Traditional Chinese Medicine Research and Treatment Analysis of Pulmonary Fibrosis

Traditional Chinese Medicine Research and Treatment Analysis of Pulmonary Fibrosis

At present, pulmonary fibrosis is an incurable disease in clinic, and the therapeutic effect of western medicine is not obvious. How to analyze the treatment of pulmonary fibrosis by traditional Chinese medicine?

Abstract: Pulmonary fibrosis is an incurable disease in modern clinic, which seriously affects the quality of life of patients. Based on the literature reports of traditional Chinese medicine on pulmonary fibrosis in recent years, this paper summarizes the research on the disease name, etiology, pathogenesis and syndrome differentiation treatment of idiopathic pulmonary fibrosis, and analyzes the present situation and advantages of traditional Chinese medicine in treating pulmonary fibrosis. There are 29 references.

[Keywords] Pulmonary fibrosis; Name of disease; Etiology and pathogenesis; Syndrome differentiation treatment; summary

Pulmonary fibrosis, also known as interstitial lung disease, is a group of diseases with diffuse alveolar inflammation and interstitial fibrosis as the basic pathological changes. There are various causes, and most pulmonary fibrosis have the same pathological process. Idiopathic pulmonary fibrosis (IPF) is the most common type of pulmonary fibrosis. IPF, also known as cryptogenic alveolitis, refers to a chronic inflammatory interstitial lung disease with unknown etiology, and its pathological changes are common interstitial pneumonia. The main manifestations are diffuse alveolitis, structural disorder of alveolar units and pulmonary fibrosis. Extensive fibrosis hardens lung tissue and reduces compliance [1]. The clinical manifestations are progressive irreversible dyspnea and cough, and almost all IPF patients eventually die of respiratory failure. The median survival time of IPF patients after diagnosis is 2 ~ 3 years, which is worse than that of lung adenocarcinoma. At present, there are very few drugs used to treat pulmonary fibrosis, and only pirfenidone [2] has been approved to treat IPF in China, but clinical research shows that the effect of this drug on prolonging survival time is not ideal. Lung transplantation is the most effective method to treat idiopathic pulmonary fibrosis, but its application is limited by the source of donors. At present, both experimental research and clinical application have proved that traditional Chinese medicine is effective in treating pulmonary fibrosis, and it shows its characteristics and advantages different from modern medicine, and has achieved satisfactory results. This paper summarizes the understanding, treatment status and progress of pulmonary fibrosis in TCM as follows.

1 TCM name of pulmonary fibrosis

If we want to find a cure for pulmonary fibrosis from TCM, we must first understand the name, etiology and pathogenesis of pulmonary fibrosis in TCM. The main clinical symptoms of pulmonary fibrosis are dyspnea, dry cough or expectoration, cyanosis, clubbing fingers and aggravation of respiratory symptoms after exercise. These symptoms are mostly attributed to lung distension, cough, lung arthralgia, lung flaccidity, asthma and other diseases in TCM literature. At present, there is no unified name for pulmonary fibrosis in traditional Chinese medicine. In recent years, pulmonary fibrosis tends to be classified into pulmonary arthralgia and pulmonary flaccidity. Li Julian and others [3] think that pulmonary fibrosis belongs to the category of pulmonary arthralgia, because the capillaries are congested and the wall is thickened in the early stage of pulmonary fibrosis, and the capillaries are reduced or blocked in the late stage due to alveolar interstitial fibrosis, which is similar to the pathogenesis of pulmonary arthralgia in traditional Chinese medicine, and the blood circulation is not smooth or even impassable. Jia Xinhua and others [4] believe that although pulmonary arthralgia and pulmonary fibrosis are not completely equivalent, there is a pathology of qi stagnation and blood stasis and even phlegm and blood stasis in the whole development process of pulmonary fibrosis, which is the characteristic of arthralgia syndrome. Zhu Xue and others [5] think that pulmonary fibrosis belongs to the category of pulmonary flaccidity in traditional Chinese medicine, because both of them are flaccidity syndrome caused by insufficient body fluid in lung leaves, and at the same time, they put forward the treatment principle of "treating flaccidity and taking Yangming alone" to treat pulmonary fibrosis. Ge Yangtao and others [6] also think that pulmonary fibrosis is highly similar to the symptoms of pulmonary flaccidity proposed by Zhang Zhongjing, such as pulse, cough, turbid saliva and shortness of breath. In addition, it has also been suggested that pulmonary fibrosis is the combination of pulmonary flaccidity and pulmonary arthralgia. The symptoms of pulmonary arthralgia in the early stage are more obvious, and the symptoms of pulmonary flaccidity in the later stage are more obvious. The author thinks that the concepts of traditional Chinese medicine diseases and modern medical diseases are different, and it is difficult to correspond one by one. Different patients with pulmonary fibrosis will show different clinical symptoms and signs due to different personal constitutions or different stages of disease development, which can be attributed to different TCM diseases according to TCM syndrome differentiation. The same disease in modern medicine may be scattered under many syndromes of traditional Chinese medicine. Similarly, a syndrome of traditional Chinese medicine may appear in many diseases of modern medicine with the same or similar symptoms. Therefore, the author thinks that the identification of TCM disease name of pulmonary fibrosis is secondary, and the key is to use the unique theoretical system of TCM to analyze the pathogenesis and evolution law of different patients with pulmonary fibrosis, treat them according to syndrome differentiation, relieve their pain, improve their quality of life and prolong their survival time.

2 TCM etiology and pathogenesis of pulmonary fibrosis

Although it is generally believed that pulmonary fibrosis belongs to the category of lung arthralgia and lung flaccidity in traditional Chinese medicine, its etiology and pathogenesis are diverse and complicated, and the literature reports have their own emphasis. Jiang Liangduo and others [7] think that the pathogenesis of pulmonary fibrosis is the loss of lung and kidney, and repeated feeling of external evil, which leads to phlegm and blood stasis blocking lung collaterals. Qu Yumin and others [8] summarized the etiology and pathogenesis as lung qi deficiency, weakness of vital qi, pathogenic turbidity invading the lung, prolonged exhaustion of lung leaves and prolonged exhaustion of body fluids. Cui Yun and others [9] think that the main manifestations of this disease are lung obstruction, obstruction of lung collaterals and deficiency of both lung qi and yin, and the main pathogenesis in the middle and late stage is lung flaccidity, phlegm and blood stasis combined with lung collaterals and lung lobe dystrophy. Liu Xiaoming and others [10] think that this disease is closely related to congenital and acquired, and it is a syndrome of excess and deficiency. The pathogenesis is congenital deficiency and acquired deficiency, and phlegm, blood stasis, toxin and evil are intertwined, resulting in lung qi obstruction and lung collateral obstruction. Lan Zhihui and others [1 1] think that yang deficiency is one of the important pathogenesis in the development of pulmonary fibrosis, which makes qi, blood and body fluid run poorly, leading to phlegm turbidity, drinking water and blood stasis blocking lung collaterals, so yang deficiency can occur in all stages of pulmonary fibrosis, especially in the later stage of the disease. Lu et al. [12] think that the pathogenesis of this disease is that pathogenic toxin invades the lung, leading to lung qi deficiency, body fluid accumulating in phlegm and blood stasis, and finally leading to lung deficiency and phlegm stasis. It is pointed out that "qi stagnation", that is, abnormal lung function, is the basic pathogenesis of pulmonary fibrosis. Tan Xiaoli and others [13] think that this disease is a syndrome of excess and deficiency, and blood stasis in pathogenic factors is not only the pathological product of this disease, but also the new pathogenic factor of this disease and the main pathological factor accompanying the whole process of the disease. The combination of drugs for promoting blood circulation and removing blood stasis can obviously improve the symptoms of patients with pulmonary fibrosis. Yuan Biao et al [14] put forward that the basic pathogenesis of pulmonary fibrosis is "lung deficiency and collateral stasis". Among them, yin deficiency leading to collateral failure and lung qi deficiency as the basis, phlegm and blood stasis blocking collateral and heat toxin as the standard, and it is pointed out that deficiency in essence and excess in essence are mutually causal. Deficiency of lung qi and insufficient gasification will lead to blood stasis in body fluid, and phlegm and blood stasis will block lung collaterals. Yin deficiency and blood deficiency, blood does not carry qi, and lung collaterals are not nourished, which also leads to blood stasis blocking collaterals. On the contrary, lung collaterals and yin and body fluid can't work, and blood stasis will aggravate the degree of qi deficiency and yin deficiency for a long time. To sum up, although the etiology and pathogenesis of pulmonary fibrosis are complex, it is generally believed that the basic pathogenesis of pulmonary fibrosis is deficiency in essence but excess in substance. The deficiency in essence is the deficiency of vital qi, whether it is congenital or acquired. Different stages can show different deficiency syndromes, such as lung qi deficiency in the early stage, spleen, lung, qi and yin deficiency in the middle stage and kidney yang deficiency in the later stage. Of course, due to different constitutions, some patients may show yang deficiency from the beginning. In fact, phlegm, blood stasis and toxin block lung collaterals. Deficiency of substance and excess of substance are the basic pathogenesis of pulmonary fibrosis. Under this basic pathogenesis, due to individual differences, different patients have different specific incidence opportunities. Clinically, we should follow the method of syndrome differentiation and treatment of traditional Chinese medicine and formulate individualized treatment plans.

3. Methods of differentiation and treatment of pulmonary fibrosis

The etiology and pathogenesis of pulmonary fibrosis are complex and diverse, and the treatment methods are also diverse. Liu Yuqing and others [15] think that the method of invigorating qi and promoting blood circulation should run through the whole treatment process, and Yupingfeng powder, ginseng, astragalus root, Atractylodes macrocephala, Codonopsis pilosula and so on can be used to replenish lung and replenish qi. Radix Salviae Miltiorrhizae, Rhizoma Chuanxiong, Radix Angelicae Sinensis, Radix Curcumae, Lumbricus, etc. It is used for promoting blood circulation and removing blood stasis, and helps to promote blood circulation with qi-regulating drugs such as Fructus Aurantii and Susong. Yang Li [16] divided pulmonary fibrosis into six types, treated it according to syndrome differentiation, and achieved good clinical effects: Yin deficiency and dryness-heat syndrome, mainly clearing lung, resolving phlegm and moistening dryness, treated with Qingzao Jiufei decoction; Deficiency of both qi and yin was treated by supplementing qi, resolving phlegm and nourishing yin, plus Shengmai Powder. Syndrome of deficiency of both qi and yin combined with blood stasis should be treated with Shengmai Powder and Taohong Siwu Decoction. The syndrome of deficiency of both qi and yin combined with phlegm-heat was treated by supplementing qi and nourishing yin, clearing heat and resolving phlegm, and was treated by Pingchuan Guben Decoction and Sangbaipi Decoction. The syndrome of yang deficiency and water deficiency is mainly warming yang, removing blood stasis and promoting diuresis, and Zhenwu decoction and Bufei decoction are used to treat it. Syndrome of deficiency of yin and yang is treated by restoring yang to save yin, benefiting qi and restoring pulse, Shenfu decoction and Shengmai powder. Guo Gang [17] put forward five methods of pulmonary fibrosis, namely, tonifying lung qi, invigorating spleen and resolving phlegm, tonifying kidney and absorbing qi, promoting blood circulation and removing blood stasis, and dispersing lung qi, which can be treated according to syndrome differentiation in clinic. He believes that lung qi deficiency is the cause and pathological result of pulmonary fibrosis, and lung qi should be supplemented throughout the whole treatment process, which can be treated with ginseng, Pseudostellaria heterophylla, Astragalus membranaceus, Rhodiola and American ginseng. Spleen is the organ for producing phlegm, and spleen deficiency will lead to phlegm turbidity blocking lung collaterals. Pericarpium Citri Tangerinae, Rhizoma Pinelliae, Fructus Trichosanthis, Arisaema cum bile, Poria, Atractylodis Rhizoma, Atractylodis Rhizoma, etc. can be selected to strengthen the spleen and resolve phlegm. In clinical practice, tonifying kidney and receiving qi is the main treatment method for deficiency of both qi and yin with phlegm and blood stasis blocking collaterals and deficiency of both spleen and kidney with phlegm and blood stasis blocking collaterals. Cornus officinalis, Ophiopogon japonicus, Lily, Lycium barbarum, Aster, Farfara Flos, Walnut Kernel, Gecko, Cordyceps sinensis, Aquilaria Resinatum, Cinnamomum cassia and Magnetite can be selected. Blood stasis can lead to obstruction of lung collaterals, so drugs such as lumbricus, centipede, Eupolyphaga Seu Steleophaga, leech, Carapax Trionycis, Curcumae Rhizoma, Sparganum Rhizoma are selected to promote blood circulation and remove blood stasis. The disorder of lung ascending and descending is the common pathogenesis of all lung diseases. We should spread and descend lung qi, and turn on and off the qi machine. We can choose almond, perilla, peucedanum, platycodon grandiflorum, ephedra, Schisandra chinensis, ginkgo and other drugs. Qiu Songping [18] thinks that it is very important to treat pulmonary fibrosis with drugs for promoting blood circulation and removing blood stasis, and it should be used in sufficient amount at the initial stage of the disease. Salvia Miltiorrhiza, Angelica sinensis, Ligusticum Chuanxiong, Notoginseng Radix, Peach Blossom, Carthamus tinctorius, Ginkgo biloba, Rhizoma Sparganii, Rhizoma Curcumae and Hirudo are the basic choices. At the same time of promoting blood circulation and removing blood stasis, drugs should be added and subtracted according to symptoms, such as Flos Lonicerae, Fructus Forsythiae, Folium Isatidis, Radix Isatidis, Herba Taraxaci, Flos Chrysanthemi Indici, Herba Houttuyniae, Radix Bupleuri, Radix Puerariae, etc. It is suitable for patients with wind-heat pathogen invading the lung. Plaster, Scutellaria baicalensis Georgi, Trichosanthis Radix, Pinellia ternate, Platycodon grandiflorum, Almond, Fritillaria thunbergii, etc. Added to those with phlegm-heat obstructing the lung; Ginseng, Radix Astragali, Atractylodis Rhizoma, Poria, etc. Suitable for patients with heart-lung qi deficiency; Ginseng, Radix Astragali, Atractylodis Rhizoma, Poria, Radix Rehmanniae, Radix Scrophulariae, Radix Ophiopogonis, etc. Used for patients with deficiency of both qi and yin; Radix Aconiti Lateralis Preparata, Ramulus Cinnamomi, Asari, Zingiberis Rhizoma, Cortex Cinnamomi, Pericarpium Arecae, Cortex Acanthopanacis, Polyporus, Alismatis Rhizoma, etc. Used for heart, spleen, kidney yang deficiency and watery; Radix Aconiti Lateralis Preparata, Zingiberis Rhizoma, Cortex Cinnamomi, Fructus Psoraleae, Radix Morindae Officinalis, Radix Rehmanniae Preparata, Radix Ophiopogonis, Fructus Lycii, Ginseng, etc. Zhang Xueyan [19] proposed that pulmonary fibrosis should be treated from the kidney. If both lungs and kidneys are deficient, both lungs and kidneys will be supplemented, and the qi of deficiency will be absorbed. Jinkui Shenqi Pill and Shengmai Powder should be added and subtracted. Kidney deficiency and lung deficiency should be treated with Jinkui Shenqi Pill and Perilla Jiangqi Decoction. Liu Jiasheng et al. [20] pointed out that this disease should be treated early, and the general treatment principle is to tonify lung and kidney, promote blood circulation and remove blood stasis. It is considered that the early stage of this disease is characterized by phlegm and blood stasis, and the treatment is mainly to eliminate phlegm and blood stasis, while not forgetting to replenish deficiency; The chronic protracted period is characterized by insufficient positive energy and excessive evil energy. At this time, it is necessary to give priority to sparse and tonic, take long-term slow attack as the principle, combine sparse and tonic, and restore the function of viscera. Wei Yadong et al. [2 1] divided pulmonary fibrosis into six stages: in the early stage, lung qi deficiency, common cold invaded the lung, characterized by dry cough, little white phlegm, red tongue, thin white fur and floating pulse, and treated with Zhisou Powder; In the acute stage, phlegm-heat blocks the lung, and the lung is unclear. The main symptoms are heavy and turbid cough, excessive phlegm, chest tightness, red tongue with yellow coating and slippery pulse. Jinqing Huatan Pill is used to treat it. The main manifestations of phlegm and blood stasis in the late stage are dyspnea, expectoration, hemoptysis, cyanosis of mouth and lips, dark tongue and slippery pulse. The treatment was Xuefu Zhuyu decoction combined with Liujunzi decoction. Long-term lung and kidney deficiency, wheezing when not moving, wheezing when moving, frequent cough, extreme fatigue, irregular stool, pale tongue, white fur and thready pulse. Treated with nourishing yin and clearing lung decoction or Baihe Gujin decoction plus Qiwei Duqi decoction, the deficiency-cold type in this period is mainly chills, expectoration, loose stool, pale tongue, white fur and thready pulse. At the end stage, lung collaterals and heart pulse are blocked, kidney qi is deficient, and qi, blood, yin and yang are seriously out of balance. The treatment is quite difficult and the prognosis is not good. If it's urgent, you need treatment. It is the basic idea to treat by stages according to syndrome differentiation. Clinically, we should not be bound by the existing classification, but should combine disease differentiation with syndrome differentiation, treat it differently and treat it individually.

Treatment of pulmonary fibrosis with traditional Chinese medicine

Because of the complexity of the etiology and pathogenesis of pulmonary fibrosis, it is sometimes difficult to classify it clinically. At this time, doctors often study special prescriptions according to clinical experiments. Wang Kai et al [22] treated pulmonary fibrosis by nourishing yin and benefiting qi. According to clinical observation, the total effective rate of taking Yangyin Yiqi recipe in treating pulmonary fibrosis is higher than that of oral prednisone. The prescription is composed of Maimendong decoction, in which ginseng, licorice, jujube and japonica rice are removed, and Atractylodis Rhizoma, Lily, Radix Astragali, Radix Codonopsis, Radix Glehniae, Radix Rehmanniae, Rhizoma Polygonati Odorati, Fructus Schisandrae Chinensis, Bulbus Fritillariae Cirrhosae, Radix Asteris and Caulis Bambusae are added. Wu et al. [23] treated with self-made Bufei Huoxue decoction (Radix Astragali, Radix Codonopsis, Carthami Flos, Fritillaria thunbergii, Radix Salviae Miltiorrhizae, Rhizoma Chuanxiong, Radix Angelicae Sinensis, Lily, Ginkgo biloba, Fructus Aurantii preparata, Perilla frutescens, Bulbus Allii Macrostemon) for 3 months at the same time of basic treatment, and its total clinical efficacy, symptom score, pulmonary function index and arterial blood gas were better than those of oral prednisone alone. On the basis of routine treatment, Yang Jie [24] found that the improvement of arterial blood gas, lung function and symptom score was obviously better than that of routine treatment alone. Mars et al. [25] found that the clinical effect of Wei Fei Granule on pulmonary fibrosis was very obvious. Methods: 20 patients with/kloc-0 were randomly divided into control group (59 cases) and treatment group (6/kloc-0 cases). The control group was given basic treatment such as prednisone acetate tablets, while the treatment group was given Wei Fei granules (Radix Panacis Quinquefolii, Radix Notoginseng, Fructus Corni, Fructus Schisandrae Chinensis, Radix Asteris, Radix Ophiopogonis, Ginkgo biloba and Radix Glycyrrhizae Preparata) on the basis of basic treatment. After two months of treatment, the effective rate of the treatment group was significantly higher than that of the control group. Zhang Gui et al. [26] discovered Hu Qi Huoxue decoction (Polygonum cuspidatum, Radix Astragali, Radix Salviae Miltiorrhizae, Radix Angelicae Sinensis, Pericarpium Citri Tangerinae, Radix Glycyrrhizae, etc.) for treating pulmonary fibrosis. ) is obviously better than hormone therapy alone, and it is safe and low-cost. Foliage [27] 54 patients with pulmonary fibrosis were treated with glucocorticoid and Feixian recipe (Schisandra chinensis, dried ginger, Scutellaria baicalensis, Bupleurum, Codonopsis pilosula, Pinellia ternata, Radix Glycyrrhizae Preparata, Trichosanthis Radix, Platycodon grandiflorum, Ramulus Cinnamomi, Fructus Trichosanthis, etc. ) In addition to routine anti-infection and oxygen inhalation. Two months later, it was found that the effective rate of Feixianfang treatment group was significantly better than that of glucocorticoid control group. Hou Congling et al [28] randomly divided 60 patients into control group and treatment group. The control group was given oral prednisone for basic treatment, while the treatment group was given Peiyuan Huoxue recipe (Fructus Psoraleae, Radix Rehmanniae Preparata, Fructus Corni, Herba Epimedii, Radix Angelicae Sinensis, Radix Salviae Miltiorrhizae, Lumbricus, Radix Astragali, Radix Ophiopogonis, etc.). ) in addition to basic treatment. Both groups were given the same nutritional support. After two months of treatment, the treatment group is obviously superior to the control group in improving clinical symptoms. In addition to prescription treatment, Li Rong [29] fully demonstrated the rationality of moxibustion Shu Fei and Gao Yuyu in treating pulmonary fibrosis: Shu Fei mainly treats lung diseases, Gao Zhu mainly treats visceral diseases, and moxibustion itself is beneficial to tonic. Clinical practice has proved that moxibustion with Shu Fei and Gao Yishu has obvious curative effect. This method is the Senna method to supplement the attack, that is, supporting yang and benefiting qi and dredging meridians.

5 abstract

Pulmonary fibrosis is an incurable disease in clinic at present. The curative effect of western medicine is not obvious, but Chinese medicine has shown obvious advantages in treating pulmonary fibrosis. The thinking of TCM treatment is different from that of modern medicine. Traditional Chinese medicine believes that the occurrence of pulmonary fibrosis is the result of the destruction of the dynamic balance of yin and yang of zang-fu organs, meridians, qi and blood after pathogenic factors act on human body. Treatment also begins with restoring the dynamic balance of the body. This method and purpose is not to eliminate pathogenic factors, but to treat diseases by stimulating the human body's own disease resistance and rehabilitation ability, so as to get rid of exogenous pathogens and restore the normal function of viscera. According to the theory of traditional Chinese medicine, pulmonary fibrosis is located in the lung, but it is closely related to spleen, kidney, liver, heart and large intestine. At present, Chinese medicine has a basic understanding of the pathogenesis of pulmonary fibrosis, that is, the pathogenesis of this disease is a mixture of insufficient vital qi and phlegm and blood stasis blocking collaterals. The lung is the storage of phlegm, and the spleen is the source of phlegm. The formation of phlegm is related to the imbalance of water regulation function of lung and transport and transformation function of spleen. Spleen and lung are weak, and phlegm is endogenous. This situation should be treated with both spleen and lung. Kidney governs water, and abnormal renal function can also lead to the formation of phlegm and turbidity; Kidney governs qi. Elderly patients with kidney deficiency are characterized by dyspnea when they don't breathe, and dyspnea is serious when they are active. At this time, both lungs and kidneys should be treated. According to the principle that the liver belongs to wood and the lung belongs to gold, a strong liver fire combined with the patient's impatience due to illness will lead to a "wood fire fine", which will lead to liver fire invading the lung, leading to weak lung qi and forming phlegm and blood stasis. At this time, the liver and lungs should be treated together. In the late stage of pulmonary fibrosis, qi deficiency can not help the heart to promote blood circulation, and the heart rhythm is accelerated or even edema. At this time, the lungs and heart should be treated. The lung and large intestine are from the outside to the inside, and the fu-organs are blocked. Turbid gas can't fall down, which can affect the expansion and decline of the lungs and affect the metabolism of water and liquid to form phlegm. At this time, the lungs and intestines should be treated together. In a word, pulmonary fibrosis is a multi-organ disease, and the etiology, pathogenesis and treatment scheme proposed in this paper are only a part. Clinical treatment should be based on the principle of combining syndrome differentiation of zang-fu organs with eight classes, treating the same disease differently, and integrating the five zang-fu organs, highlighting the characteristics of individualized treatment.

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