How Do You Treat Asthma in Your Practice?

Abstract

Asthma, from the Greek word Aazein, means “to pant.” Corpus Hippocraticum (460 – 360 bc) is the earliest text where asthma is found as a medical term.¹

In 2015, 358 million people globally had asthma.² About 25 million Americans have asthma. This is 7.6% of adults and 8.4% of children.³ It is more common in boys than in girls.³ Prevalence of asthma is more common among Puerto Rican patients than among any other ethnic group.⁴

Asthma is characterized by recurrent shortness of breath, wheezing, or coughing caused by reversible bronchoconstriction. Thickening of air passages and blockage by mucus also contribute. Although asthma is classified as intrinsic (nonallergic) and extrinsic (allergic), the treatment is very similar in both varieties.

Mild cases have normal respiratory function between attacks.

Investigations include a chest X-ray to rule out other pulmonary disorders; measurements of ventilatory functions—forced expiratory volume in 1 second(FEV₁) and peak expiratory flow rate (PEFR)—several times per day; and the patient's response to bronchodilators. Variability through the day with a morning dip in PEFR is diagnostic. Skin allergy testing can help avoid aggravating factors in some cases.

Asthma in Chinese Medicine

Chinese Medicine uses the term Xiao-Chuan to describe asthma. Xiao is wheezing, Chuan is breathlessness, and they often go together. In the healthy state, the Lung Qi moves downward and the Kidneys holds it down. Lungs control inhalation and the Kidneys control exhalation. Liver Qi normally ascends and the upward direction of the Liver Qi and downward direction of Lung Qi are usually coordinated. When the descending of the Lung Qi is defective, due to Lung Qi Deficiency or Kidney Deficiency (failure to receive the descending Lung Qi), or obstructed by the ascending Excessive Liver Qi (Liver Yang Rising) or obstructed by Phlegm (Spleen Deficiency) or Wind, asthma results. In Xiao Chuan, Phlegm is central to its pathology. In atopic asthma (extrinsic) Phlegm is not a factor and the wheezing is caused by bronchoconstriction produced by the Wind. This is not the usual external or internal Wind; it is a Wind that is persistently lodged in the air passages and produces bronchospasms when the patient is exposed to allergens, cold weather, or emotional stress. Deficiencies of both Lungs and Kidneys are involved.

Treatment

In acute attacks, the aim is to relieve symptoms. When the symptoms are relieved, the pathology can be targeted.

In very severe attacks of asthma, Western medicine treatment is recommended.

A basic combination for all types of asthma would be CV 22 (the most important point), Ding Chuan (Extra Point 0.5 cun lateral to GV 14), CV 17 (Influential Point for respiratory system), BL 13 (Back Shu Point of the Lung), LU 6 (Xi-Cleft Point of the Lung), PC 6 (Distal Point for chest disorders), ST 40 (point for Phlegm)—all are reduced, and KI 3 (Source Point for Kidney)—which is reinforced. One should acquire proficiency in the technique of needle insertion at CV 22.

KI 7 is the Tonification Point of the Kidney. In Excess conditions of the Lung (see Table 1) reinforcing KI 7 will reinforce the Kidney, which is often Deficient in asthma. Because of the fact that Lung is the Mother of Kidney in the Five Element Cycle, such a stimulation will cause the Excess of the Lung being sucked by the Son Kidney—a win–win situation. That is, the Deficient Kidney is reinforced and the Lung Excess is reduced. So too, stimulation of LU 7 and KI 6, in that order, by the reduction method will open the CV channel and that would help in normalizing the Kidney and Lung.

Table 1.
Signs, Symptoms, Diagnosis and Treatment of Chinese Syndromes Associated with Asthma

Excess patterns

Pathology Symptoms Tongue/pulse Points Herbs

Invasion of Lungs by Wind Cold Rapid breathing, aversion to cold, lack of perspiration & white phlegm T—Thin white coating Reduce LU 5, LU 7, BL 12, BL 13 & Ding Chuan Ma Huang Tang—Ephedra Decoction

P—Floating

Phlegm Heat in Lungs Rapid breathing, aversion to heat, perspiration & yellow phlegm T—Yellow coat Reduce BL 13, LU 5, ST 40, LI 4, CV 22 Ding Chuan, LI 11& LU 7 Qing Qi Hua Tang—Clearing Qi and resolving Phlegm Decoction

P—Slippery, rapid

Deficiency patterns

Lung Qi Deficiency Shortness of breath, cough, daytime sweating, catch colds easily & aversion to cold T—Pale Reinforce Ding Chuan, BL 13, BL 47, ST 36, LU 9, LU 7, DU 12 & CV 15 & Moxa. Ren Shen Bu Fei Tan—Ginseng Tonifying the Lungs Decoction

P—Empty Rt front position

Lung Yin Deficiency Scanty sputum, dry mouth and throat, night sweating & dry cough T—Red, peeling coat Reinforce Ding Chuan, BL 13, BL 43, LU 9, KI 6, BL 38, CV 4, SP 6 & LU 10. Yang Yin Quing Fei Tang—Nourishing Yin and Clearing the Lung Decoction

P—Rapid, thread

Spleen Qi Deficiency Slight abdominal distension, tiredness, weakness of limbs, loose stools & tending toward obesity T—Pale Reinforce CV 12, SP 6, SP 3, ST 36, BL 20, BL 21 & Ding Chuan Liu Jun Zi Tang—Six Gentleman Decoction

P—Empty

Kidney Yang Deficiency Lower back pain, coldness, lassitude, edema in the legs & impotence T—Pale, wet Reinforce BL 23, KI 3, GV 4 & CV 4 You Gui Wan—Restoring the Right Kidney Pill

P—Deep, weak Kidney pulse

Combined Excess and Deficiency patterns

Liver Yang Rising due to Liver Yin/Blood Deficiency Throbbing headache, dizziness, numbness of limbs, blurred vision, muscular weakness, cramps & withered nails T—No coating & red in Yin Deficiency, Pale in Blood Deficiency Reduce TB 5, PC 6, LI 4, GB 43, GB 38 Tian Ma Gou Teng Yin—Gastrodia uncaria Decoction

P—Wiry Reinforce SP 6, LR 8, ST 36 & KI 3.

Signs and Symptoms shown in bold indicate the diagnosis.

P, Pulse; T, Tongue; Rt, right.

Some patients might feel tired with the above combination of points; in such cases, BL 13 may be omitted. The same combination can be used in late summer as a preventative for expected asthma in autumn and winter.

Medical acupuncturists who prefer to use the same group of points in all cases can use the above combination.

If the Chinese Disharmony Patterns are treated with a view toward reducing recurrences—and this is the preferred method for the current author—the details given in Table 1 can be followed.

Auricular points

These are generally used during the asthma attack.

The most important points are Lung 1, Lung 2, Kidney C, Adrenal Gland C, Sympathetic Autonomic Point, and Stop Wheezing point.

Other points include Antihistamine, Bronchi, Point Zero, Shen Men, Allergy Point, Apex of the Ear, Tranquilizer Point, Master Cerebral, Spleen C, Occiput, Spleen E and Psychosomatic Reactions 1. Select 3–4 points for each treatment using point locator or tenderness.

Evidence for acupuncture

The evidence for acupuncture in the treatment of asthma includes the following studies:
(1) In patients with acute bronchospasm, acupuncture resulted in increase of PEFR and FEV₁.⁵

(2) Acupuncture stimulation resulted in reduction of immunoglobulin E levels in patients with asthma.⁶

(3) Acupuncture stimulation was followed by increased levels of cluster of differentiation (CD) 4 + and interleukin (IL) 8, and reduced levels of IL 6, IL 10, and eosinophils.⁷

(4) Jobst et al. reviewed 16 reports on the efficacy of acupuncture in asthma. In 10 studies, acupuncture was found to be better than placebo and sham acupuncture, whereas 6 studies showed no difference.⁸

(5) In another review by Lewith and Watkins, 9 of the 10 trials showed positive short-term improvement of lung function and subsequent reduction in the use of medication after acupuncture.⁹

(6) A Cochrane database review did not find enough evidence to recommend acupuncture treatment for asthma, due to the inadequate quality in the studies.¹⁰

(7) Patients with chronic obstructive asthma experienced clinically significant improvement in quality of life when their standard care was supplemented by acupuncture or acupressure. ¹¹

(8) A double-blinded randomized study in 23 nonsmoking asthmatics found that there was significant improvement in the patient's quality of life and reduction in the use of bronchodilators after acupuncture, but these benefits were not supported by improvement in respiratory function.¹²

Case

Three illustrative cases were published by the current author in an earlier issue of this journal.¹³ One of them is included here for the reader's convenience.

A 4-year-old girl had a recurring wheeze (about once per week as recorded by her mother) for ∼3 years. She was prescribed a salbutamol inhaler to use when needed, budesonide twice daily, and, on occasion, oral prednisolone. This patient had a tendency to catch colds and was treated in the emergency department (ED) of a public hospital on several occasions for recurrent wheezing. Between these episodes, her chest examination results were clear. Her tongue was pale and her pulse was empty, especially in the right front position (Lung). There was no family history of asthma. This was a case of recurrent wheezing caused by Lung Qi Deficiency. A slight shortness of breath and an empty Lung pulse were sufficient to make this diagnosis.

The following points were used:
• LU 9—Source point

• LU 7—Connecting point

• BL 13—Back Shu point

• CV 6—to tonify Qi

• GV 12—to tonify Lung Qi

• ST 36 and CV 12—to tonify Stomach and Spleen, respectively (thus tonifying Earth to nourish Metal).

It is the author's practice to support acupuncture treatments with homeopathic dilutions of mineral salts, calcium phosphate, and natrum sulfate (30 c) at twice-weekly intervals in all cases of wheezing. This helps reduce the number and duration of acupuncture treatments. In severe cases acupuncture treatments are used on alternate days.

This patient was treated twice weekly with acupuncture for 2 months and then monthly for 1 year. The inhalers were gradually withdrawn and she had no further wheezing episodes. During the first 2 months of treatment, she had one additional ED visit.

It has been the experience of the author that, while most patients respond favorably, children respond far better than adults do as far as long-term improvements are concerned; and this is especially so when acupuncture was supported by nutritional supplements as described. It is often said that many children will outgrow asthma. This is an optimistic statement: Children with severe asthma are very unlikely to outgrow it. Many cases labeled as asthma in children are actually asthmalike syndromes (bronchitis, bronchiolitis, etc.) and these are the patients who tend to outgrow these conditions.¹⁴

The positive effects of those nutritional supplements to acupuncture in children cannot be overemphasized; these beneficial effects have not been observed in adults.

	Excess patterns
Invasion of Lungs by Wind Cold	Rapid breathing, aversion to cold, lack of perspiration & white phlegm	T—Thin white coating	Reduce LU 5, LU 7, BL 12, BL 13 & Ding Chuan	Ma Huang Tang—Ephedra Decoction
P—Floating
Phlegm Heat in Lungs	Rapid breathing, aversion to heat, perspiration & yellow phlegm	T—Yellow coat	Reduce BL 13, LU 5, ST 40, LI 4, CV 22 Ding Chuan, LI 11& LU 7	Qing Qi Hua Tang—Clearing Qi and resolving Phlegm Decoction
P—Slippery, rapid
	Deficiency patterns
Lung Qi Deficiency	Shortness of breath, cough, daytime sweating, catch colds easily & aversion to cold	T—Pale	Reinforce Ding Chuan, BL 13, BL 47, ST 36, LU 9, LU 7, DU 12 & CV 15 & Moxa.	Ren Shen Bu Fei Tan—Ginseng Tonifying the Lungs Decoction
P—Empty Rt front position
Lung Yin Deficiency	Scanty sputum, dry mouth and throat, night sweating & dry cough	T—Red, peeling coat	Reinforce Ding Chuan, BL 13, BL 43, LU 9, KI 6, BL 38, CV 4, SP 6 & LU 10.	Yang Yin Quing Fei Tang—Nourishing Yin and Clearing the Lung Decoction
P—Rapid, thread
Spleen Qi Deficiency	Slight abdominal distension, tiredness, weakness of limbs, loose stools & tending toward obesity	T—Pale	Reinforce CV 12, SP 6, SP 3, ST 36, BL 20, BL 21 & Ding Chuan	Liu Jun Zi Tang—Six Gentleman Decoction
P—Empty
Kidney Yang Deficiency	Lower back pain, coldness, lassitude, edema in the legs & impotence	T—Pale, wet	Reinforce BL 23, KI 3, GV 4 & CV 4	You Gui Wan—Restoring the Right Kidney Pill
P—Deep, weak Kidney pulse
	Combined Excess and Deficiency patterns
Liver Yang Rising due to Liver Yin/Blood Deficiency	Throbbing headache, dizziness, numbness of limbs, blurred vision, muscular weakness, cramps & withered nails	T—No coating & red in Yin Deficiency, Pale in Blood Deficiency	Reduce TB 5, PC 6, LI 4, GB 43, GB 38	Tian Ma Gou Teng Yin—Gastrodia uncaria Decoction
P—Wiry	Reinforce SP 6, LR 8, ST 36 & KI 3.

References

MedicalNewsToday.com Asthma History Through Ages. Online document at: www.medicalnewstoday.com Accessed November 15, 2018.

GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional and national incidence, prevalence and years lived with a disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016; 388(10053):1545–1602.

Asthma and Allergy Foundation of America. Asthma Facts and Figures. Online document at: www.aafa.org/page>asthma-facts.aspx Accessed November 18, 2017.

United States Environmental Protection Agency. Asthma. Online document at: www.epa.gov/asthma Accessed November 18, 2017.

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	Excess patterns
Pathology	Symptoms	Tongue/pulse	Points	Herbs
Invasion of Lungs by Wind Cold	Rapid breathing, aversion to cold, lack of perspiration & white phlegm	T—Thin white coating	Reduce LU 5, LU 7, BL 12, BL 13 & Ding Chuan	Ma Huang Tang—Ephedra Decoction
Invasion of Lungs by Wind Cold		P—Floating	Reduce LU 5, LU 7, BL 12, BL 13 & Ding Chuan	Ma Huang Tang—Ephedra Decoction
Phlegm Heat in Lungs	Rapid breathing, aversion to heat, perspiration & yellow phlegm	T—Yellow coat	Reduce BL 13, LU 5, ST 40, LI 4, CV 22 Ding Chuan, LI 11& LU 7	Qing Qi Hua Tang—Clearing Qi and resolving Phlegm Decoction
Phlegm Heat in Lungs		P—Slippery, rapid
	Deficiency patterns
Lung Qi Deficiency	Shortness of breath, cough, daytime sweating, catch colds easily & aversion to cold	T—Pale	Reinforce Ding Chuan, BL 13, BL 47, ST 36, LU 9, LU 7, DU 12 & CV 15 & Moxa.	Ren Shen Bu Fei Tan—Ginseng Tonifying the Lungs Decoction
Lung Qi Deficiency		P—Empty Rt front position		Ren Shen Bu Fei Tan—Ginseng Tonifying the Lungs Decoction
Lung Yin Deficiency	Scanty sputum, dry mouth and throat, night sweating & dry cough	T—Red, peeling coat	Reinforce Ding Chuan, BL 13, BL 43, LU 9, KI 6, BL 38, CV 4, SP 6 & LU 10.	Yang Yin Quing Fei Tang—Nourishing Yin and Clearing the Lung Decoction
Lung Yin Deficiency		P—Rapid, thread
Spleen Qi Deficiency	Slight abdominal distension, tiredness, weakness of limbs, loose stools & tending toward obesity	T—Pale	Reinforce CV 12, SP 6, SP 3, ST 36, BL 20, BL 21 & Ding Chuan	Liu Jun Zi Tang—Six Gentleman Decoction
Spleen Qi Deficiency		P—Empty		Liu Jun Zi Tang—Six Gentleman Decoction
Kidney Yang Deficiency	Lower back pain, coldness, lassitude, edema in the legs & impotence	T—Pale, wet	Reinforce BL 23, KI 3, GV 4 & CV 4	You Gui Wan—Restoring the Right Kidney Pill
Kidney Yang Deficiency		P—Deep, weak Kidney pulse	Reinforce BL 23, KI 3, GV 4 & CV 4	You Gui Wan—Restoring the Right Kidney Pill
	Combined Excess and Deficiency patterns
Liver Yang Rising due to Liver Yin/Blood Deficiency	Throbbing headache, dizziness, numbness of limbs, blurred vision, muscular weakness, cramps & withered nails	T—No coating & red in Yin Deficiency, Pale in Blood Deficiency	Reduce TB 5, PC 6, LI 4, GB 43, GB 38	Tian Ma Gou Teng Yin—Gastrodia uncaria Decoction
Liver Yang Rising due to Liver Yin/Blood Deficiency		P—Wiry	Reinforce SP 6, LR 8, ST 36 & KI 3.	Tian Ma Gou Teng Yin—Gastrodia uncaria Decoction