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Treatment for the sinking of the Great Qi (Da Qi, the vital qi filling the chest and governing respiration) in the chest, resulting in shortness of breath insufficient to sustain normal breathing. Or the patient exerts effort to breathe, appearing similar to asthma (Chuan Zheng). Or the breath is about to cease, with danger imminent. The accompanying symptoms may include alternating chills and fever, dry throat with thirst, chest fullness and palpitations (Zheng Chong), mental confusion and forgetfulness; such a variety of conditions is indeed difficult to enumerate completely. The pulse is deep, slow, and weak, particularly pronounced at the Guan position. In severe cases, the six pulses may be incomplete or irregular and uncoordinated.

Sheng Huang Qi (Raw Astragali Radix, 6 qian) Zhi Mu (Anemarrhenae Rhizoma, 3 qian) Chai Hu (Bupleuri Radix, 1.5 qian) Jie Geng (Platycodonis Radix, 1.5 qian) Sheng Ma (Cimicifugae Rhizoma, 1 qian)

In cases where the Qi of the Qi Division is extremely deficient and sinking, add Ren Shen (Ginseng Radix et Rhizoma) by discretion, several qian, or additionally add Shan Yu Rou (Corni Fructus, removed pits) several qian, to converge the dispersion of the Qi of the Qi Division, ensuring that the lifted Qi does not sink again, which is even better. If the Great Qi sinks excessively, causing a bearing-down sensation in the lower abdomen or increased pain, change Sheng Ma to 1.5 qian, or double it to 2 qian.

Sheng Xian Tang (Decoction for Lifting the Sinking Qi) uses Huang Qi as the principal herb because Huang Qi is excellent at tonifying Qi and lifting Qi. However, its nature is slightly warm, so Zhi Mu’s cool and moistening properties are used to balance it. Chai Hu is an herb of the Shaoyang (Lesser Yang) channel, capable of guiding the sinking Great Qi to ascend from the left. Sheng Ma is an herb of the Yangming (Bright Yang) channel, capable of guiding the sinking Great Qi to ascend from the right. Jie Geng acts as the boat and oar among herbs, carrying the power of the other herbs upward to reach the chest, thus serving as a guide. For cases of extreme deficiency in the Qi of the Qi Division, adding Ren Shen by discretion serves to cultivate the root of Qi. Adding Shan Yu Rou prevents the dissipation of Qi. Regarding the bearing-down sensation in the lower abdomen or increased pain, this indicates that the person’s Great Qi has sunk to the deepest depths, requiring the strong lifting power of Sheng Ma to raise it; hence, Sheng Ma is increased by 0.5 qian or doubled to 2 qian. Such is the intention behind the formula. As for flexible modifications according to circumstances, it depends on the clinician’s ability to adapt wisely.

The Great Qi fills the chest and governs pulmonary respiration. Throughout the human body, from the anus (Fei Men) to the anus (Po Men), one Qi prevails. Yet this Qi has a source of generation, a place of cultivation, and a place of accumulation. Heaven generates Water first; the Kidneys form initially. Within the Mingmen (Gate of Life) connected to the Kidney system (the membrane enveloping the kidneys connects to the spine, counting seven segments from below), Qi stirs intermittently. This is the Qi of Primordial Yuan (Yuan Qi) providing the beginning, what the *Neijing* calls “Minor Fire generates Qi.” Once generated by Minor Fire, this Qi slowly ascends, cultivated by the postnatal Qi from water and grain, forming a majestic momentum. It accumulates in the spacious cavity of the chest, establishing a firm root. Thus, the Great Qi originally takes Yuan Qi as its foundation, water and grain Qi as its nourishment, and the chest as its dwelling. Although all are Qi, only the Qi in the chest is uniquely named Great Qi, truly because it supports the whole body, serves as the leader of all Qi, envelops the exterior of the lungs, and controls the pivot of respiration; therefore, it is solemnly called Great Qi. The Great Qi is internal Qi. Respiratory Qi is external Qi. When a person feels that the external respiratory Qi and internal Qi are not continuous, it means the Great Qi is deficient and tending to sink, unable to tightly envelop the exterior of the lungs. If physicians do not understand the cause, they mistakenly diagnose it as Qi stagnation and use methods to open and disperse it. In severe cases, when breathing is about to stop and requires effort to breathe, they mistakenly diagnose it as rebellious Qi causing asthma and use methods to descend it. Consequently, the sinking becomes deeper, and danger appears immediately. Those who experience frequent chills and fever: generally, the Great Qi in the chest is the Yang Qi of the Upper Jiao. When it sinks, it does not sink entirely, nor does it fail to rise after one sinking. At the initial stage of sinking, Yang Qi is constrained and unsmooth, causing chills; after sinking, Yang Qi accumulates and desires to diffuse, causing heat. When Yang Qi accumulates to the extreme and then unblocks, rising slightly again, slight sweating occurs and heat resolves. Dry throat occurs because fluids cannot follow the Qi upward. Fullness arises from difficulty in respiration. Palpitations occur because the Heart sits above the diaphragm, suspended within the Great Qi; when the Great Qi sinks, the Heart loses its support. Mental confusion and forgetfulness occur because the sinking Great Qi cannot reach the brain, leaving the brain marrow and nerves without reliance. These conditions often result from overexertion relative to strength, working on an empty stomach, engaging in activity before recovery from illness, prolonged diarrhea, excessive use of Qi-breaking medicines, or spontaneous sinking due to extreme Qi deficiency. Various causes differ, yet their pulse signs of fine, slow, and weak qualities, along with shortness of breath in the chest, closely resemble Cold-Fluid Accumulation in the Chest (Han Yin Jie Xiong). However, if the pulse appears cold-cool and the patient indeed fears cold-coolness and feels shortness of breath, it is Cold-Fluid Accumulation in the Chest; if the pulse appears cold-cool but the patient does not fear cold-coolness and only feels shortness of breath, it is Sinking of the Great Qi. Even regarding shortness of breath alone, there is a distinction between the shortness of breath of Sinking Great Qi and that of Cold-Fluid Accumulation in the Chest. In Cold-Fluid Accumulation, one feels as if something is pressing down; in Sinking Great Qi, one often feels that upper Qi and lower Qi are not continuous. Clinicians must examine carefully (see Li Yin Tang for details on Cold-Fluid Accumulation in the Chest).

It is common knowledge that the Lungs govern respiration. To say that the Lungs’ ability to breathe relies on the Great Qi in the chest is unknown not only to non-medical people but also rarely known even among physicians, and rarely mentioned in medical texts. When I first studied medicine, I was unaware of this Qi. Only through careful clinical experience did I confirm that besides pulmonary Qi respiration, there is another Qi stored in the chest governing lung respiration. This Qi can support the whole body, invigorate the spirit, and sustain mental faculties, cognitive abilities, and physical movements. When this Qi is deficient, respiration becomes difficult, limbs feel sore and lazy, spirit becomes confused, and mental/cognitive functions decrease suddenly. If this Qi is deficient and sinks, or sinks excessively, the person’s breathing may suddenly stop, leading to unconsciousness. Having experimentally verified that this accumulated Qi in the chest has a crucial relationship with the whole body, yet still not knowing what to name it, I found no reference in medical texts. Only in the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), under the Water Qi chapter, beneath Guizhi Jia Huang Qi Tang, is the phrase “When the Great Qi rotates, the pathogenic Qi disperses.” Later, seeing Yu Jiayan’s *Yi Men Fa Lv* stating: “The five Zang and six Fu organs, major and minor collaterals, circulate day and night without ceasing, relying on the Great Qi in the chest to manage them,” I realized the accumulated Qi in the chest should be named Great Qi. Recalling reading in the *Neijing*, Heat Disease Chapter: “When the Great Qi departs, the disease days are over,” with Wang’s commentary defining Great Qi as pathogenic Qi. If the Qi in the chest is also named Great Qi, what was the basis for Zhang Zhongjing and Mr. Yu? Moreover, neither book mentions sinking. Thus, I revisited the *Neijing*, studying sentence by sentence, and learned that the Great Qi mentioned in the *Neijing* refers sometimes to external pathogenic Qi and sometimes to the Qi in the chest. I also learned that the Zong Qi (Pectoral Qi) mentioned in the *Neijing* is also the Great Qi in the chest. Furthermore, the concept of its sinking is also present in the *Neijing*. Let us interpret the *Neijing* text now. The *Lingshu · Wu Wei* chapter says: “Grain enters the Stomach; its essence first emerges from the two Jiao of the Stomach to irrigate the five Zang organs, branching into two pathways of Ying and Wei Qi. The Great Qi that gathers and does not move accumulates in the chest, named the Sea of Qi. It emerges from the Lungs, follows the throat and pharynx, so during exhalation it exits, and during inhalation it enters. The essence of Heaven and Earth usually exits three parts and enters one part; thus, without grain intake, Qi declines in half a day and diminishes in one day.” I pondered that the Lungs hang in the chest with no opening below; the Great Qi in the chest envelops the exterior of the Lungs, originally not connecting to the throat or pharynx above. Saying it emerges from the Lungs, follows the throat/pharynx, exits on exhalation, and enters on inhalation implies that the Great Qi drives the Lungs to breathe, and the Qi within the Lungs thereby moves in and out. The statement that heavenly/earthly essence exits three and enters one means that inhaled Qi, though not directly communicating with the chest, actually penetrates one-quarter through the lung membrane to nourish the Great Qi in the chest, while the remaining three parts are exhaled, replacing turbid Qi in the organs. This is the wondrous function of Qi transformation. However, this chapter focuses on nourishing humans with the Five Flavors, so it only states that diet nourishes the Great Qi in the chest, without revealing its origin. I have considered that before birth, humans breathe via the umbilicus; the chest originally has no Great Qi and needs none. As fetal Qi grows, Yuan Qi below the umbilicus gradually fills, ascending intermittently to the chest to become Great Qi. As Great Qi fills, it drives the lung membrane to breathe; upon leaving the womb, respiration occurs via the Lungs, connecting with Heaven and Earth Qi (Western medicine holds that medulla oblongata controls lung respiration, while the Great Qi in the chest is actually the prime mover of the medulla).

Regarding Great Qi being Zong Qi, I deeply investigated the *Neijing* to confirm this. The *Suwen · Ping Ren Qi Xiang Lun* says: “The great collateral of the Stomach is named Xuli, emerging from below the left breast; its movement affects the clothing, representing the pulse of Zong Qi.” Note: The Xuli collateral is the pathway for the Stomach to transport water and grain Qi to the chest to nourish the Great Qi. After penetrating the diaphragm and connecting to the Lungs, it emerges below the left breast as an artery. This artery should be the residual wave of the Great Qi; calling it Zong Qi means Zong Qi is Great Qi, honored as such because it is the master of life. The collateral is named Xuli because it penetrates the diaphragm, connects to the Lungs, and travels through the hollow spaces of the chest.

Furthermore, the *Lingshu · Ke Xie* chapter says: “Five grains enter the Stomach; their dregs, fluids, and Zong Qi divide into three tunnels. Thus, Zong Qi accumulates in the chest, emerges from the throat, penetrates the Heart vessels, and conducts respiration.” Observing this scripture, Zong Qi is clearly Great Qi, requiring no explanation. Since both passages are attributed to Bogao, not differing authors, there should be consistency. Carefully examining “penetrating Heart vessels and conducting respiration,” Great Qi not only leads all Qi but also serves as the leader of the entire body’s blood vessels. Although the *Neijing* lacks explicit text on Great Qi sinking, the principle is embedded within it. In the *Lingshu · Se Se* chapter, Leigong asks: “How do we know a person dies suddenly without illness?” Huangdi replies: “When Great Qi enters the Zang and Fu organs, the person dies suddenly without prior illness.” Above the diaphragm, Heart and Lungs are Zang, with no Fu organs. Since the classic collectively mentions Zang and Fu, it refers to the organs below the diaphragm. For the Great Qi above the diaphragm to enter the organs below the diaphragm, is this not sinking? Once the Great Qi sinks, lacking Qi to envelop the Lungs externally to drive their opening and closing mechanisms, respiration stops suddenly, causing sudden death without prior illness. From this, how important is the Great Qi to the human body!

Deeply pitying that physicians often misdiagnose Sinking Great Qi, I formulated Sheng Xian Tang. Two other formulas, Hui Yang Sheng Xian Tang and Li Yu Sheng Xian Tang, were derived from modifications of Sheng Xian Tang. Following these three formulas, I attached cured cases. The current manifestations of these diseases include: shortness of breath, palpitations, profuse sweating, mental confusion and forgetfulness, trembling voice and body, alternating chills and fever, chest fullness (due to difficult respiration, mistaken treatment for fullness leads to immediate danger), effortful breathing resembling asthma (especially common, indicating lung respiration is about to stop; the patient struggles to breathe to save themselves; mistaking this for asthma leads to immediate danger), dry throat with thirst, frequent yawning, limb flaccidity, easy hunger after eating, incontinence of urine and feces, stranguria with edema, mouth open exhaling air outward without Qi reaching up, anal prolapse, in women continuous uterine bleeding, and retrograde menstruation (mostly caused by rebellious Qi, but I have seen two cases caused by sinking Qi, both cured with Sheng Xian Tang). The variety of symptoms is hard to list. Cases are too numerous to record. Below, I briefly publish a few cured cases of Sinking Great Qi for reference.

Two brothers, the elder nearly sixty, the younger over fifty. Fearing cold in winter, they shared a small room, burning coal fire and sealing windows/doors tightly. By early spring, both felt chest fullness and shortness of breath. Because windows/doors blocked outside air, oxygen in the room was consumed by the coal fire. Lacking oxygen assistance, and suffering carbon monoxide injury, the Great Qi in the chest became deficient and sank over time, causing shortness of breath. Feeling full, and unaware of the cause, doctors prescribed dispersing/breaking medicines. As dispersing worsened fullness, they assumed insufficient dosage and continued dispersing. After several doses, the elder died due to misdiagnosis. The younger’s condition worsened but remained stable, so he sought my consultation. His pulse was weak and slow, worse on the right. He reported cold heart, bearing-down pain in the lower abdomen, and effortful breathing. Knowing his Great Qi had severely sunk, I prescribed Sheng Xian Tang, changing Sheng Ma to 2 qian, removing Zhi Mu, adding Gan Jiang (Dried Ginger) 3 qian. After two doses, the bearing-down ceased, and breathing smoothed. I changed Sheng Ma, Chai Hu, and Jie Geng to 1 qian each, continuing for several doses until cured.

A man, forty-eight years old. Suffered from chronic asthma, triggered by slight external contraction, recurring twice or thrice yearly. Xiao Qing Long Jia Shi Gao Tang (Minor Blue Dragon Decoction plus Gypsum) was usually effective. One day, the relapse was severe, with constant day-and-night asthma. Two doses of the previous formula yielded no effect. Upon consultation, his pulse was rapid (six beats per breath) with a deep and soft quality. Suspecting Yin deficiency failing to grasp Qi, causing rebellious Qi and asthma, and noting the deep/soft pulse, I dared not use descending agents. Instead, I used Shu Di Huang (Rehmanniae Radix Preparata), Sheng Shan Yao (Dioscoreae Rhizoma), Gou Qi Zi (Lycii Fructus), Xuan Shen (Scrophulariae Radix), large doses of Yin-nourishing herbs, decocted strongly, administered with 2 qian of Ren Shen pieces. After three doses, asthma lightened but persisted. On re-examination, he had someone pounding his back, reporting tightness relieved by pounding and slightly easier breathing. His pulse was no longer rapid, remaining deep and soft. Detailed inquiry revealed he had carried heavy loads with great effort, feeling Qi discomfort immediately, followed by asthma after two or three days. I realized this case involved Yin deficiency failing to grasp Qi (difficulty inhaling) compounded by excessive effort causing Great Qi sinking (difficulty exhaling). Both inhalation and exhalation required effort, making breathing urgent. Treating only with grasping-Qi methods addressed only half the cause, curing only half the asthma. I switched to Sheng Xian Tang, omitting Sheng Ma, Chai Hu, and Jie Geng, substituting with Gui Zhi Jian (Cinnamomi Ramulus apices) 3 qian. I doubled Zhi Mu and added Xuan Shen 4 qian. Several doses resulted in complete cure.

Note: Although this case involved Sinking Great Qi, initially it also included failure to grasp Qi. Sheng Ma, Chai Hu, and Jie Geng, while lifting Qi, hindered the failure-to-grasp condition; using them risked recurrence. Gui Zhi, naturally smooth and unobstructed, guides true Qi of organs upward and descends rebellious Qi well. Zhang Zhongjing’s Ling Gui Zhu Gan Tang uses it for shortness of breath to lift true Qi; Gui Zhi Jia Gui Tang uses it for Ben Tun (Running Piglet) to descend rebellious Qi. Additionally, *Shennong Ben Cao Jing* explicitly states Gui Zhi treats cough, rebellious Qi, and dyspnea. Being both excellent for lifting sinking and descending rebellion, it is a unique and precious herb for this case.

Question: How can one herb, Gui Zhi, both lift sinking and descend rebellion? Answer: Its lifting property comes from branches growing straight up, red color belonging to Fire, and warm nature. Its descending property comes from pungent taste, receiving Metal Qi to soothe Liver Wood; for rebellious Qi rising due to Liver (common), Gui Zhi can suppress it. Generally, the best herbs have unpredictable wonders. See the case of single Gui Zhi treating a strange disease after my Can Zhe Zhen Qi Tang for reference.

A man, twenty-something. Asthma upon exertion, occasional cough. Treated for years with worsening condition, diagnosed as consumptive disease incurable. Pulse was not fine/weak, but imperceptible under fingers. Knowing Great Qi was sinking and unable to drive the pulse outward to create a fluctuating shape, I prescribed Sheng Xian Tang, adding Ren Shen and Tian Dong (Asparagi Radix) 3 qian each. Several doses cured him. Due to chronic illness, I removed Sheng Ma from the original formula, powdered it, made honey pills, and advised slow consumption for over a month to consolidate recovery.

A man, twenty-four years old. Chest fullness, day-and-night cough, severe hypochondriac pain during coughing. Pulse was harmonious, slightly wiry and weak upon heavy pressure. Suspecting Qi stagnation due to pain and fullness, I gave a small amount of Qi-regulating herbs. Noting the weak pulse, I added Huang Qi. Cough and fullness worsened, accompanied by trembling voice. Inquiry revealed he worked hard in fields, caught cold, lost appetite, yet worked on an empty stomach. Based on this cause and intolerance to Qi-regulating herbs, Sinking Great Qi was certain. I prescribed Sheng Xian Tang. Four doses led to complete recovery.

Note: This case appeared difficult to distinguish. Initial lack of detailed questioning led to slight medication error. Fortunately, the mistake was caught early, and the patient recovered quickly. This shows clinicians should not pride themselves on insight while neglecting detailed questioning.

A man, around forty. Loss of voice for half a year, gradual tightening of throat, frequent ulceration, aversion to wind and cold. Winter clothes worn until early summer. Reduced diet, progressing to consumptive weakness. Multiple treatments worsened the condition. Pulse: both Cun positions weak, lacking uplift. Knowing Great Qi in the chest was sinking, I prescribed Sheng Xian Tang, adding Xuan Shen 4 qian. Two doses relieved throat tightness. Sheng Ma was removed, continuing for over ten doses until all ailments resolved.

Zhang XX from Xifeng County, eighteen or nineteen years old. Sick for years without cure, came to hospital. Symptoms: insomnia, reduced diet, limb weakness, frequent shortness of breath. Pulse: weak and flat before the Guan position. Knowing this was Sinking Great Qi causing various symptoms, I prescribed Sheng Xian Tang. For insomnia, added Shu Zao Ren (Ziziphi Spinosae Semen Preparatum) and Long Yan Rou (Longan Arillus) 4 qian each. Several doses resulted in complete cure.

Ms. Yu from Fengtian, married then widowed, living alone in her maiden home. Returned home ill, suddenly unable to speak or breathe at night. Neighbor Wang XX, my student, rushed to the hospital seeking help. Previously diagnosed and treated by me, knowing her Great Qi was deficient, I confirmed this episode was Sinking Great Qi. I prescribed Sheng Huang Qi 1 liang, Dang Gui (Angelicae Sinensis Radix) 4 qian, Sheng Ma 2 qian, decocted and taken. Speech resumed shortly. Next morning brought to hospital, pulse deep, slow, weak; shortness of breath persisted. I reduced Sheng Ma by 1 qian from the original formula, added Sheng Shan Yao and Zhi Mu 3 qian each, Chai Hu and Jie Geng 1 qian each. Several doses resulted in complete cure. Note: In this case, despite the slow pulse, Zhi Mu was still used...