Treatment of TCM Bronchial Asthma

Bronchial Asthma

Bronchial asthma is a paroxysmal allergic pulmonary disease. The attack is usually induced by the inhalation of or contact with allergens, such as pollens, dusts, insects (e.g. mite), germs, etc. During the attack, there appears severe dyspnea which is due to the spasm of bronchial smooth muscles, the swelling of bronchial mucosa, and the hypersecretion of the mucus, thus the bronchial obstruction. When the attack can not be relieved for a long time, it is the so-called “status asthmaticus''. The disease often occurs in children and youngsters. In TCM, it is classified to the categories of “Xiao'' (bronchial wheezing) and “Chuan'' (asthma).

Key Points of Diagnosis

l. Attention should be paid to the individual and family history of allergy. For those with the history of allergic rhinitis or urticaria, the diagnosis is easy to be made.

2. The onset is abrupt and frequently occurs at night. Usually patients feel all of sudden the stuffiness in chest and dyspnea, and orthopnea becomes necessary. The attack could last from several minutes to several hours. At the time, on auscultation, typical wheezes can be heard over the lung fields and moist rales may be present if pulmonary infection coexists. When the attack is finished there is frequently associated by a cough with profuse mucoid sputum.

3. The status asthmaticus: In some cases the acute attack may persist for a long time (over 24 hours), or it can not be relieved by various medicaments, so there appear severe dyspnea, associated with profuse sweating, pallor, cyanosis, tachycardia and cold extremities. Respiratory failure occurs in critical cases, and it is quite lethal without timely treatment.

4.Laboratory examinations: The cosinophilic leukocyte count may increase markedly during the attack, up to 5---15 percent or more in differential count. Sputum examination could reveal more eosinopilic leukocytes and rhomboid crystals. In serum immunological examination, the increased IgE could be found. Skin test for specific antigens is helpful to find the allergic agent, but the provocative allergic test is probably associated with potential danger of inducing the asthmatic attack. Therefore, it should be performed with caution.

Syndrome Differentiation

l. Cold syndrome

Chief Symptoms and Signs: There are manifestations of fullness and stuffiness in the chest, dyspnea with wheezing in the throat, and cough with thin sputum, frequently occurring in cold seasons or caused by exposure to cold. The tongue coating is white and slippery and the pulse is wiry and tense.

Treating Principle: To regain the dispersion of lung Qi by expelling the pathogenic cold, and eliminate phlegm to relieve asthma.

Formula: “Shegan Mahuang Tang (Belamcanda and Ephedra Decoction)”(modified):

belamcanda rhizome 10g, ephedra 10g, asarum herb 3g , pinellia tuber 10g, schisandra fruit 6g, aster root 12g, coltsfoot flower 12g, fresh ginger 10g, Chinese-date 5 pieces, bitter apricot kernel 10g, and perilla fruit 10g.

All the above materials are decocted in water for oral administration.

When to treat the remarkable chills, 10 grams of cinnamon twig are added.

When to treat very severe asthma 10 grams of both lepidium seed and earthworm are combined.

This syndrome also responds well to the formula of “Xiao Qing Long Tang (Minor Decoction of Green Dragon)”

2.Heat syndrome

Chief Symptoms and Signs: Dyspnea with wheezing, irritability and pressure in the chest, even gasping for breath, yellow and sticky sputum, thirst, frequent occurrence in hot seasons or whenever in heat environment, red tongue with yellow-sticky tongue coating, and rolling-rapid pulse.

Treating Principle: To remove phlegm-heat and renormalize the dispersion of lung Qi for relieving asthma.

Formula: the combination of “Ma Xing Shi Gan (Decoction of Ephedra, Apricot Kernel, Gypsum and Licorice)” and “San Zi Yang Qin Tang (Decoction Consisting of Three Seeds for the Aged)”(modified):

Ephedra 10g, bitter apricot kernel 10g, gypsum 30g, licorice root 6g, perilla fruit 10g, lepidium seed 10g, earthworm 12g, mulberry bark12g, trichosanthes seed 18g, and Sichuan fritillary bulb 10g.

All the above materials are decocted in water for oral administration. When there appears profuse perspiration, ephedra should be excluded. When there runs fever 30 grams of honeysuckle flower are added. When there is thick and yellow expectoration 18 grams of clamshell powder and 15 grams of glehnia root are combined.

When to treat dyspnea gasping for breath, 6 grams of eagle wood and 10 grams of magnolia bark are supplemented.

3.Dedciency syndrome

Chief Symptoms and Signs: Chronic and recurrent attacks, mild and persistent gasp at ordinary time, low and weak cough, palpitation and shortness of breath, spontaneous sweating, aversion to wind, general debility and lassitude, pale tongue with little coating, and deep thready and weak pulse.

Treating Principle: To tonify the lung and spleen and strengthen the inhalating capacity for relieving asthma.

Formula: “Renshen Gejie San (Powder of Ginseng and Gecko)” (supplemented):

Ginseng 10g, gecko 3g (ground and taken after being infused in the finished decoction), walnut kerne 15g, ophiopogon root 10g, schisandra fruit 10g, astragalus root 12g, cordyceps 12g, lily bulb l5g, poria 12g, red tangerine peel l2g, and prepared licorice root 6g.

All the above materials except gecko are decocted in water for oral administration.

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