Breathe Easy Naturally – Asthma Clinic
Asthma is a serious chronic lung disease affecting over 2 million Canadians. Asthma is a disease that is more prevalent in children affecting 10-15% of children in Canada. Asthma is the most common chronic disease of childhood in Canada and many other countries in the West. This disorder is typically episodic and remittent in nature and is characterized by the narrowing of the large and small airways due to spasm of the smooth muscles of the bronchi, edema, inflammation of the bronchial mucosa and production of tenacious mucus. Asthma can begin at any age, but most people with this condition first develop it before the age of five years old. The main symptoms of asthma are: shortness of breath, tightness in the chest, coughing and wheezing. The frequency and severity of symptoms differ from person to person. There are four types of asthma allergic, exercise-induced bronchospasm (EIB), reactive airway disease (i.e. asthma that only occurs during colds) and miscellaneous types. Included in the miscellaneous group is heartburn or reflux asthma and stress induced asthma. Improperly treated asthma may lead to a lifetime of asthma. Children can sometimes outgrow their asthma and half of these children will see a lessening of their symptoms as they move into adolescence. However, approximately fifty percent of this group will see their asthma return, often when they are in their 30s and 40’s. Asthma can cause death and approximately 10 children and 450 adults die from asthma each year in Canada.
Does Modern Medicine Treat Asthma Effectively?
52% of children currently receiving treatment from a modern medical doctor have poorly controlled asthma (according to the Asthma in Canada survey – the largest and most comprehensive survey to be done on the status or state of asthma in Canada). The results are similar for adults and similar results were found for asthma patients in both age groups in the United States. Poorly controlled asthma leads to an increase in symptoms of asthma during the day and night, absenteeism (i.e. school, work or social engagements), exacerbations (i.e. more frequent acute attacks), and increased need for ‘rescue’ medication and a lower tolerance for physical activity. Poorly controlled asthma is a burden to the child and their family as well as healthcare systems as these patients are more likely to require urgent care and hospitalization. Although statistics show that more than 50% of these children are suffering with poorly controlled asthma, 88% of parents continue to believe their child’s asthma is controlled: very well controlled (47%) and adequately controlled (41%). Moreover, 77% of general physicians and 90% of specialists surveyed also believe their asthma patients are optimally controlled even though statistics demonstrate otherwise.
Asthma and TCM
Recent research has shown that Chinese Herbal medicine is as effective in the treatment of asthma as modern medicine and does not exhibit any side effects. However, asthma has been discussed in Traditional Chinese Medicine for two millennium under the disease categories of chuan zheng, panting condition, chuan ke, coughing and panting, chuan cu, hasty breathing, xiao zheng, wheezing, condition, and xiao chuan, wheezing and panting. The modern approach to the treatment of asthma (based on whether the disease was in the acute or remission stage) was first discussed in great detail by a famous TCM doctor named Zhu Dan-xi (approximately 600 years ago). Since then the treatment of this disease has been refined and improved upon by many generations of Chinese doctors. Unlike other forms of complimentary medicine TCM has a long history of specialization including dermatology, pediatrics, gynecology and oncology. The majority of individuals seeking treatment for their asthma would see a TCM pediatrician or respiratory specialist. Practitioners who work at our Breathe Easy Naturally - Asthma clinic have completed post-graduate studies in the specialized area of TCM pediatrics and/or respiratory health problems. The main treatment used to treat asthma is Chinese Herbal Medicine although acupunture can also be beneficial in severe cases or during the acute stage. Most cases of asthma can be resolved quite effectively with the use of Chinese medicine. The course of for asthma is usually 3-6 months and depends on the severity of the condition and the individual’s current reliance on modern medicine.
Cause
The cause of asthma can be rather complex due to the multitude of factors that can aggravate or predispose an individual to this disease. In TCM, the five causes of all illnesses (including asthma) are improper diet, emotions, lifestyle, external environment and constitution (i.e. genetics). Any or all of these factors may aggravate or cause asthma. Similar to adult asthma, pediatric asthma is characterized by two stages: acute and remission. Triggers for acute attacks in children include allergens (i.e. external environment), environmental exposures to exercise (i.e. lifestyle) and infections and strong emotions (not as common a factor in children). Studies have shown children with a family history of asthma are more likely to develop asthma. In addition, most children with asthma (up to 80 percent) also suffer from significant allergies including having much higher incidences of other atopic diseases i.e. allergic rhinitis, urticaria, eczema etc.. A child with a weaker constitution such as a child whose mother smoked while they were pregnant or a child who was born with a lower birth weight are also more likely to suffer from asthma.
TCM recognizes that children have unique physiological characteristics and cannot be considered as just ‘miniature’ adults. When treating asthma, one of the main differences of pediatric physiology to be considered is that a child’s digestion (i.e. spleen and stomach) is immature, especially before the age of 6 years old when most asthma begins. This immaturity and weakness of the digestion predisposes a child to experience an incomplete breakdown of food and the accumulation of phlegm. This is the TCM explaination of why this condition is more common in children, however, in modern society most patients also present clinically with a weak digestion, due to poor diet, lack of or excessive physical exercise, worry and stress, aging process etc.. It is said in TCM, that ‘the spleen is the source of phlegm production’ and the ‘the lungs are the place where phlegm is stored’. Asthma is a good example of what happens when phlegm is produced (by a weak digestion) and this pathological matter accumulates in the lungs. Clinically, ‘phlegm in the lungs’ obstructs the circulation of qi in the lungs and can manifest as a stuffy and/or runny nose, sneezing, coughing and/or asthmatic wheezing. Phlegm is clearly a key component of all types and stages of asthma. Therefore, older TCM doctors when teaching younger doctors, often will repeat the statement that ‘there is no asthma without phlegm’.
Unfortunately, in society today individuals often consume a diet that has a large amount of fatty and cold foods, which can cause phlegm. Moreover, foods such as dairy products and peanuts also increase phlegm and should be restricted. It is important to avoid any known food allergies the patient may have as well as foods and medications that will damage the spleen and stomcah such as excessive cold, raw foods, sugar and antibiotics.
Spleen qi vacuity (i.e. weak digestion) also can result in defensive qi not securing (i.e. weak immunity) allowing easy entry of external evils which hinder and obstruct the lungs functions of diffusing and downbearing. When these evils combine with the phlegm in the lungs discussed above the lung qi’s diffusing and downbearing is more severely affected causing the main symptoms of asthma – wheezing, coughing and shortness or breath. If phlegm or dampness endures over a period of time this may lead to transformation of heat and when combined they result in phlegm heat. Blood stasis may also be a factor and is encountered clinically in older patients when asthma persists for more than two years.
Acute Stage of Asthma
As mentioned above Chinese medicine divides asthma into two stages – acute and chronic. In TCM, acute asthma is divided into two types: hot and cold. Both types share the main symptoms of asthma, which include shortness of breath, tightness in the chest, coughing and wheezing. Due to a child’s pure yang constitution and the average adults current lifestyle choices, the hot type of asthma is much more common in clinical practice. Of course it is possible to have heat and cold occurring simultaneously, for example in cases of external cold and internal heat.
The ‘Hot Type’ will present with some or all of the following symptoms: cough with yellow phlegm, fever, red face, yellowish urine, dry stools or constipation, thirst with a desire to drink, red tongue with a yellow coating and a slippery rapid pulse.
In my opinion, the ‘cold type’ is really a pattern of acute asthma without heat and may include the following symptoms: cough with clear, watery, white-colored phlegm, a cold body with no perspiration, dull, lusterless facial complexion, cold limbs, no thirst or only thirst for hot drinks only, thin white or slimy, white tongue coating and superficial, slippery pulse.
In general, the acute stage or asthma attacks are most often treated with modern medicine (one or two days) in conjunction with TCM. Most children visiting a TCM practitioner in the West will already be taking some type of “puffer” (i.e. inhaled bronchodilating medication), which can be convenient and practical (because many times asthma attacks occur in the middle of the night). It is important to remember that TCM is also effective during these acute episodes (as demonstrated by research in China and the United States) and as mentioned above the most important modality used in the treatment of asthma is Chinese Herbal Medicine. The herbal formulas used are customized according to the individual’s TCM pattern, presenting symptoms and the stage of the patient’s asthma. Acupuncture can also be helpful in the acute stage. The main treatment by a practitioner of TCM during the acute stage is an individually prescribed herbal decoction. The formula usually consists of around 10 to 15 ingredients, which are chosen based on the individual’s clinical presentation. At this stage, the child is closely monitored with clinical visits occurring every 4-7 days. Upon return visits, the herbal formula is adjusted or modified as the patient’s condition improves.
Remission Stage of Asthma
According to the current Chinese medical literature the most important modality used in the treatment of asthma in the remission stage in China is Chinese Herbal Medicine. However, other TCM modalities (acupuncture and moxibustion) can be found when browsing through medical journals. Chinese medicine is able to offer patients with asthma in the remission stage an effective way of preventing their next ‘asthma attack’. These treatments can decrease the symptoms of asthma the patient experiences, decrease their absenteeism (i.e. from school or social engagements), decrease their need for ‘rescue’ medication and increase their tolerance for physical activity.
As in the acute stage, herbal formulas used are customized according to the individual’s TCM pattern, presenting symptoms and the stage of the patient’s asthma. However, the focus of the treatment at this stage is towards to increasing the person’s immunity, increasing their lung capacity, decreasing their reliance on medications and decreasing their response to triggers. During this stage, the patient’s visits occur every two weeks and the herbal formula is adjusted as needed.
