治胸中大气下陷，气短不足以息。或努力呼吸，有似乎喘。或气息将停，危在顷刻。其兼证，或寒热往来，
或咽干作渴，或满闷怔忡，或神昏健忘，种种病状，诚难悉数。其脉象沉迟微弱，关前尤甚。其剧者，或六脉
不全，或参伍不调。
生箭 （六钱） 知母（三钱） 柴胡（一钱五分） 桔梗（一钱五分） 升麻（一钱）
气分虚极下陷者，酌加人参数钱，或再加山萸肉（去净核）数钱，以收敛气分之耗散，使升者不至复陷更
佳。若大气下陷过甚，至少腹下坠，或更作疼者，宜将升麻改用钱半，或倍作二钱。
升陷汤，以黄 为主者，因黄 既善补气，又善升气。惟其性稍热，故以知母之凉润者济之。柴胡为少阳
之药，能引大气之陷者自左上升。升麻为阳明之药，能引大气之陷者自右上升。桔梗为药中之舟楫，能载诸药
之力上达胸中，故用之为向导也。至其气分虚极者，酌加人参，所以培气之本也。或更加萸肉，所以防气之涣
也。至若少腹下坠或更作疼，其人之大气直陷至九渊，必需升麻之大力者，以升提之，故又加升麻五分或倍作
二钱也。方中之用意如此，至随时活泼加减，尤在临证者之善变通耳。
大气者，充满胸中，以司肺呼吸之气也。人之一身，自飞门以至魄门，一气主之。然此气有发生之处，
有培养之处，有积贮之处。天一生水，肾脏先成，而肾系命门之中（包肾之膜油连于脊椎自下上数七节处）有
气息息萌动，此乃干元资始之气，《内经》所谓“少火生气”也。此气既由少火发生，以徐徐上达。培养于后
天水谷之气，而磅因礴
之势成。绩贮于膺胸空旷之府，而盘据之根固。是大气者，原以元气为根本，以水谷之气为养料，以胸中之地
为宅窟者也。夫均是气也，至胸中之气，独名为大气者，诚以其能撑持全身，为诸气之纲领，包举肺外，司呼
吸之枢机，故郑而重之曰大气。夫大气者，内气也。呼吸之气，外气也。人觉有呼吸之外气与内气不相接续者，
即大气虚而欲陷，不能紧紧包举肺外也。医者不知病因，犹误认为气郁不舒，而开通之。其剧者，呼吸将停，
努力始能呼吸，犹误认为气逆作喘，而降下之。则陷者益陷，凶危立见矣。其时作寒热者，盖胸中大气，即上
焦阳气，其下陷之时，非尽下陷也，亦非一陷而不升也。当其初陷之时，阳气郁而不畅则作寒，既陷之后，阳
气蓄而欲宣则作热。迨阳气蓄极而通，仍复些些上达，则又微汗而热解。其咽干者，津液不能随气上潮也。其
满闷者，因呼吸不利而自觉满闷也。其怔忡者，因心在膈上，原悬于大气之中，大气既陷，而心无所附丽也。
其神昏健忘者，大气因下陷，不能上达于脑，而脑髓神经无所凭借也。其证多得之力小任重或枵腹力作，或病
后气力未复，勤于动作，或因泄泻日久，或服破气药太过，或气分虚极自下陷，种种病因不同。而其脉象之微
细迟弱，与胸中之短气，实与寒饮结胸相似。然诊其脉似寒凉，而询之果畏寒凉，且觉短气者，寒饮结胸也；
诊其脉似寒凉，而询之不畏寒凉，惟觉短气者，大气下陷也。且即以短气论，而大气下陷之短气，与寒饮结胸
之短气，亦自有辨。寒饮结胸短气，似觉有物压之；大气下陷短气，常觉上气与下气不相接续。临证者当细审
之（寒饮结胸详理饮汤下）。
肺司呼吸，人之所共知也。而谓肺之所以能呼吸者，实赖胸中大气，不惟不业医者不知，即医家知者亦鲜，
并方书亦罕言及。所以愚初习医时，亦未知有此气。迨临证细心体验，始确知于肺气呼吸之外，别有气贮于胸
中，以司肺脏之呼吸。而此气，
且能撑持全身，振作精神，以及心思脑力、官骸动作，莫不赖乎此气。此气一虚，呼吸即觉不利，而且肢体酸
懒，精神昏愦，脑力心思，为之顿减。若其气虚而且陷，或下陷过甚者，其人即呼吸顿停，昏然罔觉。愚既实
验得胸中有此积气与全身有至切之关系，而尚不知此气当名为何气。涉猎方书，亦无从考证。惟《金匮》水气
门，桂枝加黄 汤下，有“大气一转，其气乃散”之语。后又见喻嘉言《医门法律》谓∶“五脏六腑，大经小
络，昼夜循环不息，必赖胸中大气，斡旋其间”。始知胸中所积之气，当名为大气。因忆向读《内经》热论篇
有“大气皆去病日已矣”之语，王氏注大气，为大邪之气也。若胸中之气，亦名为大气，仲景与喻氏果何所本？
且二书中亦未尝言及下陷。于是复取《内经》，挨行逐句细细研究，乃知《内经》所谓大气，有指外感之气言
者，有指胸中之气言者。且知《内经》之所谓宗气，亦即胸中之大气。并其下陷之说，《内经》亦尝言之。
今试取《内经》之文释之。《灵枢》五味篇曰∶“谷始入于胃，其精微者，先出于胃之两焦，以溉五脏，
别出两行营卫之道，其大气之抟而不行者，积于胸中，命曰气海。出于肺，循喉咽，故呼则出，吸则入。天地
之精气，其大数常出三入一，故谷不入半日则气衰，一日则气少矣。”愚思肺悬胸中，下无透窍，胸中大气，
包举肺外，上原不通于喉，亦并不通于咽，而曰出于肺循喉咽，呼则出，吸则入者，盖谓大气能鼓动肺脏使之
呼吸，而肺中之气，遂因之出入也。所谓天地之精气常出三入一者，盖谓吸入之气，虽与胸中不相通，实能隔
肺膜通过四分之一以养胸中大气，其余三分吐出，即换出脏腑中混浊之气，此气化之妙用也。然此篇专为五味
养人而发，故第言饮食能养胸中大气，而实未发明大气之本源。愚尝思之，人未生时，皆由脐呼吸，其胸中原
无大气，亦无需乎大气。迨胎气日盛，脐下元气渐充，遂息息
上达胸中而为大气。大气渐满，能鼓动肺膜使之呼吸，即脱离母腹，由肺呼吸而通天地之气矣（西人谓肺之呼吸
延髓主之，胸中大气实又为延髓之原动力）。
至大气即宗气者，亦尝深考《内经》而得之。《素问》平人气象论曰∶“胃之大络名虚里，出于左乳下，
其动应衣，脉宗气也。”
按∶虚里之络，即胃输水谷之气于胸中，以养大气之道路。而其贯膈络肺之余，又出于左乳下为动脉。是
此动脉，当为大气之余波，而曰宗气者，是宗气即大气，为其为生命之宗主，故又尊之曰宗气。其络所以名虚
里者，因其贯膈络肺游行于胸中空虚之处也。
又∶《灵枢》客邪篇曰∶“五谷入于胃，其糟粕、津液、宗气，分为三隧。故宗气积于胸中，出于喉咙，
以贯心脉，而行呼吸焉。”观此节经文，则宗气即为大气，不待诠解。且与五味篇同为伯高之言，非言出两人，
而或有异同。且细审“以贯心脉，而行呼吸”之语，是大气不但为诸气之纲领，并可为周身血脉之纲领矣。至
大气下陷之说，《内经》虽无明文，而其理实亦寓于《内经》中。《灵枢》五色篇雷公问曰∶“人无病卒死，
何以知之？”黄帝曰∶“大气入于脏腑者，不病而卒死。”夫人之膈上，心肺皆脏，无所谓腑也。经既统言脏
腑，指膈下脏腑可知。以膈上之大气，入于膈下之脏腑，非下陷乎？大气既陷，无气包举肺外以鼓动其 辟之
机，则呼吸顿停，所以不病而猝死也。观乎此，则大气之关于人身者，何其重哉！
愚深悯大气下陷之证医多误治，因制升陷汤一方，又有回阳升陷汤、理郁升陷汤二方，皆由升陷汤加减而
成。此三升陷汤后，附载治愈之案，其病之现状∶有呼吸短气者，有心中怔忡者，有淋漓大汗者，有神昏健忘
者，有声颤身动者，有寒热往来者，有胸中满闷者（此因呼吸不利而自觉满闷，若作满闷治之立危），有努力
呼吸似喘者（此种现状尤多，乃肺之呼吸将停，其人努力呼吸以自救，若作喘证治之立危），有咽干作渴者，
有常常呵
欠者，有肢体痿废者，有食后易饥者，有二便不禁者，有癃闭身肿者，有张口呼气外出而气不上达，肛门突出
者，在女子有下血不止者，更有经水逆行者（证因气逆者多，若因气陷致经水逆行者曾见有两人，皆投以升陷
汤治愈），种种病状实难悉数。其案亦不胜录。治愈大气下陷之案，略登数则于下，以备考征。
有兄弟二人，其兄年近六旬，弟五十余。冬日畏寒，共处一小室中，炽其煤火，复严其户牖。至春初，二
人皆觉胸中满闷，呼吸短气。盖因户牖不通外气，屋中氧气全被煤火着尽，胸中大气既乏氧气之助，又兼受炭
气之伤，日久必然虚陷，所以呼吸短气也。因自觉满闷，医者不知病因，竟投以开破之药。迨开破益觉满闷，
转以为药力未到，而益开破之。数剂之后，其兄因误治，竟至不起。其弟服药亦增剧，而犹可支持，遂延愚诊
视。其脉微弱而迟，右部尤甚，自言心中发凉，少腹下坠作疼，呼吸甚觉努力。知其胸中大气下陷已剧，遂投
以升陷汤，升麻改用二钱，去知母，加干姜三钱。两剂，少腹即不下坠，呼吸亦顺。将方中升麻、柴胡、桔梗
皆改用一钱，连服数剂而愈。
一人，年四十八。素有喘病，薄受外感即发，每岁反复两三次，医者投以小青龙加石膏汤辄效。一日反复
甚剧，大喘昼夜不止。医者投以从前方两剂，分毫无效。延愚诊视，其脉数至六至，兼有沉濡之象。疑其阴虚
不能纳气，故气上逆而作喘也。因其脉兼沉濡，不敢用降气之品。遂用熟地黄、生山药、枸杞、玄参、大滋真
阴之品，大剂煎汤，送服人参小块二钱。连服三剂，喘虽见轻，仍不能止。复诊视时，见令人为其椎背，言背
常发紧，椎之则稍轻，呼吸亦稍舒畅。此时，其脉已不数，仍然沉濡。因细询，此次反复之由，言曾努力搬运
重物，当时即觉气分不舒，迟两三日遂发喘。乃恍悟，此证因阴虚不能纳气，故难于吸。因用力太过，大气下
陷，故难于呼。其呼吸皆须努力，故呼
吸倍形迫促。但用纳气法治之，止治其病因之半，是以其喘亦止愈其半也。遂改用升陷汤，方中升麻、柴胡、
桔梗，皆不敢用，以桂枝尖三钱代之。又将知母加倍，再加玄参四钱，连服数剂全愈。
按∶此证虽大气下陷，而初则实兼不纳气也。升麻、柴胡、桔梗，虽能升气，实与不纳气之证有碍，用之
恐其证仍反复。惟桂枝性本条达，能引脏腑之真气上行，而又善降逆气。仲景苓桂术甘汤，用之以治短气，取
其能升真气也。桂枝加桂汤，用之以治奔豚，取其能降逆气也。且治咳逆上气吐吸（喘也）《神农本草经》
原有明文。既善升陷，又善降逆，用于此证之中，固有一无二之良药也。
或问∶桂枝一物耳，何以既能升陷又能降逆？答曰∶其能升陷者，以其枝直上而不下垂，且色赤属火，而
性又温也。其能降逆者，以其味辛，得金气而善平肝木，凡逆气之缘肝而上者（逆气上升者多由于肝），桂枝
皆能镇之。大抵最良之药，其妙用恒令人不测。拙拟参赭镇气汤后，有单用桂枝治一奇病之案，可以参观。
一人，年二十余。动则作喘，时或咳嗽。医治数年，病转增剧，皆以为劳疾不可治。其脉非微细，而指下
若不觉其动。知其大气下陷，不能鼓脉外出，以成起伏之势也。投以升陷汤，加人参、天冬各三钱，连服数剂
而愈。因其病久，俾于原方中减去升麻，为末炼蜜作丸药，徐服月余，以善其后。
一人，年二十四。胸中满闷，昼夜咳嗽，其咳嗽时，胁下疼甚。诊其脉象和平，重按微弦无力。因其胁疼，
又兼胸满，疑其气分不舒，少投以理气之药。为其脉稍弱，又以黄 佐之，而咳嗽与满闷益甚，又兼言语声颤
动。乃细问病因，知其素勤稼穑，因感冒懒食，犹枵腹力作，以致如此。据此病因，且又服理气之药不受，其
为大气下陷无疑。遂投以升陷汤，四剂，其病脱然。
按∶此证之形状，似甚难辨，因初次未细诘问，致用药少有
差错，犹幸迷途未远，即能醒悟，而病亦旋愈。由斯观之，临证者，甚勿自矜明察，而不屑琐琐细问也。
一人，年四十许。失音半载，渐觉咽喉发紧，且常溃烂，畏风恶寒，冬日所着衣服，至孟夏犹未换。饮食
减少，浸成虚劳，多方治疗，病转增剧。诊其脉，两寸微弱，毫无轩起之象，知其胸中大气下陷也。投以升陷
汤，加玄参四钱，两剂，咽喉即不发紧。遂减去升麻，又连服十余剂，诸病皆愈。
西丰县张××，年十八九，患病数年不愈，来院延医。其证夜不能寐，饮食减少，四肢无力，常觉短气。其
脉关前微弱不起。知系胸中大气下陷，故现种种诸证。投以升陷汤，为其不寐，加熟枣仁、龙眼肉各四钱，数
剂全愈。
奉天于氏女，出嫁而孀，根据居娘门。因病还家中，夜忽不能言，并不能息。其同院住者王××，系愚门生，
急来院扣门，求为援救。原素为诊脉调药，知其大气虚损，此次之证，确知其为大气下陷，遂为疏方，用生箭
一两，当归四钱，升麻二钱，煎服，须臾即能言语。翌晨舁至院中，诊其脉沉迟微弱，其呼吸仍觉短气。遂
将原方减升麻一钱，又加生山药、知母各三钱，柴胡、桔梗各一钱，连服数剂全愈。按此证，脉迟而仍用知母
治疗胸中大气下陷，导致气短、呼吸不足以维持正常需求。或者患者努力呼吸，看起来像喘证。或者气息即将停止，危险就在顷刻之间。其兼有的症状，有的寒热往来，有的咽干口渴，有的胸中满闷、心悸怔忡，有的神志昏沉、健忘，各种病状，实在难以全部列举。其脉象表现为沉迟微弱，关前部位尤为明显。病情严重的，有时六脉不全，或脉律参差杂乱不调。
生黄芪（六钱） 知母（三钱） 柴胡（一钱五分） 桔梗（一钱五分） 升麻（一钱）
如果是气分极度虚弱而下陷的，酌情加入人参数钱，或者再加山茱萸（去净核）数钱，用来收敛气分的耗散，使提升之气不再重新下陷，效果更佳。如果大气下陷过于严重，出现少腹下坠，或者更加疼痛的，应当将升麻改为钱半，或者加倍用到二钱。
升陷汤以黄芪为主药，是因为黄芪既善于补气，又善于升气。只是它的性质稍微偏热，所以用知母的凉润来制约它。柴胡是少阳经的药物，能引导下陷的大气从左上升。升麻是阳明经的药物，能引导下陷的大气从右上升。桔梗是药中的舟楫，能承载诸药的力量上达胸中，所以用它作为向导。至于气分极度虚弱的，酌情加入人参，这是为了培补气的根本。或者再加山茱萸，这是为了防止气的涣散。至于少腹下坠或者更加疼痛的情况，说明人的大气直接下陷到了极深处，必须依靠升麻的大力来升提，所以又增加升麻五分或者加倍用到二钱。方中的用意如此，至于随时灵活加减，更在于临证医生善于变通罢了。
所谓大气，是充满在胸中，主管肺呼吸的气。人的一身，从肛门（飞门）到肛门（魄门），都由一气所主。然而这气有发生的地方，有培养的地方，有积贮的地方。天一生水，肾脏先形成，而肾系命门之中（包裹肾脏的膜油连接于脊椎自下往上数第七节处）有气息息萌动，这是先天元气资始的气，《内经》所说的“少火生气”。这气既然由少火发生，便徐徐向上到达，通过后天的水谷之气进行培养，磅礴之势形成。积贮在膺胸空旷的脏腑，根基稳固。所以大气，原本是以元气为根本，以水谷之气为养料，以胸中为宅窟的。同样是气，唯独胸中之气被称为大气，确实是因为它能撑持全身，作为诸气的纲领，包举在肺之外，主宰呼吸的枢机，所以郑重地称为大气。夫大气是内气。呼吸之气，是外气。人感觉到呼吸的外气与内气不相接续，就是大气虚而欲下陷，不能紧紧包举肺外。医生不知道病因，还误认为是气郁不舒，而用开通的方法治疗。病情严重的，呼吸即将停止，努力才能呼吸，还误认为是气逆作喘，而用降下的方法治疗。那么下陷的更加下陷，凶险危急立刻显现。那些时常发寒热的，大概因为胸中大气，就是上焦阳气，当下陷的时候，并非完全下陷，也不是一次下陷就不再上升。当它初陷的时候，阳气郁结而不通畅则发寒，已经下陷之后，阳气蓄积而想要宣通则发热。等到阳气蓄积到极点而通达，仍然微微上达，就会微汗出而热解。那些咽干的，是因为津液不能随着气上潮。那些满闷的，是因为呼吸不利而自觉满闷。那些怔忡的，是因为心在膈上，原本悬吊在大气的中间，大气既已下陷，而心就没有了依附。那些神昏健忘的，是因为大气因下陷，不能上达于脑，而脑髓神经没有了凭借。这些证候多得力小任重，或者空腹用力劳作，或者病后气力未恢复，勤于动作，或者因为泄泻日久，或者服用破气药太过，或者气分极度虚弱自然下陷，种种病因不同。而其脉象的微细迟弱，与胸中的短气，实在与寒饮结胸相似。然而诊察其脉象似寒凉，而询问果然畏寒凉，且觉得短气的，是寒饮结胸；诊察其脉象似寒凉，而询问不畏寒凉，只觉得短气的，是大气下陷。而且即使就短气而论，大气下陷的短气，与寒饮结胸的短气，也自有区别。寒饮结胸的短气，似乎觉得有物压迫；大气下陷的短气，常觉得上气与下气不相接续。临证者应当仔细审察（寒饮结胸详见理饮汤下）。
肺主管呼吸，这是人所共知的。而说肺之所以能呼吸，实际上依赖胸中大气，不仅非业医者不知，即使是医家中知道的也很少，连方书也很少提及。所以我初学医时，也不知道有此气。等到临证细心体验，才确知在肺气呼吸之外，另有气贮存在胸中，以主管肺脏的呼吸。而这气，还能撑持全身，振作精神，以及心思脑力、肢体动作，无不依赖此气。此气一旦虚弱，呼吸就觉得不利，而且肢体酸懒，精神昏愦，脑力心思，顿时减少。如果此气虚而且下陷，或者下陷过甚的，其人就会呼吸突然停止，昏然无知觉。我既然实验得知胸中有此积气与全身有至切的关系，而还不知道此气应当叫什么名字。涉猎方书，也无从考证。只有《金匮要略》水气门，桂枝加黄芪汤下，有“大气一转，其气乃散”的话。后来又见喻嘉言《医门法律》说：“五脏六腑，大经小络，昼夜循环不息，必赖胸中大气，斡旋其间”。才知道胸中所积之气，应当名为大气。因而回忆以前读《内经》热论篇有“大气皆去病日已矣”的话，王氏注大气，是大邪之气。如果胸中之气，也名为大气，仲景与喻氏究竟依据什么？而且两书中也未尝提及下陷。于是再取《内经》，逐句细细研究，才知道《内经》所说的大气，有指外感之气说的，有指胸中之气说的。并且知道《内经》所谓的宗气，也就是胸中的大气。并且其下陷的说法，《内经》也曾说过。现在试着取《内经》的文本来解释它。《灵枢·五味》篇说：“谷开始进入胃，其中的精微者，先从胃的两焦出来，以灌溉五脏，另外分出两行营卫之道，其中大气团聚而不运行的，积聚在胸中，命名为气海。出于肺，循行喉咽，所以呼则出，吸则入。天地精气，其大数常出三入一，所以谷不入，半日则气衰，一日则气少了。”我思考肺悬挂在胸中，下无透窍，胸中大气，包举肺外，上原不通于喉，也并不通于咽，而说出于肺循喉咽，呼则出，吸则入，大概是说大气能鼓动肺脏使之呼吸，而肺中之气，于是随之出入。所谓天地精气常出三入一，大概是说吸入之气，虽然与胸中不相通，实能隔着肺膜通过四分之一来滋养胸中大气，其余三分吐出，即换出脏腑中混浊之气，这是气化之妙用。然而此篇专为五味养人而发，所以只说饮食能养胸中大气，而实际并未发明大气的本源。我曾思考，人未出生时，都是由脐呼吸，其胸中原无大气，也无需乎大气。等到胎气日益旺盛，脐下元气逐渐充盛，便息息上达胸中成为大气。大气渐渐充满，能鼓动肺膜使之呼吸，即脱离母腹，由肺呼吸而通天地之气了（西方人认为肺的呼吸由延髓主持，胸中大气实际上是延髓的原动力）。
至于大气即宗气这一点，也曾深入考证《内经》而得到证实。《素问·平人气象论》说：“胃之大络名虚里，出于左乳下，其动应衣，脉宗气也。”按：虚里的络脉，就是胃输送水谷之气到胸中，以滋养大气的道路。而其贯穿膈络肺之余，又出于左乳下为动脉。是这个动脉，应当是大气的余波，而称为宗气的，是宗气即大气，因为它作为生命的宗主，所以又尊称为宗气。其络所以名为虚里的，是因为它贯穿膈络肺游行于胸中空虚之处。
又：《灵枢·邪客》篇说：“五谷进入胃，其糟粕、津液、宗气，分为三条通道。所以宗气积聚在胸中，出于喉咙，以贯通心脉，而行呼吸。”看这段经文，则宗气即为大气，不必解释。而且与《五味》篇同为伯高的话，不是出自两人，而或有异同。并且仔细审视“以贯通心脉，而行呼吸”的话，是大气的不但作为诸气的纲领，并可以成为周身血脉的纲领了。至于大气下陷的说法，《内经》虽然没有明文，但其理其实也蕴含在《内经》中。《灵枢·五色》篇雷公问曰：“人无病卒死，怎么知道？”黄帝曰：“大气进入脏腑的，不病而猝死。”人的膈上，心肺都是脏，没有所谓腑。经文既然统称脏腑，指膈下脏腑可知。以膈上的大气，进入膈下的脏腑，不是下陷吗？大气既已下陷，无气包举肺外以鼓动其开阖之机，则呼吸突然停止，所以不病而猝死。看这个，则大气关于人身，何其重要啊！
我深深怜悯大气下陷的证候医生多误治，因此制定升陷汤一方，又有回阳升陷汤、理郁升陷汤二方，都是由升陷汤加减而成。这三首升陷汤后，附载治愈的案例，其病的现状：有呼吸短气的，有心悸怔忡的，有淋漓大汗的，有神昏健忘的，有声颤身动的，有寒热往来的，有胸中满闷的（这是因为呼吸不利而自觉满闷，如果当作满闷治疗立刻危险），有努力呼吸像喘证的（这种现状尤其多，是肺的呼吸即将停止，其人努力呼吸以自救，如果当作喘证治疗立刻危险），有咽干口渴的，有常常打哈欠的，有肢体痿废的，有食后易饥的，有二便不禁的，有癃闭身肿的，有张口呼气外出而气不上达，肛门突出的，在女子有下血不止的，更有经血逆行的（证因气逆的多，如果因气陷导致经血逆行曾见过两人，都投以升陷汤治愈），各种病状实在难以全部列举。其案例也不胜枚举。治愈大气下陷的案例，略登数则在下面，以备考证征引。
有一对兄弟二人，哥哥年近六十，弟弟五十多岁。冬天怕冷，共处在一间小屋里，烧着煤火，又严密门窗。到春初，两人都觉得胸中满闷，呼吸短气。大概因为门窗不通外气，屋中氧气全被煤火烧尽，胸中大气既缺乏氧气的帮助，又兼受炭气的伤害，日久必然虚陷，所以呼吸短气。因为自觉满闷，医生不知道病因，竟然投以开破的药。等到开破后更加满闷，反而以为药力未到，而继续开破。几剂之后，哥哥因为误治，竟然致死。弟弟服药也加重，但还可以支持，于是请我诊治。其脉微弱而迟，右部尤其明显，自己说心中发凉，少腹下坠作痛，呼吸很觉努力。知道其胸中大气下陷已经很严重，于是投以升陷汤，升麻改为二钱，去掉知母，加干姜三钱。两剂，少腹就不下坠，呼吸也顺了。将方中升麻、柴胡、桔梗都改为钱，连服数剂而痊愈。
一个人，四十八岁。素有喘病，稍微受外感就发作，每年反复两三次，医生投以小青龙加石膏汤就有效。一天反复很剧烈，大喘昼夜不止。医生投以前方两剂，分毫无效。请我诊治，其脉数至六至，兼有沉濡之象。怀疑其阴虚不能纳气，所以气上逆而作喘。因为其脉兼沉濡，不敢用降气的药。于是用熟地黄、生山药、枸杞、玄参、大滋真阴的药，大剂煎汤，送服人参小块二钱。连服三剂，喘虽见轻，仍不能止。复诊时，见让人为其捶背，说背常发紧，捶之则稍轻，呼吸也稍舒畅。此时，其脉已不数，仍然沉濡。因为仔细询问，这次反复的原因，说曾努力搬运重物，当时就觉气分不舒，迟两三天就发喘。于是恍然大悟，此证因阴虚不能纳气，所以难于吸气。因用力太过，大气下陷，所以难于呼气。其呼吸都要努力，所以呼吸倍形迫促。只用纳气法治之，只治了其病因的一半，所以其喘也只治好了一半。于是改用升陷汤，方中升麻、柴胡、桔梗，都不敢用，以桂枝尖三钱代替。又将知母加倍，再加玄参四钱，连服数剂全愈。
按：此证虽大气下陷，而起初实则兼有不纳气。升麻、柴胡、桔梗，虽然能升气，实在与不纳气的证候有妨碍，用之恐怕其证仍反复。只有桂枝性本条达，能引脏腑的真气上行，而又善降逆气。仲景苓桂术甘汤，用它来治短气，取其能升真气。桂枝加桂汤，用它来治奔豚，取其能降逆气。而且治咳逆上气吐吸（喘也）《神农本草经》原有明文。既善升陷，又善降逆，用于此证之中，固是一无二的良药。
有人问：桂枝一物而已，为什么既能升陷又能降逆？回答说：其能升陷的，以其枝直上而不垂，且色赤属火，而性又温。其能降逆的，以其味辛，得金气而善平肝木，凡逆气缘肝而上的（逆气上升者多由于肝），桂枝都能镇之。大抵最好的药，其妙用常令人不测。拙拟参赭镇气汤后，有单用桂枝治一奇病的案例，可以参观。
一个人，二十多岁。动则作喘，时而咳嗽。医治数年，病转增剧，都以为是劳疾不可治。其脉非微细，而指下若不觉其动。知其大气下陷，不能鼓脉外出，以成起伏之势。投以升陷汤，加人参、天冬各三钱，连服数剂而痊愈。因为其病久，让在原方中减去升麻，为末炼蜜作丸药，慢慢服月余，以善其后。
一个人，二十四岁。胸中满闷，昼夜咳嗽，其咳嗽时，胁下疼甚。诊其脉象和平，重按微弦无力。因为其胁疼，又兼胸满，疑其气分不舒，少投以理气的药。因为其脉稍弱，又以黄芪佐之，而咳嗽与满闷益甚，又兼言语声颤动。于是细问病因，知道他平时勤耕稼穑，因为感冒懒食，还空腹用力劳作，以致如此。据此病因，且又服理气的药不受，其为大气下陷无疑。于是投以升陷汤，四剂，其病脱然痊愈。
按：此证的形状，似乎很难辨别，因为初次未细问，致用药稍有差错，犹幸迷途未远，即能醒悟，而病也随即痊愈。由此看来，临证者，千万不要自矜明察，而不屑琐碎细问。
一个人，四十岁左右。失音半年，渐觉咽喉发紧，且常溃烂，畏风恶寒，冬日所穿衣服，到孟夏仍未换。饮食减少，浸成虚劳，多方治疗，病转增剧。诊其脉，两寸微弱，毫无轩起之象，知其胸中大气下陷。投以升陷汤，加玄参四钱，两剂，咽喉就不发紧了。于是减去升麻，又连服十余剂，诸病皆愈。
西丰县张某某，年十八九，患病数年不愈，来院延医。其证夜不能寐，饮食减少，四肢无力，常觉短气。其脉关前微弱不起。知系胸中大气下陷，故现种种诸证。投以升陷汤，因为其不寐，加熟枣仁、龙眼肉各四钱，数剂全愈。
奉天于氏女，出嫁而寡居，独居娘家。因病还家中，夜忽不能言，并不能息。其同院住者王某某，是我的门生，急来院敲门，求援救。原来素为诊脉调药，知其大气虚损，此次之证，确知其为大气下陷，于是为其疏方，用生黄芪一两，当归四钱，升麻二钱，煎服，须臾即能言语。翌晨抬至院中，诊其脉沉迟微弱，其呼吸仍觉短气。于是将原方减升麻一钱，又加生山药、知母各三钱，柴胡、桔梗各一钱，连服数剂全愈。按此证，脉迟而仍用知母
Treatment for the sinking of the Great Qi (Da Qi, the vital qi filling the chest and governing respiration) in the chest, resulting in shortness of breath insufficient to sustain normal breathing. Or the patient exerts effort to breathe, appearing similar to asthma (Chuan Zheng). Or the breath is about to cease, with danger imminent. The accompanying symptoms may include alternating chills and fever, dry throat with thirst, chest fullness and palpitations (Zheng Chong), mental confusion and forgetfulness; such a variety of conditions is indeed difficult to enumerate completely. The pulse is deep, slow, and weak, particularly pronounced at the Guan position. In severe cases, the six pulses may be incomplete or irregular and uncoordinated.
Sheng Huang Qi (Raw Astragali Radix, 6 qian) Zhi Mu (Anemarrhenae Rhizoma, 3 qian) Chai Hu (Bupleuri Radix, 1.5 qian) Jie Geng (Platycodonis Radix, 1.5 qian) Sheng Ma (Cimicifugae Rhizoma, 1 qian)
In cases where the Qi of the Qi Division is extremely deficient and sinking, add Ren Shen (Ginseng Radix et Rhizoma) by discretion, several qian, or additionally add Shan Yu Rou (Corni Fructus, removed pits) several qian, to converge the dispersion of the Qi of the Qi Division, ensuring that the lifted Qi does not sink again, which is even better. If the Great Qi sinks excessively, causing a bearing-down sensation in the lower abdomen or increased pain, change Sheng Ma to 1.5 qian, or double it to 2 qian.
Sheng Xian Tang (Decoction for Lifting the Sinking Qi) uses Huang Qi as the principal herb because Huang Qi is excellent at tonifying Qi and lifting Qi. However, its nature is slightly warm, so Zhi Mu’s cool and moistening properties are used to balance it. Chai Hu is an herb of the Shaoyang (Lesser Yang) channel, capable of guiding the sinking Great Qi to ascend from the left. Sheng Ma is an herb of the Yangming (Bright Yang) channel, capable of guiding the sinking Great Qi to ascend from the right. Jie Geng acts as the boat and oar among herbs, carrying the power of the other herbs upward to reach the chest, thus serving as a guide. For cases of extreme deficiency in the Qi of the Qi Division, adding Ren Shen by discretion serves to cultivate the root of Qi. Adding Shan Yu Rou prevents the dissipation of Qi. Regarding the bearing-down sensation in the lower abdomen or increased pain, this indicates that the person’s Great Qi has sunk to the deepest depths, requiring the strong lifting power of Sheng Ma to raise it; hence, Sheng Ma is increased by 0.5 qian or doubled to 2 qian. Such is the intention behind the formula. As for flexible modifications according to circumstances, it depends on the clinician’s ability to adapt wisely.
The Great Qi fills the chest and governs pulmonary respiration. Throughout the human body, from the anus (Fei Men) to the anus (Po Men), one Qi prevails. Yet this Qi has a source of generation, a place of cultivation, and a place of accumulation. Heaven generates Water first; the Kidneys form initially. Within the Mingmen (Gate of Life) connected to the Kidney system (the membrane enveloping the kidneys connects to the spine, counting seven segments from below), Qi stirs intermittently. This is the Qi of Primordial Yuan (Yuan Qi) providing the beginning, what the *Neijing* calls “Minor Fire generates Qi.” Once generated by Minor Fire, this Qi slowly ascends, cultivated by the postnatal Qi from water and grain, forming a majestic momentum. It accumulates in the spacious cavity of the chest, establishing a firm root. Thus, the Great Qi originally takes Yuan Qi as its foundation, water and grain Qi as its nourishment, and the chest as its dwelling. Although all are Qi, only the Qi in the chest is uniquely named Great Qi, truly because it supports the whole body, serves as the leader of all Qi, envelops the exterior of the lungs, and controls the pivot of respiration; therefore, it is solemnly called Great Qi. The Great Qi is internal Qi. Respiratory Qi is external Qi. When a person feels that the external respiratory Qi and internal Qi are not continuous, it means the Great Qi is deficient and tending to sink, unable to tightly envelop the exterior of the lungs. If physicians do not understand the cause, they mistakenly diagnose it as Qi stagnation and use methods to open and disperse it. In severe cases, when breathing is about to stop and requires effort to breathe, they mistakenly diagnose it as rebellious Qi causing asthma and use methods to descend it. Consequently, the sinking becomes deeper, and danger appears immediately. Those who experience frequent chills and fever: generally, the Great Qi in the chest is the Yang Qi of the Upper Jiao. When it sinks, it does not sink entirely, nor does it fail to rise after one sinking. At the initial stage of sinking, Yang Qi is constrained and unsmooth, causing chills; after sinking, Yang Qi accumulates and desires to diffuse, causing heat. When Yang Qi accumulates to the extreme and then unblocks, rising slightly again, slight sweating occurs and heat resolves. Dry throat occurs because fluids cannot follow the Qi upward. Fullness arises from difficulty in respiration. Palpitations occur because the Heart sits above the diaphragm, suspended within the Great Qi; when the Great Qi sinks, the Heart loses its support. Mental confusion and forgetfulness occur because the sinking Great Qi cannot reach the brain, leaving the brain marrow and nerves without reliance. These conditions often result from overexertion relative to strength, working on an empty stomach, engaging in activity before recovery from illness, prolonged diarrhea, excessive use of Qi-breaking medicines, or spontaneous sinking due to extreme Qi deficiency. Various causes differ, yet their pulse signs of fine, slow, and weak qualities, along with shortness of breath in the chest, closely resemble Cold-Fluid Accumulation in the Chest (Han Yin Jie Xiong). However, if the pulse appears cold-cool and the patient indeed fears cold-coolness and feels shortness of breath, it is Cold-Fluid Accumulation in the Chest; if the pulse appears cold-cool but the patient does not fear cold-coolness and only feels shortness of breath, it is Sinking of the Great Qi. Even regarding shortness of breath alone, there is a distinction between the shortness of breath of Sinking Great Qi and that of Cold-Fluid Accumulation in the Chest. In Cold-Fluid Accumulation, one feels as if something is pressing down; in Sinking Great Qi, one often feels that upper Qi and lower Qi are not continuous. Clinicians must examine carefully (see Li Yin Tang for details on Cold-Fluid Accumulation in the Chest).
It is common knowledge that the Lungs govern respiration. To say that the Lungs’ ability to breathe relies on the Great Qi in the chest is unknown not only to non-medical people but also rarely known even among physicians, and rarely mentioned in medical texts. When I first studied medicine, I was unaware of this Qi. Only through careful clinical experience did I confirm that besides pulmonary Qi respiration, there is another Qi stored in the chest governing lung respiration. This Qi can support the whole body, invigorate the spirit, and sustain mental faculties, cognitive abilities, and physical movements. When this Qi is deficient, respiration becomes difficult, limbs feel sore and lazy, spirit becomes confused, and mental/cognitive functions decrease suddenly. If this Qi is deficient and sinks, or sinks excessively, the person’s breathing may suddenly stop, leading to unconsciousness. Having experimentally verified that this accumulated Qi in the chest has a crucial relationship with the whole body, yet still not knowing what to name it, I found no reference in medical texts. Only in the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), under the Water Qi chapter, beneath Guizhi Jia Huang Qi Tang, is the phrase “When the Great Qi rotates, the pathogenic Qi disperses.” Later, seeing Yu Jiayan’s *Yi Men Fa Lv* stating: “The five Zang and six Fu organs, major and minor collaterals, circulate day and night without ceasing, relying on the Great Qi in the chest to manage them,” I realized the accumulated Qi in the chest should be named Great Qi. Recalling reading in the *Neijing*, Heat Disease Chapter: “When the Great Qi departs, the disease days are over,” with Wang’s commentary defining Great Qi as pathogenic Qi. If the Qi in the chest is also named Great Qi, what was the basis for Zhang Zhongjing and Mr. Yu? Moreover, neither book mentions sinking. Thus, I revisited the *Neijing*, studying sentence by sentence, and learned that the Great Qi mentioned in the *Neijing* refers sometimes to external pathogenic Qi and sometimes to the Qi in the chest. I also learned that the Zong Qi (Pectoral Qi) mentioned in the *Neijing* is also the Great Qi in the chest. Furthermore, the concept of its sinking is also present in the *Neijing*. Let us interpret the *Neijing* text now. The *Lingshu · Wu Wei* chapter says: “Grain enters the Stomach; its essence first emerges from the two Jiao of the Stomach to irrigate the five Zang organs, branching into two pathways of Ying and Wei Qi. The Great Qi that gathers and does not move accumulates in the chest, named the Sea of Qi. It emerges from the Lungs, follows the throat and pharynx, so during exhalation it exits, and during inhalation it enters. The essence of Heaven and Earth usually exits three parts and enters one part; thus, without grain intake, Qi declines in half a day and diminishes in one day.” I pondered that the Lungs hang in the chest with no opening below; the Great Qi in the chest envelops the exterior of the Lungs, originally not connecting to the throat or pharynx above. Saying it emerges from the Lungs, follows the throat/pharynx, exits on exhalation, and enters on inhalation implies that the Great Qi drives the Lungs to breathe, and the Qi within the Lungs thereby moves in and out. The statement that heavenly/earthly essence exits three and enters one means that inhaled Qi, though not directly communicating with the chest, actually penetrates one-quarter through the lung membrane to nourish the Great Qi in the chest, while the remaining three parts are exhaled, replacing turbid Qi in the organs. This is the wondrous function of Qi transformation. However, this chapter focuses on nourishing humans with the Five Flavors, so it only states that diet nourishes the Great Qi in the chest, without revealing its origin. I have considered that before birth, humans breathe via the umbilicus; the chest originally has no Great Qi and needs none. As fetal Qi grows, Yuan Qi below the umbilicus gradually fills, ascending intermittently to the chest to become Great Qi. As Great Qi fills, it drives the lung membrane to breathe; upon leaving the womb, respiration occurs via the Lungs, connecting with Heaven and Earth Qi (Western medicine holds that medulla oblongata controls lung respiration, while the Great Qi in the chest is actually the prime mover of the medulla).
Regarding Great Qi being Zong Qi, I deeply investigated the *Neijing* to confirm this. The *Suwen · Ping Ren Qi Xiang Lun* says: “The great collateral of the Stomach is named Xuli, emerging from below the left breast; its movement affects the clothing, representing the pulse of Zong Qi.” Note: The Xuli collateral is the pathway for the Stomach to transport water and grain Qi to the chest to nourish the Great Qi. After penetrating the diaphragm and connecting to the Lungs, it emerges below the left breast as an artery. This artery should be the residual wave of the Great Qi; calling it Zong Qi means Zong Qi is Great Qi, honored as such because it is the master of life. The collateral is named Xuli because it penetrates the diaphragm, connects to the Lungs, and travels through the hollow spaces of the chest.
Furthermore, the *Lingshu · Ke Xie* chapter says: “Five grains enter the Stomach; their dregs, fluids, and Zong Qi divide into three tunnels. Thus, Zong Qi accumulates in the chest, emerges from the throat, penetrates the Heart vessels, and conducts respiration.” Observing this scripture, Zong Qi is clearly Great Qi, requiring no explanation. Since both passages are attributed to Bogao, not differing authors, there should be consistency. Carefully examining “penetrating Heart vessels and conducting respiration,” Great Qi not only leads all Qi but also serves as the leader of the entire body’s blood vessels. Although the *Neijing* lacks explicit text on Great Qi sinking, the principle is embedded within it. In the *Lingshu · Se Se* chapter, Leigong asks: “How do we know a person dies suddenly without illness?” Huangdi replies: “When Great Qi enters the Zang and Fu organs, the person dies suddenly without prior illness.” Above the diaphragm, Heart and Lungs are Zang, with no Fu organs. Since the classic collectively mentions Zang and Fu, it refers to the organs below the diaphragm. For the Great Qi above the diaphragm to enter the organs below the diaphragm, is this not sinking? Once the Great Qi sinks, lacking Qi to envelop the Lungs externally to drive their opening and closing mechanisms, respiration stops suddenly, causing sudden death without prior illness. From this, how important is the Great Qi to the human body!
Deeply pitying that physicians often misdiagnose Sinking Great Qi, I formulated Sheng Xian Tang. Two other formulas, Hui Yang Sheng Xian Tang and Li Yu Sheng Xian Tang, were derived from modifications of Sheng Xian Tang. Following these three formulas, I attached cured cases. The current manifestations of these diseases include: shortness of breath, palpitations, profuse sweating, mental confusion and forgetfulness, trembling voice and body, alternating chills and fever, chest fullness (due to difficult respiration, mistaken treatment for fullness leads to immediate danger), effortful breathing resembling asthma (especially common, indicating lung respiration is about to stop; the patient struggles to breathe to save themselves; mistaking this for asthma leads to immediate danger), dry throat with thirst, frequent yawning, limb flaccidity, easy hunger after eating, incontinence of urine and feces, stranguria with edema, mouth open exhaling air outward without Qi reaching up, anal prolapse, in women continuous uterine bleeding, and retrograde menstruation (mostly caused by rebellious Qi, but I have seen two cases caused by sinking Qi, both cured with Sheng Xian Tang). The variety of symptoms is hard to list. Cases are too numerous to record. Below, I briefly publish a few cured cases of Sinking Great Qi for reference.
Two brothers, the elder nearly sixty, the younger over fifty. Fearing cold in winter, they shared a small room, burning coal fire and sealing windows/doors tightly. By early spring, both felt chest fullness and shortness of breath. Because windows/doors blocked outside air, oxygen in the room was consumed by the coal fire. Lacking oxygen assistance, and suffering carbon monoxide injury, the Great Qi in the chest became deficient and sank over time, causing shortness of breath. Feeling full, and unaware of the cause, doctors prescribed dispersing/breaking medicines. As dispersing worsened fullness, they assumed insufficient dosage and continued dispersing. After several doses, the elder died due to misdiagnosis. The younger’s condition worsened but remained stable, so he sought my consultation. His pulse was weak and slow, worse on the right. He reported cold heart, bearing-down pain in the lower abdomen, and effortful breathing. Knowing his Great Qi had severely sunk, I prescribed Sheng Xian Tang, changing Sheng Ma to 2 qian, removing Zhi Mu, adding Gan Jiang (Dried Ginger) 3 qian. After two doses, the bearing-down ceased, and breathing smoothed. I changed Sheng Ma, Chai Hu, and Jie Geng to 1 qian each, continuing for several doses until cured.
A man, forty-eight years old. Suffered from chronic asthma, triggered by slight external contraction, recurring twice or thrice yearly. Xiao Qing Long Jia Shi Gao Tang (Minor Blue Dragon Decoction plus Gypsum) was usually effective. One day, the relapse was severe, with constant day-and-night asthma. Two doses of the previous formula yielded no effect. Upon consultation, his pulse was rapid (six beats per breath) with a deep and soft quality. Suspecting Yin deficiency failing to grasp Qi, causing rebellious Qi and asthma, and noting the deep/soft pulse, I dared not use descending agents. Instead, I used Shu Di Huang (Rehmanniae Radix Preparata), Sheng Shan Yao (Dioscoreae Rhizoma), Gou Qi Zi (Lycii Fructus), Xuan Shen (Scrophulariae Radix), large doses of Yin-nourishing herbs, decocted strongly, administered with 2 qian of Ren Shen pieces. After three doses, asthma lightened but persisted. On re-examination, he had someone pounding his back, reporting tightness relieved by pounding and slightly easier breathing. His pulse was no longer rapid, remaining deep and soft. Detailed inquiry revealed he had carried heavy loads with great effort, feeling Qi discomfort immediately, followed by asthma after two or three days. I realized this case involved Yin deficiency failing to grasp Qi (difficulty inhaling) compounded by excessive effort causing Great Qi sinking (difficulty exhaling). Both inhalation and exhalation required effort, making breathing urgent. Treating only with grasping-Qi methods addressed only half the cause, curing only half the asthma. I switched to Sheng Xian Tang, omitting Sheng Ma, Chai Hu, and Jie Geng, substituting with Gui Zhi Jian (Cinnamomi Ramulus apices) 3 qian. I doubled Zhi Mu and added Xuan Shen 4 qian. Several doses resulted in complete cure.
Note: Although this case involved Sinking Great Qi, initially it also included failure to grasp Qi. Sheng Ma, Chai Hu, and Jie Geng, while lifting Qi, hindered the failure-to-grasp condition; using them risked recurrence. Gui Zhi, naturally smooth and unobstructed, guides true Qi of organs upward and descends rebellious Qi well. Zhang Zhongjing’s Ling Gui Zhu Gan Tang uses it for shortness of breath to lift true Qi; Gui Zhi Jia Gui Tang uses it for Ben Tun (Running Piglet) to descend rebellious Qi. Additionally, *Shennong Ben Cao Jing* explicitly states Gui Zhi treats cough, rebellious Qi, and dyspnea. Being both excellent for lifting sinking and descending rebellion, it is a unique and precious herb for this case.
Question: How can one herb, Gui Zhi, both lift sinking and descend rebellion? Answer: Its lifting property comes from branches growing straight up, red color belonging to Fire, and warm nature. Its descending property comes from pungent taste, receiving Metal Qi to soothe Liver Wood; for rebellious Qi rising due to Liver (common), Gui Zhi can suppress it. Generally, the best herbs have unpredictable wonders. See the case of single Gui Zhi treating a strange disease after my Can Zhe Zhen Qi Tang for reference.
A man, twenty-something. Asthma upon exertion, occasional cough. Treated for years with worsening condition, diagnosed as consumptive disease incurable. Pulse was not fine/weak, but imperceptible under fingers. Knowing Great Qi was sinking and unable to drive the pulse outward to create a fluctuating shape, I prescribed Sheng Xian Tang, adding Ren Shen and Tian Dong (Asparagi Radix) 3 qian each. Several doses cured him. Due to chronic illness, I removed Sheng Ma from the original formula, powdered it, made honey pills, and advised slow consumption for over a month to consolidate recovery.
A man, twenty-four years old. Chest fullness, day-and-night cough, severe hypochondriac pain during coughing. Pulse was harmonious, slightly wiry and weak upon heavy pressure. Suspecting Qi stagnation due to pain and fullness, I gave a small amount of Qi-regulating herbs. Noting the weak pulse, I added Huang Qi. Cough and fullness worsened, accompanied by trembling voice. Inquiry revealed he worked hard in fields, caught cold, lost appetite, yet worked on an empty stomach. Based on this cause and intolerance to Qi-regulating herbs, Sinking Great Qi was certain. I prescribed Sheng Xian Tang. Four doses led to complete recovery.
Note: This case appeared difficult to distinguish. Initial lack of detailed questioning led to slight medication error. Fortunately, the mistake was caught early, and the patient recovered quickly. This shows clinicians should not pride themselves on insight while neglecting detailed questioning.
A man, around forty. Loss of voice for half a year, gradual tightening of throat, frequent ulceration, aversion to wind and cold. Winter clothes worn until early summer. Reduced diet, progressing to consumptive weakness. Multiple treatments worsened the condition. Pulse: both Cun positions weak, lacking uplift. Knowing Great Qi in the chest was sinking, I prescribed Sheng Xian Tang, adding Xuan Shen 4 qian. Two doses relieved throat tightness. Sheng Ma was removed, continuing for over ten doses until all ailments resolved.
Zhang XX from Xifeng County, eighteen or nineteen years old. Sick for years without cure, came to hospital. Symptoms: insomnia, reduced diet, limb weakness, frequent shortness of breath. Pulse: weak and flat before the Guan position. Knowing this was Sinking Great Qi causing various symptoms, I prescribed Sheng Xian Tang. For insomnia, added Shu Zao Ren (Ziziphi Spinosae Semen Preparatum) and Long Yan Rou (Longan Arillus) 4 qian each. Several doses resulted in complete cure.
Ms. Yu from Fengtian, married then widowed, living alone in her maiden home. Returned home ill, suddenly unable to speak or breathe at night. Neighbor Wang XX, my student, rushed to the hospital seeking help. Previously diagnosed and treated by me, knowing her Great Qi was deficient, I confirmed this episode was Sinking Great Qi. I prescribed Sheng Huang Qi 1 liang, Dang Gui (Angelicae Sinensis Radix) 4 qian, Sheng Ma 2 qian, decocted and taken. Speech resumed shortly. Next morning brought to hospital, pulse deep, slow, weak; shortness of breath persisted. I reduced Sheng Ma by 1 qian from the original formula, added Sheng Shan Yao and Zhi Mu 3 qian each, Chai Hu and Jie Geng 1 qian each. Several doses resulted in complete cure. Note: In this case, despite the slow pulse, Zhi Mu was still used...