Large belly skin 15g, Schisandra fruit 3g, Polygala root 10g, Tangerine peel 6g, Pinellia rhizome 6g, Fritillaria bulb 10g,

Large belly skin 15g, Schisandra fruit 3g, Polygala root 10g, Tangerine peel 6g, Pinellia rhizome 6g, Fritillaria bulb 10g, Moutan bark 6g, Ephedra herb 10g, Apricot kernel 10g, Gypsum 30g, Asarum herb 3g, Honeysuckle flower 15g, Forsythia fruit 15g, Licorice root 6g. Decoct in water and take one dose daily. Second consultation: April 30, 2005—asthma has subsided, with less phlegm; continue with Ma-Xing-Shi-Gan decoction combined with Xiao-Qing-Long decoction to consolidate the therapeutic effect. Commentary: External cold triggers latent phlegm, which transforms into heat internally, accompanied by dampness; therefore, Ephedra and Large belly skin are used together to disperse lung qi and promote diuresis. Lung qi fails to clear and descend, leading to upward rebellion of lung qi, resulting in wheezing like a roar and chest tightness with flank distension. Based on tongue and pulse diagnosis, the overall pattern is identified as internal accumulation of phlegm-heat. The Ma-Xing-Shi-Gan decoction clears lung heat, while simultaneously using herbs that transform phlegm and relieve cough. This formula is commonly used clinically by Professor Pei Zhengxue and can be applied not only to asthma but also to asthmatic bronchitis. VII. A Collection of Theories from Ancient and Modern Medical Scholars Although the "Huangdi Neijing" does not mention the term "asthma," it does record "wheezing," which is similar to the onset characteristics of this disease. For example, the "Suwen · Yin-Yang Bie Lun" states: "When yin energy contends internally and yang energy disturbs externally, the spirit sweat has not yet been retained, leading to four extremities turning cold and rising up, causing the lungs to be scorched and resulting in wheezing." The "Suwen · Mai Yao Jing Wei Lun" says: "Blood accumulating under the ribs causes wheezing." Although the "Shanghan Lun" also does not use the term "asthma," the phrase "when a patient with asthma experiences an attack, adding Houpu and Xingzi to Guizhi decoction is beneficial" may refer to patients with a history of asthma, where "attack" denotes the onset of the disease. The "Jinkui Yaolue · Fei Wei Fei Ke Sou Shang Qi Bing Mai Zheng Zhi" states: "Coughing with wheezing, accompanied by a sound like a chicken clucking in the throat, is treated with Shegan-Mahuang decoction." This refers to the treatment of asthma attacks. Zhang Zhongjing, from a pathological perspective, classified it under the category of "phlegm-dampness," calling it the "latent phlegm" syndrome, and pointed out: "Phlegm accumulated above the diaphragm causes fullness, wheezing, coughing, vomiting, and when it flares up, there are chills and fever, back pain, waist pain, tears flowing from the eyes, and the person shakes violently day and night—this must indicate latent phlegm." This describes the typical symptoms during an asthma attack. Later, there were also descriptive terms such as "xiaosou" and "xiaohou." The "Yixue Zhengzhuan" further clarified the distinction between asthma and wheezing, stating: "Asthma is defined by its sound, while wheezing is defined by its breath." Subsequent medical scholars, recognizing that "asthma always involves wheezing," generally referred to it collectively as asthma, or simply as "asthma." The "Lingshu · Wu Yue Wu Shi" says: "Therefore, patients with lung diseases have labored breathing and flared nostrils." The "Lingshu · Ben Cang" also states: "When the lungs are high, there is upper respiratory distress and shoulder breathing with coughing." The "Lingshu · Wu Xie" says: "If evil resides in the lungs, the skin becomes painful, there are chills and fever, upper respiratory distress with wheezing, sweating, and coughing that affects the shoulders and back." The "Lingshu · Ben Shen" says: "When lung qi is deficient... if it is excessive, there is wheezing and shortness of breath, with the chest expanding and breathing becoming shallow." The "Suwen · Jingmai Bie Lun" says: "There are cases where fear leads to wheezing originating from the liver, and lustful emotions harm the spleen; when one is startled, wheezing originates from the lungs, and lustful emotions harm the heart; when one falls into water or trips, wheezing originates from the kidneys and bones..." The "Suwen · Ju Tong Lun" says: "Exhaustion leads to wheezing and sweating." Zhu Danxi first coined the term "asthma," clarifying that the pathogenesis is primarily due to phlegm, and proposed the treatment principle of "prioritizing strengthening vital energy before an attack, and urgently attacking pathogenic factors once an attack occurs." The "Jingyue Quanshu · Chuan Cu" says: "Wheezing has a root—it flares up when exposed to cold or fatigue—and this is also called asthma." The "Zheng Yin Mai Zhi · Xiaobing" also points out: "The cause of asthma is phlegm-dampness lingering and forming a nest, lying dormant inside. When emotional disturbances, dietary damage, or external wind-cold forces constrict the skin surface, asthma symptoms arise." This indicates that the pathological factors of asthma are related to phlegm. The "Zhengzhi Huibu · Xiaobing" says: "Asthma is long-term phlegm-wheezing that frequently recurs because there is obstructive qi inside, non-timely external stimuli, and stubborn phlegm adhering to the diaphragm—all three combine to block the airways, creating loud noises and triggering asthma." The "Yixue Shizai Yi · Xiaozheng" also says: "Once an attack occurs, the cold qi in the lungs and the turbid phlegm in the lung membrane cling to each other, tightly blocking the airways, making it impossible to breathe normally, and instead triggering the phlegm to make snoring sounds." This highlights that during an attack, "latent phlegm" is triggered by external stimuli, phlegm rises with the qi, qi is blocked by phlegm, they interact and bind together, blocking the airways, disrupting the normal downward flow of lung qi, leading to stagnation and accumulation, ultimately causing asthma to produce roaring sounds and rapid breathing. Modern medical scholars all have their own different views and experiences: Liu Chen et al., based on the six meridian differentiation, cited the "Suwen · Mai Yao Jing Wei Lun" passage "blood accumulating under the ribs causes wheezing" to argue that blood stasis is also a root cause of asthma. Zheng Jian et al. believe that the fundamental cause of asthma is deficiency of vital energy, with latent phlegm being the root, and external pathogenic factors serving as triggers, while the closure of qi and phlegm-wheezing are the manifestations of the disease. Chronic asthma invariably involves obstruction of the meridians and blood stasis, so they consider phlegm-stasis interconnection to be the main pathogenesis of asthma. Huang Enxiang, noting the rapid onset, intermittent nature, recurrent attacks, and phlegm-wheezing characteristics of asthma, believes these align with the mutable nature of wind-pathogen, proposing that "wind excess and phlegm obstruction, along with acute airway spasm" are the main pathogenesis of acute asthma attacks, and that not only external wind invasion can trigger asthma, but also internal liver wind combined with phlegm invading the lungs, causing the golden bell to ring and asthma to occur. Liang Zhiying also believes that wind-phlegm obstruction is the main pathogenesis during asthma attacks, and treatment should focus on dispelling wind, transforming phlegm, relieving spasm, and calming wheezing. Duan Yuansheng believes that dysfunction of the Shaoyang pivot mechanism leads to qi stagnation and upward rebellion in the lungs, causing frequent asthma attacks, and that qi imbalance is the cause of recurrent asthma. Li Guoyou et al. believe that weakness of the lung, spleen, and kidney, coupled with stubborn and chronic phlegm, can lead to persistent asthma. Gao Liqing et al. believe that allergens such as pollen, dust mites, and paint should be regarded as a type of "malevolent qi" in traditional Chinese medicine. II. Western Medical Diagnosis and Treatment (---) Clinical Diagnosis 1. Bacterial Pneumonia (1) Onset is sudden, with chills, high fever, cough, purulent or bloody sputum, and severe cases may present with shock symptoms. Physical examination reveals consolidation signs and moist rales in the lungs. (2) White blood cell count and neutrophil percentage are both elevated. X-ray shows inflammatory shadows distributed across lung lobes, sometimes appearing as large, patchy, unevenly dense shadows on one or both sides of the lungs. (3) Direct sputum smear and culture can identify the pathogen. (4) Diagnosis is usually straightforward for typical cases. However, in the early stages of the disease, when consolidation signs have not yet appeared; when lesions are deep and lung signs are not obvious; when affecting elderly or young patients; or when presenting with nonspecific symptoms, diagnosis can be difficult. Clinically, if encountering unexplained shock, unexplained sudden chills and high fever accompanied by respiratory symptoms, pneumonia should be considered. (5) Pneumococcal pneumonia: ① Sudden onset, with chills, fever, chest pain, cough, and rust-colored sputum. Possible triggers include exposure to cold, rain, or fatigue. ② Chest examination may reveal consolidation signs, dullness on percussion, increased vocal fremitus, bronchial breath sounds, and moist rales. ③ X-ray shows large, uniform, dense shadows distributed by lobe or segment, or thin, uniform shadows confined to a single lung segment. ④ Sputum smear reveals Gram-positive diplococci among polymorphonuclear leukocytes, and/or sputum bacterial culture isolates pneumococcus. Anyone meeting criteria ①, ②, ③, and ④ can be diagnosed. However, in the early stages of pneumococcal pneumonia, clinical symptoms and signs in elderly patients are often atypical, so diagnosis mainly relies on criteria ③ and ④, with reference to criteria ① and ② as well. (6) Staphylococcal pneumonia: ① Sudden onset, with chills, fever, chest pain, and purulent sputum. ② Chest examination may reveal consolidation signs. ③ White blood cell count is elevated, potentially reaching 50 x 10^9/L, with increased neutrophil ratio, left shift, and toxic granules. ④ X-ray shows large-scale lobar, segmental, or lobular pneumonia, prone to cavity formation. Sputum smear and culture confirm Staphylococcus aureus, with positive coagulase test. Staphylococcal pneumonia tends to be more severe, with a higher tendency toward suppurative necrosis, easily forming abscesses or empyema. If meeting criteria ①, ④, and S, a definitive diagnosis can be made. (7) Klebsiella pneumonia: ① Sudden onset, with chills, fever, cough, and chest pain. Large amounts of viscous yellow-green purulent sputum, sometimes reddish-brown gelatinous mucus. Commonly seen in malnourished individuals, those with systemic failure, or with pre-existing chronic bronchopulmonary diseases. ② Chest examination may reveal consolidation signs. ③ X-ray shows lobar consolidation, with irregular translucent areas and subpleural collapse. ④ Sputum culture isolates Klebsiella pneumonia. Due to the thick, sticky exudate of Klebsiella pneumonia, it often causes subpleural collapse and is prone to cavity formation, so X-ray changes have distinctive features. Clinically, sometimes a more typical reddish-brown gelatinous sputum can be coughed up. If also meeting criterion ④, a definitive diagnosis can be made. (8) Pseudomonas pneumonia: Renner points out that anyone with the following clinical conditions, combined with relevant X-ray findings, should consider this diagnosis. ① Immune disorders: congenital IgG deficiency. Undergoing immunosuppressive therapy. ② Mechanical factors or impaired cellular defense functions: alcoholism, malignant tumors, diabetes, and heart/kidney dysfunction; post-surgery or burn injuries; tracheostomy; chronic lung diseases (asthma, emphysema, chronic bronchitis). ③ Massive bacterial infection: aerosol inhalation therapy, resuscitation, etc., where equipment contamination is possible; intravenous infusion contamination; and those who have previously used large amounts of antibiotics. ④ X-ray The basic presentation is bronchopneumonic nodular lesions, widely distributed throughout both lungs, with possible cavities and pleural effusion, occasionally showing interstitial lesions. X-ray findings are related to the disease course. In the early stages, when there is fever, the lungs are congested, and X-ray shows pulmonary interstitial edema. After 48–72 hours of illness, due to the aggregation of consolidating lesions around the small bronchi, X-ray shows nodular lesions distributed along the bronchi, bilaterally, mainly affecting the lower parts of both lungs. If, after antibiotic treatment, the lesions still develop rapidly, pulmonary Pseudomonas infection should also be considered. Nodular lesions expand and merge, X-ray shows large, uniformly dense fused lesions, distributed by subsegment, segment, and lobe, eventually forming large lobar consolidation, with the affected area exceeding one lung lobe, resulting in a very poor prognosis. Between extensive nodular lesions, many small circular translucent areas are often seen, with thin walls, varying numbers, and inconsistent timing of formation. Previously thought to be tiny abscesses, but not pathologically confirmed, they may represent normal secondary pulmonary lobules between nodular lesions, or possibly the valve-like action formed by small bronchial inflammation, leading to lobular emphysema. After 48 hours of illness, due to lung tissue necrosis, pus cavities may form, varying in size, with thin walls, similar to the cavities in Staphylococcal pneumonia. Pneumonia caused by sepsis presents as scattered nodular lesions, mostly located under the pleura. Often accompanied by small amounts of pleural effusion, rarely moderate or larger volumes. Occasionally seen pneumothorax and giant bullae. After recovery, due to relatively lack of chronic inflammatory changes pathologically, the chest X-ray may show some residual destructive lesions, but also residual thin-walled cystic cavities and bronchial dilatation. Pleural fluid is often not completely absorbed, and no residual lung atelectasis is seen. (9) Escherichia coli pneumonia: ① The usual route of infection is through the gastrointestinal or genitourinary tract, spreading via the bloodstream. ② Clinical characteristics: often nausea, vomiting, and abdominal pain. ③ Lesions commonly occur in the lower lobes of the lungs. ④ Escherichia coli pneumonia is generally sensitive to cefuroxime, cefotaxime, cefoperazone, and carbenicillin. (10) Haemophilus influenzae pneumonia: ① Patients with chronic obstructive pulmonary disease are prone to developing this condition. ② Symptoms include high fever and purulent sputum, often accompanied by shortness of breath. ③ Peripheral blood counts show that most white blood cells are within the normal range or slightly elevated. ④ X-ray shows bronchopneumonia, sometimes with large areas of consolidation. S take a smear of the patient's lower respiratory secretions and perform Gram staining, allowing preliminary identification of Haemophilus influenzae under the microscope. To confirm this bacterium, it must be isolated using agar medium containing rabbit blood. (11) Anaerobic bacterial pneumonia: ① Often caused by anaerobic bacteria such as melanoid bacilli, fragile bacilli, fusiform bacilli, and Streptococcus pneumoniae. ② Commonly seen in hospitalized patients, those with gingival infections, or alcoholics who become infected through inhalation. ③ Onset is slow, gradually presenting symptoms over 1–2 weeks, such as weight loss, cough, and in half of the cases, copious foul-smelling purulent sputum, with about 20% of patients developing lung abscesses. ④ Laboratory tests: often anemia, increased white blood cell count. Sputum culture requires strict conditions; ideally, specimens should be collected via trans-tracheal aspiration (TTA) and sent for testing in sealed conditions. Penicillin, chloramphenicol, tetracycline, metronidazole, and other drugs are effective treatments. (12) Legionnaires' disease: It is a type of pulmonary inflammation caused by the Gram-negative bacterium Legionella. The main basis for diagnosing Legionnaires' disease: ① Clinical manifestations: fever, chills, cough, chest pain, and other respiratory infection symptoms. ② Chest X-ray shows inflammatory shadows. ③ Respiratory secretions, sputum, blood, or pleural fluid are cultured on activated charcoal yeast extract agar (BCYE) or other special media, and Legionella grows. ④ Direct fluorescence testing of respiratory secretions is positive. S indirect fluorescence testing (IFA) shows antibody titers increasing fourfold or more, reaching 1:128 or higher, before and after testing. Blood tube agglutination test (TAT) shows antibody titers increasing fourfold or more, reaching 1:160 or higher, before and after testing. Microscopic agglutination test shows antibody titers increasing fourfold or more, reaching 1:64 or higher, before and after testing. Anyone meeting criteria ① and ②, along with any one of items ③, is diagnosed with Legionnaires' disease. 2. Viral Pneumonia (1) Clinical manifestations are generally mild, with slow onset, headache, fatigue, fever, cough, and a small amount of mucous sputum. Physical signs are often absent. White blood cell count is normal, slightly elevated, or slightly low. (2) X-ray shows inflammatory shadows in the lungs, appearing as spots, patches, or uniformly dense areas. (3) Diagnosis relies on clinical manifestations and X-ray examinations, ruling out bacterial and other pathogen-induced pneumonia. Confirmation depends on virological testing and viral culture. 3. Fungal Pneumonia (1) Aspergillosis. ① This disease often occurs in patients with weakened immune function and bone marrow suppression. ② Symptoms include chills, fever, cough, and difficulty breathing. ③ X-ray shows scattered or dense patchy or nodular shadows in both lungs. ④ Pathogen testing helps with diagnosis. (2) Allergic bronchopulmonary aspergillosis. British scholar Hinson et al. (1952) first reported allergic bronchopulmonary aspergillosis, but to date there is still no unified diagnostic standard for this disease. Currently, the diagnostic criteria proposed by Rosenberg are more commonly used: ① Asthma. ② Increased peripheral blood eosinophil count. ③ Rapid-type reaction to aspergillus antigen skin test (+). ④ Positive result for aspergillus-specific precipitin test (+). S serum total IgE antibody titer increases. G proximal bronchial dilation (confirmed by plain film or bronchography). Transient fixed pulmonary infiltrates. Secondary diagnostic criteria: ① Multiple sputum cultures or microscopic examination revealing brownish aspergillus (+). ② History of coughing up brownish sputum plugs or particles. ③ Arthus phenomenon appearing in aspergillus skin test. Only those meeting the above seven primary criteria can be diagnosed with this disease. (3) Candida pneumonia. The following conditions can serve as references for diagnosing Candida pneumonia: