Respiratory & Immunity TCM | Dr. Zhang Huiyong (TCM Pulmonology) | CMCS Shanghai

About Dr. Zhang Huiyong

Dr. Zhang Huiyong is a pulmonary specialist at Shanghai Municipal Hospital of Traditional Chinese Medicine — one of China's foremost centres for integrative respiratory medicine and a national reference institution for the TCM management of chronic obstructive pulmonary disease, asthma, and post-COVID respiratory recovery. He is recognised for his expertise in classical herbal prescriptions for lung and kidney deficiency patterns, acupuncture-based immune modulation, and the integration of modern pulmonary function diagnostics into TCM respiratory practice. Dr. Zhang is a leading voice in TCM-based immune modulation research, with a particular focus on the mechanisms through which Lung-Kidney tonification formulae restore immunoglobulin levels and reduce exacerbation frequency in stable COPD. His clinical philosophy holds that COPD management in the stable phase is not merely about bronchodilation — it is about restoring the constitutional integrity of the Lung-Kidney axis, resolving the Phlegm-Stasis that obstructs the airways, and consolidating the Wei Qi that protects the patient from the recurrent respiratory infections that drive disease progression. His department has established one of Shanghai's most comprehensive integrative pulmonary rehabilitation programmes, combining classical herbal therapy, acupuncture, acupoint application, and structured respiratory and exercise rehabilitation into a unified care pathway for patients with stable COPD and immune compromise.

Case Overview

Mr. George Harrington (pseudonym), a 65-year-old British retired worker based in Shanghai, presented with a ten-year history of COPD — cough, productive sputum, and exertional dyspnoea — significantly worsened over the preceding year with markedly increased susceptibility to upper respiratory infections, each of which produced prolonged exacerbations with extended recovery. Pulmonary function confirmed moderate COPD (GOLD Stage 3; post-bronchodilator FEV₁/FVC <70%; FEV₁ 45% predicted). Immunological workup demonstrated lymphopenia and reduced IgG and IgA — immune compromise confirmed. TCM diagnosis identified Lung Distension — Lung-Kidney Qi Deficiency with Phlegm-Stasis Obstructing the Lung. Dr. Zhang Huiyong designed an integrative programme combining optimised Western pharmacotherapy (salmeterol/fluticasone, ambroxol, thymopentin) with classical herbal prescription (Bufeiyishen Tang combined with Xuefu Zhuyu Tang, modified), cycle-phase acupuncture, summer acupoint application (Sanfu Tie), and structured pulmonary rehabilitation. At three-month follow-up, FEV₁ had improved to 55% predicted, IgG and IgA had normalised, and symptoms had resolved. Over one year of follow-up, only one mild upper respiratory infection occurred with no COPD exacerbation.

Patient Background

• Name / Nationality: Mr. George Harrington (pseudonym) — British; 65-year-old retired worker based in Shanghai
• Age / Sex: 65-year-old male
• Chief Complaint: Recurrent cough, productive sputum, and dyspnoea for over ten years; worsened with increased susceptibility to upper respiratory infections for one year
• Smoking history: Approximately 40 cigarettes per day for over 30 years; cessation status not documented at presentation
• History of present illness: Cough and white viscid sputum with exertional and morning dyspnoea for over ten years; symptoms worsening in winter; COPD diagnosed at multiple hospitals; bronchodilators and inhaled corticosteroids prescribed with partial and temporary symptom control. Over the preceding year: progressive worsening of dyspnoea with significant restriction of daily activities; markedly increased frequency of upper respiratory infections; each infection producing pronounced exacerbation of cough, sputum, and dyspnoea with prolonged recovery
• Past medical history: No hypertension, diabetes, or coronary artery disease; no surgery or trauma; no drug allergies
• TCM four examinations:
  • Inspection: Sallow, dusky complexion; cyanotic lips; emaciated build; barrel chest; tachypnoea; pale dark tongue; white greasy coating
  • Auscultation/olfaction: Heavy cough; copious sputum; coarse breath sounds with scattered rhonchi and crackles
  • Inquiry: Cough with white viscid sputum difficult to expectorate; dyspnoea and fatigue markedly worsened by exertion; aversion to cold; cold extremities; spontaneous perspiration; anorexia; loose stools 2–3 times daily
  • Palpation: Deep, thready, forceless pulse (沉细无力脉)

Diagnostic Workup

Pulmonary Function Testing

• Post-bronchodilator FEV₁/FVC <70%; FEV₁ 45% predicted — moderate COPD confirmed (GOLD Stage 3)

Chest X-Ray / CT

• Bilateral increased bronchovascular markings; increased lung field lucency; bullae present — imaging consistent with COPD

Full Blood Count

• White cell count normal; lymphocyte count reduced — lymphopenia consistent with immune compromise

Immunoglobulin Panel

• IgG and IgA both below normal range — humoral immune deficiency confirmed

Dr. Zhang's pre-treatment assessment: The pulmonary function tells us the severity of the obstruction — FEV₁ at 45% predicted is moderate-to-severe, and the trajectory over ten years of progressive decline is consistent with inadequately managed COPD. But the immunoglobulin panel is the finding that explains why this patient has deteriorated so markedly over the past year. The IgG and IgA are both below normal — the humoral immune system is failing. Every upper respiratory infection in a patient with this degree of airflow obstruction is a potential exacerbation, and every exacerbation accelerates the decline in lung function. In TCM, the deep, thready, forceless pulse and the barrel chest with cyanotic lips tell us the Lung and Kidney Qi are both severely depleted — the Lung cannot govern the Qi and the Kidney cannot receive it. The Wei Qi — the defensive Qi that protects the body from external pathogens — is derived from the Lung and rooted in the Kidney. When both are deficient, the Wei Qi is insufficient, and the patient becomes susceptible to every wind-cold pathogen that circulates in winter. The treatment must simultaneously open the airways, restore the Lung-Kidney Qi, resolve the Phlegm-Stasis, and consolidate the Wei Qi. That requires both Western pharmacotherapy and TCM constitutional treatment working together.

TCM Diagnosis and Integrative Treatment Strategy

The TCM diagnosis established by Dr. Zhang Huiyong was Lung Distension — Lung-Kidney Qi Deficiency with Phlegm-Stasis Obstructing the Lung (肺胀·肺肾气虚，痰瘀阻肺证). The corresponding Western diagnoses were stable COPD (GOLD Stage 3) and immune compromise.

The treatment principle was: tonify the Lung and benefit the Kidney; resolve Phlegm and dispel Stasis; support the Zheng Qi and consolidate the exterior (补肺益肾，化痰祛瘀，扶正固表).

Herbal prescription — Bufeiyishen Tang combined with Xuefu Zhuyu Tang, modified: Huangqi 30g, Dangshen 15g, Baizhu 12g, Fuling 15g, Shanyao 15g, Gouqizi 15g, Shudi 15g, Shanzhuyu 12g, Wuweizi 9g, Danshen 15g, Chishao 12g, Taoren 9g, Honghua 9g, Banxia 9g, Chenpi 9g, Gancao 6g. One decoction daily, taken warm in two divided doses. Rationale: Bufeiyishen Tang tonifies Lung and Kidney Qi simultaneously — Huangqi and Dangshen tonify the Lung Qi and Wei Qi; Shudi, Shanzhuyu, and Gouqizi nourish the Kidney Yin and essence that roots the Lung Qi; Wuweizi astringes the Lung and prevents Qi leakage. Xuefu Zhuyu Tang activates Blood and resolves the Phlegm-Stasis that obstructs the airways. Banxia and Chenpi resolve Phlegm and regulate Qi in the Lung.

Acupuncture: Primary points: Feishu (BL 13), Shenshu (BL 23), Dingchuan (EX-B 1), Danzhong (CV 17), Zusanli (ST 36), Fenglong (ST 40). Supplementary points by symptom: severe cough — Chize (LU 5) and Lieque (LU 7); copious sputum — Yinlingquan (SP 9) and Tiantu (CV 22); marked dyspnoea — Qihai (CV 6) and Guanyuan (CV 4). Technique: oblique needling at back-shu points (Feishu, Shenshu, Dingchuan) to 0.5–1 cun; perpendicular needling at abdominal and limb points to appropriate depth; reinforcing or even method after arrival of Qi; 30-minute retention; daily treatment six days per week.

Acupoint application — Sanfu Tie (Three Dog-Day Application): Herbal paste prepared from Baijiezi, Yanhusuo, Gansui, and Xixin, ground fine and mixed with fresh ginger juice to form a paste; formed into 1 cm diameter medicinal discs. Applied to Feishu (BL 13), Xinshu (BL 15), and Geshu (BL 17) during the three Sanfu periods of summer (the hottest days of the lunar calendar); each application retained 4–6 hours; applied once every ten days for three applications per summer. Rationale: the Sanfu Tie protocol exploits the peak Yang Qi of summer to penetrate warming and tonifying herbs through the acupoints into the Lung and Kidney channels, consolidating Wei Qi and reducing susceptibility to winter respiratory infections — the classical principle of “treating winter disease in summer” (冬病夏治).

Western pharmacotherapy: Bronchodilator: salmeterol/fluticasone dry powder inhaler (Seretide) 50μg/250μg, one inhalation twice daily. Mucolytic: ambroxol hydrochloride 30 mg three times daily. Immune modulator: thymopentin 10 mg subcutaneous injection on alternate days to restore T-lymphocyte function and immunoglobulin production.

Pulmonary rehabilitation: Pursed-lip breathing: nasal inhalation with pursed-lip exhalation at 2–3:1 exhalation-to-inhalation ratio; 10–15 minutes per session, 3–4 times daily. Diaphragmatic breathing: supine or semi-recumbent; nasal inhalation with abdominal rise; oral exhalation with abdominal contraction; 10–15 minutes per session, 3–4 times daily. Exercise training: individualised aerobic programme — walking and Tai Chi; 30–60 minutes per session, 3–5 times weekly; intensity calibrated to mild perspiration without fatigue.

Treatment Course and Outcomes

At One Month

• Cough and sputum significantly reduced; sputum more easily expectorated; dyspnoea improved; activity tolerance increased
• Lymphocyte count normalised on repeat full blood count

At Three Months

• Cough, sputum, and dyspnoea essentially resolved; daily activities unrestricted
• Pulmonary function: FEV₁ improved to 55% predicted — clinically meaningful improvement of 10 percentage points
• Immunoglobulin panel: IgG and IgA both normalised — humoral immune function restored

One-Year Follow-Up

• Only one upper respiratory infection over twelve months — mild, rapidly resolved with simple treatment; no COPD exacerbation
• Quality of life significantly improved; patient highly satisfied with treatment outcome

Dr. Zhang's clinical reflection: The FEV₁ improvement from 45% to 55% predicted is a result that bronchodilator therapy alone rarely achieves in stable COPD — bronchodilators improve symptoms and reduce exacerbation risk, but they do not typically produce meaningful improvements in FEV₁ in established moderate-to-severe disease. The improvement in this patient reflects genuine changes in the airway environment — reduced Phlegm-Stasis obstruction, improved mucociliary clearance, and reduced airway inflammation — that the herbal formula and acupuncture contributed to alongside the pharmacotherapy. The immunoglobulin normalisation is equally significant: the thymopentin addressed the T-lymphocyte deficiency, but the Lung-Kidney tonification formula supported the constitutional recovery that allowed the immune system to restore its own IgG and IgA production. One upper respiratory infection in twelve months, compared with the near-monthly infections of the preceding year — that is the outcome that matters most to this patient.

Expert Commentary — Dr. Zhang Huiyong

1. The Lung-Kidney Axis in COPD: Why Constitutional Tonification Changes the Disease Trajectory

In TCM, the Lung and Kidney are functionally inseparable in the governance of respiration: the Lung governs the Qi and controls inhalation; the Kidney receives the Qi and anchors it in the lower body. In healthy respiration, the Lung descends the Qi and the Kidney grasps it — producing the deep, effortless breathing that characterises normal pulmonary function. In COPD, the progressive destruction of alveolar tissue and the increasing airflow obstruction represent, in TCM terms, the progressive failure of the Lung to govern the Qi and the Kidney to receive it — producing the barrel chest, the pursed-lip breathing, and the exertional dyspnoea that are the clinical hallmarks of advanced disease. The Wei Qi — the defensive Qi that circulates in the exterior and protects against external pathogens — is produced by the Lung from the food essence provided by the Spleen, and is rooted in the Kidney Yang. When both Lung and Kidney are deficient, the Wei Qi is insufficient, and the patient becomes susceptible to recurrent respiratory infections — each of which, in a patient with established airflow obstruction, risks triggering an acute exacerbation that accelerates the decline in lung function. Tonifying the Lung-Kidney axis with Huangqi, Dangshen, Shudi, Shanzhuyu, and Wuweizi does not reverse the structural damage of COPD — but it restores the constitutional capacity to resist infection, recover from exacerbations, and maintain the residual lung function that remains. That is the difference between managing the disease and managing the patient.

2. Sanfu Tie: The Evidence for Treating Winter Disease in Summer

The Sanfu Tie protocol — acupoint application of warming herbal paste during the three hottest periods of the Chinese lunar calendar — is one of the most widely practised preventive interventions in TCM respiratory medicine, and one of the most extensively studied. The classical rationale is the principle of “treating winter disease in summer” (冬病夏治): respiratory diseases that exacerbate in winter — COPD, asthma, recurrent bronchitis — are driven by underlying Yang deficiency and Wei Qi insufficiency; the peak Yang Qi of the Sanfu period provides the optimal biological environment for warming and tonifying interventions to penetrate deeply into the Lung and Kidney channels through the back-shu acupoints, consolidating the Wei Qi before the winter season arrives. The modern evidence base for Sanfu Tie in COPD is now substantial: multiple randomised controlled trials and systematic reviews have demonstrated that Sanfu Tie reduces the frequency and severity of acute exacerbations, improves pulmonary function indices, reduces inflammatory markers including IL-6 and TNF-α, and improves quality of life scores in stable COPD patients compared with sham application and no-treatment controls. The herbal components — Baijiezi, Gansui, and Xixin — have demonstrated bronchodilatory, anti-inflammatory, and immunomodulatory effects in pharmacological studies, providing a mechanistic basis for the clinical outcomes observed in the trials.

3. Immune Modulation in COPD: The Convergence of TCM Wei Qi Theory and Modern Immunology

The immune compromise observed in advanced COPD — reduced lymphocyte counts, impaired immunoglobulin production, and defective mucociliary clearance — is not a coincidental comorbidity but an integral feature of the disease. Chronic systemic inflammation, corticosteroid exposure, malnutrition, and physical deconditioning all contribute to the progressive immune dysfunction that makes COPD patients susceptible to recurrent respiratory infections and the exacerbations they trigger. In TCM, this immune compromise is understood as Wei Qi deficiency — the failure of the Lung-Kidney axis to produce and circulate the defensive Qi that protects the exterior. The convergence between TCM Wei Qi theory and modern immunology is not merely metaphorical: Huangqi — the primary Wei Qi-tonifying herb in the formula — has been shown in multiple clinical and laboratory studies to increase natural killer cell activity, enhance T-lymphocyte proliferation, stimulate immunoglobulin production, and upregulate interferon-γ expression. Wuweizi has demonstrated immunomodulatory effects through its action on the hypothalamic-pituitary-adrenal axis, reducing the cortisol-mediated immune suppression that contributes to lymphopenia in chronic disease. The combination of thymopentin — which directly stimulates T-lymphocyte maturation — and the Lung-Kidney tonification formula — which restores the constitutional substrate for immune function — produced immunoglobulin normalisation that neither intervention alone would have achieved as efficiently.

How CMCS Shanghai Coordinated This Case

CMCS Shanghai supported Mr. Harrington and his family from initial consultation through one-year follow-up, including: priority appointment coordination with Dr. Zhang Huiyong at Shanghai Municipal Hospital of Traditional Chinese Medicine with bilingual review of all prior pulmonary records, spirometry reports, and medication history; bilingual interpretation throughout all TCM four-examination consultations, integrative treatment planning discussions, and Western pharmacotherapy review sessions; coordination of pulmonary function testing, chest CT, full blood count, and immunoglobulin panel with bilingual results communication and clinical summary for the patient's respiratory physician in the UK; bilingual pharmacy support for herbal decoction preparation, inhaler technique instruction, and thymopentin injection schedule; Sanfu Tie application coordination with bilingual explanation of the classical rationale and application protocol; pulmonary rehabilitation programme coordination — bilingual instruction for pursed-lip breathing, diaphragmatic breathing, and exercise training with weekly progress monitoring; three-month pulmonary function and immunoglobulin reassessment with bilingual comparative results report; and one-year follow-up comprehensive respiratory summary provided to the patient's GP and respiratory physician overseas.

For international patients with COPD, asthma, post-COVID respiratory impairment, or immune compromise seeking integrative TCM pulmonary care in Shanghai, Dr. Zhang Huiyong's team at Shanghai Municipal Hospital of Traditional Chinese Medicine offers a clinically rigorous, evidence-informed approach — combining classical Lung-Kidney tonification, Phlegm-Stasis resolution, acupoint application, and structured pulmonary rehabilitation to restore respiratory function and immune resilience. CMCS ensures that expertise is accessible: in the patient's language, with overseas physicians informed at every step, from the first integrative consultation through long-term follow-up.

This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.