On Treatment Of Chronic Cough By Traditional Chinese Medicine

The thesis makes a systematic and in-depth research on the treatment of chronic cough by traditional Chinese medicine from three aspects of theory, clinic observation and summarization of tutor’s experiences.The first part of the thesis focuses on the theories, and starts with the systematic review of insights on cough from ancient works on Chinese medicine. The Nei Jing (Classic of Internal Medicine) indicated that the disease location mainly lies in lung, while the dysfunction of viscera can also bring cough. Specialists of past generations have gained a better understanding to the pathogeny, pathogenesis and syndrome of chronic cough on the basis of Nei Jing and through their own experiences. During Ming and Qing dynasties, the cough was divided into two categories, that is, external factors and internal injury, and it is indicated that the differentiation of syndromes and signs should be guided by Yin and Yang (two opposing principles in nature, the former feminine and negative and the latter masculine and positive), and deficiency and excess. Based on such understanding, they undertook the treatment through overall differentiation analysis, which leaves behind invaluable experiences for the followers to take the differentiation treatment. After that, the thesis introduces the present research status of the Chinese medicine on chronic cough. In Chinese medicine, the disease belongs to the categories of "chronic cough", and always delays chronically and attacks repeatedly for long disease duration and complex pathogenesis, combined pathogens from internal and external frequently. Most medical specialists think that the clinical manifestations of chronic cough cannot be classified as excess or deficiency syndrome only, and, at most time, the disease represents mixed syndrome of deficiency and excess, or cold and heat. The therapeutic methods are also diversified, such as treatment from viscera, sputum or wind evil, and in other therapies, the external application of Chinese medicine, acupuncture injection accompanied with spray inhalation and physical therapy of acupuncture etc are also included. All of these show that Chinese medicine has a very good therapeutic effect on chronic cough with little side-effect, which brings the treatment of chronic cough by Chinese medicine a very bright future in spite of much room for further researches. The thesis also discusses in details the pathogeny, pathogenesis, essentials of differentiation and symptoms and signs of a disease of chronic cough on the basis of the theory of Chinese medicine and clinical practices. In this part, it explains that the pathogeny covers all aspects of external affection and internal injury, and generally pathogenesis arises from pathogenic factor affecting lung and the air (qi) in the lung upward invading. It may be caused by lung failing to ventilate the pathogenic factors from external, which bring lung air stasis and obstruction, or from its own disease and illness of other viscera bringing lung into trouble. The main viscus where the affection occurs is lung, while the other viscera of liver, spleen, stomach, kidney and heart are related to the affection. The pathology factors are wind evil, phlegm, fire and blood stasis. It is because of the weakened body resistance and the evil-factors’ lingering that the cough delays to recover, and the other diseases may be produced from dryness and impairment of body fluids, such as asthma may be occurred out of repeated attacking of cough. On the aspect of identification essentials, the thesis discusses such subjects as identification of disease’s stage, main symptoms, pathology factors and prognosis. In discussing symptoms and signs, the thesis summarizes 11 kinds of common symptom types and makes a brief analysis on common diagnostics.The second part of the thesis makes a summary of my tutor’s experiences on treatment of chronic cough, discussing about the treatment principles, methods, medicine taking taboo, etc. It is pointed out that the treatment of cough always focuses on ventilation as the first step in spite of the difference between external affection and internal injury. The method of ventilation is not only applicable to the early stage of cough, but suitable for the cough with a long duration as long as the disease diagnosed as obstruction of the lung air. Chinese ephedra is the main herb for lung ventilation. The main pathologic factor of chronic cough out of internal injury is phlegm, so phlegm control is one of the important principles in cough treatment. Since the phlegm is varied from cold, wet, hot or dry, corresponding expectorant medicine should be prescribed in accordance with property of phlegm syndrome. At the same time, the difference between true and false cold or heat of the phlegm should be identified clearly. For long duration of chronic cough, the disease shall be treated according to the actual situation since it always manifests the symptom as cold and heat interwoven, deficiency and excess mixed, and changeable between cold and heat, or between deficiency and excess, external cold with interior heat, interior retention of phlegm with exopathic cold, wind cold transforming into heat, wind heat transforming into dry evil etc. A patient affected by chronic cough should be treated by the method of Huo Xue Hua Yu (promoting blood circulation to dispel blood stasis) and medicinal insects, which can dispel wind evil as well as relieving spasm. Since the cough is related to several viscera, the treatment of the disease shouldn’t be decided until an integrated differentiation has been made to the syndromes so as to enhance the effects. Cases with pathogenic factor and syndrome withering but serious coughing remaining during the late stage of the affection, can be dosed cough remedy properly.The third part of the thesis makes a clinical research on laryngeal cough, a frequent type of chronic cough. Objective: To observe the clinical curative effect on laryngeal cough by Qu Feng Li Yan Han Ji (buccal pill for wind evil dispelling and sore-throat relieving) that prepared according to the method of eliminating wind evil and ventilating lung air, and relieving sore-throat and cough. Method: According to the plan, 60 patients were divided into two groups at random, treatment and control, with 30 patients each. The two groups are comparable in such aspects as gender, age, disease duration, severity of illness etc. The treatment group are dosed with Qu Feng Li Yan Han Ji (the pill is composed of Chinese ephedra, almond, roasted batryticated silkworm, cicada slough, thunberg fritillary bulb, loquat leaves, stenona root, figwirt root, India trumperflower, balloonflower, raw liquorice and fructus momordicae etc.). The herbs are decocted and concentrated with honey added into pills of 0.5 g each. The patient is required to have two pills in mouth per hour, 24 pills a day, with each two weeks as a treatment period. The treatment is observed for 1-2 periods. The control group are dosed with prepared Chinese medicine cough powder (the cough powder is prepared with balloonflower, fineleaf schizonepeta, aster root, stenona root, white swallowwort, liquorice and tangerine peel etc.). The patient is required to take 3 g once, three times a day, with each two weeks as a treatment period. We observe such data as curative effect, cardinal symptom, sign score, changes of tongue veins, blood percentage before administration, and chest fluoroscopy or full chest X-ray to give a clear diagnosis. Tests for safety include body temperature, pulse, breath, and blood pressure before and after administration, routine examinations of blood, urine, stool, liver and kidney function inspection and electro-cardiograph etc.Results: The result of clinical observation shows that the patients who suffered chronic laryngeal cough had an obvious improvement in such clinical symptom as throat itching, cough and expectoration etc. after dosed with Qu Feng Li Yan Han Ji, as well as improvement of the clinical signs such as laryngeal redness and swelling, hyperplasia of pharynx wall lymph follicle by some degree. The medicine has a fast drug efficacy with a clinical control and obvious effective rate up to 80%, which is higher than 50% of the control group. There is a significant difference (P<0.05) between the two groups. In the control group dosed with cough powder, the drug efficacy is slow. Generally, the improvement yields to the treatment group, though part of the patients got some improvement in symptom. As for as the toxic and side effect, there is no adverse reaction arisen in the treatment group and no abnormal changes in the safety data of liver and kidney function, which shows that Qu Feng Li Yan Han Ji is safe and nontoxic.Conclusions: Qu Feng Li Yan Han Ji is predominant in treatment of chronic laryngeal cough with less side-effect and lower cost. After the medicament transforms into buccal pills, the pills can directly apply a long-term effect on the affected part and brings better therapeutic effect. The dosage form suitable for the treatment of main symptom of laryngeal cough is an important factor besides the right establishment of the therapeutic methods and reasonable recipe formulation.