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Abstract: The patient in this case is a 42-year-old female with recurrent coughing episodes for more than 4 months. The main features of the cough are: a heavy cough at night, chest tightness and breath-holding when the cough is severe, and occasional paroxysmal coughing, which is associated with cough variant asthma, i.e. croup in Chinese medicine. Therefore, anti-infective treatment should not be administered, and inhalation of hormonal drugs, etc., can be chosen to accelerate the relief of symptoms together with Chinese herbal identification therapy. After treatment, the patient’s cough was greatly reduced and all symptoms were relieved.
Basic information】Female, 42 years old
Disease Type】Cough variant asthma
Hospital】Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine
Date of Consultation】April 2011
Treatment plan】Therapeutic treatment with Chinese herbal medicine (Han Xia Diarrhea Heart Soup plus reduction: Nan Sha Shen, Sheng Huang Qi, Jiang Han Xia, Dry Ginger, Scutellaria, Huang Lian, Chen Pi, Hou Pu, Licorice, Zhan Dong Hua, Aster, Su Zi, Su Ye, Almond)
Treatment Period】Outpatient consultation, 2 weeks of self-administered medication
Effectiveness】Cough greatly reduced, all symptoms relieved
I. Initial interview
The patient had been taking compound licorice tablets, compound methonamine capsules, montelukast sodium tablets, cephalosporin antibiotics, and levofloxacin mesylate for intravenous anti-infection, all of which failed to relieve her cough. At present, he has a nocturnal cough, waking up in the middle of the night, dry cough with little sputum, distention after eating, dry throat and itchy throat, spontaneous sweating, fear of cold, normal stool, fat tongue with teeth marks, greasy and slightly yellow coating, and smooth pulse. The chest frontal and lateral radiographs were normal, the blood picture was normal, the pulmonary ventilation function was normal, and the airway excitation test (+) was normal. The preliminary diagnosis was cough variant asthma, that is, croup in Chinese medicine.
Positive airway excitation test
Patient’s tongue
II. Treatment history
According to the patient’s current condition, the diagnosis of cough variant asthma is relatively clear, and the patient refused to use hormonal drugs for fear of side effects such as obesity, oral fungal infection and hoarseness after using hormones, so he was only treated with tonics. The prescription is as follows: Nan Sha Ginseng, Sheng Huang Qi, Ginger, Ginger, Scutellaria, Huang Lian, Chen Pi, Hou Pei, Licorice, Radix et Rhizoma, Aster, Su Zi, Su Ye, Almond, etc.
III. Treatment effect
The patient reported that the cough was significantly less than before, and he could sleep at night, and the itching and dryness of the throat were reduced. The cough basically disappeared and other symptoms such as chest congestion also basically disappeared. In summary, the patient visited the clinic, self-medication for 2 weeks, cough greatly reduced, all symptoms relief.
IV. Notes
Although cough is a common symptom of respiratory diseases and patients usually take antibiotics for anti-infection treatment when cough occurs, it should be noted that not all coughs are caused by bacterial infections, so it is best not to use antibiotics at will when cough occurs, but to use them under the guidance of a doctor. As cough variant asthma is a type of asthma and a chronic cough, it may recur, therefore, attention should also be paid to the following in terms of diet and living in general.
1. avoid contact with food, drugs, irritating odors, etc. that can cause acute attacks of cough variant asthma, such as cold air, perfume, flower dew, etc.
2. It is easy to catch a cold during the change of seasons, and a cold can easily trigger an acute attack, so pay attention to increasing and decreasing clothing according to weather changes.
3. pay attention to a light diet during acute attacks, and pay attention to avoiding foods that are spicy and stimulating, too salty and too sweet, so as not to aggravate the cough, and not to eat too greasy, so as not to produce phlegm.
4. Avoid overexertion and staying up late.
V. Personal insight
If simple cough symptoms occur, or if cough is the main symptom and is accompanied by chest tightness when the cough is severe and is not accompanied by other respiratory symptoms such as fever, fatigue and sore throat, the possibility of cough variant asthma should be considered, and tests such as airway reversibility, or airway excitation test are needed to further confirm the diagnosis. If cough variant asthma is identified, it can be effectively controlled with hormonal inhalation anti-inflammatory drugs, usually together with TCM evidence-based treatment. In this case, the patient’s chronic cough was treated with pungent openings and bitter descents from the spleen and stomach theory, and was treated with Han Xia Di Xuan Xin Tang. Since coughing for a long time must hurt the qi-yin of the lung and stomach, ginseng was replaced with Nan Sha Shen, which belongs to the lung meridian and functions to benefit qi, nourish yin and resolve phlegm. Modern pharmacology has confirmed that it has a strong cough suppressing effect and can restrain the bitter dryness of dry ginger, Han Xia, Scutellaria and Lian. If the cough belongs to the spasmodic cough of cough variant croup, add draconic and antispasmodic products such as dongxianglong and dilong as appropriate; for patients with upper airway cough syndrome, especially rhinitis, often add cranberry, xinyi, dahurica and beehive as appropriate; if the cough is prolonged and lung qi is easily depleted, add huangqi and wuweizi as appropriate; if the form is cold and fearful of cold, with recurrent attacks, add erxian tang as appropriate to warm the kidney qi, often use Xianmao and Xianling spleen; for those with loose stools, add tonic bone fat If the stool is loose, add Boneset and Pueraria Mirifica.