Objective To study the clinical efficacy of Xiaoqinglong decoction combined with the conventional protocol of western medicine in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) presenting with exterior cold and interior fluid retention syndrome, and to evaluate its effect on the short-term prognosis of patients.

Methods A total of 124 AECOPD patients presenting exterior cold and interior fluid retention syndrome were divided into an observation group (62 cases) and a control group (62 cases) using a random number table. Patients in the control and observation groups were managed with conventional western medicine treatment protocols consisting of bronchodilators, glucocorticoids, and antibacterial drugs. In addition, patients in the observation group were also given Xiaoqinglong decoction at one dose per day for 10 days in succession. The primary outcome indicators included the total effective treatment rate and the main traditional Chinese medicine (TCM) syndrome scores before treatment and after 10 days of Xiaoqinglong decoction treatment. The secondary outcome indicators included infection and inflammatory indicators, including white blood cell count (WBC), procalcitonin (PCT), interleukin (IL)-6, C-reactive protein (CRP), and arterial blood gas indicators, including arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), and arterial oxygen saturation (SaO₂), measured before treatment and after 10 days of treatment, adverse drug reactions during treatment, and the severity of dyspnea assessed by the modified Medical Research Council (mMRC) dyspnea scale at the 1-month follow-up after discharge.

Results Compared with baseline findings for the same group before treatment, the main TCM syndrome scores and the total score were reduced in both groups after treatment (P < 0.05). After treatment, compared with those of the control group, the syndrome scores for cough, aversion to cold, nasal congestion, and runny nose, and the total score in the observation group were lower (P < 0.05). The total effective treatment rate in the observation group (94.91%) was significantly higher than that in the control group (82.76%) (P < 0.05). After 10 days of treatment, the levels of PaCO₂, WBC, PCT, IL-6, and CRP in both groups were significantly reduced compared with those before treatment (P < 0.05). After treatment, the levels of PaCO₂, WBC, PCT, IL-6, and CRP in the observation group were lower than those in the control group (P < 0.05). Compared with those before treatment, PaO₂ and SaO₂ levels in both groups increased significantly after 10 days of treatment (P < 0.05). During the course of treatment, no severe adverse reactions, such as liver or kidney dysfunction, occurred in either group. No adverse reactions associated with Xiaoqinglong decoction were observed. No patients in either group reached mMRC grade 4 at the 1-month follow-up after discharge. The mMRC grades in both groups declined at the 1-month follow-up after discharge compared to those before treatment (P < 0.05). At the 1-month follow-up after discharge, the mMRC grades of patients in the observation group were lower than those of the control group (P < 0.05).

Conclusion Xiaoqinglong decoction combined with the conventional protocol of western medicine deminstrates good clinical efficacy in treating patients with AECOPD of exterior cold and interior fluid retention syndrome, and can effectively improve the TCM syndromes, relieve the symptoms of dyspnea, reduce the inflammatory response, promote the resolution of infection, delay disease progression, improve short-term prognosis, and shows better safety.