High Fever, Delirium, Unconsciousness, Staring Eyes — Doctor Zhang Xichun Used the White Tiger Plus Ginseng Decoction to Treat Typhoid Complicated by Meningitis

Opening: in the dead of winter, a sixty-year-old schoolmaster suddenly “lost his mind”

It was winter, in Bali Village west of Yanshan County, Hebei. A private school teacher in his sixties — Li Shuyan — suddenly fell ill. At first it seemed like nothing more than a chill from the wind, and nobody paid it much attention. But within days the old man was not himself: a burning fever, raving nonsense, unconsciousness, his eyes staring straight ahead without blinking, his hands and feet twitching in waves. His family was terrified: this was no cold — this looked like a matter of life and death.

💬 Note from Doctor Luo: We happen to be in exactly this season right now, and reading Doctor Zhang Xichun’s cases is especially useful for understanding how Chinese medicine treats external-contraction illness. Today we begin his cold-damage section (shang han men) — the section on external-contraction disease. Throughout history, external-contraction illness has been the most common and the most dangerous of all diseases, and the wisdom Chinese medicine built up around it deserves to be told in detail.

Who was the patient? An old private school teacher from Yanshan

Li Shuyan was Doctor Zhang Xichun’s fellow townsman — Zhang Xichun’s hometown was Yanshan County, Hebei. The old gentleman was past sixty and worked as a meng shu jiao yuan — a teacher at a traditional village school who taught children their first lessons. He had one chronic complaint: he was prone to dizziness — whenever there was a bit of heat in the upper burner, his mind would not be clear.

At the end of the twelfth lunar month that year, he happened to catch a chill — the cold wind blew on him and the illness began. Once the external cold got in, the body started marshaling its energy to fight back, and in that fight the fever came on — in the language of Chinese medicine, the disease passed into the yang ming.

💬 Note from Doctor Luo: What does “the disease passed into the yang ming” mean? Here we should first explain the six-channel pattern differentiation of Zhang Zhongjing’s Treatise on Cold Damage (Shang Han Lun). Taking invasion by cold as his example, Zhang Zhongjing demonstrated the body’s defense lines at different levels: tai yang — the pathogen has just arrived at the surface and the body begins to resist; yang ming — the body mobilizes all its energy to resist, resists too hard, and fever develops; shao yang — energy is running a little low, resistance comes and goes, hence alternating chills and fever; going deeper, tai yin and shao yin are both states of insufficient resistance. These are the six defensive states of the body facing an external pathogen. In the Republican era there was a famous cold-damage expert, Zhu Weiju, who explained these six levels with great clarity — the framework I am using here comes from him.

How ill was he? A tongue coating like armor and eyes staring wide

By the time Doctor Zhang Xichun was called in, Li Shuyan was already gravely ill. Zhang Xichun’s description is a list of ominous signs:

First, the tongue coating was yellow turning black, dry like “jia cuo” — like a layer of armor. The tongue would not even come out — it was no longer under the control of the mind. Dry and scorching hot: this is the mark of extreme dryness-heat.

Second, he raved without stopping. He talked nonsense endlessly, with no logic at all — he was completely unconscious. Ask him whether he was cold or hot and he did not know.

Third, both eyes stared straight ahead without blinking.

Fourth, both hands twitched restlessly. They trembled so much that taking his pulse was difficult.

Fifth, the pulse was forceful yet not solid. On the surface it seemed strong, but pressed down it had no strength — five beats per breath, a little faster than normal. His bowels had not moved for four days, and he urinated without knowing it — he wet himself without realizing.

💬 Note from Doctor Luo: Look at Zhang Xichun’s conclusion — this is a case of excess disease with a deficient pulse. The disease itself is excess: there really is pathogenic qi present. But the pulse is deficient — press down and there is no strength — which means qi and blood are exhausted and can barely resist the pathogen. That is why all these dangerous signs have appeared. A black, dry tongue coating means yang ming heat is at its peak and fluids cannot rise to moisten the mouth; staring eyes mean liver fire rushing upward; trembling hands mean liver heat consuming the blood, with internal wind about to stir; delirium and unconsciousness mean the external heat is so fierce that it rises and causes inflammation of the meninges, affecting the brain and its nerves. So Zhang Xichun’s diagnosis was: typhoid (cold damage) complicated by meningitis.

Was this really meningitis? First, tell “meningitis” from “encephalitis”

Seen through modern eyes — was this really meningitis? Doctor Luo Dalun honestly says: put a question mark on it.

💬 Note from Doctor Luo: The common symptoms of meningitis are headache and vomiting, especially projectile vomiting. This patient did not vomit prominently, and we are too far from the late Qing and Republican era to reconstruct the examinations of that time — there were no blood tests back then. But here is the thing: does it matter for Chinese medicine whether it could be confirmed as meningitis? Not really. Zhu Weiju divided external pathogens into organic pathogens and inorganic pathogens. Organic pathogens are microorganisms — bacteria, viruses — and we do not need to know exactly which one it is. Inorganic pathogens are the six excesses (liu yin) of the environment — wind, cold, summer heat, dampness, dryness, fire. This man fell ill from cold: in cold weather the upright qi is trapped, and organic pathogens slip in through the opening. What we study is the reaction the inorganic pathogen produces inside the body — the interaction between body and pathogen. Whatever pattern the body enters, we adjust according to that pattern. That approach still works today.

What Western medicine calls a “cytokine storm,” Chinese medicine understood two thousand years ago

What does “the disease passing into the yang ming” actually mean? It means the body switches into a different state: at first the body is cold; suddenly it detects a pathogen entering, mobilizes all its energy to resist, and the resistance produces high fever — this state of over-resistance is what yang ming is.

Here is the problem: resisting too hard can end up hurting the body itself. When the heat is too great, the fluids inside the body are steamed dry, and the body can no longer resist at all. In the recent pandemic many doctors reported that patients were ultimately destroyed by over-resistance — an immune response that was excessive, an over-answer to the threat.

💬 Note from Doctor Luo: Western medicine calls this a cytokine storm — a storm of immune troops launching a suicidal, blitzkrieg attack on the source of infection. But if the attack goes too far, healthy organs are damaged, even leading to multiple organ failure. The physicians of ancient China were very clever about this: when yang ming over-resistance and high heat injure the yin, they used cooling herbs to dial the body’s state back down, so it would not over-respond. Once the body returns to its normal state and fights the pathogen normally, it can clear the pathogen by itself. If you are cold, warm you up; if you are hot, cool you down; blood stasis — dissolve it; phlegm dampness — clear it. Restore the body to its normal running state and leave the rest to the body itself. That is the principle of Chinese medicine.

A side lesson: why both cold damage and warm disease use the White Tiger Decoction

Let us take this opportunity to clarify the relationship between cold damage (shang han) and warm disease (wen bing). What is warm disease? It is a state in which the body is usually low on fluids (jin ye), meets hot environmental weather, and is attacked by heat pathogen. The organic pathogen may be any bacterium or virus — it does not matter. When the body is short of fluids, external dryness-heat makes the fluids even scarcer. To use Doctor Luo Dalun’s analogy: the riverbeds (channels) that transport the defense troops have run dry, the troops cannot reach their posts, and the organic pathogen slips in.

Once the pathogen enters a body already short of fluids, and the weather outside is hot, the illness easily jumps straight into a high-fever state — this too is the yang ming state: the body resists and produces heat. This heat evaporates the body’s fluids even faster, so fluids become more insufficient still — the heat must be cleared, and again the White Tiger Decoction (Baihu Tang) is usually the tool. The warm-disease school calls this condition heat entering the qi level (re ru qi fen) — the warm-heat pathogen has entered the qi level.

💬 Note from Doctor Luo: Now you can see it clearly: cold damage is caused by cold — it starts with cold, but a sturdy body still resists, and over-resistance produces fever, entering the yang ming state. Warm disease is insufficient fluids meeting heat pathogen, also entering a high-heat pattern. Very often cold damage and warm disease enter the same pattern, and the same methods are used. The warm-disease physicians also used many of Zhang Zhongjing’s formulas. So you see, cold damage and warm disease converge in the end — the White Tiger Decoction works for both.

Breaking down the prescription: White Tiger Plus Ginseng, clearing heat while supplementing qi and fluids

In ordinary cases of yang ming heat exuberance, what formula did Zhang Zhongjing use? The White Tiger Decoction. But this patient had excess disease with a deficient pulse, insufficient upright qi, and heavily damaged fluids. Clearing heat alone would not do — he needed to clear and supplement at the same time. So Zhang Xichun used the White Tiger Plus Ginseng Decoction (Baihu Jia Renshen Tang), with additional herbs to nourish the true yin.

The first formula, with generous doses:

• Sheng shi gao (raw gypsum, pounded fine) — the large-dose workhorse for clearing heat
• Sheng di huang (raw Rehmannia) 2 liang (about 60 g) — cools the blood and nourishes yin; also a large dose
• Ye tai shen (wild codonopsis / dangshen) — this is the “ginseng” of the White Tiger Plus Ginseng Decoction. In Zhang Zhongjing’s time the ginseng was not the northeastern variety; it was a Shanxi herb now extinct, and today dangshen (codonopsis) is used in its place — it supplements qi and generates fluids
• Tian hua fen (Trichosanthes root) — many people assume it is pollen, but it has nothing to do with pollen at all! It is the root of the Trichosanthes (Chinese cucumber) vine: nourishes yin, moistens dryness, generates fluids
• Bei sha shen (glehnia root) — nourishes yin and generates fluids
• Zhi mu (anemarrhena) 6 qian (about 18 g) — together with raw gypsum and codonopsis, this forms the core of the White Tiger Decoction
• Sheng bai shao (white peony) 6 qian (about 18 g) — nourishes yin, moistens dryness, softens and restrains the liver (liver wind is stirring, after all)
• Sheng huai shan yao (Chinese yam) 6 qian (about 18 g) — this is Zhang Xichun’s signature: the original White Tiger Decoction contains jing mi (rice), but Zhang Xichun believed Chinese yam worked better than rice, so whenever he used the White Tiger formula he replaced the rice with huai yam
• Gan cao (licorice) 4 qian (about 12 g) — harmonizes the middle and resolves toxins
• He ye bian (edge of lotus leaf) — lifts the clear and sends down the turbid, dispels summer heat. Zhang Xichun held that these cooling medicines, riding on the lotus leaf, could reach the chest directly to clear the inflammation of the meninges

Taken in three divided doses, with two raw egg yolks stirred into each dose — raw egg yolk greatly nourishes the true yin; this is Zhang Zhongjing’s technique.

💬 Note from Doctor Luo: A small story from daily life: I have known many long-lived elderly people who, every morning, pour boiling water over a raw egg and drink it down in one gulp. Nutritionists would say there are bacteria and it is bad for health — but I have genuinely watched old people drink it this way. It is the same principle as our use of egg yolk to greatly nourish the true yin. When the decoction is boiled and very hot, you stir the yolk in so it turns half-cooked — exactly the same idea.

The turn: once the bowels move, “adding fluid to move the boat”

After taking the medicine, the next morning the patient had a bowel movement once — his fluids had been too scanty for the bowels to move; now that the fluids were sufficient, this is called zeng ye xing zhou — “adding fluid to move the boat”: fill the riverbed with water and the boat sails. Chinese medicine is full of this kind of thinking.

Looking again at the tongue coating: it was drier but somewhat improved, though still without saliva. His spirit was a little clearer than before, with only occasional raving; his eyes no longer stared — he could blink; more than half the convulsions had stopped; the pulse was slightly slower than before, with a little more root on deep pressure — the upright qi was a bit stronger. Zhang Xichun said: these are all auspicious signs — good omens!

The second formula, only slightly modified from the first:

• Sheng shi gao (raw gypsum) 4 liang (about 120 g) — still a large dose, to clear the remaining heat
• Sheng di huang (raw Rehmannia) 2 qian (about 6 g) — cut from 2 liang to 2 qian! Earlier the fluids were desperately low, so a large dose of Rehmannia was used to top up the yin fluids immediately; now the upright qi was stronger and the fluids better, so the dose came down
• Ye tai shen (wild codonopsis) — supplements qi; still a large dose
• Da gan gou qi (goji berry) 1 liang (about 30 g) — one of the heavier goji doses Zhang Xichun ever used; nourishes the liver and kidney yin
• Sheng huai shan yao (Chinese yam) 1 liang (about 30 g) — dose increased: supplements the spleen and supports the upright qi. Notice — Zhang Xichun was beginning to strengthen the root
• Tian hua fen, bei sha shen, zhi mu — the same nourish-yin-and-generate-fluids team
• Sheng hang shao (white peony) 6 qian (about 18 g) — restrains and softens the liver
• Gan cao (licorice) 4 qian (about 12 g) — resolves toxins; with the peony it forms the Shao Yao Gan Cao Tang (Peony and Licorice Decoction)

💬 Note from Doctor Luo: What does the Peony and Licorice Decoction do? It generates fluids and relaxes cramping of the sinews — it is excellent for muscle spasms. This patient still had some twitching, so it was included. Look how every herb in Zhang Xichun’s prescription has a purpose: clearing heat, supplementing qi, nourishing yin, softening the liver, freeing the channels — each one has its own job.

Ten hours later, all the diseases were cured

The decoction was prepared and taken slowly — about ten hours to finish the whole pot. Then the patient’s spirit cleared completely and all the diseases were cured: no more coma, no more raving — he was awake and clear-headed. Such a critical illness, and Zhang Xichun essentially turned it around with two prescriptions.

After the case, Zhang Xichun added a special note: for the convulsions of this kind of meningitis, antelope horn (ling yang jiao) works best — convulsions mostly belong to liver wind stirring internally, and antelope horn specifically clears heat from the liver channel, hitting the target precisely. But antelope horn is extremely expensive, and the apothecaries were full of fakes, so he did not use it. In modern practice, if one treats this kind of disease, antelope horn can indeed be used.

💬 Note from Doctor Luo: Understand this: whether what Zhang Xichun treated back then was really meningitis, we put a question mark on it. Even if it was, or even if it was Japanese encephalitis or something else, it would not matter — because we know there is an organic pathogen sitting there; we set it aside for the moment and study what pattern the body has entered. The body enters a yang ming pattern of high heat and over-resistance, so we cool it down and restore its normal running. Look at this prescription: is there any herb that kills bacteria or viruses in it? No. But once the body returns to normal, it can clear the external pathogen by itself.

A bonus story: in the 1950s, the White Tiger Decoction versus a Japanese encephalitis epidemic

Speaking of this, we must tell the story of a remarkable real-world battle in the history of Chinese medicine — the epidemic of epidemic encephalitis B (Japanese encephalitis) in China in the 1950s.

At that time Japanese encephalitis broke out across China with an extremely high fatality rate — far higher than the later SARS. The Shijiazhuang municipal health bureau decided to bring in Chinese medicine, and called in a physician from a family that had practiced for generations — Guo Keming. Studying the patients’ symptoms — high fever, convulsions, seizures — Mr. Guo thought: is this not exactly the White Tiger Decoction pattern (Baihu Tang zheng) described in Chinese medicine? So he prescribed mainly the White Tiger Decoction and the Qing Wen Bai Du Yin (Clear Epidemics and Eliminate Toxins Drink), chiefly the White Tiger Decoction.

What happened? He treated more than thirty cases of Japanese encephalitis with not a single death — at the time it was regarded as a miracle. Why? Because Western medicine at the time had no good weapons against viruses — exactly like COVID-19 today, before any antiviral drugs existed. And Chinese medicine came up with thirty-odd cases, zero deaths.

💬 Note from Doctor Luo: The news shook the whole country. The Ministry of Health promoted the method nationwide, awarded the Chinese medicine team the first ministry-level science and technology progress award since the founding of the People’s Republic (the original text says “jia zeng jiang,” an additional award), with a prize of 10,000 yuan — in 1955, 10,000 yuan was a fortune! The Chinese medicine team was also received personally by Chairman Mao Zedong and Premier Zhou Enlai; the method was promoted nationwide and made public to the world so foreigners could come and learn it. Why could foreigners do nothing at the time? Because there was no specific drug. The Chinese medicine approach was: whatever the organic pathogen turns out to be — no rush to study that — just look at what pattern the body has entered. High-heat over-resistance pattern? Calm it down, let it fight the pathogen slowly, and the body will defeat it on its own. Which herb in the White Tiger Decoction kills viruses? None of them kill viruses — they adjust your body.

Epilogue: the Treatise on Cold Damage is a treasure house

Doctor Zhang Xichun’s case is finished, but the wisdom of Chinese medicine for external-contraction illness is far from exhausted. The Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases) is a treasure house — Zhang Zhongjing essentially wrote down every reaction the body can have when an external pathogen arrives: every level of reaction, every pattern. Whatever the pattern, you adjust it; the body clears the pathogen by itself. This wisdom still works today, and in the fight against epidemics it is still being used by Chinese medicine to do its part.

💬 Note from Doctor Luo: Tomorrow we will continue with more of Doctor Zhang Xichun’s stories. The White Tiger Decoction — if we truly wanted to cover the yang ming pattern, it would take a long time; today is just a brief introduction. If you love Chinese medicine, really study the Treatise on Cold Damage — it will do you real good. There is an important skill in studying it called memorizing the patterns (bei tang zheng): for each formula, under what circumstances it is applied and what typical symptoms the patient will show, Zhang Zhongjing summed up with remarkable precision. For example, san yang he bing — when tai yang, yang ming, and shao yang are all disordered and the heat is at its peak, the patient will have a distended abdomen and heavy body, difficulty turning over, loss of taste, a grimy face, delirium, and involuntary urination. Memorize these and the moment you see a patient you can match the picture at once — this tells you which formula to use. That is one of the eternal charms of the Treatise on Cold Damage.

Compiled from Doctor Luo Dalun’s commentary on Doctor Zhang Xichun’s case records; the original case appears in Records of Chinese Medicine with Western Reference (Yixue Zhongzhong Canxi Lu).

What to take away

• A high fever that turns into delirium, unconsciousness, staring eyes, and twitching is a yang ming over-resistance crisis — the body has thrown everything into the fight and is scorching its own fluids. The answer is not to fight harder but to cool the pattern down: clear heat while supplementing qi and fluids, with the White Tiger Plus Ginseng Decoction.
• “Excess disease with a deficient pulse” — the disease looks fierce, but a pulse that collapses on deep pressure tells you the upright qi is exhausted. When qi and blood cannot resist the pathogen, every dangerous sign appears; supplementing the root is part of the treatment, not an afterthought.
• Typhoid and warm disease often converge into the same pattern — both can reach a high-heat yang ming state, which is why Zhang Zhongjing’s White Tiger Decoction serves both schools.
• “Adding fluid to move the boat” — constipation in a febrile illness is often not a blockage but a dry riverbed: top up the fluids and the bowels move on their own.
• Chinese medicine does not need to identify the microbe — whether the organic pathogen is a bacterium, a virus, or something else, what matters is the pattern the body has entered. Restore the normal running state and the body clears the pathogen itself, as proven by the 1950s Japanese encephalitis campaign with its thirty-plus cases and zero deaths.