Herb School

Case Report:

Optimal Results for Allergic Asthma

 and 

Eczema as it relates to Eastern Medicine  

Theresa Mhanna

Integrative case management  

2017

Abstract:

What is unique about this paper is that it brings Eastern and Western Medicine together and shows a correlation. Asthma and Eczema have been a medical issue for thousands of years. It has become a national problem in America in the past 100 years. People are using the health care system more than ever. This article will review the theory of CM (Chinese medicine). And how it can help both conditions together. It will cover asthma and eczema give diagnosis, acupuncture and Chinese herbs. The main concerns for the patient were the quality of life and getting off of strong western medications that lowered her immune system. The main diagnosis was allergic asthma and eczema. The use of western medication was used in the beginning to repress the symptoms the patient was experiencing, Acupuncture and Chinese herbs were used to balance the body, clear heat, and restore harmony. In the end, the patient was able to cut back on western medication and is presently continuing acupuncture treatments with Chinese herbs. Recommendations to continue treatment of acupuncture and Chinese herbs. Exercise at least three times a week. Practice daily eating regiments that focus on non-inflammatory foods and avoid foods that trigger allergic responses.

Lessons to take away will be:

1.      scientific evidence that asthma and eczema are related.

2.     Chinese medicine can make a difference

3.     Protocols with acupuncture and herbal formulas that work for this situation

Key Words: Asthma, Allergies, Eczema, Chinese Herbs, Filaggrin, Inflammatory

Title:

Case Report: Optimal Results for Allergic Asthma
and Eczema as it relates to Eastern Medicine

Introduction:

In an article posted Mar 2006 by Christian Nordqvist, Eczema and Asthma hope for millions of gene defect identified States that a gene that produces filaggrin, a protein which prevents skin dryness, is deficient. Lack of filaggrin in your body can cause the skin to be dry and inflamed more easily, and then eczema can develop. Lack of Filaggrin can also create more foreign bodies to enter the lungs that can lead to asthma. (Nordqvist, 2006)

This case is unique because it takes two western conditions and allows us to treat them as one in eastern medicine and get results.

Patient Information:

            Ms. V is a pleasant 28-year-old female, non-smoker, single, religious, strong family support,135 #’s, height is 5’1”, that presents with allergic asthma and eczema. There are scabs on her head and in the folds of her elbows, her hands are ridden with wrinkly, dry, patchy, itchy, rough, thick, red skin. Her face is dry, patchy, flaky, rough, red/pale skin all over.  She was identified at the age of 4 with asthma and eczema. She is admitted to the local hospital a minimum of 2 times a year since childhood due to her conditions. She sees a specialized doctor for her health conditions three times a year. She lives in a pet free home. Diagnosed with learning disabled in elementary school. She has been diagnosed with attention deficient disorder and episodes of excessive anxiety/fearfulness. She works as a manager of a local grocery store. She is allergic to Nuts, Wheat, Dairy, Eggs, Hops Cats, Horses, Dogs, Dandelion, Trees, Grass, Red dye. No Know Drug Allergies. Siblings have been known to have allergies and asthma. Father has Alcoholism and mother has Multiple sclerosis, PTSD, Tourette’s. Ms. V is a none smoker, drinks socially, single with a boyfriend, and goes to church on a regular basis. In general, she doesn’t have pain but when eczema and asthma get inflamed her skin will itch and be painful and emotional can cause conditions to worsen. Menstruation is regular, no cramps, no clots, and five days.

Clinical Findings:

Clinical findings have been red, itchy, dry, scaly skin on her face, arms, and hands. She has dry eyes, runny and congested nose. Her mouth is dry, and she has difficulty swallowing pills and foods. Her respiratory is wheezy, SOB, and a tight chest. She has trouble with foods because of her allergies which cause inflammation. Her body feels hot to her except in the winter when she has difficulty keeping warm. She does not like the cold. A physical examination found that her Shen is clear and engaged. The sound in her voice sounds frustrated; her eyes are slightly red, nose stays congested with clear mucus. Her upper right quadrant of her abdomen is tender. Her body is toned.

Timeline:

Ms. V started seeking acupuncture treatments in 2013. She has been a work in progress. She will begin to see results and feel better then she stops treatments for 3 to 9 months. Below is the timeline for the latest treatments.

Acupuncture Treatments:  

11/15/2017	Acupuncture Treatment	Asthma 4/10	Eczema 3/10
10/25/2017	Acupuncture Treatment	Asthma 4/10	Eczema 4/10
10/13/2017	Lab Test received	Blood Count	High Eosinophils Absolute and High Basophils Relative
10/11/2017	Acupuncture Treatment	Asthma 4/10	Eczema 3/10
9/27/2017	Acupuncture Treatment	Asthma 5/10	Eczema 3/10
9/13/2017	Acupuncture Treatment	Asthma 5/10	Eczema 4/10
8/30/2017	Acupuncture Treatment	Asthma 7/10	Eczema 6/10

Diagnostic Assessment:

Lab results for 10/13/2017 showed high Eosinophils Absolute and high Basophils Relative count. High Eosinophils Absolute count can be a sign of eczema, cancer or parasite infection. (Mayo Clinic Staff, 2016) A high Basophils Relative count can be a sign of allergies, virus infection, parasites, and other inflammatory conditions. (Health Blurbs, 2015) A blood test is taken to monitor inflammatory markers and to make sure that the Azathioprine (immune suppressant drug) is not creating other malignancies to develop. Azathioprine can increase the risk of cancer and lymphoma.

Asthma is a chronic inflammatory, non-curable disease. People who have asthma experience breathing difficulties such as wheezing, tightness in chest, coughing, SOB (Mayo Clinic, 2016)

Eczema is a chronic inflammatory, non-curable condition of the skin. It causes the skin to be itchy, red, thick, cracking, flaky, sometimes blisters of the skin.  

Both conditions require a physical exam by a doctor. A yearly examine is necessary to keep conditions under control. How are they related? In Western Medicine, they both affect the autoimmune response. They both appear to be in people with a weak constitution, allergies, both parents or one of the parents had the disease or irritants. (The Mayo Clinic Staff, 2017) They both have inflammation. One has to swell of the skin the other is swelling of the lungs. One can lead to the other.

In Eastern Medicine her diagnosis is different. In Eastern Medicine, in school, I learned the lungs manifest externally in the skin and body hair. Lung Qi disperses through the whole body by descending. The lungs regulate the opening and closing of pores of the skin. The lungs spread food essences and body fluids. Body fluids are distributed like a mist in between the skin and muscles. If the lungs don't do this, then the skin becomes dry and compromised.  We look at the all the symptoms as western medicine does but because we look at the body as a whole we address these issues accordingly such as the dry, itchy, red, thick skin is related to the lung which is also giving her issues with difficulty with breathing. We would then give a diagnosis of Kidney Jing and Lung deficiency with wind heat. The wind is itchy, and the heat is the redness. Now, this is a complicated case, so we have to address this one issue at a time. Kidney is

Getting the body balanced and healthy enough to eliminate the drug Azathioprine from Ms. V’s life is a challenge.

Therapeutic Intervention:

Past interventions have included Albuterol inhaler, Singular, Azathioprine, and Triamcinolone acetonide daily, and cortisone shots. All of these are still being used on daily bases minus the cortisone shots. The cortisone shots had a short-term effect and caused her gluteus maximus to indentation the size of her fist that lasted months. The cortisone shots are known to cause brittle bones, a weakened immune system, and this concerned Ms. V.

Western types of intervention she is still prescribed Albuterol inhaler as needed, epi-pen as needed in case of emergency, Triamcinolone ointment daily, and Azathioprine 50mg daily. This has worked relatively well with keeping her condition at a minimum, but it is like a giant band-aid that is covering up the problem because every time she stops taking the medications her conditions flares up like an uncontrollable fire.

Eastern types of intervention have been acupuncturing, cupping and Chinese herbs. Ms. V has been working with me for a couple of years now off/on. When she is consistent with treatments of acupuncture, her skin and asthma are more under control. She has been consistent for eight weeks now. She has been receiving acupuncture treatment 1x a week for 30 minutes with cupping as needed to release stress and tight muscles. The points used are Nei Ting (ST 44), Pi Shu (BL 20), Tai Xi (K3), Shen Shu (BL23), Fei Shu (BL 13), Zong Fu (L 1), Kong Zui (L 6), Zu San Li (ST 36), San Yin Jiao (SP 6), Tia Yuan (L 9), Tan Zhong (Ren 17), He Gu (LI 4), Feng Shi (GB 31), Shao Fu (H 8), Shen Men (H 7), Feng Long (ST 40), Tai Chong (LR 3), Xue Hai (SP 10)

An herbal formula that she will be prescribed is Bu Zhong Yi Qi Tang three times a day for five weeks to correct the immunological imbalance and quite the inflammatory conditions internally and Huang Lian Jie Du Tang when her eczema is flaring up for five days or as recommended on an appropriate basis. (Penner, 2017) Because of her difficulty swallowing pills or food the smallest of tea pills are prescribed. She is not compliant with teas. Keeping her on the Bu Zhong Yi Qi Tang for four weeks then I will switch her to Sha Shen Mai Dong Wan for four weeks to assist dryness of the lungs and skin, and Wu Mei Wan to help with her allergies. (Hall, 2008)

Follow-up and Outcomes:

Ms. V has been taking a break from Acupuncture treatments for six weeks. She will resume treatments of the same protocol.  She is to do blood tests every four weeks according to a western doctor. The importance of following up with treatment is to keep her system from reverting to its old self. She is not the most discipline yet in her life with eating habits and needs the reinforcement for the balance in her body.

The importance of giving her a break is to see how her body tolerates non- treatment and continues on its own and for how long and to help her with compliance of showing up for appointments by giving her a break in routine. The one thing that she has maintained consistency with is working out and exercise. This has been extremely beneficial to her for Qi and blood flow.

Her compliance is off and on throughout a 4-year period. It’s the inner struggle to keep fighting the conditions, and sometimes she lets it get the best of her or she is doing well and gets involved with enjoying her life and the conditions come back fiercely at her and then it’s like starting over. There is always a chance that she might have an adverse reaction to the Chinese herbs because she has allergies to many things.  An epi-pen is prescribed to her from her western doctor for such  

Discussion:

Ms. A is responding well to the treatment plan that set forth. The limitation I have is this is a chronic disease and takes time to get the conditions under control.

Through the course of treatment, Ms. A has experience better quality of breathing. She also states that the breathing exercises have helped her breath better and helped keep her calm when dealing with anxiety. When Ms. A first began treatment, she rated her breathing at 8 out of 10. 10 being worse and 0 being most comfortable. Now she evaluates her breathing at a 5. She has not had to take singular for two weeks now. During last treatment, Ms. A says that she benefits from taking this formula, and she is excited to continue therapy. The goal is to get her eczema under control, so she starts to reduce the dosage amount of the medication Azathioprine. Re-Evaluate as needed.

Goals/lifestyle: 

1.       Asthma will stabilize around a 2/10 in the course of 6 more months 

2.       Eczema will stabilize around a 2/10 in the course of 6 more months 

3.       Diet will consist of eating foods that are anti-inflammatory and that she is not allergic to 

4.       Exercise will continue as is  

Patient Perspective:

           Ms. V stated "I was born with severe eczema, allergies, and asthma, the doctors put me on medications that were for kidney transplants (even though I've never had a kidney transplant, imagine how bad that is for your body). For ten years my body was on hard drugs. Then I started doing Oriental Medicine, acupuncture and cupping. I don't break-out in hives and rashes every other day. This woman has not only given me a healthier way of living; she saved my life".
Patient signature on file

Resources

Hall H, (July 29, 2008), An Herbal Cure for Peanut Allergies?, Science-Based Medicine, Retrieved from https://sciencebasedmedicine.org/an-herbal-cure-for-peanut-allergy/

Health Blurbs, (2015), Basophils Function, High, Low Basophil Count, Health Blurbs, Retrieved from http://www.healthblurbs.com/basophils-function-high-low-basophil-count/ 

Liu C, Wilson N, Swoden H, ( n.d.), Written Chinese, Retrieved from  https://www.writtenchinese.com/  

Mayo Clinic Staff, (Aug. 30, 2016), Diseases and Conditions Asthma, Mayo Clinic, Retrieved from https://www.mayoclinic.org/diseases-conditions/asthma/basics/definition/con-20026992

Mayo Clinic Staff, (Sept. 29, 2016), symptoms Eosinophilia, Mayo Clinic, Retrieved from https://www.mayoclinic.org/symptoms/eosinophilia/basics/definition/SYM-20050752

Nordqvist, C, March 21, 2006, Eczema and Asthma Hope for Millions as Gene Defect Identified, Medicine News Today, Retrieved from https://www.medicalnewstoday.com/articles/39964.php

Penner J,( 2017), Eczema, American Dragon, Retrieved from http://www.americandragon.com/conditions/Eczema.html