Diagnosis and treatment of children with bronchitis
Chief Complaint: Cough and expectoration for half a month.
History of Present Illness: Half a month ago, the patient got cough and expectoration caused by catching a cold, accompanied with chill, fever and sore throat. Then he was led to the local clinic for treatment. After physical examination, it was diagnosed as common cold and he was treated with intravenous dripping "Penicillin, Amikacin" and "Ribavirini" and oral taking some antibiotics and antipyretics. After 1 week' s treatment, the chill, fever and soreness of throat all disappeared while the cough and expectoration couldn' t be relieved yet. Furthermore, the cough became from original intermittent dry cough to present paroxysmal spasmodic cough, the expectoration got more severe and the expectorated sputum became more and more profuse in amount, it became from primary less thin whitish sputum to present more thick whitish sputum. His cough occurred frequently all a day, accompanied with constant expectoration. Sometimes the severe cough prevented him from sleeping in the nighttime. In addition, the patient got excessive sweat, poor appetite and anorexia as usual. Then he was led to our hospital for treatment by his mother on January 8,2000. After the illness came on, his stool was loose and formless, the urine was white and abundant. The appetite got poor and his sleeping was not smooth and steady. There was not other complaint.
Physical Examination: The patient was conscious with a normal general condition. The pulse was thready and soggy, the tongue was light red with a thin layer of white fur. The respiratory sounds in lungs were harsh. Some bubbling sounds and scattered dry rales were heard in the lower lungs. HR was 88 beats/min. The cardiac rhythm was regular, there weren't systolic murmur and diastolic murmur. The abdomen was normal. There was not other abnormal sign.
Examination of Chest Roentgenogram: It showed the lung markings were all increased and disorderly. There were some pieces of cloud like or wad-like shadows near the both hilus of lungs. It showed there was an inflammatory of the hilus of lungs and the bronchus.
Diagnosis: Infantile Bronchitis.
Differentiation: This disease, in TCM, belongs to the category of "KeSou"(cough). It was caused by deficiency of spleen qi and the accumulated phlegm in lungs. At the beginning of this illness, the symptoms such as chill, fever, cough, soreness of throat and so on all belonged to the category of superficial syndrome of wind heat type, originally it could be easily cured by the superficies-relieving decoction formed by some pungent flavored and cool propertied herbs such as decoction of Mulberry Leaf and Chrysanthemum. Unfortunately the patient was treated by the excessive anti-inflammatory treatment. Because the antibiotics were poured into the blood-circulation directly and quickly, they then quickly flew into all the skin, straie and the five Zang-organs and six Fu organs. Not only the superficial syndrome of wind-heat type was relieved quickly but also a lot of water was directly poured into the five Zang organs and the six Fu-organs. Because the six Fu organs are only responsible for transmission and not for reception, the poured water could not easily affect their normal functional activities. Meanwhile the five Zang-organs are only responsible for reception and not for transmission, furthermore, the infantile qi of the five Zang organs is too tender to be hurt, the poured water could easily affect their normal functional activities. In the five Zang-organs, the lung is the most tender organ and it's most easy to be hurt. After the lungs received a lot of water, the received water accumulated together and then turned into pathogenous dampness-phlegm in lungs, so that the patient got the profuse, thick whitish sputum. In addition, spleen is fond of dryness and sick of dampness. After A lot of cold water was poured into spleen, spleen qi was then restrained. The restrained spleen-qi couldn't support its normal functional activities, then spleen couldn't be in charge of digestion and transportation as normal, therefore, the restrained spleen-qi could not transport the accumulated phlegm-dampness in lungs effectively. This is the just reason why the patient got the continuous cough, poor appetite and anorexia after the soreness of throat, chill and fever all disappeared.
Therapeutic Principle: Invigorating spleen-qi and eliminating the pathogenous dampness phlegm, activating qi and smoothing the chest.
DangShen,Pilose Asiabell Root 30g
BaiZhu,Bighead Atractylodes Rhizome 12g
FuLing, Tuckahoe 9g
GuaLouPi,Trichosanthes Fruit 15g
QingPi,GreenTangerine Peel 6g
ZhiKe,Fruit of Citron 9g
ShanYao,Chinese Yam Rhizome 18g
LaiFuZi,Radish Seed 9g
YiYiRen,Coix Seed 18g
ShenQu,Medicated Leaven 10g
WuMei,Black Plum 6g
WuWeiZi,Schisandra Fruit 12g
SuYe,Perilla Leaves 9g
ZhiGanCao, Prepared Liqurice Root 6g
All the above drugs were to be decocted in water for oral taking. 3 doses were prescribed. Cold, cool and greasy food was forbidden during the treatment, taking the decoction in morning, afternoon, evening separately.
Effect Observation: After taking the 3 doses, the patient was led to me for reexamination by his mother on January 12,2000. His mother told me the cough disappeared, the expectorated sputum got greatly less than before. While there were poor appetite and anorexia yet, furthermore, some common daily activities could easily cause his excessive sweating, so that his underclothes and underpants were always wetted by his sweating. In addition, his sleeping got smooth and steady, the urination and defecation got normal. Physical examination showed the respiratory sounds in lungs were clear, only some scattered dry rales could be heard occasionally. The pulse was thready and rapid, the tongue was red with a thin layer of white fur. There was not other abnormal sign. All these signs showed the restrained spleen qi had been invigorated and the accumulated phlegm-dampness had been eliminated while there was stagnated heat in lungs. Then the followed therapeutic principle should be clearing away heat, invigorating spleen qi and activating qi, firming the superficies and restraining the excessive sweat.
ShaShen, Ladybell 20g
BaiZhu,Bighead Atractylodes Rhizome 10g
HuangLian,Coptis Root 5g
HuangQin,Scutellaria Root 5g
ghiHuangQi,Moxa-prepared Milkvetch Root 18g
DangGui,Chinese Angelica Root 6g
ShanYao,Chinese Yam Rhizome 15g
YiYiRen,Coix Seed 15g
BaiBianDou, Hyacinth Bean 12g
ZhiShi,Immature Bitter Orange 10g
ShenQu,Medicated Leaven 8g
XiangYuan, Citron Fruit 12g
SangBaiPi,Mulberry Bark 6g
ZhiMu,Windweed Rhizome 8g
ShengGanCao,Raw Liquorice Root 5g
All the above drugs were to be decocted in water for oral taking. 5 doses were prescribed. Hot and greasy food was forbidden during the treatment, taking the decoction in morning, afternoon and evening separately.
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