Theory discussion on airway remodeling of bronchial asthma

Xian-Wei Jiang,Zhan-Ping Ma

1Shaanxi University of Traditional Chinese Medicine,Xianyang,China; 2Shaanxi Traditional Chinese Medicine Hospital,Xianyang,China.

Abstract According to modern research,the pathogenesis of asthma mainly includes airway inflammation,airway hyperresponsiveness,airway remodeling,etc.Airway remodeling is the key factor that leads to the progress of asthma,and it is also the main factor that leads to airway hyperresponsiveness and irreversible airflow restriction.Traditional Chinese medicine believes that "phlegm and blood stasis"block the airway and narrow the lumen is the most important factor in the treatment of asthma.

Keywords: Airway remodeling,Lung and kidney deficiency,Phlegm and blood stasis

Introduction

Bronchial asthma is a chronic airway inflammation mediated by a variety of inflammatory cells [1].Its epidemiological survey shows that there are nearly 20 million patients with bronchial asthma in China,with a prevalence rate of 2.1%,and the number is increasing year by year [2].Therefore,it is urgent to actively prevent and cure asthma.in recent years,studies have shown that airway remodeling is an important feature of bronchial asthma.Airway wall structural changes in patients with bronchial asthma caused by airway inflammation,tissue injury and subsequent abnormal repair are called airway remodeling [3].The main pathological changes include epithelial cell changes and mucous gland hyperplasia,subepithelial fibrosis,airway smooth muscle cell proliferation and migration,airway wall angiogenesis and so on [4].These structural changes can lead to persistent airway hyperresponsiveness and irreversible airflow obstruction and reduce the sensitivity or even resistance of patients with asthma to conventional drugs.Therefore,airway remodeling is not only the root cause of repeated attacks and worsening of the disease,but also the key factor in the progress of the disease.

According to traditional Chinese medicine,bronchial asthma should belong to the category of "asthma syndrome and asthma syndrome".The main pathogenesis is phlegm in the lung,which becomes the root of the disease.every time external evil causes,the phlegm blocks the airway,and the reverse occurrence of lung qi is the disease [5].Asthma is mainly located in the lung,long-term disease involves the spleen and kidney,and the condition for a long time,sputum does not disappear,uneven distribution of body fluid,qi block,blood retention and motionless,blood stasis block,and phlegm drink each other.Phlegm and blood stasis help each other,block qi,qi can not decline,so ascending eventually become asthma,so "phlegm drink,blood stasis" is the main factor of asthma patients' condition worsening.Based on the lung and kidney deficiency,phlegm and blood stasis,this paper discusses the theoretical basis of airway remodeling and its diagnosis and treatment,and provides different ideas for the prevention and treatment of asthma with traditional Chinese medicine.

1 Analysis on the syndrome type of qi deficiency of lung and kidney and combination of phlegm and blood stasis

The syndrome of "deficiency of lung and kidney qi and combination of phlegm and blood stasis" is the syndrome type established by Ma Zhanping,a famous doctor of traditional Chinese medicine in Shanxi Province,who summed up the clinical diagnosis and treatment of asthma for many years,and established the Yichuanping prescription of "tonifying the kidney and tonifying the lung,activating blood circulation and removing phlegm".The curative effect is remarkable in clinical treatment in the past ten years.

1.1 Lung and kidney qi deficiency and phlegm lying in the lungs

Asthma,also known as asthma syndrome,is a recurrent lung disease characterized by wheezing in the throat,dyspnea,and even wheezing [5].Traditional Chinese medicine believes that "volting phlegm" is the main cause of the disease,phlegm retention in the lungs,phlegm blocking the airway when evil is caused,and the acute occurrence of the airway is the disease.In the synopsis of the Golden Chamber,phlegm drink cough pulse syndrome and treatment pointed out: "phlegm disease above the diaphragm,full of wheezing,cough and vomiting,hair is cold and hot" If a person vibrates a drama,there must be a drink."Phlegm drinkers are mostly Yin evil caused by deficiency of Zang-fu organs and deficiency of Yang in the body.Asthma is mainly located in the lungs,the course of the disease is prolonged,the child disease and the mother will continue to the spleen,the golden water will extend to the kidneys,and eventually the lungs,spleen and kidneys will be insufficiency,and the deficiency of qi will reduce the phantom function and cause the body to produce sputum drink.The lung is the source of water,the upper focal point,the main propaganda and the subduing,spreading water,such as the irritation of mist and dew; the spleen and stomach,the central focal point,the main transport and transformation of the subtle water,such as the decomposed place; the kidney,the lower focal point,is a whole body The place where Yuanyang lives is also the power of bladder qiification,like a ditch of water.If the three internal organs are weak,the water will not be digested when it enters the stomach.The body fluid cannot be infused,and the bladder cannot be warmed,and sputum is eventually formed.The tangible sputum remains in the lungs.This is what we call "the spleen produces sputum.The lungs are the organs for storing sputum" However,the kidney is the foundation of the whole body.When the lung inhales natural gas,it needs the assistance of the kidney's qi-accepting function to maintain the depth of the breath.This is "the lung is the foundation of qi,and the kidney is the root of qi".Moreover,there is still a relationship of mutual growth of gold and water between the lung and kidney,and mutual capital between yin and yang.Therefore,the deficiency of lung and kidney is emphasized in the clinical treatment of asthma.

1.2 The course of the disease is long,the blood stasis enters the veins

Recurrent asthma attacks,prolonged course of disease,involving many internal organs,organ wasting,phlegm and drinking endogenous,obstructed in the airway,the qi machine will not run smoothly,but the lungs,the main joints and the direction of the whole pulse,the lungs are weak,help The function of the heart's blood flow will be reduced,and the blood flow will be stagnant and stagnant.In addition,the body fluid and blood of the human body are of the same origin,and the organs are damaged and their transport and dispersal functions are reduced,so the body produces phlegm and blood stasis.The phlegm stays in place,and the qi machine cannot function,causing the body to produce blood stasis,the blood stasis will stay in the veins,block the qi machine,and turn into phlegm.This is not only a chronic asthma,organ wasting,and turning from deficiency to solid.Both of them are pathological products,which remain in the lungs,cause and effect each other,and help each other,then the disease becomes more and more serious.For example,the blood syndrome cloud covers the person's airway,there is no blockage,there is blood stasis,airway obstruction,do not rise or fall and wheeze,"it is necessary to know that phlegm and water is caused by blood stasis,but if blood stasis is removed,phlegm and water will disappear."Modern studies have also proved that adding the method of promoting blood circulation and removing blood stasis in the treatment is quite effective in clinical practice.For example,Zhou [6] et al.usedDachaihu decoctionandGuizhi Fuling pillsto observe the clinical efficacy of blood stasis chronic bronchial asthma.It was found that the application of activating blood and removing blood stasis drugs can improve the clinical effect of bronchial asthma can relieve the suffering of patients and improve the quality of life.Therefore,the course of asthma is prolonged,and the combination of "phlegm-fluid retention and blood stasis" has become a key problem in clinical diagnosis and treatment of asthma.This is the origin of the syndrome of "qi deficiency of lung and kidney,syndrome of intermingled phlegm and blood stasis" syndrome.

2 Qi deficiency of lung and kidney and combination of phlegm and blood stasis are the factors of airway remodeling.

Modern medicine believes that airway remodeling is the root cause of difficult treatment of asthma,and most of the clinical symptoms are recurrent and serious cough,asthma,shortness of breath,chest tightness and so on.The pathological changes mainly included epithelial cell changes and mucous gland hyperplasia,subepithelial fibrosis,airway smooth muscle cell proliferation and migration,airway wall angiogenesis.Traditional Chinese medicine believes that "phlegm and blood stasis" are blocked in the lungs,narrow lung tract and adverse qi,which are the factors that are difficult to treat asthma.The irreversible airflow limitation caused by airway remodeling is similar to that of "phlegm and blood stasis" in traditional Chinese medicine.At the same time,Yu et al [7] confirmed the correlation between airway remodeling and phlegm and blood stasis in asthma rat model by measuring plasma intercellular adhesion molecule (ICAM-1),whole blood viscosity and pathological changes of lung tissue to measure the degree of airway remodeling.

2.1 Qi deficiency of lung and kidney and airway remodeling

According to traditional Chinese medicine,asthma lasts for a long time,first in the lung,then spleen and kidney,and finally deficiency of the three internal organs of the lung,spleen and kidney,deficiency of qi,loss of power of gasification,deficiency of yang,and accumulation of yin and evil.Deficiency of qi is the root cause of phlegm and blood stasis.Phlegm and blood stasis help each other,block the airway and reverse the qi,then the disease becomes critical.Modern studies have shown that airway remodeling is closely related to a variety of inflammatory factors,and chronic airway inflammation is an important reason for the formation of airway remodeling.However,the mechanism of airway inflammation is not clear,but the airway remodeling caused by chronic airway inflammation,such as airway mucosal edema,hyperplasia,subepithelial fibrosis and airway wall vascular regeneration,are consistent with the stagnation of phlegm and blood stasis in the lung caused by qi deficiency.And in the airway remodeling asthma patients,there are epithelial cell exfoliation,injury and goblet cell proliferation,complete airway epithelium can remove foreign particles,play a protective role [3].This performance is consistent with the loss of external function of qi deficiency,so it can be inferred that qi deficiency is the root cause of airway remodeling.Zhang et al [8] found that astragalus membranaceus may inhibit airway remodeling by inhibiting the expression of TGF- β1.The results of this experimental study show that tonifying qi drugs are effective in the treatment of airway remodeling,and the root cause of airway remodeling is "qi deficiency of lung and kidney".

2.2 Syndrome of intermingled phlegm and blood stasis and Airway remodeling

In the course of asthma,the combination of phlegm and blood stasis is the fundamental pathogenesis of its procrastination.The production of phlegm and blood stasis blocks the airway,which further narrows the airway and makes the qi block more serious,which is cause and effect with qi deficiency of lung and kidney,and circulates repeatedly.Continue to aggravate the patient's condition.In a variety of pathological changes of airway remodeling,mucous gland hyperplasia and secretion increased,and airway mucous membrane edema led to the increase of mucus in the airway and airway stenosis,resulting in ventilation disorders and TCM visible phlegm retention in the lungs,blocking the airway performance coincidentally.Airway smooth muscle cell proliferation and migration and airway wall vascular regeneration cause airway structural changes,while the decrease of ventilation function is consistent with TCM qi block,blood retention and local changes caused by blood stasis blocking collaterals.Airway subcutaneous fibrosis is the excessive deposition of collagen and other non-collagen proteins in the reticular plate under the airway basement membrane,which thickens the reticular plate [3].This phenomenon is consistent with the performance of phlegm and blood stasis gluing to each other in the airway,so that the airway lumen continues to narrow.In modern research,it has also been shown that the methods of resolving phlegm and promoting blood circulation play a positive role in interfering with airway remodeling in asthma.For example,Lin et al [9] found that promoting lung,phlegm and blood circulation can improve airway remodeling in asthmatic rats,and its mechanism is related to the regulation of TGF β1/Smad signal pathway.Combined with the study of TCM theory and modern mechanism,we can infer that the combination of phlegm and blood stasis is the direct cause of airway remodeling.

Conclusion

According to traditional Chinese medicine,the main pathogenesis of asthma lies in "ambushing phlegm".The main pathology of the disease is "phlegm strike,move with cough and sipping sound".Phlegm drink as the root of the disease,when evil is triggered,then the reverse on the qi,phlegm asthma,there is a whistling sound.However,the disease is a symptom of deficiency and excess.During the attack of asthma,the lung qi is dissipated,then the spleen and kidney are weak,the phlegm is endogenous,the blood stasis is stagnant,and the airway is blocked by phlegm and blood stasis,which leads to the recurrence of the disease.At the same time,"phlegm and blood stasis" block qi,dissipate Zang-fu qi,the body is even more deficient,more vulnerable to external evil attack,easy to develop this disease.Therefore,the conversion between deficiency and reality of the disease has become the fundamental factor of the gradual aggravation of the disease.

Modern medicine believes that airway remodeling is the main contradiction to be solved in refractory asthma.In this paper,through the analysis of the syndrome of "deficiency of lung and kidney qi and combination of phlegm and blood stasis" and comparison with the pathological manifestations of airway remodeling,it is clear that airway remodeling is closely related to qi deficiency,phlegm and blood stasis in the theory of traditional Chinese medicine,and its airway remodeling mechanism and clinical manifestation are closely related to "lung and kidney qi deficiency" in traditional Chinese medicine.The formation mechanism and clinical manifestations of "combination of phlegm and blood stasis" are highly consistent,so it can be considered that "deficiency of lung and kidney qi and combination of phlegm and blood stasis" is an important factor in the formation of airway remodeling in asthma.The methods of replenishing qi,promoting blood circulation and expelling phlegm should be carried out all the time.

To sum up,asthma,as a recurrent disease,seriously affects the daily life of patients and brings heavy economic pressure to patients.As a key node in the treatment of refractory asthma,airway remodeling is the direction of prevention and treatment of asthma in recent years.Traditional Chinese medicine has unique advantages such as multi-target and definite curative effect in the treatment of asthma.therefore,based on the theory and modern research of traditional Chinese medicine,this paper discusses the formation mechanism and treatment of airway remodeling based on the syndrome of "deficiency of lung and kidney qi and combination of phlegm and blood stasis".In order to make up for the shortcomings in the treatment of western medicine with the advantages of traditional Chinese medicine,provide different ideas and methods for the prevention and treatment of asthma,but also to reduce the burden of patients and improve their quality of life.