I. Anatomy, Physiology, and Pathology

I. Anatomy, Physiology, and Pathology
Chronic bronchitis (commonly referred to as chronic bronchitis) refers to chronic non-specific inflammation of the tracheal and bronchial mucosa and surrounding tissues. Clinically, it is mainly characterized by long-term cough, sputum production, or accompanied by wheezing. This disease is one of the common and frequently occurring illnesses in China, with the onset age mostly above 40. As age increases, the incidence gradually rises, reaching as high as 15% or more in those over 50. Smokers are significantly more likely to develop the disease than non-smokers, and it often recurs when the weather turns cold. Early symptoms are mild and easily overlooked, but once the condition progresses and develops into obstructive emphysema or even cor pulmonale, the treatment effect is often poor. Therefore, early prevention and control of chronic bronchitis are of great importance.
II. Western Medical Diagnosis and Treatment (---) Clinical Diagnosis
At the National Clinical Conference on Chronic Bronchitis in November 1979, the diagnostic criteria for chronic bronchitis were discussed and formulated:
(1) Clinically, the main symptoms are cough and sputum production, or wheezing, with episodes lasting for 3 months each year and continuing for 2 years or more.
(2) Other diseases that can cause cough, sputum production, or wheezing must be ruled out (such as pulmonary tuberculosis, pneumoconiosis, lung abscess, heart disease, cardiac insufficiency, bronchiectasis, bronchial asthma, chronic nasopharyngeal diseases, etc.).
(2) Western Medical Treatment
(1) Quit smoking or avoid smoke irritation.
(2) During acute attacks, patients may have severe coughing, increased purulent sputum, or fever and worsening shortness of breath; they should rest appropriately and receive antibiotic treatment.
(3) For asthmatic-type chronic bronchitis with asthma symptoms, bronchodilators can be used.
(4) During the remission phase of chronic bronchitis, patients should avoid various pathogenic factors and enhance their body's resistance to disease to consolidate the therapeutic effect.
(5) Patients with dyspnea and emphysema can engage in respiratory muscle exercise.
(6) Patients with severe emphysema need oxygen therapy, either continuous or intermittent. Long-term low-flow oxygen therapy has been proven to improve quality of life and prolong survival. Indications for long-term oxygen therapy include: when the patient is conscious and at rest, the arterial blood oxygen partial pressure is between 55 and 59 mmHg, and the electrocardiogram shows a pulmonary p-wave or clinically there is right heart failure or hematocrit exceeds 55%.
III. Professor Pei Zhengxue’s Way of Thinking
Chronic bronchitis is mainly characterized by cough, sputum production, and wheezing. The “Plain Questions · On Cough” has systematically discussed the symptom of cough: “The Yellow Emperor asked: What causes coughing in the lungs? Qi Bo replied: All five viscera and six bowels can cause coughing, not just the lungs... The skin and hair are the union of the lungs; the skin and hair are the first to be invaded by pathogenic factors, and the pathogenic factors enter through this union.” Liu Hejian said: “Cold, heat, dryness, humidity, wind, and fire—these six qi can all cause coughing.” Zhang Jingyue also said: “The real manifestation of asthma is that the pathogenic factor resides in the lungs; the pathogenic factor in the lungs is either wind-cold or fire-pathogen.” The “Danxi Heart Method” states: “When the lungs swell and cough, whether on the left or right side, one cannot sleep; this is because phlegm mixed with blood stasis obstructs the flow of qi and causes illness.” The “Blood Disorder Treatise” says: “The human airway must not be blocked; if there is blood stasis inside, it will obstruct the airway and prevent the ascent and descent of qi, thus causing cough... It should be known that the obstruction of phlegm and water is caused by blood stasis, but if the blood stasis is removed, the phlegm and water will naturally dissipate.” Professor Pei Zhengxue points out that the causes of the disease are nothing but “external invasion” and “internal injury,” closely related to phlegm and blood stasis. External invasion is most closely related to cold weather and sudden climate changes, which affect the onset and fluctuation of the disease. The lungs govern qi and breathing; lung qi flows downward in a clear and pure manner, which can regulate the waterways as the source of water; the lungs also promote the outward release of qi and are connected to the skin and hair; they open the nasal passages. If lung qi is weak, the body’s defense against external pathogens is not strong, and external pathogens easily invade through the nose or body surface, entering the lungs internally; then the lung qi cannot be released or descend properly, and lung qi reverses upward, causing cough and wheezing. Internal factors, especially dysfunction of the three organs—the lungs, spleen, and kidneys—are extremely closely related. Ancient scholars once said: “Coughing originates from the lungs,” “The spleen is the source of phlegm, and the lungs are the reservoir of phlegm,” “The lungs are the master of qi, and the kidneys are the root of qi,” “Coughing occurs in the lungs, but its root lies in the kidneys.” If the spleen is weak and unable to function properly, water and dampness accumulate inside, forming phlegm. Spleen weakness leads to phlegm formation, which then seeps into the lungs and causes cough and wheezing. If kidney yang is deficient and unable to warm the spleen, water spreads everywhere, forming phlegm and drink that invades the lungs (water-drink invading the lungs), resulting in cough and sputum. “Phlegm and blood stasis share the same origin”; dysfunction of the three organs—the lungs, spleen, and kidneys—will inevitably lead to dysfunction of the triple burner’s qi transformation function, blockage of qi flow, stagnation of qi and blood, and qi stagnation combined with blood stasis, causing cough. “Long-term illness enters the meridians” and the lungs’ ability to govern all the veins means that any dysfunction in the lungs’ ascending and descending functions will affect the normal flow of blood, leading to phlegm and blood stasis. Phlegm and blood stasis are intertwined, becoming the root cause of chronic bronchitis, which repeatedly flares up and never fully heals. IV. Traditional Chinese Medicine Syndrome Differentiation and Prescription
(---) Acute Phase

1. Wind-Cold Syndrome
   Symptoms: Cough, shortness of breath, throat itch, thin white sputum or foamy sputum, chills, no sweat despite fever, possibly accompanied by headache, limb soreness, nasal congestion, clear runny nose, and sneezing. Tongue coating is thin and white, pulse is floating and tight.
   Treatment Principle: Disperse wind and cold, stop cough and transform phlegm.
   Prescription: Ephedra and Cinnamon Twig Decoction combined with Xiao Qinglong Decoction, with modifications.

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Ephedra 10g, Cinnamon Twig 12g, Apricot Kernel 10g, Gypsum 10g, White Peony Root 15g, Notopterygium 12g, Angelica Pubescens 12g, Angelica Dahurica 6g, Asarum 3g, Pinellia 10g, Dried Ginger 6g, Schisandra 6g, Licorice 6g. 2. Wind-Heat Syndrome Symptoms: Frequent and severe coughing, coarse breathing or hoarse cough, dry throat and sore throat, unsatisfactory expectoration, sticky or thick yellow sputum, sweating during coughing, dry mouth, sore throat, yellow nasal discharge or accompanied by fever, sweating, headache, aversion to wind, dry stools and yellowish-red urine. Tongue coating is thin and yellow, pulse is floating and rapid or floating and slippery. Treatment principle: Clear heat and disperse lung qi, transform phlegm and stop coughing. Prescription: Modified Ma-Xing-Shi-Gan Decoction, Huangyu Erma Zao Tang combined with Sangju Yin. Ephedra 10g, Apricot Kernel 10g, Gypsum 30g, Scutellaria 10g, Houttuynia 15g, Honeysuckle 15g, Asarum 10g, Mulberry Leaf 10g, Chrysanthemum 10g, Peppermint 6g, Forsythia 15g, Platycodon 15g, Apricot Kernel 10g, Reed Rhizome 15g, Licorice 6g. (2) Chronic Protracted Phase

1. Lung-Spleen Deficiency Symptoms: Cough, shortness of breath and dyspnea, weak and low voice, feeble cough, thin and watery sputum, shortness of breath after exertion, spontaneous sweating, aversion to wind, copious sputum, chest tightness and distension, bland taste and poor appetite, loose stools, tongue body pale red or pale and plump, white greasy or white slippery coating, pulse fine and weak or fine and rapid. Treatment principle: Strengthen spleen and tonify lung, replenish qi and nourish yin. Prescription: Xiangsha Liujunzi Decoction, Erchen Decoction, Shengmai Powder combined with Yangyin Qingfei Decoction. Agarwood 6g, Amomum 10g, Pinellia 6g, Tangerine Peel 6g, Codonopsis 10g, Poria 12g, Atractylodes 10g, Licorice 6g, Ophiopogon 10g, Schisandra 3g, Rehmannia 12g, Scrophularia 10g, Fritillaria 10g, White Peony Root 10g, Moutan Bark 6g.
2. Spleen-Kidney Deficiency Symptoms: Long-standing cough and asthma, shortness of breath and fatigue, often feeling that breath is insufficient for rest, poor appetite. In cases of kidney yin deficiency, there is dry throat and dry mouth, five-center vexation and heat, sticky sputum that is hard to cough up, red tongue with little coating, or even a smooth, bare tongue without coating, pulse fine and rapid; in cases of kidney yang deficiency, there is aversion to cold and cold limbs, soreness and weakness in the lower back and knees, frequent nocturnal urination, loose stools. The tongue is plump and pale, or dark purple with ecchymoses, white or white slippery coating, pulse deep, fine and weak. Treatment principle: Strengthen spleen, tonify lung and nourish kidney, consolidate qi and strengthen foundation. Prescription: Liuwei Dihuang Decoction combined with Dingchuan Decoction, with modifications. Rehmannia 12g, Chinese Yam 10g, Cornus Fruit 15g, Alisma 10g, Poria 12g, Moutan Bark 6g, Ginkgo 10g, Ephedra 10g, Farfara 10g, Pinellia 6g, Mulberry Bark 10g. For kidney yin deficiency, add Ophiopogon and Schisandra to nourish yin and moisten the lungs, generate fluids and stop coughing, replenish qi and generate fluids, contract the lungs and nourish the kidneys; for kidney yang deficiency, add Cinnamon Twig and processed Aconite to warm and tonify kidney yang. During the clinical remission phase, symptoms are mainly due to deficiency of lung, spleen and kidney qi, such as shortness of breath, fatigue, poor appetite, etc. The condition is relatively stable, and the pathogenesis is mostly deficiency with less excess. The main focus is on reinforcing the body's vital energy and consolidating the foundation. Treatment should focus on replenishing qi and tonifying kidney, warming yang and strengthening spleen, often using Erchen Decoction, Shengmai Powder, Yupingfeng Powder, Xiangsha Liujunzi Decoction, Buzhong Yiqi Decoction, Liuwei Dihuang Decoction with modifications. V. Analysis of Professor Pei Zhengxue’s Prescriptions Professor Pei Zhengxue, based on clinical observations from ancient and modern medical practitioners as well as modern medical literature, points out that the causes of chronic bronchitis are essentially limited to “external invasion” and “internal injury,” closely related to phlegm and blood stasis. When diagnosing and treating, it is important to carefully distinguish between excess pathogenic factors and deficiency of vital energy; when pathogenic factors are dominant, the primary focus should be on eliminating them. At the same time, considering the high altitude, cold climate, and dry conditions of Northwest China, he proposed the theory that the pathogenesis of chronic bronchitis in this region during the acute phase is “wind-cold onset, alternating dryness and dampness, followed by transformation into fire.” In clinical practice, prescriptions such as Xingsu San, Maxing Shigan Tang, Sangju Yin, Xiaoqinglong Tang, Zhousou San, Erchen Tang, Huangyu Erma Zao Tang, etc., are commonly used. Among these, Xingsu San combined with Maxing Shigan Tang with modifications (Apricot Kernel 10g, Perilla Leaf 10g, Tangerine Peel 6g, Pinellia 6g, Frontal Parsley 10g, White Frontal Parsley 10g, Poria 12g, Platycodon 20g, Citrus Aurantium 10g, Pear Peel 20g, Ephedra 10g, Gypsum 30g, Licorice 6g) are most frequently prescribed. In this formula, Apricot Kernel has a mild warming property, while Perilla Leaf is pungent and warm; the former focuses on moistening the lungs and stopping cough, while the latter aims to dispel wind-cold, both serving as principal herbs. Erchen Tang is added to warm and transform phlegm and dampness as an adjunct treatment, then Frontal Parsley is added to descend qi and Platycodon to lift qi, so that the flow of qi becomes unobstructed, plus Ephedra to dispel cold, Gypsum to clear heat, and Pear Peel to generate fluids—these herbs together achieve the effect of warming and dispersing cold-dampness, moistening the lungs and transforming phlegm. Additionally, there is the Ma-Gui combination for wind-cold onset (Ephedra 10g, Cinnamon Twig 10g, Apricot Kernel 10g, Gypsum 30g, Chuanxiong 6g, Angelica Dahurica 6g, Asarum 3g, Notopterygium 10g, Angelica Pubescens 10g, Ledebouriella 12g, Licorice 6g), which is adjusted according to clinical needs. For patients with wind-cold symptoms such as chills, fever, generalized body pain, pale tongue with white coating, and floating, tight pulse, add Cinnamon Twig 10g, Notopterygium 12g, and a small amount of scallion white; if there is also chills and body pain, persistent coughing, and a floating, slow pulse, indicating wind-cold obstructing the surface and internal dampness, add Jingjing 10g, Bai Bu 10g, and Zi Bi 10g to the original formula; if wind-cold enters the interior and transforms into heat, with phlegm-heat congesting the lungs, symptoms include yellow, thick, or foul-smelling sputum, and fever, then add Mulberry Bark 15g, Lycium Bark 15g, and Houttuynia 15g to the original formula; for sore throat, add Honeysuckle 15g, Forsythia 15g, Dandelion 15g, and Bidens 15g; for hemoptysis, add Flower Stone 15g, Raw Hematite 15g, and Three Seven 3g (to be taken separately); for dry throat