Interstitial lung fibrosis is one of the intractable diseases of the respiratory system, with complex etiology, protracted course and poor prognosis, seriously affecting the quality of life of patients, most of whom eventually die of respiratory failure. In view of the complex and difficult disease characteristics of this disease, this paper intends to discuss the detailed mechanism of the disease from the perspective of phlegm evil in Chinese medicine, in order to provide a theoretical basis for clinical treatment.
1.The concept of phlegm mountain
Phlegm is an intrinsic pathological product in TCM theory, mostly caused by the dysfunction of the viscera and the failure of the fluids to return to the right chemistry, and is one of the water-damp phlegm and phlegm drinks. Water-damp phlegm and phlegm are of the same origin and different streams, four in number and one in number, all of them are pathological products formed by the obstruction of human fluids in the process of transmission and excretion, which stay in the body. From the texture, thick and turbid for phlegm, clear and thin for drink, more clear for water, and wet is water diffusion impregnated in the human body state, its shape and quality is not as obvious as phlegm drink and water. Therefore, it is said that the wet gathered for water, water into drink, drink condensed into phlegm. So phlegm often with wet, water, drink can be divided and can not be separated.
2, the formation of phlegm
The formation of phlegm mainly has both internal and external causes. External causes are mostly due to six external influences or epidemic evil, such as “Jing Yue Quan Shu” said: “wind and cold phlegm to evil from the skin and hair, invade the lungs, lung gas unclear and even phlegm.” The internal cause is mostly a pathological product resulting from the dysfunction of the internal organs of the body due to the action of internal injury factors. Interstitial lung fibrosis is an internal injury disease in TCM, so internal causes often play a more important role in the development of this disease. In detail, the phlegm formed by internal injuries is mainly related to the following aspects.
(1) Loss of health of the spleen, unfavorable production of phlegm and dampness
The spleen and the stomach are the basis of the latter and the source of biochemical energy and blood. The spleen is responsible for raising clearness and the stomach is responsible for lowering turbidity. If the spleen and stomach are healthy and healthy, the stomach will receive and cook, and the spleen will transport and transform the rising and clearing functions normally and produce water, grain and essence. When the function of the spleen and stomach is dysfunctional, it will affect the production, operation and distribution of qi and blood, resulting in a series of pathological manifestations. If the patient is addicted to thick sorghum, alcoholic wine, fatty and sweet, spicy and fishy products, which affects the function of the spleen and stomach, the water and grain do not return to the correct transformation, and the grain becomes stagnant and the water becomes 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 loss of transmission, stay in the middle Jiao, breeding dampness. Or over-eating cold and cold, the spleen and Yang loss of exhibition, water and grain into phlegm and dampness. In addition, excessive thinking or exertion can also injure the spleen and cause it to lose its function of transportation and transformation, causing water and dampness to stop inside and condense into phlegm. Since the spleen and stomach are the primary organs for transporting water and grain, the loss of function will directly lead to the production of phlegm and dampness, so it is said that “the spleen is the source of phlegm”.
(2) the lung is out of tune, the perfusion is out of order, phlegm and dampness are stored inside
The lungs are responsible for breathing and regulating the water channels. The lung is the main regulator of the water channels, which means that the lung’s function of propagation and purification has the function of draining and regulating the distribution, operation and excretion of fluid in the body. The Su Wen – the meridians and veins say: “Drinking into the stomach, overflowing essence, upward transmission to the spleen, spleen qi disperses essence, up to the lungs, through the regulation of the water channel, downward transmission to the bladder, water essence four cloth, five meridians parallel.” It can be seen that, although the water in the body from the spleen and stomach, but the transmission, operation and excretion of water, but also depends on the lungs to open and regulate to maintain a dynamic balance. Therefore, it is said that “the lungs are the source of water”. When the lungs are self-inflicted or other internal organs are affected, resulting in a malfunction of the lungs in promoting and regulating the water channels and distributing fluid, the pathological situation of fluid stagnation and phlegm production can occur. When phlegm is stored in the lung, the lung Qi is not conducive, and phlegm gushes through the airway and causes coughing and phlegm production.
(3) Insufficient kidney energy, yin and yang are weak, indirectly producing phlegm
The kidney is the master of water, presiding over and regulating the metabolism of fluids in the body, and this role depends mainly on the balance of kidney yin and kidney yang to complete. When there is a deficiency of kidney energy and a weakening of yin and yang, it will have an effect on fluid metabolism. In other words, when the kidney yang is insufficient for various reasons, the ability of transpiration and gasification of water and fluid decreases, and water-dampness is not transformed and floods for harm, flooding the skin for edema, overflowing the heart and shooting the lungs for panic, coughing, suffocating asthma, breathing difficulties, and inability to lie down. When the lungs are affected by water-drink, the perfunctory function is lost, thus producing phlegm-dampness, and when combined with water-drink, it is phlegm-damp water-drink, which is retained in the lungs and becomes harmful. When the kidney yin is insufficient, yin does not control yang, deficiency fire is generated within, decoction of fluid into phlegm, phlegm evil reaches the lungs with the lift of qi, affecting the physiological function of the lungs.
(4) Unfavorable San Jiao, loss of qi-transformation, internal production of phlegm and dampness
”The Sanjiao is the official of the dysfunction, and the water channels come out of it.” This is a physiological summary of the water-liquid flow in the San Jiao. The whole body’s water metabolism is accomplished by the synergistic action of the lungs, spleen and kidneys, but the Sanjiao must be used as a channel for normal movement in and out. If the Qi-transformation of the three jiao is not favorable, the evidence of change will arise. As stated in the Classic of the Classes, “If the upper jiao is not treated, water will flood the plateau; if the middle jiao is not treated, water will stay in the middle and lower jiao; if the lower jiao is not treated, water will disrupt the two stools.” When the three organs of the lungs, spleen and kidneys are dysfunctional, it affects the qi-transformation of the three jiao, then the water and liquid transportation is out of order, either producing water-drinking or phlegm-dampness, and the related internal organs pathology appears.
(5) Loss of liver drainage, adverse qi flow, and phlegm transformation of fluid
The liver is a rigid organ, which is responsible for the draining of qi and 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 and mentally unstable, who are worried and stagnant, or who are depressed and angry and hurt the liver, will suffer from a loss of drainage of the liver and stagnation of qi. One kind of transformation is the decrease of the ability of the fluid to run due to the stagnation of qi, thus producing phlegm and dampness; another kind of transformation is the transformation of qi stagnation into fire over time and the decoction of the fluid into phlegm by fire and heat. Phlegm is a tangible product, once produced and can increase the Qi stagnation, and can be harmful with blood stasis, thus leading to aggravation of the disease cycle.
3.Phlegm performance
(1)The manifestation of phlegm
The main clinical manifestations of the disease are chronic cough, occasional coughing of sputum and progressive shortness of breath. Clinical symptoms include difficulty in breathing after activity, chest tightness, shortness of breath, shortness of breath, cough, dry cough, or small amount of white mucous sputum, dark tongue with thin white greasy coating, smooth or astringent pulse, or fever, dry stool, yellow sputum, red tongue with yellow greasy coating, smooth or fine pulse. Respiratory failure, pulmonary heart disease and right heart failure occur in late stage with high mortality.
(2) Implicit indicators of sputum
Modern research has found that patients with this disease mostly have the following abnormal indicators. The abnormal manifestations of microcirculation of A-fold: the increase of heterogeneous tubular collaterals, the appearance of capillaries with distortion, dilatation, blurring of tubular collaterals, peripheral exudation, slowing down of flow velocity, abnormal flow pattern in the form of granular flow and granular line flow, etc. Secondly, phlegm and dampness are manifested by whole blood viscosity, red blood cell pressure, sedimentation, platelet aggregation function, increased fibrinogen and slowed down red blood cell electrophoresis. Therefore, blood rheology index can be used as an observation index of phlegm evidence, especially invisible phlegm.
In terms of blood rheology: Fang Yongqi demonstrated that the rheological characteristics of blood in patients with phlegm evidence are highlighted by increased thickening, viscosity, aggregation and coagulation of blood. Since patients with this disease are often treated with glucocorticoids, they are prone to hyperlipidemia. Sun Gang tested metabolic indicators such as glucose and lipids in patients with phlegm and non-phlegm evidence, and found that cholesterol, triglycerides, and fibrinogen were significantly elevated in the phlegm type. Therefore, there is a close relationship between phlegm and elevated blood lipids.
4.Characteristics of phlegm
(1) Slow onset, insidious disease
Most of the disease has a chronic, recurrent and gradually aggravating course, and its symptoms are characterized by a mild cough and sputum at the beginning, followed by progressive dyspnea, chest tightness and shortness of breath, shortness of breath at every turn, and severe symptoms such as cyanosis and swelling at a later stage. From the perspective of traditional Chinese medicine, the production of phlegm is mostly related to the weakness of the body and the dysfunction of the internal organs after a long illness, and the phlegm evil is not obvious at the initial stage, once there is detectable evidence, the disease is often advanced.
(2) complex nature of the disease, and other evil
The formation of phlegm in the previous article discussed in detail the mechanism of phlegm production by dysfunction of various internal organs. In fact, the dysfunction of internal organs not only generates phlegm, but also blood stasis, water-dampness, fire-heat, poisonous evil and qi stagnation, and phlegm can be generated by external wind and cold evil. When phlegm and dampness are produced, the nature of heat or cold changes according to the patient’s constitution or treatment medication, manifesting as wind phlegm, cold phlegm, hot phlegm, wet phlegm or even dry phlegm. And phlegm evil often with blood stasis, water and dampness, fire and heat, poisonous evil, qi stagnation each other, resulting in the disease appear cold and heat mixed, deficiency and reality, treatment is difficult to get quick results.
(3) Phlegm is divided into visible and hidden, and causes disease together
The manifestation of phlegm in the previous article discussed in detail the manifest and invisible indicators of phlegm. Both manifest and invisible indicators are pathological manifestations, which cause the lung to lose its function of propagation and suction, resulting in a variety of symptoms. The hidden indicators are discovered with the help of modern research, which is a welcome point that we can apply to Chinese medicine and guide clinical treatment. For example, the application of phlegm-transforming herbs can be advanced for hidden indicators. It has been shown that the herbal medicine of benefiting qi and resolving phlegm can lower blood lipid and has anticoagulant effect.
(4) Serious damage to the human form
The disease is chronic and gradually aggravated, with many causative factors, many lesions involving internal organs, complex nature of the disease, easy to be combined with stasis of blood, heat and toxicity, qi stagnation and other evil qi or pathological products, resulting in complex symptoms of mixed deficiency and reality, cold and heat, so it is difficult to get quick results in the clinic and difficult to heal. At this time, the patient’s respiratory function is severely impaired, and the respiratory function of the main qi division 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 bleeding, convulsions, and fainting, resulting in death of yin and yang.