Traditional Chinese Medicine for Allergic Asthma and CoughAdina Stanescu, R.TCMP October 1, 2013
Allergic asthma has become an epidemic in Westernized countries, showing dramatic increases over the last few decades. In Ontario, according to a 2010 study published in the American Journal of Epidemiology, asthma incidence increased by over 70% between 1996 and 2005. The study called for more effective strategies to deal with this great public health problem.
Another development in the understanding of allergic asthma has been the realization that in addition to the classic symptoms of wheezing and breathlessness, night time coughing may be the main presenting symptom, especially in children. This is now identified as cough-variant asthma. It may, in fact, occur without any wheezing, causing many children to remain undiagnosed while they suffer with repeated colds that trigger night time coughing, typically between 3 a.m and 5 a.m. These “colds,” in fact, are more likely to be allergic responses, as asthmatic children also tend to have multiple environmental allergies. Whatever the trigger, asthmatic patients have chronic inflammation of their airways, which makes them hyper-responsive to any stimulus, be it viral, allergic, climactic or emotional.
Traditional Chinese Medicine has treated asthma successfully for a long time, and contemporary TCM herbalists have further honed their approach based on modern understandings and discoveries about immunology and allergy. This means that in addition to continuing to treat each patient based on their particular presentation, we often also include herbs that have been validated by biochemical analysis to have a normalizing effect on the allergic response, such as Sophora flavescentis, reishi mushroom, mume plum, and Stellaria dichotoma root.
In fact, a 2005 study published in the Journal of Allergy and Clinical Immunology caused quite a stir when it showed that a combination of Reishi mushroom, Sophora root, and Licorice root can achieve the same control over asthma symptoms as inhaled corticosteroids – the cornerstone of conventional treatment.
But in actual TCM clinical practice, we do not aim only for symptom control of the asthma, but rather for its long term elimination. This is very achievable with a two pronged approach:
1) Control symptoms with herbal bronchodilators and anti-inflammatories, and
2) Strengthen the lung and calm the immune response with tonics and anti-allergic, immune modulating herbs. It is this second phase of treatment that makes TCM treatment priceless, because Western medicine simply has not developed drugs that are able to accomplish this, leaving patients forever dependent on inhalers.
Let’s see how the treatment works in practice.
INITIAL PHASE – This phase needs to address active disease, presenting with regular episodes of wheezing, chest tightness, or coughing. Within these symptoms, we must also differentiate whether each patient’s asthma is cold, hot, or largely neutral. This will depend on their constitution and lifestyle as well.
For instance, a hot asthma presentation will have thicker, yellower, and stickier mucus than the cold asthma one, which will typically have clear, thin sputum. The hot asthma tongue will be red with a yellow coat, and there is more likely to be thirst. Very good herbs for the hot presentation are Scutellaria baicalensis, Houttuynia cordata, and Gypsum, a cooling mineral supplement.
In cold asthma, the tongue coat is wet, white and the tongue proper is normal or pale. Warming, pungent and scattering herbs like Asarum, fresh ginger and cinnamon will be included to dispel the cold which further constricts the bronchi. This warming approach can also be considered when the cold winter season brings on the worst symptoms.
Lastly, if no particular cold or heat signs predominate, we use a neutral combination of medicinals. Whatever herbs we choose, their function will be to open the bronchial passages and relieve bronchospasm, stop cough, and calm wheeze.
Some of the most important herbs that do this are honey-fried Ephedra, Prunus armeniaca seed, Sophora flavescentis root, and Periostracum cicada. These will also stop coughing, but if this symptom is very pronounced, we may add specific ingredients such as Peucedanum root, coltsfoot flowers (used in Western herbalism as well), or loquat leaf.
Once wheezing and coughing has begun to decrease, which happens surprisingly quickly, the most important aspect of therapy can begin – the strengthening and regulating phase. This will ensure that relapses will decrease and eventually stop altogether.
STRENGTHENING PHASE – Immune function and response is controlled by three main organs in TCM: the lung, spleen and kidney. In the strengthening phase of treatment, we use herbs to strengthen one or more of these organs in order to regulate the immune response. What we want is neither weak nor overly “touchy” immunity, and many TCM herbs have the apparently miraculous ability to calibrate this complex system. Among these ingredients, a few stand out: Astragalus, Reishi mushroom, Jiao Gu Lan, and the sour fruits Schisandra, Mume, Terminalia and Cornus.
Astragalus is now well known in the holistic world, and it appears in many immune boosting formulas. One of its TCM functions is to “secure the exterior” – in other words to build a strong defence system against viral or allergic invaders. When prepared by frying with honey, it has an additional effect of strongly regulating digestion and absorption.
Modern medicine has now corroborated that healthy gastrointestinal function is integral to correct immunity. In TCM we say that the digestive system nourishes and supports the lung.
Reishi (known as Ling Zhi in TCM terminology) is a well known tonic in Chinese and Japanese medicine. Mush-rooms in general appear to have complex functions against allergy, while helping to protect from cancer, regulate the immune system, and protect from the physiological effects of stress. Reishi’s stated functions in Traditional Chinese Medicine are to calm the mind, boost the Qi, stop cough and transform phlegm. Therefore, it is an ingredient that can concurrently address the active as well as the strengthening phase of asthma and cough treatment, and you will recall that it was one of the three herbs in the asthma study above.
The sour fruits are very interesting. They should be used only when active symptoms have largely abated, because they have an astringent, constricting function that can aggravate active asthma. But in the strengthening phase, they help to stabilize and repair the lining of the airway, normalize mucous secretions, and enhance the effects of other tonics. It also appears that the chemical constituents responsible for the very sour taste of these fruits have a highly anti-allergic effect and prevent further abnormal reactions, when combined with other appropriate tonics. Mume plum shows great promise against food allergies as well, a condition very much related to allergic asthma.
Finally, Jiao Gu Lan, or Gynostemma pentaphylla, is a herb from the ginseng family, with many of the same active chemicals, but with a cooling, detoxifying nature. This is a very useful characteristic, as inflammation tends to produce heat, as do drug inhalers. This herb can work to strengthen the body while simultaneously clearing heat and subduing chronic inflammation. Jiao Gu Lan has also been studied for many related respiratory conditions such as tracheitis and bronchitis, as well as an anti-cancer medicinal.
These important tonics may well be combined with other herbs to suit the individual patient, for example for concurrent food allergies, seasonal allergies, or mental emotional stress. Elderly patients will also benefit from the addition of kidney tonics such as Cuscuta seed, cooked Rhemannia, and Cornus officinalis.
Working With Asthma Inhalers
If, as is often the case, patients are using conventional inhalers to control their asthma, we work alongside these with herbs. It is never advisable to suddenly discontinue medication of any kind. It is common to use an orange “preventer” inhaler daily, which is often a corticosteroid, and a blue “rescue” inhaler, a bronchodilator, as needed. Upon starting herbal treatment, people will naturally notice less need for the blue inhaler, and once the herbal treatment has achieved further cumulative effects, they can discuss weaning off the orange inhaler with their doctor.