Interstitial lung fibrosis is a common disease of the respiratory system and includes both idiopathic and secondary types. Once the disease develops, it is difficult to reverse and its progression can only be slowed by aggressive treatment. In most patients, the disease is recurrent, progressively worsens, and eventually leads to respiratory failure and death. The author attempts to explore the Chinese medical theory of the disease’s intractable nature and poor prognosis, and believes that an important mechanism in the development of the disease is the involvement of blood stasis. The following is a detailed description.
1. The concept of stasis
Stasis, also known as silt, is the abbreviation of blood stasis, which originally refers to the accumulation of blood that does not work, and is an intrinsic pathological product in the theory of Chinese medicine. In the book of Shuowen Jiezi, it is explained that: “Stasis is also the accumulation of blood”. The dictionary says: “Stasis is the accumulation of blood. It means stasis of blood. It refers to the stagnation of blood in the body in a certain place”. Silt” originally refers to the sediment in water, but also has the meaning of “stagnation, non-circulation”. The Dictionary says: “Silt, the disease of accumulation of blood”. Generally speaking, if the blood leaving the meridians cannot be dissipated and stagnated in a certain place in time, or if the blood flow is not smooth and its operation is obstructed and it accumulates in the meridians or organs in a stagnant state, it is called blood stasis.
2. Sources of Blood Stasis
There are two main sources of blood stasis: on the one hand, traumatic factors such as fall, flash and contusion damage the tendons and internal organs of the body, directly causing damage to the meridians and veins, and the blood does not follow the meridians and overflows outside the veins as stasis; on the other hand, it is a pathological product resulting from the dysfunction of the internal organs of the body due to the action of internal injury factors. The latter often has a more important role in the pathogenesis of the disease. In detail, stasis mainly originates from the following aspects.
(1) Loss of spleen health, internal growth of phlegm and dampness, and qi obstruction
The spleen and stomach are the origin of the posterior, the source of Qi and blood biochemistry, and the master of blood control. Qi and blood are the material basis for the normal functioning of the internal organs. Fundamentally, the qi and blood of a person are biochemically generated by the normal function of the stomach to receive and cook, and the spleen to transport, transform, and raise and clear. Therefore, when the spleen and stomach are dysfunctional, it will affect the generation, operation and distribution of qi and blood, resulting in a series of pathological manifestations. For example, if the patient’s appetite for thick sorghum, alcoholic wine, fatty sweet and spicy and fishy products affects the function of the spleen and stomach and does not normalize, the grain will become stagnant and water will become wet, resulting in phlegm and water-dampness. The spleen and stomach health and transportation failure, long clear Yang does not rise turbid Yin does not descend, water and grain essence lost in transmission, stay in the middle Jiao, breeding dampness. Dampness and turbidity always affect the lift of qi, resulting in a decrease in the ability to gasify and push. Qi is the marshal of blood, qi line is blood line, qi stagnation is blood stasis, resulting in blood stasis. In addition, if the spleen is weak and unable to control the blood, the blood will overflow outside the veins and become stasis directly. Once stasis of Blood is produced, it is often combined with phlegm and dampness to cause harm. If phlegm and stagnation obstruct the airway, the patient will have coughing and phlegm, chest tightness and wheezing, dull complexion and blue lips.
(2) Loss of drainage of the liver, unfavorable qi flow and stagnation of blood flow
The liver is a rigid organ, which is responsible for draining and collecting blood. It can regulate the qi flow and discharge the emotions, as well as the normal distribution of fluids, bile and qi and blood. As stated in the Nei Jing, all diseases are born from qi, which is often closely related to the loss of liver drainage. Patients who are emotionally unstable, worried about qi, or depressed and angry, resulting in the loss of liver drainage and qi stagnation, will have different transformations over time. The other transformation is that qi stagnation turns into fire over time and fire-heat torments the blood, resulting in blood stasis or blood overflowing outside the veins. In addition, if the liver does not collect blood, the blood will be easily stagnated in the blood vessels and become stasis. Blood stasis is a tangible product, and once it is produced, it can aggravate Qi blockage, thus leading to aggravation of the disease cycle.
(3) Insufficient heart qi, weak propulsion, stagnation of blood vessels
The Heart harbors the God and is the master of the Blood vessels. The normal operation of blood depends first of all on the propulsive effect of heart qi. If the patient has insufficient endowment, weak quality, or is old and physically weak, or has been sick for a long time, resulting in insufficient heart qi, weakness in promoting blood vessels, and poor blood flow, blood vessels stagnation will occur. The stagnation of blood can in turn affect the flow of qi, making it difficult for yin and yang to reach the lungs and further aggravate the disease. Clinically, many patients with this disease have manifestations of blood stasis in both symptoms and laboratory tests, such as obscure face, blue lips and nails, increased red blood cells, increased blood viscosity, etc. In advanced stages, when the right heart function is even affected, resulting in right heart insufficiency, obvious signs of blood stasis in Chinese medicine such as stasis in the body circulation.
(4) Lung Qi is unfavorable, the disease affects blood, and blood stagnation is stasis
The lung is the master of qi, the division of respiration, and the master of the joints towards the hundred veins. The heart and lungs are closely related to each other as the heart and lung vessels are connected to the lungs. Deficiency of Lung Qi cannot regulate the operation of Heart and Blood, resulting in overwork of the “Heart Master”, deficiency of Heart Qi and Heart Yang, and inability to promote Blood vessels, resulting in stagnation of Blood flow and palpitations of the Heart, blue lips and tongue and nail bed, and very mobile neck veins.
(5) Deficiency of the five viscera, failure to restore Qi and Blood, and prolonged illness into the complex
The patient’s internal injury, diet, fatigue, disease congestion, prolonged illness will deplete the vital energy, resulting in the loss of the five organs, insufficient qi and blood, and the deficiency of the ligaments, the disease evil invade the ligaments. Ye Tianshi said that “the meridian is the main qi, the luo is the main blood” and “at first the qi is knotted in the meridian, but for a long time the blood is injured into the luo”, putting forward the theoretical doctrine of long term disease into the luo. According to Ye’s reasoning, after a long illness enters the luo, it will lead to stagnation of blood flow, and therefore stasis of blood is produced.
3.The manifestation of stasis
(1) Manifestation of stasis
The main clinical manifestations of the disease are chronic cough, occasional coughing of sputum, and progressive shortness of breath. In all stages of the disease, there are different degrees of blood stasis. In mild cases, the tongue is dark red and the veins under the tongue are tortuous; in severe cases, the lips and nails are cyanotic, the face is dark, the chest is stuffy, the chest is painful, and the neck pulse is very mobile.
(2) Implicit indicators of stasis
Modern research has found that patients with this disease have different degrees of invisible stasis such as increased blood viscosity, elevated plasma thromboxane B2, and reduced capillary count. Secondly, endothelin-1 also has a facilitating role in the formation of this disease; it is the strongest vasoconstrictor known to date and promotes mitosis. The fibrogenic factors TGF-β and PDGF all promote the synthesis and release of ET-1 and synergistically stimulate fibroblast proliferation leading to pulmonary fibrosis. Endothelin-1 is significantly elevated during the formation of pulmonary fibrosis, and its value increases as the disease worsens. In addition, most patients with this disease have hypoxemia in the late stage, hypoxia can cause pulmonary capillary congestion, stasis, endothelial cell swelling, basement membrane thickening, neutrophil retention, platelet aggregation, microcirculation disorders, resulting in increased pulmonary blood flow resistance, thus contributing to the occurrence and development of hyperviscosity.
4.Characteristics of stasis
(1) Slow onset, insidious disease
The disease is characterized by a chronic course, recurrent attacks and gradual aggravation, and its symptoms are also manifested by a mild cough and sputum at the beginning, followed by progressive dyspnea and severe symptoms such as cyanosis and swelling at a later stage. From the perspective of traditional Chinese medicine, stasis of blood is mostly caused by the weakness of the body after a long illness, and the dysfunction of the internal organs is not restored, and the damage caused by stasis of blood is not obvious at the initial stage.
(2) Complexity of the disease, and the intermingling of other evils
The origin of stasis in the previous article discussed in detail the generation of stagnant blood due to dysfunction of various internal organs. In fact, dysfunction of the internal organs does not only produce blood stasis, but also phlegm, water-dampness, fire-heat, poisonous evil, and qi stagnation, and external warmth and poisonous evil can also boil the blood to form stasis. When blood stasis is generated, it becomes hot or cold with the patient’s constitution, and often gels with phlegm, water-dampness, fire-heat, poisonous evil and qi stagnation, making the disease difficult to treat because of the mixture of cold and heat and the combination of deficiency and reality.
(3) Stasis is divided into manifest and hidden, and causes disease together
The manifestations of stasis are discussed in detail in the previous article, which discusses the manifest and invisible indicators of stasis. Both manifest and invisible indicators are pathological manifestations that cause the lung to lose its function of declaring and suctioning, resulting in a variety of symptoms. The hidden indicators are discovered with the help of modern research, which is a welcome point that can be applied to Chinese medicine and guide clinical treatment. For example, herbs that activate blood circulation and remove blood stasis can be applied in advance for hidden indicators. Studies have shown that herbs that activate blood circulation and remove stasis can improve blood rheology and dynamics, anti-thrombosis, improve microcirculation, and inhibit abnormal tissue proliferation, which can inhibit inflammatory response, inhibit abnormal tissue proliferation, and improve blood supply to lung tissues from multiple links thus preventing and treating interstitial lung fibrosis.
(4) Severe damage and injury to the human form
The disease is chronic and gradually aggravated, with many causative factors, many lesions involving the internal organs, complex nature of the disease, easy to be combined with phlegm and dampness, heat and toxicity, gas stagnation and other evil or pathological products, resulting in the complex symptoms of mixed deficiency and reality, cold and heat, so it is difficult to get quick results in the clinical, lingering difficult to cure. At this time, the patient’s respiratory function is severely impaired, and the respiratory function of the lung is severely disordered, with phlegm, water-dampness, toxicity and stagnation, resulting in loss of one organ and all five organs, deficiency of both yin and yang, emaciation or swelling, severe asthenia, and even hemorrhage, convulsions, and fainting, resulting in death of yin and yang.