ABSTRACT
Acute exacerbation of chronic sinusitis (AECS) presents a recurring clinical challenge marked by intensified nasal congestion, facial pain, and purulent discharge, often triggered by identifiable external or internal factors. In homoeopathy, these triggers—known as exciting causes—plays an important role in both diagnosis and remedy selection. This article explores the role of exciting causes in AECS from a classical homoeopathic perspective, drawing on the writings of Hahnemann, Kent, Boenninghausen, and others. It highlights how emotional stress, weather exposure, environmental irritants, and lifestyle factors act as precipitating agents in susceptible individuals. The article emphasizes the importance of individualized case-taking that includes a clear understanding of these causes, and how they can lead to more accurate, effective, and holistic treatment. Additionally, it outlines dietary guidance and supportive measures such as yoga and lifestyle modifications to prevent recurrence and promote long-term sinus health. Integrating classical principles with modern clinical understanding, this article presents a comprehensive, cause-centered approach to managing AECS through homoeopathy.
Key words – acute exacerbation of chronic sinusitis, exciting cause, homeopathy, management, complementary therapies, holistic treatment.
Introduction
Chronic sinusitis is a long-standing inflammation of the sinuses, usually for over 12 weeks, usually with associated facial pain, nasal blockage, postnasal drip, and loss of taste and smell. It becomes most uncomfortable when it recurs acutely—acute exacerbation of chronic sinusitis (AECS)—with worsening symptoms of fever, headache, yellow or green nasal discharge, and facial pain.
These acute attacks characteristically affect everyday functioning, lower quality of life, and compel patients toward serial antibiotic treatment or surgery. It is at this point that homoeopathy, with its personalized and cause-oriented treatment, can provide significant alleviation.
Exciting Cause
In homoeopathy, the exciting cause refers to an external or internal trigger that precipitates or worsens a latent or chronic disease state. Identifying and addressing the exciting cause is crucial in managing AECS, as it guides the selection of the most appropriate remedy and offers clues to prognosis.
Common Exciting Causes in AECS:
- Sudden exposure to cold, damp weather
- Suppressed skin eruptions
- Emotional stress (grief, anger, anxiety)
- Overuse of decongestants or nasal sprays
- Environmental irritants (dust, smoke, allergens)
- Poorly managed acute colds
- Sudden temperature changes (air conditioning, hot showers followed by cold exposure)
Pathophysiology and Role of Triggers
Acute exacerbation involves a reactivation of underlying inflammation, often complicated by secondary infection. The mucosal lining swells due to allergic or infectious response, obstructing normal drainage. This can lead to:
- Sinus pressure and congestion
- Thick or discoloured nasal discharge.
- Postnasal drip and sore throat
- Frontal or maxillary facial pain
- Triggers like cold air or emotional stress disrupt immune response and mucociliary clearance, providing fertile ground for pathogens. In homoeopathy, these triggers form part of the totality of symptoms and help differentiate remedies.
Understanding the Exciting cause
Exciting causes means a cause which excites a disease condition. Dr. Hahnemann mentioned the use of exciting causes in the aphorism 5 and 73 of organon of medicine. Dr Hahnemann emphasized that identifying and removing the exciting cause may itself be curative in some cases. However, if the exciting cause triggers a deeper chronic miasm, then constitutional treatment is necessary.
Boenninghausen emphasized the importance of etiology in remedy selection, often giving it decisive weight in acute prescribing. For example, when the exciting cause is grief, remedies like Ignatia or Natrum muriaticum are preferred. If the cause is exposure to cold, Aconite or Hepar sulphur may be indicated. Boenninghausen’s Therapeutic Pocket Book presents a structured approach to analyzing symptoms, where modalities often reveal exciting causes. He emphasized that factors such as exposure to cold, dampness, or exertion should not be overlooked.
Dr Kent emphasized that on the mental and emotional cause. He said that many diseases are caused by grief, disappointment, emotional shock, etc.
Dr Stuart closely said in his philosophy that its is important to ascertain whether the patient has met with any accidents or mechanical injuries, or has suffered any mental shock or trial, such as grief, fright, anxiety or worry, business losses or reverses, unhappy domestic experiences, disappointment in love, etc., and fix the dates and sequence. Such experiences have a powerful influence in causing or predisposing to disease besides being valuable to the prescriber as guiding symptoms.
Types of exciting causes:-
Emotional exciting causes – like grief, fear, disappointment, anxiety, fear, stress, etc.
Physical exciting causes :- like exposure to cold winds, heat ,overeating, etc.
Mechanical exciting causes :- like injury, accidents, burns, insect bites
Homeopathic Management
Aconitum napellus
Causes- Sudden onset after cold dry wind exposure; high fever, anxiety, restlessness.
When the attack comes on suddenly after an exposure to cold, dry wind, with chilliness followed by fever. There is yet no discharge, but from the congestion the nose is stopped up, swollen, hot and dry, and this stoppage is apt to change from side to side. There is tingling and burning in the nose with a throbbing frontal headache > open air.
Arsenic Album
Thin, watery, excoriating discharge. Nose feels stopped up, with fluent coryza. Nose colds descend to the chest. Cold sores; in nose. Sneezing, without relief. Can not bear the sight or smell of food. Hay fever. Knotty swelling of the nose. Nose pointed. Acne of nose. Nosebleed, after a fit of passion or vomiting. Dyspnoea felt in my nose. Sneezing, with biting watery coryza.
Nux vomica
Exposure to cold after overheating; overuse of stimulants; irritability; nasal blockage at night.Has colds caused by cold weather with a dry, stuffed up nose, scrappy throat.
Belladonna
Congestion and throbbing pain, especially after exposure to sun or cold draft; sudden, intense symptoms.
Kali bichromicum
Thick, ropy yellow-green discharge; sinus pain over the root of the nose; worsens in the morning. Chronic inflammation of frontal sinuses with stopped up sensation. Septum ulcerated. Abscess. Ozone. Nasal diphtheria. Two loose bones as if rubbing together on blowing the nose. Loss of smell. Nose; feels heavy; dry. Nasal polypi.
Pulsatilla
Exacerbation after eating rich/fatty food or in warm rooms; bland, yellowish discharge; better in open air. Loss of smell, with catarrh. Foul discharge or odour before the nose. Coryza; obstruction of nose worse lying down or in a room; better going out in the open air. Green; orange coloured, foetid, urinous, nasal discharge; chronic bland yellow discharge. Nosebleed, before, during and from suppressed menses.
Natrum muriaticum
Sinus symptoms following grief or emotional suppression; clear nasal discharge; frontal headache. Colds with watery discharge, causing vesicular eruptions about nose and mouth worse on going to cold air, and on exertion.
Hepar sulph
Exacerbation after uncovering head; hypersensitivity to cold air; sharp sinus pain; pus formation. Stops up or sneezes and runs from the nose every time he goes into the cold dry wind. Nosebleed; after singing. Sore pain at the root of my nose. Stuffed painful nose. Smells like old cheese. Hay fever. Ripened colds and old catarrh. Sneezes from every cold wind.
Supportive Measures in Holistic Management
In conjunction with constitutional remedies, lifestyle and environmental adjustments play a key role in preventing recurrence.
Lifestyle Advice:
- Avoid known triggers like cold drinks, air conditioners, and allergenic dust.
- Use warm steam inhalation to relieve congestion.
- Maintain nasal hygiene with gentle saline rinses.
- Ensure adequate hydration and rest during flare-ups.
Yoga and Breathing Techniques:
Specific yogic practices like Anulom Vilom (alternate nostril breathing) and Jal Neti (nasal cleansing) can help improve nasal airflow, enhance mucosal clearance, and reduce stress-related triggers.
Dietary Guidance:
Avoid cold, sour, and heavy foods during acute episodes.
Prefer light, warm, anti-inflammatory meals like soups, herbal teas, and cooked vegetables.
Include spices like turmeric, ginger which have natural antimicrobial and decongestant properties.
Case-Taking: Focus on Individual Reaction
A homoeopath must gather a complete picture, including:
- Time and nature of symptom onset
- Sensitivity to weather, food, emotions
- Modalities (what worsens or relieves symptoms)
- Mental and emotional state before and during the episode
Identifying the exciting cause helps determine if the acute state is a flare-up of the chronic infection, or if suppression or miasm is at the background.
Conclusion: Treat the Flare, Understand the Cause
Acute exacerbation of chronic sinusitis presents both a challenge and opportunity in homoeopathic treatment. By identifying the exciting cause, remedies can be tailored not only to relieve acute symptoms but also to prevent further recurrence.
Homoeopathy thus offers a cause-oriented, constitution-based, and symptom-sensitive approach to sinusitis management—helping patients avoid the cycle of suppression, dependency on decongestants, or repeated antibiotics.
With individualized care, lifestyle adaptation, and awareness of triggers, patients can achieve long-term relief and better sinus health—naturally and holistically.
References
1. Hahnemann S. Organon of Medicine, 6th ed.,
2. Kent JT. Lectures on Homoeopathic Philosophy, Lecture VI
3. Allen H. Keynotes and Characteristics with Comparisons
4. Boericke W. Pocket Manual of Homeopathic Materia Medica
5. Hering C. Guiding Symptoms of Our Materia Medica
6. Brook I. “Microbiology and management of chronic sinusitis.” Paediatric Infect Dis J.
7. Fokkens WJ, et al. “EPOS 2020.” Rhinology Supplement
8. Telles S. “Yoga in sinusitis.” Indian J Physiol Pharmacol
9. Singh M. “Lifestyle in sinusitis.” J Ayurveda Integr Med
10. Boenninghausen C. Therapeutic Pocket Book Author
11. Practical homeopathic therapeutics – W. A. Dewey
12. Materia Medica of Homoeopathic Medicines – S. R. Phatak
Author
Dr. Heema Mukesh Gandhi, P.G. Scholar,
Department of Organon of Medicine and Homoeopathic Philosophy,
Government Homoeopathic Medical College & Hospital, Ayush Parisar, Near Kaliyasot Dam, Bhopal,
Madhya Pradesh, India.
Under the Guidance of:
Dr. Rakesh Sonkusare
(Asso. Professor)
Department of Organon of Medicine and Homoeopathic Philosophy,
Government Homoeopathic Medical College & Hospital,
Ayush Parisar, Near Kaliyasot Dam, Bhopal, Madhya Pradesh, India.
