These granulomas are distinctly different from caseating granulomas seen in other disease processes, especially tuberculosis, in which lung tissue is permanently destroyed. Pulmonary sarcoidosis does not involve the destruction of lung tissue. It does, however, render it nonfunctional. Ultimately, damage to lung tissue and other organs is due to the mass affect of granulomas.
Granulomas can resolve spontaneously. This occurs when fibroblasts proliferate and produce collagen. Granulomas become enclosed and later replaced by collageous fibrous tissue, shown in Figure 3 and Figure 4. Figure 4 Figure 3: Extracellular collagen C is being produced by fibroblasts arrows which are difficult to see at this magnification.
Figure 5 Figure 4: More Advanced Collagenous Fibrosis. Higher magnification showing elongated fibroblasts FB with more extensive collagenous fibrous tissue C. Effectively, the normal lung tissue becomes peppered with fibrous tissue, looses its elasticity, resulting in loss of lung function.
While a large percentage of patients recover with minimal to mild loss of lung function, many have more severe damage, requiring the use of oxygen and even a respirator. If sarcoidosis is wide spread throughout the lungs and other organs, it can prove fatal. Allopathic medicine classifies sarcoidosis according to types based on X-Ray analysis. There are types , with Type 1 Figure 5 having little lymphadenopathy and normal lung parenchyma.
Type 4 Figure 6 is quite severe with permanent lung fibrosis. It is important to note that these types do not build on one another. Type 1 does not necessarily lead to Type 2, and Type 2 to 3. They are instead used to classify the extent of organ involvement 9 , as illustrated in the X-Rays of Figures 5 and 6.
Figure 6 Figure 5: Thoracic lymphadenopathy with normal lung parenchyma. Figure 7 Figure 6: Extensive permanent lung fibrosis. While Western medical diagnosis is difficult to make without biochemical, radiological and pulmonary function testing, or even taking a biopsy, Chinese medical diagnosis is more readily made.
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The core of Chinese medicine is based upon diagnosing and treating what is seen and not what is measured on an X-ray, MRI, under a microscope or through chemical analyses. However, allopathic methods of understanding diseases and their processes should be taken into account. The above examination of the Western disease process of pulmonary sarcoidosis is important.
It does not alter the understanding of the Chinese energetic model, but rather adds depth to that understanding. In TCM and Western medicine, the lungs are responsible for respiration and the mucous membranes of the respiratory tract. In Chinese medicine, the Lungs are additionally characterized as doing the following:. The first two parts - governing Qi and controlling the acts of dispersing and descending - are closely linked. The Lungs are viewed as the highest internal organ of the body.
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The Lungs, therefore, act like an umbrella over the rest of the internal organs. The Lungs collect Qi during inhalation and have the function of sending that Qi downwards to the other organs. In addition, the Lungs are a key component in the immune response of the body. The Lungs are then responsible for dispersing the immune or defensive energy throughout the whole body. In the basic Western medical symptomology of sarcoidosis, two other common manifestations are skin problems and swelling to the legs and ankles.
These are fundamental associations to the Lung energies in Chinese medicine. The Lungs regulate the water passages of the body - a strong parallel to the lymphatic system, which is also involved in sarcoidosis. Also the Lungs manifest on the skin. It, therefore, follows in Chinese medicine that when you have an inflammatory response in the respiratory system, you may also see inflammatory responses on the skin. In Western medicine these are just symptoms. In Chinese medicine these are all indications that the Lung Qi is out of balance.
Two concepts require further elaboration to fully understand the scope of pulmonary sarcoidosis and how the entire body is affected. A closer look at the energetic components of the immune function, and the nature of the granulomas is needed. When considering the energetic origins of the immune function and granuloma formation, the energetic dynamic of pulmonary sarcoidosis is clearer. As mentioned above, the main function of Wei Qi is to protect the body from external pernicious influences which are classified as Heat, Cold, Damp, Dry, Wind and Summer Heat.
Other sources include two additional types of pernicious influences as Toxins and Purulent Qi. Because Wei Qi circulates beneath the skin, it falls under the responsibilities of the Lungs. The Lungs disperse Wei Qi over the entire body and regulate the opening and closing of the pores. Any of these external invasions may disrupt the circulation of Wei Qi through the outer portion of the body and thus inhibits the Lungs dispersing function.
When this occurs, the Lung Qi has a tendency to slow or Stagnate. Conversely, when the Lungs Qi is simply weak or Deficient, the Wei Qi is not properly regulated and circulated which leaves the body more susceptible to external pathogenic influences. Though the Lungs play a prominent role in the regulation of Wei Qi and the subsequent immune function, three other systems also contribute to the Wei Qi.
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First, Wei Qi is also derived from the functions in the Middle Jiao, or the digestive system. This is because the Spleen and Stomach have a key role in the production of Wei Qi. Second, Wei Qi has its origins in the Kidneys. Third, Extraordinary Vessels also play a role in its circulation. The Extraordinary Vessels are the meridians that guide fetal development.
Though still important, once a person is born, these particular vessels serve a less prominent role. While there are eight Extraordinary Vessels, only three contribute to the Wei Qi and protecting against external pathogenic influences. These are the Ren, Du, and Chong vessels, which run up the front of the body, the back of the body and through the center of the body, respectively. This also adds to the importance of the Kidneys because all of the extraordinary vessels derive their energy from the Kidneys.
Therefore, if any of these systems are compromised a window of opportunity is opened for pulmonary sarcoidosis to develop. This situation is further compounded when the Lungs, too, are energetically out of balance causing a stagnation condition. The list of potential causes of pulmonary sarcoidosis from a Western medical perspective is numerous. The causes include a number of infectious diseases but also can arise from neoplasms, foreign substances, immunological abnormalities and a number of idiopathic reasons.
From a TCM perspective, pulmonary sarcoidosis can be viewed, primarily, as being caused by one of the eight external pathogenic factors mentioned above. Wind is frequently the carrier of the others and therefore is often a component of the energetic imbalance. In addition, if Wind Dry enters the Lungs, the fluids of the Lung will be impaired, become more viscous and Stagnate.
Because of this Stagnant condition, there is energetic friction occurring. The Lungs want to descend and disburse the Qi but cannot. Having compromised the Wei Qi, this low level Heat arising from any of the external pathogenic factors ultimately results in a weakening of the Lung Qi.
This energetic situation parallels the inflammatory response in the lungs. The energetic condition could stall at this point only leaving the Lung Qi weakened. If this Heat condition persists, however, over time it can progress further to Lung Yin Deficiency. The Yin energies are responsible for cooling the body. Therefore, a Deficient Yin condition is one whereby the body lacks sufficient Yin to cool at a homeostatic level, thus allowing an internal Heat condition to arise.
If the infective or irritant agent creates a Lung Yin Deficient situation, this Deficient Heat can further damage the fluids. When fluids dry out, this could further lead to the formation of stagnant Phlegm. Another important dimension to consider in pulmonary sarcoidosis is the formation of granulomas.
In Chinese medicine, granulomas can be viewed as a type of Phlegm. Phlegm can be considered in different ways. In sarcoidosis, the granulomas also represent a form of Phlegm. When the digestion function is not in balance, the ability of the Spleen to transform the food taken in is not optimized and a Damp and Phlegm condition can arise. As previously mentioned, in normal healthy conditions, the Spleen then transports Qi to the Lungs.
When out of balance, the Spleen instead can transport that Dampness and Phlegm to the Lungs. Although the Spleen is the main organ that produces Phlegm, the Liver and Kidneys also play a role. The Liver is responsible for the smooth flow of Qi in the body. This can affect the entire body, including the Lungs. Any Stagnation condition can give rise to Phlegm. The additional Heat can dry out Dampness and produce and accumulation of Phlegm.
The Kidneys also play a role in the production of Phlegm. One of the Kidneys' energetic functions is to transform and excrete fluids. If the Kidneys fail to do this, then Dampness can accumulate. Again, if that Dampness stays, it can Stagnate into Phlegm. The Kidneys have a direct connection to the Lungs. The Lungs are supposed to descend the Qi to the Kidneys upon inhalation. To reciprocate, the Kidney Yang energy contributes to the proper balance of Wei Qi through the Lungs. Because of this connection with the Kidneys, a Lung and Kidney Yin Deficiency could evolve, compounding the Deficient Heat and exacerbating the Phlegm.
While the Spleen is largely responsible for the production of Phlegm, the Lungs are known as the container of Phlegm in Chinese medicine. This is why the greatest incidence of granuloma formation occurs in the lungs: It does not matter where the imbalance is that creates Phlegm, i. Spleen, Kidney, or Kidneys, it all can be stored in the Lungs. When the Lungs contain Phlegm, as in granuloma formation, they cannot function in a normal manner. Unfortunately, there are seldom direct one-to-one links from Western to Eastern medicine. This holds true, too, when considering pulmonary sarcoidosis.
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Chinese guidelines on prevention and treatment for bronchial asthma basic version II. Chin Community Doctors ; Chinese guidelines on prevention and treatment for bronchial asthma basic version. The Ministry of Health of China. Guidelines on diagnosis and rehabilitation for childhood autism. Chin J Child Care ; Guidelines on diagnosis and treatment for pandemic influenza Int J Respir ; Guidelines for chronic obstructive pulmonary disease. Guidelines on diagnosis and treatment for hand-foot-mouth disease Guidelines on the management for primary liver cancer J Clin Oncol ; Guidelines on diagnosis and treatment for NDM1 generic drug resistant enterobacteriaceae bacterial infection.
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Is there level I evidence for complementary and alternative medicine CAM in oncology? An analysis of Cochrane reviews. WHO traditional medicine strategy: World Health Organization , Quality assessment of clinical guidelines in China: Status of clinical research in China. Lancet ;
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