Elderly Man with Nonstop Phlegm, Dizziness and Weakness? Doctor Zhu Danxi Diagnoses a Great Deficiency (Da Xu Zheng), Rebuilds Vital Qi with Large Tonics, and Clears Phlegm-Heat Gently with Lian Bai Wan

Patient search terms: spitting phlegm mouthful after mouthful / too much phlegm / dizziness / heavy head / weak hands and feet / elderly body weakness / poor appetite / bowel movement every few days

Medical names for this condition: phlegm syndrome (deficiency-type phlegm) · great deficiency (da xu zheng) · spleen and kidney qi deficiency · phlegm-heat disturbing the interior

Opening: with that much phlegm, Doctor Zhu Danxi said “don’t rush to dissolve it”

Today we continue with the stories of Doctor Zhu Danxi’s consultations. And this one is about his true specialty — dissolving phlegm.

Doctor Luo Dalun sets the stage first: Doctor Zhu Danxi was especially skilled at treating miscellaneous diseases (za bing), and the most common disease factor lurking inside them is phlegm. Phlegm comes in two kinds. One is tangible phlegm — the stuff you cough up, the kind you can see. The other is intangible phlegm — body fluids that, for various reasons, are repeatedly concentrated until they turn into thick, sticky liquid, clogging the channels and blocking the flow of qi and blood. This kind is also called phlegm. It is both a cause of disease and a product of long illness — phlegm and disease are mutually causative (hu wei yin guo).

💬 Note from Doctor Luo: Zhu Danxi had any number of methods for treating phlegm. He divided it into many types — damp phlegm, heat phlegm, cold phlegm, wind phlegm, old phlegm, and food phlegm from indigestion. What to do if the phlegm sits above the diaphragm, what to do if it sits in the channels, what to do if it sits in a particular spot, how to tell damp phlegm from heat phlegm — he wrote it all down with complete clarity.

By Doctor Zhu Danxi’s own account, he produced a great many formulas for resolving phlegm. In volume 2 of his book Dan Xi Zhi Fa Xin Yao, the discussion of phlegm is extremely detailed, and it is followed by his disciples’ summaries of their master’s experience. But the phlegm in today’s story is somehow special — special enough that Doctor Zhu Danxi did something completely out of character: he did not start by resolving the phlegm.

Who was the patient? A 79-year-old gentleman

The original case opens with six characters: “yi nan zi nian qi shi jiu sui” — a man, seventy-nine years old. A 79-year-old gentleman.

Seventy-nine is a great age even today. In ancient times it was truly remarkable — “ren sheng qi shi gu lai xi,” “since ancient times, few have lived to seventy.” Reaching seventy was already an achievement in old China; this gentleman had pushed all the way to seventy-nine.

💬 Note from Doctor Luo: When a patient is this old, you must read the case with extra care. The very same illness in a young person and in an old person may call for completely different treatment.

The symptoms: heavy, dizzy head; weak hands and feet; phlegm mouthful after mouthful

What was troubling the old gentleman? The original text says it tersely: head dizzy and heavy, hands and feet without strength, spitting phlegm mouthful after mouthful — tou mu hun er zhong, shou zu wu li, tu tan kou kou xiang ji.

tou mu hun er zhong — his head was dizzy, and it also felt heavy, so heavy he could barely lift it; he only felt comfortable lying down. shou zu wu li — his hands and feet had no strength at all. And then the most striking detail: tu tan kou kou xiang ji — he spat phlegm mouthful after mouthful; no sooner was one mouthful out than the next one rose up. The phlegm was endless.

💬 Note from Doctor Luo: At this point, an ordinary doctor’s mind would start spinning immediately: this much phlegm — the tongue coating must be thick and greasy too. Stick out the tongue: thick, greasy coating, the classic image of phlegm. So what are you waiting for? Resolve the phlegm!

But Doctor Zhu Danxi did not rush to resolve the phlegm. He first did what a doctor should do — he took the pulse.

The pulse settles the whole case: this is a great deficiency (da xu zheng)

When Doctor Zhu Danxi felt the pulse, the left pulse was scattered, large, and slow (san da er huan). “Scattered” (san) is a sign that upright qi is leaking away outward. “Large” (da) here is not the surging fullness of an excess pattern — it is the body’s last-ditch effort; when deficiency becomes extreme, the pulse can paradoxically appear large. Add “slow” (huan) — it was beating sluggishly. And the right pulse? Slow and large, but not matching the left — compared with the left hand, it lagged a notch behind.

Pressed deeper — chong an jie wu li — press down hard, and there was no strength at all.

💬 Note from Doctor Luo: The two hands of the pulse have different territories: the left hand reflects the heart, liver, and kidney; the right hand reflects the lung, spleen, and mingmen (life gate) — above all, the spleen and stomach. The right pulse being even weaker than the left tells you what? That the stomach qi is already very weak.

Doctor Zhu Danxi asked one more question: how are the bowels? The answer: once every three or four days. Add that to the earlier detail that the appetite had been slightly reduced — the appetite was failing and the stool was scanty too. That settled it: the spleen and stomach were already in decline.

Now Doctor Zhu Danxi had his answer, and he pronounced it in four characters — “ci da xu zheng”: this is a great deficiency. This old gentleman did not have a phlegm syndrome; he had a great deficiency — the deficiency type of all deficiency types.

And then came his most striking remark: “ruo yong feng yao, zhi chun xia zhi jiao bi si” — if you use wind-dispelling herbs [to clear the phlegm], this man will surely die by the turn of spring into summer. If you followed the ordinary line of reasoning — resolve the phlegm, dispel the wind, scatter the pathogen, push it outward with wind herbs — then when spring warmed into summer, this old gentleman would not survive.

💬 Note from Doctor Luo: Why? Because his upright qi was already dispersing. His fluids (jin ye) were insufficient to begin with; once spring arrives and the weather turns hot, qi is consumed even more. When the heat comes, he may simply not be able to hold on. Doctor Zhu Danxi saw it in a flash: to resolve the phlegm and dispel the wind at this point would be to kill him.

The prescription: large-dose tonics as the base, with the little Lian Bai Wan pills alongside

The direction was set: “dang yu bu yao zuo da ji fu shi” — use tonics, and use them in large doses.

Which herbs? Huang qi (astragalus) and ren shen (ginseng) to tonify qi; dang gui (angelica) to nourish the blood; bai shao (white peony) to restrain the liver and nourish the blood; bai zhu (atractylodes) to strengthen the spleen alongside the huang qi and ren shen; and a touch of chen pi (tangerine peel) to move the qi — so that everything you pour in doesn’t just stagnate. Decoct it strong as a soup, in large amounts.

💬 Note from Doctor Luo: Remember this pattern — ren shen, bai zhu, huang qi, plus dang gui and bai shao, with a little chen pi. This is Doctor Zhu Danxi’s most common foundation for supporting upright qi. It’s not that he doesn’t know how to resolve phlegm — it’s that this patient’s most urgent need right now is upright qi.

But the decoction alone was not enough. He also prescribed thirty Lian Bai Wan pills to be taken with it. What is Lian Bai Wan? It is huang lian (coptis) and huang bai (phellodendron), stir-fried with ginger juice, ground into powder, mixed with fresh ginger juice into a paste, and rolled into small pills. And Doctor Zhu Danxi had a particular refinement: in winter, add a little gan jiang (dried ginger) to the formula — because huang lian and huang bai are intensely cold; processed with ginger juice they are no longer so cold, and in winter the extra dried ginger makes them gentler still.

Why huang lian and huang bai? The heat-phlegm must be cleared, and the tonics must not run too hot

At this point you may be puzzled: isn’t this a great deficiency? If he is so deficient he needs heavy tonics, why pair them with cold herbs like huang lian and huang bai?

Doctor Zhu Danxi had his reasons. The old gentleman’s phlegm was heat-phlegm (re tan). There was heat inside him, and the heat agitated the phlegm — and that is what made his head spin. Heat-phlegm must be cleared: clear the heat, dissolve the phlegm, and the dizziness stops. So the huang lian and huang bai, stir-fried with ginger juice and made into pills, were there to clear the phlegm-heat.

💬 Note from Doctor Luo: Look at the combination: on one side, large doses of ren shen and huang qi build up the upright qi; on the other side, huang lian and huang bai gently clear the phlegm-heat. Medicines that clear phlegm-heat are attacking herbs, and they must be carried by large amounts of tonics. At the same time, huang lian and huang bai also restrain the warming, drying nature of the tonics — so the tonics don’t make the body run too hot and create fire. Two birds with one stone.

Doctor Luo Dalun also translates this thinking into a modern frame: think of all the current talk about protecting the gut microbiome. The Chinese ancients routinely used large amounts of spleen-tonifying herbs together with a little damp-heat clearing herbs (huang lian, huang bai, huang qin and the like). The spleen-tonifying herbs feed the beneficial bacteria in the gut; the damp-heat clearing herbs kill off the harmful bacteria. The classic ancient spleen-tonifying formula has exactly this structure: lots of spleen tonic + a little damp-heat clearing + a little qi moving.

A year and a half of treatment: energy like a young man

How long did the old gentleman keep this up? A year and a half.

Think about that: a year and a half, continuously taking large-dose tonics to support upright qi, with the little Lian Bai Wan pills gently clearing the phlegm-heat. After that year and a half, Doctor Zhu Danxi described him in a single phrase — “jing li ru shao zhuang shi”: his energy was like that of a young man. After the treatment, his vitality matched what it had been in his youth.

💬 Note from Doctor Luo: This case carries particular weight. Doctor Zhu Danxi talked about so much phlegm and so many ways to dissolve it — cold, warm, hot, cool — and then closed with this case, precisely to tell us: never treat only the disease you see; you must also protect the person.

Doctor Luo’s reading one: an elderly person’s phlegm is often not real phlegm — the organs are depleted

Why does he say that? Doctor Luo Dalun explains the truth about phlegm in the elderly.

Many old people do have phlegm when their bodies are very weak. Why? Because their organ functions have declined across the board — spleen, lung, and kidney all weakened, their astringing and transforming powers insufficient. The body responds by increasing secretions: the eyes water constantly, eye discharge increases, the nose runs, the phlegm comes. Go to the countryside and you’ll see many elderly people spitting mouthful after mouthful — an enormous amount of phlegm.

💬 Note from Doctor Luo: At this moment you must stay clear-headed: don’t see phlegm and go all out dissolving it — his upright qi is about to be gone. Feel the pulse and you can tell the upright qi is nearly spent. But if you lack experience and just see that thick coating — “oh, too much phlegm, let’s dissolve it” — you’d be wrong. The truth is his organ functions have declined; phlegm-turbidity and dampness stagnate internally, and that is why the coating is so thick. If you resolve the phlegm by the routine approach, he may truly not make it. Especially with patients in the late, severe stage of illness — the moment you dissolve the phlegm, the person may be gone. Many people stumble exactly here. Preserving the upright qi is the most critical thing.

Doctor Zhu Danxi read the person accurately: he never made a fuss about “dissolving phlegm” at all — he went straight to large-dose tonics: ren shen, huang qi, bai zhu, dang gui, bai shao. That is the skill of a master. When the upright qi recovers, the phlegm naturally grows less and less.

Doctor Luo’s reading two: phlegm involves all five organ systems

Phlegm is produced in connection with all five organs:

• Kidney deficiency generates phlegm: when kidney qi is insufficient and the mingmen (life gate) fire is weak, the spleen also weakens; when spleen earth does not flourish, water-dampness floods. Elderly people with kidney qi deficiency have phlegm surging out constantly — some is white and thin, some as dark as ink. In this case you must tonify the kidney qi — even Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet). When the kidney qi is replenished, the phlegm resolves. Much middle-aged phlegm is also connected to this.
• Spleen deficiency generates phlegm: spleen deficiency with heavy dampness naturally produces phlegm.
• Lung qi not firm generates phlegm: when lung qi is insufficient, external pathogens slip in and the phlegm increases.

💬 Note from Doctor Luo: So you have to see clearly: is this phlegm caused by depleted organs, or by an external pathogen? This gentleman’s case was organ depletion — so support the upright qi right away. When the upright qi is sufficient and organ function recovers, the opportunities for phlegm to form diminish. That is the essential point.

Doctor Luo’s reading three: attack and tonify together — restore production while catching the spies

So what was the point of pairing it with Lian Bai Wan? Doctor Luo Dalun explains that a depleted elderly person like this, strictly speaking, almost always carries a bit of infection inside — some chronic, low-grade inflammation, not always in the same place: sometimes in the lungs or trachea, sometimes in the bladder or urethra. In modern language, there is infection in the body; in Chinese medicine language, a bit of pathogenic qi (xie qi) lies hidden inside, and Doctor Zhu Danxi identified it as phlegm-heat.

So what do you do? You cannot only support the upright qi — if you just pour in tonics until the old man is covered in bumps, burning hot, dizzy from the excess, that won’t do either. And you cannot only clear the pathogen — with upright qi this weak, the body cannot withstand the assault.

💬 Note from Doctor Luo: Where is Doctor Zhu Danxi’s brilliance? He added huang lian and huang bai to clear damp-heat and dissolve phlegm — and processed them with ginger juice so they stay gentle and do not injure upright qi. Only a master prescribes this way: on one hand he sees your deficiency, on the other he also sees a bit of pathogen inside you. That is why this formula could be taken for years — the pathogen is chronic, there’s no rush, it gets cleared slowly, which is exactly why he took it for a year and a half. Support the upright qi on one side, gently clear a little phlegm-heat on the other.

Doctor Luo Dalun offers an analogy: it is like a newly founded nation — restore production while still catching the spies. Restoring production alone won’t work: the spies plant a bomb today, stir up trouble tomorrow, and you can’t take it. Catching spies alone won’t work either: production never recovers and the country collapses. Catch the spies and restore production at the same time — that is attack and tonify together (gong bu jian shi).

💬 Note from Doctor Luo: A physician who can prescribe like this sees the human body with total clarity — what age, what condition, what problems will arise — he has it all in mind. A one-track mind can’t do it: either “I see deficiency, so I tonify hard,” or “I see phlegm, so I dissolve phlegm hard.” But he: first preserve the person (protect the upright qi), while noticing a bit of pathogen and adding medicines that clear pathogenic heat.

The ending: he treated not the disease, but the body

A year and a half later, the old gentleman’s energy was like that of a young man — not just the phlegm gone, but his entire body restored, as it had been in his youth.

💬 Note from Doctor Luo: This is a true act of merit. What did Doctor Zhu Danxi actually treat? Not just the phlegm. Not even just the disease. He treated the body — restoring it to excellent condition, as if he were young again. Bringing a body back to that level is the highest realm of body care.

Doctor Luo Dalun also points out a lesson for study: notice that Doctor Zhu Danxi so often used both hands at once — decoction and pills working together. Doctor Luo does the same himself: decoctions and pills together, oral formulas and foot-soak formulas together — all learned from these masters. Read more of the old books, and your mind holds more possibilities: when a situation is tangled and complex, how do you attack on several fronts at once? There are many approaches that can be pursued simultaneously.

That is the story of Doctor Zhu Danxi’s consultation today. Tomorrow, we continue with more of Doctor Zhu Danxi’s cases.

Compiled from Doctor Luo Dalun’s interpretation of Doctor Zhu Danxi’s case records (from Dan Xi Zhi Fa Xin Yao, volume 2; Doctor Luo Dalun’s Traditional Chinese Medicine Stories series).