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As mentioned before, COPD is comparable to chuan zheng (喘证). Let’s look at treatment methods for chuan zheng (喘证) by first looking into the hot and cold divisions and the appropriate treatment.

Treatment for External Cold causing Internal Fluid (外寒内饮)

Xiaoqinglong tang (小青龙汤) is the formula of choice if the symptoms present water running from a tap – see Professor Huanghuang’s description of this formula in his books. Note the herbs most useful are dried ginger (干姜), xixin (细辛), wuweizi (五味子) and banxia (半夏). This formula is useful for treating catarrhal symptoms caused by a variety of external stimuli, and is not restricted to what we understand as a cold stimuli.

It is said that external cold (外寒) causes internal fluid and phlegm generation (内饮). My opinion is that the cold here is not the stimuli, but rather the presentation of disease. Catarrhal inflammation is ”cold’ compared to purulent inflammation which is more ‘heaty.’ This inflammation creates a need to cough upward, resulting in the phenomenon termed ‘lung qi not descending (肺气不降)’.

The classic jinkui yaolue (金匮要略) mentions the use of shegan mahuang tang (射干麻黄汤) in treating dyspnea when the wheezing sounds (水鸡声) featured prominently. Note that this formula is very similar to xiaoqinglong tang (小青龙汤) in makeup, and hence is well positioned to treat ‘cold’ symptoms. That said, guizhi is not present to provide the mahuang tang (麻黄汤) oomph that that xiaoqinglong tang (小青龙汤) has. In using mahuang (麻黄) alone without assistance from guizhi (桂枝), this formula is not as strong in resolving the exterior symptoms. However, its focus is more on treating the breathing difficulty as well as cough – notice the present of ziyuan (紫苑) and kuandonghua (款冬花). As for the presence of shegan (射干), it is worth its salt in the area of soothing the throat.

Treatment for Breathing Difficulties with Heaty Presentation

The most important idea here is that if there is heaty presentation, we must use cold herbs.

The most classic of cold herbs is gypsum (石膏). And the most useful herb pair then is ephedra and gypsum. To me at least, the first consideration is whether or not it is a xiaoqinglong pattern. If it is, we can add gypsum to xiaoqinglong decoction to get xiaoqinglong jia shigao tang (小青龙加石膏汤) – see next section for more. If not, then we can go along the route that includes daqinglong tang (大青龙汤) – which is more like mahuang tang (麻黄汤) plus shigao (石膏), which then needs ginger and jujube to protect against – and maxingshigan tang (麻杏石甘汤) – where the focus is on clearing the heat. If maxing both exterior resolution and heat clearance is necessary, then applause and welcome yuebi tang (越婢汤), which really is no longer about just resolving the exterior, but is about ridding the body big time of fluids. Anyway, this is the gypsum anthology.

Then we have herbs like huangqin (黄芩) and sangbaipi (桑白皮). Representative formulas include dingchuang tang (定喘汤) and sangbaipi tang (桑白皮汤).

Once again, consideration can be given to

1. Any phlegm? Using pinella
2. Any cough? Again, ziyuan (紫苑) and kuandonghua (款冬花) are first to come to mind. Also consider suzi (苏子) and xingren (杏仁).

Treatment of Cold Wrapping Hot Symptoms

Otherwise, if the body presents with symptoms of heat, TCM thinks of it as fluid stagnation causing heat (饮郁化热), the result of which would be heat symptoms like vexation and breathing difficulty (烦躁而喘). We can think of a catarrhal infection turning infectious and purulent, and heat is often associated with suppurative inflammation (化脓性炎症). In this case, we can use the idea of xiaoqinglong jia shigao tang (小青龙加石膏汤). Shigao is used to counter the heaty symptoms. The same can be seen in the use of houpu mahuang tang (厚朴麻黄汤), which adds downbearing to the slew of functions – remember it is 5liang of houpu.

Treatment for Sticky Phlegm

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. Consider the use of pinella (半夏) in yuebi jia banxia tang (越婢加半夏汤). Banxia (半夏) is useful for ‘downbearing lung qi (降肺气)’. yuxingcao (鱼腥草), huangqin (黄芩) and gualoupi (瓜蒌皮) are good for sticky phlegm that is hard to cough out. For the wheezing symptoms, think of shegan (射干) and tinglizi (葶苈子). If there is yin damage, add tianhuafen (天花粉), zhimu (知母) and maidong (麦冬).

Treatment when Thick Phlegm is Present

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.

Pulmonary Encephalopathy

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

Treatment during Remission of COPD

肺脾肾气虚: During remission (缓解期). 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.

Treatment for Cor Pulmonale (肺源性心脏病)

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 is unique is the 冬病春治 method 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 skinny blokes (体质消瘦) who require more protein intake.
• 气功 and 自我按摩 and 唱歌
• Preventive measures for 老年性肺部感染

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