Can’t Speak, Voice Gone, Throat Tight and Ulcerated? Doctor Zhang Xichun’s Case of Loss of Voice from Sunken Chest Qi
What people search for: loss of voice / hoarse, can’t speak / voice gone / tight throat / ulcerated throat / wearing a padded coat in summer because of the cold Corresponding medical terms: loss of voice (shi yin) · throat impediment (hou bi) · sinking of the pectoral qi of the chest (xiong zhong da qi xia xian) · insufficiency of middle qi (zhong qi bu zu)
Opening scene: a man who could not speak, still wearing a padded coat in summer
During the Republican era, Doctor Zhang Xichun recorded a patient like this in his Yixue Zhongzhong Canxi Lu (Records of Chinese Medicine with Reference to Western Medicine): a man in his forties who had lost his voice for half a year already.
💬 Note from Doctor Luo: What does “loss of voice” (shi yin) mean? It means your speech makes no sound — either the voice turns hoarse and raspy, or you cannot get a word out at all. In Chinese medicine this is called “loss of voice.” Throat disorders are extremely common, and today’s case is a classic example of Doctor Zhang Xichun using his signature theory of sunken pectoral qi to cure one. Notice this: Doctor Zhang Xichun was especially gifted at treating sunken pectoral qi, and in the formulas he used for it, the dose of astragalus (huang qi) in Shengxian Tang is very large — he was a physician with a special mastery of and experience with astragalus.
How bad it got: the throat tighter and tighter, ulcerated, the man sliding toward consumptive exhaustion
This was not a matter of simple hoarseness. Over half a year, the illness grew worse step by step:
- Tightness in the throat — the throat felt tighter every single day, as if something were squeezing it shut, and it frequently ulcerated (in today’s terms, sores/ulcers that kept coming back);
- Aversion to wind and cold — so afraid of cold that he was still wearing the clothes of winter when summer was almost here; everyone else had changed into thin short jackets, and he was still bundled in his winter padded coat;
- Loss of appetite — he ate less and less, and grew weaker and weaker.
💬 Note from Doctor Luo: Look at this combination — hoarse, throat ulcerated, afraid of cold, barely eating. This is what is called “gradually turning into consumptive exhaustion” (xu lao): the body breaking down day by day. At this point the family hurriedly called in doctors to treat him — and what happened? No matter what they did, it would not heal. Throat disease is truly not always easy to cure, and his condition only grew worse — so what was to be done? It was time to call in Doctor Zhang Xichun.
The previous doctors’ approach: clearing heat and resolving toxins — the more they treated, the worse it got
One doctor after another came, and none of them did any good. Doctor Luo Dalun says he suspects the previous physicians all shared roughly the same reasoning — clearing heat and resolving toxins (qing re jie du).
💬 Note from Doctor Luo: Why did they all clear heat and resolve toxins? The logic seems plain: the throat is ulcerated — and ulceration indicates what? That there is heat inside! If there is heat, of course you must clear it — that is what most people think. But here is the thing: when a throat condition is acute, many cases genuinely are heat patterns — if it is caused by an external pathogen, for example, it is very likely a heat pattern. But plenty of them are cold patterns, so never assume they are all heat. These days we reflexively clear heat and resolve toxins, and that is exactly why some throat cases will never get better no matter how they are treated.
Doctor Zhang Xichun takes the pulse: the cun pulse barely there — the problem was not the throat, it was the qi
Doctor Zhang Xichun arrived and first took the pulse. And in that single pulse reading he found the real problem:
Both cun pulses were faint — the cun position on both hands was so weak it could barely be felt, with almost no sense of rising movement at all.
💬 Note from Doctor Luo: First, a word about the cun, guan, and chi positions. When you feel the pulse at the wrist, it is divided into three positions: cun (inch), guan (bar), and chi (cubit). The cun pulse governs the upper part of the body — the left cun pulse corresponds to the heart, the right cun pulse to the lungs, and both heart and lungs sit up top. So when a person’s qi mechanism sinks — when qi is moving downward instead of rising — it shows up on the pulse: the cun pulses become especially weak, sometimes impossible to feel at all. The moment Doctor Zhang Xichun felt this pulse he made his call: this too was sinking of the pectoral qi of the chest!
Would you dare use astragalus? The most critical question in the whole case
The disease sat in the throat, and the throat was ulcerated — by convention that calls for clearing heat and resolving toxins. But Doctor Zhang Xichun would not go along with convention. He intended to use a large dose of astragalus, in the form of his own creation, Shengxian Tang (Ascending the Sunken Qi Decoction).
💬 Note from Doctor Luo: Would you dare use astragalus? That is worth a moment of thought. Using warm, tonifying astragalus for a throat disease sounds almost perverse. But Doctor Zhang Xichun had a special mastery of astragalus — in treating sunken pectoral qi, the dose of astragalus in Shengxian Tang is very large. In his whole career, he can be described as the physician who took astragalus to its utmost. His judgment in this case was that the patient’s throat problem was rooted not in heat at all, but in insufficiency of middle qi and sinking of the pectoral qi.
The Inner Canon’s answer: disharmony of the nine orifices arises from the stomach and intestines
On what basis did he make this judgment? Doctor Zhang Xichun carried the Huangdi Neijing (Yellow Emperor’s Inner Canon) in his foundation.
💬 Note from Doctor Luo: The Neijing says: “Disharmony of the nine orifices arises from the stomach and intestines.” The nine orifices (the two eyes, two ears, two nostrils, the mouth, and the throat) tend to go wrong because of the stomach and intestines (the spleen and stomach). When your spleen and stomach are disordered and the clear qi fails to rise, the nine orifices will make trouble. So when we look at a throat illness, we must not stubbornly clear heat and resolve toxins — the thought of the Inner Canon tells us that very often the root of the disease lies in the spleen and stomach, in the middle qi. In this case, Doctor Zhang Xichun fixed firmly on the root of “sunken pectoral qi and insufficiency of middle qi,” and so he did not clear heat and resolve toxins — whereas, I suspect, every earlier doctor had done exactly that.
The prescription: Shengxian Tang, plus four liang of figwort root
The direction was set, and the formula followed: Shengxian Tang — with a large dose of astragalus as the sovereign herb (astragalus in large quantity both tonifies qi and lifts it), paired with anemarrhena (zhi mu), bupleurum (chai hu), platycodon (jie geng), and bugbane root (sheng ma) to raise the sunken pectoral qi back up; to this he added four liang of figwort root (xuan shen) specifically for the throat.
💬 Note from Doctor Luo: This combination is fascinating. Astragalus is sweet and warm, lifting and raising — it is the general in chief; figwort root nourishes yin, guides fire downward, and cools and soothes the throat — it is the second in command. On one side the qi is tonified and lifted, on the other the ulceration of the throat is moistened and healed. Not a single heat-clearing or toxin-resolving herb, not a single cold medicine — the whole treatment rests on four characters: “tonify qi and raise the sunken”.
The result: two doses, and the tightness in the throat was gone
Once the medicine went down, the effect came with astonishing speed:
After two doses — the tightness in the throat disappeared! Doctor Zhang Xichun then removed the sheng ma from the formula (the disease momentum had eased, and there was no longer any need for aggressive lifting), and continued for more than ten doses — and in the end every complaint was cured.
💬 Note from Doctor Luo: Look at this: from start to finish, not one heat-clearing, toxin-resolving herb was used. The earlier doctors cleared more and more and the patient only worsened; Doctor Zhang Xichun used sweet, warm astragalus and it worked — this is the craft of pattern discrimination. A great many throat disorders are cold patterns and deficiency patterns, and a reflexive approach of clearing heat and resolving toxins will often fail to cure them.
What to take away: throat troubles — don’t fixate on “heat”
The case is told, and Doctor Luo Dalun lays out the lesson once more:
💬 Note from Doctor Luo: Doctor Zhang Xichun teaches us a line of thinking — the sinking of the pectoral qi can give rise to all kinds of diseases, and one of the ways it shows itself is that the throat develops problems. These days, when we regulate throat complaints, most of us clear heat and resolve toxins — but this line of thinking deserves reconsideration: every disease, at minimum, divides into cold and heat, and it can never be heat forever — a great many throat diseases are in fact cold patterns. If the true cause is sunken pectoral qi and insufficiency of middle qi, then sweet, warm astragalus is what actually works; if you go on clearing heat and resolving toxins instead, this patient will never be cured. That is the insight this case offers us today.
Bonus: Doctor Zhang Xichun and his lifelong bond with astragalus
💬 Note from Doctor Luo: To close, a word about the bond between Doctor Zhang Xichun and astragalus. He created Shengxian Tang (from the Yixue Zhongzhong Canxi Lu), specifically to treat sinking of the pectoral qi of the chest — that breath of qi in the chest (which Chinese medicine calls zong qi, the pectoral qi) is the foundation that governs breathing and the beating of the heart; once this qi sinks, a person becomes short of breath and wheezy, and all kinds of strange diseases follow. In treating sunken pectoral qi, astragalus was absolutely the main force — astragalus tonifies qi and can also lift qi, gradually hoisting the sunken pectoral qi back up. He said that people with sunken pectoral qi often show a faint cun pulse, sometimes impossible even to feel. Today’s patient, who had lost his voice, had half a year of illness cured by this sweet, warm astragalus — which shows that when you treat a disease by its true root, it counts for more than piling on any amount of heat-clearing, toxin-resolving medicine.
Compiled from Doctor Luo Dalun’s commentary on Doctor Zhang Xichun’s medical cases; the original case comes from the Yixue Zhongzhong Canxi Lu (published in installments c. 1918–1934).