Dr. Zhou Pingan on “Treating interstitial lung fibrosis from lung paralysis”

The name of lung paralysis originated in the Nei Jing. There are five articles on this disease in the Nei Jing, including a study of the etiology and pathogenesis, a diagnostic study, and a list of pulse evidence, with different emphases. In the “Su Wen – Theory of Paralysis”, it is said: “All five organs have a combination, and those who have been ill for a long time and do not go away, are internally surrendered to their combination. …… skin paralysis has not been, and again feel in the evil, within the lungs, the so-called paralysis, each to its time heavy feeling in the wind, cold and wet gas.” And also cloud: “Where the paralysis of the five viscera, lung paralysis is annoying full panting and vomiting. …… panting, paralysis gathered in the lungs.” “Su Wen・Yu Ji true organ theory”: “wind and cold guest in people, so that people hair straight, the skin closed and for heat, when it is, can sweat and hair, or paralysis is not benevolent swelling pain, when it is, can soup iron and fire moxibustion stab and go to the, not treatment, the disease into the house in the lungs, called lung paralysis, hair cough on the gas.” “Su Wen – five organs generated”: “white, the pulse of the to also, wheezing and floating, the upper deficiency, the lower real, alarm, there is a buildup of gas in the chest, wheezing and deficiency, called lung paralysis, cold and heat, get drunk and make the internal.” Su Wen – the four times of the thorns from the theory: “Shao Yin has a surplus, sick skin paralysis vague rash, insufficient, sick lung paralysis.” Ling Shu – the form of the disease of the internal organs of evil qi: “slightly large, for lung paralysis, leading to the back of the chest, from the evil to see daylight.” Throughout the above, lung paralysis is one of the paralysis of the internal organs, and is a serious disease in paralysis. The skin is not healthy, so it is not benevolent. (The lung is the master of the skin, and the skin paralysis does not stop when it is heavily affected by wind, cold, and dampness, which is internally stored in the lung, resulting in lung paralysis. The symptoms are: irritability, fullness, panting, vomiting, wheezing, panting upward, leading to the back of the chest, and seeing the sunlight with evil, with a floating, slightly large pulse. The pathogenesis emphasizes the accumulation of Qi in the chest, and the nature of the disease is deficiency, which is related to the deficiency of Shaoyin kidney in addition to the disease of the organ itself. Many interpretations of the etiology and pathogenesis of lung paralysis in the Nei Jing have been made in later times. Wang Bing said: “The foot Shaoyin vein from the kidney through the liver into the lungs, so …… deficiency disease lung paralysis also.” The Classics” that “its cause drunk to enter the room …… kidney deficiency son steal mother’s gas.” All of them are following the text to note the scriptures. The majority of clinical doctors have made new interpretations of lung paralysis from clinical practice. The “symptoms of pulse treatment” said: “the cause of lung paralysis, or form cold limbs cold, or form hot drinking heat, the lung for the Huagai, evil heat and cold, or sadness and moving in the lung damage, and the lung paralysis of the disease is made.” The “in the Tibetan Classic” is said: “paralysis, wind, cold, summer and dampness in the human viscera is also. …… wind, cold, summer and dampness into the lungs, it is called gas paralysis. Gas paralysis, worry, thought, joy and anger too much, then the gas is knotted in the upper, long and does not disappear then hurt the lungs, lung injury is angry gradually decline, then the evil day win.” It is believed that the focus of the pathogenesis of lung paralysis lies in qi. The “Identification Record” further points out that: “Lung paralysis is caused by a deficiency in the gas exhausted people and do not know it, the lungs are the official of the phase Fu, ruling the section out of the place, governing the whole body of the gas, …… is the gas is the lung full, not the lung is the main gas, lung disease is the gas disease, … … …but lung paralysis is qi paralysis as well. …… The lung is injured, and the wind, cold and damp evils fill the lung orifices and become paralysis.” The meaning of “Paralysis” is explained in the book “The so-called paralysis is caused by the wind, cold and dampness. Luo Mei added cloud: “Where the seven emotions overuse, it can also hurt the dirty gas and paralysis, without the three gas into the house in its combination. So it is, the yin gas is quiet, the gods hide, mania is extinct, so the gas does not feed and rebellious panting, it is paralysis in the lungs.” Shen Jinao said: “paralysis both into the lungs, then the organs paralysis and impassable.” It is believed that paralysis of the internal organs is the main cause of lung paralysis. Wang Yuguang of the Department of Respiratory Medicine, Beijing Hospital of Traditional Chinese Medicine, based on a search of ancient treatises on lung paralysis, the author collected the treatment rule because “clear evil in the upper, must use light clear gas medicine, such as bitter cold treatment in the lower, the upper knot more closed”, so “all drugs are always about light and floating, without heavy turbid smell, … … …suitable for the treatment of light and clear delicate organs”. He emphasized the use of mildly pungent to open and mildly bitter to descend, and believed that it was advisable to use bitterness and pungency to open the blockage of lung paralysis and lung qi. He made good use of Reed Stem Soup, Scape Drabble and Jujube Diarrhea Lung Soup, and Diabai San to treat lung paralysis. The symptoms of lung paralysis are characterized by a mixture of deficiency and actuality, with the disease being characterized by a deficiency of the lung qi, and the symptoms being characterized by a depression of the lung qi in the upper jiao. However, the symptoms described clinically by various schools vary and are easily confused with those of other diseases of the lung system. Xu Lingyue had a negative opinion on Ye’s single discipline of pulmonary paralysis: “The symptoms listed are only wheezing and coughing, and it is unnecessary to establish a separate discipline of pulmonary paralysis”. However, this paper argues that the Nei Jing first advocates lung paralysis and explicitly states that those who have paralysis in their organs will die, indicating that lung paralysis has a poor prognosis and is not a common external cough and wheeze, but is also different from other lung diseases such as asthma, wheezing, lung distension, and branch drinking, in which coughing and wheezing are the main symptoms, and has its own etiology and prognosis. The “class evidence of treatment” said: “all paralysis …… good by the Ying Wei first deficiency, the coup is not dense, wind, cold and moisture take advantage of the weakness of the internal attack, the right qi is blocked by the evil and can not declare the line, and thus stay stagnant, blood and gas stagnation, long and become paralysis.” Paralysis, also closed, wind, cold and damp three gas mixed to, congestion of the meridians, qi and blood can not and disease for paralysis. Therefore, the essence of the pathology of paralysis of the internal organs should also be the stagnation of qi and blood. The pathogenesis of visceral paralysis should be due to deficiency, deficiency is the combination of its external paralysis for a long time, resulting in the deficiency of dirty qi, or the deficiency of the visceral self, in the role of external six sexes, diet and seven emotions and other pathogenic factors dysfunction, qi stagnation, blood and blood circulation coagulation and become paralysis. In the case of pulmonary paralysis, deficiency of lung qi is the root of the disease, with qi deficiency, qi stagnation, qi deficiency and blood stasis, qi stagnation and blood stasis, occlusion of blood vessels and channels, and phlegm, dampness and heat obstruction, leading to the continuous development of visceral paralysis. The author reviewed the literature on the deficiency of Qi in the chest and the deficiency of Qi in the clouds and concluded that the deficiency of Qi in the chest or the deficiency of Qi in the clouds is the initial and central link in the pathogenesis of pulmonary paralysis. The Qi gathered in the chest is called Zong Qi, which is also known as Tan Zhong, also known as the Sea of Qi. Zong Qi is mainly composed of natural clear Qi and water and grain clear Qi, while lung Qi is one of the main components of Zong Qi. The lung qi is the main component of the lung qi. The lung qi drives the respiratory function of the lung and travels up the respiratory tract, throat and nose, and the respiratory function of the lung, as well as the strength of speech, voice and breathing, are all related to the strength and weakness of the lung qi. Read the medical essays: “the zong qi, moving qi, where breathing, speech and voice, as well as the movement of the body, the strength of the tendons, the function of the zong qi.” The medical discipline law Ming・Identify the method of breath also said: “breath out of the nose, the gas is distributed in the Tan, Tan in the main airway …… or clear or Xu, or short or rapid, salty enough to account for the strength and weakness of the gas.” Therefore, shortness of breath, shortness of breath, especially when moving is short of breath is treating lung paralysis prescriptions nearly 20, the flavor of the medicine up to about 70, the number of drugs to appear in order are: ginseng, atractylodes, licorice, half asia, loquat leaves, cinnamon, Chen Pi, Poria. Seven of the prescriptions use blood activators such as angelica, chuanxiong, and yujin. In the treatment of pulmonary paralysis, the ancients paid attention to invigorating the Blood while benefiting the Qi. In the above-mentioned medical schools, the symptoms and signs of pulmonary paralysis did not go beyond the scope of the Nei Jing, and they were appended to the scope of paralysis, which was described in the treatment of paralysis of the internal organs. The most detailed discussion of this disease is found in the Clinical Guide to Medicine, which establishes pulmonary paralysis as a separate discipline, adjacent to and alongside croup, asthma, cough, and pulmonary impotence. Ye’s lung paralysis case 16, the cause of the disease is divided into external and internal injury two ends: “the six sexes of the gas, one has a touch, that can cure the disease, …… the most fear of wind and fire, the evil is the loss of its clear and sober descending order, so the paralysis is not clear carry on”; can also be due to “get the sorrow of The lungs are affected by the disease, the upper jiao is not working, the lower cavity is not accessible, and the surrounding qi is blocked”, resulting in lung paralysis. In terms of symptomatology, there are mild symptoms such as chest constipation, cough, phlegm, cold and fever, and dangerous and acute symptoms such as wheezing when lying down, dry nasal orifices, moaning and breathing, syncope due to up and down interruptions, and no sound from stagnation of Qi, as well as paralysis pain, and painful external symptoms when the muscles are seated. It is worth noting that in addition to the pulmonary symptoms, the case also contains details of the accompanying gastrointestinal symptoms, such as distension in the epigastric region, distension of the stomach, distension of the grain, distension of the abdomen, belching without spreading, and erratic rebellion, which corresponds to the Neijing’s “annoying fullness, panting and vomiting”. The treatment reflects the deficiency of Zong Qi. Zong Qi travels through the Heart Vessel and moves Qi and blood, that is, “Zong Qi accumulates in the chest, comes out of the throat, and travels through the Heart Vessel and moves the breath,” as stated in “Ling Shu – Evil Guest”. It is the central link between the respiration of the lungs and the blood vessels of the heart, and helps the heart to move the blood. Insufficient zong qi can’t help the heart to move the blood, and then the blood will stagnate. As stated in “The Spiritual Pivot: The True Evil of the Stabbing Section”, “If the vital energy does not stop, the blood in the veins stagnates and stagnates.” It manifests as palpitations and shortness of breath, ashen, cyanotic face, blue tongue with petechiae and large floating pulse. The “Keizhong Ginseng Xilu” expressly states that the atmosphere in the chest is the zong qi, and that the atmosphere in the chest is trapped: “The shortness of breath is not enough to rest, or the breath will stop, not in a moment, and its concurrent evidence …… or full of boredom and anxiety …… its pulse is sluggish and weak. ” It is very similar to the “Clinical Guide to Medical Cases” Lung Paralysis Dangerous Evidence. The lung is not able to promote the function of the main qi, the main section, the lung is depressed and paralyzed, the water cannot be regulated, phlegm and blood stagnation is stored in the lung, the lung is closed more sharply, the lung body is damaged, the lung is not in charge, the toxins are stopped inside, the lung’s organs are really decayed, the development of asthma, syncope. In this paper, we believe that lung paralysis may mainly include interstitial lung fibrosis in modern medicine. Interstitial pulmonary fibrosis is a restrictive type of ventilatory dysfunction disease, and the epidemiology, pathology, symptoms, signs and prognosis of this group of diseases are significantly different from those of obstructive ventilatory dysfunction diseases such as chronic obstructive pulmonary disease, which are mainly characterized by locomotor dyspnea, shallow and rapid breathing, shortness of breath on movement, dry cough, wheezing and cyanosis, including idiopathic interstitial pulmonary fibrosis and interstitial pulmonary fibrosis secondary to certain autoimmune system diseases, The prognosis is poor, especially in idiopathic interstitial pulmonary fibrosis. Interstitial fibrosis secondary to scleroderma is similar to pulmonary paralysis due to dermatological paralysis, while idiopathic interstitial fibrosis is comparable to auto-paralysis. Interstitial fibrosis is characterized by shortness of breath, shallow and rapid breathing, and restrictive ventilatory dysfunction. The decrease in total lung volume, spirometry, and functional residual air volume in pulmonary function tests should be the essence of pulmonary paralysis and deficiency of Qi. The pathological changes of pulmonary capillary endothelial cells and pulmonary arterioles, which are the main components of the pulmonary interstitium, also indicate the intrinsic connection with the pathogenesis of pulmonary ligament paralysis. The pathological changes of pulmonary interstitial fibrosis from the perspective of Chinese medicine and pulmonary paralysis from the perspective of Western medicine have remarkable consistency in terms of etiology, pathomechanism, syndromic features, and prognosis. Therefore, as an independent disease, pulmonary paralysis is considered to be comparable to interstitial lung fibrosis in this paper. As for its treatment, it should be different from common cough and asthma. The author believes that the treatment should be based on the root of the disease. If there is a deficiency of Qi and the atmosphere in the chest is sunken, then the atmosphere should be replenished, and if the veins are blocked, then the blood should be invigorated to open the channels. As for qi blockage, it is appropriate to start with Ye Tianshi’s slight bitterness to promote and subdue, and slight pungency to open up, while the dampness, heat, phlegm and turbidity in the symptoms should be treated on the basis of promoting qi flow. The formula is based on the principle of promoting and clearing the qi flow.