Experience in TCM Emergency Treatment of Heart Failure and Edema Caused by Cardiopulmonary Disease
This was a patient with acute exacerbation of COPD leading to obstructive emphysema, cor pulmonale, cardiopulmonary failure, respiratory acidosis, right-sided pleural effusion, and interstitial lung disease. The patient was the mother of a friend who has long been on good terms with me.
When sent to the hospital, the patient was covered all over in edema, with a markedly swollen face, and her condition was critical. The doctor communicated with the family, informing them that the patient's life was in danger, and had the family sign the informed-consent form to prepare them psychologically.
The patient's son called me for help. Given that the patient was over eighty, critically ill, and the mother of an old friend (making a doctor-patient dispute unlikely), I decided to take the risk and try treating her.
Edema associated with cor pulmonale falls under TCM diseases such as water-qi, phlegm-fluid retention, and lung distention. The treatment principle should be based primarily on warming yang and promoting water metabolism. Given the patient's heart failure, it was necessary to consider combining a formula with emergency heart-failure effects, such as Huangqi Shengmai Yin (Astragalus Pulse-Generating Drink).
So I prescribed the following formula:
Prepared aconite 15g (decocted first), Baishao 15g, Fuling 15g, Baizhu 10g, Shengjiang 15g, raw Huangqi (Astragalus) 30g, Renshen (ginseng) 10g, Maidong (Ophiopogon) 10g, Wuweizi (Schisandra) 10g.
This is a combination of Zhenwu Tang and Huangqi Shengmai Yin. Zhenwu Tang warms yang and promotes water metabolism; Huangqi Shengmai Yin boosts qi, nourishes the heart, and tonifies the lungs. The former resolves edema; the latter strengthens the heart and supplements the lungs.
At the same time, I instructed the patient's family to purchase Jisheng Shenqi Wan (the Jingui Shenqi Wan produced by Tong Ren Tang that contains Cheqianzi (Plantago seed) and Niuxi (Achyranthes) in its ingredients is Jisheng Shenqi Wan) and give it to the patient orally.
Jisheng Shenqi Wan is a derivative formula of Shenqi Wan from the Jingui Yaolue (Essential Prescriptions from the Golden Cabinet). It comes from the Zhangshi Yitong and was included in the Yanshi Jisheng Fang, hence the name Jisheng Shenqi Wan. It is one of the medicines with the most pronounced effect in tonifying the kidney and promoting water metabolism.
In Japanese Kampo medicine, Jisheng Shenqi Wan is also called Niucha Shenqi Wan (Ox-Cart Kidney-Qi Pill). The Japanese named it Niucha Shenqi Wan because, on the basis of Shenqi Wan, this formula adds Niuxi and Cheqianzi. Japan's Ministry of Health, Labour and Welfare has already recommended this medicine as an adjuvant for cancer patients developing various effusion problems.
Among domestically produced medicines, the small water-honey pills of Jingui Shenqi Wan produced by Beijing Tong Ren Tang are of good quality. Taking it 2-3 times daily, 20-25 pills each time, works reasonably well in promoting urination and resolving edema for patients with edema due to kidney-yang deficiency.
After the patient's family followed this prescription for half an hour, the elderly woman began to pass urine. Thereafter the urine volume grew larger and larger, and her condition improved. After one day, the edema was resolving; after two or three days, the facial swelling subsided and she basically returned to normal.
Chronic cardiopulmonary disease is hard to eradicate, and generally one can only survive with it; acute attacks are often dangerous. But when using medicine, as long as the therapeutic strategy is correctly identified, it is not impossible to save the patient. The key to TCM emergency treatment lies in accurate pattern differentiation and resolute medication. If one fears and delays, the condition will surely be missed.
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