Always Hungry, Can’t Stop Eating? Doctor Zhang Xichun’s Answer: Two Cases of Ravenous Appetite from Sinking of the Great Qi
Patient search terms: always hungry / eating nonstop / never full no matter how much I eat / hungry to the point of panic / hands shaking and sweating when hungry / shivering all over when hungry Medical terms: sinking of the great qi (da qi xia xian) · ravenous appetite (xiao gu shan ji) · middle wasting (zhong xiao) · warm pathogen sunk deep
The opening: one word — “hungry” — hides two hair-raising cases
Everyone has heard of xiao gu shan ji (消谷善饥) — “digesting food quickly and always hungry.” In this pattern, the stomach runs hot, the appetite is enormous, and no matter how much the person eats, the hunger never goes away. But today Doctor Luo is going to talk about a path that very few people know: when the great qi (大气) in the chest collapses downward, a person can also go “hunger mad” — so hungry that the hands shake, sweat pours out, and the heart races.
And that’s not even the whole story. The first patient only showed this hunger after being treated almost to death — to the point of losing consciousness. Let’s start at the beginning.
Case one: a warm disease treated into delirium and bed-picking
There was a young man in his thirties who caught a warm disease (wen bing, 温病) in early summer. The physician used cooling, clearing herbs — that step was correct. The trouble began when he also added qi-breaking herbs — zhe shi (hematite) and qing dai (indigo naturalis) — to move and break up the qi. After seven or eight doses of that combination, the man collapsed: he started talking nonsense, lost consciousness, and hovered on the edge of a coma.
And then came a scene that makes anyone who knows medicine shiver:
💬 Note from Doctor Luo: When an elderly person is gravely ill, you may see a few unconscious movements. Xun yi mo chuang (循衣摸床) — the hand strokes the edge of the clothes or the bed, fingers rubbing and pinching; cuo kong li xian (撮空理线) — the hand reaches into the air as if finding and straightening threads. These are signs of a critically failing patient! I have seen it in hospitals — a long-term critically ill patient, consciousness already clouded, the hand still making these automatic movements. It tells you the illness has truly reached the deepest degree.
The young man trembled all over. The other physicians who were called in took one look and said: “The internal wind has already stirred (内风已动). He is deficient to the extreme — not only has the external invasion never resolved, the interior has already broken down. There is nothing to be done.”
Doctor Zhang Xichun takes the pulse: the pathogen rode the qi-breaking herbs deep into the body
Then Doctor Zhang Xichun arrived. He took the pulse: about five beats per breath — slightly fast; the floating position was weak, but press deeper and it was forceful. Then the tongue: a slightly yellow coating — that said there was still some heat. And yet — oddly — his skin was not hot at all. The body and the tongue did not match.
Doctor Zhang Xichun understood at once: the warm-heat pathogen, carried down by the qi-breaking medicines, had sunk deep and could not get out (温热之邪，随破气之药下陷已深，不能外出也). The qi had run downward, and the heat pathogen had followed it inside, buried in the depths of the body — which is why no heat could be felt on the surface.
💬 Note from Doctor Luo: This sentence was actually written into the case record afterward, when Doctor Zhang Xichun was recalling what had happened — at the time, he may not have seen it this clearly. But the direction of the treatment was right: the pathogen had sunk in, so it had to be pushed outward. And at that moment Doctor Zhang Xichun reached for the herb he was best at using: sheng shi gao (raw gypsum).
The prescription: two liang of raw gypsum as the vanguard, four doses in one day
The formula: sheng shi gao (raw gypsum), two liang, to push the heat outward; zhi mu (anemarrhena), to clear heat; and ye tai shen (野台参, wild codonopsis grown on Wutai Mountain) — to support the upright qi (zheng qi) — the last two at one liang each, heavy doses all around. It was decocted into two teacups and taken warm in two portions.
The crucial part was how it was drunk: from noon until evening, he drank two full doses in a row — four administrations of medicine in total — the dose doubled, the medicinal force unbroken.
💬 Note from Doctor Luo: This is how Doctor Zhang Xichun treated acute cases — not one bowl of medicine to sip through the day. Because the upright qi urgently needed support, he kept the medicinal force connected dose after dose, never letting it run dry.
He slept through the night, and the next morning he was clear-headed and able to eat. But then came something that stunned the whole family.
The illness was cured — and the man went “hunger mad”: five meals in half a day
Within half a day, the young man ate five times — and still felt hungry, still wanted more. The people caring for him dared not give him any more: “Won’t he burst?” But the moment they withheld food, his whole-body trembling came back and he started talking nonsense again. Panicked, the family hurried to call Doctor Zhang Xichun back.
Doctor Zhang Xichun took the pulse: it was roughly even now, the floating position still a little weak. He mulled over the question — why does this man want to eat so desperately? — and suddenly the answer hit him.
💬 Note from Doctor Luo: There are two reasons here. First, the great qi in the chest had been broken by the qi-breaking herbs and had run downward; the qi was insufficient, and although ginseng had been used a few times, the qi had not yet recovered — so the body sent out a call for reinforcements, appealing to the water-and-grain qi (水谷之气), hoping to take in more nourishment and pull the upright qi back up. This is the body’s instinctive distress signal. Second, when the great qi sinks, the stomach qi loses its support and control — it descends too quickly. The stomach’s nature is to descend smoothly (以通降为顺), but now the whole qi mechanism is rushing downward, so whatever food goes in whooshes straight down — and the person is hungry again almost immediately. Put the two reasons together, and you get “hunger madness.”
The aftercare formula: ye tai shen with mai men dong, plus one herb to lift the qi
Doctor Zhang Xichun prescribed ye tai shen, a little over one liang, paired with mai men dong (麦门冬, ophiopogon), three qian, to nourish yin — ginseng with mai men dong, because codonopsis leans slightly warm and the pairing balances it out. This is the foundation of Sheng Mai Yin (生脉饮, the Pulse-Engendering Decoction). Then he added chai hu (bupleurum), two qian — what was that for? To lift the medicinal action upward.
💬 Note from Doctor Luo: Remember this distinction — in acute emergencies Doctor Zhang Xichun used ginseng with chai hu to lift the qi upward; in calm, chronic situations he used raw astragalus (sheng huang qi) to lift it gently and steadily. These are the two different ways of treating the acute and the chronic forms of sinking of the great qi.
The bowl of soup was decocted and drunk — and from that point on, the illness was finished. One or two doses solved the whole affair. Every doctor had said the man was beyond saving; in Doctor Zhang Xichun’s hands — accurate diagnosis, one prescription, two doses in a row, then one more — and he was well.
💬 Note from Doctor Luo: Why is this man a master? Accurate diagnosis. A case like this, most of us might never have seen — who would ever imagine that “extremely hungry” could be caused by sinking of the great qi? This is what it means to broaden your knowledge. And remember this: a truly qi-deficient person, hungry to a certain degree, has trembling hands and a slightly shaking body, and should also be sweating — very much like the pre-meal hypoglycemia some people experience today: palpitations, hunger, sweating, shaking hands, better as soon as they eat something. But the “hunger” of sinking of the great qi is far more serious than ordinary low blood sugar.
Case two: the young woman whose appetite surged — and palpitations whenever she was hungry
Now a second case, one that feels closer to everyday life. There was a young married woman whose appetite suddenly surged — she ate everything, and in great quantities. If she went even a short time without food, her heart seized up with palpitations (怔忡) — she absolutely had to eat at once.
The physicians who saw her all said the same thing: this is the middle wasting pattern (中消) — one of the “three wasting-thirsts” (san xiao) of xiao ke disease: the upper wasting is thirst, always wanting to drink; the middle wasting is a tremendous appetite; the lower wasting is trouble with urination. But no matter how they treated it, nothing worked.
💬 Note from Doctor Luo: The descriptions of the three wasting-thirsts differ a little across the classical literature, but one point is consistent everywhere: middle wasting = an enormous appetite. This woman, however, was not middle wasting. Doctor Zhang Xichun analyzed it: first, the great qi had sunk, the stomach qi was weak and descended too fast, and food passed through without being absorbed properly; second, as the qi grew weaker and weaker, the body kept calling to the spleen and stomach for help, so the spleen and stomach felt hungry all the time. Two reasons — and again, it was sinking of the great qi!
So Doctor Zhang Xichun prescribed Sheng Xian Tang (升陷汤, the Lift the Sinking Decoction), with long gu (dragon bone) and mu li (oyster shell) added, five qian each.
💬 Note from Doctor Luo: Why add long gu and mu li? This woman had palpitations (zheng chong), and long gu and mu li settle the spirit and calm the mind; on top of that, they are astringent — they hold the medicinal force in place. One herb, several uses. A few doses, and the young woman’s illness was cured.
Doctor Zhang Xichun’s supplement: ginseng for external invasion, astragalus for internal injury
After these two cases, Doctor Zhang Xichun added a note explaining why — in the first case — he had used ginseng instead of his usual favorite, astragalus.
💬 Note from Doctor Luo: Doctor Zhang Xichun said: external invasions of cold and warm disease damage the body fluids (jin ye) most of all, and ginseng can tonify the qi and generate fluids. That is why, reading the Shang Han Lun (Treatise on Cold Damage), he found that whenever an external disease caused qi deficiency, Zhang Zhongjing always used ginseng and never astragalus; while in the Jin Gui Yao Lue (Essentials from the Golden Cabinet), which treats internal injuries, astragalus appears far more often. Doctor Zhang Xichun followed this rule and swapped the astragalus for ginseng. It also reveals his style: in true emergencies he used ginseng; in calm, chronic situations he used astragalus — acute and slow, each with its own discipline.
Saying it plainly: the great qi and the spleen and stomach are “grasshoppers tied to the same string”
Doctor Luo finally digs down to the root. Why does sinking of the great qi change the appetite? Because although the great qi lives mainly in the chest, between the heart and the lungs, it also occupies the middle-upper burner, and its relationship with the spleen and stomach is extremely close. Remember the earlier case of the frightened patient who, after eating, found the breath wouldn’t come up and had to breathe deeply and let out long sighs — that was living proof that sinking of the great qi is bound up with stomach function.
So where does the root of qi deficiency come from? An injured spleen and stomach: regularly skipping meals, going hungry, and on top of that working and toiling — the spleen and stomach are damaged, they cannot absorb nutrients, and the person becomes qi-deficient; when qi deficiency runs long enough, it shows most clearly in heart and lung function, and that is what we call sinking of the great qi. So at the root, sinking of the great qi and injury to the spleen and stomach are intimately connected.
💬 Note from Doctor Luo: There is one more trap that people fall into most easily — many people who feel short of breath after meals, whose breath simply won’t come up, assume “something is blocked inside” and take chest-opening, qi-moving medicines — and the more they take, the worse it gets. This is why so many patients are shuffled from one big hospital to another and never get better. When the direction is wrong, the more medicine you take, the more harm you do.
Cured is not the end: regulate the spleen and stomach, eat your meals on time
Doctor Zhang Xichun could solve this problem with a few doses of Sheng Xian Tang — but Doctor Luo reminds us: once the qi has been lifted back up, the task is actually not finished — you still have to regulate and tonify the spleen and stomach and get your eating back to normal. If you drink the Sheng Xian Tang on one side, but on the other you skip breakfast and starve yourself, feast and famine by turns — the decoction is wasted.
💬 Note from Doctor Luo: From now on, when you meet a person who is “always hungry, eating nonstop, and hungry to the point of palpitations, trembling hands and sweating” — keep a string in your mind: first consider whether it might be sinking of the great qi. Doctor Luo doesn’t mind spending the words — he wants to explain this problem thoroughly, because once you know where the trap is, you can avoid it in the future. He mentioned that the editor will compile every symptom caused by sinking of the great qi into one big table, so that everyone can see at a glance how many parts of the body this one disease can drag into trouble. And he gave a preview: tomorrow he will tell two warning cases of people who didn’t know about sinking of the great qi — some of them even died of it. This disease is truly no small matter.
Based on Doctor Luo Dalun’s explanation of Doctor Zhang Xichun’s case records, from Yi Xue Zhong Zhong Can Xi Lu (《医学衷中参西录》, published in installments between 1918 and 1934).