Treatment of cough variant asthma

  Cough variant asthma (CVA), also known as cryptogenic asthma or cough asthma, is a special type of asthma with cough as the main clinical manifestation. However, in clinical practice, we have observed a type of cough that is different from wind-cold, wind-heat, or wind-dryness, but is merely a cough with a calm nature and has the characteristics of wind evidence, and has been treated from the perspective of wind, with good results. The disease is characterized by long-lasting coughing bouts, itchy pharynx, sudden onset and sudden cessation, continuous coughing, shortness of breath, no or little sputum, discomfort in the throat, thin white coating, and floating pulse, which is similar to wind evidence, hence the name “wind cough”. Tracing the origin of the cough, the Book of Rites contains that “the country has a lot of wind coughs in the summer season when the spring order …… is in force”, and the Treatise on the Origin of Diseases elaborates on the ten coughs, “one is wind cough, which is a cough that wants to speak, but cannot speak at all”. Subsequent prescriptions are cold cough, branch cough, liver cough, heart cough, spleen cough, lung cough, etc.; in later times, Ming? Qin Jingming’s “The Cure of Symptoms and Pulses” also states that “coughing with wind is a type of cough, also known as wind cough.”  ”Wind cough” is mainly a cough, mostly without or with little phlegm. The dry cough may come on suddenly, with bouts of coughing, staccato coughing, or even choking coughing. It can also be an irritating, contracted cough that is difficult to suppress, or accompanied by nasal congestion, runny nose, nasal itch or pharyngeal itch. The itch triggers a cough that does not stop; it is also triggered by allergic factors, such as cold air, fumes, odors, and dirty air, and there is airway hyperreactivity. In the context of current Western studies, the term “wind cough” is linked to the names of cough variant asthma, post-infectious cough and allergic cough.  According to Western medicine, CVA has no obvious symptoms or signs such as wheezing, shortness of breath, or asthma, but has airway hyperresponsiveness, mainly manifested as an irritating dry cough, mainly at night. Cold, cold air, dust and fumes can easily trigger or aggravate the cough, and treatment is based on glucocorticoids combined with bronchodilators.  In Chinese medicine, there is a saying that “the doctor is also the mind.” It refers to a kind of thinking that is not fixed; similarly, there are no gateways to medicine, so we should strengthen our knowledge base with an open and tolerant mind, which may have the effect of “magic. Any medicine must be accumulated in practice, medical academic theory development is not independent, the current Chinese medicine absorb modern medical testing means is very necessary, which can not only deepen the understanding of disease, physical and chemical testing indicators can be used as an extension of the four diagnosis of Chinese medicine, but also for Chinese medicine diagnosis and treatment to provide an objective basis for reference, which is conducive to summarize and discuss the laws of Chinese medicine diagnosis and treatment.  This is like proofreading books, the more editions you can refer to, the more credible the proofreading will be. When studying ancient literature, Western medicine can also be used as a kind of “proofread version”. We can draw on the pathophysiology and physiology of asthma in Western medicine and the treatment rules of dermatology in Chinese medicine to summarize the treatment of the disease mechanism of the wind evil offending the lungs.  According to him, the main symptoms of the disease are paroxysmal cough, itchy throat, and shortness of breath, which are characterized by paroxysmal and spasmodic attacks, often with sudden onset and abrupt cessation, reflecting the characteristics of “wind evil as a disease is good at moving and changing several times” and “when the wind is strong, the contracture is rapid”. “The wind evil offends the lung, the lung qi is not pronounced, and the airway is contracted” is the core pathogenesis of the disease, so the treatment should be based on the wind, and the treatment method of “draining the wind and pronouncing the lung, slowing down and stopping the cough” was formulated.  The Su Wen – Tai Yin Yang Ming Lunar History says: “Those who are injured by wind, the upper part will suffer first.” This disease often has a history of external sensation, and the symptoms of external sensation are relieved, but the cough is difficult to be cured, because the wind evil has attacked the lungs. The disease is characterized by early morning and nocturnal exacerbations, as stated in Ling Shu? Wind Theory says: “The symptoms of lung wind are sweating and evil wind …… coughing and shortness of breath on Sundays, but even at curtains.”  Itch is another main symptom of this disease, the throat itch is cough, difficult to suppress, reflecting the characteristics of “wind evil can cause itching”. The disease is often triggered by allergic factors, which is caused by the wind evil offending the lung, the loss of lung health, and the invasion of external evil. At the same time, most patients also suffer from allergic rhinitis, eczema, etc., or allergic constitution, and the severity of symptoms often progresses with the degree and severity of coughing attacks, so Chinese medicine mostly treats such allergic diseases from the wind, which also supports that the attacks of this disease are related to wind.  The disease is recurrent, sometimes mild and sometimes severe, and aggravated by triggers or in spring and winter. The attack of this disease is characterized by paroxysmal cough, shortness of breath, and itchy throat, so it is necessary to “dredge the wind and promote the lung to relieve the cough”. Wind is the longest of all diseases”, as stated in the “Clinical Guide to Medicine”, “If the disease is caused by wind, treat it with pungency and calmness; if it is caused by cold, treat it with pungency and warmth”.  However, it is also common to have cold and hot and dry evils, and there are differences in the patient’s constitution, so the treatment should follow the evidence according to the manifestations of the concurrent evidence. For example, in cases of wind and heat, if the pharynx is itchy and a little mucous sputum is not easy to get out, or if a small amount of yellow sputum is coughing, add a little clearing medicine as appropriate; in cases of cold, if a little sputum is coughing sharply in cold wind and the pharynx is itchy, add the right amount of pungent and warm products; in cases of dryness, if the pharynx is dry and little sputum is coughing, or if the intestines are dry and the stool is dry, it is appropriate to add products that nourish yin and generate fluid. Because the disease is difficult to stop coughing and itching at the slightest stimulus, “urgency is to treat the symptoms”, and slow astringency can yield miraculous results; repeated coughing is a long-standing disease that enters the ligaments, and blood needs to be activated, “gold and water are related to each other”, and coughing for a long time and the kidneys, “slow is to treat the root The “gold and water are in symbiosis” and cough is long-standing and affects the kidneys.  The sage Wu Jutong “treats the upper jiao like a feather, not lightly but not lifted”, using medicine to emphasize the lightness of the spirit to promote movement, and strive to take advantage of the situation to regulate the lung qi and drive away external evil, so that the lung’s propagation and suction function can be restored, and the disease will heal itself. He has also refined and summarized the following recipes for cough relief: roasted ephedra, almonds, aster, soursop, sophora, burdock, roasted loosestrife, prehnum, dilaemon, cicada, white peony and schisandra. On the basis of this formula, we also directed the development of “Su Huang Cough Capsules”.  In this formula, Ephedra and Dilong are both holy medicines for cough and asthma, one is warm and the other cold, one promotes and the other descends, complementing each other; Cicadella is light and floating, entering the lung and liver meridians, so it is combined with the previous medicine to enhance the dispersal of internal wind; Dilong and Cicadella are used together to enhance the antispasmodic effect; Su Zi descends Qi, Su Ye disperses wind, the combination of the two medicines disperses in the descending; Burdock stops coughing and relieves itching; “The lung wants to be collected, eat acid to collect it urgently “, Wu Wei Zi and Bai Shao, sour and sweet, transform yin, moisten the lung and stop cough, can ease the high reaction state of the airway.  The combination of sour and astringent herbs with pungent and dispersing herbs can not only avoid the disadvantage of astringent but also restrain the dryness of pungent and warm, one dispersing and one astringent, which are opposite to each other.  At the same time, “treating in accordance with its nature” means that cough is a reaction of the organism to expel evil from the outside, so it is advisable not to just stop it but to help it in accordance with its nature. The organism drives the evil outside and strives too much, the airway is contracted, so a little acid astringency is added to suppress its surplus.  Secondly, wind tends to be accompanied by cold, and cold closes the lung, so the treatment should be pungent and warm. Therefore, even if heat is seen, the lung should not be cleared too much to prevent the cold from curbing the lung.  Furthermore, the dry cough of this disease is not a result of the injury to the lung, but a result of the loss of propagation of the lung. However, wind is a yang evil, and it hurts yin over time, so you can add nourishing yin and generating fluids at your discretion. There are also patients with phlegm cough, do not focus on phlegm, because phlegm for the symptoms, but the original in the wind, the lung loss of propagation, cough into phlegm, can add pungent, propagation of wind and cold, the lung again propagation, phlegm since also removed.  The prescription for this disease is a dynamic balance between dispersing and collecting, ascending and descending, warming and clearing, with a pungent and flat period. The deep meaning of this, need to taste carefully, deep thought to understand, in order to apply flexibly, the effect is like rafter, can learn and nurture both here, then is everyone method.