Coughing for Two Years, Ten Doctors, No Improvement — Doctor Zhang Xichun Treated Consumptive Cough with Li Quan Yin (Sweet Spring Decoction)
Patient search terms: chronic cough that won’t heal / coughing so badly you can’t stand / wheezing at the slightest movement / lungs full of phlegm / no appetite / body growing weaker Medical terms: consumption (lao zhai) · consumptive cough (xu lao ke sou) · tuberculosis · lung qi deficiency
Opening: two years of coughing, and the man was nearly finished
Today we continue our series on Doctor Zhang Xichun (张锡纯) with a patient who coughed for two straight years — and in those two years he changed more than ten doctors, swallowed several hundred doses of medicine, got not a bit better, and grew weaker all the time. Reading that, don’t you feel a knot in your stomach for him?
💬 Note from Doctor Luo: This kind of illness was called lao zhai (痨瘵) in the old days, and most people today simply understand it as tuberculosis. But a portion of these patients are actually suffering from consumptive cough caused by insufficiency of upright qi — the root qi is weak first, and the lungs can no longer hold up their function. It was precisely this kind of patient that Doctor Zhang Xichun treated.
Who was the patient? In the northeastern winter, he coughed until he couldn’t stand
The patient was Su Huitang (苏惠堂) from Shenyang, in his early thirties, with a consumptive cough that had not healed in two years. In the old days, patients like this were common in the northeast — when winter came and the cold set in, he was done for: he coughed so hard he literally could not stand, and when you listened to his chest, it was all phlegm. At the slightest movement he began to wheeze; his appetite dwindled, and he could not eat.
💬 Note from Doctor Luo: Mark those four characters — “wheezing on slight movement” (dong ze zuo chuan, 动则作喘) — the lung qi had already sunk to a serious degree. Add the loss of appetite on top of it, and the source of qi and blood production was cut off; the man could only grow weaker and weaker. At a moment like this, to keep changing doctors and swallowing cough-suppressing medicines — the direction was simply wrong.
The turning point: a brother-in-law in Beijing discovered a book
Just as the patient was getting worse, the turning point arrived — his brother-in-law, in Beijing, noticed that the book Medical Records Integrated Chinese and Western Medicine (《医学衷中参西录》) had been reprinted. He flipped through it, was greatly impressed, and immediately wrote home to Shenyang: hurry to the Lida Hospital of Chinese Medicine and get treated there! The hospital was right there in Shenyang.
💬 Note from Doctor Luo: Lida Hospital of Chinese Medicine was founded by Doctor Zhang Xichun in Shenyang. This passage always feels close to my heart — so many of Doctor Zhang Xichun’s cases come from Shenyang, and that is my hometown.
How did Doctor Zhang Xichun think? The single most important stroke in the whole case
When the patient arrived, Doctor Zhang Xichun felt his pulse first: in one respiration, the pulse beat six times — very fast — yet within its thinness and weakness there was still a root. With a root, there is still hope of treatment. Then he asked about the symptoms: the upper burner frequently ran hot, with some irritability; the bowels moved only once every three or four days, often dry — all of these are signs of heat.
💬 Note from Doctor Luo: Doctor Zhang Xichun did not record the tongue in this case, but what would such a patient’s tongue look like? The tongue body is red, the coating is thin or absent, and there may even be cracks — the classic picture of yin deficiency with heat. Put the rapid pulse, the dry stools and the upper-burner heat together and the mechanism of the illness is clear: deficiency of both qi and yin, heat in the lungs and stomach, with stasis lurking in addition.
The prescription: one liang of Chinese yam takes the lead — Li Quan Yin
Doctor Zhang Xichun gave Li Quan Yin (醴泉饮, Sweet Spring Decoction), adjusted to the patient’s condition: sheng shan yao (生山药, raw Chinese yam) 1 liang as the leading herb; ren shen (人参, ginseng) 4 qian (~12 g) to tonify qi; sheng di (生地, raw Rehmannia) 5 qian to nourish yin; tian dong (天冬, asparagus root) 4 qian and xuan shen (玄参, Scrophularia root) 4 qian to nourish yin and clear heat; sheng zhe shi (生赭石, raw hematite) in a generous dose — because the stools were dry and days apart, he wanted the medicine to carry things downward; and gan cao (甘草, licorice) 2 qian to harmonize the formula. In addition, he made a point of adding sheng ji nei jin (生鸡内金, raw chicken gizzard lining) 2 qian.
💬 Note from Doctor Luo: Why add raw ji nei jin? Because the patient had been ill a long time — long illness becomes stasis — there was obstruction inside the body. When Doctor Zhang Xichun treated patients with chronic illness, he very often added a little something to dissolve stasis; that was his hard-won experience.
The treatment took a turn: half cured, then adjusted once more
After a few doses, his appetite improved, and the stools were no longer dry — now once every other day. But there was still a little heat in the chest — so he removed 2 qian of hematite and added 2 qian of zhi mu (知母, Anemarrhena root) to clear the heat. Then Doctor Zhang Xichun produced one more move: each evening, after finishing the decoction, he had the patient take a little aspirin washed down with sugar water.
💬 Note from Doctor Luo: Doctor Zhang Xichun believed aspirin was excellent at clearing pathogenic factors from the lungs and driving heat outward. Taken at night, the body would sweat slightly and the heat would escape. But the moment he saw sweating, he immediately switched the aspirin to daytime use — he did not want the patient to sweat, for fear of harming upright qi. You see how finely he judged the measure — that is the mark of a careful master.
The result: within five or six days, the cough was cured too
After several days of this, the heat was no longer felt, and the pulse had calmed — only the cough had not yet completely healed. Doctor Zhang Xichun then added a little more Western medicine — six fen of a Western preparation (the transcript reads “ji ya su”, 挤压酥; the exact name awaits verification) and four fen of peppermint ice — very small amounts, mixed with mung bean flour into pills the size of parasol-tree seeds, three pills a day, while the decoction continued as before. The result: five or six days later the cough was gone, and his health was sound from that time on.
💬 Note from Doctor Luo: Notice — for this single patient, Doctor Zhang Xichun used three different Western medicines in sequence. What does “medicine integrated with Chinese and Western” (yi xue zhong can xi, 医学衷中参西) really mean? Chinese medicine fights the main battle; Western medicine lends support on the flank. In his mind there was never any quarrel between Chinese and Western medicine — if it was good for the patient, he used it. That breadth of mind is worth learning from.
Bonus: Doctor Zhang Xichun’s core method for lung disease
For two days running now — yesterday’s Zi Sheng Tang (资生汤, Nourishing Life Decoction) and today’s Li Quan Yin — we have been looking at formulas for lung disease arising from consumption. Doctor Zhang Xichun’s thinking is actually remarkably clear:
💬 Note from Doctor Luo: It comes down to one sentence: use Chinese yam as the main battlefield — greatly tonify the spleen and lungs, fill up the upright qi, and switch on the function of the spleen and lungs. In Zi Sheng Tang he paired the yam with bai zhu (atractylodes); in Li Quan Yin he paired it with xuan shen, niu bang zi (burdock seed), sheng di and tian dong — herbs that nourish yin and clear heat. The yam delivers the heavy punch of tonification; the other herbs assist according to the situation. Once upright qi is sufficient, pathogenic qi has nowhere to lodge itself — a single sweep and it is driven out. In both formulas the yam is used at one liang or more. Grasp this thread, and you have grasped Doctor Zhang Xichun’s core method.
Compiled from Doctor Luo Dalun’s lectures on Doctor Zhang Xichun’s case records, from Medical Records Integrated Chinese and Western Medicine (《医学衷中参西录》).