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Overview

COPD (慢性阻塞性肺病aka慢阻肺) is a category of disease where 通气不畅. Main causes of disease include 久病肺虚，外感，痰挟血瘀. Usually emotions are not so important, although there are emotional manifestations, mainly 情绪低落. Those who have this are usually skinny, because it’s a 高消耗病. Clinical manifestations include 咳嗽，咯痰，later as 喘证 and 肺胀 in those who have 肺气肿.

COPD is a common 并发症, infection after disease, especially if immune suppresors are used. Can classify as 咳嗽, 喘证, and also 温病初起. For non-deficient people, see replete symptoms like high fever and 喘咳 strong, but normally both deficient and replete, there will be 呼吸衰竭. Kids have high fever, spasms, kesou, but elderly have slower reaction, may only show low fever and weak cough. so hard to detect pneumonia and 肺部感染.

Diagnosis & Treatment

外寒内饮：Use 小青龙汤 as base formula if the symptoms present as a running tap. Note the herbs most useful are 干姜，细心、五味子，半夏. For this formula, think of external stimuli causing internal fluid and phlegm generation (内饮). It is catarrhal inflammation which then causes 肺气不降. If exterior signs are not significant, and 《金匮要略》 focuses on the 水鸡声, then use 射干麻黄汤, especially if the body tends to cold. Else, if the body tends to heat (usually due to weak constitution), TCM thinks of it as 饮郁化热，and symptoms like 烦躁而喘 will present itself – 小青龙加石膏汤. The heat is often associated with infection and the concomitant immune reaction.

痰热郁肺: Here we see heat symptoms that are not due to weak constitution. Rather the heat is often a strong immune defence. Use 越婢加半夏汤 or 麻杏石甘汤, where we understand 麻黄 and 石膏 to be the crucial elements. 姜枣草 are the supportive herbs. So is 杏仁 for 麻黄. 半夏 to 降肺气. 鱼腥草，黄芩，瓜蒌皮 is good for sticky phlegm that’s hard to expectorate. For the wheezing symptoms, think 射干，葶苈子. If there is yin damage, add 花粉，知母，麦冬.

痰瘀阻肺: Phelgm and mucus is profuse and thick, setting this pattern apart from the first (water dripping from tap) and the second (hot and dry). Think 葶苈大枣泻肺汤（for 支饮）combined with桂枝茯苓丸. Also think 三子养亲汤（白芥苏、加莱菔）Note that 葶苈子 can also be added to other patterns when there is 喘息不得卧.

痰蒙神窍: This pattern is less likely seen by TCM doctors. Usually presents during 肺心脑病 and patient is sent to ICU.

肺脾肾气虚: During remission. See which ZF is deficient and add accordingly. There will fundamentally be a 肺肾problem, which we addressing using 补肺汤 or 补虚汤, adding 参蛤散. Add 参苓白术散 if 脾虚 symptoms present themselves. Also mentioned is the simple formula called 人参胡桃汤.

阳虚水泛: This is when the COPD starts causing right heart failure, causing edema etc. Western medicine will apply 强心药. TCM employs 真武汤 for strengthening the heart and 五苓散 for the edema.

Other Treatment options

• Acupuncture: what’s unique is the 冬病春治 where we can 帖敷.
• 食疗: Stuff to 化痰 e.g. 半夏山药粥（created by 张锡纯, author of 《衷中参西录》），痰壅方，饴姜元，姜汁天冬膏; Stuff to 补益正气 e.g. 核桃生姜泥，五味子汤，珠玉二宝粥

Commonsensical measures:

• More water to dilute the phlegm
• Avoid stimulating substances in the air and food
• Eat more proteins (most patients are 体质消瘦
• 气功 and 自我按摩 and 唱歌
• 老年性肺部感染