Shortness of Breath After Anger or Fright? Doctor Zhang Xichun’s Modified Shengxian Decoction (Lift the Sinking) for Sinking of Great Qi Caused by Emotion
Search terms this page answers: shortness of breath after anger / shortness of breath after a fright / short of breath / not enough qi / heart racing after a scare / can’t get my breath up after meals / always sighing
Medical terms: sinking of great qi (da qi xia xian) · qi deficiency (qi xu) · sinking of the great qi of the chest · qi sinking (qi xian)
Opening: a listener’s question puts everyone’s doubt into words
Doctor Luo Dalun begins his discussion of Doctor Zhang Xichun with a message from a listener. This friend wrote: once, after receiving a fright, he felt as if his great qi had sunk (da qi xia xian), and he asked — can that really happen?
Doctor Luo’s answer was direct: Yes, it really can.
💬 Note from Doctor Luo: Sinking of great qi is one of Doctor Zhang Xichun’s signature diagnoses. Many people assume it has nothing to do with emotion — in fact, the opposite is true: emotion is one of the most important triggers for sinking of great qi. The two cases we discuss today are both tied to emotion — one came from fright, the other from anger.
Case one: a fire in the courtyard frightened the young wife into “shortness of breath”
The first patient was a young woman in her twenties from a wealthy family. What was her physical constitution like? Doctor Zhang Xichun wrote four characters in the original record: zi bing su lei ruo — her endowment was weak from birth, and her health had never been robust.
💬 Note from Doctor Luo: Zi bing su lei ruo means constitutionally insufficient from birth — the body was never very strong. This is the foundation of the whole story. For a healthy, robust person, emotion rarely causes sinking of great qi; but once a person is weak, emotion can set off all sorts of changes in the body’s qi mechanism. So people of frail constitution must be especially careful with the “knife” of emotion.
How did she fall ill? Because a fire broke out in the courtyard, and her fright was extreme — the flames suddenly leapt up, the fire grew faster than anyone could have expected, and it terrified her, frightened her terribly.
When fright and fear stir the qi, how does the qi move? There is an old saying in Chinese medicine: jing ze qi luan, kong ze qi xia — fright throws the qi into disorder, and fear makes the qi sink downward.
💬 Note from Doctor Luo: The seven emotions each move the qi in their own way — joy slows and slackens the qi; anger makes it rise; worry gathers it; brooding knots it; grief dissolves it; fear sinks it; and fright throws it into disorder. This young wife was suddenly startled, and the qi “whooshed” downward — that is where the trouble began.
From then on she began to feel short of breath — the qi was insufficient. Then came palpitations (xin zhong zheng chong) — a constant sense that her heart was racing, fluttering and restless inside. Especially after meals, she felt the breath would not come up. She also frequently sighed (chang zuo tai xi) — she constantly needed to let out a long breath and take a forceful deep breath.
Doctor Zhang Xichun takes the pulse: the great qi had been frightened into sinking
Doctor Zhang Xichun came and felt her pulse. The pulse was nearly calm and even, but the right-hand position — which corresponds to the lungs, spleen, and the gate of life (ming men) — showed an abnormality. His judgment was crisp: the great qi of the chest had sunk because of fright.
💬 Note from Doctor Luo: The Huangdi Neijing (Yellow Emperor’s Inner Classic) teaches that fear makes the qi sink (kong ze qi xia, kong ze qi xian). Her qi was never abundant to begin with — she was frail ordinarily — and then this fright drove the qi downward, and the great qi of the chest sank. That is why she was short of breath — there simply was not enough qi. And the palpitations — the heart qi and heart blood were both weakened along with it.
How was it treated? Doctor Zhang Xichun used his famous formula Shengxian Tang (Lift the Sinking Decoction), but added one herb — long yan rou (longan flesh, dragon-eye fruit) 5 qian (15 g).
Why add longan? Because of the palpitations — that is heart qi insufficiency, heart blood insufficiency, a deficient heart. What does Chinese medicine use to tonify the heart? Longan flesh.
💬 Note from Doctor Luo: Long yan rou is a herb that tonifies both qi and blood. Dried, it takes on a reddish color; red enters the heart, so it nourishes heart blood and settles the spirit. At the same time it tastes sweet, and sweetness enters the spleen, so it also tonifies the qi. Thus longan flesh both tonifies the qi of the heart and spleen and nourishes heart blood and settles the spirit — its effect on the heart is especially good. The formula used Shengxian Tang to lift the qi upward on one side, and added longan to nourish the heart and settle the spirit on the other — both hands working at once.
What was the result? Four doses, and the patient was cured.
💬 Note from Doctor Luo: Another illness cured in four doses — so fast it makes you marvel. Why so fast? That is Doctor Zhang Xichun’s skill: he identified clearly that this was sinking of great qi brought on by fright, his differentiation was accurate, his prescription struck the vital point directly, and the illness dissolved on its own. What we learn from case records is exactly this: when the diagnosis is accurate, the cure comes quickly.
Case two: a life too full of frustration — until the breath nearly stopped
The second case is also tied to emotion. The patient was again a woman in her twenties, from a comfortable family, but there were too many troubles at home and too many frustrating things in life, so she was often angry — frequently irritated, resentful, and furious.
Slowly she began to feel short of breath — the qi seemed impossible to draw up, and she felt weak. Then came dry throat and thirst — her throat was always parched and she constantly wanted to drink water.
How severe did it become? She felt as if her breath was about to stop (zi jue qi xi jiang ting) — as though breathing might cease at any moment, and she had to strain hard to keep taking the next breath.
💬 Note from Doctor Luo: When weakness deepens far enough, even the most basic act of breathing feels like an effort — drawing each breath in and letting it out is laborious, and the moment you stop trying, breathing seems to slow toward a stop. Real patients do experience this feeling — it is a sign of deficiency carried to a serious degree. Everyone should remember the weight of that state.
Doctor Zhang Xichun felt her pulse: the left pulse was as usual, but the right showed slow arrival and urgent departure, unable to lift the finger even a fraction — the right pulse rose slowly, then withdrew urgently, and could not push the doctor’s finger up at all. In other words, the pulse was extremely weak.
Why does anger “push” the qi down instead of up? Doctor Zhang Xichun explains a key principle
Doctor Zhang Xichun’s analysis: this was certainly related to her anger. The Huangdi Neijing says zhong qi guan xin mai — the middle qi runs through the heart pulse. Doctor Zhang Xichun held that the “middle qi” here is the great qi, and the great qi is connected to the heart pulse. Constant anger caused the great qi to sink, and when the great qi sinks it cannot drive the pulse outward — the pulse cannot be pushed up, so when the doctor’s hand rests on the wrist, there is no strength.
But here a doubt arises: we understand fear makes the qi sink — but anger makes the qi rise — the qi clearly moves upward. Why, then, does anger cause the great qi to sink instead?
Doctor Zhang Xichun explained this carefully, and it is a crucial principle:
💬 Note from Doctor Luo: Pay attention — when we say “anger makes the qi rise” or “anger makes the qi rebel upward,” that “qi” refers to the qi of the liver and gallbladder (gan dan zhi qi), not the great qi of the chest. When you get angry, what rushes upward is the liver-gallbladder qi — in plain words, liver fire surging up. At this point there are two possibilities. If the person is robust, the liver-gallbladder qi rushing upward can sometimes actually push the chest’s great qi up along with it — which is why some listeners write in and say that when they get angry, their sinking-of-great-qi symptoms actually disappear; their bodies are still strong. But if the person is qi-deficient and frail, the great qi of the chest is already faint and cannot hold its position — as the liver-gallbladder qi charges upward, it squeezes the chest’s great qi down below. That is how the great qi gets “pushed” into sinking.
So Doctor Zhang Xichun emphasized again and again across several of his cases: when the qi moves upward, the liver-gallbladder qi can easily crowd out the great qi of the chest and make it sink instead. The foundation of this situation is always that the person is already weak.
Why does eating make the breath run even shorter?
This patient had another distinctive feature: whenever she ate, she felt even more short of breath — the symptom stood out especially at mealtimes. Why?
💬 Note from Doctor Luo: The reasoning links together link by link. When the great qi sinks, the qi becomes deficient, and all the qi of the body weakens along with it — the stomach qi also becomes deficient. Stomach qi lacks the strength to rot and transform food and drink, so the appetite fails and eating becomes a problem. On top of that, this woman was constantly angry — the liver qi ran rampant sideways and attacked the spleen earth (gan qi heng ni, ke fa pi tu). The spleen and stomach were damaged, the intake of grain decreased, and her appetite certainly shrank. So at mealtimes, the symptoms of sinking great qi stood out especially clearly. The two conditions feed each other — Doctor Zhang Xichun laid out the whole causal chain for you.
The prescription: still Shengxian Tang, but zhi mu raised to 6 qian
The qi had sunk — what to do? He prescribed — again — Shengxian Tang. But because the patient was often thirsty, which indicated heat in the body, he raised zhi mu (anemarrhena) to 6 qian.
💬 Note from Doctor Luo: Zhi mu is a cool, moistening herb that clears internal heat. Doctor Zhang Xichun’s original Shengxian Tang already contains zhi mu, to temper the warm, drying nature of huang qi and sheng ma. This patient had dry throat, thirst, and heat in the body, so he increased the dose of zhi mu — strengthening the power to clear heat and moisten dryness.
The result: three doses, and more than half the illness was resolved — and the right pulse was stronger than before.
Then Doctor Zhang Xichun made a key adjustment: he removed sheng ma (bugbane). Why? Because this patient was prone to anger, and her liver qi was rising — he did not want to lift things upward any further. After removing sheng ma, several more doses brought a full recovery.
The disease is cured — but is the root gone? The last step of treatment is the heart
The illness was cured, but Doctor Luo Dalun reminds us: the root of the disease had not been removed.
💬 Note from Doctor Luo: Where was the root? In her constant anger — too many troubles at home. Doctor Zhang Xichun later developed specific formulas for exactly this kind of patient — formulas that regulate the qi and soothe the liver on one side while lifting the qi upward on the other. And ultimately, such patients must adjust their emotions, or the illness will easily return.
Why? Because the root of the disease is habitual anger. Many women who are constantly angry end up truly weak and perpetually tired — do not imagine that anger makes you stronger. It does not: many people are being drained by it, and in the end the great qi is consumed, gradually sinking.
💬 Note from Doctor Luo: So for such patients, on the one hand you soothe the liver and regulate the qi, on the other you lift the upright qi. At the same time, the patient herself must think it through — study a little of the Daodejing, listen to Buddhist teachings, and let go of the frustrations around her. If the liver fire does not surge upward, the great qi will not sink downward — that is the real way to remove the root of the illness.
What Doctor Zhang Xichun leaves us: emotion is the “fuse” for sinking of great qi
Doctor Luo Dalun says that cases like these show us the developmental process of the illness: what kind of problem chronic bad moods and habitual anger eventually produce — the case displays it for you in full.
💬 Note from Doctor Luo: The two cases today were both sinking of great qi caused by bad emotions. Sinking of great qi really is connected to emotion. When we study Chinese medicine and listen to case records, we are really broadening our horizons — the more you have seen, the better you know where the mines and the dangers are, and you simply avoid touching them; and in some situations you quickly defuse the mine. That is the purpose of listening to today’s case.
He also remarked: listening to me explain these case records, your understanding of sinking of great qi probably already surpasses that of an ordinary student in school — because teachers in the classroom may not explain it this finely, and these things are the precious clinical experience that famous physicians accumulated over decades. Hearing more of it can do you no harm.
Compiled from Doctor Luo Dalun’s explanations of Doctor Zhang Xichun’s case records; the cases come from Records of Chinese Medicine with Western Reference (《医学衷中参西录》).