Can’t Control Urination, Breath That Sinks, and a Cold Lower Belly? Doctor Zhang Xichun’s Two-Step Answer

Patient search terms: urinary incontinence / loss of bladder control / can’t hold urine / shortness of breath / can’t catch the breath / labored breathing / weak limbs / cold lower abdomen Medical terms: sinking of the great qi (da qi xia xian) · urinary incontinence · cold deficiency of the lower burner · impaired qi transformation of the bladder

The opening: Doctor Zhang’s “diseases of qi” chapter — it starts with learning to recognize qi

Doctor Luo Dalun presents Doctor Zhang Xichun’s case records by weaving back and forth — formulas one day, cases the next, then formulas again — so that everything sinks in. This session opens the chapter on diseases of qi.

Qi is extraordinarily important in the body; it is one of the forms of life itself: qi fills the whole body and is everywhere — as long as there is qi, a person is alive; when the qi is gone, the person is gone. The qi in different parts of the body has different names: chest qi, middle qi, the great qi (this is what Doctor Zhang Xichun called it), lung qi, stomach qi, liver qi, kidney qi, spleen qi — and also the nutritive and defensive qi (ying wei zhi qi) that protects the body and stands guard against illness. The constant growth and development of every organ are all tied to qi.

💬 Note from Doctor Luo: Diseases of qi can be roughly divided into six types — qi deficiency (qi xu): the righteous qi is insufficient, the whole body has no strength, and you’re exhausted all day; rebellious qi (qi ni): qi moves abnormally upward — stomach qi that should descend refuses to, and you belch and reflux; when liver qi rushes upward you get dizziness; qi depression and qi stagnation (qi yu qi zhi): when you’re gloomy and depressed, the qi gets blocked — many people today grow all kinds of nodules, and a great many are related to qi depression and stagnation; qi sinking (qi xian): qi moves downward and can no longer be held in place — some people get rectal prolapse, some can’t pull their breath up when speaking, some get a sagging stomach; this is sinking of the great qi; qi collapse (qi tuo): the righteous qi can’t stay within, large amounts leak outward, and bodily functions suddenly fail; qi blockage (qi bi): the qi mechanism suddenly seals shut, the clear orifices are blocked, and the person faints. The case today is qi moving downward — sinking of the great qi.

Who was the patient? Chen Yuting, a Tianjin merchant

The patient was Chen Yuting, a native of Tianjin, thirty-five years old, in business for a living — not old at all. But she had a constitution that was naturally weak; her foundation was poor, and she often felt that the breath could not rise — with every breath, it seemed the qi simply wouldn’t come up.

This had been going on for a long time: she had come to see Doctor Zhang Xichun repeatedly. Whenever she felt the breath failing to rise, Doctor Zhang gave her Sheng Xian Tang (Lift the Sunken Qi Decoction), and after drinking it the problem resolved on the spot.

💬 Note from Doctor Luo: Many friends have had their eyes opened by listening to the explanation of Sheng Xian Tang — so that’s why I’m always tired, why the qi in my chest won’t lift, why I always suspected my heart was at fault! These are all sinking of the great qi. Some people had been treated for years without results, and a few doses of Sheng Xian Tang set them right. Quite a few people in the comment section have written, “Sheng Xian Tang really works.”

This time it was serious: overwork plus cold — the qi sank all the way down to the lower belly

Later, on one occasion, she overworked herself while traveling on business — in business there’s no choice, it was exhausting — and at the same time she caught cold. The illness suddenly flared up again: not only did the great qi sink, but a new problem appeared: urinary incontinence — she could no longer control her urine.

What did it feel like? The qi in the chest sank and sagged with every breath — each breath felt as if the qi was going down, dropping away, and she had to strain to exhale, yet it was still hard to get the qi to come up. Doctor Zhang Xichun was particularly careful to distinguish exhaling from inhaling: in fact, people with sinking of the great qi find both exhaling and inhaling difficult. The main sensation is a weak, oppressed feeling in the chest — not a blocked feeling, but something more like emptiness, as if there’s nothing to push with. This patient’s case was more severe: the qi sank all the way down to the lower abdomen (shao fu) — and when the qi dropped, the urine could no longer be controlled, turning into full incontinence. On top of that, her lower burner felt especially cold, and her limbs were weak.

One touch of the pulse: both wrists were deep and soft (chen ru), and the right wrist’s inch and bar positions were the deepest and softest of all — the lung pulse and spleen pulse on the right side were sinking hard, telling you the righteous qi was headed downward.

💬 Note from Doctor Luo: Sometimes Doctor Zhang Xichun analyzes a disease so finely that people have trouble matching themselves to it. In plain terms: breathing is very labored, the chest feels oppressed and empty, and the qi feels like it’s dropping — that’s sinking of the great qi.

How Doctor Zhang thought about it: when the great qi fails, the heart and lungs fail first

Doctor Zhang Xichun’s diagnosis: a severe case of sinking of the great qi of the chest (xiong zhong da qi xia xian zhi ju zhe).

What is the great qi? The great qi accumulates in the chest and holds up the heart and lungs, the center of the body — the functions of the heart and lungs are activated, driven, and carried on by it. Once the great qi starts moving downward, the heart and lung functions fail first, and the most obvious sign is a breathing problem — in reality, while the breath goes wrong, the heart also goes wrong.

Doctor Zhang Xichun’s analysis: when the great qi is deficient and sinks, the blood circulation loses its driving force, which is why the pulse is deep and soft; when the lung qi is weak, even straining to exhale can’t lift the breath upward; the great qi rotates through the whole body from the chest and governs the triple burner (san jiao) — when the great qi is deficient, the limbs feel weak; and because the body can no longer secure and hold fluids, the water easily escapes — hence the urinary incontinence.

And why was the lower burner so cold? Doctor Zhang’s explanation: the cold pathogen that had invaded, carried along by the sinking great qi, had sunk down into the lower burner.

💬 Note from Doctor Luo: How are we to understand this? When a person’s qi deficiency is severe and the great qi sinks, the body has no strength to resist the outside cold; once the cold takes hold, the whole body takes on a yang-deficient state — in fact at this point the whole body is cold, it’s just that the qi has sunk to the lower burner and the illness manifests mainly below, so the lower burner feels it most strongly. In the past, people said sinking of the great qi was mainly a breathing problem; in modern society, though, heart problems are also very obvious — patients get checked and the heart often shows something abnormal, because the functions of both heart and lungs are affected.

The first formula: don’t rush to lift the qi — build up the righteous qi first

How was it treated? Doctor Zhang Xichun prescribed two formulas, and they were different: drink the first one, then a little over an hour later, drink the second.

The first formula: ye tai shen (wild Codonopsis) 5 qian (15 g) — wild dangshen, the variety from Mount Wutai — wu fu zi (black aconite) 4 qian (12 g) — what we call hei fu zi today — and sheng huai shan yao (raw Huai Chinese yam) 1 liang (30 g).

Codonopsis tonifies qi and supports the righteous qi; aconite warms the yang and drives out cold — everyone knows that aconite warms the yang of the kidney channel and the yang of the spleen channel. Doctor Zhang Xichun explains: ren shen (ginseng) and fu zi (aconite) pair together particularly well — ginseng tonifies, and aconite’s heat can be carried swiftly to the whole body. Chinese yam greatly tonifies the lung, spleen, and kidney and also has an astringent, securing quality. The three herbs together protect and strengthen the qi transformation (qi hua) of the lower burner — so the problem of urinary incontinence is relieved right away.

💬 Note from Doctor Luo: Why drink this one first and that one later? This is the technique of treating in layers: the first formula tonifies qi, warms the yang, and secures the lower burner — lay the foundation first — and an hour later, lift upward. The late old master Li Ke used to say: lifting and holding up is easy — but if you lift it all at once, the person faints — because the lower burner is too deficient. So when you see someone whose lower burner is deeply deficient, first support the righteous qi, build it up fully, and only then lift — that’s how the qi can actually be raised. If the foundation isn’t laid and you force the issue with astragalus plus lifting herbs, some people get dizzy and some actually faint — this is called ti tuo, “lifting into collapse.”

A little over an hour later, the second formula takes the stage: modified Sheng Xian Tang

The second formula was Sheng Xian Tang with modifications: sheng jian qi (raw astragalus) 1 liang (30 g) — note that Doctor Zhang Xichun normally used raw astragalus at about ten-something to eighteen grams, but in this case he used thirty grams — a heavy dose! To it he added sheng huai shan yao (raw Huai Chinese yam) 1 liang (30 g), chao bai zhu (dry-fried white atractylodes) 4 qian (12 g) to tonify the spleen, jing yu rou (dogwood fruit) 4 qian (12 g) to tonify the yin of the liver and kidney, bi xie (fish-poison yam), and the upward-lifting pair sheng ma (cimicifuga) 1.5 qian (4.5 g) and chai hu (bupleurum) 1.5 qian (4.5 g).

Astragalus tonifies qi — it’s the leading herb of Sheng Xian Tang. Chinese yam tonifies qi — and as Doctor Luo has pointed out all the way through this series, Doctor Zhang Xichun used Huai yam in nearly every formula, and in generous amounts at that. Atractylodes tonifies the spleen; dogwood fruit tonifies the yin of the liver and kidney.

The most distinctive herb here is bi xie:

💬 Note from Doctor Luo: In the past everyone said bi xie was a water-draining herb — it drains water and separates the clear from the turbid — so many people treated it as a medicine to increase urination. Doctor Zhang Xichun insisted this error absolutely had to be corrected — bi xie actually reduces urination (suo xiao bian)! It strengthens the bladder’s function and enhances its securing, astringent power. Put into this formula, it targets exactly the problem of urinating too much and losing control, adding protective power and shrinking the urine output. Pair that with sheng ma and chai hu lifting upward — while tonifying qi, the lifting herbs pull the sunken great qi back up. That is Sheng Xian Tang with additions: Huai yam, dogwood fruit and the other tonics, plus bi xie to reduce urination.

The result: the urine steadied, and the breath was still one breath short

The family followed Doctor Zhang Xichun’s instructions and had her drink both formulas. The result: the cold in the lower burner and the urinary incontinence both healed — the lower burner was no longer cold, and the urine was held. But she still felt her breath was a bit short of qi, the qi still couldn’t quite lift — the body was no longer aching-weak, but there was still a sense of lack of strength — which told Doctor Zhang the sinking of the great qi was still present.

So the first formula was set aside, and she continued with the second, this time with a change: chai hu was removed and gui zhi (cinnamon twig) 1 qian (3 g) was added — gui zhi can generate liver qi and unblock it, letting the liver qi rise. After several consecutive doses, her breathing was smooth again.

Wrapping up: reduce sheng ma and gui zhi again — five doses to full health

Doctor Zhang Xichun adjusted the formula once more: sheng ma and gui zhi were further reduced, both down to 1 qian (3 g) each. With this version she took five consecutive doses, and the result was that her body was healthy and normal again — so he told her to stop; no more medicine was needed.

💬 Note from Doctor Luo: What can we learn from this case? Sinking of the great qi itself isn’t today’s main point (we’ve covered Sheng Xian Tang before, and more cases are coming later). Today’s main point is: when a person’s body is deficient to a certain degree, lifting herbs should not be used rashly. Doctor Zhang Xichun was extremely cautious — facing a patient who was simultaneously at the extreme of qi deficiency and yang deficient, he used aconite to warm the yang and wild Codonopsis with Huai yam to support the righteous qi — first propping up the righteous qi, and only then applying the tonifying-plus-lifting formula. This kind of layered prescribing is exactly where a great physician’s thoroughness shows. Treat in layers — support the righteous qi first, lift second, with a little time between the two formulas — that is the takeaway we should study.

Modern takeaway: how many people shuttle between hospitals for years, never knowing they have sinking of the great qi

After finishing this case, Doctor Luo reflected with feeling: the greatest benefit of presenting Doctor Zhang Xichun’s case series is that — many friends have sinking of the great qi without knowing it, years of treatment that never succeeded, and in the end they fixed their own bodies with Sheng Xian Tang. Reading those comments, he was astonished: so many ordinary people have sinking of the great qi!

💬 Note from Doctor Luo: Think about it — it makes sense. Modern people have plenty of qi deficiency and plenty of exhaustion, so the qi gets plenty of chances to sink. Because this knowledge hasn’t been spread, people don’t know how to describe the illness, they don’t mention it to their TCM practitioner, and the practitioner doesn’t necessarily recognize sinking of the great qi either — so the patient endures years of suffering, shuffled from hospital to hospital, never cured. That is why both TCM practitioners and ordinary people need to learn much more about sinking of the great qi: know what it is and how to adjust it, so we can protect ourselves better. This is the most meaningful thing about presenting Doctor Zhang Xichun’s sinking-of-the-great-qi section.

Case source: Records of Chinese Medicine with Western Reference by Doctor Zhang Xichun; commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).