Study Of Declaring Lung And Eliminating Qi In The Treatment Of Pneumonia In The Elderly

Pneumonia in elderly, a common and frequently-occurring respiratory disease, has increasing morbidity, mortality and severity with aging. Because of specificity of the affected population, complexity of the disease and the growth of the aged population, pneumonia in elderly is one of the most common respiratory diseases.Combined treatment of Chinese medicine with modern medicine is salient while modern medicine has dissatisfactory treatment.According to clinical characteristics, this disease could be put under the category of febrile diseases. For the sake of better TCM treatment, under the guidance of the theory of febrile diseases, clinical application of Declaring Lung and Eliminating Qi is discussed from the aspects of theory research, clinical observation and experiments.The research is divided into 4 parts. The first part, literature reviews, mainly reviews the achievements of domestic and overseas research on treatment of pneumonia in elderly by Chinese medicine and modern medicine. Western medicine chooses potent antibiotics and comprehensive treatments according to bacterial infection rule in hospitals and in communities, before the results of pathogens and susceptibility test come out. Most scholars suggest that all the above treatments can not generate effects because of the high rate of infections, fast progress, atypical clinical symptoms, high rate of missed diagnosis, many complications, slow clinical remission, many related diseases, specificity of the aged and their basic diseases. The reasons of occurrence of pneumonia in elderly include weak resistibility and febrile evils invading lung. The initial stage and intermediate stage are manifested with sputum, heat, cough, wheezing and dyspnea. The pathogenesis is accumulation of pathogenic heat in the lung and failure of lung qi in dispersion. Treatment of Declaring Lung and Eliminating Qi focuses on relieving lung-heat and dispersion failure. TCM has advantages in treatment of pneumonia in elderly. Therefore, study of the mechanism of such law should be furthered.The second part mainly studies TCM theories of pneumonia in elderly. Intertwining of deficiency, phlegm, depression and stagnation is the constitutional characteristic of pneumonia in elderly. Exuberant lung-heat, physically weakness and evil pathogens are its pathogenesis. Heat evils damaging vital qi and closure of lung collaterals are the main reasons of deteriorated cases, causing sudden depletion of heart yang, invasion of cardial sac by pathogen, breathing failure and lung atrophy. So, the law of Declaring Lung and Eliminating Qi is an important treatment of pneumonia in elderly. The law refers to combination of drugs of ventilating lung qi when clearing heat at qi, to dispel lung heat and avoid the stagnation of evil heat. There is an obvious effect at the initial stage and intermediate stage. The basic application principle of Declaring Lung and Eliminating Qi is identifying main syndromes and grasping disease courses. Exuberant lung-heat is a key symptom differentiation. At the same time, the special physic constitution and other factors should be taken into account. Other treatment methods, such as eliminating sputum and reliving cough, lowing qi to dispel asthma, promoting blood circulation to remove blood stasis, nourishing qi and yin, moistening dryness and catharsis, and cooling yingfen and blood, should be combined to control lung infection as soon as possible to promote recovery.In partâ…¢,clinical research,60 cases of conformed senile CAP from Chinese Medicine Hospital of Jiangsu Province were randomly divided into a control group (30 cases), treated with general treatment and anti-infective therapy, and a treatment group (30 cases), treated with Ventilating-lung-qi and clearing-heat Formula, general treatment and anti-infective therapy.Results:(1) There is no statistically significant difference between two groups in cure rate, marked effect and effective power, that is to say, the efficacy of two groups are equivalent.(2) The comparison of syndrome's effect shows that the effect of the treatment group was significantly better than that of the control group. Comparing the two groups markedly effective, there was with significant differences and significantly better than the control group. (3) Comparison of individual symptoms and signs:There is no obvious advantage in the treatment group in dealing with fever, aversion to cold, cough, sputum, and tongue. But there are advantages in fever time, pulse, and pulmonary rales.(4) The levels of serum WBC, N, CRP were significantly decreased after treatment, but the difference between the two groups was no of statistical significance. ESR level in the control group has no significant difference before and after treatment, but that of the treatment group has significant difference. The difference in the two groups before and after treatment is also significant The treatment group was significantly better than the control group. The results of clinical trial show that Ventilating-lung-qi and clearing-heat Formula has some advantages in relieving symptoms and signs, reducing fever time and improving pulmonary rales.In part IV, experiments, to further study mechanism of the law of Declaring Lung and Eliminating Qi and prevention of pulmonary fibrosis caused by lung infections, the following experimental studies were carried out:(1) experiment of protecting acute lung injury and protection impact on death rates induced by bleomycin treated by Ventilating-lung-qi and clearing-heat Formula:the prescription can reduce the degree of acute lung injury, inhibit increase of lung index and has a significant protective effect in the early lung injury. The result shows that the prescription has the role of ventilating lung qi and eliminating evils, inhibiting inflammatory response and protecting lung. (2) experiment of the prescription in affecting immunity of acute lung injury in rats induced by bleomycin:the prescription can reduce the degrees of TNF-a, IFN-y, IL-4 levels of bleomycin-induced lung injury in rats. It shows that one mechanism of the prescription to treat acute lung injury and to prevent pulmonary fibrosis could be affecting inflammatory factors and anti-infection immune-related factors. (3) experiment of the prescription in interfering Bleomycin-induced pulmonary fibrosis in rats:the prescription can reduce the degree of bleomycin-induced pneumonia and pulmonary fibrosis.(4) experiment of the prescription in affecting ERK1/2 and NF-KB signal pathway of pulmonary fibrosis in rats:the results suggest that the prescription can significantly reduce the levels of ERK1/2 and NF-KB of lung tissues and has significantly difference compared with the model group. It shows that this is one of mechanisms of the prescription in treating acute lung injury and preventing pulmonary fibrosis via interfering with ERKl/2 and NF-KB signal pathway.In short, four parts above initially illustrate the mechanism. Its findings not only provide TCM theoretical guidance for clinical treatment of pneumonia in elderly, but also lay a good basis for further theoretical, clinical and experimental studies.