[Research progress on TCM regulation of macrophage polarization for treatment of pulmonary diseases]

Macrophages are the central regulators of immune microenvironment homeostasis in lung tissue. Their polarization imbalance not only amplifies inflammatory storms and exacerbates pulmonary parenchymal injury, but also induces immune evasion, drives pathological repair, and promotes tumor progression, playing an important role in the development and prognosis of pulmonary diseases. They have therefore become a key therapeutic target for intervention in lung-related diseases. A large body of research has demonstrated that both TCM compound formulas and bioactive monomeric components can dynamically regulate the M1/M2 macrophage polarization balance at different stages of disease through a network-based mechanism involving multiple components, multiple targets, and multiple pathways. This holistic regulatory effect not only effectively blocks the malignant progression from "inflammation-fibrosis-tumor", but also benefits from the low toxicity and high bioavailability characteristics of most TCM constituents, offering novel individualized strategies for the prevention and treatment of pulmonary diseases. Based on the pathological axis of "macrophage polarization imbalance-immune microenvironment disorder-disease progression", this review systematically summarizes recent advances in TCM interventions targeting macrophage polarization in the treatment of acute lung injury(ALI)/acute respiratory distress syndrome(ARDS), pulmonary infection(PI), asthma, pulmonary fibrosis(PF), chronic obstructive pulmonary disease(COPD), and lung cancer(LC). It highlights key molecules, signaling pathways, and transcriptional regulatory axes targeted by TCM compound formulas and monomeric compounds in regulating macrophage function and remodeling the immune microenvironment. In addition, this article identifies current limitations in the field, aiming to provide TCM-based strategies and a scientific foundation for the precise prevention and treatment of pulmonary diseases.