Shortness of Breath and a Sinking Pain in the Lower Belly After Coal-Stove Poisoning? Doctor Zhang Xichun’s Shengxian Tang (Lift the Sunken Chest Qi) Case
Search terms this page answers: shortness of breath / can’t catch my breath / suffocating / chest tightness / cold feeling in the chest / dragging pain in the lower belly / labored breathing
Medical terms: da qi xia xian (collapse of the great qi of the chest) · impaired heart and lung function (after carbon monoxide poisoning) · Shengxian Tang (Lift the Sunken Qi Decoction)
Opening: one coal fire nearly killed two brothers
Today we continue the story of Doctor Zhang Xichun treating da qi xia xian — the collapse of the great qi of the chest. The name sounds esoteric, but modern people suffer from it far more than anyone realizes — it’s just that Doctor Zhang’s teaching hasn’t received the attention it deserves, and so people wander from doctor to doctor without ever getting well. Doctor Luo Dalun plans to walk through, one by one, the dozen-plus cases in which Doctor Zhang treated collapsed chest qi. This one starts with a carbon monoxide poisoning.
💬 Note from Doctor Luo: Doctor Zhang Xichun wrote up dozens of cases of collapsed chest qi, and in every single one he spelled out the cause with complete clarity. Don’t get impatient — listen through all of these cases and you’ll end up with a very deep impression of what this disease really is.
Who were the patients? Two brothers heating a winter room with a coal stove
The patients were two brothers: the elder nearly sixty years old, the younger in his fifties — both well into middle age and beyond. To escape the winter cold, the two of them crowded into one small room, sealed the doors and windows shut, and warmed themselves with a coal-burning stove.
💬 Note from Doctor Luo: When you shut the doors and windows in winter and heat the room by burning coal, the thing you fear most is carbon monoxide poisoning. Whenever carbon-based fuel burns incompletely, it produces carbon monoxide.
Where did the disease come from? Carbon monoxide stole the oxygen
What happens when carbon monoxide gets into the body? It slips into the bloodstream and binds to the red blood cells, robbing them of their ability to carry oxygen — you’re breathing air that clearly contains oxygen, but the body can’t absorb it, and the oxygen level in your system keeps falling. In severe cases, carbon monoxide poisoning kills outright.
These two men burned coal like this day after day, and nothing happened at the time. But when spring arrived, both brothers began to feel something was wrong: their chests were full and oppressed, their breathing was short — they never had enough air, they felt suffocated, and breathing felt weak and effortful.
💬 Note from Doctor Luo: This shows the carbon monoxide poisoning had already seriously damaged both brothers’ heart and lung function. Doctor Zhang Xichun’s judgment was this: the great qi of the chest is normally sustained by oxygen; now the oxygen wasn’t enough, and prolonged injury by coal gas was bound to turn into deficiency — the great qi of the chest had collapsed, which is why breathing was short. In today’s language: their heart and lung function had been destroyed.
The wrong doctor’s blunder: treating deficiency as though the qi were blocked
Sick to this degree, of course they called in a physician. But the physician who came didn’t know the cause. He saw a full, oppressed chest and assumed the qi must be stuck inside — so he prescribed qi-breaking, qi-moving herbs — medicines that force the qi to circulate and “open things up.”
What happened? The patients were already deficient. Hammering them with qi-moving, qi-breaking herbs only made the deficiency worse, and the oppression grew heavier and heavier. The physician thought the dose was simply too small, added more herbs, and increased the amounts. After a few doses, the elder brother collapsed and died. Why? The qi of the chest had become too weak — the heart and lung function had already sunk to an extreme low, with the qi sagging downward — and you were still forcing the qi to move. The body simply could not take it.
💬 Note from Doctor Luo: This is one of the great taboos of Chinese medicine — mistaking deficiency for excess. It’s common even today: a woman’s blood is severely depleted and her period stops; someone assumes it’s blood stasis blocking things up and pounds away with blood-moving, stasis-resolving herbs — and the patient can’t tolerate it. When qi and blood are exhausted to the limit, even mild liver-qi stagnation should be treated cautiously — the patient can’t handle qi-moving herbs. You have to build up the qi and blood first, and then gently course the liver while continuing to tonify. In this case the elder brother was depleted to the extreme, and the qi-breaking “chest-opening” herbs finished him off at once.
Doctor Zhang Xichun takes the pulse: frighteningly weak, and sinking downward
The elder brother was gone, and the younger brother’s illness grew worse with every dose — instead of improving, he was sinking. Luckily he was a bit younger and could still hold on. Seeing that this doctor couldn’t help, the family hurried to fetch Doctor Zhang Xichun.
Doctor Zhang took the pulse: it was weak and faint — upright qi insufficient, spirit exhausted and strength failing. The right-hand pulse was even weaker. The right wrist corresponds to the lung, spleen, and ming men (the gate of life) — so in collapsed-chest-qi patients, the lung and spleen positions are usually weak. What’s more, the pulse position had shifted downward — instead of sitting at the wrist, it sank low and drifted down.
💬 Note from Doctor Luo: This is the pulse signature of collapsed chest qi: it doesn’t float up, it sags down — and it’s very weak. If you feel carefully, the pulse position is displaced downward.
Symptom decoded 1: a cold feeling in the chest — cold where, exactly?
What were the younger brother’s symptoms? Weak, labored breathing for sure — no strength, a sense of suffocation, as if the qi in the chest had to be hauled upward with real effort. And there was one distinctive symptom: a cold feeling in the chest (xin zhong fa liang).
Where exactly is this “coldness in the chest”? Many people can’t understand Doctor Zhang Xichun — he’s always saying the “heart” feels cold or the “heart” feels hot. What does he mean by “heart”?
💬 Note from Doctor Luo: In ancient times, the heart and the stomach were usually described together. The heart itself has little sensation of heat and cold — but the stomach is extremely sensitive to it. So when the classics say the “heart,” they are often really talking about the stomach — the feeling inside the stomach. The sensations of these two organs usually match; they rarely contradict each other sharply. Doctor Zhang Xichun did understand anatomy — dissection had already become common by the Republican era — but when describing sensations he still used the old blanket term. So “a cold feeling in the chest” is a composite sensation of the whole middle and upper jiao — if that whole region feels cold, that’s it.
Symptom decoded 2: a sinking pain in the lower abdomen — don’t jump straight to appendicitis
The second symptom deserves special attention: a sinking, dragging pain in the lower abdomen. When the great qi of the chest collapses, the qi travels downward, and the internal organs tend to droop with it. The sagging organs press on the lower abdomen, qi and blood can’t circulate smoothly, and pain flares up in some spot.
💬 Note from Doctor Luo: These days, the moment anyone feels lower-abdominal pain, they assume organic disease — appendicitis? A gynecological problem? Usually it’s none of those. When drooping organs press on the lower abdomen and qi and blood stall, you get lower-abdominal pain. Doctor Zhang Xichun didn’t go into all this; he simply said the great qi had collapsed and the qi mechanism of the lower jiao was blocked. But we need to know: a sinking pain in the lower abdomen is very often linked to collapsed chest qi.
The prescription: Shengxian Tang (Lift the Sunken Qi Decoction), with zhi mu removed and dried ginger added
Doctor Zhang Xichun could see the collapse of the chest qi clearly, so he gave Shengxian Tang — the formula we’ve discussed before: sheng huang qi (raw astragalus) to tonify qi, especially lung qi; zhi mu (anemarrhena) cool and moist, to restrain the heat-nature of the astragalus; matched with jie geng (platycodon), sheng ma (cimicifuga), and chai hu (bupleurum) to lift the medicinal force upward.
This time, the formula was adjusted: sheng ma was changed to 2 qian (6 g); zhi mu was removed; and gan jiang (dried ginger) 3 qian (9 g) was added.
💬 Note from Doctor Luo: Why remove the zhi mu? Because this patient had a cold feeling in the chest — the yang qi was running short, so the cool, moistening herb was no longer needed. Swapping zhi mu for dried ginger lets the body warm up again.
Two doses, and it worked: the sinking pain vanished, the breathing smoothed out
After two doses, the sinking sensation in the lower abdomen was gone, and breathing became smooth again. Once the symptoms had clearly eased, Doctor Zhang reduced sheng ma, chai hu, and jie geng all to 1 qian (3 g) each — the lifting force no longer needed to be strong; a touch was enough. He continued for several more doses, and the patient was cured.
💬 Note from Doctor Luo: This case is especially meaningful. Carbon monoxide poisoning causing collapsed chest qi gives us a model: collapsed chest qi is closely tied to damage of the heart and lung function. Many people don’t understand what da qi xia xian really is. Read this case and you’ll see it at a glance — where in the body this disease strikes, and why, becomes completely clear.
Today’s summary: when these three symptoms come together, think of collapsed chest qi
Take note of today’s symptoms. First: a cold feeling in the chest — a composite sensation of the middle and upper jiao, not the heart itself being cold. Second: a sinking pain in the lower abdomen — caused by drooping organs pressing down. Third: breathing is oppressed; you have to strain to get air in. When these three line up together, the person very likely has collapsed chest qi.
💬 Note from Doctor Luo: My specialty is TCM diagnosis, and when I read old case records I love collecting diagnostic evidence. If we teach collapsed chest qi but you can’t recognize it, what good is that? So I pull out the diagnostic evidence from every single case and explain the reasoning — once you understand it and have gathered all the symptoms, you can make the judgment yourself, and one adjustment sets things right. That’s a wonderful thing.
Adapted from Doctor Luo Dalun’s explanation of Doctor Zhang Xichun’s case records. Source: Records of Chinese Medicine with Western Reference (《医学衷中参西录》), published in installments 1918–1934.