Fever Every Afternoon, Coughing Phlegm All Night, Growing Weaker Day by Day? Doctor Zhang Xichun’s Zhu Yu Er Bao Porridge (Chinese Yam with Coix Seed) for a Young Man’s Consumptive Cough
Patient search words: fever every afternoon / running a fever once afternoon comes / cough that will not stop / coughing and spitting phlegm at night / phlegm with every cough / growing weaker day by day / cannot eat
Corresponding medical terms: consumptive cough (lao sou) · consumptive cough from exhaustion (xu lao ke sou) · dual deficiency of lung and spleen · afternoon fever
Opening: working in the fields on an empty stomach, the youth fell ill
In yesterday’s story, Doctor Zhang Xichun used dried Chinese yam slices paired with burdock seed (niubangzi) to treat a cough left over from a cold that had not been fully cleared — tonifying on one side while driving out the lingering pathogen on the other. Today’s case is again about yam, but this time the partner is coix seed (yiyiren) — and the disease is a different one entirely: consumptive cough (lao sou).
💬 Note from Doctor Luo: Everyone, take note — Doctor Zhang Xichun attached enormous importance to a particular cause of illness: working on an empty stomach. We hardly pay attention to this anymore, but in Doctor Zhang Xichun’s eyes, laboring on an empty stomach can bring on all sorts of diseases. The youth in today’s case was brought down by exactly this.
Who was the patient? A poor boy who had to work even when he was sick
The patient was a youth — not yet grown. Children back then were different from children today: today a young person devotes himself to his studies, but in those days the family was poor, and even the children had to work.
The youth caught a cold first. After the cold, his appetite went — he did not feel like eating, which is very common; nobody has much appetite while ill. The problem was: he still had to go out and work in the fields. On an empty stomach, he went to the fields and labored, working and working without rest — and in the end, he fell ill.
💬 Note from Doctor Luo: Why was Doctor Zhang Xichun so attentive to this detail? Because after a cold, the upright qi (zheng qi) is busy fighting the pathogen. If at that point you go and burn up your physical strength on an empty stomach, the upright qi is hollowed out, and the pathogen finds it easy to burrow deeper in. Doctor Zhang Xichun seized firmly on this cause.
How ill was he? Fever every afternoon, and coughing phlegm all night long
What illness did the boy have? Lao sou — consumptive cough. What is consumptive cough? It is the kind of coughing born of exhaustion and deficiency (xu lao) — not an externally contracted cough, not one caused by catching a chill, but one in which the body itself has become deficient and keeps coughing on its own.
His coughing had a very regular pattern: every afternoon, once noon had passed, his body would start to feel feverish — a bit like running a temperature; and then all through the night he coughed up phlegm — cough, and out came phlegm; cough, and out came phlegm; the phlegm never stopped all night.
💬 Note from Doctor Luo: Do not underestimate this kind of cough. Some people really are like this — one cough and a great deal of phlegm comes up. Consumptive cough is a deficiency pattern: the body’s provisions (its upright qi) are running short, and both the lung and the spleen can no longer hold up.
Two months under the previous doctors: nourishing yin and tonifying the kidney — the more they tonified, the weaker he grew
Because the boy was young, the doctors before him took it for granted that this was deficiency, and so they used medicines to nourish yin and tonify the kidney, occasionally adding a little ren shen (ginseng) and huang qi (astragalus) — thinking that a bit of tonification could do no harm.
And the result? After two months of treatment, not the slightest effect. The illness was actually getting worse: his food intake grew smaller and smaller — he could eat less and less; his phlegm grew more and more — every night he coughed up a big pile of it; and gradually he could no longer even get out of bed — he lay there, nothing but a picture of extreme weakness.
💬 Note from Doctor Luo: There is a lesson here: when you see deficiency and simply tonify, when you see coughing and simply moisten, sometimes the direction is wrong — the more you tonify, the more you block. Nourishing-yin and tonifying-kidney medicines lean toward the rich, cloying side (zi ni). This boy’s spleen and stomach were already weak; the more he took them, the less he wanted to eat, and the phlegm only increased. That is why Doctor Zhang Xichun never simply slapped the word "deficiency" on a patient and prescribed tonics.
Doctor Zhang Xichun takes the pulse: weak and rapid (xu shu) — both lung and spleen are injured
What to do? Doctor Zhang Xichun was summoned. He placed his fingers on the pulse: xu shu — weak and rapid — the pulse was weak, and it beat fast, and there was also a slight wiry quality (xian), taut like a strung zither string.
From this, Doctor Zhang Xichun judged: this person’s lung and spleen are both injured (fei pi jie you shang sun) — the upright qi of the lung is insufficient, the upright qi of the spleen is insufficient too; both organs are deficient.
💬 Note from Doctor Luo: A weak-and-rapid pulse tells you the foundation is deficient, but there is also heat and phlegm stirring inside. At a time like this you cannot simply tonify, and you cannot simply clear. Doctor Zhang Xichun produced a formula that was extremely clever — and made entirely of things you eat.
The prescription: Zhu Yu Er Bao Porridge — three ingredients, all grains and fruit
What formula? Zhu Yu Er Bao Zhou — the Pearl-and-Jade Second Treasure Porridge — remember this formula, everyone. Its composition is very simple:
- Dried Chinese yam slices, 2 liang (about 60 g) — a fairly large amount;
- Raw coix seed (sheng yimi), 2 liang (about 60 g) — note, it must be raw, not stir-fried (pharmacy coix comes in raw and stir-fried forms; here use the raw);
- Persimmon frost cake (shi shuang bing), 8 qian (about 24 g) — this is the white frost on the outside of dried persimmons, melted and pressed into cakes; it is called persimmon frost cake.
The preparation also has its method: first pound the dried yam slices and the coix seed into coarse bits, then boil them until thoroughly cooked, then cut the persimmon frost cake into small pieces and stir it in, letting it melt, and then take it freely, as you like.
💬 Note from Doctor Luo: Have him eat it twice a day — once in the morning and once in the evening is enough. It is all food-based therapy; you can buy every ingredient at the pharmacy — and yet it cured a consumptive cough that had put the boy flat on his back in bed. That is where Doctor Zhang Xichun’s brilliance lies.
Why this combination? Yam tonifies the spleen, coix drains dampness — tonify on one side, clear on the other
What is the reasoning behind this formula? Chinese yam tonifies the spleen; coix seed has the action of draining dampness — so it tonifies on one side and, on the other, clears out dampness-heat.
💬 Note from Doctor Luo: Doctor Zhang Xichun himself explained the subtlety: if you use yam alone, taken in quantity it tends to become sticky and clogging (nian ni) — purely tonifying inward can sometimes block things up; if you use coix alone, it only drains outward, pushing the dampness out — but if a person’s upright qi is insufficient, simply draining dampness can actually injure the body. Put the two together — one tonifies, one drains — and there is exactly no drawback.
That is why Doctor Zhang Xichun so often used yam and coix together — another of his classic herb pairs.
What was the persimmon frost cake for? A lung-moistening, cough-stopping "snack"
Why add persimmon frost cake to the formula? Because the boy was still coughing — the persimmon frost cake’s job is to moisten the lung and stop the cough, and it is a food-based remedy, very gentle.
💬 Note from Doctor Luo: Note well: if the patient were merely deficient and not coughing, the persimmon frost cake could actually be left out. This is how flexible Doctor Zhang Xichun’s prescribing was: the core is yam tonifying the spleen and coix draining dampness, and the persimmon frost cake was added on the spot in response to the single symptom of "coughing."
Half a month later: the illness was cured
What effect did the formula have? Taken twice a day, the boy simply drank this porridge. And the result — half a month later, the illness was completely cured.
💬 Note from Doctor Luo: Look at how Doctor Zhang Xichun treated illness: his force was very strong, his dosages fairly large, and the results came quickly. Why? Because he struck precisely at the key point, and his formulas were very simple — just these three ingredients, all of them food-based remedies. This is a highly refined way of practicing medicine.
Bonus: yam with coix — how to use it at home
What do we learn from today’s case? A practical everyday lesson: when tonifying the spleen, using yam alone can sometimes become sticky and clogging; paired with coix, the effect is better — the dampness is removed, so the tonification does not stagnate.
Some friends ask: what is the difference between yam with coix and yesterday’s yam with burdock seed?
💬 Note from Doctor Luo: The difference is crucial — pairing with burdock seed (niubangzi) is for a cough that lingers after a cold with a little external pathogen still present; the burdock seed is responsible for clearing the pathogen. Pairing with coix is for a person with weak spleen and stomach: I tonify the spleen for you, but at the same time you have dampness, so coix is used to remove the dampness — this is a purely spleen-and-lung-tonifying pair. One clears pathogen, the other removes dampness — different directions.
So how do you use it in daily life? Doctor Luo gave a very practical way to judge: look at the tongue.
💬 Note from Doctor Luo: If you look at the tongue and see tooth marks along the edges (chi hen) — that is the sign of qi deficiency with heavy dampness. Whenever I recommend yam water, I usually add a little coix as well. The two should be in equal proportion: however much dried yam slices you use, use the same amount of coix — paired this way, it is very balanced. This is an experience Doctor Zhang Xichun has handed down to us; do write it down, because you can use it at home both for cooking porridge and for making soup.
Based on Doctor Luo Dalun’s commentary on Doctor Zhang Xichun’s case records; the case is from the Yixue Zhongzhong Canxi Lu (Records of Chinese Medicine with Reference to Western Medicine).