I. Etiology and pathogenesis
Asthma syndrome is often caused by many diseases, and the causes are very complicated. The common causes are exogenous pathogens entering the lungs, phlegm turbidity, emotional imbalance, chronic illness and fatigue. , leading to lung qi fluctuation, dereliction of duty, or insufficient absorption of qi-controlled kidney.
(1) Exogenous pathogen invading the lung: exogenous pathogenic wind-cold or wind-heat can not be dissipated in time, and the pathogen accumulates in the lung, blocking lung qi, which can not be released, and goes against the wind, causing asthma.
(2) Connotation of phlegm and turbidity: All acute and chronic diseases affect the lung, resulting in obstruction of lung qi, loss of distribution of gas and liquid, and phlegm and turbidity coagulation of body fluid; Or the spleen loses health, phlegm is endogenous, the upper part is dry in the lung, the airway is blocked, the qi movement is unfavorable, and the downward trend is abnormal, which is often an important internal cause of asthma.
(3) Emotional disorder: emotional frustration, anxiety and qi stagnation, liver failure to release, lung qi obstruction, or depression and anger hurting the liver, liver qi riding on the lung, lung qi can not be depressed; Up more and down less, breathing against the wind.
(4) Chronic illness and fatigue: Chronic illness leads to weak lung qi deficiency, cough hurts lung qi, lung qi deficiency declines, and qi loss leads to shortness of breath. Lung-qi deficiency and poor blood circulation can also cause qi deficiency and blood stasis, leading to increased dyspnea.
If the disease persists for a long time, from lung and kidney, or from fatigue to kidney, the essence will be ingested, and the qi and yin of the lung will be lost, so that the kidney will not be shaded, and the true element of the kidney will be damaged, which will not help the lung to inhale, and the qi will be absorbed, and from the lung, more will come out and less will come in. If the kidney yang is weak, the kidney does not control the water, the water pathogen overflows, the lung is dry and the heart is strong, the lung qi is flushed, and the heart yang is weak, it will also cause asthma, which is manifested as the symptoms of deficiency and excess.
In the severe stage of this syndrome, not only the lung and kidney are deficient, but also the disease can reach the heart when the solitary yang is about to be removed. Because the heart pulse is connected with the lung, the treatment of lung qi regulates the operation of painstaking efforts, the kidney pulse is connected with the heart, and the heart and kidney help each other, and the heart yang is rooted in the fire of life gate. The rise and fall of heart yang is closely related to congenital kidney qi and acquired respiratory qi. Therefore, deficiency of lung and kidney can also lead to heart qi and heart yang failure, blood vessel agitation, blood stasis, blue complexion, blue lips and nails, and even asthma and hyperhidrosis leading to yin and yang loss, and the condition is critical.
Second, the clinical manifestations and diagnosis
1. Clinical manifestations
Dyspnea is a characteristic syndrome of asthma, and its clinical manifestations are varied. In the light, just breathe hard, take a deep breath and inhale, and generally lie flat. In severe cases, you can see your nose flapping, your mouth open, your shoulders lifted, your stomach turned over, you sit up and breathe, and your face and lips are cyanotic. Acute patients often show deep and long breathing, with exhaled breath as the fastest, chest full of tightness, even chest full of gas, high voice and excessive phlegm. Asthma has nothing to do with labor and body position. Patients with slow onset mostly show weak breathing and body fatigue, with deep breathing as the fastest, low voice as the short, and exercise as the aggravation. Asthma is obviously related to delivery and body position. If the condition is critical and the shortness of breath persists, you can see cold sweat in limbs, sudden drop of body temperature and blood pressure, palpitation, blue face and purple lips and other dyspnea crises.
diagnose
(1) is characterized by shortness of breath, dyspnea, occasional mouth opening, shoulder lifting, tangy nose, inability to lie flat, and cyanosis of lips.
(2) Most patients have a history of chronic cough, asthma, tuberculosis, palpitation and other diseases, which are induced by external factors and fatigue.
(3) Both lungs can smell dry and wet beeps or wheezing.
(4) It is helpful to check the total number of white blood cells and neutrophils, or X-ray chest film and electrocardiogram.
(5) Differential diagnosis: Asthma syndrome is mainly differentiated from shortness of breath and asthma.
Third, dialectical treatment.
1. Excessive asthma
(1) wind-cold bundle lung type
Syndrome differentiation: cough, asthma, chest tightness, white and thin phlegm, no thirst; At first, the common symptoms were aversion to cold, fever, anhidrosis, headache, itchy throat and itchy nose. The tongue is not red, the coating is thin and white, and the pulse is tight.
Treat warming heart and relieving exterior syndrome, dispersing lung and relieving asthma.
Mahuang decoction: 9 grams of ephedra, 6 grams of cassia twig and 6 grams of almond.
6 grams, 3 grams of roasted licorice.
If the symptoms are not serious, cassia twig can be removed; Perilla frutescens and Peucedanum praeruptorum aggravate asthma. Adding Rhizoma Pinelliae, Pericarpium Citri Tangerinae or Rhizoma Arisaematis Preparata and Semen Sinapis Albae to eliminate dampness and eliminate phlegm; Chest distress plus Fructus Aurantii, Radix Platycodi and Caulis Perillae; If asthma is uneven after sweating, sweating is not smooth, and the pulse is slow, Guizhi Thickening Puxingzi Decoction can be used to recuperate the camp, reduce qi and relieve asthma.
(2) External cold and internal drinking type
Syndrome differentiation and classification: wheezing, cough, thin phlegm like water, aversion to cold, fever without sweat, cold limbs, cold back, pale face, thirst or thirst. The tongue coating is white and smooth, and the pulse is tight.
Rotate to warm lung and dispel cold, relieve exterior syndrome and hangover.
Xiaoqinglong Decoction: Herba Ephedrae (removing knots), Rhizoma Pinelliae (washing), Ramulus Cinnamomi (peeling), 9 grams of Radix Paeoniae Alba, 6 grams of Asari, 6 grams of dried ginger, Radix Glycyrrhizae Preparata and 6 grams of Schisandra chinensis.
Almond, Belamcanda, Peucedanum and Aster are added for severe cough; For those who have excessive phlegm and cough and can't rest, you can combine Jujube Xie Fei Decoction; For those who are irritable, red in the face and cough with internal heat, Xiaoqinglong decoction is added with gypsum and reed root, which is slightly cooled after decoction.
(3) Phlegm-dampness blocking lung type
Syndrome Differentiation: Asthma, cough, excessive and sticky phlegm are not suitable for vomiting, chest tightness and nausea.
The tongue coating is white and greasy and the pulse is slippery.
Treating phlegm, descending adverse qi, dispersing lung and relieving asthma.
The prescription of Sanzi Yangqin Decoction and Erchen Decoction is: 9 grams of dried tangerine peel, Pinellia tuber, Poria, white mustard seed, radish seed, bitter orange and almond, 9 grams of perilla seed, barley kernel/0/2g, 6 grams of licorice and 3 slices of ginger.
For those with stuffy mouth, chest tightness and fullness, 9 grams of Rhizoma Atractylodis and 9 grams of Cortex Magnolia Officinalis are added. For patients with excessive phlegm who can't lie flat, add 9g of prickly heat and 6 g of Gleditsia sinensis; For patients with yellow and thick phlegm, 9g of Danxing, 9g of Tianzhu Yellow, 9g of Anemarrhena asphodeloides, 9g of Fructus Trichosanthis, 9g of Scutellariae Radix, and 0/2g of Houttuynia cordata/kloc-0 are added; ; For patients with asthma due to qi deficiency, 9g of Radix Peucedani, 9g of Cortex Magnolia Officinalis, 9g of Radix Angelicae Sinensis, 3g of Cortex Cinnamomi and 3g of Lignum Aquilariae Resinatum are added.
(4) Wind-heat invading lung type
Syndrome differentiation: fever, bad wind, sweating, thirst, cough and wheezing, yellow and thick phlegm. The tip of the tongue is red, the coating is thin and yellow, or thin and dry, and the pulse is floating.
Treating wind, clearing heat and dispersing lung.
Maxingshi dry soup: ephedra 9 g, almond 9 g, aster 9 g, coltsfoot 9 g, burdock 9g, gypsum 15 ~ 30 g, licorice 6 g and platycodon 6g.
For patients with shortness of breath, 6g of Belamcanda, 9 g of Lumbricus, 9 g of Ginkgo biloba and 9 g of Oyster are added; For patients with severe cough and itchy throat, add 3g of cicada slough and 6g of stiff silkworm, such as 9 g of Fritillaria; For patients with sore throat and dry tongue, 9g of Cortex Mori, 9g of Fructus Forsythiae, 9g of Scutellariae Radix and 9g of Rhizoma Anemarrhenae are added; For those with yellow and thick phlegm and poor expectoration, add 6g of peach kernel, 9g of winter melon seeds, 5 g of reed rhizome/kloc-0, and 9 g of prickly heat seeds; For patients with chest distress and adverse qi, 9g of Fructus Trichosanthis, 9 g of Fructus Aurantii and 9 g of Raphani seeds are added.
(5) Dryness and heat damage the lungs.
Syndrome Differentiation: Fever, aversion to wind, shortness of breath, scanty phlegm, difficulty in vomiting, chest and arm pain, blood in phlegm, dry mouth and nose, and dry stool. The tip of the tongue is red, the coating is thin and Huang Gan, and the pulse is floating.
Fingers clear body fluid, moisten dryness, spread lung and relieve asthma.
Prescription Qingzao Jiufei Decoction: Mulberry Leaf 12g, Gypsum Fibrosum, Colla Corii Asini (Chemical), Ophiopogon japonicus and Loquat Leaves 8g each, Sesame 4g, Ginseng 5g, Almond 6g and Glycyrrhiza 3g.
For patients with dyspnea, excessive phlegm, yellow fur and firm pulse, Semen Raphani, Semen Lepidii, Petunia and Radix et Rhizoma Rhei can be added.
(6) Phlegm-heat blocking lung type
Syndrome differentiation: dyspnea, red face, chest tightness, burning, dry mouth, yellow and thick sputum, or white and sticky, which is not conducive to vomiting. Thick and greasy tongue coating, dry and red tongue and slippery pulse.
Clearing heat and resolving phlegm, dispersing lung qi and relieving asthma.
Maxingshi dry soup: 6 grams of ephedra, 9 grams of almonds, 24 grams of gypsum and 6 grams of licorice.
Scutellariae Radix, Folium Isatidis, Radix Isatidis and Herba Hedyotidis Diffusae can be added for severe internal heat; If asthma and phlegm are excessive, Belamcanda, Mulberry and Lepidium can be added. Semen Cassiae, Fructus Trichosanthis and Radix et Rhizoma Rhei are added for constipation and abdominal distension.
(7) Types of external cold and internal heat
Syndrome differentiation: aversion to cold and fever, no sweat or less sweat, dyspnea, yellow and thick phlegm, cough and vomiting, thirst. The red tongue coating on the tip of the tongue is thin, white and yellowish, and the pulse is floating.
Treating exterior and interior, resolving phlegm and relieving asthma.
Prescription of Dingchuan Decoction: Herba Ephedrae 9g, Folium Ginkgo and Scutellariae Radix 65438±05g each, Perilla frutescens, Rhizoma Pinelliae Preparata, Flos Farfarae and Almond 65438±02g each, Cortex Mori 65438±08g, and Radix Glycyrrhizae preparata 6g. Daily 1 dose, decocted in water, three times before meals, 2 weeks for 1 course of treatment.
2. Asthma due to deficiency
(1) Deficiency of both spleen and lung
Syndrome differentiation: shortness of breath, fatigue, expectoration, spontaneous sweating and fear of wind, pale face, not very red tongue and thready pulse; Or red face, dry mouth, sore throat, night sweats, red tongue with little coating or peeling, and rapid pulse; Or eat less at the same time, abdominal distension is uncomfortable after a meal, loose stool is even after a meal, or stool is not full, muscles are thin, and phlegm is much.
Treating spleen and benefiting qi, nourishing soil and producing gold.
Fangzhongyiqi Decoction and Shengmai Powder: Astragalus membranaceus 18g, Ginseng 10g, Radix Glycyrrhizae Preparata 9g, Atractylodes macrocephala and Ophiopogon japonicus 15g, Angelica sinensis, Pericarpium Citri Tangerinae, Cimicifuga Cimicifuga, Bupleurum and Schisandra chinensis 6g each.
(2) Deficiency of kidney yang
Syndrome differentiation: Asthma lasts for a long time, breathing more, inhaling less, getting worse with a little activity, breathing discontinuity, nervousness, sweating, cold limbs, backache, nocturia, floating face, swollen tibia, listlessness and excessive phlegm. The tongue is light, the pulse is heavy and weak, or the string is large and weak.
Treating warming kidney and receiving qi.
Prescription Jinkui Shenqi Pill: Radix Rehmanniae108g, Poria 78g, Rhizoma Dioscoreae, Fructus Corni (processed with wine), Cortex Moutan, Rhizoma Alismatis, Ramulus Cinnamomi, Radix Achyranthis Bidentatae (decapitated), Semen Plantaginis (processed with salt) 27g each, and Radix Aconiti Lateralis (processed with salt) 4.5g.. Adding 35-50g refined honey and a proper amount of water pills per100g powder, and drying to prepare water pills; Or add refined honey 1 10 ~ 130 g to make honeyed pills.
(3) Deficiency of kidney yin
Syndrome differentiation dyspnea leads to shortness of breath, tinnitus, backache, severe dyspnea when moving, dry mouth, upset, fever in hands and feet, flushing, night sweats and yellow urine. Red tongue and thready pulse.
Treat nourishing yin, replenishing essence and relieving asthma.
Prescription drug Heche Jujube Pill: 200g of Radix Rehmanniae Preparata and Carapax et Plastrum Testudinis (prepared), 65438 050g of Eucommia ulmoides Oliv. (fried with salt) and 65438 000g of Cortex Phellodendri (fried with salt), and 65438 000g of Placenta Hominis, Radix Asparagi, Radix Ophiopogonis and Achyranthis Radix (fried with salt). The above eight medicines are pulverized into fine powder, sieved and evenly mixed. Every 100g of powder is added with 30-40g of refined honey, dried and made into water pills; Or adding 80- 100 g refined honey to make small honey pills or large honey pills.
Fourth, adjuvant therapy.
1. Prescription
(1) Baohe Pill, Xiaokechuan (applicable to empirical study).
(2) Qiwei Duqi Pill, Heche Jujube Pill, Zuogui Pill, Gui You Pill, Jingui Shenqi Pill and Heche Jujube Pill (applicable to deficiency syndrome).
2. Prescription
(1) 30g of Herba Ephedrae, 30g of Fructus Schisandrae Chinensis and 30g of Radix Glycyrrhizae are ground into fine powder and divided into 30 packages, each time 1 package, twice a day, each time 1.
(2) Ardisia Ardisia, Gardenia each 25g, Gypsum Fibrosum 1 5g, Platycodon grandiflorum12g, dried earthworm 9g, honey 30g, fel Sus Domestica15g, Glycyrrhiza uralensis Fisch, decocted in water (suitable for asthma due to excess and heat).
(3) 9g of Pinellia ternata, 6g of Gleditsia sinensis (peeled and baked), 3g of Glycyrrhiza uralensis Fisch, 3 slices of ginger, decocted in water (suitable for phlegm and asthma).
(4) Radix Asteris, Bulbus Fritillariae Cirrhosae, Fructus Schisandrae Chinensis each 45g, Caulis Akebiae and Radix et Rhizoma Rhei each 60g, Semen Armeniacae Amarum 2 1, Rhizoma Cynanchi Stauntonii 30g, and Folium Bambusae 22g, with * * * as coarse powder, decocted in water each time 1 5g, and taken with warm clothes1day for three days.
(5) Ginseng 15g, Gecko 1 (stir-fried), almond 30g, Fritillaria cirrhosa 30g, Placenta Hominis 30g, ground into fine powder, 3g each time, 1, 2-3 times a day (suitable for deficiency asthma).
3. Acupuncture therapy
(1) Those with excess syndrome should acupuncture Dazhui, Shu Fei, Zhongshan, Quchi, Tiantu and Fenglong.
(2) Deficiency syndrome can moxibustion Qi Hai, Guanyuan, Shenque, Sanyinjiao, Shenshu and other points.
Verb (abbreviation of verb) nursing
(1) Live regularly, pay attention to cold and warmth, do a good job in indoor hygiene, and avoid the stimulation of smoke, pollen and other inducing factors.
(2) Diet should be moderate and light, and avoid greasy, sweet and spicy food, wine pulp and phlegm.
(3) Get rid of the habit of smoking.
(4) Keep a happy mood and avoid internal injuries caused by seven emotions.
(5) Attention should be paid to physical exercise to improve lung function during remission.