Lung abscess is a disease due to the attack of virulent wind-heat on the lungs, which results in the accumulation of heat and blood stasis and the formation of abscesses; the disease is characterized by fever, chest pain and cough with discharge of foul or even purulent and bloody sputum. The malady appears with a sudden onset of chilliness, rigor, remittent fever as high as 39-40 C, chest pain and cough. The sputum is small in amount and frothy in the beginning, and late it increases in amount and becomes mucous and purulent. As the abscess is formed, large amounts of foul purulent or bloody sputum are discharged, which may form an upper frothy layer, a middle layer of thin mucus and a thick purulent layer at the bottom after settling down for several hours.

Etiology and Pathogenesis

Virulent wind-heat attacks the lungs, which are already affected by endogenous heat. Both exogenous and endogenous evils act on the lungs and render them incapable of keep qi pure and descendant; in turn, heat accumulates and blood stagnates, and lung abscess ensues.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Differentiation between lung abscess and wind-warm syndrome: A case of wind-warm syndrome may develop into lung abscess in cases of erroneous treatment. Although the wind-warm syndrome also presents such symptoms as fever, cough, restlessness, thirst, chest pain and dyspnea, it can be distinguished from lung abscess by the absence of high fever, chills and discharge of profuse, foul and purulent sputum.

(b) Differentiation between lung abscess and pulmonary flaccidity-syndrome: Lung abscess usually manifests itself as a sthenia-syndrome with a sudden onset and a short duration. Pulmonary flaccidity-syndrome is a disorder which involves atrophy of the lung lobe due to exhaustion of qi and yin and damage as asthenic heat, or asthenia-cold of lung-qi which is characterized by an insidious onset and a prolonged duration and manifests itself as an asthenia-syndrome. However, a longstanding case of lung abscess, when its treatment is delayed or erroneous, may develop into pulmonary flaccidity-syndrome because of consumption of lung-yin by phlegm-heat.

(c) Identification of the stages of the disorder: Lung abscess may be grouped under various stages according to its progress, i.e., the early stage (with superficies-syndrome), the stage of abscess formation, the stage of abscess rupture and the convalescence stage.

B. Therapeutic principles

Expelling evil is the major therapeutic principle for lung abscess, including clearing away heat and toxic materials, eliminating blood stasis and draining off pus. Before the formation of abscess, the therapy of clearing the lungs and dissipating suppuration should be adopted, and in cases where abscess has occurred, draining off pus and clearing away toxic materials is the therapy recommended. When superficies-syndrome marked by fever and chilliness exists, drugs with the actions of clearing away heat and expelling superficial evils should be added. In the convalescence period, the therapy of expelling residual heat and tonifying yin and qi ought to be employed. for chronic cases with deficiency of healthy qi and retention of evils, the therapy of supporting healthy qi and expelling evils should be applied.

Classification and Treatment

A. Early stage

Manifestations: Fever, chilliness, cough with white frothy sputum, chest pain, thin yellow tongue coating and floating and rapid, smooth pulse.

Therapeutic principles: Dispel the superficial evil with drugs of acrid taste and cool nature, clear the lungs and expel toxic materials.

Prescription: Antiphlogistic Powder with Lonicerae and Forsythiae

Flos Lonicerae 10 g
Fructus Forsythiae 15 g
Herba Schizonepetae 10 g
Herba Menthae 5 g
Rhizoma Phragmitis 30 g
Radix Platycodi 10 g
Semen Armeniacae Amarum 10 g
Radix Scutellariae 10 g
Herba Houttuyniae 30 g

Remarks: Add Bulbus Fritillariae Cirrhosae and Exocarpium Citri Grandis for cases with severe cough. Add Gypsum Fibrosum and Rhizoma Anemarrhenae for those with high fever. Add Fructus Trichosanthis and Radix Curcumae for those with chest pain and dyspnea. Add Semen Benincasae, Cortex Mori Radicis and Folium Eriobotryae for those with productive cough.

B. Stage of abscess formation

Manifestations: Sthenic fever, vigor, cough with foul, purulent sputum, dyspnea, chest pain, sweating, restlessness, red tongue and yellow greasy coating and smooth and rapid pulse.

Therapeutic principles: Clear the lungs, eliminate blood stasis and dissipate abscess.

Prescription: Decoction of Phragmitis

Rhizoma Phragmitis 30 g
Semen Coicis 30 g
Semen Benincasae 15 g
Semen Persicae 10 g
Radix Platycodi 10 g
Flos Lonicerae 30 g
Flos Chrysanthemi Indici 30 g
Herba Houttuyniae 30 g
Gypsum Fibrosum 30-60 g
Rhizoma Anemarrhenae 10 g
Radix Glycyrrhizae 5 g

Remarks: Add Radix Rehmanniae, Cortex Moutan Radicis and Rhizoma Bletillae, and omit Persicae for cases with bloody sputum. Add Rhizoma Coptidis, Fructus Gardeniae and Herba Taraxaci for those with serious heat-toxic syndrome. Add Bolus of Cornu Rhinocerotis and Radix Rehmanniae for those with odorous sputum due to the retention of heat-toxin. Add Semen Lepidii seu Descurainiae and Fructus Perillae for those with profuse sputum and dyspnea.

C. Stage of abscess rupture

Manifestations: Cough wit profuse, purulent and bloody sputum, or porridge-like and odorous sputum, flushed face, fever, chest distress and pain, red tongue with yellow greasy coating and smooth and rapid pulse.

Therapeutic principles: Drain off pus, clear away toxic materials and clear the lungs.

Prescription: The Addition of Platycodi Decoction

Radix Platycodi 15-30 g
Semen Benincasaw 30 g
Herba Houttuyniae 10 g
Fructus Forsythiae 15 g
Semen Coicis 20 g
Herba Patriniae 30 g
Bulbus Fritillariae Thunbergii 10 g
Fructus Gardeniae 10 g

Remarks: Add Semen Fagopyri Esculenti for cases with high fever and profuse sputum. Add Rhizoma Bletillae, Nodus Nelumbinis Rhizomatis and Rhizoma Imperatae for those with bloody sputum. Add Radix Trichosanthis and Rhizoma Anemarrhenae for those with restlessness and thirst. Add Radix Adenophorae Strictae and Radix Ophiopogonis for those with consumption of yin and body fluids. Add Fructus Trichosanthis, Fructus Aurantii Immaturus and Radix et Rhizoma Rhei for those with constipation.

D. Convalescence stage

Manifestations: Cough with small amount of bloody and purulent sputum, afternoon fever, fatigue, shortness of breath, night sweating, emaciation, dryness of throat and mouth, red tongue with a little coating and thready and feeble, rapid pulse.

Therapeutic principles: Nourish qi and yin, and clear away the residual heat.

Prescription: The Modification of Adenophorae Strictae for Clearing the Lungs

Radix Adenophorae Strictae 15 g
Radix Pseudostellariae 10 g
Cortex Albizziae 15 g
Semen Benincasae 15 g
Flos Lonicerae 10 g
Radix Astragali 15 g
Radix Platycodi 10 g
Rhizoma Bletillae 10 g
Radix Glycyrrhizae 5 g

Remarks: Add Folium Mahoniae, Radix Cynanchi Atrati and Cortex Lycii Radicis for cases with continuous low fever. Add Rhizoma Atractylodis, Rhizoma Dioscoreae and Poria for those with poor appetite and loose stool. Add Radix Cynanchi Atrati, Bulbus Fritillariae Thunbergii and Herba Patriniae for treating those with purulent sputum.

Experiential Prescription

A. Herba Houttuyniae (12 g) and Rhizoma Phragmitis (fresh, 60 g) prepared as decoction; one dose daily.

B. Herba Patriniae (30 g), Bulbus Fritillariae Thunbergii (10 g) and Fructus Jujubae (5 pieces) prepared as decoction; one dose daily.

C. Rhizoma Coicis (fresh) prepared as heated juice; taken thrice a day. D. Semen Coicis (120 g) and vinegar (250 g) concentrated under a soft fire; for oral use.

Copyright 1995 Hopkins Technology