Jake Paul Fratkin, OMD, L.Ac. The Herbalist’s Corner
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month. Many patients need to follow-up with herbal products and monthly acupuncture visits for up to two years. This approach, in my opinion, resolves the issue, and as the child grows, asthma does not return.
The Western medical approach, while commendable for minimizing the severity and frequency of attacks, does not cure the condition, and may have negative consequences. The typical medical response uses albuterol inhalers (Proventil, Proair, Ventolin, etc), taken daily or on an as need basis, combined with a low-dose steroid inhaler (Pulmicort, Symbicort, Flovent, Qvar, Advair), taken daily. Some doctors are also using leukotriene modifiers to inhibit inflammation (Singulair).
Albuterol is a β2 agonist, relaxing bronchospasm. Clinically, I am comfortable with patients taking Albuterol for exercise-induced asthma, and it is certainly the medicine of choice for acute asthma attack when given in a nebulizer. The medicine can cause hyper-yang symptoms such as restlessness, anxiety or disturbed sleep. If given or taken in excess, it may deplete potassium, raising blood pressure or leading to tachycardia or palpitations.
When I started my practice, Albuterol was the main drug given in pediatric cases, with prednisone used for acute emergency room visits. In the last 10-15 years, inhaled low-dose steroids are being recommended in every case. The medical world thinks that low-dose inhaled steroids are safe, although it has been shown to slightly slow or reduce normal growth. In adults, long-term use has been related to the development of cataracts. In TCM (Traditional Chinese Medicine), these side effects indicate kidney impairment. Hyperactive symptoms indicate an elevation of kidney yang, while cataracts indicate a depletion of kidney yin. In Functional Medicine, steroids can injure the adrenals (use it or lose it): the body senses cortisol, and thereby reduces natural production. Long-term use will damage normal adrenal function. I cannot help but believe that daily use of inhaled low-dose steroid can damage a child’s kidney/adrenal function. We see this clinically by the patient developing a dependence on the steroids. Stop them, and asthmatic attacks return. For this reason, I endeavor to get the child off steroids, and work to strengthen both lung and kidney function. I encourage Albuterol inhaler for episodic wheezing, and Albuterol nebulizer for acute attacks. As the TCM therapies do their work, we find that the patient needs the inhaler less and less.
The Clinical Presentation of Asthma
Western medicine attributes asthma to allergies, causing bronchial spasm and inflammation. Many asthmatic children have food triggers, typically glutens (wheat, rye, barley) and/or diary (including goat). Because restriction of the foods is difficult for school-aged children, confirming the allergy is helpful. IgG blood tests, skin or RAST test for IgE, muscle-testing, electrodermal testing – are all useful. In my experience, dairy plays more of an active role than glutens, but glutens can be inflammatory for some individuals. Removing the food irritant is usually an important component to therapy, especially in the beginning. Other allergen triggers include the hair and dander of cats, dog, rabbits, horses; also dust mites.
On the initial visit, a detailed history is important. The age of onset, frequency and severity of attacks, their awareness of perceived triggers, family history of asthma or food allergies, their pharmaceutical medications – all these are significant. Listening to the lungs with a stethoscope is essential – it will show strength of the breath, the degree of bronchial spasm and restriction, the presence of rales (“crackles”, like Velcro being pulled apart), and wheezing (high pitched whistle-like on exhale), and whether the lungs are dry or phlegmy.
In the modern TCM literature from China, we see four patterns in asthma: invasion of lungs by wind-cold, accumulation of phlegm-heat in lungs, deficiency of lung qi, and deficiency of kidney qi. (See Practical Therapeutics of Traditional Chinese Medicine, Wu, Fischer and Fratkin, Paradigm 1997).
In my practice, in the chronic passive stage, what I typically see is deficiency of lung qi and yin. Where there has been prolonged steroid use, there may co-exist deficiency of kidney qi. I rarely see accumulation of phlegm. In an acute attack, one needs to differentiate phlegm-heat or phlegm-damp, internal heat, wind-cold or wind-heat-toxin. Asthmatics easily go into labored breathing and cough when they catch a cold. In any of these cases, the appropriate differentiation and herbal therapy needs to be applied. (See Fratkin, Plotting Acute Cough, Acupuncture Today, May, 2007.)
Pediatric Asthma: A Case History. Casey B. (not his real name), 9-year-old male, came to the clinic in April, 2015. His mother reported his history: he was born two weeks premature, and the mother had been given antibiotics during pregnancy. He had all of his immunizations before 6 months of age. Casey has had asthma since 6 months old, with a history of colic. He was taken off of dairy and glutens, and occasional ingestion will aggravate his asthma. He has had two major attacks requiring prednisone and antibiotics, and needs an Albuterol nebulizer once or twice a year. He takes Pulmicort daily, and Albuterol inhaler for any exercise-induced labored breathing, using it two to three times a week. Asthma is easily triggered by activity in the cold air, as well as frequent episodes of common cold. The mother’s main concern was frequency of “getting sick”, and was hoping to improve Casey’s immune system.
On this first visit, Casey was recovering from a cough following one of his frequent colds. He was not in obvious asthmatic distress – his breathing seemed regular, and his shoulders were not hunched. I asked him to cough, and could hear a deep rattle, although the cough itself was weak.
Stethoscope examination revealed some rales with slight wheezing. Inhalation was quicker than exhalation. Pulses were slightly weak in the lung and spleen position; the tongue was not significant. (Lung phlegm, contrary to common misconceptions, does not show as a coat on the tongue, unless there is significant phlegm in the stomach as well.)
On the first visit, we did not have time to do a complete acupuncture treatment, although I treated ear points using a low-level laser. I followed a computer program recommended protocol for cough (Auriculo 3D), which included shenmen, sympathetic, adrenal, spleen, lung 1 and lung 2, and trachea. The low-level laser I use for the ear is a 200 Hz RJ from Germany, applying 1 joule on each point. I choose laser frequencies based on Nogier’s recommendations for ear regions (A, B, C, etc).
With all of my patients, I will either customize an herbal formula to be given as an extract-granule powder, or, if they can swallow pills, we will use manufactured products. In Casey’s first visit, the initial phase of wind invasion was over, and we did not see or hear signs of heat trapped in the lungs. I concentrated on resolving phlegm, diffusing lung qi, promoting lung qi, and stopping cough, and gave two formulas. The first was Qi Guan Yan Wan, which is available from both Plum Flower and Herbal Times. (Description and ingredients and can be found in my book Essential Chinese Formulas, p. 94-95). The second was Yu Ping Feng Wan (Essential Chinese Formulas, p. 516).
On the next visit, I started acupuncture treatments, which we continued twice monthly. I’d like to explain what it is I do with acupuncture, because it is not a commonly known approach. My system is called the Three-Level Acupuncture Protocol, which is based on Japanese systems of meridian balance. This approach balances the meridians as a foundation (the root), while using TCM approach and ear for branch treatment. It is very effective for pediatric asthma, and actually, this is the approach I do with all of my patients.
TCM acupuncture, as most readers know, has point prescriptions based on diagnosis (the main complaint) and then subdivided into specific patterns of differentiation. In contrast, Japanese meridian balance methods such as Keiraku Chiryo or Toyohari evaluate the patient for excesses and deficiencies in each of the twelve channels. The method is not one of point-combinations based on pattern differentiation, but on balancing the channels as the root treatment. Traditionally, diagnosis is done with Nan Jing pulse diagnosis, which assigns each of the 12 primary channels to a particular pulse position. These are compared for signs of excess or deficiency, and point selections are based on specific patterns. In 3-Level Protocol, the first level balances the primary channels according to the traditional Japanese approach. I then integrate Miki Shima’s Somato-Auricular Therapy (SAT), which balances the second and third levels, the eight extraordinary channels and the divergence channels. I am only able to do this thanks to computerized meridian diagnosis, specifically, the Acugraph program, which includes SAT. Once acupoints are measured, the program indicates point selection.
In Casey’s case, we applied Japanese teishin tools to tonify and disperse weak and excess channels. I then used body-point laser (808 Hz, 4 joules using the American-made LZ30), on the point recommendations on the Acugraph program for the SAT protocol. Finally, we use the LZ30 laser with the 4-point broad application head, much as we would use a Chinese moxa stick or Japanese moxa cup. We “laser massage” the chest and back along the channels, and between the upper ribcage, and also treat points such as Ren 17, LU 2, DU 12, BL 13, etc.
I used 3-Level Protocol on Casey for all of his treatments, twice monthly. Daily, he was provided a dong chong xia cao (Pulvis Cordyceps), 2 capsules once or twice a day. Herbal formulas were rotated every month, choosing from the following: Ping Chuan Wan, Ding Chuan Wan, and Bu Fei Wan. (See Chapter 3F, Essential Chinese Formulas, Fratkin.) If common cold or cough were present, I would suspend the asthma treatment and treat with appropriate formulas.
Casey has done very well. He stopped Pulmicort very early in our work, and has used Albuterol puffer only occasionally. There have been no acute attacks requiring nebulizer or emergency room visits. His lungs are much stronger, and we never really needed to address kidney deficiency. He has had no episode of common cold or cough in the last 8 months. Acupuncture treatments are now given once a month, and herb dosing has been reduced to once a day. Even though he is now 11 years old, he is a competition gymnast who practices at least 2 hours a day, and often up to six hours. The key to his success was continual herbal support, combined with regular meridian balance acupuncture.