李××，年二十六岁，得大气下陷兼消食证。
病因 其未病之前二年，常觉呼吸短气，初未注意。继因校中功课劳心短气益剧，且觉食量倍增，因成
消食之证。
证候 呼吸之间，觉吸气稍易而呼气费力，夜睡一点钟许，即觉气不上达，须得披衣起坐，迟移时，气
息稍顺，始能再睡。一日之间，进食四次犹饥，饥时若不急食，即觉怔忡。且心中常觉发热，大便干
燥，小便短赤，其脉浮分无力，沉分稍
实，至数略迟。
诊断 此乃胸中大气下陷，兼有伏气化热因之成消食也。为其大气下陷，是以脉象浮分无力，为
其有伏气化热，是以其沉分犹实，既有伏气化热矣，而脉象转稍迟者，因大气下陷之脉原多
迟也。盖胃中有热者，恒多化食，而大气下陷其胃气因之下降甚速者，亦恒能多食。今既病大气
下陷，又兼伏气化热，侵入胃中，是以日食四次犹饥也。此宜升补其胸中大气，
再兼用寒凉之品以清其伏气所化之热，则短气与消食原不难并愈也。
处方 生箭 （六钱） 生石膏（一两捣细） 天花粉（五钱） 知母（五钱） 玄参（四钱
）升麻（钱半） 柴胡（钱半） 甘草（钱半）
共煎汤一大盅温服。
复诊 将药连服四剂，短气已愈强半，发热与消食亦大见愈，遂即原方略为加减俾再服之。
处方 生箭 （六钱） 天花粉（六钱） 知母（六钱） 玄参（六钱）
净萸肉（三钱） 升麻（钱半） 柴胡（钱半） 甘草（钱半）
共煎汤一大盅，温服。
方解 方中去石膏者，以伏气所化之热所余无多也。既去石膏而又将花粉、知母诸凉药加重者，因
花粉诸药原用以调剂黄 之温补生热，而今则兼用之以清伏气所化之余热，是以又加重也。至于前
方之外，又加萸肉者，欲以收敛大气之涣散，俾大气之已升者不至复陷，且又以萸肉得木气最浓，酸敛之
中大具条畅之性，虽伏气之热犹未尽消，而亦不妨用之也。
效果 将药又连服四剂，病遂全愈。俾停服汤药，再用生箭 、
天花粉等分轧为细末，每服三钱，日服两次以善其后。
或问 脉之迟数，恒关于人身之热力，热力过盛则脉数，热力微
弱则脉迟，此定理也。今此证虽有伏气化热，因大气下陷而
脉仍迟，何以脉之迟数与大气若斯有关系乎？答曰∶胸中大气亦名宗气，为其实用能斡旋全身，故曰
大气，为其为后天生命之宗主，故又曰宗气。《内经》谓宗气积于胸中以贯心脉而行呼吸，深思《内
经》之言，知肺叶之 辟，固为大气所司，而心机之跳动，亦为大气所司也。今因大气下陷而失
其所司，是以不惟肺受其病，心机之跳动亦受其病而脉遂迟也。
病因：在发病前两年，他常感觉呼吸短促，起初并未在意。后来因为学校功课劳心费力，导致短气症状加剧，并且觉得食量倍增，因此形成了消谷善饥的证候。
证候：呼吸时，感觉吸气稍容易而呼气费力。夜间睡眠约一小时后，就感觉气不能上达，必须披衣坐起，过一会儿，气息稍微顺畅，才能再次入睡。一天之中，进食四次仍然感到饥饿，饥饿时如果不急忙进食，就会感到心慌悸动。且心中常觉发热，大便干燥，小便短赤。其脉象浮取无力，沉取稍实，脉率略迟。
诊断：这是胸中大气下陷，兼有伏气化热因而形成消谷善饥的证候。因为大气下陷，所以脉象浮取无力；因为有伏气化热，所以脉象沉取仍实。既然已有伏气化热，但脉象反而稍迟，是因为大气下陷的脉象原本多迟。大概胃中有热者，常常容易消化食物，而大气下陷导致胃气下降速度很快的人，也常常能吃得多。如今既患大气下陷，又兼伏气化热侵入胃中，所以一天吃四次饭仍然感到饥饿。此症应当升补胸中的大气，再兼用寒凉药物以清除伏气所化的热，那么短气和消谷善饥原本不难同时治愈。
处方：生黄芪（六钱）、生石膏（一两，捣细）、天花粉（五钱）、知母（五钱）、玄参（四钱）、升麻（一钱半）、柴胡（一钱半）、甘草（一钱半）。
共煎成一大盅汤药，温服。
复诊：将药连续服用四剂后，短气症状已痊愈大半，发热和消谷善饥也大有好转，于是就在原方基础上稍作加减，让他继续服用。
处方：生黄芪（六钱）、天花粉（六钱）、知母（六钱）、玄参（六钱）、净山茱萸（三钱）、升麻（一钱半）、柴胡（一钱半）、甘草（一钱半）。
共煎成一大盅汤药，温服。
方解：方中去掉石膏的原因，是因为伏气所化的热已经剩下不多了。既然去掉了石膏，却又将花粉、知母等凉性药物加重用量，是因为花粉等药原本是用来调和黄芪温补可能产生的热，而现在则是兼用来清除伏气所化的余热，所以又加重了用量。至于在原方之外，又加入山茱萸，是想用它来收敛涣散的大气，使已经上升的大气不再重新下陷，而且因为山茱萸得木气最浓，酸敛之中具有条畅的特性，虽然伏气的热还没有完全消除，也不妨使用它。
效果：将药又连续服用四剂后，病遂完全痊愈。让患者停服汤药，再用生黄芪、天花粉等量研为细末，每次服用三钱，每日两次，以巩固疗效。
或问：脉象的迟与数，通常与人体热力的盛衰有关，热力过盛则脉数，热力微弱则脉迟，这是定论。如今此证虽有伏气化热，但因为大气下陷而脉仍迟，为什么脉象的迟数与大气有这样密切的关系呢？答曰：胸中的大气又名宗气，因为它的作用能斡旋全身，所以叫大气；因为它作为后天生命的宗主，所以又叫宗气。《内经》说宗气积聚于胸中以贯通心脉并推动呼吸，深思《内经》的话，知道肺叶的张开与闭合，固然由大气所主管，而心脏机能的跳动，也是由大气所主管的。如今因为大气下陷而失去了它所主管的功能，所以不仅肺受其病，心脏机能的跳动也受其影响而导致脉迟。
Li XX, aged 26, suffered from a syndrome of sinking of the Huiqi (Vital Qi) accompanied by excessive appetite.
Etiology: For two years prior to the onset of illness, he often felt shortness of breath, which he initially ignored. Subsequently, due to the mental exertion of schoolwork, his shortness of breath worsened, and he experienced a significant increase in appetite, leading to the syndrome of excessive appetite.
Symptoms: During respiration, inhalation was slightly easier while exhalation was laborious. After sleeping for about an hour at night, he felt that Qi failed to ascend, requiring him to sit up with clothes on. After a while, when breathing became slightly smoother, he could sleep again. Throughout the day, even after eating four times, he still felt hungry; if he did not eat immediately upon feeling hungry, palpitations would occur. He often felt heat in the heart region, dry stools, and scanty dark urine. His pulse was weak at the superficial level (Fu), slightly solid at the deep level (Chen), and slightly slow (Chi).
Diagnosis: This is a syndrome of sinking of the Huiqi (Vital Qi) in the chest, complicated by latent pathogenic Qi transforming into heat, which resulted in excessive appetite. Because the Huiqi (Vital Qi) is sinking, the pulse is weak at the superficial level; because latent pathogenic Qi has transformed into heat, the pulse remains solid at the deep level. Although there is heat from latent pathogenic Qi, the pulse is slightly slow because the pulse characteristic of sinking Huiqi (Vital Qi) is often slow. Generally, those with heat in the stomach tend to digest food quickly, and those whose Stomach Qi descends rapidly due to sinking Huiqi (Vital Qi) also tend to eat more. Now, suffering from both sinking Huiqi (Vital Qi) and latent pathogenic Qi transforming into heat invading the stomach, he feels hungry even after eating four times a day. The treatment should involve raising and tonifying the Huiqi (Vital Qi) in the chest, combined with using cold-natured herbs to clear the heat transformed from latent pathogenic Qi. In this way, shortness of breath and excessive appetite can be cured simultaneously.
Prescription: Sheng Huangqi (Raw Radix Astragali Membranacei, 6 qian), Sheng Shigao (Raw Gypsum Fibrosum, 1 liang, crushed fine), Tianhuafen (Radix Trichosanthis, 5 qian), Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis, 5 qian), Xuanshen (Radix Scrophulariae Ningpoensis, 4 qian), Shengma (Rhizoma Cimicifugae Foetidae, 1.5 qian), Chaihu (Radix Bupleuri, 1.5 qian), Gancao (Radix Glycyrrhizae Uralensis, 1.5 qian).
Decoct together in a large cup of water and take warm.
Second Visit: After taking the medicine continuously for four doses, shortness of breath had improved by more than half, and fever and excessive appetite had greatly subsided. Therefore, slight modifications were made to the original prescription for continued use.
Prescription: Sheng Huangqi (Raw Radix Astragali Membranacei, 6 qian), Tianhuafen (Radix Trichosanthis, 6 qian), Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis, 6 qian), Xuanshen (Radix Scrophulariae Ningpoensis, 6 qian), Jing Yurou (Cleaned Fructus Corni Officinalis, 3 qian), Shengma (Rhizoma Cimicifugae Foetidae, 1.5 qian), Chaihu (Radix Bupleuri, 1.5 qian), Gancao (Radix Glycyrrhizae Uralensis, 1.5 qian).
Decoct together in a large cup of water and take warm.
Analysis of Prescription: Shigao (Gypsum Fibrosum) was removed because the heat transformed from latent pathogenic Qi was no longer significant. Although Shigao was removed, the dosage of cold-natured herbs like Tianhuafen (Radix Trichosanthis) and Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis) was increased because these herbs originally served to balance the potential heat generated by the warming and tonifying effects of Huangqi (Radix Astragali Membranacei); now they are used to clear the residual heat from latent pathogenic Qi, hence the increased dosage. Regarding the addition of Yurou (Fructus Corni Officinalis) to the previous formula, it was intended to astringe the dissipating Huiqi (Vital Qi), preventing already ascended Qi from sinking again. Furthermore, since Yurou (Fructus Corni Officinalis) possesses strong Wood Qi characteristics, its sour astringency contains a free-flowing nature. Thus, even though the heat from latent pathogenic Qi has not completely dissipated, it is safe to use.
Outcome: After taking the modified medicine continuously for another four doses, the illness was completely cured. The patient was instructed to stop taking decoctions and instead take equal parts of Sheng Huangqi (Raw Radix Astragali Membranacei) and Tianhuafen (Radix Trichosanthis) ground into fine powder, taking 3 qian each time, twice daily, to consolidate the recovery.
Q&A: The slowness or rapidity of the pulse is generally related to the body's thermal energy; excessive heat leads to a rapid pulse, while weak heat leads to a slow pulse, which is a fixed principle. In this case, although there is heat from latent pathogenic Qi, the pulse remains slow due to the sinking of Huiqi (Vital Qi). Why does the pulse rate have such a close relationship with Huiqi (Vital Qi)? A: The Huiqi (Vital Qi) in the chest is also called Zongqi (Pectoral Qi). It is called Huiqi (Vital Qi) because its function can coordinate the whole body, and it is called Zongqi (Pectoral Qi) because it serves as the master of postnatal life. The *Neijing* states that Zongqi (Pectoral Qi) accumulates in the chest to penetrate the heart vessels and govern respiration. Deep reflection on this statement reveals that the opening and closing of lung lobes are governed by Huiqi (Vital Qi), and so is the beating of the heart. Now, due to the sinking of Huiqi (Vital Qi) and the loss of its governing function, not only the lungs suffer disease, but the heart's beating is also affected, resulting in a slow pulse.