Main Points of Diagnosis

1. Long-term cough, sputum production and dyspnea which attack repeatedly and fluctuate are worse in autumn and winter. There may be fever, exacerbation of cough and mucopurulent sputum production, and dyspnea is more marked if acute concurrent infection is present.

2. Chronic bronchitis usually persists for many years. It can be classified into 3 stages, acute episodic stage, chronic persistent stage and clinically remissive stage. The last stage may last for a period of time and an attack may be induced by infections or catching a cold. Based on the clinical manifestations, the disease can be divided into simple chronic bronchitis and chronic asthmatic bronchitis. In the former, cough and sputum production are predominant. In the latter, in addition to the above symptoms, there are dyspnea and wheezing, indicating that the spasm of the smooth muscles of bronchi and bronchioli is an important pathogenic factor.

3. On auscultation, moist rales can usually be heard. Wheezes can be heard in patients with asthmatic bronchitis. In patients with chronic bronchitis of long duration, a complicating obstructive emphysema is commonly present. In such cases, the respiratory sounds are diminished, heart sounds become faint, intercostal spaces are widened, the thorax is barrelshaped, and there is hyperresonance on percussion.

4. On radiographic examination the lung-markings are increased in the lower lung fields. Pulmonary functional tests show no change in the early stage, but in the late stage residual volume is increased, maximal ventilatory equivalent and time vital capacity are decreased.  

Differentiation and Treatment of Common Syndromes     

1. Interior Retention of Phlegm with Exopathic Cold

Main Symptoms and Signs: Cough with whitish thin sputum, dyspnea, or accompanied with chills and headache, whitish and moist fur of the tongue, string-like and tight or floating and tight pulse.

Therapeutic Principle: Relieving exterior syndrome and warming the interior organs, ventilating the lung to resolve phlegm retention.

Recipe: Modified Minor Decoction of Green Dragon.

ephedra

cinnamon twig

schisandra berry

white peony root

asarum herb

pinella tuber

dried ginger

coltsfoot flower

licorice root

All the above herbs are to be decocted in water for oral administration.

The disorder is marked with absence of exterior syndrome, manifested as cough with profuse sputum which is whitish and mucous, feeling of fullness and distress in the chest, anorexia, abdominal distension, all these suggest that the accumulation of phlegm-dampness is in the lung. The principle of treatment should be aimed at eliminating dampness and removing phlegm. The above recipe can be modified for treatment with the exception of ephedra, cinnamon twig and white peony root, and with the addition of 12 grams of red tangerine peel, 15 grams of poria, 10 grams of perilla seed, 10 grams of magnolia bark and 10 grams of atractylodes rhizome.

2. Stagnation of Phlegm-Heat

Main Symptoms and Signs: Bad cough with thick yellowish sputum, thirst, dry throat, yellow-colored urine, constipation, reddened tongue with yellow fur, slippery and rapid or taut and rapid pulse.

Therapeutic Principle: Removing pathogenic heat and resolving phlegm.

Recipe: Modified Prescriptions of Lung-Heat Expelling Powder combined with Decoction for Clearing Away Lung-Heat and Dissolving Phlegm.

mulberry bark

wolfberry bark

scutellaria root

anemarrhena rhizome

Sichuan fritillary bulb  

bitter apricot kernel

stemona root

trichosanthes seed

honey fried loquat leaf

platycodon root

All the above herbs are to be decocted in water for oral administration.

Besides, 20 grams of gypsum are added for the case with high fever; 15 grams of clam shell powder for the case with profuse sputum which is difficult to cough out; 20 grams of lily bulb and 20 grams of dried rehmannia root for treating the case of yin deficiency of both the lung and kidney marked by nonproductive cough or little sputum, hot sensation in the palms and soles, night sweat, reddened tongue with little fur, fine and rapid pulse.

3. Deficiency of Both Lung and Spleen

Main symptoms and Signs: Weak cough, spontaneous perspiration, shortness of breath, tendency to catch cold, exacerbation of cough in contact with wind-cold, or anorexia and loose stools, thin whitish fur of tongue, and deep fine pulse.

Therapeutic Principle: Nourishing the lung by reinforcing the function of the spleen.

Recipe: Modified Decoction for Tonifying the Lung.

codonopsis root

astragalus root

schisandra berry

aster root

coltsfoot flower

white atractylodes rhizome

poria

honey-fried licorice root

All the above herbs are to be decocted in water for oral administration.  

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