Asthmatic dyspnea is marked by shortness of breath, bronchial weezing, breathing through the mouth and difficulty in lying down. Some TCM literature differentiates between asthma and dyspnea. As the Yi Xue Xin Wu (The Medical Compendium) points out: "Dyspnea refers to a disorder of breathing rythm, while asthma refers to the presence of abnormal sounds during respiration." Shortness of breath, then, is asociated with dyspnea, while bronchial wheezing is an asthmatic symptom. Clinically, both dyspnea and asthma can be observced at the same time, thus they will be discussed together.

Asthmatic dyspnea can appear in bronchial asthma, asthmatic bronchitis, pulmonary emphysema and pulmonary heart disease. Asthmatic dyspnea may result from either external pathogens or internal injury. Clinically, it is due to either an excess of pathogens or a deficiency of vital energy; the former is called excess asthmatic breathing and the latter, deficient asthmatic dyspnea.

Differentiation between excess and deficiency should first be made in order to design an appropriate treatment. The main manifestations of the excess type are: deep inhalation and difficult exhalation, harsh breathing, a rapid, excess pulse and a sudden onset. This disease should be treated by relieving the asthma and resolving phlegm. The deficient type is marked by a shortness of breath following any exertion, a weak voice, and a submerged and thready or large floating pulse. It should be treated by reinforcing and consolidating kidney qi.

Both deficiency and excess cases are often seen togetheer in the clinic. In excess cases, a deficiency of vital energy may be present, while in deficiency cases, the disease is usually aggravated by external pathogens. Deficiency complicated by excess should be treated by strengthening the body's resistence against pathogenic factors. While the disease is in the exacerbation stage(excess), it should be treated by expelling the pathogens, and when it is in remission, vital energy should be strengthened.
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There are several types of asthma, according to Chinese medical theory, and as many different methods of treating it. Perhaps the best known of the therapies is the use of ma-huang formulas. Ma-huang contains ephedrine and pseudoephedrine that dilate bronchial passages and relieve asthmatic breathing. Ma-huang formulas are usually only suitable for those persons who suffer from a syndrome that originates primarily in the Lungs and does not involve other organs such as the Spleen, Liver or Kidney. A history of lung problems, acute attacks of wheezing, and symptoms of pain or numbness in the limbs suggest the use of ma-huang formulas.

The following formulas use ma-huang; they are listed in order of the relative proportion of ma- huang in the entire formula. All formulas listed in this article are Sun Ten extracts unless otherwise indicated. Ma-huang, Licorice, and Apricot Seed Combination (33%)
Ma-haung Combination (32%)
Ma-huang and Magnolia Combination (25%)
Ma-huang and Morus Formula (20%)
Ma- huang and Ginkgo Combination (15%)
Minor Blue Dragon Combination (11%)

A typical pharmacologic dose of ephedrine for relieving asthma is 25 mg to 50 mg. The Ma- huang, Licorice and Apricot Seed Combination and the Ma-huang Combination granules provide this amount when taken in a dosage of 2.5 to 5.0 grams at one time. It is not uncommon to use two or more doses in one day. The other formulas provide a lower dosage of ephedrine, but contain some active ingredients that may compensate fully, so that at 2.5 to 5.0 grams at one time, a satisfactory result is obtained. Note that two formulas often suggested for asthma, Ma-haung and Ginkgo Combination and Minor Blue Dragon Combination, have relatively small proportions of ma-huang and are thus more suitable for regular use in those with chronic asthmatic breathing than for those who suffer acute attacks of asthma. The use of high doses of ma-huang may cause transient hypertension, heart palpitations, or sleeplessness in some individuals. Regular use of lower doses usually does not produce such reactions.

Another approach to relieving asthma is the treatment of stagnant Qi, usually associated with symptoms of edema and digestive disturbance. The Spleen may be involved in these asthma cases when there is persistent anxiety with stagnancy in the circulation of Qi and accumulation of Moisture. Usually, this syndrome results in the production of excessive phlegm, and there may be greater constriction of breathing after eating. Herbs such as pinellia and citrus are used to dry up the excess moisture. Magnolia bark and perilla (fruit or leaf) for dispersing stagnant Qi and Moisture are included to open up the center and promote deeper breathing. Bupleurum may be used to aid the Liver in circulating the Qi. Formulas that combine these elements include:

Pinellia and Magnolia Combination
Perilla Fruit Combination
Ma-huang and Magnolia Combination
Atractylodes and Cardamon Combination
Pinellia 16 (Seven Forests)
Cyperus 18 (Seven Forests)

These formulas are used when there is tension in the diaphragm but weakness in the abdomen. Note that Ma-huang and Magnolia Combination fits this category of formulas, as well as having a substantial amount of ma-huang.

Kidney weakness is another source of asthma. This is especially the case with those who have had long-term use of pharmaceuticals to treat asthma, for those with a life-long history of asthma, and for those showing other symptoms of Kidney disorders. Formulas for Kidney-related asthma usually contain schizandra, rehmannia, dioscorea, and corpus. These herbs nourish and astringe the Kidney Essence. The formulas that tonify the Kidney may affect adrenal hormones which in turn influence breathing. Examples are:

Rehmannia and Schizandra Formula
Gecko-A (Seven Forests)
Lycium Formula Ping Chuan Pill (patent medicine)
Pulmonary Tonic Pills (patent medicine)

The two patent formulas contain a small amount of material that benefits both Lung and Kidney. Lycium Formula is a general Kidney nourishing prescription that is usually not expected to have a quick action, but rather a cumulative effect with prolonged administration.

A persistent dry cough, or a cough with thickened and difficult to expectorate sputum, may produce severe difficulty in breathing under certain conditions such as climactic dryness. It is treated by formulas containing ophiopogon. Examples of formulas indicated for chronic coughing that contain ophiopogon include (proportion of ophiopogon indicated):

Ophiopogon Combination (39%)
Ophiopogon and Trichosanthes Combination (23%)
Ginseng 6 (20%; Seven Forests)
Eriobotrya and Ophiopogon Combination (12%)
Phellodendron Combination (11%)
Platycodon and Fritillaria Combination (10%)
Lily 14 (9%; Seven Forests)

These formulas generally treat a Yin-deficient syndrome, and other Yin nourishing herbs, such as rehmannia, lily, and fritillaria contribute to overcoming the dryness or lack of fluidity of sputum. Ginseng is often included as an ingredient to increase Lung Qi and to produce fluids for the lung (American ginseng, included in the Ginseng 6 formula, is considered especially useful for lung disorders). Some difficulties in treatment of asthma arise because a formula most suited for long-term use is applied for immediate relief of asthmatic attacks or because strong dispersing therapies intended for acute disorders are applied to a chornic syndrome. Treatment of the lungs alone may be inadequate when the Kidney is involved, and conversely, treatment of the Kidney alone may be inadequate if chronic lung weakness is also involved. It is important to consider the dryness or moistness of the condition and select or modify a formula accordingly. Most of the ma-huang formulas and formulas for Spleen involvement (accumulation of dampness) have a drying effect, while most of the Kidney nourishing formulas and the ophiopogon prescriptions have a moistening action. Some patients may require a mixed treatment to address accumulation of pathologic fluids accompanied by deficiency of normal Yin.
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* Food allergy test may be appropriate
* serum IgE. If elevated, skin test for air bourne allergens
* IgG4 and IgE food and air borne panels
* DHEA-SO4
* Adrenal stress index test
* If patient has been using steroids and/or antibiotics, check stool for candita and serum candita antigen
* Consider PANTOX or other antioxidant panel 

· Magnesium 250-500 mg/day · Vitamin B6 50 mg TID · Vitamin C 3-5 gm/day · Vitamin B 12, 1000 mcg/day IM for 30 days (self administration can be taught) · Quercetin 400 ma, twenty minutes before meals . N-acetylcysteine 500-1000 mg/day Consider Gastrocrom if multiple food allergies exist Add DHEA to bring levels to upper range of normal for age
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The following approaches to therapy can be considered:

* While awaiting food allergy panel, can begin immediately Allergy Elimination Diet or Ultra Clear.
* If significant emotional issues are present, mind-body counseling; if patient is already in therapy, consider emotional release bodywork, e.g., Reiki, Therapeutic Touch.
* Elimination of all offending foods from allergy panel, all food additives and chemicals from diet. If IgG4 panel shows large number of allergens, further testing for maldigestion and hyperpermeability.
* If intestinal hyperpermeability is present, check liver detoxification capacity and oxidative stress. 

Recent studies of asthma conducted in the U.S. have revealed that virtually all cases are associated with an inflammation of the bronchial passages. The implication, based on modern pharmacology, is that the anti-inflammatory corticosteroid sprays are the drugs of choice. It is known, however, that repeated application of these steroids can lead to serious side-effects, including dependence on higher doses or more frequent applications of the steroids, and adrenal insufficiency. Until about fifty years ago, adrenaline (norepinephrine) was administered by injection as a treatment for asthma--it is mainly a bronchodilator. This drug was later replaced by ephedrine, derived from the Chinese herb ma-huang, which could be taken orally and which has a longer action than adrenaline; it has anti-inflammatory and bronchodilating effects.

In recent years, aminophylline and corticosteroids have been prominent drugs for asthma. Childhood asthma is differentiated from general bronchial asthma because many children who suffer from regular asthma attacks will find the incidence declining with age. This is probably because hormonal changes, including a change in the regulatory mechanisms for natural production of corticosteroids, influence the inflammatory responses. Of course, should the asthmatic condition fail to resolve at this time, chronic adult asthma ensues. It has been pointed out that some pediatric asthma is due to milk allergies. The theoretical basis of Chinese treatments for pediatric asthma is that children have a basically vigorous constitution when considering their Kidney energy: none of the modern formulas contain the Kidney nourishing herbs used for asthma and chronic bronchitis in the elderly (e.g. rehmannia, epimedium, deer antler, lycium fruit and other Essence nourishing herbs). However, children may suffer from the more superficial condition of Qi deficiency of the Spleen and Lung, thus calling for tonic therapies with herbs such as codonopsis, astragalus, and polygonatum (in the more ancient prescriptions, aconite, peony, and cinnamon twig were used as tonics). Alternatively, they tend to suffer from heat syndromes, for which a variety of cold energy herbs are applied. The treatment of pediatric asthma is highly experimental at this time. New formulations, not at all similar to the ancient prescriptions, are being used in China. For example, in a clinical study published by the Hubei Journal of Traditional Chinese Medicine (1989), seventy cases of asthma in children were treated with Hai Shi Tang, made with mactra shell, pyrrosia, almond (xingren), and schizandra. It was given two to three times daily for a period of three days. The major signs and symptoms were alleviated or eliminated for 84% of those treated; they could lie down comfortably. The effects of the decoction were noted an average of 1.5 hours after administration and lasted for eight hours (after which, another dose would need to be taken). The mactra shell, like that of other bivalves, is rich in calcium carbonate which has an antispasmodic effect. Pyrrosia is listed in the modern Materia Medica as a treatment for urinary disorders, but it also has very strong antitussive, expectorant, and anti-asthmatic effects. Almond (the less bitter alternative to apricot seed, kuxingren) and schizandra are common ingredients in anti-asthma prescriptions. In a study published in the New Journal of Traditional Chinese Medicine (1989), 66 cases of asthmatic bronchitis in children were divided into two groups. One group received Western medications (32 cases) and the other (34 cases) received Chuan Zhi Tang, made with arisaema, platycodon, peucedanum, uncaria, scute, and licorice. The time required to relieve the symptoms of asthmatic breathing and coughing were shorter for the Chinese medicine group than the Western medicine group by three days (4.9 and 6.5 days for asthmatic breathing and coughing with Western medicine, and only 1.9 and 3.1 days respectively for Chinese medicine). Arisaema is a phlegm-resolving agent that is frequently used in treatment of childhood diseases. Platycodon and peucedanum are common ingredients in formulas for lung diseases, including bronchitis due to infection. Uncaria and scute clear heat and relieve spasms. In a study published in the Chinese Journal of Integrated Traditional and Western Medicine (1988), a tonic prescription was given to 40 children 3-12 years old with Qi deficiency who suffered from asthma. The basic formula consisted of astragalus, codonopsis, polygonatum (huangjing), agrimony, scute, and licorice. It would be modified according to specific symptoms or concerns. For example, with acute symptoms of coughing and wheezing, perilla seed and mows bark were added; if an acute upper respiratory ailment occurred, the astragalus and codonopsis was temporarily eliminated and replaced by isatis root, mows leaf, and schizonepeta; if diarrhea or loose stool appeared, polygonatum was removed and hoelen and atractylodes were added; if the appetite was low, citrus and crataegus were added. Agrimony is a hemostatic that also has strong anti-inflammatory actions. A course of treatment was two months and no other therapies were employed during that period; the asthmatic breathing was improved by the use of the herb formulas. A control group of twenty healthy children were also studied. It was found that GCR (a biochemical that interacts with leukocytes) and the ratio of cAMP/cGMP (an established measure for inflammatory responses) in healthy children and in children who were in a period of remission from asthma showed similarly high values (OCR: 8840 vs 8550; cAMP/cGMP: 4.6 vs 5.1), while those who were suffering from asthmatic breathing showed low values (5610; 3.1). A study of 100 children with asthma, age range of five months to five years, was reported in the Liaoning Journal of Traditional Chinese Medicine (1989). Wu Hu Tang, with ma-huang, almond, licorice, gypsum, camellia leaf bud (camellia is the source of ordinary green tea), lonicera, trichosanthes fruit, and earthworm, was used. If phlegm was a problem, arisaema and chih-shih were added. When asthmatic breathing and irritability were present, schizandra was added. If blood stasis was detected by examination of the finger tips, mouth, and lips, salvia was added. For constipation, rhubarb was added. Treatment was for three to seven days and was deemed curative in these cases. The formulas described above for each of the four studies have notably different contents, with almost no overlap. In only the last of these Chinese reports is the herb ma-huang, used in so many ancient therapies for asthma, utilized. In contrast, Japanese doctors, perhaps because of the combined influence of Western medicine and the reliance on ancient formulas, use ma-huang formulas almost exclusively. In a Japanese study, reported in 1982, 65 asthmatic children were given Minor Blue Dragon Combination over an extended period of time. Of these, 51 responded favorably. In a substudy, 19 of the children were given the herb formula on an empty stomach and serum cortisol, ACTH, and free fatty acid were measured at various times thereafter. It was found that cortisol and ACTH levels increased starting thirty minutes after ingestion and continued to increase. Another Japanese evaluation of 31 cases of pediatric asthma treated with Minor Blue Dragon Combination was reported the same year. The report stated that four cases were conspicuously effective, twelve cases were effective, and another four cases were fairly effective. In the effective cases, most children showed lowered levels of IgE after medication, while among the ineffective cases, most children showed no change in IgE, suggesting that this was part of the mechanism of action (IgE production is part of an allergy response mechanism). Side-effects were limited to two cases of soft stool. Similarly, case reports from Japan of pediatric asthma therapies were presented in the OHAI Bulletin (1981) with success claimed for use of Ma-huang and Magnolia Combination and Minor Blue Dragon Combination. In contrast, a Japanese study of bronchial asthma in 181 children using the formula Bupleurum and Magnolia Combination (which does not contain ma-huang) was reported in Wakan Yaku (1979). In some cases a ma-huang formula, either Ma-huang and Apricot Seed Combination or Minor Blue Dragon Combination was used as an adjunct. During asthma attacks, Western drugs might also be used temporarily. The children suffered bronchial asthma either from infection, allergy type reaction, or a mixture. It was concluded that asthmatic breathing associated with infection responded better than atopic asthma or mixed types. Since infections are usually self-limiting, this report suggests that the Bupleurum and Magnolia Combination was not especially effective. For example, among 37 children with infectious bronchial asthma, the attacks subsided completely in 28 of them after a full year of therapy. The ma-huang formulas used as adjuncts apparently aided in relieving asthmatic attacks according to the research report; they are regarded as having a warming nature. The reasons for the difference in therapies between China and Japan is worth exploring further. It may reflect differences in current thinking about Oriental therapies, differences in the population groups, or different selection of patients for treatment. As the result of similar considerations, Western children might be treated with variations of these formulas. Mechanisms for the action of the therapies are partly explained by measures of cortisol, ACTH, IgE, cyclic nucleotides, and leukocyte stimulators; these may help to better explain the precise situations in which the herbs and formulas will prove most effective.

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