Plague Hits Your City: High Fever, Swollen Head and Face, Terrible Sore Throat? The Ming Dynasty Imperial Physician Doctor Gong Tingxian’s Arsenal of Anti-Plague Formulas — Er Sheng Jiu Ku Wan, Ren Shen Bai Du San, Niu Bang Qin Lian Tang and Sheng Jiang San

Patient search terms: plague / epidemic fever / pandemic / high fever with headache and body aches / swollen head and face (big-head plague) / severe sore throat / how ancient Chinese medicine treated epidemics

Corresponding medical names: epidemic febrile disease · warm epidemic (wen yi) · heat toxin pattern

Opening: the ancients feared plague too — but they left us an enormous toolbox

The Chinese people have an immense store of experience fighting plague. Take the medical sage Doctor Zhang Zhongjing: in his own lifetime, his family of more than two hundred people lost two-thirds of its members in under ten years — to plague. That is why he wrote the Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases); in truth, that book is itself the product of a war against plague.

💬 Note from Doctor Luo: The ancient Chinese accumulated so much experience that when a real plague arrives — the kind with a terrifying death rate that spreads everywhere — foreigners really have no answer. Even today, Western medicine has no great weapon against viruses; new drugs haven’t come out, and even the CEOs of the companies researching them catch the disease and get infected. But we Chinese truly do have methods: in the early days of COVID in Wuhan, when Chinese medicine went in, it visibly lowered the death rate and the rate of severe cases — it played a huge role. We have far too many methods to deal with this kind of situation. Something like Omicron, in front of Chinese medicine, is basically… compared with the plagues of antiquity, this is a very low level. Very, very low.

What happened in Kaifeng in the spring of 1586?

In the spring of the bingxu year of the Wanli reign (1586), Doctor Gong Tingxian was living in Bianliang — that is, Kaifeng, called Daliang in ancient times. That spring, a great plague erupted in Bianliang: townspeople died in droves from the disease; whole streets were infected, some even wiped out entirely — in some lanes everyone died, in some families every member died, and those infected were gone within a few days.

💬 Note from Doctor Luo: Friends, this is plague — not a cold. It isn’t a little sneezing, a sore throat and a fever that frighten people to death. Compared with real plague, that is a completely different level. In a true great plague, people lose their lives within days; it spreads incredibly fast, even wiping out whole families. It is extremely serious.

What were the symptoms of this plague? Headache, body pain, aversion to cold with blazing fever — feeling cold all over while burning with high fever; swollen head and face — the head swollen, the neck thick; severe throat pain, and the mind somewhat clouded. Doctor Gong judged: this was an externally-contracted disease — a severe, fatal, fast-spreading one — in other words, plague. He analyzed that this was “winter should be cold but instead turned hot” — that year the climate was abnormal and hot when it should have been cold, so people were struck by irregular qi, and come spring it erupted as plague, in summer as heat disease. The name of this disease was datou wen da re zhi zheng — “big-head plague with great heat”, i.e. the swelling of the head and face.

💬 Note from Doctor Luo: In fact, Doctor Li Dongyuan treated exactly this disease in his day — the same kind of plague — and saved countless lives. This kind of plague, in which people die rapidly after infection, is indeed very serious.

Every doctor in the city failed — how did he become famous overnight?

At the time, people did not understand this plague well, and the physicians’ skill was insufficient: they all followed the old formulas — using ancient prescriptions to treat it — and the treatments failed. But Doctor Gong Tingxian was different: he examined the patients’ symptoms himself, analyzed and distinguished the pattern, and wrote his own prescriptions. The results were excellent — countless were saved, and his fame shook Zhongzhou (the Central Plains); across the whole central region his influence spread instantly, and everyone knew his name. In the preface to the Wan Bing Hui Chun (Return of Spring for Myriad Diseases), someone wrote: “All the physicians of the region bowed their heads and placed themselves beneath him” — the entire region’s doctors admired him wholeheartedly, acknowledged he outclassed them, and studied under him.

💬 Note from Doctor Luo: Now everyone is curious — what formulas did Doctor Gong Tingxian actually produce? How did he treat this illness? He said: I have created a secret formula, called Er Sheng Jiu Ku Wan.

Secret formula number one: Er Sheng Jiu Ku Wan — rhubarb paired with pig-tooth gleditsia

Er Sheng Jiu Ku Wan (Two Sages Rescue from Suffering Pill) treats cold damage and plague whether or not the disease has passed through the channels — it can be taken at any stage. But Doctor Gong emphasized one thing especially: only people with strong, robust constitutions may take it; the weak must use other methods.

The medicine is just two ingredients: da huang (rhubarb), four liang (about 120 g), soaked in wine, steamed and dried; and zhu ya zao jiao (pig-tooth gleditsia pod), two liang (about 60 g) — the gleditsia pods you know from trees, except this is the kind that has been bitten by insects and grown crooked, shaped like a pig’s tooth, hence the name. The two herbs are ground into powder, made into small pills with water, about the size of mung beans; take fifty to seventy pills each time, washed down with mung bean soup — the mung bean soup moderates the medicine’s harshness, because the herbs also irritate the digestive tract lining. After taking it, sweating is the goal — you must sweat.

💬 Note from Doctor Luo: What does da huang do? It clears the heat of the three burners, unblocks the intestines and drains heat — a cold, cool herb that drains the heat toxin out. What does pig-tooth gleditsia do? First, it expels phlegm — when phlegm-dampness is heavy, it pushes the phlegm out. Second, it opens the orifices and wakes the mind — if phlegm has blocked the orifices shut, it can open them. Third, it disperses masses and reduces swelling. Doctor Gong himself said: use pig-tooth gleditsia to open the orifices and induce sweating, letting the evil qi go out; use da huang to drain all the fires and unblock the interior. Exterior and interior unblocked together — one dose brings sweat, and once you sweat the disease is cured.

Doctor Gong himself called this “a true immortal formula”. Once the pills were made, the common people packed his doorway — the whole room was jammed; people came day and night asking for the formula, and he could not receive them all. The number of lives saved could not be counted. For robust, strong-bodied patients, this formula worked every single time.

Small stories about pig-tooth gleditsia: fumigating the anus, blowing into the nose

Doctor Luo took extra time to talk about pig-tooth gleditsia. It is usually made into powder and used externally, or for fumigation.

💬 Note from Doctor Luo: Take an intestinal blockage — an acute abdominal emergency, an intestinal obstruction. The ancients would light pig-tooth gleditsia, burn it, and fumigate the anus; after a while the belly starts to gurgle, and the stool can be passed. This herb is rarely used in decoctions because it is somewhat irritating. I tried it myself once — when I was a student, I grabbed some gleditsia pods, ground them into powder, added a little xi xin (asarum) and a few other things, and made a powder. I told a classmate: your nose is stuffed? I’ll give you a prescription — blow a little of this in. Then I left. Two days later the classmate came to me: “What on earth did you give me? It got up into my nasal cavity — I don’t know where so much nasal discharge came from; it just poured out endlessly, and I was sneezing and blowing my nose without stopping!” I said, “Well, is your nose unblocked?” “It’s unblocked, all right — it just wouldn’t stop at the time. I used endless tissues, sticky mucus just kept coming out.” He had no idea where so much mucus had come from. So yes, it is somewhat irritating.

What about weak patients? Start with a dose of Ren Shen Bai Du San

Er Sheng Jiu Ku Wan is for the robust. Those of weak natural endowment can’t take it — so what about the weak? Doctor Gong’s method: first give Ren Shen Bai Du San (Ginseng Toxin-Expelling Powder) — mild cases are cured by it, and most ordinary cases are cured by it. Doctor Gong recorded that this formula works generally for plagues in all four seasons — whatever the season, if there is an epidemic it can be used.

💬 Note from Doctor Luo: I’ve talked about Ren Shen Bai Du San before — especially during the Wuhan epidemic, in 2019 and 2020, I gave a dedicated audio lecture on Ren Shen Bai Du San. Why use Ren Shen Bai Du San for COVID? Listen to the thinking behind the formula and you’ll understand: support upright qi, dispel wind and expel evil.

What is in Ren Shen Bai Du San? Qiang huo (notopterygium), du huo (angelica pubescens), qian hu (peucedanum), chai hu (bupleurum), chuan xiong (Sichuan lovage) — these are all wind herbs: they disperse wind and expel evil, increasing the body’s permeability. When an external evil arrives, you increase permeability and drive the evil out; while this is happening the body heats up and sweats, and qi and blood circulate briskly. Zhi ke (bitter orange) moves qi; jie geng (platycodon) carries the medicine upward and regulates the qi mechanism, and herbs that go downward all have their route; fu ling (poria) removes dampness; ren shen (ginseng) supports upright qi; gan cao (licorice) harmonizes all the herbs — at half the usual dose. On top of those wind-expelling herbs, add one herb — ren shen — and it becomes “Ren Shen Bai Du San”: on one hand the wind herbs drive out the evil, stirring the body to summon energy and push the evil out; on the other hand ginseng supports upright qi, so the upright is never injured.

💬 Note from Doctor Luo: This formula treats cold damage, plague, wind-warm disease, wind-dizziness, pain in the four limbs, aversion to cold with blazing fever, stiff neck and painful eyes — whether the patient is old or a small child, all may take it. In the miasmic regions of Lingnan — the southern mountains where the miasma is especially heavy — or when plague is epidemic, or when a person’s wind-phlegm is especially heavy, or for those living in damp low-lying places near swamps and marshes — for things like jiao qi (foot qi) and weakness and atrophy, this medicine is indispensable. Note that this “foot qi” is not today’s athlete’s foot; it is the kind of weakness and atrophy caused by heavy dampness. Take three to five doses, stopping when it resolves; some circulating versions add a little bo he (mint) as well.

When plague spread nationwide, how did the ancients save herbs? — Decocting powder (zhu san)

Plague in ancient times spread across the whole country — it never stayed in one place. So was there enough Chinese medicine to go around? The ancients met this problem too. In a mass epidemic, they stopped decocting whole-herb soups — boiling decoctions is wasteful — some herbs, after you finish boiling them, are still white in the middle; the medicinal strength hasn’t been extracted. What did the ancients do? They ground the herbs into powder and decocted the powder to drink — where one full dose of herbs would be decocted, with the powder you use one-third or one-fifth of the amount. Using too much is not allowed.

💬 Note from Doctor Luo: I experimented with this once — when I was a student I caught a cold and made Yin Qiao San (Honeysuckle and Forsythia Powder) according to the formula: I ground the herbs into powder. But I didn’t boil one spoonful of the powder — I boiled the whole formula, drank all of it, and oh boy, my body couldn’t take it: the strength attacked outward, my heart rate went over a hundred, my whole body burned, and I felt awful. I even went to the hospital — to the affiliated hospital of Liaoning University of Chinese Medicine to find my teacher. The teacher said: “Yin Qiao San shouldn’t make you react this violently — we turn yin qiao into a decoction, fifteen or twenty grams of jin yin hua (honeysuckle), that’s how we prescribe it.” I had ground up the entire formula and boiled it all — the reaction was extreme. Later everyone analyzed it: “Did you use too much of the powder?” Only then did I learn that when you decoct powder, you must use much less. That was a joke from my student days.

How did the ancients do it? They ground the herbs into powder and decocted the powder — one liang (about 30 g) per dose, three slices of ginger, decocted in water until about eight-tenths remained (roughly half the water boiled away), drunk warm. Or they ground it into powder and simply steeped it in boiling water to drink — a method for emergencies.

Not cured yet? Niu Bang Qin Lian Tang — heat toxin in the upper burner

If Ren Shen Bai Du San did not cure the patient, it means the heat toxin is inside and still pronounced — so clear heat and resolve toxin to push it outward: Niu Bang Qin Lian Tang (Arctium, Scutellaria and Coptis Decoction). Doctor Gong said: when the extreme heat is above — the crown of the head swollen, or the face swollen, or swelling rising from above the ear root — in short, when the swelling is in the upper part, this formula brings complete recovery.

💬 Note from Doctor Luo: This formula resembles Doctor Li Dongyuan’s Pu Ji Xiao Du Yin: huang qin (baical skullcap), huang lian (coptis), jie geng (platycodon), lian qiao (forsythia), niu bang zi (arctium fruit) — these all clear heat and resolve toxin; da huang (rhubarb) — drains and purges the heat toxin; jing jie (schizonepeta), fang feng (saposhnikovia), qiang huo (notopterygium) — dispel wind; shi gao (gypsum), one and a half qian (about 4.5 g) — a very small amount; in fact it could be more; gan cao (licorice), one qian (about 3 g). Ground into powder, add one slice of ginger, decoct in water, and after a meal press it down slowly, little by little — one cup of medicine divided into twenty servings, drunk sip by sip, so the medicinal strength keeps working in the upper body. Be sure to take it after a meal, not before — the medicine should stay up top.

The immortal formula that came out of the palace: Nei Fu Xian Fang — the ancestor of Sheng Jiang San

Around the same time, Doctor Gong also recorded another formula, called Nei Fu Xian Fang (Inner Palace Immortal Formula) — an immortal formula handed down from within a prince’s mansion. It specialized in treating swollen neck, datou wen (big-head plague), toad plague (hama wen, mumps-like swelling), and the like. What’s in it? Bai jiang can (white stiff silkworm), two liang; jiang huang (turmeric), two and a half qian; chan tui (cicada slough), two and a half qian; da huang (rhubarb), four liang — ground into powder and formed into pills with a paste binder.

💬 Note from Doctor Luo: What is this formula? It is precisely the Sheng Jiang San (Ascending-Descending Powder) we talk about later. Sheng Jiang San is still commonly used in our clinics today: when there is heat toxin, when heat toxin accumulates — for example, an externally-contracted disease flaring into heat, heat toxin congested and stored up, the throat painfully swollen — we often add this formula into the prescription: jiang can plus jiang huang, plus chan tui, plus da huang — the effect is excellent. All these formulas were recorded by famous physicians, and their effects really are excellent — they are the distilled experience of ancient Chinese medicine; using them absolutely raises the cure rate. Doctor Gong also collected Doctor Li Dongyuan’s Pu Ji Xiao Du Yin, calling it Pu Ji Xiao Du San — these are all treatments for plague.

Epilogue: one physician, one entire arsenal

Doctor Luo sighed with admiration: a single physician listed this many formulas — and there were many more behind them that cannot all be told. Ancient Chinese medicine had a vast number of approaches to plague. The whole world has little answer to plague — but the Chinese people have far too many methods, because our ancestors left us a whole arsenal of weapons, and the weapon storehouse is full of options.

💬 Note from Doctor Luo: What Doctor Gong Tingxian faced was a plague that spread street by street, killing many people, even wiping out whole families — the next morning the whole family was dead. Yet he had methods to treat it, and countless people were saved — the numbers cannot be counted — which proves the treatment worked. From then on his fame grew; and that is why later, when someone in Prince Lu’s household fell ill, he was invited to treat it. He cured them, and when they tried to give him a great deal of money, he would not accept it. Prince Lu said: this man is a person of principle — he won’t even take money. So the prince had a plaque made for him, reading 「Yi Lin Zhuang Yuan」— “Number One Scholar of Medicine” — the top scholar of Chinese medicine. We should study the experience of this Number One Scholar of Medicine with real diligence.

At the end, Doctor Luo both wrapped up his talk and “wrapped up” the formulas: just know about Er Sheng Jiu Ku Wan — don’t go and try it yourself — that should be left to the relevant experts. For ordinary people, grasping the approach is enough: the thinking of Ren Shen Bai Du San, the thinking of Niu Bang Qin Lian Tang, the thinking of Pu Ji Xiao Du Yin — we only need to know how to read them. A throat painfully swollen, swollen so thick you can barely speak, the head swollen huge — what do you do? Use these methods to resolve it. When the moment truly comes, we will have the ideas and know what to use. Ren Shen Bai Du San even comes as a ready-made medicine; if there is an epidemic in some places, you can stock a little.

💬 Note from Doctor Luo: Dear friends, today’s medical-case story ends here — though actually it wasn’t one medical case, but the process of treating a plague, one could say the distilled thinking of many cases. Because in this plague campaign his influence was so great and he saved so many lives, Doctor Gong Tingxian’s fame shook Zhongzhou; in the whole central region he became famous overnight, and then gained nationwide fame. We must value this kind of experience. Learning Chinese medicine means learning to protect yourself well, to have a few more approaches than other people. See you tomorrow.

Compiled from Doctor Luo Dalun’s lectures on Doctor Gong Tingxian’s medical stories; the formulas come from Doctor Gong Tingxian’s Wan Bing Hui Chun (Return of Spring for Myriad Diseases, published 1587) and other works.