I. Western medical diagnosis: acute exacerbation of chronic obstructive pulmonary disease
Chinese medical diagnosis: asthma, pulmonary distension disease
II. Definition: In 2000, the European and American Consensus Conference proposed a commonly used operational definition of AECOPD: patients with persistent deterioration beyond normal day-to-day variation compared to the stable phase, i.e., patients with COPD underlying the acute onset of the disease, requiring adjustment of conventional medications. Most studies still use the Antoine definition and staging criteria, and the diagnosis is made by having at least two of the following three items: (i) worsening shortness of breath, (ii) increased sputum volume, and (iii) sputum becoming purulent. The 2007 Chinese COPD guidelines define AEC0PD as a patient who has a short period of sustained deterioration beyond the daily condition and requires a change in C0PD medication, and who has a short period of increased cough, shortness of breath and wheezing, with increased purulent or mucopurulent sputum, which may be accompanied by a significant increase in fever and other symptoms.
III. Etiology and pathology
1. Western medical etiology and pathology
(1) Etiology: The most common cause of AECOPD is tracheobronchial infection, mainly viral and bacterial infection. The cause of some AECOPD cases is difficult to determine, but environmental physicochemical factors may play a role. The cause of exacerbations in some cases is difficult to determine. Pneumonia, congestive heart failure, pneumothorax, pleural effusion, pulmonary thromboembolism, arrhythmia, etc. can cause symptoms similar to COPD exacerbation and need to be differentiated.
(2) Pathophysiology: The characteristic pathological changes of COPD exist in the central airway, peripheral airway, lung parenchyma and vascular system of the lung. In the central airways – trachea, bronchi and fine bronchi with an inner diameter greater than 2-4 mm – inflammatory cells infiltrate the superficial epithelium; mucus-secreting glands are enlarged and increased mucus secretion is caused by an increase in cupular cells. In the peripheral airways – small bronchi and fine bronchi with an inner diameter of less than 2 mm – chronic inflammation leads to a recurrent cycle of airway wall damage and repair processes. The repair process leads to structural remodeling of the airway wall, increased collagen content and scar tissue formation, and these pathological changes cause narrowing of the airspace and result in fixed airway obstruction.The typical destruction of the lung parenchyma in COPD patients is manifested by lobar central emphysema, involving dilatation and destruction of the respiratory fine bronchioles. In milder cases, these disruptions often occur in the upper regions of the lung, but the disease progresses and can be diffusely distributed throughout the lung with disruption of the pulmonary capillary bed. Endogenous protease and anti-protease imbalance in the lung due to genetic factors or inflammatory cells and mediators is the main mechanism of pulmonary destruction in emphysematous lung, with oxidation and other inflammatory consequences also playing a role.The pulmonary vascular changes in COPD are characterized by thickening of the vessel wall, which begins early in the disease. Intimal thickening is the earliest structural change, followed by increased smooth muscle and inflammatory cell infiltration of the vessel wall. increased smooth muscle, proteoglycans and collagen further thicken the vessel wall in COPD exacerbations. The pathophysiological changes that are characteristic of COPD appear on top of the pulmonary pathology of COPD, including mucus hypersecretion, ciliary dysfunction, airflow limitation, lung hyperinflation, abnormal gas exchange, pulmonary hypertension, and pulmonary cardiopathy. Mucus hypersecretion and ciliary dysfunction lead to chronic cough and sputum, which can precede other symptoms and pathophysiological abnormalities. Restriction of expiratory airflow is a hallmark of pathophysiological changes in COPD and is key to the diagnosis of the disease, mainly due to fixed airway obstruction and the consequent increase in airway resistance. Disruption of alveolar attachments impairs the ability of small airways to remain open, but this plays a lesser role in airflow limitation. As COPD progresses, peripheral airway obstruction, lung parenchymal destruction, and abnormalities of the pulmonary vasculature reduce pulmonary gas exchange capacity, producing hypoxemia and later hypercapnia. Long-term chronic hypoxia can lead to extensive pulmonary vasoconstriction and pulmonary hypertension, often accompanied by intimal hyperplasia, fibrosis and occlusion of certain vessels, resulting in structural reorganization of the pulmonary circulation. The process of structural reorganization of the pulmonary vasculature may involve vascular endothelial growth factor, fibrogenic factor, and endothelin (ET)-1. Patients with chronic hypoxia-induced pulmonary hypertension have a significant increase in ET21 expression in the pulmonary vascular endothelium. Pulmonary hypertension in late COPD is an important cardiovascular complication of COPD and leads to chronic pulmonary heart disease and right heart failure, suggesting a poor prognosis; exacerbation of COPD aggravates the above pathological changes and leads to aggravation of various symptoms.
2. Chinese medicine etiology and pathogenesis
The disease evolves gradually from chronic cough and develops slowly. Those who have been ill for a long time or are old and weak are more likely to feel external evil, resulting in a worsening of the disease. The cause of the disease involves dysfunction of the internal organs and the invasion of the six evil spirits. The disease is located in the lung and involves the spleen and kidney. Normally, the deficiency is the main cause of the disease, but when the disease is repeatedly attacked by external evil, the deficiency will be mixed with reality. When the disease is prolonged, the deficiency of the lung, spleen and kidney becomes more serious and eventually leads to panting.
Clinical manifestations
The main symptoms of COPD exacerbation are shortness of breath, often accompanied by wheezing, chest tightness, increased cough, increased sputum volume, change in sputum color and/or viscosity, and fever, etc. In addition, symptoms such as general malaise, insomnia, drowsiness, fatigue, depression and mental disorders may also occur.
2. Physical signs
Early signs may not be obvious. In the early stage, the signs may not be obvious, such as hyperinflated chest, enlarged anterior and posterior diameters, restricted diaphragmatic movement, hyperclear sounds on percussion, narrowed or not easily percussive heart sounds, distant heart sounds on auscultation, generally weakened breath sounds and prolonged expiration, and dry and wet rales in both lungs when the lung infection is complicated. In the late stage, the patient’s dyspnea is aggravated, and he often adopts a forward leaning position, with the neck and shoulder auxiliary respiratory muscles participating in respiratory movement, and the breathing is often lip constriction and expiration, with cyanosis of the lips and signs of pulmonary hypertension and right ventricular hypertrophy, and even signs of right heart failure.
3.Laboratory examination and other examinations
(1) Chest X-ray examination: enlarged lung volume, increased anteroposterior diameter of the thorax, flattened ribs, thickened rib space; increased transparency of the lung field, lowered diaphragm position, narrowed heart overhang, reduced and slender vascular texture around the lung field, etc.
(2) CT examination of the chest: CT examination, especially high-resolution CT, is more sensitive and specific than ordinary chest X-ray, and it can determine lesions such as lobar central type and total lobar type, understand the size and number of pulmonary blisters, estimate the extent of emphysema in non-blistered areas, and be useful for anticipating the effect of surgical procedures. However, CT should not be used as a routine examination.
(3) Pulmonary function tests: Pulmonary function tests are important for the diagnosis of obstructive emphysema as well as for estimating its severity, disease process and prognosis. a. The first second exertional expiratory volume M exertional lung volume (FEV1/FVC) is a sensitive indicator of mild COPD, often 60% in obstructive emphysema. b. Changes in lung volume such as residual air volume (RV), increased RV/TLC (lung volume) Can also be used as an index of emphysema, RV/TLC 40% is important for the diagnosis of obstructive emphysema.
(4) Arterial blood gas examination: Arterial blood gas examination is the most objective and sensitive indicator of hypoxemia, hypercapnia and acid-base imbalance, and is also a meaningful indicator to determine the prognosis of the disease and the efficacy of treatment. Early COPD patients may show mild to moderate hypoxemia and respiratory alkalosis. As the disease progresses, in addition to hypoxemia, hypercapnia may also appear.
V. Diagnosis
(A) Key points of diagnosis in Chinese medicine.
1. Characterized by shortness of breath and shortness of breath, difficulty in breathing, or even opening the mouth and lifting the shoulders, nasal agitation, inability to lie down, and cyanosis of the lips and mouth.
2. Most of them have a history of chronic cough, croup, consumption, palpitation, etc., and are triggered by external sensation and exertion.
(B) Western medical diagnosis.
1.History of chronic bronchitis, bronchial asthma, chronic fibro-cavernous tuberculosis, pneumoconiosis, bronchiectasis and other chronic lung diseases, or seen in elderly and thin people.
2, clinical manifestations of cough, sputum, shortness of breath, dyspnea, chest tightness and other symptoms than the previous aggravation, while having emphysema signs such as barrel-shaped chest, lung percussion over clear sound, low breath sounds on auscultation.
3.X-ray examination shows increased lung volume, enhanced lung field translucency, parallel ribs, widened rib space, decreased diaphragm mobility, low flat position, and reduced heart shadow, often in vertical position.
4.Electrocardiogram examination is generally normal or shows low voltage.
5.Pulmonary function examination Increased residual air volume, decreased maximum ventilation, and decreased lung volume in the first second time.
VI. Differential diagnosis
1.Western medicine differential diagnosis
The diagnosis of obstructive pulmonary emphysema is based on a comprehensive analysis of medical history, clinical symptoms, signs, and laboratory tests. Pulmonary function tests (RV, RV/TLC) are important for determining airflow obstruction and its severity, and for the diagnosis of emphysema. Chest X-ray examination is of greater significance for the diagnosis of emphysema and for the identification of other causes of lung diseases. Arterial blood gas analysis is important for determining hypoxemia and the severity of hypoxemia, the presence of hypercapnia and acid-base imbalance.
2.Chinese medicine class evidence identification
(1) Shortness of breath
Both are respiratory abnormalities, but wheezing is characterized by difficulty in breathing, opening the mouth and lifting the shoulders, and even inability to lie down; shortness of breath is also known as less breath, weak and shallow breathing, or short breath is not enough to breathe, seemingly wheezing but silent, and inability to lift the shoulders but lying down as fast.
(2) Croup
Both croup and asthma are characterized by difficulty in breathing, but croup refers to sound, with difficulty in breathing and croup in the throat, and is an independent disease with recurrent attacks; asthma refers to breath, with difficulty in breathing without croup in the throat, and is a symptom of many acute and chronic diseases. Generally speaking, croup must be accompanied by wheezing, but wheezing may not be accompanied by croup.
VII. Treatment
(A) Western medical treatment
1.Out-of-hospital treatment
Patients with mild COPD exacerbation in the early stage can be treated outside the hospital, but special attention should be paid to the changes of the disease and the timing of hospital treatment should be decided in time. Long-term home oxygen therapy (LTOT): correcting hypoxia has an important role in COPD patients with progressive hypoxemia, and LTOT has been shown to improve the survival rate of COPD patients with chronic respiratory failure. LTOT can be performed when the respiratory failure is stable for 3-4 weeks and the partial pressure of oxygen is below 55 mmHg with or without hypercapnia.LTOT is usually performed by inhalation of oxygen through a nasal cannula at a flow rate of 1.5-2.5 L/min, and the partial pressure of oxygen is usually above 60 mmHg. The duration of oxygen inhalation should not be less than 15 hours/day. Rehabilitation therapy: Rehabilitation therapy can improve the mobility and quality of life of patients with progressive airflow obstruction and severe respiratory distress with little activity. It includes respiratory physiotherapy, muscle training, nutritional support, psychiatric treatment and education, etc.
Out-of-hospital treatment for COPD exacerbations includes increasing the amount and frequency of bronchodilators used in the past. If anticholinergics have not been used, they can be added until the disease is in remission. In more severe cases, higher doses of nebulizer therapy can be given for several days. For example, 2500 μg of salbutamol and 500 μg of ipratropium bromide, or 1000 μg of salbutamol plus 250-500 μg of ipratropium bromide by nebulized inhalation.
Systemic use of glucocorticoids is beneficial in exacerbation treatment and may accelerate remission and recovery of pulmonary function. If the patient’s basal FEV1 is less than 50% of the expected value, additional glucocorticoids, such as oral prednisolone 30-40 mg daily for 7-10 d, may be considered in addition to bronchodilators.
Antibiotics should be given when COPD symptoms worsen, especially when sputum volume increases and is purulent. The choice of antibiotics should be based on the type of common pathogens and drug sensitivity of the patient’s location.
2. Hospitalization
The main treatment methods during the exacerbation of COPD are
1. Controlled oxygen therapy: oxygen therapy is the basic treatment for COPD exacerbation patients in hospital. Patients with COPD exacerbation without serious comorbidities can easily achieve satisfactory oxygenation levels (PaO2>60mmHg or SaO2>90%) after oxygen therapy, but there is a possibility of potential CO2 retention. The route of oxygen administration includes a nasal cannula or a Venturi mask, with the Venturi mask being more precise in regulating the concentration of inhaled oxygen. Arterial blood gases should be rechecked after 30 min of oxygen therapy to confirm that oxygenation is satisfactory without causing CO2 retention or acidosis.
2. Antibiotics: When patients have increased dyspnea, cough with increased sputum and purulent sputum, antibiotics should be actively selected according to the type of common pathogens and drug sensitivity of the patient’s location. Since most acute exacerbations of COPD are induced by bacterial infections, anti-infective therapy has an important role in the treatment of COPD exacerbations.
3. Bronchodilators: Short-acting β2 agonists are more suitable for COPD exacerbation treatment. If the efficacy is not significant, it is recommended to add anticholinergic drugs. For more serious COPD exacerbations, intravenous theophylline can be considered; monitoring blood theophylline concentration is of some significance in estimating the efficacy and side effects.
4. Glucocorticoids: Inpatients with COPD exacerbation are recommended to take or use intravenous glucocorticoids on top of bronchodilators.
5. Mechanical ventilation: ① Non-invasive mechanical ventilation: the application of non-invasive positive pressure ventilation (NIPPV) in patients with acute exacerbation of COPD can reduce PaCO2 and respiratory distress, thus reducing the use of tracheal intubation and invasive mechanical ventilation, shortening the number of days of hospitalization and reducing the morbidity and mortality rate of patients. The use of NIPPV should pay attention to the reasonable operation method, avoid air leakage, gradually increase the auxiliary inspiratory pressure starting from low pressure and adopt the method that is conducive to reducing PaCO2, so as to improve the effect of NIPPV.
6. Other inpatient treatment measures: appropriate fluid and electrolyte supplementation under volume and electrolyte monitoring; attention to nutritional supplementation, gastrointestinal supplementation of elemental diet or intravenous high nutrition for those who cannot eat; consideration of heparin or low molecular heparin for patients who are bedridden, erythropoietic or dehydrated, regardless of the history of thromboembolic disease; active sputum evacuation treatment (e.g., stimulation of cough, percussion of the chest, postural drainage, etc.) (e.g., by cough stimulation, chest percussion, postural drainage, etc.); identification and treatment of concomitant diseases (coronary artery disease, diabetes mellitus, etc.) and comorbidities (shock, diffuse intravascular coagulation, upper gastrointestinal bleeding, renal insufficiency, etc.).
(B) Chinese medicine treatment
1.The main points of Chinese medicine dialectic.
(1) The first thing to do is to distinguish the deficient from the real. In real asthma, the breathing is deep and long, the exhalation is fast, the breath is coarse and high, accompanied by phlegm and cough, the pulse is strong, and the disease is urgent; in deficient asthma, the breathing is short and difficult to continue, the deep inhalation is fast, the breath is timid and low, there is little phlegm and cough, the pulse is weak or floating large and hollow, and the disease is slow and sometimes light and heavy. The disease is slow, sometimes light and sometimes heavy. It is worse in case of exertion.
(2) Actual asthma should be identified with external sensation and internal injury. External sensation has a rapid onset and short duration, often due to external wind-cold or wind-heat, mostly due to superficial evidence; internal injury has a longer duration or recurrent attacks, often due to phlegm obstructing the lung or liver qi rebellious to the lung, without superficial evidence, and with phlegm symptoms such as chest tightness, cavernous gangrene and phlegm, or liver qi stagnation such as emotional stimulation and choking in the throat.
(3) Deficiency wheezing should be identified with the lesion organs Lung deficiency is short of breath after exertion, wheezing is lighter, often accompanied by s white face, spontaneous sweating, easy to catch a cold; kidney deficiency also has wheezing at rest, even more so when moving, accompanied by pale face, red cheek, fear of cold, waist and knee weakness; heart qi, heart yang weakness, wheezing persists, accompanied by cyanosis, palpitation, swelling, pulse knot generation.
2.Analysis of evidence
(1) External cold and internal drinking evidence
Symptoms: cough, runny nose, shortness of breath, sound of phlegm in the throat, white and thin phlegm, chest tightness and suffocation, obscure face, mouth not thirsty, or like warm drinks. Pale tongue, thin white coating, smooth pulse, floating and tight pulse or tight strings.
Treatment: Dispersing cold and warming the lung to dissolve drinks.
Formula: Xiao Qing Long Tang with addition and subtraction.
Ephedra 9g Gui Zhi 9g Hosin 3g Dried Ginger 6g
Radix Panax notoginseng 9g White peony 9g Wu Wei Zi 6g Roasted licorice 6g, etc.
Proprietary Chinese medicine: external cold and internal drinking evidence can be used Xiao Qing Long granules, cough and asthma six flavor combination.
Moxibustion: Acupuncture points: Tanzhong and Hegu, three strokes each time, once a day, seven days as a course of treatment.
Evaluation of efficacy: Patients with mild symptoms in this stage have better effect of Chinese medicine treatment, which can make patients’ condition reversed rapidly and is the key stage to improve the overall efficacy.
(2) Phlegm blockage evidence
Symptoms: coughing and wheezing, sputum and saliva, fullness in the chest, shortness of breath, inability to lie down, and painful suffocation in the heart and chest. With tiredness and fatigue, mucous mouth and dullness, nausea and loose stools, white and greasy coating, slippery pulse.
Treatment: Drain turbidity, expel phlegm and open knots.
Formula: Broadening the chest and regulating the lung.
Radix Pseudostellariae 15g, Poria 15g, Psidium guajava 30g, Allium cepa 12g
Almond 12g Chen Pi 12g Peach kernel 12g Di Long 12g
Ephedra 9g Glycyrrhiza glabra 6g.
Chinese patent medicine: Spleen qi deficiency can be used to supplement Zhong Yi Qi pill or Huang Qi granules, kidney deficiency can be used to Jin Shui Bao.
Injections: For spleen qi deficiency, Astragalus injection can be used for sedation. Spleen and kidney yang deficiency can be used to asthma can cure injection intramuscular injection.
Moxibustion: Acupuncture points: foot three li and spleen yu, three strokes each time, once a day, seven days as a course of treatment.
Evaluation of therapeutic efficacy: Good clinical efficacy was achieved in the treatment of this evidence by using Kuaguaguaguo Allium and Allium soup as the main composition of the broad chest and lung treatment. It has obvious effects of suppressing cough, resolving phlegm and calming asthma, improving pulmonary ventilation, improving hypoxemia and reducing pulmonary arterial hypertension.
(3) Evidence of phlegm-heat congestion in the lung
Symptoms: coughing with shortness of breath and shortness of breath, yellow and thick sputum that is not easily discharged, chest fullness and irritability, distended eyes, dry mouth and thirst for drinking, yellow urine and dry stool. The tongue is red, with yellowish greasy coating or no coating, and the pulse is smooth and counted.
Treatment: Clearing heat and detoxifying toxins, resolving phlegm and calming asthma.
Prescription: Ma Heng Shi Gan Tang with Qian Jin Wei Zhi Tang, plus or minus.
Ephedra 6g, almond 9g, gypsum 24g, licorice 6g
Reed Stem 60g, Coix Seed 30g, Dong Gua Ren 24g, Peach kernel 9g, etc.
Proprietary Chinese medicine: phlegm-heat congestion in the lung can be used in ten flavors of gentian flower capsules, golden buckwheat tablets, and Beixiang capsule. If the cough and phlegm are thick and the stool is constipated, Pores and Pores Pill can be used.
Injections: phlegm-heat congestion lung evidence can be used punctuate injection, phlegm-heat clear injection, fishy grass injection.
Ultrasonic nebulization: fishy grass injection, fresh bamboo leech oral solution ultrasonic nebulization, and oxygen-driven inhalation.
Moxibustion: Acupuncture points: Tanzhong and Dazhi, three strokes each time, once a day, seven days as a course of treatment.
Assessment of efficacy: Infection is an important causative agent of AECOPD. As seen clinically, patients in this stage often present with phlegm and heat in the lung, which is caused by volatile phlegm and heat, and is related to infection. Clearing heat and detoxifying phlegm is an important treatment for this stage.
(4) Pulmonary Qi Stagnation and Closure Evidence
Symptoms: Often triggered by emotional stimulation, with sudden onset of shortness of breath, coarse breath, chest tightness and choking in the throat, but with little or no phlegm sound in the throat. Usually, the patient is worried and depressed, with insomnia and palpitations. Thin coating and string pulse.
Treatment: To open depression, subdue Qi and calm asthma.
Remedy: Wu Mao Drinking Zi with addition and subtraction.
Mu Xiang 6g Shen Xiang 6g (later down) Betel nut 9g Citrus aurantium 9g Tai Wu Yao 9g, etc.
Prepared Chinese medicines: for those whose attacks are related to emotion, take Chai Hu and Liver Pill; for those who also have cold symptoms, take Tong Xuan Li Lung Pill; for those who have more phlegm, take Zhu Li and Phlegm Pill.
Moxibustion: Acupuncture points: Liver Yu and Tanzhong, three strokes each time, once a day, seven days as a course of treatment.
Evaluation of efficacy: Patients with this type of disease often suffer from lung qi stagnation due to emotional and mental disorders, worry and qi stagnation, and unfavorable qi flow, so keeping a cheerful mood to cooperate with treatment can reduce recurrence and improve the efficacy.
(5) Phlegm stasis blocking the lung
Symptoms: coughing and coughing with sputum, shortness of breath, rebellious phlegm, stuffiness in the chest, blue and purple lips and nails, lumpiness under the dorsum, dull face, blue and purple lips and nails, purple and dark tongue, cloudy coating, slippery pulse.
Treatment: Removing phlegm and eliminating blood stasis
Formula: Peach-Hong Siwu Tang combined with Scape Drabble and Jujube Diarrhea Lung Soup, plus or minus.
Radix Angelicae Sinensis 12g, Radix Paeoniae Alba 12g, Radix Rehmanniae Praeparata 9g, Rhizoma Ligustici Chuanxiong 12g
Peach kernel 15g, safflower 15g, scape seed 9g, jujube 4.
Chinese patent medicines: Chuanxiong Ligusticum and Piangyu Combination can be used for those with phlegm and stasis obstructing the lung; Blood stasis can be added to Blood Mansions and Stasis Granules for those with heavy blood stasis.
Injections: Bitter Dish Injection and Calendula Officinalis Injection can be used for intravenous injection.
Moxibustion: Take acupuncture points: Foot San Li and Kidney Yu, three strokes each time, once a day, seven days as a course of treatment.
Evaluation of efficacy: As important pathological factors of COPD, phlegm and stasis often interact with each other, creating mutual support and making it difficult to resolve. For COPD patients with heat symptoms, sticky phlegm that cannot be removed, especially in the acute exacerbation stage, the addition of blood-vitalizing and stasis-transforming herbs or Chinese medicine can significantly improve the efficacy and prognosis of patients on the basis of conventional treatment.
(6) Phlegm-heat clouding the orifice
Symptoms: coughing and shortness of breath, confusion, restlessness, empty lines, indifferent expression, drowsiness, coma, dark red tongue, white or yellowish greasy coating, thin and slippery pulse.
Treatment: Clearing heat, eliminating phlegm and opening the orifice
Formula: Clearing phlegm and removing phlegm with addition and subtraction.
Radix Panax notoginseng 12g, Poria 12g, Bile Yellow Star 10g, Chen Pi 12g
Citrus aurantium 10g, Acorus calamus 12g, Bamboo Roo 10g, etc.
Proprietary Chinese medicine: An Gong Niu Huang Wan can be used.
Injections: can be used to wake up the brain Jing or Qing Kai Ling injection intravenously.
Enema: can use Da Cheng Qi Tang with flavor to retain the enema.
Recipe: Rhubarb 15g, Mangosteen 10g (punch), Citrus aurantium 30g, Houpao 30g
Scutellaria 15g Fritillaria 30g.
Moxibustion: Acupuncture points: Yongquan and Guangyuan, three strokes each time, once a day, seven days as a course of treatment.
Evaluation of efficacy: This type of evidence is critical, mostly seen in patients with pulmonary encephalopathy, which has a poor prognosis if not controlled in time, and should be actively treated. The TCM method of clearing heat, cleaning phlegm and opening the orifice can promote the absorption of inflammation and the discharge of phlegm.
(7) Yang deficiency and water flooding
Symptoms: shortness of breath, upward flow of phlegm and saliva, inability to lie down, wheezing and coughing are worse when moving, palpitations, shortness of breath, restlessness, swelling of the limbs with little urination, cold extremities, abdominal distension, ashen face, blue lips, fat tongue with tooth marks on the side, white fur, sunken and slippery pulse.
Treatment: Warming Yang and inducing diuresis.
Formula: Zhen Wu Tang plus or minus.
Fu Ling 30g, Paeonia lactiflora 9g, Atractylodes macrocephala 6g, Ginger 9g
Gunnison 15g, Semen scabra 30g, Dilaemon 9g, Jujube 15g
Traditional Chinese medicine: For Yang deficiency and watery evidence, Jin Kui Kidney Qi Pill or Jisheng Kidney Qi Pill can be used.
Injection: Intravenous injection of Ginseng and Radix et Rhizoma.
Moxibustion: Acupuncture points: Spleen Yu, Sanyinjiao, Guan Yuan, three strokes each time, once a day, seven days as a course of treatment.
Assessment of efficacy: COPD patients with right heart failure complicated by pulmonary heart disease are mostly manifested by Yang deficiency and water flooding, and the treatment of warming Yang and promoting water is mostly effective.
IX. Prognosis
With the development of the disease, a variety of complications may occur, such as respiratory failure or chronic pulmonary heart disease, heart failure, etc. The prognosis is poor.
Prevention and care
1. Educate or persuade patients to quit smoking. Pay attention to climate change, prevent the occurrence of colds, influenza and chronic bronchitis.
2, diet, eat less meat and fatty, spicy food, but also careful living, smooth mood, appropriate labor and escape, avoid cold and heat.