A 56-year-old man with severe, refractory pneumonia, extreme fatigue, and cervicothoracic spinal dysfunction was successfully managed using a self-formulated Lung-clearing herbal strategy combined with manual spinal adjustment.

Case ID: CHC-0060

Case Summary

This case describes a 56-year-old man who presented with a severe, refractory respiratory infection complicated by structural spinal pain. He had recently been hospitalized for bullous pneumonia (pneumonia with pulmonary bullae) and treated with a two-week course of antibiotics and steroids, which failed to resolve his chronic cough, dyspnea, and extreme fatigue. The original report documented a conventional diagnosis of cervicothoracic syndrome and bullous pneumonia, alongside a TCM assessment of Lung Impediment (Fei Bi) driven by Wind-Cold-Damp-Toxin obstructing the Lung collaterals. He was managed through a highly integrative approach combining “Zhao’s Balanced Spinal Adjustment” to correct mechanical chest/neck restrictions with a self-formulated Qingfei Zhuyu Tang (Clear Lung and Expel Stasis Decoction) to eliminate the deep lung infection and rebuild his exhausted immune system.

Patient Presentation

• Patient: 56-year-old male (Surname: Tang).
• Main Complaint: Severe cough and asthma, extreme fatigue, low-grade fever, and chest/back pain.
• History: The patient sought initial consultation on January 7, 2020. A long-term smoker, he had recently been admitted to another hospital’s emergency respiratory department with acute sore throat, fever, dry cough, severe dyspnea, profuse sweating, and muscle weakness. Chest CT/MRI confirmed “pulmonary bullae pneumonia.” After two weeks of comprehensive treatment (antibiotics, steroids, etc.), his condition stagnated. For the past three days, he suffered from a persistent low-grade fever, extreme weakness, poor appetite, and unremitting cough and asthma.
• Physical Exam: His complexion was sallow and emaciated, and he spoke with extreme difficulty (nearly inaudible). He experienced day and night cough/asthma, spontaneous sweating, profuse night sweats, and a sensation of freezing pain in his chest, back, and limbs.
• Spinal Exam: He exhibited a stiff neck with palpable painful myofascial nodules (especially at C3-C5). His T2-T4 thoracic spinous processes were deviated with sharp tenderness. Lung auscultation revealed asthmatic breathing, decreased breath sounds, and fine wheezing.

Examination and Diagnosis

• Conventional Diagnosis: 1. Cervicothoracic syndrome; 2. Pulmonary bullae pneumonia.
• TCM Tongue and Pulse: The lips were dark and slightly black. The tongue body was dark red with stasis macules (瘀斑) on the edges, and a slightly yellow, greasy coating at the root. The pulse was floating, fine, and weak (脉浮细无力).

TCM Assessment

The original practitioner interpreted the presentation as Lung Impediment driven by Wind-Cold-Damp-Toxin Obstructing the Lung Collaterals (肺痹 – 风寒湿毒闭阻肺络).

According to the holistic principles of yin and yang Chinese Medicine the prolonged invasion of a severe pathogen (virus/bacteria) completely exhausted the patient’s righteous Qi, leading to his extreme fatigue and weak voice. The external Wind-Cold-Dampness transformed into a deep toxin, severely obstructing the Lung collaterals. Because the Lungs govern Qi and blood circulation, this obstruction led to severe localized blood stasis—objectively confirmed by his dark lips and the stasis macules on his dark red tongue.

Furthermore, his severe coughing mechanics combined with his underlying spinal condition (cervicothoracic subluxations) created a physical “traffic jam” in his neck and chest. These structural misalignments (C3-C5, T2-T4) compressed the local nerves and blood vessels, further trapping the pathological fluids in the Lungs and causing the freezing back pain.

Treatment Approach

The primary treatment principle was to diffuse and unblock Lung Qi, warm and transform phlegm-dampness, ascend the clear and expel the turbid, and resolve stasis to expel toxicity (宣通肺气，温化痰湿，升清辟浊，化瘀排毒). The strategy utilized a dual mechanical-internal approach: manually adjusting the spine to physically open the chest cavity and nerve supply, while using heavy herbal decoctions to actively purge the pneumonia and rebuild his core Yang energy.

Interventions and Herbal Formulas

• Zhao’s Balanced Spinal Adjustment (Manipulative Therapy):
  • Muscle Relaxation: The practitioner first applied gentle maneuvers to manually soften and unblock the severe myofascial spasms and “sinew nodes” in the C3-C5 and T2-T4 regions.
  • Spinal Adjustment: Rotational maneuvers were applied to correct the cervical and thoracic subluxations (bone misalignments), restoring dynamic balance to the spine and relieving the autonomic nervous system tension restricting his lungs.
• Initial Herbal Formula (January 7, 2020): A 14-herb self-formulated Qingfei Zhuyu Tang (Clear Lung and Expel Stasis Decoction).
  • Diffusing Lungs and Resolving Phlegm: Mi Ma Huang (Honey-fried Ephedra, 10g), Bei Xing Ren (Apricot Seed, 10g), Ting Li Zi (Descurainia, 10g), and Zhe Bei Mu (Fritillaria, 20g) formed a powerful core to aggressively open the airways, drain trapped lung fluids, and stop the asthma.
  • Drying Dampness and Expelling Turbidity: Jiang Hou Po (12g), Fa Ban Xia (12g), Xin Hui Chen Pi (5g), Fu Ling (20g), and Cang Zhu (12g) dried the heavy dampness and transformed the sticky phlegm.
  • Releasing the Exterior and Relaxing Muscles: Gui Zhi (10g), Ge Gen (Pueraria, 10g), and Bai Shao (12g) relaxed the severe neck/back spasms and pushed the remaining cold out of the muscle layer. Huang Qin (10g) cleared the smoldering heat, and Wu Wei Zi (10g) astringed the leaking sweat. (2 doses).
• Second Visit (January 9, 2020): His breathing was significantly smoother, his voice was stronger, and sweating was reduced. Sputum was now easy to expectorate. To deeply boost his exhausted immunity while continuing to clear the Lungs, the practitioner added Huang Qi (20g), Tai Zi Shen (10g), Hong Jing Tian (Rhodiola, 10g), and Tao Ren (10g) to move blood. Long Gu (20g) and Mu Li (20g) were added to anchor the severe sweating. (3 doses).
• Third Visit (January 12, 2020): His appetite returned, his complexion and lips were rosy, the cough was relieved, night sweats stopped, and his limbs were warm. The tongue stasis macules were visibly fading. To consolidate the cure and help him rebuild his lung capacity, the formula shifted to strongly fortify the Spleen and Kidneys: Ren Shen (Ginseng, 10g), Bai Zhu (20g), and Dan Shen (10g) were added to the base. (5 doses).

Follow-Up

• A subsequent WeChat follow-up confirmed that the patient’s complexion was rosy, his tongue had turned a healthy red with the stasis completely resolved, his physical strength was fully restored, and he experienced no further discomfort.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the application of orthopedic spinal adjustment to treat a severe, life-threatening internal respiratory infection.

The patient had already received maximum conventional pharmacological therapy (antibiotics and steroids) with poor results. Professor Zhao recognized that the patient’s severely restricted thoracic spine (T2-T4) was mechanically trapping his lungs, preventing them from expanding and clearing the infection. By manually unlocking the spine and simultaneously administering a heavy, customized herbal decoction to clear the Lung fluids and boost the Spleen/Kidney Yang, the practitioner broke the pathological stalemate. The integration of local authentic herbs like Xin Hui Chen Pi and Huazhou Ju Hong further optimized the phlegm-transforming effect, rescuing the patient from a critical state of exhaustion.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine Original title: 【以案说医】招仕富：自拟清肺逐瘀汤治疗肺痹案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: September 3, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation