Diagnosis and treatment of children with bronchitis

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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.

Recipe:

  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.

Recipe :

  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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