Pulmonary emphysema

　　The occurrence of this disease is often due to prolonged lung deficiency, phlegm and blood stasis, and often exacerbated by recurrence of external pathogens.

　　1. Prolonged lung disease:Pulmonary emphysema is more common in chronic lung diseases such as chronic cough, chronic asthma, chronic wheezing, and pulmonary tuberculosis, which develop gradually due to prolonged neglect. It is a kind of destination for chronic lung diseases. Therefore, chronic lung diseases have also become the basic cause of pulmonary emphysema.

　　2. Attacks by six pathogenic factors:Six pathogenic factors can not only lead to the occurrence of diseases such as chronic cough, chronic asthma, chronic wheezing, and fluid retention, but also can induce and exacerbate these diseases. Repeated attacks make them difficult to heal, leading to the transformation of pathogenesis and gradually evolving into pulmonary emphysema. Therefore, being attacked by external pathogens should be considered as a cause of pulmonary emphysema.

　　3. Weakness due to aging:Pulmonary emphysema patients can be seen in adolescents and young adults, but they are the minority, and the elderly are more common. With aging, the body becomes weak, and both the lung and kidney are insufficient. Weakness in the body cannot protect against external pathogens, which is the basis for the recurrence of six pathogenic factors. After being attacked by pathogens, the body's resistance is unable to overcome the pathogens, leading to severe illness. Repeated attacks further weaken the body's resistance, creating a cycle that promotes the formation of pulmonary emphysema. The病变 begins in the lung, followed by the spleen and kidney, and eventually affects the heart and liver. Because the lung governs Qi, opens the orifices in the nose, and is externally connected to the skin and hair, it governs the defense against external pathogens. Therefore, external pathogens often first invade the lung through the mouth, nose, and skin and hair, leading to the obstruction of lung Qi in ascending and descending, resulting in coughing when ascending and descending is abnormal, and asthma when ascending and descending is disordered. Over time, lung Qi becomes deficient, and the function of governing Qi is impaired. If the lung disease affects the spleen, the spleen's Qi is robbed by the lung, leading to both lung and spleen deficiency. The lung is the master of Qi, and the kidney is the root of Qi. When the lung is injured, the kidney Qi becomes exhausted, leading to shortness of breath and difficulty in breathing. Moreover, the kidney governs water, and when kidney Yang is deficient, Qi cannot transform into water, leading to edema when water pathogens overflow. If water pathogens attack the heart and lungs, it can cause asthma, coughing, palpitations, and edema. The lung is connected to the heart through the heart's pulse, and lung Qi assists the heart in circulating blood. When the lung is deficient, the regulation of Qi is impaired, leading to sticky blood circulation, which is not smooth, and blood stasis in the lung pulse, further obstructing lung Qi. This causes Qi deficiency and blood stasis, leading to blood stasis and Qi depression, which are malignant consequences from the lung to the heart, and clinical symptoms such as palpitations, cyanosis, edema, and dark purple tongue quality can be seen. The heart Yang originates from the true fire of the Gate of Life, and when kidney Yang is weak, it further leads to the decline of heart and kidney Yang, which can present with life-threatening symptoms such as asthma and sudden collapse.

　　The pathological factors include phlegm-retention, fluid retention, blood stasis, Qi deficiency, and Qi stagnation, which influence each other and are often seen in the same disease. The production of phlegm and fluid originates from the stagnation of lung Qi, the failure of the spleen to perform its function, and the failure of body fluid to return to normal transformation, gradually due to lung deficiency, inability to distribute body fluid, spleen deficiency, inability to transform and transport, and kidney deficiency, inability to evaporate, leading to further accumulation of phlegm-retention. Phlegm, fluid, and dampness (retention) all belong to the stagnation of body fluid. The retention of phlegm, fluid, and dampness (retention) leads to the pathological condition of blocking Qi movement and airways, the lung unable to absorb clean and expel turbid Qi, insufficient clean Qi and excessive turbid Qi, lung Qi swelling and unable to condense and descend, causing the chest to be bloated and oppressed as if stopped up. Phlegm-retention and fluid retention can also damage healthy Qi and impede the circulation of the blood. The formation of Qi deficiency and Qi stagnation is due to Qi rooted in the kidney, governed by the lung, the body already weak from old age, lower Yang deficiency, and added to long-term asthma and cough, chronic non-recovery, necessarily impairing lung Qi, recurrent attacks, affecting both the lung and kidney, leading to the deficiency of both. The lung does not govern Qi, leading to Qi stagnation, the kidney does not receive Qi, leading to Qi reversal, Qi movement should rise but does not, should descend but does not, lung and kidney Qi unable to interconnect, leading to difficulty in the entry of clean Qi and the exit of turbid Qi, congestion in the chest, and obstruction in the lung, forming pulmonary emphysema. The formation of blood stasis is related to lung and kidney Qi deficiency, failure of Qi to move blood, and obstruction by phlegm-retention. After the formation of blood stasis, it also leads to Qi stagnation due to blood stasis, further aggravating the blockage of phlegm and Qi in the chest, becoming an important pathological link in pulmonary emphysema.

　　Thus, the pathological nature of pulmonary emphysema is mostly characterized by superficial excess and root deficiency. Superficial excess includes phlegm, fluid retention, blood stasis, and Qi stagnation; phlegm can be cold-differentiated or hot-differentiated; root deficiency refers to Qi deficiency of the lung, spleen, and kidney, with Yang deficiency and even Yin-Yang deficiency in the late stage. The basic pathogenesis is the impairment of both the body and function of the lung, disordered respiratory function, Qi congestion in the chest, and retention in the lungs, with phlegm and blood stasis blocking the lung airways, leading to lung body swelling, weakness in contraction and expansion, and the formation of pulmonary emphysema. If there is retained fluid inside and recurrence of external cold and wind, it can become a syndrome of external cold and internal fluid retention. Sensitivity to wind-heat or transformation of phlegm-retention into heat can manifest as phlegm-heat syndrome. Exuberant phlegm-retention or internal disturbance of phlegm-heat, obscuring the heart orifices, leading to loss of consciousness, drowsiness, and even coma; internal closure of phlegm-heat, consumption of essence Yin by heat, malnourishment of the liver and kidney, Yin deficiency with hyperactivity of fire, liver fire with phlegm disturbing upwards, Qi reversal and phlegm rising, internal movement of liver wind leading to limb tremors and convulsions; and迫血妄行, leading to bleeding. It can also be caused by severe Qi deficiency, failure of Qi to control blood, resulting in bleeding. The further development of the disease can lead to Yin deficiency affecting Yang, Yang deficiency failing to transform Qi and water, becoming a syndrome of Yang deficiency and water泛滥; when Yang deficiency reaches the extreme, phenomena such as cold limbs, sweating, and weak pulse may appear, indicating the loss of Yuan Yang.

　　Emphysema is the late stage of various chronic pulmonary diseases, so it has long-term symptoms such as cough, expectoration, and dyspnea, and the expansion of the chest and the process of disease progression from the lung to the heart are gradually formed. In the early stage, in addition to cough and expectoration, there may be fatigue or palpitations after exercise. As the course of the disease progresses, the obstruction and swelling of lung Qi gradually increases, and the chest sounds are resonant, and the patient feels oppressed as if blocked, with worsening palpitations and shortness of breath, or cyanosis of the face and nails. Further development may lead to symptoms such as a strong pulsation of the jugular veins, a mass in the right hypochondrium, edema of the lower limbs, and even abdominal dropsy. In the late stage of the disease, the dyspnea and cough become more severe, and the patient can not lie flat, with an increase in white sticky sputum or expectoration of yellow-green sputum, obvious cyanosis, headache, and sometimes restlessness, confusion, drowsiness, delirium, or tremors, and even hemoptysis, vomiting blood, or hematochezia. The tongue is usually dark purple or purple, with thickened and darkened sublingual veins.

　　Dyspnea, cough, sputum, and distension, that is, shortness of breath, cough, expectoration, chest fullness, and bloating as if blocked, are the characteristic symptoms of emphysema. Long-standing disease may present with symptoms such as cyanosis of the lips and nails, palpitations, and edema. If accompanied by external pathogens or inappropriate treatment, complications such as coma, convulsions, and even dyspnea may occur.

　　There is a certain connection between various symptoms of emphysema, and the symptoms often change from one to another. The prognosis is affected by factors such as the patient's constitution, age, course of the disease, and treatment. Generally speaking, those with a strong constitution, youth, short course of the disease, and mild symptoms, who receive timely and effective treatment, can control the condition basically, live with the disease, and extend their life. Conversely, the condition may deteriorate. If symptoms such as breathless cough, frothy blood-tinged sputum, vomiting blood, or hematochezia; or phlegm affecting the mind, liver wind stirring, delirium, coma, tremors, and convulsions; or symptoms such as dyspnea, drowsiness, sweating, cold limbs, faint pulse, internal closure and external loss of essence appear, and timely treatment is not provided, the prognosis is poor. The key to preventing this disease is to pay attention to the treatment of the primary disease. Once suffering from diseases such as cough, asthma, dyspnea, and tuberculosis, active treatment should be sought to prevent the disease from developing. Strengthening physical exercise and taking tonifying and reinforcing herbal medicine regularly can help improve the body's resistance to diseases. After the disease occurs, it is advisable to adapt to the temperature and prevent colds, avoid contact with smoke and dust to prevent the exacerbation of the disease. If the disease is triggered by external factors, treatment should be sought immediately to prevent exacerbation. Quitting smoking and drinking, and avoiding excessive intake of spicy, cold, and raw foods. Those with edema should consume low-salt or salt-free diets.

　　1, Routine clinical examination:Physical examination shows barrel-shaped chest, percussion sound of the chest is hyperresonant, wheezing or sputum sound and moist drumming sound can be heard in the lungs, and the heart sound is distant.

　　2, X-ray examination:It is the most commonly used and preferred imaging examination method for the heart and large blood vessels, and can clearly diagnose many heart and large blood vessel diseases.

　　3, Electrocardiogram examination and other supportive examinations for the diagnosis of emphysema and pulmonary heart disease in Western medicine.

　　1, Diet should be light, delicious, nutritious, easy to digest, and avoid spicy and stimulating, fried and baked foods.

　　2, For those with cold fluid binding the lung, avoid cold and raw foods.

　　3, For those with phlegm-heat in the lung, it is advisable to drink herbs that clear heat and resolve phlegm.

　　4, For those with heart failure or edema, a low-salt or salt-free diet should be provided.

　　5, For those with excessive sweating, provide fluid replacement and potassium-rich foods.

　　6, For those with poor appetite, eat less and more often, and pay attention to the color, smell, and taste of food.

　　1, Differential diagnosis and treatment

　　Key points of differentiation

　　1, Differential diagnosis of root and branch, deficiency and excess The essence of lung atrophy is that the branch is excess and the root is deficient. It is necessary to distinguish the main and secondary of root and branch, and the severity of deficiency and excess. Generally, when affected by exogenous factors, it is inclined to excess pathogenic factors, while in daily life, it is inclined to deficiency of the root. Excess pathogenic factors are phlegm turbidity and blood stasis. In the early stage, phlegm turbidity is predominant, and gradually phlegm and blood stasis become equally important, and it can also be accompanied by Qi stagnation, water and fluid retention, etc. In the later stage, phlegm and blood stasis are obstructed, vital energy is deficient, and both root deficiency and branch excess are equally important.

　　2, Differential diagnosis of lung atrophy based on Zang-fu Yin and Yang The early stage of lung atrophy is mainly due to Qi deficiency or both Qi and Yin deficiency, with the disease location in the lung, spleen, and kidney. In the later stage, Qi deficiency and Yang deficiency occur, mainly involving the lung, kidney, and heart, or both Yin and Yang deficiency.

　　2, Treatment principles

　　According to the principles of root and branch, deficiency and excess, the treatment principle of this disease is to choose祛邪扶正. Generally, when affected by exogenous factors, it is inclined to excess pathogenic factors, and the emphasis is on expelling pathogenic factors. According to the nature of the pathogenic factors, different methods are adopted to expel pathogenic factors and ventilate the lung (acrid and warm, acrid and cool), descend Qi and resolve phlegm (warm transformation, clear transformation), warm Yang and promote diuresis (penetrate Yang, dilute and permeate), activate blood circulation and remove blood stasis, and even open the orifices, calm the wind, and stop bleeding, etc. In daily life, it is inclined to deficiency of vital energy, and the emphasis is on reinforcing vital energy. According to the different Yin and Yang of the zang-fu organs, it is respectively nourished by the heart and lung, invigorating the kidney and spleen, or regulating Qi and Yin, or considering both Yin and Yang. When vital energy is about to fail, it should reinforce vital energy and solidify it, rescue Yin and return Yang. Expelling pathogenic factors and reinforcing vital energy have only the difference of main and secondary, and generally they are used to complement each other.

　　3, Differential diagnosis and treatment based on syndrome differentiation

　　1, Internal fluid due to wind-cold

　　Symptoms: Coughing, dyspnea, chest stuffiness, unable to lie down, shortness of breath, urgent breathing, expectoration of white, thin sputum, frothy, chest fullness, aversion to cold, body aches all over, or dry mouth without desire for drinking, ashen complexion, swollen tongue, pale tongue color, white slippery tongue coating, floating and tense pulse.

　　Treatment method: Warm the lung and disperse cold, reverse the adverse flow and clear phlegm.

　　Prescription: Xiao Qinglong Decoction.

　　Fangzhong Mahuang, Guizhi, Ganjiang, Xixin warm the lung to disperse cold and transform fluid; Banxia, Gancao to expel phlegm and reverse the adverse flow; Zhuhai Bai Shao, Wuwei Zi to consolidate lung Qi, so that there is a balance between dispersion and consolidation. If there is coughing with upward Qi, and there is a sound in the throat like that of a water chicken, with superficial cold not being prominent, the Mahuang Guizhi Decoction can be used. If the fluid becomes stagnant and transforms into heat, causing restlessness and asthma, with a floating pulse, the Mahuang Guizhi Decoction with Shigao can be used to clear the stagnant heat.

　　2. Phlegm heat pent up in the lung

　　Symptoms: Coughing and asthma with rough breath, yellow or white sputum, sticky and difficult to expectorate, chest fullness and restlessness, bulging eyes, or fever with sweating, or slight aversion to cold, yellow urine and dry stool, thirst for drinking, dark red tongue, yellow or yellow greasy coating, slippery rapid pulse.

　　Treatment Method: Clear lung heat, reverse and relieve asthma.

　　Herbs: Yupei Ji Banxia Decoction.

　　The formula uses maohuang and shigao, a combination of acrid and cool, which can ventilate the lung and disperse pathogens, and cool to clear lung heat; pinellia and shengjiang disperse fluid and resolve phlegm to reverse; licorice and dates calm the interior and repel the exterior to reinforce the body and expel pathogens.

　　If there is internal excess of phlegm heat, the phlegm is sticky and not easy to expectorate, add huxingcao, scutellaria, guava peel, fritillaria, and haipaifen to clear phlegm heat. Phlegm heat congestion can also be treated with Sangbaipi Decoction. For constipation and abdominal fullness due to phlegm heat congestion, add da huang and fengxiaoyao to clear the bowels and relieve heat. For phlegm sounds and asthma, unable to lie down, add shegan and xingyezi to resolve lung qi and relieve asthma. If phlegm heat injures the body fluid, causing dry mouth and tongue, add fengfan, zhimu, and maimendong to generate body fluid and moisten dryness.

　　3. Phlegm and blood blocking the lung

　　Symptoms: Coughing with excessive phlegm, white or frothy in color, phlegm sounds in the throat, unable to lie down due to asthma, chest fullness, oppression as if blocked, pale and dark face, purple lips and nails, dark or purple tongue, thickened sublingual veins, greasy or turbid greasy coating, wiry slippery pulse.

　　Treatment Method: Clear phlegm and remove blood stasis, and resolve lung qi and relieve asthma.

　　Herbs: Xingye Dazao Xiefei Decoction combined with Guizhi茯苓Buli Pill.

　　The formula uses xingyezi to clear phlegm and relieve obstruction to open the lung qi; dates are added to sweeten and warm the center and moderate the drug properties, so that purgation does not harm the body; guizhi promotes yang and transforms qi, warms and resolves cold phlegm; poria removes dampness and resolves phlegm; danpi and chishao assist guizhi in promoting blood circulation and resolving blood stasis. For excessive phlegm, add Sanzi Yangqin Decoction to resolve phlegm, lower qi, and relieve asthma. This syndrome can also be treated with Suzi Jiangqi Decoction added with honghua and danshen to resolve phlegm and remove blood stasis. If bowel qi is not smooth and there is difficulty in defecation, add da huang and houpu to clear the bowels and relieve obstruction.

　　4. Phlegm obstructing the orifices

　　Symptoms: The coughing, shortness of breath, and asthma worsen daily, phlegm is not easy to expectorate, expression is dull, drowsiness, or even confusion, delirium, restlessness, and anxiety, especially at night, coma, picking up the air, or limb stiffness and convulsions, dark red or pale purple tongue, or purple and dark, white greasy or yellow greasy coating, fine slippery and rapid pulse.

　　Treatment Method: Clear phlegm and open the orifices.

　　Herbs: Ditan Decoction combined with Anping Niuhuang Pill or Zhibao Dan.

　　The Ditan Decoction uses pinellia, poria, licorice, bamboo shavings, and胆南星 to clear heat and remove phlegm; tangerine peel and枳实to regulate qi and promote the flow of phlegm to relieve obstruction; calamus to open orifices; and ginseng to reinforce the body and prevent collapse. Anping Niuhuang Pill or Zhibao Dan are added to clear the heart and open the orifices. If there are white greasy tongue coating and signs of cold, replace胆南星 with制南星, and use Suhe Xiangwan to open the orifices. If there is internal excess of phlegm heat, body heat, restlessness, delirium, confusion, red tongue with yellow coating, add scutellaria, sangbaipi, xingyezi, tianzhuhuang, and bamboo juice to clear heat and resolve phlegm. For heat congealing in the large intestine with obstruction of the bowels, add da huang and fengxiaoyao to clear the bowels and relieve heat. If phlegm heat stirs up the liver wind with convulsions, add gouteng, quanshe, and lingyangjiaofen to cool the liver and stop the wind. For purple lips and nails and obvious blood stasis, add honghua, taoren, and shuizhi to activate blood and remove stasis. If heat injures the blood vessels, and there is bleeding from the skin and mucous membranes, hemoptysis, or hematochezia with bright red blood, match with cooling and blood-stopping herbs such as shuiniujiao, shengdi, danpi, zizhucao, and shengdahuang; if the blood color is dark, limbs are cold, the tongue is pale and bloated, and the pulse is deep and faint, it indicates yang deficiency and failure to control blood, and it is treated with herbs that warm the meridians and control blood, such as paojiang, cebecan, and tongbian or Huangtu Decoction, Baiye Decoction.

　　5. Lung and kidney qi deficiency

　　Symptoms: Short and difficult breathing, low and hesitant cough, chest fullness and shortness of breath, or even opening the mouth and raising the shoulders, unable to lie down, coughing, sputum like white foam, difficult to expectorate, palpitations, chills and sweating, pale complexion, pale or dark purple tongue, white slippery coating, deep and fine pulse.

　　Treatment method: Nourish the lung and kidney, and reduce qi and asthma.

　　Prescription: BuXu Decoction combined with Shen Ge powder.

　　The formula uses ginseng, astragalus, poria, and licorice to benefit the lung and spleen; gecko and schisandra to nourish the lung and kidney; ginger and pinellia to warm the lung and transform fluid retention; magnolia and tangerine peel to promote qi and resolve phlegm, relieve asthma.桃仁, 川芎, 水蛭 can also be added to activate blood circulation and remove blood stasis. If there is lung deficiency with cold, aversion to cold, pale tongue, add cassia and asarum to warm the yang and disperse cold. With yin injury, low fever, red tongue with little coating, add ophiopogon, polygonatum, and anemarrhena to nourish yin and clear heat. In cases of pale complexion, profuse cold sweat, cold extremities, blood pressure drop, and pulse almost fainting, add Shenshuang Decoction with gecko powder or black tin pill to supplement qi and kidney, and return yang to secure the body. In addition, Shenshu, Shengmai, Shenmai, and Shenshu Qing injection can also be selected according to circumstances.

　　6. Yang deficiency and water overflow

　　Symptoms: Facial edema, lower limb swelling, or even general swelling, epigastric and abdominal distension, or abdominal fullness with fluid, oliguria, palpitations, shortness of breath, unable to lie down, expectoration of thin sputum: aversion to cold, cyanosis of the face and lips, thick and dark tongue, white slippery coating, deep and weak pulse or alternating pulse.

　　Treatment method: Warm the yang and transform fluid retention.

　　Prescription: Zhenwu Decoction combined with Wuling Powder.

　　The formula uses aconite and cassia bark to warm the yang and transform qi to promote water flow; poria, atractylodes, poria, alisma, and ginger strengthen the spleen and promote diuresis; white peony bark collects yin and harmonizes yang. Red sage, red peony, zeylanic, motherwort, and northern五加皮 can also be added to promote blood circulation and diuresis. In cases of severe edema, the upper part of the lungs and heart are soaked, causing palpitations, shortness of breath, and inability to lie down, coughing up white frothy sputum, add amomum, bupleurum, and fennel to promote qi and expel water.