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. 2018 Apr 1;30(2):100–112. doi: 10.1089/acu.2018.29078.cpl

How Do You Treat Asthma in Your Practice?

PMCID: PMC6011376  PMID: 29937957

Asthma, from the Greek word Aazein, means “to pant.” Corpus Hippocraticum (460 – 360 bc) is the earliest text where asthma is found as a medical term.1

In 2015, 358 million people globally had asthma.2 About 25 million Americans have asthma. This is 7.6% of adults and 8.4% of children.3 It is more common in boys than in girls.3 Prevalence of asthma is more common among Puerto Rican patients than among any other ethnic group.4

Asthma is characterized by recurrent shortness of breath, wheezing, or coughing caused by reversible bronchoconstriction. Thickening of air passages and blockage by mucus also contribute. Although asthma is classified as intrinsic (nonallergic) and extrinsic (allergic), the treatment is very similar in both varieties.

Mild cases have normal respiratory function between attacks.

Investigations include a chest X-ray to rule out other pulmonary disorders; measurements of ventilatory functions—forced expiratory volume in 1 second(FEV1) and peak expiratory flow rate (PEFR)—several times per day; and the patient's response to bronchodilators. Variability through the day with a morning dip in PEFR is diagnostic. Skin allergy testing can help avoid aggravating factors in some cases.

Asthma in Chinese Medicine

Chinese Medicine uses the term Xiao-Chuan to describe asthma. Xiao is wheezing, Chuan is breathlessness, and they often go together. In the healthy state, the Lung Qi moves downward and the Kidneys holds it down. Lungs control inhalation and the Kidneys control exhalation. Liver Qi normally ascends and the upward direction of the Liver Qi and downward direction of Lung Qi are usually coordinated. When the descending of the Lung Qi is defective, due to Lung Qi Deficiency or Kidney Deficiency (failure to receive the descending Lung Qi), or obstructed by the ascending Excessive Liver Qi (Liver Yang Rising) or obstructed by Phlegm (Spleen Deficiency) or Wind, asthma results. In Xiao Chuan, Phlegm is central to its pathology. In atopic asthma (extrinsic) Phlegm is not a factor and the wheezing is caused by bronchoconstriction produced by the Wind. This is not the usual external or internal Wind; it is a Wind that is persistently lodged in the air passages and produces bronchospasms when the patient is exposed to allergens, cold weather, or emotional stress. Deficiencies of both Lungs and Kidneys are involved.

Treatment

In acute attacks, the aim is to relieve symptoms. When the symptoms are relieved, the pathology can be targeted.

In very severe attacks of asthma, Western medicine treatment is recommended.

A basic combination for all types of asthma would be CV 22 (the most important point), Ding Chuan (Extra Point 0.5 cun lateral to GV 14), CV 17 (Influential Point for respiratory system), BL 13 (Back Shu Point of the Lung), LU 6 (Xi-Cleft Point of the Lung), PC 6 (Distal Point for chest disorders), ST 40 (point for Phlegm)—all are reduced, and KI 3 (Source Point for Kidney)—which is reinforced. One should acquire proficiency in the technique of needle insertion at CV 22.

KI 7 is the Tonification Point of the Kidney. In Excess conditions of the Lung (see Table 1) reinforcing KI 7 will reinforce the Kidney, which is often Deficient in asthma. Because of the fact that Lung is the Mother of Kidney in the Five Element Cycle, such a stimulation will cause the Excess of the Lung being sucked by the Son Kidney—a win–win situation. That is, the Deficient Kidney is reinforced and the Lung Excess is reduced. So too, stimulation of LU 7 and KI 6, in that order, by the reduction method will open the CV channel and that would help in normalizing the Kidney and Lung.

Table 1.

Signs, Symptoms, Diagnosis and Treatment of Chinese Syndromes Associated with Asthma

  Excess patterns    
Pathology Symptoms Tongue/pulse Points Herbs
Invasion of Lungs by Wind Cold Rapid breathing, aversion to cold, lack of perspiration & white phlegm T—Thin white coating Reduce LU 5, LU 7, BL 12, BL 13 & Ding Chuan Ma Huang Tang—Ephedra Decoction
P—Floating
Phlegm Heat in Lungs Rapid breathing, aversion to heat, perspiration & yellow phlegm T—Yellow coat Reduce BL 13, LU 5, ST 40, LI 4, CV 22 Ding Chuan, LI 11& LU 7 Qing Qi Hua Tang—Clearing Qi and resolving Phlegm Decoction
P—Slippery, rapid
  Deficiency patterns    
Lung Qi Deficiency Shortness of breath, cough, daytime sweating, catch colds easily & aversion to cold T—Pale Reinforce Ding Chuan, BL 13, BL 47, ST 36, LU 9, LU 7, DU 12 & CV 15 & Moxa. Ren Shen Bu Fei Tan—Ginseng Tonifying the Lungs Decoction
P—Empty Rt front position
Lung Yin Deficiency Scanty sputum, dry mouth and throat, night sweating & dry cough T—Red, peeling coat Reinforce Ding Chuan, BL 13, BL 43, LU 9, KI 6, BL 38, CV 4, SP 6 & LU 10. Yang Yin Quing Fei Tang—Nourishing Yin and Clearing the Lung Decoction
P—Rapid, thread
Spleen Qi Deficiency Slight abdominal distension, tiredness, weakness of limbs, loose stools & tending toward obesity T—Pale Reinforce CV 12, SP 6, SP 3, ST 36, BL 20, BL 21 & Ding Chuan Liu Jun Zi Tang—Six Gentleman Decoction
P—Empty
Kidney Yang Deficiency Lower back pain, coldness, lassitude, edema in the legs & impotence T—Pale, wet Reinforce BL 23, KI 3, GV 4 & CV 4 You Gui Wan—Restoring the Right Kidney Pill
P—Deep, weak Kidney pulse
  Combined Excess and Deficiency patterns    
Liver Yang Rising due to Liver Yin/Blood Deficiency Throbbing headache, dizziness, numbness of limbs, blurred vision, muscular weakness, cramps & withered nails T—No coating & red in Yin Deficiency, Pale in Blood Deficiency Reduce TB 5, PC 6, LI 4, GB 43, GB 38 Tian Ma Gou Teng Yin—Gastrodia uncaria Decoction
P—Wiry Reinforce SP 6, LR 8, ST 36 & KI 3.
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Signs and Symptoms shown in bold indicate the diagnosis.

P, Pulse; T, Tongue; Rt, right.

Some patients might feel tired with the above combination of points; in such cases, BL 13 may be omitted. The same combination can be used in late summer as a preventative for expected asthma in autumn and winter.

Medical acupuncturists who prefer to use the same group of points in all cases can use the above combination.

If the Chinese Disharmony Patterns are treated with a view toward reducing recurrences—and this is the preferred method for the current author—the details given in Table 1 can be followed.

Auricular points

These are generally used during the asthma attack.

The most important points are Lung 1, Lung 2, Kidney C, Adrenal Gland C, Sympathetic Autonomic Point, and Stop Wheezing point.

Other points include Antihistamine, Bronchi, Point Zero, Shen Men, Allergy Point, Apex of the Ear, Tranquilizer Point, Master Cerebral, Spleen C, Occiput, Spleen E and Psychosomatic Reactions 1. Select 3–4 points for each treatment using point locator or tenderness.

Evidence for acupuncture

The evidence for acupuncture in the treatment of asthma includes the following studies:

  • (1) In patients with acute bronchospasm, acupuncture resulted in increase of PEFR and FEV1.5

  • (2) Acupuncture stimulation resulted in reduction of immunoglobulin E levels in patients with asthma.6

  • (3) Acupuncture stimulation was followed by increased levels of cluster of differentiation (CD) 4 + and interleukin (IL) 8, and reduced levels of IL 6, IL 10, and eosinophils.7

  • (4) Jobst et al. reviewed 16 reports on the efficacy of acupuncture in asthma. In 10 studies, acupuncture was found to be better than placebo and sham acupuncture, whereas 6 studies showed no difference.8

  • (5) In another review by Lewith and Watkins, 9 of the 10 trials showed positive short-term improvement of lung function and subsequent reduction in the use of medication after acupuncture.9

  • (6) A Cochrane database review did not find enough evidence to recommend acupuncture treatment for asthma, due to the inadequate quality in the studies.10

  • (7) Patients with chronic obstructive asthma experienced clinically significant improvement in quality of life when their standard care was supplemented by acupuncture or acupressure. 11

  • (8) A double-blinded randomized study in 23 nonsmoking asthmatics found that there was significant improvement in the patient's quality of life and reduction in the use of bronchodilators after acupuncture, but these benefits were not supported by improvement in respiratory function.12

Case

Three illustrative cases were published by the current author in an earlier issue of this journal.13 One of them is included here for the reader's convenience.

A 4-year-old girl had a recurring wheeze (about once per week as recorded by her mother) for ∼3 years. She was prescribed a salbutamol inhaler to use when needed, budesonide twice daily, and, on occasion, oral prednisolone. This patient had a tendency to catch colds and was treated in the emergency department (ED) of a public hospital on several occasions for recurrent wheezing. Between these episodes, her chest examination results were clear. Her tongue was pale and her pulse was empty, especially in the right front position (Lung). There was no family history of asthma. This was a case of recurrent wheezing caused by Lung Qi Deficiency. A slight shortness of breath and an empty Lung pulse were sufficient to make this diagnosis.

The following points were used:

  • • LU 9—Source point

  • • LU 7—Connecting point

  • • BL 13—Back Shu point

  • • CV 6—to tonify Qi

  • • GV 12—to tonify Lung Qi

  • • ST 36 and CV 12—to tonify Stomach and Spleen, respectively (thus tonifying Earth to nourish Metal).

It is the author's practice to support acupuncture treatments with homeopathic dilutions of mineral salts, calcium phosphate, and natrum sulfate (30 c) at twice-weekly intervals in all cases of wheezing. This helps reduce the number and duration of acupuncture treatments. In severe cases acupuncture treatments are used on alternate days.

This patient was treated twice weekly with acupuncture for 2 months and then monthly for 1 year. The inhalers were gradually withdrawn and she had no further wheezing episodes. During the first 2 months of treatment, she had one additional ED visit.

It has been the experience of the author that, while most patients respond favorably, children respond far better than adults do as far as long-term improvements are concerned; and this is especially so when acupuncture was supported by nutritional supplements as described. It is often said that many children will outgrow asthma. This is an optimistic statement: Children with severe asthma are very unlikely to outgrow it. Many cases labeled as asthma in children are actually asthmalike syndromes (bronchitis, bronchiolitis, etc.) and these are the patients who tend to outgrow these conditions.14

The positive effects of those nutritional supplements to acupuncture in children cannot be overemphasized; these beneficial effects have not been observed in adults.

References

  • 1.MedicalNewsToday.com Asthma History Through Ages. Online document at: www.medicalnewstoday.com Accessed November15, 2018
  • 2.GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional and national incidence, prevalence and years lived with a disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545–1602 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Asthma and Allergy Foundation of America. Asthma Facts and Figures. Online document at: www.aafa.org/page>asthma-facts.aspx Accessed November18, 2017
  • 4.United States Environmental Protection Agency. Asthma. Online document at: www.epa.gov/asthma Accessed November18, 2017
  • 5.Virsik KP, Kristulek P, Bangha O, Urban Š. The effect of acupuncture on pulmonary function in bronchial asthma. In: Herzog H, Empey DW, Matthys H, Perruchoud A, Widdicombe JG, eds. Progress in Respiration Research, vol. 14 1980;14:271–275. [from Asthma: International Congress on Respiratory Diseases, Basel, October 1979; 6th General Meeting of the European Society for Clinical Respiratory Physiology (SEPCR)] [Google Scholar]
  • 6.Christensen PA, Laursen LC, Taudorf E, Sørensen SC, Weeke B. Acupuncture and bronchial asthma. Allergy. 1984;39(5):379–385 [DOI] [PubMed] [Google Scholar]
  • 7.Joos S, Schott C, Zou H, Daniel V, Martin E. Immunomodulatory effect of acupuncture in the treatment of allergic asthma: A randomized controlled study. J Altern Complement Med. 2000;6(6);519–525 [DOI] [PubMed] [Google Scholar]
  • 8.Jobst KA. A critical analysis of acupuncture in pulmonary disease, efficacy and safety of the acupuncture needle. J Altern Complement Med. 1995;1(1):57–85 [DOI] [PubMed] [Google Scholar]
  • 9.Lewith GT, Watkins AD. Unconventional therapies in asthma: An overview. Allergy. 1996;51(11);761–769 [PubMed] [Google Scholar]
  • 10.McCarney RW, Brinkaus B, Lasserson TJ, Linde K. Acupuncture for chronic asthma. Cochrane Database Syst Rev. 2004;1:CD000008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Maa SH, Sun MF, Hsu KH, et al. Effect of acupuncture or acupressure on quality of life of patients with chronic obstructive asthma: A pilot study. J Altern Complement Med. 2003;9(5):659–670 [DOI] [PubMed] [Google Scholar]
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  • 13.Sudhakaran P. Preschool wheezing: An acupuncture approach. Med Acupunct. 2015;27(6):447–452 [Google Scholar]
  • 14.MayoClinic.org Will My Child Outgrow Asthma? Online document at: https://www.mayoclinic.org/diseases-conditions/childhood-asthma/expert-answers/outgrow-asthma/faq-20058116 Accessed on November21, 2017
Med Acupunct. 2018 Apr 1;30(2):100–112. doi: 10.1089/acu.2018.29078.cpl

Article

Some years ago, while working with the respiratory department of a university hospital in the East of England, I investigated which acupuncture points are traditionally noted as acting on the respiratory system. I was amazed to find more than 80! My textbooks showed that all points on the Lung meridian were included, but also most of the Kidney, Stomach, and Spleen points on the anterior chest wall, together with Bladder points on the posterior wall and a couple each of Gall Bladder, Liver, Pericardium, and Small Intestine points laterally. All the thoracic Conception Vessel, Governing Vessel, and Huatuojiaji points have a respiratory relationship, as do the Extra point Dingchuan and a few distant points, such as KI 3 and KI 4, and ST 36 and 40.

This offered such a wide choice of points that I needed some method of narrowing the field. I therefore searched PubMed for trials of acupuncture for respiratory disease. I inspected each report and noted which acupuncture points were used, paying particular attention to trials that had recorded positive outcomes for patients who had received acupuncture. This gave a clear consensus for points regularly and effectively used in the treatment of asthma.

Included in the protocol of almost every research group were: the Lung Back-Shu point BL 13; CV 17; and Dingchuan, occasionally with GV 14. Generally, a Lung point was used, of which LU 7 was popular, and often a distant point, such as KI 3 or ST 36. The general anti-inflammatory point LI 4, sometimes with LI 11, was commonly used, and also SP 6. Other points featured included ST 40, BL 17, GV 20, and various Conception Vessel points.

Starting with the frequently used points, my approach, after history and examination, is to find the prominent—and usually easily identified—spine of C-7. I insert a needle at GV 14, just inferior to this bony prominence. This acts as a marker to place needles 0.5 cun on each side, at Dingchuan. I then run a finger down the back, counting spines to the lower border of the spinous process of T-3. I insert needles on both sides of this at BL 13.

Anteriorly, CV 17 is the Qi Influential Point. It is also where a sternal anomaly occurs in roughly 6% of the population. This is a foramen in the midline, directly over the heart. It is essential, therefore, to needle horizontally under the skin, given that fatal cardiac tamponade has been reported from inadvertently traversing the foramen and puncturing the heart.1 To avoid puncturing the lung, needles of 2 cm or less should be used at all chest points.

These points I use as standard, adding points related to the type or cause of the asthma. During acute exacerbation, or exercise induced asthma, I add LU 7 unilaterally, especially if there is associated coughing. If the acute attack has been caused by—or results in—chest infection, I use LU 7 on one side and LI 4 on the other. When the asthma has a significant allergic element, I use both LI 4 and 11. In obese and late-onset patients, ST 36 may be of benefit, particularly as these patients often have comorbid knee osteoarthritis.

Anxiety and stress is a feature for some patients, so the antianxiety point GV 20 may help. Some patients develop abdominal breathing. I use the diaphragm points BL 17, but try to teach these patients better breathing habits. It is worth checking the accessory muscles of respiration for trigger points, notably the sternocleidomastoid, scalene, and pectoralis muscles.2

I start a treatment course with manual stimulation, but may progress to using electroacupuncture at 2/100 Hz to the BL 13 pair, and LI 4 and LI 11. Sessions are twice per week, reducing to weekly, and then maintenance once a month, if the patient feels this is beneficial. However, standard medical treatment must remain the appropriate basic care for both acute and chronic asthma, although the addition of acupuncture may provide some improvement in symptoms and quality of life, with possibly reduced hospital admissions. The Cochrane review did not recommend acupuncture for asthma, as the trials available were too small and unreliable.3 Thus, I offer acupuncture only to patients who are poorly stabilized on conventional medication.

Asthma is notoriously placebo-responsive, so this could be part of the mechanism, but the calming effects of acupuncture's general boost of serotonin, endorphins and oxytocin is likely to help. Of particular relevance to asthma, there is increased production of adrenocorticotropic hormone and catecholamines, together with inhibition of histamine release.4 More specifically: the point BL 13 is over the sympathetic ganglion at T-3, so this should have a bronchodilatory effect, and “asthmatic” rat experiments have shown reductions in the inflammatory cytokines interleukin (IL) 6 and IL 10, together with inducing lymphocyte proliferation and reduced eosinophil counts, all of which is suggestive of autonomic modulation of the immune system.5

References

  • 1.Ernst E, Zhang J. Cardiac tamponade caused by acupuncture: A review of the literature. Int J Cardiol. 2011;149(3):287–289 [DOI] [PubMed] [Google Scholar]
  • 2.Simons DG, Travell JG, Simons LS. Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual, vol. 1: Upper Half of Body, 2nd ed Baltimore: Lippincott Williams & Wilkins; 1998 [Google Scholar]
  • 3.McCarney RW, Brinkhaus B, Lasserson TJ, Linde K. Acupuncture for chronic asthma. Cochrane Database Syst Rev. 2004;1:CD000008 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Hayhoe S. Effects of acupuncture in bronchial asthma. J R Soc Med. 1982;75(11):917. [PMC free article] [PubMed] [Google Scholar]
  • 5.White A. Acupuncture for respiratory conditions. In: Filshie J, White A, Cummings M, eds. Medical Acupuncture: A Western Scientific Approach, 2nd ed Edinburgh: Elsevier; 2016:489–502 [Google Scholar]
Med Acupunct. 2018 Apr 1;30(2):100–112. doi: 10.1089/acu.2018.29078.cpl

Article

In Traditional Chinese Medicine (TCM), acute asthma is associated with physiologic hyperactive Qi energy. Excess Qi energy causes bronchial spams, leading to obstructed airways, causing shorter breath and acute disorder of the respiratory tract. Asthma attacks are also associated with acute sadness and severe emotional disturbance. Acute sadness causes accumulation of Phlegm in the windpipe obstructing the airway, causing shortness of breath. In Western medicine, asthma attacks can be caused by severe allergies and blockage of the bronchus due to mucus and allergens.

In order to treat acute asthma, LU 6 × 2 and CV 17 can be used. LU 6 × 2 is used for acute disorder of the lung. CV 17 is useful for treating and balancing the hyperactivity of the Lung, as well as easing the asthma attack. Cupping CV 17 and BL 13 × 2 in combination with LU 6 is very helpful. In order to calm the asthma attack immediately, it is important to cup LU 1 × 2, this eases asthma attacks. If you add BL 13 × 2, this will enhance the response tremendously and settle the Lung allowing proper breathing.

It is important to treat mental components, as they can cause emotional sadness, which leads to asthma attacks. Cupping CV 17 is very useful for treating acute sadness; using BL 15 with cupping on the back will also release anxiety and tension. If the patient has a history of depression it is wise to use PC 6 and TE 5, for ventilation of emotional pollution. HT 7 × 2 is also very useful for addressing anxiety, tension, and stress.

For patients with asthma, you can use CV 17, BL 13 × 2, and LU 1 × 2 to prevent asthma attacks. For patients who have a great deal of Phlegm in the chest it is important to used ST 8 × 2 and ST 40 × 2 needles to reduce Phlegm accumulation in the windpipe. It is also important to treat the patient's immune system to prevent infection and strengthen the immune system. The following points are very useful for immune protection:

  • • GV 14

  • • LI 11 × 2

  • • SP 6 × 2

  • • SP 10 × 2

  • • ST 36 × 2.

Apart from giving the immune system therapy, you should also balance a patient's body, mind, and spirit. For balancing the body, you should use SP 21 × 2. As a physiologic barometer, it is also wise to use LI 11 × 2. For mental components of balancing, you should use Ex-HN 1 × 4. For spiritual balancing, GB 41 is useful. If it is pertinent to the therapy, you should add GV 9 with BL 17 x 2 and BL 46 × 2.

Chakra imbalance can be a root cause of asthma, especially after physical and/or emotional trauma. This imbalance can cause Stagnant Throat chakra energy, which can lead to Phlegm accumulation, causing an asthma attack. To treat Phlegm accumulation, use ST 40 × 2 and ST 8 × 2 as well as LU 7 × 2 and SI 3 × 2. To open the flow of energy in the Throat chakra, use CV 22 and CV 23.

Other causes of asthma in TCM are Deficiencies of the Kidney and Spleen. Given that asthma can be genetic, treating KI 6 × 2 for prevention can produce a great response. KI 3 × 2, KI 7 × 2, KI 10 × 2, BL 23 × 2, and GV 4 can enhance the Kidney Qi and prevent Kidney Deficiency. Spleen Deficiency can also cause asthma attacks. Enhancing Spleen energy with SP 6 × 2, SP 9 × 2, and SP 10 × 2 can increase the immune response and prevent asthma attacks.

To maintain a patient's health, use LR 3 × 2; this point allows the constant smooth flow of Qi. Use SP 10 × 2 for the constant smooth flow of Blood circulation. You should see the patient twice for the first week, then once every 2 weeks four times, and then once per month four times.

In order to maintain good health and responses in patients with asthma, auricular acupuncture is also very effective for supporting their health. Needle the following points:

  • • Shen Men for relaxation

  • • Lung for asthma

  • • Adrenal Gland for immune system

  • • Occiput for healing.

Ask the patient to perform ear presses four times a day for 1 minute.

Other techniques can also be successful. Ask the patient to practice Qigong exercises, especially breathing exercises. I have found that asthma has one of the best responses to acupuncture and Qigong.

Other TCM approaches that may be used are:

  • (1) Medical Qigong Breathing Exercise—The patient should breathe in while visualizing blue colors and breathe out slowly while visualizing white colors, for 20 minutes every morning and every evening.

  • (2) Herbal medicine is also very useful to prevent asthma attacks and maintain the Lung. I recommend the Ping Chuan pill for asthma attack, the Crocodile Bile pill for Phlegm, and the Zehn Zhu An Shen Yang Xin Pill for relaxation and anxiety.

  • (3) Dietary therapy that involves increasing the intake of white food with pungent smells is wise. The patient should be advised to avoid eating shellfish and red meat.

Overall, the TCM approach to asthma generally has a slower response than Western medicine; however, the TCM approach is holistic, natural and produces little-to-no side-effects.

Med Acupunct. 2018 Apr 1;30(2):100–112. doi: 10.1089/acu.2018.29078.cpl

Article

Asthma can be caused by Deficiencies in Lung and/or Defensive Kidney Qi, and by pathogenic exposure to Wind. Acute attacks, therefore, would require treatment to expel Wind, in addition to inhalers and evidence-based Western approaches. Prevention of asthma then focuses on nourishing Kidney and Lung QI. Strengthening Kidney and Lung Qi, using the Super Ming Men with BL 13 (the Lung meridian Shu point) with gentle electrical stimulation at 2 Hz is the foundation of treatments when the symptoms are well-controlled.

Poor control can be a challenge for some patients. My asthma and allergy colleagues say: “If you want to control asthma, then control the nose.”1 Likewise, patients with asthma who receive acupuncture respond well to opening the nose. LI 20 is a powerful point to open the nose and sinuses, as well as BL 2 and ST 2 for sinus disease.

When symptoms are exacerbated by allergies or other exposures, patients respond well to treating the nose as well as the Lung with the following method:

  • • LI 20 and ST 2 crossed with the black electrode to BL 2 with the red electrode bilaterally at 10 Hz for 15 minutes

  • • LI 4, if there are significant nasal symptoms, or LI 10 if the symptoms are primarily Lung-related

  • • KI 3 to tonify Kidney Qi

  • • SP 4 to dispel Damp.

The Four Gates (LI 4 and LR 3) herbal formulae may be used in addition to the above to improve resilience and reduce the risk of poor control.

References

  • 1.Scadding G, Walker S. Poor asthma control?—then look up the nose. The importance of co-morbid rhinitis in patients with asthma. Prim Care Respir J. 2012;21(2):222–228 [DOI] [PMC free article] [PubMed] [Google Scholar]
Med Acupunct. 2018 Apr 1;30(2):100–112. doi: 10.1089/acu.2018.29078.cpl

Article

Asthma is a chronic inflammatory disease of the airways in the lung. Coughing, shortness of breath, chest tightness, and wheezing are common symptoms of patients with asthma. It does not affect only children but also adults. An asthma attack can be life-threatening. Asthma causes considerable burden to patients and reduces their quality of life. Asthma is not curable, and management of it is complicated. Usage of daily long-term medication discomforts patients with asthma. For this reason, patients seek complementary medicine modalities. The World Health Organization recommends practicing acupuncture to relieve symptoms of asthma.1

Asthma in Traditional Chinese Medicine

Asthma occurs as a respiratory disorder when pathology exists in the Lung (LU), Large Intestine (LI), and Conception Vessel (CV) channels, according to the acupuncture perspective.2 Regulation and balancing the obstructive Qi helps resolve asthma symptoms. The best time to treat asthma with acupuncture is between attacks. However, acupuncture may be used to treat acute asthma attacks.

Acupuncture Treatment Protocol

I use classical acupuncture points without a formal Traditional Chinese Medicine diagnosis. Combining local and distal points is essential in every session. Acupuncture points that are close to the lungs on the anteroposterior chest wall may be considered as local points for treating asthma. The body acupuncture points for asthma are shown in Table 1.3,4 The needles are left in place for 30 minutes. I use body and auricular points together in every session. Auricular points are selected according to an electrical point finder. Ear Shen Men, ear Lung Point, and ear ACTH point must be needled, if I cannot detect these points with the electrical point finder. An ear semipermanent needle is used for 2–3 weeks. The ear needles are changed every 2–3 weeks. Patients with asthma need at least 20 sessions. I give treatment three times per week for the first 10 sessions. After that, I suggest 1 session per week for 5 sessions and 1 session every 15 days for the remaining 5 sessions.

Table 1.

Body Acupuncture Points for Asthma

Points Special points Actions
LU 1 Front-Mu point of Lung Regulates the Lung Qi
LU 2 — Clears Lung Heat
LU 9 Yuan Source Point of the Lung channel Strengthens the Lung & transforms Phlegm
LI 4 Yuan Source point of the Large Intestine channel Causes homeostasis & regulates Qi & Blood strongly
BL 13 Back-Shu point of Lung Tonifies the Lung Qi & clears Heat from the Lung
CV 17 Front-Mu point of the Pericardium Regulates Qi and descends counterflow Lung Qi
CV 22 Meeting point with yinwei mai Descends counterflow Lung Qi & alleviates coughing and dyspnea
GV 14 Meeting point with all Yang channels Calms internal Wind, strengthens Qi
GV 20 Meeting point with BL–GB–TH–LIV channels Calms Wind & calms Shen
Ex-HN 3 (Yintang) Harmonizing effect Opens the channels, calms Shen & eliminates internal Wind
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Illustrative Case

A 35-year-old female complained of having asthma for more than 7 years. The points used to treat her were LU 1, LU 2, LU 9, LI 4, BL 13, CV 22, GV 14, GV 20, and Ex-HN 3. She was treated three times per week for 10 sessions. Then she received one session per week for five sessions, and one session every 15 days for the remaining five sessions. She presented with an asthma attack after the second session of treatment. She was treated during the attack with acupoints LU-5 (sedative points of lung), CV-22 (emergency point for acute asthma attack), GV-20 (important point for descending the Yang), LI-4 (homeostatic and anti-inflammatory point), and Ear ACTH point (anti-inflammatory point, has bronchodilator effect). She did not have another asthma attack during the treatment sessions. Her sleeping quality improved after four sessions. Symptoms decreased after 10 sessions. She received a total of 20 sessions.

References

  • 1.Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. Online document at: http://www.iama.edu/OtherArticles/acupuncture_WHO_full_report.pdf Accessed November19, 2017
  • 2.Jin GY, Jin JJX, Jin LL. Contemporary Medical Acupuncture. New York: Higher Education Press/Springer; 2007 [Google Scholar]
  • 3.Ellis A, Wiseman N, Boss K. Fundamentals of Chinese Acupuncture. Brookline, MA: Paradigm; 2004 [Google Scholar]
  • 4.Liu Z, Liu L, Fun W, Zhang Z. Essentials of Chinese Medicine. London, UK: Foundation of Chinese Medicine/Springer; 2010 [Google Scholar]
Med Acupunct. 2018 Apr 1;30(2):100–112. doi: 10.1089/acu.2018.29078.cpl

Article

Asthma is a chronic condition with an ever-increasing global incidence. It is estimated that ∼300 million people are currently affected by asthma.1 Western medicine defines asthma as a condition that causes chronic inflammation in the airways, leading to a state of hyperresponsiveness and resulting in bronchospasm and an increase in mucous production that causes a mechanical limitation to air flow. Usual symptoms are wheezing, coughing, chest tightness, and shortness of breath. Western medicine relies on a pharmacologic approach to treatment, based on ß-2 agonists, glucocorticoids, leukotriene modifiers, and theophylline, among other agents.1 Even with such a broad arsenal of allopathic medicines available, many patients still seek nonconventional healing techniques.

Traditional Chinese Medicine (TCM) uses syndrome differentiation of the disease nature, mostly with four main characteristics (Cold/Heat, Excess/Deficiency) and recognition of specific patterns related to the affected organs in order to determine a diagnosis. The resulting disease nature, concluded through syndrome differentiation, promotes a comprehensive understanding of the relationship between pathogenic factors and the individual affected by such illness.2

Interestingly enough, there is a classical TCM scenario described as “[t]he pattern of Cold-Phlegm obstructing the Lung” that could represent what Western medicine defines as asthma, once the scenario refers to the condition of the Lung failing to disperse and descend due to the retention of mixed Cold and turbid Phlegm. The etiology of this condition would be Lung impairment due to Phlegm retention plus pathogenic Cold attack, direct attack of pathogenic Cold-Dampness, or even upward transmission of Phlegm from the middle Jiao due to Spleen and Stomach Yang Deficiency.2

With that TCM rationale in mind, Hong Jin Pai, MD, PhD, from our acupuncture service at the São Paulo University Clinics Hospital, in São Paulo, Brazil, developed a standard acupuncture treatment to treat patients with asthma. The treatment is comprised of two stages in the same session:

The first stage involves 30 minutes of resting with needles placed at: GV 17 and GV 22; LU 1 and LU 6; and ST 36 and SP 9. Cupping is performed with cups placed between LU 1 and the sternum bilaterally

The second stage involves another 30 minutes resting with needles placed at: BL 12 and BL 13. Then the Extra point Dingchuan (0.5 cun lateral to C-7) is needled. Finally, cupping is performed with cups placed just lateral to the spine between the T-2 and T-4 bilaterally.

This protocol was submitted to testing in a randomized, controlled crossover study in patients with mild and moderate asthma conducted at our hospital.3 We were able to analyze the response to 10 sessions of acupuncture in 74 patients who were evaluated with spirometry, induced sputum-cell count, exhaled nitric oxide, daily peak flow, symptom diaries, use of medication, Short Form–36 and Questionnaire on Quality of Life—Asthma. The sham procedure consisted of minimally puncturing nonacupoints; patients were permitted to maintain their usual regimen of pharmacologic agents and rescue medication.

Although the results showed that symptoms were eased with either verum or sham acupuncture, with no significant difference between the tested groups, we did find a decrease in eosinophils (P = 0.035) and neutrophils (P = 0.047), an increase in macrophages (P = 0.001), and an improvement in peak flow (P = 0.01) after verum acupuncture, which were not seen in the group receiving the sham procedure. This points to the possible inflammation-reducing effect of this “Phlegm draining and Lung Qi harmonizing” set of acupoints.

Thus, in conclusion, we find it very useful to use this set of acupoints as add-on therapy for patients with asthma who are struggling to maintain stable clinical conditions while on optimized pharmacologic regimens.

References

  • 1.Global Initiative for Asthma. The Global Strategy for Asthma Management and Prevention, 2017. Online document at: http://www.ginasthma.org/ Accessed December27, 2017
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Med Acupunct. 2018 Apr 1;30(2):100–112. doi: 10.1089/acu.2018.29078.cpl

Article

Acupuncture has been used in patients with chronic obstructive pulmonary disease (COPD) and asthma.1–3 There was a clinical opportunity for acupuncture treatment in a patient with asthma at the Teikyo Ikebukuro acupuncture and moxibustion clinic. This report presents the details of this clinical experience to show the improvement of respiratory function and easing of clinical symptoms in this patient, who had undergone the acupuncture treatment every week for 8 weeks.

A 46-year-old male patient, at 170-cm tall and 85-kg weight, was diagnosed with asthma. He had a high level of immunoglobulin E at 183 IU/mL, a persistent decrease of pulmonary function, and a low value of forced expiratory volume in 1 second (FEV1) at 3.33L (FEV1% was 68.8%). He also had some clinical complaints that included stuffiness and muscle stiffness in his back and chest. The Western medications he used were 10 mg/day of montelukast sodium, 15 mg 3 times/day of dextromethorphan hydrobromide hydrate, 200 mg 2 times/day of clarithromycin orally. An aerosol of salmeterol xinafoate—with fluticasone propionate—had also been administered 14 days after the date of his diagnosis.

On the day after he started the medications, acupuncture was performed at bilateral acupoints (LU 1, LI 18, BL 13, BL 42, SI 11, SI 12, SI 13, SI4, and SI 15—eighteen points in all) that corresponded to tender points on the following respiratory muscles.* These included the: pectoralis major; pectoralis minor; sternocleidomastoid; trapezius; erector spinae; rhomboid muscle; levator scapulae; infraspinatus; and supraspinatus. Disposable needles, 0.16-mm diameter, were used to provide 20 minutes of stimulation. He received acupuncture 8 times over 2 months.

After each acupuncture session, a pulmonary function test showed immediate improvement, compared with before acupuncture, at 4.0% of FEV1%. Evaluation at the eighth week showed increases of FEV1 at 4.03 L and FEV1% at 111%. Moreover, reduction of this patient's clinical symptoms, such as dyspnea and wheezing, was evaluated by a categorical face scale. The symptoms' mean value had decreased from 4.8 to 1.6 points.

These findings suggest that acupuncture treatment on the tender points on the parts of respiratory muscles might be an effective alternative treatment method for a patient with asthma.

*

Locations of acupoints on the respiratory muscles are: LU 1, pectoralis major and pectoralis minor; LI 18, sternocleidomastoid; BL 13 and BL 42, trapezius, erector spinae, and rhomboid muscle; and SI 11, SI 12, SI 13, SI 14, and SI 15, levator scapulae muscle, infraspinatus muscle and supraspinatus muscle.

References

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Med Acupunct. 2018 Apr 1;30(2):100–112. doi: 10.1089/acu.2018.29078.cpl

Article

Asthma is one of the most commonly observed chronic inflammatory diseases in current society, with more than 300 million people affected worldwide.1 The disease is characterized by wheezing, breathlessness, and airway limitation.2 Pharmacotherapy is typically used to treat asthma, but the efficacy of conventional pharmacotherapy is variable. Although pharmacogenomic approaches have been considered as a potential treatment for this condition, their translation into clinical practice is difficult.3,4 Considering these issues, complementary and alternative medicine (CAM) is often used for asthma treatment, especially in the United States and Europe.5–7 Surveys in these countries have revealed that more than 40% of individuals with asthma had used CAM. One of the most common forms of CAM used for asthma is herbal medicine.8 This Clinical Pearl introduces briefly our clinical experiences and the current literature on the treatment of asthma with herbal medicine.

Clinical Experiences and the Literature on Chronic Asthma

In our experience, TJ-96 (Saiboku-to) at a dosage of 7.5 g/day is sometimes effective in reducing patients' subjective symptoms of asthma. This observation is supported by a randomized controlled study of 33 patients conducted by Urata et al.9 Eucalyptol is another herbal medicine used to treat asthma, and its use is also supported by a randomized clinical trial.10 According to Schäfer, approximately half of patients with asthma are satisfied with these complementary herbal therapies.7 In addition to these clinical experiences, we have summarized the current literature below.

In 2008, Arnold et al. published a Cochrane review analyzing 27 studies (total N = 1925) of 21 different herbal preparations.11 Among the reviewed studies, the following preparations were reported to ease the patients' symptoms: boswellia, eucalyptol, ginger, PulmoFlex, propolis, Tylophora indica, TJ-96 (Saiboku-to), Liu-Wei-Huang-Wan, Shen-Ling-Bia-Shu-San, and Jai-Wei-Si-Jun-Zi-Tang. However, as mentioned by the researchers, the quality of many of the studies under review was relatively low. For example, although all of the studies were designed to be randomized controlled studies, only 4 reported the implemented randomization and blinding methods. Moreover, assessment methods for objective outcomes, such as forced expiratory volume in 1 second (FEV1) varied, and mean sample size was not justified (mean [minimum, maximum]; 69 [8, 334]). Considering these issues, the reviewers concluded that additional qualified studies in accordance with the Consolidated Standards of Reporting Trials guidelines were necessary.

Update on Adult Asthma

Since the review by Arnold et al.,12 several individual reports and systematic reviews have been published.13,14 In the most recent review on adult asthma, Shergis et al. focused their analysis on a combined therapy consisting of herbal medicine in conjunction with routine pharmacotherapy.14 In their examination, the researchers used 9 databases, including PubMed, Embase, and Allied Health and Complementary Medicine. In total, 29 studies (total N = 3001) were included in the review. Multi-ingredient herbal preparations used in the studies consisted of licorice root, crow-dipper, astragali, and angelica. The results from a pooled analysis demonstrated that the combined therapy improved lung function (FEV1, mean difference [MD] 95% confidence interval [CI]: 7.81% [5.79, 9.83]; peak expiratory flow rate, MD 95% CI: 65.14 [58.87, 71.41] L/minutes); asthma control (MD of asthma score 95% CI: 2.47 [1.64, 3.29] points); and salbutamol usage (MD 95% CI: −1.14 [−2.20, −0.09] puffs/day), compared with the use of routine pharmacotherapy alone. However, the quality of the studies evaluated using the Cochrane Risk of Bias Tool and the Grading of Recommendations Assessment, Development, and Evaluation system was low-to-moderate.

Herbal medicine could be effective as a complementary therapy to routine pharmacotherapy for the treatment of asthma. However, herbal medicine should be used carefully, as the use of herbal medicine has been associated with an increase in hospital admissions.15 Herbal medicines can cause problems due to drug interactions and inappropriate dosages. Well-designed studies are needed to clarify the efficacy and safety of herbal medicines before they can be used actively in clinical practice.

References

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Med Acupunct. 2018 Apr 1;30(2):100–112. doi: 10.1089/acu.2018.29078.cpl

Article

Asthma is one of the most widespread chronic respiratory diseases, affecting ∼300 million sufferers worldwide and is continually increasing. It is usually characterized by chronic airway inflammation. The most common symptoms of asthma are wheezing, shortness of breath, dyspnea, chest tightness, and coughing. These symptoms vary over time and in intensity. There can be an increase in mucous production and variable expiratory airflow limitation.1,2 Pharmacologic treatment includes short-acting or long-acting β-2 agonists, glucocorticoids, a leukotriene modifier, and theophylline, among others. Various approaches, particularly nonconventional healing techniques,3 have been studied with respect to their ability to help patients with asthma achieve both symptom control and improvement in their quality of life.

Asthma in Traditional Chinese Medicine

In Traditional Chinese Medicine (TCM) theory, asthma is differentiated clearly between the actual attacks and the periods between attacks. When the attacks happen, it is considered to be an acute, Excess condition, and the objective is to disperse the Excess and stop the attack. Wind, a nonsubstantial pathogenic factor, lodges in the bronchi and combines with Cold or Heat pathogenic factors to cause bronchospasms. The Lungs and Kidneys work together to produce “Wei Qi” or Defensive Qi. It is a Yang energy that is manufactured from the food the patient ingests. The Kidneys have the ability to produce Defensive Qi, and the Lungs spread Defensive Qi near the outer surface of the whole body to ward off pathogenic factors, such as Wind, Cold, and Heat. When the Lungs or Kidneys are weak, there is often a Deficiency of Defensive Qi, making the patient more vulnerable to colds, infections, asthma attacks, etc.4

Some acupuncture treatments, based on TCM meridian theory, comprise a system of noninvasive therapeutic procedures of applying processed Chinese herbal medicine formulations to acupoints.5,6

Acupuncture Treatment

My clinical experience with using the acupoints is DU14 (Da Zhui), BL12 (Feng Men), BL 13 (Fei Shu), Ex-B 1 (Ding Chuan) and ST 36 (Zu San Li) is based on the theory of TCM for treating asthma.7 After the needle insertion, the De Qi sensation is induced. The twisting and lifting–thrusting manipulations are performed evenly for 30 seconds every 10 minutes and the needles are withdrawn after 30 minutes. The 0.30-mm × 40-mm disposable needle is used for DU 14 and ST 36, and the 0.25-mm × 25-mm disposable needle is used for BL12, BL13, and Ex-B 1.

The effects of treatment are as follows:

  • • DU 14 (Da Zhui): Clears Wind; firms and regulates the surface; dispels pathogenic factors; calms Wind; and strengthens Qi and Yang in Deficiency conditions.

  • • BL 12 (Feng Men): Expels Wind and releases the Exterior; spreads and descends the Lung Qi; and tonifies the Defensive Qi (Wei Qi).

  • • BL 13 (Fei Shu): Tonifies, spreads and descends the Lung Qi; nourishes the Lung Yin; and clears Heat from the Lung.

  • • EX-B1 (Ding Chuan): Harmonizes Lung Qi.

  • • ST 36 (Zu San Li): Tonifies Qi and Yang, nourished the Blood and Yin.

Acupuncture is very effective for treating asthma and is also effective for treating airway inflammation. It is also important to use a combination of acupuncture with herbal medicine and other related complementary therapies.

References

  • 1.Su L, Meng L, Chen R, et al. Acupoint application for asthma therapy in adults: A systematic review and meta-analysis of randomized controlled trails. Forsch Komplementmed. 2016;23(1):16–21 [DOI] [PubMed] [Google Scholar]
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Med Acupunct. 2018 Apr 1;30(2):100–112. doi: 10.1089/acu.2018.29078.cpl

Article

Asthma is a common disease that is slightly more common in male children and in female adults who have a genetic predisposition to develop the condition. It is a chronic inflammatory disorder of the airways, and this underlies disease chronicity and contributes to airway hyperresponsiveness and airflow limitation.

The strongest identifiable predisposing factor for the development of asthma is atopy, but obesity is increasingly recognized as a risk factor. Exposure of sensitive patients to inhaled allergens increases airway inflammation, airway hyperresponsiveness, and symptoms. Reducing exposure reduces pathologic findings and clinical symptoms. Symptoms are episodic wheezing, difficulty in breathing, chest tightness, and cough. Excess sputum production is common. The frequency of asthma symptoms is highly variable. Some patients have infrequent, brief attacks of asthma, while other patients can suffer nearly continuous symptoms. Asthma symptoms can occur spontaneously or be precipitated or exacerbated by many different triggers. Asthma symptoms are frequently worse at night; circadian variations in bronchomotor tone and bronchial reactivity reach their nadir between 3 am and 4 am, increasing symptoms of bronchoconstriction. Wheezing or a prolonged expiratory phase during normal breathing correlates well with the presence of airflow obstruction. Chest examination can yield normal results between exacerbations in patients with mild asthma.1

In modern Western scientific literature, information about treating asthma with acupuncture is still widely based on animal models. Researchers from the College of Traditional Chinese Medicine (TCM), North China University of Science and Technology, stated that acupuncture could reduce the expression of protein kinase B (PKB/AKT) in lung tissues of rats with asthma, leading to relieved inflammation reaction and airway remodeling,2 and also could improve airway inflammatory response and remolding of asthma by inhibiting transforming growth factor β1 (TGF-β1) expression in the lung tissues of rats with bronchial asthma.3

Researchers from the Affiliated Hospital of Nanjing, University of Chinese Medicine, found that acupoint application could improve airway remodeling by downregulating the expression of TGF-β1/Smad 3 in the airway of mice with chronic asthma.4 Researchers from the Clinical College of Acupuncture–Moxibustion and Orthopedics, Anhui University of Chinese Medicine, observed the effect of moxibustion at Feishu (BL 13) and Shenshu (BL 23) on peripheral blood T-cells and serum interleukin (IL) in rats with asthma to explore moxibustion's immunologic mechanisms in relieving asthma. The researchers concluded that moxibustion could reduce the levels of serum immunoglobulin (Ig)E and IL-1β, and increase the level of serum IL-1 Ra, which could play an important role in the treatment of asthma.5

A multicenter study in Germany found that, in patients with allergic asthma, adding acupuncture treatment to routine care was associated with increased improvement in disease-specific and health-related quality of life factors, compared to treatment with routine care alone.6 Another multicenter study in China concluded that acupoint application might be a valid complementary and alternative therapy for asthma in adults. This application contributed especially to improving pulmonary function and reducing the patients' levels of IL and IgE. However, more studies with longer follow-ups are warranted to confirm the current findings.7

However, a review from the Discipline of Chinese Medicine, School of Health and Biomedical Sciences, at RMIT University, in Melbourne, Victoria, Australia, concluded that no reliable conclusions regarding the effects of acupressure on allergic rhinitis (AR) and asthma could be drawn, due to the small number of available trials, which had significant heterogeneity of study designs and high or unclear risks of bias. Further, more rigorously designed randomized controlled trials are needed. Acupressure seems to be safe for symptomatic relief of AR and asthma, although larger studies are required to be able to robustly confirm its safety.8

Researchers from São Paulo University Medical School concluded that verum and sham acupuncture have different effects and outcomes on asthma control. The study's crossover approach was not effective because both interventions led to easing of asthma symptoms, and improvements in quality of life and inflammatory cell counts. Thus, sham acupuncture cannot serve as a placebo in trials with acupuncture as the main intervention for asthma.9

According to Traditional Chinese Medicine (TCM), asthma may be caused by internal or external pathogenic factors. Internal dysfunction affects the internal organs Lung, Spleen, and Kidney. External factors are Wind, Cold, and Phlegm. Initial symptoms start as the Excess type, but they usually evolve to Deficiency or mixed syndromes. For Excess syndromes, the Lung meridian must be treated for Cold Wind, and Stomach and Spleen must be treated for Heat and Phlegm. Suggested points are: Dingchuan, Tiantu (CV 22), Xuanji (CV 21), and Shanzhong (CV 17); plus Feishu (BL 13), Lieque (LU 7), and Hegu (LI 4) for Cold Wind; and Chize (LU 5), Fenglong (ST 40) and Dazui (GV 14) for Phlegm and Heat.10

For Deficiency syndromes, the Lung and Kidney must be tonified, and moxibustion is a good option. Suggested points are Dingchuan, Taiyuan (LU 9), Feishu, and Shanzhong; for Lung Deficiency Zusanli (ST 36) may be added; and for Kidney Deficiency, Shenshu (BL 23), Mingmen (GV 4), Qihai (CV 6), and Guanyuan (CV 4) may be used.10

References

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