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 deficiency.

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 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.

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 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.

Herbal Treatment: The herbal formula of choice dispels cold, warms up the interior, eliminates phlegm and relieve bronchial spasm.
Recomended Ingredients: 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.

Acupuncture:
Main Points: Feishu (BL 13), Lieque (LU7), Fengmen (BL 12), Tanzhong REN 17, Chize (LU5).

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.
 
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:  The herbal formula of choice clears Lung heat, dissolves phlegm and relieves asthma.

Recomended Ingredients:  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.

Acupuncture:
Main Points: Dazhui DU 14, Hegu (LI 4), Tanzhong REN 17, Fenglong (ST 40), Feishu (BL 13), and Kongzui (LU6).

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.