Two Months Without Sleep, Unable to Eat, Wasting Away? Doctor Miao Xiyong’s Case of Yin-Deficiency Insomnia: Large-Dose Ginseng to Tonify Qi and Settle the Spirit

Patient’s search words: lying awake all night / insomnia / two months without sleep / no desire for food / getting thinner and thinner / restless, unable to sleep Medical terms: yin deficiency with fire (yin xu huo wang) · insomnia (bu mei) · emotional and mental disorder (shen zhi bing) · insufficiency of heart qi

Opening: two months without a single night’s sleep — the whole family thought she was finished

One day in the late Ming dynasty, Doctor Miao Xiyong was called to see a patient — the wife of Gu Taixue (Gu the Imperial College Student), a classmate and close friend of Doctor Miao. The case was alarming from the very first sentence.

💬 Note from Doctor Luo: Let me first introduce this Doctor Miao Xiyong — a great physician of the late Ming, courtesy name Zhongchun, from Changshu, Jiangsu. He wrote the Xian Xing Zhai Yi Xue Guang Bi Ji (Extensive Medical Notes from the Studio of First Awakening) and the Shen Nong Ben Cao Jing Shu (Commentary on the Divine Husbandman’s Classic of the Materia Medica), and he was one of the originators of the warm-pathogen (wen bing) school. His case collection has an interesting history: it was first compiled and published by his friend Ding Yuanjian (a late-Ming scholar-official and Miao’s admirer), under the title Xian Xing Zhai Bi Ji; later Doctor Miao revised and expanded it himself into the Guang Bi Ji. So some of the cases in this book are clearly Miao Xiyong’s own, while a few read more like Ding Yuanjian’s personal records — scholars have debated this for centuries. Just keep that in mind as you read.

What illness did the lady have? The book states it plainly: yin xu huo zheng — yin deficiency with fire. In one phrase, the root mechanism is exposed from the very start.

How bad was it? Two months sleepless, food refused, the body wasting away

The symptoms that followed were each more alarming than the last:

Che ye bu mian zhe liang yue — for two full months, she never slept a single night; yin shi ju fei — she could not swallow a mouthful of food; xing ti ri xiao — day by day she grew thinner, wasting away before everyone’s eyes.

💬 Note from Doctor Luo: Two months without sleep — what does that mean? Think about it: what kind of person can lie there with her eyes open for two months and never sleep? On top of that, she ate nothing and kept losing weight — her emotions had clearly fallen into deep disorder. The ancient record is brief and does not describe her depression, but imagine: two months sleepless, two months unable to eat — her spirit was in chaos. That is why the book says "zhong wai yi qi bi wu jiu yi" — everyone in the household and beyond believed there was no saving her.

One touch of the pulse: don’t panic, it can be cured — but slowly

The whole family was preparing for the worst when Doctor Miao said, lightly, one sentence: "Bi wu da hai" — there is certainly no great harm, she can be cured. But he immediately added: "Yao duo xu shi ri" — this will not be cured in a day or two; she must take medicine for quite some time.

💬 Note from Doctor Luo: This sentence shows his mastery. An ordinary doctor, seeing "two months without sleep, food entirely refused," would panic and start pounding away with heavy, spirit-suppressing herbs. Doctor Miao instead said "no great harm" — because he saw the essence at a glance: though the patient was deficient, her organs were not damaged. That is the settled judgment of a master; ordinary practitioners do not have this level. And it is precisely this reasoning that convinces me this case is Miao Xiyong’s own hand, not Ding Yuanjian’s — no one without such settled judgment would dare use large doses of ginseng for this kind of illness.

Breaking down the prescription: large-dose ginseng leads, and Sheng Mai San is hidden inside

Doctor Miao wrote the prescription — eight herbs in all, with an extremely clear logic:

Ren shen (ginseng), in large dose — the soul of the entire formula; suan zao ren (sour jujube seed) to nourish the blood; fu shen (poria with pine root) to calm the spirit; yuan zhi (polygala root) to nourish the heart, calm the spirit and smooth the emotions; sheng di (raw rehmannia) to nourish yin; dang gui (angelica root) to nourish the blood and the liver blood; wu wei zi (schisandra berry) to astringe and gather; mai dong (ophiopogon root) paired with the ginseng to keep the ginseng from overheating.

💬 Note from Doctor Luo: Notice something? Ginseng, plus the wu wei zi and mai dong at the end — what do those three form together? Sheng Mai San, the Pulse-Reviving Powder! This formula is built on Sheng Mai San, with ginseng leading. Suan zao ren nourishes the blood; fu shen calms the spirit — a note here: fu shen is the part of poria that grows wrapped around a pine root; cut it open and you find the pine-wood core inside. Its spirit-calming power is much stronger than plain poria. Yuan zhi tunes the heart and settles the spirit; sheng di nourishes yin; dang gui nourishes the blood and the liver blood; wu wei zi is sour and astringing; mai dong pairs with ginseng to keep it from being too hot. The whole prescription runs on one track: tonify the qi, nourish the blood, calm the spirit, nourish the yin.

Amber, cinnabar, gold and silver: the old rule of heavy, settling spirit medicine

The formula also contained something especially refined — hu po (amber), chen sha (cinnabar), and gold and silver vessels.

💬 Note from Doctor Luo: What were these for? They are for severe cases. Amber calms the spirit; chen sha (zhu sha, cinnabar) is the classic heavy, settling spirit-calmer; and gold — gold also has the power to settle the spirit and quiet the heart. In the old days, some medicines were wrapped in a layer of gold leaf before being swallowed, precisely for this settling intent — Zhu Sha An Shen Wan (Cinnabar Spirit-Settling Pill) and An Gong Niu Huang Wan (Bezoar Resurrection Pill) are made the same way. How was it used here? Generally you first decoct the amber, cinnabar and gold or silver in water, then use that water to cook the eight herbs — this is the traditional method of preparing the formula.

There is a delightful historical anecdote hidden here: after the founding of the People’s Republic, gold was so precious that even the national treasury was short of it — yet the Tong Ren Tang pharmacy still needed gold leaf for its medicines, and applied to the state. The matter eventually reached Premier Zhou Enlai — was the gold really necessary? Tong Ren Tang submitted a report explaining that tradition truly required it, and the effect was excellent. The government put the people’s health first and specially approved an allotment of gold to Tong Ren Tang for making gold leaf.

More than a hundred doses: deficiency is rebuilt slowly

How much of this medicine did Lady Gu take? Yi bai yu ji — more than a hundred doses — before she recovered.

💬 Note from Doctor Luo: Later someone asked Doctor Miao why he treated her this way. His explanation: "Ci bing sui shu xu, ran zang fu wu sun; xin jing sui you huo, ran bu shuo fei" — although this illness is one of deficiency, the organs have not been damaged; although there is fire in the heart channel, it has not scorched the lungs (if the fire had burned the lungs, the heat would have climbed dangerously high). Therefore "duo fu bu yin shou lian zhi ji, ze shui huo zi ran sheng jiang" — take many doses of yin-nourishing, astringing medicine, and water and fire will naturally rise and fall. This is the classic principle "zhuang shui zhi zhu, yi zhi yang guang" — strengthen the ruler of water in order to restrain the brightness of yang: nourish the yin to control the fire. He also said that in a chronic illness, if the pulse is even and the body does not burn with fever, there is nothing else to worry about. You see — over a hundred doses, without a single setback, because he had seen the road clearly from the very first step.

Why ginseng? The Divine Husbandman’s Classic already said it plainly

After the case, Doctor Luo noted: this case may look small, but it is actually remarkable — it contains a core method.

💬 Note from Doctor Luo: The core method is in four characters: "large-dose ginseng." Open the Shen Nong Ben Cao Jing — the earliest classic of Chinese pharmacology — and read what it says about ginseng: "Ginseng is sweet and slightly cold; it chiefly tonifies the five organs, settles the essence-spirit, anchors the hun and po, stops palpitations and fright, dispels pathogenic qi, brightens the eyes, opens the heart and benefits wisdom; taken long-term it lightens the body and prolongs life." Do you notice? "Tonifies the five organs" is just one phrase — the remaining seventy percent is all about regulating the spirit: settling the essence-spirit, anchoring the hun and po, stopping palpitations and fright, opening the heart and benefiting wisdom! Why? The principle is this: when the upright qi of the organs is sufficient, the mental functions they govern work normally; form and spirit are united. When your "form" — the material foundation — declines, when the qi is deficient, the heart spirit goes wrong. And when the spirit goes wrong, it in turn weakens the organs further — a vicious cycle. Ginseng greatly tonifies the primal qi; when the heart qi is made sufficient, the heart spirit gradually gathers itself back. The scattered spirit, once it has a form to cling to, returns to normal function. This is the fundamental knowledge for treating mental illness — unfortunately many people today have lost these functions of ginseng from the classic, and no longer know how to use them.

A centuries-old mistake: must mental illness always be treated by clearing phlegm-heat?

Doctor Luo then turned to a detour in the history of Chinese medicine’s treatment of mental illness.

💬 Note from Doctor Luo: Beginning in the Jin-Yuan era, some physicians proposed treating mental disorders — mania, madness, and the like — by clearing phlegm-heat. Once this idea appeared, generation after generation copied it: tian zhu huang (bamboo shavings concretion), zhu li (bamboo sap) and gua lou (trichosanthes fruit) to clear phlegm-heat; huang lian (coptis), huang qin (scutellaria) and zhi zi (gardenia) to clear heat; some even used vomiting methods to expel the hot phlegm. This is a strange phenomenon in the history of Chinese medicine — whenever one school proposed an idea and argued it plausibly, later generations copied it for centuries; they might fail to cure a hundred patients, but if they cured two, they would say "the ancients were right," and keep copying. The result? Later mental illness — especially mania (schizophrenia-spectrum disorders) — was almost always treated by clearing phlegm-heat; depression got the same treatment too. I think that is quite inappropriate.

The clear-headed one: Chen Shiduo of the late Ming used ginseng to lead in every mental case

There were also clear-headed physicians.

💬 Note from Doctor Luo: Chen Shiduo of the late Ming treated mental illness with ginseng leading the prescription almost every time — very clear-headed. He distinguished deficiency from excess: even when phlegm was present, it was phlegm slowly brewed by a weakened body; a little phlegm-resolving was fine, but the root treatment was always to support the upright qi. Yet people did not dare follow him: "Ginseng is too hot — won’t the patient get even more delirious, even more manic?" That single fear, passed down generation after generation, blocked the road. Later an old doctor told me the truth — a veteran physician in Shanghai who specialized in psychiatric illness said: Chinese medicine must be honest — I have tried the phlegm-heat-clearing method in case after case, and not one was cured. Yet the tradition continues, and people conclude that Chinese medicine cannot treat mental illness at all. Rheumatoid arthritis, chronic kidney disease — there are excellent formulas sitting right there for all of them; it is just that no one studies them, the patients never get better, and everyone says "Chinese medicine can’t help."

The path today: soothe the liver + tonify the qi + settle with heavy minerals

So what is the right road? Doctor Luo laid out his own clinical approach.

💬 Note from Doctor Luo: Many people today use Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction) to soothe the liver — I recommend it too. But there is another very important road, and it is the road of today’s case: ginseng leading to tonify the qi, with herbs to nourish the heart blood, then long gu (dragon bone) and mu li (oyster shell) in large doses to settle and astringe — the dragon bone and oyster shell should be used heavily, thirty grams and up, sometimes up to sixty grams, with a little honey-fried huang qi (astragalus). The effect is very, very good — it can even treat many severe psychiatric illnesses. For yin deficiency, add sheng di (raw rehmannia) and mai dong (ophiopogon) to nourish yin; for yang deficiency — pale tongue, aversion to cold — add rou gui (cinnamon bark) and gui zhi (cinnamon twig) to warm the yang, and generally use red ginseng to tonify both qi and blood. One caution: suan zao ren has been driven by speculation to absurd prices; I no longer recommend it — long yan rou (longan flesh) can substitute. But fu shen cannot be replaced; it must stay in the formula.

After Coco Lee: mental illness is no longer a small matter

Finally, Doctor Luo brought the topic to the present — this is the real reason he chose to tell this case.

💬 Note from Doctor Luo: After Coco Lee’s death, many people began to pay attention to depression. Let me tell you plainly: this is no small matter — mental illness has become a major hidden danger in society today. Leave adults aside — children are even more heartbreaking: the rat race is beyond description, the high-school entrance exam, the college entrance exam, staying up late night after night, going to bed after midnight; over time the heart qi becomes insufficient and the body breaks down. Such children should first have the liver soothed, then gradually have their qi and blood rebuilt; only when the body is restored can they recover on their own, with psychological counseling and pressure relief added. Otherwise this could genuinely ruin a life — no joke. In some high-school classes, more than half the students are taking antidepressants — what will become of the nation? Chinese medicine actually has many good methods: support the upright qi, soothe the liver, calm the spirit — some nourish yin, some warm yang — treat by pattern. Today’s case is one important thread in that approach. I hope it inspires you, and I hope clinicians in Chinese medicine will consider mental illness from every angle and rescue people from this suffering.

Closing: when upright qi is sufficient, there is a foundation for joy

Doctor Luo closed with a line worth pondering:

💬 Note from Doctor Luo: In ordinary life it is the same — when your upright qi is insufficient, you are bound to be wilted; how many people with insufficient upright qi are genuinely happy? When the upright qi is sufficient and the qi and blood are full, then you have the foundation for joy. So adjust the body well, and the emotions will naturally steady. This is the most fundamental principle of treating emotional illness in Chinese medicine: not to fight the emotions head-on, but to rebuild the roots of the body.

What to take away

1. Insomnia plus total loss of appetite and rapid weight loss points to the spirit. Two months without a single night’s sleep, food refused, wasting away — this is not a small physical problem; the emotions and the spirit have collapsed. The ancient record calls it yin deficiency with fire.
2. Doctor Miao’s judgment: "no great harm," but it takes time. Because the organs were not damaged, the disease could be cured — but deficiency must be rebuilt slowly: more than a hundred doses before recovery. Do not expect chronic emotional illness to resolve in a week.
3. The formula’s architecture: ginseng in large dose leads; Sheng Mai San (ren shen, mai dong, wu wei zi) is hidden inside; plus suan zao ren to nourish the blood, fu shen to calm the spirit, sheng di and dang gui to nourish yin and blood. Tonify the qi, nourish the blood, calm the spirit, nourish the yin — one track throughout.
4. The Divine Husbandman’s Classic on ginseng: about seventy percent of its described functions concern regulating the spirit — settling the essence-spirit, anchoring the hun and po, stopping palpitations, opening the heart and benefiting wisdom. Tonifying the qi is the root treatment for a scattered heart spirit.
5. A caution from history: not every mental illness is phlegm-heat. The phlegm-heat-clearing approach was copied for centuries with very poor results. Chen Shiduo’s road — ginseng leading, deficiency and excess distinguished — was the clear-headed one.
6. For today’s emotional disorders: soothe the liver (Chai Hu Jia Long Gu Mu Li Tang), tonify the qi (large-dose ginseng), and settle with heavy minerals (long gu, mu li in large doses), adjusting for yin or yang deficiency. Suan zao ren can be replaced by longan; fu shen cannot.
7. When the qi is sufficient and the blood is full, there is a foundation for joy — adjusting the body is the deepest way to steady the emotions.

Compiled from Doctor Luo Dalun’s commentary on the medical cases of Doctor Miao Xiyong; the case comes from the Xian Xing Zhai Yi Xue Guang Bi Ji (Extensive Medical Notes from the Studio of First Awakening, late Ming, by Doctor Miao Xiyong).