🌿 Folk Prescriptions

Obstructive emphysema falls under the category of chronic obstructive pulmonary disease (COPD), characterized by incomplete reversible airflow limitation. Its pathological basis is chronic inflammation and structural changes in the terminal bronchioles and lung parenchyma, ultimately leading to airway narrowing and progressive increase in airflow resistance. Traditional Chinese Medicine (TCM) does not have this exact name, but related discussions exist in conditions such as "cough," "shortness of breath," "phlegm-dampness," and "lung distention," particularly closely related to "lung distention" in etiology, pathogenesis, clinical presentation, disease progression, and prognosis. Generally, in early stages, the disease affects the lungs; in mid-stage, it impacts the spleen; in late stages, it involves the heart and kidneys. Pathological factors include wind, phlegm, blood stasis, heat, water, dampness, and toxic turbidity. The pathogenesis is typically a mixture of deficiency and excess, with qi deficiency, blood stasis, and phlegm obstruction being the most common syndromes. Treatment follows a staged approach (acute exacerbation phase vs. remission phase), classifying by syndrome characteristics, yielding good clinical results. Below is a brief overview of medication and differential diagnosis:
One, Wind-Heat Invading Lung, Lung Losing Function of Dispersion and Descent
This type commonly appears in the initial stage of COPD exacerbation, often triggered by external wind-heat pathogens. Symptoms include cough, shortness of breath, wheezing, chest tightness, difficult expectoration, sticky or yellow-thick phlegm, often accompanied by aversion to wind, fever, headache, thirst, and yellow nasal discharge. Tongue coating is thin yellow, pulse is floating rapid or floating slippery.
Treatment Method: Dispel wind, clear heat, regulate lung, resolve phlegm. Formula: Sang Ju Yin combined with Ma Xing Shi Gan Tang. Ingredients: Mulberry leaf 10g, mulberry bark 10g, chrysanthemum 10g, apricot kernel 10g, forsythia 12g, honey-fried ephedra 6g, raw gypsum 30g, platycodon 6g, peucedanum 10g, arctium 10g.
Two, Phlegm-Heat Blocking Lung, Both Qi and Yin Damaged
This type commonly appears in the acute exacerbation phase of COPD, especially in those with recurrent episodes prone to lung abscess (bronchiectasis). Symptoms include shortness of breath, chest tightness, cough, shortness of breath, abundant sticky yellow phlegm, difficult to expectorate, sometimes with a foul odor or blood streaks, accompanied by dry mouth, constipation, irritability, insomnia, fatigue, weak speech. Tongue is red, coating is scanty or thin greasy, with patchy desquamation, pulse is fine slippery or slippery fine rapid.
Treatment Method: Clear heat, resolve phlegm, regulate lung, relieve wheezing. Formula: Xiao Xian Xiong Tang combined with Qing Qi Hua Tan Tang with modifications. Ingredients: Whole guallu 30g, scutellaria 10g, pinellia 10g, peach kernel 10g, apricot kernel 10g, citri fructus 10g, anemarrhena 10g, fritillaria 10g, lomatium 10g, forsythia 10g, gardenia 10g, southern saussurea 10g. If phlegm is yellow like pus or has a foul odor, indicating lung abscess, add reed rhizome 15g, bletilla rhizome 15g, coix seed 30g, houttuynia 30g, houttuynia 15g, dandelion 15g to clear heat, detoxify, resolve phlegm, and eliminate abscess.
Three, Phlegm-Dampness Accumulating in Lung, Qi Deficiency and Blood Stasis
This type commonly appears after the acute exacerbation phase of COPD, with cough and shortness of breath significantly reduced but still abundant phlegm, often triggering cough. After phlegm is expectorated, cough stops. Phlegm is white or grayish, viscous or thick and clumped, accompanied by chest tightness, epigastric fullness, nausea, poor appetite, fatigue, loose stools, pale tongue with dark color, white greasy coating, fine slippery or soft slippery pulse.
Treatment Method: Dry dampness, resolve phlegm, descend counterflow, stop cough. Formula: Pingwei Er San Tang (Pingwei San, Erchen Tang, Sanzi Yangqin Tang) with modifications. Ingredients: White atractylodes 10g, white atractylodes 10g, tangerine peel 10g, pinellia 10g, poria 15g, magnolia bark 6g, perilla seed 10g, perilla stem 10g, stir-fried radish seed 10g, stir-fried citri fructus 10g, white mustard seed 6g.
Four, Yin Deficiency with Blood Stasis and Phlegm Concretion
This type commonly appears in the remission phase of COPD. Symptoms include shortness of breath, cough with little phlegm, white or yellow in color, sticky and difficult to expectorate, accompanied by dry mouth and throat, dark lips, emaciated body, heat in the body, irritability, restless sleep, red or dark red tongue, scanty or greasy coating, fine slippery rapid pulse.
Treatment Method: Nourish yin, clear heat, harmonize blood, resolve phlegm. Formula: Jinshui Liu Jun Jian with modifications. Ingredients: Angelica 15g, cooked rehmannia 15g (mixed with sandalwood), tangerine peel 10g, pinellia 10g, poria 15g, golden fleece 10g, anemarrhena 10g, fritillaria 10g, sea floatstone 10g, honey-fried loquat leaf 10g, moutan 15g, salvia 15g.
Five, Qi Deficiency with Blood Stasis and Phlegm Obstruction
This is the most common syndrome in the remission phase of COPD, visible in early, middle, and late stages. Symptoms include shortness of breath, exacerbated by exertion, cough with abundant phlegm, white and sticky or foamy, prone to catching colds, often triggered by weather changes, accompanied by dark lips, epigastric fullness, poor appetite, fatigue, pale dark tongue, thin greasy or white slippery coating, fine slippery pulse.
Treatment Method: Tonify Qi, activate blood, resolve phlegm, relieve wheezing. Formula: Liu Junzi Tang combined with Yu Pingfeng San with modifications. Ingredients: codonopsis 15g, astragalus 20g, atractylodes 10g, poria 15g, tangerine peel 10g, pinellia 10g, peach kernel 10g, apricot kernel 10g, stir-fried coix seed 30g, saposhnikovia 6g, angelica 10g, platycodon 6g.
Six, Qi-Yin Deficiency with Phlegm and Blood Stasis Blocking Meridians
This type commonly appears in the remission phase of COPD. Symptoms include breathlessness and palpitations, worse with exertion, little phlegm, sticky and difficult to expectorate, cyanosis of lips and nails, irritability, insomnia, weak voice, shortness of breath, fatigue, dry mouth, constipation, tender red or pale dark tongue, scanty or thin greasy coating, central desquamation, deep fine or fine sluggish pulse.
Treatment Method: Tonify Qi and nourish yin, resolve phlegm, unblock meridians. Formula: Shengmai Yin combined with Xuanfu Dai Zhe Tang with modifications. Ingredients: prince ginseng 15g, ophiopogon 10g, schisandra 6g, xuanfu flower 10g (wrapped), hematite 10g, pinellia 10g, northern and southern saussurea 15g each, anemarrhena 10g, fritillaria 10g, honey-fried loquat leaf 10g, angelica 10g.
Seven, Spleen-Kidney Yang Deficiency with Internal Retention of Fluid
This type commonly appears in severe COPD with right heart failure. Symptoms include shortness of breath and palpitations, unable to lie flat, cough with clear or frothy phlegm, facial and limb edema, cold intolerance, reduced urination, epigastric fullness, poor appetite, cyanotic face and lips, pale swollen tongue with dark color, white greasy or wet slippery coating, deep fine pulse.
Treatment Method: Warm yang, strengthen spleen, drain lung, promote diuresis. Formula: Zhenwu Tang combined with Sang Su Gui Ling Yin with modifications. Ingredients: processed aconite 10g, mulberry bark 10g, perilla seed 10g, fritillary bulb 10g, cinnamon twig 10g, pig and poria 15g each, atractylodes 10g, echinacea 10g, alisma 10g, red peony 10g, motherwort 30g.
Eight, Liver-Kidney Yin Deficiency with Phlegm Obscuring the Clear Orifices
This type commonly appears in severe COPD with respiratory failure. Symptoms include coughing, wheezing, difficult expectoration, apathetic expression, confused consciousness, somnolence or even coma, or agitation and delirium, muscle twitching, red or dark red tongue, small and thin tongue, white greasy or yellow greasy coating, fine slippery rapid pulse.
Treatment Method: Soothe liver, extinguish wind, clear phlegm, open orifices. Formula: Yiguanyin, Changpu Yujin Tang combined with Ditan Tang with modifications. Ingredients: raw and cooked rehmannia 15g each, cornus 20g, scrophularia 10g, calamus 10g, curcuma 10g, pinellia 10g, bear bile 6g, poria 10g, bamboo shavings 10g, citri fructus 10g, rhubarb 6g.
In summary, obstructive emphysema is commonly characterized by deficiency of the root and excess of the branch. The root deficiency primarily involves qi deficiency, qi-yin deficiency, and spleen-kidney yang deficiency, while the branch excess mainly involves phlegm, blood stasis, wind, and heat. During acute exacerbation, treat the branch first; during remission, treat both root and branch, balancing deficiency, phlegm, and blood stasis. For severe COPD with right heart failure or respiratory failure, combination of TCM and Western medicine is essential to quickly control symptoms and prevent further deterioration.