Acute bronchitis, dry cough

Chapter 18

Acute bronchitis, dry cough Summary Essence: A hyper alpha-sympathetic spasmophilia of fragilized bronchi in response to an aggressor. Terrain: (1) Irritation of the bronchus: environmental or infectious and (2) Spasmophilia: Alpha > Para, low Beta with (3) Inflammation: hyperfunctioning central thyroid + adaptative cortisol with (4) Dry cough: from insufficient mucous to protect irritated bronchus.

Treatment goals Symptomatic: Emollient, antitussive, spasmolytic, antiinfectious (as indicated). Terrain: ●

● ●

●

●

ANS: ⇓ Alpha > Para, relaunch Beta (to resolve spasmophilia) CORTICO: ⇓ Cortisol THYRO: ⇓ TRH and TSH, adapt thyroid according to situation DRAIN: 1-Exocrine Pancreas-Pulmonary axis, 2-Hepato-Splenic, 3-Intestines, 4-Skin (as indicated) DIET: Pancreas sparing

Sample treatment 1. Neuroendocrine-infectious: Passiflora incarnata MT 40 mL, Fabiana imbricata MT 40 mL, Cornus sanguinea GM 40 mL, Lavandula angustifolia EO 1.5 mL, Cinnamomum zeylanicum EO 1 mL: 3 mL three times per day for 10–14 days (Table 18.6). 2. Emollient-drainage-infectious: Agrimonia eupatoria MT 60 mL, Malva sylvestris MT 60 mL, Eucalyptus smithii or globulus EO 2 mL: 3 mL three times per day for 10–14 days (cf. Table 18.8). 3. Topical antispasmodic: Eucalyptus spp. EO 8 drops, Lavandula angustifolia EO 4 drops, Cupressus sempervirens EO 3 drops + 1 tbsp carrier oil.

Terrain in detail Precritical terrain There is, prior to the time of exposure to the inciting agent, a global hyperfunctioning of the terrain that targets and The Theory of Endobiogeny. https://doi.org/10.1016/B978-0-12-816965-0.00018-4 © 2020 Elsevier Inc. All rights reserved.

fragilizes the bronchi to maintain an increased oxygen requirement: 1. Endocrine, hyperfunctioning a. Pituitary b. Thyroid: TSH, T4 c. Pancreas, Endocrine d. Adrenal cortex (lesser role) 2. ANS: Para, hyperfunctioning 3. Emunctory a. Defense, oversolicited and taxed i. Exocrine pancreas ii. Spleen: Immunity b. Congestion i. Colon ii. Liver iii. Skin

Agent The agent provokes a supraphysiologic oxygen demand that is beyond the adaptation capability of the patient, further diminishing the already-fragilized buffering capacity. This neuroendocrine adaptation response will determine if the bronchitis is wet or dry (cf. Chapter 19: Acute bronchitis, wet). Common aggressors include: 1. Pathogens: viruses most common 2. Particulates: allergens, tobacco smoke, etc. 3. Gastric secretion reflux: microaspiration 4. Cold air

Critical terrain 1. ANS: Hyper Alpha > Para, with spasmophilia: blocked or delayed beta 2. Corticotropic: Adaptive cortisol 3. Thyrotropic: a. Central: Hyperfunctioning TRH, TSH b. Peripheral: Thyroid response varies; greater the activity, greater the inflammation tends to be in the face of elevated cortisol 4. Emunctories: a. Broncho-pulmonary unit: congested due to exocrine pancreatic overactivity 139

140 SECTION | C  Assessment and treatment of common disorders

b. Spleen and Liver: oversolicited, overtaxed, and congested c. Intestines: congested d. Skin

Mechanisms Hyperinflammatory response with insufficient mucous to protect the airway, or, high inspissated mucous, which is difficult to expectorate.

History and BoF findings During acute bronchitis, typical symptoms of an ­irritable, spasmodic cough, with or without fever, of 10 or less days duration will be present. In a patient with known history of recurrent seasonal bronchitis, evaluate the precritical terrain in the preceding season to institute prophylaxis. Some possible correlations between precritical symptoms and Biology of Functions are presented in Table 18.1.

Physical exam and BoF findings During presentation with acute bronchitis, the following may be observed on physical exam with some possible Biology of Functions correlations (Table 18.2)

Result Inspiratory, spasmodic dry cough

TABLE 18.1  Precritical terrain symptoms and Biology of Functions correlations. Area

Finding

Terrain

BoF

Psyche

Acute stress, Exacerbation of chronic stress

Complex, varied

⇑ Serotonin, ⇓ PL, ⇑ Potential histamine, ⇑/⇓ βMSH/αMSH + ⇑ Noxious free radicals ⇑/⇓ LMI, ⇑ Thyroid relaunching, Thyroid relaunching corr.

Insomnia, reduced stress tolerance Alpha

GERD, Gastritis, constipation, insomnia

High Alpha

Para

Good sleeper, good eater, seldom cries, shy, introverted, sweats easily, eczema, prolonged expiratory phase

High Para

Thyro

Vivid dreams, nightmares

TRH

⇑ Thyroid relaunching, Thyroid relaunching corr., HypothalamoMetabolic, TRH/TSH

Hypoglycemic tendencies

TSH + Insulin

TSH serum <1.5 + ⇓ Insulin resistance

Tonsil hypertrophy

Latent hypothyroidism

TSH serum > 3 + ⇓ Genito-thyroid ⇑ fT4

Heat intolerance Pancreas, Exocrine

Recurrent ENT infections, eczema, mucus with dairy/gluten, bloating

Over-solicited, insufficient

⇑/⇓ Somatostatin

Spleen

Unfocused effort, fatigue, impaired adaptability, depressive tendency, recurrent infections

Splenic congestion

⇓ PMI

Liver

Poor immune response, loss of appetite especially in AM, chills

Hepatic congestion

⇑/⇓ LMI

Colon

Constipation, acne on buttocks

Colon congestion

⇓ Pelvic congestion

TABLE 18.2  Critical terrain signs and biology of functions correlations. Area

Finding

Terrain

BoF

Airways

Spasmodic cough: inspiratory, dry

Alpha ≫ Para, Beta delayed

⇑/⇓ LMI + ⇓ PMI + ⇑ Noxious free radicals, Proinflammatory, Inflammation

Alpha

Cold extremities, dry mucous membranes, stringy saliva

Elevated alpha > para

⇑/⇓ LMI + ⇓ PMI

Acute bronchitis, dry cough Chapter | 18  141

TABLE 18.2  Critical terrain signs and biology of functions correlations—Cont’d Area

Finding

Terrain

BoF

Neuro

Chvostek

Spasmophilia

⇑/⇓ LMI + ⇓PMI

Brisk DTR, Clonus, Eyelid flutter on Glabella tap

⇑ TRH

⇑ Thyroid relaunching, Thyroid relaunching corr.,

Adrenals

Tender on palpation, Tender Cortisol point

Adrenal oversolicitation

⇑ Cortisol, Adaptation-permissivity Varies: Adrenal cortex, often: Cortisol/Adrenal cortex ratio > 4

Thyro

Pain of palpation of tibial prominence

Adaptative TSH

⇓ TSH serum

Cold sensitivity (T3), heat intolerance (T4), weight loss, pruritis

Hyperfunctioning peripheral thyroid

⇑ Thyroid index, Thyroid yield

Immuno

Suprasternal notch: Tender on palpation

Thymus congested from oversolicitation

⇑ IL-1

Pancreas

Tender: above umbilicus

Congestion: general

N/A

Tender, right of umbilicus

Oversolicitation: exocrine

⇑/⇓ Somatostatin

Tender, left of umbilicus

Oversolicitation: endocrine

N/A

Tender, right of umbilicus

Vascular hepatic congestion

⇑/⇓ LMI

Tender, right of umbilicus

Metabolic hepatic congestion

⇑/⇓ LMI

Tender: various points

Colon congestion

Depends on points tender

Liver

Colon

Key: DTR: Deep tendon reflex; LMI: Leukocyte mobilization index; PMI: Platelet mobilization index.

Treatment Acute bronchitis During acute bronchitis, antibiotics should be avoided unless proven bacterial etiology in a fragilized patient. The general emphasis of treatment is listed in Table 18.3 in columns from left to right. The general approach is three-fold: 1. Symptomatic, localized to bronchi (Tables 18.3 and 18.8) 2. Neuroendocrine, in following order of emphasis (Table 18.4) a. Reduce Alpha

b. Reduce Corticotropic: Cortisol, balance Cortisol:adrenal cortex ratio on BoF c. Reduce Thyrotropic: TRH, TSH, thyroid (as indicated) d. Oligoelements (discussed later) 3. Drainage (Table 18.5), in following order of emphasis a. Pancreas-sparing diet b. Pancreato-Pulmonary axis c. Hepato-Splenic d. Intestines e. Skin (as indicated)

TABLE 18.3  Medicinal plants with polyvalent symptomatic actions. Plant

Antispasm.

Agrimonia eupatoria

•

Arctium lappa

Decon.

Anti-inflam.

Anti-infect.

•

•

•

•

Ceanothus americanus

•

•

Cinnamomum zeylanicum

•

•

Cornus sanguinea

Lavandula angustifolia

•

•

Eucalyptus ssp.

• •

Emol.

•

• •

142 SECTION | C  Assessment and treatment of common disorders

TABLE 18.3  Medicinal plants with polyvalent symptomatic actions—Cont’d Plant

Antispasm.

Decon.

Anti-inflam.

Malva sylvestris Plantago major

•

Populus nigra

•

•

Emol.

•

•

• •

Viola tricolor

Anti-infect.

•

•

•

Zea mays

•

•

Key: Anti-infect.: Anti-infectious, Anti-inflam.: Anti-inflammatory, Antispasm.: Antispasmodic, Emol: Emollient.

TABLE 18.4  Medicinal plants for neuroendocrine regulation. Axis

Primary

Other

⇓ Alpha, Para

Passiflora incarnata MT, Lavandula angustifolia EO

Valeriana officinalis MT, Tilia tomentosa GM, Matricaria recutita MT

⇑ Beta

Cinnamomum zeylanicum EO

Satureja montana EO

⇓ ACTH

Matricaria recutita MT

Passiflora incarnata MTa

⇓ Cortisol

Passiflora incarnata MT

Leonurus cardiaca MTb, Sequoia gigantea GM

Support global adrenal

Ribes nigrum GM

Quercus pedunculata GM. Glycyrrhiza glabra MT

⇓ Thyrotropic: Via central inhibition

TRH: Fabiana imbricata MT

TRH: Leonurus cardiaca MT

TSH: Cornus sanguinea GM

TSH: Zea mays GM

Somato: Delay Insulin/⇑ Insulin resistance

Malva sylvestris MT, Arnica montana MT

Indirectly: ⇓ Cortisol, block TSH

Key: EO: Essential oil, GM: Gemmomacerate, MT: mother tincture. a

Indirect via Alpha-sympatholysis.

b

Reduces cortisol fixation.

TABLE 18.5  Polyvalent medicinal plants with drainage and pulmonary tropism. Plant

Pancr.-pulm

Agrimonia eupatoria Plantago major

Liver

Intestines

•

•

•

•

•

•

•

•

Ceanothus americanus

Hepato-splenic

Skin

•

Viola tricolor

•

Key: Pancr.-Pulm: Pancreatic-Pulmonary axis.

Exemplary prescriptions Based on an Endobiogenic approach to acute dry bronchitis, a number of prescriptions can be derived. 1. Neuroendocrine-infectious: 3 mL three times per day for 10–14 days (Table 18.6) Passiflora incarnata MT 40 mL, Fabiana imbricata MT 40 mL, Cornus sanguinea GM 40 mL, Lavandula

angustifolia EO 1.5 mL, Cinnamomum zeylanicum EO 1 mL; An alternate formula is presented in Table 18.7. 2. Emollient-drainage-infectious: 3 mL three times per day for 10–14 days (Table 18.8) Agrimonia eupatoria MT 60 mL, Malva sylvestris MT 60 mL, Eucalyptus ssp. EO 2 mL. 3. Topical antispasmodic: Apply up to every hour for relief of cough

Acute bronchitis, dry cough Chapter | 18  143

Eucalyptus spp. EO 8 drops, Lavandula angustifolia EO 4 drops, Cupressus sempervirens EO 3 drops + 1 TBSP carrier oil; Instructions: (a) Mix carrier oil and EOs in glass bowl, (b) Apply with friction rub in circular and up/down motions for 3–4 min, (c) Cover chest with a shirt or blanket, then heated pad or towel; Alternative: Diffuse undiluted essential oils within 2 feet (0.6 m). 4. Oligoelements: (a) Spasmodic cough: Magnesium oligo: 1–2 droppers every 4 h for first three days; (b) Inflammation: Selenium: 1–2 droppers every 4 h for first three days. 5. Diet Pancreas sparing, favor root vegetables: turnip, black radish, yams, and, juices of carrot, quince, chervil, cabbage, lettuce, mulberry, apple, and turnip.

TABLE 18.6  Neuroendocrine-infectious prescription. Amount and form

Replacements and alternatives

Passiflora incarnata

40 mL MT

Matricaria recuctita EO

Fabiana imbricata MT

40 mL MT

Leonurus cardiaca MT, Fabiana imbricata MT

Cornus sanguinea

40 mL GM

Zea mays GM, Lycopus europaeus MT

Lavandula angustifolia

1.5 mL EO

Eucalyptus ssp. EO 1.5 mL

Cinnamomum zeylanicum

1 mL EO

Thymus vulgaris EO 0.5 mL + Satureja montana EO 0.5 mL

Herb

TABLE 18.7  Neuroendocrine-infectious prescription alternate. Herb

Amount and form

Replacements and alternatives

Ribes nigrum

60 mL GM

Quercus pedunculata GM

Populus nigra

60 mL GM

Ceanothus americanus MT

Satureja montana

0.5 mL EO

Cinnamomum zeylanicum, Menyanthes trifoliata MT

Cinnamomum zeylanicum

0.5 mL EO

Satureja montana, Rosa canina GM

TABLE 18.8  Emollient-drainage-infectious prescription. Amount and form

Replacements and alternatives

Agrimonia eupatoria

60 mL MT

Plantago major MT

Malva sylvestris

60 mL MT

Arnica montana MT 40 mL + Glycyrrhiza glabra MT 20 mL

Eucalyptus smithii

2 mL EO

Eucalyptus globulus (unrectified) EO 2 mL

Herb