Li**, M , 80 years old, retired cadre, Lanzhou, Gansu Province
Initial diagnosis (October 15, 2011): Five years ago, the patient inadvertently caught cold and developed a cough, coughing sputum and yellow color, which improved after anti-inflammatory treatment. However, since then, he often had recurrent attacks, coughing up large amounts of yellow pus sputum with shortness of breath and shortness of breath, and went to the respiratory department of the Provincial People’s Hospital. After examination, he was diagnosed with “bronchial dilatation” and was treated accordingly (the specific medication used is not known), and his condition improved. Four days ago, due to a sudden change in weather, his cough, sputum and shortness of breath worsened, and he coughed up a lot of pus sputum with a low fever and a temperature of 37.8°C. He took “cephalosporin and licorice tablets” at home with poor results and came to our hospital for further treatment. He was admitted to our hospital with the following symptoms: coughing, coughing up large amount of pus sputum with chest tightness, shortness of breath, aggravated by movement, unable to lie down, no hemoptysis, poor sleep, poor sleepiness, dry stool, yellow urine, red tongue, yellow greasy moss, smooth pulse. Physical examination: T 37.8℃ P 88 times/min R 22 times/min BP 120/80mmHg. acute face, sallow face, coarse respiratory sounds in both lungs, small wet stalls can be heard in the left lung Mu 86 times/min, rhythmical, remaining (-). His blood count showed N 0.84, L 0.10; blood gas analysis: PH 7.51, PCO2 33mmHg, PO2 54mmhHg; electrolytes: K 2.79mmol/l, Na 132.6mmol/l, CL 91.7mmol/l. He had been postoperative for more than 10 years after gastrectomy for gastric cancer and had a history of coronary heart disease for more than 6 years, and his condition was still stable. Chinese medicine diagnosis: pulmonary carbuncle, evidence of: phlegm-heat congestion, lung qi not descending; Western medicine diagnosis: 1, bronchial dilatation combined with infection; 2, postoperative gastric cancer; 3, coronary artery disease (stable angina). Chinese medicine treatment: to resolve phlegm and clear heat, to relieve the lung and calm asthma, based on the formula of Scape Drabble and Jujube Diarrhea Lung Soup with Artemisia Scutellaria and Qing Gall Bladder Soup, plus and minus.
Scape Dracaena 20g, Jujube 10g, Scutellaria baicalensis 12g, Artemisia annua 15g, Houpai 10g, Morinda citrifolia 12g
Bamboo Roo 10g Citrus aurantium 10g Bitter Almond 10g Tong Cao 10g Slippery Rock (decoction) 10g
Glycyrrhiza glabra 15g Qian Hu 10g Jiang Han Xia 10g Di Long 12g Silkworm 10g
Take one dose a day with water for 4 doses.
Second Diagnosis: (October 20, 2011): The patient’s cough and sputum were slightly reduced and he could still lie down, but the sputum volume was still high, with chest tightness, dizziness, poor sleep, a vivid tongue with little moss and a yellowish moss at the back root of the tongue, and a slippery pulse. The main evidence remains the same, but the phlegm-dampness in the upper jiao has been reduced, while the evil heat has the tendency to enter the camp, and the internal congestion of damp-heat in the middle and lower jiao is still present, so the treatment goes up to bamboo rhizome and mulberry bark, plus calamus and yujin to clear heat and cool the camp and open the orifices; still using artemisia scutellaria to clear the phlegm-heat, the formula is as follows.
Prescription.
Scutellaria baicalensis 12g Artemisia annua 12g Magnolia officinalis 10g Radix ginger and Sempervivum 10g Acorus calamus 10g Ulva lucidum 10g
Fructus Atractylodis Macrocephalae 15g Fructus Scopariae 12g Silphium 10g Jujube 10g Radix Bupleurum 20g Semen Coicis 20g
Bitter almond 10g Fried wheat sprout 10g Dioscorea 10g Tongcao 10g Qianhu 12g Slippery stone 10g
Decoction with water, one dose a day, take 5 doses.
Third Diagnosis: (October 26, 2011): The patient’s cough disappeared, coughing and shortness of breath were significantly reduced, chest pain was relieved, but he did not feel like eating and drinking, was weak, slept poorly, especially at night, his tongue was reddish without coating, and his pulse was weak. The treatment is to benefit qi and nourish yin, nourish the yin of the lung and stomach to preserve gastric fluid, and maintain one point of stomach qi.
Radix Codonopsis pilosulae 20g Mai Dong 15g Wu Wei Zi 10g Radix Rehmanniae 20g Yam 20g
Cornu Cervi Pantotrichum 20g Rhizoma Polygonatum 10g Dendrobium 15g White Lentil 12g Fructus Lycii 10g
Lily 12g Agaricus blazei 10g Poria 10g Sandy sesame seed (later) 6g Fried malt 10g
Morus Alba 10g
Decoction with water, one dose a day, take 5 doses.
Fourth diagnosis: (November 1, 2011): cough, coughing phlegm, chest pain and shortness of breath disappeared, poor appetite, not thinking about eating, dry mouth without desire to drink, poor sleep, fatigue and weakness, red and vivid tongue without moss, with crackles, thin and soft pulse. Treatment: Strengthening the spleen and stomach, benefiting Qi and Ying.
Roasted Astragalus Membranaceus 50g Fried Yam 30g Radix et Rhizoma Polygonati 20g Rhizoma Polygonati 15g Fructus Schisandrae 10g Dendrobium 15g
Agaricus blazei 10g White Lentil 10g Sandy Nut (later) 6g Lily 12g White Peony 15g Stir-fried Wheat Germ 10g
Atractylodes macrocephala 10g Radix Rehmanniae 20g Radix et Rhizoma Polygonati 10g Radix et Rhizoma Glycyrrhizae 10g
Decoction with water, one dose a day, take 20 doses.
Fifth consultation: (November 22, 2011): In the past week, he complained that his appetite had increased significantly, his sleep had improved, his fatigue and weakness had disappeared, he basically had no cough or asthma, but still had a small amount of white mucous sputum, his stool was regulated, his tongue was red with thin white moss, and his pulse was weak, he continued to take 10 doses of the original formula, and then he was well in January.
This disease belongs to the category of “bronchial dilatation” in Western medicine and “asthma and cough” in Chinese medicine, while the patient had residual gastritis caused by years of postoperative gastric cancer, with weakness of the spleen and stomach. In the acute stage, the cough is caused by a deficiency of the spleen and a loss of transportation, with phlegm and turbidity growing inside the lung, and then external evil entering the lung and turning heat into phlegm and heat, resulting in a cough in which phlegm and heat rebel and congest the lung, with a red tongue, yellow and greasy coating, and a slippery pulse. Therefore, the treatment should be taken to clear the phlegm-heat and unblock the qi of the three jiao, so that the damp-heat evil can be removed from the pathway, and then the evil heat will be removed from the outside, and the prescription adopts Artemisia Scutellaria Clear Gallbladder Soup with Scapularia Daji Drainage Lung Soup plus reduction, which has a good effect; however, the medicine has mostly dry and cold drugs that can damage the stomach qi of the body, and the qi-yin of the stomach is depleted, which in turn damages the stomach yin, resulting in extreme weakness, not thinking about eating and drinking, poor sleep, red tongue like vivid red, no moss, etc. Stomach qi decay. Therefore, in the late stage of treatment, the main concern should be to support the stomach qi, and if we can keep one point of stomach qi, we can get one point of vitality.