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Pneumonia is a common childhood lung system disorder clinically marked by fever,cough,shortness of breath,nasal flaring and phlegm congestion.It occurs all year round but prevails in winter and spring.Any age can get sick.The younger the children are,the higher the incidence rate will be.The prognosis of pneumonia is closely related to the age,the constitution,the severity of the pathogenic factors and the nursing.With proper treatment at the early stages,the prognosis is generally favorable.For patients of young age and weak physique,the disease is subject to repeated attacks and is lingering and intractable.In severe cases,it is easily complicated with heart yang deficiency and liver depression syndrome and other deteriorated patterns.Infantile pneumonia in western medicine can refer to the treatment of this disease.
The external causes of this disease involve wind invasion while the internal causes involve the immaturity of the zang-fu organs.Pneumonia may also occur when other diseases affect the lung.
The lung governs qi,controls breathing,and is related to skin and body hair.The wind pathogen attacks the body through the skin,the body hair,the mouth or the nose,and all will affect the lung,causing the failure of lung qi to disperse and descend, wei -yang obstructed and stagnated,manifesting at the beginning as fever,aversion to cold and cough,etc.Wind is the chief pathogen of many diseases and often mixes with other pathogenic factors,so the etiologies are classified into wind-cold type and wind-heat type.Clinically there is a syndrome of lung blocked due to wind-cold and syndrome of lung blocked due to wind-heat.
If the pathogens invade the lung- wei ,transforming into heat and scorching fluids which then transform into phlegm obstructs the airways.Lung qi is obstructed and stagnated,manifesting with fever,cough,shortness of breath,nasal flaring,and phlegm rale,etc.The lung governs qi and links with all the vessels.If the pathogenic factors are excessive or the healthy qi is deficient,the disease can develop further,spreading from the lung to other zang and fu organs.The lung and the large intestine are interior-exteriorly related.Failure of lung qi to descend will prevent qi of the large intestine from moving downwards,leading to an excess in the fu organs manifesting as abdominal distension and constipation and so on.If heat toxins transform into the fire and inwardly invade and sink into the yueyin level to stir up liver wind,then a deteriorated pattern can manifest with high fever,unconsciousness,and convulsions.Qi acts as the commander of blood.The lung qi is obstructed and blocked,affecting the heart,which will cause inhibited blood flow and roughness and stagnation of the vessels.This is a serious condition of qi stagnation and blood stasis manifesting with cyanotic lips and nails,ecchymosis on the tongue; or the heart fails to receive nourishment,so the heart qi insufficiency or even heart yang deficiency and failure may result.This relatively critical condition manifests with whitish complexion,cold limbs,rapid breathing,restlessness,enlargement of abdominal mass below the right costal region,weak and thready pulse.In severe cases,patients may die of interior obstruction and exterior collapse.
In the later stage,the gradual retreat of pathogens,and damage and exhaustion of healthy qi may lead to lingering pathogen due to deficient healthy qi.Pathogenic heat affecting the lung,consumption of lung yin and lingering residual pathogens may lead to a syndrome of yin deficiency and lung heat;congenital weakness,or lung damaged by lasted a cough and affecting the spleen,may lead to a syndrome of lung and spleen qi deficiency.
In short,the main location of pneumonia is in the lung,and it also commonly affects the spleen while also inwardly invading the heart and liver.Phlegm and heat are the pathological products as well as the etiological factors.The pathomechanism mainly lies in the develop-ment of lung qi obstruction and stagnation.
a.History of external-contraction pathogenic wind or contagious diseases.
b.Clinical manifestations Acute onset,mild cases with fever,cough,and excessive phlegm,severe cases with shortness of breath,nasal flaring,and even restlessness,pale complexion,cyanotic lips,and nails,cold limbs,enlargement of the liver in short time;possibly continuous high fever,coma and delirium,and tic of limbs.Newborn infants with qi-yang deficiency may not have the previously mentioned typical symptoms,but there may be audible and moderate rales in the lungs.
c.Auxiliary examination
Chest X-ray : increased and disordered lung markings,small patchy or patchy shadows,or uneven large shadows.
Routine blood test : White blood cell count and neutrophils in bacterial pneumonia increase; the number of white blood cells in viral pneumonia is normal or decreases,and lymphocytes increase.
Etiological examination : By bacterial culture,virus isolation,and mycoplasma pneumoniae detection,corresponding etiological diagnosis can be obtained.
It is mainly related to asthma and cough.(See table 6–1)
a.Differentiating common syndrome and deteriorated syndrome
Typical symptoms of common syndrome include fever,cough and shortness of breath;dyspnea with an open mouth and raised-shoulder breath,nasal flaring,and tears indicates severe cases in common syndromes; during the course of disease,there are deteriorated syndromes: heart-yang deficiency syndrome manifesting with pale or cyanotic complexion,cold limbs,depressed,cloudiness of consciousness; syndrome of pathogens invading and sinking into the liver and heart manifesting with irritability and delirium,uneven breath,even convulsions.
b.Differentiating cold and heat
Syndrome of lung block due to wind-cold manifests with a slight fever,aversion to cold,clear and thin phlegm,no red lips,tongue,and throat at the early stage; syndrome of lung block due to wind-heat manifests with intense high fever,sticky and thick phlegm,red lips,tongue and throat.Syndrome of phlegm-heat blocking lung manifests with fever,cough,phlegm obstruction,short breath,irritability-restlessness,constipation and yellow urine,red tongue with yellow coating,and rapid pulse at the climax.
c.Differentiating deficiency and excess
At the early stage or the climax of the disease,main manifestations as fever,cough,asthma,phlegm obstruction indicate excess syndrome; during the recovery period,symptoms like inability to cough,or a cough with less sputum,lusterless complexion,spontaneous sweating,and poor appetite indicate deficiency syndrome.
The basic treatment principles are to open the lung and resolve phlegm.The treatment is determined based on syndrome differentiation according to the different stages and different symptoms and signs.At the early stage,provide treatment to disperse wind,release exterior and open the obstruction; at the climax stage of phlegm-heat blocking lung,provide treatment to clear heat,dispel phlegm,unblock lung and relieve asthma; for cases accompanied by qi stagnation and blood stasis,provide treatment to activate blood and resolve stasis; at the recovery stage of qi-yin damage and consumption,provide treatment to tonify qi and nourish yin.If there are deteriorated cases,provide treatment for heart-yang deficiency to warm and nourish heart-yang; for pathogens invading jueyin to extinguish wind for resuscitation.This disease is a serious one of the children’s lung diseases.In the course of treatment,attention should be paid to the change of the condition,and combine traditional Chinese and Western medicine when necessary.In addition to oral medicinals,the disease can also be treated with external application therapies.
Common Syndrome
◆ Wind-Cold Blocking Lung
Signs and Symptoms: aversion to cold with fever,no sweating,bucking,breathlessness,white and thin phlegm,no thirst,normal throat,normal tongue with thin white or white greasy coating,floating and tight pulse,or floating and red finger venules.
Essentials: aversion to cold with fever,no sweating,white and thin phlegm,normal throat.
Treatment Principles: Unblock the stagnancy with pungent and warm medicinal,ventilate lung and relieve a cough.
Formula: Modified Huá Gài Săn (Florid Canopy Powder,华盖散) from Beneficial Formulas from the Taiping Imperial Pharmacy ( Tài Píng Huì Mín Hé Jì Jú Fāng ,太平惠民和剂局方).
Medicinals: má huáng (Herba Ephedrae), xìng rén (Semen Armeniacae Amarum), gān căo (Radix et Rhizoma Glycyrrhizae), sāng bái pí (Cortex Mori), zǐ sū zǐ ( Fructus Perillae), chén pí (Pericarpium Citri Reticulatae),and chì fú líng (Poria Rubra).
Modifications: For profuse phlegm with a greasy white tongue coating,add bàn xià (Rhizoma Pinelliae) and lái fú zǐ (Semen Raphani);for body pain without sweating,add guì zhī (Ramulus Cinnamomi); for cases accompanied by fever,thirst,red complexion,and restlessness,add shí gāo (Gypsum Fibrosum),or replace the formula with Dà Qīng Lóng Tāng (Major Green Dragon Decoction,大青龙汤).
◆ Wind-Heat Blocking Lung
Signs and Symptoms: fever,cough,short breath,or flaring nares,sticky and thick sputum,nasal congestion with thick discharge,red throat,red and swelling tonsil,red tongue with thin white or thin yellow coating,floating and rapid pulse,or floating and purple finger venules.
Essentials: fever,cough,short breath,red throat,and red tongue.
Treatment Principles: Ventilate lung,clear heat,and resolve phlegm and unblock the stagnancy.
Formula: Modified Yín Qiào Săn (Lonicera and Forsythia Powder,银翘散) from Systematic Differentiation of Warm Diseases ( Wēn Bìng Tiáo Biàn ,温病条辨) combined with Má Xìng Shí Gān Tāng (Ephedra,Apricot Kernel,Gypsum and Licorice Decoction,麻杏石甘汤) from On Cold Damage ( Shāng Hán Zhèng ,伤寒证).
Medicinals: má huáng (Herba Ephedrae), xìng rén (Semen Armeniacae Amarum), shí gāo (Gypsum Fibrosum), gān căo (Radix et Rhizoma Glycyrrhizae), jīn yín huā (Flos Lonicerae Japonicae), lián qiáo (Fructus Forsythiae), yú xīng căo (Herba Houttuyniae), guā lóu ké (Pericarpium Trichosanthis), lái fú zǐ (Semen Raphani),and shè gān (Rhizoma Belamcandae).
Modifications: For obvious fever,add huáng qín (Radix Scutellariae) and sāng bái pí (Cortex Mori); for profuse phlegm,add guā lóu (Fructus Trichosanthis) and lái fú zǐ (Semen Raphani); for fever with sore throat,add shè gān (Rhizoma Belamcandae), chán tuì (Cicadae Periostracum) and guà jīn dēng (franchet groundcherry persistent calyx or fruit).
◆ Phlegm-Heat Blocking Lung
Signs and Symptoms: cough,panting,breathlessness with flaring nares,phlegm rales from the throat,fever,vexation,cyanosis in mouth and lips,red complexion,constipation,scanty and yellow urine,red tongue with yellow or yellow greasy coating,rapid or rapid slippery pulse,or cyanotic finger venules seen in the qi pass.
Essentials: high fever,cough,phlegm rales,panting,red tongue with the yellow greasy coating.
Treatment Principles: Clear heat,remove phlegm,open the lung and relieve panting.
Formula: Modified Wǔ Hǔ Tāng (Five Tigers Decoction,五虎汤) from Compilation for and Supplement to Diagnosis and Treatment ( Zhèng Zhì Huì Bǔ ,证治汇补) with Tíng Lì Dà Zăo Xiè Fèi Tāng (Lepidium/Descurainiae and Jujube Lung-Draining Decoction,葶苈大枣泻肺汤) from Essentials from the Golden Cabinet ( Jīn Guì Yào Lüè ,金匮要略).
Medicinals: zhì má huáng (Herba Ephedrae Praeparata cum Melle), xìng rén (Semen Armeniacae Amarum), shí gāo (Gypsum Fibrosum), gān căo (Radix et Rhizoma Glycyrrhizae), xì chá ( g reen tea), tíng lì zǐ (Semen Lepidii; Semen Descurainiae),and huáng qín (Radix Scutellariae).
Modifications: For high fever and red complexion,add yú xīng căo (Herba Houttuyniae) and hǔ zhàng (Rhizoma Polygoni Cuspidati); for profuse phlegm and qi regurgitating,add zhè bèi mǔ (Bulbus Fritillariae Thunbergii), xiān zhú lì (Succus Bambusae)and lái fú zǐ (Semen Raphani); for cyanosis lips,add dān shēn (Radix et Rhizoma Salviae Miltiorrhizae) and táo rén (Semen Persicae).
◆ Pathogenic Heat Blocking Lung
Signs and Symptoms: persistent high fever,severe cough,breathlessness with flaring nares,even asthma,no tears,and nasal discharge,dry nares like coom,red face and lips,vexation,thirst,dark urine,constipation,red and dry tongue with a yellow and rough coating,slippery and rapid pulse.
Essentials: persistent high fever,severe cough,breathlessness with flaring nares,red tongue with a yellow and rough coating,slippery and rapid pulse.
Treatment Principles: Clear heat,resolve toxins,purge the lung and open the blockage.
Formula: Modified Huáng Lián Jie Dú Tāng (Coptis Toxin-Resolving Decoction,黄连解毒汤)from Formulas to Keep Up One’s Sleeve ( Zhǒu Hòu Fāng ,肘后方) with Sān Ào Tāng (Rough and Ready Three Decoction,三拗汤) from Beneficial Formulas from the Taiping Imperial Pharmacy ( Tài Píng Huì Mín Hé Jì Jú Fāng ,太平惠民和剂局方).
Medicinals: mì má huáng (Herba Ephedrae Praeparata cum Melle), kǔ xìng rén (Semen Armeniacae Amarum), zhǐ qiào (Fructus Aurantii), huáng lián (Rhizoma Coptidis), huáng qín (Radix Scutellariae), zhī zǐ (Fructus Gardeniae), shēng shí gāo (Gypsum Fibrosum),and zhī mǔ (Rhizoma Anemarrhenae).
Modifications: For serious heat toxin,add hǔ zhàng (Rhizoma Polygoni Cuspidati), pú gōng yīng (Herba Taraxaci) and chóng lóu (Rhizoma Paridis); for constipation and abdominal distention,add dà huáng (Radix et Rhizoma Rhei) and xuán míng fěn (Natrii Sulfas Exsiccatus); for dry mouth and nose without tears and nasal discharges,add lú gēn (Rhizoma Phragmitis), xuán shēn (Radix Scrophulariae)and mài dōng (Radix Ophiopogonis).
◆ Yin Deficiency with Lung Heat
Signs and Symptoms: a long course,mild fever,night sweating,dry coughing with less phlegm,flushed face,dry mouth,constipation,red tongue with less or peeled coating or no coating,thready and rapid pulse,or pale purple finger venules.
Essentials: dry coughing with less phlegm during the later stage of pneumonia,red tongue with less or peeled coating.
Treatment Principles: Nourish yin,clear heat,moisten lung and relieve a cough.
Formula: Modified Shā Shēn Mài Dōng Tāng (Radix Adenophorae and Radix Ophiopogonis Decoction,沙参麦冬汤) from Systematic Differentiation of Warm Diseases ( Wēn Bìng Tiáo Biàn ,温病条辨).
Medicinals: shā shēn (Radix Adenophorae), mài dōng (Radix Ophiopogonis), yù zhú (Rhizoma Polygonati Odorati), sāng yè (Folium Mori), tiān huā fěn (Radix Trichosanthis), gān căo (Radix et Rhizoma Glycyrrhizae), biăn dòu (Semen Lablab Album),and xuán shēn (Radix Scrophulariae).
Modifications: For uncleared lung heat,add huáng qín (Radix Scutellariae) and dì gǔ pí (Cortex Lycii); for repeated low fever,add qīng hāo (Herba Artemisiae Annuae) and zhì biē jiă (Carapax Trionycis Praeparata); for night sweating,add fú xiăo mài (Fructus Tritici Levis), duàn mǔ lì (calcined Concha Ostreae) and duàn lóng gǔ (calcined Os Draconis).
◆ Lung-Spleen Qi Deficiency
Signs and Symptoms: a long course,repeated mild fever,lusterless complexion,profuse sweating,weak coughing,poor appetite,loose stools,lassitude,lack of strength,pale tongue with thin white or white greasy coating,thready and weak pulse,or pale red finger venules.
Essentials: weak coughing,lusterless complexion,spontaneous sweating,poor appetite,pale tongue with the thin white coating.
Treatment Principles: Reinforce lung,invigorate spleen,boost qi and resolve phlegm.
Formula: Modified Rén Shēn Wǔ Wèi Zǐ Tāng (Ginseng and Schisandra Decoction,人参五味子汤) from The Grand Compendium of Pediatrics ( Yòu Yòu Jí Chéng ,幼幼集成).
Medicinals: dăng shēn (Radix Codonopsis), bái zhú (Rhizoma Atractylodis Macrocephalae), fú líng (Poria), wǔ wèi zǐ (Fructus Schisandrae Chinensis), mài dōng (Radix Ophiopogonis), chén pí (Pericarpium Citri Reticulatae), bàn xià (Rhizoma Pinelliae),and gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For a serious cough,add kuăn dōng huā (Flos Farfarae) and zǐ wăn (Radix et Rhizoma Asteris); for profuse deficiency sweating with any movement,add duàn mǔ lì (calcined Concha Ostreae) and duàn lóng gǔ (calcined Os Draconis); for profuse sweating and common cold,add guì zhī (Ramulus Cinnamomi), bái sháo (Radix Paeoniae Alba) and fú xiăo mài (Fructus Tritici Levis); for poor appetite,add shén qū (Massa Medicata Fermentata), gǔ yá (Fructus Setariae Germinatus) and mài yá (Fructus Hordei Germinatus); for loose stools,add shān yào (Rhizoma Dioscoreae), wèi mù xiāng (Radix Aucklandiae Rosc.) and wèi gé gēn (Radix Puerariae Lobatae Rosc.).
Deteriorated Syndrome
◆ Heart Yang Deficiency
Signs and Symptoms: sudden shortness of breath,flusteredness worsened when move,restlessness,pale or grayish complexion,cold forehead sweating,or lassitude,short and weak breathing,cold limbs,enlarged liver under right flank,dark purple tongue with thin coating; thready,weak,rapid and swift pulse,cyanotic finger venules reaching the life pass.
Essentials: sudden shortness of breath,flusteredness worsened when move,pale or grayish complexion,cold limbs,enlarged liver; thready,weak,rapid and swift pulse.
Treatment Principles: boost qi,warm yang,and save from collapse.
Formula: Modified Shēn Fù Lóng Mǔ Jiù Nì Tāng (Ginseng,aconite,Dragon Bone,and Oyster Decoction for Resuscitation,参附龙牡救逆汤) (Proved Formula).
Medicinals: rén shēn (Radix Ginseng), fù zǐ (Radix Aconiti Lateralis Praeparata), lóng gǔ (Draconis Os; Fossilia Ossis Mastodi), mǔ lì (Concha Ostreae), bái sháo (Radix Paeoniae Alba),and gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For qi and yang deficiency,replace the formula with Dú shēn Tāng (Single Ginseng Decoction) or Shēn Fù Tāng (Ginseng and Aconite Decoction),with the frequent oral administration to rescue from the crisis.An intravenous drip Shēn Fù Zhù Shè Yè (Ginseng and Aconite Injection,参附注射液) can also be used; for qi and yin exhaustion,add Shēng Mài Zhù Shè Yè (Pulse-Engendering Injection,参麦注射液) by intravenous drip; for blood stasis with symptoms of pale complexion and liver enlargement,add dān shēn (Radix et Rhizoma Salviae Miltiorrhizae), hóng huā (Flos Carthami),or Dān Shēn Zhù Shè Yè (Salviae Miltiorrhizae Radix et Rhizoma Injection,丹参注射液) by intravenous drip.
This syndrome is an urgent deteriorated case of pneumonia.The urgent task of treatment is to save the dying heart Yang,and cooperate with western medicine emergency treatment if necessary.
◆ Pathogens Invading Heart and Liver
Signs and Symptoms: high fever,vexation,tics of limbs,coma and delirium,neck rigidity,anoopsia,red tongue with yellow coating,rapid pulse,cyanotic finger venules reaching the life pass or going through passes to reach nails.
Essentials: high fever,coma,and tics of limbs.
Treatment Principles: Clear heat,purge fire,pacify liver and extinguish wind.
Formula: Modified Líng Jiăo Gōu Téng Tāng (Antelope Horn and Uncaria Decoction,羚角钩藤汤) with Niú Huáng Qīng Xīn Wán (Bovine Bezoar Heart-Clearing Pill,牛黄清心丸),both from Revised Popular Guide to ‘On Cold Damage’ ( Chóng Dìng Tōng Sú Shāng Hán Lùn, 重订通俗伤寒论).
Medicinals: líng yáng jiăo fěn (Cornu Saigae Tataricae Pulvis), gōu téng (Ramulus Uncariae Cum Uncis), fú shén (Sclerotium Poriae Pararadicis), yuăn zhì (Radix Polygalae), bái sháo (Radix Paeoniae Alba), shēng dì huáng (Radix Rehmanniae), gān căo (Radix et Rhizoma Glycyrrhizae), huáng lián (Rhizoma Coptidis), huáng qín (Radix Scutellariae), zhī zǐ (Fructus Gardeniae), yù jīn (Radix Curcumae),in addition to Niú Huáng Qīng Xīn Wán (Bovine Bezoar Heart-Clearing Pill,牛黄清心丸).
Modifications: For persistent high fever,add shí gāo (Gypsum Fibrosum); for tics of limbs,add jiāng cán (Bombyx Batryticatus)and quán xiē (Scorpio); for unconsciousness with profuse sputum,add dăn nán xīng (Arisaema cum Bile), shí chāng pú (Rhizoma Acori Tatarinowii) and tiān zhú huáng (Silicea Bambusae Concretio).
◆ Chinese Patent Medicines
1. Xiăo Ér Fèi Rè Ké Chuăn Kǒu Fú Yè (Children’s Lung-Clearing Cough and Wheezing-Relieving Oral Liquid,小儿肺热咳喘口服液) for the syndrome of wind-heat blocking lung.
2. Jīn Zhèn Kǒu Fú Yè (Jinzhen Oral Liquid) for the syndrome of phlegm-heat blocking lung.
3. Hóu Zăo Săn (Houzao Powder,猴枣散) for the syndrome of phlegm-heat blocking lung.
4. Shēn Líng Bái Zhú Săn (Ginseng,Poria and Atractylodes Macrocephalae Powder,参苓白术散) for the syndrome of lung-spleen qi deficiency.
5. Yăng Yīn Qīng Fèi Táng Jiāng (Yin-Nourishing and Lung-Clearing Syrup,养心清肺糖浆) for the syndrome of yin deficiency and lung heat.
◆ External Therapy
1.Plastering Therapy
Powder of dà huáng (Radix et Rhizoma Rhei) and máng xiāo (Natrii Sulfas) and mashed garlic are mixed in proportion to 4:1:4 with water into a paste.Put the paste on dressings before implementing it onto the scapular region and the part where obvious moist rales are heard or where obvious changes are seen with X-ray.It is lasting for 15 to 30 minutes according to different ages,once a day for 7 days as a course.Two courses are necessary.This method is applicable to the syndrome of wind-heat blocking the lung and phlegm blocking the lung.
2.Cupping Therapy
It is applicable to cases of profuse phlegm and lingering rales during the later period of pneumonia.
◆ Acupuncture and Moxibustion
Main acupoints: LU 5 ( chǐ zé ),LU 6 ( kǒng zuì ),LI 4 ( hé gǔ ),BL 13 ( fèi shù ) and ST 36 ( zú sān lǐ ).
Points combination: LU 11 ( shào shāng ),ST 40 ( fēng lóng ),LI 11 ( qū chí ) and RN 12 ( zhōng wăn ),applicable to syndrome of phlegm-heat blocking the lung; RN 6 ( qì hăi ),RN 4 ( guān yuán ) and DU 20 ( băi huì ),applicable to syndrome of heart-yang deficiency.
1.Keep the air fresh in the living room,increase the outdoor activities properly,strengthen the physical exercise and strengthen the physique.
2.Try to keep away from the crowded public places and prevent all kinds of infectious diseases.
3.Regulate and restore health in time.
4.Maintain the ward comfortable,air circulation,appropriate temperature and humidity; try to make the children quiet,and observe the therapeutic effect.
5.Keep the respiratory tract unobstructed,help the children to take the appropriate body position,raise the bed at 30° to 60°,for the respiratory movements and exudation of respiratory secretions,guide the patients for an effective cough,timing turning over,backslapping and changing postures in favor of expectoration.
6.For children with fever,monitor their temperature and watch out the occurrence of high fever convulsions.
7.Supplement nutrition and moisture.Children should take high calorie,high protein,and digestible diet,and drink plenty of water.The rate of infusion is strictly controlled during intravenous infusion,and volumes of infusion and urine of 24 hours should be recorded for severe cases.
8.Observe the condition closely to prevent the occurrence of deteriorated cases.
FENG,female,age 6.Initial Visit: April 20,1983.
The patient was hospitalized for coughing for 1 weeks,accompanied by fever and asthma for a day.She coughed with phlegm a week ago and was given Xiăo Ér Ᾱn (Compound Sulfadimidine Powder for Children,小儿安),but no effect.Present symptoms are worsening cough,fever,asthma increased gradually; a temperature of 38.3 degrees Celsius,asthma,shoulder raising with breathing,greenish complexion,flaring nares,perioral cyanosis,dry lips,dry and moist rales heard from the lungs,heart rate of 183 per minute,low blunt heart sounds,2 cm beneath hepatic ribs,yellow tongue coating,and rapid pulse.X-ray examination showed small patches of shadow in both lungs.She was diagnosed with pneumonia (wind-heat invading lung syndrome) at acute stage combined with heart failure (heart qi deficiency).The treatment is to clear heat,ventilate lung,and relieve a cough and asthma.
Prescriptions:
1.Supplemented Má Xìng Shí Gān Tāng (Ephedra,Apricot Kernel,Gypsum and Licorice Decoction,麻杏石甘汤): má huáng (Herba Ephedrae) 6 g, xìng rén (Semen Armeniacae amarum) 6 g, shēng shí gāo (Gypsum Fibrosum) 30 g, jīn yín huā (Flos Lonicerae Japonicae) 9 g and lián qiáo (Fructus Forsythiae) 9 g; decocted in water for oral take,one dose a day.
2. Yú Xīng Căo Zhù Shè Yè (Houttuyniae Injection,鱼腥草注射液),2 mL each time for intramuscular injection,twice a day.
3. Shēn Mài Zhù Shè Yè (Ginseng Rubra and Ophiopogonis Injection,参麦注射液)4 mL with 10% glucose injection 20 mL for intramuscular injection,once a day.
After 2 days of treatment,the temperature became normal,symptoms of flaring nares and perioral cyanosis disappeared,cough and asthma reduced,heart rate was 130 beats/min,and wet rales still heard in both lungs.The condition was improved,the prescription was maintained,but Shēn Mài Zhù Shè Yè was stopped.
The treatment was continued for 2 days,and the condition continued to improve.Change the prescription to supplemented Xiè Bái Săn (White-Draining Powder,泻白散): sāng bái pí (Cortex Mori) 9 g, dì gǔ pí (Cortex Lycii) 6 g, jié gěng (Radix Platycodonis) 6 g and zhè bèi mǔ (Bulbus Fritillariae Thunbergii) 6 g,decocted in water for oral take,one dose a day.Five days later,symptoms disappeared except a cough with night sweating and a few wet rales in both lungs.Then,according to the treatment of spleen-lung qi deficiency in the recovery period,prescription was changed into supplemented Liù Jūn Zǐ Tāng (Six Gentlemen Decoction,六君子汤): dăng shēn (Radix Codonopsis) 9 g, fú líng (Poria) 9 g, bái zhú (Rhizoma Atractylodis Macrocephalae) 9 g, fă xià (Rhizoma Pinelliae Praeparatum) 6 g, bái jiè zǐ (Semen Sinapis) 6 g, chén pí (Pericarpium Citri Reticulatae) 3 g,and gān căo (Radix et Rhizoma Glycyrrhizae) 4.5 g,decocted in water for oral take,one dose a day.In addition,applying Shāng Shī Zhǐ Tòng Gāo (Damp-Removing Pain-Killing Ointment,伤湿止痛膏)onto both BL 13 ( fèi shù ) for 2 days.The symptoms completely disappeared,no rales were heard,and X-ray test showed coarse bronchovascular markings and no substantial inflammatory changes.
Source: Yu Zhen-xi,He Mei-yan. Study of Treatment of Children’s Pneumonia in Traditional Chinese Medicine (attached: analysis of the curative effect of 163 cases).[J].Guangxi Journal of Traditional Chinese Medicine,1989,12 (2): 1–4.