医学衷中参西录：治大气下陷方

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。

This formula works for a condition, in which the Big Qi in the chest sunk. The person feels short of breath. He breath hard as having asthma, or the breath would stop as a life-threaten condition. He may have cold-hot shift, or dryness in throat and thirsty, or have fullness in the chest and palpitation, or loss of mind, or frequent memory loss. The symptoms can be largely variable and hard to list all of them.

生箭（六钱）知母（三钱）柴胡（一钱五分）桔梗（一钱五分）升麻（一钱）
Huangqi 18 gram, Zhimu 9 gram, Chaihu 4.5 gram, Jiegen 4.5 gram, Shengma 3 gram.

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。
For those who has extreme Qi-Sunk condition, add little Renshen (about 5 to 9 gram), or add Shanyurou several grams (remove kernel), to restrain the exhausting Qi and to make the raised Qi not sink again. If the Qi sinks too much, the person feels falling on the lower abdomen, or pain there, increase the amount of Shengma to 4.5 grqam, or to 6 gram.

升陷汤，以黄芪为主者，因黄芪既善补气，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。
Shengxian Tang uses herb Huangqi as its main ingredient. Herb Huangqi is good at nourishing Qi and raising the Qi too. Its herbal nature is little bit hot, so the Zhimy is used to balance its hot side effect. Chaihu is the herb belonging to the Shaoyang meridian. It can bring the Qi up from the left side of the body. Shengma is the herb working in the Yangming meridian. It can bring the Qi raising from the right side of the body. Jiegeng works as a ship to bring the functions of all other herbs up to the chest, so it is used as guider. If the Qi is very much weak, add little Renshen to nouristh the foundation of the Qi. The addition of Shanyurou is to prevent the dispersing of the Qi. If the person feels falling or even pain in the lower abdomen, it suggests that the Qi has sunk too deep. He Shengma has to be used in a high amount to solve it. This is the rough idea for the use of each herb in the formula. The formula still needs to be modified according person’s body condition.

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。

… The Big Qi means the Qi in the chest. The reason to call it Big Qi, is that it can hold and support the Qi in every other part of the body. It is the leader of the whole body Qi. It folds the lung, dominates the breath, so it is called the Big Qi, for emphasize.

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。
The Big Qi is the inside Qi. The breathed Qi is the outside Qi. If a person feels the breathing Qi cannot conduct with the inside Qi, it suggests that the Big Qi is sinking, or has sunk, so it fails to hold and sustain the lung to work. If the doctor has no this concept, and mis-regards the Qi-sunk condition to be Qi stagnation, he would use herbs to open or to loss the Qi. If the Qi sunk condition is severe, the breath is to stop. Only with hard breath again, can the breath continue. This condition can be mis-diagnozed as asthma to use Qi-suppressing therapy, so the Qi would be more sinking and the condition becomes worse so to risk the life. The mechanism for a cold-hot shift feeling is that, when the Qi starts to sink, the Yang Qi is stagnated to cause cold feeling. After sink, the Yang Qi tries to disperse so to cause hot feeling. When the Yang Qi accumulates little bit more, it disperses up to cause littele sweat to solve the problem for a movement. The dryness in the throat is because the Yingye cannot raising up to wet the throat. The fullness feeling in the chest is because the harsh of the breath. The palpitation is because the heart is above the diagram, pending in the Big Qi, having nowhere to attach when the Big Qi sinks. The person’s mind/brain is cloudy and has poor memory, because the Big Qi sinks, fails to raise up to the brain, so the nerves in the brain is short of nourish.

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）。
The Qi-sink condition is usually due to hard physical work (when the body is weak); or to work hard after a severe disease; or to long term of diarrhea; or to overtake of Qi-breaking therapy, or to the Qi being very weak. The reason can be largely variable. Its mild, weak, late pulse, as well as the short of breath, is similar to the condition of Cold-stagnation in chest. If the person feels chilly, and dislikes cold, short of breath, it is the Cold-stagnation in chest. If the person does not feel chilly or cold, but only short of breath, it belongs to the Big Qi-sink condition. Even the short of breath in these two conditions are different. The person with Cold-stagnation, though with the short of breath, feels as there is a heavy stuff to press; the person with the Big Qi-sink, feels the inhalation and exhalation does not connect each other. It should be carefully distinguished in clinic. (see more introduction for the Cold-stagnation in the Liyin Tang).

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？
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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。
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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）。
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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。
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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！
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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。
I feel very deep pity that the Qi-sink condition is mis-diagnozed and mis-treated, so I set up this Shengxian Tang, as well as Huiyang Shengxian Tang and Liyu Shengxian Tang. The later two formulas are deduced from the Shengxian Tang. Following each of these Shengxia Tang, there are clinic case reports indicating its applications in clinic. Some patient felt short of breath; some felt palpitation, some had heavy sweat; coudy mind/brain; shacking voice and/or body; cold-hot shift feeling; fullness in chest, hard breath as asthma; dry throat with thirsty; yawning, paralysis; easy hungry after eating; leak of urine and/or stool; block of urine with body swelling; exhalation with open mouth but feeling the air not out; protrution of anus; uterus bleeding; reverse menstruation (most case is due to air-reverse, but there are two cases which are due to the Qi-sink. They got recovered by taking the Shengxian Tang). The clinic manifestations are much largely variable. Here I cite some of the cases for reference.

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。
There was a man with his brother. He was about 60 years of old, and his brother, about 50. One day in a winter, they stayed in a room with a coal stove in the middle room to burn for heat, with door and windows closed tightly. Up to the early spring, both men felt fullness in the chest, short of breath. Since the room was closed on the door and windor, , there was no outside air come in the room, the oxygen in the room was exhausted by the stove. … Doctor who took care of them did not that the reason for this condition is the Qi-sink, so as usually gave them Qi-breaking therapy. After take the herbs, the men felt more fullness and tightness in the chest. The doctor thought that the amount of the herbs might be not enough, so used more strong Qi-breaking herbs. After several doses, the old brother got difficulty to get up the bed, due to the mis-treatment. The younger brother’s condition became worse too, but could still hold. When I saw them, the pulse was weak and late, especially on the right side. The person said he felt cold in the heart and falling feeling on the lower abdomen, hard in breath. It was therefore known that the Qi has sunk, so they were given Shengxian Tang, with herb Shengma 6 gram was changed, Zhimu removed, and Ganjiang 9 gram added. After taking for two doses, the falling feeling on the lower abdomen stop, the breath was also easier. The Shengma, Chaihu and Jiegeng, all are changed to only 3 gram. Additional several more doses solved the condition completely.

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，见令人为其捶背，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。
A man, 48 years of old, suffered from asthma for many years. The asthma recurred upon common cold every time. It can be twice to tree times a year. Doctors had given him Xiao Qinglong Tang plus Shigao. It worked each time. One, it recurred again. He suffered from the severe asthma day and night without stop. Doctor used the previous herbal formula, no any effect. When I was invited, I found his pulse being frequent as up to six times per breath-circle, with somehow deep and ru feeling. I suspected him having Yin deficiency with difficult to inhalate, so the Qi reversed up to cause the asthma. Since his pulse was deep and ru, I dared not to use Qi-descending herbs. The herbal formula I prescribed contained Shoudi, Shanyao, Goujizi, Xuanshen, to nourish the Yin. I also asked him to take a small piece of Renshen, which is swallowed with the help of the cooked herbal tea. After three doses, the asthma appeared to be less, but still not stop. At the second visit, I saw that he asked other person to pound his back. He said he always felt tightness on the back. The tightness felt less after pounding, as well as easier the breath. His pulse was not frequent but still deep and ru. Upon asking again, he said that, the reason for this time was that he had had worked very hard to move heavy staff physically. He felt short of breath at that movement, but two to three days later he got the asthma again. I then realized suddenly that his condition was due to Yin deficiency, which is hard to inhale are in. The extensive labor work caused Big Qi sink, so he felt hard to exhale. For him, both inhalation and exhalation were difficult, so the use of Qi-restraining therapy alone soled only half of reason, so the asthma reduced half level. Then, he was given the Shengxian Tang, with the removal of Shengma, Chaihu and Jiegeng, but with the addition of Guizhi tips 9 gram and Xuanshen 12 gram, and with double of Zhimu. Several doses later, the condition was completely solved.

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。
Comments: though this condition belongs to the Qi-sink, but it is combined with difficulty in the inhalation. The herb Shengma, Chaihu and Jiegeng, all can raise the Qi, and all are conflicting with the inhalation. Use of them may make things worse. The herb Guizhi is opening and dispersing in its herbal nature, can bring the True Qi up, and also bring bring the reversed Qi back and down. That Mater Zhang Zhongjing used the Ling Gui Zhu Gan Tang is due to the Guizhi’s ability to raise the True Qi. In herbal formula of Guizhi Jia Gui Tang, it is used to suppress the reversed Qi down. It is also used to treat asthma, which has been indicated clearly in the book ）《Shengong Bencao Jing》. It is only the Guizhi, that can either raise the Qi and suppress the reversed Qi. It is the only best herb in this formula (Shengxian Tang).

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。
It may be asked, why the Guizhi has both Qi-raising and Qi-suppressing property? Answer: Due to its branch growing up rather than down, its color being red that belongs to Fire, so its nature being warm, so that it can raise the Qi. Due to its spicy taste, that belongs to Metal and so good at suppressing Liver Wood (reversed Qi moves up along with the Liver meridian), Guizhi can therefore suppress the reverse Qi down. The best herb, its marvelous effects are usually difficult to predict. After I developed Shenzhe Zhengqi Tang, I used Guizhi alone for treatment in a case. Readers can check.

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。
A patient, about 20 years of old, had easy asthma with little physical activity, and had cough from time to time. He visited doctors for several years, the condition became worse. All believed that his condition would not be able to solve. His pulse was not thin or subtle, but hard to feel it open press. It is so known as a Qi-sink condition, the Qi is so weak to push the pulse out to form a waving pulse. He was given the Shengxian Tang, with addition of Renshen 9 gram and Tianmendong 9 gram. After several doses, the condition was well improved. Since he got this disease for a long time, the Shengma in the original formula has been removed. The formula was then prepared as pill with honey. He was asked to take the pills after several months for a maintenance.

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，又以黄芪佐之，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。

On patient, 24 years of old, felt fullness in the chest, cough day and night. He felt pain on the side of abdomen when cough. His pulse was calm, but it was mild and thin and weak when pressed hard. For his pain on the side of abdomen, together with the chest fullness, it was suspected to be Qi stagnation, so he was given little Qi-improving therapy. For the pulse being weak, herb Huangqi was used to help the Qi. After use of the herbs, the cough and the chest fullness were worse, with additional shacking voice in speak. I asked his disease history again in detail, knowing that he worked very hard in field. He did not eat regularly due to common cold, but continued the heavy labor work. So the condition occurred. For this history, again with the failure of the Qi-improving herbal formula, it was suspected to be Qi-sink condition. He was given the Shengxian Tang for four doses. The condition was completely solved.

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。

Comments: This case is difficult to diagnosis. Since in the beginning, there was no detailed asking, the herbal therapy committed some mistake. It was lucky that the mistake did not go too far, so the correction of the therapy solved the problem. From this case, it is therefore known that, doctors should not make his/her prejudice to think things on granted. Doctors should ask the sick history in detail, to prevent any mistake.

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。
A patient, about 40 years of old, suffered from loss of voice for half year. He felt tightness on throat gradually. The throat was ulcer commonly. He dislikes wind and felt chilly. The clothes for winter can bear to summer without change. He had reduced diet, showed exhausting condition. He had visited various doctors without any improvement but worse. His pulse was slightly weak in the Chong position on both wrists, no up-waving feeling. It was diagnosed as Big Qi-sink. He was given the Shengxin Tang, with addition of Xuanshen 12 gram. Two doses later, throat was no longer tight. After removal of Shengma from the formula, the formula was taken for about ten doses, and the condition was completely solved.

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。
Mr. Zhang, who lived in Xifeng county and was 18 years of old, was sick for several years. He had poor sleep, reduced diet, weak arms and legs, short of breath. His pulse was weak on the Chong position, so it was diagnosed as Qi-sink condition. He was given Shengxian Tang. For his poor sleep, added processed Suanzaoren and Longyanrou 12 gram each in the original formula. After several days of herbal intake, the condition was solved.

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，脉迟而仍用知母者，因大气下陷之脉大抵皆迟，非因寒凉而迟也，用知母以济黄之热，则药性和平，始能久服无弊。
Mrs. Yu, who lived in Fengtian county, came to her mother’s home. She got sick and could not speak suddenly one night and felt hard to have breath. Mr. Wang, who was my student, lived in the same yard with her mother, hurried to me asking for help. Mr. Wang knew her and worked as her doctor before, so knowing that she was usually Qi deficiency. This time, her condition was believed to be Qi-sink. I gave her formula, which was Huangqi 30 gram, Danggui 12 gram, Shengma 6 gram. After drink of the herbal tea, she could speak pretty soon again. Next morning I met her again in the yard, I felt her pulse deep, late and weak. She still felt short of breath. So the formula was: Shengma 3 gram, Shanyao 9 gram, Zhimu 9 gram, Chaihu 3 gram, and Jiegeng 3 gram. After several days, the condition was solved. For this case, to use the Zhimu when the pulse was late (not mean slow, the slow pulse and the late pulse are different feeling and they bear different meaning). The pulse due to Qi-sink is usually late, which is not due to cold-cool condition. The Zhimu is used to balance the hot from Huangqi, so that the whole formula is mild in nature and can be drink for a long time.

奉天袁姓少妇，小便处常若火炙，有时觉腹中之气下坠，则炙热益甚。诊其脉关前微弱，关后重按又似有力。其呼吸恒觉短气，心中时或发热。知其素有外感伏邪，久而化热，又因胸中大气下陷，伏邪亦随之下陷也。治以升陷汤加生石膏八钱，后渐加至二两，服药旬日全愈。

Mrs. Yuan, a young lady, felt burning in urethra, falling feeling on lower abdomen, which was worse when warmed with moxibustion. Her pulse was weak and subtle on the Chong position, while it was stronger on the Guan position. She felt short of breath, hot feeling in heart from time to time. It is suspected that she had out-coming Xie Qi in the body, that hold and hidden in the body. For a long time, the hidden Xie Qi turned into Fire, which followed the Sunk-Qi down to the lower part of the body. The patient was given Shengxian Tang, with addition of Shigao 24 gram, which as later increased to 60 gram. After about ten days, the condition was fixed completely.

或疑大气下陷者，气不上达也，喘者，气不下降也，何以历述大气下陷之病状，竟有努力呼吸有似乎喘者？

Question: In the Qi-sink, the person feels air not up; in the asthma, he feels air not down. Why in the above cases, the patient with the Qi-sink condition feels hard to breath, as having asthma?

答曰：此理不易骤解，仍宜以治愈之案证之。
Answer: this question is not easy to answer by short words. Let’s see a example of a success case.

一人，年二十余。因力田劳苦过度，致胸中大气下陷，四肢懒动，饮食减少，自言胸中满闷，其实非满闷乃短气也，病患不善述病情，往往如此。医者不能自审病因，投以开胸理气之剂，服之增重。又改用半补半破之剂，服两剂后，病又增重。又延他医，投以桔梗、当归、木香各数钱，病大见愈，盖全赖桔梗升提气分之力也，医者不知病愈之由，再服时，竟将桔梗易为苏梗，升降易性，病骤反复。自此不敢服药。

One patient, about 20 years of old, worked very hard in farm, so he got the Qi-sink condition. He had poor diet, complained fullness in chest, though it was only fullness but not short of breath. Patients, if not good to describe his suffering, usually tell doctor a unclear feeling. The previous doctor was unable to identify the reason, and he gave the patient Qi-opening therapy, which made the condition worse. Later the half-nourishing and half-opening therapy was used. After two doses, the condition became worse again. A following doctor used Jiegeng, Danggui and Muxiang, several gram for each, the condition was much improved. In the formula, it was the herb Jiegeng, that raises the Qi up. The doctor did not know the reason. In following formula, he changed the Jiegeng to Sougeng, so the nature of the formula changed from raising to suppressing, the patient’s condition became worse again. Then he dared not to take any therapy more.

迟延二十余日，病势垂危，喘不能卧，昼夜倚壁而坐；假寐片时，气息即停，心下突然胀起，急呼醒之，连连喘息数口，气息始稍续；倦极偶卧片时，觉腹中重千斤，不能转侧，且不敢仰卧；其脉乍有乍无，寸关尺或一部独见，或两部同见，又皆一再动而止。此病之危，已至极点。因确知其为大气下陷，遂放胆投以生箭一两，柴胡、升麻、净萸肉各二钱。煎服片时，腹中大响一阵，有似昏愦，苏息片时，恍然醒悟。自此呼吸复常，可以安卧，转侧轻松。其六脉皆见，仍有雀啄之象。自言百病皆除，惟觉胸中烦热，遂将方中升麻、柴胡皆改用钱半，又加知母、玄参各六钱，服后脉遂复常。惟左关三五不调，知其气分之根柢犹未实也，遂用野台参一两，玄参、天冬、麦冬（带心）各三钱，两剂全愈。

After delay for about 20 days, the condition was much worse to threaten the life. He had asthma and hard to lie down. He could only lie on the wall for a short sleep, since once he falled sleep for a movement, the breath would stop, he would feel fullness in the stomach area, he cried awake, had hurry breath several times, so the breath could continue. When he was very tired, he felt very heavy in the abdomen, hard to turn his body, so that he dared not to lie with face up. His pulse could be felt some, but not other times. The pulse could be felt only on one or two position on the wrist, but stop soon again. The risk of the disease reached to the peak. Since it was sure that this was the Qi-sink condition, he was given Huangqi 30 gram, Chaihu 6 gram, Shengma 6 gram, Shanyurou 6 gram. After drinking of the tea for a movement, he had big sound in his abdomen for some times. He looked as coma, but soon waked up. From then his breath waas as normal and could lie down face up and could turn body easily. His pulse turned being felt, though it felt as the bird biting. He said his condition was much better, though only felt hot in the chest. So, in the following formula, herb Shengma and Chaihu were changed to only 4.5 gram, with addition of Zhimu 18 gram, Xuanshen 18 gram. The therapy improved his pulse, thoug the rhythm of the left pulse was still irregule, which was known as the root of the Qi was not enhanced yet. Then herbal formula with wild Taishen 30 gram, Xuanshen 9 gram, Tianmendong 9 gram, maidong 9 gram, was used. Two doses of this formula solved the last problem.

盖人之胸中大气，实司肺脏之呼吸。此证因大气下陷过甚，呼吸之机关将停，遂勉强鼓舞肺气，努力呼吸以自救，其迫促之形有似乎喘，而实与气逆之喘有天渊之分。观此证假寐片时，肺脏不能努力呼吸，气息即无，其病情可想也。设以治气逆作喘者治此证之喘，以治此证之喘者治气逆作喘，皆凶危立见。然欲辨此二证，原有确实征验：凡喘证，无论内伤外感，其剧者必然肩息（《内经》谓喘而肩上抬者为肩息）；大气下陷者，虽至呼吸有声，必不肩息。盖肩息者，因喘者之吸气难，不肩息者，因大气下陷者之呼气难也。欲辨此证，可作呼气难与吸气难之状，以默自体验，临证自无差谬。又喘者之脉多数，或有浮滑之象，或尺弱寸强，大气下陷之脉，皆与此成反比例，尤其明征。

It is the Big Qi in the chest that dominates the breath. In this case, the Big Qi sunk to much, so the breath is to stop. The person has to try to breath to save his own life, appearing as asthma, but it is not real asthma. The two conditions are much different. This is evidenced by the fact that, when the person falls into sleep for only a movement, the lung cannot continue to have breath hard, the inhalation and exhalation stops. It would be very dangerous, when the therapy that is used to treat the asthma is used for treat the Qi-sink condition, or when the therapy that should be used to treat the Qi-sink condition is used to treat asthma. There is concrete way to identify these two conditions: in the asthma, no matter it is due to the outside Xieqi invasion, or to inside organ damages, the person would raise his should to have breath in severe cases. In Qi-sink condition, though the person may have noise in breath, he has no such shoulder raising phenomena in breath. The shoulder raising is due the difficulty in inhalation, while no such shoulder raising is due to the difficulty being in the exhalation. Readers can try by your self to experience the difference, by trying difficulty in inhalation or exhalation. Again, the pulse in the asthma is usually frequent, or is floating-slippery, or the pulse is weak in the Chi position but strong in the Chong position. In the Qi-sink condition, it is stronger in the Chi position, but weak in the Chong position.

一人，年四十许。每岁吐血两三次，如此四年，似有一年甚于一年之势。其平素常常咳嗽，痰涎壅滞，动则作喘，且觉短气。其脉沉迟微弱，右部尤甚。知其病源系大气下陷，投以升陷汤，加龙骨、牡蛎、生地黄各六钱，又将方中知母改用五钱，连服三剂，诸病皆愈。遂减去升麻，又服数剂以善其后。
A person, about 40 years of old, had blood-vomit twice or three times per year. This has been repeated for four years. The symptoms appears worse and worse each year. He usually had cough with large amount of phlegm. He felt as asthma with little physical activity. His pulse was deep and late and weak mostly in the right side. It was known that his condition belongs to Qi-sink. He was given Shengxian Tang, with removal of herb Longgu, Muli and Shengdi, each for 18 gram, and with the change of Zhimu to 15 gram. Continued this formula for three doses, the condition was completely solved. So the herb Shengma was removed from the formula. He was asked to take additional several doses for a maintenance.

或问：吐血之证，多由于逆气上干，而血随气升。此证既大气下陷，当有便血溺血之证，何以竟吐血乎？
Question: the blood-vomit is usually caused by Qi-reverse, in which the blood follows the reversed Qi up. The case here is due to the Qi-sink, it should be bleeding in the stool or urine, how does it show as vomit?

答曰：此证因大气陷后，肺失其养，劳嗽不已，以致血因嗽甚而吐出也。究之胸中大气，与上逆之气原迥异。夫大气为诸气之纲领，大气陷后，诸气无所统摄，或更易于上干。且更有逆气上干过甚，排挤胸中大气下陷者（案详参赭镇气汤下）。至便血溺血之证，由于大气下陷者诚有之，在妇女更有因之血崩者（案详固冲汤下）。又转有因大气下陷，而经血倒行，吐血衄血者（案详加味麦门冬汤下）。是知大气既陷，诸经之气无所统摄，而或上或下错乱妄行，有不能一律论者。
Answer: This is because the Qi-sink makes the lung have no nourishment, so there is continuous cough, and so much so to cause bleeding from the cough. When the Big Qi sunk, the other Qi in the body lost their governer to them. They therefore are easier to move reverse up. There is even a condition, in which the reversed Qi rushes up in the lung, and suppress the Big Qi sink down (see the statement for herbal formula Shenzhe Zhengqi Tang). For the bleeding from the urine or stool, it is very common in the Qi-sink condition. In women, it can also show as heavy bleeding from uterus. (see discussion in detail for herbal formula of Guchong Tang). In addition, there is condition, in which the menstruation blood hushes up reversely to the nose or stomach, causing bleeding from the nose or vomit. (see discussion for Maimendong Tang). Therefore, it is known that, if the Big Qi is sunk, other Qi in the body lost their leader/supervisor, moves up or down to cause various bleeding, rather than only one kind of bleeding.

或问：龙骨、牡蛎为收涩之品，大气陷者宜升提，不宜收涩。今方中重用二药，皆至六钱，独不虑其收涩之性，有碍大气之升乎？答曰：龙骨、牡蛎最能摄血之本源。此证若但知升其大气，恐血随升气之药复妄动，于升陷汤中，加此二药，所以兼顾其血也。且大气下陷后，虑其耗散，有龙骨、牡蛎以收敛之，转能辅升陷汤之所不逮。况龙骨善化瘀血（《神农本草经》主瘕），牡蛎善消坚结（观其治瘰可知）。二药并用，能使血之未离经者，永安其宅，血之已离经者，尽化其滞。加于升陷汤中，以治气陷兼吐血之证，非至稳善之妙药乎。
It may be asked, the herb Longgu and Muli belongs to restraining herbs, they should not be used in the Qi-sink condition, since in this condition, it needs Qi-raising herbs. Now, the Shengxian Tang contains large amount of the two herbs, up to 18 gram, you don’t worry that their restraining nature may prevent the Qi raising by the whole formula? Answer: The herb Longgu and Muli is powerful herb to restrain the root of blood. For fear that the other herbs in the formula raise the Qi, which may cause the blood rush up to cause some other problems, the two herbs are used for the prevention of the blood rushing up. Also, after the Qi sunk, for fear it may disperse off, so the two herbs can work to restrain it back in the body. The herb Longgu is good at solve/melt the stagnated/dead blood, and the Muli good at solve/melt the mass in the body. The combination of them could make the blood stay inside the blood vessels if they are still in the vessels, and make the bleed/dad blood disappear if the blood has left away from the blood vessels. So, the addition of them in the Shengxian Tang to treat the bleeding in the Qi-sink condition, should be a marvelous idea.

按：吐血证最忌升麻。此证兼吐血，服升陷汤时，未将升麻减去者，因所加之龙骨、牡蛎原可监制之，而服药之时，吐血之证，犹未反复也。若恐升麻有碍血证时，亦可减去之，多加柴胡一钱。
Comments: in blood-vomit condition, it is forbidden to use the herb Shengma. In the Qi-sink condition with bleeding, the Shengma is still used, since there are Longgu and Muli to prevent the over raising effect by the Shengma. If still worry the use of the Shengma, it can be removed, but with addition of Chaihu to repace it.

一人，年四十余。小便不利，周身漫肿，自腰以下，其肿尤甚。上焦痰涎杜塞，剧时几不能息。咳嗽痰中带血，小便亦有血色。迁延半载，屡次延医服药，病转增剧。其脉滑而有力，疑是湿热壅滞，询之果心中发热。
One patient, about 40 years of old, had harsh in urine, swelling in whole body especially bellow the lower back. He also had cough and phlegm. He could not have breath when the cough and phlegm were severe. There was blood in the phlegm, as well as in the urine. The disease has been delayed for some time, and he tried several doctors for the treatment too, but eh condition became worse.

遂重用滑石、白芍以渗湿清热，佐以柴胡、乳香、没药以宣通气化。为其病久，不任疏通，每剂药加生山药两许，以固气滋阴。又用药汁，送服三七末二钱，以清其血分。数剂热退血减，痰涎亦少，而小便仍不利。偶于诊脉时，见其由卧起坐，因稍费力，连连喘息十余口，呼吸始顺。且其脉从前虽然滑实，究在沉分。此时因火退，滑实既减，且有濡象。恍悟此证确系大气下陷。遂投以升陷汤，知母改用六钱，又加玄参五钱，木通二钱，一剂小便即利。又服数剂，诸病全愈。
In the herbal formula gave to him, it contained Huashi, Baishao to clear the Wetness and Hot, the Chaihu, Ruxiang and Muoyao, to open the Qi moving channels. For his long sick history, the losing function of the herbs may not be so easy, so added Shanyao to fix the Qi and the Yin. With the help of the herbal tea, drink 6 gram of herb Sanqi, to clear Xie Qi in the blood. After several doses, the Hot and the phlegm were reduced, but the urine was still harsh, not smooth. Occasionally during the clinic healing, it was noticed that, when he got up from the lying down to sitting up, it was hard for him, so he needed to have asthma-like breath for some time, then the breath felt better. In addition, his pulse was slippery and strong before, but it was in the deep position. Now, due to the reduction of the Fire, the slippery feeling on the pulse was reduced, but there was a feeling of ru in the pulse. It was suddenly realized that, this was a condition of Qi-sink. S, he was given the Shengxian Tang, in which the Zhimu was changed to 18 gram, with the addition of Xuanshen 15 gram, Mutong 6 gram. One doses made the urine smooth. Additional several doses solved the problem completely.

一人，年四十七。咳嗽短气，大汗如洗，昼夜不止，心中怔忡，病势危急。遣人询方，俾先用山萸肉（去净核）二两煎服，以止其汗。翌日迎愚诊视，其脉微弱欲无，呼吸略似迫促。自言大汗虽止，而仍有出汗之时，怔忡见轻，仍觉短气。知其确系大气下陷，遂投以升陷汤，为其有汗，加龙骨、牡蛎（皆不用）各五钱，三剂而愈。

One patient, about 47 years of old, had cough and short of breath. He had sweat as washing, day and night. He felt palpitation. He was in a very life-threaten condition. He send someone come to ask for therapy. He was given Shangyurou 60 gram to cook and to drink, to stop sweat. Next day, when I came to him, his pulse was subtle and weak, the breath appeared some level of short. He said that the big sweat stop but still have mild sweat from time to time. The palpitation was reduced but still had short of breath. It was therefore known that his condition belongs to Qi-sink. He was so given Shengxian Tang, with Longgu 15 gram, and Muli 15 gram. Three doses solved his problem.

一妇人，年二十余。资禀素羸弱，因院中失火，惊恐过甚，遂觉呼吸短气，心中怔忡，食后更觉气不上达，常作太息。其脉近和平，而右部较沉。知其胸中大气，因惊恐下陷，《内经》所谓恐则气陷也。遂投以升陷汤，为心中怔忡，加龙眼肉五钱，连服四剂而愈。
A lady, about 20 years of old, was slim and thin. Due to fire in her yard, she was scared very much, then felt short of breath and palpitation. This symptom was much worse after eating and she tended to have long sign. Her pulse was calm, but it was deep in right side. It was so believed to be the Qi-sink condition, due to the scare, which make the Qi sink. In the book《内经》, it said that fear/scare makes the Qi sink. She was therefore given the Shengxian Tang. For her palpitation, it was added Longyanrou 15 gram. Four doses solved her condition.

一妇人，年二十余。因境多拂郁，常作恼怒，遂觉呼吸短气，咽干作渴，剧时，觉气息将停，努力始能呼吸。其脉左部如常，右部来缓去急，分毫不能鼓指。《内经》谓宗气贯心脉，宗气即大气也。此证盖因常常恼怒，致大气下陷，故不能鼓脉外出，以成波澜也。遂投以升陷汤，为其作渴，将方中知母改用六钱，连服三剂，病愈强半，右脉亦较前有力，遂去升麻，又服数剂全愈。
A lady, about 20 years of old, felt frequent angry due to her living environment. She felt short of breath, dry throat to thirsty. When the condition was worse, she felt as the breath was to stop. Only after hard to breath, could she felt better inhalation and exhalation. Her pulse in the left side was normal but it in the right side came late and disappeared soon and hardly to touch the fingers of doctor. This is the Qi-sink condition. Due to the sink of the Qi, it cannot pump the pulse up to form a waving pulse. She was given the Shengxian Tang, with the change of Zhimu to 18 gram. After three dose intakes, her condition was improved half, and her pulse on the right side became stronger. Then the Shengma was removed from the formula. The modified formula was continued take for several additional doses and the condition was completely solved.

或问：《内经》谓恐则气陷，前案中已发明之。然《内经》又谓怒则气逆也，何以与此案中之理，相矛盾乎？答曰：《内经》所谓怒则气逆者，指肝胆之气而言，非谓胸中大气也。然肝胆之气上逆，上冲大气亦上逆者，故人当怒急之时，恒有头目眩晕，其气呼出不能吸入，移时始能呼吸，此因大气上逆也。有肝胆之气上逆，排挤大气转下陷者，拙拟参赭镇气汤下，有治验之案可考也。况大气原赖谷气养之，其人既常恼怒，纳谷必少，大气即暗受其伤，而易下陷也。
It may be asked: in the book《Nei Jing》, it said that scare would cause the Qi to sink. It has been discussed and explained in the previous cases. In this book, it also said that angry causes reverse of Qi. How it conflicts with your explanation in this case, in which frequent angry caused the sink of the Qi? Answer: in the book stating that angry causes reverse of Qi, the Qi means the Liver-Gall Bladder Qi, not the Big Qi. When the Liver-Gall Bladder Qi rushes up, the Big Qi may rush up too. So, when a person feels angry, he usually feels dizziness, the Big Qi is exhalated out but hard to inhalated in for some time. This is due to the Big Qi rushes reversely up. There is also a condition, in which the Liver-Gall Bladder Qi rushes up, which suppresses the Big Qi down. There is case report listed under my Shenzhe Zhengqi Tang. The Big Qi depends on the diet Qi to nourish. If the person has frequent angry, his diet would be poor. The Big Qi gets damage in a silent manner and is easy to be suppressed by the reversed Liver Qi.

一妇人，因临盆努力过甚，产后数日，胁下作疼，又十余日，更发寒热。其翁知医，投以生化汤两剂，病大见愈。迟数日，寒热又作。遂延他医调治，以为产后瘀血为恙，又兼受寒，于活血化瘀药中，重加干姜。数剂后，寒热益甚，连连饮水，不能解渴。时当仲夏，身热如炙，又复严裹浓被，略以展动，即觉冷气侵肤。后愚诊视，左脉沉细欲无，右脉沉紧，皆有数象。知其大气下陷，又为热药所伤也。其从前服生化汤觉轻者，全得芎升提之力也。治以升陷汤，将方中知母改用八钱，又加玄参六钱，一剂而寒热已，亦不作渴。从前两日不食，至此遂能饮食。惟胁下微疼，继服拙拟理郁升陷汤，二剂全愈。
A woman felt pain in the side of abdomen several days after childbirth, due to heavy labor. About ten days later, she got cold-hot shift. His husband who knew some medicine gave her herbal formula Shenghua Tang two doses. The condition was much improved. Later several days, the cold-hot feeling occurred again. So she was introduced to another doctor for treatment. The second doctor thought her condition was due to the blood stagnation, together with cold-invasion, added in his formula the herbal Ganjiang. Several doses later, the cold-hot feeling was much worse. She drunk water again and again but still felt thirsty. That was in summer. Her body was hot as burning but wanted to cover the body with heavy covering. With very little movement, she would feel cold deep in the muscle. When I saw her, her left pulse was deep, thin near no pulse, right pulse was deep and tight. Both pulses were frequent (not means fast). I thought it the Qi-sink condition, which was again damaged by the hot herbs. The improvement of her condition, previously when she took the Shenghua Tang, was due to the Qi-raising effect of the herbs in that formula. She was then given Shengxian Tang, with the change of herb Zhimu into 24 gram, and the addition of Xuanshen 18 gram. One dose made her cold-hot shift stop, as well as the thirsty feeling. She could not eat in previous two days, not she can start to eat. She felt only pain on the side of the abdomen. She was given Liyu Shengxian Tang two doses. Everything turned normal after that intake.

按：产后虽有实热，若非寒温外感之热，忌用知母，而不忌用玄参，以玄参原为治产乳之药，《神农本草经》有明文也。此证虽得之产后，时已逾月，故敢放胆重用知母。
Comments: Commonly, the herb Zhimu would not be used in woman after childbirth, unless if she gets Cold- or Wind-invasions (common cold). However, herb Xuanshen is used in such condition, since this herb is originally used in woman to produce milk, as clearly indicated in the book《Shennong Bencao Jing》. The condition for this woman occurred several months after the childbirth, so the herb Zhimu was decided to use.

或问：紧为受寒之脉，故伤寒麻黄汤证，其脉必紧。此证既为热药所伤，何以其右脉沉紧？答曰：脉沉紧者，其脉沉而有力也。夫有力当作洪象，此证因大气下陷，虽内有实热，不能鼓脉作起伏之势，故不为洪而为紧，且为沉紧也。其独见于右部者，以所服干姜之热，胃先受之也。
It may be asked: tight pulse is the evidence for Cold-invasion in the body, so as indicated in the Shanghan Mahuang Tang, in which the pulse is deep and strong. This condition was damaged by hot herbs, how her right pulse was deep and tight? Answer: deep and tight pulse means the pulse is deep and strong. The tight feeling feels as big waving. In this case, for the Big Qi-sink, the pulse could not jump up as such waving feeling, though there is Shi Hot in the body, so the pulse is tight but not as waving. Such pulse can be only felt on the right side, since the hot from the herb Ganjian, would work first in the Stomach.

按：脉无起伏为弦，弦而有力，即紧脉也。若但弦，则为寒矣。仲景平脉篇谓“双弦者寒，偏弦者饮。”究之饮为稀涎，亦多系因寒而成也。
Comments: String pulse means the pulse feels as a tight line, without waving feeling. It the pulse feels as string and strong, it is called tight pulse. If it is only string, it indicates Cold in the body. In Master Zhang Zhongjing’s book, it is said that “String pulse on both wrists suggests Cold in the body; string pulse on one side suggests Yin (water) condition.” However, the Yin (water) condition belongs to diluted saliva/phlegm, which is also mostly due to Cold in the body.

一妇人，年三十余。得下痿证，两腿痿废，不能屈伸，上半身常常自汗，胸中短气，少腹下坠，小便不利，寝不能寐。延医治疗数月，病势转增。诊其脉细如丝，右手尤甚。知其系胸中大气下陷，欲为疏方。病家疑而问曰：“大气下陷之说，从前医者，皆未言及。然病之本源，既为大气下陷，何以有种种诸证乎？”答曰：人之大气虽在胸中，实能统摄全身，今因大气下陷，全身无所统摄，肢体遂有废而不举之处，此两腿之所以痿废也。其自汗者，大气既陷，外卫之气亦虚也。其不寐者，大气既陷，神魂无所根据附也。小便不利者，三焦之气化，不升则不降，上焦不能如雾，下焦即不能如渎也。至于胸中短气，少腹下坠，又为大气下陷之明征也。遂治以升陷汤，因其自汗，加龙骨、牡蛎（皆不用）各五钱，两剂汗止，腿稍能屈伸，诸病亦见愈。继服拙拟理郁升陷汤数剂，两腿渐能着力。然痿废既久，病在筋脉，非旦夕所能脱然。俾用舒筋通脉之品，制作丸药，久久服之，庶能全愈。
A woman, about 30 years of old, got paralysis on her legs, which could not bend or strech. She has frequent sweat on the upper half body, felt short of breath in the chest, falling feeling on the lower abdomen, harsh urine, and poor sleep. She visited doctors for several months for the treatment, but the condition only became worse. Her pulse was thin as string, especially on the right side. It was diagnosed as Qi-sink condition. I was to write a prescription for her, when her family member asked: “Previous doctors never mentioned the Qi-sink condition. If it is, what kinds of clinic manifestations it might have? The answer is: though the Big Qi is located in the chest, it can govern the whole body. Now, when it sinks, it cannot govern the whole body, so that the extremes loss their function. This is the reason for the paralysis in her legs. The sweat is because, when the Qi-sink, the out-defending Qi is also weak. The poor sleep is due to the Spirit having nowhere to attach in the Qi-sink condition. The harsh urine is due to the Qi in the three Jiao failing to raise. If it could be raise, it would be able to fall down to create urine. The short of breath in the chest and falling feeling in the lower abdomen are the clear evidence for the Qi-sink. For all of these reasons, she was given Shengxian Tang. Due to the sweat, herb Longgu 15 gram, and Muli 15 gram was used. After two doses, the sweat stoped and the leg could stretch and bend little bit more. Continued take of the Liyu Shengxian Tang for several more doses, the leg had more power and force. However, since the paralysis has been there for a long time, the damage is more on the tendons, and it is not easy to get recover in a short time. She was later given herb pills for a long time take.

一妇人，年三十许。胸中满闷，不能饮食。医者纯用开破之药数剂，忽然寒热，脉变为迟。医者见脉迟，又兼寒热，方中加黄、桂枝、干姜各数钱，而仍多用破气之药。购药未服，愚应其邻家延请，适至其村，病家求为诊视，其脉迟而且弱，问其呼吸觉短气乎？答曰：今于服药数剂后，新添此证。知其胸中大气因服破气之药下陷。时医者在座，不便另为疏方，遂谓医曰：子方中所加之药，极为对证，然此时其胸中大气下陷，破气药分毫不可再用。遂单将所加之黄、桂枝、干姜煎服。寒热顿已，呼吸亦觉畅舒。后医者即方略为加减，又服数剂全愈。
A woman, abut 30 years of old, felt fullness in the chest and hard to eat. Doctors had used Qi-breaking therapy several doses, she suddenly felt cold and hot and her pulse became late. The doctor saw the pulse being late, together with the cold and hot, so added herb Huangqi, Guizhi and Ganjian in the formula, but still with more Qi-breaking herbs in it. Before she took that herbs, I was invited to see her. Her pulse was late and weak. When asked if she feel short of breath, she said yes, which happened after take that herbal tea. It is therefore diagnosed as the Qi-sink condition due to the use of the Qi-break herbs. … I asked her to take the Huangqi, Guizhi and Ganjiang to cook and to drink. After took the herbal tea, the cold-hot stopped and the breath became more smooth. That doctor modified on this base little for several doses. The condition was well improved.

门人高××曾治一人，年三十余。因枵腹劳力过度，致大气下陷。寒热往来，常常短气，大汗淋漓，头疼咽干，畏凉嗜睡，迁延日久，不能起床。医者误认为肝气郁结，投以鳖甲、枳实、麦芽诸药，病益剧。诊其脉，左寸关尺皆不见，右部脉虽见，而微弱欲无。知其为大气下陷，投以升陷汤，加人参三钱，一剂左脉即见，又将知母改用五钱，连服数剂全愈。
Mr. Gao, one of my students, treated one patient before. The patient, about 30 years of old, had Qi-sink condition due to heavy labor work. He felt cold-hot shift, frequent short of breath, heavy sweat, headache and dry mouth. He liked cool room and feel drowsy. For a long time of delay in the recovery, he could not get up the bed. Doctors mis-regarded his condition as Liver Qi stagnation, giving him herbal formula containing Biejia, Zhishi and Maiya, but the condition became worse. His pulse was hard to touch on the left side, and very weak on the right side. It was known as Qi-sink condition. He was prescribed the Shengxian Tang, with addition of Renshen 9 gram. After taking only one dose, the pulse could be touched on the left side. The herb Zhimu in the formula was changed to 15 gram. Several doses later, the condition got recovered completely.

高××又治一妇人，年三十许。胸中短气，常常出汗，剧时觉气不上达，即昏不知人，移时始苏，睡时恒自惊寤。诊其脉，微弱异常，知其胸中大气下陷甚剧。遂投以升陷汤，知母改用五钱，又加人参、萸肉（去净核）各三钱，连服数剂全愈。
Mr. Gao also treated another patient, who was about 30 years of old. The patient felt short of breath in the chest, frequent sweat. If the condition was severe, he may loss consciousness and waked up after a movement. He could also feel scare to wake up. His pulse was very weak. It was diagnosed as Qi-sink. She was given the Shengxian Tang, with the change of herb Zhimu into 15 gram, and with addition of Renshen 9 gram, Shanyurou 9 gram. After take of the herbal tea for several doses, the condition recovered completely.

大气下陷之证，不必皆内伤也，外感证亦有之。一人年四十许，于季春得温证，延医调治不愈，留连两旬，病益沉重。后愚诊视，其两目清白无火，竟昏愦不省人事，舌干如磋，却无舌苔。问之亦不能言语，周身皆凉，其五六呼吸之顷，必长出气一口。其脉左右皆微弱，至数稍迟，此亦胸中大气下陷也。盖大气不达于脑中则神昏，大气不潮于舌本则舌干，神昏舌干，故问之不能言也。其周身皆凉者，大气陷后，不能宣布于营卫也。其五六呼吸之顷，必长出气者，大气陷后，胸中必觉短气，故太息以舒其气也。遂用野台参一两、柴胡二钱，煎汤灌之，一剂见轻，两剂全愈。
The Qi-sink condition is not always necessary to be caused by deterioration of inside organs. It can also be caused by outside Xieqi invasion. One man, about 40 years of old, suffered from an infectious disease. He had been visiting doctors for the treatment for some time but the condition became worse. When I saw him, he even lost his consciousness. His eye was pale; his tongue was very dry, and had no any tongue covering. There was no any response to asking (she could not speak). The whole body was cold. For her breath, after every five to six times of breath, she had to have a long sign. Her pulse was subtle and weak, and late. This was also the Qi-sink condition. The Big Qi can not reach the brain so to cause loss of consciousness. It can not wet the tongue, so the tongue is dry. Due to the loss of consciousness and dry tongue, she cannot speak. The Big Qi sunk, it cannot disperse to the Yin and Wei of the body, so the body was cold. After the Qi sunk, there was less Qi in the Chest, so she had to have a long sign from time to time to smooth the air coming in and out of the chest. She was given herb wild Taishen 30 gram, Chaihu 6 gram to cook and to drink. One dose made her condition much better and two doses solved her problem.

按：此证从前原有大热，屡经医者调治，大热已退，精神愈惫。医者诿为不治，病家亦以为气息奄奄，待时而已。乃迟十余日，而病状如故，始转念或可挽回，而迎愚诊视。幸投药不瘥，随手奏效，是知药果对证，诚有活人之功也。

Comments: this patient had high fever before. After treatment by other doctors, the fever was solved, but the energy level was very low. The previous doctors though it was difficult to treat, so refused to continue. The family members of the patient also though there was not way to help. For the later about ten days, the condition was the same, so they thought there might have chance to treat. Then they asked me to have a look at that woman. It was lucky that the therapy used was correct, so the effect was pretty good. It is therefore known that if the herbs can save the life, if they are used matching the patient’s condition.

又按：此证若不知为大气下陷，见其舌干如斯，但知用熟地、阿胶、枸杞之类滋其津液，其滞泥之性，填塞膺胸，既陷之大气将何由上达乎？愚愿业医者，凡遇气分不舒之证，宜先存一大气下陷理想，以细心体察，倘遇此等证，庶可挽回人命于顷刻也。
Second comments: for this case, if the doctor has no concept of the Qi-sink in mind, he/she might start to use the herbs, such as Shoudi, Ajiao and Goujizi, since the patient had dry tongue. These herbs have sticky nature, tending to fill up the chest. By this, how could the sunk Qi rise again into the chest? I wish our doctors bear the concept of the Qi-sink in mind, whenever you meet a patient with Qi stagnation symptom. Be careful to identify the clinic manifestation, so that patient’s life might be saved again in a short time.

一人，年三十余。于初夏得温病，医者用凉药清解之，兼用枳实、青皮破气诸品，连服七八剂，谵语不省人事，循衣摸床，周身颤动。再延他医，以为内风已动，辞不治。后愚诊视，其脉五至，浮分微弱，而重按似有力，舌苔微黄，周身肌肤不热，知其温热之邪，随破气之药下陷已深，不能外出也。遂用生石膏二两，知母、野台参各一两，煎汤两茶杯，分二次温服。自午至暮，连进二剂，共服药四次，翌日精神清爽，能进饮食，半日进食五次，犹饥而索食。看护者不敢复与，则周身颤动，复发谵语，疑其病又反复，求再诊视。其脉象大致和平，而浮分仍然微弱。恍悟其胸中大气，因服破气之药下陷，虽用参数次，至此犹未尽复，故亟亟求助于水谷之气，且胃中之气，因大气下陷无所统摄，或至速于下行，而饮食亦因之速下也。遂用野台参两许，佐以麦门冬（带心）三钱、柴胡二钱，煎汤饮下，自此遂愈。

A patient, about 30 years of old, got a Wen disease in early summer. Doctors used cooling herbs to solve the problem, with the additional use of herb Zhishi and Qingpi to break the Qi. The formula had been taken for several doses. The patient developed into loss of consciousness, and chattering. Another doctor saw him and believed he had had inside Wind condition, so refused to continue the treatment. When I saw him, his pulse was five time per breath-circle. It felt weak on light tough, but seemed strong when heavily touched. The tongue covering was slight yellow. The body muscle was not hot. It was believed that the Wen Xie had had sunk deep due to the use of the Qi-breaking therapy, so it could not move out. So I prescribed her the herb formula: Shigao 60 gram, Zhimu 30 gram, and wild Taishen 30 gram. From the noon to the evening, she took two of this dose. The next day, she felt clear in mind, and could eat some. She ate five times within half day, but still felt hungry and wanted to eat. The helper dared not to give her more food to eat. She so had whole body shacking and had delirious chat. The helper suspected the condition returned, so asked me have a look again. … Her pulse was calm, though weak upon light touch. I suddenly realized that her Big Qi sunk, due to the use of Qi-breaking herbs. It has not raised up yet, though I had used Renshen several times. Her body was eager to get help for the Qi from diet. The stomach Qi, due to loss of control/govern by the Big Qi, moves without regulation, and rushed down quickly to cause easy hungry feeling. She was given wild Taishen 30 gram, Maimendong 9 gram, and Chaihu 6 gram. The problems all were solved.

或问：子所治大气下陷证，有两日不食者，有饮食减少者。此证亦大气下陷，何以转能多食？答曰：事有常变，病亦有常变。王清任《医林改错》载有所治胸中瘀血二案：一则胸不能着物，一则非以物重压其胸不安，皆治以血腑逐瘀汤而愈。夫同一胸中瘀血，其病状竟若斯悬殊，故同一大气之下陷也，其脾胃若因大气下陷，而运化之力减者，必然少食；若大气下陷，脾胃之气亦欲陷者，或转至多食。曾治一少妇，忽然饮食甚多，一时觉饥不食，即心中怔忡。医者以为中消证，屡治不效。向愚询方，疑其胸中大气下陷，为开升陷汤方，加龙骨、牡蛎（皆不用）各五钱，数剂而愈。盖病因虽同，而病之情状，恒因人之资禀不同，而有变易。斯在临证者，细心体察耳。
It may be asked: in your Qi-sink cases, some felt no appetite and ate nothing for two to three day; some had reduced eating; how could the patient has increased appetitie and craved for eating? Answer: everything could have exception, so could the disease/symptoms. Dr. Wang Qinren in his book 《Yilin Gaicuo》introduced two cases with blood stagnation in the chest. One patient cannot bear any pressure on his chest. another one wants a heavy pressure on his chest. Both cases were solved with the same herbal formula Xuefu Zhuyu Tang. You see, the same reason for the blood stagnation showed opposite and different symptoms. For the same reason, in the Qi-sink, if the Spleen-stomach has reduced digestion ability, the person has reduced eating; if the Spleen-stomach Qi also fall along with the Big Qi, the person could then have increased eating and strong craving. There has been a case. The patient was a lady. She ate very much every day. If she did not eat for a movement, she would feel palpitation. Doctors though she has Xiaoke condition[1], so the following therapy to her none worked. When she visited me, I thought she might have the Qi-sink condition. I gave her formula Shengxian Tang, in which the Longgu was 15 gram, and Muli 15 gram too. Several doses solved her problem. All of these suggest that, for the same disease entity, the clinic manifestations could be largely variable and even opposite from person to person for different body constitution. Medical stuff should be careful in the work.

按：此证与前证，虽皆大气下陷，而实在寒温之余，故方中不用黄芪，而用人参。因寒温之热，最能铄耗津液，人参能补气，兼能生津液，是以《伤寒论》方中，凡气虚者，皆用人参，而不用黄芪也。
Comments: this case, as well as the previous cases, belongs to Qi-sink condition. All conditions followed the Cold-invasion or Wind-invasion, so in the formula, the herb Renshen was used, but not herb Huangqi. The Cold-Wind invasion tends to exhaust body Jingye, while the Renshen is good at nourishing Qi, as well as creating more Jingye. This is the reason that in the Shanghan Lun, it was used the Renshen, not Huangqi, in case there is Qi deficiency.

上所列者，皆大气下陷治验之案也。然此证为医者误治及失于不治者甚多，略登数则于下，以为炯戒。
The cases introduced above are the successful examples of Qi-sink. In fact, there are many Qi-sink conditions that has been mis-diagnosed and mis-treated. Here we introduce some, to remind our doctors in clinic.

庚戍秋，在沧州治病，有赵姓，忽过访，言有疑事，欲质诸先生。问何疑？曰：予妹半月前来归宁，数日间，无病而亡，未知何故？愚曰：此必有病，子盖未知耳。×曰：其前一日，觉咽喉发闷，诊其脉沉细，疑其胸有郁气，俾用开气之药一剂，翌日不觉轻重，惟自言不再服药，斯夕即安坐床上而逝。其咽喉中发闷，并不甚剧，故曰无病也。愚曰：此胸中大气下陷耳。时行箧中有治大气下陷诸案，因出示之，且为剖析其理。×泫然流涕曰，斯诚为药误矣。
One autumn, I worked in Changzhou. There a mane named Mr. Zhao, who visited me and told me he had some questions to ask me. I asked what question. He said: his sister came to him in this city half month ago. Several days later, she died without disease. Why, and what might be the reason. I said, she must have a disease, but you did not know yet. He said: the day before she died, she felt stiff in the throat. Her pulse was deep and thin, I suspected she had stagnated Qi in the chest. So, I prescribed a Qi-breaking formula to her. The next day, she did not feel any improvement or worse, but said she would not take any medicine more. Soon she died when she sit on the bed. Her tight throat was not very severe, so it was thought no disease. I said: her condition belongs to Qi-sink. I had case records in my luggage for the Qi-sink, so I got take them out to show him and explained it for him. He cried that it was his mistake.

一人，年三十余。呼吸短气，胸中满闷。医者投以理气之品，似觉稍轻，医者以为药病相投，第二剂，遂放胆开破其气分。晚间服药，至夜如厕，便后遂不能起。看护者，扶持至床上，昏昏似睡，呼之不应，须臾张口呼气外出，若呵欠之状，如斯者日余而亡。后其兄向愚述之，且问此果何病？因历举大气下陷之理告之。其兄连连太息，既自悔择医不慎，又痛恨医者误人，以后不敢轻于延医服药。
One person, about 30 years of old, felt short of breath and fullness in the chest. Doctors gave him Qi-opening therapy. He felt kind of improvement. Doctor thought the treatment was correct. In the second formula, he used Qi-breaking herbs. At night, the patient went to the washroom. He could not get up after bowel movement. He was helped to the bed, without clear consciousness, and without response upon calling. Pretty soon, he opened mouth exhalation, as a yawn. After several days, the person died. Later, his brother told me the treatment history and asked what disease it was? I explained him the Qi-sink, its reason, and the correct treatment for him. His brother signed again and again and felt very regret.

一农家媪，年五十余。因麦秋农家忙甚，井臼之事皆自任之，渐觉呼吸不利，气息迫促。医者误认为气逆作喘，屡投以纳气降气之药，气息遂大形迫促，其努力呼吸之声，直闻户外。延愚诊视，及至，诊其脉左右皆无，勉为疏方，取药未至而亡，此亦大气下陷也。其气息之迫促，乃肺之呼吸将停，努力呼吸以自救也，医者又复用药，降下其气，何其谬哉！
One farm lady, about 50 years of old, was very busy in the house work. She gradually felt harsh in breath, urgent in breath. Doctor thought she has asthma due to Qi-reverse, so prescribed Qi-restraining and Qi-suppressing herbal formula. She felt more urgent in breath. The sound of her breath could be heard outside of the house. When I saw her, her pulse could be touched on both wrists. I tried to prescribe herbs for her, but she died before the herbs were bought back. This is also a Qi-sink condition. The urgent breath is the sign of breath is to stop, so the body tried hard to save by itself. When the doctor used Qi-suppressing herbs, it made the condition worse. How wrong it is!

一诸生，年五十六，为学校教员，每讲说后，即觉短气，向愚询方。愚曰，此胸中大气，虚而欲陷，为至紧要之证，当多服升补气分之药。彼欲用烧酒炖药，谓朝夕服之甚便。愚曰，如此亦可，然必须将药炖浓，多饮且常饮耳。遂为疏方，用生黄四两、野台参二两，柴胡、桔梗各八钱，先用黄酒斤许，煎药十余沸，再用烧酒二斤，同贮瓶中，置甑中炖开，每饭前饮之，旬日而愈。后因病愈，置不复饮。隔年，一日步行二里许，自校至家，似有气息迫促之状，不能言语，倏忽而亡。盖其身体素胖，艰于行步，胸中大气，素有欲陷之机，因行动劳苦，而遂下陷，此诚《内经》所谓“大气入于脏腑，不病而猝死”者也。方书有气厥，中气诸名目，大抵皆大气下陷之证，特未窥《内经》之旨，而妄为议论耳。
One man, about 56 years of old, was a teacher. He felt short of breath, the movement he talked. He asked me for help. I said, his condition belonged to Qi-sink, which was a urgent condition needing improvement soon. He should take more Qi-raising herbs. He wanted to use the liquor to cook the herbs, for the aim that the herb tea would be easy to take. I said, you can do that way, but the herbal tea should be condensed. It should be taken for a longer time. The herbal formula I prescribed to him contains: Huangqi 120 gram, Wild Taishen 60 gram, Chaihu 24 gram, and Jiegeng 24 gram. The herbs were cooked with wine 250 ml for tens of boiling. The mixture were then mixed with 500 ml of wine again, and saved in a bottle. Put the bottle in a big pot, add water in the pot, brought to boil. Drink the herbal tea before every meal. Several days later, the condition was improved well. So stopped the drink. Next year, he walked two miles from the school to home, with some level of short of breath, hard to speak, and died suddenly. The person is overweight, hard to walk usually, the Big Qi in the chest had tendency to sink. Due to his hard walk, the Big Qi sunk then. This is what said in the book 《Nei Jing》that, “If the Big Qi moves into the organs, the person would die suddenly without disease.” In some medical books, there are terms, such as Qi Jue or Zhong Qi. They are about the Qi-sink condition. The authors did not understand the meaning of the 《Nei Jing》so discussed in a wrong way.

按：《内经》原有气厥二字，乃谓气厥逆上行，非后世所谓气厥也。

Comment: In the book 《Nei Jing》, there is the term “Qi Jue”. It means the Qi rushing up reversely, not the meaning of “Qi Jue” used by later doctors.

或问：案中所载大气下陷证，病因及其病状，皆了如指掌矣。然其脉之现象，或见于左部，或见于右部，或左右两部皆有现象可征，且其脉多迟，而又间有数者，同一大气之下陷也，何以其脉若是不同乎？答曰：胸中大气包举肺外，原与肺有密切之关系，肺之脉诊在右部，故大气下陷，右部之脉多微弱者其常也。然人之元气自肾达肝，自肝达于胸中，为大气之根本。其人或肝肾素虚，或服破肝气之药太过，其左脉或即更形微弱，若案中左部寸关尺皆不见，左脉沉细欲无，左关参伍不调者是也。至其脉多迟，而又间有数者，或因阴分虚损，或兼外感之热，或为热药所伤，乃兼证之现脉，非大气下陷之本脉也。
It might be asked: in the cases introduced, the reason and clinic manifestations for the Qi-sink are clear. But, for its pulse, it might be shown sometimes on the lift side, and in other cases, it was on the right side, or on both sides. The pulse was mostly a late pulse, but in same cases, it was frequent. Why for the same Qi-sink condition, the pulse was different? Answer: The Big Qi is located in the chest, near more closely to the lung. The pulse of the lung is on the right side, so in the Qi-sink condition, the pulse on the right side is weaker. However, the body Yuan Qi moves from the Kidney to the Liver, then from the Liver to the chest. The Yuan Qi is the root, and the base for the Big Qi in the chest. If the person for a long time had weakness in the Liver and Kidney, or if he/she took Liver Qi-breaking herbs too much, the left pulse would also be weak, as introduced in the case above, in which the pulse could not be touched on both side, or the left pulse was deep and thin (almost could not touch), or the pulse on the Chun position of the lift side is irregular. The reason for its late pulse, with sometimes frequent, is due to the Yin deficiency, or ot the Hot from the fire from invasion by out-coming Xie Qi, or to the damage by the hot herbs. It was the accompanying pulse, not the original pulse of the Qi-sink.

或问：李东垣补中益气汤所治之证，若身热恶寒、心烦懒言，或喘、或渴、或阳虚自汗，子所治大气下陷案中，类皆有之。至其内伤外感之辨，谓内伤则短气不足以息，尤为大气下陷之明征。至其方中所用之药，又与子之升陷汤相似。何以其方名为补中益气，但治中气之虚陷，而不言升补大气乎？答曰：大气之名，虽见于《内经》，然《素问》中所言之大气，乃指外感之邪气而言，非胸中之大气也。至《灵枢》所言，虽系胸中大气，而从来读《内经》者，恒目《灵枢》为针经而不甚注意。即王氏注《内经》，亦但注《素问》而不注《灵枢》。后人为其不易索解，则更废而不读。

I might also be asked: the herbal formula of Buzhong Yiqi Tang, by doctor Li Zhonghen works for hot body, chilly, annoyed feeling, lazy to talk, or asthma, or thirsty, or Yang deficient sweat. Such symptoms can also be found in the Qi-sink condition you introduced. In talking about the distinguish of the out-coming Xie Qi invasion or the damage of inside organs, it is mentioned that in the inside damage condition, the person would feel short of breath, which is much similar to the Qi-sink condition. The herbal ingredients used in his formula are also very similar to what you used in the Shengxian Tang. Why the name of his formula is called Buzhong Yiqi Tang, which is claimed to raise the Zhong Qi (e.g. the Middle Qi), not mention to raise the Big Qi? Answer: the term Big Qi, though can be found in the book 《Nei Jing- Souwen》, means the out-invading Xie Qi, not the Big Qi in the chest. The Big Qi mentioned in the book 《Ling Su》, though means the Big Qi, was not paid attention by doctors when they read the book, since they thought that 《Ling Su》is a book for acupuncture. Dr. Wang made explanation of the book 《Nei Jing》, but he only explained the 《Ling Su》not the 《Su Wen》part. This part is hard to understand, without good explanation, so that the later doctors tended not to read it any longer.

至仲景《伤寒》、《金匮》两书，惟《金匮》水气门，有“大气一转，其气乃散”之语。他如《难经》、《千金》、《外台》诸书，并未言及大气。是以东垣于大气下陷证，亦多误认为中气下陷，故方中用白术以健补脾胃，而后来之调补脾胃者，皆以东垣为法。夫中气诚有下陷之时，然不若大气下陷之尤属危险也。间有因中气下陷，泄泻日久，或转致大气下陷者，可仿补中益气汤之意，于拙拟升陷汤中，去知母加白术数钱。若但大气下陷，而中气不下陷者，白术亦可不用，恐其气分或有郁结，而、术并用，易生胀满也。
Upon to the Master’s book 《Shang Han》and 《Jin Kui》, only in the chapter of Water-steam in the《Jin Kui》, is there the statement “When the Big Qi turns, the Qi dispersed”. No any mention about the Big Qi, in the books, such as 《Nan Jing》、《Qian Jin》、and《Wai Tai》. So, Doctor Zhang Donghen mis-regarded the Qi-sink as the Middle Qi sink condition, so used Baizhu to nourish the Spleen-Stomah. The later doctors followed his way to nourish the Spleen-Stomach. Though the Middle Qi (in the Spleen-Stomach) has time to sink, but it is not as dangerous as the sink of the Big Qi (in the chest). There could be case, in which the patient has long term of diarrhea due to the sink of the Middle Qi, then turned to be the sink of the Big Qi. In such case, it can be recommended to follow Dr. Zhang Donghen’s Buzhong Yiqi Tang, to my Shengxian Tang, remove the herb Zhimu, but add Baizhu several grams. If there is only the sink of the Big Qi, not accompanied the sink of the Middle Qi, the herb Baizhu does not neede to add, for the consideration that, the combination of the Huangqi and Baizhu in one formula may cause fullness in the body, since there may have chance that the body has already had Qi stagnation.

按：补中益气汤所治之喘证，即大气下陷者之努力呼吸也。若果系真喘，桔梗尚不宜用，况升麻乎？愚少时观东垣书，至此心尝疑之，后明大气下陷之理，始觉豁然，而究嫌其立言欠妥。设医者，真以为补中益气汤果能治喘，而于气机上逆之真喘亦用之，岂不足偾事乎？此有关性命之处，临证者当审辨之。
Comments: the asthma treated by the herbal Buzhong Yiqi Tang is the condition, in which the patient with Big Qi tried to have breath. If it is true asthma, the herb Jiegeng should not be used, not to speak of the Shengma. When I was young and when I read book by Dr. Donghen, I had had doubt about this. Later, when I realize the meaning of the Qi-sink, I realized the mistake of him, and felt that his statement is not so correct. For example, if the doctor really believe that the Buzhong Yiqi Tang can be used in the treatment of asthma, and use it in an asthma due to the Qi-reverse, wouldn’t it be dangerous? This is a question about life, doctor must be clear about it in clinic work.

直隶青县张××来函：
Letter from Mr. Zhang, from Qing county, Zhili province:

湖朝鲜××妻，年六旬，素多肝郁，浸至胸中大气下陷。其气短不足以息，因而努力呼吸，有似乎喘；喉干作渴；心中满闷怔忡；其脉甚沉微。知其胸中大气下陷过甚，肺中呼吸几有将停之势，非投以升陷汤，以升补其大气不可。为录出原方，遵注大气；陷之甚者将升麻加倍服。一剂后，吐出粘涎数碗，胸中顿觉舒畅。又于方中加半夏、陈皮，连服三剂，病遂霍然。盖此证因大气下陷，其胸肺胃脘无大气以斡旋之，约皆积有痰涎，迨服药��，大气来复，故能运转痰涎外出，此《金匮》水气门所谓“大气一转，其气（水气即痰涎）乃散”也。后大气下陷证数见不鲜，莫不用升陷汤加减治愈。
A lady, about 60 years of old, suffered from Liver stagnation, which developed into the chest to cause the Qi-sink condition. She felt short of breath, so she breathed very hard, appearing as asthma; dry throat and thirsty; palpitation and fullness in the chest; and deep the weak pulse. It was known that she had Qi-sink, which was so severe that her breath might stop, and the Shengxian Tang is the only thing could save her. I followed the Shengxian Tang formula, doubled the herb Shenma. After take of one dose, she spilt out several bowls of phlegm and felt much release in the chest. Then in the formula, added Banxia, Chenpi. Three doses later, the whole condition was much improved. In this condition, due to the Qi-sink, there was no Big Qi to adjust the Middle Qi, so there accumulated Phlegm. After drinking of the herbs, the Big Qi restored, so the Middle Qi could function to move the phlegm out. This is the meaning in the 《Jin Kui》 “When the Big Qi turns, the Qi (e.g. the Water-steam Qi, e.g. the phlegm and saliva) dispersed”. Later I saw many cases with the Qi-sink condition. All are solved with the Shengxian Tang.

族婶母，年四十余岁，身体素弱。因境遇不顺，又多抑郁。癸亥十月下旬，忽患头疼甚剧，已三日矣，族叔来舍，俾生往诊。及至，闻呻吟不已，卧床不起，言已针过百会及太阳两处，均未见效。其左脉微细如丝，按之即无，右脉亦无力，自言气息不接，胸闷不畅，不思饮食，自觉精神恍惚，似难支持，知其胸中之大气下陷也。其头疼者，因大气陷后，有他经之逆气乘虚上干也。遵用升陷汤原方，升提其下陷之大气，连服数剂全愈。

A lady, about 40 years of old, my relative, was weak in the body condition. She felt sadness and depression for her poor family environment. One day in an October, she got severe headache. It lasted for three days. I was then invited to have a look at her. She groaned continuously, hard to get up. I was told that she got acupuncture on her Baihui and Taiyang points, none worked. Her left pulse was subtle and weak as silk, which disappeared when touch with heavier force. The right pulse was weak too. She told that she felt short of breath, fullness in the chest, no desire to eat, cloudy mind. I believed that it is a Qi-sink condition. Her headache was due to the reversed Qi rushing up from other meridians, after the sink of the Big Qi from chest. The original Shengxian Tang was followed. Several doses solved her problem.

程姓男孩，年五岁，乳哺不足，脱肛近四载，医不能治。其面白神疲，身体孱弱；大肠坠出二寸许，用手塞入，旋又坠出；其脉濡弱无力；呼吸促短，状若不能接续。知其胸中大气下陷，下焦之气化因之不能固摄也。仿用升陷汤方，用生箭芪四钱，知母二钱，桔梗、柴胡、升麻各一钱，潞参、净萸肉各三钱煎汤一盅，分两次温饮下。连服二剂，肛即收缩。乃减去升麻，再服三剂，全愈。
A boy with family-name Chen, five years of old, had poor breast milk nourish and suffered from anus prolapse for four years. He was pale on his face, tired in spirit, thin and slim in body constitution. His large intestine protruded out for two inches. If put it back, it would come out again. His pulse was ru and weak; breath was short as hard to continue. I thought his condition as Qi-sink. The anus prolapse was due to the Lower Jiao Qi cannot restrain the anus. The Shengxian Tang was followed by using Huangqi 12 gram, Zhimu 6 gram, Jiegeng 3 gram, Chaihu 3 gram, Shengma 3 gram, Renshen 9 gram, and Shanyurou 9 gram. After drinking of two doses, the anus stopped to prolapse. The formula was repeated another three doses with the Shengma removed. All conditions were well improved.

××之内，以其夫病势沉重，深恐难起，忧虑成疾。心内动悸，痞塞短气。医者以为痰郁，用二陈汤加减清之，病益加剧。因鉴其父为药所误（其父因下痢十余日，医用大黄四钱降之复杯而卒），遂停药不敢服。
A wife, for worry disease of her husband, got long term depression and sick. She felt palpitation, short of the breath and fullness in chest. Doctor thought her condition as Phlegm stagnation, used herbal formula Erchen Tang but the condition became worse. Since previously, her father was mis-treated by medicine, she dared not to continue herbal therapy on herself.

此际愚正在城中为其夫调治余病。俟愚来家求诊，见其满面油光，两手尺寸之脉皆极沉，惟关脉坚而有力。愚曰：“此乃胸中大气下陷，何医者不明如是，而用清痰之二陈也。今两关脉之坚弦，乃彼用药推荡之力。”诊际，大气一陷，遂全身一战，冷汗满额，心即连次跳动十余次。遂用升陷汤，再仿逍遥散、炙甘草汤之意，提其下陷之气，散其中宫之滞，并以交其心肾。一剂而三部平，大气固。嗣因尺中太微，而理气药及升柴等药皆不敢用，遂按治大气下陷方之意及治虚劳之法，精心消息，调治而愈。

At that time, I was in the city to treat her husband. I was invited her home to see her. Her face was oily and bright. The pulse on the Chong and Chi positions was very deep, only strong and hard on the Guan position. I said: “This is the Qi-sink condition. How could doctor not know it but use Phlegm-clearing therapy, e.g. the Erchen Tang. Now the strong and string pulse on the Guan position was due to the pushing force of that herbs. The movement I felt her pulse, her Qi sunk. She felt shacking on the whole body, with cold sweat on the forehead, and palpitation. I used Shengxian Tang and also mimic the Xiaoyao San and Zhi Gancao Tang, to raise her sunk Qi and to disperse the stagnation in the middle part of the body, and to conduct the Heart and Kidney. One dose re-balanced the all upper, middle and lower part of the body. For the weak pulse on the Chi position, the Qi-opening hers, as well as the Qi-raising herbs, such as Shengma and Chaihu were dared not to use, but followed the way to treat the Qi-sink and the exhausting condition. Later the lady was recovered soon.

有冯××，务农而家小康。其母章氏，年正八秩，体丰善饭。一日忽觉左手麻痹，渐至不能持碗。越朝方食面饼，倏然僵厥，坐向下堕，肢冷额汗，气息仅属。人皆以为猝中也，聚商救治，自午至晡，逐见危殆，来请吾为筹挽救简方，以老人素不服药，且口噤鼻塞，恐药汁亦难下咽耳。吾意谓年老久厥，讵能回阳？姑嘱以红灵丹少许吹鼻中，倘嚏气能宣通，再议用药。乃药甫入而嚏作，似渐苏醒。然呼吸甚微，如一线游丝，恐风吹断。先按口鼻，温度甚低，音在喉中，犹言誓不服药。诊其脉，则沉微，察其瞳，亦涣散。遂确定为大气下陷。
Mr. Feng was a farmer with pretty rich family. His mother Mrs. Zhang, had full body and good appetite. One day, she felt suddenly numb on the left hand, which was gradually hard to hold a bowl. One day, when she stretch her arm to grab a stuff, she suddenly lost consciousness. Her body fall down. Her extremes were cold with cold sweat on the head and with mild and weak air inhalation and exhalation. Everyone thought that she got a stroke. They gathered to discuss the way to save her but from the noon to the afternoon, her condition became worse. They came to ask my help and said that the old lady usually dislike taking of herbs. Now she was even tight in the mouth and the nose was blocked, worrying that it might be very difficult to feed her any herbs. I thought that the lady was old and had a long time reverse cold in her extremes, hard to restore her Yang Qi? I asked them to blow herb powder Hongling Dan into her nose. If she had sneeze, then consider the drink of the herbal tea. In deed, she got sneeze after the herbs were blowed into her nose. She appears to wake up soon, but her breath was still very weak as a thin silk. When touch, her mouth and nose were cold. The voice from her throat said she would definitely not drink any herbal tea. Her pulse then was deep and subtle. Her pupil was dispersed. So, I though her condition was Qi-sink.

但值耄年，势难遽投重峻之剂，爰照升陷汤方而小其剂，用生箭一钱五分，知母八分，净萸肉一钱，柴胡四分，升麻三分。煎服须臾，即渐有转机。续进两剂，逐次平复。继俾服潞党参，每日二钱，加五味子五粒，广陈皮少许，频饮代茶。今春见之，较未病前更倍康强矣。

Since she was very old, it is hard to give her large amount of herbs. So I followed the Shengxian Tang but use small amount. The herbal formula contained Huangqi 4.5 gram, Zhimu 2.4 gram, Shangyurou 3 gram, Chaihu 1.2 gram, and Shengma 0.9 gram. After drinking of the herbal tea, the condition was improved somehow. Continuous use of two doses, the condition was calm down. The following herbal formula contained Dangshen 6 gram, Wuweizi five granules, Chenpi little. She was asked to drink this herb as regular tea. This spring, when I saw her, her body was much more stronger than before.

山东德州卢××来函：
Letter from Mr. Lu, Dezhou city, Shandong province:

五家嫂及内子两人，系因家务心力煎劳，自觉无日不病者。五家嫂怔忡异常，每犯此病，必数日不能起床，须人重按其心，终日面目虚浮，无病不有。而内子则不但怔忡，寒热往来，少腹重坠，自汗、盗汗，亦无定时，面目手足及右腿无日不肿。而两人丸药日不离口，不但无效，更渐加剧。后侄查大气下陷一切方案，确知两人皆系大气下陷无疑。服升陷汤数剂，并加滋补之味，而各病若失，现今均健壮如常矣。

My sister-in-law and my wife, felt sick everyday for heavy house and home labor work. My sister-in-law felt palpitation very much. Once sick, she would be able to get up the bed and she needed someone to press her chest. Her face was swelling and bloating, with lots of discomfort. My wife felt not only palpitation, but also cold-hot shift, falling feeling on the lower abdomen, sweat day and night, swelling on the face, eyes, hands and feet, as well as continuous swelling on the right leg. They both continued herbal drinks but the condition had no any improvement. Later when I learned the concept of Qi-sink, I thought that they both had Qi-sink condition. I used Shengxian Tang to them, with addition of some nourishing herbs, feor several doses to them. Their conditions were much improved as there was no any problem. Now, they both are pretty healthy.

直隶盐山孙××来函：
Letter from Mr. Song, Yanshan city, Zhilli province:

一九二六年冬，河东友人翟××之母乳部生疮，疼痛难忍，同事王××约往诊视。翟××言，昨日请医诊治，服药一剂，亦不觉如何，惟言誓不再服彼医方药。生诊视时，其脉左关弦硬，右寸独微弱，口不能言，气息甚微，病势已危险万分。生断为年高因病疮大气下陷，为开升陷汤，以升举其气，又加连翘、丹参诸药，以理其疮。一剂能言，病患喜甚，非按原方再服一剂不可。后生又诊数次，即方略为加减，数服全愈。后遇此证数次，亦皆用升陷汤加减治愈。
In the winter of 1962, a lady, who is the mother of my friend Mr. Ju, got ulcer on her breast, which was very painful. My colleague, Dr. Wang, was invited to see her. Mr. Ju said, she took the herbs from Dr. Wang yesterday, but swear no longer taking any herbs. When I saw her, her pulse on the Guan position of the left side was string and hard, weak and subtle on the right side. She could not speak, and the breath was very weak. The condition was very dangerous. I thought that she was old, and got the Qi-sink condition due to the ulcer on the breast. I so prescribed Shengxian Tang for her to raise Qi. In the formula, I added herb Liangqiao, and Danshen and other herbs, to solve the problem on the breast. Only one dose, she could speak. She was very happy and wanted to take the exact formula once more. I saw her later for several times again with little modification of the formula and she got recovered soon. Later I saw several such similar cases, all are solved with Shengxian Tang.

奉天桓仁县阎××来函：
Letter from Mr. Yan, Huanren city, Fengtian province:

客岁家慈得大气下陷证，吾以向未行医，未敢率尔用药，遂聘本县名流再三延医，终无效验。迟至今岁正月初二日，气息奄奄，迫不及待，遂急用升陷汤，遵方后所注更番增减，按证投药，数月沉疴，数日全愈。
Years ago, my mother got the Qi-sink condition, I dared not to give her prescription, for I did not practice medicine before. I invited one of famous doctor in our city to see her several times, but no effect. Early spring this year, her condition turned worse, so her life was in dangerous. I have to give her the Shengxian Tang in a hurry way by myself. I followed the introduction for the Shengxian Tang for a modification of the formula. The several month’s disease was solved within several days.

一妇人，产后乳上生痈，肿疼殊甚。延西医治不效，继延吾延医。其脓已成，用针刺之，出脓甚多，第二日已眠食俱安矣。至第三日，忽神昏不食，并头疼。其母曰：“此昨日受风寒以致如此。”诊其脉，微细若无，身无寒热，心跳，少腹微疼，知非外感，当系胸中大气下陷。投以升陷汤，两剂全愈。

A lady suffered from carbuncle on her breast, which was swelling and very painful. She got treatment by Western medicine a while, no any improvement, so I was invited for the treatment. There had already pus on the affected breast. After pounching to it, there was lots of pus flowing out. The second day, she could have nice sleep and eat reasonably. On the third day, she suddenly fall into loss of consciousness with headache. Her mother said: “She got Cold-Wind attack yesterday, that makes her condition as such”. Her pulse was subtle, weak as there was no pulse. Her body was no hot or cold feeling on touch. Heart beat fast and strong, little pain on the lower abdomen. So, it was known as not a common cold, but the Qi-sink condition. She was given the Shengxian Tang two doses. The problem was solved.

治心肺阳虚，大气又下陷者。其人心冷、背紧、恶寒，常觉短气。
This formula is used to solve the Heart-Lung Yang deficiency with Qi-sink condition, in which the person feels cold in the heart, tightness on the back, chilly and has short of breath.

生黄芪（八钱）干姜（六钱）当归身（四钱）桂枝尖（三钱）甘草（一钱）
Huangqi 24 gram, Ganjiang 18 gram, Danggui (boy part) 12 gram, Guizhi (tip part) 9 gram, Gancao 3 gram.

周身之热力，借心肺之阳，为之宣通，心肺之阳，尤赖胸中大气，为之保护。大气一陷，则心肺阳分素虚者，至此而益虚，欲助心肺之阳，不知升下陷之大气，虽日服热药无功也。

The warm of the body depends on the Yang Qi of the heart and the lung to disperse. The Yang Qi of the Heart and the Lung depends on the Big Qi in the chest to protect. When the Big Qi sinks one level, the person who usually has the Heart-Lung Yang Qi deficiency would be weaker. To surppor the Heart-Lung Yang Qi, but do not know to raise the sunk Qi, there would be no use to drink the warm herbs.

或问：心脏属火，西人亦谓周身热力皆发于心，其能宣通周身之热宜矣。今论周身热力不足，何以谓心肺之阳皆虚？答曰：肺与心同居膈上，左心房之血脉管，右心房之回血管，皆与肺循环相通，二脏之宣通热力，原有相助为理之妙。然必有大气以斡旋之，其功用始彰耳。

It might be asked: The Heart belongs to the Fire. The western medicine also believes that the body warm comes from the heart, which can disperse the warm to the whole body. In discussion of the weakness in the hot in the body, how it is said that the Heart and the Lung both have Yang deficiency? Answer: The Lung and the Heart both locate above the diagram, The blood vessels in the heart conduct with the lung. They work together to disperse the warm to the body. But such function of them needs the adjustment and governing by the Big Qi.

按：喻嘉言《医门法律》最推重心肺之阳，谓心肺阳旺，则阴分之火自然潜伏。至陈修园推展其说，谓心肺之阳下济，大能温暖脾胃消化痰饮。皆确论也。

Comments: Dr. Yu Jiayan, in book 《Yimen Falu》emphasized the importance of the Yang Qi in the Heart and the Lung. It is said that, if the Yang Qi is sufficient in the Heart and the Lung, the Fire in the Yin part would stay quiet and calm. Later, Dr. Chen Xiuyuan futher developed his statement. He said that the disperse of the warm from the Heart and Lung down could warm up the Spleen-Stomach for digestion and melt the phlegm. This is true.

一童子，年十三四，心身俱觉寒凉，饮食不化，常常短气，无论服何热药，皆分毫不觉热。其脉微弱而迟，右部兼沉。知其心肺阳分虚损，大气又下陷也。为制此汤，服五剂，短气已愈，身心亦不若从前之寒凉。遂减桂枝之半，又服数剂全愈。俾停药，日服生硫黄分许，以善其后。
A child, about 13 to 14 years of old, felt cold/chilly in the heart and body. He had poor eating, felt short of breath. He felt no any warm when he drunk warming herbs. His pulse was subtle and weak and late. There was further deep on the pulse on the right side. It was believed to be the Yang deficiency in the Heart and the Lung, with the Qi-sink. The herbal formula used for him was this Huiyang Shengxia Tang. After five doses, his short of breath was cured. His body was no longer cold as before. So, the herbal Guizhi was removed from the formula. Additional several doses solved his remaining problems completely. Later, he was asked to take the brimstone powder for a maintenance.

一人，年五十余。大怒之后，下痢月余始愈。自此胸中常觉满闷，饮食不能消化。数次延医服药，不外通利气分之品，即间有温补脾胃者，亦必杂以破气之药，愈服病愈增重。后愚诊视，其脉沉细微弱，至数甚迟。询其心中，常有觉凉之时。知其胸中大气下陷，兼上焦阳分虚损也。遂投以此汤，十剂全愈。后因怒，病又反复，医者即愚方，加浓朴二钱，服后少腹下坠作疼，彻夜不能寐，复求为延医，仍投以原方而愈。
A man, about 50 years of old, due to heavy angry, suffered from diahhrea, which recovered several months later. From then, he felt fullness on the chest, had poor digestion. He visited several doctors for the treatment. The herbs used are the Qi-lubricating herbs. Even if there were some warming herbs, they are mixed with Qi-breaking herbs. The more take of the herbal tea, the worse his condition. Later, I saw him. His pulse was deep, thin, subtle and weak. The pulse was also late (not frequent). He felt cold in the heart from time to time. It was known that he had Qi-sink with Yang deficiency in the Heart and Lung. He was given this Huiyang Shengxian Tang. Ten doses solved his problem completely. Later due to angry, his problem recurred again. Doctor used this formula but with addition of herb Houpu 6 gram. After drinking, the patient felt falling and pain on the lower abdomen, could not have any sleep at night. I was asked again. He was given the exact formula, which solved his problem again.

赵姓媪，年近五旬，忽然昏倒不语，呼吸之气大有滞碍，几不能息，其脉微弱而迟。询其生平，身体羸弱，甚畏寒凉，恒觉胸中满闷，且时常短气。即其素日资禀及现时病状以互戡病情，其为大气下陷兼寒饮结胸无疑。然此时情势将成痰厥，住在乡村取药无及，遂急用胡椒二钱捣碎煎两三沸，澄取清汤灌下。须臾胸中作响，呼吸顿形顺利。继用干姜八钱煎汤一盅，此时已自能饮下。须臾气息益顺，精神亦略清爽，而仍不能言，且时作呵欠，十余呼吸之顷必发太息，知其寒饮虽开，大气之陷者犹未复也。遂投以拙拟回阳升陷汤。服数剂，呵欠与太息皆愈，渐能言语。
A old lady, with family name of Wen, and about 50 years of old, suddenly fall into loss of consciousness, harsh breath near to stop. Her pulse was subtle and weak and late. She was very weak and slim for her life. She felt chilly and dislike cold usually, and felt fullness in the chest and had short of breath. Considering her sick history and current symptoms, her condition was believed to be the Qi-sink with cold-phlegm in the chest. Her condition now was to develop into the Phlegm-Jue condition. Since the herbs were not so available in the countryside, she was given Ganjiang 6gram to cook and to drink with help by others. Pretty soon later, there were sounds from her chest, and her breath appeared smooth. Then she was given the Ganjiang 24 gram to cook and to drink. At that time, she could drink the herbal tea by herself. Soon, her breath was much easier and her consciousness became little clearer, but stil could not speak, with yawn from time to time. For every ten times of breath, he would have a long yawn. It was known that, her Cold-Yin was opened, but the sunk Qi was not raised yet. She was then given the Huiyang Shengxian Tang. After several doses, the yawn and long sign stop and she could gradually speak.

按：此证初次单用干姜开其寒饮，而不敢佐以赭朴诸药以降下之者，以其寒饮结胸又兼大气下陷也。设若辨证不清而误用之，必至凶危立见，此审证之当细心也。

Comments: in this case, the single herb Ganjiang was used to break the Cold-Yin in the chest, not daring to use the Qi-suppressing herbs, such as Daizheshi or Houpo, for the reason that the Cold-Yin and the Qi-sink co-existed. If the diagnosis was not clear, the life was in risk. In clinic, it must be very careful.

治胸中大气下陷，又兼气分郁结，经络湮淤者。
This formula is used to treat the Qi-sink condition with Qi-stagnation and with block in meridians.

生黄芪（六钱）知母（三钱）当归身（三钱）桂枝尖（钱半）柴胡（钱半）乳香（三钱，不去油）没药（三钱，不去油）
Huangqi 18 gram, Zhimu 9 gram, Danggui (body part) 9 gram, Guizhi (tip part) 4.5 gram, Chaihu 4.5 gram, Ruxiang 9 gram, and Moyao 9 gram.

胁下撑胀，或兼疼者，加龙骨、牡蛎（皆不用）各五钱；少腹下坠者，加升麻一钱。
If the person feels bloating feeling on the side of the abdomen, or feels pain, add herb Longgu 15 gram, Muli 15 gram. If he feels falling and bloating in the lower abdomen, add Shenma 3 gram.

一妇人，年三十许。胸中满闷，时或作疼，鼻息发热，常常作渴。自言得之产后数日，劳力过度。其脉迟而无力，筹思再三，莫得病之端绪。姑以生山药一两，滋其津液，鸡内金二钱、陈皮一钱，理其疼闷，服后忽发寒热。再诊其脉，无力更甚，知其气分郁结，又下陷也。遂为制此汤，一剂诸病皆觉轻，又服四剂全愈。
A woman, about 30 years of old, had fullness feeling in the chest. She also felt pain there from time to time. She felt warm air form her breath from nose, and usually felt thirsty. She said that the problem happened several days after her childbirth, when she had hard labor work too much. Her pulse was weak and late. I had thought her condition for a long time without a clear idea. So, I gave her Shanyao 30 gram to nourish her Jingye, Jineijin 6 gram, Chenpi 3 gram, to disperse her pain and fullness on the side of the abdomen. After drinking of the tea, she suddenly had cold-hot shift. Her pulse turned to be weaker. So I realized that her condition was Qi-sink with Qi-stagnation. So she was given this Liyu Shengxian Tang. One dose made her feel better. Additional four doses solved her problem.

一少女，年十五。脐下左边起一瘕，沉沉下坠作疼，上连腰际，亦下坠作疼楚，时发呻吟。剧时，常觉小便不通，而非不通也。诊其脉，细小而沉。询其得病之由，言因小便不利，便时努力过甚，其初腰际坠疼，后遂结此瘕。其方结时，揉之犹软，今已五阅月，其患处愈坚结。每日晚四点钟，疼即增重，至早四点钟，又渐觉轻。愚闻此病因，再以脉象参之，知其小便时努力过甚。上焦之气，陷至下焦而郁结也。遂治以理郁升陷汤，方中乳香、没药皆改用四钱，又加丹参三钱、升麻钱半，二剂而坠与疼皆愈。遂去升麻，用药汁送服朱血竭末钱许，连服数剂，瘕亦消。
A girl, 15 years of old, had a mass showing on her lower left abdomen, which felt heavy to fall and the feeling conducted to the lower back. The lower back also felt pain, which was so much so that he had yawn from time to time. When she felt much pain, her urine was not easy. If she tried hard to urinate, she would feel pain the lower back, so for a long time, she felt a mass on the abdomen. From beginning, the mass was felt soft. After five months, it became hard. The pain became severe at 4 o’clock every night and it turned better in the 4 o’clock in the morning. I heard this case, combined with her pulse, knowing that she got the Qi-stagnation due to hard in urination, which made her Big Qi sunk to the lower abdomen. She was then given this Liyu Shengxian Tang. The herb Ruxiang and Moyao were changed to 12 gram, with addition of Danshen 9 gram, Shenma 4.5 gram. Two doses of the herbal tea solved her falling and pain in the abdomen. So the the Shenma was removed, but with addition of Xuejie powder, 2 to 3 gram, which was drunken as powder. Several doses of the herbal drinking solved her problem completely.

或问：龙骨、牡蛎为收涩之品，兼胁下胀疼者，何以加此二药？答曰：胁为肝之部位，胁下胀疼者，肝气之横恣也，原当用泻肝之药，又恐与大气下陷者不宜。用龙骨、牡蛎，以敛戢肝火，肝气自不至横恣，此敛之即以泻之，古人治肝之妙术也。且黄芪有膨胀之力，胀疼者原不宜用，有龙骨、牡蛎之收敛，以缩其膨胀之力，可放胆用之无碍，此又从体验而知道也。尝治一少妇，经水两月不见，寒热往来，胁下作疼，脉甚微弱而数至六至。询之常常短气，投以理郁升陷汤，加龙骨、牡蛎各五钱，为脉数，又加玄参、生地、白芍各数钱，连服四剂。觉胁下开通，瘀血下行，色紫黑，自此经水调顺，诸病皆愈。盖龙骨、牡蛎性虽收涩，而实有开通之力，《神农本草经》谓龙骨消瘕，而又有牡蛎之咸能软坚者以辅之，所以有此捷效也。

It might be asked: the herb Longgu and Muli are restraining herbs. How can they be used in person with bloating and pain on the side of the abdomen? Answer: the side of the abdomen belongs to the Liver. The bloating and pain on the side of the abdomen indicates that the Liver Qi is boorishing. It supposes to use Liver-clearing herbs, but fears that such herbs are not suit for Qi-sink. The use of the Longgu and Muli can restrain the Liver Fire, so that the Liver Fire would not boorish. From old time, it is believed that, restraining the Liver is to clearing/lashing the Liver. This is smart way of old people to treat the Liver problem. Huangqi has a property to bloat. It originally is not used in bloating pain. The Longgu and Muli for their restraining property can solve this side effect. This is experienced in my clinic work. I have tried to treat a young lady. She has no menstruation for two months. She had cold-hot shift feeling, bloating pain on the side of abdomen. Her pulse was subtle and weak and it was also frequent as up to 6 times per breath-circle. She also felt short of breath. She was given the Lliyu Shengxian Tang, with the addition of Longgu 15 gram, Muli 15 gram. For the pulse was frequent, the herb Xuanshen, Shendi, and Baishao were added for some grams. After intake of the herbal tea for four doses, she felt the easier on the side of the abdomen. The stagnated blood was cleared from the menstruation, the color of which was black. From then her menstruation turned normal. Every thing turned normal. The herb Longu and Muli, though have ability to restrain, but also to open, and to disperse. It is said in the book《Shengnong Bencao Jing》that Longgu is to disperse and melt the mass. The Muli is salty in taste, and it can work to make the hard mass soft to disappear. This is the reason for the function of the herbs.

治脾气虚极下陷，小便不禁。
This formula is used to solve the leak of urine due to the Spleen Qi deficieny and Qi-sink.

生黄芪（四钱）白术（四钱）桑寄生（三钱）川续断（三钱）萸肉（四钱，去净核）龙骨（四钱，捣）牡蛎（四钱，捣）川萆薢（二钱）甘草（二钱，蜜炙）
Huangqi 12 gram, Baizhu 12 gram, Sanjisheng 9 gram, Chuan Xuduan 9 gram, Shanyurou 12 gram, Longgu 12 gram, Muli 12 gram, Chuan Pixie 6 gram, Gancao 6 gram (processed with honey).

《内经》曰：“饮入于胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱。”是脾也者，原位居中焦，为水饮上达下输之枢机，枢机不旺，则不待上达而即下输，此小便之所以不禁也。然水饮降下之路不一，《内经》又谓“肝热病者，小便先黄”，又谓“肝壅两（胁也）满，卧则惊悸，不得小便。”且芍药为理肝之主药，而善利小便。由斯观之，是水饮又由胃入肝，而下达膀胱也。至胃中所余水饮，传至小肠渗出，此又人所共知。

故方中用黄芪、白术、甘草以升补脾气，即用黄芪同寄生、续断以升补肝气，更用龙骨、牡蛎、萸肉、萆薢以固涩小肠也。又人之胸中大气旺，自能吸摄全身气化，不使下陷，黄芪与寄生并用，又为填补大气之要药也。
In this formula, Huagnqi, Baizhu, Gancao work to raise the Spleen Qi, e.g. the Huangqi and Sanjisheng and Xuduan are to raise Liver Qi. The Longgu, Muli, Shanyurou and Pixie work to hold the small intestine. If the Big Qi in the chest is sufficient, it can govern the Qi metabolism in the whole body, not letting it shrink or sink. The combined Huangqi and Sangjisheng works to supply more Qi to the body.

或问：黄芪为补肺脾之药，今谓其能补肝气何也？答曰：肝属木而应春令，其气温而性喜条达，黄芪性温而升，以之补肝，原有同气相求之妙用。愚自临证以来，凡遇肝气虚弱，不能条达，一切补肝之药不效者，重用黄芪为主，而少佐以理气之品，服之，复杯之顷，即见效验（治验详黄芪解）。是知谓肝虚无补法者，非见道之言也。
It may be asked: the Huangqi is the herb to supply the Lung and Spleen, how it is to supply the Liver? Answer: The Liver belongs to the Wood and the Spring. It is warm and it likes smooth and strech. The herb Huangqi is warm and raising in herbal nature. They are co-vibrating relationship. After I started the clinic work, whenever I met the condition, in which the Liver Qi is very weak, hard to strech, and every herb to support the liver did not work, I would use the large amount of Huangqi, with little other herbs to lubricate the Liver Qi. After a short time of the herbal drink, the patient could feel improvement of his condition. (see the explanation for herb Huangqi). It is therefore known that the statement is wrong that there is no way to support the Liver.

或问：《神农本草经》谓桑寄生能治腰疼、坚齿发、长须眉，是当为补肝肾之药，而谓其能补胸中大气何也？答曰：寄生根不着土，寄生树上，最善吸空中之气，以自滋生，故其所含之气化，实与胸中大气为同类。尝见有以补肝肾，而多服久服，胸中恒觉满闷，无他，因其胸中大气不虚，故不受寄生之补也。且《神农本草经》不又谓其治痈肿乎？然痈肿初起，服之必无效，惟痈肿溃后，生肌不速，则用之甚效。如此而言，又与黄芪之主痈疽败证者相同，则其性近黄芪，更可知矣。
It may also asked: in the book《Shennong Bencao Jing》, it is stated that the herb Sanjisheng can treat lower back pain, enhance the teeth and hair, to grow eyebrown and moustauche. It is a herb to supply the Liver and Kidney. How it can work to supply the Big Qi in the chest? Answer: the Sangjisheng’s root does not touch soil, but growing as quest in a tree. It is good at to breath Qi in the air to nourish itself. So, the Qi it contains is similar to the Qi in the chest. It can be experienced that, in clinic, after long time of intake of herbs to supply the Liver and Kidney, the person would feel fullness in the chest. There is no other reasons, but the Qi in the chest is not sunk, not deficient, so the person can not accept more Qi from the herbs. Did you see in the book 《Shennong Bencao Jing》that the Huangqi can work for the carbuncle? But it does not work if the carbuncle just happened. Only when the carbuncle is broken, and the process for the muscle grow is slow, then the Huangqi works. So, the function of the Sangjisheng is similar to the Huangqi in the treatment of carbuncle. So its herbal nature is similar to the Huangqi.

或问：萆薢世医多用以治淋，夫淋以通利为主，盖取萆薢能利小便也。此方中用之以固小便，其性果固小便乎，抑利小便乎？答曰：萆薢为固涩下焦之要药，其能治失溺，《名医别录》原有明文。时医因古方有萆薢厘清饮，遂误认萆薢为利小便之要药，而于小便不利、淋涩诸证多用之。尝见有以利小便，而小便转癃闭者，以治淋证，竟致小便滴沥不通者，其误人可胜道哉！盖萆薢厘清饮之君萆薢，原治小便频数，溺出旋白如油，乃下焦虚寒，气化不固之证，观其佐以缩小便之益智，温下焦之乌药，其用意可知。特当日命名时，少欠斟酌，遂致庸俗医辈，错有会心，贻害无穷，可不慎哉！

It might be asked: the herb Pixie is usually used for the treatment of urine tract infection. The principle in the treatment of the urine infection is to open, for the believing that herb Pixie can open the urine tract to promote the urination. How do you use it in your formula to fix, to hold the urine? Its function is to promote or to prevent the urination? Answer: yes, the herb Pixie is the herb to fix the Lower Jiao. It has been indicated clearly in book 《Mingyi Bielu》that it can work for the urine leak. The current doctors thought it is the key herb to open the urine tract, for there is a herbal formula called Pixie Liqing Yin. Liqing here means to promote no-pain urine. So it is used often in the condition with harsh urine, painful urine, or urine with infection. There is cases, in which it is used to promote urine, but the urine became stop. It is used to solve pain in urine, but caused block and harsh in the urination. How wrong this concept mis-leads us! The key herb in the herbal formula Pixie Liqing Yin is originally used in condition, in which the urine is frequent, the urine is as white in color and as oil. This is the Cold-weak condition in the Lower Jiao, in which the Qi is weak to hold the urine. Look at the co-use of the herb Yizhiren that works to shrink the urine (reduce the frequency of urine), and the herb Wuyao that works to warm the Lower Jiao, the function of the Pixie Liwing Yin is clear. It is due to the less careful at the time to name the formula, so it caused the misunderstanding of the function of the herb Pixie. How pity it is!

[1] A condition similar to type I diabetes.

[2] Huiyang means Yang restoring in Chinese.

[3] Liyu means to disperse the stagnated Qi, in Chinese. Li means disperse. Yu means stagnation or blocked mass.