Asthma

WESTERN MEDICINE DEFINITION:

Asthma affects approximately 15 million Americans today. It is a pulmonary disorder characterized by wheezing and dyspnea due to obstruction and inflammation of the breathing channels. 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 hyperthyroidism.
CLINICAL MANIFESTATION:
An asthma attack creates a combination of; spasms of the bronchi, inflammation of the breathing channels 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 experience marked respiratory distress, cyanosis, require use of accessory muscles, wheezing, lethargy and possibly mental confusion. Patients with severe asthma may not have any wheezing, as very little air can move in and out of the Lungs.
DIAGNOSIS:
Asthma is diagnosed by the characteristic episodes of wheezing, coughing, dyspnea or chest tightness interspersed with asymptomatic intervals. Objective confirmation can be made with repeated spirometry tests performed over symptomatic and asymptomatic periods. A Spirometry tester 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 tests for allergens, blood tests for antibodies, and an Inhalation Bronchial Challenge Test may assist in identifying the correct culprit. An 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. A blood test for antibodies helps to determine the degree of sensitivity to that specific allergen. Additionally, an Inhalation Bronchial Challenge Test can be performed to confirm the direct correlation between an allergen and an initiation of the 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 during the test.
TREATMENT:
Drug treatments of asthma include; a) management of an acute attack and b) maintenance on a daily basis. Five groups of drugs are commonly used for treating asthma:
1. Beta-adrenergic drugs are bronchodilators that relax the smooth muscle and widen the breathing tubes. They are commonly used for relieving sudden attacks of asthma and preventing exercise-induced asthma. Common examples of Beta-adrenergic drugs include 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 tremors.
2. Theophylline also relaxes the 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.
3. Corticosteroids block the inflammatory response and reduce the asthma symptoms. Systemic corticosteroids (such as prednisone) may be used to treat an acute asthma attack. Inhalation of corticosteroids (such as Azmacort) may reduce the likelihood of an asthma attack through desensitization to allergens.
Although effective, there is a wide range of side-effects resulting from long-term use of corticosteroids including, but not limited to; poor wound healing, decreased immunity, retarded growth in children, GI bleeding, hunger and weight gain.
4. 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 to patients who have exercise-induced asthma.
Cromolyn (Intal) is relatively safe but has occasional side effects such as cough and hoarseness.
5. 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 (Atrovent).

Here, we would like to introduce some basic Traditional Chinese Medicine (TCM) knowledge regarding asthma.

CHINESE MEDICINE DEFINITION:

In TCM, asthma is called "xiao chuan", which means wheezing and dyspnea (breathlessness), 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 the mouth to grasp air, raising of the shoulders, flaring 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 that may be present in many different types of pulmonary syndromes such as asthma, acute bronchitis, chronic bronchitis and emphysema.
Acupoint Injection Therapy (AIT) for Asthma uses herbs and vitamins, injected directly into Acupuncture points by Dr. Li.
ETIOLOGY:
In TCM, there are many factors that may trigger an asthma attack. Examples include; 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. The Lung dominates the Qi and manifests itself 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 caused by the invasion of external pathogenic factors are most likely to occur when the temperature is cold or if there is a rapid change in the weather. External pathogenic factors may also include pollen, cigarette smoke and other allergens.
Diet can also trigger an asthma attack. Raw and cold food may injure the Spleen and contribute to the stagnation of fluid circulation, as well as an increase in the production of phlegm. Heavy, sweet and greasy foods tend to create phlegm as well as heat in the body. Fish, crabs, shellfish and other seafood have also been noted to increase the likelihood of asthma attacks.
Congenital weakness and chronic illness are also common causes of asthma. Children with asthma generally have congenital Kidney Qi deficiency. On the other hand, people with a chronic illness, such as patients with chronic cough and recurrent cold/flu, are likely to have a Lung deficiency.
PATHOLOGY:
The fundamental cause of asthma is the presence of phlegm. In TCM, three organs -- the Lung, the Spleen and the Kidney -- control the passage of water. The Lung regulates the water passage in the upper jiao. The Spleen transports and transforms water in the middle jiao. The Kidney dominates water metabolism in the lower jiao. Imbalance of Yin and Yang in any of these three organs may lead to stagnation in the water's circulation, which then contributes to the production and storage of phlegm in the Lungs. Storage of phlegm in the Lungs becomes the main cause for recurrent asthma attacks.
In addition to phlegm, chronic asthma will lead to deficiency of the Lung, the Spleen and the Kidney. Deficiency of the Lung creates difficulty for the Lungs to inhale the air, while a deficiency of the Kidney creates difficulty for the Kidneys to receive or grasp air. This is further complicated if the Spleen is also deficient and there is an excess amount of phlegm that obstructs the breathing passages. Overall, the condition becomes more and more complicated as the underlying syndrome aggravates a "deficient" condition and the numerous symptoms create an "excessive" condition.

DIFFERENTIAL DIAGNOSIS FOR AN ASTHMA ATTACK:
An asthma attack is considered as the acute or excess phase of the illness, where urgency of treating the symptoms may outweigh that of treating 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. Acupoint Injection Therapy (AIT) treatment of an asthma attack is very effective.
Severe asthma patients who have been on long-term steroids treatment may not respond quickly or effectively enough by taking herbs or acupuncture alone. AIT, however, offers us a much more effective way by combining acupuncture with herbal medicine in order to solve more complicated situations effectively. Moreover, we can take care of multiple disorders simultaneously with multiple injections at different points. Thus the patients can also reduce the taking of multiple drugs, including steroids, gradually.

ASTHMA DUE TO COLD TEMPERATURE
When coldness 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 a congestion in the chest. Patients will experience hyperventilation, shortness of breath, tachypnea, tightness and a feeling of suffocation in the chest. The Lung will also lose its ability to regulate the passage of water and as a result, phlegm will form. 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 -- the amount can vary from scanty to profuse. General signs and symptoms of cold attacking the body are; chills, intolerance to cold (cold weather, cold food, cold drinks), absence of perspiration, headache, body aches and pains, gray and/or cyanotic complexion. The tongue coating is usually white and greasy. The pulse is wiry and tight.

COUGH SYMPTOMS
This indicates an imbalance is present in the Lung. In TCM the Lung is known as the "tender organ", as it is the one which is affected by climatic factors. In addition, sadness and loss often manifest themselves as Lung illnesses. For recurrent problems manifesting themselves in the Lung as symptoms like a cough, it is recommended to execute a regular Qi Gong, practice meditation and daily exercises such as swimming or walking. Most coughs are mild in nature and are relatively easy to treat by ones self.
Three of the most common types of cough are discussed here:
1) CHESTY COUGH
This may be caused by invasion of a climatic influence, as in relation to the common cold. The problem here is more severe, as the influence has descended into the Lungs and is interrupting the normal flow of Qi. This situation occurs in people who say a cold always goes into their chest.
The symptoms will be those of the common cold with a cough. There may or may not be sputum.
DIET
Proper diet in a common cold is helpful in the first stages. Later, eat foods which strengthen the Lungs (soups, chicken, dates, honey and malt sugar). Add amiable root (Huang Qi). Avoid greasy food, seafood, spicy food, alcohol and tobacco.
ACUPUNTURE: Perform kneading on Lu5 and LI4 and Burnishing on UB13.
HERBS:
Consider either Yin Qiao Jie Du Pian or Sang Ju Yin for the acute symptoms. When these have subsided, consider strengthening Lung energy with either Bu Zhong Yi Qi Wan or Liu Jun Zi Wan.
2) DRY COUGH
The cough may also be caused by internal factors, such as Dryness in the Lungs due to lack of fluid (Yin). Or smoking and living or working in dry, hot conditions may be a factor. In this case, there is a cough with little or no sputum, dry mouth and perhaps dry skin.
DIET
A generally healthy diet should be used with the addition of streamed foods to help moisten the Lungs. Avoid greasy food, seafood, spicy food, alcohol and tobacco.
ACUPUNCTURE
Use the vibrating technique on UB13, Lu9 and K6
HERBS
Consider either Chuan Bei Pi Pa Gao or, if chronic, Yang Yin Qing Fei Tan3)
3) PHLEGMY COUGH
A cough with lots of Phlegm is usually due to a weakness of the Lung and the Spleen. Dampness accumulates because of the Spleen's weakness and ascends to the Lungs. It collects there, causing cough with sputum, tiredness, muzzy head, poor appetite and loose stools.
DIET
Eat only healthy foods. Avoid cold, raw food. Eat warm foods and those with warm energy. Strengthen the Lungs with soups, chicken, dates, honey and malt sugar. Add 10g Asiable root(Dang shen), 5g ginseng (Ren shen), 10g yellow milk-vetch root (Huang qi) to vegetable soup. Avoid processed foods which lead to Dampness.
4) Perform kneading on UB20, CV12, St36, UB 13 and St 40
HERBS
When less tired and with a good appetite, take Er Chen Wan in warm climates. When more tired, experiencing poor appetite and/or loose stools, take Liu Jun Zi Wan. Chuan Bei Jing Pian clears white sputum from the Lungs. Use Chuan Bei Pipa Lu or Qing Qi Hua Tan Wan when there is yellow sputum. Also, drink Coltsfoot Flower tea.

DIFFERENTIATED DIAGNOSIS IS THE KEY to choosing suitable herbs and acupuncture points in order to treat asthma effectively.
1) ASTHMA DUE TO COLD:
HERBS:
Certain herbs are injected into certain Acupuncture points to dispel cold, warm up the interior, eliminate phlegm and relieve bronchial spasms, such as;
a. Ephedrae (ma huang) and cinnamon twigs (gui zhi) to dispel the cold factor, arrest wheezing and move water by smoothing the Qi flow of the Lung. It also encourages urination and thus dispels the congested fluids in the Lung. This herb not only has a bronchodiating effect but also dispels fluids from the Lung.
b. Mustard seed (bai jie zi), asarum (xi xin) and dry ginger (gan jiang) can warm the Lung, dissolve congested fluid and help the Lung resume its normal function. This is quite beneficial when cold, because patients with water metabolism problems in the Lung will experience constriction and a sudden blockage of fluids.
c. Magnolia bark (hou po) is used to regulate the Lung Qi that is impeded by the congested fluids.
d. Apricot seed (xing ren), lepidium (ting li zi), and pinelliae (ban xia) eliminate phlegm, transform congested fluids and reduce wheezing.
e. Schizandra (wu wei zi) protects the Lung by preventing leakage of Qi.
f. Lumbricus (di long) is used to relieve wheezing and dilate the bronchi.
g. White peony (bai shao), containing paeoniflorin, which helps lumbricus (di long), has an antispasmodic effect on the smooth muscle of the bronchiby.
h. Baked licorice (zhi gan cao) supplements Qi, stops coughing, moderates spasms and alleviates pain.
ACUPUNCTURE PRIMARY 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. 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 best results, cupping may be applied with acupuncture for these two points.
ACUPUNCTURE 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.

2. ASTHMA DUE TO HEAT:
When heat attacks the Lung, it will no longer be able to dominate Qi and control respiration. At this time, patients generally experience a choking sensation, coughing spells and intercostal distention. Patients will also have phlegm, characterized by; wheezing, crackling, moist croaks or a 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 their breathing. Some other symptoms of asthma caused by heat are; fever, irritability, perspiration, headache, thirst, flushed face, possible fever and aversion to cold. The tongue is red with a yellow greasy coating. The pulse is superficially rapid or wiry.
HERBS:
a. Yi Xin Cao is the herbal choice to release Heat. It clears Lung heat, dissolves phlegm and relieves asthma.
b. Ephedrae (ma huang) together with Yi xin cao (Heat) facilitates the movement of Lung Qi and controls wheezing.
c. Ephedrine and norephedrine together with ephedrae (ma huang) have a prolonged bronchodilating effect.
d. Gypsum (shi gao) clears Lung heat and neutralizes the warmth and diaphoretic effects of ephedrae (ma huang).
e. Mulberry bark (sang bai pi) and lycium root bark (di gu pi), a pair also seen in Drain Xie Bai San, drain Lung heat and stop coughing and wheezing.
f. Trichosanthes rind (gua lou pi) clears Lung heat, expands the chest, and dissolves the phlegm.
g. Belamcanda (she gan) clears heat, relieves toxicity and soothes sore throat due to heat and wheezing.
h. Lepidium (ting li zi) drains the Lung, eliminates phlegm and reduces wheezing.
i. Apricot seed (xing ren) stops coughing and calms wheezing.
j. Lumbricus (di long) stops muscle spasm of the airways to relieve wheezing.
l. Schizandra (wu wei zi) in small amounts is used to inhibit the leakage of Lung Qi in order to prevent Qi loss.
m. Baked licorice (zhi gan cao) moderates spasms and supplements Qi
ACUPUNCTURE PRIMARY POINTS:
Dazhui DU 14, Hegu LI 4, Tanzhong REN 17, Fenglong ST 40, Feishu UB 13 and Kongzui LU 6.
TECHNIQUE:
Focus on breaking up the Lung, clearing heat, dissolving phlegm, and lowering adverse rising Qi. Dazhui DU 14 and Feishu UB 13 .
ACUPUNTURE SUPPLEMENTAL 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 a lot of water.

3. ASTHMA DUE TO DEFICIENCY IN ORGAN FUNCTIONS
It is very common for patients who have recurrent asthma attacks to have a Kidney deficiency. When having an asthma attack, patients are said to have "an upper excess with a lower deficiency."
"Upper excess" refers to phlegm stagnation in the Lung and is characterized by recurrent or continuous wheezing. This worsens after exertion, causing labored inhalation and smooth exhalation with a 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 the 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 windy weather and spontaneous sweating. Deficiency of the Spleen is characterized by increased production of phlegm and sputum. Patients may have red cheeks and a red tongue with a scanty coating. Pulse is thready and rapid.
HERBS:
a. Shen Mai, Dan Shen, Huang Qing, Dang Gui (deficiency) is the herbal choice. It tonifies the Kidney Yang, directs the rebellious Qi downward, arrests coughing and wheezing, and eliminates excessive phlegm.
b. Ephedrae (ma huang), in conjunction with Huang Qing, Shen Mai,Dan shen, Dan Gui (deficiency), expels exterior wind and relieves dyspnea. Ephedrine and norephedrine, two active ingredients of ephedrae (ma huang), are bronchodilators which can open the breathing tubes, relieve wheezing and dyspnea.
c. 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.
d. 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.
e. Lumbricus (di long) stops muscle spasm of the breathing passages to relieve wheezing.
f. Schizandra (wu wei zi) tonifies the Lung and the Kidney to relieve wheezing.
g. Raphanus (lai fu zi) tonifies the Spleen and reduces the production of phlegm.
h. Citrus Peel (chen pi) dries up dampness and eliminates phlegm.
i. Cinnamom bark (rou gui) prolongs inhalation, warms the Kidney Yang and helps restore the Kidney's ability to grasp the Qi.
j. Bupleurum (chai hu) regulates the Qi.
k. Tangkuei (dang gui) nourishes the blood in the Liver and indirectly treats coughing and other Qi-reversion symptoms by regulating the blood.
l. Bupleurum (chai hu) regulates the Qi Tangkuei (dang gui) and nourishes the blood in the Liver while indirectly treating the cough and other Qi-reversion symptoms by regulating the blood.
n. Fresh ginger (sheng jiang) and perilla leaf (su ye) disperse coldness and dilate the Lung.
o. Baked licorice (zhi gan cao) and jujube (da zao).

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, a Citrus and Pinellia Combination (Er Chen Tang) can be added to dry dampness, transform phlegm and regulate Qi.

REMISSION STAGE:
Patients in the remission stage show no signs or symptoms of asthma such as wheezing or dyspnea. Compared to when they are under attack, the patients appear completely different and usually manifest few or no symptoms. Treatment principles during the remission stage should focus on balancing the underlying deficiencies of the related internal organs; namely the Lung, the Spleen and the Kidney. Depending on the severity, herbal treatment must continue for at least 6 months for maximum effectiveness.

LUNG DEFICIENCY:
Patients with a Lung deficiency commonly have asthma attacks triggered by changes in the 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 a Lung deficiency may have mild symptoms of shortness of breath, low voice and a frequent low wheezing sound in the throat. Sputum is clear or white and scanty or sticky. Aversion to windiness and spontaneous sweating are two key signs of a 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 a thin white coat or thin coating of some sort. The pulse is weak and thready, or thready and rapid.
HERBS
a. Astragalus & Siler Formula (Yu Ping Feng San) and Ginseng & Ophiopogon Formula (Sheng Mai San) and a Ginseng and Aster Combination (Bu Fei Tang) are excellent formulas for maintenance in order to tonify the Lung and prevent recurrent asthma attacks.
b. Astragalus & Siler Formula (Yu Ping Feng San) tonifies Qi and strengthens the exterior. It is commonly used for patients who have a Wei (Defensive) Qi deficiency characterized by spontaneous perspiration, aversion to cold and frequent infection with the common cold and/or flu.
c. 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 a Spleen deficiency commonly have asthma attacks triggered by an improper diet, such as cold or spicy foods. During the remission stage, the asthmathic may have occasional shortness of breath, dyspnea, low voice, fatigue, poor appetite, epigastric distention, loose stool or diarrhea after eating greasy or fried foods, and possible edema. Sputum is white, thick and copious. The tongue is pale with teeth marks. The coating is white or greasy. Pulse is thready and soft.

HERBS
a. Major Six Herb Combination (Liu Jun Zi Tang), Ginseng and Astragalus Combination (Bu Zhong Yi Qi Tang) are the herbal formulas of choice to tonify a Spleen deficiency. Major Six Herb Combination (Liu Jun Zi Tang) tonifies the Spleen and dissolves the phlegm. It is used for patients with a Spleen deficiency exhibiting residual phlegm in the Lung.
b. Ginseng and Astragalus Combination (Bu Zhong Yi Qi Tang) tonifies the Middle Jiao and raises the 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.
c. Hoelen and Atractylodes Combination (Ling Gui Zhu Gan Tang) can be used if the patient shows prominent water stagnation in the middle jiao manifesting fullness in the chest, hypochondria, shortness of breath, profuse sputum, and palpitation.
KIDNEY DEFICIENCY:
Patients in this category are generally older or have a very chronic history of asthma. More patients in this category have a Kidney Yang deficiency than Kidney Yin deficiency. Asthma attacks for these patients are usually triggered by over-exertion or by minute changes in the weather, lifestyle or the environment.
Common symptoms of Kidney Yang and Yin deficiencies include:
a. The key symptom is longer exhalation than inhalation
b. Relief after deep inhalation accompanied by short, accelerated respiration with labored inhalation
c. Interrupted respiration
d. Cough with frothy or sticky sputum
e. Frail appearance with weakness of the lower back and knees
f. Withered shen and dyspnea after exertion
In addition to the above symptoms, patients with a Kidney Yang deficiency will exhibit spontaneous perspiration, coldness of the limbs and extremities, a pale face, edema, and a pale tender and flabby tongue with a deep, slow pulse. In the case of a Kidney Yin deficiency, patients may have flushed cheeks, dryness of throat, irritation and perspiration with an oily texture, a skinny tongue with no coating and a deep, thready and rapid pulse.

HERBS
a. Ginseng, Gecko Formula (Ren Shen Ge Jie San) and Rehmannia Eight Formula (Ba Wei Di Huang Wan) is the best formula to tonify the Kidney Yang and Qi and prevent recurrent asthma attacks.
b. Capital Qi Pill (Du Qi Wan or Qi Wei Du Qi Wan) combined with Ginseng and Ophiopogon Formula (Sheng Mai San) is recommended for a Kidney Yin deficiency.

ACUPUNCTURE TREATMENT DURING THE REMISSION STAGE
MAIN ACUPUNTURE POINTS:
Feishu UB 13, Pishu UB 20, Shenshu UB 23, Gaohuangshu UB 43, Qihaishu UB 24, Zusanli ST 36, Taixi K 3, Taiyuan LU 9, and Dingchuan (Soothing Asthma).
SUPPLEMENTARY POINTS:
Neiguan P 6, Guanyuan REN 4, Tanzhong REN 17 are used for shortness of breath and tachypnea. Yinxi H 6 and Houxi SI 3 are added if the patients perspire easily after movement or light exercise. Guanyuan REN 4 can be added to tonify Lung Qi. Use moxa on Guanyuan REN 4 if the Kidney is deficient and cannot grasp the Qi. Neiguan P 6 and Renzhong REN 17 may be added if there is Heart Yang deficiency. Xuanji REN 21 and Shufu K 27 are added for feeling of oppression in the chest. Lastly, SanYinjiao SP 6 and ShangQiu SP 5 can be used to tonify the Spleen.
TECHNIQUE:
Acupuncture treatment for deficiency-type asthma should focus on tonifying the underlying deficiency - dissolve phlegm and relieve asthma. Feishu UB 13 and Gaohuangshu UB 43 should be tonified, followed by 10 minutes of cupping. Pishu UB 20 and Shenshu UB 23 are tonified with or without moxa. Dingchuan (Soothing Asthma) should be tonified. All the remaining points should be tonified.
EAR ACUPUNCTURE
MAIN POINTS:
Dingchuan, Adrenal, Lung, Trachea, Subcortex, Endocrine and Sympathetic Nerve.
TECHNIQUE:
Three to four points are selected for each treatment. Use the strong stimulation techniques.

PREVENTION
As stated in the etiology section, the main triggering factors of asthma include invasion of the external pathogenic factors; diet, emotional disturbances, congenital weakness and chronic illnesses. Therefore, the best prevention is the avoidance of the triggering factors. External pathogenic factors such as wind-heat, wind-cold, or drastic change in temperature, may be avoided by staying home, or wearing adequate clothing when exposed. Allergens such as pollen may be avoided by wearing a facial mask. The frequency of asthma attacks will be reduced with a balanced diet; low in spicy, raw, greasy and/or sweet food. Vigorous exercise is not recommended, and patients should always warm up before exercising. In addition, they should be performing the desired activities at a slower pace. Tai-chi Qi-gong will help strengthen the body and prevent recurrent asthma attacks. In conclusion, improving the patient's cardiopulmonary fitness is the key to recovery.

CLINICAL EXPERIENCE ON TREATMENT OF ASTHMA WITH ACUPOINT INJECTION THERAPY ( AIT ):

BASIC PRESCRIPTIONS
GROUP A POINTS:
HE GU (LI4), NEI GUAN (HG6), YU JI (L10), FENG LONG (St 40), DA ZHUI (Du 14).
GROUP B POINTS:
LIE QUE (L7), FU LIU (K7), QI HAI (R6), DA ZHUI (Du 14).
CHILDREN'S POINTS:
HE GU (LI4), SI FENG (S 94), DA ZHUI (Du 14).
Group A points for acute attacks, group B points for remission treatment. When the acute condition is relieved, use group B points once or twice a week accordingly for long-term treatment.

DIFFERENTIATE THE SYMPTOM:
WIND HEAT: Da Huang Ten, Yi Xin Cao, Ban Lan Guan
SYMPTOMS AND SIGNS:
Wheezing, shortness of breath, thirst, dry mouth, red tipped tongue, thin yellow tongue coating, rapid and forceful pulse.
WIND COLD: Dan Shen, Dan Gui, Shen Mai
SYMPTOMS AND SIGNS:
Thin white phlegm, aversion to wind and cold, pale tongue with thin white coating, tight and floating pulse.
SPECIFIC ACUPUNCTURE POINTS, HERBS AND VITAMINS ARE CHOSEN TO STRENGTHEN IMMUNITY AND PREVENT ASTHMA RECURRENCE.

CASE HISTORIES: treated by acupoint injection therapy ( AIT )

Case 1 :

Male patient, 8 years old with chronic asthma.
The patient was diagnosed as an asthmatic for about 5 years. He started getting frequent attacks recently, aggravated when lying down. Having been a long-term user of Ventolin, steroids and antibiotics, he was suffering from nasal congestion, chest fullness, profuse phlegm.
SYMPTOMS AND SIGNS
Pale complexion, fatigue, coughing with white sputum, raw tongue with white greasy coating, slippery and thready pulse.
TREATMENT
Used herbs and vitamin B & C accordingly injected directly into group A points and B points for one month (a total of 15 treatments) to get asthma under control. Then he was given treatments twice a week and his drugs (Ventolin, steroids and antibiotics) were gradually reduced. His general body condition improved significantly.
After 3 months he could stop all the drugs and there were no more asthma attacks, so we reduced the treatments to once a week in order to maintain his situation for another 3 months. Later, the patient did not have to come regularly unless he got a cold. We followed up on him for 5 years.
Now he hardly even catches a cold, no asthma at all, and he is a member of the school swimming team.

Case 2 :

TREATING CHRONIC BRONCHITIS WITH AIT
Male patient, 66 years old.
Chronic bronchitis, suffering chronic cough for about 5 months, and received Western medical treatment with little result.
FIRST VISIT SIGNS AND SYMPTOMS:
A cough with small amounts of white sputum (worse at night), poor appetite, abdominal bloating after meals, loose stools (3-4 times a day), fullness of the chest, tiredness, shortness of breath, pale tongue with white coating, slippery pulse.
TCM DIAGNOSIS
Phlegm-Damp retention due to Spleen Qi Deficiency.
TREATMENT STRATEGY
First, eliminate Phlegm and promote circulation of Lung Qi to alleviate the coughing.
Then, tonify the Spleen Qi to prevent the formation of Phlegm.
TREATMENT
Da Huang Ten , Shen Mai and Vitamin B were the chosen medicine. Treated with daily injections in specific acupuncture points for one week. Stopped antibiotics. Instructed the patient to avoid chili, deep-fried and toasted food, Bar-B-Q'd food and ice cream.
RESULTS:
The patient reported his condition much improved. Cough and sputum were significantly reduced, digestion and bowel condition improved.
Reduced AIT to three times per week, then twice a week and then once a week. The patient reported that his cough stopped and other symptoms improved greatly. He felt very happy about the results after one month. After follow-up for one more month, the patient reported by phone that all symptoms had completely cleared.