Sheng Xian Tang

Rise the Sunken Decoction · 升陷汤

A classical formula that tonifies Qi and lifts sunken Qi, used for shortness of breath, chest oppression, and fatigue caused by sinking of the chest Qi.

Origin 《医学衷中参西录》(Records of Chinese Medicine in Reference to Western Medicine) by Zhang Xichun — Late Qing dynasty, ~1909 CE
Composition 5 herbs
Huang Qi
King
Huang Qi
Chai Hu
Deputy
Chai Hu
Sheng Ma
Deputy
Sheng Ma
Zhi Mu
Assistant
Zhi Mu
Jie Geng
Envoy
Jie Geng
Explore composition

Educational content Consult qualified TCM practitioners for diagnosis and treatment

Patterns Addressed

In TCM, symptoms don't appear randomly — they cluster into recognizable patterns of disharmony that reveal what's out of balance in the body. Sheng Xian Tang is designed to correct these specific patterns.

Why Sheng Xian Tang addresses this pattern

Sheng Xian Tang directly treats Qi sinking, particularly of the pectoral Qi. The sinking leads to inability to support respiration and circulation, causing shortness of breath, chest oppression, and fatigue. Huang Qi tonifies and lifts, while Chai Hu and Sheng Ma reinforce the upward movement. Jie Geng guides the effect to the chest, and Zhi Mu prevents overheating, making the formula precisely targeted to raise the sunken Qi.

A practitioner would look for one or more of these signs

Shortness Of Breath

Feeling of not being able to catch one's breath, especially with exertion.

Fatigue

Profound tiredness and heaviness in the body.

Chest Oppression

Tightness or pressure in the chest.

Commonly Prescribed For

These conditions can arise from the patterns above. A practitioner would consider Sheng Xian Tang when these conditions are specifically caused by those patterns — not for all cases of these conditions.

TCM Interpretation

In TCM, chronic heart failure is often seen as a combination of Qi deficiency and Qi sinking, particularly of the pectoral Qi. The heart relies on pectoral Qi to pump blood effectively; when this Qi sinks, symptoms like shortness of breath, fatigue, and edema can occur. The root is a deficiency of both Lung and Heart Qi.

Why Sheng Xian Tang Helps

Sheng Xian Tang directly tonifies and lifts the pectoral Qi. Huang Qi strengthens the heart's pumping force, while Chai Hu and Sheng Ma raise the sunken Qi, improving oxygen delivery and reducing breathlessness. Zhi Mu prevents overheating, which is important in heart conditions where inflammation may be present.

Also commonly used for

Coronary Artery Disease

Alleviates chest pain and shortness of breath by strengthening chest Qi and circulation.

Hypotension

Raises sunken Qi to help normalize low blood pressure and associated dizziness.

Gastroptosis

Lifts sunken Qi to support the stomach and reduce prolapse symptoms.

Asthma

Helps in cases where asthma is due to Qi sinking rather than excess phlegm, improving breathing.

What This Formula Does

Every TCM formula has a specific set of actions — here's what Sheng Xian Tang does in the body, explained in both everyday and TCM terms

Therapeutic focus

In practical terms, Sheng Xian Tang is primarily used to support these areas of health:

TCM Actions

In TCM terminology, these are the specific therapeutic actions that Sheng Xian Tang performs to restore balance in the body:

How It Addresses the Root Cause

TCM doesn't just suppress symptoms — it aims to resolve the underlying imbalance. Here's how Sheng Xian Tang works at the root level.

This formula addresses the sinking of the pectoral Qi (zong qi), which is the vital force stored in the chest that governs breathing and supports the heart's circulation. When this Qi becomes deficient and sinks, it can no longer properly lift and expand the lungs, leading to shortness of breath, a feeling of not getting enough air, chest oppression, and fatigue. The pulse becomes deep, slow, and weak, especially at the front position. This condition often arises after prolonged illness, overwork, or excessive use of Qi-dispersing herbs, and may involve both the Lung and Heart systems.

Formula Properties

Every formula has an inherent temperature, taste, and affinity for specific organs — these properties determine how it interacts with the body

Overall Temperature

Slightly Warm

Taste Profile

Predominantly sweet with some bitterness; sweet tonifies and raises Qi, bitter clears heat and dries dampness.

Ingredients

5 herbs

The herbs that make up Sheng Xian Tang, organized by their role in the prescription

King — Main ingredient driving the formula
Deputy — Assists and enhances the King
Assistant — Supports or moderates other herbs
Envoy — Directs the formula to its target
King — Main ingredient driving the formula
Huang Qi

Huang Qi

Astragalus root

Dosage 15 - 30g
Temperature Slightly Warm
Taste Sweet (甘 gān)
Organ Affinity Spleen, Lungs

Role in Sheng Xian Tang

Tonifies Qi and raises the sunken pectoral Qi; the primary herb that directly addresses the sinking.
Deputies — Assists and enhances the King
Chai Hu

Chai Hu

Bupleurum root

Dosage 3 - 6g
Temperature Slightly Cool
Taste Acrid / Pungent (辛 xīn), Bitter (苦 kǔ)
Organ Affinity Liver, Gallbladder, Lungs

Role in Sheng Xian Tang

Assists in lifting the sunken Qi from the left (Shaoyang direction), reinforcing the lifting action.
Sheng Ma

Sheng Ma

Cimicifuga rhizome

Dosage 3 - 6g
Temperature Slightly Cool
Taste Acrid / Pungent (辛 xīn), Sweet (甘 gān)
Organ Affinity Lungs, Spleen, Stomach, Large Intestine

Role in Sheng Xian Tang

Assists in lifting the sunken Qi from the right (Yangming direction), synergizing with Chai Hu.
Assistant — Supports or moderates other herbs
Zhi Mu

Zhi Mu

Anemarrhena rhizome

Dosage 6 - 12g
Temperature Cold
Taste Bitter (苦 kǔ), Sweet (甘 gān)
Organ Affinity Lungs, Stomach, Kidneys

Role in Sheng Xian Tang

Cools and moistens to moderate Huang Qi's warm nature, preventing excessive heat while also mildly tonifying Qi.
Envoy — Directs the formula to its target
Jie Geng

Jie Geng

Balloon flower root

Dosage 3 - 6g
Temperature Neutral
Taste Bitter (苦 kǔ), Acrid / Pungent (辛 xīn)
Organ Affinity Lungs

Role in Sheng Xian Tang

Directs the formula's actions upward to the chest, acting as a messenger to guide the other herbs.

Why This Combination Works

How the herbs in Sheng Xian Tang complement each other

Overall strategy

The formula directly tonifies the pectoral Qi and lifts it back to its proper place in the chest, restoring normal respiration and circulation.

King herbs

Huang Qi (Astragalus) is the king herb. It powerfully tonifies Qi and has a natural upward-lifting action, making it ideal for raising sunken Qi. It enters the Lung and Spleen channels, directly supplementing the source of pectoral Qi.

Deputy herbs

Chai Hu (Bupleurum) and Sheng Ma (Cimicifuga) serve as deputies. Chai Hu lifts the sunken Qi from the left (Shaoyang direction), while Sheng Ma lifts from the right (Yangming direction). Together they reinforce the upward movement, ensuring the Qi rises symmetrically.

Assistant herbs

Zhi Mu (Anemarrhena) is the assistant. It is cool and moistening, counteracting the warm nature of Huang Qi to prevent excessive heat. It also has a mild Qi-tonifying effect itself, as recorded in the Shen Nong Ben Cao Jing.

Envoy herbs

Jie Geng (Platycodon) acts as the envoy. It directs the entire formula upward to the chest, like a boat carrying the medicinal effects to the upper body.

Notable synergies

Huang Qi paired with Chai Hu and Sheng Ma creates a strong lifting force that specifically targets sunken pectoral Qi. The combination of Zhi Mu with Huang Qi balances warming and cooling, making the formula suitable for long-term use without causing dryness or heat.

How to Prepare

Traditional preparation instructions for Sheng Xian Tang

Combine the herbs in a pot with 3-4 cups of water. Bring to a boil, then simmer until reduced to about 1.5-2 cups. Strain and take the decoction warm, usually divided into two doses per day.

Common Modifications

How practitioners adapt Sheng Xian Tang for specific situations

Added
Ren Shen

6-10g, to strongly tonify original Qi

Shan Zhu Yu

6-12g, to astringe and prevent further Qi leakage

Ren Shen powerfully supplements Qi, while Shan Zhu Yu stabilizes and consolidates, preventing the tonified Qi from dispersing.

Educational content — always consult a qualified healthcare provider or TCM practitioner before using any herbal formula.

Contraindications

Situations where Sheng Xian Tang should not be used or requires extra caution

Caution

Not suitable for patterns of excess heat, high fever, or yin deficiency with fire. The formula's warming and lifting nature may exacerbate these conditions.

Caution

Use with caution in patients with hypertension, hyperthyroidism, or Liver Yang rising, as the formula's ascending action may raise blood pressure or aggravate symptoms.

Caution

Use with caution in patients with bleeding disorders or taking anticoagulants, due to potential blood-moving effects of some herbs.

Caution

The original text notes '斟酌' (use with careful consideration), indicating that the formula should be prescribed only when the pattern of pectoral Qi sinking is clearly diagnosed.

Special Populations

Important considerations for pregnancy, breastfeeding, and pediatric use

Pregnancy

Generally not contraindicated but should be used with caution. Sheng Ma (升麻) may theoretically stimulate uterine contractions; avoid in early pregnancy or if there is risk of miscarriage. Huang Qi (黄芪) is generally considered safe in pregnancy for Qi deficiency patterns. Best used under guidance of a qualified TCM practitioner.

Breastfeeding

Generally considered safe during breastfeeding, but no specific studies on breast milk transfer of the herbs in this formula. Caution is advised; monitor the infant for any adverse reactions. Consult a healthcare provider before use.

Children

Dosage for children is typically 1/3 to 1/2 of the adult dose, adjusted by a qualified practitioner based on age, weight, and severity of the condition. Not suitable for children with heat patterns, high fever, or excessive fire. Monitor for signs of dryness, constipation, or irritability, and discontinue if adverse reactions occur. Use only under professional supervision.

Drug Interactions

If you are taking pharmaceutical medications, be aware of these potential interactions with Sheng Xian Tang

  • Huang Qi (黄芪): May inhibit CYP1A2, CYP2D6, and CYP2C9 enzymes, potentially increasing blood levels of drugs metabolized by these pathways (e.g., warfarin, theophylline, some antidepressants). Monitor closely if used concurrently.
  • Chai Hu (柴胡): May induce CYP3A4, potentially reducing efficacy of drugs metabolized by this enzyme (e.g., certain calcium channel blockers, immunosuppressants).
  • Sheng Ma (升麻): Has a lifting and raising effect; may counteract the action of antihypertensives or beta-blockers, possibly leading to elevated blood pressure or increased heart rate.
  • Zhi Mu (知母): Its cooling and moistening nature may potentiate the effects of diuretics or hypoglycemics; monitor fluid and electrolyte balance.
  • No well-documented serious drug interactions exist, but caution is advised when combining with prescription medications. Consult a healthcare provider before concurrent use.

Usage Guidance

Practical advice for getting the most out of Sheng Xian Tang

Best time to take

30 minutes before meals or 1–2 hours after meals, preferably in the morning and early afternoon.

Typical duration

Typically prescribed for 2–4 weeks, with reassessment by a practitioner. For chronic conditions, may be continued for several months under professional guidance.

Dietary advice

Avoid cold, raw, and greasy foods while taking this formula, as they can impair the Spleen's Qi-raising function. Favor warm, easily digestible foods. Avoid excessive spicy or pungent foods that may disperse Qi. Limit alcohol and caffeine, which can counteract the formula's consolidating effect.

Sheng Xian Tang originates from 《医学衷中参西录》(Records of Chinese Medicine in Reference to Western Medicine) by Zhang Xichun Late Qing dynasty, ~1909 CE

Classical Texts

Key passages from the classical Chinese medical texts that first described Sheng Xian Tang and its clinical use

升陷汤,以黄芪为主者,因黄芪既善补气,又善升气。唯其性稍热,故以知母之凉润者济之。柴胡为少阳之药,能引大气之陷者自左上升。升麻为阳明之药,能引大气之陷者自右上升。桔梗为药中之舟楫,能载诸药之力上达胸中,故用之为向导也。
— 张锡纯《医学衷中参西录》
胸中大气下陷,气促急短,呼吸困难,脉沉迟微弱,或参伍不调。
— 张锡纯《医学衷中参西录》
大气下陷者,气短不足以息,或努力呼吸,有似乎喘;或气息将停,危在顷刻。
— 张锡纯《医学衷中参西录》

Historical Context

How Sheng Xian Tang evolved over the centuries — its origins, lineage, and place in the broader tradition of Chinese medicine

升陷汤 (Sheng Xian Tang) was created by Zhang Xichun (张锡纯, 1860–1933), a prominent physician of the late Qing dynasty and early Republic period. It first appeared in his influential work 《医学衷中参西录》 (Records of Chinese Medicine in Reference to Western Medicine), published in 1909. Zhang Xichun is celebrated for his integration of Chinese and Western medical knowledge, and 升陷汤 is considered his signature formula for treating 'sinking of the pectoral Qi' (大气下陷).

Zhang derived the formula from Li Dongyuan's 补中益气汤 (Bu Zhong Yi Qi Tang), removing herbs like Bai Zhu and Dang Shen, and adding Zhi Mu and Jie Geng. The formula's theoretical foundation lies in the concept of 'pectoral Qi' (宗气) from the 《黄帝内经》 (Huang Di Nei Jing). Zhang's innovation was to focus on raising the sinking Qi of the chest rather than just the middle Qi, making the formula more targeted for respiratory and cardiovascular collapse syndromes.

Modern Research

3 published studies investigating the pharmacological effects or clinical outcomes of Sheng Xian Tang

1

Network Pharmacology Study on the Mechanism of Sheng Xian Tang in Treating Heart Failure

Wang MZ, Fu DY, Yao L, et al. Journal of Chinese Patent Medicine, 2021; 43(1): 228-234.

This study used network pharmacology to analyze the active ingredients of Sheng Xian Tang and their targets in heart failure treatment. 76 active compounds were identified, acting on 197 heart failure-related targets including AKT1, IL-6, and VEGFA. The formula was found to regulate PI3K-Akt, IL-17, HIF-1, and TNF signaling pathways, contributing to anti-inflammatory, antioxidant, and pro-angiogenic effects.

DOI
2

Clinical Observation of Modified Sheng Xian Tang in Adjunctive Treatment of Acute Episode of Chronic Pulmonary Heart Disease

Li E, Wang ZX, Lv JJ. China Pharmacy, 2016; 27(26): 3700-3703.

A randomized controlled trial of 208 patients with acute exacerbation of chronic pulmonary heart disease. The group receiving modified Sheng Xian Tang in addition to standard Western treatment showed significantly improved cardiac function (NYHA class), FEV1, and clinical symptom scores compared to the control group (P<0.05). The total effective rate was 98.1% in the observation group vs 90.4% in the control group. No significant adverse reactions were observed.

DOI
3

Observation on the Therapeutic Effect of Sheng Mai San Mixed Jiawei Sheng Xian Tang on Heart Failure with Reduced Ejection Fraction of Qi Deficiency Blood Stasis Type

Li YJ, Zhang H, Hao ST, et al. Tianjin Medical Journal, 2025; 53(8): 860-864.

This clinical study of 90 patients with heart failure with reduced ejection fraction (HFrEF) of Qi deficiency blood stasis type found that adding Sheng Mai San mixed with Jiawei Sheng Xian Tang to standard sacubitril/valsartan therapy significantly improved LVEF, reduced LVEDD, and lowered NT-proBNP, TNF-α, IL-6, and Gal-3 levels compared to standard therapy alone (P<0.05). The combined group had a higher total effective rate.

DOI

Research on TCM formulas is growing but still limited by Western clinical trial standards. These studies provide emerging evidence and should be considered alongside practitioner expertise.