Yang Guo-xiu

Department of Acupuncture, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210029, China

Experience on Treatment of Infantile Asthma by Acupuncture plus Herbal Medicine

Yang Guo-xiu

Department of Acupuncture, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210029, China

Acupuncture-moxibustion Therapy; Acupuncture Medication Combined; Cupping Therapy; Asthma; Child

Asthma is commonly termed “roaring disease”, referring to gurgling with sputum in the throat, characterized by difficult and rapid breathing. Infantile asthma belongs to a kind of bronchitis, and would occur repeatedly and become a chronic disease. Because the defending function of the respiratory system in children has not been complete and the immune system of the respiratory tract has not been matured, the hyperactive inflammatory reaction would happen, if stimulated by inducing factors of some allergen, infection or emotional depression, so as to develop dyspnea, increased secretion of phlegm, and spasm of bronchial smooth muscle, hindering the normal ventilation of air and resulting in asthma, manifested by the clinical symptoms of dyspnea, shortness of breath, unsmooth expectoration, and wheezing. In severe cases, patients may also present with cyanosis of the lips, facial puffiness and breathing with an open mouth and raised shoulders. Before each seizure, some indicating signs would occur in some patients with asthma, such as itching sensation in the nose, itching sensation in the eyelids, sneezing, lacrimation, dry cough, and sore throat, etc., caused by infection of the respiratory tract. If induced by allergy to food, there are often symptoms of vomiting, abdominal pain and urticaria. At this moment, the physical examinations should find pale and edema in the nasal mucus, slight congestion in the tonsil, and wheezing, and slight flatulence by abdominal percussion. At this moment, if proper treatment is given, the symptoms can be relieved. I treated infantile asthma patients according to their seizure and remission phases. Now, the report is given as follows.

1 Seizure Phase

When infantile asthma attacks, first there will be stuffy sensation in the chest, and then dyspnea, cough with foaming sputum, difficult expectoration, shortness of breath, panting, nose flapping, and disability to lie down in serious condition, sitting up to breathe in order to relieve panting, mental irritability, lip cyanosis, etc. According to the investigation in 2000, asthma induced by infection of the respiratory tract and allergy accounts for 90.3%. Therefore, the classification of the inducing factors would be more significant to the clinical treatment. The early seizure of infantile asthma is a mostly excessive syndrome and can be divided into two patterns.

1.1 Wind-cold pattern

Major acupoints: Lieque (LU 7), Hegu (LI 4), Waiguan (TE 5), Fenglong (ST 40), Feishu (BL 13), Fengmen (BL 12).

Adjunct acupoints: Yingxiang (LI 20) was added for clear nasal discharge; Yintang (GV 29) for headache; Xuehai (SP 10) and Sanyinjiao (SP 6)for urticaria; Feishu (BL 13) and Fengmen (BL 12) would not be used for children below 3 years old. The needles are punctured with the reducing technique. Then cupping method would be used on the back.

Herbal drugs: Together with acupuncture treatment, herbal medicine therapy would be given, i.e.Er Chen Tang, composed ofZiSu Ye(Folium Perillae),Xing Ren(Semen Armeniacae Amarum),Zhi Ban Xia(Rhizoma Pinelliae),Chen Pi(Pericarpium Citri Reticulatae),Fu Ling(Sclerotium Poria),Gan Cao(Radix Glycyrrhizae),Jie Geng(Radix Platycodi),Ma Huang(Herba Ephedrae).

Explanation: Upon contraction of wind and cold, accumulation of cold fluid in the lung, and obstruction in airway, the symptoms can be dyspnea, cough, panting, gurgling with sputum in the throat, thin and white sputum with foam, difficult expectoration, no fever, or cold or heat sensation without perspiration, no thirst, white and slippery tongue coating, floating and tense pulse. Its pathogenesis is accumulation of cold fluid in the lung, and the treatment should be designed to dispel cold, disperse the lung, stop panting and dissolve phlegm. Hegu (LI 4) and Waiguan (TE 5) are punctured to relieve the superficial symptoms and dispel cold. Lieque (LU 7), Feishu (BL 13), Fengmen (BL 12) and Fenglong (ST 40) are punctured to expel wind, relieve the superficial symptoms, stop panting and dissolve phlegm. Herbal medicine therapy is given bySan Ao Tang,Gan Jie Tang,Er Chen TangplusZi Su Ye(Folium Perillae), for the purpose to strengthen the cooperative effect of dispelling cold, disperse the lung, stop panting and dissolve phlegm. And alsoZi Su Ye(Folium Perillae) has the detoxifying and anti-allergic effects. Therefore, it is most appropriate for asthma induced by infection of exogenous pathogenic wind and cold or ingestion of shrimp and crab.

1.2 Wind-heat pattern

Major acupoints: Dazhui (GV 14), Hegu (LI 4), Chize (LU 5), Kongzui (LU 6), Danzhong (CV 17), Fenglong (ST 40).

Adjunct acupoints: Gaohuang (BL 43) and Feishu (BL 13) were added for serious panting by cupping therapy; Dazhui (GV 14) was taken out after fever declines, Shaoshang (LU 11) and Shangyang (LI 1) were added for severe feverish sensation, by pricking with three-edged needle to bleed several drops.

Operation: The acupoints are punctured with the reducing manipulation. Dazhui (GV 14) is punctured without needle retaining, without twisting, rotating, lifting and thrusting technique.

Herbal medicine: Together with acupuncture treatment, herbal medicine therapy is given, byMa Xing Shi Gan TangandXie Bai San, mainly composed ofMa Huang(Herba Ephedrae),Xing Ren(SemenArmeniacae Amarum),Sheng Shi Gao(Gypsum Fibrosum) (finely ground),Gan Cao(Radix Glycyrrhizae),Sang Bai Pi(Cortex Mori),Huang Qin(Radix Scutellariae),Jin Yin Hua(Flos Lonicerae),Bei Mu(Bulbus Fritillariae Cirrhosae),Tian Zhu Huang(Concretio Silicea Bambusae).

Explanation: Upon contraction of wind and heat, accumulation of heat fluid in the lung and failure of the lung in the cleaning and descending ability, the symptoms can be cough, panting, hoarse breathing, obvious gurgling with sputum in the throat, thick sputum with profuse foam, difficult expectoration, flushed complexion, fever without perspiration at the beginning, and then perspiration with lingering fever, thirst with preference of drinks, emotional irritability, red tongue, floating and yellow tongue coating, slippery and rapid pulse. Its pathogenesis is accumulation of heat and fluid in the lung. The treatment should be designed to clear away heat, descend lung-qi, stop panting and dissolve phlegm. Dazhui (GV 14) and Hegu (LI 4) are punctured to expel wind and reduce heat. Chize (LU 5) and Kongzui (LU 6) are punctured to descend lung-qi and stop panting. Danzhong (CV 17) and Fenglong (ST 40) are punctured to regulate qi and dissolve phlegm. In the treatment by herbal medicine,Ma Xing Shi Gan Tangis used to clear away heat and promote the lung in its cleaning ability, plusJin Yin Hua(Flos Lonicerae),Huang Qin(Radix Scutellariae) andSang Bai Pi(Cortex Mori) for strengthening the heat-clarifying, anti-inflammatory and detoxifying effects.Bei Mu(Bulbus Fritillariae Cirrhosae) andTian Zhu Huang(Concretio Siliceae Bambusae) are the important drugs for dissolving dryness and phlegm.

Besides, severe seizure of infantile asthma, if not relieved after a 24-hour routine treatment, is termed persistent seizure. If it lingers for too long time, and both deficient and excessive syndromes appear in the sick child with poor constitution, such as the critical phenomena of aggravated dyspnea, opening the mouth, raising the shoulders, emotional irritability, disability to lie down, profuse sweating, pale complexion, cyanosis, cold sensation in the four limbs, thready and fast pulse, severe hypoxia, respiratory failure, and heart failure, the sick child must be hospitalized immediately and treated with comprehensive treatment of oxygen, rehydration, anti-infective, anti-viral and anti-asthmatic measures. At the same time, Neiguan (PC 6), Ximen (PC 4), Taiyuan (LU 9), Zusanli (ST 36) are punctured and Guanyuan (CV 4) and Qihai (CV 6) are applied with moxibustion for reinforcing qi to prevent prostration. Chinese patent medicines ofSheng Mai Yin,Shen Qi Gao,Qing Kai LingandShuang Huang LianOral Liquid are selected to support the anti-pathogenic ability and dissipate pathogens.

2 Remission Phase

In the remission phase, infantile asthma is generally characterized by no obvious symptoms, with basically normal activities of daily life, food ingestion, playing and reading, but is easy to reoccur and even attacks repeatedly, leading to poor constitution and sub-health status for long time. This is because of babyish yin and yang and weak immune functions and lower anti-pathogenic ability. Therefore, it is necessary to adjust the life habit of the sick child, and offer prompt medical treatment to enhance the immune ability and anti-pathogenic ability. The application of acupuncture and herbal medicine is very importantly significant for prevention and rehabilitation of infantile asthma. Infantile asthma is mainly divided into two types of symptoms in relation with the lung deficiency and spleen deficiency in the remission phase.

2.1 Lung deficiency

Major acupoints: Gaohuang (BL 43), Feishu (BL 13), Taiyuan (LU 9), Fenglong (ST 40).

Adjunct acupoints: Yinxi (HT 6) was added for profuse perspiration.

Operation: The needles are punctured with the reinforcing technique. The acupoints on the back are applied with mild moxibustion by moxa roll or cupping method.

Herbal medicine: The herbal formula is modifiedSheng Mai YinandBai Hua Gao, composed mainly ofRen Shen(Radix Ginseng),Mai Men Dong(Radix Ophiopogonis),Wu Wei Zi(Fructus Schisandrae),Bai He(Bulbus Lilii),Kuan Dong Hua(Flos Farfarae).Hong Zao(Fructus Ziziphi Jujubae) andFu Xiao Mai(Fructus Tritici Levis) are added for profuse spontaneous sweating.

Explanation: In the remission phase of infantile asthma, those with lung deficiency would often present with sneezing, nasal obstruction, spontaneous sweating, aversion to wind, susceptible to cold, shortness of breath, low voice, lassitude, a pale tongue and white tongue coating, weak and thready pulse. The treatment is designed to reinforce the lung, benefit qi and support the body surface. Gaohuang (BL 43) is used for deficient fatigue, cough and panting. Taiyuan (LU 9) is combined with Feishu (BL 13) for reinforcing and benefiting lung qi and consolidating the body surface. Fenglong (ST 40) is used to harmonize the stomach and dissolve phlegm. Herbal formula is composed of modifiedSheng Mai YinandBai Hua Gao.Ren Shen(Radix Ginseng) is sweet and warm and used to reinforce the lung qi greatly, as a monarch drug.Mai Men Dong(Radix Ophiopogonis) is used to stop sweating, clear away heat from the heart and moisten the lung, as a minister drug.Wu Wei Zi(Fructus Schisandrae) is sour and warm and used to astringe the lung and gather the dispersing qi, as a assistant drug.Kuan Dong Hua(Flos Farfarae) is used to relieve panting and remove phlegm.Bai He(Bulbus Lilii) is used to reinforce and benefit the lung qi.

2.2 Spleen deficiency

Major acupoints: Gaohuang (BL 43), Feishu (BL 13), Zusanli (ST 36), Sanyinjiao (SP 6).

Adjunct acupoints: Applied mild moxibustion by moxa roll to Tianshu (ST 25) and Qihai (CV 6) diarrhea.

Operation: The needles are punctured with the reinforcing technique. The acupoints on the back are applied with mild moxibustion by moxa roll or cupping method.

Herbal medicine: The herbal formula is modifiedHuang Qi Bu Qi Tang, mainly composed ofHuang Qi(Radix Astragali),Fang Feng(Radix Ledebouriellae),Bai Zhu(Rhizoma Atractylodis Macrocephalae),Bai He(Bulbus Lilii),Kuan Dong Hua(Flos Farfarae).Zhi Ban Xia(Rhizoma Pinelliae praeparata) andChen Pi(Pericarpium Citri Tangerinae) are added for those with excessive phlegm.

Explanation: Infantile asthma in the remission phase is often manifested by sallow complexion, poor appetite, full sensation in the abdomen, loose stools, flabby and tender tongue, white and greasy tongue coating, soft and slow pulse. The treatment is designed to benefit qi, consolidate the body surface, strengthen the spleen and reinforce the lung. Gaohuang (BL 43) and Feishu (BL 13) are punctured to benefit qi and consolidate the body surface. Pishu (BL 20), Zusanli (ST 36) and Sanyinjiao (SP 6) are punctured to strengthen the spleen, harmonize the stomach, and assist the resource of transformation and production, for supplementing qi and blood. “If the internal healthy qi is enough, the pathogens could do nothing,” so as to prevent reoccurrence of asthma. In the treatment by herbal medicine,Huang Qi(Radix Astragali) is supposed to reinforce qi, consolidate the body surface and stop sweating.Bai Zhu(Rhizoma Atractylodis Macrocephalae) is supposed to strengthen the spleen, and reinforce the spleen for promoting the lung.Bai He(Bulbus Lilii) andKuan Dong Hua(Flos Farfarae) are supposed to replenish the lung and stop panting, often used in the cases with deficiency of both spleen and lung.

Whereas there is no eradicative therapy for infantile asthma, acupuncture therapy in combination of herbal medicine has better therapeutic effect for the treatment and prevention of asthma in the seizure phase and remission phase and needs to be popularized in the clinical application and deserves further study.

Translator: Huang Guo-qi

R246.4

B

Date: October 20, 2012

Author: Yang Guo-xiu, doctor. E-mail: shengzhong@jshtcm.com