I. Etiology and Pathogenesis Chinese medicine believes that deficiency of lung, spleen and kidney in children is the main internal cause of this disease. The main causes of this syndrome are lung essence, spleen deficiency, kidney deficiency, or congenital deficiency, or diseases, which may easily lead to dysfunction of three viscera, disorder of body fluid metabolism, and accumulation of phlegm and dampness. External factors such as sudden climate change, cold temperature imbalance, contact with foreign bodies, overeating, cold, sour and salty, etc. The pathogenesis of this disease mainly lies in the long-term stagnation of phlegm and turbidity and repeated attacks.
During the attack, phlegm rises with qi, and qi is blocked by phlegm, which blocks the airway and narrows the pulmonary duct.
The movement of qi is unfavorable, which leads to difficulty in breathing and shortness of breath. At the same time, the entry and exit of gas leads to phlegm stagnation and wheezing.
Second, the clinical manifestations and diagnosis
1. The clinical manifestations are acute or occult, and the acute attack may involve exposure to irritants (such as cold air, harmful gas, wet paint, etc.). ) or contact with allergens (such as room dust, mites, pollen, etc.). ).
Medical history. Signs of acute respiratory obstruction appear quickly, which can appear within a few minutes, mainly airway smooth muscle spasm. The onset of respiratory virus is slow, and the frequency and degree of coughing and wheezing gradually increase within a few days. Easy to attack at night. Symptoms and signs of asthma include cough (early dry cough), wheezing, shortness of breath, difficulty in breathing extension, three concave signs, cyanosis, excessive lung inflation, tachycardia and pulse strangeness. Some children only cough but don't breathe, or they don't cough. Shortness of breath is not necessarily accompanied by wheezing.
When children have extreme dyspnea, common asthma symptoms such as wheezing and wheezing may not appear, but wheezing will appear after airway relief and obstruction relief. Dyspnea can make it difficult for children to move or even talk. In severe obstruction, the child's performance is to lift the shoulder and sit.
It is more difficult for children to exhale than to inhale. In infants, expiratory prolongation is not obvious, so it is not easy to distinguish inspiratory dyspnea from expiratory dyspnea. Some children will have abdominal pain, which is due to excessive exertion of abdominal muscles and diaphragm. Due to the excessive expansion of the lungs, it may touch the liver and spleen.
Current situation of asthma: severe dyspnea occurs during severe asthma attack, and cyanosis still occurs after oxygen inhalation. If the symptoms are still not relieved after three times of aminophylline bronchodilator or corticosteroid, it is called asthma status quo if it lasts for more than 6 hours.
2. Diagnosis According to the medical history and typical asthma attack, the diagnosis is generally not difficult.
(1) Adrenaline test: 0.0 1 ml/kg of adrenaline was injected subcutaneously every time (quantitative atomization inhalation tests such as Chuanlening, Bricanyl and amiodarone can also be used), and asthma basically disappeared to 4 after 10 ~ 15 minutes. If the score is greater than 8, it is diagnosed as infantile asthma.
(2) Asthma in children: ① Age above 3 years; ② Main symptoms and signs: including wheezing, shortness of breath or chest tightness, paroxysmal cough; There is wheezing in the lungs, which must be repeated for more than 3 times; (3) wheezing attacks often have certain seasons, times and corresponding inducing reasons; ④ The use of antiasthmatic drugs (bronchodilators) can relieve and relieve wheezing symptoms; ⑤ The forced expiratory volume (FEV 1) increased by more than 15% after 0.5% salbutamol was atomized and inhaled; 6. There are often individuals or families (referring to
First-and second-degree relatives) allergic history.
Among them, Articles ② and ④ are necessary conditions, while Articles ③ and ⑥ are reference conditions. Article 5 is an auxiliary condition.
(3) allergic cough: The clinical manifestations of some children with asthma are extremely atypical. Repeated cough is the only complaint. They are often diagnosed as "upper respiratory tract infection" or "bronchitis" and abuse antibacterial drugs for a long time, but the symptoms persist. Diagnostic criteria: ① Children can get sick at any age, but preschool children are more common; ② Recurrence of cough 1 month or more, characterized by onset at night or early morning, dry cough and scanty phlegm; ③ No clinical signs of infection or long-term use of antibiotics is ineffective; ④ The use of antiasthmatic drugs can relieve cough.
(4) Auxiliary examination: The diagnosis of children's asthma generally does not need special laboratory examination, but it needs to further distinguish whether it belongs to exogenous, endogenous or mixed asthma, further understand its etiology and pathogenesis, evaluate curative effect and evaluate prognosis, so some laboratory examinations are needed.
(5) Pulmonary function examination: Pulmonary function examination is of great significance for estimating the severity of asthma and judging the curative effect. Generally, it includes vital capacity, pulmonary ventilation, diffusion function, velocity-volume diagram and respiratory mechanics test, but it needs more precise instruments and cannot be monitored at any time.
(6) Blood gas analysis: Blood gas analysis is an important laboratory test to measure the condition of asthma, especially for severe patients with hypoxemia and hypercapnia, which can be used to guide treatment.
(7) Other laboratory tests: including inhaling different concentrations of methacholine or histamine, exercise test can be used for suspected asthmatic children with normal lung function test, and in vitro tests such as radioimmunoassay test, enzyme-linked immunosorbent assay, histamine release test and basophil degranulation test can be used to detect allergens. It is reported that children with asthma are short of zinc.
(8) Differential diagnosis: It should be differentiated from bronchiolitis, asthmatic bronchitis, tuberculosis of bronchial lymph nodes, bronchiectasis, foreign bodies in respiratory tract and tropical eosinophilia. In addition, bronchial asthma in children should be differentiated from congenital laryngeal wheezing, retropharyngeal abscess and gastroesophageal reflux.
Third, dialectical treatment.
1. Onset
(1) heat asthma type
Syndrome differentiation: shortness of breath, wheezing in the throat, chest height, shortness of breath, sudden cough and choking, thick phlegm and sticky yellow gum, which is not suitable for coughing and vomiting, full chest and diaphragm, irritability, red face and thirst, bitter taste and thirst, body heat and sweating. Red tongue, yellow greasy fur and slippery pulse.
Treat clearing heat, dispersing lung, resolving phlegm and descending adverse flow.
The prescription of Yuemai Plus Pinellia Decoction is: ephedra 6g, gypsum 15g, ginger 3g, Pinellia 9g, licorice 3g and jujube 5g.
9g of Arisaema cum bile and 9 g of Fructus Trichosanthis are added for patients with excessive phlegm. Add 9g of Fagopyrum cymosum and 9g of Radix Isatidis,15g; Houttuynia cordata is used for patients with fever; If lung yin is injured and phlegm heat is unclear, go to Mahuang Gaza Ginseng 9g, Polygonatum odoratum 9g and Fritillaria 6g.
(2) Cold asthma type
Syndrome differentiation: shortness of breath, wheezing in the throat, scanty sputum, white foam, chest tightness and diaphragm, dull and blue complexion, not thirsty or fond of hot drinks. The tongue coating is white and slippery, and the pulse is tight or slippery.
Warming lung and dispelling cold, resolving phlegm and inducing resuscitation.
The prescription of Belamcanda Mahuang Decoction: 6 grams of ephedra, 6 grams of Belamcanda, 3 grams of ginger, 9 grams of Asari, 9 grams of Aster, 9 grams of Farfara, 3 grams of Schisandra chinensis, 9 grams of Pinellia ternata and 5 Chinese dates.
9 grams of dried tangerine peel and 9 grams of white mustard seed are added for patients with excessive phlegm; Add Sanzi Yangqin Decoction (perilla seed 9g, white mustard seed 9g, radish seed 12g) and prickly heat 9g for those who vomit less and have severe asthma; 9 grams of Radix Aconiti Lateralis and 6 grams of Rhizoma Zingiberis Recens are added for patients with cold limbs and weakness; 9 grams each of Flos Magnoliae and Fructus Xanthii are added for itchy throat and sneezing; 9g of Folium Perillae, 9 g of Ramulus Cinnamomi and 9 g of Rhizoma Ligustici Chuanxiong are added to patients with aversion to cold and nasal congestion and runny nose.
2. Remission period
(1) lung qi deficiency
Syndrome differentiation: pale face, shortness of breath, laziness, low voice, fatigue, spontaneous sweating, chills, and tepid limbs. The moss is thin and light, and the pulse is thin and weak.
Clearing heat and resolving phlegm, dispersing lung and relieving asthma.
The prescription is Radix Astragali 12g, Radix Saposhnikoviae 6g, Rhizoma Atractylodis Macrocephalae 9g, Ramulus Cinnamomi 6g, Radix Paeoniae Alba 9g, Radix Glycyrrhizae 3g, 3 slices of ginger and 5 pieces of jujube.
9g of Angelica sinensis and 6 g of terminalia chebula are added for patients with repeated cough and asthma; 9 grams of Pinellia ternata, 9 grams of dried tangerine peel and 9 grams of perilla are added for patients with white phlegm vomiting. Ginseng 9g, Ophiopogon japonicus 9g and Schisandra 9g are added for shortness of breath and hyperhidrosis; Palpitation and insomnia adds 9g of Lily, 9g of Poria and 6 g of Polygalae; When asthma is stable, you can take 6g of Shenge powder (Ginseng and Gecko) to invigorate qi and nourish the lungs, so as to strengthen the body resistance and consolidate the foundation.
(2) Spleen deficiency type
Syndrome differentiation: cough with excessive phlegm, eating less, fullness, yellow complexion, false stool, muscle wasting, fatigue and fatigue. Less moss, pale color, slow and weak pulse.
Treating spleen and benefiting qi, dispersing lung and resolving phlegm.
Prescription drugs are codonopsis pilosula, Atractylodes macrocephala, Poria cocos and Pinellia ternata, 6 grams of dried tangerine peel and 3 grams of licorice.
6g of Cinnamomum cassia, 6g of dried ginger, 9g of Chinese yam and 6 g of nutmeg are added to those with cold limbs in loose stool. For patients with abdominal distension and chest distress, 9 grams of Radix Aucklandiae, 9 grams of Semen Sinapis Albae and 9 grams of Zingiberis Rhizoma each are added; Radix Astragali 12g, Radix Angelicae Sinensis 9g, Radix Paeoniae Alba 9g, and Arillus Longan 6g are added for patients with pale complexion due to qi deficiency.
(3) Kidney deficiency.
Syndrome differentiation: pale face, chills, tepid lower limbs, limp feet, palpitation and shortness of breath when moving, clear stool, or nocturnal enuresis. The tongue is pale with white fur and weak pulse.
Treating warming kidney and receiving qi.
24g of Radix Rehmanniae Preparata, 02g of Cornus officinalis 65438+ Rhizoma Dioscoreae, 9g of Poria, Cortex Moutan, Alismatis Rhizoma, Walnut Meat, Psoralea corylifolia, 3g of Placenta Hominis powder (swallowed), 3g of Radix Aconiti Lateralis Preparata and 3g of Gecko.
Adding Chinese milk vetch15g; Used for cold limbs and frequent wheezing; For patients with severe asthma, 6 grams of Schisandra chinensis, 9 grams of Alpinia oxyphylla, 9 grams of Alisma orientalis, 0/5 grams of calcined keel/kloc-0, and 30 grams of calcined oyster are added for enuresis; 6 grams of dried ginger, 9 grams of nutmeg, 9 grams of Atractylodes macrocephala and 9 grams of Poria are added into the thin stool; Ginseng 6g, Schisandra 9g, ochre 15g are added for patients with asthma like cattle and sweating like oil.
Fourth, adjuvant therapy.
1. Prescription
(1) powder: purple Ge Fen, Paeonia lactiflora and Glycyrrhiza powder, and Jiangqidingchuan powder.
(2) Pill ointment: Datura stramonium pill, Hanchuan pill, Mujingzi pill, Zhubei Dingchuan pill, Xiaochuan ointment and Zhichuan Guben syrup.
(3) Tablets: Xiaoerling tablets, Chuansouning tablets, Wenyang tablets and Haizhu Pingchuan tablets.
2. Prescription
(1) Ginseng (Radix Codonopsis doubled) and Gecko (removing head and feet) are studied together, and taken 15g daily, and mixed with white honey.
(2) 2 pieces of Placenta Hominis, dried in the sun, ground into powder, encapsulated, 1 ~ 2g daily, and taken with boiling water.
(3) decoct 3-6g of roasted ephedra, 6-9g of almond, 3-4g of raw licorice and 3-5g of ginger in water.
(4) 4-6g ginkgo, 3-4g fried ephedra, 6-9g almond, 3-4g licorice, 6-9g perilla, 6-12g mulberry bark, 6-9g scutellaria baicalensis, 6-9g Pinellia ternata and 6-9g farfara.
(5) 25g of Pinellia ternata, 20g of Radix Astragali, Radix Bupleuri and Scutellariae Radix, 65438 05g of Ramulus Cinnamomi, Radix Paeoniae Alba, Fructus Schisandrae Chinensis, Radix Sophorae Flavescentis and Periostracum Cicadae, 65438 00g of Herba Ephedrae, Radix Glycyrrhizae, Asari and Lumbricus, and 6g of dried ginger are decocted in water.
3. Off-site treatment
(1) Semen Sinapis Albae 12g, Rhizoma Corydalis 12g, Asari 2 1g, Radix Kansui 12g, Moschus 0. 15g, * * finely ground, mixed with ginger juice, and mixed with ginger juice.
(2) Cure 30g of Semen Sinapis Albae and Rhizoma Corydalis, 50g of Radix Kansui 1 5g and 0/5g of Asari/kloc-5 into medicinal cakes, add Flos Caryophylli and Cortex Cinnamomi, and apply them to three pairs of acupoints, namely, Dingchuan acupoint, Shu Fei acupoint and plaster acupoint, for 2 hours each time, and apply them every 5 days1time, *.
Verb (abbreviation of verb) nursing
(1) The room should be ventilated and sunny. It is warm in winter and cool and ventilated in summer.
Avoid contact with special smells.
(2) The diet should be light and nutritious. Avoid cold, greasy, spicy, sweet and sour foods, seafood, fish and shrimp, so as not to induce asthma.
(3) Pay attention to the changes of heart rate and pulse condition to prevent asthma.
(4) pay attention to prevent recurrence, avoid all kinds of inducing factors, exercise properly and enhance physical fitness.
(5) Pay attention to the climate impact, do a good job of cold protection and warmth, and wear a mask when going out in winter.
Especially when the climate changes or seasons change, it is necessary to prevent asthma caused by colds. If you have exogenous diseases, you should treat them in time.
(6) prevent excessive activity and emotional excitement, so as not to induce asthma.