(E) Pros and cons of glucocorticoid therapy in acute progression In the acute progression stage of patients with interstitial pneumonia, the correct use of hormones will often turn the patient around. However, there are often many exceptions, I think, there are the following cases, should try not to use; if in use, to quickly withdraw the intravenous massive use of hormones; preferably as soon as possible, as soon as possible to reduce the amount of the patient’s condition will be controlled. 1, chronic interstitial lung disease acute exacerbation stage, it is not easy to too long excessive use of drugs. 2, subacute interstitial pneumonia recurrent episodes, especially in the relatively stable period of patients, such as connective tissue disease complicating interstitial pneumonia. 3.Elderly people, patients with poor physique and eating less calories. 4, patients with many comorbidities, hypertension, coronary heart disease, diabetes mellitus. Example 3 Patient XX Miao, Case No. 170329, female, 67 years old, was admitted to my ward on January 13, 2011 with idiopathic interstitial pulmonary fibrosis as an outpatient due to “chest tightness and breathlessness for 1.5 months”. History: the patient was admitted to the hospital more than 40 days before the cold fever (body temperature up to 38.9 ℃), with chest tightness, breathlessness, fatigue, shortness of breath after activity, no cough sputum, no hemoptysis, the local clinic to the cold to give antibiotics (specific details are not known), the condition of the disease is relieved, the body temperature gradually decreased to about 37 ℃, but chest tightness and breathlessness worsened progressively, and then seek medical treatment in the Shandong Provincial Chest Hospital, the chest CT test showed interstitial fibrosis, inflammation of the lungs. Fibrosis, lung inflammation. So from 2010-12-20 to 2011-1-13 in a provincial hospital in Shandong Province, hospitalized in anti-infection, anti-inflammatory treatment: methylprednisolone 500mg IV Qd for 3 days and then changed to 40mg Bid 15 days Cyclophosphamide 0.2 IV Qod for 11 days and then changed to Biw for 12 days to January 13, 2011, but the patient’s clinical symptoms did not improve significantly, in order to seek a combination of traditional Chinese and Western medicine treatment. He was admitted to our ward. Admission evidence: chest tightness, breathlessness, aggravated by movement, unable to tolerate any light activity, mask oxygen inhalation oxygen flow 10L/min calm oxygen saturation of 80%-90%, a slight cough oxygen saturation can fall to 60%-79%, with cough sputum, fatigue, sweaty, poor sleep, no fever, no chest pain, no hemoptysis, two bowel movements, no fever, no chest pain, no hemoptysis, no blood loss, no fever, no chest pain, no chest pain, no hemoptysis, no blood loss, no blood loss, no blood loss, no blood loss, no blood loss, no blood loss, no blood loss, no blood loss. No fever, no chest pain, no hemoptysis, bowel movement. Past history: 1 year ago due to facial leukoplakia in our hospital to vitiligo to give Chinese patent medicines orally (specific details are not known), external “compound kaliziran tincture” treatment for 8 months; 12 years ago there is a history of arthritis, has been cured. She denies any history of infectious diseases or allergies, and has worked as a teacher for a long time, retired for more than 29 years. Physical examination: T 36.6 P 95 beats/min R 29 beats/min BP 113/80mmhg, elderly female, moderate nutrition, depressed, passive recumbent position, cyanosis of lips and mouth, bursting sounds heard in both lungs, obvious in both lower lungs, heart rate 95 beats/min, rhythm is whole, no pathologic murmur is heard in each valvular auscultation area, and there is no swelling in both lower limbs. Auxiliary examination: chest CT: interstitial pneumonia, calcified foci in the left lower lung. Cardiac ultrasound: tricuspid valve mild regurgitation, pulmonary valve mild regurgitation; pulmonary hypertension (mild). PANCA: 1.37U/L, CANCA: 0.77u/L. Chinese medicine diagnosis: pulmonary impotence; Western medicine diagnosis: idiopathic interstitial fibrosis Diagnostic and therapeutic procedures: January 13th admission to the Chinese medicine internal medicine nursing routine level 1 care, severe disease, continuous mask oxygenation, continuous electrocardiographic monitoring; methylprednisolone 40mg drip bid; methylprednisolone 40mg static bid; cyclophosphamide 0.2g static Qod; omeprazole 40mg static qd; low molecular heparin 5000u subcutaneous injection qd; ginseng alkaline injection 200ml static qd, danshen powder 0.8g static qd, ginseng qiqi fuzheng injection 250ml static qd; January 18th, the patient’s chest tightness and breathlessness significantly reduced, can dress themselves and other light activities, resting On January 18th, the patient’s chest tightness and breathlessness decreased significantly, and she could put on clothes and other light activities on her own, and her oxygen saturation was maintained at above 90% when she was in the state of oxygen intake concentration of 5L/min, so she stopped continuous oxygen intake by mask and changed it to oxygen intake by nasal catheter; she stopped continuous electrocardiographic monitoring; she stopped cyclophosphamide; she changed to Methylprednisolone 20mg IV bid; and she was given Picrinrinone, Danshen powder, and Radix Astragali Fucus Injection. On January 25th, the patient could stand on his own under oxygen inhalation, and his appetite improved significantly, and bursting sounds could still be heard at the bottom of both lungs; he stopped methylprednisolone and switched to oral Medrol 12mg bid; he stopped Picrasidine and switched to XINBEIKE 200u IV qd; and he followed the use of Danshen Ginseng Powdered Needle and Radix Astragali Fuzheng Injectable Liquid. February 9, the condition continues to reduce, can walk around the bed about 10 meters, so stop the seriousness of the disease, change the second level of care, Medrol reduced to 8mg bid, stop omeprazole needle; stop Xin Beike, following the use of ginseng alkaloids, danshen powder injection, ginseng astragali Fuzheng injection; March 8, the patient was discharged routinely, discharged the patient’s chest tightness and suffocating breath aggravated by the activity, can walk independently for 30 meters or so, occasional coughing and sputum, fatigue and sweating, without fever, without hemoptysis, sleep can be two, and the patient can walk independently. There was no fever, no hemoptysis, sleep, and bowel movement. A few crackles were detected at the bottom of both lungs. March 8-April 5, the first month after discharge from the hospital after March 20, every night basically no oxygen, daytime oxygen 3L/min, in the quiet, sitting up, blood oxygen is generally more than 90, the heart rate is about 100. Eat normally, sleep very well, normal urination and defecation. Sunbathing on the balcony every day, moderate but relatively regular activity, cheerful mood, range of activities limited to indoors. A daily dose of tonic Medrol Methylprednisolone Tablets 1 capsule bid Bailing Capsules 0.5g 4 capsules/times 3 times/day Pulmonary Cough Capsules 4 capsules/times 3 times/day Eucalyptus Pinocampus Enteric Softgel Capsules 1 capsule/times 1 time/day Xinkang 0.5 capsule/times 2 times/day Lutel 1 capsule/times 2 times/day Omeprazole 2 capsules/times 2 times/day Ensure Calcium By Aspirin 1 capsule/day 2 May 2012 Patient’s current condition basically restored to normal. She can go up and down 4 floors and do normal housework. Medrol Methylprednisolone Tablets 1 capsule/day Bailing Capsules 0.5g4 capsules/times 3 times/day Pulmonary Cough Capsules 4 capsules/times 3 times/day Eucalyptus-Pinocamphe Enteric Softgel Capsules 1 capsule/times 1 time/day The above cases were rapidly withdrawn from the high dose of hormone use, and the patient’s condition could be controlled. At present, the patient has recovered as normal. It is worth thinking about. (F) Antibiotics are frequently used in the progression of interstitial pneumonia. But, sometimes it will make the bacterial flora imbalance and lead to the aggravation of the disease. In the following cases, the course of antibiotics should have strict control 1, patients with severe and advanced disease. 2, Patients with chronic recurrent episodes of debility. 3. patients with advanced age and multiple comorbidities. Example 4 Male 72 years old Fever, coughing up a lot of pus sputum, wheezing, aggravated by movement, sputum culture Pseudomonas aeruginosa after 10 days of combined antibiotic treatment Pulse slippery, reddish-red tongue, yellowish and slightly greasy fur, Western medicine diagnosis Interstitial pneumonitis, pleural effusion, cardiorespiratory insufficiency Chinese medicine diagnosis Wheezing Chinese medicine diagnosis Gas deficiency and blood stasis, phlegm and drink internal aggregation Treatment: 1. Stop using western medicine and antibiotics 2. 10 Bailing capsule 3. 4 Lung Force Cough capsules Three times a day. 3 times a day 4. Ginoton 1 capsule twice a day 5 Chinese medicine 1 dose a day Codonopsis pilosulae 12 Astragalus membranaceus 18 Atractylodes macrocephala 12 Huanglian 6 Rhizoma ligustici chuanxiong 9 Pueraria lobata 9 Fritillariae vulgaris 9 Dandelion 15 Yunling 15 Psidium guajava 12 Angelica sinensis 9 Platycodon grandiflorus 12 Job’s tears coix lacryma 30 Fructus gravy 24 Chinese yam 24 Rehmannia rehmanniae 15 Hovenia citrus shells 12 Fructus zeylanica 12 Radix et Rhizoma Glycyrrhizae 12 Sandalen 6 Glycyrrhiza glabra 6 Ginger 3 slices, Jujubes 5 Twenty days later, the patient’s pleural fluid disappeared, the inflammation in lungs decreased, and hypertrophied heart shrinkage, and the symptoms were obviously improved. (VII) Early treatment of pulmonary fibrosis by combining traditional Chinese and Western medicine (I) Characteristics and patterns of the onset of subacute interstitial pneumonia 1, the chronic onset of subacute interstitial lung disease, often found in inadvertent physical examination, such as colds, routine checkups, etc.; or the patient has a gradual complication of chronic connective tissue disease. 2, patients have no or only mild clinical symptoms. 3, these stable patients with medication should be a larger dose of drugs to control the possible progression of the disease? After all, the patient has developed diffuse lung damage in an unnoticed state. Example 5: Zong XX, female, age, diagnosed in April 2007 with interstitial pulmonary fibrosis. She has been treated with traditional Chinese medicine since then. During this period, the patient was able to do housework, walk to the market to buy food, cook at home, and come to the hospital by herself to see the doctor and pick up medication. The finger oxygen meter, has been between 85-90%. Example 6, because of the improvement of the hypoxia condition, the patient has the improvement of dyspnea in the early stage, the improvement of mobility, the improvement of face color, the improvement of appetite, the improvement of defecation difficulty and so on. Many patients’ nails, which were black in color and rough on the surface due to long-term hypoxia, also improved and gradually produced nails with normal color, which became the basis for observing the patient’s condition. This is a case of nail changes in a patient who has been taking medicines such as herbal tonics and Baering capsules since May 9, 2012 until now (September 28th). Four months is close to fading out the nails that were there during oxygen deprivation. Nail changes in patients who have been taking medications such as herbal tonics and Bailing capsules from May 9, 2012 to the present (September 28th). Four months are close to fading out the nails that were present during oxygen deprivation. Example 7, Nail changes in a patient who has been taking medications such as Chinese herbal tonics and Bailing capsules from August 10, 2012, to the present (September 28) Nails of normal color have just appeared in more than forty days. (ii) The application of glucocorticoids in the early treatment of pulmonary fibrosis by combining traditional Chinese and Western medicine 1) Dosage: For those with slow and insidious progression (before and after lung CT slice control observation) without significant clinical symptoms, it is recommended that hormone therapy should not be given as much as possible, and only traditional Chinese medicine should be used. For those with clinical symptoms and X-ray progression after treatment with traditional Chinese medicine alone, methylprednisolone tablets 4mg/day or prednisone 5mg/d should be given in the morning, and the dose should be adjusted according to the change of the follow-up condition, and the dosage should be often reduced or stopped. For those with recent progression of lung inflammation (based on the clinical manifestations of bouts of cough or worsening of dyspnea, and mild progression of lesions on recent CT films of the lungs), methylprednisolone tablets 4-8 mg/day twice or prednisone 5-10 mg/day twice, depending on the condition of the patient. For more severe patients (those who feel dyspnea when walking on the ground), the dose of methylprednisolone tablets 12mg/2 times a day or prednisone 15mg/2 times a day should be increased according to the condition. For severe or acute exacerbation of AIP, IPF patients with intravenous shock therapy (methylprednisolone injection 40-80mg/day 2-3 times). 2) Course of treatment: in principle, for the progression of the disease and the clinical symptoms of the obvious start with a larger dose, such as moderate or more serious conditions of oral prednisone 15-30mg / d (other preparations can be converted to the corresponding dose), to be relieved after the disease is reduced to a maintenance dose, continuous use of drugs for 3 months – half a year, according to the patient’s degree of improvement and continue to reduce the drug until discontinued. In severe patients or patients with acute exacerbation of IPF (AE-IPF) or AIP, after 5-10 days of intravenous shock therapy, change to methylprednisolone tablets 12mg/day 2-3 times or prednisone 15mg/day 2-3 times, and then gradually reduce the dose to the maintenance dose according to the patient’s condition. After 6 months to 1 year of continuous use of the drug, according to the clinical evaluation of pulmonary function, chest X-ray, pulmonary function examination, can continue to reduce the dosage to stop the drug. Some patients need to use the drug for more than 2-3 years to continue to reduce the dosage to stop the drug with the improvement of the condition. 3) Combined use: ①Bailing capsule 2 grams, three times a day; lung force cough capsule 1.2 grams, three times a day. Sweating, shortness of breath patients Yupingfeng granules, 3-6 grams, twice a day. ② Chinese medicine, dialectic medication, dialectic treatment, Chinese medicine soup, one dose per day. ③ If the condition requires intravenous administration of adrenal glucocorticoid, it needs to be injected subcutaneously at the same time with low molecular heparin 5000u, once a day, to prevent arterial thrombosis caused by long-term use of hormones, and coagulation indexes should be observed. ④ Calcium tablets and antacids are useful to prevent side effects such as osteoporosis and gastrointestinal tract. ⑤ For those with obvious progression of lung inflammation, three groups of Chinese herbs are often administered intravenously at the same time-clearing agent of heat (bitter sambucus alkaloids, andrographis paniculata), blood-activating agent (danshen and chuanxiong), and qi-benefiting agent (ginseng and astragalus fuzheng injections of ginseng and muiracha), which can effectively alleviate the progression of the patients’ conditions.