Chronic obstructive pulmonary disease (COPD) is a common chronic airway inflammatory disease.The most basic western medical treatments for COPD are bronchodilators and corticosteroids. Bronchodilators mainly act directly on the bronchial smooth muscle, dilating the airway and relieving airflow restriction. Corticosteroids suppress the inflammatory responses such as those mediated via PI3K, NF-κB or MAPK activation, thus preventing airflow restriction. For COPD patients who feel that conventional treatment is still lacking in areas such as symptomatic relief, some turn to TCM in hope of better managing their condition.

In TCM, COPD falls under the term “Fei Zhang (肺胀)” which roughly translate into “Lung Distention”. This condition was first mentioned in the ancient literature Huang Di Nei Jing (黄帝内经) as well as later texts such as Danxi’s Experiential Therapy (丹溪心法). In TCM context, “Fei Zhang” (which we now understand to include COPD) is considered a deficiency syndrome that is often also associated with phlegm and blood stasis. This is referenced in olden texts such as Jingyuequanshu《景岳全书》and Yilingaicuo《医林改错》.“Fei Zhang” is described to present with breathlessness and cough, and Zhubingyuanhoulun 《诸病源候论》 further describes 2 states, an active and a quiet state, which corresponds to the acute exacerbation and stable stages of COPD.

A few Chinese formulas and herbs have been studied extensively in regards to COPD. One of the most common formulas used is Yupingfengsan (玉屏风散), a traditional Chinese medicine formula, comprising 3 herbs, Astragalus Radix (黄芪), Rhizoma Atractylodes macrocephala (白术) and Radix saposhnikoviae (防风).  Yupingfengsan has been well studied and has shown to possess both pro- and anti-inflammatory effects in cultured macrophages. Research has shown that it is able to repress inflammatory response both in COPD rat model and cigarette smoke extract (CSE)-treated human lung bronchial epithelial line Beas-2B cells in vitro via the TGF-β1/Smad2 signaling pathway. Yupingfengsan was shown to reduce TGF-β1, Smad2 and Collagen I which are important proteins in TGFβ1/Smad2 signal transduction, blocking the TGF-β1/Smad conduction pathway, thereby inhibiting inflammatory factors and pulmonary inflammatory reactions.

We looked at research papers on TCM medication combined with western medication in treating stable phase COPD. Based on the results provided in each respective paper, the combination of TCM medication and western medication can reduce lung inflammation by decreasing the activation of antibodies. This led to significant improvement in patients’ lung functions (FEV%, FVC, FEV1), quality of life and the gravity of symptoms. Side effects of TCM medication seen in patients were mild to none. Even though there were no reports showing that the addition of TCM intervention worsened patient outcomes, but there were also papers reporting no significant difference in terms of clinical efficacy or improvement of lung function in COPD patients.

In conclusion, TCM medication combined with Western medicine can effectively control the stable phase of COPD and improve lung function and various clinical indicators. At the same time, there is no significant increase in the incidence of adverse reactions, hence it is an effective and safe adjuvant treatment. However, there were also flaws in the papers. Some papers did not cover Quality of Life findings, some papers did not report on Adverse Events, some papers did not report on Acute Exacerbations, and many lacked post treatment follow up, hence while overall results point towards the safety and efficacy of TCM in managing stable stage COPD, we are unable to effectively summarize the long-term efficacy of traditional Chinese medicine in treating COPD.

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