Laryngogenic cough is a cough caused by a throat disease, which is difficult to treat by identifying and treating the cough disease in internal medicine.
It is characterized by coughing when the throat is itchy, or coughing when the throat is itchy, or coughing when it is not itchy, dry cough without sputum or little sputum, especially at night, with loud coughing sounds, or even choking and coughing continuously, resulting in red face and red eyes and sleepless nights, or even abdominal pain and urine loss, without chest tightness and shortness of breath. The cough is very unpleasant and continuous paroxysmal coughing, unless drinking water, the cough is endless, and the disease lasts for months or even years.
The patient’s blood count and X-ray examination are normal, the breath sounds of both lungs are clear or rough on auscultation, and the pharynx is seen to have mucosal congestion and redness or lymphatic follicular hyperplasia in the posterior pharyngeal wall, hypertrophy of the lateral pharyngeal cord, enlarged or dried tonsils, and scar adhesions. Some cases had a history of recent upper respiratory tract infection or cold, and after treatment, other symptoms disappeared, but the cough remained untreated or worsened than before. Wang Yuming, Department of Otolaryngology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine
From November 2006 to November 2008, the author treated 43 cases of laryngogenic cough using the open yon pricking method and used oral acute syrup as a control (43 cases) with satisfactory results. The results are reported as follows:
1. General information
All cases came from the outpatient clinic and ward of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, and were randomly divided into treatment and control groups according to the order of consultation, of which 43 cases were in the treatment group. There were 19 male cases. Among the 43 cases in the treatment group, 19 were male and 24 were female; the youngest was 16 years old. The oldest was 60 years old. The average age was 34 years; the shortest duration of the disease was 10 days. The longest was 4 years. The average was 2 months. Of the 43 cases in the control group. 23 males. The minimum age was 14 years. The oldest was 62 years old. The average age was 36 years; the shortest duration of the disease was 13 days. The longest was 3 years. The average was 2.5 months. After statistical treatment, there was no statistical difference between the two groups in terms of gender, age and duration of disease (P>0.05), which was comparable.
2. Diagnostic criteria.
With reference to the Diagnostic Efficacy Criteria for Chinese Medicine Evidence promulgated by the State Administration of Traditional Chinese Medicine on June 28, 1994, the Guidelines for Clinical Research on New Drugs (Traditional Chinese Medicine) for the Treatment of Acute and Chronic Pharyngitis and Acute and Chronic Tonsillitis promulgated by the Pharmacy Bureau of the Ministry of Health in 1988, and He Shaoqi’s Modern Chinese Medicine Internal Medicine [3] were formulated as follows.
① Mostly due to repeated colds left over from this disease, adverse physical and chemical stimuli induce or aggravate the disease; ② Patients have a strange itchy throat, paroxysmal dry cough, cough due to itch, no cough without itch, accompanied by dry throat, less sputum, sore throat, pharyngeal mucous sensation, foreign body sensation in the pharynx, burning sensation, hoarseness, etc.; ③ pharyngeal signs: chronic congestion of the posterior pharyngeal wall, hypertrophy of the pendulous, hypertrophy and swelling of the lateral pharyngeal cord, hyperplasia of lymphatic follicles in the posterior pharyngeal wall, tonsils are The tonsils are enlarged above degree I, scar adhesions, surface and crypt orifice or secretions, etc.; ④ normal blood count, chest X-ray or chest X-ray to exclude lung lesions.
3.Treatment method
Treatment group: all applied with open yon prick blood method. Patients take sitting position, open mouth, press the tongue with tongue depressor, expose palatal tonsils and lymphatic follicles of posterior pharyngeal wall and lateral pharyngeal cords, if necessary, spray the posterior pharyngeal wall and tonsil surface with 1% cocaine, hold tonsil scalpel, do bird pecking-like action on tonsils, each knife depth 2~3 mm, 4~5 times on each side, if there is lymphatic follicle hyperplasia, prick one by one, pierce the follicles, if the lateral pharyngeal cords are hypertrophic and swollen, perform cluster puncture on the surface of lateral pharyngeal cords. If the lateral pharyngeal cord is hypertrophic and swollen, a cluster of puncture is performed on the surface of the lateral pharyngeal cord, with a small amount of bleeding, and spitting 2~3 mouthfuls of blood is considered appropriate. 3~5 days, 4 times is a course of treatment, usually no more than 5 times. Record and fill in the operation measurement form.
Control group: oral acute syrup: 10ml each time, three times a day, 7 days as a course of treatment, observe 1~2 courses of treatment. (Acute syrup produced by Sichuan Taiji Group Fuling Pharmaceutical Factory, specifications, each bottle of 200m1, lot 005296, composed of ephedra, Qianhu, fishy grass, golden buckwheat, four seasons, Aster, Citrus aurantium, licorice, maitake, etc., function: clear heat and moisten the lung, resolve phlegm and stop cough. Indications: Upper respiratory tract infection, cough after cold, etc. Checking the relevant domestic data, the drug function and main treatment meet the requirements of clinical research, recognized as effective, safe and comparable control principles.)
4. Indicators and efficacy observation
①. Quantitative criteria for symptoms and signs.
Main symptoms and signs.
Irritating dry cough
Normal 0 points None
Mild 2 points Dry cough intermittently, not affecting normal life and work
Moderate 4 points: frequent daytime bouts of cough, sleep and life are slightly affected
Severe 6 points Day and night paroxysmal cough, affecting rest and sleep, or even abdominal pain and urine loss
Itchy throat Normal 0 points None
Mild 2 points Occasional, not obvious
Moderate 4 points Intermittent, more pronounced
Severe 6 points Persistent, very obvious
Foreign body sensation in the throat Normal 0 points None
Mild 2 points Occasional, not obvious
Moderate 4 points Intermittent, more pronounced
Severe 6 points Persistent, very pronounced
Tonsils Normal 0 points No congestion, no scar adhesions or secretions
Mild 2 points Mild congestion, no scar adhesions and secretions
Moderate 4 points Moderate congestion, visible scar adhesions or secretions
Severe 6 points Dark red congestion, scar adhesions and secretions
Lymphatic follicles in the posterior pharyngeal wall
Normal 0 points No lymphatic follicle hyperplasia and congestion in the posterior pharyngeal wall
Mild 2 points Mild hyperplasia and congestion of lymphatic follicles in the posterior pharyngeal wall
Moderate 4 points Mild to moderate hyperplasia and moderate congestion of lymphoid follicles in the posterior pharyngeal wall
Severe 6 points The lymphatic follicles in the posterior pharyngeal wall are heavily hyperplastic, like curtains, and heavily congested with dark red color
Secondary symptoms and signs.
Dry throat Normal 0 points None
Mild 1 point Occasional, not obvious
Moderate 2 points Intermittent, more pronounced
Severe 3 points Persistent, very pronounced
Normal 0 points None
Mild 1 point Occasional, not obvious
Moderate 2 points Intermittent, more pronounced
Severe 3 points Persistent, very pronounced
Lateral pharyngeal cord Normal 0 points No congestion, hypertrophy, swelling
Mild 1 point Mild congestion, hypertrophy and swelling
Moderate 2 points Congestion, hypertrophy and swelling more pronounced
Severe 3 points congestion hypertrophy swelling is very obvious
②. Efficacy assessment criteria.
The efficacy of individual symptoms and comprehensive efficacy of each case were judged by the percentage change of the integral value of symptoms and signs before and after treatment (nimodipine method). Each patient’s lung function measured value/expected value % was the statistical index, expressed as A/P%.
Clinical cure: cough and other symptoms and signs basically disappeared, and the symptom reduction rate was >90%;
Effective: Significant improvement of cough and other symptoms, with a symptom reduction rate of <90% to 60%;
Effective: cough and other symptoms have improved, with a reduction rate of <60% to 30%;
Ineffective: no change in symptoms, symptom reduction rate <30%.
4 Results
In the treatment group, there were 17 cases of clinical cure, 13 cases of apparent effect, 9 cases of effective, and 4 cases of invalid, with a total effective rate of 90.7%; in the control group, there were 11 cases of clinical cure, 8 cases of apparent effect, 9 cases of effective, and 15 cases of invalid, with a total effective rate of 65.1%. After statistical treatment, x2=8.845,P=0.031<0.05, the efficacy of the treatment group was significantly better than that of the control group. See Figure 1.
Table 1 Comparison of clinical efficacy between two groups of patients Example (%)
n Cured (%) Effective (%) Ineffective (%) Total effective rate (%)
Treatment group 43 17(39.5) 13(30.2) 9(20.9) 4(9.3) 90.7
Control group 43 11(25.6) 8(18.6) 9(20.9) 15(34.9) 65.1
Note: x2=8.845,P=0.031<0.05
5.Discussion
Laryngogenic cough is a common and frequent disease in otolaryngology. Its coughing etiology is caused by pharyngeal disorders and is characterized by itchy pharynx that is coughing and no itchy coughing. It belongs to the categories of “pharyngeal itch”, “laryngeal paralysis”, “milk moth” and “cough” in traditional Chinese medicine, and is the cause of acute and chronic pharyngitis, acute and chronic tonsillitis and other coughs. It is one of the clinical manifestations of acute and chronic pharyngitis, acute and chronic tonsillitis and other respiratory diseases. In the 20 years since Professor Gan Zu Wang, a famous veteran Chinese medicine practitioner, proposed the name laryngogenic cough in 1985, promising results have been achieved both in terms of basic theoretical research and clinical treatment experience, but the disease is often lingering and difficult to cure. However, the disease is often intractable, and clinical treatment with Chinese and Western drugs is difficult to completely cure. The treatment of laryngogenic cough is becoming another problem that needs to be solved in the new century.
Modern medicine believes that the onset of laryngogenic cough is closely related to viral infection and environmental pollution, mostly due to atmospheric pollution, dry air, inordinate smoking, long-term consumption of spicy foods or repeated external sensations that cause chronic congestion in the pharynx, dryness of the mucosa, and hyperplasia of the lymphatic follicles in the posterior pharyngeal wall, resulting in increased local sensitivity and causing coughing in the pharynx or tracheal mucosa due to irritation. Modern medicine often uses anti-infection, phlegm, powerful cough suppressants, ultrasonic nebulization and surgical treatment, which are effective but have a long treatment course and long side effects, and have a high incidence and are difficult to cure, which seriously affects the quality of life of patients.
From a physiological and anatomical point of view, the pathogenesis of laryngogenic cough is explained as follows: in the pharynx, there are not only cough receptors but also an afferent nerve, the vagus nerve, which is involved in the cough reflex [4]; the sensory nerves in the pharynx come from the pharyngeal plexus composed of the sanguinopharyngeal nerve, the pharyngeal branch of the vagus nerve and the sympathetic nerve; the sensory nerves in the larynx come from the branches of the vagus nerve, the supraglottic nerve and the retroglottic nerve. We believe that inflammation of the larynx may be the pathological basis for the pathogenesis of laryngogenic cough, as inflammation of the larynx stimulates certain receptors in the larynx, excites the vagus nerve, transmits nerve impulses to the medulla oblongata, and triggers a series of coordinated reflex effects. The cough is caused.
Cough is generally considered to be one of the main symptoms of lung diseases. However, as stated in the Nei Jing, “all five viscera and six internal organs cause coughing, not only the lungs”. According to Dryer, laryngogenic cough is mainly caused by laryngeal diseases, and most patients are found to have a history of chronic pharyngitis and upper respiratory tract infections. According to Chinese medicine, the causes of laryngogenic cough are internal and external. The external causes are mostly due to cold and flu. Zhang Jinyue has advocated that “all six gases cause cough, and wind and cold are the main causes”. Cold is a disease. It is the wind-cold evil invade the lung guard skin and hair by taking advantage of deficiency. If you fail to release it in time, and for a moment of peace, take excessive sweet cough syrup, the floating evil can not be released, trapped in the lung meridian, only depressed in the throat and caused. The internal cause is mostly due to chronic laryngitis that is not cured for a long time and is triggered by repeated attacks.
The General Principles of Miscellaneous Diseases says: “When a long-standing illness is difficult to cure, first investigate the source of its origin”. According to the main symptom of laryngogenic cough, “itching and coughing”, Dryer often looks at the “itchy symptoms” and explores the causes in depth. He said, “The itch can originate from the withering of the fluid, or even from depression and fire.” The depression, for the ascending can not rise, the descending can not descend, when the transformation can not be transformed also, the five organs are sick, the qi mechanism is not normal, depression, depression for a long time to produce heat, or addicted to eating spicy, spicy, fried, fried, smoke, wine, people will develop for the fire of the five will. Fire on the inflammation is dry, the fire cooked under the Jin withered. So the throat is dry and want to drink, drinking water will stop. Fire evil refining liquid, gel for phlegm is phlegm sticky hard to cough, cough out for cool. Due to the feeling of external evil, poor diet, emotional depression, air pollution and other reasons leading to fire-heat internal depression, burning the fluid into phlegm, phlegm-heat mutual knot, stagnation in the throat, blocking the airway, obstructing the lift of qi and the development of wood disease.
For example, “If the throat itches and coughs, the fire-heat gas rushes upward, and the fire wants to issue while the smoke rises first, and the pharyngeal gas rushes to the throat, so it itches and coughs” (True Medical Tradition) and “Dry coughs are evidence of fire and phlegm stagnation” (Danxi Xinfa – Cough XVI) both illustrate well the mechanism of phlegm and fire The mechanism of cough caused by phlegm-fire stagnation. At the same time, “prolonged illness enters the ligament”, and phlegm-heat stagnation in the throat for a long time hinders the flow of qi and blood, resulting in blood stagnation and stasis, so patients often have signs of blood stasis, which manifests as blood stasis in the dilated blood vessels of the posterior pharyngeal wall. There is also a clear discussion of phlegm-heat stasis caused by the accumulation of phlegm and fire in the throat for a long time, and the mirror is red and has no white film. Therefore, the core pathogenesis of laryngogenic cough is the internal wind caused by fire, dryness, phlegm and stasis, that is, according to Chinese medicine, “no wind does not make itch”.
It is a characteristic external treatment method of TCM, which is an advantageous treatment of the motherland medicine. The original method of our group is to use a sickle-shaped knife for tonsil surgery to peck or prick upward on the tonsils, lymphatic follicles of the posterior pharyngeal wall and lateral cords of the pharynx. The mechanism of this therapy may have the following aspects: First, this therapy is in line with the “bloodletting therapy” of Chinese medicine. Bloodletting therapy has various functions such as opening and dispersing depression, dispelling heat and phlegm, unblocking meridians, removing blood stasis and swelling.
The pharynx is on the top, the main point of the circulation of the meridians, is located in a narrow place, easy to yong, easy to stagnate and easy to gather, and the fire-heat inflammation on the top, its potential is urgent, and when it meets the narrow place, the yong will stagnate and gather there and cause disease, so among the causes, fire-heat is one of the most common causes of pharyngeal diseases, therefore, there is a clinical theory that “all diseases of the pharynx belong to fire”. For example, “Confucianism and the matter of relatives – Volume 3, throat and tongue slow and hard medicine different explanation” said: “pharynx and larynx, will be loosened and tongue, these four, the same in a door, but its use is different and its disease, a word can be understood.
The Eastern Medical Treasure. Shape, Volume 3. Throat” is more clearly pointed out: “the throat disease belong to the fire”. If the fire moves phlegm, then the fire becomes phlegm in the throat and quarrels, and the single moth, double moth, plum kernel and other evidence will rise. Through the Kaiyong blood pricking method, the blood is pricked to remove heat, unblock the blood vessels, break the stasis and open up the phlegm, so that the fluid can be stored and the fire can be removed, and the wind can be quenched and the itch can be stopped to treat laryngeal cough and cure the lesion. Secondly, this therapy has the effect of incision and drainage. Chronic tonsillitis is a disease in which inflammatory changes in the saphenous fossa are the main cause. Infectious factors such as bacteria and viruses cause hyperplasia or detachment of the epithelium of the saphenous fossa, while inflammatory exudates accumulate in the saphenous fossa and palsy marks form, which together lead to poor drainage of the saphenous fossa.
In chronic pharyngitis, lymphatic follicle hyperplasia and swelling of the lateral pharyngeal cord in the pharyngeal wall cause impaired circulation of the lymphatic tissue loop in the pharynx, which affects the function of the human lymphatic system and prevents the elimination of inflammation. The blood pricking method can open the mouth of the saphenous fossa, destroy the germs in the fossa, and make the discharge of secretions, which can reduce or eliminate the inflammatory lesions. Through repeated “puncture and incision” drainage, the secretions are discharged smoothly and the lymphatic reflux is smooth, which facilitates the elimination of inflammatory lesions and fundamentally solves the long-standing causes of laryngogenic cough, thus completely eliminating or reducing the attacks of laryngogenic cough.
Through preliminary clinical research. However, we should continue to expand the sample size and conduct further in-depth studies in terms of modern medical pathology, physiology, airway resistance, and airway reactivity.