The Lows Of Syndrome Differentiation And Treatment For Infectious Acute Lung Injury

The paper discusses the laws of syndrome differentiation and therapeutic rules foracute lung injury caused pulmonary infection in Traditional Chinese Medicine, andelucidates the pathogenesis, syndrome differentiation, therapeutic principles and methodsof infectious acute lung injury based on the ancient medical literatures and modemclinical and experiment data.The paper puts forward the main pathogenic factor and features include suddenaffection by exopathogen, violent conflict between pathogen and vital Qi and impetuouschange of the morbid condition, and causing blockage of lung Qi, damaging lungparenchyma, stagnating the blood vessels and causing blood stasis; misdistribution ofbody fluid causing water pathogen; collapse of Vital Qi due to heat pathogen damagingYin fluid. In the morbid process of infectious acute lung injury, the pathogenic heat is theprimary factor, the basic pathogeneses of lung injury are pathogenic heat or heat toxinaccumulating in the lung and the lung failing both dispersing and descending, and theyrun through the whole morbid process; the secondary pathogenic factors include phlegm,water pathogen and blood stasis, they are important to the formation of lung injury; themain feature of the clinical manifestation is blockage of the lung Qi. In the early andmiddle stage, the main pathogenic factor is heat toxin, accompanied by phlegm heat,blood stasis, water pathogen and blockage of lung Qi; the main features of the clinicalpresentation include "sudden onset", "violent morbid condition" and "blockage of thelung Qi". At the final stage of the disease, the main pathogenesis of the disease iscoexistence of the deficiency and excess, the deficiency aspect may include lung Qi andYin deficiency, Qi deficiency of lung and kidney, asthenia kidney failing to hold Qi andcollapse of the vital Qi; and the excess aspects include phlegm, water pathogen and bloodstasis stagnating in the lung. In the severe case, the syndrome may be collapse of the vitalQi and lung failing to dominate Qi and control respiration due to the extreme deficiencyof the lung Qi. In the syndrome differentiation of acute lung injury, we’d better notice the followingaspect. Firstly, understand the basic feature of infectious acute lung injury. ALI is causedby Exopathogen invading suddenly, there is violent conflict between Exopathogen andVital Qi with severe morbid condition, and cause blockage of the lung Qi and damage thelung parenchyma, the clinical manifestation may show high fever, dyspnea andsuppression of the breath. The pathogenesis at final stage may show deficiency typeaccompanied by excess, or lung Qi and Yin deficiency, collapse of the vital Qi. The casewith intense pathogenic heat and severe morbid state can damage Vital Qi and Yinquickly, make the lung failing to dominate Qi and control respiration, cause respiratoryfailure. The syndrome always has the features of "sudden onset", "violent morbidcondition" and "blockage of the lung Qi" compared with common lung-heat syndrome.Secondly, differentiate the Wei, Qi, Ying and Xue phases and the transference of thedisease. There may be a short time of exterior syndrome at beginning of the disease, thenthe pathogen invade into the Qi, Ying and Xue phases rapidly. If the pathogen is veryintense or the Vital Qi is deficient, the pathogen may transmit disobey the orders, andinvading the interior promptly after occurrence, the syndromes may be intense heat inboth Qi, Ying and Xue phases, or abnormal transmission of the pericardium and causingblockage syndrome of the pericardium, or syndromes of Ying and Xue phases. At thefinal stage of the disease, the main pathogenesis is coexistence of deficiency and excess,the deficiency syndrome may be lung Qi and Y’m deficiency, lung and kidney Qideficiency, asthenia kidney failing to hold Qi or collapse of Vital Qi etc. The excesssyndromes may be phlegm, water pathogen and blood stasis stagnating in the lung.Severe case may show lung failing to dominate Qi, collapse of the Vital Qi and collapseof the origin of the blood and Qi.Thirdly, differentiate the nature of the pathogen. Acute lung injury may be caused byvarious pathogens, different pathogen can show special clinical manifestation of theirown. The pathogens include wind-heat, dry-heat, summer-heat and damp-heat orpestilential pathogen, they all have the features of scorching nature and causing diseaseswiftly.Fourthly, differentiate the deficiency and excess of the syndrome and the mixture ofthe pathogen. At the beginning, there is violent conflict between Vital Qi and pathogen,the main syndrome is excess one; along with the morbid progress, the pathogen damage Qi and Yin, the syndrome may be excess accompanied by deficiency in the middle stageof the disease, and deficiency type accompanied by excess, and deficiency type as itsmain aspect at final stage. In addition, in the morbid progress, there may be pathogenicproducts such as phlegm, water pathogen and blood stasis, and these may influence thepathologic changes in the lung and the entire body. So the doctors should consideratethem in the clinical treatment.Finally, analyze the transmission of the pathogen among the differentZangfu-organs. In the progress of the infectious acute lung injury, the pathogenaccumulate in the lung, cause the lung failing to disperse and descend, and failing ofQi-vary and smoothness of water passages, it may cause disorders of the Qi-movementof the Zangfu-organs and the entire body; and the pathogenic factors, such as phlegm,water pathogen, blood stasis and Qi blockage, may also influence the otherZangfu-organs, and make the pathogen transmit into the other organs, and cause multipleorgans damage. The disease may involve stomach, large intestine, liver, pericardium andkidney, etc.According to the pathologic changes of the infectious acute lung injury andphysiological function of the lung, the therapeutic principle should be supporting Vital Qiand eliminating pathogens. At the early stage of the infectious acute lung injury, the mainpathogenesis is excess, accompanied with deficiency of the vital Qi, the therapeuticprinciple should be eliminate the pathogen, in the middle stage, intense pathogen damagethe Vital Qi, the therapeutic principle should be made on the basis of differentiating thepathogenesis, if the main aspect is excess type, the principle should be eliminating thepathogen; if the main aspect is deficiency type, the principle should be supporting theVital Qi. At the final stage of the disease, Vital Qi and Yin fluid is damaged distinctly, theprinciple should be supporting the Vital Qi, and combined with eliminating surpluspathogen. The paper stress on coordinating the dialectical relationships amongsupporting Vital Qi, eliminating pathogen and regulating Zangfu-organ.In the course of the acute lung injury, there may be heat-toxin, phlegm-heat, bloodstasis and water pathogen, the clinical feature of disease is blockage of lung Qi. At finalstage, the syndromes may be lung Qi and Yin deficiency, deficiency of lung and kidneyor collapse of Vital Qi. The paper put forward the therapeutic methods of clearing awaylung heat, eliminating heat-toxin, disperse lung Qi, resolving phlegm and dispelling water pathogen, promoting blood circulation to remove blood stasis and tonifying lungQi to astringe collapse for acute lung injury. Because the main pathogenesis of thedisease is pathogenic heat accumulating in the lung and the lung failing to disperse anddescend, it is the primary method to clear away lung heat running through the entirecourse of disease, dispersing lung Qi is indispensable for treating the disease, andresolving phlegm, eliminating water pathogen, promoting blood circulation to removeblood stasis, tonifying lung Qi to astringe collapse or astringing lung Qi to treat collapseare important methods for treating acute lung injury.According to modem clinical and experimental studying, the mechanisms ofinfectious acute lung injury are related to the excess immunoreaction and apoptosis andrepair of the alveolar epithelial cells. The mechanisms of the disease are related to thepathogenic heat, heat-toxin, phlegm heat, blood stasis and blockage of Qi. The paper putforward that the study of treating the disease by TCM should focus on the followingfields, i.e. the mechanisms of dispelling pathogen by TCM; the mechanisms ofpreventing pathologic injury to the lung by TCM, such as protecting pulmonarymicrangium endothelial cells and alveolar epithelial cells, improving circulation state andventilatory function; researching on the complex mechanism of apoptosis in the morbidprogress of acute lung injury, and the action of different therapy of TCM on apoptosis.On the basis of the theoretical studying, the paper discusses the mechanism oftreating the disease by Shengjiang powder, the representative formula for the method ofdispersing the lung and purging the Fu-organs. We observed the influence of Shengiiangpowder on the expression ofNF-κB in pulmonary micrangium endothelial cells and theexpression of ICAM-1 in terminal bronchiolar epithelium, the results show thatShengjiang powder may inhibit the expression of NF-κB in pulmonary micrangiumendothelial cells of model rats, the difference between the treating groups and controlgroup is significant. The experiments also show that the Shengjiang powder withdifferent dose can inhibit the expression of ICAM-1 in terminal bronchiolar epithelialcells obviously, there is significant difference between treating groups and control group,and the effect of the powder with high dose has better effect than middle and low doseone, and there is no significance among three groups. The results shows that Shengjiangpowder can prevent and treat acute lung injury through inhibit inflammatory reaction,preventing apoptosis, protecting lung tissues by inhibiting the expression of NF-κB in pulmonary micrangium and expression of ICAM-1 in bronchiolar epithelium.