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Asthma is a recurrent lung system disease characterized by wheezing and difficulty in breathing.At the onset,it manifests as wheezing and tachypnea,shortness of breath,gurgling phlegm in the throat,and prolonged expiration.In severe cases,the child cannot lie flat and displays difficult breathing with an open mouth and raised-shoulders with cyanotic lips.This disease occurs during specific seasons,appearing more often in winter and spring as well as during sudden weather or temperature changes.It usually occurs or becomes serious in the early morning or during the night.Involving a high genetic predisposition,asthma often occurs in 1–6 years old.After standard treatment and nursing,the disease can be gradually recovered.But if there is a failure to prevent and treat asthma,it can occur repeatedly; this situation may persist into adulthood or last throughout the lifetime.Asthmatic bronchitis and bronchial asthma in western medicine can be referred to the treatment of this disease.
The etiology of asthma includes both extrinsic and intrinsic causes.The intrinsic causes lie in an insufficiency of lung,spleen and kidney functions which result in the retention of phlegm and rheum; this is the “obstinate root” of asthma.Extrinsic causes refer to a wide range of stimuli,including exposure to external pathogenic factors,foreign bodies,inappropriate diet,disturbance of emotions,and overstrains.Asthma occurs mostly in the lung,and the basic pathomechanism is the retention of phlegm and rheum.It is triggered by external factors.
The child zang-fu organs are delicate and immature,lung-qi is insufficient,and the body fluid remains in the lung collaterals and accumulates into phlegm since it cannot disperse and compress regularly; the deficiency of spleen qi leads to failure of transportation and transformation so as the phlegm forms due to accumulated dampness; the kidney qi is deficient and is not able to warm and gasify the body fluid so that the stagnation of fluid-dampness coagulates to phlegm.Asthma,therefore,is induced by deficiency of lung,spleen and kidney qi,disorders of body fluid regulation,phlegm accumulation and retention in addition to external factors.Recurrent episodes of asthma cause lung qi dissipation,manifesting as lung and spleen qi deficiency,which,if persists long,will lead to deficient and weak kidney qi,manifesting as spleen-kidney yang deficiency.And a few children with asthma have yin deficiency themselves or the prolonged consumption of lung and kidney yin,manifesting as lung-kidney yin deficiency.
In short,at the stage of the attack,asthma is dominated by the excess of pathogenic qi,with internal stagnation qi,external contractions and phlegm lodging in the diaphragm,which combine to obstruct the airways and gives rise to asthma.At the remission stage,asthma is dominated by the deficiency of healthy qi,manifesting as different syndromes of lung,spleen and kidney deficiency.Because it is difficult to remove the insidious phlegm,prevent the external pathogens,identify the pathogenic factors,and regulate the child constitutions,asthma is lingering and difficult to cure.If the obstruction of the airways aggravates,causing lung qi stagnation and blood stasis,there will be cyanosis of mouth and fingertips.If the pathogenic qi is excessive and the healthy qi weak,there will appear pale complexion due to yang deficiency,cold sweating in the forehead,cold limbs,and weak pulses.
◆ Essentials of Diagnosis
1.History Mostly having a history of infantile eczema,allergic rhinitis,or an asthmatic family history.
2.Clinical manifestations There is often a sudden onset and premonitory symptoms such as sneezing and coughing.During the attack,the patient may experience shortness of breath,breathlessness,wheezing,coughing,difficulty in lying flat,restlessness,cyanotic lips,and wheezing rales in both lungs,with wheezing rales mainly in the expiratory phase and a prolonged expiratory phase.With secondary infection,medium and fine rales can be heard.
3.Auxiliary examination
a.Routine blood test: Total number of white blood cells is normal,and eosinophils can be increased.The number of leu-kocytes and neutrophils are increased with the bacterial infection.
b.Lung function test: Forced expiratory volume (FEV 1 ) in the first second is the best single index to evaluate the severity of airway obstruction and asthma severity.It is a good index to judge the subclinical variation of asthma by calculating the variation rate of PEF a day.
c.Imaging examination: Chest X-ray examination shows that most of the children in the attack period show hyperinflation,increased opacity,and increased lung markings.Most of them are normal during remission.Chest X-ray and CT are used for differential diagnosis and detection of complications.
◆ Differential Diagnosis
Asthma is mainly differentiated from pneumonia,and identified according to the medical history,course of disease,signs and concomitant symptoms.(See table 6–1)
Asthma is divided into attack and remission stages,and the presenting syndromes are mainly differentiated according to cold,heat,deficiency and excess,and the involvement of the lung,spleen,and kidney.At the attack stage,it is mainly dominated by excess pathogens,manifesting as phlegm rales in the throat and shortness of breathing and panting,and it is important to distinguish from cold and heat according to symptoms,tongue,pulses,urine,and stools: heat asthma presents with a cough and wheezing with yellow phlegm,fever and red complexion,dry mouth,red tongue,dry stools,and rapid pulses; cold asthma presents with cough and wheezing,fear of could,profuse clear thin phlegm,thin sloppy stools,pale lips,tongue and throat with white slippery coating; cases of external cold and internal heat present with syndromes of exogenous wind cold and internal heat; cases of lung excess and kidney deficiency present with long course of disease,severe panting,pale tongue and weak pulse.At the remission stage,asthma is relieved,dominated by the deficiency of healthy qi,and it is differentiated from the deficiency of the lung,spleen,and kidney: lung and spleen qi deficiency often presents with spontaneous perspiration,repeatedly catching a cold,profuse phlegm and loose stool; spleen and kidney yang deficiency often present with poor appetite,loose stool,short breath with movements,bright pale complexion,increased nocturia,cold body and limbs; lung and kidney yin deficiency presents with flushed face,emaciation,short breath,dry cough with little phlegm,red tongue with little coating,fine and rapid pulse.
Table 6–1 Differential Diagnosis
Asthma should adhere to the principle of long-term,standardized and individualized treatment.At the attack stage,the aim of treatment is to eliminate the pathogenic factors and to treat the symptoms,distinguishing between cold and heat,deficiency and excess.At the remission stage,the aim is to strengthen healthy qi to treat the disease root,reinforcing lung,spleen,and kidney,restoring the function of the zang-fu organs,and removing latent phlegm inside the body.For severe and critical cases,the treatment should combine Chinese and western therapies.Asthma is a stubborn illness which requires a comprehensive treatment with a variety of therapies,such as application therapy, tuina, and so on.
Attack Stage
◆ Cold Asthma
Signs and Symptoms: a cough,short breath,wheezing,clear and thin phlegm and nasal discharge,nasal congestion,sneezing,a cold body without sweating,whitish complexion and cold limbs,clear urine in large amounts,loose stools,pale tongue with white coating,floating pulse or red finger venules.
Essentials: wheezing,clear and thin phlegm,pale tongue with white coating,floating pulse or red finger venules.
Treatment Principles: Warm the lung for dispelling cold,resolve phlegm for relieving panting.
Formula: Modified Xiăo Qīng Lóng Tāng (Minor Green Dragon Decoction,小青龙汤)from On Cold Damage ( Shāng Hán Lùn ,伤寒论).
Similar formula: Modified Shè Gān Má Huáng Tāng (Belamcanda and Ephedra Decoction,射干麻黄汤) from Essentials from the Golden Cabinet ( Jīn Guì Yào Lüè ,金匮要略).
Modified Xiăo Qīng Lóng Tāng is applied to cases with wind-cold fettering the exterior,cold phlegm obstructing the lung,and severe superficies cold; Shè Gān Má Huáng Tāng is applicable for cases with slight superficies cold.
Medicinals: zhì má huáng (Herba Ephedrae Praeparata cum Melle), guì zhī (Ramulus Cinnamomi), xì xīn (Radix et Rhizoma Asari), gān jiāng (Rhizoma Zingiberis), bàn xià (Rhizoma Pinelliae), wǔ wèi zǐ (Fructus Schisandrae Chinensis), bái sháo (Radix Paeoniae Alba), zhì gān căo (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle).
Modifications: For phlegm obstruction and short breath,add zǐ sū zǐ (Fructus Perillae), bái jiè zǐ (Semen Sinapis) and lái fú zǐ (Semen Raphani); for severe cough,add zǐ wăn (Radix et Rhizoma Asteris), kuăn dōng huā (Flos Farfarae) and xuán fù huā (Flos Inulae); for serous wheezing and rales,add shè gān (Rhizoma Belamcandae) and dì lóng (Pheretima); for panting,add tíng lì zǐ (Semen Lepidii; Semen Descurainiae).
◆ Heat Asthma
Signs and Symptoms: a cough,short breath,wheezing,sonorous voice,yellow and thick phlegm,fever with a red complexion,restlessness and thirst,dry and hard stools,yellow urine,red throat,red tongue,yellow or yellow and greasy coating,slippery and rapid pulse,and purple finger venules.
Essentials: wheezing,sonorous voice,yellow and thick phlegm,red tongue,yellow or yellow and greasy coating,slippery and rapid pulse,and purple finger venules.
Treatment Principles: Clear lung-heat and resolve phlegm,relieve a cough and panting.
Formula: Modified Dìng Chuăn Tāng (Arrest Wheezing Decoction,定喘汤) from Numerous Miraculous Prescriptions for Health Cultivation ( Shè Shēng Zhòng Miào Fāng ,摄生众妙方).
Medicinals: zhì má huáng (Herba Ephedrae Praeparata cum Melle), shí gāo (Gypsum Fibrosum), kǔ xìng rén (Semen Armeniacae Amarum), sāng bái pí (Cortex Mori), huáng qín (Radix Scutellariae), bàn xià (Rhizoma Pinelliae), tíng lì zǐ (Semen Lepidii; Semen Descurainiae), zǐ sū zǐ (Fructus Perillae), shè gān (Rhizoma Belamcandae), guā lóu (Fructus Trichosanthis),and zhì gān căo (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle).
Modifications: For heavy wheezing,add dì lóng (Pheretima) and jiāng cán (Bombyx Batryticatus); for profuse phlegm,add dăn nán xīng (Arisaema cum Bile) and zhú lì (Succus Bambusae); for severe cough,add băi bù (Radix Stemonae) and kuăn dōng huā (Flos Farfarae).
◆ Exterior cold and Interior Heat
Signs and Symptoms: panting,short breath,cough with wheezing,nasal congestion with thin discharge,or fever with aversion to cold,yellow,and sticky phlegm,thirst,yellow urine,dry and hard stools,red throat,red tongue,white thin or yellow thin coating,slippery and rapid or floating and tight pulse,floating and red or deep and purple finger venules.
Essentials: panting,short breath,cough with wheezing,nasal congestion with thin discharge,or fever with aversion to cold,yellow,and sticky phlegm,yellow urine,dry and hard stools.
Treatment Principles: Release exterior cold,clear interior heat,relieve panting and coughing.
Formula: Modified Dà Qīng Lóng Tāng (Major Green Dragon Decoction,大青龙汤)from On Cold Damage ( Shāng Hán Lùn ,伤寒论).
Medicinals: má huáng (Herba Ephedrae), guì zhī (Ramulus Cinnamomi), bái sháo (Radix Paeoniae Alba), xì xīn (Radix et Rhizoma Asari), wǔ wèi zǐ (Fructus Schisandrae Chinensis), bàn xià (Rhizoma Pinelliae), shí gāo (Gypsum Fibrosum), huáng qín (Radix Scutellariae), tíng lì zǐ (Semen Lepidii; Semen Descurainiae), zǐ sū zǐ (Fructus Perillae).
Modifications: For preponderant heat,add zhī zǐ (Fructus Gardeniae), yú xīng căo (Houttuyniae Herba) and hǔ zhàng (Rhizoma Polygoni Cuspidati); for serious cough,add sāng bái pí (Cortex Mori), qián hú (Radix Peucedani) and zǐ wăn (Radix et Rhizoma Asteris);for heavy panting, shè gān (Rhizoma Belamcandae) and sāng bái pí (Cortex Mori).
◆ Lung Excess with Kidney Deficiency
Signs and Symptoms: a relative prolonged course,persistent wheezing and panting,short breath with oppression in the chest which worsens with movement,cough with profuse phlegm,gurgling phlegm in the throat,lusterless complexion,aversion to cold with cold limbs,mental fatigue,poor appetite,clear urine in large amounts,pale tongue,white and thin or white and greasy coating,thready and weak pulse,and light-colored finger venules.
Essentials: persistent wheezing and panting,short breath with oppression in the chest which worsens with movement,cough with profuse phlegm,gurgling phlegm in the throat,mental fatigue,poor appetite,pale tongue,white and thin or white and greasy coating,and thready and weak pulse.
Treatment Principles: Purge the lung for relieving asthma,and invigorate the kidney for improving inspiration.
Formula: Modified Sū Zǐ Jiàng Qì Tāng (Perilla Fruit Qi-Descending Decoction,苏子降气汤) from Teachings of [Zhu] Dan-xi ( Dān Xī Xīn Fă ,丹溪心法).
Categorized Formula: Modified Dū Qì Wán (Qi-Restraining Pill,都气丸) from Symptoms,Causes,Pulses,and Treatment ( Zhèng Yīn Mài Zhì ,症因脉治) with Shè Gān Má Huáng Tāng (Belamcanda and Ephedra Decoction,射干麻黄汤) from Essentials from the Golden Cabinet ( Jīn Guì Yào Lüè ,金匮要略).
Sū Zǐ Jiàng Qì Tāng is applicable to cases with lung excess,while Shè Gān Má Huáng Tāng to cases with kidney deficiency.
Medicinals: sū zǐ (Fructus Perillae), bàn xià (Rhizoma Pinelliae), qián hú (Radix Peucedani), ròu guì (Cortex Cinnamomi), hòu pò (Cortex Magnoliae Officinalis), kǔ xìng rén (Semen Armeniacae Amarum), zǐ wăn (Radix et Rhizoma Asteris), kuăn dōng huā (Flos Farfarae)and chén pí (Pericarpium Citri Reticulatae).
Modifications: For shortness of breath with any activity,add zǐ shí yīng (Fluoritum)and hē zǐ (Fructus Chebulae); for aversion to cold with cold limbs,add zhì fù zǐ (Radix Aconiti Lateralis Praeparata) and yín yáng huò (Herba Epimedii); for profuse and white phlegm with continual sputum,add bái guǒ (Semen Ginkgo)and qiàn shí (Semen Euryales).
Remission Stage
◆ Lung and Spleen Qi Deficiency
Signs and Symptoms: lusterless and pale complexion,short breath,spontaneous sweating,forceless cough,mental fatigue with on desire to speak,emaciation,poor appetite,loose bowels,easily catching colds,pale tongue with a white and thin coating,thready and weak pulse,and light-colored finger venules.
Essentials: spontaneous sweating,easily catching colds,poor appetite,loose bowels,pale tongue with a white and thin coating,and thready and weak pulse.
Treatment Principles: Reinforce the lung,fortify the spleen,relieve a cough and reduce phlegm.
Formula: Modified Rén Shēn Wǔ Wèi Zǐ Tāng (Ginseng and Schisandra Decoction,人参五味子汤) from The Grand Compendium of Pediatrics ( Yòu Yòu Jí Chéng ,幼幼集成).
Medicinals: dăng shēn (Radix Codonopsis), bái zhú (Rhizoma Atractylodis Macrocephalae), fú líng (Poria), wǔ wèi zǐ (Fructus Schisandrae Chinensis), mài dōng (Radix Ophiopogonis), chén pí (Pericarpium Citri Reticulatae), bàn xià (Rhizoma Pinelliae), zǐ wăn (Radix et Rhizoma Asteris), jú hóng (Citri Rubrum Exocarpium), zhì gān căo (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle).
Modifications: For qi deficiency,add tài zǐ shēn (Radix Pseudostellariae) and huáng jīng (Polygonati Rhizoma); for profuse sweating,add duàn lóng gǔ (Draconis Os Praeparatum), duàn mǔ lì (calcined Concha Ostreae) and nuò dào gēn (Radix Oryzae Glutinosae); for poor appetite,add shā rén (Fructus Amomi) and shān zhā (Fructus Crataegi); for loose stools,add shān yào (Rhizoma dioscoreae) and biăn dòu (Semen Lablab Album).
◆ Spleen-kidney Yang Deficiency
Signs and Symptoms: pale complexion,cold body,and cold limbs,panting and coughing with movement,short breath,palpitation,limp legs,abdominal distension,poor appetite,diarrhea or loose stools,frequent urine,pale tongue with a white and thin coating,thready and weak pulse,and light-colored finger venules.
Essentials: cold body and cold limbs,panting and coughing with movement,abdominal distension,poor appetite,diarrhea or loose stools,pale tongue with a white and thin coating,thready and weak pulse.
Treatment Principles: Warm the kidney,fortify the spleen,consolidate and improve qi reception.
Formula: Modified Shèn Qì Wán (Kidney Qi Pill,肾气丸) from Essentials from the Golden Cabinet ( Jīn Guì Yào Lüè ,金匮要略).
Medicinals: fù zǐ (Radix Aconiti Lateralis Praeparata), ròu guì (Cortex Cinnamomi), shān zhū yú (Fructus Corni), shú dì huáng (Radix Rehmanniae Praeparata), shān yào (Rhizoma Dioscoreae), yín yáng huò (Herba Epimedii), fú líng (Poria), bái zhú (Rhizoma Atractylodis Macrocephalae), hé táo rén (Semen Juglandis),and wǔ wèi zǐ (Fructus Schisandrae Chinensis).
Modifications: For deficiency with obvious dyspnea,add gé jiè (Gecko) and dōng chóng xià căo (Cordyceps); for serious cough,add kuăn dōng huā (Flos Farfarae) and zǐ wăn (Radix et Rhizoma Asteris); for frequent urination at night,add yì zhì rén (Alpiniae Oxyphyllae Fructus), tù sī zǐ (Semen Cuscutae)and bǔ gǔ zhī (Fructus Psoraleae).
◆ Lung-kidney Yin Deficiency
Signs and Symptoms: Flushed complexion,night sweating,emaciation,short breath,hot palms and soles,dry cough with little phlegm,panting,lack of strength,red tongue with a partly peeled coating,thready and rapid pulse,and reddish finger venules.
Essentials: A dry cough with little phlegm,night sweating,emaciation,short breath,red tongue with a partly peeled coating,thready and rapid pulse.
Treatment Principles: Reinforce the kidney,a string the lung,nourish yin and promote qi absorption.
Formula: Modified Mài Wèi Dì Huáng Wán (Ophiopogon,Schisandra and Rehmannia Pill,麦味地黄丸) from Prolonging Life and Preserving the Origin ( Shòu Shì Băo Yuán ,寿世保元).
Medicinals: mài dōng (Radix Ophiopogonis), wǔ wèi zǐ (Fructus Schisandrae Chinensis), shú dì huáng (Radix Rehmanniae Praeparata), shān zhū yú (Fructus Corni), shān yào (Rhizoma Dioscoreae), gǒu qǐ zǐ (Fructus Lycii), băi hé (Bulbus Lilii), běi shā shēn (Radix Glehniae), zǐ hé chē (Placenta Hominis),and mǔ dān pí (Cortex Moutan).
Modifications: For night sweating,add zhī mǔ (Rhizoma Anemarrhenae) and huáng băi (Cortex Phellodendri Chinensis); for rough choking cough,add băi bù (Radix Stemonae)and kuăn dōng huā (Flos Farfarae); for tidal fever,add biē jiă (Carapax Trionycis) and dì gǔ pí (Cortex Lycii).
◆ Chinese Patent Medicines
1. Xiăo Qīng Lóng Hé Jì / Kē Lì (Minor Green Dragon Mixture or Granules,小青龙合剂/颗粒)for cold asthma.
2. Xiăo Ér Ké Chuăn líng Kǒu Fú Yè / Kē Lì (Infantile Asthma Relieving Liquid or Granules,小儿咳喘灵口服液/颗粒) for heat asthma.
3. Sū Zǐ Jiàng Qì Wán (Perilla Fruit Qi-Descending Pill,苏子降气丸) for the syndrome of Lung-excess and Kidney-deficiency.
4. Yù Píng Fēng Kǒu Fú Yè / Kē Lì (Jade Windbarrier Liquid or Granules,玉屏风口服液/颗粒)for syndrome of lung-spleen qi deficiency.
5. Gù Běn Ké Chuăn Piàn (Consolidate the Root Relieve a cough and Asthma Pill,固本咳喘片) for the syndrome of spleen-kidney yang deficiency.
6. Gé Jiè Dìng Chuăn Wán (Gecko Arrest Wheezing Pill,蛤蚧定喘丸) for the syndrome of Lung-kidney yin deficiency.
◆ Application Therapy
According to the formula in Comprehensive Medicine According to Master Zhang ( Zhāng Shì Yī Tōng ,张氏医通),grind 30 g of bái jiè zǐ (Semen Sinapis),30 g of yán hú suǒ (Rhizoma Corydalis),15 g of gān suì (Radix Kansui),and 15 g of xì xīn (Radix et Rhizoma Asari) into fine powder,which is divided into three portions;each portion is applied every ten days.Take one portion of powder mixed with shēng jiāng zhī (ginger juice) to make a thick paste the size of a one-cent coin.Apply to acupoints băi láo (EX-HN 15),BL 13 ( fèi shù ), gāo huāng (the region below the heart).Keep the paste for 2–4 hours before removing it.It can be removed ahead of time if the skin becomes red or small blisters appear.The application is performed on 3 ten-day periods during midsummer for three consecutive years.It is applicable during asthma remission stage.
◆ Tuina Therapy
Push kăn gōng ,push tài yáng ,knead RN 22( tiān tū ),press and knead RN 17 ( dàn zhōng ),ST 18 (rǔ gēn ),and rǔ páng ,knead the navel,supplement pí tǔ ,clear fèi jīng ,move bā guà ,pinch sì héng wén ,knead băn mén ,knead SJ 3( jīng níng / zhōng zhǔ ),pinch wǔ zhǐ jié ,pinch,knead and grasp BL 57 ( chéng shān ) of both sides,knead BL 61 ( pú cān ),press and knead DU 14 ( dà zhuī ), dìng chuăn (EX-B 1) and BL 13( fèi shù ),push aside the scapula,and grasp GB 21 ( jiān jǐng ).
Modification according to symptoms: for cold asthma,additionally push sān guān ,press and knead GB 20 ( fēng chí ); for heat asthma,additionally clear dà cháng and push down six fu -organs,push aside RN 17 ( dàn zhōng ),knead ST 40 ( fēng lóng ),push BL 10( tiān zhù ),and push the spine; for kidney deficiency with wheezing,additionally,supplement shèn jīng and fèi jīng ,rub RN 12( zhōng wăn ),knead dān tián (pubic region),press and knead ST 36 ( zú sān lǐ ),BL 20 ( pí shù ),BL 13 ( fèi shù ),and BL 23 ( shèn shù ).
◆ Acupuncture Therapy
Babies within 3 months should not be applied with acupuncture; infants should be applied with less needling,without retention of the needles; for elder children,the needles can be retained for 20 minutes; deep needling cannot apply to the acupoints with important organs internally on the chest or the back.
1.Body acupuncture
a.Attack stage
Main Points: DU 14 ( dà zhuī ),BL 12 ( fēng mén ),BL 13 ( fèi shù )
Matching points: for external contractions,combine LI 4 ( hé gǔ ); for phlegm obstruction and qi counterflow,combine RN 22 ( tiān tū )and RN 17 ( dàn zhōng ); for profuse phlegm,combine RN 12 ( zhōng wăn ) and ST 36 ( zú sān lǐ ).
Manipulation: Retain the needle for about 20 minutes,and through lifting,thrusting,twirling,with even supplementation and drainage method,manipulate the needling 2–3 times; withdrawing the needles,cupping is applied to the area between DU 14 ( dà zhuī )and BL 13 ( fèi shù ),or bilateral BL 13 ( fèi shù )with retention for about 10 minutes.
b.Remission stage
Main Points: GB 20 ( fēng chí ),PC 6 ( nèi guān ),ST 36 ( zú sān lǐ ),RN 17 ( dàn zhōng ).
Points Combination: for lung-qi deficiency,add LU 9 ( tài yuān ) and SP 3 ( tài bái ); for spleen-qi deficiency,add SP 3 ( tài bái ) and SP 6 ( sān yīn jiāo ); for kidney-qi deficiency,add KI 3 ( tài xī ) or KI 6 ( zhào hăi ).
Manipulations: manipulate the needles with reinforcing method,with retention for about 20 minutes.
2.Auricular Acupuncture
Point Locating: Trachea ( qì guăn ),Lung ( fèi ),Adrenal Gland ( shèn shàng xiàn ),Wind Stream( fēng xī ),Endocrine ( nèi fēn mì ), Shen Men ( shén mén ),Apex of Antitragus ( duì píng jiān ).
Manipulations: After routine disinfection of the auricle,the prepared adhesive tape with vacca segetalis is stuck to the ear points.If military papules appear on the local skin,accompanied by itching feeling,it should be stopped.Instruct the child to press several times a day,and press it continuously during the attack.Alternate it on the two ears,10 times for 1 course.
3.Moxa Roll Moxibustion Therapy
Point Locating: DU 14 ( dà zhuī ),BL 13 ( fèi shù ),BL 12 ( fēng mén ),BL 43 ( gāo huāng ),BL 23 ( shèn shù ),RN 6 ( qì hăi ),LU 9 ( tài yuān ),RN 17 ( dàn zhōng ),ST 36 ( zú sān lǐ ).
Manipulations: It is applied to 4–5 points each time,for 10–20 minutes per acupoint,once a day,20–30 times in succession.It is used at remission stage or as an adjuvant therapy for winter diseases treated in summer.
1.Publicize the GINA Act,raise public awareness of asthma,follow the principle of “doctors treating carefully and patients preventing carefully”,and improve the level of prevention and management of asthma.
2.For the family genetic gene of allergies,early intervention measures should be taken by screening and changing diet habits.
3.Avoid catching cold,and pay attention to the prevention of respiratory tract infection in the climate changes.Positively treat and clear the infection lesions,such as timely treatment of nasal sinusitis,nasal polyps,tonsillitis,and dental caries,etc.
4.Avoid exposure to allergens,such as pollen,food with additives,and avoid various inducing factors,such as passive smoking,paint smell,cold drinks and so on.
5.Avoid strenuous exercise,overwork and mental/emotional stimulation.
6.The living environment should be sunny and airy.Keep warm in winter and cool in summer.
7.The diet should be light and nutritious,avoiding foods that are raw,cold,greasy,spicy,oversweet or oversour,and seafood like shrimp or fish.
8.Note any changes in breathing,heart rate,and pulses to prevent the onset of asthma.
GAO,female,age 3.5.Initial visit:August 4th,1991.
The child had suffered dyspepsia with a recent attack within the past 3 days.The symptoms were fever,dry cough without phlegm,wheezing in the throat at night,disturbed sleep,dry stool,and yellow urine.General examinations: temperature:37.6℃,with a fatigue and red complexion and dry lips; red tongue with a white thick coating; pure heart sounds,bubbling sounds and wheezing sounds in the lung; soft abdomen,without touching the liver and the spleen; strong pulses.Blood routine examination: white blood cell count 8 × 10 9 /L,lobulated 50%,lymphocytes 50%; lung X-ray: slight lung markings.The diagnosis was bronchial asthma(asthma of heat).
Treatment: clearing lung,removing fever,and relieving asthma.
Formula: sāng bái pí (Cortex Mori) 7.5 g, huáng qín (Radix Scutellariae) 7.5 g, kǔ shēn (Radix Sophorae Flavescentis) 3 g, zhǐ shí (Fructus Aurantii Immaturus) 7.5 g, shè gān (Rhizoma Belamcandae) 7.5 g, sū zǐ (Fructus Perillae) 7.5 g, dì lóng (Pheretima) 7.5 g, bái qū cài (Herba Chelidonii) 7.5 g,and cè băi yè (Cacumen Platycladi) 7.5 g.It was decocted in water for the oral dose,combined with Xiăo Ér Xiāo Ké Chuăn Jiāo Náng (Capsule for Children’s Asthma,小儿消咳喘胶囊) 0.5 g once a time,three times a day.After 2 days of treatment,the fever was reduced,cough and wheezing were relieved,and the stools were no longer dry.After successive administration for 8 days,there was no cough,no wheezing,and a normal condition.Clinical symptoms were resolved.
Analysis: Heat asthma is a clinically common syndrome,especially in young children with asthma.In this case,the treatment of pediatric asthma focuses on treating symptoms,relieving cough and asthma.In the formula, sāng bái pí (Cortex Mori), huáng qín (Radix Scutellariae), kǔ shēn (Radix Sophorae Flavescentis),and shè gān (Rhizoma Belamcandae) made a group to clear lung and remove fever; sū zǐ (Fructus Perillae), dì lóng (Pheretima), bái qū cài (Herba Chelidonii),and cè băi yè (Cacumen Platycladi) were to stop a cough and relieve panting; and zhǐ shí (Fructus Aurantii Immaturus) was to eliminate stagnation and facilitate excretion.
Source: Wang Lie,Infant Medical Record.Jilin Science & Technology Press,2000: 97–98.