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Mr. Li from Tianjin, aged thirty-two, whose profession was pulling a rickshaw, suffered from the syndrome of sinking of the Great Qi (Daqi).

Etiology: He felt hungry in his abdomen but had not eaten; after running seven or eight li on an empty stomach, he contracted this disease.

Symptoms: Shortness of breath and panting, heat sensation in the heart region, aversion to food, soreness and weakness of the limbs, and fatigue. Any slight movement caused him to feel short of breath, insufficient for respiration. His pulse was wiry and hard on the left side, while the Cun (inch) and Guan (bar) positions on the right side were deep and powerless.

Diagnosis: This is a case of sinking of the Great Qi in the chest, accompanied by stagnant heat in the Liver and Gallbladder. The Great Qi in the chest is originally the Postnatal Zong Qi (Gathering Qi), which can substitute for the Prenatal Yuan Qi (Original Qi) to govern the whole body; however, it must rely on the Qi derived from water and grain for nourishment. In this case, enduring hunger and excessive labor led to the sinking of the Great Qi; the deep and powerless pulse at the right Cun and Guan positions is clear evidence. Since the livelihood of several family members depended on his single labor, and because the Qi sank, he could not continue working, facing imminent starvation. Consequently, irritability and fire arose in the Liver and Gallbladder; the wiry and hard pulse on the left side is clear evidence. Treatment should employ my proposed Shengxian Tang (Ascending the Sinking Decoction) to raise and tonify the Great Qi in the chest, assisted by cooling and moistening herbs to clear the heat of the Liver and Gallbladder.

Prescription: Raw Astragali Radix (Sheng Huangqi) (8 qian), Anemarrhenae Rhizoma (Zhimu) (5 qian), Platycodonis Radix (Jiegeng) (2 qian), Bupleuri Radix (Chaihu) (2 qian), Cimicifugae Rhizoma (Shengma) (1.5 qian), Raw Paeoniae Radix Alba (Sheng Baishao) (5 qian), Gentianae Scabrae Radix (Longdancao) (2 qian).
Decoct together in a large bowl of water, take warm.

Outcome: After taking two doses consecutively, all symptoms disappeared completely, and he was fully recovered.

Mrs. Song from Tianjin, around forty years old, contracted the syndrome of sinking of the Great Qi with coldness throughout the body during mid-summer.

Etiology: Her innate constitution was weak, and she usually felt deficient in Qi. Accidentally exerting herself to carry heavy objects, she subsequently experienced shortness of breath and coldness throughout the body.

Symptoms: During respiration, she often felt that her Qi could not ascend. Although it was hot summer weather, she felt cold even wearing a lined jacket. The illness was slightly lighter in the morning and worsened gradually in the afternoon; she had to exert effort to breathe. Even wrapped in a large cloak, she sometimes shivered with cold. She ate very little, yet digestion remained poor. Her pulse was deep and fine, almost imperceptible before the Guan position, and although slightly better behind the Guan position, it remained deep. There were fewer than four beats per breath.

Diagnosis: This is deficiency and damage of the Yang Qi of the Heart and Lungs in the Upper Jiao, combined with the sinking of the Great Qi in the chest. Due to the deficiency of Heart and Lung Yang, there is aversion to cold throughout the body and failure to digest food. Due to the sinking of the Great Qi in the chest, there is shortness of breath. In the morning, when Qi transformation ascends, the illness is mild; after noon, when Qi transformation descends, the illness aggravates. I propose treating with Huiyang Shengxian Tang (Return Yang and Ascend Sinking Decoction), adding potent Codonopsis Radix (Dangshen) to assist.

Prescription: Raw Astragali Radix (Sheng Huangqi) (8 qian), Wild Codonopsis Radix (Yetai Dangshen) (4 qian), Dried Zingiberis Rhizoma (Ganjiang) (4 qian), Angelicae Sinensis Radix (Dangguishen) (4 qian), Ramulus Cinnamomi (Guizhijian) (3 qian), Glycyrrhizae Radix et Rhizoma (Gancao) (2 qian).
Decoct together in a large bowl of water, take warm.

Outcome: After taking three doses consecutively, her breathing became smooth, though occasional shortness of breath persisted. Coldness throughout the body ceased, although she still needed thick coverings when sleeping at night. Digestion improved, and the pulse showed significant recovery. Subsequently, Codonopsis Radix was removed from the original prescription, and both Dried Zingiberis Rhizoma and Ramulus Cinnamomi were reduced to 2 qian each. Raw Dioscoreae Hypoglaucae Rhizoma (Sheng Huaishanyao) 8 qian was added, allowing for several more doses to consolidate the effect.

Commentary: The Heart is the Sovereign Fire and the master of the body's thermal energy. The Lung resides in the Upper Jiao along with the Heart, connected physically, with blood circulation interlinked breath by breath; thus, they assist each other in governance, jointly ruling the Yang Qi of the Upper Jiao. However, although this Qi is located in the Upper Jiao, it is actually like the sun shining in the zenith, illuminating the earth below; its thermal energy penetrates to the Middle Jiao, causing food in the Stomach to be cooked and rotted (digested), and further penetrates to the Lower Jiao, causing the Minister Fire of the Mingmen to flourish, warming the internal Zang-Fu organs externally and warming the whole body. This relies entirely on the distribution and unblocking action of this Yang Qi. Specifically, the Heart and Lung are encompassed within the Great Qi of the chest; the original dynamic power for its distribution and unblocking truly depends on the Great Qi. In this case, the Yang Qi of the Heart and Lung was originally deficient, relying previously on the Great Qi for protection, so it could still sustain itself. When the Great Qi sank and lost its protective function, signs of deficiency-cold suddenly appeared. This formula focuses on raising and tonifying the Great Qi in the chest, assisting with cultivating the Yang Qi of the Heart and Lung. The disease and medicine match perfectly (like a needle and a thistle seed), hence efficacy is achieved upon administration.