Chest Tightness, Shortness of Breath That Won’t Get Better? First Check Whether It Is the “Sinking of the Great Qi”

Opening: yesterday’s cliffhanger, fully explained today

In yesterday’s story about Doctor Zhang Xichun, Doctor Luo Dalun mentioned that he used raw huang qi (astragalus) to treat a condition called “da qi xia xian” (the sinking of the Great Qi). Friends asked: what exactly is this sinking of the Great Qi? Where does this illness come from? Today Doctor Luo takes the doctrine Doctor Zhang Xichun valued above all others and walks through it from beginning to end.

💬 Note from Doctor Luo: This concept of the sinking of the Great Qi was discovered by Doctor Zhang Xichun himself, and he gave it its name. He prized this doctrine his entire life and used it to cure an enormous number of patients. Let us first get the concept clear, and then, as we work through his case records one by one, the light will suddenly go on — many of our own symptoms are actually caused by qi sinking downward.

The first time Doctor Zhang Xichun ran into this illness: a young man bedridden for two months suddenly could not catch his breath

There was once a patient in his twenties who had been bedridden for two months and could not get up. Every kind of treatment had failed. What was wrong with him? His spirit was clouded — he drifted through the days in a daze; his limbs were heavy and weak — no strength in his arms or legs; apart from that, he did not feel any particular pain. Many doctors had been called in, and none could name the illness; their medicines did nothing.

Then one day, a very strange symptom suddenly appeared:

💬 Note from Doctor Luo: He suddenly could not breathe anymore — breathing became terribly laborious, he opened his mouth to exhale, and once the breath went out it would not come back; it could neither rise nor escape. When the breath was blocked to the extreme, his anus even bulged out! After roughly the time of twenty breaths, the breath would finally pass through. This attack repeated seven or eight times in a single day and night. It was terrifying.

The moment Doctor Zhang Xichun arrived, he took the pulse and found that at the guan (bar) position the pulse barely rose — at the cun (inch) position of the wrist, the pulse was so weak it could hardly be felt. Doctor Zhang understood at once: this should be the sinking of the Great Qi — the Great Qi of the chest could no longer preside over the hinge of respiration. This was his first case of treating sinking Great Qi, as he himself recorded; the name of the disease was coined only later.

How did he treat it? He prescribed: ren shen (ginseng) one liang, chai hu (bupleurum) three qian, zhi mu (anemarrhena) two qian. After a single dose, the man’s breathing was smooth again. Later he reduced chai hu to two qian and increased zhi mu to four qian; after a few more doses, the illness was cured.

Why ren shen in the first formula, but huang qi later? — Doctor Zhang Xichun’s own analysis

There is a detail here well worth pondering: why did Doctor Zhang Xichun use ren shen rather than huang qi the first time he treated sinking Great Qi?

💬 Note from Doctor Luo: Doctor Zhang Xichun said himself that when he first treated this disease he did not yet know how effective huang qi could be, so he used ren shen. Later he summed up his experience: when the qi has been very badly damaged, ren shen is truly needed; when the qi has not been so severely wounded, huang qi should be used. His analysis was — ren shen is stronger than huang qi at supplementing qi; huang qi is stronger than ren shen at generating qi and lifting it upward. So if the Great Qi is sinking but its root is not wounded — it is only falling — use huang qi to lift it slowly upward; if the Great Qi is sinking and its root has already been badly wounded, then ren shen is genuinely required. One supplements, the other lifts; you choose according to how deficient the qi has become.

What exactly is that ball of qi in the chest? — Doctor Zhang Xichun’s thinking

So what is this Great Qi, and how did Doctor Zhang Xichun figure it out? He said that there should be a ball of qi in the human chest. Chinese medicine divides qi very finely — there is kidney qi, spleen qi, lung qi, liver qi, heart qi — the qi of each of the five organs — and guarding the outside of the body there is also wei qi (defensive qi). And in the chest there is a ball of Great Qi, related to both lung qi and heart qi, to which Doctor Zhang Xichun gave the name “da qi” (the Great Qi).

💬 Note from Doctor Luo: The Great Qi supports the entire body; it opens and closes the hinge of respiration and lets the chest cavity hold the organs in place. If this ball of qi weakens, a person feels that breathing has no force and the chest feels tight — this qi is one of the fundamental driving forces of life.

When the Great Qi weakens, what happens? — The trap is being treated for something else

Doctor Zhang Xichun discovered that when the Great Qi weakens, the symptoms that appear are wildly varied — and most easily mistaken for other illnesses:

First, chest tightness. Breathing has no force, and the chest feels oppressed. Many people assume it is qi stagnation, so they are given qi-regulating herbs —

💬 Note from Doctor Luo: And the result is the more you regulate, the tighter the chest becomes! The qi was already deficient; if you then use qi-regulating, qi-breaking medicines, the qi becomes even more deficient, so of course the more you treat, the more blocked it feels. This is the most common misdiagnosis.

Second, shortness of breath. Breathing seems to have no strength, as if it is about to stop. Some people take it for rebellious qi causing wheezing, like asthma, and press the qi downward —

💬 Note from Doctor Luo: But the qi was already deficient and moving downward; press it down further and it only gets worse. The direction is completely reversed, and that won’t work either.

Third, alternating chills and fever. Cold one moment, hot the next. Doctor Zhang Xichun’s analysis: when the qi has sunk to the extreme, yang qi is about to emerge; a moment later the body rebels and tries to rise, so heat returns; then it sinks again and the person turns cold again.

Fourth, a dry throat. The throat is always parched. Because the qi has moved downward, body fluids can no longer ride the qi upward; the upper body gets no moisture, so of course it dries out.

Fifth, palpitations and a racing, empty heart. The heart thumps emptily, restless and fearful all day long, a constant sense of dread. Because heart qi is turned by the Great Qi — heart qi is itself part of the Great Qi; when the Great Qi is insufficient, the heart has no driving force and palpitations appear.

Sixth, a clouded mind and poor memory. Mental energy is low, you forget things easily, and your head feels foggy when you think. Because essential qi can no longer ascend to the brain, and brainpower runs short.

💬 Note from Doctor Luo: Now look at these symptoms — chest tightness, shortness of breath, alternating chills and fever, dry throat, heart palpitations, forgetfulness. Don’t they look terribly familiar? How many patients in hospitals go from department to department without ever being cured, when the root may lie right in this ball of qi? Doctor Zhang Xichun did not realize at first that this was “the Great Qi.” He only noticed: these symptoms would not respond to conventional treatment, yet if you hold the qi in place and lift it upward, they get better. So what was this qi called? He began to search the classics for evidence.

Where did Doctor Zhang Xichun dig up the term “Great Qi”? — Three classic passages, one name

Doctor Zhang Xichun loved to read, and he combed the classics until he found the source of “da qi” — in more than one place:

💬 Note from Doctor Luo: The first place is Zhang Zhongjing’s Jin Gui Yao Lue (Essentials from the Golden Cabinet). Under the Gui Zhi Jia Huang Qi Tang (Cinnamon Twig plus Astragalus Decoction) entry in the chapter on water qi, there is a line: “When the Great Qi turns, the qi disperses” — there the term “Great Qi” appears. Doctor Zhang Xichun read it and thought: that is interesting.

💬 Note from Doctor Luo: The second place is in the writing of Doctor Yu Jiayan. Yu Jiayan was a famous physician of the Qing dynasty; Doctor Luo has told his story before, including his book Yi Men Fa Lu (Laws of the Medical Profession). In that book Yu Jiayan wrote: “The great and small channels of the five organs and six bowels circulate day and night without rest, and all rely on the Great Qi of the chest turning among them.” — There “Great Qi” appears again. Yu Jiayan had a genuinely creative insight into this Great Qi. In fact, the real popularization of the term “Great Qi” began with Yu Jiayan.

💬 Note from Doctor Luo: The third place is the Huang Di Nei Jing (Yellow Emperor’s Classic of Internal Medicine) — in the Ling Shu chapter it says: “The Great Qi that gathers and does not move accumulates in the chest and is named the Sea of Qi (qi hai).” You see, the classics had already said it long ago — this ball of Great Qi accumulates in the chest and is called the Sea of Qi.

Set these three classic passages side by side, and Doctor Zhang Xichun had his foundation: once this qi becomes insufficient and moves downward, it causes all kinds of problems in a person — and this state is called the sinking of the Great Qi.

The house formula for sinking Great Qi: Sheng Xian Tang

The name was settled. How to treat it? The method Doctor Zhang Xichun devised became the famous Sheng Xian Tang (Raise the Sinking Decoction): a large dose of raw huang qi (astragalus), a little zhi mu (anemarrhena), plus chai hu (bupleurum), jie geng (platycodon) and sheng ma (cimicifuga).

💬 Note from Doctor Luo: Zhi mu clears heat — it clears lung heat — and here it serves to check the warmth of huang qi: huang qi is slightly warm, so a little zhi mu prevents overheating. Chai hu, jie geng and sheng ma are all herbs whose nature rises upward. Jie geng in particular is what Chinese medicine calls a “boat-and-oar” herb (zhou ji zhi ji) — it is like a boat that carries the medicinal action upward. So when you see jie geng in a formula, understand: some of the other herbs will ride jie geng’s nature and move upward.

Once this formula was created, it became extremely important — Doctor Zhang Xichun prized Sheng Xian Tang his whole life and used it to treat a very large number of sinking-Great-Qi cases. In the episodes to come, Doctor Luo will tell you these remarkable stories one by one.

Modern people: seven or eight out of ten are qi deficient — the scalloped tongue is the signal

With the theory explained, Doctor Luo turns the conversation back to ourselves: everyone, do not underestimate this breath of qi — there are truly very few of us with sufficient qi in daily life.

💬 Note from Doctor Luo: When I give lectures I often say: everyone present, stick out your tongue and check each other for teeth marks on the sides. I tell you, seventy or eighty percent of people will have them. What do teeth marks mean? — Qi deficiency. Qi deficiency causes fluids to stagnate, the tongue body swells, and pressed against the teeth it leaves marks.

💬 Note from Doctor Luo: Among modern people, qi deficiency is extremely common. Is this normal? It is not. We now live “taking the abnormal as the normal” — treating what is not normal as if it were — and in truth none of it is quite normal. This shows that people’s qi is insufficient. When qi is insufficient, many people develop qi sinking downward — perhaps not as severe as Doctor Zhang Xichun’s sinking Great Qi, but many people certainly have the tendency. The problem is: all the symptoms such people develop, we treat as some other disease — that is the big problem. So we must now pay special attention to what Doctor Zhang Xichun taught about the sinking of the Great Qi.

Starting tomorrow, the sinking-Great-Qi stories, one by one

Today we have thoroughly explained “what the sinking of the Great Qi is”: once that ball of qi in the chest drops, chest tightness, shortness of breath, palpitations, dry throat, forgetfulness — all manner of strange ailments arrive. So what are the actual stories of sinking Great Qi? And how did Doctor Zhang Xichun use Sheng Xian Tang to bring person after person back from the brink?

💬 Note from Doctor Luo: Everyone, starting tomorrow, we will go through them one by one. Listen to these case records section by section and analyze them bit by bit, and you will discover: many of our own ailments really are caused by qi sinking downward.

Thank you, friends. That is all for today — see you tomorrow.

Compiled from Doctor Luo Dalun’s series explaining the case records of Doctor Zhang Xichun.