Traditional Chinese medicine believes that this disease falls under the categories of "cough," "pleural fluid retention," "thoracic fluid retention," and "lung distension." It is often caused by lung deficiency leading to weak defense against external pathogens, repeated invasions of external evils, or prolonged untreated conditions, resulting in the retention of phlegm and turbidity. When lung qi fails to disperse and descend properly, it rises and causes coughing and wheezing. If fluid accumulates in the chest and ribs, it leads to "pleural fluid retention." If fluid invades the chest and lungs, it results in "thoracic fluid retention." If lung deficiency affects the kidneys, and the lungs fail to dominate qi, the kidneys cannot receive qi, leading to panting and shortness of breath that worsens with activity. If the disease persists and affects the heart, it may eventually lead to the decline of heart and kidney yang, presenting critical symptoms such as respiratory failure.

bubble_chart Modern Research

Diffuse fibrosing alveolitis is a non-specific diffuse lung disease primarily caused by abnormal immune function of the body and influenced by multiple factors. Its clinical manifestations are characterized by symptoms such as fever, cough, purulent sputum, chest tightness, and dyspnea. Based on its clinical features and pathological changes, it is generally classified into acute (or subacute) and chronic types.

Modern medicine believes that the occurrence of this disease is related to immune abnormalities in the body. Patients exhibit increased serum immunoglobulins, and some develop autoantibodies with lymphocyte and plasma cell infiltration in the alveolar interstitium; immunofluorescence antibody tests of lung tissue show antigen-antibody complex deposits in the alveolar walls and interstitium; IgG levels in bronchial secretions are significantly elevated. This disease is effectively treated with glucocorticoids or immunosuppressants. The pathological changes mainly involve alveolar epithelial injury, leading to infiltration of various cells such as lymphocytes, plasma cells, macrophages, and eosinophils due to the nature of the triggering substances; chronic cases form nodules and diffuse fibrotic tissue proliferation; in the late stage [third stage], due to alveolar septal necrosis, fibrosis, and destruction of alveolar structure, focal lung qi swelling and honeycomb lung develop.

1. History includes long-term, repeated exposure or infection with various allergens in living or working environments, or a family history of primary interstitial pneumonia.
2. Symptoms mainly include fever, cough, expectoration of purulent sputum, chest tightness, slight hemoptysis, dyspnea after exercise, and even cyanosis and clubbing of fingers. Chest examination may reveal crackles and dry rales in both lungs.
3. Laboratory tests of blood and fluids may show increased immunoglobulins IgG, IgA, IgM; positive rheumatoid factor and antinuclear antibodies; positive C-reactive protein.
4. Imaging studies in the acute or subacute phase may resemble bronchopneumonia, while in the late stage [third stage], there is thickening of cord-like lesions and the appearance of honeycomb-like small lucent areas. If the heart is involved, signs of cor pulmonale may be present.

bubble_chart Pattern Analysis

1. External Pathogen Invading the Lung︰Fear of cold, fever, cough, thick and sticky phlegm, chest tightness, and shortness of breath. Red tongue with thin coating, floating pulse. Disperse wind and dissipate pathogens, ventilate the lung and relieve cough. Modified Mulberry Leaf and Chrysanthemum Decoction. Mulberry Leaf 12g, Chrysanthemum Flower 10g, Mentha 10g, Forsythia 12g, Bitter Apricot Seed 12g, Platycodon Root 10g, Reed Rhizome 12g, Liquorice Root 5g, Peucedanum 15g, Great Burdock Achene 20g. For severe lung heat, add Skullcap Root 10g and Heartleaf Houttuynia Herb 12g; for thick and difficult-to-expectorate phlegm, add Patrinia 12g and Trichosanthis Fruit peel 15g; for wind-cold fettering the lung, add Schizonepeta 10g, Saposhnikovia Root 12g, and Perilla Leaf 12g.
2. Retention of Fluid in the Chest and Hypochondrium︰Fever, fear of cold, distending pain in the chest and hypochondrium, profuse sputum with cough, aggravated pain when turning or breathing, fullness in the intercostal region, shortness of breath, rapid breathing. White greasy tongue coating, deep and wiry pulse. Drain the lungs and regulate qi, suppress cough and relieve asthma. Modified Pepperweed and Jujube Lung-Draining Decoction. Descurainiae Semen 20g, Chinese Date 7 pieces, White Mulberry Root-Bark 15g, Bupleurum 10g, Submature Bitter Orange 15g, Peony Root 10g, honey-fried Ephedra 10g, Bitter Apricot Seed 10g, Platycodon Root 10g. If the pathogen is excessive and healthy qi is not yet weakened, consider adding 3–5g of roasted Gansui Root powder (to be swallowed). If the exterior pattern has resolved or the patient has constitutional yang deficiency, reduce honey-fried Ephedra to 6g and add Asarum 6g.
3. Yin Exhaustion and Yang Collapse︰Persistent panting, lifting shoulders and retracting abdomen, cyanotic lips, blood-streaked sputum, dirty and restless face, cold limbs, beaded sweating, and tortuous sublingual veins. The pulse is floating, large, and rootless. Benefit yin and restore yang, astringe the lungs and secure collapse. Modified Shenfu Longmu Decoction combined with Hei Xi Dan. Ginseng 10g, prepared Aconite Lateral Root 10g (to be decocted first), raw Fossil Bone 30g (to be decocted first), raw Oyster Shell 30g (to be decocted first), Asiatic Cornelian Cherry Fruit 20g, Schisandra Fruit 15g, Hei Xi Dan 5g (to be taken with decoction). If cyanotic lips and tortuous sublingual veins are observed, add Salvia 20g, Chinese Angelica 10g, Sichuan Lovage Rhizome 15g; if thick and difficult-to-expectorate sputum is present, add Bile Arisaema 15g, fresh Bamboo Juice 20–30g (to be mixed and taken).
4. Lung Deficiency with Fluid Retention︰Cough, wheezing, chest fullness, shortness of breath, and even inability to lie flat, with copious white phlegm. Often triggered by cold, initially may be accompanied by aversion to cold, body aches, and other exterior patterns. Recurrent episodes of cough and wheezing often persist for years. Tongue coating is white and greasy, pulse wiry and tight. Warm the lung and resolve fluid retention, relieve wheezing, and stop cough. Modified Minor Green-Blue Dragon Decoction. Dried Ginger 10g, Asarum 6g, Pro Formula Pinellia 12g, Honey-fried Ephedra 10g, Cinnamon Twig 12g, Schisandra Fruit 6g, Platycodon Root 10g, Dried Tangerine Peel 10g, Bitter Apricot Seed 12g. If the exterior pattern has resolved or the patient has constitutional yang deficiency, remove Ephedra and add Poria 15g, Liquorice Root 5g. If there is excessive phlegm and severe wheezing, add Lepidium Seed 15g, White Mulberry Root-Bark 12g. If wheezing, chest fullness, restlessness, thirst, and yellow greasy tongue coating are present, remove Asarum, Cinnamon Twig, and Ephedra, and add Fourstamen Stephania Root 12g, Ginkgo Seed 10g.
5. Lung-kidney Qi Deficiency︰Chronic panting with prolonged duration, characterized by more exhalation and less inhalation, worsened upon exertion, weak and low coughing sounds, sweating on the forehead, fear of wind, emaciation, mental fatigue, and shortness of breath. The tongue appears pale with a thin coating, and the pulse is deep, thin, and weak. Treatment aims to nourish the lungs and relieve panting, while strengthening the kidneys to improve qi reception. Modified Pulse-Reinforcing Powder combined with Golden Chamber Kidney Qi Pill is prescribed. Ingredients include Ginseng 10g (simmered separately and mixed in), Ophiopogon Tuber 20g, Schisandra Fruit 20g, Unprocessed Rehmannia Root 12g, Asiatic Cornelian Cherry Fruit 20g, Alisma 12g, Moutan Bark 10g, Chinese Yam 20g, Poria 15g, Cassia Bark 10g, and Prepared Aconite Lateral Root 10g (decocted first). For cases with lung deficiency and cold, remove Ophiopogon Tuber and add Astragalus Root 20g and Dried Ginger 15g. For concurrent lung and spleen disorders with qi deficiency and sinking, add Cimicifuga Rhizome 10g, Bupleurum 10g, and Dried Tangerine Peel 12g. For insufficient kidney qi, add Psoralea 10g, Walnut Kernel 15g, and Tokay Gecko 5g (ground and swallowed). If accompanied by bluish-purple tongue and intermittent pulse, add Salvia 15g, Chuanxiong 10g, and Red Peony Root 10g. For upper excess and lower deficiency, add Cultivated Purple Perilla Fruit 20g, Pinellia 10g, and Aquilaria 10g.