天津李××，年三十二岁，拉洋车为业，得大气下陷证。
病因 腹中觉饥，未吃饭，枵腹奔走七八里，遂得此病。
证候 呼吸短气，心中发热，懒食，肢体酸懒无力，略有动作，即觉气短不足以息。其脉左部
弦而兼硬，右部则寸关皆沉而无力。
诊断 此胸中大气下陷，其肝胆又蕴有郁热也。盖胸中大气，原为后天宗气，能代先天元气主
持全身，然必赖水谷之气以养之。此证因忍饥劳力过度，是以大气下陷，右寸关之沉而无
力其明征也。其举家数口生活皆赖一人劳力，因气陷不能劳力继将断炊，肝胆之中遂多
起急火，其左脉之弦而兼硬是明征也。治之者当用拙拟之升陷汤，升补其胸中大气，而辅以
凉润之品以清肝胆之热。
处方 生箭 （八钱） 知母（五钱） 桔梗（二钱） 柴胡（二钱）
升麻（钱半） 生杭芍（五钱） 龙胆草（二钱）
共煎汤一大盅，温服。
效果 将药连服两剂，诸病脱然全愈。
天津宋氏妇，年四旬，于仲夏得大气下陷，周身发冷证。
病因 禀赋素弱，居恒自觉气分不足，偶因努力搬运重物，遂觉呼吸短气，周身发冷。
证候 呼吸之间，恒觉气息不能上达，时当暑热，着夹衣犹觉寒凉，头午病稍轻，午后则
渐剧，必努力始能呼吸，外被大氅犹或寒战，饮食少许，犹不消化。其脉关前沉细欲无，关后
差胜亦在沉分，一息不足四至。
诊断 此上焦心肺之阳虚损，又兼胸中大气下陷也。为其心肺阳虚，是以周身恶寒而饮
食不化，为其胸中大气下陷，是以呼吸短气，头午气化上升之时是以病轻，过午气化下降之时所
以增剧也。拟治以回阳升陷汤加党参之大力者以补助之。
处方 生箭 （八钱） 野台党参（四钱） 干姜（四钱） 当归身（四钱）
桂枝尖（三钱） 甘草（二钱）
共煎汤一大盅，温服。
效果 将药连服三剂，气息已顺，而兼有短气之时，周身已不发冷，惟晚间睡时仍须浓复，饮食
能消化，脉象亦大有起色。遂即原方去党参，将干姜、桂枝皆改用二钱，又加生怀山药
八钱，俾再服数剂，以善其后。
帮助 心为君火，全身热力之司命，肺与心同居膈上，一系相连，血脉之循环又息息相通，是以与心
相助为理，同主上焦之阳气。然此气虽在上焦，实如日丽中天，照临下土，是以其热力透至中焦，
胃中之饮食因之熟腐，更透至下焦，命门之相火因之生旺，内温脏腑，外暖周身，实赖此阳气为布护
宣通也。特是，心与肺皆在胸中大气包举之中，其布护宣通之原动力，实又赖于大气。此证心肺之
阳本虚，向赖大气为之保护，故犹可支持，迨大气陷而失其保护，遂致虚寒之象顿呈。此方以升补
胸中大气为主，以培养心肺之阳为辅，病药针芥相投，是以服之辄能奏效也。
天津的李先生，三十二岁，以拉洋车为职业，患上了大气下陷证。
病因：腹部感到饥饿，尚未进食，空腹奔走七八里路，因此得了这个病。
证候：呼吸短促气急，心中发热，不想吃东西，肢体酸软倦怠无力，稍微有一点动作，就感觉气短得喘不上气来。他的脉象左侧部弦而兼硬，右侧部寸部和关部都沉而无力。
诊断：这是胸中大气下陷，同时肝胆又蕴藏着郁热。因为胸中的大气，原本是后天的宗气，能够代替先天的元气主持全身机能，但必须依赖水谷之气来滋养它。此证因忍受饥饿且过度劳累，导致大气下陷，右寸关脉沉而无力就是明显的证据。他全家几口人的生活都依靠他一人劳作维持，因为气陷而不能继续劳作，即将断炊，肝胆之中于是多起了急躁之火，左脉弦而兼硬就是明显的证据。治疗时应当使用我拟定的升陷汤，提升补益胸中的大气，并辅以凉润的药物来清泻肝胆的热邪。
处方：生黄芪（八钱） 知母（五钱） 桔梗（二钱） 柴胡（二钱）
升麻（一钱半） 生白芍（五钱） 龙胆草（二钱）
共同煎煮成一大碗汤剂，温服。
疗效：将药连续服用两剂，各种病症完全痊愈。
天津宋家的妇人，四十岁左右，在仲夏时节患上大气下陷，伴有周身发冷的症状。
病因：先天禀赋素来虚弱，平时自觉气分不足，偶然因为用力搬运重物，于是觉得呼吸短促气急，周身发冷。
证候：呼吸之间，常常觉得气息不能上达，当时正值暑热天气，穿着夹衣仍然觉得寒凉，上午病情稍轻，下午则逐渐加重，必须努力才能呼吸，外面披着大氅有时还会寒战，吃很少的东西，仍然不消化。她的脉象关前部位沉细几乎摸不到，关后部位稍好但也处于沉分，一息不足四至。
诊断：这是上焦心肺的阳气虚损，又兼有胸中大气下陷。因为心肺阳气虚，所以周身恶寒且饮食不化；因为胸中大气下陷，所以呼吸短促气急。上午是气化上升的时候，所以病情较轻；过了中午是气化下降的时候，所以病情加重。拟定用回阳升陷汤，加入有力的党参来补助。
处方：生黄芪（八钱） 野台党参（四钱） 干姜（四钱） 当归身（四钱）
桂枝尖（三钱） 甘草（二钱）
共同煎煮成一大碗汤剂，温服。
疗效：将药连续服用三剂，气息已经顺畅，偶尔还有短气的情况，周身不再发冷，只是晚上睡觉时仍然需要厚盖被子，饮食能消化，脉象也有很大好转。随即在原方中去掉党参，将干姜、桂枝都改为二钱，又加生怀山药八钱，让再服用几剂，以巩固疗效。
帮助（按语）：心为君火，是全身热力的主宰，肺与心同处膈上，相互联系，血脉循环又息息相通，所以与心相助为理，共同主管上焦的阳气。然而这股气虽然位于上焦，实际上如同太阳高悬中天，照耀大地，所以它的热力透达至中焦，胃中的饮食因此被熟腐消化，更透达至下焦，命门的相火因此生旺，在内温暖脏腑，在外温暖周身，确实依赖这阳气来布护宣通。特别是，心与肺都在胸中大气的包举之中，其布护宣通的真正动力，实在依赖于大气。此证心肺的阳气本已虚弱，向来依赖大气为之保护，所以还能够支撑，等到大气下陷而失去保护，于是导致虚寒的现象顿时呈现。此方以提升补益胸中大气为主，以培养心肺之阳为辅，病与药如针与芥子般相投合，所以服用后就能奏效。
Mr. Li from Tianjin, aged thirty-two, whose profession was pulling a rickshaw, suffered from the syndrome of sinking of the Great Qi (Daqi).
Etiology: He felt hungry in his abdomen but had not eaten; after running seven or eight li on an empty stomach, he contracted this disease.
Symptoms: Shortness of breath and panting, heat sensation in the heart region, aversion to food, soreness and weakness of the limbs, and fatigue. Any slight movement caused him to feel short of breath, insufficient for respiration. His pulse was wiry and hard on the left side, while the Cun (inch) and Guan (bar) positions on the right side were deep and powerless.
Diagnosis: This is a case of sinking of the Great Qi in the chest, accompanied by stagnant heat in the Liver and Gallbladder. The Great Qi in the chest is originally the Postnatal Zong Qi (Gathering Qi), which can substitute for the Prenatal Yuan Qi (Original Qi) to govern the whole body; however, it must rely on the Qi derived from water and grain for nourishment. In this case, enduring hunger and excessive labor led to the sinking of the Great Qi; the deep and powerless pulse at the right Cun and Guan positions is clear evidence. Since the livelihood of several family members depended on his single labor, and because the Qi sank, he could not continue working, facing imminent starvation. Consequently, irritability and fire arose in the Liver and Gallbladder; the wiry and hard pulse on the left side is clear evidence. Treatment should employ my proposed Shengxian Tang (Ascending the Sinking Decoction) to raise and tonify the Great Qi in the chest, assisted by cooling and moistening herbs to clear the heat of the Liver and Gallbladder.
Prescription: Raw Astragali Radix (Sheng Huangqi) (8 qian), Anemarrhenae Rhizoma (Zhimu) (5 qian), Platycodonis Radix (Jiegeng) (2 qian), Bupleuri Radix (Chaihu) (2 qian), Cimicifugae Rhizoma (Shengma) (1.5 qian), Raw Paeoniae Radix Alba (Sheng Baishao) (5 qian), Gentianae Scabrae Radix (Longdancao) (2 qian).
Decoct together in a large bowl of water, take warm.
Outcome: After taking two doses consecutively, all symptoms disappeared completely, and he was fully recovered.
Mrs. Song from Tianjin, around forty years old, contracted the syndrome of sinking of the Great Qi with coldness throughout the body during mid-summer.
Etiology: Her innate constitution was weak, and she usually felt deficient in Qi. Accidentally exerting herself to carry heavy objects, she subsequently experienced shortness of breath and coldness throughout the body.
Symptoms: During respiration, she often felt that her Qi could not ascend. Although it was hot summer weather, she felt cold even wearing a lined jacket. The illness was slightly lighter in the morning and worsened gradually in the afternoon; she had to exert effort to breathe. Even wrapped in a large cloak, she sometimes shivered with cold. She ate very little, yet digestion remained poor. Her pulse was deep and fine, almost imperceptible before the Guan position, and although slightly better behind the Guan position, it remained deep. There were fewer than four beats per breath.
Diagnosis: This is deficiency and damage of the Yang Qi of the Heart and Lungs in the Upper Jiao, combined with the sinking of the Great Qi in the chest. Due to the deficiency of Heart and Lung Yang, there is aversion to cold throughout the body and failure to digest food. Due to the sinking of the Great Qi in the chest, there is shortness of breath. In the morning, when Qi transformation ascends, the illness is mild; after noon, when Qi transformation descends, the illness aggravates. I propose treating with Huiyang Shengxian Tang (Return Yang and Ascend Sinking Decoction), adding potent Codonopsis Radix (Dangshen) to assist.
Prescription: Raw Astragali Radix (Sheng Huangqi) (8 qian), Wild Codonopsis Radix (Yetai Dangshen) (4 qian), Dried Zingiberis Rhizoma (Ganjiang) (4 qian), Angelicae Sinensis Radix (Dangguishen) (4 qian), Ramulus Cinnamomi (Guizhijian) (3 qian), Glycyrrhizae Radix et Rhizoma (Gancao) (2 qian).
Decoct together in a large bowl of water, take warm.
Outcome: After taking three doses consecutively, her breathing became smooth, though occasional shortness of breath persisted. Coldness throughout the body ceased, although she still needed thick coverings when sleeping at night. Digestion improved, and the pulse showed significant recovery. Subsequently, Codonopsis Radix was removed from the original prescription, and both Dried Zingiberis Rhizoma and Ramulus Cinnamomi were reduced to 2 qian each. Raw Dioscoreae Hypoglaucae Rhizoma (Sheng Huaishanyao) 8 qian was added, allowing for several more doses to consolidate the effect.
Commentary: The Heart is the Sovereign Fire and the master of the body's thermal energy. The Lung resides in the Upper Jiao along with the Heart, connected physically, with blood circulation interlinked breath by breath; thus, they assist each other in governance, jointly ruling the Yang Qi of the Upper Jiao. However, although this Qi is located in the Upper Jiao, it is actually like the sun shining in the zenith, illuminating the earth below; its thermal energy penetrates to the Middle Jiao, causing food in the Stomach to be cooked and rotted (digested), and further penetrates to the Lower Jiao, causing the Minister Fire of the Mingmen to flourish, warming the internal Zang-Fu organs externally and warming the whole body. This relies entirely on the distribution and unblocking action of this Yang Qi. Specifically, the Heart and Lung are encompassed within the Great Qi of the chest; the original dynamic power for its distribution and unblocking truly depends on the Great Qi. In this case, the Yang Qi of the Heart and Lung was originally deficient, relying previously on the Great Qi for protection, so it could still sustain itself. When the Great Qi sank and lost its protective function, signs of deficiency-cold suddenly appeared. This formula focuses on raising and tonifying the Great Qi in the chest, assisting with cultivating the Yang Qi of the Heart and Lung. The disease and medicine match perfectly (like a needle and a thistle seed), hence efficacy is achieved upon administration.