2 Medication Treatment

Maintain a quiet environment indoors with fresh air and appropriate temperature and humidity to ensure the patient’s rest. Additionally, the following traditional remedies can be used: 3g of Fritillaria cirrhosa per dose, taken three times daily, boiled in water. Garlic, sliced into 2–3 pieces and cooked together with 120g of white sugar, was consumed within 3 days for those over 1 year old, and within 2 days for those under 2 years old. He Shou Wu, 6–12g, and Licorice Root, 1.5–3g, were decocted in water. Verbena, 15–30g per day, was also decocted in water. Bile, commonly obtained from pig, cow, sheep, or chicken bile, was powdered and taken 0.3–0.5g per dose, twice daily; chicken bile was taken in portions of half a piece per year, up to a maximum of 3 pieces, taken 1–2 times daily. Baikeling tablets were taken once daily, 1 tablet for children aged 1 year and older, and 10–15 tablets for those over 10 years old, taken three times daily. Other treatments included Luocui Pills, taken twice daily, 1 pill each time; Baiketing Syrup (composed of Fritillaria cirrhosa, White Houttuynia, Ephedra sinica, Licorice Root, and Reed Grass), taken twice daily, 10ml for children aged 1–3 years, 15ml for children aged 3–6 years, and 20ml for those over 16 years old. Fresh Reed Grass and White Reed Grass were each taken in 30g, along with 15g of Winter Melon Seeds, decocted in water and taken once daily. Shaanxi is known for its traditional Chinese medicine preparations like Peach Blossom Powder.

(2) Medication Treatment

In the early stages, antibiotics can be used, with erythromycin being the preferred choice at 30–50mg/kg·day, and chloramphenicol at 30–50mg/kg·day. SMZco is also effective. To manage spasms, corticosteroids and Vitamin K may be considered; for whooping cough-related encephalopathy or seizures, sodium phenytoin 5mg/kg intramuscularly, or diazepam 0.1–0.3mg/kg intravenous injection, along with mannitol or sorbitol 1–2g/kg intravenous infusion, and dexamethasone intravenous drip to reduce intracranial pressure.

(3) Other Treatments

1. Acupuncture: Points such as Dingchuan, TianTu, ChiZe, HeGu, DaChui, BanLong, and SiFeng are selected for stimulation, with an acupuncture duration of 6–8 minutes. Acupuncture points can also be stimulated through point injections. For example, using the “Plum Blossom” technique, stimulate areas around the neck, sacrum, and spinal region, once daily.

2. Cupping Therapy: Take the ShenZhu point, once daily.

3. Massage and Mobilization: Use the Eight Trigrams, press the HeGu point, massage the Lung Meridian, press the Soft Two Doors, press the Five Finger Joints, massage the Spleen and Stomach, press the HeGu point, massage the Yuzhi, press the ChiZe point, once daily.

4. Apply fresh ginger or garlic slices, smear them with cow’s milk or egg white, and gently rub the chest area from top to bottom, 2 times daily, for several minutes each time.

5. Apply external cough-relief patches (composed of Euphorbia, Aconite, Flos Carthami, Asarum, White Mustard Seed, Dried Ginger, Kozakia, Datura, Sesame Oil, and Pine Resin) to the sides of the 1st, 3rd, and 5th thoracic vertebrae.

(Jiao Fuchu, Wu Bin) Chapter 12: Infectious Diseases – Pulmonary Tuberculosis
I. Overview

Pulmonary tuberculosis is a chronic lung infection caused by Mycobacterium tuberculosis. Its primary clinical features include cough, chest pain, hemoptysis, fever, night sweats, weight loss, and an elevated erythrocyte sedimentation rate. Mycobacterium tuberculosis is a strictly aerobic bacterium that is acid-resistant; after Gram staining, it often shows a weak positive reaction. The bacterial cell wall contains 60% lipids and is hydrophobic, allowing it to adapt to harsh environments. Unlike the structure of Escherichia coli enzymes, which rapidly proliferate due to their ability to synthesize deoxyribonucleic acid, Mycobacterium tuberculosis’s ribonucleic acid polymerase has a distinct structural difference, resulting in extremely slow growth of its ribonucleic acid chains. Consequently, Mycobacterium tuberculosis reproduces very slowly. Unlike internal or external toxins, Mycobacterium tuberculosis’s pathogenic mechanisms lie in the outer layer of its cell wall, where neighboring bacteria connect head-to-tail, forming a membrane-like filamentous factor composed of chitin, honey, and glucosamine, as well as strong acidic sulfur lipids. Mycobacterium tuberculosis is highly susceptible to drug resistance.

Pulmonary tuberculosis is a chronic respiratory infectious disease. Patients with open pulmonary tuberculosis—especially those with cavitated tuberculosis—carry the bacteria in their sputum, making them a major source of infection. There are also instances of infection through drinking milk. According to estimates, China has approximately 7 million active cases of pulmonary tuberculosis, indicating that the tuberculosis epidemic remains quite severe. The pathological manifestations of tuberculosis are characterized by a mixture of nodules, infiltrates, caseous necrosis, and cavities, which can be categorized into two main types: proliferative lesions and exudative lesions. The tissue reactions triggered by Mycobacterium tuberculosis’s invasion depend on the ratio between the number of specific T cells in the body and the amount of bacteria present in the tissues; the structural characteristics of the affected organs also play a role. When the bacterial load in the tissues is low but the number of sensitized T cells is high, nodules form (proliferative lesions). Tuberculous nodules are primarily composed of multiple layers of radiating epithelial cells, with Langhans giant cells at their center. This type of proliferation indicates that the body’s immune response is dominant, and the infection is contained. However, if the bacterial load in the tissues is high and the number of specific sensitized T cells is strong, exudative lesions develop. Further progression of the pathological tissues depends on the balance between the body’s allergic sensitivity and immune function. Recent studies have shown that tuberculosis has a genetic component. Measles, whooping cough, pneumoconiosis, pulmonary neoplasms, diabetes, and other conditions can easily trigger the onset of pulmonary tuberculosis.

II. Diagnosis

(1) Epidemiology

Patients with a history of contact with patients with open pulmonary tuberculosis, a positive family history, or symptoms such as exudative pleurisy, anal fistula, prolonged lymphadenopathy, or a history of increased tuberculosis allergy, as well as recurrent or prolonged colds lasting more than 3–4 weeks, accompanied by cough, blood in sputum, or blood in phlegm, should be considered.

(2) Clinical Manifestations

Symptoms include fatigue, weakness, general discomfort, hot flashes, flushing of the cheeks, weight loss, night sweats, poor appetite, weight loss, cough, expectoration, blood in sputum or hemoptysis, chest tightness, shortness of breath, and menstrual irregularities.

Further examination, including deep inhalation and listening to fine rales, can aid in diagnosis. Dense infiltrative lesions in the lungs,

L Source Chronic fibrotic cavitated tuberculosis with fibrous tissue proliferation and contraction

The base of the neck is firm, with dull percussion sounds, and auscultation reveals bronchial and alveolar breath sounds, sometimes accompanied by moist rales.

The chest appears depressed, with reduced tactile fremitus, dull percussion, and bronchial breath sounds, often accompanied by moist rales.

(3) Tuberculin Test

This test measures the body’s allergic reaction to Mycobacterium tuberculosis and its metabolic products, helping to determine whether a patient has been infected with tuberculosis. It serves as an auxiliary diagnostic tool. While direct smear, bacterial culture, and animal inoculation can detect Mycobacterium tuberculosis, the tuberculin test is particularly useful when the presence of the bacteria is confirmed. A positive tuberculin test, along with an elevated erythrocyte sedimentation rate, aids in diagnosing tuberculosis-related inflammation and confirming the diagnosis. Due to the large number of contaminants in sputum, researchers have recently been exploring ideal serological testing methods to better assess the disease.

(4) X-ray Examination

X-ray imaging plays a crucial role in diagnosing pulmonary tuberculosis, providing important information about the nature, location, extent, and progression of lesions, as well as aiding in determining treatment plans. On X-rays, pulmonary tuberculosis lesions generally appear as follows: ① nodular lesions with relatively high density and clear margins, surrounded by dense tissue; ② cloud-like or patchy lesions with lower density and blurred margins, indicative of inflammatory exudative lesions; ③ lesions with well-defined borders, often seen in the diagnosis of pulmonary tuberculosis; ④ cavities with translucent, ring-shaped boundaries. Typically, lesions of various types coexist. Although X-ray imaging is highly valuable in diagnosing pulmonary tuberculosis, small lesions may be obscured by shadows from ribs, mediastinum, diaphragm, heart, and other structures; therefore, fluoroscopic imaging is often recommended for better visualization.

III. Traditional Chinese Medicine Understanding and Treatment of Pulmonary Tuberculosis

(1) Historical Medical Perspectives on Pulmonary Tuberculosis

In ancient times, pulmonary tuberculosis was referred to as “lung consumption” or “tuberculosis.” Infantile pulmonary tuberculosis was known as “lung deficiency.” Early records in the Neijing, such as “the bones grow thin, the flesh sinks, the chest feels full, breathing becomes difficult, shoulder and neck pain arise, and the body heats up, causing skin peeling and redness…” (Suwen, “Yujihua Zang Lun”). The Ling Shu, “Yu Ban” section stated, “Coughing causes physical decline, body heat, and a rapid pulse.” Jin Dynasty scholar Ge Hong wrote in “Zhu Bei Bei Ji Fang,” “Corpse decay,” “after death, the disease spreads to others, even affecting the entire household.” Tang Dynasty scholar Wang Tao noted in “Wai Tai Mi Yao,” “Bone dryness leads to corpse decay, regardless of age—infants are especially vulnerable to this disease, and the transmission of the disease is even more painful for infants.” After the Song and Yuan Dynasties, the term “tuberculosis parasite” became widely accepted as a key concept in the understanding of the disease. Ge Ke Jiu’s “Shi Yao Shen Shu” stated, “Coughing with blood, spitting up phlegm, bone dryness and heat, kidney deficiency, essence depletion, pale complexion, dry mouth and throat… eating becomes difficult, and energy is completely lost.” The “Pu Ji Shi Bei Fang” clearly identified the cause of the disease as “lung worms,” and there was also the theory of “tuberculosis parasites.” The “Dan Xi Xin Fa” proposed that “tuberculosis is mainly due to yin deficiency,” emphasizing the importance of nourishing yin and clearing fire. The “Yi Xue Zheng Zhuan” further established two fundamental principles: killing parasites and replenishing deficiency, which remain in use today.

(2) Traditional Chinese Medicine Understanding of the Pathogenesis of Pulmonary Tuberculosis

Based on historical medical perspectives, pulmonary tuberculosis arises when internal damage leads to weakened vital energy, insufficient qi and blood, and depletion of yin essence, allowing tuberculosis parasites to invade the body. Conditions such as illness, grief, or long-term interactions with patients—especially when relatives care for patients day and night—can all contribute to infection. Individuals with congenital deficiencies or those who indulge in excessive desires, such as overindulgence in alcohol and food, early marriage, excessive worry and fatigue, or those who have suffered from serious illnesses like measles or whooping cough, or who have experienced childbirth, may experience depletion of qi and blood, fluids, and bodily essence, leading to a weakened immune system and reduced resistance to disease. Poor living conditions, malnutrition, cramped housing, dampness, and overcrowding also increase the risk of infection. As described in “Gujin Yitong, Lao Zhi Lao Men,” “These parasites… ... affect the weak-willed… over time, they lead to the development of tuberculosis.” When parasites invade the body, they often first attack the lungs—this is why “though the five viscera may show different symptoms, they all ultimately converge in the lungs.” However, “these pathogens move around, taking advantage of the five viscera.” Generally, the initial lesion occurs in the lungs, often affecting the spleen and kidneys, and may eventually spread throughout the five viscera. Tuberculosis is primarily associated with yin deficiency, and in terms of pathological characteristics, yin deficiency is often the underlying cause. As the “Yi Men Fa” “Yin Deficiency is common in nine out of ten cases, while yang deficiency is only one or two out of ten.” Generally speaking, in the early stages, the lungs are damaged, lung yin is depleted, and the lungs lack moisture. Subsequently, both lung and kidney become diseased, affecting the heart and liver as well. Yin deficiency leads to excess fire, or when lung and spleen are affected simultaneously, qi and yin are both harmed. Later stages may see yin damage combined with yang deficiency, ultimately leading to a critical condition where both yin and yang are compromised. Ju Hui Xian, a renowned expert in integrated Chinese and Western medicine for tuberculosis in Shaanxi, believed that the ancient saying about “pulmonary tuberculosis being a condition of yin deficiency without actual manifestation” was limited by the technological level of the time. The documented records we see represent late-stage clinical symptoms, while the early stages of tuberculosis often involve stagnation of phlegm, dampness, and water in the lungs—a key pathological mechanism. He also believed that lung qi deficiency in the early stages was functional qi deficiency, while in the mid- and late stages, it evolved into organic qi deficiency. Functional qi deficiency often showed quick relief after a few days or even a single day of treatment, whereas organic qi deficiency in the later stages often resulted in irreversible pathological damage, making recovery difficult. He developed Qian Jin Sha Tablets, which proved highly effective in treating early stages of dampness and heat accumulation.

(3) Traditional Chinese Medicine Differentiation and Classification of Symptoms, and Formulas

1. Lung Yin Deficiency: Characterized by dry cough, hoarseness, scant, sticky phlegm with streaks of blood, subtle chest pain, bone dryness and heat, and a feeling of heat in the palms and soles, especially in the afternoon, with night sweats and weight loss. The tongue is red with a thin yellow coating, the pulse is fine and rapid, and the erythrocyte sedimentation rate is often elevated, with low hemoglobin levels. Treatment focuses on nourishing yin, moistening the lungs, clearing heat, and killing parasites. The formula includes Yuehua Wan with adjustments: 12g of Sa Shen, 12g of Mai Dong, 10g of Tian Dong, 18g of Sheng Di, 15g of Bai Bu, 20g of Bai Ji, 30g of Shan Yao, 15g of Yun Ling, 12g of Chuan Bei, 10g of Ju Hua, 15g of A Jiao (dissolved in water), and 3g of San Qi (taken orally). The formula is prepared by boiling the herbs in water, taken once daily.

2. Yin Deficiency with Excess Fire: Characterized by coughing, shortness of breath, thick, yellow phlegm, and occasional blood in sputum.

P.S. Coughing with bright red blood, with a red tongue, a yellowish greasy coating, and a slippery, rapid pulse. The erythrocyte sedimentation rate is elevated, and white blood cells may also be present—blood, red blood, red blood.

This formula includes 10g of Hu, 30g of Bai Li, 20g of Sheng Di, 12g of Mai Dong, 12g of Jie Yi, 12g of Bei Mo, 12g of Dang Gui, 15g of Qing Hao.

Chapter 2: Infectious Diseases

Cellular hypoxia

Low levels. Treatment focuses on nourishing yin and clearing fire, while strengthening qi and yin. The formula includes Yuehua Wan with adjustments: 12g of Sha Shen, 12g of Mai Dong, 10g of Tian Dong, 18g of Sheng Di, 15g of Bai Bu, 20g of Bai Ji, 30g of Shan Yao, 15g of Yun Ling, 12g of Chuan Bei, 10g of Ju Hua, 15g of A Jiao (dissolved in water), and 3g of San Qi (taken orally). The formula is prepared by boiling the herbs in water, taken once daily.

4. For Yang Deficiency, treatment focuses on warming the body and alleviating coldness, with symptoms like fatigue, fear of cold, and coughing with little energy. The formula includes Taizi Shen, 15g of Yun Ling, 15g of Bai Zhu, 30g of Shan Yao, 12g of Jie Yi, 12g of Bai Li, and 12g of Dang Gui, along with 15g of Qing Hao. The formula is prepared by boiling the herbs in water, taken once daily.

Adjustments can be made: for severe coughing, add almond, wintergreen, Platycodon grandiflorus, Bai Ji, and mulberry bark; for blood in sputum, add lotus root, Bai Ji, reed grass, cypress leaves, blood charcoal, and small thistle; for bone dryness and heat, add artemisia, turtle shell, silver chuanxiong, coptis chinensis, and tree bark; for spontaneous sweating and night sweats, add calcined dragon bone, calcined oyster shell, floating wheat, five-flavor berry, five-grain seeds, and ephedra roots; for chest pain, add yuanhu, orange peel, and curcuma.

(4) Traditional Chinese Medicine Resources on the Differentiation and Treatment of This Disease