Chronic bronchitis in the elderly

　　The causes of senile chronic bronchitis are extremely complex, and they are not yet fully understood. In recent years, the medical community believes that the related factors of the disease are as follows:

　　1. Smoking
　　Smoking is the main cause of chronic bronchitis. The incidence of chronic bronchitis in smokers is 4 to 5 times higher than that in non-smokers, and the incidence increases with the duration and amount of smoking. The smoke of tobacco contains various harmful components, such as tar, nicotine, carbon monoxide, furfural, and others. These harmful substances can directly or indirectly damage the bronchial mucosal epithelium, even causing squamous metaplasia; inhibit or damage the movement of bronchial mucosal cilia, causing them to fall over, become shorter, or even fall off; stimulate the hyperplasia of mucus glands, causing excessive secretion of mucus, which is prone to secondary infection by microorganisms; inhibit the phagocytic function of pulmonary macrophages; smoking can also cause bronchospasm.

　　2. Air pollution
　　Harmful gases in the atmosphere, such as nitrogen oxides, sulfur dioxide, and chlorine, have irritant and cytotoxic effects on the bronchial mucosa, which can cause inflammation of the mucosa; harmful organic and inorganic dust in the atmosphere, such as silicon dioxide, coal dust, cotton fibers, and sugar dust, can also cause pulmonary fibrosis, impairing the lung's clearance function and creating conditions for the invasion of pathogenic microorganisms.

　　3. Infection
　　Infection by pathogenic microorganisms is another important factor in the onset and exacerbation of chronic bronchitis.

　　4. Allergic factors
　　Endogenous or exogenous antigens can cause delayed or rapid-onset allergic reactions, leading to bronchospasm and resulting in tissue damage and inflammation. Especially for asthmatic chronic bronchitis, allergic factors are an important cause.

　　5. Meteorological factors
　　Climate change, especially cold, dry, and high temperatures, can damage the function of cilia and the blood circulation of respiratory tract mucosa, leading to a decrease in local barrier function and making it more susceptible to infection by pathogenic microorganisms.

　　6. Other
　　Autonomic nervous system dysfunction may also be an internal cause of the disease; vitamin deficiencies, especially the lack of vitamin C and A, can reduce the body's resistance and make it susceptible to chronic bronchitis; senile adrenal and adrenal cortex dysfunction, delayed laryngeal reflex, degeneration of respiratory tract defense function, decline in function of the mononuclear-macrophage system, malnutrition, and other factors can increase the incidence of chronic bronchitis.

　　

　　The common complications of chronic bronchitis in the elderly include the following items:

　　1. Emphysema
　　It is also one of the most common complications of chronic bronchitis in the elderly, and obstructive chronic bronchitis and obstructive pulmonary emphysema are collectively known as COPD.

　　2. Pulmonary heart disease
　　It is a common complication in the later stage of chronic bronchitis in the elderly.

　　3. Bronchopneumonia
　　Chronic bronchitis in the elderly with complications may lead to the spread of inflammation to the surrounding lung tissue of the bronchi. Patients may have chills, fever, exacerbated cough, increased sputum volume, and purulent sputum. Weak elderly patients often do not have chills or fever, but only increased sputum, shortness of breath, dyspnea, and palpitations; scattered moist sounds can be heard at the base or in the lower two lung fields.

　　4. Bronchiectasis
　　Some elderly patients with chronic bronchitis have recurrent episodes, leading to deformation and narrowing of the lumen, and expansion forming at the distal end.

　　Chronic bronchitis in the elderly often starts insidiously, most often in middle-aged and young adults, and a few in the elderly. Patients often develop symptoms in cold seasons, with cough and sputum, especially in the morning, with sputum appearing white, sticky, and frothy. As the condition progresses, persistent cough and sputum throughout the year occur, with exacerbation in winter and spring. Some patients have episodes preceded by acute respiratory tract infections, at which time fever, catarrhal symptoms of the upper respiratory tract may occur, followed by significant worsening of cough and sputum, increased sputum volume, and sputum becoming thick or yellowish purulent. A few patients may also have blood in their sputum. After cough and sputum increase, asthma-like attacks often occur in patients with asthmatic chronic bronchitis. Elderly patients often have emphysema, and often have obvious shortness of breath and dyspnea.

　　Early chronic bronchitis in the elderly often has no signs. Sometimes,粗糙的呼吸音、肺底部干性或湿性啰音可以听到；喘息型发作时有广泛的哮鸣音；阻塞型呼吸音低弱，呼气时间延长。Early X-ray examination of chronic bronchitis in the elderly often shows no abnormalities, while in those with a longer course, increased and rough lung markings can be seen, especially in the lower two lungs, and sometimes

　　Given that chronic bronchitis in the elderly is one of the most common diseases among the elderly, its incidence rate is on the rise globally, seriously affecting the health of the elderly, and its prevention should be fully emphasized. Smoking is the most important cause of chronic bronchitis, and passive smoking will also significantly harm health, so smoking cessation should be promoted. Although quitting smoking cannot completely recover chronic bronchitis in the elderly, it can significantly delay the progression of the disease and partially restore lung function. Eliminating or improving air pollution is also a very important measure for preventing chronic bronchitis in the elderly. In addition, reasonable nutrition, physical exercise, strengthening physical fitness, and preventing colds are all beneficial to the prevention of chronic bronchitis in the elderly.

　　Senile cough, expectoration, or asthma with recurrent attacks for at least 3 consecutive months a year, lasting for 2 years or more, and excluding other cardiovascular diseases can be diagnosed.
　　Laboratory examination:Blood routine examination may show a normal total white blood cell count, but an increased neutrophil count. Sputum examination shows that during the acute attack, sputum often appears purulent. Smear examination shows a large number of neutrophils, and in patients with asthma, there are more eosinophils. Sputum culture shows growth of Streptococcus pneumoniae, Haemophilus influenzae, and Klebsiella catarrhalis, etc.
　　Other auxiliary examinations:X-ray examination shows patchy hazy shadows in both lower lung fields.

　　Patients should have a light diet, eat more vegetables and fruits, properly balance the diet, and ensure adequate nutrition; avoid smoking and alcohol, spicy food, greasy food, and cold food. Recommended diet as follows:
　　1. An appropriate amount of maltose, honey, and scallion juice, melt and pour into bottles for storage. Take 1 teaspoon each time, three times a day.
　　2. Two eggs, 50 grams of sesame oil, and an appropriate amount of vinegar. Beat the eggs and fry in sesame oil, add vinegar and eat, once in the morning and once in the evening.
　　3. Peanut 100-150 grams, cook with rock sugar and an appropriate amount of water until soft, eat the peanuts and drink the soup, once or twice a day.
　　4. Almond 15 grams, pounded repeatedly, filter the juice with water, add 1 teaspoon of honey, and drink with hot water, twice or three times a day.
　　5. One pear, peeled and core removed, add 9 grams of Baimu powder and 30 grams of rock sugar, steam until done, eat in the morning and evening.
　　6. Pumpkin 500 grams, peeled and cut into small pieces, 15 dates, and an appropriate amount of brown sugar, boil in water to make a soup for consumption, once or twice a day.
　　7. One fresh orange, peeled and cut into 4 slices, add 15 grams of rock sugar, steam for half an hour, eat with the peel, one slice in the morning and one in the evening.
　　8. Winter melon seeds and skin 20 grams,麦冬Maidong 15 grams, boil in water to make a decoction for consumption, one dose per day, taken in the morning and evening.
　　9. Sweet almond 10 grams, chew slowly, twice a day, with effects of cough relief, expectoration, and asthma control.

　　The key to TCM diagnosis and treatment is to identify the patient's condition, differentiate between the root and branch, and differentiate between chronic and acute diseases. Following the TCM theory of 'treating the branch in urgency and the root in remission', during the acute attack, treatment focuses on the branch, or is combined with Western medicine for inflammation, antispasmodic, cough relief, and expectoration. During the remission period, treatment focuses on consolidating the root, mostly with TCM and Chinese herbal medicine. The main focus is on regulating and supplementing the lung, spleen, and kidney. Specific treatment is as follows:

　　1. External cold and internal fluid retention
　　Main Symptoms: Fear of cold, fever or no fever, no sweating, cough, asthma, wheezing in the throat, copious clear and thin phlegm. Feeling cold in the limbs. The condition often worsens with cold weather. Pale tongue with thin white or slippery coating. Wiry and slippery pulse.
　　Treatment Method: Warming the lung to resolve fluid, and ventilating the lung to resolve phlegm.
　　Prescription: Modified Xiaoxiong Decoction (Shang Han Za Bing Lun).
　　Herbs: Mahuang 10g, Guizhi 10g, Baishao 10g, Ganjiang 8g, Xixin 3g, Fashen 10g, Wuweizi 10g, Gancao 3g.
　　Modification: For those with internal retained heat and flushed face due to irritability, add Gypsum fibrosum, Scutellaria baicalensis, and Houttuynia cordata; for those with severe cough and asthma, add杏仁, Inula, and Platycodon grandiflorus; for those with thin and watery sputum, add white mustard seed, 海浮石, and Citrus reticulata Blanco.

　　2, External Cold and Internal Heat
　　Principal Symptoms: Aversion to cold, no sweating or insufficient sweating, asthma, cough, thick sputum, difficult to expectorate, red tip of the tongue, greasy coating, slippery and rapid pulse.
　　Therapeutic Method: Ventilate the lung and clear heat.
　　Prescription: Dingchuan Decoction (from She Sheng Zhong Miao Fang).
　　Medicines: 6g of Borneol, 9g of Ephedra (root removed), 10g of Morus alba bark, 10g of Scutellaria baicalensis, 9g of Farfarae flos, 9g of Perilla Seed, 10g of Pinellia ternata, 9g of Prunus armeniaca, 3g of Licorice.
　　Modification: For those with severe heat, add Gypsum fibrosum, Houttuynia cordata, and Lonicera japonica; for those with dry stools, add Trichosanthes kirilowii, Ophiopogon japonicus, and枳壳.

　　3, Phlegm-Heat Stagnation in the Lung
　　Principal Symptoms: Fever, sweating, cough, yellow and thick sputum, difficult to expectorate; in severe cases, cough with asthma, flushed face, thirst, desire for drinking, dry stools, red tongue with thick yellow greasy coating, slippery and rapid pulse.
　　Therapeutic Method: Clear heat and dissolve phlegm, ventilate the lung and relieve cough.
　　Prescription: Qingjin Huatan Decoction (from Tongzhi Fang).
　　Medicines: 10g of Scutellaria baicalensis, 10g of Gardenia jasminoides, 10g of Platycodon grandiflorus, 12g of Ophiopogon japonicus, 10g of Morus alba bark, 5g of Fritillaria thunbergii, 15g of Trichosanthes kirilowii, 6g of Citrus reticulata Blanco, 10g of Poria, 5g of Licorice.
　　Modification: For those with severe heat and purulent sputum, add Benincasa hispida seed, Coix Seed, bamboo shoot root, Lonicera japonica, and Dandelion to clear heat and expel phlegm; for those with severe cough, add杏仁, Inula, and Loquat leaf to disperse lung Qi; for those with dry stools, add Rhei, Alumen, and枳壳 to purge heat and relieve constipation.

　　4, Phlegm Dampness Invading the Lung
　　Principal Symptoms: Cough, stuffy sputum, white and sticky sputum, especially prominent in the morning; accompanied by shortness of breath, chest stuffiness, fatigue, and lassitude, pale tongue with thin white slippery coating, soft or slippery pulse.
　　Therapeutic Method: Strengthen the spleen to relieve asthma, remove phlegm and relieve cough.
　　Prescription: Suizi Jiangqi Decoction.
　　Medicines: 9g of Perilla Seed, 9g of Magnolia officinalis, 9g of Pinellia ternata, 6g of Angelica sinensis, 6g of Bupleurum chinense, 3g of Cinnamon, 5g of Licorice (baked), 2 slices of ginger, 1 date, 2g of Perilla frutescens.
　　Modification: For those with excessive phlegm, add white mustard seed, uncooked Oyster shell, and powder of蛤壳; for severe cough, add杏仁, Inula, and Stemona; for chest stuffiness, add枳壳 and Platycodon grandiflorus.

　　5, Deficiency of Spleen and Lung Qi
　　Principal Symptoms: Cough, shortness of breath, thin and clear sputum, pale complexion, spontaneous sweating and aversion to wind, poor appetite, anorexia, loose stools; or edema of the head, face, and limbs, often exacerbated by colds, with prolonged illness and difficulty in recovery. Pale and bloated tongue with tooth marks on the edges, thin white coating, weak and thready pulse.
　　Therapeutic Method: Strengthen the spleen and boost Qi.
　　Prescription: Liujunzi Decoction.
　　Medicines: 5g of Ginseng (to be decocted separately), 10g of Atractylodes macrocephala, 10g of Poria, 5g of Licorice (baked), 10g of Pinellia ternata, 10g of Citrus reticulata Blanco.
　　Modification: For those with excessive self-sweating, add braised Astragalus, floating wheat, Schisandra, Oyster shell, and牡蛎 to control sweating and reinforce the exterior; for those with poor appetite and loose stools, add stir-fried Coix Seed, Chinese yam, malt, Amomum villosum, and ginger to invigorate the spleen and open the stomach; for those with chronic diarrhea due to sinking of Qi, combine the methods of lifting Yang and correcting sinking, and add Astragalus, Cimicifuga, Saposhnikovia, Platycodon grandiflorus to the formula.

　　6, Deficiency of Lung Yin
　　Principal Symptoms: Dry cough with little phlegm, sticky or pale yellow sputum. Evening heat, flushed cheeks, dry mouth and throat, night sweats, insomnia; occasionally blood-streaked sputum or hemoptysis; emaciated body. Red tongue with little coating, thin and rapid pulse.
　　Therapeutic Method: Nourish Yin and moisten the lung, clear heat and relieve cough.
　　Prescription: Yuehua Pill.
　　Medicines: 10g of Asparagus cochinchinensis, 10g of Ophiopogon japonicus, 9g of raw Rehmannia, 10g of Shudihuang, 12g of Huai山药, 9g of Bai bu, 20g of Schisandra chinensis, 3g of Bletilla striata (powdered), 10g of Eucheuma, 10g of Fuling, appropriate amount of Lophura nycthemera liver, 3g of notoginseng, 9g of chrysanthemum, and 9g of mulberry leaf.
　　Additions and Subtractions: For those with severe heat syndrome, add Scutellaria baicalensis, Houttuynia cordata, and Gardenia jasminoides; for those with severe Yin deficiency, add Hedysarum multiflorum, Baishao, and Yuquan; for those with abundant sputum or hemoptysis, add Herba epimedii, Folium selaginellaceum, blood residue, and Baizhi powder; for those with severe evening fever and night sweats, add Yinchaihu and Luosha.

　　7. Deficiency of both Lung and Kidney
　　Main Symptoms: Cough, shortness of breath, spontaneous sweating and aversion to wind, abundant sputum with a salty taste, soreness and weakness in the waist and knees, tinnitus, night sweats, pale tongue with thin white fur, weak pulse.
　　Treatment Method: Jinshui Liujun Decoction.
　　Medicines: 5g of Radix ginseng (decocted separately and taken), 10g of Shudihuang, 10g of Baishao, 10g of Danggui, 10g of Fuling, 9g of Chenpi, 9g of Banxia, 5g of Zhigancao.
　　Additions and Subtractions: For those with soreness and weakness in the waist and knees, add Duzhong, Yinyanghuo, Buguzhi, Susong, and Shanyao; for those with night sweats, add Longgu and Momordica charantia; for those with frequent sputum or hemoptysis, add Herba epimedii, Folium selaginellaceum, blood residue, and Baizhi powder; for those with severe evening fever and night sweats, add Yinchaihu and Luosha.

　　8. Deficiency of Yang in the Spleen and Kidney
　　Main Symptoms: Recurrent cough, shortness of breath, more exhalation than inhalation, abundant thin sputum, cough and asthma exacerbated by movement, dizziness and palpitations, aversion to cold and cold limbs, chest tightness and reduced appetite, soreness and weakness in the waist and legs, frequent night urination, pale tongue with thin white fur, deep and fine pulse.
　　Treatment Method: Strengthen the spleen and dissolve phlegm, warm the kidney and absorb Qi.
　　Prescription: Jinkui Shenqi Wan and Hezhong Wan.
　　Medicines: 5g of Radix ginseng (decocted separately and taken), 5g of Guizhi, 5g of prepared Aconitum carmichaelii, 10g of Shudihuang, 10g of Shanyao, 10g of Huai山药, 10g of Fuling, 8g of Danpi, 10g of Zexie, 10g of Baizhu, 8g of Ganjiang, 5g of Zhigancao.
　　Additions and Subtractions: For those with deficiency of Qi and fatigue, add Astragalus, and use more Radix ginseng, Bai-zhu, and Zhigancao; for those with spleen deficiency, cough with abundant sputum, it is advisable to remove Shudihuang and add Kouren, Fahan, and Chaoshuangshu; for those with severe kidney deficiency and cough, add products such as Cordyceps sinensis, Bajitian, Buguzhi, Yinyanghuo, and Huhua.

　　Among the above 8 types, they often intermingle with each other. When selecting prescriptions and medicines, it is advisable to use them with additions, subtractions, modifications, and combinations. In addition, due to the long course of chronic bronchitis in the elderly, common symptoms such as phlegm and blood stasis can be seen.活血化瘀 herbs such as peach kernel, safflower, angelica sinensis, chuanxiong, red peony, and salvia miltiorrhiza can be added to the formula.