Hereditary Cough and Wheezing? Doctor Zhang Xichun’s Step-by-Step Treatment of Consumptive Lung Disease (Chen Linsheng, Age 18)
Search terms this page answers: panting bent over a table / coughing day and night without stopping / coughing all night so you can’t sleep / everyone in the family coughs / cough much worse in cold weather / coughing and spitting phlegm / hereditary lung weakness
Medical terms: fei lao (consumptive lung disease) · lung qi weakness · kidney qi deficiency · hereditary constitution · lung qi transformation obstructed
Opening: a patient whose name and address were written out in full
In the winter of the nineteenth year of the Republic (1930), a very special patient came to Tianjin. Doctor Zhang Xichun wrote his name and address down in the case record with complete clarity — Chen Linsheng, from Jiangsu Province, eighteen years old that year, living at Yu San Li, District 1, Tianjin.
💬 Note from Doctor Luo: When Doctor Zhang Xichun wrote up his cases, he always recorded the patient’s real name and real address — Chen Linsheng, from Jiangsu, living at Yu San Li, District 1, Tianjin, age eighteen. What does that tell us? These cases are genuine and reliable — they weren’t made up.
And what was the young man’s illness? The very sound of it makes your heart sink — consumptive lung disease with coughing — and he had had it since early childhood. By now the disease had grown so severe it was almost beyond describing.
Who was the patient? A lung disease that ran in the family
Where did the illness come from? Doctor Zhang Xichun stated it plainly in the case record: the patient’s mother had consumptive lung disease and coughed constantly; going back further, his maternal grandmother — the “waipo” in northern Chinese — had the same disease. The patient himself had developed coughing as a small child, which is why Doctor Zhang said the illness was hereditary in nature.
💬 Note from Doctor Luo: Why would it be inherited? In fact, constitution is passed down — if the mother’s lung qi is chronically weak, and she conceives and bears a child, that child is very likely to inherit her constitution. Add to that the fact that a family lives together in one environment — everyone breathing the same smoky cooking fires, the same poorly ventilated rooms, eating the same food, keeping the same schedule, living under the same conditions — and of course the illnesses they develop look alike. We see this all the time in ordinary life: families that eat together and live on the same rhythm tend to come down with similar ailments. Part of it is environment; part of it is heredity.
How bad was it? From “coughs at every cold” to “panting bent over a table”
What was the boy like as a child? The illness was very mild: in warm weather he was no different from anyone else — perfectly normal. But at the slightest cold he would immediately start coughing — and the cough would clear up once treated, or even heal on its own in two or three days without any treatment.
💬 Note from Doctor Luo: On this evidence, the disease probably was not tuberculosis. If it were a true TB infection, the symptoms would not stay this mild. Doctor Zhang Xichun’s records use the word “fei lao” (consumptive lung disease), and later generations have never really settled whether these cases were tuberculosis. Let me offer my analysis: in fact, a portion of them were not tuberculosis at all — they were deficiency-type lung diseases caused by exhaustion of the body. Today’s case is, with high probability, the latter kind.
After the age of ten, the illness gradually worsened: warm weather was fine, but in cold weather the coughing became especially severe. Medication would improve things up to a point, but the illness immediately rebounded. By sixteen or seventeen the disease had escalated — repeated courses of medicine did nothing, though he could still barely hold on.
By the winter of the nineteenth year of the Republic, when he came to see Doctor Zhang Xichun, the disease was grave indeed: day and night he panted bent over a table, and every cough brought up phlegm — unceasing, around the clock. No Chinese herbal formula helped at all; nothing worked. As a last resort the family brought in Western-style injections, one every day — the injections didn’t cure the cough and wheezing, but at least they guaranteed the patient would get through that day safely.
Taking the pulse: one touch, and Doctor Zhang knew where he stood
Doctor Zhang Xichun took the pulse: in both hands, the front portion of the pulse (the cun / inch position) floated slightly, while both chi (foot) positions were rootless on heavy pressure — the chi positions correspond to the kidneys and the lower burner, and when both chi are rootless, it means the kidney qi is seriously depleted.
💬 Note from Doctor Luo: Look at this case: several members of the household with lung disease — grandmother, mother, son — a constitution that was frail from childhood, and now the young man is bent over a table panting and coughing day and night. This is an extremely severe illness.
What was Doctor Zhang’s diagnosis? This kind of hereditary disease is not easy to cure — the roots run deep, and you can only adjust things little by little. So what was the underlying cause? — the qi transformation of the lung organ could not flow freely.
Doctor Zhang’s reasoning: the lung’s tiny “pipes” were clogged with phlegm
Why couldn’t the lung’s qi transformation flow? We have to start with what the lung does. Chinese medicine teaches that the lung governs qi — the lungs breathe continuously, drawing in the fresh, clear qi of the air for the whole body. It also teaches that the lung faces the hundred vessels and that the lung is the official of the prime minister — the heart is the monarch, the lung is the chancellor, and the lung, like a tide, rhythmically pushes the qi of the channels and vessels along.
💬 Note from Doctor Luo: What Doctor Zhang Xichun called the “air-conducting tubes” of the lung are what we usually call the lung collaterals and the bronchi — the lungs are packed with extremely fine structures, some tubular, some vesicular, such as the alveoli. When lung function declines, those very fine tubes are easily blocked by phlegm. Why is the disease mild in warm weather and severe in cold? Because when the weather is warm, the air sacs relax and the illness is mild; when it turns cold, the air sacs constrict and the illness flares up. You see how carefully Doctor Zhang thought — he considered how the lung’s concrete structures change under different conditions. And by the way — his book is called Records of Chinese Medicine with Western Reference (《医学衷中参西录》), which means “I base myself on Chinese medicine, but I also consult Western medicine.” He was, in effect, an advocate of combining Chinese and Western medicine. Already in the Republican era he urged Chinese-medicine doctors to consult Western knowledge, and that outlook is as important today as it ever was. It’s a pity that some practitioners today insist they are “pure Chinese medicine” and refuse to look at ultrasounds, CT scans, or ECGs at all — Doctor Zhang Xichun could learn from Western medicine in the 1920s, yet some people today have actually moved backward. That’s a real loss.
So how to treat it? Nourish and build the qi transformation of the lung — tonify the lung qi so the lung opens and closes with strength; and at the same time unblock the air tubes of the lung so they flow freely without obstruction. But that’s not all — the patient’s two chi pulses were rootless, meaning that not only the lung was sick: the liver and kidneys were also abnormal, with kidney essence depleted. So this disease could not be cured in one stroke — it had to be adjusted step by step.
The first prescription: yam and goji as the foundation, san qi to open the lung collaterals
The first formula led with two chief herbs: sheng huai shan yao (raw Huaìshan yam) 1 liang (about 30 g) and da gan gou qi (sweet goji berries) 1 liang.
💬 Note from Doctor Luo: This is essentially Doctor Zhang Xichun’s standard opening move — when he needs to tonify the lung while the kidney channels are also deficient, he pairs these two: raw Huaìshan yam greatly tonifies the lung, spleen, and kidney — all three organs, especially the spleen and lung; goji berry simultaneously tonifies the liver and kidney. The pair works together to support the body’s upright qi and nourish the essence of the five organs.
Then came: tian hua fen (trichosanthes root) 3 qian (moistens dryness and resolves toxins, with a special affinity for the lung — it is a vine plant with a dredging, unblocking function, able to push deeply lodged pathogenic toxins outward); tian dong (asparagus root) (tonifies the lung and kidney, nourishes yin and moistens dryness); sheng hang shao (white peony) 3 qian (nourishes yin and restrains the liver qi, and can gather the stifled heat of the upper burner and drain it through the urine); xing ren (apricot kernel), skin removed, 2 qian (sends lung qi downward, transforms phlegm and stops cough); gan cao (licorice) (clears heat and resolves toxins, acting on the heat-toxin of the upper burner).
Then came an ingredient quite unlike the others: guang san qi (Guangxi notoginseng), pounded, 2 qian 6 fen.
💬 Note from Doctor Luo: San qi is also called tian qi. Why did Doctor Zhang Xichun write “guang san qi”? Because san qi was first produced in Tianzhou, on the border between Guangxi and Yunnan, and the san qi grown there was called guang san qi, or tian qi. After the Republican era, fewer and fewer people grew san qi in Guangxi and production shifted to Yunnan — the very best area is Wenshan in Yunnan, which is why Wenshan san qi is so famous. The two are the same plant with the same effect; it’s just that Yunnan sits at high altitude, and san qi grown in that plateau environment develops a richer, deeper medicinal nature. In any case, san qi is an herb that both invigorates blood and resolves stasis, and stops bleeding.
So why put san qi in a formula for lung disease? Doctor Zhang Xichun explained it himself: san qi is the sacred herb for stopping reckless bleeding, and it is also the sacred herb for dredging stagnant blood. When the qi of the lung is weak, it cannot push the blood along, and the blood in the lung congeals and stalls — and the lung, of all organs, is densely laced with collaterals. Once qi and blood congeal, the whole function of the lung system declines. Using san qi to invigorate the blood and resolve stasis opens the blood vessels of the lung so the lung collaterals can flow again — this is one of Doctor Zhang’s most important ideas.
💬 Note from Doctor Luo: The thinking of famous physicians is never random speculation — it is the distillation of experience. Today many elderly people suffer from interstitial pneumonia, pulmonary fibrosis, and obstructive lung disease, which are extremely hard to treat. In the treatment of obstructive lung disease, san qi is used very widely and holds great promise. I once met an older practitioner who told me that in these obstructive lung diseases, san qi is a must-use herb — and that idea comes straight out of case records like this one, from Doctor Zhang Xichun.
Two more ingredients in the formula deserve mention: wu wei zi (schisandra berry), pounded, 2 qian, and ting li zi (lepidium seed).
💬 Note from Doctor Luo: The skin of wu wei zi is sour, and the kernel contains all five flavors — it can enter all five organs and tonify them all. That was Li Dongyuan’s teaching. Its most outstanding action is sour astringency: when coughing and wheezing, the lung qi rebels upward, and you must gather it back — otherwise once the cough starts it runs completely out of control. Zhang Zhongjing, when treating cough and wheezing, often paired wu wei zi with gan jiang (dried ginger) and xi xin (asarum) — dried ginger sends the qi outward, wu wei zi draws it back in, one releasing and one astringing, and the lung’s function returns to normal. The kernel of wu wei zi also has a salty taste, and salt enters the kidney, so it tonifies the kidney as well. The Changbai Mountains in northeastern China produce a great deal of wu wei zi; in the old days people soaked it in liquor, and it came out the color of red wine — delicious. Unfortunately, in recent years the drug administration removed it from the list of substances permitted as both medicine and food, so it can no longer be used casually.
Then there is ting li zi — the seed of the ting li plant, pungent, bitter, and cold in nature. Its action is to drain the lung and promote water metabolism: it discharges the water-qi of the lung, and once that happens the phlegm resolves easily, so it stops cough and calms wheezing. It also works on edema anywhere in the body, slowly driving the water pathogen out through the urine. Because it is especially cold, gan cao (licorice) is paired with it to modify the cold nature.
And xi xin (asarum) 1 qian (3 g) — in Zhang Zhongjing’s Xiao Qing Long Tang (Minor Blue-Green Dragon Decoction), the trio of xi xin, wu wei zi, and gan jiang together is wonderfully effective for stubborn coughs caused by cold. Xi xin is pungent and warm, mildly toxic, and enters the heart, lung, and kidney channels: it releases the exterior and disperses cold, and warms the lung to dissolve fluid-retention. But there is an old rule: xi xin must not exceed one qian — no more than about 3 g. Doctor Zhang used exactly 1 qian (3 g), and it must not be used long-term.
The preparation was also exacting: the san qi was not added to the decoction. After the other herbs were cooked, the san qi powder was taken with the strained liquid — 1 qian during the day and another 1 qian in the evening.
A turning point: four doses improved two-thirds of it, but the chi pulses still had no root
How did it go? After four doses, the cough and wheezing improved by two-thirds at once — he could now lie down and sleep two or three hours at a stretch. A man who had coughed all night and couldn’t even lie flat could now sleep two or three hours — that is no small thing. The state of lung qi rebelling upward and running out of control had clearly turned around.
💬 Note from Doctor Luo: But — the two chi pulses still had no root. The chi positions correspond to the kidney, which means the kidney qi was still deficient. This was the moment to tonify upright qi, so the next step was to bring out the formula that settles the qi back into the kidneys.
So, following the shift in the condition, Doctor Zhang wrote a second formula: sheng huai shan yao 1 liang and da gan gou qi 1 liang (unchanged, to support upright qi), plus ye dang shen (wild codonopsis) 3 qian (tonifies qi), sheng zhe shi (raw hematite), ground fine, 6 qian (18 g), sheng huai di huang (raw rehmannia) 6 qian (nourishes yin), sheng ji nei jin (raw chicken gizzard lining) 1.5 qian (resolves stasis, opens the appetite, aids digestion), shan yu rou (cornus fruit) 4 qian (tonifies the essence of the liver and kidney; sour, so it astringes), tian hua fen 4 qian, tian dong 3 qian (nourishes yin), niu bang zi (burdock seed), pounded, 3 qian (resolves toxins, clears the throat), and gan cao 2 qian.
💬 Note from Doctor Luo: Why the zhe shi (hematite)? Because he was afraid the heat of the dang shen would surge upward. Ginseng and codonopsis can make the head feel full — the qi rises. Zhe shi is a mineral, heavy and sinking, so its action runs downward — when ginseng is paired with zhe shi, the tonifying power goes straight down to the yongquan point (KD1) at the sole of the foot — that is Doctor Zhang’s personal insight. Besides, with coughing and wheezing this violent, the qi of the stomach and the chong (thoroughfare) vessel is constantly forced upward by the rebellion, and the hematite presses the stomach qi and the chong vessel qi downward, so the cough and wheeze can’t get worse. As for the niu bang zi — Doctor Zhang often paired raw Huaìshan yam with niu bang zi to treat wheezing coughs in people whose lung qi is weak while a little pathogen remains. When a child keeps coughing after a cold, you can borrow this same idea. But niu bang zi is very hard to pound — it’s dry as a little stone. If you really use it, grind it to powder in a food processor; that works much better — only when you crack it open can its medicinal nature come out.
The result: nine doses, and the cough and wheezing were completely gone
He took this formula for five more doses — added to the four before, that is nine doses in all, and the cough and wheezing were completely cured! The man who had coughed all night long was now perfectly fine.
💬 Note from Doctor Luo: You’d think that would be the end of it — but look how high Doctor Zhang Xichun’s standards were: the pulse was still beating a little fast (five beats per breath), and the patient still felt slightly winded when moving about. Doctor Zhang said this meant the yin of the lower burner was insufficient and could no longer hold on to the yang — the lower yin was not astringing, and the yang qi of the upper burner floated slightly. He had to enrich the true yin and tonify the kidney essence evenly, so that the yin becomes full enough to anchor the yang — then the qi would stop surging upward, and the wheezing would stop. So on to the next formula!
The master stroke: Doctor Zhang’s “standard configuration” for tonifying deficiency in his later years
The third formula arrived: sheng huai shan yao 1 liang, da gan gou qi 1 liang, shu huai di huang (prepared rehmannia) 1 liang, and jing shan yu rou (cornus fruit) 4 qian — the herbs Doctor Zhang Xichun used most in tonifying deficiency, and in the case records of his later years, whenever he tonified deficiency, these were the ones.
💬 Note from Doctor Luo: What is prepared rehmannia? It is the shu di huang made in Wen County, Jiaozuo, Henan Province, and it tonifies the essence of the liver and kidney. In my view, when it comes to supplementing essence, virtually no herb in the Chinese materia medica surpasses prepared rehmannia — modern people consume too much, and illnesses of kidney-essence deficiency are everywhere; the single most important herb for replenishing kidney essence is shu di huang. Shan yu rou tonifies the liver and kidney and in fact also supports the heart. Look at Jin Gui Shen Qi Wan (Eight-Ingredient Kidney Qi Pill) — of its eight ingredients, the three strongest tonics are shu di huang, shan yao, and shan yu rou. Doctor Zhang Xichun studied Zhang Zhongjing’s idea and brought these herbs to life, and by adding gou qi berries he made the power even greater.
Then he added: xuan shen (scrophularia root) (clears heat, resolves toxins, nourishes yin), yuan zhi (polygala root) (generates fluid in the lung, moistens dryness and transforms phlegm, stops cough and calms wheezing, and regulates the opening and closing of the lung — this is Doctor Zhang’s own insight), bei sha shen (glehnia root) (nourishes yin and moistens dryness, generates fluids), huai niu xi (achyranthes root) (tonifies the liver and kidney, strengthens the lower back and knees, invigorates blood and draws blood downward), yun ling pian (poria) 2 qian (strengthens the spleen and promotes water metabolism), su zi (perilla seed), stir-fried and pounded, 2 qian 6 fen (sends rebellious qi downward and calms wheezing, stops cough and transforms phlegm; its action runs downward), niu bang zi, pounded, 2 qian (resolves toxins), and sheng ji nei jin 1.5 qian (invigorates blood, resolves stasis, opens the appetite).
💬 Note from Doctor Luo: This formula is built on tonification, with a touch of cough-and-wheezing medicine and a touch of toxin-resolving medicine — and the whole medicinal movement is downward: su zi goes down, huai niu xi draws the blood downward, so the entire formula sends the qi mechanism downward. This is the exquisite art of Chinese prescribing: knowing where the medicine should go, what needs tonifying, and then adding a guiding herb (a “messenger”) to direct the medicinal force where you want it — this is what we would call precision targeting today. Huai niu xi is different from chuan niu xi: chuan niu xi mainly unblocks the channels and collaterals, while huai niu xi mainly tonifies the liver and kidney. Where is it produced? Wen County, Jiaozuo, Henan — the home of the four famous Huaì medicines: Huaìshan yam (huai shan yao), Huaì rehmannia (huai di huang), Huaì achyranthes (huai niu xi), and Huaì chrysanthemum (huai ju hua). That region sits right next to Chenjiagou, the birthplace of tai chi — a place of remarkable people, and the birthplace of the medical sage Zhang Zhongjing as well.
The ending: eight more doses, and he could walk without wheezing
The formula was decocted into one large bowl and taken warm. After eight doses, he could walk and move about without any wheezing — the man who had spent twenty-four hours a day panting bent over a table, coughing and spitting phlegm, now didn’t even wheeze when walking, and his pulse had returned to normal.
💬 Note from Doctor Luo: Think about it — from a man bent over a table around the clock, coughing and wheezing without pause, to walking and moving normally with a normal pulse — that is no small achievement, and Doctor Zhang Xichun actually brought him all the way back. You’d think it was time to stop the medicine, but Doctor Zhang wasn’t finished — he wrote one more aftercare formula.
Bonus: the aftercare master stroke — yam powder with pear juice
What was the aftercare formula? Every day, take sheng huai shan yao (raw Huaìshan yam) powder, mix it with water, cook it into a tea-thick broth, and drink it like tea; then stir in a little fresh pear juice (the natural juice of raw pears) and take it daily as a snack — that was how he brought the case to a close.
💬 Note from Doctor Luo: What is this? It’s Doctor Zhang Xichun’s master stroke — after a disease is cured, take yam powder every day to nourish upright qi, strengthen the spleen and stomach, and make the lung qi robust. This is how great physicians design their aftercare. Why do I emphasize yam powder so much? Because I learned it from Doctor Zhang Xichun — read his book through and you’ll know: which herb matters, how to combine them, when to use the slices and when to use the powder. Today’s case is a classic: against a patient this ill, with a family history to boot, Doctor Zhang advanced step by step, improving things a little at a time — and in the end he used only a little over ten doses, in a bit more than two weeks, and the disease was completely gone. If Chinese medicine were practiced at this level, there would be far fewer lung patients in the hospitals.
Adapted from Doctor Luo Dalun’s explanation of Doctor Zhang Xichun’s case records. Source: Records of Chinese Medicine with Western Reference (《医学衷中参西录》), published in installments 1918–1934.