Haven’t Sneezed in Years and Always Feel Weak? Doctor Wang Mengying’s Case of Yang Qi Not Spreading — When a Sneeze Is a Gift
Patient search terms: not sneezing / haven’t sneezed in years / weak body / no energy / thick tongue coating / why do people sneeze
Medical terms for this condition: yang qi failing to spread (yang qi bu xuan bu) · deficiency of upright qi · phlegm-dampness blocking the collaterals · lung qi obstructed (the lungs govern all the qi of the body)
Opening: something that makes the heart heavy
Today we continue the stories of how Doctor Wang Mengying (王孟英) treated his patients. Before we begin, Doctor Luo Dalun shared a few words from the heart: we have been telling these case stories for a while now, and it isn’t easy to keep at one thing every day — so why keep going? Because health matters too much. After the pandemic, people’s constitutions changed at the root. Many people now suffer all kinds of strange illnesses, and their bodies have been damaged.
💬 Note from Doctor Luo: A couple of mornings ago I picked up my phone and saw that my doctoral classmates’ group chat was full of praying-hand emojis. My heart sank — when everyone posts that at once, something has happened. I scrolled: the day before, a classmate had passed away from heart disease. Our PhD class had two or three hundred people, from China-Japan Friendship Hospital and every other hospital you can name. We studied together in the first year and only split up among different advisors in the second and third. These classmates are now exactly at the age of supporting aging parents and young children, and they are the workhorses of their departments — outpatient clinics, ward rounds, research, papers, and for those in administrative posts, even more leadership duties. The heart suddenly can’t take it, and the person is gone. Around us, more and more people are dying of heart disease.
💬 Note from Doctor Luo: In front of health, it doesn’t matter whether you’re a Chinese-medicine doctor or a Western-medicine doctor, or how high your degree is — everyone is equal. Whoever is exhausted is the one who may break down; whoever doesn’t take it seriously, whoever is careless, may be the one who breaks down. I used to argue that people should push themselves when the time came. I don’t argue that anymore. You must understand your own health, protect yourself, and adjust constantly.
People who never study medicine, then ask everyone when they get sick
Many people don’t want to learn anything about health in ordinary times. The moment they fall ill, they ask everyone: What is yin deficiency? What should I do about rhinitis? Give me a prescription!
💬 Note from Doctor Luo: A good Chinese-medicine doctor asks carefully: How is your appetite? How are your bowel movements and urine? He asks plenty of questions. Some doctors have a big reputation: the patient extends the wrist, the pulse is felt, the tongue barely looked at, and the doctor says, “You don’t need to say anything else — I know everything.” He tells his students to take prescription number so-and-so and add a couple of herbs. The patient hasn’t even finished describing the symptoms before he’s dismissed to “next.” My Weibo has thirty-three thousand messages; open it at random and there’s always a patient writing: “I traveled to every major Chinese-medicine hospital in the country, and my illness only got worse.” Everyone around bursts out laughing. In reality, many people’s illnesses have never been well treated.
So Doctor Luo says: learn a little medical knowledge, be clear in your own mind, and take good care of yourself — not so that you can treat yourself, but because the person chiefly responsible for your health is you. What harm is there in learning a little more? In this post-pandemic era, learning a little Chinese medicine matters enormously.
Who was the patient? An official, in tears, begging Doctor Wang Mengying to accompany him to his new post
In the spring of the wuxu year (c. 1838, the 18th year of the Daoguang reign), an official named Zhang Yunong was about to leave for a new post. His title was Sima, which Doctor Luo explains simply means he was a man in office. He insisted that Doctor Wang Mengying travel with him.
💬 Note from Doctor Luo: Why didn’t Doctor Wang Mengying want to go? Because he knew that Zhang Yunong’s illness ran deep — “shou bing zhi shen.” And this man’s official duties were overwhelming; his mind could never be at ease. Whenever some official trouble arose, he would agonize over it day and night, racking his brains. Doctor Wang Mengying said: “Truly this is not something that medicine and food can remedy.” His body was not something a few prescriptions could fix. You see, even among the greatest physicians of the Qing dynasty, there were patients they could not help. Zhang Yunong didn’t distrust Doctor Wang Mengying — he was devoted to him — but he was not his own master, throwing his whole heart into his career, and even a doctor could do nothing about that.
At that, Zhang Yunong’s tears came. He wept and pleaded: just accompany me for the journey! When we arrive, stay if you like, or come back if you wish. He even brought Doctor Wang Mengying’s good friends around to persuade him. Moved by such sincerity, Doctor Wang Mengying agreed to cross the river with him on the same boat and see him on his way.
One question on the boat: how long has it been since you sneezed?
On the journey, Zhang Yunong chatted with Doctor Wang Mengying about his health: how weak he was, how sickly he felt. Doctor Wang Mengying listened, and then suddenly asked a strange question:
“Gong qi jiu bu ti hu?”
— Sir, has it been a long time since you sneezed?
💬 Note from Doctor Luo: Now that’s an interesting question. Zhang Yunong thought about it — and it was true: “cheng ran you nian” — indeed, it had been years since he last sneezed. Why was that? Doctor Wang Mengying explained: “This is yang qi failing to spread” (yang qi bu xuan bu). The yang qi could not spread out; its strength was too weak to circulate through the whole body. Zhang Zhongjing had discussed this phenomenon but left no specific treatment. Doctor Wang Mengying smiled and said: “I will give you a sneeze as a gift.” He called it a gift of a sneeze, but what he actually did was increase your upright qi.
Breaking down the prescription: ginseng leads the charge, tonifying qi while resolving phlegm and opening the lungs
The first herb in Doctor Wang Mengying’s prescription was Korean ginseng — it led the formula as the sovereign herb, to greatly tonify the yuan qi (original qi).
💬 Note from Doctor Luo: And the rest? Dried ginger warms the yang and the middle burner; schisandra fruit astringes and gathers, tonifying the essence of the five viscera — ginseng with schisandra, plus ophiopogon root, gives us the familiar Sheng Mai Yin (Pulse-Engendering Drink); acorus root opens the orifices, awakens the spirit, resolves phlegm and drains dampness, increasing the permeability of the channels; Chinese chive bulb frees the yang and opens the collaterals; pinellia resolves phlegm; tangerine peel regulates qi, resolves phlegm and tunes the lung qi; aster root opens the lung qi, moistens the lungs and stops cough; platycodon root opens the lung qi; and licorice harmonizes everything at the end. The whole formula is built around tonifying the upright qi, and everything else is about resolving phlegm, regulating qi and opening the lung qi — opening up the blocked movement of qi.
Why did he pair qi tonics with so many phlegm-resolving, lung-opening herbs? This is the Chinese-medicine habit of attacking on several fronts at once.
💬 Note from Doctor Luo: Illness is complicated; it doesn’t come in one tidy pattern. It’s not that people fall ill exactly the way the textbooks describe — one side yang deficiency, one side yin deficiency. It’s rarely that simple. Usually, on a foundation of insufficient upright qi, the upright qi is too weak to push blood and qi through the body; dampness congeals, and congeals again until it becomes phlegm — phlegm-dampness blocks the collaterals. With phlegm-dampness stuck there, the upright qi has even less way through. So the strategy must be: while supporting the upright qi, add herbs that move qi and open the lung qi, increasing permeability — dissolve the phlegm, drain the dampness, open the lung qi — and only then, when you tonify, can the qi actually get in. Doctor Wang Mengying could see it: this Sima Zhang Yunong had phlegm in his body, and his tongue coating was thick and greasy, so he used herbs to spread the qi mechanism and open the lung qi, while using ginseng to tonify the upright qi at the same time.
Not two li down the road — the sneeze came!
Doctor Wang Mengying wrote the prescription. The boat docked, they went ashore to buy the herbs, decocted them, and Zhang Yunong drank the medicine. Then the whole party continued on in sedan chairs.
Before they had traveled two li, Zhang Yunong’s sedan chair at the front suddenly stopped. Someone hurried back to Doctor Wang Mengying’s chair with the news:
“The Sima has started sneezing!”
💬 Note from Doctor Luo: Everyone marveled: Doctor Wang Mengying’s skill with herbs could reach this far! From a single question — “has it been a long time since you sneezed?” — he had seized the root of the illness. One dose of medicine, not even two li of road, and the sneeze arrived. This little story records one of Doctor Wang Mengying’s delightful moments in practice.
Doctor Luo’s classroom: what exactly is a sneeze?
Now, you should all know: what is sneezing, really?
Sneezing is the body’s attempt to expel an external pathogen. When the air changes and a pathogen comes, the body knows to fight back, and it sneezes to push the pathogen out — you can only sneeze when you have upright qi.
💬 Note from Doctor Luo: When your upright qi is insufficient, the body has no ability to resist at all. The pathogen comes and simply “garrisons troops” there, then marches straight in — you don’t even have the strength to fight back. So when a person goes for a long time without sneezing, it isn’t that they never meet pathogens — living in this world, who never meets a pathogen? It means the upright qi can no longer organize any resistance whatsoever. Doctor Wang Mengying saw that Zhang Yunong’s upright qi was insufficient and his phlegm-dampness was blocking things up, so he dissolved the phlegm and lifted the upright qi — and the body immediately responded.
The ancients also had the sneeze-inducing method (qu ti fa): to make a person sneeze, you take a rolled paper twist or something similar and tickle the nose, making him sneeze once. What for? To spread and free the lung qi — because the lungs govern all the qi of the body, and the lungs govern regulation (zhi jie), controlling the rhythm at which qi and blood move through all the channels of the body. Once the lung qi opens, the circulation of qi and blood through the whole body becomes truly smooth.
💬 Note from Doctor Luo: Sneezing is like sweating — both are “responses.” Using warm, slightly heating herbs to make a person sweat a little is not about the sweating itself pushing the pathogen out; it’s that the qi and blood are now moving smoothly and with strength, and only then does the person sweat lightly. Sneezing works the same way: once the lung qi opens and the upright qi is sufficient, the body wants to clear out the pathogens lurking in the nasal passages and throat — this is a good sign.
Doctor Luo’s closing note: if the body still responds, the upright qi is still there
This case is not a great dramatic illness. Its brilliance lies in observation — Doctor Wang Mengying looked at one unremarkable detail, “haven’t sneezed in a long time,” saw through to the essence of yang qi failing to spread and upright qi being insufficient, and one dose of medicine delivered the sneeze right on schedule.
💬 Note from Doctor Luo: Learn a little Chinese medicine, and watch the signals your own body sends. After the pandemic, everyone’s bodies are showing all kinds of problems — all kinds of blood stasis, phlegm-dampness, and upright qi deficiency — completely different from before. So it matters even more to adjust constantly and take good care of yourself. Remember: the person chiefly responsible for your health is always you. Tomorrow, we’ll continue with the stories of how Doctor Wang Mengying treated his patients.
Compiled from Doctor Luo Dalun’s recorded lectures on the case records of Wang Mengying; the case is from Wang’s Case Records (《王氏医案》, also known as 《回春录》).