Can’t Eat, Bloated Belly, Constant Diarrhea? The Same Ginseng That Cured Him — Then Nearly Killed Him

Patient search terms: can’t eat / no appetite / poor appetite / bloated belly / diarrhea / frequent diarrhea / loose stools / no energy at all

Opening: the same patient — ginseng cured him three years ago, and the same ginseng nearly destroyed him three years later

This is a story worth telling, because it is a test question in “treating the same disease with different methods.”

In Wuxi there lived a patient named Qin Gong’an (some records write Qin An — let’s not get hung up on the name). The first time he came for treatment, the diagnosis was zhong qi xu bu neng shi — middle qi deficiency, unable to eat. His middle qi (the qi of the spleen and stomach that holds everything up) was insufficient, so he could barely get any food down; his appetite was terrible. Doctor Miao Xiyong treated him mainly with ginseng and cured him. But three years later he fell ill again — once more unable to eat. This time a doctor heard, “Last time ginseng cured him,” and prescribed ginseng accordingly. The result? Not only did the patient fail to improve — he got worse.

Same symptom. Three years earlier, ginseng saved his life. Three years later, the same ginseng caused harm. The difference between these two moments is exactly what today’s lesson is about: tonifying spleen qi versus nourishing spleen yin.

💬 Note from Doctor Luo: Friends, this kind of story fills the old books — the same person, the same “can’t eat,” yet the cause this year and the cause three years later are completely different. Chinese medicine calls this tong bing yi zhi — “the same disease, different treatments.” If you simply memorize “can’t eat → use ginseng,” you are cutting a notch in your boat to mark where a sword fell in the water — a rigid, outdated method that will get you into trouble sooner or later. This story is the perfect example.

Who was the patient: middle qi deficiency, bloated after a few bites, and always running to the toilet

Doctor Miao Xiyong writes his case records with great economy. Right at the start he names the cause: “zhong qi xu bu neng shi” — middle qi is deficient, so food cannot be taken. Middle qi is weak, so the appetite fails.

Why does middle qi deficiency ruin the appetite? Everyone knows the feeling: no appetite, bloated after the smallest meal, food that doesn’t digest. Because qi deficiency means the body lacks the power to transform and transport — the spleen and stomach can’t turn the wheel anymore. Food piles up in the stomach, distended and uncomfortable, so of course you don’t want to eat. That was Qin Gong’an’s state exactly: whatever he ate was hard to digest, his stomach felt blocked and miserable, his chest and diaphragm felt tight. And here’s the twist — his belly was bloated, yet he constantly had diarrhea, leaking downward at the same time.

💬 Note from Doctor Luo: Notice this detail: the belly is distended, but the stool is still loose. This is not “stuck solid” — it is “too weak to hold things in.” When spleen-stomach qi is deficient, it can’t contain and anchor, so qi leaks downward — hence bloating and diarrhea at the same time. This kind of “deficient bloating” and true “excess bloating” require completely opposite treatments. Mix them up and people get hurt.

The first doctor got it wrong: it was deficiency, but he used qi-breaking herbs and made the diarrhea worse

Qin Gong’an first consulted another physician. This doctor looked at the case and thought: your belly bloats after eating — isn’t that qi stagnation stuck inside? Then let’s move the qi! So he prescribed zhi qiao (bitter orange) and qing pi (green tangerine peel) — the so-called qi-breaking herbs. Qing pi is the peel of unripe green tangerines; it “breaks” qi much harder than chen pi (aged tangerine peel) — it pushes straight into the “breaking” direction.

The result? The diarrhea became stubborn and unmovable — xia li wan gu bu hua. He passed food that was completely undigested, and his complexion turned a sickly pale-white.

Why was this a mistake? Because the same “food won’t digest and the belly bloats” can be excess or deficiency:

• Excess pattern: for example, anger and frustration stagnating the qi, or overeating piling up as food stagnation. Here you use qi-moving and food-dissolving herbs (jiao san xian — charred hawthorn, charred barley sprout and charred medicated leaven; chen pi; fo shou — finger citron; yu jin — turmeric root tuber) to open the blockage. Once the stuck stuff dissolves, the body relaxes. People in the excess pattern have clear markers: a thick, greasy, yellow tongue coating, bad breath, acid reflux, nausea, and a belly that feels hard when pressed.
• Deficiency pattern: the body genuinely cannot transform and transport — and this is now very common, built up slowly over years. These people show a pale, bloodless face, no strength anywhere, a weak breathy voice, and a swollen tongue with teeth marks on the sides, pale and tender in substance. Qi deficiency means no power to transform; they bloat after a few bites, the belly feels full, yet diarrhea continues anyway.

💬 Note from Doctor Luo: For a deficiency pattern, qi-breaking herbs make things worse the more you move the qi. The patient already has no power to transform — break the qi further and the spleen and stomach simply stop turning altogether. So learn this distinction well: thick greasy yellow coating, bad breath, acid reflux, nausea, hardness on pressing = excess (break it downward). Pale face, no energy, weak voice, swollen tongue with teeth marks = deficiency (build it upward). One goes down, one goes up — never reverse them.

Doctor Miao Xiyong’s prescription: ginseng 4 qian as the lead — a generous dose

When the family saw the patient getting worse under treatment, they hurriedly summoned Doctor Miao Xiyong. One look and he said: this is middle qi deficiency. The bloated belly, the inability to eat — it is all deficiency, all the result of failing to transform and transport.

What did he prescribe? Ren shen (ginseng), 4 qian — a solid dose; by this time Doctor Miao was already using northeastern (Jilin) ginseng, which acts powerfully. Paired with:

• Bai zhu (atractylodes), 2 qian — works with the ginseng to strengthen the spleen;
• Ju hong (red tangerine peel), a bit over 1 qian — moves the qi, but only lightly, a touch here and there;
• Processed gan jiang (dried ginger), 7 fen — a very small amount, just to warm the middle burner a little;
• Zhi gan cao (honey-fried licorice), 1 qian (about 3 g);
• Da zao (jujube) and rou dou kou (nutmeg) — to warm the spleen and stomach. When deficiency has lasted long, there is usually some yang deficiency underneath, so he added a few warming herbs.

After four or five doses, his body began to improve steadily. Once he was on the mend, Doctor Miao raised the ginseng dose — up to about 1 liang, roughly 30 g at a time! Relying on that single large dose of ginseng, the disease was completely cured.

💬 Note from Doctor Luo: Doctor Miao Xiyong was one of the great popularizers of ginseng — he used it masterfully. See his logic: since you are qi-deficient and cannot transform and transport, I will use ginseng — the number-one qi tonic — to push upward and lift the qi of the spleen and stomach. Four qian to start, then double the dose once improvement begins, to 1 liang (30 g) at a time — a bold move for his era. His brilliance: he knew the disease was deficiency, he knew which herb to lead with, and the main herb subdued the illness the moment it landed.

Why is ginseng so good? It tonifies yuan qi, strengthens the spleen and lung, generates fluids, and settles the spirit

Using this case, Doctor Luo Dalun explains ginseng’s four great functions in full:

First — it greatly tonifies yuan qi (original qi). When yuan qi is on the verge of collapse and a person is drained to the bone, ginseng is the herb that rebuilds it.

Second — it strengthens the spleen and benefits the lung. For the spleen: this targets spleen-stomach weakness — eating little, stools that never firm up, diarrhea out of nowhere (qi deficiency can’t hold things in), fatigue and lethargy — the “I’m dead tired all day, I collapse on the sofa after every meal, my limbs don’t even feel like mine” kind of exhaustion; also qi-deficient vomiting and diarrhea. All respond especially well. For the lung qi: panting at the slightest exertion, spontaneous sweating, constant fatigue, and endless recurring colds — this is lung qi not secure, and ginseng’s spleen-and-lung tonification is remarkably effective.

Third — it generates fluids and stops thirst. People with qi deficiency or dual qi-yin depletion get extremely thirsty, often with a parched mouth. Ginseng generates body fluids — especially paired with mai men dong (ophiopogon) and sha shen (glehnia) — and the effect is excellent. People assume ginseng always causes “heat” or上火; in fact ginseng generates fluids. In the old days, for dry mouth, thirst, and wasting-thirst (xiao ke), ginseng with fluid-generating herbs worked very well.

Fourth — it calms the spirit and settles the mind. When qi deficiency leaves heart-lung qi insufficient, the chest feels somehow unsettled, and the person becomes anxious, fearful, palpitation-prone — “something terrible is about to happen,” soul not in the body. For this kind of spirit disturbance rooted in qi deficiency, Doctor Luo’s experience is: use qi-tonifying herbs such as ginseng and atractylodes, with ginseng as the lead. When qi and yin are replenished, the person gradually settles down.

💬 Note from Doctor Luo: Ginseng looks like a little human figure, and the ancients felt it must be extraordinary. Its spirit-settling power is real — I have treated patients with spirit disorders, fearful and restless, soul-not-in-the-body states, and in general I use qi tonics with ginseng as the lead. Once the qi and yin are filled up, they slowly recover. This is one of ginseng’s most overlooked functions.

Three years later, the relapse: same inability to eat — this time ginseng failed

Three years later, Qin Gong’an fell ill again: han re bu shi — alternating chills and fever, and once more unable to eat.

The doctor who came heard the history: “This patient had this illness before; Doctor Miao Xiyong cured him with ginseng! Simple — I’ll use ginseng too!” He did — and the patient’s condition grew worse.

The doctor was baffled. How could ginseng fail this time? He can’t eat — same as before! At a loss, he went back to fetch Doctor Miao.

Doctor Miao came, looked, and said: this time is different — ci yin xu ye, this is yin deficiency! It needs yin-nourishing treatment; ginseng must not be used (bu yi yong shen).

💬 Note from Doctor Luo: There it is — the difference between the skilled and the unskilled. The unskilled doctor memorizes symptom-to-herb correspondences: can’t eat → ginseng. The skilled doctor reads the pattern: three years ago you were qi-deficient; now you are yin-deficient. Same symptom, completely different mechanism. Using ginseng to build qi on top of yin deficiency is like pouring oil on the fire of deficiency heat — how could it not make things worse?

The yin-nourishing formula: Sheng Mai San with the ginseng removed, plus achyranthes, goji berry, peony, poria and dendrobium

This time Doctor Miao’s prescription: mai men dong (ophiopogon) and wu wei zi (schisandra) — this is the base of Sheng Mai San (Generate the Pulse Powder), but with the ginseng removed! Mai men dong nourishes yin; wu wei zi is sour and astringent, gathering the yin of the five organs. He then added:

• Niu xi (achyranthes) — tonifies liver and kidney, strengthens the sinews and bones;
• Gou qi zi (goji berry) — tonifies the essence of liver and kidney;
• Shao yao (peony) — nourishes and astringes liver yin;
• Fu ling (poria) — drains dampness and strengthens the spleen — once the dampness is gone, spleen qi rises again;
• Shi hu (dendrobium) — nourishes yin;
• Suan zao ren (sour jujube seed) — nourishes the blood;
• Bie jia (turtle shell) — clears deficiency heat, drawing the pathogen out from the yin level.

After about ten-plus doses, he was completely cured.

💬 Note from Doctor Luo: Mai men dong, wu wei zi, niu xi, gou qi zi, shao yao, shi hu, fu ling — these are the most commonly used yin-nourishing herbs. Remember them; you can write them out directly. This patient was in fact spleen yin deficient, and Doctor Miao Xiyong systematized a whole method for treating spleen yin — those are the core herbs, and that’s all.

The spleen-yin doctrine: textbooks say “the spleen has yang but no yin” — actually, Chinese medicine was missing a piece

Here is an important academic point: the spleen-yin doctrine (pi yin xue shuo).

Everyone calls Zhu Danxi the representative of the yin-nourishing school — but that’s actually a bit of a misunderstanding. What Zhu Danxi called “nourishing yin” was nourishing blood plus clearing heat. He mixed yin and blood together, treated blood as the main thing, and added some heat-clearing herbs — that, he called nourishing yin. The “yin” he spoke of is not the same thing we mean today.

Doctor Miao Xiyong was a true yin nourisher, and he paid particular attention to spleen yin, establishing the spleen-yin doctrine. Every organ has yin and yang: liver yin and liver yang, heart yin and heart yang, kidney yin and kidney yang… but when it comes to the spleen, the textbooks only ever speak of spleen yang and spleen qi. Spleen yin is almost never discussed — as if the spleen had yang but no yin. That is the missing piece in Chinese medicine.

💬 Note from Doctor Luo: Doctor Miao Xiyong explained spleen yin clearly back in the Ming dynasty: yin deficiency shows differently in each organ, and when it lands on the spleen, it is spleen yin insufficiency. Later this doctrine was inherited by Ye Tianshi in the Qing dynasty, who extended it into stomach yin — which is why, in treating stomach disease today, we so often use Ye Tianshi’s method of nourishing stomach yin. Trace the spleen-yin doctrine to its root, and it is Doctor Miao Xiyong who proposed it.

What does a spleen-yin-deficient person look like? Red tongue, no coating — often with teeth marks

What does spleen yin insufficiency look like? Also a distended belly, frequent failure to transform and transport, bloated after a few bites — but there is one key difference from spleen yang (qi) deficiency: the tongue is red — bright red; the coating is very thin or absent — and yet often there are teeth marks on the sides (spleen-deficiency signs and yin-deficiency signs together). The tongue shape isn’t necessarily thin; some people have a full, fleshy tongue — but it is red.

Such people like cold drinks — they feel cool, moist, and comfortable; spicy food makes them miserable. At the same time there are yin-deficiency signs: hot palms and soles, night sweats — and spleen-deficiency signs: a distended belly and no appetite.

💬 Note from Doctor Luo: Note this: a spleen-yin-deficient person doesn’t want to eat — because the spleen and stomach are dry, parched, withered, with no fluids to moisten them; food feels uncomfortable and hard to transform. This is not the stomach-yin-deficiency pattern of “hungry, desperately wanting to eat but unable to get food down.” One is “doesn’t want to eat,” the other is “can’t get food in” — different mechanisms. And why are so many children today spleen-yin deficient? Day after day of beef, lamb, spicy mala hotpot — hot-natured foods make the body hotter and hotter while yin drains away. When the yin depletion lands on the spleen, you get spleen yin deficiency.

Bonus: children whose meat-heavy diets create spleen yin deficiency — how to fix it

Doctor Luo has a special warning for today’s parents: some children eat beef, lamb, steak every day, plus mala hotpot and spicy dry-pot dishes — too many hot-natured foods, and the child becomes spleen-yin deficient.

The signs: frequent stomach trouble, a big distended belly, bright red lips, bright red tongue — and in worse cases even spirit problems: mania, hyperactivity. Why? The spleen governs thinking and worry; and from the gut-microbiome angle, changes in the intestinal flora interact with the emotions. So many children who are emotionally agitated and hyperactive are tied to exactly this chain.

What to do? Nourish spleen yin. The basic strategy is nourish yin plus strengthen the spleen: sha shen (glehnia), mai men dong (ophiopogon), gou qi zi (goji berry), shao yao (peony), shi hu (dendrobium) for nourishing yin, plus fu ling (poria) to strengthen the spleen; you may also add huai shan yao (Chinese yam), lian zi rou (lotus seed), and bai bian dou (white hyacinth bean) — yin nourishment plus spleen tonic is exactly how you nurture spleen yin. In later classic cases of spleen yin deficiency we will come back to bai bian dou and yi yi ren (pearl barley).

💬 Note from Doctor Luo: The spleen-yin doctrine that Doctor Miao Xiyong created has extremely wide application today — because modern people consume so many high-calorie, hot-natured foods, the body runs hotter and hotter, the yin depletion lands on the spleen, and the result is deficiency heat in the spleen-yin-deficient. Children especially. This is not some dead theory from a few hundred years ago — it is something you can use every single day.

Two lessons to carry with you today

This case is small, but there is a great deal to learn from it:

First — for loss of appetite and diarrhea from spleen qi deficiency, the qi-tonifying herbs matter most, and ginseng is the core. Si Jun Zi Tang (Four Gentlemen Decoction) leads with ginseng; Gui Pi Wan (Restore the Spleen Pill) also contains ginseng. Remember ginseng’s use: it strengthens the spleen and benefits the lung, and it is especially effective for spleen qi deficiency, undigested food, inability to eat, and diarrhea.

Second — don’t cut the boat to find your sword. The illness of last winter got last winter’s formula; when the same person falls ill this summer, the cause may have changed completely. The patient’s condition and habits three years on may all be different. You have to take up and trim the prescription at every visit — bian zheng lun zhi, treat according to the pattern, never “match the symptom to the slot.”

💬 Note from Doctor Luo: The story ends here, but keep the lesson in your heart: first, distinguish deficiency from excess; second, recognize that the pattern changes with the person. To tonify spleen qi use ginseng; to nourish spleen yin use mai men dong, sha shen, gou qi zi, shao yao, and shi hu paired with fu ling. Keep these two approaches in mind, and the next time a relative or friend “can’t eat and bloats after meals,” you will at least know roughly which direction the wind is blowing — and which way to point them for a doctor.

Case compiled from Doctor Luo Dalun’s public lectures on Doctor Miao Xiyong’s case records; the case comes from Xian Xing Zhai Yi Xue Guang Bi Ji (《先醒斋医学广笔记》) by Doctor Miao Xiyong (Ming dynasty).