🌿 Folk Prescriptions

Steroid dependence and its side effects remain a clinical challenge. This phenomenon is commonly observed in the treatment of bronchial asthma and other conditions with steroid therapy. Combining traditional Chinese medicine (TCM) can reduce steroid dependence and side effects while achieving better therapeutic outcomes. Based on my clinical experience, I will discuss four aspects—tonifying the kidney, regulating the liver, strengthening the spleen, and treating the lung—as follows.
First, Tonifying the Kidney Method
There are numerous reports in China regarding the use of tonifying the kidney method in treating bronchial asthma. Clinical and animal studies have demonstrated that the TCM concept of "kidney" is closely related to the hypothalamic-pituitary-adrenal axis in Western medicine. The tonifying kidney method mainly includes nourishing kidney yin and warming kidney yang. In my clinical practice, for steroid-dependent asthma, the application of this method always seeks balance between yin and yang, involving several specific approaches:
1. Nourishing Yin and Reducing Fire: This method counteracts Cushing’s syndrome-like side effects. After high-dose steroid use exceeding 20 days, especially in patients newly starting steroids, symptoms such as moon face, buffalo hump, pregnancy-like abdomen, irritability, sweating, insomnia, facial flushing, red tongue with thin yellow coating, and slippery or floating rapid pulse may gradually appear—indicating signs of internal fire ascending. It is crucial not to mistake these for real heat and treat them with bitter-cold herbs. Instead, nourishing yin and reducing fire should be used—"strengthening the master of water to control excessive yang." Since steroids can be considered pure yang, fiery substances in TCM, sudden high-dose administration easily injures kidney water, leading to deficiency of yin and excess of fire. At this stage, administering Zhi Bai Di Huang Wan (modified) significantly improves subjective symptoms, allowing continued steroid use and maintaining an effective dose for optimal therapeutic effect. For example, a young female patient with bronchial asthma had been taking prednisone at 20 mg/day for over a month, showing obvious Cushing’s syndrome features, irritability, insomnia, sweating, and facial flushing. Steroid reduction was impossible; even reducing to 5 mg/day triggered dyspnea and wheezing heard on auscultation. Previously, she received intravenous steroids (exact drug and dosage unknown), and oral prednisone was gradually reduced from 60 mg/day to 20 mg/day. Examination revealed a red tongue with thin yellow coating and slightly rapid pulse. A prescription was made: Anemarrhena 10g, Fritillaria 10g, Phellodendron 6g, Rehmannia 15g, Cornus 10g, Alisma 10g, Moutan 10g, Poria 10g, Earthworm 12g, Oyster Shell (pre-boiled) 30g, Mulberry Bark 10g, Night-Blooming Cereus 30g. After five doses, irritability and sweating improved, sleep became slightly better. After twelve doses, despite still taking prednisone 20 mg/day, no significant discomfort occurred. The tongue turned noticeably paler, coating became thin and white. Then, warming yang herbs like Psoralea, Purple Stone, and Epimedium were gradually added, enabling smooth steroid tapering.
2. Warming Yang and Tonifying the Kidney to Facilitate Steroid Reduction: Using warming yang and tonifying kidney methods during steroid tapering has gained increasing recognition among physicians. I often add warming yang and tonifying kidney herbs when preparing to reduce steroids in asthmatic patients, or prescribe formulas like Jin Kui Shen Qi Wan. This usually ensures smooth tapering without rebound phenomena. In the above case, after adding warming yang herbs and adjusting based on tongue and pulse findings—alternately emphasizing nourishing yin or warming yang—the patient underwent six months of adjustment, eventually discontinuing steroids. Follow-up for one year showed no recurrence of asthma.
3. First Tonify Yin, Then Tonify Yang for Smooth Steroid Withdrawal: For asthmatics using steroids, we must consider how to taper and discontinue early. I generally combine nourishing yin herbs with steroids, regardless of whether Cushing’s syndrome-like symptoms are present, to prevent yin deficiency and yang hyperactivity. When preparing to reduce steroids, I add warming yang and tonifying kidney herbs, which typically allows smooth tapering and reduces dependency and relapse. The previous case illustrates this well.
4. Dual Tonification of Yin and Yang, Balancing Qi and Blood to Reduce Steroid Dependence: Some steroid-dependent patients exhibit signs of both qi and blood deficiency and dual yin-yang deficiency, such as fatigue, soreness in waist and knees, frequent colds—especially common in long-term steroid users, some even developing aseptic necrosis of the femoral head. To reduce steroids in such patients, I often combine herbs that tonify yin, yang, qi, and blood, including blood-rich, vital substances like placenta, gecko, and deer antler frost. For instance, a 50-year-old male asthmatic patient had intermittently used steroids for six years, and for the past three years maintained low-dose therapy with prednisone 5 mg/day, unable to reduce further. Any reduction caused chest discomfort and dyspnea. He was overweight, with sallow complexion, mild facial and lower limb edema, fatigue, pale swollen tongue, darkish tongue body, thin white coating, and weak, slippery pulse at the heel. A formula was prescribed: Astragalus 15g, Saposhnikovia 10g, Earthworm 12g, Angelica 10g, Psoralea 10g, Rehmannia 12g, Ligustrum 10g, Perilla Seed and Stem each 10g, Poria 15g, Cinnamon 3g, etc. After continuous use for several months and adding placenta tablets (2 tablets, three times daily), steroid dosage was reduced to 2.5 mg/day, then gradually discontinued entirely while continuing placenta tablets alone.
5. Treating Cold and Heat Simultaneously, Harmonizing Yin and Yang to Reduce Steroid Dosage: Some asthmatic patients who have used steroids repeatedly often show mixed cold and heat patterns. For example, they may present with facial redness, heart annoyance, thirst, yellow tongue coating, slippery pulse, yet also fear cold, cold limbs, loose stools, susceptibility to external pathogens, large pale tongue, darkish tongue body—all simultaneously. In such cases, I prefer modifying Wu Mei Wan (Apricot Kernel Pill), using a combination of pungent opening, bitter descending, sour astringing, warming qi, nourishing yang, enriching blood, and promoting circulation. Adjustments are made based on whether cold or heat predominates or if both are equally present. For example, a 32-year-old male with extrinsic bronchial asthma experienced severe attacks requiring emergency IV steroids and aminophylline. Oral prednisone was used for maintenance. Due to his mixed cold-heat presentation, he was treated with modified Wu Mei Wan (decoction), successfully tapering steroids. He reported that without herbal medicine, steroid use duration would be longer and dosage higher.
Second, Liver-Regulating Method
The liver-regulating method essentially involves smoothing qi movement and harmonizing blood. Though it includes soothing liver qi and regulating liver blood, the goal is to ensure smooth flow of qi and blood. Ancient texts state: “The organ governing qi is the lung; regulation of qi lies in the liver,” “The liver has yin essence but yang function,” “Yin is easily depleted, qi easily stagnated.” Moreover, qi stagnation easily transforms into fire, wind, phlegm, or blood stasis. If qi movement remains smooth and does not reverse, wind and fire cannot arise, nor can phlegm and stasis form. Of course, existing phlegm and stasis inevitably obstruct qi flow. Given that qi stagnation and reversal are key pathogenic mechanisms in asthma, treatment of steroid-dependent asthma must constantly emphasize liver regulation to benefit lung function. Clinically, whenever steroid-dependent asthmatics show signs of disharmony in qi and blood, whether qi stagnation or blood stasis, treatment should focus on the liver. Modern research suggests that the TCM liver plays a crucial role in the neuro-endocrine-immune network. Patients with liver qi stagnation often have impaired immune function. Thus, liver regulation—meaning harmonizing qi and blood—can enhance immune function, thereby helping reduce steroid dependence in asthmatics. Whenever asthmatics present with chest and rib discomfort, emotional depression or irritability, dark tongue with thin coating, and wiry pulse, I prefer Si Ni San (Four Reversal Powder) with modifications. For blood stasis predominance, I use Dang Gui Shao Yao San (Angelica and Peony Powder); for combined qi stagnation and blood stasis, I modify Xue Fu Zhu Yu Tang (Blood House Stagnation-Removing Decoction). Especially in female patients whose condition relates closely to menstruation, liver regulation is particularly important. During premenstrual exacerbations, treatment focuses on soothing qi and activating blood. Postmenstrual flare-ups due to qi deficiency are managed with Xiao Yao San (Free and Easy Wanderer Powder) modifications, balancing liver and spleen; those due to yin deficiency are managed with Zi Shui Qing Gan Yin (Nourishing Water to Clear Liver Decoction) modifications, balancing liver and kidney.
Third, Spleen-Strengthening Method
In treating steroid-dependent asthma, any clinical signs of spleen deficiency or phlegm excess warrant the use of spleen-strengthening methods. This approach primarily includes strengthening spleen qi and resolving phlegm. Since the spleen is central and the foundation of postnatal health, strong spleen function supports innate vitality. A healthy spleen enhances defensive qi, making the body less susceptible to external invasion. Additionally, the spleen is the source of phlegm production. Qi deficiency impairs blood propulsion, leading to blood stasis. Phlegm and stasis are interdependent and often coexist. Given that qi deficiency, phlegm obstruction, and blood stasis are critical factors in recurrent and difficult-to-treat bronchial asthma, for spleen-deficient patients with steroid dependence, treatment should be tailored according to the relative severity of qi deficiency, phlegm obstruction, and blood stasis. Whenever patients present with thick, greasy tongue coating, pale swollen tongue body, darkish color, and slippery pulse, phlegm resolution must be prioritized. Yellow greasy coating calls for clearing and transforming phlegm—use Xiao Xian Xiong Tang (Minor Sunken Chest Decoction) combined with Wen Dan Tang (Warm Bile Decoction) with modifications. White greasy coating requires warming transformation—commonly use Er Chen Tang (Two Ingredients Decoction) combined with San Zi Yang Qin Tang (Three Seeds Nourishing Old Age Decoction) with adjustments. Dark tongue warrants addition of blood-activating herbs. Generally, steroids should not be tapered until the greasy coating clears. For patients with spontaneous sweating, fatigue, frequent external infections, pale swollen tongue, thin white coating, and floating, weak pulse, the method of strengthening spleen qi and consolidating the root is indicated. I favor Yu Ping Feng San (Astragalus and Saposhnikovia Powder) combined with Shen Ling Bai Zhu San (Ginseng and Poria Powder) with modifications. For example, a 37-year-old male patient had suffered from bronchial asthma for 30 years since childhood following pneumonia. He was allergic to dust mites and mold. His asthma worsened in summer and autumn, but for the past three years, he had near-continuous episodes. In the last year, his condition deteriorated, and he had been on steroids for over eight months. Prednisone dosage dropped to 10 mg/day before he felt chest discomfort and wheezing was audible on auscultation. Examination revealed thick, root-deep white greasy coating, pale dark tongue body. A formula combining Er Chen Tang, San Ao Tang, and San Zi Yang Qin Tang (called "Er San San Tang") plus Earthworm and Salvia were prescribed. After the tongue coating cleared, steroid tapering began, supplemented by Liu Jun Zi Tang (Six Gentlemen Decoction). Later, Ren Shen Ha Jie Fen (Ginseng and Gecko Powder, containing 30g ginseng and one pair of geckos ground into powder), 3g twice daily, was taken for about four months. Steroids were completely discontinued without worsening asthma.
Fourth, Lung-Regulating Method
In treating steroid-dependent asthma, whether addressing symptoms or root causes, lung-regulating herbs are frequently required. Lung regulation involves using herbs to promote, descend, warm, clear, tonify, moisten, or astringe the lung, to regulate lung qi, remove phlegm turbidity, tonify lung qi, nourish lung yin, and maintain normal lung functions of dispersion and descent. Since asthma originates in the lungs, both deficiency and excess lead to lung involvement. As Li Zhongzi of the Qing Dynasty stated: “Asthma is a chronic, recurring form of phlegm and panting. Internal obstruction of qi, external exposure to seasonal pathogens, and fixed phlegm in the diaphragm combine to block airways, causing turbulent airflow and resulting in asthma.” Because patients present differently during steroid therapy, lung-regulating methods must be adjusted accordingly. These include clearing and promoting (e.g., honeysuckle, forsythia, platycodon), warming and promoting (e.g., ephedra, apricot seed, schizonepeta), clearing and descending (e.g., scutellaria, lonicera, mulberry bark), warming and descending (e.g., inula flower, perilla seed, bai qian), tonifying lung qi (e.g., astragalus, codonopsis), nourishing lung yin (e.g., adenosma, ophiopogon), and astringing the lung (e.g., schisandra, prunus). While the ultimate goal is to overcome steroid dependence through comprehensive body regulation, lung-regulating methods must not be neglected.
In summary, solving steroid dependence in asthma requires both disease-based and syndrome-based diagnosis and treatment. We must integrate macroscopic and microscopic syndromes, considering the patient's presenting symptoms, signs, and laboratory indicators to establish treatment principles, prescriptions, and medication. Although emphasis may lie in tonifying the kidney, regulating the liver, strengthening the spleen, or treating the lung, the ultimate aim remains supporting lung dispersion and descent, facilitating steroid withdrawal and curing asthma. The above experiences are offered for reference by fellow practitioners.