Idiopathic pulmonary fibrosis (IPF) is characterized by increasing incidence and mortality in the context of global population aging, with poor prognosis and substantial economic burden. In traditional Chinese medicine (TCM), accurate syndrome differentiation is essential for effective treatment. However, the heterogeneity of IPF syndromes, shaped by both temporal evolution and regional differences, has not been systematically investigated from a long-term, macroscopic perspective.

To investigate the spatiotemporal evolution of TCM syndromes and syndrome elements in IPF from 1997 to 2025 based on a comprehensive literature analysis.

Relevant studies on TCM interventions for IPF were retrieved from CNKI, VIP, WanFang Data, CBM, and PubMed. The search timeframe was from database inception to April 2025. After screening according to predefined criteria, data including TCM syndromes, syndrome elements, publication year, region, and author affiliations were extracted. The studies were categorized into four periods (1997-2003, 2004-2010, 2011-2017, and 2018-2025) and seven geographical regions in China. Statistical analyses, including association rule mining, hierarchical clustering, and descriptive statistics.

A total of 172 studies involving 11 680 patients were included. Publications were most frequent in North China, with Beijing University of Chinese Medicine contributing the largest number. Fifty TCM syndromes were identified, among which qi-yin deficiency, phlegm-blood stasis congealing, qi deficiency with blood stasis, and lung-kidney qi deficiency were the most prevalent. Seventeen syndrome elements were extracted, with qi deficiency, blood stasis, yin deficiency, and phlegm turbidity being the most common pathological elements, while the lung and kidney were the predominant disease-location elements. Temporal analysis showed that qi-yin deficiency and phlegm-blood stasis congealing consistently predominated across all periods. The proportions of qi-yin deficiency and lung-kidney qi deficiency increased from 1997 to 2017 but declined thereafter, whereas qi deficiency with blood stasis exhibited a continuous upward trend. Syndrome element analysis indicated that qi deficiency, yin deficiency, blood stasis, and phlegm turbidity persisted throughout the disease course, with phlegm turbidity showing a decreasing trend in recent years. Regional analysis revealed that qi-yin deficiency predominated in most regions, whereas phlegm-blood stasis congealing was more common in Northeast China, and lung-kidney qi deficiency in Southwest China. Association rule and clustering analyses consistently identified core combinations of qi deficiency, yin deficiency, blood stasis, and phlegm turbidity.

The core TCM syndromes of IPF are characterized by qi-yin deficiency and phlegm-blood stasis congealing, with qi deficiency, yin deficiency, blood stasis, and phlegm turbidity forming the fundamental pathological basis throughout disease progression. These findings, revealing the core pathological basis and its spatiotemporal evolution, support the implementation of region-specific, dynamic, and individualized treatment strategies based on syndrome patterns, providing evidence for precision TCM diagnosis and management.