Asthma is a common chronic inflammatory condition of the airways that produces reversible spasm of the airways, making it hard to breathe.

Asthma is believed to be caused by a combination of genetic and environmental factors. Genetic factors including family history, but also epigenetics (heritable factors other than those related to DNA sequence- meaning that the potential to have a genetic defect is there but it is switched ‘on’ or ‘off’ with the influence of an external or environmental factors).

Other causes are:

• Environmental: sensitivty and exposure to pollution, allergens, environmental chemicals, formaldehyde, phthalates, paracetemol use of the mother while pregnant, indoor allergens, mold, exposure to passive smoking.
• Hygiene Hypothesis: We have been too clean and reduced a ‘healthy’ exposure to bacteria and viruses during childhood.
• Medical conditions: Atopy, where the triad of atopic eczema, rhinitis and asthma occur together in childhood.
• Obesity

Treatment

1. avoid allergens -extrinsic: animal dander, house dust mite, mold, pollen, foods
2. avoid irritants -intrinsic: cigarette smoke, odors, fumes, changes in temp, pressure, humidity, aspirin, sulfites, NSAID’s, tartrazine (FD&C yellow dye #5), cold air, exercise, emotional upset

Drug treatment
a. B-adrenergic agents

i. bronchial smooth muscle relaxation
ii. epinephrine, metaproterenol, terbutaline, albuterol
b. theophylline
i. bronchial smooth muscle relaxation
c. corticosteroids
d. cromolyn sodium: for maintenance tx, inhibits mediator release & reduces airway hyperreactivity. safe
e. anticholinergic agents: block cholinergic pathways -atropine

Chinese Medicine

In Chinese medicine the acute phase, chronic phase and remission phases of asthma are treated differently.

The initial investigation is to discover what the cause or irritant is. Once the irritant is identified and dealt with, if possible, the patho-mechanism of disease is divided into sub categories or a Chinese medical frame work. These divisions, discovered thousands of years ago when there were no autopsies, blood tests etc, still apply and work today.

Acute Phase Herbal:

Cold-Phlegm

Signs & Symptoms: Rapid breathing with wheezing at a feeling of force and oppression in the chest, cough with scanty, clear or white sputum; symptoms aggravated by exposure to cold
Additional Symptoms: dull, pale/bluish-white complexion, no thirst or desire for warm drinks, aversion to cold and cold limbs
Tongue: white, moist coat
Pulse: wiry, tight or floating, tight or slippery, tight
Treatment Principles: Warm the Lungs, scatter Cold, transform Phlegm, calm wheezing
Herbal Treatment: She Gan Ma Huang Tang, Su Zi Jiang Qi Wan, Ma Huang Tang, Xiao Qing Long Tang

Phlegm-Heat

loud wheezing with breathlessness, choking cough with rattling sound in the throat, fake, sticky, yellow sputum that is difficult to expectorate
Additional Symptoms: sweating, irritability, anxiety, thirst, headache, sensation of heat

Tongue: read with yellow, greasy coat
Pulse: slippery, rapid or slippery, wiry
Treatment Principles: Clear Heat, restore the descending of Lung Qi, transform Phlegm, stop wheezing
Herbal Treatment: Ding Chuan Tang, Qing Qi Hua Tang Wan, Wen Dan Tang

Acute Phase Acupuncture

Basic Points: CV22, Dingchuan, CV17, LU1, ST40, BL17, PC6

Points based on pattern:
Cold: LU7, LI4, BL12
Heat: LU5, LU6, GV14
Cupping on upper back and chest.
Plum Blossom needle: lightly tap along the paraspinal muscles of the upper back and/or along the course of the Lung channel

GV-14 (strengthen yang and expel pathogen), CV-22 (open chimney expel stagnation), Ding Chuan (MBW1) (regulate qi settle wheeze), PC-6 (calms stifling in chest and assists st40 (remove phlegm), CV12 (strengthens water metabolism and reg qi)

Chronic Phase Herbal:

Lung Qi Vacuity
Signs and Symptoms: Chronic, slight wheezing sound in the throat, slight cough with thin, clear sputum, shortness of breath 

Additional Symptoms: spontaneous sweating, weak voice, fatigue, aversion to wind or worsening of symptoms with exposure to wind, tendency to catch colds, stuffy or runny nose with clear discharge
Tongue: pale with thin, white coat
Pulse: weak
Treatment Principles:Supplement the Lungs and consolidate the exterior
Herbal Treatment: Yu Ping Feng San, Bu Fei Wan

Spleen Qi Vacuity

Signs and Symptoms: Chronic, slight wheezing sound in the throat, slight cough with thin, clear sputum, shortness of breath

Additional Symptoms: poor appetite, epigastric and abdominal distention, loose stool, fatigue
Tongue: pale with white, moist or thin, greasy coat
Pulse: weak or soft
Treatment Principles: Supplement the Spleen, boost Qi, transform Phlegm
Herbal Treatment: Liu Jun Zi Tang

Kidney Qi Vacuity (Kidneys not Grasping the Qi)

Signs and Symptoms: chronic, slight wheezing sound in the throat, shortness of breath, more difficulty inhaling than
exhaling, symptoms worse with fatigue or exertion
Additional Symptoms: sore and weak low back and knees, tinnitus, spontaneous sweating (aversion to cold with cold limbs and impotence if more Yang vacuity)
Tongue: pale
Pulse: deep, weak
Treatment Principles: Supplement the Kidneys, boost the Qi, stop wheezing
Herbal Treatment: Jin Gui Shen Qi Wan, Yu Lin Bu Shen Wan

Kidney Yin Vacuity

Signs and Symptoms: chronic, slight wheezing sound in the throat, shortness of breath, more difficulty inhaling than exhaling, symptoms worse with fatigue or exertion
Additional Symptoms: sore and weak low back and knees, tinnitus, sensation of heat, night sweating, malar flush, insomnia
Tongue: red with scanty coat
Pulse: thin, rapid
Treatment Principles: Supplement the Kidneys, nourish Yin, drain Fire, stop wheezing
Herbal Treatment: Zhi Bai Di Huang Wan, Ma Wei Di Huang Wan

Atopic Asthma

Wei Qi Deficiency: Yu Ping Feng Wan, Xu Han Ting

Yang Deficiency: Ba Ji Yin Yang Wan

Chronic/Remission Phase Acupuncture

Basic Points: BL13, LU9, CV17, ST40, LU1, Ding Chuan

Points based on pattern:
LU Qi Xu: CV6, BL43, ST36, SP3
SP Qi xu: BL20, ST36, SP3, CV12
KI xu: BL23, KI3, CV6, CV4

Tung Acupuncture: Four Horses, Sanchasan, andLI20, as well as 1010.19 and 1010.20 Water Gold

GV-14 (strengthen yang and expel pathogen), CV-22 (open chimney expel stagnation), Ding Chuan (MBW1) (regulate qi settle wheeze), PC-6 (calms stifling in chest and assists st40 (remove phlegm), CV12 (strengthens water metabolism and reg qi)
Summer moxibustion: apply 3-5 cones of moxa on sliced ginger to BL13, BL43, GV14, BL20, BL23 until skin becomes red at each point. Do this daily, with 10 times equaling 1 course of treatment. Do one course each month for three months before the asthma season begins ( i.e., fall/winter).

Cupping: sliding cups along upper back until skin becomes dark red. Do this once a week, four times equaling 1 course of treatment. Do this two months before the asthma season begins.