A Teenager Always Cold, Bloated After Every Meal, and Short of Breath? Doctor Zhang Xichun’s Case of Heart-Lung Yang Deficiency with Sinking of the Great Qi
What people search for: always feeling cold / body feels chilled / bloated after meals / shortness of breath / a child who is always cold Corresponding medical terms: heart-lung yang deficiency · sinking of the great qi · food not transforming · undigested food in the stool
Opening scene: a boy of thirteen or fourteen who complained of cold all day long
Today’s patient is a teenage boy of thirteen or fourteen. What was his illness? Say it again and again, and it comes down to a single word — cold. He always felt chilled, his body felt cold, everything felt heavy and sunken, and he was cold all the time.
💬 Note from Doctor Luo: Everyone, today we continue with how Doctor Zhang Xichun treated sinking of the great qi (da qi xia xian). Previously we discussed the Shengxian Decoction (Decoction to Raise the Sinking). Today’s formula builds on the Shengxian Decoction but adds herbs that warm the yang — it is called the Huiyang Shengxian Decoction (Decoction to Return the Yang and Raise the Sinking, 回阳升陷汤). Why would a cold child need to be treated this way? Read on.
Bloated after every meal — with undigested food still in the stool
Besides feeling cold, the boy also had food not transforming (yin shi bu hua) — after he ate something, his stomach would swell up, tight and heavy, and the food seemed to sit there half the day without going down. A normal person, after a meal, feels full at first and then gradually digests it; only someone with insufficient upright qi (zheng qi) feels bloated after every single meal.
💬 Note from Doctor Luo: What does “food not transforming” mean? It means the food isn’t digested and the belly feels bloated and heavy. The more serious version is undigested food in the stool (wan gu bu hua) — when the stool comes out, the food is still there, passed out whole, barely changed. This is also a form of food not transforming. Remember this diagnostic marker.
The real trouble: “not enough breath” — and a pile of warming herbs that did nothing at all
The boy also often felt short of breath (duan qi) — as if he couldn’t quite get the air in. His family took him to doctor after doctor, and the doctors thought: this is plainly yang qi deficiency (yang qi bu zu)! So they prescribed warming, tonifying herbs. And the result? No matter what heating medicine they used, the symptoms did not improve in the slightest — the boy still never felt warm. Only then did they call in Doctor Zhang Xichun.
💬 Note from Doctor Luo: Pay attention — this is the most crucial stroke in the whole case: cold and yang deficiency should respond to warming the yang. Why did nothing work at all? The answer is coming. Sometimes it isn’t that the disease was misnamed; it’s that one layer of the disease mechanism was overlooked.
Doctor Zhang Xichun takes the pulse: weak, faint and slow — both hands sunken
Doctor Zhang Xichun came and felt the pulse: weak, faint and slow (wei ruo er chi) — the beat was very slow and very faint, especially on the right hand; when he pressed the left hand, the pulse was deep (chen), so deep he had to press down hard to feel it. He judged this to be deficiency of the yang aspect of the heart and lungs — both heart yang and lung yang were insufficient — combined with sinking of the great qi (da qi xia xian), and the great qi had already sunk halfway.
💬 Note from Doctor Luo: Here, a word of Chinese medicine theory: people usually hear about lung qi and lung yin, and rarely hear about lung yang — but in fact every organ has qi, blood, yin and yang, so the lungs also have lung yang and lung blood. Our current-day theory of Chinese medicine is sometimes not taught completely. In this case, heart-lung yang deficiency was the foundation underneath everything.
Where was the root? — Once the great qi sank, nobody was guarding the yang of the heart and lungs
How did Doctor Zhang Xichun reason it out? He said: the heat of the whole body relies on the yang of the heart and lungs to spread it. The yang of the heart and lungs is like the sun in the sky — it warms the qi of the channels and distributes heat to every part of the body. And what protects the yang of the heart and lungs? The great qi of the chest — the great qi sits mainly in the region of the heart and lungs.
💬 Note from Doctor Luo: Once the great qi sinks, the force that guards and protects the heart and lungs is lost, and the yang of the heart and lungs naturally grows weaker and weaker; and when the yang of the heart and lungs is insufficient, it in turn makes the sinking of the great qi worse — the two illnesses cause each other in a cycle. So the great qi had to be lifted back up quickly, or the yang of the heart and lungs would grow weaker and weaker. That is why merely warming the yang did not work.
Huiyang Shengxian Decoction: the Shengxian formula as the base, plus a blaze of warming fire
Once the pattern was recognized, Doctor Zhang Xichun created a formula of his own — the Huiyang Shengxian Decoction (Decoction to Return the Yang and Raise the Sinking, 回阳升陷汤): raw astragalus (sheng huang qi), eight qian (about 24 g) as the chief herb — not an especially large amount; dried ginger (gan jiang), six qian (about 18 g) — now this is a very large amount, roughly 18 grams in modern measure, and the decoction it made was pungent and hot, full of warming power; dang gui shen (the body of Chinese angelica), four qian (about 12 g), to nourish the blood; cassia twig tips (gui zhi jian), three qian (about 9 g), to lift upward; and licorice (gan cao), one qian (about 3 g), to round it off.
💬 Note from Doctor Luo: Why cassia twig tips? Doctor Zhang Xichun held that the nature of cassia twig can both ascend and descend: first, it can send qi downward; second, it can generate and move the qi upward — the branches of the cassia tree all grow upward, and especially the twig tips, whose qi moves upward, so it can open and free the channels. The famous Gui Zhi Tang (Cassia Twig Decoction) has cassia twig as its chief herb. What Doctor Zhang Xichun borrowed here is precisely that rising power — he even once cured a similar disorder of the qi movement with cassia twig alone.
Five doses and the shortness of breath was gone; half the cassia twig, a few more doses, and he was cured
There was nothing exotic in the formula: the main force was raw astragalus, joined by warming dried ginger, blood-nourishing Chinese angelica, and lifting cassia twig tips. The original Shengxian Decoction contained chai hu (bupleurum), jie geng (platycodon) and other herbs, but this formula used only cassia twig to do the lifting. The decoction was prepared and given to the boy — after five doses, the shortness of breath vanished!
💬 Note from Doctor Luo: Doctor Zhang Xichun then halved the amount of cassia twig in the formula, had him take a few more doses, and the boy’s illness was completely cured. See, the key to success was not the number of herbs — it was getting the direction right — lifting the great qi on one hand and warming the heart yang on the other, doing both at the same time.
The little aftercare secret: a tiny pinch of raw sulfur every day
The cure was not the end of it. Doctor Zhang Xichun also instructed the boy: take a tiny bit of raw sulfur (sheng liu huang) every day — a very, very small amount — to warm the yang and drive out the deep-rooted cold. The boy gradually recovered his health this way.
💬 Note from Doctor Luo: The use of raw sulfur is one of Doctor Zhang Xichun’s special touches for aftercare — the disease is already cured, and this herb is used to pull out the residual cold at the root, little by little. Exactly how it should be taken, Doctor Luo says he will explain in a future session. For now, remember this way of thinking: aftercare is just as important as treatment.
Doctor Luo’s note one: feeling cold doesn’t always mean “warm the yang” — first check for sinking of the great qi
Why tell this boy’s case today? To tell you this: sinking of the great qi can affect the heart-lung yang, and it can also make yang deficiency symptoms worse; conversely, insufficiency of heart-lung yang aggravates the sinking of the great qi — the two feed each other.
💬 Note from Doctor Luo: This case shows that sinking of the great qi sometimes comes together with cold symptoms. When we meet cold symptoms, we tend to think of warming the yang, and for some patients it works well; but for other patients who carry an additional disease mechanism, warming the yang alone fails. For example, I have met people who feel intensely cold but are actually blood deficient (xue xu) — no amount of warming the yang does anything, yet as soon as you nourish the blood, they recover. So when you see a person who is always cold, don’t rush to prescribe hot herbs — first ask: could there be sinking of the great qi? Could it be blood deficiency?
Doctor Luo’s note two: children today also sink their great qi — lighten their load
This case is special because the patient was a child. Doctor Luo wants to remind everyone: teenagers are also prone to sinking of the great qi. Forget Republican-era China, let’s talk about now — many children are actually quite overworked, with injured spleen and stomach; heavy schoolwork, little exercise, insufficient upright qi — and some of them do develop sinking of the great qi.
💬 Note from Doctor Luo: How do we protect our children? First, keep their diet normal; second, don’t let them overwork. On the internet, some parents schedule ten-plus hours — even eighteen hours — of study time a day for their kids. That is far too exhausting. Such children get no exercise, and after one bout of extreme fatigue, the body starts to break down. Let children exercise, don’t pile the schoolwork so high, keep the diet regular — and the child will naturally be healthy.
Compiled from Doctor Luo Dalun’s narration of Doctor Zhang Xichun’s medical cases; the original case comes from Yixue Zhongzhong Canxi Lu (Records of Chinese Medicine with Reference to Western Medicine).