The Role of Traditional Chinese Medicine in Acute Lung Injury: Targeting Programmed Cell Death

Abstract: Acute lung injury (ALI) is a critical clinical condition with high mortality and morbidity. It initially manifests as hypoxemia, pulmonary interstitial edema, and pulmonary inflammation, and may progress to acute respiratory distress syndrome, posing a serious threat to human health. Conventional treatments have certain limitations, underscoring the urgent need for new therapeutic strategies. Traditional Chinese Medicine (TCM), with its advantages of low cost, low risk of drug resistance, and fewer adverse effects, has accumulated extensive experience in ALI treatment through its multi-component, multi-target, and multi-pathway regulatory effects. Research has shown that various TCM-derived active compounds from plants, animals, or microorganisms can effectively regulate programmed cell death (PCD), thereby reducing inflammatory responses, suppressing oxidative stress, and ameliorating ALI-induced lung tissue damage. Against this backdrop, this review aims to elucidate the mechanisms by which traditional Chinese medicine improves ALI by regulating individual and interacting PCD pathways, and to systematically evaluate the impact of existing evidence and barriers to translation on the clinical application potential of this therapeutic strategy. Based on a systematic literature search in databases including PubMed, Web of Science, Science Direct, and Google Scholar for studies published up to December 2025, this review comprehensively summarizes the pharmacological actions, mechanisms, efficacy, and safety of TCM with PCD-regulating functions, and proposes a novel TCM-PCD-ALI regulatory axis, aiming to fill the current gap in understanding the relationship between PCD and ALI, provide more treatment options for patients with ALI, and advance the development of therapeutic strategies in this field. Keywords: acute lung injury, programmed cell death, traditional Chinese medicine, molecular mechanisms