Treatment of Asthma
with Herbs and Acupuncture
by Dr. Alex Chen,
L.Ac., O.M.D., Ph.D. and Dr. John Chen, L.Ac., O.M.D., Ph.D., Pharm.D.
DEFINITION: Asthma affects
approximately 15 million Americans today. It's a pulmonary disorder
characterized by wheezing and dyspnea due to obstruction and
inflammation of the airways. Asthma may be triggered by allergy,
exertion, irritant particles, weather, psychological stress, etc.
ETIOLOGY: There are many causes of
asthma. Allergens such as pollens, smoke, alcohol, house dust and animal
hair may trigger an asthma attack. Asthma may also be induced by
non-allergy related factors such as exertion, cold air, stress, anxiety,
crying, hearty laughing, and viral infection. Common morbidity
associated with asthma include sinusitis, allergic rhinitis,
gastroesophageal reflux, cardiovascular disease, diabetes, obesity, and
CLINICAL MANIFESTATION: In an asthma
attack, there will be a combination of spasm of the bronchi,
inflammation of the airways, and increased mucous secretion. In mild to
moderate cases, the patients will experience shortness of breath,
wheezing, hyperpnea, and use of accessory muscles (such as neck and
chest muscles) to facilitate breathing. Anxiety and sweating are
commonly seen in asthmatics as they struggle for air. In severe cases,
the patients will experience marked respiratory distress, cyanosis, use
of accessory muscles, wheezes, lethargy and possibly confusion. Patients
with severe asthma may not have any wheezing as there is very little air
moving in and out of the lungs.
DIAGNOSIS: Asthma is diagnosed based
on the characteristic episodes of wheezing, coughing, dyspnea or chest
tightness interspersed with asymptomatic intervals. Objective
confirmation is made with repeated spirometry tests performed over
symptomatic and asymptomatic periods. Spirometry is a device that
measures the breathing capacity of the lungs and is helpful in making
the diagnosis, assessing the severity of the illness, and monitoring the
effectiveness of the treatment.
If the asthma is allergy-induced, identification of the allergen is very
important. Skin test for allergen, blood test for antibodies, and
Inhalation Bronchial Challenge Test may assist in identifying the
correct culprit. Allergic skin test helps to identify the allergen, but
an allergen that causes an allergic reaction on the skin may not
necessarily induce an asthma attack. Blood test for antibodies helps to
determine the degree of sensitivity to that specific allergen.
Additionally, an Inhalation Bronchial Challenge Test can be done to
confirm the direct correlation between an allergen and an initiation of
asthma attack. Since the patient will have to inhale a diluted solution
of the allergen in the challenge test, there is a slight risk of a
severe asthma attack.
TREATMENT: Drug treatments of asthma
include management of an acute attack and maintenance on a daily basis.
Five groups of drugs are commonly used for treating asthma.
Beta-adrenergic drugs are bronchodilators that relax smooth muscle and
widen the airways. They are commonly used for relieving sudden attacks
of asthma and preventing exercise-induced asthma. Common examples of
Beta-adrenergic drugs includes epinephrine (Primatene Mist or
AsthmaHaler), isoproterenol (Isuprel), metaproterenol (Alupent),
pirbuterol (Maxair), terbutaline (Brethaire) and albuterol (Proventil
or Ventolin). Common side-effects of Beta-adrenergic drugs include
increased Heart rate, nervousness, restlessness, headache and muscle
Theophylline: Theophylline also
relaxes bronchial smooth muscle and is commonly used to treat and/or
prevent bronchial asthma. Common trade names of theophylline include
Theo-Dur, Theo-24, Uniphyl and Slo-bid. Common side-effects of
theophylline include nausea, vomiting, nervousness, restlessness,
insomnia, and in severe cases, seizures and arrhythmia.
block the inflammatory response and reduce the asthma symptoms.
Systemic corticosteroids (such as prednisone) may be used to treat
acute asthma attack and inhalation of corticosteroids (such as
Azmacort) may reduce the likelihood of asthma attack through
desensitization to allergens. Though effective, long-term use of
corticosteroids has a wide range of side-effects including but not
limited to poor wound healing, decreased immunity, retarded growth in
children, GI bleeding, hunger and weight gain.
Cromolyn (Intal): Cromolyn
(Intal) inhibits the release of inflammatory substances from mast
cells and is used to prevent but not treat asthma. When taken
regularly, cromolyn (Intal) is especially helpful in patients who have
exercise-induced asthma. Cromolyn (Intal) is relatively safe but has
occasional side-effects such as cough and hoarseness.
Anticholinergic drugs produce bronchodilation by preventing smooth
muscle contraction. Anticholinergic drugs are less potent and have a
slower onset of action in comparison with beta-adrenergic drugs.
Examples of anticholinergic drugs include atropine and ipratropium
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 Oriental 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
PATHOLOGY: The fundamental cause of
asthma is the presence of phlegm. In Oriental 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
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.
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
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 has a
tendency 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.
The herbal formula of choice is Asmatrol
(Cold). It dispels cold, warms up the interior, eliminates phlegm and
relieve bronchial spasm. The recommended dosage is 4-6 capsules TID.
In Asmatrol (Cold), ephedrae (ma huang)
and cinnamon twigs (gui zhi) dispel the cold factor, arrest wheezing
and move water by smoothing the Qi flow of the Lung. Besides the
bronchodiating effect, ephedrae (ma huang) can also promote urination
and thus dispel the congested fluids in the Lung. Due to the cold,
patients with water metabolism problems in the Lung will experience
constriction and a sudden blockage of fluids. Mustard seed (bai jie
zi), asarum (xi xin) and dry ginger (gan jiang) warm the Lung,
dissolve congested fluid and help the Lung resume its normal function.
Magnolia bark (hou po) is used to regulate the Lung Qi which is
impeded by the congested fluids. Apricot seed (xing ren), lepidium
(ting li zi), and pinelliae (ban xia) eliminate phlegm, transform
congested fluids and reduce wheezing. Schizandra (wu wei zi) is used
to protect the Lung by preventing the leakage of Qi. Lumbricus (di
long) is used to relieve wheezing and dilate the bronchi. White peony
(bai shao), containing paeoniflorin helps lumbricus (di long) achieve
the antispasmodic effect on the smooth muscle of the bronchi. Baked
licorice (zhi gan cao) supplements Qi, stops coughing, moderates
spasms, alleviate pain and harmonizes the formula.
MAIN POINTS: Feishu UB 13, Lieque
LU 7, Fengmen UB 12, Tanzhong REN 17, and Chize LU 5.
TECHNIQUE: Acupuncture treatment
for cold asthma should focus on sedating the Lung and eliminating
the phlegm. The points should be sedated and left in place for 30
minutes. Renzhong REN 17 should be stimulated until the needling
sensation disperses to both sides of the chest. Chize LU 5 should be
needled against the flow of the channel. Feishu UB 13 and Fengmen UB
12 should be sedated for 2 minutes. For best result, cupping may be
applied with acupuncture for these two points.
SUPPLEMENT POINTS: Shenzhu DU 12
and Dazhui DU 14 may be added for patients with headache and body
ache. Yingxiang LI 20 and Shangxing DU 23 may be added for stuffy
nose and runny nose.
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: ASMATROL
The herbal formula of choice is Asmatrol
(Heat). It clears Lung heat, dissolves phlegm and relieves asthma.
The recommended dosage is 4-6 capsules TID.
In Asmatrol (Heat), ephedrae (ma huang)
facilitates the movement of Lung Qi and controls wheezing. Ephedrine
and norephedrine in ephedrae (ma huang) have a prolonged
bronchodialating effect. Gypsum (shi gao) clears Lung heat and
neutralizes the warmth and diaphoretic effects of ephedrae (ma
huang). Mulberry bark (sang bai pi) and lycium root bark (di gu pi),
a pair also seen in Drain the White Powder (Xie Bai San), drain Lung
heat and stop coughing and wheezing. Trichosanthes rind (gua lou pi)
clears Lung heat, expands the chest, and dissolves the phlegm.
Belamcanda (she gan) clears heat, relieves toxicity, and soothes
sore throat due to heat and wheezing. Lepidium (ting li zi) drains
the Lung, eliminates phlegm and reduces wheezing. Apricot seed (xing
ren) stops coughing and calms wheezing. Lumbricus (di long) stops
muscle spasm of the airways to relieve wheezing. A small amount of
schizandra (wu wei zi) is used to inhibit the leakage of Lung Qi in
order to prevent Qi loss. Baked licorice (zhi gan cao) moderates
spasms, supplements Qi and harmonizes all the herbs in this formula.
MAIN POINTS: Dazhui DU 14, Hegu LI
4, Tanzhong REN 17, Fenglong ST 40, Feishu UB 13 and Kongzui LU 6.
TECHNIQUE: Acupuncture treatment
for asthma due to heat should focus on disperse the Lung, clear heat,
dissolve phlegm, and lower adverse rising Qi. Dazhui DU 14 and Feishu
UB 13 are sedated for 2 minutes followed by immediate removal of the
needles. The remaining points should be sedated and needles left in
place for 20 minutes.
SUPPLEMENT POINTS: Tiantu REN 22
and Dingchuan (Soothing Asthma) may be used if there is severe
dyspnea. Yuji LU 10 and Daling P 7 are added if patients experience
irritability and chest fullness. Zhaohai K6 and Taixi K3 are added if
the patient is thirsty and drinks lots of water.
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: ASMATROL
The herbal formula of choice is Asmatrol
(deficiency). It tonifies Kidney Yang, directs the rebellious Qi
downward, arrest coughing, wheezing and eliminates excessive phlegm.
The recommended dosage is 4-6 TID.
In Asmatrol (deficiency), ephedrae (ma
huang) expels exterior wind and relieves dyspnea. Ephedrine and
norephedrine, two active ingredients of ephedrae (ma huang) are
bronchodilators which can open the airway, relieve wheezing and
dyspnea. Apricot seed (xing ren), perilla seed (su zi), and lepidium
(ting li zi) reverse the uprising Lung Qi, eliminate phlegm, and
relieve coughing and wheezing. Mustard seed (bai jie zi), gleditsia
fruit (zao jiao), pinellia (ban xia), magnolia bark (hou po), and
peucedanum (Qian hu) eliminate phlegm and relieve coughing and
wheezing. Lumbricus (di long) stops muscle spasm of the airways to
relieve wheezing. Schizandra (wu wei zi) tonifies the Lung and the
Kidney to relieve wheezing. Raphanus (lai fu zi) tonifies the Spleen
and reduces the production of phlegm. Citrus Peel (chen pi) dries up
dampness and eliminates phlegm. To prolong inhalation, cinnamom bark
(rou gui) warms the Kidney Yang and helps restore the Kidney's ability
to grasp the Qi. Bupleurum (chai hu) regulates the Qi and tangkuei
(dang gui) nourishes the blood in the Liver and indirectly treats
coughing and other Qi-reversion symptoms by regulating the blood.
Fresh ginger (sheng jiang) and perilla leaf (su ye) disperse coldness
and dilate the Lung. Baked licorice (zhi gan cao) and jujube (da zao)
harmonize the formula.
Note on Phlegm:
Since Phlegm is the fundamental cause of
asthma, it is present in all types of asthma patients. For profuse,
white or yellow sputum in the different types of asthma patients
mentioned above, Citrus and Pinellia Combination (Er Chen Tang) can be
added to dry dampness, transform phlegm and regulate Qi.
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 should 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 month for maximum
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.
For maintenance, Astragalus & Siler
Formula (Yu Ping Feng San) and Ginseng & Ophiopogon Formula (Sheng Mai
San) and Ginseng and Aster Combination (Bu Fei Tang) are excellent
formulas to tonify the Lung and prevent recurrent asthma attacks.
Astragalus & Siler Formula (Yu Ping Feng
San) tonifies Qi and strengthens the exterior. It is commonly used for
patients who have Wei (Defensive) Qi deficiency characterized by
spontaneous perspiration, aversion to cold, and frequent infection of
common cold and flu.
Ginseng & Ophiopogon Formula (Sheng Mai
San) and Ginseng and Aster Combination (Bu Fei Tang) tonify the source
Qi, nourish Yin, and generate body fluid. It is used for Qi and Yin
deficiencies of the Lung with chronic asthma, cough, scanty sputum,
shortness of breath, increased respiration, spontaneous perspiration
and dry mouth.
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 teethmarks. Coating is white or greasy. Pulse is thready and
The herbal formulas of choice to tonify
Spleen deficiency are Major Six Herb Combination (Liu Jun Zi Tang) and
Ginseng and Astragalus Combination (Bu Zhong Yi Qi Tang). Major Six
Herb Combination (Liu Jun Zi Tang) tonifies the Spleen and dissolves
the phlegm. It is used for patients with Spleen deficiency with
residual phlegm in the Lung. Ginseng and Astragalus Combination (Bu
Zhong Yi Qi Tang) tonifies the Middle Jiao and raises Yang in the
body. It is used for patients with deficiency of both the Stomach and
the Spleen Qi leading to sinking of the Yang.
If the patient shows prominent water
stagnation in the middle jiao manifesting in fullness in the chest and
hypochondria, shortness of breath, profuse sputum, and palpitation,
Hoelen and Atractylodes C