Bronchial asthma is and episodic allergic pulmonary disease. The attack is mostly induced by the inhalation of or contact with allergens, such as pollens, dusts, insects (such as mite), germs, etc. During the attack, patients have severe dyspnea which is due to spasm of bronchial smooth muscles, swelling of the bronchial mucosa, and hypersecretion of the mucus, leading to bronchial obstruction. When the attack can not be relieved for a long time, it is called "status asthmaticus." The disease is often seen in children and teenagers. In TCM, it is attributable to the categories of "xiao" (bronchial wheezing) and "chuan" (dyspnea).  

Main Points of Diagnosis

1. Notice whether there is an allergic history of the patient and his family. For patients with histories of allergic rhinitis and urticaria, the disease is easy to be diagnoses.

2. The onset is abrupt, frequently occurring at night. Usually the patients suddenly have a sense of suffocation and of constriction in the chest, and orthopnea. The attack lasts from several minutes to several hours. On auscultation, typical wheezes can be heard over the lung fields. Moist rales may be present if pulmonary infection coexists. Termination of the episode is frequently accompanied by a cough with profuse mucoid sputum.

3. The status asthmaticus: In some cases the acute attack may persist for a long time (over 24 hours), or the episode can not be relieved by various drugs. The patients have severe dyspnea, accompanied with profuse sweating, pallor, cyanosis, tachycardia and coldness of limbs. Respiratory failure may occur in critical cases, and death may ensue if timely treatment is not given.

4. Laboratory examinations: The eosinophilic leukocyte count may increase markedly during the attack, up to 5¡ª15 percent or more in differential count. Sputum examination may reveal more eosinopilic leukocytes and rhomboid crystals in the sputum. Serum concentration of IgE may be increased. Skin test for specific antigens is helpful to find the allergic agent, but the provocative allergic test may have potential danger of inducing asthmatic attack. Therefore, it should be performed with caution.  

Differentiation and Treatment of Common Syndromes     

1. Asthma of Cold Type

Main Symptoms and Signs: A feeling of fullness and distress in the chest, dyspnea with wheezing sound in the throat, cough with thin sputum, frequent attacks in cold seasons or caused by cold, whitish, moist and glossy fur of the tongue, taut and tight pulse.

Therapeutic Principle: Ventilating the lung and expelling pathogenic cold, eliminating phlegm to relieve asthma.

Recipe: Belamcanda and Ephedra Decoction with additional ingredients.

belamcanda rhizome

ephedra

asarum herb

pinellia tuber

schisandra fruit

aster root

coltsfoot flower

fresh ginger

Chinese date

bitter apricot kernel

perilla fruit,

All the above drugs are to be decocted in water for oral administration.

Besides, 10 grams of cinnamon twig is added for the case with chill, 10 grams of epimedium seed and 10 grams of earthworm for the case with sever asthma, which also responds well to the treatment of Minor Decoction of Green Dragon.

2. Asthma of Heat Type

Main Symptoms and Signs: Dyspnea with wheezing, irritable oppressed sensation in the chest even gasping for breath, yellowish mucoid sputum, thirst, frequent occurrence in hot seasons or onset closely associated with heat, reddened tongue with yellow greasy fur, slippery and rapid pulse.

Therapeutic Principle: Removing heat-phlegm and facilitating the flow of the lung-qi to relieve asthma.

Recipe: Modified Prescriptions of Decoction of Ephedra, Apricot Kernel, Gypsum and Licorice combined with Decoction of Three Kinds of Seeds for the Aged.

ephedra

bitter apricot kernel

gypsum

perilla fruit 

licorice root

perilla fruit

epimedium seed

earthworm

mulberry bark

trichosanthes seed

Sichuan fritillary bulb

All the above herbs are to be decocted in water for oral administration.

In case of profuse perspiration, ephedra is removed from the above recipe, on the other hand, 30 grams of honeysuckle flower is added if fever is present; 18 grams of powder of clam shell, 15 grams of glehnia root are employed for patients who cough with thick yellowish sputum; 6 grams of eagle wood and 10 grams of magnolia bark for patients with dyspnea and adverse flow of qi.

3. Asthma of Deficiency Type

Main Symptoms and Signs: Chronic and recurrent attacks for a long time, constant minor and persistent asthma at ordinary times. The sound of cough being low and weak, palpitation and shortness of breath, spontaneous perspiration and aversion to wind, general debility, pale tongue with little fur, deep thready and weak pulse.

Therapeutic Principle: Tonifying the lung and spleen, improving inspiration to relieve asthma.

Recipe: Powder of Ginseng and Gecko with additional ingredients.

ginseng

gecko

gecko, (ground and taken after being infused in the finished decoction)

walnut kernel

ophiopogon root

schisandra berry

astragalus root

cordyceps

lily bulb

poria

red tangerine peel

prepared licorice root

All the above herbs except gecko are to be decocted in water for oral administration.  

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