🌿 Folk Prescriptions

Steroid dependence and its side effects remain a clinical challenge. In the treatment of bronchial asthma and other conditions with steroid therapy, such issues are frequently encountered. 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 the four approaches of tonifying the kidney, regulating the liver, strengthening the spleen, and treating the lung as follows.
1. Tonifying the Kidney Method
The use of tonifying the kidney method in treating bronchial asthma has been widely reported in China. Clinical and animal experiments have demonstrated that the TCM concept of the kidney is closely related to the pituitary-adrenal cortical function in Western medicine. The tonifying kidney method mainly includes nourishing kidney yin and warming kidney yang. My clinical experience indicates that 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 can counteract Cushing's syndrome-like side effects. After high-dose steroid use exceeding 20 days, especially in patients newly receiving 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 gradually appear—indicating signs of internal fire. It is crucial not to misdiagnose these as real fire 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 and leads to deficiency of yin and excess of fire. At this stage, taking Zhi Bai Di Huang Wan (modified) significantly improves subjective symptoms, allowing continued steroid use and ensuring adequate dosage for optimal effect. For example, a young female patient with bronchial asthma had taken prednisone orally at 20 mg/day for over a month, showing obvious Cushing’s syndrome features—irritability, insomnia, sweating, facial flushing. Steroid reduction was impossible; decreasing to 5 mg/day triggered severe dyspnea and audible wheezing bilaterally. Previously, she received intravenous steroids (dose unspecified), 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 formulated: Anemarrhena 10g, Fritillaria 10g, Phellodendron 6g, Rehmannia glutinosa 15g, Cornus officinalis 10g, Alisma 10g, Moutan 10g, Poria 10g, Periplaneta 12g, Oyster shell (decocted first) 30g, Mulberry bark 10g, Night-blooming cereus 30g. After five doses, irritability and sweating improved, sleep slightly better. After twelve doses, despite continuing prednisone at 20 mg/day, no significant discomfort occurred, the tongue color became noticeably paler, the coating turned thin and white. Then, warming yang herbs like Psoralea corylifolia, Purple fluorite, and Epimedium were gradually added, enabling smooth steroid tapering.
2. Warming Yang and Tonifying the Kidney to Facilitate Steroid Reduction: This method is increasingly recognized by physicians as an adjunct during steroid tapering. I often add warming yang and kidney-tonifying herbs when preparing to reduce steroids in asthmatic patients, or prescribe Jin Kui Shen Qi Wan (a ready-made formula). This usually ensures a smooth tapering process without rebound phenomena. In the above case, after adding yang-warming herbs and adjusting based on tongue, pulse, and symptom patterns—alternating between nourishing yin and warming yang—the patient was managed for half a year before discontinuing steroids entirely. 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 medication from the beginning. I generally combine nourishing yin herbs even if there are no Cushing’s-like signs, preventing the development of yin deficiency and yang hyperactivity. When preparing to reduce steroids, I add warming yang and kidney-tonifying herbs. This typically allows smooth tapering and reduces the risk of steroid dependence and relapse. The previous case clearly illustrates this principle.
4. Dual Tonification of Yin and Yang, Balancing Qi and Blood to Reduce Steroid Dependence: Some steroid-dependent patients exhibit signs of qi and blood deficiency and dual yin-yang deficiency, such as fatigue, weakness 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 commonly use herbs that tonify both yin and yang and benefit 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, maintaining low-dose prednisone at 5 mg/day for the past three years, unable to reduce further—any decrease caused chest discomfort and dyspnea. He was overweight, with pale, dull complexion, mild facial and lower limb edema, fatigue, a large, pale dark tongue, thin white coating, and weak, slippery pulse at the deep position. A prescription was made: Astragalus 15g, Saposhnikovia 10g, Earthworm 12g, Angelica 10g, Psoralea 10g, Rehmannia glutinosa 12g, Ligustrum 10g, Perilla seed and stem each 10g, Poria 15g, Cinnamon 3g. After continuous use for months and adding placenta tablets (2 tablets, 3 times daily), steroid dose was reduced to 2.5 mg/day, then discontinued entirely while continuing placenta tablets alone.
5. Treating Cold and Heat Simultaneously, Harmonizing Yin and Yang to Reduce Steroid Dose: Some asthmatic patients who have used steroids repeatedly may present mixed cold-heat symptoms. For example, facial redness, restlessness, thirst, thin yellow tongue coating, slippery slightly rapid pulse coexist with cold aversion, cold limbs, loose stools, susceptibility to external pathogens, a large pale tongue, and dark tongue body. In such cases, I prefer modifying Wu Mei Wan (Plum Pill), combining pungent opening, bitter descending, sour astringing, warming qi, nourishing yang, nourishing blood, and promoting circulation. Adjustments are made according to whether cold or heat predominates or both are present. For example, a 32-year-old male with exogenous bronchial asthma experienced severe episodes requiring emergency IV steroids and aminophylline. Oral prednisone was maintained afterward. Due to mixed cold-heat presentation, multiple treatments involved modified Wu Mei Wan as decoction, enabling smooth steroid reduction. The patient reported that without herbal medicine, steroid use duration would be longer and dosage higher.
2. Liver-Regulating Method
The liver-regulating method essentially involves smoothing qi flow and harmonizing blood. Although it includes soothing liver qi and regulating liver blood, the goal is to ensure smooth qi and blood movement. Ancient texts state: "The governing of qi lies in the lungs, but regulation of qi lies in the liver," "Liver has yin essence but yang function," "Yin is easily depleted, qi easily stagnated," and "Qi stagnation easily transforms into fire, wind, phlegm, and stasis." If qi flow 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 regulation. Since qi stagnation and reversal are key pathogenic mechanisms in asthma, treatment of steroid-dependent asthma must constantly emphasize liver regulation to support lung function. Clinically, whenever steroid-dependent asthmatics show signs of disharmonious qi and blood, or qi stagnation or blood stasis, they should be treated from a liver perspective. Modern research suggests the liver plays a crucial role in the neuro-endocrine-immune network. Patients with liver depression syndrome 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 favor 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 Stasis-Removing Decoction). Especially in female patients whose attacks correlate with menstruation, liver regulation is particularly important. Severe symptoms premenstrually are primarily treated by regulating qi and activating blood. Postmenstrual onset, if due to qi deficiency, I modify Xiao Yao San (Free and Easy Wanderer Powder) to regulate liver and spleen; if due to yin deficiency, I modify Zhi Shui Qing Gan Yin (Nourishing Water to Clear Liver Decoction) to treat liver and kidney simultaneously.
3. 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 mainly includes strengthening the spleen to invigorate qi and eliminating phlegm through spleen strengthening. Since the spleen is central to digestion and the foundation of postnatal health, strong spleen function enhances defensive capacity of the lungs, making them less susceptible to invasion. Also, the spleen is the source of phlegm production. Qi deficiency impairs blood propulsion, leading to stasis. Phlegm and stasis mutually reinforce each other and easily combine into disease. As qi deficiency, phlegm obstruction, and blood stasis are key factors in recurrent and difficult-to-cure bronchial asthma, for spleen-deficient types of steroid-dependent asthma, treatment should be selected based on the relative severity of qi deficiency, phlegm obstruction, and blood stasis. If the patient presents thick, greasy tongue coating, pale swollen tongue with dark appearance, and slippery pulse, phlegm elimination must be prioritized. Yellow greasy coating requires clearing and transforming phlegm—use Xiao Xian Xiong Tang combined with Wen Dan Tang (Modified); white greasy coating calls for warming transformation—commonly use Er Chen Tang combined with San Zi Yang Qin Tang (Three Seeds Nourishing the Elderly Decoction); if the tongue is dark, add blood-activating herbs. Generally, steroids should not be tapered until the greasy coating disappears. If the patient shows spontaneous sweating, fatigue, frequent external infections, large pale tongue, thin white coating, and floating, weak pulse, the method of strengthening spleen, invigorating qi, and consolidating the root should be applied. I prefer modifying Yu Ping Feng San (Astragalus and Saposhnikovia Powder) combined with Shen Ling Bai Zhu San (Ginseng, Poria, and White Atractylodes Powder). For example, a 37-year-old male patient had suffered from bronchial asthma for 30 years, starting after childhood pneumonia, allergic to dust mites and molds. His condition worsened in summer and autumn, but over the past three years, he has had near-continuous episodes. In the last year, his condition deteriorated, and he had been on steroids for more than eight months. Oral prednisone was reduced to 10 mg/day, but he felt chest discomfort and audible wheezing bilaterally. Examination revealed thick, root-deep white greasy coating, pale dark tongue. A prescription was made: Er Chen Tang (Two Ingredients Decoction), San Ao Tang (Three Disobedience Decoction), San Zi Yang Qin Tang (Three Seeds Nourishing the Elderly Decoction) combined, plus earthworm and salvia. After the greasy coating cleared, steroid tapering began, supplemented with Liu Jun Zi Tang (Six Gentlemen Decoction). Subsequently, Ren Shen Ha Jie Fen (Ginseng and Gecko Powder, 30g ginseng, 1 pair gecko ground into powder), 3g twice daily, was used for about four months. Steroids were completely discontinued without worsening asthma.
4. Lung-Treating Method
In treating steroid-dependent asthma, regardless of addressing symptoms or root causes, lung-treating formulas are often required. "Lung-treating" refers to using herbs that promote, descend, warm, clear, tonify, moisten, or astringe the lung to regulate lung qi, remove phlegm turbidity, tonify lung qi, moisten 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 and disease manifestation. As Li Zhongzi of the Qing Dynasty stated: "Asthma is a chronic, recurring form of phlegm and panting. It arises from internal stagnation, external pathogenic invasion, and fixed phlegm in the diaphragm. These three factors combine, block the airway, cause turbulent airflow, and result in asthma." Because patients exhibit varied presentations during steroid therapy, lung-treating methods must be adjusted accordingly. They can be broadly categorized as: clearing and dispersing (e.g., honeysuckle, forsythia, platycodon), warming and dispersing (e.g., ephedra, apricot kernel, schizonepeta), clearing and descending (e.g., scutellaria, loquat leaf, mulberry bark), warming and descending (e.g., inula flower, perilla seed, spikenard), tonifying lung qi (e.g., astragalus, codonopsis), nourishing lung yin (e.g., adenosma, ophiopogon), and astringing the lung (e.g., schisandra, plum). While the ultimate goal is to overcome steroid dependence and achieve comprehensive body regulation, lung-treating methods must not be overlooked.
In summary, resolving steroid dependence in asthma requires both disease-specific and syndrome-based treatment. It demands macroscopic syndrome differentiation alongside microscopic analysis, integrating clinical manifestations, physical signs, laboratory tests, and other indicators to establish treatment principles, formulate prescriptions, and select medicines. Though emphasis may lie in tonifying the kidney, regulating the liver, strengthening the spleen, and treating the lung, the ultimate aim remains supporting lung dispersion and descent to enable safe steroid withdrawal and cure asthma. These experiences are offered for reference among fellow practitioners.