MEDICAL ACUPUNCTURE
Volume 30, Number 2, 2018
# Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2018.29078.cpl
How Do You Treat Asthma in Your Practice?
A sthma, from the Greek word Aazein, means ‘‘to
pant.’’ Corpus Hippocraticum (460 – 360 bc) is the
earliest text where asthma is found as a medical term.1
In 2015, 358 million people globally had asthma.2 About
25 million Americans have asthma. This is 7.6% of adults
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and 8.4% of children.3 It is more common in boys than in
girls.3 Prevalence of asthma is more common among Puerto
Rican patients than among any other ethnic group.4
Asthma is characterized by recurrent shortness of breath,
wheezing, or coughing caused by reversible bronchocon-
striction. Thickening of air passages and blockage by mucus
also contribute. Although asthma is classified as intrinsic
(nonallergic) and extrinsic (allergic), the treatment is very
similar in both varieties.
Mild cases have normal respiratory function between
attacks.
Investigations include a chest X-ray to rule out other
pulmonary disorders; measurements of ventilatory functions—
forced expiratory volume in 1 second(FEV1) and peak expi-
ratory flow rate (PEFR)—several times per day; and the
patient’s response to bronchodilators. Variability through the
day with a morning dip in PEFR is diagnostic. Skin allergy
testing can help avoid aggravating factors in some cases.
Asthma in Chinese Medicine
Chinese Medicine uses the term Xiao-Chuan to describe
asthma. Xiao is wheezing, Chuan is breathlessness, and they
often go together. In the healthy state, the Lung Qi moves
downward and the Kidneys holds it down. Lungs control
inhalation and the Kidneys control exhalation. Liver Qi
Medical Acupuncture is pleased to continue this regular fea-
ture, Clinical Pearls, which we have found to be very useful for,
and practical to the readership, and very popular. All of us are
confronted with clinical challenges, especially when dealing with
therapeutic strategies. We hope this ongoing collection of Clinical
Pearls will be easily accessible and ready to put into action for the
benefit of our patients, and even ourselves. How often do we ask
our colleagues: ‘‘How do you treat. ?’’ This time, we posed the
question: ‘‘How do you treat Asthma in your practice?’’ Herein
lie your contributions. We trust that our readership will continue
to participate in this section by either asking the questions or
supplying the ‘‘Pearls.’’ If you have a ‘‘question’’ you would like
to see answered, please send it to our managing editor, Yael Ben-
Porat, at: yaelbenporat@me.com We encourage and welcome
your input and participation. Please address your answers to
‘‘Pearls’’ to our managing editor, Yael Ben-Porat, at: yaelben-
porat@me.com
100
CLINICAL PEARLS
normally ascends and the upward direction of the Liver Qi
and downward direction of Lung Qi are usually coordinated.
When the descending of the Lung Qi is defective, due to
Lung Qi Deficiency or Kidney Deficiency (failure to receive
the descending Lung Qi), or obstructed by the ascending
Excessive Liver Qi (Liver Yang Rising) or obstructed by
Phlegm (Spleen Deficiency) or Wind, asthma results. In
Xiao Chuan, Phlegm is central to its pathology. In atopic
asthma (extrinsic) Phlegm is not a factor and the wheezing
is caused by bronchoconstriction produced by the Wind.
This is not the usual external or internal Wind; it is a Wind
that is persistently lodged in the air passages and produces
bronchospasms when the patient is exposed to allergens,
cold weather, or emotional stress. Deficiencies of both
Lungs and Kidneys are involved.
Treatment. In acute attacks, the aim is to relieve symp-
toms. When the symptoms are relieved, the pathology can be
targeted.
In very severe attacks of asthma, Western medicine
treatment is recommended.
A basic combination for all types of asthma would be CV
22 (the most important point), Ding Chuan (Extra Point 0.5
cun lateral to GV 14), CV 17 (Influential Point for respiratory
system), BL 13 (Back Shu Point of the Lung), LU 6 (Xi-
Cleft Point of the Lung), PC 6 (Distal Point for chest dis-
orders), ST 40 (point for Phlegm)—all are reduced, and KI 3
(Source Point for Kidney)—which is reinforced. One should
acquire proficiency in the technique of needle insertion at
CV 22.
KI 7 is the Tonification Point of the Kidney. In Excess
conditions of the Lung (see Table 1) reinforcing KI 7 will
reinforce the Kidney, which is often Deficient in asthma.
Because of the fact that Lung is the Mother of Kidney in the
Five Element Cycle, such a stimulation will cause the Excess
of the Lung being sucked by the Son Kidney—a win–win
situation. That is, the Deficient Kidney is reinforced and the
Lung Excess is reduced. So too, stimulation of LU 7 and KI 6,
in that order, by the reduction method will open the CV
channel and that would help in normalizing the Kidney and
Lung.
Some patients might feel tired with the above combina-
tion of points; in such cases, BL 13 may be omitted. The
same combination can be used in late summer as a pre-
ventative for expected asthma in autumn and winter.
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Table 1. Signs, Symptoms, Diagnosis and Treatment of Chinese Syndromes Associated with Asthma

Excess patterns

Pathology Symptoms Tongue/pulse Points Herbs

Invasion of Lungs by Wind Cold
Phlegm Heat in Lungs
Lung Qi Deficiency
Lung Yin Deficiency
Rapid breathing, aversion to cold,
lack of perspiration & white phlegm
Rapid breathing, aversion to heat,
perspiration & yellow phlegm
Deficiency patterns
Shortness of breath, cough, daytime
sweating, catch colds easily &
aversion to cold
Scanty sputum, dry mouth and throat,
night sweating & dry cough
T—Thin white coating Reduce LU 5, LU 7, BL 12,
P—Floating BL 13 & Ding Chuan
T—Yellow coat Reduce BL 13, LU 5, ST 40,
P—Slippery, rapid LI 4, CV 22 Ding Chuan,
LI 11& LU 7
T—Pale Reinforce Ding Chuan, BL 13,
P—Empty Rt front position BL 47, ST 36, LU 9, LU 7,
DU 12 & CV 15 & Moxa.
T—Red, peeling coat Reinforce Ding Chuan, BL 13,
P—Rapid, thread BL 43, LU 9, KI 6, BL 38,
Ma Huang Tang—Ephedra Decoction
Qing Qi Hua Tang—Clearing
Qi and resolving Phlegm Decoction
Ren Shen Bu Fei Tan—Ginseng
Tonifying the Lungs Decoction
Yang Yin Quing Fei Tang—
Nourishing Yin and Clearing

101
Spleen Qi Deficiency
Kidney Yang Deficiency
Liver Yang Rising due to Liver
Yin/Blood Deficiency
Signs and Symptoms shown in bold indicate the diagnosis.
P, Pulse; T, Tongue; Rt, right.
CV 4, SP 6 & LU 10. the Lung Decoction
Slight abdominal distension, tiredness, T—Pale Reinforce CV 12, SP 6, SP 3, Liu Jun Zi Tang—Six Gentleman
weakness of limbs, loose stools & P—Empty ST 36, BL 20, BL 21 & Decoction
tending toward obesity Ding Chuan
Lower back pain, coldness, lassitude, T—Pale, wet Reinforce BL 23, KI 3, You Gui Wan—Restoring the
edema in the legs & impotence P—Deep, weak Kidney pulse GV 4 & CV 4 Right Kidney Pill
Combined Excess and Deficiency patterns
Throbbing headache, dizziness, T—No coating & red in Reduce TB 5, PC 6, LI 4, Tian Ma Gou Teng
numbness of limbs, blurred vision, Yin Deficiency, Pale in GB 43, GB 38 Yin—Gastrodia
muscular weakness, cramps & Blood Deficiency uncaria Decoction
withered nails P—Wiry Reinforce SP 6, LR 8,
ST 36 & KI 3.
 102
Medical acupuncturists who prefer to use the same group
of points in all cases can use the above combination.
If the Chinese Disharmony Patterns are treated with a
view toward reducing recurrences—and this is the preferred
method for the current author—the details given in Table 1
can be followed.
Auricular points. These are generally used during the
asthma attack.
The most important points are Lung 1, Lung 2, Kidney C,
Adrenal Gland C, Sympathetic Autonomic Point, and Stop
Wheezing point.
Other points include Antihistamine, Bronchi, Point Zero,
Shen Men, Allergy Point, Apex of the Ear, Tranquilizer Point,
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Master Cerebral, Spleen C, Occiput, Spleen E and Psychoso-
matic Reactions 1. Select 3–4 points for each treatment using
point locator or tenderness.
Evidence for acupuncture. The evidence for acu-
puncture in the treatment of asthma includes the following
studies:
(1) In patients with acute bronchospasm, acupuncture
resulted in increase of PEFR and FEV1.5
(2) Acupuncture stimulation resulted in reduction of
immunoglobulin E levels in patients with asthma.6
(3) Acupuncture stimulation was followed by increased
levels of cluster of differentiation (CD) 4 + and in-
terleukin (IL) 8, and reduced levels of IL 6, IL 10, and
eosinophils.7
(4) Jobst et al. reviewed 16 reports on the efficacy of
acupuncture in asthma. In 10 studies, acupuncture
was found to be better than placebo and sham acu-
puncture, whereas 6 studies showed no difference.8
(5) In another review by Lewith and Watkins, 9 of the 10
trials showed positive short-term improvement of
lung function and subsequent reduction in the use of
medication after acupuncture.9
(6) A Cochrane database review did not find enough
evidence to recommend acupuncture treatment for
asthma, due to the inadequate quality in the studies.10
(7) Patients with chronic obstructive asthma experienced
clinically significant improvement in quality of life
when their standard care was supplemented by acu-
puncture or acupressure. 11
(8) A double-blinded randomized study in 23 nonsmoking
asthmatics found that there was significant improvement
in the patient’s quality of life and reduction in the use of
bronchodilators after acupuncture, but these benefits were
not supported by improvement in respiratory function.12
Case
Three illustrative cases were published by the current
author in an earlier issue of this journal.13 One of them is
included here for the reader’s convenience.
CLINICAL PEARLS
A 4-year-old girl had a recurring wheeze (about once per
week as recorded by her mother) for *3 years. She was
prescribed a salbutamol inhaler to use when needed, bude-
sonide twice daily, and, on occasion, oral prednisolone. This
patient had a tendency to catch colds and was treated in the
emergency department (ED) of a public hospital on several
occasions for recurrent wheezing. Between these episodes,
her chest examination results were clear. Her tongue was
pale and her pulse was empty, especially in the right front
position (Lung). There was no family history of asthma.
This was a case of recurrent wheezing caused by Lung Qi
Deficiency. A slight shortness of breath and an empty Lung
pulse were sufficient to make this diagnosis.
The following points were used:
 LU 9—Source point
 LU 7—Connecting point
 BL 13—Back Shu point
 CV 6—to tonify Qi
 GV 12—to tonify Lung Qi
 ST 36 and CV 12—to tonify Stomach and Spleen, re-
spectively (thus tonifying Earth to nourish Metal).
It is the author’s practice to support acupuncture treat-
ments with homeopathic dilutions of mineral salts, calcium
phosphate, and natrum sulfate (30 c) at twice-weekly in-
tervals in all cases of wheezing. This helps reduce the
number and duration of acupuncture treatments. In severe
cases acupuncture treatments are used on alternate days.
This patient was treated twice weekly with acupuncture
for 2 months and then monthly for 1 year. The inhalers were
gradually withdrawn and she had no further wheezing epi-
sodes. During the first 2 months of treatment, she had one
additional ED visit.
It has been the experience of the author that, while most
patients respond favorably, children respond far better than
adults do as far as long-term improvements are concerned; and
this is especially so when acupuncture was supported by nu-
tritional supplements as described. It is often said that many
children will outgrow asthma. This is an optimistic statement:
Children with severe asthma are very unlikely to outgrow it.
Many cases labeled as asthma in children are actually asth-
malike syndromes (bronchitis, bronchiolitis, etc.) and these are
the patients who tend to outgrow these conditions.14
The positive effects of those nutritional supplements to
acupuncture in children cannot be overemphasized; these
beneficial effects have not been observed in adults.
REFERENCES
1. MedicalNewsToday.com Asthma History Through Ages.
Online document at: www.medicalnewstoday.com Accessed
November 15, 2018.
2. GBD 2015 Disease and Injury Incidence and Prevalence Col-
laborators. Global, regional and national incidence, prevalence
 CLINICAL PEARLS
and years lived with a disability for 310 diseases and in-
juries, 1990–2015: A systematic analysis for the Global
Burden of Disease Study 2015. Lancet. 2016;388(10053):
1545–1602.
3. Asthma and Allergy Foundation of America. Asthma Facts and
Figures. Online document at: www.aafa.org/page>asthma-
facts.aspx Accessed November 18, 2017.
4. United States Environmental Protection Agency. Asthma.
Online document at: www.epa.gov/asthma Accessed Novem-
ber 18, 2017.
5. Virsik KP, Kristulek P, Bangha O, Urban Š. The effect of
acupuncture on pulmonary function in bronchial asthma. In:
Herzog H, Empey DW, Matthys H, Perruchoud A, Widdi-
combe JG, eds. Progress in Respiration Research, vol. 14 1980;
14:271–275. [from Asthma: International Congress on Re-
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spiratory Diseases, Basel, October 1979; 6th General Meeting
of the European Society for Clinical Respiratory Physiology
(SEPCR)]
6. Christensen PA, Laursen LC, Taudorf E, Sørensen SC, Weeke
B. Acupuncture and bronchial asthma. Allergy. 1984;39(5):
379–385.
7. Joos S, Schott C, Zou H, Daniel V, Martin E. Im-
munomodulatory effect of acupuncture in the treatment of
allergic asthma: A randomized controlled study. J Altern
Complement Med. 2000;6(6);519–525.
8. Jobst KA. A critical analysis of acupuncture in pulmonary
disease, efficacy and safety of the acupuncture needle. J Al-
tern Complement Med. 1995;1(1):57–85.
9. Lewith GT, Watkins AD. Unconventional therapies in asth-
ma: An overview. Allergy. 1996;51(11);761–769.
10. McCarney RW, Brinkaus B, Lasserson TJ, Linde K. Acu-
puncture for chronic asthma. Cochrane Database Syst Rev.
2004;1:CD000008.
11. Maa SH, Sun MF, Hsu KH, et al. Effect of acupuncture or
acupressure on quality of life of patients with chronic ob-
structive asthma: A pilot study. J Altern Complement Med.
2003;9(5):659–670.
12. Biernacki W, Peake MD. Acupuncture in treatment of stable
asthma. Respir Med. 1998;92(9):1143–1145
13. Sudhakaran P. Preschool wheezing: An acupuncture ap-
proach. Med Acupunct. 2015;27(6):447–452.
14. MayoClinic.org Will My Child Outgrow Asthma? Online
document at: https://www.mayoclinic.org/diseases-conditions/
childhood-asthma/expert-answers/outgrow-asthma/faq-20058116
Accessed on November 21, 2017.
Address correspondence to:
Poovadan Sudhakaran, MBBS, PhD
MastACU, MastTCM
26 Tuckers Road
Templestowe 3106
Australia
E-mail: dr.p.sudhakaran@gmail.com
S ome years ago, while working with the respiratory de-
partment of a university hospital in the East of England, I
investigated which acupuncture points are traditionally no-
103
ted as acting on the respiratory system. I was amazed to find
more than 80! My textbooks showed that all points on the
Lung meridian were included, but also most of the Kidney,
Stomach, and Spleen points on the anterior chest wall, to-
gether with Bladder points on the posterior wall and a couple
each of Gall Bladder, Liver, Pericardium, and Small Intes-
tine points laterally. All the thoracic Conception Vessel,
Governing Vessel, and Huatuojiaji points have a respiratory
relationship, as do the Extra point Dingchuan and a few
distant points, such as KI 3 and KI 4, and ST 36 and 40.
This offered such a wide choice of points that I needed
some method of narrowing the field. I therefore searched
PubMed for trials of acupuncture for respiratory disease. I
inspected each report and noted which acupuncture points
were used, paying particular attention to trials that had re-
corded positive outcomes for patients who had received
acupuncture. This gave a clear consensus for points regu-
larly and effectively used in the treatment of asthma.
Included in the protocol of almost every research group
were: the Lung Back-Shu point BL 13; CV 17; and Ding-
chuan, occasionally with GV 14. Generally, a Lung point
was used, of which LU 7 was popular, and often a distant
point, such as KI 3 or ST 36. The general anti-inflammatory
point LI 4, sometimes with LI 11, was commonly used, and
also SP 6. Other points featured included ST 40, BL 17, GV
20, and various Conception Vessel points.
Starting with the frequently used points, my approach,
after history and examination, is to find the prominent—and
usually easily identified—spine of C-7. I insert a needle at
GV 14, just inferior to this bony prominence. This acts as a
marker to place needles 0.5 cun on each side, at Dingchuan.
I then run a finger down the back, counting spines to the
lower border of the spinous process of T-3. I insert needles
on both sides of this at BL 13.
Anteriorly, CV 17 is the Qi Influential Point. It is also
where a sternal anomaly occurs in roughly 6% of the pop-
ulation. This is a foramen in the midline, directly over the
heart. It is essential, therefore, to needle horizontally under
the skin, given that fatal cardiac tamponade has been re-
ported from inadvertently traversing the foramen and
puncturing the heart.1 To avoid puncturing the lung, needles
of 2 cm or less should be used at all chest points.
These points I use as standard, adding points related to the
type or cause of the asthma. During acute exacerbation, or
exercise induced asthma, I add LU 7 unilaterally, especially
if there is associated coughing. If the acute attack has been
caused by—or results in—chest infection, I use LU 7 on one
side and LI 4 on the other. When the asthma has a significant
allergic element, I use both LI 4 and 11. In obese and late-
onset patients, ST 36 may be of benefit, particularly as these
patients often have comorbid knee osteoarthritis.
Anxiety and stress is a feature for some patients, so the
antianxiety point GV 20 may help. Some patients develop
abdominal breathing. I use the diaphragm points BL 17, but
try to teach these patients better breathing habits. It is worth
 104
checking the accessory muscles of respiration for trigger
points, notably the sternocleidomastoid, scalene, and pec-
toralis muscles.2
I start a treatment course with manual stimulation, but
may progress to using electroacupuncture at 2/100 Hz to the
BL 13 pair, and LI 4 and LI 11. Sessions are twice per week,
reducing to weekly, and then maintenance once a month, if
the patient feels this is beneficial. However, standard med-
ical treatment must remain the appropriate basic care for
both acute and chronic asthma, although the addition of
acupuncture may provide some improvement in symptoms
and quality of life, with possibly reduced hospital admis-
sions. The Cochrane review did not recommend acupunc-
ture for asthma, as the trials available were too small and
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unreliable.3 Thus, I offer acupuncture only to patients who
are poorly stabilized on conventional medication.
Asthma is notoriously placebo-responsive, so this could
be part of the mechanism, but the calming effects of acu-
puncture’s general boost of serotonin, endorphins and oxy-
tocin is likely to help. Of particular relevance to asthma,
there is increased production of adrenocorticotropic hor-
mone and catecholamines, together with inhibition of his-
tamine release.4 More specifically: the point BL 13 is over
the sympathetic ganglion at T-3, so this should have a
bronchodilatory effect, and ‘‘asthmatic’’ rat experiments
have shown reductions in the inflammatory cytokines inter-
leukin (IL) 6 and IL 10, together with inducing lymphocyte
proliferation and reduced eosinophil counts, all of which is
suggestive of autonomic modulation of the immune system.5
REFERENCES
1. Ernst E, Zhang J. Cardiac tamponade caused by acupuncture:
A review of the literature. Int J Cardiol. 2011;149(3):287–289.
2. Simons DG, Travell JG, Simons LS. Travell & Simons’ Myo-
fascial Pain and Dysfunction: The Trigger Point Manual, vol.
1: Upper Half of Body, 2nd ed. Baltimore: Lippincott Williams
& Wilkins; 1998.
3. McCarney RW, Brinkhaus B, Lasserson TJ, Linde K. Acu-
puncture for chronic asthma. Cochrane Database Syst Rev.
2004;1:CD000008.
4. Hayhoe S. Effects of acupuncture in bronchial asthma. J R Soc
Med. 1982;75(11):917.
5. White A. Acupuncture for respiratory conditions. In: Filshie J,
White A, Cummings M, eds. Medical Acupuncture: A Western
Scientific Approach, 2nd ed. Edinburgh: Elsevier; 2016:489–
502.
Address correspondence to:
Simon Hayhoe, MSc, MBBS, MRCA
Pain Management Department
University Hospital, Turner Road
Colchester CO4 5JL
United Kingdom
E-mail: simonhayhoe@doctors.org.uk
CLINICAL PEARLS
I n Traditional Chinese Medicine (TCM), acute asthma
is associated with physiologic hyperactive Qi energy.
Excess Qi energy causes bronchial spams, leading to ob-
structed airways, causing shorter breath and acute disorder of
the respiratory tract. Asthma attacks are also associated with
acute sadness and severe emotional disturbance. Acute sad-
ness causes accumulation of Phlegm in the windpipe ob-
structing the airway, causing shortness of breath. In Western
medicine, asthma attacks can be caused by severe allergies
and blockage of the bronchus due to mucus and allergens.
In order to treat acute asthma, LU 6 · 2 and CV 17 can be
used. LU 6 · 2 is used for acute disorder of the lung. CV 17
is useful for treating and balancing the hyperactivity of the
Lung, as well as easing the asthma attack. Cupping CV 17
and BL 13 · 2 in combination with LU 6 is very helpful. In
order to calm the asthma attack immediately, it is important
to cup LU 1 · 2, this eases asthma attacks. If you add BL
13 · 2, this will enhance the response tremendously and
settle the Lung allowing proper breathing.
It is important to treat mental components, as they can cause
emotional sadness, which leads to asthma attacks. Cupping
CV 17 is very useful for treating acute sadness; using BL 15
with cupping on the back will also release anxiety and tension.
If the patient has a history of depression it is wise to use PC 6
and TE 5, for ventilation of emotional pollution. HT 7 · 2 is
also very useful for addressing anxiety, tension, and stress.
For patients with asthma, you can use CV 17, BL 13 · 2, and
LU 1 · 2 to prevent asthma attacks. For patients who have a
great deal of Phlegm in the chest it is important to used ST
8 · 2 and ST 40 · 2 needles to reduce Phlegm accumulation in
the windpipe. It is also important to treat the patient’s immune
system to prevent infection and strengthen the immune system.
The following points are very useful for immune protection:
 GV 14
 LI 11 · 2
 SP 6 · 2
 SP 10 · 2
 ST 36 · 2.
Apart from giving the immune system therapy, you
should also balance a patient’s body, mind, and spirit. For
balancing the body, you should use SP 21 · 2. As a physi-
ologic barometer, it is also wise to use LI 11 · 2. For mental
components of balancing, you should use Ex-HN 1 · 4. For
spiritual balancing, GB 41 is useful. If it is pertinent to the
therapy, you should add GV 9 with BL 17 x 2 and BL 46 · 2.
Chakra imbalance can be a root cause of asthma, espe-
cially after physical and/or emotional trauma. This imbal-
ance can cause Stagnant Throat chakra energy, which can
lead to Phlegm accumulation, causing an asthma attack. To
treat Phlegm accumulation, use ST 40 · 2 and ST 8 · 2 as
well as LU 7 · 2 and SI 3 · 2. To open the flow of energy in
the Throat chakra, use CV 22 and CV 23.
Other causes of asthma in TCM are Deficiencies of the
Kidney and Spleen. Given that asthma can be genetic,
 CLINICAL PEARLS
treating KI 6 · 2 for prevention can produce a great re-
sponse. KI 3 · 2, KI 7 · 2, KI 10 · 2, BL 23 · 2, and GV 4
can enhance the Kidney Qi and prevent Kidney Deficiency.
Spleen Deficiency can also cause asthma attacks. Enhancing
Spleen energy with SP 6 · 2, SP 9 · 2, and SP 10 · 2 can
increase the immune response and prevent asthma attacks.
To maintain a patient’s health, use LR 3 · 2; this point
allows the constant smooth flow of Qi. Use SP 10 · 2 for the
constant smooth flow of Blood circulation. You should see
the patient twice for the first week, then once every 2 weeks
four times, and then once per month four times.
In order to maintain good health and responses in patients
with asthma, auricular acupuncture is also very effective for
supporting their health. Needle the following points:
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Shen Men for relaxation

Lung for asthma
 Adrenal Gland for immune system
 Occiput for healing.
Ask the patient to perform ear presses four times a day for
1 minute.
Other techniques can also be successful. Ask the patient
to practice Qigong exercises, especially breathing exercises.
I have found that asthma has one of the best responses to
acupuncture and Qigong.
Other TCM approaches that may be used are:
(1) Medical Qigong Breathing Exercise—The patient
should breathe in while visualizing blue colors and
breathe out slowly while visualizing white colors, for
20 minutes every morning and every evening.
(2) Herbal medicine is also very useful to prevent asthma
attacks and maintain the Lung. I recommend the Ping
Chuan pill for asthma attack, the Crocodile Bile pill
for Phlegm, and the Zehn Zhu An Shen Yang Xin Pill
for relaxation and anxiety.
(3) Dietary therapy that involves increasing the intake of
white food with pungent smells is wise. The patient
should be advised to avoid eating shellfish and red meat.
Overall, the TCM approach to asthma generally has a slower
response than Western medicine; however, the TCM approach
is holistic, natural and produces little-to-no side-effects.
Address correspondence to:
Steven K.H. Aung, CM, AOE, MD, PhD, FAAFP
Faculty of Medicine and Dentistry
Faculties of Extension, Pharmacy & Pharmaceutical Sciences
and Rehabilitation Medicine
and School of Public Health
University of Alberta
9904-106 Street
Edmonton, Alberta T5K 1C4
Canada
E-mail: draung@aung.com
105
A sthma can be caused by Deficiencies in Lung and/or
Defensive Kidney Qi, and by pathogenic exposure to
Wind. Acute attacks, therefore, would require treatment to
expel Wind, in addition to inhalers and evidence-based
Western approaches. Prevention of asthma then focuses on
nourishing Kidney and Lung QI. Strengthening Kidney and
Lung Qi, using the Super Ming Men with BL 13 (the Lung
meridian Shu point) with gentle electrical stimulation at 2 Hz
is the foundation of treatments when the symptoms are well-
controlled.
Poor control can be a challenge for some patients. My
asthma and allergy colleagues say: ‘‘If you want to con-
trol asthma, then control the nose.’’1 Likewise, patients
with asthma who receive acupuncture respond well to
opening the nose. LI 20 is a powerful point to open the nose
and sinuses, as well as BL 2 and ST 2 for sinus disease.
When symptoms are exacerbated by allergies or other
exposures, patients respond well to treating the nose as well
as the Lung with the following method:
 LI 20 and ST 2 crossed with the black electrode to BL 2
with the red electrode bilaterally at 10 Hz for 15 minutes
 LI 4, if there are significant nasal symptoms, or LI 10 if
the symptoms are primarily Lung-related
 KI 3 to tonify Kidney Qi
 SP 4 to dispel Damp.
The Four Gates (LI 4 and LR 3) herbal formulae may be
used in addition to the above to improve resilience and re-
duce the risk of poor control.
REFERENCE
1. Scadding G, Walker S. Poor asthma control?—then look up the
nose. The importance of co-morbid rhinitis in patients with
asthma. Prim Care Respir J. 2012;21(2):222–228.
Address correspondence to:
Mary Ann Barnes, MD
St. Elizabeth Family Medicine Residency Program
413 South Loop Drive
Edgewood, KY 41017
E-mail: maryann.barnes@stelizabeth.com
A sthma is a chronic inflammatory disease of the
airways in the lung. Coughing, shortness of breath,
chest tightness, and wheezing are common symptoms of
patients with asthma. It does not affect only children but also
adults. An asthma attack can be life-threatening. Asthma
causes considerable burden to patients and reduces their
quality of life. Asthma is not curable, and management of it
is complicated. Usage of daily long-term medication dis-
comforts patients with asthma. For this reason, patients seek
complementary medicine modalities. The World Health
 106 CLINICAL PEARLS

Organization recommends practicing acupuncture to relieve weeks. Patients with asthma need at least 20 sessions. I give
symptoms of asthma.1 treatment three times per week for the first 10 sessions. After
that, I suggest 1 session per week for 5 sessions and 1
Asthma in Traditional Chinese Medicine session every 15 days for the remaining 5 sessions.

Asthma occurs as a respiratory disorder when pathology

exists in the Lung (LU), Large Intestine (LI), and Concep- Illustrative Case
tion Vessel (CV) channels, according to the acupuncture
A 35-year-old female complained of having asthma for
perspective.2 Regulation and balancing the obstructive Qi
more than 7 years. The points used to treat her were LU 1, LU 2,
helps resolve asthma symptoms. The best time to treat
LU 9, LI 4, BL 13, CV 22, GV 14, GV 20, and Ex-HN 3. She
asthma with acupuncture is between attacks. However,
was treated three times per week for 10 sessions. Then she
acupuncture may be used to treat acute asthma attacks.
received one session per week for five sessions, and one session
every 15 days for the remaining five sessions. She presented
Acupuncture Treatment Protocol with an asthma attack after the second session of treatment. She
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I use classical acupuncture points without a formal Tra- was treated during the attack with acupoints LU-5 (sedative
ditional Chinese Medicine diagnosis. Combining local and points of lung), CV-22 (emergency point for acute asthma
distal points is essential in every session. Acupuncture attack), GV-20 (important point for descending the Yang), LI-4
points that are close to the lungs on the anteroposterior chest (homeostatic and anti-inflammatory point), and Ear ACTH
wall may be considered as local points for treating asthma. point (anti-inflammatory point, has bronchodilator effect). She
The body acupuncture points for asthma are shown in did not have another asthma attack during the treatment ses-
Table 1.3,4 The needles are left in place for 30 minutes. I sions. Her sleeping quality improved after four sessions.
use body and auricular points together in every session. Symptoms decreased after 10 sessions. She received a total of
Auricular points are selected according to an electrical point 20 sessions.
finder. Ear Shen Men, ear Lung Point, and ear ACTH point
must be needled, if I cannot detect these points with the
electrical point finder. An ear semipermanent needle is used REFERENCES
for 2–3 weeks. The ear needles are changed every 2–3
1. Acupuncture: Review and Analysis of Reports on Controlled
Table 1. Body Acupuncture Points for Asthma Clinical Trials. Online document at: http://www.iama.edu/
OtherArticles/acupuncture_WHO_full_report.pdf Accessed No-
Points Special points Actions vember 19, 2017.
2. Jin GY, Jin JJX, Jin LL. Contemporary Medical Acupuncture.
LU 1 Front-Mu point of Lung Regulates the Lung Qi New York: Higher Education Press/Springer; 2007.
LU 2 — Clears Lung Heat 3. Ellis A, Wiseman N, Boss K. Fundamentals of Chinese Acu-
LU 9 Yuan Source Point of Strengthens the Lung & puncture. Brookline, MA: Paradigm; 2004.
the Lung channel transforms Phlegm 4. Liu Z, Liu L, Fun W, Zhang Z. Essentials of Chinese Medicine.
LI 4 Yuan Source point of Causes homeostasis & London, UK: Foundation of Chinese Medicine/Springer; 2010.
the Large Intestine regulates Qi & Blood
channel strongly Address correspondence to:
BL 13 Back-Shu point Tonifies the Lung Qi & Yasemin Cayir, MD
of Lung clears Heat from the Ataturk University Research
Lung and Practice Center for Acupuncture
CV 17 Front-Mu point of the Regulates Qi and
and Complementary Therapy Modalities
Pericardium descends counterflow
University Street, 25040
Lung Qi
CV 22 Meeting point with Descends counterflow Erzurum
yinwei mai Lung Qi & alleviates Turkey
coughing and dyspnea E-mail: dryasemincayir@yahoo.com
GV 14 Meeting point with all Calms internal Wind,
Yang channels strengthens Qi
GV 20 Meeting point with Calms Wind & calms
BL–GB–TH–LIV Shen

Ex-HN 3
channels
Harmonizing effect Opens the channels,
A sthma is a chronic condition with an ever-
increasing global incidence. It is estimated that *300
million people are currently affected by asthma.1 Western
(Yintang) calms Shen & medicine defines asthma as a condition that causes chronic
eliminates
inflammation in the airways, leading to a state of hyperre-
internal Wind
sponsiveness and resulting in bronchospasm and an increase
 CLINICAL PEARLS
in mucous production that causes a mechanical limitation to
air flow. Usual symptoms are wheezing, coughing, chest
tightness, and shortness of breath. Western medicine relies
on a pharmacologic approach to treatment, based on ß-2
agonists, glucocorticoids, leukotriene modifiers, and the-
ophylline, among other agents.1 Even with such a broad
arsenal of allopathic medicines available, many patients still
seek nonconventional healing techniques.
Traditional Chinese Medicine (TCM) uses syndrome dif-
ferentiation of the disease nature, mostly with four main
characteristics (Cold/Heat, Excess/Deficiency) and recogni-
tion of specific patterns related to the affected organs in order
to determine a diagnosis. The resulting disease nature, con-
cluded through syndrome differentiation, promotes a com-
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prehensive understanding of the relationship between
pathogenic factors and the individual affected by such illness.2
Interestingly enough, there is a classical TCM scenario
described as ‘‘[t]he pattern of Cold-Phlegm obstructing the
Lung’’ that could represent what Western medicine defines
as asthma, once the scenario refers to the condition of the
Lung failing to disperse and descend due to the retention of
mixed Cold and turbid Phlegm. The etiology of this con-
dition would be Lung impairment due to Phlegm retention
plus pathogenic Cold attack, direct attack of pathogenic
Cold-Dampness, or even upward transmission of Phlegm
from the middle Jiao due to Spleen and Stomach Yang
Deficiency.2
With that TCM rationale in mind, Hong Jin Pai, MD, PhD,
from our acupuncture service at the São Paulo University
Clinics Hospital, in São Paulo, Brazil, developed a standard
acupuncture treatment to treat patients with asthma. The
treatment is comprised of two stages in the same session:
The first stage involves 30 minutes of resting with needles
placed at: GV 17 and GV 22; LU 1 and LU 6; and ST 36 and
SP 9. Cupping is performed with cups placed between LU 1
and the sternum bilaterally
The second stage involves another 30 minutes resting
with needles placed at: BL 12 and BL 13. Then the Extra
point Dingchuan (0.5 cun lateral to C-7) is needled. Finally,
cupping is performed with cups placed just lateral to the
spine between the T-2 and T-4 bilaterally.
This protocol was submitted to testing in a randomized,
controlled crossover study in patients with mild and mod-
erate asthma conducted at our hospital.3 We were able to
analyze the response to 10 sessions of acupuncture in 74
patients who were evaluated with spirometry, induced
sputum-cell count, exhaled nitric oxide, daily peak flow,
symptom diaries, use of medication, Short Form–36 and
Questionnaire on Quality of Life—Asthma. The sham pro-
cedure consisted of minimally puncturing nonacupoints;
patients were permitted to maintain their usual regimen of
pharmacologic agents and rescue medication.
Although the results showed that symptoms were eased
with either verum or sham acupuncture, with no significant
107
difference between the tested groups, we did find a decrease
in eosinophils (P = 0.035) and neutrophils (P = 0.047), an
increase in macrophages (P = 0.001), and an improvement in
peak flow (P = 0.01) after verum acupuncture, which were
not seen in the group receiving the sham procedure. This
points to the possible inflammation-reducing effect of this
‘‘Phlegm draining and Lung Qi harmonizing’’ set of acu-
points.
Thus, in conclusion, we find it very useful to use this set
of acupoints as add-on therapy for patients with asthma who
are struggling to maintain stable clinical conditions while on
optimized pharmacologic regimens.
REFERENCES
1. Global Initiative for Asthma. The Global Strategy for Asthma
Management and Prevention, 2017. Online document at: http://
www.ginasthma.org/ Accessed December 27, 2017.
2. Yiqin W, chief ed. Diagnostics of Traditional Chinese Medi-
cine. National Planned University Textbooks for International
Traditional Chinese Medicine Education. Beijing, China:
Higher Education Press; 2006:416–417.
3. Pai H, Azevedo RS, Braga ALF, et al. A randomized, con-
trolled, crossover study in patients with mild and moderate
asthma undergoing treatment with traditional Chinese acu-
puncture. Clinics (São Paulo). 2015;70(10):663–669.
Eduardo G. D’Alessandro, MD1
Chin An Lin, MD, PhD2
3
and Hong Jin Pai, MD, PhD
1
Instituto do Câncer do Estado de São Paulo
2
Sao Paulo University Clinics Hospital–Faculdade
de Medicina da Universidade de São Paulo
3
Centro de Estudo Integrado de Medicina Chinesa
São Paulo, Brazil
Address correspondence to:
Eduardo G. D’Alessandro, MD
Instituto do Câncer do Estado de São Paulo
Avenida Dr. Arnaldo, 251–Térreo–Reabilitação
São Paulo–SP–01246-000
Brazil
E-mail: e.g.dalessandro@gmail.com
A cupuncture has been used in patients with chronic
obstructive pulmonary disease (COPD) and asthma.1–3
There was a clinical opportunity for acupuncture treatment
in a patient with asthma at the Teikyo Ikebukuro Acu-
puncture and Moxibustion Clinic at Teikyoheisei Uni-
versity. This report presents the details of this clinical
experience to show the improvement of respiratory function
and easing of clinical symptoms in this patient, who had
undergone the acupuncture treatment every week for 8
weeks.
 108
A 46-year-old male patient, at 5 feet 7 inches tall and 187
pounds weight, was diagnosed with asthma. He had a high
level of immunoglobulin E at 183 IU/mL, a persistent de-
crease of pulmonary function, and a low value of forced ex-
piratory volume in 1 second (FEV1) at 3.33L (FEV1% was
68.8%). He also had some clinical complaints that included
stuffiness and muscle stiffness in his back and chest. The
Western medications he used were 10 mg/day of montelukast
sodium, 15 mg 3 times/day of dextromethorphan hydro-
bromide hydrate, 200 mg 2 times/day of clarithromycin
orally. An aerosol of salmeterol xinafoate—with fluticasone
propionate—had also been administered 14 days after the date
of his diagnosis.
On the day after he started the medications, acupuncture
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was performed at bilateral acupoints (LU 1, LI 18, BL 13, BL
42, SI 11, SI 12, SI 13, SI4, and SI 15—eighteen points in all)
that corresponded to tender points on the following respira-
tory muscles.* These included the: pectoralis major; pector-
alis minor; sternocleidomastoid; trapezius; erector spinae;
rhomboid muscle; levator scapulae; infraspinatus; and su-
praspinatus. Disposable needles, 0.16-mm diameter, were
used to provide 20 minutes of stimulation. He received acu-
puncture 8 times over 2 months.
After each acupuncture session, a pulmonary function test
showed immediate improvement, compared with before
acupuncture, at 4.0% of FEV1%. Evaluation at the eighth
week showed increases of FEV1 at 4.03 L and FEV1% at
111%. Moreover, reduction of this patient’s clinical symp-
toms, such as dyspnea and wheezing, was evaluated by a
categorical face scale. The symptoms’ mean value had de-
creased from 4.8 to 1.6 points.
These findings suggest that acupuncture treatment on the
tender points on the parts of respiratory muscles might be an
effective alternative treatment method for a patient with
asthma.
REFERENCES
1. Li M, Zhang X, Bao H, Li C, Zhang P. Acupuncture for
asthma: Protocol for a systematic review. Medicine (Balti-
more). 2017;96(26):e7296.
2. Suzuki M, Muro S, Ando Y, et al. A randomized, placebo-
controlled trial of acupuncture in patients with chronic ob-
structive pulmonary disease (COPD): The COPD-Acupuncture
Trial (CAT). Arch Intern Med. 2012;172(11):878–886.
3. Suzuki M, Namura K, Ohno Y, et al. The effect of acupuncture
in the treatment of chronic obstructive pulmonary disease. J
Altern Complement Med. 2008;14(9):1097–1105.
*Locations of acupoints on the respiratory muscles are: LU 1,
pectoralis major and pectoralis minor; LI 18, sternocleidomastoid;
BL 13 and BL 42, trapezius, erector spinae, and rhomboid muscle;
and SI 11, SI 12, SI 13, SI 14, and SI 15, levator scapulae muscle,
infraspinatus muscle and supraspinatus muscle.
CLINICAL PEARLS
Kenji Imai, PhD, LAc1
Motoyuki Imai, PhD, CE/ME2
and Tatsuya Hisajima, PhD LAc1
1
Teikyo Ikebukuro Acupuncture and Moxibustion Clinic
Department of Acupuncture and Moxibustion
Faculty of Health Care, Teikyoheisei University,
Toshimaku
2
Department of Electrical Engineering
Faculty of Engineering, Tokyo University of Science
Tokyo, Japan
Address correspondence to:
Kenji Imai, PhD, LAc
Department of Acupuncture and Moxibustion
Faculty of Health Care
Teikyoheisei University
2-51-4, Higashiikebukuro
Toshimaku, Tokyo 170-8445
Japan
E-mail: kenji.imai1@gmail.com
A sthma is one of the most commonly observed
chronic inflammatory diseases in current society, with
more than 300 million people affected worldwide.1 The
disease is characterized by wheezing, breathlessness, and
airway limitation.2 Pharmacotherapy is typically used to
treat asthma, but the efficacy of conventional pharmaco-
therapy is variable. Although pharmacogenomic approaches
have been considered as a potential treatment for this con-
dition, their translation into clinical practice is difficult.3,4
Considering these issues, complementary and alternative
medicine (CAM) is often used for asthma treatment, espe-
cially in the United States and Europe.5–7 Surveys in these
countries have revealed that more than 40% of individuals
with asthma had used CAM. One of the most common forms
of CAM used for asthma is herbal medicine.8 This Clinical
Pearl introduces briefly our clinical experiences and the
current literature on the treatment of asthma with herbal
medicine.
Clinical Experiences and the Literature
on Chronic Asthma
In our experience, TJ-96 (Saiboku-to) at a dosage of 7.5 g/
day is sometimes effective in reducing patients’ subjective
symptoms of asthma. This observation is supported by a
randomized controlled study of 33 patients conducted by
Urata et al.9 Eucalyptol is another herbal medicine used to
treat asthma, and its use is also supported by a randomized
clinical trial.10 According to Schäfer, approximately half of
patients with asthma are satisfied with these complementary
herbal therapies.7 In addition to these clinical experiences,
we have summarized the current literature below.
 CLINICAL PEARLS
In 2008, Arnold et al. published a Cochrane review ana-
lyzing 27 studies (total N = 1925) of 21 different herbal
preparations.11 Among the reviewed studies, the following
preparations were reported to ease the patients’ symptoms:
boswellia, eucalyptol, ginger, PulmoFlex, propolis, Tylo-
phora indica, TJ-96 (Saiboku-to), Liu-Wei-Huang-Wan,
Shen-Ling-Bia-Shu-San, and Jai-Wei-Si-Jun-Zi-Tang. How-
ever, as mentioned by the researchers, the quality of many of
the studies under review was relatively low. For example,
although all of the studies were designed to be randomized
controlled studies, only 4 reported the implemented ran-
domization and blinding methods. Moreover, assessment
methods for objective outcomes, such as forced expiratory
volume in 1 second (FEV1) varied, and mean sample size
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was not justified (mean [minimum, maximum]; 69 [8,
334]). Considering these issues, the reviewers concluded
that additional qualified studies in accordance with the
Consolidated Standards of Reporting Trials guidelines
were necessary.
Update on Adult Asthma
Since the review by Arnold et al.,12 several individual
reports and systematic reviews have been published.13,14 In
the most recent review on adult asthma, Shergis et al. fo-
cused their analysis on a combined therapy consisting of
herbal medicine in conjunction with routine pharmaco-
therapy.14 In their examination, the researchers used 9 da-
tabases, including PubMed, Embase, and Allied Health and
Complementary Medicine. In total, 29 studies (total
N = 3001) were included in the review. Multi-ingredient
herbal preparations used in the studies consisted of lico-
rice root, crow-dipper, astragali, and angelica. The results
from a pooled analysis demonstrated that the combined
therapy improved lung function (FEV1, mean difference
[MD] 95% confidence interval [CI]: 7.81% [5.79, 9.83];
peak expiratory flow rate, MD 95% CI: 65.14 [58.87,
71.41] L/minutes); asthma control (MD of asthma score
95% CI: 2.47 [1.64, 3.29] points); and salbutamol usage
(MD 95% CI: -1.14 [-2.20, -0.09] puffs/day), compared
with the use of routine pharmacotherapy alone. However,
the quality of the studies evaluated using the Cochrane
Risk of Bias Tool and the Grading of Recommendations
Assessment, Development, and Evaluation system was
low-to-moderate.
Herbal medicine could be effective as a complementary
therapy to routine pharmacotherapy for the treatment of
asthma. However, herbal medicine should be used carefully,
as the use of herbal medicine has been associated with an
increase in hospital admissions.15 Herbal medicines can
cause problems due to drug interactions and inappropriate
dosages. Well-designed studies are needed to clarify the
efficacy and safety of herbal medicines before they can be
used actively in clinical practice.
109
REFERENCES
1. Olin JT, Wechsler ME. Asthma: Pathogenesis and novel
drugs for treatment. BMJ. 2014;349:g5517.
2. Krishnan JA, Lemanske RF Jr, Canino GJ, et al. Asthma
outcomes: symptoms. J Allergy Clin Immunol. 2012;
129(3[suppl]):S124–S135.
3. Park HW, Tantisira KG, Weiss ST. Pharmacogenomics in
asthma therapy: Where are we and where do we go? Annu Rev
Pharmacol Toxicol. 2015;55:129–147.
4. Davis JS, Weiss ST, Tantisira KG. Asthma pharmacoge-
nomics: 2015 update. Curr Allergy Asthma Rep. 2015;
15(7):42.
5. Ernst E. Complementary therapies for asthma: What patients
use. J Asthma. 1998;35(8):667–671.
6. Blanc PD, Trupin L, Earnest G, et al. Alternative therapies
among adults with a reported diagnosis of asthma or rhino-
sinusitis: Data from a population-based survey. Chest. 2001;
120(5):1461–1467.
7. Schäfer T. Epidemiology of complementary alternative
medicine for asthma and allergy in Europe and Germany. Ann
Allergy Asthma Immunol. 2004;93(2[suppl1]):S5–S10.
8. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alter-
native medicine use in the United States, 1990–1997: Results
of a follow-up national survey. JAMA. 1998;280(18):1569–
1575.
9. Urata Y, Yoshida S, Irie Y, et al. Treatment of asthma patients
with herbal medicine TJ-96: A randomized controlled trial.
Respir Med. 2002;96(6):469–474.
10. Juergens UR, Dethlefsen U, Steinkamp G, et al. Anti-
inflammatory activity of 1.8-cineol (eucalyptol) in bronchial
asthma: A double-blind placebo-controlled trial. Respir Med.
2003;97(3):250–256.
11. Arnold E, Clark CE, Lasserson TJ, Wu T. Herbal interven-
tions for chronic asthma in adults and children. Cochrane
Database Syst Rev. 20081:CD005989.
12. Clark CE, Arnold E, Lasserson TJ, Wu T. Herbal interven-
tions for chronic asthma in adults and children: A systematic
review and meta-analysis. Prim Care Respir J. 2010;19(4):
307–314.
13. Li X-M. Treatment of asthma and food allergy with herbal in-
terventions from Traditional Chinese Medicine. Mt Sinai J Med.
2011;78(5):697–716.
14. Shergis JL, Wu L, Zhang AL, et al. Herbal medicine for
adults with asthma: A systematic review. J Asthma. 2016;
53(6):650–659.
15. Blanc PD, Kuschner WG, Katz PP, et al. Use of herbal products,
coffee or black tea, and over-the-counter medications as self-
treatments among adults with asthma. J Allergy Clin Immunol.
1997;100(6[pt1]):789–791.
Kazuki Ide, PhD
and Koji Kawakami, MD, PhD
Department of Pharmacoepidemiology
Graduate School of Medicine and Public Health
Kyoto University
Sakyo-ku, Kyoto, Japan
 110
Address correspondence to:
Kazuki Ide, PhD
Department of Pharmacoepidemiology
Graduate School of Medicine and Public Health
Kyoto University
Yoshidakonoe-cho
Sakyo-ku, Kyoto 606-8501
Japan
E-mail: ide.kazuki.2r@kyoto-u.ac.jp
A sthma is one of the most widespread chronic re-
spiratory diseases, affecting *300 million sufferers
worldwide and is continually increasing. It is usually char-
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acterized by chronic airway inflammation. The most com-
mon symptoms of asthma are wheezing, shortness of breath,
dyspnea, chest tightness, and coughing. These symptoms
vary over time and in intensity. There can be an increase in
mucous production and variable expiratory airflow limita-
tion.1,2 Pharmacologic treatment includes short-acting or
long-acting b-2 agonists, glucocorticoids, a leukotriene
modifier, and theophylline, among others. Various ap-
proaches, particularly nonconventional healing techniques,3
have been studied with respect to their ability to help patients
with asthma achieve both symptom control and improve-
ment in their quality of life.
Asthma in Traditional Chinese Medicine
In Traditional Chinese Medicine (TCM) theory, asthma is
differentiated clearly between the actual attacks and the
periods between attacks. When the attacks happen, it is
considered to be an acute, Excess condition, and the ob-
jective is to disperse the Excess and stop the attack. Wind, a
nonsubstantial pathogenic factor, lodges in the bronchi and
combines with Cold or Heat pathogenic factors to cause
bronchospasms. The Lungs and Kidneys work together to
produce ‘‘Wei Qi’’ or Defensive Qi. It is a Yang energy that
is manufactured from the food the patient ingests. The
Kidneys have the ability to produce Defensive Qi, and
the Lungs spread Defensive Qi near the outer surface of
the whole body to ward off pathogenic factors, such as Wind,
Cold, and Heat. When the Lungs or Kidneys are weak,
there is often a Deficiency of Defensive Qi, making the
patient more vulnerable to colds, infections, asthma at-
tacks, etc.4
Some acupuncture treatments, based on TCM meridian
theory, comprise a system of noninvasive therapeutic pro-
cedures of applying processed Chinese herbal medicine
formulations to acupoints.5,6
Acupuncture Treatment
My clinical experience with using the acupoints is DU14
(Da Zhui), BL12 (Feng Men), BL 13 (Fei Shu), Ex-B 1
CLINICAL PEARLS
(Ding Chuan) and ST 36 (Zu San Li) is based on the theory
of TCM for treating asthma.7 After the needle insertion, the
De Qi sensation is induced. The twisting and lifting–
thrusting manipulations are performed evenly for 30 sec-
onds every 10 minutes and the needles are withdrawn after
30 minutes. The 0.30-mm · 40-mm disposable needle is
used for DU 14 and ST 36, and the 0.25-mm · 25-mm dis-
posable needle is used for BL12, BL13, and Ex-B 1.
The effects of treatment are as follows:
 DU 14 (Da Zhui): Clears Wind; firms and regulates the
surface; dispels pathogenic factors; calms Wind; and
strengthens Qi and Yang in Deficiency conditions.
 BL 12 (Feng Men): Expels Wind and releases the Ex-
terior; spreads and descends the Lung Qi; and tonifies
the Defensive Qi (Wei Qi).
 BL 13 (Fei Shu): Tonifies, spreads and descends the
Lung Qi; nourishes the Lung Yin; and clears Heat from
the Lung.
 EX-B1 (Ding Chuan): Harmonizes Lung Qi.
 ST 36 (Zu San Li): Tonifies Qi and Yang, nourished the
Blood and Yin.
Acupuncture is very effective for treating asthma and is
also effective for treating airway inflammation. It is also
important to use a combination of acupuncture with herbal
medicine and other related complementary therapies.
REFERENCES
1. Su L, Meng L, Chen R, et al. Acupoint application for asthma
therapy in adults: A systematic review and meta-analysis of
randomized controlled trails. Forsch Komplementmed. 2016;
23(1):16–21.
2. GBD 2015 Chronic Respiratory Disease Collaborators. Global,
regional, and national deaths, prevalence, disability-adjusted
life years, and years lived with disability for chronic obstruc-
tive pulmonary disease and asthma, 1990–2015: A systematic
analysis for the Global Burden of Disease Study 2015. Lancet
Respir Med. 2017;5(9):691–706.
3. Yin LM, Wang Y, Xu YD, et al. Efficacy of acupuncture for
chronic asthma: Study protocol for a randomized controlled
trial. Trials. 2015;16:424
4. Jiao Y, Wu Z, Zhou W, et al. Explanation of evidence-based
guidelines of clinical practice with acupuncture and moxibus-
tion: Adult bronchial asthma [in Chinese]. Zhongguo Zhen Jiu.
2016;36(5):529–531.
5. Wang Z, Li J, Xie Y, et al. Traditional Chinese Medicine
ZHENG identification of bronchial asthma: Clinical investi-
gation of 2500 adult cases. Complement Ther Med. 2017;30:
32–101.
6. Chen YZ. Recent status of prevention and treatment of asthma in
China [in Chinese]. Zhonghua Er Ke Za Zhi. 2004;42(2):81–82.
7. Shao JM, Ding YD. Clinical observation on 111 cases of
asthma treated by acupuncture and moxibustion. J Tradit Chin
Med. 1985;5(1):23–25.
 CLINICAL PEARLS
Address correspondence to:
Yun Jin Kim, PhD
School of Medicine
Xiamen University Malaysia
Jalan Sunsuria Bandar Sunsuria
Sepang, Selangor 43900
Malaysia
E-mail: neurokim76@naver.com
A sthma is a common disease that is slightly more
common in male children and in female adults who
have a genetic predisposition to develop the condition. It is a
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chronic inflammatory disorder of the airways, and this un-
derlies disease chronicity and contributes to airway hy-
perresponsiveness and airflow limitation.
The strongest identifiable predisposing factor for the de-
velopment of asthma is atopy, but obesity is increasingly
recognized as a risk factor. Exposure of sensitive patients to
inhaled allergens increases airway inflammation, airway
hyperresponsiveness, and symptoms. Reducing exposure
reduces pathologic findings and clinical symptoms. Symp-
toms are episodic wheezing, difficulty in breathing, chest
tightness, and cough. Excess sputum production is common.
The frequency of asthma symptoms is highly variable.
Some patients have infrequent, brief attacks of asthma,
while other patients can suffer nearly continuous symptoms.
Asthma symptoms can occur spontaneously or be precipi-
tated or exacerbated by many different triggers. Asthma
symptoms are frequently worse at night; circadian varia-
tions in bronchomotor tone and bronchial reactivity reach
their nadir between 3 am and 4 am, increasing symptoms of
bronchoconstriction. Wheezing or a prolonged expiratory
phase during normal breathing correlates well with the
presence of airflow obstruction. Chest examination can
yield normal results between exacerbations in patients with
mild asthma.1
In modern Western scientific literature, information
about treating asthma with acupuncture is still widely
based on animal models. Researchers from the College of
Traditional Chinese Medicine (TCM), North China Uni-
versity of Science and Technology, stated that acupuncture
could reduce the expression of protein kinase B (PKB/
AKT) in lung tissues of rats with asthma, leading to re-
lieved inflammation reaction and airway remodeling,2 and
also could improve airway inflammatory response and re-
molding of asthma by inhibiting transforming growth
factor b1 (TGF-b1) expression in the lung tissues of rats
with bronchial asthma.3
Researchers from the Affiliated Hospital of Nanjing,
University of Chinese Medicine, found that acupoint ap-
plication could improve airway remodeling by down-
regulating the expression of TGF-b1/Smad 3 in the airway
of mice with chronic asthma.4 Researchers from the Clinical
111
College of Acupuncture–Moxibustion and Orthopedics,
Anhui University of Chinese Medicine, observed the effect
of moxibustion at Feishu (BL 13) and Shenshu (BL 23) on
peripheral blood T-cells and serum interleukin (IL) in rats
with asthma to explore moxibustion’s immunologic mech-
anisms in relieving asthma. The researchers concluded that
moxibustion could reduce the levels of serum immuno-
globulin (Ig)E and IL-1b, and increase the level of serum
IL-1 Ra, which could play an important role in the treatment
of asthma.5
A multicenter study in Germany found that, in patients
with allergic asthma, adding acupuncture treatment to rou-
tine care was associated with increased improvement in
disease-specific and health-related quality of life factors,
compared to treatment with routine care alone.6 Another
multicenter study in China concluded that acupoint appli-
cation might be a valid complementary and alternative
therapy for asthma in adults. This application contributed
especially to improving pulmonary function and reducing
the patients’ levels of IL and IgE. However, more studies
with longer follow-ups are warranted to confirm the current
findings.7
However, a review from the Discipline of Chinese
Medicine, School of Health and Biomedical Sciences, at
RMIT University, in Melbourne, Victoria, Australia, con-
cluded that no reliable conclusions regarding the effects of
acupressure on allergic rhinitis (AR) and asthma could be
drawn, due to the small number of available trials, which
had significant heterogeneity of study designs and high or
unclear risks of bias. Further, more rigorously designed
randomized controlled trials are needed. Acupressure seems
to be safe for symptomatic relief of AR and asthma, al-
though larger studies are required to be able to robustly
confirm its safety.8
Researchers from São Paulo University Medical School
concluded that verum and sham acupuncture have different
effects and outcomes on asthma control. The study’s
crossover approach was not effective because both inter-
ventions led to easing of asthma symptoms, and improve-
ments in quality of life and inflammatory cell counts. Thus,
sham acupuncture cannot serve as a placebo in trials with
acupuncture as the main intervention for asthma.9
According to Traditional Chinese Medicine (TCM), asth-
ma may be caused by internal or external pathogenic factors.
Internal dysfunction affects the internal organs Lung, Spleen,
and Kidney. External factors are Wind, Cold, and Phlegm.
Initial symptoms start as the Excess type, but they usually
evolve to Deficiency or mixed syndromes. For Excess syn-
dromes, the Lung meridian must be treated for Cold Wind,
and Stomach and Spleen must be treated for Heat and
Phlegm. Suggested points are: Dingchuan, Tiantu (CV 22),
Xuanji (CV 21), and Shanzhong (CV 17); plus Feishu
(BL 13), Lieque (LU 7), and Hegu (LI 4) for Cold Wind;
and Chize (LU 5), Fenglong (ST 40) and Dazui (GV 14)
for Phlegm and Heat.10
 112
For Deficiency syndromes, the Lung and Kidney must be
tonified, and moxibustion is a good option. Suggested points
are Dingchuan, Taiyuan (LU 9), Feishu, and Shanzhong; for
Lung Deficiency Zusanli (ST 36) may be added; and for
Kidney Deficiency, Shenshu (BL 23), Mingmen (GV 4),
Qihai (CV 6), and Guanyuan (CV 4) may be used.10
REFERENCES
1. Chesnutt AN, Chesnutt MS, Prendergast TJ. Pulmonary dis-
orders. In: Papadakos MA, McPhee SJ, Rabow MW, eds.
Current Medical Diagnosis & Treatment 2018. New York:
McGraw-Hill. Online document at: http://accessmedicine.
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2017;37(4):406–410.
3. Han J, Li S, Zhao Y, Yang J, Yu Y, Sun N, Cui J. Acu-
puncture for TGF-b1 expression in lung tissues of asthma rats
[in Chinese]. Zhongguo Zhen Jiu. 2017;37(7):741–746.
4. Liu CY, Qin S, Liu LY, et al. Inhibitory effect of acupoint
application on airway remodeling and expression of TGF-b 1/
Smad 3 in the lung tissue of chronic asthma mice [in Chi-
nese]. Zhen Ci Yan Jiu. 2017;42(2):153–158.
5. Chen XH, He HM. Effects of moxibustion at ‘‘Feishu’’ (BL
13) and ‘‘Shenshu’’ (BL 23) on peripheral blood T cells and
serum interleukin in asthmatic rats [in Chinese]. Zhen Ci Yan
Jiu. 2017;42(2):159–162.
CLINICAL PEARLS
6. Brinkhaus B, Roll S, Jena S, et al. Acupuncture in patients
with allergic asthma: A randomized pragmatic trial. J Altern
Complement Med. 2017;23(4):268–277.
7. Su L, Meng L, Chen R, et al. Acupoint application for asthma
therapy in adults: A systematic review and meta-analysis of
randomized controlled trials. Forsch Komplementmed. 2016;
23(1):16–21.
8. Liang Y, Lenon GB, Yang AWH. Acupressure for respira-
tory allergic diseases: A systematic review of randomized
controlled trials. Acupunct Med. 2017;35(6):413–420.
9. Pai HJ, Azevedo RS, Braga AL, Martins LC, Saraiva-
Romanholo BM, Martins M de A, Lin CA. A randomized,
controlled, crossover study in patients with mild and
moderate asthma undergoing treatment with traditional
Chinese acupuncture. Clinics (São Paulo). 2015;70(10):
663–669.
10. Hsing WT. Clinical experience. In: Wen, TS, ed. Manual of
Acupuncture Therapy [in Portuguese]. São Paulo: Editora
Manole; 2008:319–321.
Address correspondence to:
Yolanda Maria Garcia, MD, PhD
Internal Medicine Department
São Paulo University Medical School
R. Teodoro Sampaio, 352cj57
São Paulo, SP 05406-000
Brazil
E-mail: yolanda@usp.br