I. Treatment of chronic interstitial lung disease
The most common is chronic obstructive pulmonary disease (COPD) with interstitial lung fibrosis.
This is followed by chronic proliferative fibrotic lesions due to tuberculosis, pneumoconiosis, and silicosis.
It is a group of refractory chronic lung diseases characterized by cough, wheezing, sputum, dyspnea with activity, obstructive restrictive pulmonary dysfunction and decreased pulmonary diffusion.
The pathological changes are non-specific chronic extensive small airway obstruction with alveolitis and interstitial lung inflammation with proliferative lesions and diffuse pulmonary fibrosis.
Two, three exploratory recommendations.
1, the disease should be divided into three categories: acute, subacute and chronic, on the basis of which a combination of Chinese and Western medicine should be used for classification and treatment.
2, based on the above understanding, we do not agree to do lung biopsy for patients with this disease, because it is far less meaningful to patients than the damage it brings.
3, change the concept of interstitial lung disease treatment, the patient with the disease can survive as the purpose of treatment?
We believe that the disease should be divided into three categories: acute, subacute and chronic, which is the most clinically meaningful classification method at present, and we believe that this classification method has important clinical significance for the combined treatment of interstitial lung disease by Chinese and Western medicine.
Acute interstitial lung disease has a rapid onset, rapid changes, and critical condition often requires timely diagnosis and accurate medication, and most patients can be turned to safety. It is often caused by viral infections, SARS, avian influenza and various acute respiratory infections of unknown origin resulting in ARDS are this type of acute interstitial pneumonia.
Subacute interstitial lung disease has an insidious onset, often with recurrent attacks and progressive exacerbations, and the effectiveness of medication is difficult to judge, but requires accurate judgment, adherence to long-term correct medication, and most patients can survive with the disease. It includes idiopathic interstitial lung fibrosis and various connective tissue diseases complicated by interstitial lung fibrosis.
Chronic interstitial lung disease is delayed, prone to recurrent attacks, and each attack, easily resolved. It often requires a long-term treatment program and many patients can show significant improvement. It is often a combination of COPD and chronic lung diseases such as tuberculosis and silicosis with interstitial fibrosis. (Talk about my three opinions on the diagnosis and treatment of interstitial lung disease) 2009 3 10
4. Treatment of acute, subacute and chronic classification
Third, the mastery of treatment principles. “If it is acute, treat its symptoms; if it is slow, treat its root cause”. “Acute disease is treated urgently, slow disease is treated slowly.” This is often for glucocorticoid dosing, dosage and regimen.
1, acute interstitial lung disease, the dose should be appropriately large, short course of treatment impact, intravenous drug-based, seeking rapid effect, saving lives. However, the dose and course of treatment and the mode of administration may vary greatly depending on the specific disease, physical condition and the priority of the disease.
The principle is that the smallest dose and shortest course of treatment that can be given orally instead of intravenously is the best.
2, subacute interstitial lung disease, the dose should be small, the course of treatment will be long, oral-based.
The principle is to do the maximum possible not to destroy the patient’s own self-adjustment mechanism.
We believe that the reason why this category of patients is dominated by the elderly and middle-aged women is often due to the weakening and destruction of self-adjustment mechanisms. In particular, the impairment of the normal state of the adrenergic axis is often an important factor in the exacerbation and progression of chronic inflammation. High-dose glucocorticoid shock therapy further destroys the patient’s self-adjustment mechanism and is a precipitating factor for rapid adrenocortical failure. Therefore, cautious use of shock therapy, especially in severe patients using a combination of Chinese and Western drug therapy and multiple drugs in small doses, is often the key to the successful gradual stabilization of the patient’s condition.
Treatment medication should be prioritized according to the patient’s condition. For example, the acute progressive phase of rheumatoid arthritis is controllable by high doses of hormones; however, patients in a relatively stable phase, high-dose shock therapy often has the opposite effect.
Interstitial lung disease is such that treatment must be prioritized separately. This is important to save the patient’s life. This is because, in most patients, the process of disease stabilization is chronic and progressive.
At this time, the existence of the patient’s self-adjustment mechanism often determines whether the patient can survive, especially for severe patients, often marking the patient’s weakened adrenal cortical function and the body’s emergency dysfunction.
3, glucocorticosteroid therapy for chronic interstitial lung disease, can not be used, including inhaled hormones.
”Do not be slow to treat” chronic diseases through active treatment, often the opposite of what we want.
The slow treatment of chronic diseases is the treatment of chronic diseases and chronic management. Chronic obstructive pulmonary disease and interstitial lung fibrosis, can be long-term use of Yu Ping Feng granules, six junzi pills, etc. to supplement the lung qi, to reduce recurrent colds, improve the patient’s adrenocortical hormone level, increase the patient’s resistance to disease, reduce recurrent attacks, has a very good clinical effect.
4, so that the purpose of treatment changes to long-term survival with disease, which requires avoiding factors that cause aggravation of the disease, as follows.
Avoid the presence of unstable factors, which are often the cause of progressive exacerbations in patients.
(1) The presence of relatively serious psychological factors of fear in patients ;
(2) Hormonal shock, or immunosuppressive therapy;
(3) The presence of prolonged allergic factors in the vicinity of survival;
(4) Excessive fatigue;
(5) Bad lifestyle habits;
(6) Long-term use of drugs and foods that affect the control of inflammation in the lungs, or even lead to inflammation;
(7) Viral infection causing increased inflammation in the lungs;
(8) long-term application of a variety of high-dose antibiotics leading to dysbiosis;
(9) Excessive use of oxygen, especially high concentrations of oxygen;
(10) Comorbidities, such as pulmonary vasculitis due to diabetes mellitus;
(11) Insufficient intake of calories, etc.
6, leading to recurrent exacerbation of interstitial lung disease with malnutrition mechanism
(1) drug-related increased energy consumption of the body;
(2) gastrointestinal digestion and absorption dysfunction;
(3) increase in catabolism of the body;
(4) Decreased intake;
(5) Other factors: such as adaptive regulatory mechanisms, depression, smoking, and lack of nutritional knowledge.
Some people have given appropriate caloric, protein support to COPD patients with outpatient malnutrition, and the average increase in body weight was 2.4 kg, the average improvement in grip strength was 5.5 kg, the average increase in expiratory muscles was 14.9 cmH2O, the average increase in walking distance was 429 m, and the average improvement in inspiratory muscle strength was 11.4 cmH2O.
We also had the same results with the above Chinese medicine treatment. This is a gain of understanding of the principle of “treating the disease at its source” in TCM.
There are also some benefits of TCM dietary therapy: for example, take a domestic hen and remove its internal organs, add 30 grams each of astragalus, cordyceps (or Bailing capsule), codonopsis, and sandy nuts, boil it on a gentle fire, eat the chicken and drink the soup, one every nine days after the winter solstice. Then, if phlegm is not easy to cough up, early in the morning a fresh egg, 10 grams of walnuts, sesame oil, honey, a small spoonful of each rinse. For long-term use, you can choose Yu Ping Feng granules.
Review the above content: the main points of thinking and exploring the combination of Chinese and Western medicine in the treatment of interstitial lung disease
First, the disease should be divided into three categories: acute, subacute and chronic, on the basis of which the combination of Chinese and Western medicine is classified and treated.
Second, change the concept of treatment of subacute and chronic interstitial lung disease, the patient with the disease can survive as the purpose of treatment, Chinese and Western medicine treatment should be long-term treatment, conditioning as the principle of treatment.
Third, the key points of clinical Chinese and Western medicine combined treatment of interstitial lung disease are
(a) Interstitial lung disease of Chinese medicine diagnosis points.
1, identify the disease progression pattern.
2.Identify the characteristics and classification of the disease.
3.Identify the physical characteristics of the patient.
(B) The main points of combined Chinese and Western medicine treatment of interstitial lung disease: 1.
1.Emergency treatment for acute diseases and slow treatment for slow diseases.
2.Treatment must be sought at the root of the disease.
3, Chinese and Western medicine together, complementary advantages.