Coughing with Chest Pain and Blood-Streaked Sputum? What Do You Do When Your Elderly Mother Is Bedridden?

What the patient searched for: coughing with chest pain / cough with blood in the sputum / blood-streaked sputum / elderly person coughing and gasping for breath / autumn dry cough / lung infection / it hurts to cough

What the doctors would call it: lung abscess (fei yong, pulmonary abscess) · severe lung infection · phlegm-heat congesting the lungs · insufficient body fluids · the lung and the large intestine are paired (fei yu dachang xiang biaoli)

The opening scene: that autumn, the whole city was coughing

One day in the late Ming and early Qing dynasty, the famous Jiangxi physician Doctor Yu Jiayan (喻嘉言) went out on a house call. The patient was no stranger — it was the elderly mother of his friend Lu Lingyi, an old lady who chanted Buddha’s name and ate vegetarian food every single day.

That year, autumn came in strangely. Doctor Yu wrote eight characters in his case record: this year the autumn metal qi is excessive — the dryness of autumn had run out of control, and because the dry qi dominated, “the damp earth could not generate life, and there was no one who did not cough.” Doctor Luo Dalun says that when Doctor Yu looked around, nearly everyone around him was coughing: dry coughs — the whole city was full of coughing.

💬 Note from Doctor Luo: Let me first explain a background concept — the five movements and six qi (wu yun liu qi). Every year the qi of heaven and earth moves according to the pattern of wind, cold, summer heat, dampness, dryness, and fire. If it moves normally, most of us can handle it. But if it turns abnormal — say, the winter is exceptionally cold, the summer exceptionally hot, or the autumn exceptionally dry — then when it goes too far, some people will fall ill. Who falls ill? The people whose bodies already have problems. So when autumn dryness runs wild and is drier than normal, who has trouble? People whose body fluids are insufficient — those with yin deficiency, those short on fluids. Already deficient, and then hit with extraordinary dryness — illness is the natural result.

Everyone in the city was coughing, but this old lady fell sicker than anyone. Why? Because hers was a blood-deficient, dry constitution: she had eaten vegetarian for years, so her intestines were starved of oils and fats; her body fluids were insufficient; and on top of that the weather was extraordinarily dry — her body’s balance collapsed at once. The poisonous dryness struck her harder than it struck anyone else, and gradually she fell gravely ill.

Who was the patient: a vegetarian, Buddha-chanting old lady who had bled after menopause

This old mother chanted Buddha’s name and ate vegetarian food every day. In Doctor Luo’s words, her intestines were like a withered, dried-up stalk — starved of oils. What’s more, her tian gui (menstrual essence) had already ended — after menopause, she still had bleeding that would not stop, something like flood-like and dripping uterine bleeding (beng lou). Doctor Yu had treated her for that years before, and she had been fully cured for a long time.

💬 Note from Doctor Luo: Speaking of vegetarianism — a friend once asked me: “Is long-term vegetarianism good? Especially for the elderly?” Let me give you my view. If it’s for religious faith, I won’t judge. But as far as the body is concerned, it depends on your constitution and your state. If you normally eat rich, greasy food and now switch to vegetarian, that’s a good thing. But for some elderly people, I would not recommend a complete vegetarian diet long-term — it’s fine to eat some eggs and drink some milk to supplement protein. Some elderly people who stay strictly vegetarian for years are perfectly healthy, but others see their whole constitution decline — especially their resistance to disease falls. I have seen such elderly people: poor health, and when you ask, they’re vegetarian. So my advice is: elderly people with weak bodies should not be absolute vegetarians; they can supplement some protein.

How sick was she: the moment she coughed it hurt terribly, and her sputum was bloody and foul

When the old lady fell ill, the symptoms were more frightening than the last:

• Tightness and swelling in the chest and flanks — her chest and both rib-sides felt tightly swollen;
• Rapid, urgent breathing — she panted desperately;
• Inability to lie still — she could not rest even lying down, could not sleep;
• Violent pain on coughing — the instant she coughed, she was seized with terrible pain;
• Blood-streaked, foul sputum — her sputum carried blood and had a fishy smell;
• Difficulty eating — food would not go down;
• Difficulty speaking — her voice would not come out;
• Alternating chills and fever — one moment a cold shudder, the next a burning fever.

And on top of all that, in the afternoon (ri bu), when the dryness-metal qi held sway, every misery doubled — come afternoon, the fever blazed higher and every ache grew worse.

💬 Note from Doctor Luo: Here is a diagnostic key — remember it. The twelve hours of the day correspond to the organs: morning corresponds to the liver, noon to the heart, afternoon to the lung channel, and evening to the kidney. The old lady’s misery doubling every afternoon tells you this is a lung problem — when the lung channel is on duty, lung disease is at its worst. Also, “violent pain on coughing” — the moment she coughed the pain was unbearable — means something major is wrong inside the lung; and “blood-streaked, foul sputum” — the fishy smell — means the tissue inside has already begun to rot, turning to pus and abscess. These are all very serious signs.

The pulse confirmed it: sometimes large and sometimes small, sometimes deep and firm, sometimes wiry and tight. She had previously taken some lung-clearing herbs, on the assumption that clearing the lung heat would be enough — but after taking them, it was like pouring a little water onto scorched earth: useless. Her sons were all at a loss, knowing this was a critical condition.

Doctor Yu Jiayan’s diagnosis: a lung abscess was forming

An old person sick to this degree — needless to say, this was severe. After examining her, Doctor Yu told the family plainly: a lung abscess is about to form (fei yong jiang cheng).

What is a lung abscess? It means the tissue inside the lung is rotting — the blood is defeated, the flesh decays, and pus forms an abscess. The ancients called a sore on the surface of the body a yong (carbuncle), and one growing inside the organs an inner carbuncle (nei yong): a lung abscess is an inner carbuncle of the lung. Usually the lung has heat inside it; stagnant blood combines with external pathogens, the lung develops an abscess, and finally the pus forms and the blood is defeated. This is what we now call a severe lung infection — and a fairly advanced stage of it.

💬 Note from Doctor Luo: How do you identify a lung abscess? Mainly look for: high fever; coughing, sometimes coughing blood; thick, turbid, foul-smelling phlegm — with a very strong odor; obvious chest pain. When these appear, today’s severe pulmonary infections caused by external pathogens can all be treated by the principles for lung abscess. The ancient Chinese accumulated extremely rich experience here — for example, the Qianjin Weijing Tang (Reed Rhizome Decoction) I’ve discussed before is a famous formula for lung abscess (suppuration inside the lungs).

Moreover, the treatment of lung abscess proceeds in clear stages: first comes the early stage, with external-contraction signs; then the abscess-forming stage, when the abscess is brewing (the old lady was stuck at this stage, which is why Doctor Yu said it was “about to form”); then the pus-draining stage, when the abscess breaks and the pus comes out — at this point treatment must accelerate the expulsion of pus, because only by draining the pus can the patient recover; and finally the recovery stage. Four stages, and the treatment strategy for each is completely different.

First move: Tingli Dazao Xiefei Tang, to open the lung qi

The old lady’s age was a problem — an advanced age is hard to bear treatment (gao nian nan ren), and the case was genuinely difficult. Doctor Yu changed his approach and first used an old formula from the Jingui Yaolue (Essential Prescriptions of the Golden Coffer): Tingli Dazao Xiefei Tang (Lepidium Seed and Jujube Lung-Draining Decoction).

💬 Note from Doctor Luo: This formula has just two herbs: Tinglizi (lepidium seed), which drains water and the lung; and Dazao (jujube), which protects the qi of the spleen and stomach. It dates back to Zhang Zhongjing’s time, and has long been used to treat the lung abscess presentation of breathing so hard you cannot lie down, fullness all over the body, chest fullness, swelling, stuffy nose with clear nasal discharge, and cough with wheezing — the clear discharge appears because there is excess dampness inside. In regular regulation it is especially good at transforming away the excessive water-qi inside the lung and restoring the free flow of the lung’s qi mechanism. Doctor Yu used it here quite ingeniously: the old lady actually suffered from insufficient body fluids throughout her whole body, but right now the problem was lung qi stagnation — locally in the lung there was stagnant blood and congealed dampness — so the first step was to open the lung qi. This formula must be prescribed by a doctor; don’t use it on your own.

He opened the congestion of the lung qi, and the effect was immediate: the old lady’s breathing eased — her panting calmed a little, she could take some food, her phlegm came up more easily, and she could turn onto her side. Great signs of life — the sons felt there was hope and were very pleased.

Don’t get too optimistic: the illness is moving too fast, and I’ve calculated sixty days

But Doctor Yu immediately threw cold water on them: don’t be too optimistic, gentlemen. This illness is advancing too quickly; I was forced to take quick effect with medicine — and this kind of lung-draining, water-dispelling formula is not something I would normally use: the old lady is very weak, and hers is a body short of fluids, so this medicine cannot be used much. Now that we’ve opened the lung qi, it can easily close up again — because her upright qi (zheng qi) is ultimately insufficient. If the lung closes again, and the stagnant blood, dampness, and qi pile up together again, the earlier methods will no longer work.

So he said: now that the lung qi is open and the mechanism is flowing, we must quickly work on every front. And then he started counting the days — it must be sixty days: by the Winter Solstice, autumn will be completely over, the drying metal qi will have retreated, and the lung metal can rest. So I will regulate her for sixty days, and in those sixty days I hope to turn her around. For a true recovery, we must wait until the season when the metal qi holds sway has passed — when the dryness of heaven and earth retreats, the pressure on the lung will lighten.

The sons heard this and begged him: “Please, doctor, treat her at once!”

Sixty days of living flexibility: the art of adapting the formula to the moment

Over those sixty days, the old lady hovered between crisis and calm — one moment in danger, the next at ease. Doctor Yu spun the whole treatment with living flexibility (da lü jie yi huo fa wo xuan): using agile methods, adjusting constantly to the patient’s changes. This is where a physician’s real skill shows.

💬 Note from Doctor Luo: This is the most valuable part of the whole case. Doctor Yu Jiayan laid out several contradictions: a lung abscess cannot be casually tonified, yet the old lady’s spleen deficiency meant the lung could not be generated (the spleen engenders the lung in the five-element cycle). The lung dryness called for moistening herbs, but with her spleen deficiency, moistening herbs tend to become sticky and stagnant in the middle burner — hard to digest, food won’t break down. What to do? Add small amounts of ginseng (ren shen) and baizhu (atractylodes) inside the lung-clearing herbs to tonify the spleen — I clear the lung as needed, clearing heat, resolving toxins, dispersing stagnant blood, and freeing the lung qi, while adding a little ginseng and baizhu to boost the spleen. If the next day shows obvious lung dryness and the dry cough flares again, add a little ejiao (donkey-hide gelatin) to moisten the dryness. And so he adjusted, day after day. Do you see? Supporting and regulating from both the yin and yang sides: while clearing heat and resolving toxins, don’t forget the spleen and stomach fear cold-natured herbs — don’t injure them; while tonifying the spleen, there is still heat to clear over there, and if fluids are insufficient, moisten the lung with ejiao. This is the constant work of adjustment.

Why so cautious? Doctor Luo says, for any elderly person’s lung disease, once they reach the stage of being bedridden with a severe lung infection, life and death hang by a thread — one slip of control, a sudden turn for the worse, and the person is gone; this is no joke. So in treating such disease, constantly revising the formula is essential: if today the body feels a bit cold and food won’t go down, quickly tonify the spleen; if tomorrow the cough turns dry, add ejiao to moisten the lung. You must adjust at all times, or the illness can advance suddenly at any moment.

💬 Note from Doctor Luo: Speaking of lung disease in the elderly — this is a real and current problem. We see it all the time now: at the very end, many elderly people die from lung problems — endless coughing with phlegm, weak lung qi, repeated infections. Especially in the north, when winter cold arrives and air pollution adds to it, infection comes fast, and many old people end up passing away from lung infections. The ancients’ experience is very usable: I often use Qianjin Weijing Tang plus Jiegeng Tang — both are lung-clearing. But pay attention: the heat-clearing, toxin-resolving herbs, such as yuxingcao (fish mint) and daqingye (isatis leaf), are excellent medicines that can dissolve the heat-toxin in the lung — but you must consider the spleen and stomach: these bitter-cold herbs, drunk down, are more than a weak-spleen person can bear. Drink them and the diarrhea comes pouring out, or the stomach turns cold and you don’t want to eat. That delicate calibration is the key — Doctor Yu’s few sentences here are all the words of experience. And why use ejiao to moisten dryness? Because when there is heat in the body, heat injures the body fluids; the fluids are constantly dried up, and dryness follows. The lung is a delicate organ (fei wei jiao zang) — if it gets too hot and the fluids are insufficient, the lung withers, and the illness becomes hard to treat.

The day the Beginning of Winter arrived: the old lady herself said, “I can live”

The sixty days passed slowly, and regulation continued until the Beginning of Winter (Lidong) was approaching. Then something remarkable happened: the old lady suddenly said it herself —

“The scene inside me has suddenly become wonderfully clear and refreshing — I can live. “ My inner feeling has suddenly turned so clear and light that I may have a chance at life — I can survive!

💬 Note from Doctor Luo: Doctor Yu Jiayan himself marveled — “extraordinary!” The patient herself had such a clear sensation. Why? Because the patient feels it: after more than sixty days of clearing heat, resolving toxins, supporting upright qi, and moistening the lung, going back and forth — and then, the moment the Beginning of Winter arrives, the dryness of the season retreats, the weather is about to change, and the patient’s sensitivity is the keenest of all. Doctor Yu was a man who understood the seasons — he regulated his patient according to the solar terms, calculated when recovery could come, and pinched the timing as he adjusted day by day. Only someone with deep insight into the changes of nature can do this.

Once the seasonal dryness retreated, the dryness of the lung metal began to move downward. The lung and the large intestine are paired (fei yu dachang xiang biaoli) — the dryness went into the large intestine, and the old lady went five or six days without a bowel movement: constipation. Doctor Yu gave her a slight moistening of the intestines, and it resolved at once, the symptom vanishing. This small closing problem was easy to fix.

Then came Light Snow (Xiaoxue), the weather turned cold, and the old lady was as healthy as ever, stronger than before — her body was sturdier than before she fell ill, and she ate more. Her stomach had been empty for a long time, so she naturally added meals, her appetite improved, and she wanted to eat more. Once her appetite returned to a normal level (with water and grain fully received), the disease was completely cured. The sons were deeply grateful and wrote down the entire case.

Bonus: if your body fluids run low, protect yourself like this in autumn

When the case was finished, Doctor Luo Dalun summed up three knowledge points for everyone:

💬 Note from Doctor Luo: First, keeping the body balanced and nutritionally sound is very important. I don’t advocate that elderly people become absolute vegetarians — of course, some elderly people are thin and don’t burn much, so a vegetarian diet may give them enough nutrition; that’s fine. But others can’t manage it. If someone has been eating well and suddenly switches to strict vegetarianism, that doesn’t work. Long-term strict vegetarianism can indeed cause problems; supplementing some protein is appropriate. Second, what a lung abscess is — a severe lung infection, where the blood is defeated, the flesh rots, and pus forms an abscess. Even today, with antibiotics, in severe lung abscesses the effect of Chinese medicine is very clear — many people develop antibiotic resistance, and endless infusions don’t help, while Chinese medicine has enormous treatment experience here, with Qianjin Weijing Tang and so on working very well. Third, Doctor Yu Jiayan’s regulating wisdom — first open the lung qi, then clear the lung, and then at all times tonify the spleen when it is deficient and moisten the lung when it is dry, flexibly adjusting to the patient’s changes. Students of Chinese medicine in the colleges should appreciate this principle of constant adjustment.

And finally, the health tip for ordinary people: if your body fluids are insufficient and your lung qi is weak, in years when autumn dryness runs wild, protect yourself — tonify the lung, moisten the lung, don’t go to places that are extremely dry and hot, don’t damage your body fluids, so that lung dryness doesn’t become more obvious. Care in daily life is how you stay healthy.

Compiled from Doctor Luo Dalun’s explanation of the case of Doctor Yu Jiayan, from Yu Yi Cao (Records of Meaningful Insights).