A Case of the Treatment of with Cryptogenic Organizing Pneumonia by WANG Lihua
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1.Graduate School, Jiangxi University of Chinese Medicine, Nanchang 330006, China
2.Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang 330006, China
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YUAN XunXun, WANG LiHua. A Case of the Treatment of with Cryptogenic Organizing Pneumonia by WANG Lihua[DB/OL].(2023-10-26)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43053432&Fpath=home&index=0
病史摘要,2,患者史某,男,57岁,主因“咳嗽伴咯痰1月”,2021年4月5日就诊于江西中医药大学附属医院呼吸与危重症医学科门诊。患者1个月前出现咳嗽咯痰伴咯血,于外院住院治疗,予头孢类药物抗感染治疗,咯血有所好转,但咳嗽伴咯吐白痰一直未愈。2021年3月17日行胸部CT引导下肺穿刺活检术,病理结果提示:(肺)镜下见肺泡间隔增宽,肺泡上皮增生,纤维组织增生,肺泡腔内可见纤维素性渗出物,较多慢性炎细胞浸润,符合机化性肺炎改变。确诊为隐源性机化性肺炎,拟予糖皮质激素等药物治疗,但患者既往高血压病史20余年,心肌梗死病史4年,脑梗死、糖尿病病史1年,恐激素治疗导致不明确副作用,遂至我科就诊。四诊信息 咳嗽,咯吐少量白色泡沫痰,且于夜间加重。语声低微,左侧肢体肌力下降,活动受限,行走呈踉跄步态。稍有胸闷气短,无胸痛,无心慌心悸。无恶寒发热,无异常汗出,无眩晕头痛。纳食较差,夜寐一般,二便平。舌质暗红,舌体胖大,边有齿痕,苔厚腻。左脉沉细,右脉弦滑。中医诊断 肺痿病,肺脾两虚、痰瘀内阻证西医诊断 隐源性机化性肺炎;高血压病3级(极高危);2型糖尿病;脑梗死后遗症干预措施 中医以补肺健脾、涤痰行瘀为治法,处方以枳桔六君子汤加味。嘱避风寒,慎起居,畅情志,复诊随证加减处方。疗效转归 患者服药一周后,咳嗽趋缓,且痰量增多,较前易咯出,无胸闷气短,纳可,神疲乏力及语声低微较前好转。此后两个月历经四诊,加减处方,复查胸部CT示右上肺条索状阴影明显吸收,症状尽数缓解。一年后随访,患者再未复发,诸症皆平,复查胸部CT示:较前片炎性病灶已吸收,双肺未见明显异常。
Summary of case history, Patient SHI, male, 57 years old, presented to the Department of Respiratory and Critical Care Medicine of the Affiliated Hospital of Jiangxi University of Chinese Medicine on 5 April 2021 with the main reason of "cough with sputum for 1 month"; the patient presented with cough and sputum with hemoptysis 1 month ago and was hospitalized outside the hospital. On 17 March 2021, a CT-guided pulmonary puncture biopsy was performed on the chest, and the pathological findings showed widened alveolar septa, alveolar epithelial hyperplasia, fibrous tissue hyperplasia, fibrinous exudate in the alveolar cavity, and more chronic inflammatory cells infiltrating the lung. The patient was diagnosed with cryptogenic organizing pneumonia and was administered glucocorticoids and other drugs. However, the patient had a history of hypertension for more than 20 years, myocardial infarction for 4 years, cerebral infarction and diabetes mellitus for 1 year. Cough with a small amount of white foamy sputum, which worsens at night. His voice is muffled, his left limb strength is reduced, his movement is limited and he walks with a staggering gait. There is slight chest tightness and shortness of breath, no chills or fever, no abnormal sweating, no vertigo or headache, no chest pain, no panic or palpitations, poor appetite, average sleep at night, flat stool. The tongue is dark red, with a fat body and tooth marks on the sides, and a thick, greasy coating. The left pulse is sunken and thin, while the right pulse is stringent and slippery.,TCM diagnosis, western medicine diagnosis,Western medicine diagnosis, cryptogenic organizing pneumonia; hypertension grade 3 (very-high-risk); type 2 diabetes mellitus; sequelae of cerebral infarction.,Therapeutic methods,2,TCM is based on tonifying lung and spleen, clearing phlegm and alleviating blood stasis, and the prescription is Zhiju Liujunzi Decoction. Tell them to keep out the cold, live cautiously, have a pleasant attitude, and add or decrease medicines for follow-up appointments.,Clinical outcomes, One week after taking the medicine, the patient's cough reduced and the volume of sputum rose, which was easier to evacuate than previously. In the next two months, after four consultations, the prescriptions were added and deleted, and a repeat chest CT indicated considerable absorption of the right upper lung striated shadow, and all symptoms were resolved. A follow-up visit one year later showed no recurrence and all symptoms had subsided. A repeat chest CT showed that the inflammatory lesions had resolved from the previous film and no significant abnormalities were seen in both lungs.
隐源性机化性肺炎肺痿治痿独取阳明
cryptogenic organizing pneumoniapulmonary impotencetreatment of flaccidity mainly with yangming meridian
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