Recent Advances in Prevention and Treatment of Bronchial Asthma with lntegrated TCM-WM

　　
With the development of modern basic medicine, it is certain that bronchial asthma is pathologically and physiologically characterized by hyper-reactivity of airway resulting from airway allergic inflammation (A.A.I.). To evaluate the curative effect of TCM, WM or TCM-WM, Pulmonary function and inflammation marker in the airway, such as the number of inflammatory cells, cell factor, cell mediate etc., as well as the symptoms, signs, tongue and pulse should be noticed. Treatment for bronchial asthma with the integrated TCM-WM. TO the patients at the critical stage, we give TCM decoction according to the differentiation of syndromes, and inject intravenously bronchodilator at the same time, until the patients' conditions are stabilized. To the patients of moderate and mi1d type, TCM can relieve asthmatic attack. To those at the remission stage, the therapeutic method of Fu Zheng Gu Ben, which means strengthening the body resistance to consolidate the constitution can be used.

Advances in the integrated TCM-WM treatment for bronchial asthma:
(l) The research of pharmacology about bronchial asthma with integrated medicine:
1).In experimental asthma made in the guinea pig, dyspnea and airway inflammation was limited by perfusion with Tripterygium Wilfordii Hook. This Chinese herb was proved to regulate the expression of GM-CSF mRNA, decrease the infiltration of eosinopenia and neutrophilic granulocyte in the airway and improve the impairment of bronchial epithelia;

2).While perfusion with a complex prescription, which was composed of Scorppio, Agkistroden and Geko. In the experimental asthma, the level of histamine, PGE and IgE was decreased;

3).Chai Pu Decoction (Decoction of Radix Bupleuri and Cortex Magnolia) could prevent the guinea pig model from asthma which was induced by allergen; prevent the airway from infiltration of eosinopenia, inhibit the immediate type of asthma, lower the hyperactivity of the airway and prevent the airway from eosinopenia's adhesion. Szaikosponin extracted from Radix Bupleuri might prevent the eosinophil and neutrophil cells from adhering to the region of inflammation in airway;

(2) Clinical observation:
1).Wen Yang Pian (Yan-warming Tabella) could decrease the total amount of IgE and specific IgE in Serum, elevate PC20 value of histamine in halational bronchial challenge provocative test. It was considered that patients with bronchial asthma had a potential hypofunction of the hypothalmus-pituitary-adrenal axis, While after administration, the function of the axis was recovered, the numbers and function of CD8 and interferon-γ (IFN-γ ) increased while the synthesis of IgE in B-lymphocytes decreased;

2).Ginkgolide BN502l, which was extracted from Folium Ginkgo, could correct the responsiveness in airway;

3).The result of blood rheology micro-circulation and the biopsy through fibromoscope suggested that "AAI" have a direct bearing on drugs for relieving blood stasis. Thus, administration of the herb of promoting blood circulation and re1ieving blood stasis might lower the hyper-responsiveness (HBR) and anti-inflammation in airway;

4).Some prescriptions of TCM, are effective for bronchial asthma. such as Xiao Qinglong Decoction, Ma Xing Shi Gan Decoction, Xiao Chaihu Decoction, Chai Pu Decoction, Zhi Chuan Decoction, Houpo Mahuang Decoction and so on, which can decrease the amount of total IgE in serum. Its mechanisms may involve inhibiting the number and function of CD4, blocking up the activation of IL4 (intrleukin-4) and increasing the numbers and function of CD8, raising the activation of IFN- γ and inhibiting the IgE synthesis of B lymphocytes. It is demonstrated that TCM can not only relieve bronchial asthma, but also resist airway allergic inflammation.

The efficacy of herb medicine for anti-allergic inflammation in airway mainly through the following three routes:
A. Inhibiting degranulation of inflammatory cells;
B. Inhibiting cytokines and adhesion molecules;
C. Inhibiting releasing of the inflammatory mediators from inflammatory cells.

The present situation on the treatment of integrated TCM-WM for corticosteroid-dependent bronchial asthma: Up to now there is no ideal therapeutic method for it in WM or in TCM. Taking cortison or its derivatives not only has inevitable side effect but also inhibits the hypothalmus-pituitary-adrenal axis, resulting in adrenocortical atrophy and leading to clinical symptoms such as iatrogenic obesity hypertension, hyper-glycoplasmia, and so on, which are apt to cause infection of bronchus. This is a knotty problem for physicians at present. However, the integrated TCM-WM treatment that strengthening body resistance and restoring normal functioning of body to consolidate the constitution, which is based on syndrome differentiation, can promote the rate of withdrawal.

By Xu Jianzhong