Palpitations, Shortness of Breath, Can’t Catch Your Breath After a Fright? Doctor Zhang Xichun’s Case of Fright-Induced Sunken Chest Qi
What people search for: palpitations / heart racing / flustered / shortness of breath / can’t catch your breath / palpitations after a fright Corresponding medical terms: sinking of the pectoral qi of the chest (xiong zhong da qi xia xian) · fright injuring the qi · insufficiency of heart qi
Opening scene: suddenly, the family courtyard catches fire
Today’s story begins with a scene that makes your heart leap into your throat — a fire broke out in the family courtyard. Flames suddenly burst out right in their own yard, and the whole household was terrified. One family member in particular — a young woman in her twenties — was frightened beyond measure, scared nearly out of her wits.
💬 Note from Doctor Luo: Everyone, today we continue with Doctor Zhang Xichun’s treatment of sunken chest qi (da qi xia xian). Why do people run when there’s a fire? Because they’re afraid — what if it burns you? You panic. But who could have guessed that this one fright would frighten a full-blown illness right out of her?
Who was the patient? Frail to begin with
This young woman, in her twenties, had always been rather weak — in Doctor Zhang Xichun’s own words, “zibing su lei ruo” (资禀素羸弱), meaning her physical foundation had never been very good to begin with.
💬 Note from Doctor Luo: There’s a crucial foreshadowing here: given the same fright, a person with a strong constitution may come through just fine, while someone whose foundation is deficient is the one who ends up in trouble. Remember this point — Doctor Luo will come back to it on purpose later.
After the fright, the illness arrived
Once the fire was over, the illness came. What symptoms? It began with shortness of breath — she felt she couldn’t quite draw the breath up, the qi never seemed to keep up.
💬 Note from Doctor Luo: On shortness of breath, Doctor Zhang Xichun once explained that when the qi is insufficient, the deficiency may show more clearly on the exhale. That’s not from this case — he described it in other cases. If you listen to enough of these, you’ll see that Doctor Zhang Xichun described every symptom with extraordinary delicacy.
Then came palpitations of the heart (xin zhong zheng chong) — a fluttering, unsettled feeling in the chest, her heart racing wildly, restless and ill at ease all day long.
💬 Note from Doctor Luo: A heart that flutters and races wildly — this relates to weakness of heart qi. So when the heart is disordered, racing, with that restless dread, everyone, this is a sign of deficiency, not excess. Don’t look at a fast heartbeat and reach for herbs to clear heat and drain fire.
And here’s the stranger part: after eating, the qi felt even less able to rise — it seemed to be trapped inside her chest. So she often took long, deep breaths — she sighed constantly, letting out long “aahh…” breaths all the time.
💬 Note from Doctor Luo: See how these symptoms string together: shortness of breath, a fluttering racing heart, qi unable to rise after meals, constant sighing. Every single one points in the same direction — the qi was moving downward, and could no longer come up.
Doctor Zhang Xichun takes the pulse: the right hand gives it away
For an illness this serious, of course Doctor Zhang Xichun was called in. When he took her pulse, it was fairly even and calm, except that the right pulse was a little deep (chen) — you had to press down slowly, layer by layer, before it would show itself.
💬 Note from Doctor Luo: Everyone, in Doctor Zhang Xichun’s sunken-chest-qi cases, many of them specifically note that the right pulse was especially weak. For example, one case reads “the pulse was fine as a silk thread, especially on the right hand” — the right side was more pronounced. Why so much attention to the right pulse? Because Chinese medicine holds: the right pulse represents qi, and the left pulse represents blood. A weak right pulse suggests the person’s qi is insufficient; a weak left pulse suggests blood deficiency. That’s why Doctor Zhang Xichun always noted the state of the right hand in particular.
Based on this pulse and these symptoms, Doctor Zhang Xichun judged: this young woman had sunken chest qi — the great qi of the chest had sunk (xiong zhong da qi xia xian).
Why does fright sink the chest qi? “Fear makes the qi descend” (kong ze qi xia)
So why had the great qi sunk? Because of the fright.
💬 Note from Doctor Luo: Everyone, earlier we discussed that working hard on an empty stomach can cause the chest qi to sink — right, that was cause number one. Today we have cause number two: a sudden fright, a severe scare, can also sink the chest qi. Why? Because the Neijing (Inner Classic) teaches that “fear makes the qi descend” (kong ze qi xia) — when you are terrified, the qi very easily moves downward.
At this point Doctor Luo unpacks the whole doctrine of the seven emotions (qi qing), taking it apart piece by piece: different emotions change the way qi moves in different ways — joy makes the qi relax and scatter (xi ze qi huan): great joy dissolves and disperses the qi; anger makes the qi rise (nu ze qi shang): fury flushes the qi upward; worry makes the qi stagnate (you ze qi ju): anxiety gathers the qi and holds it still; overthinking makes the qi knot (si ze qi jie): excessive rumination ties the qi into knots; shock makes the qi chaotic (jing ze qi luan): a sudden scare throws the qi into confusion; fear makes the qi descend (kong ze qi xia): terror drives the qi downward. Joy, anger, worry, thought, sorrow, shock, fear — each emotion has its own temperament.
💬 Note from Doctor Luo: You see, the seven emotions wound a person in completely different ways. This young woman suffered “shock plus fear” combined — shock threw the qi into chaos, fear drove it downward; once the qi was in chaos and heading down, how could the great qi of the chest not sink?
The prescription: Shengxian Tang as the base, plus one herb — dried longan pulp
Once the diagnosis was firm, the formula was simple. Doctor Zhang Xichun used Shengxian Tang (Ascending the Sunken Qi Decoction) — a large dose of huang qi (astragalus), matched with zhi mu (anemarrhena), plus sheng ma (cimicifuga), chai hu (bupleurum), and jie geng (platycodon). The logic of the formula is crystal clear: huang qi tonifies the qi, while sheng ma, chai hu, and jie geng all lift upward — together they raise the sunken great qi back up where it belongs.
💬 Note from Doctor Luo: Doctor Zhang Xichun’s formulas are actually quite simple — but behind the simplicity lies precise pattern discrimination. He knew you had sunken chest qi; once the qi is lifted, the illness is cured. Yet this case has one finishing touch: because she had palpitations, a fluttering racing heart, Doctor Zhang Xichun judged there might be some deficiency of heart blood as well, so he added one herb — dried longan pulp (long yan rou), five qian — not a lot in total, about 15 grams. On the one hand, tonify the qi and lift the sinking; on the other, nourish heart blood and settle the spirit.
Four doses, and the illness was completely cured
What was the result? After four consecutive doses, the illness was completely cured — fully recovered.
💬 Note from Doctor Luo: Look at how Doctor Zhang Xichun treated illness — the results came fast and they came well. Why so good? Because his pattern discrimination was accurate — he knew this was sunken chest qi; once the qi was lifted, the illness was done. So just four doses and the patient was well. That is the weight of the four words “accurate recognition of the pattern” (ren zheng zhun que).
Doctor Luo’s reminder: don’t underestimate a fright
So what does this case remind us of? During times of fright, all kinds of illness can easily arise. An ordinary person may survive a scare unharmed, but if that person is usually deficient — qi weak, constitution thin — then after the fright, more serious illness can appear — for example, the sunken chest qi Doctor Zhang Xichun describes. Once the chest qi sinks, breathing problems begin, heart problems begin, and so on, and so forth.
💬 Note from Doctor Luo: The same happens in our own day. I meet people who constantly feel an emptiness and fluttering in the chest, always with a touch of dread. Someone slams a hand on the table — everyone else is fine, but this person jumps at the “bang,” heart racing for ages afterward, always feeling that something bad is about to happen, heart fluttering anxiously the whole time. Everyone, for this kind of person calming the spirit alone is not enough — what do you do? You must supplement the heart qi: tonify the qi and settle the spirit at the same time. Only then can the illness be treated. That’s why Doctor Zhang Xichun used Shengxian Tang here at large dosage to tonify the qi — once the qi was lifted, the symptoms were cured.
Bonus: What’s the use of listening to medical case stories, anyway?
What’s the use of talking through these cases? Doctor Luo says: people’s diseases come in every shape and form, but once you’ve heard enough of them, you discover — in the end they all follow the same principles. If you meet a similar situation, we don’t expect you to become a doctor — but if you can remember, “Oh, Doctor Luo told this case, and it resembles this person closely — could his problem be caused by the same thing?” — the moment that thought occurs to you, you may be able to help him.
💬 Note from Doctor Luo: When you run into such a problem in daily life, if you’ve heard my stories and know the principles inside them, you’ll know how to guard against it. So I talk to you for a few minutes every day, trying to pry open the reasoning bit by bit. And if you’re a student at a Chinese medicine school, listening now and then is enjoyable too, I think — you’ll grow interested in Chinese medicine, and interested in this doctor, Doctor Zhang Xichun. All right, friends — see you tomorrow!
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》, published in installments between 1918 and 1934).