Over the last 50-75 years, the incidence of asthma in industrialized countries has steadily increased, especially among children, to alarming proportions. Scientists around the world are studying this “epidemic,” as well as researching the long-term effects of taking anti-asthma drugs such as bronchodilators. In China, research on the efficacy of acupuncture and herbal medicine in the treatment of asthma shows that traditional Chinese medicine compares favorably with standard Western treatment, and provides an alternative approach for those who want to strengthen their bodies natural defenses and avoid the long-term use of drugs.
Asthma is an immune-system-related respiratory disorder in which the breathing passages become narrow or blocked, and are typically inflamed. Asthma can be “extrinsic” or “intrinsic.” Extrinsic asthma is caused by an allergic reaction to a foreign substance (called an allergen) such as pollen, animal dander, animal fur, dust, mold, food additives, or feather pillows, and it is strongly seasonal. Intrinsic asthma is a non-seasonal, non-allergic type of asthma. Trigger factors for intrinsic asthma attacks include air pollutants, tobacco smoke, strong odors, cold weather, physical exertion, emotional stress, or temperature or humidity changes. Often, an episode of intrinsic asthma will follow a severe respiratory infection.
Asthma in Chinese Medicine
In traditional Chinese medicine theory, asthma is clearly differentiated between the actual attacks and the periods between attacks. When the attacks are happening, this is considered to be an acute, Excess condition, and the objective is to disperse the Excess and stop the attack. Wind, a non-substantial pathogenic factor, lodges in the bronchi and combines with Cold or Heat pathogenic factors to cause bronchospasms.
Between attacks, the body is considered to be in a Deficiency condition. The Lungs and Kidneys work together to produce “wei qi,” or Defensive Chi. Defensive Chi can be thought of as analogous to the immune system. It is a Yang energy that is manufactured from the food we eat. The Kidneys are the root of our ability to produce Defensive Chi, and the Lungs spread Defensive Chi near the outer surface of our bodies to ward off pathogenic factors like Wind, Cold, and Heat. When the Lungs or Kidneys (or both) are weak, there is often a deficiency of Defensive Chi, making us more vulnerable to colds, infections, asthma attacks, etc. It is thought that a person’s Defensive Chi can be weak due to a hereditary constitutional weakness (up to 75% of children with asthma have a family history of the disorder); but mothers who smoke during pregnancy and childhood immunizations are also cited as contributing factors in asthma.
Acupuncture can have a remarkable effect in stopping an acute asthma attack. Many patients experience immediate relief after an acupuncture treatment, feeling that the airway blockage was simply removed. Because bronchospasms result from over-stimulation of the parasympathetic nervous system, some traditional acupuncture points for “calming the spirit” are widely used for asthma. Stimulation of these points can relieve both physical and emotional stress, possibly because they trigger the release of neurotransmitters in the brain. The patient can therefore experience both a physical release from his bronchial constriction, and also an emotional or psychological release from the fear of constriction and suffocation.
In Chinese philosophy, and in Chinese medicine, man is seen as an integral part of nature. The fact that allergen-induced asthma attacks are strongly seasonal, with the most devastating attacks occurring in winter and spring, leads Chinese medicine practitioners to coordinate their treatment of asthma sufferers with the seasons. In the winter and spring, during attacks, the emphasis is on dispersing the pathogenic factors of Wind, Cold, and Heat. In the summer, attention is turned to tonifying the Deficiency condition of the Lungs and Kidneys, and stimulating the body to increase its reserves of Defensive Chi. Because summer is the most Yang time of the year, the energy of the season is used to build up the body’s supply of Yang energy.
Science Says
Scientific studies in China and elsewhere show that the ancient Chinese medicine theories have a basis in scientific fact. The whole scope of traditional Chinese medicine is an elaborate and elegant construct which can’t be scientifically proven in its entirety, but modern research reveals a number of mechanisms that support the ancient healing arts:
Neuro-regulation of Air Passages. Researchers at Nanjing University of Traditional Chinese Medicine found that relieving asthma attacks by acupuncture is closely related to neuro-regulation of air passages. They further found that sympathetic nerve excitement and diastolization of the smooth muscle of the bronchial tubes can be achieved by stimulating acupuncture points on the back. The systaltic function of the smooth muscles of the airways is regulated through the neuroendocrine center of the hypothalamus, and this function can be measurably affected by needling certain back shu points.
Serum cAMP and cAMP/cGMP. Levels of certain substances in the blood called cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) seem to have a bearing on asthma patients. Asthma patients experiencing wheezing and breathlessness have lower serum levels of cAMP and cAMP/cGMP. Many clinical studies conducted in China found that acupuncture can increase the levels of serum cAMP and cAMP/cGMP.
RBC-CR1R. Red blood cells have the function of transporting oxygen to body tissues, and also aid in immunoabsorption. In traditional Chinese medicine, the Kidneys have the function of generating and controlling bone growth, storing our genetic essence, generating bone marrow, and aiding in the production of blood. Kidney Deficiency in traditional Chinese medicine and low red blood cell counts in conventional medicine are related. Research in Hangzhou Red Cross Hospital shows that the immunological index of red blood cells (RBC-CR1R) was markedly increased after optimum-timing acupuncture treatment for Kidney Deficiency, compared with the control group.
Acidocyte Regulation. An acidocyte is a type of white blood cell. An increase in acidocyte levels indicates allergic reaction in an organism. A clinical study at the Affiliated Yueyang Hospital of Shanghai University of Traditional Chinese Medicine shows that acupuncture at UB13 (Fei Shu), LU5 (Chi Ze), LU7 (Lie Que), ST40 (Feng Long), Ren 22 (Tian Tu), and extra point Ding Chuan can decrease acidocyte levels.
17-Hydroxy Corticosteroid in Urine. Traditional Chinese medicine believes that there exists a correlation between asthma and the pattern of Kidney Deficiency. Clinical observations reveal that asthma patients tend to have lower levels of the hormone 17-hydroxy corticosteroid in their urine, which is closely related to Kidney Deficiency in Chinese medicine. Many clinical studies show that acupuncture can increase the level of 17-hydroxy corticosteroid in urine.
Regulate Hypophalmus-pituitary-adrenocortical function. It is believed that asthma attacks are correlated with a lower hypophalmus-pituitary-adrenocortical function. Clinical research found that tonifying the Kidneys with acupuncture and Chinese herbal medicine can improve that function and relieve asthma attacks.
More Support
In a randomized, controlled clinical trial in the department of the Osler Chest Unit, Churchill Hospital, Oxford, England, twelve matched pairs of patients with chronic obstructive pulmonary disease received either traditional acupuncture or placebo acupuncture over a three-week treatment period. After treatment, the traditional acupuncture group showed a significant improvement in terms of subjective scores of breathlessness and six-minute walking distance. Kim Jobst at Oxford University conducted a parallel study of the efficacy of acupuncture on asthma. This study also showed improvements by two measures: “quality of life” scores, and breathlessness measurements.
These clinical trials at Oxford indicate that acupuncture treatments achieved the following goals: reduced the spasmodic tendency in the bronchi; kept the lungs from contracting at the least little irritant in the air; opened narrowed blood vessels in the lungs; and promoted relaxation and the ability to breathe more fully.
By Wei Liu, TCMD, MPH, LAC and Changzhen Gong, PhD, MS - The American Academy of Acupuncture and Oriental Medicine (AAAOM)
The practice of acupuncture and moxibustion is based on the theory of meridians. According to this theory, qi (vital energy) and blood circulate in the body through a system of channels called meridians, connecting internal organs with external organs or tissues. By stimulating certain points of the body surface reached by meridians through needling or moxibustion, the flow of qi and blood can be regulated and diseases are thus treated. These stimulation points are called acupuncture points, or acupoints.
Acupoints reside along more than a dozen of major meridians. There are 12 pairs of regular meridians that are systematically distributed over both sides of the body, and two major extra meridians running along the midlines of the abdomen and back. Along these meridians more than three hundred acupoints are identified, each having its own therapeutic action. For example, the point Hegu (LI 4), located between the first and second metacarpal bones, can reduce pain in the head and mouth. The point Shenmen (HT 7), located on the medial end of the transverse crease of the wrist, can induce tranquilization.
In acupuncture clinics, the practitioner first selects appropriate acupoints along different meridians based on identified health problems. Then very fine and thin needles are inserted into these acupoints. The needles are made of stainless steel and vary in length from half an inch to 3 inches. The choice of needle is usually determined by the location of the acupoint and the effects being sought. If the point is correctly located and the required depth reached, the patient will usually experience a feeling of soreness, heaviness, numbness and distention. The manipulator will simultaneously feel that the needle is tightened.
The needles are usually left in situ for 15-30 minutes. During this time the needles may be manipulated to achieve the effect of tonifying the qi. Needle manipulations are generally involved with lifting, thrusting, twisting and rotating, according to treatment specifications for the health problem. Needling may also be activated by electrical stimulation, a procedure usually called electro-acupuncture, in which manipulations are attained through varying frequencies and voltages.
Treatment protocols, frequency and duration are a matter of professional judgment of the practitioner, in consultation with the patient. A common course of treatment may initially involve between ten and fifteen treatments spaced at approximately weekly intervals, and spread out to monthly later in a program.
A professional practitioner will always warn the patient of the possibility of exacerbation at the start of a course of treatment. The patients may find that in the short term after treatment, the symptoms may in fact get worse before an improvement sets in. This is a quite common feature of acupuncture treatment.
Patients should inquire about types of needles used prior to treatment. Most practitioners now use pre-packed and sterilized disposable needles that are only once. If re-useable needles are being used patients should ask to see the sterilization procedures that the practitioner adopts.
The effectiveness of an acupuncture treatment is strongly dependent upon an accurate Chinese medical diagnosis. The needling skills and techniques of the practitioner will also influence greatly the effectiveness of the outcome. Acupuncture can be remarkably effective in many conditions, but in the West, patients often use acupuncture as the last option for their long-term chronic problems. Therefore we sometimes see the treatment as slow and in some cases of marginal benefit. With the gradual establishment of acupuncture as the treatment of choice for many people, the effectiveness of the approach with acute as well as with more chronic conditions is being recognized.
Acupuncture is often conducted in combination with Moxibustion. Moxibustion is the process where moxa sticks, made of dry moxa leaves (Artemisia vulgaris) is ignited and held about an inch above the patients’s skin over specific acupuncture points. Moxa is available in a loose form that can be used for making moxa cones. Alternatively, moxa is packed and rolled in a long stick like a large cigar, about 15-20 cm long and about 1-2 cm in diameter. The purpose of this process is to warm the qi and blood in the channels. Moxibustion is most commonly used when there is the requirement to expel cold and damp or to tonify the qi and blood. A single treatment of moxibustion usually lasts 10-15 minutes. Needle-warming moxibustion combines needling and moxibustion by attaching a moxa stub (about 2 cm long) to an inserted needle. This method enhances the effects of needling and is often used to treat chronic rheumatism and rheumatoid arthritis.