🌿 Folk Prescriptions

Obstructive emphysema falls within the category of chronic obstructive pulmonary disease (COPD), characterized by incompletely 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. Although traditional Chinese medicine lacks this exact disease name, conditions such as “cough,” “asthma,” “phlegm-dampness,” and “lung distention” have relevant discussions, particularly closely related to “lung distention” in terms of 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 the most common syndromes being qi deficiency, blood stasis, and phlegm obstruction. Treatment follows a stage-based approach (acute exacerbation vs. remission phase), classifying treatment according to symptom patterns, yielding good clinical results. Below is a brief overview of medication and syndrome differentiation:
I. Wind-Heat Invading the Lungs, Lung Function Impaired
This type commonly appears in the early stages of COPD exacerbation, often triggered by external wind-heat pathogens. Symptoms include cough, shortness of breath, wheezing, chest tightness, difficult expectoration of sticky or yellowish 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.
Therapeutic Principle: Dispel wind, clear heat, regulate lung function, 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.
II. Phlegm-Heat Obstructing the Lungs, Both Qi and Yin Damaged
This type commonly appears in the acute exacerbation phase of COPD, especially in recurrent cases prone to lung abscess (bronchiectasis). Symptoms include wheezing, chest tightness, cough, shortness of breath, abundant sticky yellow phlegm, difficult expectoration, sometimes with a foul odor or blood streaks, accompanied by dry mouth, constipation, restlessness, insomnia, fatigue, weak speech. Tongue is red, coating is scant or thin greasy, with partial desquamation, pulse is fine slippery or slippery fine rapid.
Therapeutic Principle: Clear heat, resolve phlegm, regulate lung function, relieve wheezing. Formula: Xiao Xian Xiong Tang combined with Qing Qi Hua Tan Tang with modifications. Ingredients: Whole trichosanthes 30g, scutellaria 10g, pinellia 10g, persica 10g, apricot kernel 10g, citri aurantium 10g, anemarrhena 10g, fritillaria 10g, eupatorium 10g, forsythia 10g, gardenia 10g, southern safflower 10g. If phlegm is yellow like pus or has a foul odor, indicating lung abscess, add reed rhizome 15g, rush pith 15g, coix 30g, houttuynia 30g, hedyotis 15g, dandelion 15g to clear heat, detoxify, resolve phlegm, and eliminate abscess.
III. Phlegm-Dampness Accumulating in the Lungs, Qi Deficiency and Blood Stasis
This type commonly appears after the acute exacerbation phase of COPD. Cough and wheezing are markedly reduced compared to before, but phlegm remains abundant, often triggering cough. After expectoration, cough eases. Phlegm is white or gray, sticky or thick and clumpy. Accompanied by chest tightness, epigastric fullness, nausea, poor appetite, fatigue, loose stools. Tongue is pale dark, coating is white greasy, pulse is fine slippery or soft slippery.
Therapeutic Principle: Dry dampness, resolve phlegm, descend counterflow, stop cough. Formula: Ping Wei Er San Tang (Ping Wei San, Er Chen Tang, San Zi Yang Qin Tang) with modifications. Ingredients: Atractylodes lancea 10g, Atractylodes macrocephala 10g, tangerine peel 10g, pinellia 10g, poria 15g, magnolia bark 6g, perilla seed 10g, perilla stem 10g, roasted radish seed 10g, stir-fried citrus aurantium 10g, white mustard seed 6g.
IV. Yin Deficiency, Blood Stasis, Phlegm Concretion
This type commonly appears in the remission phase of COPD. Symptoms include shortness of breath, cough with little phlegm, white or yellow phlegm, sticky and difficult to expectorate, dry mouth and throat, dark lips, emaciation, feverish body, restlessness, poor sleep. Tongue is red or dark red, coating is scant or greasy, pulse is fine slippery rapid.
Therapeutic Principle: Nourish yin, clear heat, harmonize blood, resolve phlegm. Formula: Jin Shui Liu Jun Jian with additions. Ingredients: Angelica 15g, prepared rehmannia 15g (mixed with sand ginger), tangerine peel 10g, pinellia 10g, poria 15g, golden fleece 10g, anemarrhena 10g, fritillaria 10g, sea floatstone 10g, honey-fried lonicera 10g, cortex moutan 15g, salvia 15g.
V. Qi Deficiency, Blood Stasis, Phlegm Obstruction
This is the most common syndrome in the remission phase of COPD, appearing in early, middle, and late stages. Symptoms include shortness of breath, especially worsened by exertion, cough with abundant phlegm, white and sticky or frothy, 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.
Therapeutic Principle: Tonify qi, activate blood, resolve phlegm, relieve wheezing. Formula: Liu Junzi Tang combined with Yu Ping Feng San with modifications. Ingredients: codonopsis 15g, astragalus 20g, atractylodes 10g, poria 15g, tangerine peel 10g, pinellia 10g, persica 10g, apricot kernel 10g, stir-fried coix 30g, silktassel 6g, angelica 10g, platycodon 6g.
VI. Qi-Yin Deficiency, Phlegm-Stasis Blocking Meridians
This type commonly appears in the remission phase of COPD. Symptoms include breathlessness and palpitations, especially worsened by exertion, small amount of phlegm, sticky and difficult to expectorate, cyanosis of lips and nails, restlessness, insomnia, weak voice, shortness of breath, laziness, dry mouth, constipation, tender red or pale dark tongue, scant or thin greasy coating with central desquamation, deep fine or fine sluggish pulse.
Therapeutic Principle: Tonify qi and nourish yin, resolve phlegm, unblock meridians. Formula: Sheng Mai Yin combined with Xuan Fu Dai Zhe Tang with modifications. Ingredients: prince ginseng 15g, ophiopogon 10g, schisandra 6g, inula flower 10g (wrapped), hematite 10g, pinellia 10g, northern and southern safflower 15g each, anemarrhena 10g, fritillaria 10g, honey-fried lonicera 10g, angelica 10g.
VII. Spleen-Kidney Yang Deficiency, Internal Retention of Fluid
This type commonly appears in severe COPD with right heart failure. Symptoms include shortness of breath and palpitations, inability to lie flat, clear or frothy phlegm, facial and limb edema, cold aversion, reduced urination, epigastric fullness, poor appetite, cyanotic face and lips, pale swollen tongue with dark quality, white greasy or watery coating, deep fine pulse.
Therapeutic Principle: Warm yang, strengthen spleen, drain lung, promote diuresis. Formula: Zhen Wu 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.
VIII. Liver-Kidney Yin Deficiency, Phlegm Obscuring the Clear Orifices
This type commonly appears in severe COPD with respiratory failure. Symptoms include coughing, wheezing, difficult expectoration, apathetic expression, confusion, somnolence or even coma, or agitation and delirium, muscle twitching, tongue dark red or crimson, thin and small, greasy white or yellow greasy coating, fine slippery rapid pulse.
Therapeutic Principle: Soothe liver, calm wind, clear phlegm, open orifices. Formula: Yi Guan Jian, Chang Pu Yu Jin Tang combined with Di Tan Tang with modifications. Ingredients: raw and cooked rehmannia 15g each, cornus 20g, scrophularia 10g, polygala 10g, cyperus 10g, pinellia 10g, bear gallbladder 6g, poria 10g, bamboo juice 10g, citri aurantium 10g, rhubarb 6g.
In summary, obstructive emphysema is predominantly characterized by deficiency of the root and excess of the branch, with deficiency mainly involving qi deficiency, qi-yin deficiency, and spleen-kidney yang deficiency, while excess primarily involves phlegm, stasis, wind, and heat. During acute exacerbations, treat the branch first; during remission, treat both root and branch, adjusting for deficiency, phlegm, and stasis together. 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.