Chronic obstructive pulmonary disease (COPD) is characterized by incomplete and reversible airflow obstruction, which progresses gradually to emphysema and respiratory failure. In the acute exacerbation phase, patients experience significantly increased dyspnea, cough and/or sputum, and increased inflammation, which can accelerate the deterioration of lung function and lead to serious complications and death if not treated effectively [1]. Therefore, effective intervention in AECOPD is the key to improve the prognosis of COPD patients. Current pharmacological treatments are still not able to slow down the decline of lung function and improve the mortality of COPD patients, because the pathogenesis of COPD is complex and many key pathogenic mechanisms and risk factors are not fully understood. [2,3] 1. Studies on the pathogenesis of COPD in Chinese and Western medicine The chronic inflammation and emphysema of the airways, lung parenchyma and vascular system of the lung in susceptible individuals due to various external pathogenic factors are the key mechanisms and characteristic pathological changes in the pathogenesis. The main manifestation is the increase of specific inflammatory cells in different parts of the lung tissue and the structural changes in the lung tissue due to repeated injury and repair [4].The causative factors and pathogenesis of COPD are quite complex,oxidative damage, lung inflammation, overproduction of airway mucus, protease anti-protease imbalance, immune imbalance are all part of the development of COPD, and the interaction between the organism and the environment Interaction is an important factor in the pathogenesis. In recent years, there have been new developments regarding the causes and mechanisms of its pathogenesis. Liu Jun [5] et al. concluded by meta-analysis that HP infection is closely related to COPD and that HP infection may be an important risk factor for COPD. This may be related to the fact that HP infection can significantly increase inflammatory factors in serum and alveolar lavage fluid of COPD model rats, aggravate inflammatory response and inflammatory damage of lung tissue, and lead to the decrease of lung function [6]. Ma Yingjun [7] concluded that blood glucose and lipid-related indicators were positively correlated with the progression of COPD patients after analyzing clinical cases. The incidence of abnormal glucose metabolism during acute exacerbation of COPD was as high as 24.7% [8]. Therefore, the glucolipid profile of certain COPD patients deserves high attention from clinicians. COPD belongs to the category of “pulmonary distension” in Chinese medicine. According to Chinese medicine, chronic pulmonary disorders are recurrent and persistent, with deficiency of the lung and retention of phlegm, the lung is not astringent and descending, the qi is returned to the lung, and the lung is distended. When the disease is prolonged and deep, lung deficiency cannot regulate the operation of heart and blood, then blood flow is astringent and stagnant, forming blood stasis. In the acute exacerbation period, the main symptoms are actual symptoms and deficiency symptoms, and the common clinical symptoms include external cold and internal drink, phlegm-heat congestion of the lung, phlegm-damp obstruction of the lung, phlegm-stasis obstruction of the lung, lung-quench deficiency, lung-kidney qi deficiency, lung-kidney yin deficiency, and lung-kidney qi-yin deficiency. In the clinical data of 1046 patients collected by Wang Zhiwan [10], the most frequent symptom was phlegm-heat congestion of the lung. However, since the disease is prolonged, phlegm stasis blocking the lung is also more common in clinical practice. 2, the advantages of combined Chinese and Western medicine treatment After a large number of literature and clinical research shows that the main cause of COPD acute exacerbation is due to viral infection or bacterial infection. Therefore, the anti-infection treatment of COPD is a crucial part. However, due to the massive application of antibiotics in clinical medicine, the resistance of some bacteria is increasing [11], and the global strategy promulgated by GOLD in 2011 also clearly states that “continuous prophylactic application of antibiotics is ineffective in AECOPD [12]”. In addition, traditional Chinese medicine treatment can regulate the dynamic balance of the body as a whole, with the advantages of multiple pathways, multiple targets, overall regulation, and fewer adverse effects [13]. For the various symptoms arising in the acute exacerbation of COPD, such as increased mucus secretion, shortness of breath, and cough, further results can be achieved by dialectical treatment to slow down the disease progression. Tang Tianzhong [14] used the combination of lung-clearing, phlegm-removing, and phlegm-eliminating soup with traditional Western medical treatment measures to treat AECOPD, and no adverse reactions such as allergy and liver and kidney damage were found in the patients during the treatment, indicating that the combination also has good safety features. At the same time, Chinese medicine treatment has the characteristic of “treating the symptoms when it is urgent, but treating the root cause when it is slow”, so Chinese medicine treatment can be complementary in the prevention and treatment of the disease and the consolidation of the righteousness. 3.1 Combination of Chinese and Western medicine treatment for AECOPD Antibacterial therapy is an important part of the treatment of AECOPD, but with the widespread use of antibiotics, the rise of bacterial resistance and changes in the pathogenic bacteria often make the treatment less than ideal, anti-infective sequential therapy may improve the situation, that is, patients after a period of intravenous antibiotic treatment, to stop intravenous antibiotics after stabilization. In other words, after a period of intravenous antibiotic treatment, the patient’s condition is stabilized and then the intravenous antibiotics are stopped and the treatment is continued with oral antibiotics of basically the same nature. Yi Juan [15] used moxifloxacin sequential therapy and found that moxifloxacin has better efficacy than levofloxacin in improving blood gas and lung function with fewer side effects, which is worth promoting in clinical practice. Clinically, nebulized inhalation is a commonly used treatment, which can effectively remove respiratory secretions and is an effective therapy to improve ventilation. Glucocorticoid sequential nebulized inhalation has significant efficacy and rapid recovery of lung function, however, there are numerous adverse effects such as diabetes, osteoporosis, mycobacterial infection, and elevated blood glucose [16,17]. Wang Ling [18] et al. found that nebulized inhalation of phlegm fever clear caused a rapid increase in drug concentration in the respiratory tract to achieve cough suppression, expectoration, and asthma. I believe that small doses of glucocorticoids added to herbal nebulized inhalation may have the effect of increasing the efficacy and reducing the production of adverse effects. The clinical application of a large number of antimicrobials kills the infecting bacteria and also promotes the excretion of endotoxins, especially in mixed infections. The concept of concurrent treatment of bacteria and toxins is increasingly accepted, but so far, no single antimicrobial agent has been found to have a safe neutralizing effect on endotoxins [19,20]. Han Xueying [21] concluded that hemiphil can effectively improve the clinical symptoms of patients with AECOPD combined with SIRS, can significantly shorten the mean hospital stay, and can improve blood gas indexes early. Since the acute exacerbation period is mostly characterized by phlegm-heat evidence, heat-clearing and phlegm-transforming methods should be actively used to dispel external evil and reduce symptoms as much as possible [22]. Li Binwu [23] et al. used clearing lung, resolving phlegm and dispelling stasis soup with western medicine to treat patients with acute exacerbation of chronic obstructive pulmonary disease with significant efficacy, and the decrease in D-dimer was significantly greater than that in the group treated with western medicine alone. The mechanism of action is mainly focused on several major aspects such as anti-airway hypersecretion, regulation of the balance of oxidative and antioxidant systems, regulation of immunity, reduction of pulmonary arterial pressure and hemodynamics. Dang Qiang [24] compared the use of Qing-He, Phlegm and Rational Qi Tang with the control group with the addition of Mucosolvan on the basis of western medicine anti-infection, pacification, and oxygen therapy, and found that the difficulty of sputum excretion and sputum properties scores of Qing-He, Phlegm and Rational Qi Tang were lower than those of the control group, indicating that the expectorant effect of Chinese medicine may be more effective. Cheng Yixing [25] et al. used Qing-Heat and Phlegm Removal Tang to treat AECOPD with the principle of clearing heat and removing phlegm, stopping cough and calming asthma, and also tonifying the spleen and stomach to eliminate the source of phlegm production. The latest view shows that COPD is not only a chronic inflammatory disease, but also an autoimmune disease [26]. The role of immunomodulators in the acute exacerbation of COPD is receiving increasing attention. Shi, Liangxi [27] and others selected a new chemically synthesized immunomodulator, pidomod, and a Chinese medicinal preparation, yupingfeng granules, for the adjuvant treatment of AECOPD. pidomod improves the anti-infection ability of AECOPD patients mainly by stimulating and modulating cellular, humoral and non-specific immune responses. Yu Ping Feng granules are derived from the traditional Chinese medicine formula Yu Ping Feng San, which is known as the “gammaglobulin” of proprietary Chinese medicine, and consists of three Chinese herbs, namely Astragalus, Atractylodes and Fang Feng. The combined treatment of AECOPD can give full play to the advantages of combining Chinese and Western medicine, which can synergize and improve the immune function of patients and enhance clinical efficacy. Huang Shiying [28] et al. found that the treatment group of three small tonics (Xiao Qing Long Tang, Xiao Shen Che Tang, and Xiao Qing Long Tang) with low-flow oxygenation achieved better results than the conventional basic treatment for COPD, indicating the superior efficacy of this formula; and according to the clinical experience of Professor Chen Baotian, the better long-term efficacy of this formula for patients with COPD may also be related to its ability to improve the immune function of patients. 3.2 Other therapies In recent years, acupuncture therapy has been widely used in the treatment of COPD in the stable stage. Wenqian [29] et al. used warm moxibustion therapy by taking Tanzhong and Dazhi to have some effect on AECOPD treatment, and the moxibustion smoke produced by them did not have adverse effects of stimulating or aggravating respiratory symptoms of patients to some extent. “Therefore, in the treatment of AECOPD, while attacking the evil, we should pay attention to the protection of the right qi, especially the continuous “benefit of qi and warming of yang” has an important role in improving the symptoms and relieving the disease of AECOPD. In addition, acupuncture point dressing is also meaningful in the treatment of AECOPD. Firstly, it can make the medicine reach the corresponding internal organs through meridians, so that the medicine can play a role in tonifying the deficiency and dispelling the evil in the lung, spleen and kidney. It is mainly related to the characteristics of the pathogenesis of the lung and kidney Yang Qi deficiency and the blockage of lung by phlegm, dampness and water and drink during acute exacerbation of COPD [30]. The combination of Chinese and Western medicine in the treatment of AECOPD has achieved good results in clinical practice, and the use of basic Western medicine and then individualized Chinese medicine through dialectical treatment has improved patients’ vital signs, enhanced their quality of life, and further improved their prognosis. In the context of poorly understood pathogenesis of this disease, TCM treatment has unique advantages. However, its single research method, small case sample, lack of uniform standards, and poor reproducibility also hinder physicians in clinical application. Therefore, clinical studies can be conducted from carrying out the mechanism of action of TCM on COPD and evidence-based medicine with randomized large sample of multicenter, double-blind, randomized controlled observational data to develop unified standards so that TCM can play a greater role in the treatment of COPD.