Traditional Chinese Medicine for Chronic Obstructive Pulmonary Disease: Treatment Strategies, Clinical Evidence, and Mechanistic Insights

Chronic obstructive pulmonary disease (COPD) is a prevalent, preventable, and treatable chronic airway disease associated with high morbidity, mortality, and global burden. For this review, we searched PubMed, Web of Science, and major Chinese academic databases for clinical and mechanistic studies of traditional Chinese medicine (TCM) interventions for COPD, emphasizing evidence relevant to the stable phase, acute exacerbation phase, and first 8 weeks after an exacerbation, termed the acute exacerbation of COPD (AECOPD) risk window phase. Evidence from randomized trials and evidence syntheses indicates that adjunctive herbal formulae, Chinese patent medicines, acupuncture, moxibustion, acupoint-based interventions, and traditional Chinese exercise therapy may improve symptoms, 6-minute walking distance (6MWD), pulmonary-function indices, quality of life, and selected exacerbation-related outcomes. Multicenter trials have also reported benefits of syndrome-based sequential treatment during acute exacerbation and the subsequent risk window. Mechanistic studies suggest coordinated regulation of inflammatory and oxidative-stress pathways, immune homeostasis, epithelial-barrier integrity, mucus hypersecretion, apoptosis, and airway remodeling. However, confidence in these findings is limited by heterogeneous syndrome definitions and intervention protocols, small samples, incomplete blinding and allocation reporting, and insufficient long-term follow-up. Future research should prioritize standardized diagnostic criteria and outcomes, rigorously designed multicenter trials, and translational studies that link in vivo active substances and molecular targets to clinically meaningful outcomes. Graphical Abstract: https://links.lww.com/AHM/A238