Treatment of Asthma with Herbs and Acupuncture
at Acupuncture Herbs and Beyond
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation in both adults and children. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation. Both symptoms and airflow limitation are often triggered by factors such as viral respiration infections, exercise, allergen, or change in weather. There are estimated 300 million individuals affected by asthma around the world. It is estimated that approximately 346,000 people die of asthma worldwide every year.
Achieving good control of symptoms is one of the most important goals of asthma management. Poor control of asthma symptom substantially increases the risk of exacerbations. Exacerbations are the major cause of morbidity and mortality in asthmatic patients and lead to significant costs for health care systems. In addition, exacerbations also seriously diminish the quality of life of patients and their family, especially in children such as limitations on daily activities, school absences, poor sleep quality. Inhaled corticosteroids (ICS) and β2-agonists are the major medications treating asthma, and symptoms can be controlled in most patients using them. However, both systemic and local side effects of them have been reported, such as calcium and phosphate metabolism with subsequent risk of osteoporosis, adrenocortical suppression, bruising and skin thinning, dysphonia, oropharyngeal candidiasis, thirst, increased heart rate, palpitations, hypokalemia, and so forth. This fact has led to increasing interest in nondrug strategies that can assist in improving symptom control and/or reducing future risk.
Acupuncture is a form of therapy which stimulates acupoints by inserting filiform needles. The selection of acupoints is based on the syndrome differentiation from the diagnosis according to traditional Chinese medicine (TCM) theory. Thus, the choice and number of acupoints are different from 1 patient to another. Although many types of acupuncture therapy have been used in clinical practice, the most common are manual acupuncture (MA) and electroacupuncture (EA). MA is a form of stimulation by lifting, thrusting, or rotating the needle manually to manipulate the de qi sensation (a sensation of soreness, heaviness, numbness, or distension), while EA stimulates acupoints by connecting the needles to a small electrical current.
Acupuncture has been used successfully to treat asthma in China and Western countries. Previous studies indicated that acupuncture could improve symptoms of asthma, lung function, and decrease medication dosages, and could be applied as an adjunct to conventional medications. In TCM theory, the mechanism of treating asthma by acupuncture is believed to regulate and balance the obstructive Qi which can result in health problem. In Western medicine, the mechanism still remains unclear. Studies involving animals and humans have indicated that acupuncture could modulate the immune system. In a clinical study, patients treated by acupuncture demonstrated that acupuncture could reduce airway resistance in people with asthma.
DEFINITION: In Chinese medicine, asthma is called "xiao chuan", which means wheezing and dyspnea, respectively. Chinese medicine classifies xiao and chuan as two separate illnesses with different treatments. Xiao (wheezing) is characterized by a whistling sound during breathing, increased respiration rate, dyspnea and inability to rest in a horizontal position. Chuan (shortness of breath) is characterized by dyspnea, constant opening of mouth to grasp air, raised shoulder, flared nostrils and inability to rest in a horizontal position. Patients with xiao (wheezing) generally will have chuan (shortness of breath), while patients with chuan (shortness of breath) may or may not have xiao (wheezing). In Western medicine, wheezing and shortness of breath are both considered as symptoms which may be present in many different types of pulmonary syndromes such as asthma, acute bronchitis, chronic bronchitis and emphysema.
ETIOLOGY: In Chinese Medicine, there are many factors that may trigger an asthma attack. Examples include the invasion of the external pathogenic factors, diet, emotional disturbances, congenital weakness and chronic illnesses.
External pathogenic factors, such as cold or heat, commonly induce asthma attacks. Lung dominates the Qi and manifests on the skin. As the environment affects the skin, the change is reflected in the Lung. As the Lung is attacked, its function to regulate water passage becomes impaired, water begins to stagnate, and phlegm starts to form. Asthma attacks due to the invasion of external pathogenic factors is most likely to occur when the temperature is cold or if there is a rapid change in weather. External pathogenic factors may also include pollen, cigarette smoke, and any other allergens.
Diet can also trigger an asthma attack. Raw and cold food may injure the Spleen and tend to contribute to the stagnation of fluid circulation and the increase in the production of phlegm. Heavy, sweet, and greasy food tend to create phlegm and heat in the body. Fish, crabs, shellfish and other seafood have also been noted to increase the likelihood of asthma attacks as well.
Congenital weakness and chronic illness are also common causes of asthma. Children with asthma generally have congenital Kidney Qi deficiency. On the other hand, chronic illness, such as patients with chronic cough and recurrent cold/flu, are likely to have Lung deficiency.
PATHOLOGY: The fundamental cause of asthma is the presence of phlegm. In Chinese Medicine, the passage of water is controlled by three organs, namely Lung, Spleen and Kidney. Lung regulates the water passages in the upper jiao, the Spleen transports and transforms water in the middle jiao, and Kidney dominates water metabolism in the lower jiao. Imbalance of Yin and Yang in any of these three organs may lead to stagnation of the water circulation, which then contributes to the production and storage of phlegm in the Lung. Storage of phlegm in the Lung becomes the main cause for recurrent asthma attacks.
In addition to the phlegm, chronic asthma will lead to deficiency of Lung, Spleen and Kidney. Deficiency of the Lung creates an inability of the Lung to inhale the air, and deficiency of the Kidney creates an inability of the Kidney to receive or grasp air. This will be complicated further if the Spleen is also deficient and there is an excess amount of phlegm that obstruct the airway. Overall, the condition becomes more and more complicated as the underlying syndrome represents a "deficient" condition and the symptoms an "excess" condition.
Acupuncture Herbs and Beyond Director, Dr. Weihui Li, believes in the efficacy and safety of acupuncture for asthma. She applies custom techniques for differential diagnosis.
1. ASTHMA ATTACK:
Asthma attack is considered as the acute or excess phase of the illness where urgency of treating the symptoms may outweigh that of the cause. Treatment principles during asthma attacks should focus on lowering the uprising Lung Qi, relieving wheezing (bronchial spasms) and dyspnea, and dissolving the phlegm. Herbal treatment of asthma attack is quite effective. However, severe asthma patients who have been on long-term steroids treatment may not respond as quickly or as effectively to herbal treatment.
1 a. Asthma Due to Cold:
When cold initially attacks the Lung, the normal activity of the Lung to dominate Qi and control respiration will be disturbed. The pathogenic cold factor tends to constrict the bronchi leaving the patient feeling congested in the chest. Patients will show hyperventilation, shortness of breath, tachypnea, tightness and a suffocating feeling of the chest. The Lung will be also lose its function to regulate the water passages and as a result, the formation of phlegm. Clinically, the phlegm is manifested as audible wheezing in the throat, high-pitched rhonchi, thin, white foamy sputum or tenacious, white sputum that is difficult to expectorate; amount can vary from scanty to profuse. Chills, intolerance to cold (cold temperature, cold food, drinks), absence of perspiration, headache, body aches and pain, grayish, and cyanotic complexion are general signs and symptoms of cold attacking the body. Tongue coating is usually white and greasy. The pulse is wiry and tight.
Herbal Treatment: Acupuncture Herbs and Beyond herbal formula dispels cold, warms up the interior, eliminates phlegm and relieves bronchial spasm.
Technique: Acupuncture treatment for cold asthma focuses on sedating the Lung and eliminating the phlegm. Cupping may be applied with acupuncture.
Supplement Points: Additional points may be added for patients with headache and body ache or for stuffy nose and runny nose.
1 b. Asthma Due to Heat
When heat attacks the Lung, the Lung will no longer be able to dominate Qi and control respiration. Patients generally experience a choking sensation, coughing spells and intercostal distention. Patients will also have phlegm as characterized by wheezing, crackling or moist rales, roaring sound in the throat from copious sputum that is thick and difficult to expectorate. Sputum is usually yellow but may be white in some cases where heat is not as prominent. It is common for patients to raise their shoulders to help breathing. Fever, irritability, perspiration, headache, thirst with desire to drink, flushed face, possible fever with aversion to cold are some of the symptoms of asthma due to heat. The tongue is red with yellow greasy coating. The pulse is superficial rapid or wiry.
Herbal Treatment: Acupuncture Herbs and Beyond herbal formula clears Lung heat, dissolves phlegm and relieves asthma.
Technique: Acupuncture treatment for asthma due to heat focuses to disperse the Lung, clear heat, dissolve phlegm, and lower adverse rising
Supplement Points: May be used if there is severe dyspnea and added if patients experience irritability and chest fullness or if the patient is thirsty and drinks lots of water.
1 c. Asthma Due to Deficiency
It is very common for patients who have recurrent asthma attacks to have Kidney deficiency. When under attack, such patients are said to have "upper excess with lower deficiency." "Upper excess" refers to phlegm stagnation in the Lung and is characterizes by recurrent or continuous wheezing (worsens after exertion), labored inhalation and smooth exhalation, snoring sound in the throat, low-pitched rhonchi, audible wheezes, shortness of breath, a frail cough with scanty, thin, or frothy sputum, and a dry throat. "Lower deficiency refers to Kidney Qi or Yang deficiency and is characterized by difficult inhalation as Kidney cannot grasp and hold the air down. In addition, the patients may also have deficiencies of the Lung and the Spleen. Deficiency of the Lung is characterized by aversion to wind and spontaneous sweating while deficiency of the Spleen is characterized by increased production of phlegm and sputum. Patients may have red cheeks, red tongue with scanty coat. Pulse is thready and rapid.
Herbal Treatment: The Acupuncture Herbs and Beyond herbal formula tonifies Kidney Yang, directs the rebellious Qi downward, arrest coughing, wheezing and eliminates excessive phlegm.
*Note on Phlegm:
Since Phlegm is the fundamental cause of asthma, it is present in all types of asthma patients.
2. REMISSION STAGE:
Patients in remission stage show no signs and symptoms of asthma such as wheezing or dyspnea. Compared to when they are under attack, the patients appear completely different and usually manifest little or no symptoms. Treatment principle during remission stage will focus on balancing the underlying deficiencies of the related internal organs, namely the Lung, the Spleen and the Kidney. Depending on severity, herbal treatment must continue for at least 6 months for maximum effectiveness.
2 a. Lung Deficiency: Patients with Lung deficiency commonly have asthma attacks triggered by changes in weather or exposure to known allergens or viral infections. Prodromal symptoms resemble that of allergy which include sneezing, stuffy nose and rhinorrhea. During the remission stage, patients with chronic wheezing and dyspnea due to Lung deficiency may have mild symptoms of shortness of breath, low voice, frequent low, wheezing sound in the throat. Sputum is clear or white, scanty or sticky. Aversion to wind and spontaneous sweating are two key signs of Lung Qi deficiency. Patients in this category usually have low immune systems and are very susceptible to catching common colds. The tongue is usually red with thin white coat or scanty coating. The pulse is weak and thready, or thready and rapid.
2 b. Spleen Deficiency: Patients with Spleen deficiency commonly have asthma attacks triggered by improper dietary intake, such as that of cold or spicy foods. During the remission stage, there may have occasional shortness of breath, dyspnea, low voice, fatigue, poor appetite, epigastric distention, loose stool or diarrhea after intake of greasy or fried foods, and possible edema. Sputum is white, thick and copious. Tongue is pale with teeth marks. Coating is white or greasy. Pulse is thready and soft.
The Acupuncture Herbs and Beyond formula is used to tonify Spleen deficiency.
2 c. Kidney Deficiency: Patients in this category are generally older or have a very chronic history of asthma. More patients in this category have Kidney Yang deficiency than Kidney Yin deficiency.
Asthma attacks for these patients are usually triggered by over-exertion or any minute changes in the weather, lifestyle or the environment. The common symptoms of Kidney Yang and Yin deficiency include: short and accelerated respiration, labored inhalation with the key symptom of longer exhalation than inhalation; relief after deep inhalation, interrupted respiration, cough with frothy or sticky sputum, frail appearance, weakness of the lower back and knees, withered shen and dyspnea after exertion. Patients with Kidney Yang deficiency, in addition to the above symptoms, will exhibit spontaneous perspiration, coldness of the limbs and extremities, pale face, edema, a pale, tender, flabby tongue with a deep, slow pulse. In the case of Kidney Yin deficiency, patient may have flushed cheeks, dryness of throat, irritation and perspiration with oily texture, a skinny tongue with no coating and a deep, thready, rapid pulse.
ACUPUNCTURE TREATMENT DURING REMISSION STAGE:
Technique: Acupuncture treatment for deficiency-type asthma will focus on tonifying the underlying deficiency, dissolve phlegm and relieve asthma.
May be used for shortness of breath and tachypnea and are added if the patients perspire easily after movement or light exercise.
Acupuncture Herbs and Beyond provides relief for asthma in both adults and children with customized herbal formulas and differential diagnosis which leads to greater efficacy in treatment.