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Abstract: The case in this paper is an elderly woman who developed shortness of breath and shortness of breath after activity 5 years ago and thought that these were normal with age, but the shortness of breath after activity worsened year by year and progressed more slowly, and the elderly did not pay attention to it. In the last month, the above symptoms were found to be significantly aggravated, and she came to the hospital. Through the patient’s medical history as well as examination, she was diagnosed with idiopathic interstitial pulmonary fibrosis, also known as pulmonary impotence in Chinese medicine. After treatment, the discomfort was basically relieved and the quality of life was significantly improved.
Basic information】Female, 70 years old
Disease Type】Idiopathic interstitial pulmonary fibrosis (pulmonary impotence)
Hospital】Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine
Date of consultation】May 2021
【Treatment plan】Therapeutic treatment (Wei Ling Xian, Radix et Rhizoma, Silphium, Qing Feng Vine, Luo Shi Vine, San Leng, Curcuma longa, Sheng Gan Cao, Sheng Huang Qi, Fried Bai Zhu, Xian Ling Spleen, Shu Di Huang, White Lentil, Fa Han Xia, Jiao Shen Qu)
Treatment Period】Six months
Effectiveness】Basically no cough, and dyspnea is better after activity
I. Initial Consultation
The patient complained of dyspnea after activity due to cold 5 years ago, accompanied by cough and white sputum with little sputum, the patient thought it was normal to have dyspnea after activity as he got older, and once he settled down, he was fine and normal, so he did not pay attention to it, but since then the dyspnea has been progressively aggravated, and one month ago the above symptoms were significantly aggravated, so he came to the hospital. The patient had been working as an accountant for more than 30 years. When he arrived at the hospital, he had dyspnea, shortness of breath, cough, mainly dry cough, occasionally a little white mucous sputum, white tongue coating, usual fear of wind, loss of appetite, sleep, urine regulation, loose stools. A high-resolution CT examination of the lungs was performed, which showed a foveal shadow in both lower lungs. Based on the patient’s history, physical signs, and ancillary examinations, the Western medical diagnosis was idiopathic interstitial lung fibrosis, and the Chinese medical diagnosis was pulmonary impotence – deficiency of lung and kidney, and paralysis of lung channels.
II. Treatment history
The patient’s cough and sputum, fear of wind, loose stools, and weak pulse on the right ulnar side indicate that the lung and kidney are deficient, while the dark tongue with thin yellow coating and the slippery pulse on the right side indicate that the lung channels are blocked by phlegm and stagnation. After 14 doses, the patient returned to the clinic and complained that his dyspnea and shortness of breath had improved after taking the medicine, but his cough and sputum remained unresolved, he was afraid of wind, had poor appetite, slept well, regulated urine and loose stools. The tongue is light and dark with thin yellow coating, the pulse is slippery, and the two feet are weak.
The prescription was changed by adding Fa Xian Xia and Jiao Shen Qu to the above formula. After 14 more doses, the patient’s cough and sputum were reduced, dyspnea and shortness of breath improved, fear of wind improved, sleep was possible, and stool was regulated. The tongue was dark with a thin white coating, the pulse was slightly stringent at the cunguan and weak at the right ruler.
The patient was instructed to continue to take a total of 14 doses, and at the time of the follow-up consultation, the patient’s symptoms were relieved and the state was stable, so the patient was instructed to continue to take the front to consolidate the therapeutic effect.
III. Treatment effect
After the first dose, the patient’s dyspnea, wheezing and shortness of breath were better than before, and after the second dose, the patient’s appeal symptoms were less than before, while the fear of wind improved and the quality of sleep improved. After the third dose, the patient basically did not cough, and the dyspnea was also better than before after activity, and his condition was stable. Through the discriminative treatment of tonics, the patient’s life treatment has been greatly improved and he has recovered well.
IV. Notes
As the attending physician of this elderly person, I am very glad that her condition is under control. However, due to the patient’s age, she should do her activities according to her strength, do not exert herself, pay more attention to rest, maintain good living habits, live a regular life and rest, avoid staying up late, and keep a happy mood. Also pay attention to avoid colds, pay attention to seasonal changes, increase and decrease clothing appropriately, and improve their immunity, because low immunity and colds may aggravate their own diseases. You should pay attention to eating easy-to-digest, high-protein and high-vitamin food, eating more fresh vegetables and fruits, matching your diet reasonably, and avoiding spicy and stimulating foods. The prognosis of idiopathic interstitial lung fibrosis is poor. If the patient has respiratory failure, it is recommended to come to the hospital immediately for treatment and long-term oxygenation.
V. Personal insight
Idiopathic interstitial pulmonary fibrosis develops from a variety of chronic lung diseases, mainly manifesting as dyspnea and dry cough, and the treatment effect is generally limited and the prognosis is poor. This requires reminding the majority of middle-aged and elderly patients that if they have symptoms of dyspnea and dry cough, they should pay attention to them and go to the hospital in time to identify the cause to avoid irreversible consequences. In this case, after the diagnosis was clear, the patient was treated with TCM evidence-based treatment and recovered well.
The patient was suffering from deficiency of the lung and kidney and paralysis of the lung ligaments. The treatment should take into account both the deficiency and the actual situation, and should supplement the lung and kidney, remove the paralysis and open the ligaments. In this formula, Qing Feng Vine, Luo Shi Vine, San Ling and Curcuma longa are used as the monarchs. Qing Feng Vine and Luo Shi Vine are used to remove paralysis, together with San Ling and Curcuma longa, they break blood and expel blood stasis, which also has the meaning of unblocking the lung channels; Sheng Huang Qi, Fried Bai Zhu, Xian Ling Spleen and Shu Di Huang are used as the subjects, Sheng Huang Qi tonifies the lung energy and helps to consolidate the root, Fried Bai Zhu strengthens the spleen and enhances the Qi, cultivates the earth and generates gold, Xian Ling Spleen and Shu Di Huang tonify the kidney and fill the essence, emphasizing that gold and water are mutually beneficial and the lung and kidney are of the same origin. The herbs are called adjuvant medicines, namely, Wei Ling Xian, Radix et Rhizoma, Siliceae, and White Lentil. Wei Ling Xian, Radix et Rhizoma, and Siliceae help the ruling medicine to open the ligaments and remove paralysis; White Lentil strengthens the spleen and resolves phlegm, cultivates the earth to generate gold, and helps the ministering medicine to support the righteousness; raw licorice is the herb that harmonizes the medicines. At the second visit, the patient’s cough and phlegm were not significantly relieved, so he was given Fa Han Xia to subdue Qi and resolve phlegm, and Shen Qu to transport the spleen and dispel phlegm. At the third visit, the patient’s symptoms were relieved and his condition was stable. This shows that as long as the evidence is clearly identified and the right medicine is used, the treatment effect can be good.