Cough-variant Asthma (CVA) & Chinese Medicine

abstracted & translated by
Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

Cough-variant asthma (CVA) is a type of asthma in which the main symptom is a dry, non-productive cough. People with CVA often have no other “classic” asthma symptoms, such as wheezing or shortness of breath. Cough-variant asthma is sometimes called chronic cough to describe a cough that has lasted longer than 6-8 weeks. The coughing with asthma can occur during the day or at night. Anyone can get CVA at any time, but it is common in young children with childhood asthma. In addition, CVA may lead to development of “classic” asthma with symptoms that include shortness of breath and wheezing. According to modern Western medicine, like classic asthma, the causes of CVA are unknown. However, coughing may start after people are exposed to allergens, or when they are breathing in cold air. Coughing may also follow an upper respiratory infection.[1]

On pages 8-9 of issue #10, 2007 of Xin Zhong Yi (New Chinese Medicine), there is an interesting article on CVA titled “A Discussion of Professor Chao Si-xiang’s Experiences Treating Cough-variant Asthma [Via] Pattern Discrimination.” and authored by Zhang Zhong-de et al. I believe this article provides a good insight into how professional Chinese doctors treat a modern Western disease like CVA. At the time of their writing this article, the authors state that Prof. Chao had 40 years of clinical practice as a pulmonary specialist at the Guangzhou Chinese Medicine & Pharmaqcology University’s No. 2 Affiliated Hospital in Guangzhou, Guangdong.

Disease causes & mechanisms:

Prof. Chao believes that wind evils attacking the lungs resulting in nondiffusion of the lung qi is the main disease cause and mechanism of this condition. However, in individual patients, these wind evils may be mixed with dryness, cold, heat, and/or blood stasis.

Basic treatment method:

Based on the above point of view, Prof. Chao’s fundamental treatment principles for dealing with CVA are to course wind and diffuse the lungs, relax spasm and resolve tetany, stop cough and disinhibit the throat. To accomplish this, Prof. Chao takes the following prescription as his basic formula:

mix-fried Ma Huang (Herba Ephedrae)
Xing Ren (Semen Armeniacae)
Kuan Dong Hua (Flos Tussilaginis)
Zi Wan (Radix Asteris)
mix-fried Pi Pa Ye (Folium Eriobotryae)
Chan Tui (Periostracum Cicadae)
Jiang Can (Bombyx Batryticatus)
Wu Wei Zi (Fructus Schisandrae)
She Gan (Rhizoma Belamcandrae)
Niu Bang Zi (Fructus Arctii)
Zi Su Ye (Folium Perillae)
Jie Geng (Radix Platycodi) [No amounts given]

Within this formula, mix-fried Ma Huang diffuses the lungs and rectifies the qi, opens blockage and dispels evils. Xing Ren, mix-fried Pi Pa Ye, and Zi Su Ye downbear counterflow of the lung qi. Chan Tui and Jiang Can course wind, resolve tetany, and relax spasm. Jie Geng, She Gan, and Niu Bang Zi course wind, diffuse the lungs, and disinhibit the throat. Zi Wan and Kuan Dong Hua moisten the lungs and stop coughing as well as help control the other acrid, dry medicinals in the formula. When all these medicinals are used together, upbearing and downbearing are both taken care of, warming and moistening are both used, and the lung qi is depurated and downborne so that, once the lung normal diffusion and downbearing is restored, coughing is automatically leveled.

If the case tends toward wind heat, Prof. Chao commonly adds Huang Qin (Radix Scutellariae), Yu Xing Cao (Herba Houttuyniae), Chuan Bei Mu (Bulbus Fritillariae Cirrhosae), Sang Bai Pi (Cortex Mori), and Gua Lou (Fructus Trichosanthis).

If the case tends toward wind cold, Prof. Chao commonly adds Gui Zhi (Ramulus Cinnamomi), Xi Xin (Herba Asari), Zi Su Zi (Fructus Perillae), and Bai Zhi (Radix Angelicae Dahuricae).

If there is yin vacuity with lung dryness, Prof. Chao adds Mai Men Dong (Tuber Ophiopogonis), Sha Shen (Radix Glehniae), Huo Ma Ren (Semen Cannabis), Xuan Shen (Radix Scrophulariae), and Li Pi (Cortex Pyri).

If an itchy throat is marked, then Prof. Chao adds Qing Guo (Fructus Canavaliae), He Zi (Fructus Terminaliae), Di Long (Pheretima), Quan Xie (Scorpio), Bai Shao (Radix Alba Paeoniae), Zi Su Zi (Fructus Perillae), and Ying Su Ke (Pericarpium Papaveris Somniferi).

If the history of enduring cough is relatively long, Prof. Chao adds ingredients to quicken the blood and transform stasis, such as Dan Shen (Radix Salviae Miltiorrhizae), Chi Shao (Radix Rubra Paeoniae), and Chuan Xiong (Rhizoma Chuanxiong).

During periods of remission, he continues regulating and supplementing the lungs and kidneys by commonly adding Tai Zi Shen (Radix Pseudostellariae), Huang Jing (Rhizoma Polygoni), Shan Zhu Yu (Fructus Corni), Gou Qi Zi (Fructus Lycii), Rou Cong Rong (Herba Cistanchis), Yin Yang Huo (Herba Epimedii), and Dong Chong Xia Cao (Cordyceps Chinensis).

Zhang et al conclude this article by presenting four of Prof. Chao’s recent case histories of CVA. All four of these cases were reported cured or clinically controlled with between 1-2 weeks of Chinese herbal decoctions. Each of the four cases presented slightly different patterns for which Prof. Chao modified his basic formula as described above.

In another article by Yan Li-ming titled “The Treatment of 30 Cases of Cough-variant Asthma with Integrated Chinese-Western Medicine,” Dr. Yan describes a two-wing study comparing a different Chinese medicinal formula plus standard Western drug therapy to the same Western drug therapy alone.[2] In this study, there were no significant statistical differences in the sexes, ages, or duration of the condition of the members of these two groups which each was made up of 30 cases. All these cases met the four-part diagnostic criteria for CVA formulated at the 1997 National Asthma Symposium. The basic Chinese medicinal formula used in this study consisted of:

Huang Qi (Radix Astragali), 12-30g
Sheng Di (uncooked Radix Rehmanniae), 9-18g
Ma Huang (Herba Ephedrae), 6-12g
Zi Su Zi (Fructus Perillae), 12-15g
Bai Bu (Radix Stemonae), 10-20g
Sha Shen (Radix Glehniae), 10-30g
Bai He (Bulbus Lilii), 10-30g
Mai Men Dong (Tuber Opjhiopogonis), 10-18g
Zhe Bei Mu (Bulbus Fritillariae Thunbergii), 10-15g[3]

One packet of these medicinals was decocted in water and administered warm in two divided doses per day. In both groups, seven days administration equaled one course of treatment, and results were analyzed after two successive courses. Clinical control was defined as disappearance of all clinical symptoms and no recurrence within six months after stopping medication. Marked effect was defined as a decrease in clinical symptoms of 2/3 or more. Some effect meant that there was a decline in clinical symptoms of 1/3 or more, and no effect meant that there was no improvement. The following table shows the outcomes of these two groups.

Therefore, it can be seen that the group which was administered both the Western medicine and the Chinese herbal medicine got a significantly better overall therapeutic effect as well as a markedly better clinical control rate. This suggests at the very least that Chinese herbal medicine can be a useful adjunct for the Western medical treatment of CVA. However, Prof. Chao’s clinical experience also shows that Chinese medicine all by itself can also be clinically effective in treating and preventing further recurrences of CVA.

Copyright © Blue Poppy Press, 2008. All rights reserved.

Endnotes:

[1]. Cough Variant Asthma, http://www.webmd.com/asthma/guide/cough-variant-asthma, last retrieved on 1/14/2008

[2]. Yan Li-ming, “The Treatment of 30 Cases of Cough-variant Asthma with Integrated Chinese-Western Medicine,” Shan Xi Zhong Yi (Shanxi Chinese Medicine), #10, 2007, p. 42

[3]. Readers should note that, in this study, all the patients were living in Shanxi province where it is very dry, a very different climate from Prof. Chao’s in Guangzhou. Therefore, this formula is directed primarily at wind dryness evils.