Comatose, Cold All Over, Always Needing a Long Sigh After a Cold? — Doctor Zhang Xichun Treated Sinking of the Great Qi (da qi xia xian)
Patient search terms: unconscious after a cold / unresponsive and cannot be woken / whole body cold / labored breathing / always needing to take a long sigh / dry tongue Medical terms: sinking of the great qi (da qi xia xian) · sinking of the chest great qi · qi exhaustion from an external contraction · qi deficiency with clouded spirit
Opening: sinking of the great qi, and one road we have not yet discussed
We have been talking about sinking of the great qi (da qi xia xian, 大气下陷) for many days now, and you have heard every kind of presentation — but everything discussed before was internal injury. Today’s case changes the pattern: an external contraction can also drag the great qi down. Catch a cold or flu, and the great qi can still collapse. In this case, the patient had already fallen unconscious and cold all over; the previous doctor had declared him untreatable, and the family was waiting to arrange the funeral. Two doses from Doctor Zhang Xichun brought the man back to life.
Who was the patient? A springtime warm disease, dragged out for more than twenty days
The patient was around forty years old, right in the middle of life. He caught a warm disease in late spring (ji chun, 季春) — a warm disease is a heat-type external contraction, so it should have shown signs of heat. A doctor was called to treat him, but no matter what was tried, nothing worked. More than twenty days slipped away, and the illness grew worse day by day until the man was on the verge of death.
How severe was it? Coma, a cold body, and a tongue dry as a polished stone
When Doctor Zhang Xichun arrived, he saw: the patient’s eyes were clear and pale, without a spark of fire — no luster in the eyes, just a faint washed-out whiteness, not a trace of vitality. The man was already muddled and unconscious, completely unresponsive.
💬 Note from Doctor Luo: When the mouth was pried open to look at the tongue, Doctor Zhang Xichun recorded the original words “tongue dry as if chiseled” (she gan ru cuo, 舌干如磋) — “cuo” means grinding stone, polishing it smooth and flat. This tongue looked exactly like a ground stone surface: smooth and dry at the same time, with not a shred of coating on it. What sort of tongue picture is this? It is precisely the tongue of sinking of the great qi: the tongue body is pale white, often with tooth marks at the edges, a thin coating that is barely there or not there, and the whole tongue looks bloodless. If you meet someone whose tongue is exceptionally red and moist and say he has sinking of the great qi — that is basically impossible.
Then he looked further: the patient was cold all over; when he breathed, every five or six breaths he would inevitably draw one long, deep sigh; and when the pulse was taken, both wrists were weak, with a slightly slow beat — a little slow, but above all the pulse was weak.
How did Doctor Zhang Xichun read it? This is not a death sentence — it is sinking of the great qi
Doctor Zhang Xichun’s judgment: sinking of the great qi. Why? The analysis makes it clear at once —
When qi cannot rise, the head and brain get insufficient qi and blood, and the person falls into clouded consciousness and coma; when the great qi sinks, qi and blood cannot reach the upper body, the tongue loses its fluids and dries like a polished stone, the mouth cannot even move, and naturally the patient cannot answer questions; when the great qi sinks and qi and blood are deficient, the defensive and nutritive qi (wei qi and ying qi) that circulate over the body surface are insufficient and can no longer nourish the whole body, hence the whole body is cold; once the great qi in the chest collapses, shortness of breath in the chest follows — the breath feels insufficient, and the person must force out a long sigh.
💬 Note from Doctor Luo: How did the illness get dragged into this state? The previous doctor had more or less cleared the heat of the warm disease, but the patient was mentally exhausted and his upright qi could no longer hold out — the doctor concluded it was a terminal illness and refused to treat him; the family also believed there was no hope and simply waited. In fact this was not a fatal disease at all — it was sinking of the great qi. That is why the illness neither advanced nor receded, and was simply left hanging for more than twenty days. Lucky for the patient that he met Doctor Zhang Xichun.
The prescription: one liang of wild Taizai ginseng with two qian of chaihu — two herbs save a life
The formula Doctor Zhang Xichun wrote was extremely simple: ye tai shen (野台参, wild Taizai ginseng) 1 liang (30 g), paired with chai hu (柴胡, bupleurum) 2 qian (6 g).
💬 Note from Doctor Luo: What is ye tai shen? It is wild Codonopsis (dang shen) from Mount Wutai in Shanxi — hence the name “wild Taizai ginseng.” Taizai ginseng is a qi-tonifying herb; Doctor Zhang Xichun once explained that in ordinary situations we use raw astragalus (sheng huang qi), but in a true emergency, what you reach for is ginseng — with a little chaihu added to lift the qi upward. And that was all — two herbs, decocted and poured down the patient’s throat: one dose brought improvement, two doses cured him completely. A man unconscious and unresponsive, universally regarded as a dead case, brought back with two doses of medicine — that is real skill. Reading Doctor Zhang Xichun’s cases never stops being astonishing: if Chinese medicine were always like this, what quarrel between Chinese and Western medicine would there even be? It is our own skill that falls short — we must study harder. Accurate diagnosis and effective prescriptions are a blessing for ordinary people and a blessing for the development of Chinese medicine.
Knowledge point one: How can an external contraction drag the great qi down?
Doctor Luo Dalun sums up two knowledge points for everyone. The first: an external contraction can cause sinking of the great qi.
💬 Note from Doctor Luo: Why? When you suffer an external contraction, upright qi and pathogenic qi contend — the body is fighting a war — and that consumes a great deal of upright qi. When I was a child, after a fever broke and I went out walking, the sunlight outside felt dazzling and my steps were a little floaty — that was upright qi running low, the body left weakened. Young people recover quickly, two or three days and they are fine; but middle-aged and elderly people, and those whose lung and heart qi are already insufficient, burn through a great deal of upright qi after an external contraction, and that can easily lead to sinking of the great qi. This is something I had never considered before: so sinking of the great qi can also happen after an external contraction. Doctor Zhang Xichun deliberately picked out this case and placed it in his book to tell later generations — pay attention, this can happen too. So middle-aged and elderly people and those with weak bodies should be careful; once you build the qi back up, those deficiency symptoms disappear. Your weakness may not be caused by the external contraction itself, but by insufficient upright qi.
Knowledge point two is even more critical: a dry tongue — do not rush to nourish yin
The second knowledge point comes from Doctor Zhang Xichun himself, and it is a special warning: if you do not recognize this as sinking of the great qi, and you look at a tongue this dry and short of fluids, you will very easily reach for yin-nourishing, moistening herbs — some sheng di (raw Rehmannia), e jiao (donkey-hide gelatin), gou qi zi (wolfberry), trying to moisten the fluids. And the consequence?
💬 Note from Doctor Luo: Doctor Zhang Xichun said the consequences would be severe. This patient is not suffering yin deficiency, not a lack of fluids — it is sinking of the great qi; the tongue is dry because the qi cannot rise. Sheng di, e jiao and gou qi zi are all cloying, greasy herbs; used here they would block and congest the qi of the upper burner, and once the great qi has sunk, it can never come back — the consequences are unthinkable. So when you see a dry tongue, first look at the tongue color — if the tongue is very pale, never nourish yin. Not every dryness comes from insufficient fluids or yin deficiency.
The steamer analogy: in yang-deficient people, the steamer lid is dry too
What else can cause a dry mouth and tongue? Kidney yang deficiency can as well. The ancients put it with a metaphor:
💬 Note from Doctor Luo: Picture a big steaming pot. When there is fire under the steamer, vapor rises and the lid is damp; once the fire goes out and the water slowly cools, the lid turns dry. In people with kidney yang deficiency, the fire of the gate of life (ming men zhi huo) is insufficient; the fire cannot steam upward, and the upper body dries out the same way — dry mouth, thirst. That is how the ancients described it. Sinking of the great qi works the same way: the tongue is very dry, the mouth very dry — at such a moment you do not need to nourish yin, do not need to generate fluids; what you need is to lift the qi back up.
Doctor Zhang Xichun’s instruction: when breathing feels blocked, keep this in the back of your mind
Doctor Zhang Xichun therefore repeated his advice again and again: when treating patients, you must be meticulous.
💬 Note from Doctor Luo: Whenever someone says they feel “insufficient in the qi department” — breathing is a bit labored, the qi feels a little stuck, the breath does not flow smoothly — you must keep in mind that one possibility is sinking of the great qi. Look at the other symptoms together, and you can save the patient’s life. If you do not even know that sinking of the great qi exists, and you start prescribing on the spot, you are very likely to err and endanger the patient — sinking of the great qi can sometimes turn dangerous, and if the wrong medicine is given, the patient’s nostrils flare, and within moments there is danger to life. This is the benefit of studying: knowing these possibilities exist, you will not make the mistake.
Bonus story: the post-cold recovery method of a famous pediatric family in Yizheng
This reminded Doctor Luo Dalun of a visit he once made — to the head of a pediatric medical family in Yizheng, Jiangsu Province.
💬 Note from Doctor Luo: This family is one of China’s famous pediatric lineages, highly influential; the late “King of Children’s Medicine” (xiao er wang) Liu Bichen of Beijing was a disciple of this family — the family had a tradition that every disciple’s name carried the character “chen” (臣). When I visited them back then, the head was an old Mr. Sun, already in his eighties, a master of pediatrics. I asked him: after a child’s cold is cured, what medicine do you usually use to finish the job? The old gentleman said: give them Bu Zhong Yi Qi Wan (Center-Supplementing Qi-Boosting Pill, 补中益气丸) for a few days. When I heard that — this is a true master! Why do children catch colds? Their upright qi is insufficient. If you only cure the cold but do not restore the upright qi, two days later they catch another cold. Bu Zhong Yi Qi Wan fortifies upright qi and lifts the qi upward — exactly the same lesson as Doctor Zhang Xichun’s case: after a cold, the body has been fighting pathogenic qi and burned through a great deal of upright qi; if it is severe, or if treatment was improper, the great qi tends to sink, and at that moment you must tonify qi; if there is a tendency toward sinking, lift it upward a little, and the body returns to normal. For my part, I usually recommend eating a little Chinese yam after a cold to fortify upright qi — the thinking all runs along one connected thread.
Many people manage an external contraction but never pay attention to this final step of recovery. Most people do not fall as severely ill as this patient, but every external contraction damages upright qi to some degree, and topping up upright qi is never wrong; and once you feel a slight tendency of qi drifting downward, lift it up a little, and only then can the person return to normal and resist pathogenic factors again — this is the way of nurturing the body. When studying case records, connect what you learn, think deeply and awaken to more, and you will gain more. The more you understand the dangers the body can face, the better you can protect your own health.
Compiled from Doctor Luo Dalun’s lectures on Doctor Zhang Xichun’s case records, from Medical Records Integrated Chinese and Western Medicine (《医学衷中参西录》).