Integrative treatment of granulomatosis with polyangiitis based on the traditional Chinese medicine principle of soothing the liver, promoting blood circulation, resolving phlegm, and dispersing nodules

<x>Abstract</x> Granulomatosis with polyangiitis (GPA) poses significant therapeutic challenges due to its susceptibility to concurrent infections and frequent relapses. Professor SHI Zaixiang proposed the therapeutic theory of lifting depression and removing blood stasis, resolving phlegm and dispelling nodulation for GPA management. He identified the core pathogenesis as “Qi collapse with collateral obstruction and phlegm-stasis intermingling”, establishing the treatment principle of comprehensive intervention through ascending ancestral Qi, activating blood circulation, and resolving phlegm-stasis nodules. In clinical practice, Professor SHI emphasizes maintaining immune homeostasis with herbal medicine to enhance efficiency, while dynamically balancing Qi, blood, Yin, and Yang. Notably, he highlights the critical role of emotional factors in autoimmune disease progression. A representative case was provided to elucidate his clinical reasoning in GPA treatment.