"Big watery eyes" are worrying
- Sleep apnea must be prevented
Jingmei Group General Hospital/Yin Youxin
"She's snoring at night, and she still has a flute!" Aunt Liu's husband vividly learned to me a passage of Aunt Liu's sound when she sleeps: there are always a few high-pitched nasal sounds in the well-proportioned snoring, and when the nasal whistle reaches its loudest, it is followed by a gurgling phlegm that seems to roll out of the throat. Suddenly, the sound stopped abruptly, there was silence around them, and no breathing could be heard, and after five or six seconds, the great drama of the throat and nose was opened again.
Compared with the patient Aunt Liu, her husband seemed more aggrieved: "You said that she slept all night, and I couldn't close my eyes." In the daytime, I still buy vegetables and cook, and people like Galeries Lafayette close their eyes and go to the sofa to sleep, and they can sleep again without talking for three minutes. ”
Aunt Liu's face was dark, her eyes were a little blue and her lips were very purple, and she was so groggy that she didn't look energetic. And unlike the overall dark tone, Aunt Liu has a pair of big watery eyes, shining brightly. — These shining eyes worry me more than cyanosis of my lips.
Aunt Liu has a common geriatric disease, obstructive sleep apnea (OSA), a sleep-breathing disorder characterized by sleep snoring with apnea and daytime sleepiness. The disease is more common in men and postmenopausal women, and the older and more obese people are, the greater the risk of developing the disease. "Snoring" doesn't seem to matter, it is caused by a sound caused by a narrowing of the nasal cavity, throat or upper airway. Excessive relaxation of pharyngeal muscles after exertion can also cause snoring, which is why snoring is not considered a disease in TCM. However, patients with this disease have a new problem of apnea on top of snoring, breathing is held all the time, which makes the gas exchange in the lungs poor, and the brain cells are always starved of oxygen. After "sleeping" in this way, the brain does not get any rest at all, and the oxygen level in the blood is much lower than that of a healthy person. Hypoxemia caused Aunt Liu's lips to turn blue, and the poor ventilation accumulated a lot of carbon dioxide in her body all night, causing the conjunctiva of the eyes to be swollen, and her eyes were shining with watery light. Sleep apnea is more tiring than insomnia, and it can be said that every night of sleep is like a "live burial", and the patients are forced to be forgetful and sleepy by low oxygen and carbon dioxide poisoning, and become a drowsy worm during the day.
Sleep apnea belongs to the category of "drowsiness" in traditional Chinese medicine, whether it is obstructive sleep apnea caused by upper airway obstruction, central sleep apnea caused by stroke, or mixed sleep apnea with a combination of the two, all belong to "drowsiness". Most of these patients are obese patients with poor airways and may even have small purring sounds from their throats even when they are awake. Western medicine has a very straightforward and concise treatment plan for such patients - wearing a non-invasive ventilator while sleeping - by increasing air pressure to help patients open up narrow airways, so that the lungs can exchange sufficient oxygen and carbon dioxide, and improve brain hypoxia. Hearing this solution, Aunt Liu and her husband were not relieved, because the disadvantage of ventilators is patient compliance, that is, no one wants to wear them all the time. Putting a mask on the face and "pumping" it regularly is more difficult for patients to use it than the expensive price of a ventilator.
In contrast, the options for treating "drowsiness" in TCM are not so "simple and crude", but more diverse.
Most critically, patients are advised to lose weight. Obesity is the key cause of sleep apnea, and patients are treated with thread embedding of Spleen Yu, Zusanli, Fenglong, Zhongguan and Qihai every week, and cooperate with auricular pressure beans to strengthen the spleen and lose weight.
Traditional Chinese medicine can be used to strengthen the spleen and lungs. Obesity, fatigue, shortness of breath and lazy speech, this is the manifestation of spleen qi deficiency, "the Yellow Emperor's Neijing, Meridians and Separate Treatises" said that "the lungs are towards the hundred veins, and the sperm is infused into the fur", "the spleen qi disperses the essence, the upper part returns to the lungs, the water channel is regulated, and the bladder is infused down". The spleen and lung qi are in harmony with the nourishment of the skin and hair, and the "sick, lazy and sleepy" people like Aunt Liu are due to the spleen deficiency and phlegm dampness caused by overeating fat, sweet, thick and greasy, and the pure qi cannot nourish the head and face and are drowsy. Traditional Chinese medicine treatment is centered on strengthening the spleen, with drugs that calm the nerves, warm yang, and dispel phlegm and dampness. The over-the-counter medicine can be Buzhong Yiqi Pill, Liujunzi Pill or Ginseng Spleen Strengthening Pill. For elderly people with qi deficiency, you can use 3 grams of ginseng, 15 grams of astragalus, 20 jujubes to boil water, drink juice and food residues, and take them as dietary therapy.
Some medical experiments have also confirmed that TCM Qigong combined with Bigu "Convincing Qi" can treat this disease. The principle is not as simple as dieting to lose weight. Taoist Bigu advocates "no hunger and no food", and advocates the realm of "full qi and no food", which is the manifestation of Chinese medicine spleen and stomach qi and self-moderation of diet. In addition to not being hungry or eating, you should also do not eat before going to bed, traditional Chinese medicine says that "the stomach is not in harmony and restless", lying down after a meal is not only easy to cause gastroesophageal reflux and burning throat, but also because of the pressure on the diaphragm caused by the stomach, resulting in poor breathing. I don't encourage patients to actually go to Bigu, but it can be used as a reference for healthy eating. Each meal is eighty percent full, three meals are fixed, sleep on an empty stomach at night, and multigrain instead of fat.
However, obstructive sleep apnea also has emaciated patients, and I once had an elderly patient who was later identified as the cause of a falling tongue. The tongue blocks the airway, and even if you open your mouth to breathe, you often "lose your breath". The family used clips to fix the old man's tongue, fearing that the old man would fall asleep and carry his breath. Considering that the elderly were emaciated and the tongue muscles were weak, which was evidence of spleen deficiency, three injections under the tongue were given with acupuncture on the spleen acupoints, and the symptoms were quite improved.
I formulated a treatment plan for Aunt Liu to lose weight and Chinese patent medicine to strengthen the spleen, combined with a whole grain diet, and encouraged her to spend more time in the sun on warm sunny days. The spleen is yang soil, which likes dryness and dislikes dampness, and can mobilize the body's yang energy through the warmth of the sun. At the third follow-up visit, the expression on her face was much sharper, and her face was much less gloomy. Maybe it's because of weight loss, or because of the strength, Aunt Liu said that her body is brisk, she is no longer sleepy during the day, and her brain is becoming clearer, although there are still large and small snoring. If she had been tested for blood gas analysis and followed up at the beginning, her respiratory failure symptoms would have decreased and her blood oxygen levels had become normal, so the occasional snoring without pause would have been harmless.
There are many ways to treat drowsiness caused by snoring in traditional Chinese medicine, and its treatment is based on "strengthening the spleen", which is the same as the "weight loss" advocated by patients in Western medicine treatment guidelines. Acupuncture soothes the tongue muscles and ventilators open the airway. Sleep health isn't just about time, it's about quality. Effective sleep can fully relieve physical and mental fatigue, and ineffective sleep can even be harmful to health. If your friends have a habit of drowsiness and snoring, you may wish to advise them to improve their diet and exercise habits to strengthen their spleen and fitness. Health is the result of the joint efforts of doctors and patients.
Director of the State Administration of Traditional Chinese Medicine
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The author of this article is Yin Youxin
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