Acute bronchitis is an acute infectious inflammation of the bronchial tubes. All pathogens that can cause upper respiratory tract infections can cause bronchitis, often on the basis of viral infections, followed by bacterial infections. The most common viruses are rhinovirus, adenovirus, influenza virus, and parainfluenza virus, and the bacteria that cause acute bronchitis are often oropharyngeal commensal bacteria. Bacteria are prone to cause acute bronchitis in subnormal populations. Streptococcus pneumoniae, Haemophilus, Moraxella mucosae, and Bacillus pertussis are the most common pathogens. The disease is a common and frequent clinical disease with an acute onset and mild systemic symptoms, mild chills, fever, headache and generalized aches and pains, which can subside in 3~5d. Respiratory symptoms include nasal congestion, sneezing, runny nose, sore throat, hoarseness, and cough with yellow or white sputum. The cough is mainly irritating dry cough with a little mucous sputum, which may turn into mucopurulent sputum in 1-2 d. In severe cases, the cough lasts all day, often for several weeks, and sometimes there may be shortness of breath, chest tightness, chest pain, etc. 50% of patients have cough for more than 3 weeks, and 25% of patients have cough for more than 1 month. Signs: bronchial breath sounds can be heard on local auscultation, and there is a lamellar hyperdense shadow on Monk’s X-ray; the total leukocyte count or neutrophilia is elevated in the terminal blood. Sputum culture cannot differentiate viral from bacterial bronchitis. 85% of patients with acute bronchitis will recover on their own without any treatment. Antibiotics are only effective in some patients, and most patients with acute bronchitis do not require antibiotic therapy. Zhao Lancai, Department of Infectious Diseases, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine
[Identification and treatment].
There is no name for acute bronchitis in ancient Chinese medical texts, but according to clinical manifestations, it can be classified as “cough with external sensation” and “wind-warm lung fever”. The cause of the disease is the invasion of the body by six evil spirits, the external evil enters through the mouth and nose and is shed internally in the lungs, the lungs are the five viscera, the upper part of the throat, the opening of the nose, the division of respiration, the outer part of the skin and hair, and the direct integration with the outside world. If a person with Yang deficiency feels wind-cold or summer dampness, the evil is transformed from cold into phlegm-dampness blocking the lung. Chinese medicine typology: can be divided into wind-cold attacking the lung, wind-heat offending the lung, wind-dry injuring the lung, phlegm-heat congestion of the lung, and phlegm-damp obstructing the lung.
1 Wind-cold attacking the lung: heavy vicious cold, light fever (below 38℃) or no fever, heavy nasal congestion, clear runny nose, headache, aching limbs, pale tongue with white fur, floating or tight pulse. Most often occur in winter and spring, patients are mostly due to extreme fatigue, while feeling wind and cold caused by the treatment: dredge the wind to disperse cold, promote the lung to stop the cough, the formula used to stop the cough San plus or minus, thorny mustard, Qian Hu, Bai Qian, almonds, Chen Pi, sizzling Bai Bie, orris, sizzling licorice.
2 Wind-heat offending the lung: good occurrence in spring, summer and autumn, heavy fever, frequent and violent cough, high-pitched cough, or hoarse cough, yellow thick and sticky sputum, sweating when coughing, red and painful moths, dry and painful throat, yellow runny nose, thirst, headache, vicious wind, red tongue with thin yellow coating, floating pulse, treatment: dredge the wind and clear heat, promote the lung to resolve phlegm, formula with Sang Ju Drink plus or minus, mulberry leaf, chrysanthemum, orris, almonds, forsythia, rhizome, mint, raw licorice, goldenrod. Mint, raw licorice, and honeysuckle.
3 Wind-dry lung injury: dry cough, choking, itchy throat, dry and painful throat, dry lips and nose, no sputum or little sputum and sticky filaments, not easy to cough out, or sputum with blood, dry mouth, or accompanied by nasal congestion and headache, body heat, thin white tongue coating, red tongue texture, floating pulse. Treatment: Drain wind and clear the lung, moisten dryness and stop cough. The formula uses Mulberry leaf, almond, Zha Bei Mu, Sha Shen, Mountain Gardenia, Zhi Mu, Pear skin, and Lu Gen.
4 Phlegm-heat congestion of the lung; cough with coarse breath, thick or thick yellow sputum, unpleasant coughing and vomiting, or blood in the sputum, body heat, face redness, dry mouth and desire to drink, red tongue, thin yellowish greasy tongue coating, and slippery pulse. Treatment: Clearing heat and resolving phlegm to purge the lung. The formula is based on Qing Jin Hua Phlegm Tang with addition and subtraction of Scutellaria baicalensis, Gardenia jasminoides, Radix Platycodon, Macrocephalae, Morinda citrifoliae, Zha Bei Mu, Zhi Mu, Juniperus chinensis, Orange Red, Poria, Gypsum and Licorice.
5 Phlegm-dampness obstructing the lung: cough with heavy turbidity, thick white or grayish sputum, nasal congestion and pharyngeal itching, chest tightness and abdominal constipation, light or light red tongue, thin white greasy moss, and slippery pulse. Treatment: Promote the lung to stop coughing, resolve phlegm and dry dampness, select the formula of Sanjiao Tang and Er Chen Tang with addition and subtraction of ephedra, almonds, licorice, Fa Xianxia, Fu Ling and Chen Pi.
[Experimental formula
1 He-Yun Cough Soup
Drug composition: 10g of thorny mustard, 15g of Qianhu, 10g of Baiqian, 10g of almonds, 15g of Bayberry, 10g of orange red, 15g of forsythia, 15g of Momordica charantia, 15g of aster, 10g of orris, 6g of licorice, 30g of reed stem.
Addition and subtraction: add 10g of Scutellaria baicalensis and 24g of Fritillaria fritillaria for pulmonary heat; 12g of Radix Sargassum and 12g of Marble for sore throat; 12g of Radix Panax notoginseng and 15g of Bamboo Roo for excessive sputum; 15g of Salvia officinalis and 15g of Smallpox; 9g of Roasted Ephedra and 9g of Fructus Schisandrae for prolonged cough with sticky sputum; 15g of Dioscorea and 10g of Baiguo for wheezing.
Dosage: 1 dose daily, 5~7 doses for 1 course of treatment, generally 1~2 courses of treatment.
Indications: Bronchitis, coughing at night, itching in the throat and chest, prolonged phlegm, and light evidence of phlegm-heat congestion in the lung.
Source of recipe: Luo Zemin. Efficacy of Hoe Yun Cough Relief Soup in treating 120 cases of bronchitis. Anhui Clinical Journal of Traditional Chinese Medicine, 2003, 15(3): 213-214.
Case example: The patient, female, 45 years old, was admitted to the hospital on November 12, 2001, with cough and wheezing for 4 d. 4 d earlier, she developed cough, white mucous sputum, unfavorable sputum production, wheezing, especially when moving, chest tightness and weakness, swallowing discomfort, and had been treated with oral “penicillin V potassium” and “licorice tablets” in the outpatient clinic. The cough did not improve, with yellow mucous sputum, medium sputum volume, wheezing and chest tightness, shortness of breath, and was diagnosed as acute bronchitis by chest X-ray. On examination of his tongue and pulse, he had a red tongue with yellow coating and a slippery pulse. Identification: cough (phlegm-heat stagnation in the lung, loss of lung circulation and purification). Treatment: Promote heat in the lung and clear heat, dispel phlegm and calm asthma. Prescription: 10g of Radix et Rhizoma Polygonati, 15g of Qian Hu, 10g of Bai Qian, 10g of Almond, 15g of Zhe Bei, 10g of Mandarin Red, 15g of Forsythia, 15g of Radix Platycodon, 10g of Licorice, 30g of Reed Stem, 15g of Dilong, 15g of Phellodendron. 1 dose daily for 3 days, the symptoms were greatly reduced. The above formula is divided into two doses, with the addition of 12g of Psidium guajava.
The formula was developed by Mr. Yue Meizhong. According to Yue, “tracheitis” is caused by a cold, so it should not be forced to cough or to “astringent its phlegm”, and the cold evil accumulated for a long time should be dispersed by Thornbush, and the phlegm should be dispersed by Qian Hu, and the phlegm in the deep part should be dispelled by Bai Qian. The whole formula focuses on dispelling the evil and resolving phlegm, clearing the lung and generating fluid to stop coughing. Therefore, it is more effective in cases of coughing and coughing with wheezing caused by bronchitis, and it is more effective in acute bronchitis than chronic bronchitis. If it can be used in combination with early diagnosis, it can improve the efficacy.
2 Acute Bronchitis Soup
Drug composition: 4g of Ephedra, 10g each of Almond, Radix Platycodon, Bai Qian, 15g of Bupleurum, 20g of Xuan Shen, 2g each of Pepper and Wu Wei Zi.
Addition and subtraction: for nasal congestion, add Xin Yi 10g, for headache, add Qiang Wu 8g, for phlegm and dry stool, add Gua Gua Ren 8g, for phlegm and loose stool, add Cang Zhu and Fu Ling 10g each, for sore throat, add forsythia 15g.
Dosage: 1 dose daily, divided into morning and evening, observe for 3~7 d. During the period of taking the medicine, eat lightly and avoid oily and spicy food.
Indications: For acute bronchitis caused by wind-cold attacking the lung and phlegm-damp obstructing the lung, with coughing spells, white and sticky sputum, nasal congestion, itchy throat, chest tightness and wheezing as indications.
Source of recipe: Yong Shanqing. Treatment of acute bronchitis with acute branching soup. Shandong Journal of Traditional Chinese Medicine, 2008, 27(4): 275.
Case example: Male, 17 years old, first diagnosed on September 25, 2006. The patient developed nasal congestion and runny nose, sore throat, and cough 5 d ago after exposure to cold. After taking oral amoxicillin, silver forsythia tablets, and ketamine, he developed paroxysmal cough with white and sticky sputum, nasal congestion, body pain, thin white tongue coating, and floating pulse. On examination, the body temperature was 37.5℃, the pharynx was slightly congested, the tonsils were not enlarged, the respiratory sounds were coarse on auscultation, and no dry and wet woven grass was heard in both lungs. TCM diagnosis: cough, identified as wind-cold attacking the lung and phlegm-damp obstruction. Treatment: Dispersing wind and cold, relieving cough and resolving phlegm. Herbs: Ephedra 4g, Almond, Radix Platycodon, Bian Qian, Orange Red 10g each, Bupleurum 15g, Xuan Shen 20g, Pepper, Wu Wei Zi 2g each. 2 doses of the formula were taken to relieve the cough, followed by 2 doses of the original formula with addition and reduction, the cough was relieved, and the symptoms were cured with addition and reduction of 2 doses.
The efficacy of this formula lies in relieving the surface of the lungs, relieving cough and resolving phlegm, in which ephedra is the main medicine of the lung meridian, which propagates the lungs and disperses cold to stop coughing; so that the evil of wind and cold goes and the lung qi is propagated, but the dosage of ephedra should not be large, so as not to sweat too much and deplete the lung qi; almonds purge and lower the lung qi to stop coughing, a propagation and a lowering, the lung qi is regulated; orris resolves phlegm and facilitates pharynx, helping ephedra to propagate the lung; baiqian lowers qi and resolves phlegm, helping The almonds are also used to reduce the lung qi; Bai Bian, orange red cough and phlegm, pepper pungent and numb to remove the itchy throat, and Wu Wei Zi sour and sweet to astringent lung and stop cough. The whole formula has the effect of promoting the lung to disperse cold, relieving cough and resolving phlegm.
3 Radix Mulberry Bai Pi Tang
Drug composition: 15g each of roasted mulberry peel, almond, scutellaria, orris and gardenia, l0g each of semen and szechuan bayberry, 30g of fishy grass.
Add and subtract: cough and phlegm are obvious, add 15g each of orange red and sizzling lily of the valley, 30g each of whole melon basket; with wheezing, add 10g of dilaemon, 10g of honey ephedra; with chest and abdomen fullness, not thinking of eating and drinking, add I5g each of jiao sanxian, l0g of heliotrope, with Qi deficiency, add 12g of dang ginseng, 15g of astragalus; with wind-cold superficial evidence, add l0g each of thorny mustard and windbreak; with wind-heat superficial evidence, add 10g of mulberry leaf and 6g of peppermint.
Dosage: Decoction with water, 1 dose daily, divided into 2 doses. Stop taking other drugs; avoid spicy food, smoking and alcohol.
Indications: Acute bronchitis caused by phlegm-heat congestion of the lung.
Source of recipe: He Linlu. Treatment of 130 cases of acute bronchitis with addition of mulberry bark soup. Shaanxi TCM, 1998, 19(10);437.
Case example: Dang, female, 38 years old, farmer, was seen on February 12, 1996. The patient reported coughing and white sputum with nasal congestion, runny nose and itchy throat after “cold” 2 weeks ago. At the time of consultation, he was coughing, coughing yellow sputum with blood, red face, coarse breath, red tongue with yellow coating and smooth pulse. On auscultation, the breath sounds in both lungs were coarse. Diagnosis in Western medicine: acute bronchitis. Chinese medicine diagnosis: cough (phlegm-heat stagnant lung), treatment should be to clear heat and promote lung, stop coughing and resolve phlegm, the formula used Mulberry Bai Pi Tang plus flavor, Mulberry Bai Pi (sizzling), almonds, Scutellaria baicalensis, Hemisphagnum, Chuanbei, Radix Platycodon grandiflorum, Gardenia jasminoides, Orange Red I5g each, whole melon atrophy I5g, fishy grass 60g, raw rhubarb (later down), licorice 6g each, 2 doses, water decoction. He was not well fed. The above formula was modified by removing rhubarb and adding 15g each of Jiao Sanxian, 3 doses with decoction.
Explanation of clinical evidence: This formula is based on the ancient formula of Mulberry Bai Pi Tang (Jing Yue Quan Shu) with the addition of flavors, with Mulberry Bai Pi, Almond, Semen, and Chuan Bai Mu to stop cough and resolve phlegm, Huang, Gardenia, and Fishy Herb to clear lung heat, and Radix Eucommiae, which is a medicine of boat series, to guide all the medicines up to the lung. The whole formula is used to stop cough and dissolve phlegm, and to cleanse the lung and calm asthma. He Linlu treated 130 cases of acute bronchitis with the addition and subtraction of Mulberry Bai Pi Tang, resulting in 87 cases cured and 41 cases with significant effect, with a total efficiency of 98.5%.
4 Clear lung drink
Drug composition: 30g of honeysuckle, 30g of forsythia, 10g of peppermint (later down), 10g of thorny mustard spike (later down), 10g of Qianhu, 10g of Baiqian, 10g of mother of pearl, 10g of almond, 10g of orris, 15g of scutellaria, 30g of rhizome, 30 of white foxglove, 10g of licorice.
Add and subtract: add antelope horn powder 0.6g for fever; add burdock 10g for sore throat, shoot 10g for dry throat, add Xuan Shen 10g for heat injury to lung fluid and dry mouth; add Gua Pou 20g and Sang Bai Pi 20g for coughing and vomiting.
Dosage: 1 dose daily with water decoction.
Source of prescription; Liu Hongyue. Treatment of 60 cases of acute bronchitis with Qing Lung Drink plus reduction. Jilin Chinese Medicine, 2004, 24(6);24.
Case example: Tian, female, 28 years old, cadre, was first diagnosed on March 4, 2001. She complained of a cough caused by occasional wind-cold 2 d earlier, coughing and spitting white mucous sputum in large amounts that could not be easily coughed up, with a violent cough, accompanied by fever without sweating, sore throat and dry mouth, stuffy and runny nose, a red tongue with yellow fur, and a floating pulse. I gave Clear Lung Drink plus and minus: 30g of honeysuckle, 30g of forsythia, 10g of peppermint (later), 10g of thornbush (later), 10g of Qianhu, 10g of Baiqian, 10g of mother-of-pearl, 10g of almond, 10g of mandarin, 10g of burdock, 20g of mulberry bark, 15g of scutellaria, 30g of rutabaga, 30g of white foxglove, 10g of licorice, 0.6g of antelope horn powder (for decoction). 3 doses with water, On March 7, the patient had no fever, the cough was relieved, and the coughing and spitting of white sputum was reduced, and the symptoms such as nasal congestion and sore throat were alleviated. On March 11, he was given 4 doses of Clear Lung Drink, which he took with the symptoms, and on March 11, he was diagnosed with occasional cough with little sputum, and the symptoms disappeared. He was instructed to take 3 more doses to consolidate the efficacy, and the cough and sputum disappeared and he was cured.
Explanation of clinical evidence: This formula is suitable for treating coughs and coughs caused by heat entering the lung from the exterior of the body, resulting in phlegm-heat congestion. In this formula, honeysuckle, forsythia, peppermint and thorny mustard spike cool the surface and clear wind-heat; Qianhu, Baiqian, mandarin, almond, scutellaria, licorice and rhizome promote lung-heating and stop cough, clear the lung and produce fluid; Chuanbei mother and almond resolve phlegm and stop cough; Baimao root clears heat and cools blood, firstly, it consolidates the ground before illness to prevent transmission. In summary, this formula is mainly pungent, cool and clear, its effect of promoting the lung and clearing heat, resolving phlegm and relieving cough is remarkable, so it has good efficacy in treating acute bronchitis. Liu Hongyue treated 60 cases with this formula plus and minus, resulting in 38 cases cured, 20 cases with significant effect and 2 cases with no effect, with a total effective rate of 96.7%.
5 Stopping cough
Drug composition: Radix Platycodon grandiflorus 12g, Rhizoma Polygonatum 6g, Aster 10g, Radix Bupleurum 12g, Radix Bupleurum 10g, Radix Glycyrrhiza Glabra 6g, Pericarpium Citri Reticulata 8g.
Add and subtract: if external evil is prevalent, see headache, nasal congestion, runny nose, etc., add Angelica dahurica, Xin Yi Hua, Mulberry leaf; if phlegm and dampness are prevalent, see sputum, vomiting when coughing, accompanied by chest discomfort, thick and greasy tongue coating, add Poria cocos, Fa Xian Xia, Hou Pu, Almond; if heat is present, see sore throat, dry mouth, yellow sputum, slightly counted pulse, etc., add Scutellaria baicalensis, Zhe Bei Mu; if pharynx is itchy, add Cyperus rotundus, Cicada molasses; if coughing and vomiting are severe, add Loquat leaf, Rhizoma spinosus.
Dosage: 1 dose daily, divided into 2 warm doses with water decoction. Avoid fishy and fried foods during treatment, and drink more boiled water, keep warm and avoid wind and cold.
Source of prescription; Gao Shuying, Li Guoqin, Bian Yongjun, et al. Treatment of 106 cases of acute bronchitis with cough suppressant. Guangming TCM 2006, 21(12)
Case example: Chen, female, 35 years old, was first diagnosed on December 26, 2005. She complained of cough for 2 weeks, itchy and painful throat, and dry throat, and was diagnosed as acute bronchitis in a foreign hospital. She has taken Chinese and Western medicine without improvement. She has chest and rib pain with cough and little sputum. The tongue is red at the edge, the coating is white and slightly thick, and the pulse is stringent. This is a case of external cough with residual evil not yet cleared and heat symptoms. The treatment is to remove wind and heat, resolve phlegm and relieve cough. The formula is based on the following formula: 10g of Thornbush, 10g of Baiqian, 8g of Platycodon grandiflorus, 8g of Aster, 8g of Almond, 10g of Sempervis, 10g of Burdock, 10g of Momordica charantia, 8g of Medicago sativa, 10g of Cicadelle, 10g of Zebra mosqueta, 8g of Chen Pi, 3g of Glycyrrhiza glabra.
Explanation of clinical evidence: Stopping cough is a formula for treating cough in the book “Medical Heart Enlightenment” by Cheng Zhongling, a doctor of the Qing Dynasty. It has the effect of removing wind and relieving symptoms, moistening the lung and relieving cough, and relieving phlegm. In this formula, aster and bupleurum are the rulers, both of which enter the lung meridian, taste bitter, are warm but not hot, moisten but not cold, and work in stopping cough and resolving phlegm, treating coughs that do not distinguish between long and new. The minister to the orris, Bai Qian, a declaration of a descending, the lung Qi to enhance the cough and phlegm power of the ruling drug. The adjuvant orange red to regulate the phlegm; thorny mustard pungent and slightly warm, evacuate the wind, dispel the evil out, promote the lung qi, open its closed depression, have the function of opening the door to the invasion. Glycyrrhiza glabra harmonizes all the medicines and combines with Radix Platycodon grandiflorus to have a beneficial effect on the pharynx and cough, and is used as an adjuvant. The combination of all the medicines can promote the lung to stop cough and dispel wind and evil. This formula has the characteristics of being warm but not dry, moistening but not greasy, dispersing cold but not helping heat, and relieving the symptoms without hurting the positive, as the saying goes: “It is not too aggressive, but has the potential to open the door and drive away thieves”, which can be described as warming and moistening each other, and lifting and lowering each other. Because this formula has a good function of promoting the lung and stopping cough, it has achieved good results in the treatment of acute bronchitis.