Asthma is commonly known as “hoarseness disease.” “Xiao” refers to wheezing sounds in the throat, while “chuan” refers to difficult and rapid breathing; the combination of the two is called “asthma.” Other terms include “sugar asthma,” “salt asthma,” “fish and shrimp asthma,” “cold asthma,” and “heat asthma.” This condition is characterized by recurrent episodes. It is most common among adolescents and teenagers, though it also occasionally affects middle-aged and elderly individuals. Attacks can occur throughout the year, but they are more frequent during cold seasons and periods of sudden weather changes.
I. Etiology and Pathogenesis of Asthma
This disease is often caused by external exposure to seasonal irregularities, internal stagnation of qi, and viscous phlegm in the diaphragm. When phlegm and qi collide, the lungs’ ability to disperse and descend qi becomes disrupted. The manifest symptom of this disease lies in the lungs, while its root cause lies in the spleen and kidneys.
Exposure to wind-cold or wind-heat, as well as the inhalation of pollen, smoke, dust, lacquer fumes, strange odors, or medications, can impair the lungs’ ability to disperse and descend qi. This leads to the condensation of body fluids, which transform into phlegm and fluid retention, obstructing the airways. The lungs govern qi; when pathogenic factors accumulate and qi becomes congested, the lungs’ ascending and descending functions become disordered, leading to asthma. Alternatively, improper diet—such as excessive consumption of raw, cold, sour, or cold foods, as well as fish, shrimp, and rich, fatty foods—can damage the spleen and stomach, causing spleen dampness to fail to transport and transform, resulting in the internal generation of turbid phlegm. This phlegm obstructs the lungs, impedes lung qi, and blocks the airways; the interaction of qi and phlegm produces a wheezing sound in the throat. Asthma may also result from prolonged illness leading to physical weakness, emotional agitation, or excessive fatigue. The lungs govern qi, while the kidneys are the root of qi. When kidney deficiency weakens the foundation, inhaled qi cannot be properly directed to the kidneys, leading to excessive exhalation relative to inhalation and difficulty exhaling. Qi is the leader of blood; when qi flows, blood flows; when qi is deficient, blood stagnates. Insufficient yang qi leads to the subsequent development of blood stasis, manifesting as cyanosis of the lips and fingernails, as well as distended jugular veins.
Modern medicine views asthma as a paroxysmal allergic lung disease. The underlying cause is a genetic predisposition to allergies, and its onset is often triggered by inhalation of or contact with allergens. Common allergens include plant pollen, dust, insects (such as mites), certain pathogens, and medications. During an attack, airway obstruction is often caused by bronchial smooth muscle spasm, mucosal congestion, edema, and increased secretions, leading to dyspnea. In severe cases, patients may breathe with their mouths open and shoulders raised, exhibit flaring of the nostrils, be unable to lie flat, experience profuse sweating, pallor, cyanosis of the lips and nails, tachycardia, and cold extremities. Laboratory tests may reveal elevated eosinophil counts; Sputum examinations may also reveal a large number of eosinophils and prismatic crystals; serum immunological tests may show elevated IgE levels.
II. Differential Diagnosis and Treatment According to Traditional Chinese Medicine
In the early stages of asthma, the condition is often characterized by an “excess” pattern; however, with recurrent episodes, it may transform into a “deficiency” pattern.
1. Exposure to Wind-Cold: Among external pathogens, wind-cold is the most common. When wind-cold invades the exterior and affects the lungs, it causes obstruction of lung qi, disrupting its dispersing and descending functions, leading to a sensation of fullness and oppression in the chest and shortness of breath; fluid distribution is impaired, resulting in the formation of phlegm, which manifests as a cough with thin, white sputum; phlegm obstructs the airways, and the interaction of qi and phlegm produces wheezing in the throat. The sputum is scant or frothy, and coughing it up is difficult. The patient feels chilly but has no sweat, and may experience headache or body aches. Episodes typically occur in winter or after exposure to cold. The tongue coating is white and slippery, and the pulse is tight or floating and tight. The treatment principle is to promote lung function, dispel cold, resolve phlegm, and relieve wheezing. Xiao Qinglong Decoction with modifications or modified Shegan-Ma Huang Decoction may be used for treatment.
2. Exposure to Wind-Heat (i.e., Wind-Heat Invading the Lungs): Pathogenic factors of wind-heat enter the lungs through the mouth and nose, or latent heat in the lungs is further aggravated by wind-cold, preventing the heat from being dissipated. This leads to distension and fullness of lung qi, impairing the lungs’ ability to clear and regulate, resulting in coughing, wheezing, and phlegm-whistling, chest and diaphragm distress, rapid breathing, flaring nostrils, facial flushing, fever, and sweating. thick yellow phlegm that is difficult to expectorate, thirst, restlessness, and chest pain caused by coughing. These symptoms often occur during hot seasons. The tongue is red with a yellow, greasy coating, and the pulse is floating and slippery or floating and rapid. The treatment principle should be to clear heat, release the exterior, relieve wheezing, and resolve phlegm; modified Ma Xing Shi Gan Decoction or San Zi Yang Qin Decoction with appropriate adjustments may be used.
3. Excess Phlegm-Dampness Internally: Due to irregular diet, or overindulgence in raw, cold, greasy, and sweet foods, as well as excessive alcohol consumption, the spleen and stomach are damaged, causing the spleen to lose its ability to transport and transform. This leads to the formation of phlegm-turbidity, which gradually accumulates and rises to the lungs, causing the lungs to lose their ability to disperse and descend. This results in qi reversal, wheezing, and coughing, with copious, sticky phlegm; phlegm obstructing the flow of qi leads to chest fullness and oppression, and the interaction of qi and phlegm causes wheezing in the throat; damp phlegm impeding the spleen results in nausea, loss of appetite, a bland taste in the mouth, a white, greasy tongue coating, and a string-like and slippery pulse. The treatment principle should be to dry dampness, eliminate phlegm, descend qi, and relieve wheezing; San Zi Yang Qin Decoction combined with Er Chen Decoction may be used for treatment.
4. Lung Deficiency: With lung deficiency, qi lacks a proper anchor, manifesting as shortness of breath and wheezing, weak speech, a low and feeble cough, fatigue and weakness, a pale complexion, spontaneous sweating, and aversion to wind; additionally, due to insufficient lung yin, there is dryness of the mouth and throat, a red tongue with a thin coating, and a fine, small, and rapid pulse. The treatment principle is to tonify the lungs and alleviate wheezing; the modified Shengmai San formula may be used.
If accompanied by concurrent lung and spleen deficiency, the treatment should focus on tonifying the lungs, strengthening the spleen, regulating qi, and alleviating wheezing; the modified Ren Shen Ge Jiao San formula may be used.
5. Kidney Deficiency: The kidneys are the root of qi; when the kidneys are deficient, qi loses its ability to contain and regulate. Patients with this pattern present with prolonged shortness of breath, exhalation predominating over inhalation, increased shortness of breath upon exertion, physical and mental exhaustion, cold limbs and aversion to cold, spontaneous sweating, a pale tongue with a white coating, and a deep, fine pulse. The treatment principle should be to tonify the kidneys, contain qi, subdue counterflow, and alleviate wheezing. The Kidney Qi Pill may be used for treatment. Modifications should be made according to specific symptoms: for example, for cough with copious phlegm, add Asarum, Schisandra, and Perilla Seed; for severe shortness of breath, add Codonopsis, Psoralea, Chinese Yam, Ligustrum, and Schisandra; for edema in the limbs—especially the lower legs—and difficulty urinating, add the True Warrior Decoction to the treatment.
Generally speaking, excess-type wheezing results from obstruction of lung qi; it can be cured by expelling pathogenic factors and promoting the flow of qi, making treatment relatively straightforward. In contrast, deficiency-type wheezing arises from insufficient qi to support respiration and a lack of fundamental stability; tonification may not yield immediate results. If complicated by external pathogenic factors, treatment becomes particularly challenging. A thorough diagnosis and careful management are essential, and patients must adhere to a prolonged course of medication for the treatment to be effective.
III. Other Treatments
1. Acupuncture: Acupoints may be selected based on the specific syndrome. Commonly used points include Lieque (LU8), Chize (LU11), Feishu (BL13), Fengmen (BL12), Shanzhong (CV17), Kongzui (LU9), Zhongfu (LU11), Hegu (LI4), Dazhui (GV14), Fenglong (ST40), and Dingchuan (BL22). For deficiency syndromes, points such as Pishu (BL20), Zusanli (ST36), Shenshu (BL23), Taixi (KI3), Neiguan (PC6), and Shenmen (HT7) may be added.
2. Auricular Acupuncture and Auricular Acupoint Application: Commonly used points include Pingchuan, Adrenal, Trachea, Subcortical, and Sympathetic.
IV. Preventing Asthma Recurrence
Since asthma attacks are extremely painful, and repeated attacks or prolonged unresolved symptoms can easily lead to pulmonary complications—such as spontaneous pneumothorax, atelectasis, bronchiectasis, and pulmonary fibrosis—preventing recurrence is of utmost importance. Patients with asthma should take the following measures to prevent recurrence:
1. Stay warm to prevent colds;
2. Avoid foods that commonly trigger attacks;
3. Avoid exposure to triggers, such as strong odors, paint, and medications;
4. Quitting smoking and alcohol is one of the most important ways to reduce asthma attacks and prevent the condition from worsening;
5. Relieve stress, maintain a positive mindset, and engage in appropriate physical activities, such as Tai Chi or Qigong;
6. During remission periods, take traditional Chinese herbal medicine to regulate and tonify spleen and kidney function and boost immune function; however, this requires a relatively long period of treatment to be effective.