ASTHMA & ATOPIC ECZEMA Flashcards
What causes asthma?
Asthma may be caused by allergens inhaled from the air (pollen, mold spores, animal dander, or dust).
Occasionally, food (eggs, shellfish or chocolate), or drugs (aspirin) may precipitate an attack; the involvement of IgE.
Exposure to environmental airborne pollutants, especially fine particulate matter causes or exacerbates inflammation in the bronchi
Increase in atmospheric pollution, chemicals (preservatives, pesticides…) in food, possibly ‘over-sensitizing or derailing parts of the immune system producing abnormal responses to various external stimuli: excreta of dust mites.’
Less physical activity, ‘Phlegm diets’ of sweets, ice cream, dairy
What is asthma characterized by?
Characterized by: Airway obstruction Airway hyper-responsiveness Airway inflammation Bronchial narrowing Mucous in bronchi Swelling of internal layers of bronchi Contraction of the muscles in the walls of bronchi Air flow resistance on EXHALATION, air is trapped in Lung, mucous in constricted bronchi cannot be cleared by coughing
Eastern Medicine describes asthma as a mix of which three things?
EAST: Chinese texts describe asthma (not wheezing) as a disorder of Wind Cold, Kidney deficiency and Phlegm accumulation.
WEST: Presentations in the West do not always fit those patterns; complicated by medication from an early age; little or no Phlegm accumulation, few if any Kidney signs
Compare allergic asthma to non-allergic asthma
Allergic asthma:
early onset or extrinsic asthma; atopic
Etiology & pathology different from Xiao Chuan
Starts in early childhood
Appears to run in families
Often associated with eczema from birth
Atopic, IgE levels six times higher than those with non-atopic type
Main Allergens: Faecal particles of house dust mites, pollen, fungal spores, feathers, animal dander and cats’ saliva
Non-allergic asthma:
late onset or intrinsic asthma; non-atopic
not due to an allergic reaction
Theories of Xiao Chuan can be used effectively
Also:
- Phlegm is central to the pathology of both Xiao and Chuan; not in Allergic Asthma (Wind is the main pathogenic factor in allergic asthma)
- In between attacks, an asthma patient is quite normal with no signs of Phlegm
- Pathogenic factor in Allergic Asthma is Wind that is lodged in the bronchi; attacks are caused from exposure to allergens, cold weather or emotional stress
- Xiao-Chuan does not contemplate infantile eczema, which so often precedes early-onset asthma
Intrinsic vs. extrinsic asthma
Early onset Asthma (Extrinsic):
Early childhood
Familial
Eczema from birth; skin reactions to allergens
Allergens: Dust mite fecal matter, pollen, fungal spores, feathers, animal dander, cat’s saliva
Viruses can act as allergens: respiratory and influenza
Correlation of antibiotic use in infancy, first year
Late onset Asthma (Intrinsic):
Occurs later in life in non-atopic persons
Due to bronchial hyper-reactivity
Sudden wheezing, breathlessness with difficulty exhaling, no sweating, chest tightness, pale face, feeling cold, sneezing, cough, no thirst, attack prompted by cold weather, stiffness of shoulders and neck, no sweating
P: tight
TX: Release the Exterior, expel Wind Cold, restore descending of Lung Qi, calm Mind
Dingchuan, BL 12, 13; CV 22, 15; LU 7, 6; HT 7;
GB 20, 21; cupping BL 12 & 13
Ma Huang Tang Ephedra Decoction
Wind-Cold
Slight sweating, asthma attack with breathlessness, wheezing; less noisy than previous pattern; not much chilliness; tightness of chest; pale face
P: tight, slow
TX: Release the Exterior, harmonize Jing and Wei Qi; restore descending of Lung Qi, calm Mind
BL 12, 13; CV 22, LU 6, ST 36, SP 6, HT 7, CV 15; Dingchuan
Gui Zhi Jia Hou Po Xing Zi Tang
Cinnamon Decoction plus Magnolia and Prunus
Wind-Cold with sweating
Fever, aversion to Cold (if true exterior invasion, otherwise feeling of heat), h/a, chest tightness; loud wheezing; barking cough; asthma; slight thirst
T: Red sides towards front P: Rapid
TX: Release the Exterior, restore descending of Lung Qi, expel Wind Heat, calm asthma, calm Mind
LU 1, 5, 6, 7, 11; HT 7; CV 15
Sang Ju Yin Morus-Chrysanthemum Decoction
Wind-Heat
What do you want to do in between attacks of wind-cold or wind-heat?
Tonify Lung and Kidney’s Defensive Qi
BL 13, 23, 52; CV 4, KD 13, 16; LU 9; GV 12
Restore the descending of Lung Qi
LU 5, 7; CV 17; BL 13
Calm the Mind
GV 19, 24; HT 7; CV 15
In late-onset, tonify the Spleen
ST 36, 40; BL 21
How is the LV involved with asthma?
Liver involved in pathogenesis of Asthma, especially the late onset type
Liver (stress) can be a trigger for asthma attack
Stagnant Liver Qi, rebels upwards, obstructing Lung Qi; ‘Wood insulting Metal’
Liver Fire may rise, obstructing Lung Qi, dry fluids; ‘Wood insulting Metal’
Liver Yin def. draws Yin from the Kidneys causing Kidney’s not grasping Qi; dryness of Lungs
Asthma elicited by emotional stress, oppression, distention of chest, hypochondrium
T: sides may be Red in long standing cases
P: wiry
TX: Soothe the Liver, regulate Qi, restore descending of Lung Qi, calm Mind
SP 4, PC 6, LIV 14, GB 34, CV 17, BL 18
Chen Xiang Jiang Qi San Aquilaria Subduing Qi Powder
LV qi stagnation insulting the LUs
Loud wheezing, attacks of asthma elicited by emotional strain, irritability, propensity to outbursts of anger, hypochondrial and chest fullness; bitter taste, thirst
T: Red with redder sides, yellow coat
P: Wiry, rapid
TX: Clear the Liver, drain Fire, subdue rebellious Qi, restore descending of Lung Qi, calm Shen
LIV 2, 14; BL 18; PC 6; LU 7
Long Dan Xie Gan Tang
Gentiana Draining the Liver Decoction
LV Fire insulting the LUs
Infrequent asthma attacks at night, dry throat, dry cough, blurred vision, dry eyes, hypochondrial and chest distention
P: floating empty T: Red, no coat
TX: Nourish Liver Yin, move Liver Qi, restore descending of Lung Qi, calm Shen
LIV 8, SP 6, KD 3, CV 4, PC 6, SP 4
Yi Guan Jian One Linking Decoction
LV Yin deficiency
What is atopic eczema?
Eczema, at an early age or from birth, often accompanies or precedes Allergic Asthma; the conditions have the same allergic root: wealing skin reactions occurring on inhalation of allergens in patients with extrinsic asthma
In TCM terms: eczema is due to an inborn deficiency of Lung and Kidney’s defensive Qi systems.
LU control skin, linked to pores
KD nourish and moisten the skin; Ren and Chong Mai also nourish skin, have source in Kidneys
Dry, red and itchy skin lesions, itchiness spreading all over the body, moving from place to place.
(Dampness is a factor even in “dry” type)
TW 6, GB 31, BL 12, LI 11, LI 4, GV 14, SP 10, SP 6, LIV 2, HT 8, KD 6, 3; LU 9
Xiao Feng San Clearing Wind Powder
Wind-Heat eczema- acute
