Chronic Obstructive Pulmonary Disease from a Traditional Chinese Medicine Perspective: Understanding the Root Causes and Holistic Insights

Chronic obstructive pulmonary disease (COPD), often mistakenly referred to as chronic obstructive emphysema, is a prevalent and persistent respiratory condition affecting millions worldwide. While modern medicine classifies it as a progressive lung disorder characterized by irreversible airflow limitation, Traditional Chinese Medicine (TCM) offers a unique and holistic perspective on its development and underlying causes.

Understanding COPD in Western vs. TCM Frameworks

In Western medical terms, COPD is primarily associated with long-term exposure to irritants such as cigarette smoke, air pollution, or occupational dust and chemicals. It encompasses conditions like chronic bronchitis and emphysema, leading to symptoms including persistent coughing, excessive mucus production, wheezing, and gradually worsening shortness of breath. However, TCM does not categorize diseases solely based on anatomical or pathological changes but rather through patterns of imbalance within the body's energetic systems.

The TCM Diagnosis: Lung Distention (Fei Zhang)

In Traditional Chinese Medicine, COPD falls under the diagnostic category known as "Fei Zhang," or lung distention. This term describes a pathological state where the lungs become chronically over-inflated and lose their ability to properly descend and regulate qi (vital energy). According to classical TCM theory, Fei Zhang typically arises from the prolonged progression of other chronic lung disorders—such as recurrent coughs, phlegm accumulation, or asthma—that are inadequately treated or frequently relapse over time.

This ongoing dysfunction impairs the normal movement of lung qi, which should descend and disperse smoothly. When this function is compromised, it leads to stagnation and upward rebellion of lung qi, manifesting clinically as chronic cough, sputum production, dyspnea (difficulty breathing), and reduced exercise tolerance. In more advanced stages, patients may experience cyanosis, fatigue, edema, and even cardiac complications due to the strain placed on the right side of the heart—a condition recognized in both modern medicine and TCM as cor pulmonale.

Root Causes According to TCM Etiology

TCM identifies several interrelated factors contributing to the development of lung distention:

1. External Pathogenic Invaders

Repeated invasions of external pathogens—particularly wind-cold or wind-heat—can damage the lung's defensive (wei) qi and impair its dispersing and descending functions. Over time, if these infections are not fully resolved, they can transform into internal phlegm-dampness, obstructing the airways and weakening lung resilience.

2. Spleen and Kidney Deficiency

The spleen plays a crucial role in transforming fluids and preventing phlegm formation. A weakened spleen due to poor diet, stress, or constitutional weakness can lead to excess dampness and phlegm accumulation, which then ascends to obstruct the lungs. Similarly, kidney yang deficiency—often resulting from aging or chronic illness—fails to anchor the incoming qi, exacerbating breathlessness, especially during physical exertion or at night.

3. Emotional and Lifestyle Factors

Chronic emotional stress, particularly grief and sadness, directly affects the lungs in TCM. These emotions can constrict the flow of qi and contribute to stagnation. Additionally, smoking, sedentary habits, and environmental exposures further deplete lung qi and promote inflammation and obstruction.

Progressive Nature and Clinical Manifestations

One of the hallmark features of COPD, whether viewed through a biomedical or TCM lens, is its progressive and irreversible nature. Early signs may be subtle—such as mild breathlessness during activity or occasional productive cough—but over time, symptoms intensify. Patients gradually lose stamina, require more frequent rest, and may eventually struggle with daily tasks due to oxygen deprivation.

From a TCM standpoint, this progression reflects a deepening pattern of deficiency and excess: deficient lung, spleen, and kidney qi coexist with excess phlegm, fluid retention, and stagnant qi and blood. This complex interplay underscores the importance of early intervention and personalized treatment strategies that go beyond symptom management.

Toward Integrated Care and Prevention

While modern treatments focus on bronchodilators, steroids, and oxygen therapy, TCM emphasizes restoring balance through herbal formulas, acupuncture, dietary therapy, and qigong exercises. Approaches like using herbs to resolve phlegm, tonify the spleen and kidneys, and regulate lung qi have shown promise in improving quality of life and slowing disease progression.

Ultimately, understanding COPD through the lens of Traditional Chinese Medicine provides valuable insights into its root causes and encourages a more comprehensive, preventive, and patient-centered approach to care—one that aligns well with growing global interest in integrative and functional medicine.