Abstract: Based on Ye’s theory of “long-standing disease entering the ligament” and Peng Bo’s theory of “dark stasis”, and based on the rich clinical experience of pediatric cough variant asthma, and with the unique cognitive model of traditional Chinese medicine, we demonstrated that “dark stasis blocking the ligament by fugong” is the core pathogenesis of pediatric cough variant asthma. Based on the rich clinical experience of pediatric cough variant asthma, the theory of “dark stasis” was proven to be the core pathogenesis of pediatric cough variant asthma based on the unique cognitive model of TCM. Yan Yongbin, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
Keywords: cough variant asthma; core pathogenesis; fugong dark stasis blocking ligaments
Cough variant asthma (CVA), first named by Glauser [1] in 1972, is a special type of asthma with persistent or recurrent cough as the main manifestation. The understanding of this disease in TCM has not yet broken through the category of “cough”. In particular, the discussion of the etiology and pathogenesis of pediatric CVA does not reflect the special physiopathological characteristics of pediatric patients, and therefore fails to reflect the essence of the TCM pathogenesis of this disease, which has become a bottleneck for the breakthrough of TCM treatment. Inspired by the theory of “long-standing disease entering the ligament” and Peng Bo’s treatment of “dark stasis”, and based on abundant clinical evidence and theoretical research, the author realized that “dark stasis blocking the ligament” is the core pathogenesis and essence of this disease. I would like to invite my colleagues to correct me in my humble opinion.
Dark stasis within
Blocking the ligaments
Peng Bo’s treatment of “dark stasis”[2] Professor Peng Bo divides stasis evidence into clear and dark stasis according to the etiology and pathogenesis of stasis evidence and the presence or absence of pulse evidence and whether they are obvious or not: those with obvious etiology and pathogenesis and complete pulse evidence are called clear stasis, while those with obvious etiology and pathogenesis of stasis evidence but no evidence or no characteristic evidence to identify are in the hidden or not fully exposed stage of the disease. The stasis evidence in the latent state of the disease, which is not fully exposed, is called dark stasis. Summarizing his decades of clinical experience, Dr. Peng believes that the etiology and pathogenesis of dark stasis are mostly found in the following cases: (1) long-standing illness with Qi deficiency and weak agitation, resulting in dark stasis; (2) warm illness with high fever, which burns fluid and makes the blood sticky and unstable, resulting in dark stasis; (3) excessive consumption of thick flavors or spleen deficiency with loss of transportation, which prevents the transportation and excretion of blood, resulting in internal stagnation and obstructing the smooth flow of blood, resulting in internal dark stasis.
According to Peng Bo’s treatment of “dark stasis”, the author believes that dark stasis in pediatric CVA is mainly due to the following reasons: (1) deficiency of qi in prolonged coughing and weakness of agitation, resulting in dark stasis; (2) deficiency of spleen and loss of transportation, stagnation and internal stagnation, which prevents the blood from moving smoothly, resulting in dark stasis; (3) excessive consumption of thick flavors, which prevents the blood from moving smoothly, resulting in internal dark stasis. First of all, the wind evil attacks the lung, the lung qi goes upward, the cough is not treated for a long time, and the lung and spleen are both injured, just as in the “Young Children’s Collection: Coughing Evidence and Treatment”, “Coughing for a long time and not stopping, there is no other evidence, it is also lung deficiency.” In The Source and Flow of Miscellaneous Diseases, The Rhinocandle: “The lung is not injured without coughing, and the spleen is not injured without coughing soon…”. Qi is the marshal of blood, and when Qi is moving, blood is moving, and when Qi is deficient, the drum is weak and dark stasis arises. Secondly, the spleen is often deficient in children. A deficiency in the spleen leads to a loss of transportation, a failure of transportation and transformation, an internal stagnation, a stagnation of qi, and a lack of blood flow, which leads to dark stasis. Finally, children are generally fond of fatty and sweet foods, and because they need water and grain essence more urgently than adults and their digestive function is not yet complete, they are unable to transport and excrete, so stagnation and internal stagnation prevent blood from moving smoothly, resulting in internal dark stasis. The dark stasis blocks the ligaments and veins and fights with the wind, so that the lungs are not purified and the airways are contracted, resulting in a prolonged cough. Therefore, the active “elimination of dark stasis” reflects the essence of “seeking the root of the disease” in TCM, and is a good interpretation of the idea of “treating the disease before it occurs” in TCM. Therefore, the active “elimination of dark stasis” reflects the essence of Chinese medicine “seeking the root of the disease” and is a good interpretation of the idea of “treating the disease before it occurs”.
Wind evil in the ligaments becomes wind in the lungs
The lung is a delicate organ, which is not resistant to heat and cold, so it is especially weak in children, and external evil can easily enter the lung from the surface. The miscellaneous source of disease rhinoceros candle – cold source of flow” cloud: “wind evil attack, no matter where to feel, will return to the lungs.” And the wind is the first of the six, other external evil invade the body with the wind, so the external attack of the evil often to wind as the first guide. As in Suwen – Taiyin Yangming Theory, “Those who are injured by the wind are first to suffer from it. When the wind evil invades the surface of the lung guard, the lung loses its publicity and purification, the airway becomes contracted and urgent, and the wind shakes the bell, resulting in a cough. Because wind is “good at moving several times”, “wind is the longest of all diseases”, “it is light in nature”, “when wind is strong, it is contracted and rapid” and “wind is a powerful force for coughing”. “Therefore, patients with wind attacking the lungs have a sudden onset and cessation of cough, accompanied by itching of the throat and nose, choking and coughing, sneezing and itching of the airway. For example, in Ming Li Ting’s “Introduction to Medicine – General Theory of Cough”, it is said that “when the wind rides on the lung, the cough is characterized by a stuffy nose and heavy voice, a dry mouth and itchy throat, and a cough before the language is competed.” It can be seen that wind is the basic cause of this disease.
However, wind evil in this disease is not equivalent to “wind” in the general sense. The cough caused by the wind evil attacking the surface of the lung guard and the loss of lung circulation and purification is usually treated by removing the wind and relieving the cough, the condition will be relieved quickly and rarely does it persist. In addition to the symptoms of cough mentioned above, it has its own characteristics such as long coughing time (continuous coughing for more than one month), attacks mostly at night, and little effect of general wind-dispelling drugs. Therefore, the author believes that the pathogenesis of CVA is not the same as a general cough in which the wind attacks the surface of the lung guard, but rather a long-standing disease that enters the ligaments and the wind enters the interior of the ligaments (i.e., volatile wind). Specifically, the wind evil attacks the lung and is not treated properly, the evil tends to stay and the wind is mobile, and because children “often have a surplus of liver”, the internal wind is easily moved. The wind evil enters the lung ligaments, and with the dark stasis mentioned above, the airway is contracted and urgent, and the cough is made from time to time and does not heal. Because the wind evil is not on the surface of the lung guard, but is deep in the lung channels, it is ineffective in removing the wind and relieving the surface, and the cough is difficult to be cured for a long time. In conclusion, the long-standing disease entering the lung channels and the internal wind evil is the essence of the TCM pathogenesis that distinguishes CVA from typical asthma, and even more so from general cough.
Pathological experiments can be used as evidence
Modern medical research has confirmed that the mechanism of cough variant asthma is similar to that of typical asthma, i.e., airway allergic inflammation and inflammatory mediators are the important pathophysiological basis of cough variant asthma attacks, characterized by airway hyperreactivity. From the immunological point of view, CVA and typical asthma are both IgE-mediated type I allergic reactions involving multiple cells and cytokines, and chronic non-specific inflammation formed on this basis. Modern pharmacological studies have confirmed that the effects of wind drugs are multifaceted and multi-targeted. Many wind medicines have the ability to improve cellular immune function, reduce the stress response of the body to allergic factors, alleviate antagonistic histamine, and anti-allergic inflammation, which can change the small bronchi of the lung from spasm to diastole and smooth the airway, thus gradually healing the long-standing cough, and conversely, less effective without [3]. In particular, the wind-surfing and energizing drugs (such as Dilong, Baishijian, and Quanxiang) have more obvious antihistamine and bronchodilator effects. It is a common research pattern and way of thinking in TCM to measure evidence by formula, and the significant efficacy of wind medicines (especially wind-transferring medicines) in the treatment of CVA can be inferred that the core TCM pathological mechanism of CVA is “long-standing disease entering the lung and internal wind evil”.
The lungs are rich in blood transport, and almost all blood is distributed throughout the body through the lungs, except for a small portion of the A-V exchange in the heart blood supply. Lung tissues are in turn rich in coagulation factors, and when there is inflammation in the mucosa of the organ, secretions increase, which, together with the release of histamine from mast cells in the mucosa, contribute to the swelling of the vascular endothelium and increased exudation, which together form a fibrous matrix that can form thrombi under the action of platelet coagulation factors, thus producing an accumulation of microemboli in the lungs [4]. This confirms from the perspective of pathological studies that stasis of blood in the lungs of CVA patients does exist. Drugs such as Curcuma longa and Safflower can improve their blood circulation, increase blood and oxygen supply, eliminate bronchial mucosal edema, reduce obstruction, and resist platelet aggregation and inhibit their release of relevant mediators, which facilitates the relief of airway inflammation and also provides an objective basis for the use of blood-activating and stasis-transforming drugs. From the significant efficacy of blood-stasis activating drugs in treating CVA, it can be inferred that “dark stasis obstruction” is also the core pathogenesis of CVA in Chinese medicine.
Disease location: lung ligament involving liver, spleen (stomach) and large intestine
In summary, CVA in children is mainly caused by the external attack of wind evil, which enters the lung ligaments for a long time, and the internal dark stagnation of the lung ligaments, resulting in a loss of lung circulation and contracture of the lung ligaments, resulting in coughing, so the disease is located in the lung ligaments. The author believes that although cough is a lung disease, it involves the liver, spleen (stomach), large intestine and other internal organs, as stated in the Suwen Cough Theory: “All five internal organs and six internal organs cause cough, not only the lungs”. In other words, the wind evil entering the lung is closely related to the “surplus of liver”, the internal wind is easy to move, and the same qi seeks each other, and the liver evil offending the lung will easily cause the lung qi to rebel and make cough, so called “wood knocking and gold sounding”, so the onset of CVA is closely related to the liver. In children, “the spleen is often deficient”, the spleen is deficient in transport, transport and transformation, stagnation, stagnation of Qi (deficiency), dark stasis, so the onset of CVA and the spleen is also closely related. In addition, the stomach and large intestine is the main descending, the lung and large intestine, and the “Nei Jing” has “the hand Taiyin pulse, starting in the middle Jiao, lower complex large intestine, and also through the stomach, the upper part belongs to the lung” and “the lung cough does not stop, then the large intestine is affected by the” record, indicating that the lung, stomach, large intestine function together, the meridians are connected. The lung, stomach and large intestine are connected by meridians and channels, and when examined clinically, there is indeed an interdependent relationship between one glory and one injury. The clarification of the core pathogenesis of pediatric CVA in Chinese medicine is of great importance to further stop the development of the disease into typical asthma.
References
[1] Glarser FL.
Variant asthma. Ann Allergy,I972,30:457
[2] Yan YB, Liu XW. Peng Bo’s treatment of “dark stasis”. Journal of Traditional Chinese Medicine, 2005, 46(12):901
[3] Luo She-Wen. Chao Enxiang’s experience in treating cough variant asthma. Journal of Traditional Chinese Medicine, 2002, 43(1):74
[4] Chen Keji, Shi Zaixiang. Practical Blood Stasis Evidence. Beijing:People’s Health Publishing House, 1999: 71, 93, 396
Author Biography: Yan Yongbin (1969.11-), male, Han nationality, Shangqiu, Henan Province, deputy director of the fifth ward of pediatrics, deputy chief physician, master’s degree supervisor, PhD, executive member of the professional committee of Chinese medicine pediatrics of Henan Provincial Medical Association, successor of the fourth batch of national academic experience of old Chinese medicine experts, specializing in the combined Chinese and Western medicine treatment of pediatric respiratory and digestive system diseases.