天津陈××，三十五岁，于孟冬得大气下陷兼小便不禁证。
病因 禀赋素弱，恒觉呼吸之气不能上达，屡次来社求诊，投以拙拟升陷汤，即愈。后以出外劳
碌过度，又兼受凉，陡然反复甚剧，不但大气下陷，且又小便不禁。
证候 自觉胸中之气息息下坠，努力呼之犹难上达，其下坠之气行至少腹，小便即不能禁，且觉
下焦凉甚，肢体无力，其脉左右皆沉濡，而右部寸关之沉濡尤甚。
诊断 此胸中大气下陷之剧者也。此证因大气虚陷，心血之循环无力，是以脉象沉濡而迟，肺
气之呼吸将停，是以努力呼气外出而犹难上达。不但此也，大气虽在膈上，实能斡旋全身统摄
三焦，今因下陷而失位无权，是以全身失其斡旋，肢体遂酸软无力，三焦失其统摄，小便遂泄泻不禁。
其下焦凉甚者，外受之寒凉随大气下陷至下焦也。此证之危已至极点，当用重剂升举其下陷之大气，
使复本位，更兼用温暖下焦之药，祛其寒凉庶能治愈。
处方 野台参（五钱） 乌附子（四钱） 生怀山药（一两）
煎汤一盅温服，此为第一方。
又方 生箭 （一两） 生怀山药（一两） 白术（四钱炒） 净萸肉（四钱）
萆（二钱） 升麻（钱半） 柴胡（钱半）
共煎药一大盅，温服。此为第二方。先服第一方，后迟一点半钟即服第二方。
效果 将药如法各服两剂，下焦之凉与小便之不禁皆愈，惟呼吸犹觉气分不足，肢体虽不酸软，
仍觉无力。遂但用第二方，将方中柴胡减去，加桂枝尖钱半，连服数剂，气息已顺。又将方中升麻、
桂枝，皆改用一钱，服至五剂，身体健康如常，遂停药勿服。
或问 此二方前后相继服之，中间原为时无多，何妨将二方并为一方？答曰∶凡欲温暖下焦之药，
宜速其下行，不可用升药提之。若将二方并为一方，附子与升、柴并用，其上焦必生烦躁，而下
焦之寒凉转不能去。惟先服第一方，附子得人参之助，其热力之敷布最速，是以为时虽无多，下焦之寒
凉已化其强半；且参附与山药并用，大能保合下焦之气化，小便之不禁者亦可因之收摄，此时下焦
受参附山药之培养，已有一阳来复，徐徐上升之机。已陷之大气虽不能因之上升，实已有上升之根
基。遂继服第二方，黄 与升柴并用，升提之力甚大，借之以升提下陷之大气，如人欲登高山则或推之，
或挽之，纵肢体软弱，亦不难登峰造极也。且此一点余钟，附子之热力已融化于下焦，虽遇升柴之
升提，必不至上升作烦躁，审斯则二方不可相并之理由，及二方前后继服之利益不昭然乎。
Chen XX from Tianjin, aged 35, contracted a syndrome of Sinking of the Great Qi (Daqi Xiaxian) accompanied by involuntary urination in early winter.
Etiology: He had a constitutionally weak endowment and constantly felt that his breath could not ascend to the upper body. After multiple visits to the clinic, he was cured after taking my formulated Shengxian Tang (Ascending the Fallen Decoction). Later, due to excessive physical exertion while traveling and exposure to cold, the condition relapsed suddenly and severely. Not only did the Great Qi sink further, but involuntary urination also developed.
Symptoms: He felt as if the Qi in his chest was continuously sinking; even with effort, exhalation failed to reach the upper body. When this sinking sensation reached the lower abdomen, urination became uncontrollable. He also felt extreme cold in the Lower Jiao (Lower Burner) and weakness in the limbs. The pulse was deep and soggy (Chen Ru) on both sides, particularly pronounced at the Cun and Guan positions on the right side.
Diagnosis: This is a severe case of Sinking of the Chest Great Qi. Due to the deficiency and sinking of the Great Qi, the circulation of Heart Blood lacks strength, resulting in a deep, soggy, and slow pulse. The Lung Qi's respiration is nearly ceasing, which explains why exhalation is difficult despite effort. Furthermore, although the Great Qi resides above the diaphragm, it actually governs the whole body and controls the Three Jiao (Triple Burner). Now, due to its sinking and loss of position and authority, the whole body loses its governance, leading to soreness, weakness, and flaccidity of the limbs. The Three Jiao loses its control, causing urinary incontinence. The extreme cold in the Lower Jiao results from external cold pathogens sinking along with the Great Qi into the Lower Jiao. The danger of this case has reached its peak. Heavy doses should be used to lift the sinking Great Qi back to its original position, combined with herbs that warm the Lower Jiao to dispel the cold, for a cure to be achieved.
Prescription: Ye Taishen (Wild Codonopsis Root, 5 qian), Wu Fuzi (Prepared Aconite Root, 4 qian), Sheng Huai Shanyao (Fresh Chinese Yam Rhizome, 1 liang). Decoct in one cup of water and take warm. This is the First Formula.
Another Formula: Sheng Jian Huang (Raw Astragalus Root, 1 liang), Sheng Huai Shanyao (Fresh Chinese Yam Rhizome, 1 liang), Baizhu (Atractylodes Macrocephala Rhizome, 4 qian, stir-fried), Jing Yurou (Cleaned Cornus Officinalis Fruit, 4 qian), Bibi (Dioscorea Hypoglauca Rhizome, 2 qian), Shengma (Cimicifugae Rhizome, 1.5 qian), Chaihu (Bupleuri Radix, 1.5 qian). Decoct together in one large cup and take warm. This is the Second Formula. Take the First Formula first, and then take the Second Formula about an hour and a half later.
Outcome: After taking two doses of each formula according to the method, the cold in the Lower Jiao and the involuntary urination were cured. However, he still felt insufficient Qi during respiration, and although the limbs were no longer sore, they remained weak. Therefore, only the Second Formula was used, with Chaihu removed and Guizhi Jian (Tips of Cinnamon Twig, 1.5 qian) added. After several doses, the breathing became smooth. Then, the dosages of Shengma and Guizhi in the formula were reduced to 1 qian each. After five doses, his health returned to normal, and the medication was discontinued.
Interrogation: Someone asked, "Since these two formulas are taken sequentially with little time between them, why not combine them into one formula?" I replied: "Herbs intended to warm the Lower Jiao should act quickly downwards and must not be lifted by ascending herbs. If the two formulas are combined, using Fuzi (Aconite) together with Shengma and Chaihu, irritability will arise in the Upper Jiao, and the cold in the Lower Jiao will fail to dissipate. Only by taking the First Formula first can the heat power of Fuzi, assisted by Renshen (Ginseng), spread most rapidly. Thus, although the time is short, more than half of the cold in the Lower Jiao is resolved. Moreover, the combination of Renshen, Fuzi, and Shanyao greatly preserves the Qi transformation of the Lower Jiao, allowing the involuntary urination to be controlled. At this point, the Lower Jiao, nurtured by Renshen, Fuzi, and Shanyao, has regained the mechanism of 'one Yang returning' and slowly rising. Although the sunk Great Qi cannot rise immediately because of this, it has established a foundation for rising. Subsequently taking the Second Formula, where Huangqi (Astragalus) is used with Shengma and Chaihu, provides strong ascending power to lift the sunk Great Qi. It is like pushing or pulling someone who wishes to climb a high mountain; even if their limbs are weak, reaching the summit is not difficult. Furthermore, within this hour and a half, the heat of Fuzi has melted into the Lower Jiao. Even when encountering the ascending action of Shengma and Chaihu, it will certainly not cause upward movement leading to irritability. Considering this, the reasons why the two formulas cannot be combined, and the benefits of taking them sequentially, are self-evident."