Coughing Up Pus with Foul-Smelling Phlegm, Lungs Feeling Like They Are Festering?

Opening: the lungs “grow a sore,” and the phlegm that comes up smells terrifying

Today we continue the story of Doctor Wu Jutong (吴鞠通), the great Qing-dynasty master of warm disease. The illness on the table is called Fei Yong (肺痈) — lung abscess.

💬 Note from Doctor Luo: What is Fei Yong? It is a severe pulmonary infection — the lobar pneumonia class of disease — where the lungs fester like an abscess, filled with fierce heat toxin. The old texts describe it as “chou bu ke dang” — so foul it cannot be borne: the phlegm you cough up stinks, and even your breath carries the smell. When the lungs are rotting like that, imagine how grave the illness is.

So what did Doctor Wu Jutong use against it? A famous formula that had come down from the Tang dynasty — the Qianjin Weijing Tang (千金苇茎汤), the Reed Stem Decoction. How classic is it? Doctor Luo says that during the COVID era, treating elderly patients with severe lung infections, he still reached for it regularly. These two cases today show Doctor Wu Jutong using this formula against lung abscess from start to finish.

The first patient: 40 years old, strong liquor plus a heated brick bed — he “roasted” himself into a lung abscess

The first case is from the winter of Jiaqing year 14 (ji si, 1809). The patient, Mr. Tang (唐伯兄), was 40 years old — middle-aged — and note: he was a relative of Doctor Wu Jutong.

What did this Mr. Tang like to do? He drank huo jiu — strong distilled liquor; and in winter he sat on a heated brick bed. Day and night he could not sleep (zhou ye bu mei), and he was always sweating.

💬 Note from Doctor Luo: Look at this man’s lifestyle — strong liquor, a heated brick bed, heat everywhere on his body. Not sleeping at night and sweating constantly both show that heat was stored inside him. The fire pushed outward, and the sweat poured out. With that kind of foundation, the moment an external pathogen touched him, something was bound to go wrong.

And sure enough, the man caught wind (an external contraction) later. But the earlier doctors had not treated it correctly — they gave him acrid, warm, violent “lung-penetrating medicines” of the ma huang (ephedra) type.

💬 Note from Doctor Luo: Doctor Wu Jutong criticized the previous physicians: these “quick-acting” and “lung-penetrating” drugs were too fierce — they damaged the patient’s jin ye (body fluids). The external contraction was not resolved; instead it sank inward, and little by little it brewed into a lung abscess. Doctor Luo himself puts a question mark here — whether a medicine is “too fierce” cannot be judged in general terms; what matters is the dosage and whether the pattern differentiation is correct. Sometimes even strong herbs can be used without harm.

By the time Doctor Wu Jutong was called in, the illness was already grave: the lung abscess was fully formed, so foul it could not be borne, and the man coughed up about two sheng of pus a day — two big bowls of purulent sputum every single day.

The famous formula Doctor Wu Jutong brought out: Qianjin Weijing Tang (a formula from Sun Simiao’s Qianjin Yaofang)

At this point Doctor Wu Jutong used the Qianjin Weijing Tang combined with Jiegeng Tang.

💬 Note from Doctor Luo: The Qianjin Weijing Tang is a famous formula from the Tang-dynasty physician Sun Simiao’s Qianjin Yaofang (it also appears in the Waitai Miyao). “Wei jing” is the stem of the reed — what pharmacies commonly use today, lu gen (reed rhizome), is the same thing. Why is the formula called “qianjin” — “a thousand gold”? Because it comes from the Qianjin Fang; the name carries the sense of “valuable as a thousand pieces of gold.”

How is the formula composed? Wei jing (lu gen, reed), dong gua ren (wax gourd seed), yi yi ren (coix seed), tao ren (peach kernel) — just four herbs. What Sun Simiao wrote as “gua ban” is the wax gourd seed.

Taking the four herbs apart: one reed stem hides the great art of draining pus

Each of the four herbs has its own job, and Doctor Luo explains them one by one:

• Lu gen (reed rhizome / wei jing): clears and releases the heat of the lungs, drawing the heat out;
• Dong gua ren (wax gourd seed): clears above and drains below — it both releases heat and opens the large intestine so heat moves downward, and it also has the power to drain pus;
• Yi yi ren (coix seed): cool in nature, clears heat and drains pus, and pushes dampness downward — there is dampness inside a lung abscess;
• Tao ren (peach kernel): the most brilliant of the four — it transforms stasis and unblocks the network vessels.

💬 Note from Doctor Luo: Why does heat toxin keep clinging to the lungs and refuse to leave? Because phlegm and blood stasis gang up together and tangle with the heat. The lung network vessels are fine and smooth, so normal breathing works fine; but once those vessels are blocked, stasis forms and the lungs are on their way to abscess. So you must unblock the collaterals — that is exactly what tao ren does: it dissolves the stasis so the heat toxin gains an exit. Match the four herbs together — one clearing heat, one draining pus, one resolving dampness, one transforming stasis — and the whole set is complete.

And Zhang Zhongjing’s Jiegeng Tang on top

The Qianjin Weijing Tang alone was not enough — Doctor Wu Jutong also added Jiegeng Tang, which is just jie geng (platycodon) plus gan cao (licorice), a formula by Zhang Zhongjing.

💬 Note from Doctor Luo: Have you noticed — Doctor Wu Jutong is a warm-disease scholar, yet throughout these stories he has used a great many of Zhang Zhongjing’s classical formulas. Jie geng’s nature is to move upward: it opens the lung qi and the passages of the upper burner, so the medicine can get in and the pus can get out; gan cao resolves toxin and harmonizes the middle. The Jiegeng Tang of platycodon with licorice was, from the start, the formula for lungs that are festering with heat toxin. That is why the Qianjin Weijing Tang and Jiegeng Tang so often appear together when severe heat toxin is congesting the lungs.

Heavy artillery: lu gen at 240 g, platycodon at 90 g — the untold secret of Chinese medicine lies in dosage

The formula is one thing; the truly breathtaking part is the dosage.

💬 Note from Doctor Luo: Normally we prescribe lu gen at around 30 g and think that is plenty. What did Doctor Wu Jutong use? Eight liang! Eight liang is 240 g! And the platycodon — ku jie geng at three liang — 90 g! We usually write jie geng at 6 g or 10 g; even 15 g is rare. He went straight to 90 g. Tao ren one liang five qian (about 45 g), yi yi ren two liang (60 g), dong gua ren one liang, sheng gan cao one liang. Of the whole formula, lu gen was the most extreme — eight liang.

This single large dose was decocted into two big teacups, and the patient was told to finish one and a half cups over a day and night.

💬 Note from Doctor Luo: Doctor Wu Jutong had a trait worth learning for every colleague in Chinese medicine — once he was sure of the direction, he dared to use it. In ordinary cases he prescribed in qian-sized amounts like everyone else, but when a serious illness appeared, he came out with heavy doses — like armored divisions fighting a war of annihilation. There is an old saying: “the untold secret of Chinese medicine lies in the dosage” — no matter how classic the formula, if the dose is insufficient, it cannot overcome the external pathogen and it simply will not work. He proved it in practice: get the dose right, and a famous formula can genuinely save a life.

After two bowls: 80–90% of the pus gone

The result? After one and a half cups, 70–80% of the pus was gone; when both big teacups were finished, 80–90% was gone; after another half dose, there was not the slightest odor — the stench was gone.

💬 Note from Doctor Luo: You see, Doctor Wu Jutong’s judgment was exact: red tongue, yellow greasy coating, rapid and forceful pulse, coughing up foul purulent sputum — the lungs were already festering, and the diagnostic criteria were plain as day. He dared to use the large dose because he had seen the pattern clearly. Afterward he closed the case by strengthening the spleen and stomach, and the man gradually recovered. The lesson of this case: a classic formula, matched with a courageous dose, works at once.

The second patient: an official on palace duty who sweated his way into a lung abscess

The second case is Jiaqing year 24 (ji mao, 1819). The patient, Mr. Zhu (朱永斋), in his 50s, held the post of Shang Shu Fang Xing Zou — an official who served inside the imperial palace, in the study chamber of the court.

At the beginning of the second lunar month this Master Zhu caught wind, and Doctor Wu Jutong gave him one dose of Guizhi Tang; the exterior pathogen was released. But the man did not cooperate with treatment: he was timid and afraid of cold, terrified of wind — the moment he took off his heavy clothes he panicked — so he kept wearing thick clothing, wrapped up so warm that he sweated profusely.

💬 Note from Doctor Luo: Think about it — in deep winter the temperature difference between indoors and outdoors is large. You wear very thick clothes, inside you are drenched in sweat, and the moment you step outside the wind hits you — that is the most forbidden thing in winter. Sweating into the wind is the surest way to catch another external contraction. He had the means to wear thick furs, and the result was that he steamed out the sweat inside — he was making trouble for himself.

By the 4th or 5th of the month he caught wind-warmth (feng wen) again: thirst with desire for cold drink, pulse surging and large. Doctor Wu Jutong first gave a light cool-acrid formula — it did not release; the sweating increased, the thirst increased, the body heat increased. Then a single dose of the heavy cool-acrid formula (containing sheng shi gao, raw gypsum) — the fever broke, the thirst stopped, and the pulse calmed.

But he was still afraid of cold and kept his thick clothes on. On the 10th of the month, he had to serve his palace duty — working for the imperial court, he could not casually ask for leave, so day after day he hurried to the study chamber. The sweating grew worse still, and thereafter the lung abscess formed.

One formula used to the end: the Qianjin Weijing Tang — one added herb, ting li zi, and it worked

After the abscess formed, Doctor Wu Jutong used the Qianjin Weijing Tang, two to three doses a day. After five to seven days with no response — the pus had turned foul and putrid — he added ku ting li zi (bitter tansymustard seed), five qian (about 15 g):

💬 Note from Doctor Luo: Ting li zi is a fairly fierce herb — it drains the lungs and moves water, calms wheezing and stops cough. We also use it for edema, to flush water out of the body. The Weijing Tang can carry Jiegeng Tang; when it is more severe, add ting li zi — that is Doctor Wu Jutong’s ladder of additions.

With ting li zi added, the pus retreated. But it was “shi fen wei jin” — not completely clean. Ten days later it flared again: the pus re-formed, vomited up like green-bean soup, thick and foul, a full bowl each time — a huge quantity. Doctor Wu Jutong still used the previous formula, adding ting li zi, three qian (about 9 g); after two doses the illness was settled. Then he finished with strengthening the spleen and stomach and clearing phlegm-damp, and the man slowly recovered.

💬 Note from Doctor Luo: Look — this man’s formula never changed from beginning to end: always the Qianjin Weijing Tang, and when it was severe, add ting li zi. The strategy stayed the same throughout, and in the end it brought the man back. Why had it been so difficult before? Doctor Wu Jutong named the cause: this Master Zhu was pale and stout, with a long-standing phlegm-damp constitution — upright qi was insufficient from the start. Before he fell ill, in autumn and winter he reported to the palace study chamber before dawn every day, and because it was cold he forced down several cups of a folk-medicine wine to warm himself — he had never been able to hold his liquor. Doctor Wu Jutong said: that heat toxin the following year probably had a great deal to do with that wine!

The great lesson in the cause: a phlegm-damp constitution force-fed warming tonics is like adding firewood to a fire

💬 Note from Doctor Luo: Here is a big lesson — a person heavy with phlegm-damp who blindly forces warming tonics on himself: the medicinal wine was a great tonic, meant to warm him up, but his body could not transform it! Heat accumulated inside; an external pathogen came; heat met heat — and it became a lung abscess. And Mr. Tang, with his strong liquor and heated brick bed, was the same story. Think about today — is it not the same? During the pandemic, how many people fell seriously ill the moment a cold wind touched them? Dressing too thickly, steaming out sweat, random tonics, drinking liquor to stay warm — these habits really need to change.

Verified in the COVID era: elderly pneumonia, childhood pneumonia — this formula used again and again

With the two cases told, Doctor Luo brings the discussion back to today:

💬 Note from Doctor Luo: During COVID, some elderly people developed extremely severe lung infections — very common in northeastern winters. A cold wind blows, pneumonia sets in: cough, purulent sputum, severe pulmonary infection. As long as it is a heat pattern — heat toxin congested within — we regularly use the Qianjin Weijing Tang. The elderly and children have weaker resistance, and an external contraction easily develops into lobar pneumonia. Sometimes antibiotics are used, but some antibiotics do not work well; some elderly patients have been on antibiotics so long that their bodies are exhausted and no longer respond — that is when this Chinese formula earns its keep. I am not opposed to Western medicine — use antibiotics when they fit, and if the antibiotic matches the bacterial spectrum and rescues the patient, is that not better? We can also combine Chinese and Western approaches. But for pulmonary infection with chest pain, sputum with a fishy-putrid odor, and very thick phlegm, the Qianjin Weijing Tang works extremely well.

Doctor Wu Jutong proved in practice that this famous formula that has flowed through the centuries still works today. The classic formulas distilled by the ancients, can stand unchanged for a thousand years — however the epidemic mutates, however the external pathogen arrives, as long as it stirs up a heat pattern inside the lungs — heat toxin accumulating, phlegm and stasis binding together in the way — use this formula and dissolve it. That is the charm of Chinese medicine.

What to take away

• Fei Yong (lung abscess) is a severe pulmonary infection of the lobar-pneumonia class — the lungs fester like sores under fierce heat toxin, with phlegm so foul that even the breath stinks. When phlegm and blood stasis bind with heat in the lung network vessels, an abscess forms.
• The formula: the Qianjin Weijing Tang from Sun Simiao’s Qianjin Yaofang — wei jing/lu gen (reed), dong gua ren (wax gourd seed), yi yi ren (coix seed), tao ren (peach kernel) — clearing heat, draining pus, resolving dampness, transforming stasis; usually combined with Jiegeng Tang (jie geng + gan cao) from Zhang Zhongjing; when pus will not retreat, add ku ting li zi.
• Dosage is the untold secret: in these cases Doctor Wu Jutong used lu gen at 240 g and jie geng at about 90 g in a single dose — once the pattern is certain, heavy doses turn a classic formula into a life-saver. (Ordinary self-medication should stay far below these amounts.)
• Two lifestyle traps that breed lung abscess: strong liquor plus heated brick beds (Mr. Tang), and a phlegm-damp constitution force-fed warming tonic wine and thick clothes that steam out sweat (Mr. Zhu). Force-feeding warmth to a phlegm-damp body is like adding firewood to a fire.
• Modern application: for elderly and pediatric pneumonia that is a heat pattern with heat toxin congested within — cough, chest pain, foul thick sputum — the Qianjin Weijing Tang still performs excellently today, including as a complement to antibiotics in the COVID era.

Based on Doctor Luo Dalun’s commentary on Doctor Wu Jutong’s case records; the cases are from Wu Jutong’s Case Records (Qing dynasty, section on lung abscess).