Lung cancer has complex symptoms that vary depending on the location, size, type, stage of development, and presence of metastasis or complications. Early stages may have no symptoms or only mild ones. Central-type lung cancer shows symptoms earlier, while peripheral-type lung cancer appears later. Typically, coughing, hemoptysis, chest pain, fever, and shortness of breath are common across various syndromes of lung cancer. The characteristics of these syndromes are described below:
1. Coughing — This is the most common early symptom. Patients often experience paroxysmal choking coughs or high-pitched obstructive coughs with little or no sputum, or only a small amount of white sticky phlegm. If phlegm is difficult to expel or turns into heat, coughing worsens, accompanied by thick, yellow, sticky phlegm, red tongue with yellow coating, and rapid pulse. Over time, both lung yin and lung qi become damaged. Damage to lung yin leads to dry cough, hemoptysis, low-grade fever, night sweats, and red tongue; damage to lung qi leads to weak coughing, shortness of breath, spontaneous sweating, fatigue, pale red tongue, etc. In late stages, patients show weak, faint coughing, sitting upright with breathing difficulty, hoarse voice, cyanosis of lips, facial swelling, and limb edema—signs of severe deficiency in qi, blood, yin, and yang.
2. Hemoptysis — Early cases near the airway may first present with hemoptysis, intermittent or continuous, varying in quantity, color ranging from bright red to dark with foam, or mixed with pus without blending, sometimes with necrotic tissue. Major vessel rupture or tumor cavity rupture leading to hemorrhage can cause uncontrollable bleeding, airway obstruction causing suffocation, or death due to loss of blood and qi. In deficiency-type hemoptysis, bleeding cannot stop spontaneously, with phlegm and blood mixed together, lasting long. However, most cases start as excess then turn into deficiency, showing a mix of excess and deficiency.
3. Chest Pain — Patients usually experience varying degrees of chest pain. In early stages, chest pain is not prominent; instead, there is fullness and distension, pain that is not fixed, mainly due to qi stagnation. In late stages, toxic invasion and blood stasis cause pain worsening at night, fixed and stabbing like needles, even constant and unbearable, sometimes breaking bones and flesh, making it impossible to touch or move.
4. Shortness of Breath — Initially, when vital energy is not severely depleted, breathing is high and loud, chest tightness and shortness of breath appear, mostly indicating excess conditions. In late stages, toxic invasion intensifies, damaging both lung qi and yin, resulting in shortness of breath with weak voice, moderate chest tightness but not urgent, due to insufficient qi for breathing, worse during activity, better at rest, preferring to lie down and avoiding labor, with weak breathing—indicating excess toxicity and deficient vitality.
5. Fever — This is a common symptom in lung cancer. Generally, it is internal deficiency heat, manifesting as fever in the afternoon or at night, or heat in palms and soles, accompanied by irritability, night sweats, dry mouth, and sore throat. Fever can also result from phlegm and blood stasis blocking internally, or internal accumulation of toxins, causing intense fever that persists for a long time.
Late-stage lung cancer, with tumor toxins, can lead to wasting and debility. Different distant metastases often cause corresponding symptoms.
【Causes and Pathogenesis】
To date, the exact causes of lung cancer remain unclear. However, based on patient history and clinical manifestations, it is evident that this disease is closely related to deficiency of vital energy and invasion of pathogenic toxins.
1. Internal Deficiency of Vital Energy “When vital energy resides within, pathogens cannot invade.” “Wherever pathogens gather, the vital energy must be deficient.” Internal deficiency of vital energy, imbalance of zang-fu organs and yin-yang, forms the primary basis for lung cancer, known as “accumulation arises due to deficiency of vital energy, allowing pathogenic factors to take hold.” Aging, frailty, chronic lung diseases, depletion of lung qi; emotional injury leading to qi reversal and stagnation, disrupted ascending and descending functions; overwork leading to lung qi and lung yin deficiency, allowing external pathogens to enter and linger, disrupting qi flow, eventually causing blood stasis in the lungs, forming lumps.
2. Internal Accumulation of Tobacco Toxins Qing Dynasty’s Gu Songyuan stated: “Tobacco is the king of pungent and hot substances.” Long-term smoking burns body fluids, depletes yin, reduces lung yin, and causes qi to follow yin deficiency. Combined with internal retention of tobacco toxins, they block the airways, obstructing qi flow, leading to phlegm, dampness, and blood stasis coagulating into tumors.
3. Invasion of Pathogenic Toxins Lungs are delicate organs easily invaded by pathogenic toxins. Industrial fumes, asbestos, mineral dust, coal tar smoke, and radioactive substances disrupt lung's descending function, causing qi stagnation, blood stasis, toxin-stagnation interaction, and eventually forming masses.
4. Phlegm and Dampness Accumulation in Lungs Spleen is the source of phlegm production, lungs store phlegm. Spleen governs transformation and transportation; spleen deficiency leads to impaired transformation and transportation, preventing proper distribution of nutrients, causing dampness to accumulate and form phlegm, which lodges in the lungs; or irregular diet leads to internal accumulation of water-dampness and phlegm, lodging in lung channels, disrupting lung's promoting and descending functions, causing phlegm stagnation and qi obstruction, leading to blood stasis, toxin retention, and mass formation in the chest.
In summary, lung cancer results from deficiency of vital energy, imbalance of yin and yang, invasion of pathogenic toxins into the lungs, stagnation of pathogens in the lungs, leading to dysfunction of lung organs, qi stagnation, impaired promotion and descent, unsmooth qi flow, blocked blood circulation, failure of fluid distribution, phlegm accumulation, phlegm stagnation, blood vessel obstruction, and eventual binding of toxins and stasis, forming lung masses over time. Therefore, lung cancer is a condition where deficiency leads to illness, and deficiency leads to excess—a systemic deficiency with local excess. Deficiency in lung cancer is mostly yin deficiency or qi-yin deficiency, while excess involves qi stagnation, blood stasis, phlegm condensation, and toxin accumulation.
【Diagnosis】
1. Recent onset of choking cough, persistent stubborn dry cough for weeks, recurrent hemoptysis or sputum, or unexplained persistent chest pain, shortness of breath, fever, or accompanied by weight loss, fatigue, etc.
2. Age above 40, male with long-term smoking history.
3. Sputum cytology is one of the important objective diagnostic methods for lung cancer, with a positive rate around 80%, and repeated testing increases the rate.
4. Chest X-ray, CT photography, and bronchial iodine oil angiography help in early diagnosis of lung cancer.
5. Fiberoptic bronchoscopy determines lesion nature and is an important method for detecting early central-type lung cancer.
Additionally, for clinically highly suspected cases of lung cancer that remain undiagnosed after the above tests, lung biopsy or timely thoracotomy exploration may be performed.
【Differential Diagnosis Principles】
1. Differentiate between deficiency and excess syndromes. Lung cancer often relates to lung qi deficiency and interlocking of phlegm, dampness, and blood stasis. Early stages mostly show qi stagnation, blood stasis, phlegm, and toxin accumulation—predominantly excess. Late stages mostly show yin deficiency, toxin heat, and qi-yin deficiency—predominantly deficiency. Clinically, conditions are often complex, with deficiency and excess coexisting.
2. Differentiate between strength and weakness of pathogen and vital energy. Lung cancer is a highly malignant tumor with rapid progression and quick changes. Assessing the strength and weakness of pathogen and vital energy is key to grasping the principle of strengthening vital energy and eliminating pathogens, and properly selecting formulas and herbs. Generally, when lung tumors and symptoms are obvious but the patient’s physique remains robust, daily life, physical strength, activity, and appetite are not significantly affected, indicating strong pathogen and relatively sufficient vital energy—this is a phase of conflict between pathogen and vital energy. When the lungs are widely invaded or multiple metastases occur, overall condition deteriorates, leading to emaciation, fatigue, weakness, poor appetite, difficulty in daily activities, complex and variable symptoms—indicating strong pathogen and markedly weakened vital energy (deficiency with excess).
【Treatment Principles】
Strengthening vital energy and eliminating pathogens, treating both root and branch, is the fundamental principle of lung cancer treatment. Overall, the condition is deficient, locally excessive; deficiency is the root, excess is the branch. In early stages, excess dominates—treatment should focus on regulating qi, activating blood, resolving stasis, softening hardness, clearing heat, transforming phlegm, removing dampness, and detoxifying. In late stages, deficiency dominates—treatment should strengthen vital energy and eliminate pathogens, using methods such as nourishing yin and clearing heat, detoxifying and dispersing nodules, tonifying qi and nourishing yin, clearing phlegm and heat. Clinically, treatment should be adjusted according to the coexistence of deficiency and excess and each patient’s specific condition, managing urgency appropriately. Since lung cancer patients have internal deficiency of vital energy, reduced anti-cancer ability, and prominent degeneration, maintaining vital energy and protecting stomach qi must be prioritized throughout treatment.
【Differentiated Treatment】
1. Qi and Blood Stagnation
Symptoms: Unrelieved coughing, chest tightness, fixed chest pain like pricks, dark red phlegm with blood, purple lips, dark tongue or ecchymosis, thin coating, fine wiry or涩pulse.
Treatment: Activate blood, resolve stasis, regulate qi, and relieve stagnation.
Formula: Taohong Siwu Tang with modifications. This formula uses Siwu Tang to regulate blood and resolve stasis, combined with Peach Kernel, Red Flower, Peony Bark, Fragrant Fennel, and Corydalis to open meridians, activate blood, and relieve pain. If hemoptysis recurs with dark red blood, add Pu Huang, Lotus Node, Fairy Grass, Sanqi, and Red Root to resolve stasis and stop bleeding; if stasis turns into heat, injuring qi and body fluids with dry mouth and dry tongue, add Sha Shen, Tian Hua Fen, Sheng Di, Xuan Shen, and Zhi Mu to clear heat and nourish yin, replenish fluids; if poor appetite, fatigue, and shortness of breath, add Huang Qi, Dang Shen, and Bai Zhu to tonify qi and strengthen the spleen.
2. Phlegm and Dampness Accumulation in Lungs
Symptoms: Coughing, expectoration, chest tightness, thick and sticky phlegm, white or mixed white-yellow, chest tightness and pain, poor appetite, loose stools, fatigue, dark tongue, greasy white-yellow or thick yellow coating, wiry slippery pulse.
Treatment: Regulate qi, remove phlegm, strengthen the spleen, and dry dampness.
Formula: Er Chen Tang combined with Guallou Xiebai Banxia Tang. Er Chen Tang regulates qi, dries dampness, and transforms phlegm; combined with Guallou Xiebai Banxia Tang to enhance its effect in regulating qi, removing phlegm, broadening the chest, and dispersing nodules. If chest distension and severe coughing occur, add Ting Li Da Zao Xie Fei Tang to drain lung fluid; if phlegm turns into heat, thick and sticky, difficult to expel, add Hai Ge Ke, Yu Xing Cao, Jin Qiao Mai Gen, and Huang Qin to clear heat and transform phlegm; if severe chest pain with obvious stasis signs, add Yu Jin, Chuan Xiong, and Yan Hu Suo to promote blood flow and relieve pain; if fatigued and poor appetite, add Xi Dang Shen, Bai Zhu, and Ji Nei Jin to strengthen the spleen and aid digestion.
3. Yin Deficiency with Toxic Heat
Symptoms: Dry cough with little or no phlegm, or blood streaked in phlegm, severe cases with uncontrollable hemoptysis, chest pain, irritability, poor sleep, low-grade fever, night sweats, or intense fever persisting, thirst, constipation, red tongue, thin yellow coating, fine rapid or large rapid pulse.
Treatment: Nourish yin, clear heat, detoxify, and disperse nodules.
Formula: Sha Shen Mai Dong Tang combined with Wu Wei Xiao Du Yin. The formula uses Sha Shen, Wang Zhu, Mai Dong, Gan Cao, Sang Ye, Tian Hua Fen, and Sheng Bian Dou to nourish yin and clear heat; Jin Yin Hua, Ye Ju Hua, Pu Gong Ying, Zi Hua Di Ding, and Zi Bei Tian Kui to clear heat, detoxify, and disperse nodules. If hemoptysis continues uncontrollably, select Sheng Di, Bai Mao Gen, Fairy Grass, Qian Gen, and San Qi to cool blood and stop bleeding; if constipation, add Guallou and Tao Ren to moisten the intestines and relieve constipation; if low-grade fever and night sweats, add Di Gu Pi, Bai Wei, and Wu Wei Zi to nourish yin, clear heat, and stop sweating.
4. Qi-Yin Deficiency
Symptoms: Cough with little phlegm, or thin and sticky phlegm, weak coughing, shortness of breath, fatigue, pale complexion, thin body, aversion to wind, spontaneous or night sweats, dry mouth with little drinking, red or pale tongue, weak fine pulse.
Treatment: Tonify qi and nourish yin.
Formula: Sheng Mai Yin. This formula uses Dang Shen to tonify lung qi, Mai Dong to nourish yin and generate fluids, Wu Wei Zi to consolidate lung fluids; three herbs combined achieve the effect of tonifying qi, nourishing yin, and generating fluids.
If qi deficiency signs are prominent, add Sheng Huang Qi, Tai Zi Shen, and Bai Zhu to tonify lung qi and strengthen the spleen; if more yin deficiency, add Bei Sha Shen, Tian Dong, Xuan Shen, and Bai He to nourish yin and increase fluids; if phlegm is difficult to expel, little and sticky, add Bei Mu, Guallou, and Xing Ren to clear lung and transform phlegm. If lung and kidney are both diseased, progressing from yin deficiency to yang deficiency, presenting yang deficiency, add Xian Mao, Xian Ling Pi, Ba Ji Tian, Rou Cong Rong, and Bu Gu Zhi to warm and tonify kidney yang. Among these syndromes, if combined with superior vena cava compression syndrome, severe symptoms such as facial and upper chest cyanosis, swelling, hoarseness, headache, dizziness, breathing difficulty, or even coma may occur, potentially fatal within a short period. Traditional Chinese medicine treats this from the perspective of blood stasis and edema, using methods like activating blood and resolving stasis, diuresis and reducing swelling to alleviate symptoms in some patients. Common formulas include Tong Qiao Huo Xue Tang, Wu Ling San, Wu Pi Yin, and Zhen Wu Tang. For milder compression symptoms, add ingredients like Ting Li Zi, Zhu Ling, Sheng Ma Huang, and Yi Mu Cao to the differential treatment formula to clear lung congestion, activate blood, and promote diuresis. During long-term clinical research on lung cancer, several commonly used anticancer herbs have been identified: heat-clearing and detoxifying herbs: Yu Xing Cao, Long Kui, Bai Ying, Bai Hua She She Cao, Da Qing Ye, Zao Xiu, Shan Dou Gen, Pu Gong Ying, Nong Ji Li, Shi Shang Bai, Ye Ju Hua, Jin Qiao Mai, Shi Jian Chuan, etc.; phlegm-dispersing and nodule-resolving herbs: Xia Ku Cao, Shan Ci Gu, Tu Bei Mu, Tu Fu Ling, Huang Yao Zi, Guallou, Bei Mu, Nan Xing, Ban Xia, Xing Ren, Bai Bu, Ma Dou Ling, Shan Hai Luo, Ba Qia, Shou Gong, Gan Chan Pi, etc.; blood-activating and hemostatic herbs: Ru Xiang, Mo Yao, Tao Ren, Di Yu, Da Huang, Chuan Shan Jia, San Leng, E Zhu, Ze Lan, Shui Hong Hua Zi, Wei Ling Xian, Zi Cao, Yan Hu Suo, Yu Jin, Su Mu, Bai Qu Cai, Xu Chang Qing, Lu Feng Fang, San Qi, etc.; water-draining and fluid-expelling herbs: Ting Li Zi, Da Ji, Yuan Hua, Shang Lu, Che Qian Zi, Zhu Ling, Ze Xie, etc. These herbs with anticancer effects can be selected appropriately based on differentiation and the specific condition of lung cancer.
【Prognosis and Outcome】
Initially, most cases involve toxins and phlegm stagnating in the lungs, focusing on excess conditions, with mild deficiency, and the body's vital energy still strong. With proper treatment, the condition can improve. If uncontrolled, pathogenic toxins damage vital energy, causing lung and spleen qi deficiency, weakening the ability to resist pathogens, allowing further spread beyond the lungs—possibly spreading to subcutaneous tissues, invading organs and tendons, affecting joints and bones, eroding marrow and bones, or disturbing the clear orifices, even obscuring them. Deficiency worsens, consuming qi and blood, injuring yin and yang. If the face becomes hollow, body wasted, “muscle completely lost,” it often indicates the patient has entered a critical stage. For some postoperative lung cancer patients who relapse, the condition may progress from qi deficiency to yang deficiency, then gradually to essence and blood deficiency. Clinically, this presents as dual deficiency of lung, spleen, and kidney qi and yin, indicating extremely serious disease progression and poor treatment outcomes. Additionally, “phlegm-heat” is often a side of lung cancer pathology, primarily caused by phlegm and stasis turning into heat. The direct cause is cancerous masses obstructing bronchi, leading to poor drainage of phlegm and secondary infection. Once this transformation occurs, immediate intervention is needed to control heat quickly and prevent rapid deterioration of the condition.
【Prevention and Self-Care】
Although there is currently no definitive method to prevent this disease, enhancing exercise, boosting the body’s resistance to disease, and avoiding long-term exposure to carcinogens can reduce incidence. Smoking is now widely recognized as a significant factor in causing lung cancer, so active public education about the dangers of smoking and advocacy for quitting are essential. Tar, coal tar, chromium, and other substances have carcinogenic effects and should be avoided or minimized. Ionizing radiation is also a risk factor for lung cancer, so protective measures should be taken. Patients should maintain a cheerful mood, regular routines, fresh indoor air, and avoid cold exposure and wind to prevent secondary lung infections. Diet should avoid greasy, spicy, and stimulating foods, favoring mushrooms, coix seed, and seaweed.
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