Exploring the pathogenesis evolution regularity and syndrome differentiation and treatment strategy of chronic obstructive pulmonary disease from the perspective of "all qi distension and constraint belong to the lung"

Chronic obstructive pulmonary disease (COPD) is characterized by persistent and recurrent respiratory symptoms and limited airflow. In traditional Chinese medicine (TCM), COPD is generally categorized into the categories of "lung distension," "dyspnea syndrome," and "chronic cough." Zhizhenyao Dalun of Suwen states that "all qi distension and constraint belong to the lung," indicating that the lung serves as the pivot of qi movement, governing ascent, descent, entry, and exit throughout the body. Disorders such as qi counterflow, qi obstruction, and qi stagnation are therefore closely related to lung failure in diffusion, depuration, and regulation. Based on this theory, and integrating the physiological and pathological concepts that the lung governs qi, regulates systemic qi activities, corresponds to grief in emotion, and is internally-externally related to the large intestine, this study explores the core pathogenesis of COPD as dysfunction of lung qi and generalized qi constraint. The essential mechanism lies in the the failure of lung to disperse and descend, leading to impaired separation of clearness and turbidty, stagnation of qi with phlegm obstruction, and progressive deficiency over time. Consequently, a stage-based treatment strategy is proposed centered on regulating lung qi and restoring its regulatory function. For stagnation of lung qi, Sanzi Yangqin Decoction combined with Zhisou Powder is recommended to disperse the lung and regulate qi, thus restoring the ascending and descending mechanism. For failure of the lung in regulation, Peitu Shengjin Formula is applied to strengthen the lung and spleen, nourish the zang-fu organs, and consolidate the root. For phlegm obstructing the lung collaterals, Tingli Dazao Xiefei Decoction combined with Daotan Decoction is used to regulate qi, transform phlegm, and simultaneously promote diffusion and descent to clear the lung network. In cases of acute exacerbation accompanied by fu-organ excess, the principle of simultaneous regulation of the lung and large intestine is adopted, employing Xuanbai Chengqi Decoction to ventilate the lung and unblock the bowels, thus facilitating the free flow of qi. It is anticipated that this precision-oriented diagnostic and therapeutic framework, characterized by stratified pathogenesis, stage correspondence, and targeted formula application, may provide a valuable reference for the clinical prevention and treatment of COPD.