Hi David, I’m working with a case I’d appreciate your thoughts on. The person presents with a primarily cold/damp asthma picture that appears to have been triggered by suspected mold exposure in her workplace. Initially there was significant phlegm ( "wormy and white") production, but over time this has shifted toward less productive, more reactive coughing with intermittent dyspnea. ( Now, it feels like it's in the chest with distinct rhonchi) What stands out is a strong anticipatory component. She consistently experiences airway flares before appointments, deadlines, or situations where she feels pressure. Cold beverages and damp, rainy weather also exacerbate symptoms. There has been some improvement with expectorants and lung-supportive herbs, but the pattern remains labile, with periods of progress followed by flares. I’ve considered Ma Huang for its bronchodilating effects in a cold presentation, but I’m hesitant given the nervous system reactivity and anxiety-linked dyspnea ( she's visited the ER with tachycardia from airway-related anxiety). She is currently using a small amount of lobelia within a broader formula that includes aralia, horehound, osha, and grindelia (18-part formula). She uses albuterol 4/5 days, and usually once per day when needed. In a case like this, where there is clear cold/damp involvement but also a strong anticipatory/reactive component, would you consider Ma Huang appropriate in low dose, or would you avoid it in favor of less stimulating bronchodilators? I'd love to use this as a case history, but I think we have limited spots available. Thank you for your time and insight.

David said: ...( Now, it feels like it’s in the chest with distinct rhonchi) ... It sounds like either may longer be damp, rhonchi can be from inflammation as well as fluid or phlegm, so I am thinking wind/cold. ...She uses albuterol 4/5 days, and usually once per day when needed. ... I might drop the Osha at this point ...or would you avoid it in favor of less stimulating bronchodilators? ... I would avoid Ma Huang in this case, I might consider Grindelia, Drosera, Wild Lettuce and Schisandra

thank you!