This time, I will talk about a misunderstanding or limitation in the treatment of this disease by Chinese medicine, and analyze it for everyone to see.
This misunderstanding or limitation is manifested in the dialectical treatment of cough variant asthma:
There are many clinical studies on the treatment of cough variant asthma with traditional Chinese medicine, and most of them are based on the intervention of traditional Chinese medicine in acute attack, and most of them are treated according to the principle of cough and asthma, and less involved in the management of phased treatment.
This disease should be treated from "wind asthma". Because of the different etiology and pathological process, the treatment methods are different, and the emphasis is on staged treatment. The acute attack is treated by dispersing wind and dispersing lung, the chronic remission is treated by resolving phlegm and dredging collaterals, and the stable period is treated by strengthening spleen and consolidating exterior, which has obvious curative effect.
Take a simple analogy with the well-known health preservation. We all know that nourishing yang in spring and summer, nourishing yin in autumn and winter-eat more soup foods with high protein and rich vitamins and minerals in spring, and clear away heat and relieve sore throat in early spring. Summer diet should be light and vegetarian; Autumn diet should be based on the principle of' nourishing yin and moistening lung', and winter diet should pay attention to avoiding cold and temperature, converging yang and protecting yin.
Doing different things at different stages is in line with heaven, so should seeing a doctor.
An example is given to provide ideas for clinical treatment of cough variant asthma by stages.
Mr. Zheng, 4 1 year-old, had an intermittent cough for more than 2 years, which was aggravated for 2 weeks.
Two months ago, the patient coughed after catching a cold, which has been delayed for a long time. He was admitted to the hospital.
The absolute value and proportion of eosinophils in peripheral blood are normal, immunoglobulin E(IgE) is slightly increased, chest film shows a slight increase in lung texture, and lung function suggests that bronchiectasis test is positive. Have a past history of allergic rhinitis.
Combined with symptoms, medical history and laboratory examination, western medicine diagnosed cough variant asthma.
Inhalation of glucocorticoid can relieve symptoms.
Because of the side effect of hormone use on osteoporosis, patients stopped taking glucocorticoid on their own, and cough symptoms broke out intermittently. When necessary, they take glucocorticoid.
Next, the cough gets worse after catching a cold, especially at night and feeling chest tightness in the morning. In the past two days, I have often complained that I have coughed because of a cold or a pungent smell. The patient considered using hormones to induce osteoporosis, so he sought Chinese medicine treatment.
20 16 On May 25th, you found me here.
Initial symptoms: frequent cough, aggravated at night, affecting sleep, itchy throat, itchy nose and runny nose, loss of appetite, thin stool, red tongue, thin and white fur and slippery pulse.
Physical examination: The auscultation breath sounds of both lungs are thick, and no obvious dry and wet sounds can be heard.
I identified the disease as "wind wheezing", and the symptoms such as itchy throat, stuffy nose and runny nose are consistent with the characteristics of "fickle number", "mild nature" and "full spasm" of the cold, as well as itching caused by many diseases of the cold. The persistent phlegm retention of common cold leads to stagnation of lung qi, short airway and frequent cough, which belongs to cough variant asthma attack.
The main treatment is "dispersing wind and dispersing lung".
Prescription: honey ephedra, almond, lifting, dispersing lung and relieving asthma are king;
Schizonepeta tenuifolia, cicada slough, expelling wind and eliminating evil are ministers.
Clearing Pinellia ternata and tangerine peel to eliminate phlegm and regulate qi, Salvia Miltiorrhiza and Lumbricus promoting blood circulation and dredging collaterals, which means "treating wind first, promoting blood circulation and extinguishing itself", with * * * as the adjuvant and Glycyrrhiza uralensis as the blending medicine.
The second diagnosis: cough and nasopharyngeal itching are removed by half, and a small amount of phlegm is coughed up, the tongue is reddish, the coating is thin and white, and the pulse is slippery. The symptoms of the common cold are few, but the pathogen has not completely penetrated. Because of the consolidation of wind and phlegm, it still belongs to the attack period of cough variant asthma. Keep the original prescription, add Fritillaria thunbergii and orange collaterals to eliminate phlegm and turbidity, so that the cold has no attachment.
Three diagnoses: itchy nasopharynx, occasional cough, easy sputum and dark color. At this time, cough is mostly phlegm and saliva, because the common cold has been relieved, mucus and phlegm are gradually emerging, and the lung collaterals are unobstructed, which belongs to the chronic remission period of cough variant asthma. The adjustment method is to clear heat and phlegm, and clear phlegm and heat.
Prescription: Perilla frutescens, Jiang Qi and Semen Sinapis Albae are used to eliminate phlegm, Raphani seeds are used to guide phlegm stagnation, and * * * is the monarch drug to eliminate phlegm; Pinellia ternata, Poria cocos and Fructus Trichosanthis are used for eliminating dampness and resolving phlegm; Gypsum Fibrosum and Scutellariae Radix are used for clearing away heat and moistening dryness, which can help lung qi grow into a minister; Salvia Miltiorrhiza, Orange Collateral for promoting blood circulation and dredging collaterals, and Glycyrrhiza uralensis are used for harmonizing various medicines.
Four diagnosis: cough, less phlegm, all diseases are treated. This shows that the sputum has been cleared, the lung collaterals are unobstructed, and cough variant asthma has entered a stable period. According to the theory of asthma, we should legislate to strengthen the spleen, eliminate the source of phlegm, strengthen the exterior and prevent thief wind. Radix Astragali, Radix Saposhnikoviae, Rhizoma Atractylodis Macrocephalae, Poria, and Radix Ophiopogonis are added to make up for future troubles.
Follow-up: After 2 months, the condition did not recur, so I stopped taking medicine and accepted the job.
After 3 months, the condition was stable and there was no attack.
Yes, from the attack period, chronic remission period to stable period of cough variant asthma, due to different etiology and pathogenesis, the law and emphasis of treatment should be changed accordingly, and the correct way is to prescribe the right medicine.
According to the different stages of this case, we can clearly distinguish whether the cold dissipates, divide it into attack stage and remission stage by "cough and itching", and divide it into remission stage and stable stage by "phlegm" to judge whether the lung collaterals are unobstructed. Treatment has a certain degree of advance and retreat. During the attack, we must first eliminate pathogenic factors and eliminate phlegm pathogens more effectively. In remission stage, phlegm and lung flow together, promoting blood circulation and dredging lung. In the stable period, the source of phlegm should be removed and the inducement should be taken into account.
It embodies the general principle of "timely rescue, slow down the time and cure the root cause", and provides ideas and models for the clinical standardization of TCM treatment and management of cough variant asthma.
I hope it can bring some inspiration to patients, friends or family members who are reading this article.
I'm Li Shuxiang, a Chinese doctor. If you have any questions or questions about asthma and chronic obstructive pulmonary disease, please leave a message in the message area or write to me privately on my homepage. I will try my best to answer your questions and wish you a speedy recovery.