Acupuncture Treatment of Asthma
A review of the literature about acupuncture therapy for asthma reveals that the methods adopted by modern acupuncturists are relatively simple and straightforward. For the most part, it is based on needling the areas of the chest and back that are over the lungs, particularly the upper part of the lungs with a small number of adjunctive points elsewhere. Although a fairly large number of acupuncture points at the front and back of the ribcage are traditionally indicated for alleviating asthmatic breathing, relatively few are frequently mentioned in acupuncture formulas recommended in textbooks and used in clinical trials.
Since the traditional view is that asthma can arise in relation to disorders in the functions of the lung, stomach, and kidney (see Appendix A of Herbs and drugs for asthma), it is not surprising that the largest number of acupoints said to alleviate dyspnea are found on three meridians: the lung meridian; the portion of the stomach meridian that traverses the chest; and the portion of the kidney meridian that traverses the chest. Further, because the bladder meridian is used to treat all organs, and specifically to treat those that are in the area it traverses via the back shu points, there are several bladder points on the upper back that are used for treating asthma. These bladder points turn out to be amongst the most important for treating asthma, perhaps because it is a blockage in flow of qi in the back (sometimes reflected in the posture) that most strongly influences the severity of asthmatic breathing.
Following is a brief review of the individual acupoints that are described as being useful in the treatment of asthma. The acupoints are presented in three groupings: points on the lung meridian; local points on other meridians; and distal points on other meridians. Point indications are mostly derived from Fundamentals of Chinese Acupuncture (1). After presenting these points, examples of acupuncture formulas from Chinese medical texts and from research reports are provided.
The lung meridian, like that of the heart and pericardium, links the hand with the chest (see Figure 1). All of the lung meridian points are indicated for coughing and dyspnea.
Progressing along the meridian from LU-1 to LU-11, the indications for the points tend towards increased heat syndrome. Thus, LU-1 and LU-2 are mainly indicated for cough, dyspnea, and chest pain, not necessarily accompanied by heat, but LU-3 through LU-11 are indicated for various heat syndromes that produce symptoms such as hemoptysis or nosebleed, pain and swelling in the throat, fever, and mania. In particular, LU-10 and LU-11 are indicated for feverish conditions and mania and are usually not used for asthma therapy. However, in Modern Clinic Necessities for Acupuncture and Moxibustion (2), in the section on bronchial asthma, it is said that "LU-10 takes precedence over all others." Chronic asthma does not inherently involve these other heat conditions addressed by the lung meridian points, but the symptoms could arise in cases of lung diseases, such as bronchitis, which yield dyspnea as an acute symptom. Acupuncture texts that describe asthma treatment strategies and practitioners that report on their usual practices favor LU-5, LU-6, LU-7, and LU-9 (see formulas in the next two sections). LU-7 is a preferred point in asthma treatments used in modern times; although this point is said to treat heat in the palms, heat and pain in the shoulder and back, bloody urine, and other heat syndromes, it is also said to dispel cold. It is a releasing point that "courses the channels and frees the connecting vessels." LU-7 is the luo (connecting) point of the lung channel; it is physically close to PC-6 (neiguan), the luo point of the pericardium channel, which is sometimes substituted (both points are utilized to enhance the effects of other points needled at the same time). Interestingly, many acupuncture formulas for treating asthma do not include any points of the lung meridian. The points LU-2, LU-3, LU-4, LU-8, and LU-11 are not mentioned in any of the formulas described in the literature reviewed for this article.
Acupuncture points that are on the chest and back may be considered local points for treatment of asthma because the needles are inserted close to the lungs. The stomach, kidney, spleen, and conception vessel channels all have points on the chest, while the bladder meridian and governing vessel have points on the back over the lungs.
The stomach is understood to be related to asthma in two ways:
Stomach meridian points ST-12 through ST-18 are indicated for asthmatic breathing (ST-17, at the nipple, is not used). These points run down from the clavicle along the front of the rib cage (see Figure 2).
The kidney is understood to be related to asthma following the concept that the kidney system aids the downward movement of the lung qi (the kidney grasps the lung qi). Further, asthma that begins in early childhood and that which develops late in life are thought to reflect deficiencies of kidney essence. Modern research suggests that asthma is associated with deficiencies in adrenal corticosteroid production, which is occurs often in persons diagnosed as having kidney deficiency syndrome. Kidney meridian points KI-22-K-27 run up the chest, where the meridian ends at KI-27 (see Figure 3); these points are indicated in the acupuncture texts as beneficial for treating asthma.
A portion of the spleen meridian also runs along the chest (see Figure 4). The points SP-17-SP-21 are indicated for cough, dyspnea, and chest distention. The points at the top of the spleen meridian, SP-20 and SP-21, are especially suggested for this purpose.
The conception vessel runs up the center of the body, and traverses the chest from points CV-17 through CV-22 (see Figure 5); these points are indicated for asthmatic breathing. The points at the two ends of this segment, CV-17 and CV-22, are used in several acupuncture formulas for asthma. In general, points on the conception vessel treat the internal organs that are close by, though they also have other functions, and the treatment of lung and heart diseases are the associated functions of the points on the chest.
On the back, there are a large number of bladder points; the inner path of the bladder meridian has points along each of the spinal vertebrae. These points are understood to be associated with organ systems that are near their sites (a somewhat similar concept is applied in modern chiropractic therapy). BL-11-BL-17, running over the upper portion of the lungs (see Figure 6), are indicated for asthmatic breathing. In particular, BL-13 is heavily relied upon. Its name is feishu, translated as "lung hollow," and it is generally referred to as the back shu point of the lungs (it is the main association point for the lungs on the bladder meridian). It has been reported (see Acupuncture: A Comprehensive Text (3)) that "BL-13 will be sore to the touch on all asthmatics. Those patients who have received acupuncture at BL-13 with no result will be cured if moxibustion is performed there." This commentary derives from the Zhenjiu Zisheng Jing,, where it says (12): "If dyspnea is not caused by phlegm, then moxa feishu [BL-13]. If there is dyspnea and wheezing, press feishu and without exception there will be aching and pain. In that case, needle feishu and then moxa it and there will be a cure." Parallel to these inner-track bladder meridian points are the adjacent set of bladder points running along the edge of the scapula, BL-41-BL-46, which can also be used for asthma, especially BL-42-BL-45. BL-42 is known as pohu (po door), referring to the po soul that resides in the lungs (see Exploring yin and yang #4: Hun and po). BL-13 and BL-42 are parallel points. Of these points, only BL-43 is mentioned in the asthma formulas described in the next section.
Finally, there is a pair of asthma points of more recent description that are based on clinical experiences and not the standard meridian pathways (see Figure 7). These are chuanxi ("gasping;" M-BW-1a) and dingchuan ("dyspnea stabilizer;" M-BW-1b) that are on the back and lateral to GV-14 (dazhui). Dingchuan is 0.5 inches to the side of GV-14, and Chuanxi is 1 inch to the side of GV-14. Some practitioners will treat at the same time the point at 1.5 inches to the side of GV-14, which is BL-11; however, it is more common to combine one or both of the extra meridian points with GV-14 (a common formula subset is GV-14 plus Dingchuan), or to simply use GV-14 instead of these off-meridian points. Dingchuan is one of the most frequently mentioned points in the modern literature on asthma treatment and it appears to replace BL-11 for treatment of asthma, as the latter is not mentioned in any of the modern point formulas, while the adjacent points BL-12 and BL-13 are commonly used. In some texts, chuanxi is not mentioned and dingchuan is instead described as being from 0.5-1.0 inches from GV-14, so that it replaces chuanxi. Dingchuan serves as an extension of the set of Huatuo points (see Figure 8).
Aside from lung meridian points on the arm, relatively few distal points are used in treating asthma, at least as major points. Some are applied as an adjunct to treat specific manifestations of asthma. The large intestine point LI-4 is sometimes used when there is stagnation and accumulation syndrome (even though it is LI-18, which is not included in acupuncture formulas for asthma, that is specified in the medical texts as an asthma point). In cases of phlegm accumulation, ST-40 (on the leg) and/or CV-12 (on the abdomen) may be used; ST-40 is the most frequently selected. The all-around tonic point, ST-36, may be included for cases of qi deficiency or general weakness, sometimes along with a leg spleen point (SP-3, SP-6, or SP-9). KI-3 may be utilized in strengthening the kidney to alleviate asthma, and CV-4 and/or CV-6 may be used in tonifying both the spleen and kidney in order to benefit lung qi and alleviate wheezing. BL-23 is sometimes used to tonify the kidney in treatment of asthma; it is the back shu point of the kidney.
Following are some examples of point formulas listed in acupuncture texts that have been published during the past 25 years.
From An Outline of Chinese Acupuncture (4):
Dingchuan, BL-13, CV-22, CV-17.
From Essentials of Chinese Acupuncture (13):
From Acupuncture: A Comprehensive Text (3):
Dingchuan, CV-17, CV-21, CV-22; supplementary points: ST-40 (for much phlegm); GV-14 and LI-4 (for respiratory infection); CV-4 and ST-36 (for chronic asthma).
From Chinese Acupuncture and Moxibustion (5):
From: Clinical Manual of Chinese Herbal Medicine and Acupuncture (6):
From: Advanced Textbook of Traditional Chinese Medicine and Pharmacology (7):
From: Chinese Acupuncture and Moxibustion (8):
From: Modern Clinical Necessities for Acupuncture and Moxibustion (2):
Main points: BL-13, Dingchuan, GV-14, LU-7, LU-10. Secondary points: BL-12, CV-17, and PC-6.
From English-Chinese Encyclopedia of Practical Traditional Chinese Medicine (10)
From: Handbook for Treatment of Acute Syndromes (20):
Certain aspects of point selection are evident from the several examples listed above:
In clinical trials, the researchers often attempt to find the most effective point combination that they feel certain will perform well for a wide range of asthma cases. The points selected often reveal the core components of a larger formula that they might use in general practice. An extensive review of published clinical trials for asthma treatments with acupuncture (9) provided these protocols for body points:
There are some general differences between the acupuncture point formulas used in these trials compared to the textbook recommendations. These differences may reflect changes from traditional practice to modern practice. By far the most frequently mentioned points in the clinical trial formulas were dingchuan plus the other two points that are 0.5 inches on either side of it (GV-14 and Chuanxi). There were fewer bladder meridian points used, with BL-13 still the most commonly selected on that meridian. Conception vessel points along the chest were also less frequently used in these studies compared to the textbook recommendations, with CV-17 the dominant choice, followed by CV-22 (sometimes the two are used together in one formula). As with the textbook examples, back points were used more frequently than chest points. LU-7 was the only point of the lung meridian that was mentioned with some frequency. Two adjunctive points were relied upon repeatedly: ST-36 and CV-4.
In general, as indicated in the following reports by individual practitioners or clinical research teams, asthma treatment is started with daily or every other day treatment. The treatment is then reduced in frequency to about twice per week when the symptoms are somewhat alleviated, ending up with seasonal treatment only at a frequency of about once per week to maintain the effect. Acupuncture may be followed up by moxibustion or cupping.
Dr. Shao Jingming has been practicing Chinese medicine for more than 60 years; for prevention and treatment of asthma, this is a summary of his experience reported recently (14):
Dr. Shao has the practice of regularly choosing certain main and adjuvant points. feishu (BL-13), dazhui (GV-14), and fengmen (BL-12) are selected as the main points; when used together, they can not only activate the function of the lung and relieve asthma, but also prevent the relapse of asthma, showing quite good therapeutic effect on simple bronchial asthma. During the paroxysmal period, puncturing the above points can lower the resistance of the intrapulmonary gaseous passages so as to alleviate asthma over time; during the remission period, the treatment may have an effect of regulating and improving the function of the lung to consolidate the long-term effect....some adjuvant points should be added according to the accompanying symptoms: chize (LU-5) and taiyuan (LU-9) for coughing; zhongwan (CV-12) and zusanli (ST-36) for profuse sputum; shenshu (BL-23) and guanyuan (CV-4) for shortness of breath and exacerbation of asthma after motion; jueyinshu (BL-14), xinshu (BL-15), neiguan (PC-6), and zusanli (ST-36) for palpitation and lip and nail cyanosis; and yuji (LU-10) for pharyngeal and tongue dryness. As for the acupuncture maneuvers, the depth of the needle at the three main points is as follows. For adult patients, a 1.5 cun long filliform needle is inserted vertically at dazhui (GV-14) 1.3 cun deep; and 1 cun long filliform needles are inserted slowly at feishu (BL-13) and fengmen (BL-12) 0.5-0.8 cun deep to induce needling sensation....In case of deficiency of yang, acupuncture may be applied with moxibustion; in the case of deficiency of yin with internal heat, or of pulmonary infection with fever, acupuncture may be applied, followed by cupping....Clinical practice showed that treatment given in summer and autumn seasons for 3 years can basically control relapse."
At the Henan Provincial Hospital of Traditional Chinese Medicine, Dr. Chen Anmin (15) reported that:
Application of acupuncture and moxibustion during acute attacks can relieve asthma instantaneously and alleviate other symptoms. During the quiescent stage, it helps consolidate the therapeutic effect and prevent recurrence. The main points used are feishu (BL-13), dazhui (GV-14), and fengmen (BL-12). The adjunct points are chize (LU-5) and taiyuan (LU-9) for coughing; zhongwan (CV-12), zusanli (ST-36), and fenglong (ST-40) for profuse sputum; tiantu (CV-22) for oppressed sensation in chest and difficult expectoration. The needle is inserted perpendicularly in feishu (BL-13) and fengmen (BL-12) for 0.5-0.8 cun; at dazhui (GV-14) for 1-1.3 cun; and the needles are retained for about 20-30 minutes with manipulation 2-3 times with the uniform reinforcing-reducing method. After acupuncture, cupping can be applied between dazhui (GV-14) and feishu (BL-13). Acupuncture can be applied once daily during attacks and once every other day after asthma has been relieved.
In 1995, Hu Jinsheng, from the Institute of Acupuncture and Moxibustion in Beijing, traveled to Germany and performed acupuncture on patients with asthma who were steroid-dependent (15). His treatment involved applying acupuncture 4 times per week initially for two weeks, and then reducing to 3 times per week for the next two weeks, and then 2 times per week for several weeks. There were two basic acupuncture formulas; one which was a general tonification strategy that included zusanli (ST-36), sanyinjiao (SP-6), shanzhong (CV-17), baihui (GV-20), and zhongfu (LU-1) aimed at improving lung functions. The other was an asthma-specific treatment that included dingchuan, Chuanxi, and dazhui (GV-14), along with feishu (BL-13) and several other bladder meridian points. Additional points were used to treat specific symptoms. The two basic recipes were alternated. As to the treatment method and results:
The uniform reinforcing-reducing method was adopted after deqi (needling sensation) at all the above acupoints. dingchuan should be punctured to a depth of 1-1.2 cun, using a 1.5 cun long needle; and after the needling sensation was felt by the patient, a strong manipulation should be used, better with the needling sensation radiating into the chest.....the asthmatic symptoms in most of the patients began to be improved after several acupuncture treatments, with the dosage of the drugs gradually reduced. Generally, the dose of oral cortisone was decreased by 2 mg every 10 days, while that of the aerosol was controlled by the patients themselves according to the condition of the disease. The symptoms in most of the patients were markedly improved after 15 treatments, but the treatment should be continued for another 10 times to consolidate the curative effect. Thus, each asthmatic patient needs to receive approximately 30 sessions of acupuncture treatment, lasting about 3 months. Thereafter, in order to prevent its relapse, the treatment should be administered 10 times each year in the summer season [that is, once per week for 10 weeks]....The 25 cases of hormone-dependent bronchial asthma were treated by acupuncture, yielding a markedly effective [no longer take corticosteroid or its aerosol, symptoms disappear] rate of 56%, with a total effective [all patients who lowered drug dose and had symptom improvement] rate of 96%....It is worthy to mention that, in this series, there was one female patient who suffered from anaphylactic asthma induced by dog's hair. She received 10 sessions of acupuncture treatment without any improvement. In this case, the acupuncture should not be given any longer."
At the Zhejiang Institute of Traditional Chinese Medicine, Lou Baiceng reports (17):
According to the characteristics of asthma, it should be kept in mind the basic treatment principle: relieve the manifest symptoms of the disease at the stage of attack and treat its root cause during the period of intermission. Lique (LU-7), hegu (LI-4), and dingchuan, are used as the main points for symptomatic relief, using the reducing maneuver by twisting and twirling. Ginger moxibustion is executed during the intermittent period of the disease. The moxibustion is applied on feishu (BL-13) and lingtai (GV-10) on the first day of treatment; on shenshu (BL-23) on the second day, and on shanzhong (CV-17) and tiantu (CV-22) on the third day. Treatment is given every day with the above three groups of points used in turn, with 5-7 moxa cones applied on each point for each session of treatment, 9 sessions constituting a therapeutic course. The therapy is effective for the majority of cases, especially for children.
Two medical groups in Shanghai reported on the importance of patients experiencing the needling sensation and propagated sensation-the feeling that the needling sensation spreads beyond the local area being treated-in order to get good therapeutic results for asthma. In one report (18), asthma patients were treated at chize (LU-5), taiyuan (LU-9), and zusanli (ST-36). The authors evaluated the level of needle sensation and propagation from LU-5 and ST-36 (LU-9 was not considered to be a suitable site for attaining propagated sensation). The authors stated that:
In general, most of the sensations analyzed radiated slowly. Most of those at chize (LU-5) radiated upward and 20% in both directions. Those at zusanli (ST-36) radiated downward....In treating bronchial asthma by acupuncture in which needling sensations were elicited and traveled along the channels, it was shown that when strong sensations are produced and traveled along the lung channel to reach the shoulder or the upper right chest, more ideal therapeutic results are obtained, and patients can immediately feel the alleviation of the choking sensation of the chest. At the onset of asthma attacks, the insertion and retention of needles for 15 minutes can alleviate asthma, ease the symptoms and make the lung impedance graph and respiratory waves tend to normal. After one course of treatment [acupuncture every other day, for 10 sessions], all indices improved. More than 80% of the patients showing good results had experienced strong sensations, while more than 80% of the patients with poor results had had no sensation traveling along the channel.
The other group reported on treatment of children (ages 5-12 years) with asthma, using electro-stimulation of needles that were inserted superficially at the chosen acupuncture points (19). The doctors selected eight points: dingchuan, dazhui (GV-14), feishu (BL-13), shanzhong (CV-17), tiantu (CV-22), gaohuang (BL-43), hegu (LI-4), and zusanli (ST-36); these were subdivided into three sets of points, with each set treated once per week, three treatments per week; this pattern was repeated for six weeks. Electrostimulation of the needles was adjusted to produce a numbness sensation at the points for 5 minutes. For analysis of results, the patients were divided into two groups: those who definitely experienced a propagated sensation versus those who did not experience this sensation. The authors reported a difference between these two groups in the therapeutic effects (asthmatic breathing) which correlated with changes in the measured parameters such as plasma cyclic nucleotides, cortisol, and IgE. In both groups, there were measurable improvements (increased cGMP with reduced cAMP; increased cortisol; decreased IgE), but the response of those with propagated sensation was somewhat better.
Propagation of needling sensation was also emphasized by Zhu Mingqing (20) who is best known for his work with scalp acupuncture and treatment of acute syndromes. For treatment of asthma using body points, he states that the needle reaction attained at dazhui (GV-14) and dingchuan should spread to the shoulder, back, or chest; similarly, when treating tiantu (CV-22), the reaction should spread to the whole chest; and when treating neiguan (PC-6), the reaction should conduct upwardly along the medial aspect of the arms. In these cases, needling manipulation can be carried out over a period of 5-10 minutes, and the needles are not retained afterward.
The impression conveyed by textbook presentations, clinical trials, and practitioner reports about acupuncture therapy for asthma is that although there is considerable diversity in treatment strategies, it appears especially valuable to utilize upper-back points. In particular, the most frequently relied upon points are those along the horizontal line of GV-14, dingchuan, and Chuanxi, and points that are just below that line, particularly BL-13 and, to a lesser extent, BL-12 and the outer point BL-43. In all but three of the point sets listed for the clinical trials above, either dingchuan or BL-13 (or both) were used; similarly, in all but three of the textbook recommendations listed in the previous section, either dingchuan or BL-13 (or both) were included. All of the published clinical trials proclaimed a positive outcome for the treatments as did the individual practitioner reports. Although the clinical trials were not conducted in such a manner as to succeed in proving the effectiveness of the treatments by modern standards, it is clear that practitioners deem these particular points to be reliable.
In general, the front chest points used in treatment of asthma were limited to CV-17 and CV-22. The favored arm point was LU-7, though LU-5, LU-6, LU-9, and LU-10 were also used. Less frequently, PC-6 or LI-4, which are nearby the lung points (forearm/hand), were also used. Leg points that were favored were ST-36 and ST-40, occasionally with tonification points such as SP-6 or KI-3. The lower abdomen was sometimes treated, also as a tonification strategy, relying most heavily on CV-4 and CV-6, and the lower back was treated in some cases at BL-23.
The use of adjunctive points to alleviate coexisting symptoms or constitutional conditions, as well as using additional asthma-related points, may improve the outcome, but it is unclear how much improvement can be expected, given the low frequency with which the other points were deemed important enough to include in textbook recommendations and clinical trials. While there are numerous acupuncture points on several meridians that are indicated for treatment of asthma in the standard texts, it appears that most acupuncturists do not rely on meridian-based therapies for asthma, but, instead, focus primarily on local points over the upper portion of the lungs, thus placing emphasis on the modern empirical point dingchuan and the lung shu point BL-13. These and the few other points mentioned in this literature review article can serve as a basis for designing an acupuncture formula for treatment of asthma.
It is common practice in the West to treat patients on a once-per-week basis, regardless of the disease condition. As reported here, initial treatment frequency recommended by Chinese doctors is once per day or every other day, with decreasing frequency as success is attained. Thus, practitioners may learn from this review both the emphasis on using certain points and the frequency of applying acupuncture that is thought to yield the best results.
Figure 1: Points on the lung meridian.
Figure 2: Points on the stomach meridian.
Figure 3: Points on the kidney meridian.
Figure 4: Points on the spleen meridian.
Figure 5: Points on the conception vessel meridian.
Figure 6: Points on the bladder meridian.
Figure 7: dingchuan and Chuanxi. The points are slightly closer to the GV line than they appear in this illustration.
Figure 8: dingchuan as an extension of the Huatuo points.