Abstract: In this paper, we systematically explain that the TCM constitution is the intrinsic basis for the development of cough variant asthma and its symptoms, and there is a close correlation between the two. Accordingly, it is proposed that the theory of constitution should be introduced into the prevention and treatment system of this disease to realize the personalized treatment of this disease and to promote the idea of “treating the disease before it occurs” in Chinese medicine, so as to fundamentally correct the bias of the internal organs of patients with this disease, and thus find the entry point to cure and stop the development of typical asthma, and a breakthrough is expected. Yan Yongbin, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
Keywords: correlation; TCM constitution; cough variant asthma
Cough variant asthma (CVA) is a specific type of asthma with persistent or recurrent cough as the main manifestation. Modern medicine has recognized that genetic factors play a key role in its development. Inspired by this, the author has conducted an in-depth theoretical analysis and clinical tests on the correlation between the physical constitution and the disease in Chinese medicine, in order to discuss the close correlation between the two. It is discussed as follows for the benefit of our colleagues.
1 The origin of TCM physical constitution and the current status of CVA TCM cognition
1.1 The origin of TCM somatology
TCM physique refers to the strengths and weaknesses of qi, blood, yin and yang, and the structure and function of internal organs, as well as the susceptibility to certain disease-causing factors and the tendency of disease development in the pathological process, based on the innate endowment of a group or an individual in a group, formed during the process of growth and development.
In ancient times, Chinese medicine physical constitution began in the Han Dynasty, such as “Ling Shu – life and death of the rigid and soft” said: “human birth also, there are rigid and soft, there are strong and weak, there are long and short, there are yin and yang”, and in the “Treatise on Typhoid” there are “strong people, wonky people, the original cold, the old slightly loose, people originally deficient, deficient people” and other terms This laid the foundation for the classification of physical constitution in Chinese medicine. In addition, the ancient Chinese medicine on the relationship between physical and morbidity also have knowledge, such as “Su Wen – general assessment of the theory of deficiency” said: “the elimination of servant strikes, impotence and convulsions, full of gas hair rebellious, Gan fat, your people, is also the disease of sorghum.” The medical method of the heart of the “Yin organs felt by the disease, Yin is the majority, …….”
Modern Chinese medicine physical theory since the 1970s by Kuang Tongyuan, Wang Qi and other scholars proposed after nearly 20 years of research, has formed a more complete theoretical system. With the in-depth research of modern TCM constitution theory, a variety of constitution typing methods have emerged, represented by the 6-point method of Kuang Tongyuan [1] and the 7-point method of Wang Qi and Sheng Zengxiu [2]. However, studies on TCM constitution specifically for CVA patients have not been reported.
1.2 Current status of CVA TCM cognition
Cough variant asthma (CVA) is a special type of asthma with persistent or recurrent cough as the main manifestation, also known as cough asthma and cryptogenic asthma, firstly named officially by Glauser [4] in 1972. For CVA, a disease only recently recognized by Western medicine with the help of modern tests, traditional Chinese medicine has not yet distinguished CVA as an independent disease from the category of “cough”, and the understanding of its etiology and pathogenesis, diagnosis and treatment, and prevention of recurrence and evolution is mostly referred to “cough” or “croup”. “Therefore, no major breakthrough has been achieved. In particular, the theoretical research on the close correlation between somatic factors and the pathogenesis of this disease is still lacking in depth, and the role of somatic regulation based on TCM somatics in the prevention and treatment of this disease is even more lacking in theoretical exploration and clinical evidence.
2 Correlation between TCM constitution and the development of CVA
2.1 Chinese medicine constitution is the basis of CVA pathogenesis
After theoretical tracing and clinical examination, it was found that the TCM constitution is an important pathological basis for the susceptibility, pathogenesis and regression of CVA.
First, the TCM constitution determines the susceptibility of CVA. The TCM constitution reflects the body’s own physiological range of yin and yang, cold and heat, which determines the susceptibility of individuals to different diseases. As the “Spiritual Pivot – Five Changes” said: “The meat is not firm, the coup is sparse, it is good at disease wind …… rough and the meat is not firm, good at disease paralysis.” The author’s clinical investigation of CVA patients’ TCM constitution shows that among the seven constitutions designed for Qi stagnation, blood deficiency, blood stasis, stagnation, fluid deficiency and phlegm-dampness, 90% of CVA patients have Qi deficiency, blood stasis and stagnation, in other words, this special constitution of the individual determines their susceptibility to CVA.
Secondly, the TCM constitution determines the subordination of the disease mechanism of CVA. The so-called pathogenic transformation refers to the different pathogenic transformations that occur after the invasion of the body by the disease, depending on the patient’s physique. As Zhang Xugu’s “Six Qi and Yin-Yang Theory of Medicine” says: “The yin and yang of evil follows the yin and yang of the person and changes. In the author’s opinion, the key to the TCM pathogenesis of CVA is that the wind evil enters the lung channels for a long time, combined with the internal stagnation of spleen deficiency and the internal growth of dark stasis [4], which causes the wind and stasis to wrestle with the lung channels and the lung to lose its publicity and purification, resulting in a cough that does not heal for a long time. Similarly, the TCM constitution also determines the pathogenesis of CVA, and the key to the pathogenesis of CVA is precisely due to the TCM constitution of CVA patients with Qi deficiency, Blood stasis and stagnation.
Finally, the TCM constitution determines the regression of CVA. Although disease regression is influenced by various factors such as external evil, positive qi, and constitution, the author believes that the TCM constitution is the key factor in determining disease regression, especially for CVA. In my clinical practice, I found that there is a significant difference in the transformation rate of CVA patients with different TCM constitution into typical asthma, among which the transformation rate of CVA patients with blood stasis constitution is the highest. Admittedly, a large sample, long-period, multicenter research study in this area is needed in the future and is expected to be a breakthrough in curing CVA and preventing its evolution in TCM.
2.2 Epidemiological and genetic studies are available for supporting evidence
The basis of TCM physique is innate endowment, which originates from the innate essence, or what modern medicine calls genetic factors. Epidemiological and genetic studies have shown that genetic factors play a key role in the formation of asthma, thus corroborating the close correlation between TCM constitution and CVA from an experimental perspective.
CVA is a specific type of asthma. Most scholars believe that the pathogenesis of CVA is the same as that of typical asthma, which is chronic nonspecific inflammation caused by allergens or other triggers, and the formation of airway hyperresponsiveness (brochial hyper responsiveness BHR) on this basis, and genetic factors play a key role in the formation of BHR. Jin Yongtang et al [5] genetic epidemiological study of bronchial asthma showed that the risk of asthma in relatives with BHR was 8.1 times higher than that in relatives without BHR. Genetic studies have shown that BHR regulatory genes are localized on chromosomes 5q and llq. Postma [6] et al. showed by sibling pairwise analysis and LOD score analysis that BHR is linked to genetic markers D5S436 and D5S658 on chromosome 5q, that high levels of total serum IgE are linked to BHR, and that BHR susceptibility genes are located on chromosome 5q near IgE This is consistent with the hypothesis that one or more BHR susceptibility genes are present near chromosome 5q31-q33. Van Harwerden [7] showed that high polymorphism of microsatellite DNA markers on intron 5 of the high-affinity IgE receptor (FcqRIβ) gene on chromosome 11q13 showed a linkage with BHR, while in atopic patients without BHR patients showed no linkage, and mutations at or near the FcqRIβ locus affected airway responsiveness, reflecting the genetic nature of asthma.
3 Relevance of TCM constitution to CVA prevention and treatment
3.1 Somatic modulation is the intrinsic basis for personalized treatment of CVA
Because the specificity of the body constitution determines the tendency of the clinical symptoms after the onset of the disease, the characteristics of the body constitution are included in the characteristics of the “evidence”, so the clinical diagnosis of the body constitution is regarded as a prerequisite and an important basis for the identification of the evidence in Chinese medicine.
In fact, the idea of physique control has been discussed in ancient Chinese medical literature. For example, “Su Wen – Three Departments and Nine Hieroglyphs” says: “We must first measure the fatness of its shape in order to regulate the deficiency of its qi. We must first remove the blood vessels and then regulate them, without asking the number of them, in order to level the period.” This is the earliest manifestation of the idea of physical regulation. Later medical practitioners developed it on the basis of the Yellow Emperor’s Classic of Internal Medicine. In the “Medical Discourse”, it is said that “the first thing to do in treatment is to examine the strengths and weaknesses of the yin and yang of a person’s constitution, and only then can we regulate it to make it safe.” This further discusses the idea of physical regulation. And Zhang Jiebin’s “Jing Yue Quan Shu” says, “We should distinguish the difference between the person and the evidence. Cover the person, this is also; evidence, the standard also. The evidence follows the person and is the cause of success or failure. Therefore, because of the person first, because of the evidence second.” This idea not only further points out the difference between evidence-based treatment and physical regulation, but also clarifies the priority of physical regulation, “Therefore, the person is the first and the evidence is the second”.
In view of the key role of somatic factors in CVA and the modifiability of somatic characteristics, it is necessary to fully consider the somatic characteristics in the clinical identification of CVA and to take different treatment measures according to the somatic characteristics. By actively improving and correcting their constitution, we can fundamentally correct the bias of the internal organs of CVA patients, thus finding the entry point to cure and stop their development into typical asthma. Therefore, different methods of regulating the physique of CVA patients according to their different physiological characteristics, such as medication, diet, health care, etc., will fully reflect the idea of individualized treatment in Chinese medicine, which is based on the physiological and pathological specificity of human beings to prevent and treat diseases, and is in line with the trend of the development of social medicine model.
3.2 CVA constitution control is an important embodiment of the concept of “treating the disease before it happens”.
In view of the close correlation between CVA and physical constitution and its modifiability, physical constitution control is based on the clinical classification of CVA patients’ physical constitution, and the corresponding interventions such as nourishment and treatment are carried out for different types of physical constitution, so as to gradually improve the physical constitution of patients through acquired factors, so as to adjust the biased state of internal organs, yin and yang, qi and blood, eliminate the disease in the bud, and prevent its evolution to typical asthma. This idea of “prevention of change from both diseases” is a good interpretation of the idea of “treating the disease before it occurs” in the Nei Jing and the theory of “treating before evidence” of the medical sage. It can be seen that the full attention and research on the correlation between TCM constitution and cough variant asthma and the introduction of constitution theory into the prevention and treatment system of CVA will definitely provide a practical basis for the constitution therapy centering on the adjustment of constitution and health restoration, and provide a new way and reference for the modern treatment of difficult clinical evidence.
References
[1] Kuang Tongyuan. Research on somatic pathology. Journal of Chengdu College of Traditional Chinese Medicine, 1978,1(2):3-17
[2] Wang Q. Chinese medicine physical science. Beijing:China Medical Science and Technology Publishing House, 1995:70-71
[3] Stanescu DC, Teculescu DB. Exercise and cough induced asthma. Respiration,
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[4] Yan YB, Liu XW. Peng Bo’s treatment of “dark stasis”. Journal of Traditional Chinese Medicine, 2005, 46(12):901
[5] Jin YT, Chen SC, et al. Effect of airway hyperresponsiveness on bronchial asthma in adolescents. Chinese School Health.1999,20(2):141
[6] Postma DS,Bleeker ER,Amelung PJ,et a1.N Engl J Med,1995,333(14):894-900
[7]Van Herwerden L,Harrap SB,Wong ZY,et al.Lancet,1995;346(8985):1262-1265
Author Biography.
Yan YB, PhD, Chief Physician, Professor, Master’s Degree, Pediatric Infection and Digestion. Specialties: pneumonia, chronic cough, recurrent upper respiratory tract infections, drug hypersensitivity reactions; infectious mononucleosis, Kawasaki disease, unexplained fever and other infection-related diseases; anorexia, constipation, diarrhea, gastritis, abdominal pain pending investigation, infantile liver syndrome, hepatosplenomegaly and other digestive-related diseases.
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