Chinese herbal medicines for rhinosinusitis: a text-mining study with comparisons to contemporary research and clinical guidance.

Background: Rhinosinusitis is an inflammation of the paranasal sinuses and nasal cavity. It is managed with intra-nasal steroids, nasal saline irrigation, oral antibiotics and/or biologics. Chinese herbal medicines (CHMs) have long been used for nasal disorders, including rhinosinusitis, and feature in Chinese clinical guidelines for rhinosinusitis. Systematic reviews suggest some CHM formulations may be beneficial for the management of this condition.

Methods: This text mining study used an established methodology to search a database containing the full texts of more than 1,150 classical and pre-modern Chinese medicine books to identify references to disorders similar to rhinosinusitis, and the CHMs used as interventions. Ten search terms relevant to names of disorders in classical books and the major symptoms of rhinosinusitis were identified. Search results were downloaded, categorised, and analysed descriptively in SPSS®. Qualitative comparisons were made with the modern clinical Chinese medicine literature.

Results: Searches found 436 oral CHM formulae with 3,059 ingredients, 81 nasal or other topical CHMs with 142 ingredients, and 112 single natural products from classical pharmacopoeia used orally and/or topically. The earliest reference to a disorder similar to rhinosinusitis was in a Chinese medical book written approximately 2,000 years ago. Three oral CHM formulae from the search have been tested in randomised controlled trials and one is included in a clinical guideline. A sample of 13 modern specialist textbooks on Chinese otorhinolaryngology still recommended nine of the oral classical formulae. Three of the seven herbs frequently included in the classical pharmacopoeia are still listed in the official Chinese pharmacopoeia for rhinosinusitis. Nasal formulae found in classical searches differed to those tested in randomised controlled trials, although the most frequent ingredient in the classical formulae was also frequent in modern formulae. The pharmacological actions of the seven most frequently used herbs included anti-inflammatory, anti-allergic, antioxidant and/or anti-bacterial effects that may have contributed to their observed effects.

Conclusions: Results for classical interventions and the modern clinical literature overlapped for the higher frequency oral formulae and their ingredients, showing evidence of temporal continuity in their use for rhinosinusitis management. Gaps in the clinical and experimental evidence were identified, so there remains scope for further research into these CHMs to develop new interventions for rhinosinusitis.