Short of Breath After a Shock or Anger? Doctor Zhang Xichun’s Shengxian Decoction (Lift the Sinking) for Sinking of Great Qi Caused by Emotions

Search terms this page answers: short of breath after a fright / breathless after getting angry / can’t catch my breath / not enough qi / heart racing and flustered / breathless after meals / always needing to take a long deep breath

Medical terms: sinking of great qi (da qi xia xian) · palpitations and a flustered heart (zheng chong) · emotional injury from the seven emotions (qi qing nei shang)

Opening: one reader comment that raised a real question

Doctor Zhang Xichun wrote dozens of case records about the sinking of great qi (da qi xia xian), and Doctor Luo Dalun has been telling them one by one. This time, a listener left a message: once, she said, she had been badly frightened — and afterward she felt as if her great qi had sunk. Was that really possible?

💬 Note from Doctor Luo: It really is possible! The case we’re discussing today is the sinking of great qi linked to emotion. Emotion is one of the great sources of this condition — don’t ever underestimate it.

Who was the patient? A young woman who was frail to begin with

The first patient was a young woman in her twenties from a fairly wealthy family. She carried a certain “foundation” in her body — the old physicians called it zi bing su lei ruo: a constitution weak from birth, a body that had never been strong, always on the fragile side. Doctor Luo paused on this on purpose: don’t make light of that “foundation.”

💬 Note from Doctor Luo: Under normal circumstances, a sturdy, well-built person — emotion alone generally won’t drive their great qi to sink. But if the body is already weak, then when emotion hits, the qi mechanism inside the body is especially easy to throw into disorder. So that “weakness” is the premise for everything that follows.

The trigger: a fire in the courtyard — fright beyond measure

How did she fall ill? A fire broke out in her courtyard, and she was frightened beyond measure (jing kong guo shen). Fire suddenly leapt up in the yard — the flames rose faster than anyone could have predicted, far more terrifying than expected — and she was scared half out of her wits on the spot.

In Chinese medicine, how does fright move the qi? There’s a classic saying: fright makes the qi chaotic; fear makes the qi sink downward (jing ze qi luan, kong ze qi xia). The moment she was startled, the qi plunged straight down.

💬 Note from Doctor Luo: Each of the seven emotions has its own way of moving qi — excessive joy disperses qi, anger drives qi upward, worry gathers qi, brooding knots qi, grief consumes qi, fear sinks qi downward, and fright throws qi into chaos. This is basic knowledge in Chinese medicine, and it is the master switch for both of today’s cases.

Symptoms: shortness of breath, a flustered heart, and breathlessness after meals

After the fright, she developed shortness of breath — she always felt there wasn’t enough qi; a flustered heart (xin zhong zheng chong) — her heart seemed to race and pound, restless and uneasy; and especially after eating a meal, the qi would not come up; she also sighed constantly (chang zi tai xi) — she always needed to let out a long breath, to take a deep, effortful breath over and over.

💬 Note from Doctor Luo: “Zheng chong” is that flustered, pounding, uneasy feeling in the heart. Breathlessness after eating, needing to sigh — these are the classic signs of sinking great qi. The qi has dropped down; of course no matter how hard you inhale, it never feels like enough.

Doctor Zhang Xichun takes the pulse: the great qi of the chest was frightened into sinking

When Doctor Zhang Xichun felt her pulse, it was close to calm — but there was a problem with the right-side pulse (the right wrist, which corresponds to the lung, spleen, and ming men). His judgment: the great qi of her chest had sunk because of fright. The Huang Di Nei Jing (Yellow Emperor’s Inner Classic) says “fear makes qi sink downward” — when the qi was already insufficient to begin with, and then fright pressed it downward, the great qi sank.

The prescription: Shengxian Decoction plus longan meat — lifting the qi and nourishing the heart at once

He prescribed his own Shengxian Tang (Lift the Sinking Decoction), and deliberately added longan meat (long yan rou), five qian (15 g). Why longan? Because her heart was flustered and pounding — that is insufficiency of heart qi and heart blood. Longan meat tonifies both qi and blood: when dried it turns reddish, so it enters the heart, nourishes the heart blood, and calms the spirit; at the same time it is sweet, enters the spleen, and can tonify qi, strengthening the qi of the heart and spleen. Its action on the heart is especially good.

💬 Note from Doctor Luo: This pairing is wonderfully clever — Shengxian Tang lifts the qi upward while the longan meat nourishes the heart and settles the spirit; the two lines of force work together. And the result? Four doses, and she recovered completely. Why so fast? Because Doctor Zhang Xichun diagnosed accurately — he recognized that fright had sunk the great qi, wrote a formula that struck straight at the heart of the problem, and the illness dissolved. Without clinical experience, you would never guess that a problem of heart-lung function could be tied to fright and sinking great qi.

The second patient: hard circumstances and daily simmering anger

Now for the case caused by anger. This was also a woman in her twenties. Her circumstances were unfavorable and her household was full of worries — she was constantly vexed — and so she frequently grew angry, flying into rages and resentments. Gradually she too began to feel short of breath, the qi would not come up, her whole body felt weak; she also had a dry throat and was always thirsty.

How severe did it become? She felt as if her breath was about to stop (qi xi jiang ting) — as if her breathing might cease at any moment; she had to strain and force herself to catch the next breath, and the moment she relaxed, the breathing seemed ready to break off.

💬 Note from Doctor Luo: Patients really do feel this — it is the sign of deficiency reaching a certain depth, when even the most basic act of breathing has to be kept going by effort. People back then were lucky: they could find Doctor Zhang Xichun whenever they needed him. Today, try to find such a physician — you can’t.

Taking the pulse: slow arrival, hasty departure — the fingers can barely be lifted

Doctor Zhang Xichun felt her pulse: the left pulse was as usual, but the right pulse “arrived slowly and departed hastily, without the least strength to lift the fingers” — the beat came up feeling slow, yet left in a hurry, and could not push the doctor’s fingers up at all: the pulse was extraordinarily weak. He quoted the Nei Jing: “the middle qi threads through the heart vessels.” The “middle qi” he meant is the great qi; the great qi is intimately connected to the heart vessels. Because she was constantly angry, her great qi had sunk and could no longer drum the pulse outward — the pulse could not rise, and the fingers found no strength when they pressed down.

The key question: anger makes qi rise — so why did the great qi sink?

Here is the big puzzle: “Anger makes qi rise” — qi moves upward in anger, so why would it sink the great qi instead? Doctor Zhang Xichun explained this carefully — and it is the most brilliant piece of pattern differentiation in the whole case.

💬 Note from Doctor Luo: Doctor Zhang Xichun said: “anger makes qi rise, anger sends qi rebellious” refers to the qi of the liver and gallbladder — not the great qi of the chest. What rushes upward in anger is liver fire. In a strong, well-built person, the liver-gallbladder qi surging upward can sometimes carry the great qi up along with it — indeed, one listener once wrote in that when she got angry, her sinking-great-qi symptoms actually vanished; that’s because her body was still sturdy and the qi could still travel upward. But in a weak person? The great qi of the chest is already faint, barely held in place; when the liver-gallbladder qi “whooshes” upward, it dashes the chest qi into confusion, and the fragile balance that was barely being maintained is broken — the great qi gets squeezed down instead. That is the mechanism by which anger sinks the great qi. Doctor Zhang Xichun stressed this in several cases: rebellious liver-gallbladder qi easily presses the chest great qi down and sinks it — and this is very common. And the foundation of it all is a body that is weak to begin with.

Why did eating make the breathlessness worse?

The patient also had one distinctive feature: every time she ate, she felt there wasn’t enough qi. Doctor Zhang Xichun explained the whole chain: when the great qi sinks and the qi becomes deficient, the qi of the whole body is deficient — the stomach qi is also depleted — unable to ripen and transform food and drink, so her appetite suffered and eating became a problem; at the same time, because she was constantly angry, liver qi ran rampant and attacked spleen earth (gan qi heng ni ke pi tu), damaging the spleen and stomach, so that food intake must have fallen. The two causes stacked together — that is why the symptoms of sinking great qi were especially obvious right after meals.

💬 Note from Doctor Luo: This is what they call mutual causation. After Doctor Zhang Xichun laid out the whole chain, he put it in one sentence: your illness is connected to your anger. The qi has already sunk — so use Shengxian Decoction. But because she was constantly thirsty, there was heat in the body, so zhi mu (anemarrhena) was increased to six qian (18 g) — a cool, moistening herb to clear the heat.

The results: three doses cured more than half; removing sheng ma finished the job

After three doses, the illness was more than half cured — and her right pulse was stronger than before. At that point Doctor Zhang Xichun removed sheng ma (bugbane rhizome) — why? Because her illness came from anger; with liver qi running rebellious, you can no longer keep pushing everything upward. After removing sheng ma, several more doses brought a complete recovery.

The aftercare advice: the root is in your emotions — you must work it out yourself

The illness was cured, but Doctor Zhang Xichun knew perfectly well: the root had not gone away — the root was her habit of constant anger. Later he even designed formulas specifically to soothe the liver and regulate the qi, lifting the qi upward while regulating it. And for patients like her, the final, essential step is adjusting the emotions — otherwise the illness returns very easily.

💬 Note from Doctor Luo: Remember this — many women who are constantly angry end up weak, constantly tired, with no strength. Because anger is not “the more you rage, the stronger you get” — for many people it is pure consumption: the qi is burned away bit by bit, and at last the great qi sinks. So for such patients you soothe the liver and regulate the qi, lift the upright qi — and at the same time they have to think their way through it themselves — study the Dao De Jing, listen to some Buddhist teachings, and let go of the petty troubles around them. When the liver fire no longer rushes upward, the great qi will not sink downward — that is what it means to treat the root.

Closing note: reading case records is like following a master through the clinic

These two cases today were both sinking of great qi brought on by bad emotions — one by fright, one by anger. Doctor Luo asked: why do we keep telling case records? Because a famous physician sees so many kinds of patients in a lifetime, and ordinary people never get that chance. Reading one case record is like walking into the consulting room beside the master — you meet the most typical patients; and if you ever run into a similar situation yourself, you’ll know: this could be the sinking of great qi.

💬 Note from Doctor Luo: The seven emotions can cause illness — emotion can also “frighten” the qi down and “anger” the qi down. People with weak bodies especially need to be careful. After today’s lesson, your understanding of sinking great qi probably already surpasses the average student’s — these are the precious clinical lessons accumulated by masters over a lifetime. There are still a few more sessions on sinking great qi; we’ll continue.

What to take away

1. Fright and fear sink the qi; anger can squeeze it down too. “Fright makes qi chaotic, fear makes qi sink” — and in a weak body, a surge of liver-gallbladder qi can shove the chest great qi downward. Emotion is one of the great hidden causes of sinking great qi.
2. The weak “foundation” is the premise. A sturdy body can often ride out a shock or an outburst; it is the constitutionally frail who end up with sunken qi. If you are naturally weak, guard your emotions even more carefully.
3. Shortness of breath, a flustered heart, sighing, and breathlessness after meals — think of sinking great qi. Especially “breathless after eating” plus “always needing to sigh deeply”: that is the classic picture of qi that has dropped down and cannot come back up.
4. Shengxian Decoction is the formula: sheng huang qi (raw astragalus) to tonify the chest great qi, zhi mu to moisten and check its warmth, chai hu and sheng ma to lift, jie geng to carry the medicine upward. Add longan meat when the heart is flustered and the heart blood is insufficient; increase zhi mu when there is heat and thirst; and if the cause is anger with rebellious liver qi, remove sheng ma rather than lifting endlessly.
5. The root is the emotion, not the breath. Doctor Zhang Xichun said it plainly: this illness comes from anger. You can lift the qi with herbs, but if the temper does not change, the illness returns. Soothe the liver, lift the upright qi — and work on letting things go.

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.