Traditional Chinese medicine for neutrophil-mediated acute lung injury: from single-mechanism targeting to multi-mechanism synergistic regulation.

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are life-threatening acute respiratory disorders triggered by infection, sepsis, trauma, and environmental stressors, characterized by alveolar-capillary barrier destruction, pulmonary edema, and intractable hypoxemia, with a high clinical mortality rate of 30-40%. Although clinical supportive strategies have been continuously optimized, specific and effective pharmacological interventions for ALI/ARDS remain lacking, resulting in an urgent unmet clinical demand. Neutrophil dysfunction is recognized as the core pathological driver of ALI progression, which initiates a continuous pathological cascade including abnormal recruitment and migration, excessive activation, toxic inflammatory mediator release, and apoptotic imbalance. Traditional Chinese medicine (TCM) exhibits unique advantages in the prevention and treatment of ALI/ARDS with multi-target and multi-pathway regulatory characteristics, whereas a systematic and standardized mechanistic intervention framework is still absent. Herein, we systematically summarize the neutrophil-centered pathological mechanisms underlying ALI/ARDS and establish a dual-layer TCM intervention framework integrating single-mechanism precise targeting and multi-mechanism synergistic regulation. We sort out representative TCM monomers, extracts, and compound prescriptions targeting neutrophil dysfunction, further discuss their translational application potential and current research bottlenecks. This study constructs a refined and systematic theoretical network for TCM intervention in ALI/ARDS based on neutrophil immunoregulation, providing novel insights and theoretical support for subsequent mechanistic exploration, drug development, and clinical transformation of TCM in the prevention and treatment of ALI/ARDS.