Interstitial lung fibrosis is a common interstitial lung disease of the respiratory system and one of the most serious diseases of the respiratory system.
It is characterized by diffuse alveolitis and structural disorders of the alveoli leading to interstitial fibrosis. Western medicine mostly uses corticosteroids and allopathic treatment, because corticosteroids require a long medical time, the dosage should be sufficient, and the side effects are large after a long period of time. Traditional Chinese medicine emphasizes evidence-based treatment and a holistic concept, with fewer side effects.
Considerable progress has been made in the treatment of pulmonary fibrosis, and the progress of treatment research in recent years is reviewed below.
I. Disease name study.
Progressive dyspnea is the most prominent symptom of idiopathic pulmonary fibrosis, accompanied by dry cough or sputum, shortness of breath after physical activity. It is clear that it is progressively aggravated and is a difficult and serious disease in the pulmonary system. In recent years, some studies have reported that this disease belongs to the category of “pulmonary impotence”. In modern research, interstitial lung fibrosis is considered to belong to the category of “lung paralysis”. In modern research, it is believed that interstitial fibrosis belongs to the scope of “lung paralysis”. The pathological process of fibrosis in the interstitial lung consists of thickening of the alveolar wall, mechanization of exudates, deformation and atresia of the alveoli, contraction of the fibrous tissue in the interstitial lung, and reduction of the number of capillaries. The symptoms of “coughing and gasping” and “gas running and panting” belong to the category of “coughing and panting” in Chinese medicine; however, the name of the disease is also a matter of opinion, and there is no uniform conclusion.
Research on the etiology and pathogenesis of the disease
In recent years, many physicians have elaborated on the basis of their predecessors and clinical practice, which has helped many scholars understand and appreciate the etiology and pathogenesis of the disease. The lung absorbs the kidney, lowering the qi and calming the asthma; this type of evidence has a poor prognosis. According to Li Guoqin, this disease is caused by the weakness of lung qi and the inability to control qi, or the inability of qi to distribute fluid, resulting in coughing and salivation as the main symptoms. Most of them are caused by deficiency of innate endowment and deficiency of Yang Qi due to lack of nourishment,
The spleen is not healthy, the kidney is not warm, and the phlegm and stagnation are internalized and blocked in the lung. Deficiency of Qi, deficiency of the three organs of the lung, spleen and kidney is the root cause of the disease, and stagnant blood and phlegm are the symptoms of the disease.
According to the theory of “long-standing disease enters the ligaments”, poison, blood stasis and phlegm obstruct the ligaments, leading to stagnation and obstruction of the ligaments. Blood stasis, heat and toxicity are the symptoms. Xu Jian believes that deficiency of lung and kidney qi and yin and internal obstruction of phlegm and stagnation are the root of the pathological mechanism of this disease. According to Lu Weiqing, various causes lead to the dysfunction of the main qi of the lung, which affects the “command” of qi over blood, causing blood to stagnate in the lung; on the other hand, the disease is recurrent and difficult to be cured, or due to stasis blocking the veins and ligaments, the distribution of fluids is lost, and the fluids condense into phlegm over time, which gradually becomes phlegm-stasis. Therefore, phlegm and stasis are the two major pathological factors, and it is suggested that phlegm and stasis are the two major pathological features of the disease.
Identification and typing
In recent years, many physicians have put forward insightful views on the differentiation and typing of the disease through clinical experience. Guan Tianyu et al. divided it into 3 stages.
In Chinese medicine, the lung is considered to be a “delicate organ”, which is susceptible to invasion by external evil, and the lung loses its function as a propagator, and the water flow is not smooth, which accumulates in the lung and turns into phlegm, blocking the lung collaterals; the lung loses its function as a master of qi, and the qi does not move smoothly, so that the blood stops into stasis and forms stasis of blood; phlegm, water, stasis and qi interact with each other. The essence of the pathological mechanism of this stage is the deficiency of the original and the symptoms of the main symptoms.
Lung injury stage: this stage belongs to the middle or subacute stage of interstitial lung fibrosis, the lung is the main “propagation and purification”, “the main governance”, the whole body qi and blood circulation are dependent on the regulation of the lung. With the development of the disease, the accumulation of water and phlegm in the lung turns into heat, decocting fluid and refining it into phlegm, which further aggravates the disease by blocking each other’s lung ligaments.
(3) pulmonary fibrosis stage: this stage mostly belongs to the late or chronic stage of pulmonary interstitial fibrosis.
Although the pathogenesis of the disease has its own focus, it is always a deficiency of the lung Qi and a symptom of the symptoms. Zhao Keming believes that idiopathic pulmonary interstitial fibrosis is located in the lung and is closely related to the spleen and kidney. The disease is mainly characterized by deficiency, with the original deficiency being in the lung, spleen and kidney, and the symptoms being phlegm, heat and stagnation. Therefore, the treatment should be based on the principle of treating both the symptoms and the root cause, and it is divided into five types, namely, lung dryness and fluid injury type, qi and yin deficiency type, lung qi deficiency and cold type, lung and kidney qi deficiency and blood stasis type, and lung and kidney qi deficiency and phlegm heat type.
IV. Specialized formula research
Many physicians have determined the treatment rules for a certain stage of the disease and composed specific formulas to treat interstitial lung fibrosis by adding and subtracting treatment according to the evidence, which has achieved some success in the treatment of interstitial lung fibrosis. Liang’s self-prepared fibrinolytic soup achieved satisfactory results in the determination of patients’ serum matrix metalloproteinase-9 (MMP-9) concentrations on chest X-ray, time lung volume, lung volume VC, diffusion function DLco and other indexes. Zhang Xiaomei et al. formulated Astragalus-Hong Tang (15g raw Astragalus, 15g safflower, 15g angelica, 15g yujin, 15g spineflower, 15g coix seed, 10g orris, 15g guavas) based on the principles of activating blood circulation, resolving phlegm, benefiting qi, and cleansing lung ligaments, which proved to have better therapeutic effects through clinical observation of lung function and blood oxygen.
Yang Dawen formulated Kangjin San (composed of Cordyceps sinensis, Radix Astragali, Radix prunus, Cornu Cervi Pantotrichum, Epimedium, Peach kernel and leech), and randomly divided 86 patients with interstitial lung fibrosis into two groups, the control group was treated with oral prednisone and the treatment group was treated with Chinese herbal medicine Kangjin San for 3 months. The results showed that Kangjin San could significantly increase the 6MIN walking distance, improve the hypoxic condition of the body, and improve the indexes related to blood rheology in patients with interstitial lung fibrosis, and could significantly reduce the treatment cost of patients. Chen Ping treated 38 cases of idiopathic pulmonary fibrosis with N-acetylcysteine combined with Xiao Qing Long Tang, and observed the clinical symptoms and signs of patients compared with N-acetylcysteine alone,
The results showed that the combination of Chinese and Western medicines in the treatment of idiopathic pulmonary fibrosis could improve the clinical symptoms, delay the progression of the disease and improve the survival quality. Chen B [12] observed the histomorphological changes of lung tissue and calculated the HYP content of lung tissue in rats with pulmonary fibrosis by comparing the Chinese herbal medicine (composed of 12g of Sumac, 9g of Saponaria, 15g of Gaijin Yu) with prednisone group. The HYP content of lung tissues was lower than that of prednisone group, indicating that the treatment of pulmonary fibrosis with expectorant, dispersing and softening herbs is effective, which opens up the idea of clinical treatment for us.
V. Animal experimental research
1.Specialized formula experimental study
Wang Xinhua [13] used the principle of benefiting qi, nourishing yin, activating blood circulation and resolving blood stasis to intervene in pulmonary fibrosis in rats with Salvia miltiorrhiza and Salvia officinalis injection. The group with Danshen combined with Ginseng and Semen was lower than the Danshen group (P<0. 05). Conclusion:The method of benefiting qi and nourishing yin, activating blood circulation and resolving blood stasis represented by Dan Shen combined with Ginseng and Mai has a significant effect on pulmonary fibrosis. The mechanism of action was related to its reduction of TGF-β1 expression. Guo Shuwen [14] studied the level of interleukin-8 and tumor necrosis factor-α (TNF-α) and changes in blood rheology in bronchoalveolar lavage fluid (BALF) of rats with pulmonary fibrosis with the formula of benefiting qi, invigorating blood and resolving phlegm (composed of Astragalus, Ginseng, Radix Paeoniae, Angelicae, Chuanxiong, Guadua, Allium and Semen), suggesting its significant prevention and treatment of pulmonary fibrosis lesions in rats induced with pinyin The results showed that it had a significant effect on pulmonary fibrosis lesions induced by Pingyangmycin.
Jiao Fangfang took the treatment of activating blood circulation, removing phlegm and regulating the lung, and unblocking the qi flow. Zhang Yanping’s self-prepared pulmonary fibrinopine (composed of 15 g of Wei Ling Xian, 10 g of Chuan Xiong, 10 g of Sha Shen, 15 g of Sheng Huang Qi, 10 g of Wu Wei Zi, 10 g of Aster, 10 g of Glycyrrhiza glabra, 6 g, etc.) was injected into the pulmonary fibrosis model of rats. The results showed that pulmonary fibrin could effectively inhibit the abnormal proliferation of collagen in experimental pulmonary fibrosis rats. Li Yinsheng extracted curcumin from Chinese medicine turmeric and found that the collagen deposition in lung tissue of pulmonary fibrosis rats was less than that in the hormone group, and the IOD values of transforming growth factor β1 were significantly lower than those in the hormone group, suggesting that curcumin can inhibit collagen deposition in lung tissue of pulmonary fibrosis rats, and its mechanism of action may be achieved by inhibiting the expression of TGF-β1.
2.Single drug test study
Li Jiang used Chuanxiongzin to intraperitoneally inject lung fibrosis rats, and the expression of type I collagen, type III collagen and laminin in lung tissue was detected by immunohistochemistry on the 28th day.
This may be one of the mechanisms of the therapeutic effect of Chuanxiongzin injection. The results showed that the expression of MMP-2 and TIMP-1 mRNA in the tiger wort group was weaker than that in the dexamethasone group, suggesting that tiger wort could reduce alveolitis and pulmonary fibrosis by inhibiting the abnormally high expression of MMP-2 and TIMP-1 mRNA in lung fibroblasts at different times.
The degree of alveolitis and pulmonary fibrosis was reduced. Liu Yongqi used Astragalus aqueous extract and Astragalus saponin to intervene in a rat lung fibrosis model, and detected the dynamic changes of blood IFN-γ, IL-4, NO levels, lung tissue SOD and MDA levels and lung tissue pathological structure, respectively. The degree of alveolar inflammation and fibrosis in lung tissues was significantly reduced, suggesting that Astragalus is effective in the treatment of pulmonary fibrosis.
VI. Conclusion
In the past three years, a lot of research work has been carried out on pulmonary fibrosis by various medical doctors, and there are innovations in the etiology and pathogenesis of pulmonary fibrosis, as well as innovations in clinical research and animal experiments on compound drugs and single drugs, which can be said that Chinese medicine has certain advantages over Western medicine in the treatment of pulmonary fibrosis. The author believes that a unified diagnostic, typing and efficacy assessment standard should be developed nationwide for pulmonary fibrosis, and the specific types of evidence should be studied in detail, and multi-level research on effective prescriptions and drugs should be conducted on organ, cellular, molecular and genetic levels.