TCM and Respiratory Disorders
By Dr. Hong-Yen Hsu
In the aging people, the action of the various respiratory muscles is declined. The amount of elastic tissue surrounding the pulmonary alveoli and alveolar ductules has been reduced. Anteroposterior diameter of thorax increases due to decalcification of ribs and vertebrae. These morphologic and functional changes of the respiratory system cause the decrease of FVC (forced vital capacity) and FEVl (forced expiratory volume in one second). FEVl declined on average by about 32 ml per year in males, and about 25 ml per year in females after standardization for height. Also, radio of FEV1/FVC is only 71% at 64 years old.
In the elderly, chronic obstructive lung diseases, e.g., chronic bronchitis and emphysema are dominant. The incidence and mortality rates of both chronic bronchitis and emphysema are higher in the industrial countries due to air pollution and smoking. In the U.S.A, chronic obstructive lung diseases cause approximately 30,000 deaths each year. Most of the people are over 60 years old.
The majority of the patients with chronic bronchitis are beyond middle age. About 40% of old men and 20% of old women have the symptoms of chronic bronchitis, which may progress to chronic obstructive emphysema and chronic pulmonary heart disease. In Traditional Chinese Medicine, chronic bronchitis belongs to the categories of cough, phlegm retention and asthma.
Based on the patient's symptoms and the associated conformation, the following formulas are commonly used in the treatment of chronic bronchitis:
1. Phlegm retention in the lung marked by cough with whitish thin phlegm which is easily expectorated, dyspnea, or accompanied with aversion to cold, sneezing and headache, white and moist tongue coating, string-taut and tense or string-taut slippery pulse. Other exterior symptoms may be present. Minor Blue Dragon Combination (Xiao Qing Long Tang) is recommended. Tussilago (kuan dong hua) and Perilla seed (zi su zi) can be added.
2. Accumulation of phlegm-heat in the lung marked by severe cough with thick yellow phlegm, thirst, dry throat, deep colored urine, constipation, red tongue with yellow/greasy coating, rapid, slippery or rapid string-taut pulse is effectively treated with Platycodon and Fritillaria Combination (Qing Fei Tang) or Mahuang and Gingko Combination (Ding Chuan Tang). For severe heat symptoms, add gypsum (shi gao) and houttuynia (yu xing cao). For profuse phlegm which is difficult to cough out, add cyclina (hai ge fen).
3. Lung and spleen deficiencies marked by cough, thin and white phlegm, fatigue, spontaneous sweating, shortness of breath, poor appetite, tendency to catch cold, exacerbation of cough in contact with wind-cold, loose stools, thin white tongue coating, soft and moderate, or deep and thready pulse can be treated with Atractylodes and Cardamon Combination (Chuan Si Jun Zi Tang) or Six Major Herb Combination (Liu Jun Zi Tang) plus aster (zi wan), schizandra (wu wei zi) and stemona (bai bu).
4. Lung and kidney deficiency marked by cough, shortness of breath, longer expiration than inspiration, lower voice, fatigue, lassitude, spontaneous sweating, dizziness, tinnitus, soreness and weakness in the lower back and legs, and deep weak pulse may be treated with Rehmannia and Schizandra Formula (Qi Wei Du Qi Wan). If there is copious phlegm, wheezing, and a feeling of oppression in the chest, add Perilla Seed Combination (Su Zi Jiang Qi Tang).
5. Lung and kidney yin deficiency manifested with cough, wheezing, scanty phlegm, flushed face, burning sensation in the soles and palms, restlessness, insomnia, dry mouth and throat, red tongue with little coating, or fissured or denuded tongue, thready rapid pulse can be treated with Eriobotrya and Ophiopogon Combination (Qing Zao Jiu Fei Tang), or Rehmannia Six Formula (Liu Wei Di Huang Wan) plus Ginseng and Ophiopogon Formula (Sheng Mai San).
6. Spleen and kidney yang deficiency marked by cough, profuse phlegm, asthma, which is aggravated following even minimal exertion, cold extremities, intolerance to cold, frequent, profuse and clear urine, diarrhea, swollen feet, pale, puffy tongue with teeth marks, deep, thready and forceless pulse can be treated with Saussurea & Cardamon Combination (Xiang Sha Liu Jun Zi Tang) and Rehmannia Eight Formula (Ba Wei Di Huang Wan). The first two types (phlegm retention in the lung and accumulation of phlegm-heat in the lung) are usually seen in the stage of attack of chronic bronchitis; and other types in the persisting stage, or remission stage of chronic bronchitis.
In the United States a new epidemic of tuberculosis has arisen due to two factors: (1) drug resistance and (2) AIDS. While the incidence of AIDS in the elderly is relatively low, the prevalence of drug resistant tuberculosis among AIDS patients means it can more easily spread to the elderly. It is estimated that 10,000,000 Americans have a positive tuberculin test, and 30,000 new cases of tuberculosis each year, half of them are the aging people.
Tuberculosis belongs to "fei lao" in TCM. The common formulas used for treating tuberculosis are as follows:
1. Lung yin deficiency marked by dry cough, scanty phlegm, bloody phlegm, chest pain, tidal fever, flushed cheeks, dry mouth and throat, red tongue with thin yellow and dry coating, and thready and rapid pulse is commonly treated with Asparagus and Stemona Formula (Yue Hua Wan) or Lily Combination (Bai He Gu Jin Wan).
If the patient has the symptoms of hyperactivity of fire due to yin deficiency, this can be treated with Lily Combination (Bai He Gu Jin Wan) plus Chinchiu & Turtle Shell Formula (Qin Jiao Bie Jia San).
2. Both qi and yin deficiencies marked by cough, haemoptysis, tidal fever, flushed cheeks, spontaneous sweating and night sweating, poor complexion, lassitude, shortness of breath, lower voice, fatigue, reduced appetite, red tongue with little coating, and thready, rapid and weak pulse may be treated with Ginseng and Rehmannia Combination (Bao Zheng Tang ).
3. Both yin and yang deficiencies marked by cough, haemoptysis, night sweating, spontaneous sweating, intolerance to cold, shortness of breath, wheezing, edema, reduced appetite, loose stools, seminal emission, impotency, amenorrhea, red tongue with little coating, or pale puffy tongue with teeth marks, and thready and weak pulse are treated with Rehmannia and Eucommia (Bu Tian Da Zhao Wan).
For haemoptysis, add bletilla (bai ji), callicarpa (zhi zhu cao) and agrimony (xian he cao).