Zhang Xichun's Famous Formula "Sheng Xian Tang" (Raising the Fallen Decoction)
Zhang Xichun's Famous Formula "Sheng Xian Tang" (Raising the Fallen Decoction): Pattern Differentiation and Treatment for Great Qi Collapse, Heavy Dosage of Astragalus to Rescue Severe Illnesses
In the vast treasure trove of Chinese medicine, "Records of Tradition and Western Medicine in Medicine" by the renowned Qing Dynasty physician Zhang Xichun shines like a brilliant pearl. Among its contents, the "Sheng Xian Tang" is a time-honored formula for treating "Great Qi Collapse Syndrome." This formula is refined in its composition, profound in its conception, targeted in its action, and powerful in its effect, capable of resolving many difficult and complicated diseases in clinical practice. Today, we will comprehensively analyze the Sheng Xian Tang and unveil the mystery behind its reputation of "symptom relief after one dose, recovery after two."
I. Core Pathogenesis: What is "Great Qi Collapse"?
To understand Sheng Xian Tang, one must first understand what Zhang Xichun meant by "Great Qi."
Zhang Xichun believed that "Great Qi" is the "Zong Qi" (Pectoral Qi) mentioned in the "Inner Canon." It accumulates in the chest (Dan Zhong point) and is the fundamental force supporting all life activities of the human body. It governs respiration, connects with the heart and vessels, and supports the entire body. He vividly analogized: "The Great Qi envelops the lungs and governs the mechanism of respiration."
Great Qi Collapse refers to a critical state where this primordial qi in the chest is extremely deficient, unable to hold its position, collapsing downwards like the central pole of a tent breaking, leading to the decline of heart, lung, and even overall bodily functions.
II. Precise Pattern Differentiation: How to Identify Great Qi Collapse Syndrome
The key to applying Sheng Xian Tang lies in precise pattern differentiation. Misuse is not only ineffective but may even worsen the condition. Its core differentiation points are as follows:
Most Characteristic Main Symptoms
Shortness of breath insufficient for respiration, or labored breathing resembling asthma: This is the key symptom. The patient feels they cannot catch their breath, needs to exert effort to breathe, and may even open the mouth and raise the shoulders. They seem to be panting, but the essence is "difficulty inhaling," feeling like air cannot be drawn down deeply. Zhang Xichun specifically emphasized that this is fundamentally different from the "difficulty exhaling" type of wheezing caused by excess pathogens like phlegm or fire obstructing the airways.
Key Diagnostic Evidence
Pulse: Deep, slow, faint, and weak, especially in the front position (Cun pulse). The pulse is the "ironclad evidence" for diagnosis. With Great Qi Collapse, it lacks the strength to propel the blood vessels, hence the pulse is deep, slow, faint, and weak. Most crucially, the weakness of the Cun pulse is far more severe than that of the Chi or Guan pulses, as this directly reflects the decline of the Great Qi in the chest.
Common Accompanying Symptoms
Chest fullness and oppression (a feeling of emptiness and sagging)
Throat discomfort, as if something is stuck
Palpitations (heart fluttering and panic)
Mental fatigue and lack of strength, disinclination to speak or move
Alternating chills and fever, or only chills without fever (easily misdiagnosed as a common cold)
Dry throat and thirst (due to qi collapse failing to raise fluids)
Excessive sweating, urinary incontinence or retention
III. Sheng Xian Tang Formula Composition and In-Depth Analysis
Classical Formula Composition and Dosage
Monarch Herb: Sheng Huang Qi (Raw Astragalus) 18g - Greatly tonifies the Great Qi in the chest, raises the collapse and lifts the qi.
Minister Herb: Zhi Mu (Anemarrhena) 9g - Cools and moistens, counteracts the warm dryness of Astragalus, enabling tonification without causing fire.
Assistant Herbs: Chai Hu (Bupleurum) 4.5g, Sheng Ma (Cimicifuga) 3g - Assist Astragalus in raising yang and lifting the collapse.
Envoy Herbs: Jie Geng (Platycodon) 4.5g - Acts like a boat to carry the other herbs upward to the chest, opens and diffuses lung qi.
Precise Explanation of the Formula
The entire formula is rigorously structured,堪称典范 (can be called a model):
Astragalus as Monarch, Source of Qi Tonification: Raw Astragalus is used in heavy dosage for its property of tonifying qi while also raising qi, directly replenishing the collapsed Great Qi.
Anemarrhena as Minister, the Subtlety of Balance: Skillfully uses the cooling and moistening nature of Anemarrhena to restrain the warm, drying nature of Astragalus, making the formula's nature balanced and suitable for long-term use without side effects. This reflects the exquisite subtlety of Zhang Xichun's herb application.
Bupleurum and Cimicifuga as Assistants, Wings for Lifting: Bupleurum and Cimicifuga are a classic pair for lifting and raising, like two assistants working together with Astragalus to lift the sunken qi upwards.
Platycodon as Envoy, the Guiding Boat: Platycodon enters the Lung channel directly, acting like a guide, leading the power of all herbs directly to the diseased area – the chest.
The combination of these five herbs together achieves the function of "Tonifying Qi and Stabilizing Collapse, Raising Yang and Lifting the Fallen," akin to re-erecting a solid central pole for a collapsed tent.
IV. Rescuing Severe Illnesses: Why Must Astragalus Be Used in Heavy Doses?
For critical cases of Great Qi Collapse, Zhang Xichun repeatedly emphasized in his medical records that Astragalus must be used in heavy doses, often up to 60g, 80g, or even 120g. Why is this?
Mild Medicine for Severe Disease Cannot Avert Crisis
Conventional doses of Astragalus (e.g., 15-30g) might suffice for mild shortness of breath, but for severe cases where breathing is about to stop and the situation is critical, it's like using a cup of water to put out a burning cartload of wood. "Powerful medicine" must be used to "lift a thousand jun of weight." Astragalus at 80g or more acts like a high-power "lifting pump," capable of rapidly replenishing the Great Qi deficit in a short time, generating a powerful upward lifting force to reverse the critical situation.Support from a Modern Perspective
Modern pharmacological research shows that large doses of Astragalus have cardiotonic effects, improve myocardial metabolism, exhibit bidirectional regulatory effects (can raise or lower blood pressure), and enhance immune function. This highly aligns with the mechanism of "Raising the Fallen" to improve cardiopulmonary function.For critical cases of Great Qi Collapse, Zhang Xichun repeatedly emphasized in his medical records that Astragalus must be used in heavy doses, often up to 60g, 80g, or even 120g. Why is this?
Precautions for Using Heavy Doses of Astragalus
Pattern differentiation must be precise: It must be a pure deficiency pattern of Great Qi Collapse without pathogenic factors. If there is external contraction or excess fire, it must not be used, otherwise it would "shut the door and keep the burglar inside."
Must use Raw Astragalus: When raw, its lifting power far surpasses that of honey-fried prepared astragalus.
Anemarrhena's moderating role is essential: The larger the dose of Astragalus, the more important Anemarrhena's moderating role becomes to prevent excessive warm tonification.
Reduce dosage upon effect: After the critical condition is resolved, the dosage should be gradually reduced to a conventional maintenance level.
V. Recorded Clinical Case Studies
Case 1: Myasthenia Gravis (Ocular Type)
Patient: Ms. Lin, female, 42 years old.
Chief Complaint: Drooping of both eyelids, difficulty seeing for over 3 months, worse in the afternoon, accompanied by shortness of breath, low voice, and fatigue.
Examination Findings: Inability to lift both eyelids, required fingers to hold them open. Pale complexion, pale tongue with white coating, deep and weak pulse, Cun pulse almost imperceptible.
Pattern Differentiation: Great Qi Collapse, Clear Yang failing to rise, muscles and tendons lacking nourishment.
Treatment Method: Tonify Qi and Raise the Collapse, Strengthen Muscles and Arouse Paralysis.
Formula: Modified Sheng Xian Tang in heavy dosage.
Sheng Huang Qi 80g, Zhi Mu 12g, Chai Hu 6g, Sheng Ma 6g, Jie Geng 6g.
Efficacy: After 7 doses, eyelids could lift briefly on their own, shortness of breath greatly reduced. Original formula with Astragalus reduced to 60g, another 14 doses, eyelids basically returned to normal, spirit improved. Followed up with Bu Zhong Yi Qi Wan to consolidate treatment.
Case 2: Unexplained Persistent Low-Grade Fever and Palpitations
Patient: Mr. Wang, male, 35 years old.
Chief Complaint: Persistent low-grade fever (37.5-38°C) for 2 months, accompanied by heart palpitations, shortness of breath, and excessive sweating. Western medical tests showed no abnormalities.
Examination Findings: Temperature 37.8°C, sallow complexion, low and weak speech, self-reported feeling of emptiness and sagging in the chest. Pale tongue, deep, thin, and rapid pulse, weak on heavy pressure, especially weak in the Cun position.
Pattern Differentiation: Great Qi Collapse, Yin Fire Flaring Upward, Disharmony of Nutritive and Defensive Qi.
Treatment Method: Raise the Great Qi, Use Sweet and Warm Herbs to Eliminate Heat.
Formula: Modified Sheng Xian Tang combined with Gui Zhi Gan Cao Tang (Cinnamon Twig and Licorice Decoction).
Sheng Huang Qi 60g, Zhi Mu 10g, Chai Hu 5g, Sheng Ma 3g, Jie Geng 5g, Gui Zhi 10g, Zhi Gan Cao 6g.
Efficacy: After 3 doses, temperature dropped to 37.2°C, palpitations and shortness of breath reduced. After 7 doses, fever subsided, body felt cool, all symptoms resolved. This is the effect of the Great Qi being restored and rising, causing the Yin Fire to subside naturally.
Conclusion
Sheng Xian Tang is a formula that nearly perfectly integrates theory and practice. It teaches us that when encountering patients with that "indescribable discomfort," shortness of breath, fatigue, weak pulse, and faint Cun pulse, we should think outside the framework of conventional thought and consider the perspective of "Great Qi Collapse." With precise pattern differentiation, matching the formula to the pattern, and having the courage to use heavy doses of Astragalus in severe cases, one can often achieve the remarkable effect of "using minimal force to subdue a powerful opponent."
Friendly Reminder: This article aims to popularize knowledge of Chinese medicine. The use of Sheng Xian Tang, especially in large doses, must be carried out under the guidance of a licensed TCM practitioner based on the four diagnostic methods (inspection, listening/smelling, inquiry, palpation). Please do not attempt to prepare or take this formula on your own.