High Fever with Delirium and Unconsciousness? Doctor Zhang Xichun’s Raw Gypsum Water with Codonopsis for Syphilis Complicated by Epidemic Heat

The opening: Doctor Zhang Xichun walks into a Japanese hospital carrying a “bottle of wine”

In the Republican era, in Shenyang, a patient lay dying in the Dongren Hospital run by Japanese doctors. The Japanese physicians had already announced: this illness cannot be treated. It was at that moment that Doctor Zhang Xichun arrived — carrying a “bottle of wine.”

💬 Note from Doctor Luo: Western medicine had already entered China by then, and the Japanese had opened a hospital in Shenyang. The patient was a section chief in the Shenyang county government office who had contracted syphilis. He had been treated at Dongren Hospital for more than twenty days, and the more he was treated, the worse he became. The Japanese doctors said: the toxin has already spread through the whole body — there is nothing more we can do. His friend, Sun Junru, a clerk in the police affairs department (jing wu chu), was at his wit’s end and went to beg Doctor Zhang Xichun for help. Doctor Zhang Xichun could hardly refuse, and decided to go and take a look.

Who was the patient — and how sick was he?

The section chief’s name is never recorded in the case. Doctor Luo explained why: because syphilis was not considered a respectable illness, Doctor Zhang Xichun concealed his name. But the severity of his illness is described in full detail: his head and face were hugely swollen; his lower body was ulcerated; he burned with a whole-body high fever; and he had already fallen into delirium — unconscious and raving — lying there, unable to utter a single coherent sentence.

💬 Note from Doctor Luo: Shen hun zhan yu — that is, unconscious and talking nonsense. When a patient reaches this state, the Japanese hospital said there was no hope. But Doctor Zhang Xichun, hearing the description, already had a strong hunch: this illness must involve epidemic febrile disease (wen bing)! It was clearly a pattern of heat. So before he left the house, he had his family boil up a large bottle of water to bring along.

Half a jin of raw gypsum, boiled into water and poured into a wine bottle

The “water” Doctor Zhang Xichun carried was nothing ordinary: half a jin (about 250 grams, or eight liang) of raw gypsum (sheng shi gao), ground fine, boiled into one large bottle — poured into a wine bottle and sealed, disguised as liquor.

💬 Note from Doctor Luo: Why put it in a wine bottle? Because he was afraid the Japanese doctors would not let him treat the patient! The Japanese hospital said: this patient we cannot treat, and nobody can treat him — they refused to let Doctor Zhang Xichun anywhere near the ward. So Doctor Zhang Xichun carried his “wine” and said: I’m just going to visit a friend. The Japanese staff saw a bottle of liquor, thought nothing of it, and let him in. What is raw gypsum? It is the essential herb for penetrating heat and resolving toxin — used specifically for heat patterns. Doctor Zhang Xichun had judged that the patient had an epidemic heat complication, and had prepared this “gypsum water” in advance.

One touch of the pulse: large and forceful — epidemic heat beyond doubt

When Doctor Zhang Xichun entered the ward he saw: the man’s head and face were swollen enormously, red and puffy. He took the pulse — it beat large and forceful. This was ironclad evidence of blazing heat.

💬 Note from Doctor Luo: A large, forceful pulse (hong da you li) is the signature of exuberant heat. Doctor Zhang Xichun felt even more confident: syphilis or not, first treat this epidemic heat! He had the family warm the gypsum water and feed it to the patient little by little, aiming to finish the bottle within the day. That day’s gypsum water was the main assault force against the heat.

Day one: the swelling of the head and face begins to recede — but the patient is still not clear-headed

When Doctor Zhang Xichun returned the next day, there was good news: the redness and swelling of the head and face had begun to subside, and the surging force of the pulse had diminished by half — the heat was retreating. Yet the pulse was beating even faster than before, and the man remained clouded and raving, not the least bit conscious.

💬 Note from Doctor Luo: Half the gypsum water was still left. Should he keep clearing heat, or change course? Doctor Zhang Xichun stared at the pulse and pondered: a rapid pulse (shu mai) can mean two things. One is yin deficiency with heat; the other is great deficiency of the upright qi. Consider all the white-collar workers today who are exhausted day after day — their pulses race too. That is not yin deficiency; it is great deficiency of upright qi, especially in people whose kidney essence is severely depleted. Delirium and raving are not always caused by heat either — when the upright qi is insufficient, a person can also fall into delirium.

The crucial move: five qian of Lu Codonopsis, decocted and poured into the gypsum water

Doctor Zhang Xichun’s judgment was this: the patient had been battered by the heat pathogen for more than twenty days — his upright qi was now greatly depleted. Clearing heat alone, and the man could not hold out; the upright qi had to be supported. He had the family buy the medicine themselves: five qian (about 15 grams) of Lu dang shen (Codonopsis root), decocted into a soup, poured into the remaining gypsum water, to be finished in one day.

💬 Note from Doctor Luo: Note — here he used dang shen (Codonopsis), not ren shen (ginseng). Why? Doctor Zhang Xichun was wary of heat: the patient’s body was still burning inside, and ginseng is warming in nature, so at this moment ginseng would not be appropriate; Codonopsis is mild. (Doctor Zhang Xichun loosely called Codonopsis “ginseng” as well.) Lu dang shen is the Codonopsis produced in Luzhou, Shanxi — the authentic Dao-di herb. Doctor Luo also reminds us that when writing prescriptions, ginseng and Codonopsis should be chosen with care: when you truly need to greatly tonify the primordial qi in an emergency, use ginseng; for a gentler treatment that does not require such force, use Codonopsis, which is milder. Ginseng can sometimes run hot; Codonopsis stays balanced — the two can be alternated according to the situation. This move of Doctor Zhang Xichun’s follows the thinking of Doctor Zhang Zhongjing — when using raw gypsum to resolve heat, one often pairs it with a little ginseng or Codonopsis.

The turnaround: full consciousness restored — and the patient demands a transfer

On the third day, Doctor Zhang Xichun came again. The moment he walked in, the patient was awake — his mind completely clear, and the pulse calm and level. The patient opened his eyes and asked: what happened to me these past two days? When the story was told, the patient made his decision on the spot: Why should I stay in this hospital? Take me to Doctor Zhang Xichun’s hospital!

💬 Note from Doctor Luo: And so the patient checked out and moved to Doctor Zhang Xichun’s hospital for treatment. After about ten days of care, the syphilis was cured too! Look at the scale of Doctor Zhang Xichun’s skill — he turned the tide. The gypsum cleared the heat, the Codonopsis restored the upright qi, and with no reinforcements left for the pathogen, it naturally retreated.

The finishing touch: attacking the pathogen alone is not enough — support the upright qi to drive it out

The most valuable lesson of this case comes at the very end.

💬 Note from Doctor Luo: Doctor Zhang Xichun was a very careful physician. When he treated a serious illness and used raw gypsum to clear heat, he would often add a little ginseng or Codonopsis — this is Doctor Zhang Zhongjing’s thinking! In the Shang Han Lun (Treatise on Cold Damage), the Bai Hu Tang (White Tiger Decoction) clears heat, and when the upright qi is insufficient, ginseng is added — then it is called Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng). Doctor Zhang Xichun had absorbed this approach: when attacking illness in a severe case, if you only clear heat and attack the pathogen, a person with insufficient upright qi cannot bear it; pair it with Codonopsis or ginseng to replenish the upright qi, and only then can the pathogen be driven out.

Bonus: when you see ginseng or Codonopsis in a formula, that is the signal of supporting upright qi

Finally, Doctor Luo turned the day’s learning into a practical reminder.

💬 Note from Doctor Luo: When we treat externally contracted illnesses — colds with fever — it is not all about resolving toxin and inducing sweat. Often, when we see that the upright qi is insufficient, we add qi-tonifying herbs to the formula — ginseng, Codonopsis, sometimes huai shan yao (Chinese yam). When the upright qi is sufficient, only then can the pathogen be expelled. From now on, when you read a doctor’s prescription for an externally contracted illness and you see dang shen, tai zi shen (Radix Pseudostellariae), or ren shen, these are all there to support the upright qi. When children are ill, huai shan yao and lian zi rou (lotus seeds) in the formula serve the same purpose. That is today’s lesson.

When the fever will not break and the mind goes cloudy, clearing heat alone is not enough — if the upright qi is depleted, the pathogen cannot be driven out. With one bottle of gypsum water and five qian of Lu Codonopsis, Doctor Zhang Xichun pulled a patient back from the Japanese hospital’s verdict of “incurable.” Tomorrow, Doctor Luo continues with how Doctor Zhang Xichun used ginseng itself.

What to take away

• Heat is not the whole story: a blazing high fever with delirium (shen hun zhan yu) can come from exuberant heat — or from severely depleted upright qi; both must be weighed.
• The pulse is the clue: a large, forceful pulse confirms heat; a rapid pulse that persists after clearing heat may instead signal yin deficiency or great qi deficiency — many modern people with racing pulses are qi-deficient, not yin-deficient.
• Gypsum water: half a jin (about 250 g) of raw gypsum (sheng shi gao), ground fine and boiled, fed warm little by little, penetrates heat and resolves toxin.
• The Doctor Zhang Zhongjing principle: when using raw gypsum to clear heat, pair it with ginseng or Codonopsis (as in Bai Hu Jia Ren Shen Tang) so the upright qi can sustain the attack and drive the pathogen out.
• Ginseng vs. Codonopsis: use ren shen (ginseng) when the situation is urgent and the primordial qi must be greatly tonified; use dang shen (Codonopsis) — especially Lu dang shen from Luzhou, Shanxi — for gentler support. Ginseng can run hot; Codonopsis stays mild.
• Reading a prescription: dang shen, tai zi shen, or ren shen in a cold-and-fever formula means the doctor is supporting the upright qi — for children, huai shan yao and lian zi rou play the same role.

Compiled from Doctor Luo Dalun’s commentary on Doctor Zhang Xichun’s case records, originally published in Records of Chinese Medicine with Reference to Western Medicine (《医学衷中参西录》, issued serially 1918–1934).