A 55-year-old woman with a three-month history of severe coughing, chest pain, and blood-tinged sputum was managed using a blood-invigorating and Lung-collateral unblocking herbal strategy.

Case ID: CHC-0045

Case Summary

This case describes a 55-year-old woman who presented with a severe, three-month-long cough that developed after catching a cold. Her condition was refractory to conventional antibiotics and standard Lung-targeted TCM herbal formulas. The original report documented a conventional diagnosis of bronchitis and a TCM assessment of Cough driven by Qi and Blood Impedance with Phlegm-Turbidity stagnating in the Lungs. The patient was managed through a modified Xuan Fu Hua Tang approach that specifically prioritized unblocking the micro-circulation (collaterals) of the Lungs and invigorating blood to resolve the chronic cough.

Patient Presentation

• Patient: 55-year-old female (Surname: Yang).
• Main Complaint: Frequent, severe coughing producing blood-tinged sputum and occasional yellow, thick, clumpy phlegm.
• History: The patient sought initial consultation on April 17, 2021. Three months prior, she caught a cold which triggered a cough that progressively worsened. She underwent conventional anti-infection treatment at multiple hospitals with no significant improvement. Subsequently, she tried various standard TCM cough formulas (including Maxing Shigan Tang, Xiebai San, and Suzi Jiangqi Tang), but the illness remained unresolved. Associated symptoms included chest pain, chest tightness, shortness of breath, a sense of restlessness or annoyance (心烦), and a bitter taste in her mouth.

Examination and Diagnosis

• Conventional Diagnosis: Bronchitis.
• TCM Tongue and Pulse: The tongue body was dark red (舌暗红) with a thin, yellow, greasy coating. The pulse was stringy and rapid (脉弦数).

TCM Assessment

The original practitioner interpreted the presentation as Cough driven by Qi and Blood Impedance, and Phlegm-Turbidity Stagnating in the Lungs (咳嗽 – 气血痹阻，痰浊郁肺).

Within the classical framework of yin and yang Chinese Medicine there is a fundamental concept stating “prolonged illness enters the collaterals” (病久入络). The original report noted that because the patient’s illness had dragged on for months without resolution, the pathology had moved deeper than just a surface-level respiratory infection.

The heavy, turbid phlegm had physically obstructed the deep micro-vessels (collaterals) of her Lungs, causing local Qi and Blood circulation to stagnate. This severe stagnation caused the chest pain and tightness, and the trapped heat damaged the local vessels, resulting in the blood-tinged sputum. The dark red tongue directly objectively confirmed this deep blood stasis, while the yellow greasy coating and rapid pulse indicated the presence of trapped phlegm-heat. Because the local circulation was blocked, the Lungs completely lost their ability to clear and descend Qi, leading to the relentless coughing.

Treatment Approach

The primary treatment principle was to unblock the Lung collaterals and invigorate blood to transform phlegm (疏通肺络，活血化痰). The strategy aggressively shifted focus away from purely “stopping cough” to physically restoring the blood circulation within the Lung tissue itself.

Herbal Formulas and Modifications

• Initial Formula (April 17, 2021): A 14-herb decoction acting as a heavily modified Xuan Fu Hua Tang (Inula Decoction).
  • Invigorating Blood and Unblocking Collaterals: Xuan Fu Hua (Inula, 10g), Dan Shen (Salvia, 10g), Chi Shao (Red Peony Root, 10g), Qian Cao (Madder Root, 10g), Di Long (Earthworm, 10g), and Cong Bai (Scallion White, 3 stalks) formed the core to aggressively break up blood stasis, transform phlegm, and physically open the micro-vessels in the chest. Xian He Cao (Agrimony, 10g) was added specifically to astringe and stop the bleeding in the sputum.
  • Clearing Heat and Purging Phlegm: Huang Qin (Scutellaria, 15g), Sang Bai Pi (Mulberry Bark, 15g), Zhi Zi (Gardenia, 10g), Qian Hu (Peucedanum, 10g), and Chen Pi (Tangerine Peel, 10g) worked to clear the deep Lung heat, dry the heavy dampness, and remove the accumulated yellow, clumpy phlegm.
  • Nourishing Yin and Harmonizing: Nan Sha Shen (Glehnia, 15g) nourished Yin and generated fluids (to repair the damage from the chronic heat and coughing), while Zhi Gan Cao (Honey-fried Licorice, 6g) harmonized the entire prescription.
• Second Visit (April 24, 2021): After 7 doses, the cough was improved, chest pain lessened, chest tightness and shortness of breath were reduced, and the restlessness and bitter mouth were relieved. The practitioner added Lu Gen (Reed Rhizome, 15g) to further clear heat and generate fluids. (7 doses prescribed).
• Third Visit (April 30, 2021): The cough was significantly better, appetite was normal, and the chest tightness was largely resolved. The practitioner maintained the second formula for another 7 doses to consolidate the recovery.

Follow-Up

• Over the course of three weeks and dynamic herbal management, the patient’s refractory three-month cough and bloody sputum were successfully resolved, with her respiratory and cardiovascular comfort fully restored.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is its demonstration of treating a stubborn respiratory disease through the cardiovascular system (blood and collaterals).

The patient had previously taken standard Lung-clearing formulas (Maxing Shigan Tang, Xiebai San) to no avail because those formulas only treat the Lung Qi. The original practitioner recognized that a cough lasting three months with chest pain and a dark red tongue meant the pathology was no longer just about “Lung Qi”—it had become physical “Blood Stasis” in the Lung tissue. By utilizing earthworms (Di Long) and blood-moving herbs (Dan Shen, Chi Shao) to physically open the micro-circulation, the treatment allowed the trapped phlegm to finally be cleared, proving the classical wisdom that sometimes to cure a chronic cough, one must treat the blood.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source Original source: Qingyuan Maternal and Child Health Hospital / Guangdong Provincial Administration of Traditional Chinese Medicine

Original title: 【以案说医】曾宪进：疏通肺络，活血化痰法治疗支气管炎案

Practitioner: Professor Zeng Xianjin (曾宪进)

Publication date: September 18, 2024

Original language: Chinese

ChineseHerb.org version: English translation and editorial adaptation