applying acupuncture stimulation

stimulation

application

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Figure 2

Volume 4, Number 4 | Winter 2009This phenomenon was observed both when air is

In the group of pilocarpine alone, the patients

inhaled and when air is exhaled in nasal breathing.

with nasal allergy had evidently higher secretion

Electro-acupuncture

stimulations, however,

did not have effects on congestions occurred in thedecubitusposition6)

andphysiologicalnasal

volumesofnasaldischarge

thanhealthy

volunteers. On the other hand, in the combinationgroupofpilocarpine

andacupuncture

congestions induced by the pressure on the chest

stimulation, the patients with nasal allergy andside9) and nasal congestions occurred due tohealthy volunteers had similar levels of secretion

stellate ganglion blocking 8).

volumes to those of healthy volunteers (used asthe base) in the group of pilocarpine alone. As the2) Influence on nasal discharge
Electro-acupuncture stimulation applied in thesimilar manners reduces the secretion volume ofnasal discharge. As it is difficult to compare thesecretion volumes before and after applying
stimulation, an induction test 8) was conductedwith patients and healthy volunteers with the useofaerosol

spraysofpilocarpine(aparasympathetic nerve stimulant) into the nasal
cavities to compare results (Figure 3). The uppergraphs of Fig. 3 show the results of healthy
volunteers and the lower graphs are for theresults of the patients with nasal allergy. The
upper and lower graphs on the left side show theresults of pilocarpine alone, while those on theright show the results of the simultaneousadministration

ofpilocarpine

electro-acupuncture stimulation.

andresults showed, electro-acupuncture stimulation
was unable to block or inhibit the drug efficacy of
pilocarpine in either healthy volunteers or thepatients with nasal allergy, but the stimulation
reduced the secretion volumes of the patientswith nasal allergy to the levels of healthy
individuals. This phenomenon may have beencaused by the sensitivity of nasal mucous
membranes

or

their

responsivenessbeing

inhibited by electro-acupuncture stimulation.
3) Influence on sneezing
From a separate experiment, it is known thatnasal congestion or nasal discharge occurred in
the nasal provocation test using allergen extracts
could

beinhibitedbyelectro-acupuncturestimulation. Sneezes happened by allergens
stimulating the nasal mucosa could not beinhibited by electro-acupuncture stimulation. It
could

beassumedfrom

theabovethatelectro-acupuncture stimulation may not haveinfluence on sensory thresholds of the nasalmucosa8).
7. Commentary
The subject of this report is effects ofacupuncture

treatment

forsinusitis.

As

mentioned at the beginning of the report, I
consider sinusitis treatment with acupuncture toFigure 3

aim for a cure is difficult. As stated above, I
consider that in view of the influence onThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

5

Volume 4, Number 4 | Winter 2009acupuncture stimulation on nasal symptoms,

nasal congestions improved by acupuncture

acupuncture treatment can yield some practicalstimulation. Like this, the relationship of theeffect as a symptomatic treatment for sinusitis.

nasal functions with the Large Intestine

For instance, improving nasal congestion has

Meridian of Arm Yang Brightness can besome sort of potential positive influence on

considered from the author’s experiences andventilation of the paranasal sinuses. Purulent

experiments,

nasal discharge is a symptom resulted fromstimulation to the acupuncture point of hegu

inflammation, and acupuncture stimulation has

are conveyed to the central nerves systeminfluence on the secretion volume of nasal

throughdischarge through the mediation of the autonomic

mediate the autonomic nerves through thenerves. Although there are many reports released

efferent

on immunoreactions in the nasal mucosa, I expect

acupuncturestudies will be promoted on autonomic nervous

functional relation with the nasal mucosa

functions of the nasal mucosa as well as

through the pathway of neural reflex. On theanti-inflammatorytransfer

effects

occurringbythethethatsignals

afferent

pathway.
point

point

of

inducedpathway,

It

means

stimulation

thisandby

thenthat
have

pathway,

theatheacupuncture point of dazhui that has a deep

stimulation of peripheral nerves.
There are many indications for acupuncture.

connection with cervical sympathetic nerves

In the symptoms associated with sinusitis such as

may be located at the seventh cervical vertebra

headache, top heavy feeling, and deteriorated(Figure 4).

mentalfunctions,someareapparently

susceptible to treat with acupuncture. To provide
acupuncture treatment for respective associatedsymptoms to enhance the QOL of patients is oneof important purposes of acupuncture treatment.
However, if treatment cannot achieve a radicalcure,treatingrespective

symptoms

isnotbeneficial to patients. Therefore, the provision of
integrative medicine is required for the benefit ofpatients.
Lastly, I will mention about the relationshipbetween the Large Intestine Meridian of Arm

Figure 4

Yang Brightness (Yangming) 10) and the nose.
The acupuncture point of yingxiang (whichInfutureacupunctureandmoxibustionmeans meeting flavors) is located at the end of

medicine, the combination of modern medicine,the Large Intestine Meridian of Arm Yanganatomical physiology, and classical concept ofBrightness. It could be assumed that thismeridians and acupuncture points will furtheracupuncture point was named as yingxian

deepen the way of thinking toward acupuncture(meeting flavors) by ancient people who hadtreatment and enhance the clinical significance ofobserved respiratory anosmia resulted fromacupuncture.

6The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 4, Number 4 | Winter 2009

8. References
1)

KirikaeIchiro,NomuraYasuya:Shin

Jibiinkou Kagaku. Nanzando, Tokyo, 2004.
2)

Suzuki Jyunichi, Nakano Yoshiaki, Hirano
Minoru:HyoujunJibiinkouKagaku.

Igakushoin, Tokyo, 1083.
3)

Wakasugi

Bunkichi:Seijyoushinkeisetu

Hana-Allergy
BlocknoRyouhou.

Igakunoayumi, 136: 668 – 671, 1986.
4)

Masuda Yutaka: Hana-Allergy no Seijyoushinkeisetu
Block Ryouhou – Sugi-Kafunshou wo Chuushin ni –.
Igakunoayumi, 136: 673 - 676, 1986.

5)

Ishizaki Fumio: Bibu Hifuon to Bikuu-Tsuukido
tono Kankei nitsuite. Nichijibi, 90: 547 - 554,
1987

6)

KusumiTakeshi,SokugaiMichinari:deOkoru

Binenmaku-Kekkan-HannouniTaisuru

Katatebari-TsuudenShigekinoEikyou.

JournalJapaneseSocietyofBalneology,Medicine,7)

OkamotoTheClimatology

andofPhysical53 (3): 153 – 158, 1990.

Kusumi Takeshi: Hari-Tsuuden Shigeki ni
yoru Biheikan oyobi Bibu-Hifuon no Henka
ni Tsuite. Igaku/Seibutsugaku Thermography,
1: 115 – 117, 1981.

8)

Kusumi Takeshi, Ishizaki Fumuo: Bishoujyou(Bihei,Bijyuu)

niTaisuru

Katatebari-Tsuuden Shigeki no Eikyou. JIBIINKOKA TEMBO, 23 – 41, Tokyo, 1988.
9)

SakamotoMaki,Kusumi

Takeshi:Sokukyoubu Appaku de Okoru Bihei ni
Taisuru Harishigekino Eikyou. Journal ofJapan

CollegeAssociationofOriental

Toyo

Igaku.

Medicine, 19, 38 – 43. 1995.
10) Shirota

Fumihiko:

GAKKEN

ZusetsuCo., Ltd. 1979.

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