The disease is a chronic inflammation of bronchi due to
infection, physical and chemical irritations and allergic
agents. The majority of the patients are of over middle age. It
is characterized by chronic course and recurrent episodes. In
some chronic cases, the disease may progress to chronic
obstructive emphysema and chronic pulmonary heart disease. In
TCM, this disease is related to the categories of "ke sou"
(cough), "tan yin" (phlegm retention), "xiao chuan" (asthma) and
so on.
Main
Points of Diagnosis
1. Long-term cough, sputum production and dyspnea
which attack repeatedly and fluctuate are worse in autumn and
winter. There may be fever, exacerbation of cough and
mucopurulent sputum production, and dyspnea is more marked if
acute concurrent infection is present.
2. Chronic bronchitis usually persists for many years. It can be
classified into 3 stages, acute episodic stage, chronic
persistent stage and clinically remissive stage. The last stage
may last for a period of time and an attack may be induced by
infections or catching a cold. Based on the clinical
manifestations, the disease can be divided into simple chronic
bronchitis and chronic asthmatic bronchitis. In the former,
cough and sputum production are predominant. In the latter, in
addition to the above symptoms, there are dyspnea and wheezing,
indicating that the spasm of the smooth muscles of bronchi and
bronchioli is an important pathogenic factor.
3. On auscultation, moist rales can usually be heard. Wheezes
can be heard in patients with asthmatic bronchitis. In patients
with chronic bronchitis of long duration, a complicating
obstructive emphysema is commonly present. In such cases, the
respiratory sounds are diminished, heart sounds become faint,
intercostal spaces are widened, the thorax is barrelshaped, and
there is hyperresonance on percussion.
4. On radiographic examination the lung-markings are increased
in the lower lung fields. Pulmonary functional tests show no
change in the early stage, but in the late stage residual volume
is increased, maximal ventilatory equivalent and time vital
capacity are decreased.
Differentiation and Treatment of Common Syndromes
1. Interior Retention of Phlegm with Exopathic
Cold
Main Symptoms and Signs: Cough with whitish thin sputum,
dyspnea, or accompanied with chills and headache, whitish and
moist fur of the tongue, string-like and tight or floating and
tight pulse.
Therapeutic Principle: Relieving exterior syndrome and warming
the interior organs, ventilating the lung to resolve phlegm
retention.
Recipe: Modified Minor Decoction of Green Dragon.
ephedra
cinnamon twig
schisandra berry
white peony root
asarum herb
pinella tuber
dried ginger
coltsfoot flower
licorice root
All the above herbs are to be decocted in water for oral
administration.
The disorder is marked with absence of exterior syndrome,
manifested as cough with profuse sputum which is whitish and
mucous, feeling of fullness and distress in the chest, anorexia,
abdominal distension, all these suggest that the accumulation of
phlegm-dampness is in the lung. The principle of treatment
should be aimed at eliminating dampness and removing phlegm. The
above recipe can be modified for treatment with the exception of
ephedra, cinnamon twig and white peony root, and with the
addition of 12 grams of red tangerine peel, 15 grams of poria,
10 grams of perilla seed, 10 grams of magnolia bark and 10 grams
of atractylodes rhizome.
2. Stagnation of Phlegm-Heat
Main Symptoms and Signs: Bad cough with thick yellowish sputum,
thirst, dry throat, yellow-colored urine, constipation, reddened
tongue with yellow fur, slippery and rapid or taut and rapid
pulse.
Therapeutic Principle: Removing pathogenic heat and resolving
phlegm.
Recipe: Modified Prescriptions of Lung-Heat Expelling Powder
combined with Decoction for Clearing Away Lung-Heat and
Dissolving Phlegm.
mulberry bark
wolfberry bark
scutellaria root
anemarrhena rhizome
Sichuan fritillary bulb
bitter apricot kernel
stemona root
trichosanthes seed
honey fried loquat leaf
platycodon root
All the above herbs are to be decocted in water for oral
administration.
Besides, 20 grams of gypsum are added for the case with high
fever; 15 grams of clam shell powder for the case with profuse
sputum which is difficult to cough out; 20 grams of lily bulb
and 20 grams of dried rehmannia root for treating the case of
yin deficiency of both the lung and kidney marked by
nonproductive cough or little sputum, hot sensation in the palms
and soles, night sweat, reddened tongue with little fur, fine
and rapid pulse.
3. Deficiency of Both Lung and Spleen
Main symptoms and Signs: Weak cough, spontaneous perspiration,
shortness of breath, tendency to catch cold, exacerbation of
cough in contact with wind-cold, or anorexia and loose stools,
thin whitish fur of tongue, and deep fine pulse.
Therapeutic Principle: Nourishing the lung by reinforcing the
function of the spleen.
Recipe: Modified Decoction for Tonifying the Lung.
codonopsis root
astragalus root
schisandra berry
aster root
coltsfoot flower
white atractylodes rhizome
poria
honey-fried licorice root
All the above herbs are to be decocted in water for oral
administration.
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