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Student Assignment on Asthma - Chad Ryan (2015)

Chinese Medicine in Treating Asthma (Student Assignment)

Chad Ryan - 2015

Introduction

The lungs, the delicate drapes of the human trunk, are a sigh of humility with each expansion and contraction. Be it the dry air which parches the skin and saps this disperser of refined fluids of it gloss (Maciocia, 1989, pp.83-86) in a land down under, or a tormented corporeal soul which is expressing it grief (Brenner, 1999, p.277) in coping with modern life, asthma has taken on an epidemic status in the recent decades, and Australia is among those severely impinged populations. This paper will discuss asthma in the context of today, the benefits of Chinese medicine in treating asthma, and explore Chinese and Western medical techniques of treatment and diagnosis of pattern differentiated potential asthmatic syndromes.

Asthma & Wheezing

Asthma is a broad term when viewed as the set of symptoms including wheezing, difficulty breathing, chest tightness, and a persistent cough at night (National Asthma Council Australia, 2006). These symptoms become evident when the peak expiratory flow rate dips to 40-50% or less of the expected level (Young & Salzman, 2006, p.3). The narrowed airways of an asthmatic (Whiteside, 1991, p.26) may become life-threatening during an acute flare up know as an attack (Harvard Health Publications Group, 2009). Chronic asthma is a chronic inflammatory airway disease, involving bronchospasm and reversible bronchial obstruction (Martinez & Vercelli, 2013). Defined originally to mean “difficulty breathing” due to any cause, and including such systemic causes as cardiac asthma due to edema of the left ventricle and pulmonary congestion; the modern notion of asthma does denote bronchial cause of difficulty in breathing (Stedman’s Medical Dictionary, 1976, p.133).

Wheezing is a type of breathlessness being due to a reduced lung capacity because of phlegm in the lungs (Maciocia, 2004, pp.544-545). It is closely associated to asthma, but is more readily tangible in definition (Martinez & Vercelli, 2013), so a review of asthma in Chinese medicine might start by tracing a review of wheezing. Wheezing is a resonating whistle heard on exhalation, the airflow frequency and intensity being higher in asthmatics than normal individuals (Habukawa et al., 2014, pp.5-6).

Qì with Yīn Deficiency Type Wheeze

The quintessential depiction of a wheeze, as it can distinguishably be heard and felt, is the dry fatigued lung of lung qì and yīn deficiency. Long-term lung disease, or prolonged use of zōng qì dispersing or depleting medications, can result in lung qì and yīn deficiency. Shēng mài săn is used to nourish and tonify lung qì and yīn, while redirecting lung qì downwards and stopping wheezing (Chen,1998).

Smoking and steroids are particularly consuming of yīn, and after years of use count among the classic aetiologies for lung and kidney yin deficiency. bái hé gù jīn tāng prioritises its effect towards nourishing and moistening the lung yīn, while clearing heat and ceasing wheeze (馬, 2011, pp.1-2).

Yáng Deficiency Type Wheeze

Kidney yáng is important for respiration on three levels. It roots qì of the lungs, ensuring deep respiration; it is the most persistent force safeguarding fluid metabolism, with special importance in the lung for preventing pleural edema; and it the source of generation for the body’s defensive aspect, providing against infection. Jīn kuì shèn qì wán deals with kidney yang type wheeze by consolidating kidney yang and the defensive qì. Should kidney yáng malfunction, allowing congestion of fluids in the lung to become severe, zhēn wŭ tāng is the preferable formula (Mclean & Lyttleton, 1998, pp.150-152).

An alternative yáng type wheeze is a combined lung and spleen qì deficiency, as commonly seen in the inherently weak, or in those who have been exposed to and treated for recurrent upper respiratory tract or ear infections. Bŭ zhōng yì qì tāng strengthens lung and spleen qì, consolidates wèi qì, and stops wheeze (Mclean & Lyttleton, 1998, p.144).

Phlegm Fluids Type Wheeze

Unhealthy diets and upper respiratory tracts infections like sinusitis, tonsillitis and bronchitis may have a say in wheezing due to phlegm fluids. To stop this wheeze by processing phlegm, and to dry dampness for a strengthened spleen, there is the combination of sān zĭ yăng qīn tāng plus èr chèn tāng (Maclean & Lyttleton, 1998, p.132). Type-specific alterations for wheeze due to phlegm damp accumulation include sū zĭ jiàng qì tāng for a recurrent form backed by weak kidneys (Maclean & Lyttleton, 1998, p.133) and liù jūn zĭ tāng when spleen qì damage is involved (Chen, 1998).

Phlegm fluids may cause obstruction which generates heat, leading to a temporary condition of a phlegm-heat type wheeze. Má xìng shí gān tāng clears heat while expelling phlegm, and stops wheezing by redirecting lung qì downwards (Mclean & Lyttleton, 1998, p.135).

Stagnation of Smooth-Flow Type Wheeze

When the natural direction of qì flow is knotted and warped, often emotionally so, the lung qì becomes constricted, and the breath petty. Wŭ mó yĭn zĭ courses liver and lung qì according to their natural directions to stop wheeze (Maclean & Lyttleton, 1998, p.138).

Cough Variant Asthma

Cough is a common complication to be addressed in asthma, and in ‘cough variant asthma’ it is reputably the only expression. It was investigated by Niimi et al. (2000, pp.564-545) that sub-epithelial thickening of the airway occurring in cough variant asthma occurs to the extent of more than half the width of the classical asthmatic airway. This dry, non-productive state (Flaws, 2015, p.120) is later stage stagnation of pathogenic factors in the lung, and requires nourishing of lung yin, which may be achieved with qīng zào jiù fèi tāng (Miao et al., 2013, pp1-2).

Treatment Approach

The character of chronic asthma with acute exacerbations is one which grips tightly when provoked, but which leaves a victim in relative ease during the extended times between episodes. Likewise, the treatment is well adapted when containing a two-handed approach: that for the acute attacks, for urgent focus on the branch; and that which is allowed for by stability of symptoms, that goes back to the root for a long term solution. A nine day treatment course of rotational sets of points, using date seed sized moxibustion cones on thick ginger slices when cold is involved, when backed by seasonal reinforcing treatment may be enough to cure chronic asthma without relapse (Lou Bai-Ceng treats asthma, 2013, p.53).

Life Threatening Asthma

When an individual suffers from a sudden and intensified flare up of asthma they may be sweating, with a rapid pulse, flared nostrils, pursed lips, cyanosis of the lips and fingernails, along with the need to sit upright (Harvard Health Publications Group, 2009). In paediatrics, look for confusion, a silent chest with poor respiratory effort, hypotension and exhaustion as signs of a severe attack (Brough & Ram, 2011, p.14). The prospectively allergy stimulated symptoms of the most critical asthma attacks should be differentiated from pneumothorax, chronic obstructive pulmonary disease, pulmonary embolism, ischemic heart disease, congestive heart failure, epiglottis, upper airway obstruction, and vocal chord dysfunction (Young & Salzman, 2006, p.2).

Treating Acute Asthma with Chinese Medicine

The lungs are chiefly able to be invaded by cold, of which they are thoroughly unappreciative (Maciocia, 1989, p.87). To be dispersive, the lungs are designed to be expansive, but cold constricts, and so bridles lung qì descent. Má huáng tāng is the traditional herbal response to an invasion of wind cold (Maclean & Lyttleton, 1998, p.122), although pre-existing fluid congestion or internal heat in an acute wind cold attack are more aptly relieved with the respective formulas of xiăo qīng lóng tāng (馬 , 2011, p.7) and dìng chuăn tāng (Maclean & Lyttleton, 1998, p.126).

Wind heat can also attack the lungs causing acute asthma, whereby sāng jú yĭn is the formula of choice (Mclean & Lyttleton, 1998, p128). If the wheezing symptoms overshadow heat symptoms, má xìng shí gān tāng becomes the prudent choice (馬 , 2011, p.3). Should the lungs be yīn deficient when wind heat strikes, qīng zào jiù fèi tāng should be most helpful (Maclean & Lyttleton, 1998, p.129).

Dìng chuān, tiān tú and kŏng zuì are acupuncture points available in an asthmatic emergency. Dìng chuān is great for the lung as an organ susceptible to exterior harassment (Deadman & Al-Khafaji, 2007, p.572). When stimulated correctly, it radiates to the back of the throat, the purpose being to settle wheeze and qì rebellion (Lou Bai-Ceng treats asthma, 2013, p.53). Tiān tú is good for subduing rebellion and for phlegm in the throat (Deadman & Al-Khafaji, 2007, p.522). Kŏng zuì is moistening, and as cleft point of the lung distributes a hefty kick of qì to tackle an acute pathogenic blow (Deadman & Al-Khafaji, 2007, p.572). Other individually indicated acupoints hé gŭ and liè quē, if both needled using a strong reducing method allowing sensation to reach the thumb and forefinger, may dredge and disseminate the flow of lung and large intestine qì to lift the clear and direct down the turbid (Lou Bai-Ceng treats asthma, 2013, p.53).

Herbal Substitutions and Additions

Fù zǐ from zhēn wŭ tāng and shèn qì wán, xì xīn from xiăo qīng lóng tāng, as well as má huáng from má huáng tāng, dìng chuăn tāng, xiăo qīng lóng tāng and má xìng shí gān tāng are currently restricted from use in meaningful quantity in Australia (Chinese Medicine Board of Australia, 2012, pp.1, 7). The brilliance má huáng’s diaphoretic, surface-resolving, lung-ventilating, water metabolising can be but partial imitated by several herbs like jié gĕng, hòu pò and bái jiè zǐ (Dharmananda, 2000). Má huáng, fù zǐ, and xì xīn are all warm herbs which disperse the exterior, so actually share common viable substitutes such as jiāng, zĭ sū yè, guì zhī, and bái zhǐ depending on the adjunctive role wished to be emphasised most. On the other hand, if it is though better to maintain synergy, an entirely different formula may be substituted (Bensky et al., 2004, pp.3-12, 24-30, 673, 682), such as guì zhī jiā hòu pò xìng zĭ tāng for xiăo qīng lóng tāng in cases of wheezing due to wind cold invasion combined with pre-existent damp (李 et al. 2002, p.167). Fù zǐ is especially replaceable by ròu guì due to a likeness of providing internal warmth (Bensky et al, 2004, p.684). Wǔ wèi zi and wū méi are herbs with a universal role in maintaining lung function when allergens cause distress. While the lungs are not fond of constraint, they do favour restraint for the purpose of quietening rebellion, as is the function of sour restraining herbs (Bensky, 2004, pp.860-864).

Biomedical Approach

Western medical responses to asthma are broken into two categories: controller medications to work preventatively, and quick relief medications to be used when an attack is underway. The most prominent types of asthma medications in biomedicine are salbutamol and corticosteroids (MacLean & Lyttleton, 2000, p.155). These affect beta-adrenergic receptors in the lung, adrenergic receptors being hormones or neurotransmitters normally reacting in response to epinephrine, which is adrenaline, to affect muscles or organs (Furchgott, 1972, Abstract); and the beta subtype being those which cause smooth muscle relaxation upon activation (Scheid et al., 1979, Abstract). The catecholamines epinephrine and norepinephrine are constituents of má huáng (Bensky et al. 2004, p.8), which explains on another level the potent effectiveness of this classic ingredient for Chinese medicine asthmatic formulas (Stadel & Lefkowitz, 1991, Abstract).

Short acting beta2 agonists asthma relievers like Salbutamol may be prescribed before exercise (National Asthma Council Australia, 2006, p.38), but these such bronchodilators are importantly not taken as a general preventative measurement, because the body reacts to expanded bronchotubes by producing phlegm to reduce carbon dioxide losses which remains in the lung upon re-constriction (Stalmatski, 1997, p.65). Corticosteroids are controllers, increasing the synthesis of receptors, and having a multitude of secondary effects to relieve acute asthma (Townley & Suliaman, 1987). Cromolyn-based anti-inflammatory preventer medication may be quite safely inhaled, regularly as a dry powder, in a more initial line of prevention to decrease the number and severity of attacks (Whiteside, 1991, p.35).

Corticosteroids have vast natural effects throughout the body (Townley & Suliaman, 1987), and dosage is recommended not to exceed the minimum effective level (National Asthma Council Australia, 2006, pp.26), however steroid inhalers are not absorbed like oxygen by the rest of the body outside the lungs, so oral thrush, a sore dry throat and skin bruises figure among the main symptoms (Korsgaard & Ledit, 2009). The possible side effects which salbutamol may induce, of a sympathomimetic tachycardia, pounding heart, tremor and anxiety, are generally absent when the dose is normal (Barisone et al., 2010, p.12). Salbutamol scatters zōng qì which may have be congested to allow for temporary clarity, however the state of lung qì is gradually diminished as a result. Corticosteroids scatter qì too, but they also scatter lung yīn and activate primordial yáng. The retardation of response to alternative treatment is thus confounded further with corticosteroid use, as it gives pretext to the arrival of a stubborn kidney and lung yīn deficiency (MacLean & Lyttleton, 2000, p.155).

Epidemiology & Paediatric Asthma

Asthma became astoundingly rife in the latter half of the 20th century (European Lung White Book, 2012), and is now the most common chronic disease in childhood (European Lung White Book, 2012), 25% of whom it affects, compared to 10% of adults (Maclean & Lyttleton, 2000, p.157). Current trends of asthma among children tend to be more prevalent and less severe in more affluent countries (Lai et al, 2015, p.476). The outstanding rule for treating children with any asthma category is to reduce phlegm from the diet (McLean & Lyttleton, 2000, p.157). Behave calmly towards the child suffering an attack and in a state involving tachypnoea (Brough & Ram, 2011, p.14), difficulty eating or drinking, vomiting, or sensation of a frog in the throat, while undertaking required procedures, which include direct transport to a hospital when signs such as inability to speak a sentence in a single breath and reliever medication appearing less effectual than normal emerge (Asthma Australia, n.d.).

Breathing & Self-Initiated Asthma Prevention

The association of breathing is central to internal qì gōng and the enhancement of health (Jahnke et al., 2009, pp.7-8), where productive results in treatment of asthma have resulted (Sancier & Holman, 2004, p.5). A Russian medical scientist named professor Buteyko hypothesises that due to the necessity of carbon dioxide in the body’s uptake of oxygen, hyperventilation causes less oxygen to reach the body's cells. He found that all hyperventilating asthmatics recovered from asthma and associated bronchospasm, inflammation and mucus once they made their breathing regular (Stalmatski, 1997, pp.9-10, 53-55). It is also postulated by Frederick Alexander in the 1890s that postural tension is associated with poor chest expansion capable of triggering asthma attacks. Hypnosis and relaxation are methods to improve and regulate breathing and tension in posture. Homeopathic techniques may also warrant consideration (Whiteside, 1991, pp.57-66).

Conclusion

The most life threatening of acute asthmatic attacks can be treated to complete recovery in minutes in the modern age, while chronic asthma can be improved, and permanently relieved, when gentle and patient techniques are acknowledged. The techniques required for treating acute and chronic asthma are relatively non-interchangeable, but appropriate action exists for every level of severity, and as a reversibly-defined condition is always associated with hope for improvement.

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