Comatose After a Cold, Barely Breathing?
Search terms: elderly person’s cold / coma / drowsy and dazed / eyes won’t open / can’t speak / barely breathing / breath like a thread / no energy after a cold
Medical terms for this condition: cold damage (shang han) · exhaustion of primordial qi (yuan qi hao jue) · external contraction with upright-qi deficiency · Du Shen Tang (Single Ginseng Decoction) pattern
Opening scene: how did a simple cold bring someone to the edge of death?
Today we continue with the case records of Doctor Gong Tingxian. Doctor Gong was an imperial physician of the Ming dynasty — courtesy name Zicai, pen name Yunlin Shanren, from Jinxi in Jiangxi province. Prince Lu hung him a plaque naming him the “Champion of Medicine” (yi lin zhuang yuan). He wrote a mountain of books — Wan Bing Hui Chun (Ten Thousand Diseases Returning to Spring), Shou Shi Bao Yuan (Longevity and the Preservation of the Primordial), Gu Jin Yi Jian (Medical Mirror of Past and Present) — and he himself lived to the age of 97.
Today’s case is short and sharp, and it lays out one of the most important principles in Chinese medicine. The protagonist is an old woman in her seventies.
💬 Note from Doctor Luo: I’ll hold back the punchline for a moment — this looks like “a story about a cold,” but it’s really about how Chinese medicine understands the relationship between upright qi and evil qi. Get that relationship straight, and you’ll have your bearings for a great many external-contraction illnesses.
Who was the patient? A seventy-year-old woman who caught a chill
The old woman was seventy-something — already past seventy. What she caught was cold damage at its very beginning — in today’s words, she’d just caught a chill, an ordinary cold.
Her symptoms? Headache and body ache — her head hurt, and every bone in her body ached; fever with chills — she ran a fever, yet at the same time felt terribly cold. This is a textbook external-contraction illness from cold. The pathogen was still in the Taiyang (Greater Yang) channel, the exterior pattern not yet resolved.
By the usual logic, dispersing herbs were exactly right: fang feng (saposhnikovia), jing jie (schizonepeta), su ye (perilla leaf), even a little ma huang (ephedra) — induce a sweat, warm the body up, and the illness should resolve.
💬 Note from Doctor Luo: Notice: the earlier doctors’ choice of herbs was not wrong in direction. You caught cold, you’re afraid of cold, you have a fever — sweating it out with dispersing herbs is the proper road. The problem came later.
How sick was she? Ten days of failed treatment, and she slowly faded
But here’s what happened: after several doses of dispersing herbs, nothing improved. The illness dragged on — more than ten days.
After ten days, far from getting better, she got steadily worse:
She could not eat or drink — food would no longer go down. When an elderly person stops eating, that alone is serious; she sank into a daze — drowsy and foggy, barely able to stay awake; she could not speak; she could not open her eyes; only a faint breath remained at her throat — put a finger under her nose and you felt just a wisp of breath, as if she might stop breathing at any moment.
💬 Note from Doctor Luo: This state, in Chinese medicine, is called exhaustion of primordial qi (yuan qi hao jue) — it isn’t that the evil qi is terribly fierce; it’s that the body’s upright qi can no longer hold on. It is nearly spent.
The diagnosis in one phrase: exhaustion of primordial qi
With the illness at this stage, what did the earlier doctors do? One by one, they quietly withdrew — they slipped away without a word. Why? “From seventy up, the ancients are rare” — if a seventy-something grandmother died under your hands, what then? So no one was willing to take the case.
The family ran around in circles, utterly helpless, and finally summoned Doctor Gong Tingxian.
Doctor Gong came, felt the pulse, and said one weighty phrase: “Exhaustion of primordial qi.” — The upright qi was profoundly insufficient; the primordial qi was on the verge of being used up.
The prescription: a single herb — five qian of ginseng, decocted
So what was to be done? Doctor Gong’s prescription was so simple it’s hard to believe:
Five qian of ginseng (about 15 grams), decocted. When it was ready, slowly spoon it into her — gently, a little at a time.
💬 Note from Doctor Luo: Mark that phrase — “slowly spoon it in.” Not gulping it down, but feeding it gradually. A person at the point of yuan qi collapse needs the medicine to enter slowly too, leaving the upright qi room to recover. This is the fine, careful craft of emergency rescue.
The turning point: the spent ginseng simmered again — and she was cured
After it was spooned in, the old woman slowly began to revive. Her mind cleared a little, and she asked for water.
Doctor Gong told the family to simmer the spent ginseng dregs in water again and give that to her. After drinking it — instant recovery — the illness was gone at once, and her body recovered.
And the best part came later: this old woman lived another ten years before passing away, at the age of 80. She didn’t die of this illness — a decade later, of something else. In ancient times, reaching 80 was no small feat.
💬 Note from Doctor Luo: Doctor Gong himself sighed: “Ginseng can call primordial qi back from the land of nothingness — truly it has the power to raise the dead; the saying is no exaggeration.” “The land of nothingness” — a place where there is nothing at all. The primordial qi had been depleted almost to nothing, and ginseng could still call it back. It truly does have the power to snatch life from death. Not a word of exaggeration.
Don’t get the wrong idea: this is not “drink ginseng for any cold”
At this point, please don’t jump to the wrong conclusion — don’t read this case and think “when I catch a cold, I just brew ginseng water.” That would be wrong!
This case is about what ginseng can do — and even more, it’s about the relationship between upright qi and evil qi.
💬 Note from Doctor Luo: When a person gets sick, the symptoms are so vivid that everyone fixates on them — psychologists call this negativity bias. Headache, fever, chills — the manifestations of evil qi are so prominent that all eyes lock onto the pathogen, and people usually overlook the “deficiency” side. This old woman was precisely a person with insufficient upright qi. The evil qi arrived; doctors induced sweat and scattered the pathogen — the direction was right, but dispersing herbs themselves consume upright qi. The old woman’s upright qi was already weak; drained further by dispersing herbs, she collapsed — dazed, eyes shut, primordial qi exhausted.
Why does Ren Shen Bai Du San contain ginseng?
At this point, Doctor Luo brings up a wonderfully illuminating comparison — Ren Shen Bai Du San (Ginseng and Toxin-Vanquishing Powder).
Ren Shen Bai Du San is a famous ancient formula for treating epidemics, and Doctor Gong himself used it often. What’s the thinking behind it? A whole array of wind-dispelling herbs that scatter pathogens — qiang huo (notopterygium), du huo (angelica pubescens), qian hu (hogfennel root), chai hu (bupleurum), jie geng (platycodon) to regulate the qi mechanism — paired with fu ling (poria), ren shen (ginseng), and gan cao (licorice). Why add ginseng? To guard against “insufficient upright qi”: if your upright qi is sufficient, external pathogens don’t frighten you — the defense force clears them out by itself; for a person with insufficient upright qi, you must support the upright while driving out the pathogen.
💬 Note from Doctor Luo: Do you see it? This old woman had, in effect, eaten Ren Shen Bai Du San in two separate installments — the earlier doctors gave her ten days of dispersing herbs (the wind herbs of the formula), and Doctor Gong then gave her ginseng (the supporting-qi part of the formula). Separated by ten days, the formula was assembled, and the illness actually healed. On one hand this shows the old woman’s evil qi was not heavy — the earlier dispersing herbs really were dispersing the pathogen. On the other hand it shows: when upright qi is insufficient, the body lacks the strength to recover. Ginseng went in, upright qi rebounded, the evil qi departed for good, and she was well.
Doctor Zhang Xichun’s rule: whenever he used Bai Hu Tang, if the patient looked weak he always added ginseng
At this point Doctor Luo recalls a later great physician, Doctor Zhang Xichun, who taught exactly the same lesson.
Whenever Doctor Zhang Xichun used sheng shi gao (gypsum) to clear heat, whenever he used Bai Hu Tang (White Tiger Decoction), the moment he saw a patient who was a bit weak — the moment he saw an elderly person — he would always add ginseng. Why? Without ginseng, problems arise. Doctor Zhang’s own summary: “In my whole career I used Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) far more often; I rarely used Bai Hu Tang alone” — that is the voice of experience.
💬 Note from Doctor Luo: When I was studying, I read a record: in Shanghai, a veteran cadre came down with this kind of illness. A Chinese medicine doctor was called, and he didn’t add ginseng. The Bai Hu Tang went down — and something went wrong. The patient’s upright qi could not hold up, and in a flash he was gone. So Doctor Zhang Xichun’s rule is: as long as the patient’s upright qi is insufficient and the age is advanced, Bai Hu Tang must include ginseng. In my own practice, whenever I use the Bai Hu Tang approach, I generally pair it with huai shan yao (Chinese yam) — Doctor Zhang used jing mi (rice), I use Chinese yam — plus ren shen, and the results are excellent.
So when treating external-contraction illness, especially in frail people, supporting the upright must always accompany dispelling the pathogen. In prescriptions, that’s why you so often see huai shan yao, dang shen (codonopsis), and huang qi (astragalus); in severe cases, add ren shen.
Bonus: the story of northeastern ginseng — from tribute item to “northern herbs sold south”
Since this case is all about ginseng, Doctor Luo takes the opportunity to tell a long, fascinating stretch of ginseng history:
What Doctor Gong used was northeastern ginseng. In the Ming dynasty, northeastern ginseng was already flooding the market, and the ginseng trade was booming. In even earlier times, ginseng had been a tribute item — precious and rare. And the rise of the Jurchen people — Nurhaci’s clan — was tied to selling ginseng: they kept selling ginseng to the Han Chinese, and gradually grew rich.
💬 Note from Doctor Luo: In those days northeastern ginseng poured into the market, and Ming physicians — Doctor Gong Tingxian, Doctor Yu Jiayan, Doctor Miao Xiyong — all promoted ginseng enthusiastically, because it really is good: it lifts the primordial qi and lets the upright qi recover at once. Today northeastern ginseng still comes in two kinds: garden ginseng — grown in cultivated fields (some grown like crops with pesticides; and the high-grade kind grown in a designated forest clearing, planted after cutting a patch, then letting the forest regrow — that premium original ginseng is mostly exported to Japan); and forest ginseng (lin xia shen) — seeds scattered into the wild mountains, left to grow naturally for fifteen years or more, so that it resembles true wild ginseng, and its effects are better.
There’s also a curious phenomenon called “northern herbs sold south” (bei yao nan xiao): northeasterners rarely eat ginseng themselves, yet northern herbs are consumed enormously in the south. When Doctor Luo visited Changbai Mountain years ago, the locals told him: much of our ginseng is exported to Southeast Asia. Southeast Asian merchants grind ginseng into powder, put a little sachet in a bottle of mineral water, and sip ginseng water all day long.
💬 Note from Doctor Luo: I was very curious: we northeasterners get “heaty” symptoms from eating ginseng — how do they stay fine? Later, after I moved to Sanya, I understood. When the weather turns hot, heat consumes qi — the body must keep coordinating with the outside heat, sweating profusely, and qi escapes along with the sweat; the heat easily consumes qi and fluids (also called consuming qi and injuring yin). A qi-deficient person from the north arrives in the south, the weather suddenly turns scorching, and a noonday walk in the sun can bring on collapse or heatstroke. Drink ginseng water at that moment, and it replenishes qi and fluids. So a severely qi-deficient person drinking ginseng in the south not only avoids “heatiness” but feels wonderfully comfortable. Sir Run Run Shaw of Hong Kong ate northeastern wild ginseng every single day — he was Hong Kong’s biggest buyer of wild ginseng, spending 20,000 HK dollars a day on it, and lived to 107. In that fiercely hot environment, ginseng’s power to greatly tonify primordial qi while generating fluids kept his body stable. That’s the benefit.
And about “heatiness”: in fact, when ginseng makes you feel “hot,” most of the time the spleen and stomach are blocked — digestion is sluggish, so anything nourishing turns into heat. Open up the spleen and stomach first, and the ginseng will go down much better.
One last historical note: the ginseng of Zhang Zhongjing’s era was not northeastern ginseng at all — it was very likely dang shen (codonopsis) from Shangdang in Shanxi, or another Araliaceae plant similar to ginseng. It was gentler in strength, but Zhang Zhongjing was already using ginseng widely to support upright qi. By the Ming dynasty, physicians had a very thorough grasp of northeastern ginseng’s power.
Finale: one herb, truly understood, can save a life
Doctor Gong Tingxian was especially skilled with ginseng and held firmly to supporting the upright. When he treated Prince Lu’s consort, for instance, the ginseng he used ultimately added up to several jin (several kilograms) — for illnesses of very long standing, with deep accumulation, restoring the upright qi truly requires ginseng, taken slowly until the qi is full and the body recovers.
And this old woman recovered from one dose of ginseng — because Doctor Gong read the situation exactly: right now the deficiency of upright qi is the main problem, and the evil qi has essentially already been scattered. The ginseng went in, the upright qi rose, the woman revived — and lived another ten years.
💬 Note from Doctor Luo: The lesson of this story: one herb deserves to be savored and used again and again. Like Doctor Zhang Xichun in later generations — when you thoroughly understand what a single herb can do, sometimes one herb alone can save a life. When treating external-contraction illness, always keep the upright qi in your heart — while dispelling the pathogen, think of supporting the upright. That is the way of Chinese medicine.
Compiled from Doctor Luo Dalun’s narration of Doctor Gong Tingxian’s case records; the case comes from Doctor Gong Tingxian’s medical works (Wan Bing Hui Chun, Shou Shi Bao Yuan, and others).