This was a 51-year-old male who had esophageal cancer presented with persistent productive cough and white sputum after receiving radiotherapy and chemotherapy. Three days after his latest chemotherapy, he was brought to the emergency department of this hospital for evaluation due to sudden hemoptysis. In the emergency department, chest radiography revealed increased RLL infiltration and right pleural effusion. The patient was admitted with empirical antibiotics therapy, and right lower lobe pneumonia with hemoptysis was suspected. After 26 days of antibiotic therapy in the hematology and oncology ward, right empyema was found by thoracic ultrasonography and a pigtail was placed. However, his cough with profound yellow and white sputum was not improved for another 2 weeks, and the refractory cough became irritable during sleep. Therefore, a consultation with physicians of Traditional Chinese Medicine (TCM) was arranged. With 56 days of integrated traditional Chinese and Western medicine treatment, the patient was discharged in well condition. In this case report, the possible cause, pathological mechanism and principle for treatment of empyema from the TCM perspective were made. The damage of lining mucus that chemo- and radio- therapies brought to Qi, Yin of lung and stomach was proved by the tracheoesophageal fistula observed under thoracic ultrasonography. Through this pathological structure, oral bacteria flora became an opportunistic infection source in the respiratory tract. Pulmonary welling-abscesses were formed following the refractory phlegm-heat congesting in the lung, and the Chinese medical diagnosis was heat-toxin congesting lung with phlegm-heat and pus formation, which finally caused the dual vacuity of Qi and Yin. The therapeutic principles of TCM were to clear heat and to detoxify, with phlegm resolving and pus eliminating in order to boost Qi and nourish Yin. The rationales beneath the prescriptions were including: Hwang Chyi, Sang Bai Pi, Sheng Di Huang to move the bowels, clear inner heat, clear and drain the heat in lung, and relieve cough; Gua Lou Shi, Dong Gua Zi, Zhe Bei Mu, Jie Geng, Sheng Gan Tsao to help phlegm resolving, binds dispersing, and pus eliminating; Hwang Chyi for Qi supplement and pus exuding; and Sha Shen to nourish Yin and clear the lung. Further, the advantages of integrated traditional Chinese and Western medicine and the timing of Chinese medicine intervention were discussed. Hopefully, this case report could be example when the combination of modern medicine and TCM is concerned to relieve discomfort, clear inner heat, eliminate abscesses, and shorten patients’ hospital courses.