CHILDHOOD ASTHMARobert Helmer, D.TCM March 1, 2004
The Traditional Chinese Medicine Approach
Asthma is a chronic lung disease affecting over two million Canadians. It is more prevalent in children, and 10 to 15% of children in Canada suffer from this disease. Asthma can begin at any age, but most people with this condition first developed it as children. The main symptoms of asthma are: shortness of breath, tightness in the chest, coughing and wheezing. Most individuals who develop this disease begin to reveal symptoms by age five, but symptoms can arise in an older child as well. Asthma is the most common chronic disease of childhood. 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 50% of this group will see their asthma return, often when they are in their 30s and 40s. Asthma can cause death and approximately 10 children and 450 adults die from asthma each year in Canada.
Fifty-two percent of children currently receiving treatment from a modern medical doctor have poorly controlled asthma, yet 88% of parents continue to believe their child’s asthma is controlled (according to the Asthma in Canada survey – the largest and most comprehensive survey to be done on the state of asthma in Canada).
PEDIATRIC ASTHMA AND TCM IN CHINA
Traditional Chinese Medicine (TCM) journals publish 100,000 articles per year on the use of Chinese medicine to treat various medical conditions; 30,000 volumes of existing Chinese medical literature were written before the 20th century. TCM prides itself on its ability to treat and assess each person as an individual, not based entirely on a disease (i.e. asthma) or symptoms (i.e. cough, wheezing etc.). Therefore, I believe that TCM is the best treatment for most chronic health problems including asthma.
In this ancient form of medicine, healing is based on the restoration of harmony and balance within the body. This balance is restored through the use of Chinese herbal medicine, acupuncture, dietary therapy, exercise (physical and mental) and Tui Na (Chinese massage).
Asthma is discussed under the Traditional Chinese Medicine disease categories of “cough” and “panting and wheezing”. The basis of the modern TCM approach to treatment of asthma was first discussed in detail by a famous doctor named Zhu Dan-Xi (600 years ago). Since then the treatment of this disease has been refined and improved upon by many generations of Chinese doctors. Pediatrics is a distinct specialty in TCM. The majority of children seeking treatment for their asthma would see a TCM pediatrician. In TCM, the treatment of children is often different from adults and therefore most Western practitioners of Chinese medicine do not treat children. In the last few years, I have been fortunate to complete my post-graduate studies in the specialized area of TCM pediatrics. In addition to finishing these studies I have had the opportunity to work with pediatricians in China who specialize in treatment of pediatric asthma.
CAUSES OF ASHTMA IN KIDS
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), infections, and strong emotions (not common in children). Studies have shown children with a family history of asthma are more likely to develop it. In addition, most children with asthma (up to 80%) also suffer from significant allergies including higher incidences of allergic rhinitis and eczema. A child with a weaker constitution, such as a child whose mother smoked while pregnant or a child 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 is that a child’s digestion is immature, especially before the age of six years old when most asthma begins. This immaturity and weakness of the digestion (spleen) predisposes a child to experience an incomplete breakdown of food and the accumulation of phlegm. It is said in TCM that, “the spleen is the source of phlegm production” and “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 energy 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 pediatric 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 children 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 child may have as well as foods and medications that will damage the digestion (spleen) such as excessive cold, raw foods, sugar and antibiotics.
ACUTE AND CHRONIC STAGES OF PEDIATRIC ASTHMA
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, the hot type of asthma is much more common.
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.
The “cold type” is really a pattern of acute asthma without heat and may include the following symptoms: cough with clear, watery, white-coloured phlegm; a cold body with no perspiration; dull, lustreless facial complexion; cold limbs; no thirst or only thirst for hot drinks; thin white or slimy tongue coating; and a superficial, slippery pulse.
In general, the acute stage or asthma attacks should be treated with modern medicine (one or two days) in conjunction with TCM. Most children under a doctor’s care will already be taking some form of inhaled broncho-dilating medication, which can be convenient and practical. TCM is also effective during these acute episodes and the most important modality used in the treatment of pediatric asthma is Chinese herbal medicine. The herbal formulas used are customized according to the child’s TCM pattern, presenting symptoms and the stage of the patient’s asthma. The formula usually consists of around 10 to 15 ingredients, chosen based on the individual’s clinical presentation. At this stage, the child is closely monitored with clinical visits occurring every four to seven days. Upon return visits, the formula is modified as the patient’s condition improves. Acupuncture can also be helpful in the acute stage and moxabustion may be more useful in the chronic stage.
In the remission stage, some of the above symptoms have now been eliminated and reduced in severity. However, the clinical presentation is now one of vacuity rather than repletion; the child presents with signs of qi vacuity and deep-lying phlegm during the remission stage. Symptoms of qi vacuity may include a pale complexion, fatigue, lack of strength, spontaneous perspiration, cold limbs, decreased appetite, cough with phlegm, incomplete or loose stools, bedwetting, shortness of breath (especially on exertion), pale tongue and/or a weak pulse. Indicators that phlegm is present include a cough with copious white watery phlegm, nasal obstruction, a clear runny nose, and a slimy tongue fur.
During the remission stage, the focus of treatment is on preventing acute attacks through strengthening the body. Once again, the main treatment is herbal medicine, however the nature of the ingredients is now much different. The medicinals work to supplement and fortify the body’s qi in order to strengthen the body’s defensive qi (or immunity). The main organs that need to be strengthened in pediatric asthma are the spleen and lungs. In adults, the treatment during the remission stage may also include supplementation of the kidneys. In conjunction with these medicinals, the TCM doctor also prescribes ingredients to transform the remaining or deep-lying phlegm in the body.
In order to prevent an acute attack and strengthen the body, proper diet and exercise are also very important during this stage. In addition, other methods of treatment may be used. One such treatment is “winter tonification” which is a paste form of herbal medicine that is taken for six weeks in the winter to prevent the attack of the common cold and asthma for the entire year. The results of such a treatment are very good. So good in fact, that a pediatrician in China I studied with said at the very least, patients taking winter tonification will not get sick for six months. Another adjunct modality to the interior administration of Chinese herbs is herbal plasters that are applied to acupuncture points on the child’s back. This treatment is done once a week for three weeks in the winter and repeated in the summer for three weeks.
PROGNOSIS OF TREATMENT
To discuss prognosis, I will refer to the opinion I share with my professor in China. Professor Yu is specialized in the treatment of pediatric asthma and has over 40 years of experience as a pediatric doctor. Pediatric asthma can definitely be cured and asthma in adults can be relieved with the use of TCM. With persistent treatment and by modifying the herbal formula according to the patient’s clinical presentation even some of the most severe forms of pediatric asthma can be cured (i.e. three years without an exacerbation) using TCM. If a cure cannot be achieved, the child’s asthma will at least be better controlled with a decrease in daytime and nighttime symptoms, less absenteeism (i.e. school or social engagements), less exacerbations (i.e. acute attacks), a decreased need for medication, an increased tolerance for physical activity, a reduced chance of morbidity and an improved quality of life. In general, the longer a person suffers from a disease such as asthma, the more difficult it will be to treat. Moreover, the TCM treatment results of asthma are best if the child has not yet reached puberty.
With the use of TCM, your child can look forward to having improved lung function and immunity (i.e. less colds) thereby reducing or eliminating their acute attacks (i.e. inability to catch their breath). TCM’s treatment also can decrease the child’s reliance on drugs. Due to the long-term side effects of broncho-dilators, it is of utmost importance to reduce a child’s reliance on these drugs for treating their asthma. Modern medicine offers short-term relief for some of the symptoms of asthma. Traditional Chinese Medicine provides a long-term solution for those suffering from asthma and other chronic diseases.
Robert Helmer graduated from the Institute of Traditional Chinese Medicine in 1998 and several years later became the first person to specialize in the treatment of children in Ontario, using TCM. Robert is a well-respected teacher, author, and practitioner of Chinese Medicine. His post-graduate studies and work in pediatrics led him to work in China (on four occasions) as well as in England, Germany, U.S., and Canada. For more information, please contact him by email at firstname.lastname@example.org