Hello,
Thanks for asking your question. I want to first say that I am an
internal medicine physician and thus am more familiar with Eastern
approaches to chronic bronchitis. My research reflects objective,
physician-written and peer reviewed data, except when noted. If you
are looking for more information, please do so via the answer
clarification option and I will be happy to explain or expand any of
my research.
You asked the following question:
“Please provide a full description of the disease from a western
medicine perspective and also from the perspective of Traditional
Chinese Medicine. Could you also find out the treatment options from
both a western and a Traditional Chinese Medicine perspective.”
Western Medicine Approach
Chronic bronchitis is a clinical diagnosis defined by the presence of
chronic productive cough for three months in each of two successive
years in a patient in whom other causes of chronic cough have been
excluded. It is part of the clinical spectrum known as Chronic
Obstructive Pulmonary Disease (COPD).
From Merck Medicus:
“Chronic obstructive bronchitis is characterized by cough,
expectoration, and diminished airflow that may or may not partially
improve after bronchodilator inhalation. Simple chronic bronchitis, a
condition of chronic cough and expectoration with normal airflow, is
not included in the definition of COPD because chronic bronchitis
without airflow obstruction has a good prognosis. Chronic obstructive
bronchitis differs from asthmatic bronchitis only in its relatively
limited reversibility in response to pharmacologic agents.”
http://merck.praxis.md/bpm/bpm.asp?page=BPM01PU01
The etiology and pathophysiology is taken from Merck Medicus:
“Although COPD has been historically known as a smokers disease that
clusters in families and worsens as patients age, this view is overly
simplistic. In industrialized countries, cigarette smoking is the main
cause of COPD; however, in developing countries, other air pollutants,
such as particulates generated during cooking in close quarters, are
important. Pipe and cigar smoking are also associated with increased
COPD-related morbidity and mortality, but the rates are lower than
those for cigarette smokers.
The pathophysiologic changes of COPD are clues to the stage of the
disease, because they typically develop in the following order: mucus
hypersecretion, ciliary dysfunction, airflow limitation, pulmonary
hyperinflation, gas exchange abnormalities, pulmonary hypertension,
and cor pulmonale. The classic linear rate of decline of forced
expiratory volume in 1 second (FEV1) depicted in Figure 1 (see
Lifestyle Measures) is a mean of many individual courses, and
individual patients follow various courses. However, the common
statement that only 15% to 20% of smokers develop clinically
significant COPD is misleading - a much higher portion develop
abnormal lung function if they continue to smoke and do not die
prematurely (often from another smoking-related disease, such as
cardiovascular disease or lung cancer).
Asthma and COPD have similar major symptoms, but the symptoms are
usually more variable in asthma. Both conditions also have underlying
chronic airway inflammation; however, inflammation in asthma is mainly
eosinophilic and is characterized by CD4+ T lymphocytes, and
inflammation in COPD is neutrophilic and is characterized by CD8+ T
lymphocytes. The different types of inflammation may help explain, at
least in part, why asthma is much more likely than COPD to
significantly respond to corticosteroids (unless asthmatic bronchitis
is a major component).
Regardless, the large variation in patterns of lung involvement in
individual smokers strongly suggests that genetic, other host, or
other environmental factors contribute to the rate of decline in
airflow. Additional support for the apparent contribution of genetic
factors comes from the clustering in families of early-onset COPD and
different prevalence rates of COPD among certain racial groups. A
number of other risk factors related to COPD have been described and
can be classified as either environmental (including personal
environment) or host risk factors.”
http://merck.micromedex.com/bpm/bpm.asp?page=BPM01PU01§ion=report&ss=1
Treat all symptomatic COPD patients with inhaled bronchodilators,
beginning with an anticholinergic agent; then, if necessary, consider
switching to or adding a beta-agonist. Treat all patients
experiencing acute exacerbations of COPD with corticosteroids.
Consider adding theophylline to augment an inhaled anticholinergic
agent, with or without a beta-agonist.
Consider using antibiotics empirically for 5 to 7 days for
exacerbations of COPD associated with increased cough, increased mucus
volume, sputum color change, or fever.
Specific treatment options can be found here in this chart:
http://merck.micromedex.com/bpm/bpmtables.asp?page=BPM01PU01&table=BPM01PU01T09
***********************************************************************
Chinese Medicine Approach
There is little consensus in the medical community about the efficacy
of Traditional Chinese Medicine. Most of the data are obtained from
smaller studies.
Chinese Medicine Perspectives on Chronic Bronchitis
From A World of Chinese Medicine:
“In Traditional Chinese Medicine, bronchitis belongs to one of three
conformations: cough, phlegm and fluid retention, or cough and asthma.
The illness can be caused either by external pathogenic factors
(seasonal external pathogens) or interior pathogenic factors (such as
a disorder of the internal organs). In chronic bronchitis cases, the
most common cause is interior pathogenic factors which often occur in
the elderly.”
http://www.aworldofchinesemedicine.com/bronchitis.htm
From TCM (Traditional Chinese Medicine) Treatment Web:
“The disease is a chronic inflammation of bronchi due to infection,
physical and chemical irritations and allergic agents. The majority of
the patients are of over middle age. It is characterized by chronic
course and recurrent episodes. In some chronic cases, the disease may
progress to chronic obstructive emphysema and chronic pulmonary heart
disease. In TCM, this disease is related to the categories of "ke sou"
(cough), "tan yin" (phlegm retension), "xiao chuan" (asthma) and so
on.
Main Points of Diagnosis
1. Long-term cough, sputum production and dyspnea which attack
repeatedly and fluctuate are worse in autumn and winter. There may be
fever, exacerbation of cough and mucopurulent sputum production, and
dyspnea is more marked if acute concurrent infection is present.
2. Chronic bronchitis usually persists for many years. It can be
classified into 3 stages, acute episodic stage, chronic persistent
stage and clinically remissive stage. The last stage may last for a
period of time and an attack may be induced by infections or catching
a cold. Based on the clinical manifestations, the disease can be
divided into simple chronic bronchitis and chronic asthmatic
bronchitis. In the former, cough and sputum production are
predominant. In the latter, in addition to the above symptoms, there
are dyspnea and wheezing, indicating that the spasm of the smooth
muscles of bronchi and bronchioli is an important pathogenic factor.
3. On auscultation, moist rales can usually be heard. Wheezes can be
heard in patients with asthmatic bronchitis. In patients with chronic
bronchitis of long duration, a complicating obstructive emphysema is
commonly present. In such cases, the respiratory sounds are
diminished, heart sounds become faint, intercostal spaces are widened,
the thorax is barrelshaped, and there is hyperresonance on percussion.
4. On radiographic examination the lung-markings are increased in the
lower lung fields. Pulmonary functional tests show no change in the
early stage, but in the late stage residual volume is increased,
maximal ventilatory equivalent and time vital capacity are decreased.”
http://www.tcmtreatment.com/images/diseases/chronic-bronchitis.htm
Traditional Chinese Medicine Treatment of Chronic Bronchitis
A World of Chinese Medicine markets this product for the treatment of
chronic bronchitis:
http://www.aworldofchinesemedicine.com/clear-the-way.htm
Here are some data from small studies using Chinese Medicine in
bronchitis.
From The Health Library:
“Researchers at the Jianye district TCM Hospital, Nanjing conducted a
randomised controlled clinical trial to determine the efficacy of
massage, according to Traditional Chinese Medicine (TCM) principles,
in the treatment and prevention of recurrent respiratory tract
infection of children.
Incorporated into the massage was the principle of "eliminating the
pathogenic factors by supporting the healthy flow of energy"
The results showed that the therapeutic effect of the treatment group
was significantly better than those not given the treatment. All
immunologic indexes were approximately normal when the children were
re-examined 3 and 6 months following the massage. The differences were
found to be highly significant.
This showed that the Chinese Massage was very helpful in improving the
general constitution, enhancing immune functions and preventing and
treating the condition.”
http://www.internethealthlibrary.com/Health-problems/Bronchitis%20-%20researchAltTherapies.htm
Chen (1998) studies the effect of Jinshui Liujun in treating chronic
bronchitis:
“OBJECTIVE: To assess the effect of Jinshui Liujun decoction (JSL) in
treating chronic bronchitis. METHODS: The effect of JSL on expelling
the phlegm and strengthening the body resistance were observed.
RESULTS: JSL was proved to be efficacious in improving immune function
of the body and pulmonary ventilatory function (P < 0.01). JSL could
not only increase the secretion of rats' trachea mucosa and dilute
sputum, but also increase the motion speed of the pigeons' trachea
cilia, thus facilitate the removal of sputum. Compared with the normal
saline control group, both animal experiments displayed significant
statistical difference (P < 0.01), but without significant difference
when compared the JSL group with the positive drug Juhong Tanke Ye
control group. CONCLUSION: JSL has the effect of resolving phlegm as
well as improving human immunological and pulmonary ventilatory
functions.” (1)
Wei (1996) studies injection of Salviae Miltiorrhizae on chronic
asthmatic bronchitis:
“The aim of the study is to investigate the effects of Injection
Salviae Miltiorrhizae on the senile patients suffering from chronic
asthmatic bronchitis. Fifty-three patients were divided randomly into
group A(treated group, 33 cases) and group B(control group, 20 cases).
The results showed that in group A, the treatment could ameliorate the
symptoms, improve the pulmonary function, lower the PaCO2, elevate the
PaO2 and enhance the immune function. They were markedly effective in
26 cases, effective in 6 cases and ineffective in 1 case. The cases in
control group were 11, 8, 1 and 95% respectively. There was a
significant difference between the effectiveness of the two groups.”
(2)
Cheng (1991) studied ke chuan ping decoction on chronic bronchitis:
“This paper presents the results of clinical observation and
experimental research of ke chuan ping (KCP) in treating 31 cases of
chronic bronchitis compared with that of traditional prescription qing
jin hua tan decoction (QJHT) in other 31 patients with the same
conditions randomized as control. The total effective rate of KCP
group was 93.55% including 67.74% of basically cured and markedly
effective cases. The total effective rate of QJHT group was 74.19%
including 41.94% basically cured and markedly effective cases. There
were significant differences between them (P less than 0.05).
According to laboratory observation KCP had the ability to dilute
sputum viscosity, promote pulmonary ventilation function, decrease WBC
and raise PO2. Animal experimental research suggested that KCP had the
effects on reducing sputum, relieving cough, modifying stridor and
inhibiting bacteria. It was proved that KCP is a highly effective
recipe for patients with chronic bronchitis. It was also shown that
clearing away heat and dispersing phlegm therapy is an important
measure for chronic bronchitis with Biao Zheng.” (3)
Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.
Thanks,
Kevin, M.D.
Bibliography:
1) Chen A. Traditional Chinese medicine in treatment of bronchitis and
bronchial asthma. [Review] [0 refs] Journal of Traditional Chinese
Medicine. 18(1):71-6, 1998 Mar.
2) Wei ZM. Effects of injection Salviae miltiorrhizae on senile
chronic asthmatic bronchitis patients. [Chinese] Chung-Kuo Chung Hsi i
Chieh Ho Tsa Chih. 16(7):402-4, 1996 Jul.
3) Cheng CL. Clinical and experimental research on chronic bronchitis
treated with ke chuan ping decoction. [Chinese] Chung Hsi i Chieh Ho
Tsa Chih Chinese Journal of Modern Developments in Traditional
Medicine. 11(4):203-5, 195, 1991 Apr.
4) Snider. Diagnosis of chronic obstructive pulmonary disease.
UptoDate, 2002.
Links:
Merck Medicus – Chronic Obstructive Pulmonary Disease
http://merck.micromedex.com/bpm/bpm.asp?page=BPM01PU01§ion=brief
Merck Medicus – Chronic Obstructive Pulmonary Disease Practice Report
http://merck.micromedex.com/bpm/bpm.asp?page=BPM01PU01§ion=report
Search Strategy:
Google
bronchitis chinese medicine
Medline
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chronic bronchitis and drug therapy, chinese traditional
chronic bronchitis and drug therapy, oriental traditional |
Clarification of Answer by
kevinmd-ga
on
24 Dec 2002 14:22 PST
Hello,
Thanks for the clarification request. I am not an acupuncturist –
this is what I found during my websearch.
Here is a comment on the organs that bronchitis is involved with (from
a TCM perspective), suggesting it is a “Yin” disease:
“When determining the nature of a disease in Chinese Medicine, the
first aspect to be considered is whether the condition is a Yin or a
Yang type of disease. Yang type conditions are those which appear
acutely, actively, progressively and by producing heat (fever). Yin
type conditions show themselves as being cold (e.g., by producing
stasis and cold swellings), slow, passive, debilitating and
degenerating. For example, when a person contracts a cold, which is a
Yang condition, the pulse rate increases, the temperature rises, and
the face looks red; the throat becomes sore, there are body aches and
there is thirst. On the other hand, in the case of chronic bronchitis
which is a Yin condition, the person loses energy, the pulse becomes
feeble and its rate slows, the face turns yellow, and there is little
fever or inflammation. Yin conditions take always longer to cure than
Yang conditions and the Chinese Medicine Practitioner will utilise
totally different medicines and approaches for each type; Yang
diseases will be treated by sedating methods of acupuncture and
perspiration inducing or fever reducing medicines, while Yin diseases
are treated with stimulating methods of acupuncture and tonics.”
http://www.traditionalmedicine.net.au/chinsynd.htm
Here is a comment saying that bronchitis is an “invasion of the
exterior Wind”:
“The common cold and influenza are viral infections of the upper
respiratory tract. Pharyngitis (sore throat) and some forms of
bronchitis may be caused by bacteria. Medical treatment with antiviral
and antibiotic medication may only partially treat the condition.
After a course of medication one may continue to have a variety of
lingering symptoms.
In Chinese Medicine these upper respiratory infections are seen as
"invasions of exterior Wind". "Wind" refers to a complex of signs and
symptoms manifesting as "Wind-Cold" or "Wind Heat". Wind-Cold often
presents with light fever, aversion to cold, white nasal discharge and
severe body aches, whereas Wind-Heat may present with a high fever and
light body aches, yellow nasal discharge, and slight sweating.
Medical Acupuncture and Traditional Chinese Herbal Medicine can be
quite effective in the treatment of these conditions. If the treatment
is initiated during the first 24-48 hours, the illness may be
prevented. For lingering symptoms after treatment with antibiotic or
antiviral medication, often one or two treatments are sufficient to
resolve the condition.”
http://www.schulmanmd.com/html/past_spotlights_with_dr__schul.html
Here are some comments regarding acupuncture and chronic bronchitis.
Note that there is no consensus within the medical literature about
the efficacy of acupuncture.
“Bronchitis is a common lung disease, aggravated by cigarette smoke,
industrial pollutants, and dust. It involves the irreparable
destruction of lung tissue. There is often an asthmatic element in
bronchitis as irritants such as smoke and dust cause the muscular
walls of the breathing tubes to contract.
Acupuncture cannot rebuild lung tissue, but by opening up the
breathing tubes it can allow the remaining lung tissue to function
efficiently. The mechanism of acupuncture in bronchitis is probably
much the same as in asthma, allowing more air to enter the lungs.
Recent Chinese work has shown that about 50 per cent of bronchitics
'benefit' from acupuncture. The treatment must be repeated regularly
if the effect is to be maintained.”
http://www.healthy.net/asp/templates/article.asp?id=2028
This site suggests that an acupuncture point over the lung meridian
(i.e. over the lung) will help treat bronchitis:
“I like to refer to the alarm points as being the circuit box of the
body. If a health condition exists and a meridian is involved, it will
"trip a circuit breaker." If the lung meridian is involved in a case
of bronchitis, the lung alarm point is the localized therapy for those
skilled in muscle testing (applied kinesiology) but will also be
acutely tender to palpation . . . Each of the specific acupuncture
meridians has an alarm point on the anterior side of the body which is
located over the organ for which it is named, i.e., the lung meridian
is over the lung”
http://www.chiroweb.com/archives/18/01/01.html
Yin Yang house provides specific acupuncture points for bronchitis in
their website:
“Yang - Approx. level with GV 16
asthma, hyperventilation, bronchitis”
http://www.yinyanghouse.com/auricular/ynsascalp.html
Thanks,
Kevin, M.D.
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