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Li XX, aged 26, suffered from a syndrome of sinking of the Huiqi (Vital Qi) accompanied by excessive appetite.

Etiology: For two years prior to the onset of illness, he often felt shortness of breath, which he initially ignored. Subsequently, due to the mental exertion of schoolwork, his shortness of breath worsened, and he experienced a significant increase in appetite, leading to the syndrome of excessive appetite.

Symptoms: During respiration, inhalation was slightly easier while exhalation was laborious. After sleeping for about an hour at night, he felt that Qi failed to ascend, requiring him to sit up with clothes on. After a while, when breathing became slightly smoother, he could sleep again. Throughout the day, even after eating four times, he still felt hungry; if he did not eat immediately upon feeling hungry, palpitations would occur. He often felt heat in the heart region, dry stools, and scanty dark urine. His pulse was weak at the superficial level (Fu), slightly solid at the deep level (Chen), and slightly slow (Chi).

Diagnosis: This is a syndrome of sinking of the Huiqi (Vital Qi) in the chest, complicated by latent pathogenic Qi transforming into heat, which resulted in excessive appetite. Because the Huiqi (Vital Qi) is sinking, the pulse is weak at the superficial level; because latent pathogenic Qi has transformed into heat, the pulse remains solid at the deep level. Although there is heat from latent pathogenic Qi, the pulse is slightly slow because the pulse characteristic of sinking Huiqi (Vital Qi) is often slow. Generally, those with heat in the stomach tend to digest food quickly, and those whose Stomach Qi descends rapidly due to sinking Huiqi (Vital Qi) also tend to eat more. Now, suffering from both sinking Huiqi (Vital Qi) and latent pathogenic Qi transforming into heat invading the stomach, he feels hungry even after eating four times a day. The treatment should involve raising and tonifying the Huiqi (Vital Qi) in the chest, combined with using cold-natured herbs to clear the heat transformed from latent pathogenic Qi. In this way, shortness of breath and excessive appetite can be cured simultaneously.

Prescription: Sheng Huangqi (Raw Radix Astragali Membranacei, 6 qian), Sheng Shigao (Raw Gypsum Fibrosum, 1 liang, crushed fine), Tianhuafen (Radix Trichosanthis, 5 qian), Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis, 5 qian), Xuanshen (Radix Scrophulariae Ningpoensis, 4 qian), Shengma (Rhizoma Cimicifugae Foetidae, 1.5 qian), Chaihu (Radix Bupleuri, 1.5 qian), Gancao (Radix Glycyrrhizae Uralensis, 1.5 qian).
Decoct together in a large cup of water and take warm.

Second Visit: After taking the medicine continuously for four doses, shortness of breath had improved by more than half, and fever and excessive appetite had greatly subsided. Therefore, slight modifications were made to the original prescription for continued use.

Prescription: Sheng Huangqi (Raw Radix Astragali Membranacei, 6 qian), Tianhuafen (Radix Trichosanthis, 6 qian), Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis, 6 qian), Xuanshen (Radix Scrophulariae Ningpoensis, 6 qian), Jing Yurou (Cleaned Fructus Corni Officinalis, 3 qian), Shengma (Rhizoma Cimicifugae Foetidae, 1.5 qian), Chaihu (Radix Bupleuri, 1.5 qian), Gancao (Radix Glycyrrhizae Uralensis, 1.5 qian).
Decoct together in a large cup of water and take warm.

Analysis of Prescription: Shigao (Gypsum Fibrosum) was removed because the heat transformed from latent pathogenic Qi was no longer significant. Although Shigao was removed, the dosage of cold-natured herbs like Tianhuafen (Radix Trichosanthis) and Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis) was increased because these herbs originally served to balance the potential heat generated by the warming and tonifying effects of Huangqi (Radix Astragali Membranacei); now they are used to clear the residual heat from latent pathogenic Qi, hence the increased dosage. Regarding the addition of Yurou (Fructus Corni Officinalis) to the previous formula, it was intended to astringe the dissipating Huiqi (Vital Qi), preventing already ascended Qi from sinking again. Furthermore, since Yurou (Fructus Corni Officinalis) possesses strong Wood Qi characteristics, its sour astringency contains a free-flowing nature. Thus, even though the heat from latent pathogenic Qi has not completely dissipated, it is safe to use.

Outcome: After taking the modified medicine continuously for another four doses, the illness was completely cured. The patient was instructed to stop taking decoctions and instead take equal parts of Sheng Huangqi (Raw Radix Astragali Membranacei) and Tianhuafen (Radix Trichosanthis) ground into fine powder, taking 3 qian each time, twice daily, to consolidate the recovery.

Q&A: The slowness or rapidity of the pulse is generally related to the body's thermal energy; excessive heat leads to a rapid pulse, while weak heat leads to a slow pulse, which is a fixed principle. In this case, although there is heat from latent pathogenic Qi, the pulse remains slow due to the sinking of Huiqi (Vital Qi). Why does the pulse rate have such a close relationship with Huiqi (Vital Qi)? A: The Huiqi (Vital Qi) in the chest is also called Zongqi (Pectoral Qi). It is called Huiqi (Vital Qi) because its function can coordinate the whole body, and it is called Zongqi (Pectoral Qi) because it serves as the master of postnatal life. The *Neijing* states that Zongqi (Pectoral Qi) accumulates in the chest to penetrate the heart vessels and govern respiration. Deep reflection on this statement reveals that the opening and closing of lung lobes are governed by Huiqi (Vital Qi), and so is the beating of the heart. Now, due to the sinking of Huiqi (Vital Qi) and the loss of its governing function, not only the lungs suffer disease, but the heart's beating is also affected, resulting in a slow pulse.