Idiopathic Pulmonary Fibrosis Progress Of Diagnosis And Treatment Of Traditional Chinese And Western Medicine And The Tutor Experience

Objective:To introduce the advances in diagnosis and management of modern medicine for idiopathic pulmonary fibrosis (IPF), and also the advances of the Traditional Chinese medicine(TCM). Summarizing the experience from my tutor to treat this disease.Method:Through searching the literature published at home and abroad of IPF in recent years, especially in the nearly three years, discussed the advances in diagnosis and management of modern medicine and TCM. Reviewing the medical records from inpatient and outpatient, summarizing the principle from my tutor to use the medicinal herbs and prescribe medicines. The details systematically discoursing the epidemiology, pathogenesis, clinical features, diagnostic standards, differential diagnoses, treatment, natural course and prognosis of modern medicine, especially the diagnostic standards, differential diagnoses and treatment, because they were the hot researches now. The part of TCM, introducing the latest research results on the TCM names of IPF, etiology and pathogenesis, dialectical treatment, clinical observational trials and animal trials. The part of my tutor’s experience, introducing his views on the names, etiology and pathogenesis, principle of the treatment and the law how to use medicinal herbs and prescribe medicines; And also introducing the clinical trials guided by his experience and medical cases with good treatment effect.Conclusion:Now the diagnostic standards of IPF has been basically widely approved:If the IIRCT of the patient is accorded with the UIP type, then he can be diagnosed explicitly, and the invasive examinations are not necessary, such as surgical lung biopsy, TBLB or BAL. But the pathogenesis is not fully understood as yet, all the links, for example the inflammation, damage and abnormal repair, can be involved. Among these processes, alveolar epithelial cells, myo-f ibroblasts, TGF-β, TNF-α, IFN-γ, the imbalance of Thl/Th2cytokines, the local imbalance of the expression of MMP and TIMP and oxidative stress are all playing some important roles. And these links are the target of new drugs being studied. However, nearly all of the drugs that are used to treat patients with IPF are not effective as they are thought. Therefore, in the official ATS/ERS/JRS/ALAT statement of2011, the only treatments that are highly recommended are the oxygen therapy and the lung transplantation for patients with end-stage. As this disease is continuously evolutional, most of the patients will have a poor prognosis and finally died of respiratory failure. And recently the incidence rate of IPF has a trend of increasing, so IPF is also an important and difficult and baffling disease in the department of respiratory of TCM. The modern doctors of TCM believe this disease has some similarities with " fei wei " and " fei bi ",which are described in the ancient literature, so they treat IPF mostly from the understanding of these two diseases. They think the basic pathogenesis of IPF is lung, spleen and kidney deficiency, phlegm and blood stasis obstructing the lung collateral. So the main treating principle is tonifying qi.promoting blood circulation, expelling the obstruction from collaterals. Guiding by this theory, the treatment of TCM to patients with IPF has satisfied effects both in controlling symptoms, improving the quality of life and delaying the progression of the lung function. And the corresponding clinical and animal trials also show us the curative effect. But we still need more stringent clinical trials which are conformed to large sample, multicenter and randomized controlled. And also more animal trials with Chinese herbal compounds are needed to improve the effects of TCM more scientifically and fully. My tutor believes the pathogenesis of IPF is deficiency in origin and enrichment in symptom. The deficiency in origin means the qi deficiency and the lung, spleen, kidney deficiency; And the enrichment in symptom means phlegm and blood stasis. So tonifying qi to promote blood circulation, removing blood stasis and expelling the obstruction from collaterals are the main treatment. He especially pays more attention to support healthy energy, so he always uses high-dose of Qi-tonifying drugs to promote blood circulation and also strength exterior, then the evil can be got rid of, but the healthy energy can’t be damaged. Both in clinic and clinical trials, the treatment of my tutor’s experience has better effect, but we still need more in-depth study.