Can’t Catch Your Breath After Lifting Something Heavy? Doctor Zhang Xichun’s Sanqi (Notoginseng) Formula for Shortness of Breath from Blood Stasis
Patient search terms: breath cutting off while speaking / shortness of breath / breathing feels blocked / tightness in both flanks / shortness of breath worse after anger / can only get out half a sentence
Medical terms for this condition: blood stasis (yu xue) · blood stasis in the liver channel (gan jing yu xue) · shortness of breath (duan qi)
Opening: a young man in his twenties lifts something heavy — and picks up a strange illness
It had been a while since Doctor Luo Dalun last talked about Doctor Zhang Xichun, and quite a few listeners were getting impatient. So today we pick the series right back up — and we start with a strange illness.
The patient was Liu Shulin, from Baliwang Village, west of the town of Yanshan. He was twenty-five years old, in the prime of youth, and had always been strong. His trade was bricklaying and plastering — rough, heavy work, the kind of job where a man earns his living with his muscles.
💬 Note from Doctor Luo: A plasterer — someone who does heavy physical work all day long. This case reminds us that many illnesses are tied to a person’s occupation and to the way he works. As you listen, think about your own life: when you work or carry things, have you ever hurt or strained something? Sometimes you don’t notice it at the time, but the root of a disease has been quietly planted.
How did the illness begin? One hard strain, and his ribs ached for days
Here is what happened: Liu Shulin was working outside when he came across something heavy. He strained to lift it — put everything he had into heaving the load. And right then and there he felt pain under his ribs (xie xia), in the area around the ribs on both sides of the body; the pain was deep inside.
The pain lasted a few days, then stopped. Surely that was the end of it?
It was not. Although the pain went away, he kept feeling as though something under his ribs was obstructing his breathing — something inside was blocking him and interfering with his respiration. A perfectly healthy young man was left with a strange affliction from that day on.
What was so strange about it? He could only get out half a sentence before his breath gave out
Doctor Zhang Xichun painted a portrait of the illness:
- He had always been strong — twenty-five, in the prime of life, and in good shape;
- Yet the illness went untreated and dragged on — half a year — and the sturdy young man gradually became weak and emaciated, wasting away;
- The chief symptom: he constantly felt something under his right ribs obstructing his breathing — inside the right side of his ribcage it felt as if something were stuck, and his breathing was never smooth;
- And there was one especially odd symptom: when talking with people, his speech would often break off mid-sentence — his qi seemed to give out, he would stop halfway through what he was saying, and only after catching his breath could he continue;
- Whenever he got angry, the symptoms became markedly worse;
- His pulse was fairly even — the only problem was that it was slightly weak, as if it could not move freely and smoothly.
💬 Note from Doctor Luo: By this point, our veteran listeners are probably already thinking: worse when angry — this has to do with the liver channel. The liver governs free coursing (shu xie); when a person meets something infuriating and the liver qi cannot spread out, the illness flares up. This is no coincidence — the body is handing you a clue.
What did Doctor Zhang think? — Not sinking of the great qi, but a clot of stagnant blood stuck in the liver channel
How did this illness come about? Doctor Zhang’s analysis peeled the layers off one by one:
Because of excessive straining — he had pushed his strength too far. That single effort of lifting something heavy injured the body from within: pulled, strained, wounded — leaving stagnant blood (yu xue) between the channels. And which channel did the stasis occupy? Doctor Zhang’s verdict: the liver channel.
Precisely because stagnant blood was blocking the liver channel, it obstructed the ascent and descent of qi — the roadway along which qi rises and falls was jammed. That is why with every breath he felt something stuck in there.
💬 Note from Doctor Luo: Notice: this illness resembles sinking of the great qi (da qi xia xian) but is a completely different thing. Sinking of the great qi is a deficiency pattern (xu zheng) — the qi is genuinely depleted and has sunk down. This patient did have a deficient side too — after half a year he had grown thin and his pulse was weak — but the dominant problem was excess (shi): there was an injury inside, stagnant blood was blocking the passages through which qi moves, the qi could not circulate smoothly, and he lacked the drive to speak — so he had to speak half a sentence and rest half a sentence. From now on, whenever you meet a patient who says “my qi won’t come up when I talk,” hold two directions in your mind at once: if it is deficiency, it may be sinking of the great qi; if it is excess, it may be stagnant blood blocking the road.
Doctor Zhang judged: luckily this man’s pulse was still fairly even — although he had grown thin, his upright qi (zheng qi) was still there, so the condition could be treated. What was to be done? Invigorate the blood and resolve stasis (huo xue hua yu) — treat it by dissolving the stagnant blood. As the stasis slowly melted away, the flow of qi would naturally return to normal.
Why was he so certain it was the liver channel? Doctor Zhang’s theory of breathing
What grounds did Doctor Zhang have for concluding the liver channel was at fault? He laid out a theory:
Exhaling originates from the heart and lungs — it is tied to the function of the heart and lungs; inhaling is tied to the liver and kidneys — that is the teaching of the ancient texts, and so breathing is connected to the liver channel. He then went a step further and drew on Western anatomy: the paths by which you inhale, the blood vessels through which you exhale — all of these passages run through the liver channel region. So the liver channel is bound up with breathing; when the liver channel goes wrong, respiration is affected.
💬 Note from Doctor Luo: In Zhang Xichun’s day, Western medicine was just beginning to enter China. He was one of the most open-minded physicians of modern Chinese medicine — “zheng zhong can xi”: Chinese medicine as the foundation, with Western knowledge consulted as reference, comparing the two to understand the human body. So when he explained illness, he often used ancient theory plus Western anatomy together — a remarkably progressive approach for his time.
Doctor Luo adds: inhaling and exhaling — it’s not just the throat doing the work
Doctor Luo supplemented Zhang Xichun’s theory with an everyday observation, and everyone gets it instantly:
Try breathing for a moment — when you breathe, is it only the throat straining? No. You will find that the whole chest moves, the whole ribcage moves.
Speaking is the same. Say a few sentences and you will notice: it is not just the throat working — the entire chest and abdomen join in the movement, especially the chest. If there is an injury inside the flanks, then speech will be hampered — that is why this man could only get out half a sentence and then seemed to run out of qi.
💬 Note from Doctor Luo: The flanks happen to correspond to the pathway of the liver channel. So the whole chain links up: flank injury — breathing affected — speech cutting off — liver-channel blood stasis. And why did anger make it worse? Easy to explain: when you are angry, the liver qi cannot spread freely, and the liver channel region connects with this illness — so the symptoms flare. This is the stacking of disease factors — not a single cause, but several things landing together.
A diagnostic pointer: people with stagnant blood in the flanks have a bluish face
Hidden inside this case is a very practical diagnostic pointer, which Doctor Luo singled out for special attention:
If a person has an injury with stagnant blood in the flanks — from under both armpits down to above the ribs — what symptoms appear? Shortness of breath, with the qi feeling as if it cannot come up; breathing always feels obstructed, as if something inside is blocking it. This is an especially clear indicator.
Doctor Luo says: in Chinese medical diagnosis you should list the indicators one by one — when you see this, these are the possibilities; then combine them with the other symptoms, and you can determine with greater accuracy what the illness really is.
💬 Note from Doctor Luo: Let me add one pointer from my own experience — when this kind of blood stasis has lasted a long time, the patient’s face will definitely take on a bluish tinge. If you have lived in the countryside, you know: many country people don’t seek treatment when they are ill; they let it drag on, and the stasis goes untreated for a long time. When you look at such a person’s face, it is bluish — bluish and dark. So when you see someone with a bluish, dull face, think of blood stasis; combine it with flank pain and a feeling of obstruction in breathing, add a look at the tongue coating, and you can basically make the call.
And why do people with blood stasis gradually grow thin? Because stasis obstructs the movement of qi and blood — and this stasis came from injury, an internal wound. This kind of serious stasis tends to block the circulation of qi and blood and consume the upright qi, so the person gradually wastes away.
The prescription: one herb conquers all — sanqi powder, sent down with raw malt
With the disease mechanism clear, Doctor Zhang wrote his prescription — so simple it is startling, just two herbs:
Sanqi (notoginseng), 4 liang, ground into powder. Take 1.5 qian each time. How much is 1.5 qian? 4.5 grams.
Doctor Zhang himself deliberately flagged this dose. Usually we tell people that 1–2 grams of sanqi powder is plenty; why go up to 4.5 grams? Because this dose is for people with injuries — stasis caused by trauma.
How was it taken? Raw malt (sheng mai ya), 3 qian (9 g), decocted — and this malt water was used to send down 4.5 g of the sanqi powder. “Ri zai fu” — taken twice a day. In other words, he took 9 grams of sanqi powder every day — a fairly large amount.
💬 Note from Doctor Luo: Do the arithmetic: 4 liang of sanqi is 120 g; 4.5 g per dose, twice a day — and this single herb was the entire prescription for this case. You can see from this just how highly Zhang Xichun regarded sanqi. In his view, this herb specifically governs problems of stasis left behind by injury; used where it counts, a single herb can do the work of a whole formula.
Where “Guang sanqi” comes from: Tianzhou in Guangxi, rare today
Why did Doctor Zhang insist on Guang sanqi (Guangxi notoginseng)? Doctor Luo explained the herb’s history:
Sanqi was originally produced in Guangxi, in Tianzhou — which is why it is also called Tian qi (Tianzhou notoginseng). That Guangxi sanqi is now very rare — almost gone. Today, sanqi cultivation is basically concentrated in Yunnan.
💬 Note from Doctor Luo: So when you buy sanqi powder at the pharmacy today, it almost always comes from the Wenshan area of Yunnan — that is the mainstream now. “Guang sanqi” has become a historical term. But in Zhang Xichun’s day, the authentic origin of sanqi was still Tianzhou in Guangxi, so he deliberately wrote “Guang sanqi” — emphasizing that genuine, daodi (geo-authentic) herbs should be used.
Why is sanqi called a “sage herb”? Doctor Zhang’s praise
In this case, Doctor Zhang’s evaluation of sanqi was startlingly high. He said:
Sanqi is the sage herb for stopping reckless bleeding — if you are bleeding, it can stop the blood; that alone makes it a sage herb. It is also the sage herb for resolving blood stasis — if the channels are blocked by stasis, it can dissolve it. And it resolves stasis without harming the heart-blood, and can be taken long-term without ill effect — you can take sanqi powder alone for a long time, and it does no harm to the body.
Doctor Zhang’s original words: this is a “te yi zhi pin” — a special, singular substance among medicines — whose wonderful effects are almost beyond belief.
💬 Note from Doctor Luo: Why have I kept recommending sanqi powder all these years? Because I read Zhang Xichun’s books, then used it bit by bit, and discovered it truly works — countless patients have felt remarkably better with it. What Zhang Xichun wrote really came from his own clinical experience. And in turn, my years of talking about sanqi have helped make the powder familiar to ordinary people — today you can walk into any pharmacy and buy sanqi powder on the spot, which is genuinely gratifying.
Doctor Zhang also said: “I use it to eliminate accumulations and resolve stasis; over time, even old stasis responds” — those long-standing, hardened clots of stagnant blood can all be dissolved, with excellent results.
Why raw malt to send down the sanqi? Doctor Zhang once ran a curious experiment
You will naturally ask: why use raw malt water to take the sanqi powder?
Malt (mai ya) is familiar to everyone as a digestive aid — especially stir-fried malt (chao mai ya), which is excellent for dissolving food stagnation. But raw malt used raw has another talent: drinking a decoction of raw malt can soothe the liver and regulate qi, and help the liver qi grow and spread upward (sheng fa gan qi). This was a favorite of Zhang Xichun’s — in many of the formulas we have discussed, he added raw malt precisely to spread the liver qi and soothe the liver.
And here the stagnant blood sat right along the pathway of the liver channel, so raw malt’s job of soothing the liver and regulating qi was exactly on target.
💬 Note from Doctor Luo: What is even more wonderful: Zhang Xichun believed raw malt itself also has a stasis-resolving action. What was his evidence? He said: take a piece of plaster (gypsum), put barley on top, and let it sprout — and where the sprouting roots intertwined and tangled (pan gen cuo jie), the plaster was pitted and indented beneath them. Zhang Xichun felt that this intertwining, tangle-driving force was the force that resolves stasis. So whenever he encountered blood stasis, he often added one dose of raw malt to the formula to assist in invigorating the blood and resolving stasis.
So in this case, Zhang Xichun had the patient decoct raw malt and use that water to wash down the sanqi powder for invigorating the blood and resolving stasis — giving us one more way to take sanqi powder: if you want to take it, you can brew raw malt into a decoction and wash the powder down with it.
💬 Note from Doctor Luo: Let me add one more benefit that Zhang Xichun did not mention here — some people feel uncomfortable in the stomach after taking sanqi powder, and raw malt can protect the stomach qi. Taken together, the two work even better. So if you use sanqi powder, this lecture has given you an extra method: brew raw malt and wash down the sanqi powder with it — the stasis-resolving effect is better. Do give it a try.
Four days later, a strip of purple blood came out of his nostrils
The prescription was written — what was the result?
Four days into the treatment, a strip of purple blood came out of the patient’s nostrils — purple blood, probably a strand of clotted blood. After that, his breathing began to feel smooth.
He then finished the whole supply. And after finishing it? He suddenly recovered completely — thoroughly cured.
💬 Note from Doctor Luo: In all he took 4 liang of sanqi powder — 120 grams. Look at how interesting the pathway of recovery was: the stagnant blood did not simply dissolve in place — it was expelled through the nostrils, and once it came out, his breathing was immediately smooth. The stagnant blood inside the body dissolved, found a route out, the blocked airway opened, and the illness was gone. This is a very intriguing case — it lets us see with our own eyes how “resolving stasis” actually gets done.
Two things we learn from this case
Doctor Luo summed up today’s lesson in two points:
First: If you have stagnant blood, and it happens to sit in the liver channel or in the flank region, it will interfere with breathing — breathing always feels a bit blocked; and when you speak, you feel the qi is not enough. In that situation it is not necessarily sinking of the great qi — in excess patterns, stagnant blood alone can produce exactly this.
Second: We learned a way to take sanqi powder — you can brew raw malt into water and use it to wash down the sanqi powder; the stasis-resolving effect is better.
💬 Note from Doctor Luo: Actually, what is most worth savoring in this case is the way Doctor Zhang reasoned. A strange illness whose symptoms sound completely unconnected — he lifted something heavy once, his ribs ached for a few days, his speech cut off, anger made it worse — and Zhang Xichun strung them all into a single line: excessive straining → stasis left in the liver channel → the ascent and descent of qi obstructed → both breathing and speech affected. Differentiation (bian zheng) is assembling scattered clues into a complete picture. I hope this case helps you remember the indicator of “flank blood stasis.”
Compiled from Doctor Luo Dalun’s commentary on Doctor Zhang Xichun’s medical cases; the original case is from Records of Chinese Medicine with Western Reference (《医学衷中参西录》).