Suddenly Can’t Breathe or Speak in the Middle of the Night? Doctor Zhang Xichun’s Case of Sunken Chest Qi
What people search for: can’t catch a breath / can’t breathe in / difficulty breathing / suddenly unable to speak / chest tightness and shortness of breath Corresponding medical terms: sinking of the pectoral qi of the chest (xiong zhong da qi xia xian) · weakness of lung qi (fei qi xu ruo) · insufficiency of middle qi (zhong qi bu zu)
Opening scene: in the middle of the night, someone came pounding on the door of Lida Hospital
During the Republican era, in the city of Shenyang, one deep night a man rushed to the door of a hospital and hammered on it desperately: “Doctor Zhang! Director Zhang! Come quickly — save her, she’s failing!”
💬 Note from Doctor Luo: The man at the door was named Wang Zigang, and he was one of Doctor Zhang Xichun’s disciples. The hospital he was knocking at was Lida Hospital — China’s very first hospital of Chinese medicine, founded by Doctor Zhang Xichun himself. When a disciple comes pounding on your door in the middle of the night, whatever is wrong must be serious. So what had happened to the patient?
Who was the patient? An English tutor in Republican-era Shenyang
The patient was a woman surnamed Yu, nearly thirty years old, who lived in Dadongguan, Fengtian (today’s Shenyang). After she married, her husband died, and as a widow she had returned to live at her parents’ home. And she had one remarkable skill — her English was excellent.
💬 Note from Doctor Luo: Even back in the Republican era, Shenyang already had talent like this. The British merchants living in Shenyang would hire her as a tutor to teach their children Chinese — because her English was good enough to communicate with them. In those days, for a woman to make her living by such a skill was no small feat.
But her health was never good — she had always been qi deficient. Doctor Zhang Xichun had taken her pulse before and knew that her qi was very weak.
The attack: in the middle of the night, she suddenly “couldn’t breathe in” — and couldn’t speak
That day, feeling unwell, she left work early and went home. Then, in the middle of the night, it happened —
She could not speak, and she could not get her breath. In her own words, she “could not inhale” (bing bu neng xi) — the problem was not exhaling, it was that she could not draw air in, and breathing became agonizingly difficult.
Wang Zigang, who lived in the same courtyard, saw that something was terribly wrong, and ran straight to Lida Hospital — which brings us back to that pounding on the door.
💬 Note from Doctor Luo: What does “could not inhale” mean? It means difficulty drawing breath in — when you breathe, the air just will not come up. This is different from ordinary wheezing — this is breathing itself barely holding on, an extremely critical condition. Doctor Zhang Xichun did not say a word; he went out to see her.
Doctor Zhang Xichun’s diagnosis: sunken chest qi
By the time he reached the patient, Doctor Zhang Xichun already had a good idea — he had taken her pulse before and knew she was qi deficient. Now he made his call at once: the pectoral qi of the chest had sunk (xiong zhong da qi xia xian).
💬 Note from Doctor Luo: Doctor Zhang Xichun held that a person’s chest contains a mass of grand qi (da qi) — a term that comes from the Huangdi Neijing (Yellow Emperor’s Inner Canon). What does this qi do? It maintains the opening and closing of the breath in the chest and allows the lungs to inhale and exhale. Once this qi sinks — once it settles downward and there is nothing left to hold things up — the lungs are left untended, and the person becomes desperately short of breath, as if the air simply cannot be drawn in. Looking at the hospital records, Doctor Luo notes that on that night Doctor Zhang Xichun in fact did not go out to the patient’s home himself; first he listened to the symptoms his disciple relayed, and wrote out the prescription.
The prescription: three herbs, with raw astragalus leading the charge
The formula was remarkably simple — only three herbs:
- Raw astragalus (sheng huang qi), one liang — tonifies qi and lifts the sunken qi back up;
- Angelica root (dang gui), four qian (about 12 grams — not a large dose);
- Bugbane root (sheng ma), two qian — what is it for? It draws the qi upward, letting the qi move up again.
After the decoction went down, that very night, she could speak again — the words came out!
💬 Note from Doctor Luo: Here we should first get acquainted with the lead actor, astragalus. Chinese medicine uses astragalus constantly — it is an extremely common tonic herb, and its specialty is tonifying qi. Astragalus for tonification is often written as “soft astragalus” (mian huang qi). Its nature is warm, its flavor slightly sweet, and when you chew it, it has a distinctive bean-like aroma. Astragalus comes in two forms: raw astragalus (sheng huang qi) and honey-fried astragalus (mi zhi huang qi). In the old days it was said that raw astragalus secures the exterior — its action was thought to stay mostly at the surface of the body; but today, when we use raw astragalus, it is far more often for internal medicine — we use it for any kind of qi deficiency. Honey-fried astragalus is fried with honey, very sweet, and its action is to tonify the middle. My own experience is to use raw astragalus more — honey-fried astragalus often makes people run hot, and anyone with even a touch of heat can’t tolerate it; raw astragalus is more gentle and balanced. And in this case, Doctor Zhang Xichun used exactly that — raw astragalus.
Follow-up: the pulse still faint, the formula refined
The next morning, the patient was carried into the hospital. Doctor Zhang Xichun took her pulse — deep, fine, and weak — and she still felt short of breath, as if the air would not quite come up.
💬 Note from Doctor Luo: Shortness of breath, the sense that the air won’t come up — that is a hallmark of sunken chest qi. Doctor Zhang Xichun knew perfectly well that the previous night’s dose had only suppressed the acute crisis; the root had not been resolved, and the treatment had to continue.
So he revised the formula:
- Bugbane root (sheng ma) cut in half — two qian yesterday, one qian today;
- Added Chinese yam (shan yao) and anemarrhena (zhi mu) — what is the anemarrhena for? To check the warming nature of the astragalus — Doctor Zhang Xichun was wary that astragalus runs slightly warm, so he put in a little anemarrhena;
- Also added bupleurum (chai hu) and platycodon (jie geng) — both of these herbs have an upward-moving nature; their job is to raise the qi;
- Chinese yam (shan yao) — tonifies the qi of the spleen and stomach.
The key point: remove the yam, and this is Shengxian Tang
And so, after several more doses, the illness was cured — it took only a few doses in total.
💬 Note from Doctor Luo: Everyone, take note — if you remove the Chinese yam, this formula is exactly Doctor Zhang Xichun’s famous creation — Shengxian Tang (Ascending the Sunken Qi Decoction)! Keeping the yam in is for tonifying the qi of the spleen and stomach. Doctor Zhang Xichun held that astragalus tonifies qi and can also generate qi — that “generate qi” is not the “getting angry” kind of qi, but rather generating the qi of the chest anew and hoisting the sunken grand qi back up. In treating sunken chest qi, astragalus was absolutely the main force.
Note from the narrator: if chest tightness won’t heal, first ask whether the chest qi has sunk
The case is told; now Doctor Luo Dalun brings the lesson into the present day:
💬 Note from Doctor Luo: We tend to think that few people suffer sunken chest qi these days — in fact, there are a great many. Many people have heart complaints — chest tightness, all kinds of symptoms — and the methods we habitually use are widening the chest and regulating qi (kuan xiong li qi); when the heart itself feels wrong, we use activating blood and resolving stasis (huo xue hua yu). But plenty of these people are actually suffering from sunken chest qi — I have seen such patients myself. When your qi is already insufficient, and you insist on pushing it through and breaking it up, the qi only grows more deficient, and the heart never gets better. Yet when Doctor Zhang Xichun’s Shengxian Tang is applied, the effect is immediate — the qi moves upward, and the person recovers. So this theory of sunken chest qi has enormous practical relevance today.
And what exactly is sunken chest qi? Why does it still exist today? Doctor Luo leaves a hook — he will explain it in detail tomorrow.
💬 Note from Doctor Luo: To give you a first feel — once you understand sunken chest qi, you will notice that many modern people have that qi-deficient look: limbs weak, chest frequently tight, always feeling as if the breath can’t quite connect. A great many of them, to some degree, are a case of sunken chest qi.
Bonus: Master Li Ke’s “pregnant belly”
To close, here is an example Doctor Luo witnessed himself:
💬 Note from Doctor Luo: Among today’s senior Chinese medicine doctors, Master Li Ke once treated patients with a strange complaint — every afternoon their belly began to swell, growing more and more distended toward evening, until it looked as if they were pregnant. Master Li treated them by lifting the qi — tonifying it and raising it upward — and gradually the bloating disappeared. That, too, is a manifestation of sunken chest qi: the qi sinks into the middle burner and cannot be lifted, so the belly bloats. So you see — chest tightness, shortness of breath, bloating, weak limbs: these seemingly unrelated complaints may all trace back to that one mass of grand qi not being held up.
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).