Shortness of Breath, Can’t Catch Your Breath, Worse After Anger? Doctor Zhang Xichun’s Case of Anger-Induced Sunken Chest Qi
What people search for: shortness of breath / short shallow breathing / can’t draw a full breath / no strength after getting angry / palpitations and fluttering heart Corresponding medical terms: sinking of the pectoral qi of the chest (xiong zhong da qi xia xian) · sinking of middle qi · qi deficiency with sinking
Opening scene: a young woman who was never happy, short of breath until her “breath was about to stop”
The patient in today’s case is a young woman in her twenties. Her family circumstances were not good — the household relationships were complicated, and all sorts of troubles among her in-laws were tangled together. She was always unhappy and often got angry. Life was not going well, and illness quietly found its way to her door.
💬 Note from Doctor Luo: Everyone, let’s continue discussing how Doctor Zhang Xichun explained “sunken chest qi” (da qi xia xian). I suspect that by the time we finish this whole set of cases, your understanding of sunken chest qi may surpass that of many students in TCM schools — why? Because in school it was never taught this way, layer by layer, in such detail. Today’s case is another piece of the puzzle.
What was her illness? Shortness of breath — she always felt the qi was not quite enough; when she breathed, the breath came up short. At the same time she had a dry throat and thirst — her throat was always parched and she was always thirsty.
💬 Note from Doctor Luo: Everyone, the most alarming symptom is still to come — how short was her breath? In the severe episodes, she felt as if her breath was about to stop altogether: the breath was on the verge of ceasing, and she had to strain, to breathe with all her might, to catch it again. You can see how serious this shortness of breath was.
Doctor Zhang Xichun takes the pulse: the left hand is fine — the right hand gives it away
With an illness this severe, of course Doctor Zhang Xichun was called in. When he took her pulse, the left position was as normal as could be — the left pulse was exactly like a healthy person’s.
💬 Note from Doctor Luo: If you’ve been listening to my earlier talks, you should remember: Doctor Zhang Xichun held that the right pulse corresponds to qi and the left pulse corresponds to blood. People with blood deficiency show a very weak left pulse; people with qi deficiency show a very weak right pulse. This young woman’s left pulse was fine — the problem was on the right.
What was wrong with the right pulse? Slow on the rise, hurried on the fall (mai lai huan qu ji) — when the pulse beat rose, it was slow, the strength not full; when it fell, it vanished quickly, dropping away in an instant. Moreover, the pulse was very hard to press and could not lift the fingertip at all — you laid your finger on it and it was soft and limp, completely unable to raise your finger, with no beating you could feel.
Why couldn’t the pulse rise? The chest qi had sunk
How did Doctor Zhang Xichun read it? He said this was sunken chest qi (da qi xia xian). Why? The Neijing (Inner Classic) says “the ancestral qi threads through the heart vessels” — this ancestral qi, the middle qi, is what Doctor Zhang Xichun called the “great qi.” The qi must flow into the blood vessels for the pulse to beat. Now that the great qi had sunk and could no longer push the pulse outward, of course the pulse could not rise.
And where did this illness come from? Because she was so often angry, her chest qi sank.
💬 Note from Doctor Luo: At this point we have already discussed several causes of sunken chest qi. The first: working hard on an empty stomach — exercising before breakfast and then doing heavy labor causes the chest qi to sink; the second: fright — fear sends the qi downward (kong ze qi xia), so terror can also sink the chest qi; and today’s third cause: anger.
Anger is supposed to send qi “upward” — how can it sink the qi down?
Here is a big question: Chinese medicine says “anger makes the qi rise” (nu ze qi shang) — when you are angry, the qi surges upward. How could anger instead cause the chest qi to sink? Doctor Zhang Xichun argued this question out specifically.
💬 Note from Doctor Luo: Doctor Zhang Xichun said that people find this contradictory only because they haven’t distinguished two different kinds of qi. What the Neijing means by “anger makes the qi rebel and rise” refers to the qi of the liver and gallbladder — that is liver fire and wrath surging upward, not the great qi of the chest. Those are two different things. And when the liver-gallbladder qi surges upward, what happens? It pushes the great qi of the chest downward. This was one of Doctor Zhang Xichun’s ideas.
In addition, once you are angry, the spleen and stomach start to malfunction — the liver qi running sideways attacks the spleen earth; wood overcomes earth (mu ke tu). In modern terms, bad emotions cause disorders of the digestive system. When the spleen and stomach fail, you don’t want to eat, you take in less food, less nourishment — so where is your great qi to come from? Its source is insufficient, and naturally it sinks.
💬 Note from Doctor Luo: I think there is also a third cause. When your wrath flares up, it can stir up the heart fire. What happens when the heart fire blazes? It burns away the heart qi, and that too leads to sunken chest qi — the qi becomes insufficient; wrath stirring the heart fire also burns the blood and vessels, so the great qi of the chest becomes more and more insufficient. We can analyze it with all kinds of theories, but what Doctor Zhang Xichun did was observe the phenomenon: anger causes the chest qi to sink.
The prescription: still Shengxian Tang, with extra zhi mu to clear the heat
Once the diagnosis was firm, the formula was easy. Doctor Zhang Xichun used his old standby — Shengxian Tang (Ascending the Sunken Qi Decoction). In this formula, the dose of huang qi stayed unchanged, but because this young woman’s liver fire was too strong, he changed zhi mu to six qian (about 18 g) — added a little extra, to clear the heat.
💬 Note from Doctor Luo: Shengxian Tang is Doctor Zhang Xichun’s representative formula for sunken chest qi: raw huang qi as the chief herb, matched with chai hu (bupleurum) and sheng ma (cimicifuga) to lift the qi upward, jie geng (platycodon) to carry the medicine up, and zhi mu (anemarrhena) to clear deficiency heat. In this case the liver fire was rampant, so he raised zhi mu to six qian — the herbs were the same few, the doses shifted with the pattern — this is the fine precision of Doctor Zhang Xichun’s prescribing.
Three doses and more than half cured; remove sheng ma to finish
What was the result? After three doses, the illness was more than half cured — she was mostly well. When he took the right pulse again, it had begun to rise a little, with more strength than before. So Doctor Zhang Xichun removed sheng ma from the formula, and after several more doses the illness was gone.
💬 Note from Doctor Luo: You see — once Doctor Zhang Xichun diagnosed the pattern accurately, a few doses brought results. Extraordinary. Removing sheng ma was deliberate — sheng ma lifts very strongly, and since the illness was already mostly cured and the pulse had risen, he withdrew this powerful herb so as not to lift too far.
What this case tells us: illnesses of emotion are more common than we think
What lesson does this case carry? Anger causes the chest qi to sink.
💬 Note from Doctor Luo: Everyone, the diseases caused by emotion are so many — more than we may have imagined. If after getting angry you always feel weak, or feel palpitations and a fluttering heart (xin qi zheng chong), heart palpitations and anxiety, and all kinds of similar problems, you should know: one possibility is sunken chest qi (da qi xia xian). Consider this a heads-up.
And in closing, Doctor Luo Dalun offers everyone two pieces of advice: try not to get angry; keep your emotions optimistic.
💬 Note from Doctor Luo: If you have the chance, listen to my lectures on the Dao De Jing in my Dalun Academy (大伦书院) — it’s good to learn to see life a little more clearly. Through a person’s life, when the heart is broad and the qi flows smoothly, that mass of great qi in the chest stays steady and secure, and illness naturally grows fewer. That’s all for today — tomorrow we continue with Doctor Zhang Xichun’s healing stories.
Compiled from Doctor Luo Dalun’s commentary on Doctor Zhang Xichun’s case records; the original case comes from Yixue Zhongzhong Canxi Lu (《医学衷中参西录》).