Afraid of the Plague? Caught a Chill, Fever, Chills and Aches All Over? Ren Shen Bai Du San (Ginseng Toxin-Vanquishing Powder) — Ginseng Leads the Charge

💬 Note from Doctor Luo: Dear friends, good morning, everyone. Today we continue our discussion of how to prevent and treat the plague. Today I’m going to start introducing some formulas, and the first one is Ren Shen Bai Du San (Ginseng Toxin-Vanquishing Powder). The moment you see the words “Bai Du” — “vanquishing toxins” — you know what this is about: supporting the upright qi and defeating the pathogenic qi, right? So today let me introduce Ren Shen Bai Du San to all of you.

Opening: you know it from the name alone — support the upright, defeat the pathogen

Ren Shen Bai Du San — just look at the two characters “bai du” (vanquishing toxins) and the meaning is clear: hold up the upright qi and drive the pathogen out. It is the first formula in Doctor Luo Dalun’s plague-prevention series, and a name that carries real weight among the ancient anti-epidemic formulas. This formula has a pedigree — and an extraordinary one at that.

💬 Note from Doctor Luo: This formula truly has a pedigree. Where does it come from? In the Song dynasty there was a book called the Tai Ping Hui Min He Ji Ju Fang (the Imperial Grace Formulary). I’ve introduced many formulas that come from this book before — for example, Si Jun Zi Tang (Four Gentlemen Decoction) for tonifying qi, Si Wu Tang (Four Substances Decoction) for nourishing blood, and Huo Xiang Zheng Qi San (Agastache Qi-Correcting Powder), which we recommend in times of plague — all of these are from this book.

The ‘curated formulary’ the Song emperors assembled themselves

How did the Tai Ping Hui Min He Ji Ju Fang come into being? It has quite a story behind it — the Song royal house, the Song government, collected the effective proven formulas that were working especially well among the people, organized them, and published this book.

💬 Note from Doctor Luo: This book had an enormous influence on later generations. Why? Because the formulas selected by the Song emperors were the cream of the crop — the formulas people submitted were all genuinely effective. You wouldn’t dare submit a made-up one; if you just casually invented a formula and handed it in, you wouldn’t dare. So these were all carefully selected formulas. An enormous number of the classic formulas that appear later in Chinese medicine come from this book, which makes the Tai Ping Hui Min He Ji Ju Fang a work of very high value — the formulas in it really are refined.

What does it treat? — ‘Shang han shi qi,’ which simply means externally contracted illness

So what illness does this formula treat? Here is the original wording from the Tai Ping Hui Min He Ji Ju Fang, which Doctor Luo translated into plain language:

💬 Note from Doctor Luo: The Song-dynasty Tai Ping Hui Min He Ji Ju Fang says it can treat shang han shi qi — that is, externally contracted illness: headache with a stiff neck — your head aches and your neck feels rigid; high fever with chills; body aches and restlessness; and han yong ke sou — the kind of cough caused by cold; nasal congestion with a heavy voice — a stuffed-up nose; wind-phlegm headache; and ou hui han re — vomiting, chills and fever. All of these it treats together. So when you look at that original description, what does it treat? Externally contracted illness.

Its standing in later ages: it shows up in almost every plague chapter

How highly was this formula regarded in later generations? The words of one great Ming-dynasty physician say it best.

💬 Note from Doctor Luo: Basically, in the writings of later physicians, whenever plague is discussed, this formula appears. For example, right now in my hand, right on my desk, is the surviving work of the Ming-dynasty physician Doctor Gong Tingxian — the one hailed as the ‘Number One Scholar of Medicine’ (Yi Lin Zhuang Yuan). In his book Wan Bing Hui Chun (The Return of Spring in Ten Thousand Diseases), when you flip to the section on plague, which formulas does he bring out? Pu Ji Xiao Du Yin (Universal Salvation Toxin-Dispelling Decoction) is there, and what else? Ren Shen Bai Du San. And what does he say it treats? It is ‘universally applicable to the four-season epidemics’ — no matter what season a plague strikes, this formula can be brought into battle. So this formula held a very high position in later generations.

Ten ingredients, nicknamed the ‘Ten-Ingredient Decoction’ — the whole craft lies in the character ‘san’ (powder)

So what exactly makes this formula so remarkable? First, let’s look at the composition.

💬 Note from Doctor Luo: First, look at the composition of this formula. The first ingredient, naturally, is ren shen — ginseng; I’ll explain shortly why ginseng is in here. Then there is chai hu (bupleurum), gan cao (licorice), jie geng (platycodon), chuan xiong (Sichuan lovage), fu ling (poria), zhi ke (bitter orange), qian hu (hogfennel root), qiang huo (notopterygium), and du huo (pubescent angelica) — ten ingredients in all. So this formula has a nickname, an alias: the Ten-Ingredient Decoction.

But strictly speaking, it is not just a matter of ten herbs — the ancients did not use it the way we grab herbs and boil a decoction today. There was another layer of craft:

💬 Note from Doctor Luo: In those days, the first thing done with this formula was to grind it into coarse powder — rou mo, coarse powder. Today we could grind it into a very fine powder; back then they made it into coarse powder. Boiling this powder is called zhu san — ‘decocting a powder.’ Why is it called Ren Shen Bai Du San — ‘Powder’? Because in those days it was always used as a powder. Why powder? As we consider it now, in the earlier years of Chinese history the economy was poor and medicinal herbs did not circulate easily, so herbs were precious. Decocting whole-herb soups the way we do today is actually quite extravagant — many of us who boil soups nowadays notice that after decocting, if you break open a slice of yam it is still white inside, and if you cut open the fu ling it still has a white core. What does that tell you? That our way of boiling actually wastes some of the medicine — some of it never gets fully extracted.

Why did they use the powder back then? Because grinding everything up before boiling enlarges the dissolution surface — one boil extracts more potency:

💬 Note from Doctor Luo: Let me give you an example. If you boil nine grams of chai hu, then if you grind it into powder, three grams may be enough — because the extraction is more efficient; the finer the powder, the better the extraction. Back when I studied Chinese medicine, as a student, I ran my own experiment. Once I caught a cold, got a prescription, and asked the pharmacy to grind it into powder for me, and I boiled the powder. My goodness — after drinking it my whole body could hardly bear it. I had drunk this formula before and knew its strength, but once it was ground into powder and boiled, I found the strength had multiplied severalfold; my body simply could not handle it. So recently a manufacturer told me that when herbs are ground into ultrafine powder and tested, some herbs show a more than tenfold increase in potency — and there are published papers on this.

Behind that single character ‘san’ (powder) is a clever accounting of saving herbs and boosting effect. How was this powder boiled in those days?

💬 Note from Doctor Luo: When the powder was boiled, fresh ginger was used — a few slices of ginger — plus a little mint, and the powder was boiled in that water. Which means two more ingredients were added to the ten: fresh ginger and mint. At the time, all the medicinal ingredients were in equal amounts — ge deng fen, equal parts. How much would you prepare? The Tai Ping Hui Min He Ji Ju Fang says thirty liang of each — and what was that for? Disaster relief. When a plague really broke out, they made a large batch and distributed it to the common people. How was each dose taken? Each dose was two qian — six grams. You took six grams of the coarse powder, added a bit of ginger and mint, decocted it in water, and drank the liquid. That is how this formula was taken back then.

Ginseng leads the charge: who says you can’t use tonics for externally contracted illness?

Next comes the soul of the formula: why does an anti-plague formula use ginseng at the head? In the Qing dynasty, people attacked this point fiercely.

💬 Note from Doctor Luo: In the Qing dynasty, some people did criticize the use of ginseng, saying that when the external pathogen arrives, using ginseng seals the pathogen in — Doctor Xu Lingtai always said this. Actually, that is somewhat one-sided. Why? In Doctor Zhang Zhongjing’s Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases), ginseng is used in many places. Although the ginseng of Zhang Zhongjing’s era is not the same as today’s, the general direction is the same — why wasn’t Zhang Zhongjing afraid of sealing the pathogen in with ginseng?

So why exactly is ginseng used here? Doctor Luo says this is precisely where people fail to understand the two characters ‘zheng qi’ (upright qi):

💬 Note from Doctor Luo: In treating plague and externally contracted illness, you must always take the patient’s upright qi into account — you must learn the art of supplementation. Why? Think about it: when a plague comes, some people are fine and others fall ill. The same external pathogen hits everyone; some are fine, but you get it — why? It must be that your upright qi is insufficient. When the upright qi is deficient, the pathogen invades you easily; and once it gets in, you have trouble driving it out — your upright qi is not strong enough to expel it. So when the upright qi is deficient, the pathogen pushes deeper in; and especially when the problem is caused by plague, the plague qi is fierce and may not even follow the six-channel transmission of cold damage — it can plunge straight inward and make all the channels erupt with illness at once. So at that moment what matters most? The upright qi — the upright qi is the commanding factor. People with upright qi — you’ll notice that after a plague passes, some with strong constitutions recover quickly once the illness resolves. The same happened with this pneumonia: some people had mild cases and slowly recovered; others — the elderly — passed away. So the upright qi is the key to resisting plague and external pathogens.

The direction of this formula is crystal clear: ginseng as the sovereign, supporting the upright first — and the earlier, the better:

💬 Note from Doctor Luo: By the time the pathogen has completely overrun your body and you are already critical, this formula no longer works well — because the system has already collapsed. But when the plague pathogen first arrives, when that li qi (pestilential qi) first gets in, quickly use ginseng to replenish the upright qi, and with that upright qi as the rear guard, it can command, inspire, and galvanize the other medicines. Because behind ginseng there are nine other herbs, and it lets each of them walk into its own channel — each herb enters a different channel — and in that way drive the pathogen out. That is the special role of ginseng in this formula.

The remaining nine herbs: each walks its own channel, some rising, some descending

Ginseng leads the team; the nine herbs each do their own job. First, the two ‘wind herbs’:

💬 Note from Doctor Luo: Qiang huo (notopterygium) — it expels wind and disperses the pathogen, but which way does it lean? Toward the Taiyang channel, and it can expel the wind pathogen from above. Du huo (pubescent angelica) also expels wind and disperses the pathogen, and it can remove dampness; moreover it enters the Shaoyin kidney channel, so from below it dredges the wind out from within. So qiang huo and du huo are a matched pair.

These two herbs share another trait — they are fragrant:

💬 Note from Doctor Luo: Both of these herbs smell distinctly fragrant. When they were boiled, the ancients differed from modern people — the ancients called this fragrance; a modern person smells it and calls it ‘medicine smell.’ What do modern people call fragrance? Rose is fragrance, perfume is fragrance. To the ancients, this was a fragrant herb. And what is special about this kind of fragrance? It is called fang xiang qu shi — aromatic herbs dispel dampness, aromatic herbs dispel turbid, filthy qi. If the tongue coating is very thick and greasy, it can remove it. So judging from this formula, what should such a patient’s tongue coating look like? It should be a fairly thick, greasy coating.

Aromatic herbs can transform damp turbidity — so patients suited to this formula usually have a fairly thick, greasy tongue coating. These two herbs expel wind, and there is a saying in Chinese medicine that ‘wind can overcome dampness’ (feng neng sheng shi): herbs that expel wind often also remove dampness. Here Doctor Luo brings up the approach of the late Doctor Zhao Shaoqin of Beijing University of Chinese Medicine:

💬 Note from Doctor Luo: When we treat kidney disease and the patient’s body is full of dampness, what do we do? We often use herbs like bai zhi (angelica dahurica) and du huo — because wind can overcome dampness. This is the approach of Doctor Zhao Shaoqin of Beijing University of Chinese Medicine: when treating kidney disease, if the patient’s tongue coating is thick and greasy, what does he use? Huo xiang (agastache), pei lan (eupatorium), bai zhi, and du huo — and why? Wind can overcome dampness; I’ll remove your dampness this way.

Next, the rising-and-descending pairings:

💬 Note from Doctor Luo: Then there are chai hu and jie geng. Chai hu disperses the pathogen outward, moving upward; jie geng’s nature also carries it upward. Chai hu can clear and scatter the pathogen of the Shaoyang channel; it rises. Jie geng enters the lung channel — the Taiyin lung channel — and rises. So chai hu and jie geng rise together, pushing the pathogen outward. Zhi ke and qian hu, by contrast, have a descending nature — what do they do? They resolve phlegm and direct qi downward. So you see, there is rising and there is descending.

Beyond rising and descending, there is also qi and blood, drying and percolating:

💬 Note from Doctor Luo: This formula also contains chuan xiong. What does chuan xiong do? It moves the qi within the blood. Your body has been trapped by turbid, filthy qi, by dampness; the earlier herbs open it up for you — remove the dampness, scatter the turbid, filthy qi; then I use chuan xiong to get the qi and blood circulating again. And then fu ling is added — what does fu ling do? Fu ling blandly percolates to drain dampness. You have dampness, don’t you? I’ll remove that dampness for you too. So you see, this formula disperses the pathogen through different channels, and it has rising and descending, herbs that move qi and blood, and herbs that remove dampness.

The last two ingredients are the ‘extras’ added when the powder is boiled:

💬 Note from Doctor Luo: Finally, gan cao is added — gan cao harmonizes the various medicines and anchors the central region. Then fresh ginger — ginger also sweats the exterior and releases the exterior, and it can remove dampness and ward off filth — that filthy qi can also be dispelled. Then a little mint — mint is acrid-cool exterior-releasing; it transmits the pathogen outward. So together the formula becomes quite complete.

Three dynasties of plague practice recorded by Doctor Yu Jiayan in Yu Yi Cao

How effective is this formula, really? Doctor Yu Jiayan, the famous late-Ming/early-Qing physician, left a detailed record in his book Yu Yi Cao (Herbs of Hidden Meaning). Doctor Luo has told many stories from Yu Yi Cao before — Yu Jiayan’s understanding of this formula ran especially deep.

💬 Note from Doctor Luo: I once talked about a physician named Yu Jiayan. If you’ve read my earlier stories of Chinese medicine, you’ll have come across him. A famous physician of the late Ming and early Qing, he wrote a book called Yu Yi Cao. Many of the stories I told about Yu Jiayan’s practice came from Yu Yi Cao. In Yu Yi Cao there is a whole essay devoted to the question of why ginseng belongs in the treatment of externally contracted and cold-damage illness. So his understanding of ginseng’s role in this formula was especially profound. And at the end of that essay, he appended a record of the treatment results of Ren Shen Bai Du San.

What did he record? Let’s begin with the Jiajing reign:

💬 Note from Doctor Luo: He recorded that during the Jiajing reign, a warm epidemic once spread through many places in Jiangnan and Huaibei — to what extent? It spread door to door, street to street, infecting whole neighborhoods — everyone’s illness looked similar. Once it swept through, an entire street fell ill, so the number of patients was enormous. And how was it treated? With this formula — Ren Shen Bai Du San with doubled ginseng — meaning ginseng was added, its dose doubled, and qian hu and du huo were removed, and the people took it. The result: fu zhe jin xiao — everyone who took it had excellent results; wu quan wu guo shi — essentially no failures.

Then in the Wanli reign, the plague returned:

💬 Note from Doctor Luo: By the Wanli reign, the plague was epidemic again. Everyone who took this formula to disperse the exterior pathogen — who took it right at the onset of illness — wu bu quan huo, not one failed to survive. So you see, this is a very good formula for treating plague.

Someone once asked Yu Jiayan: why did you double the ginseng and remove qian hu and du huo? His answer carries the compassion of a physician living through chaotic times:

💬 Note from Doctor Luo: He said: these are times of war and famine; people’s upright qi is far too deficient — people often cannot even eat their fill, so their upright qi is weak. That is why I doubled the ginseng. And why remove qian hu and du huo? Because the upright qi is too deficient and the body too weak — I dare not make them sweat too much. That was Yu Jiayan’s explanation of the formula.

By the Chongzhen reign, amid war and famine, plague swept through once more:

💬 Note from Doctor Luo: He recorded that by the Chongzhen reign the plague came again, spreading street by street, house to house. And he found that the physicians treating it everywhere, when they added ginseng to their formulas for sweating, harmonizing the middle, regulating the interior, removing dampness, and regulating the spleen and stomach, the patients’ chances of survival rose dramatically. Then Yu Jiayan said: these matters are ‘what everyone has seen and heard’ (ci ren ren suo gong jian gong wen zhe) — I’m not making this up in a book. When a plague breaks out, what medicine cured people and what medicine killed them — everyone saw it with their own eyes. So using ginseng in the treatment of externally contracted illness has its reasons.

Bonus: Yu Jiayan also used this formula for dysentery, creating the ‘rowing the boat upstream’ method

Yu Jiayan did more than treat plague with this formula — he also opened up a brand-new treatment path with it:

💬 Note from Doctor Luo: Yu Jiayan also made an invention here. He used this formula to treat dysentery — the kind where the pathogenic toxin has sunk inward and is draining downward. What do I do for that? It’s called ni liu wan zhou — rowing the boat against the current: against the river’s flow, I pull your upright qi back up and push the pathogen out. He used it for dysentery and thereby created the ‘ni liu wan zhou’ method of treating dysentery in Chinese medicine. That is a story for another time; we can talk about it later if the chance comes.

Can it still be used today? It proved itself during the Wuhan epidemic

Is such an ancient formula still useful now? Doctor Luo says: yes — and it was verified just a few years ago.

💬 Note from Doctor Luo: In the treatment of the Wuhan pneumonia, some TCM doctors used this Ren Shen Bai Du San, and the results were excellent — after taking it, patients’ fevers broke. So this formula is well worth our study.

But Doctor Luo also said something regrettable:

💬 Note from Doctor Luo: Very regrettably, for such a classic formula, there is almost no ready-made patent medicine on the market today. You think: this matches my condition, I’d like to take some — you go to the pharmacy to buy it — and there is no such medicine. What does that tell you? It tells you that what we have done is far from enough, that our excavation of ancient Chinese medicine culture is far from sufficient — this is very backward. So I hope everyone will come to know this formula better, and that one day it can be made into a ready-made medicine that people can use in emergencies.

When can you use it? — caught a chill, heavy dampness, thick tongue coating

So when can Ren Shen Bai Du San be used? Doctor Luo gives very practical indications:

💬 Note from Doctor Luo: It doesn’t have to be a plague — for an ordinary cold, as long as you feel you’ve been exposed to cold, your body’s dampness is a bit heavy, your tongue coating is a bit thick, and the tongue body is not bright red in color, then you can use this formula to expel wind, disperse the pathogen, and support the upright qi — push the pathogen out. If there is a bit of heat inside, the formula can be adjusted — we can add some huang qin (baical skullcap), and some shuang hua — jin yin hua (honeysuckle) — you can adjust it, adding a little heat-clearing medicine, and the effect is also excellent. So this is a foundational formula for treating plague, and an important line of thinking.

That’s it for today’s talk on Ren Shen Bai Du San:

💬 Note from Doctor Luo: Next I’ll be introducing several more formulas. I hope everyone will come to understand them well, and I hope everyone learns to protect themselves. That’s all for today — thank you, everyone, and see you tomorrow.

Compiled from Doctor Luo Dalun’s health lecture series (Ren Shen Bai Du San — opening episode of the plague-prevention series). The formula comes from the Song-dynasty Tai Ping Hui Min He Ji Ju Fang (the Imperial Grace Formulary).

What to take away

• Ren Shen Bai Du San is the Song dynasty’s official anti-plague formula, from the Tai Ping Hui Min He Ji Ju Fang — the same government-curated formulary that gave us Si Jun Zi Tang, Si Wu Tang, and Huo Xiang Zheng Qi San. It treats externally contracted illness (shang han shi qi): headache with stiff neck, high fever with chills, body aches, cold cough, stuffy nose, and vomiting with alternating chills and fever — and Doctor Gong Tingxian of the Ming dynasty called it ‘universally applicable to the four-season epidemics.’
• The whole craft is in the ‘powder.’ The herbs are ground into coarse powder and boiled with ginger and mint — grinding enlarges the dissolution surface, so less herb delivers more effect (Doctor Luo’s student-era experiment: the powdered version hit several times harder; published ultrafine-powder research shows more than tenfold potency gains). The original bulk preparation for disaster relief used thirty liang of each herb, equal parts, with each dose being two qian (six grams).
• Ginseng as the sovereign is the soul of the formula. The claim that ginseng ‘seals the pathogen in’ (made famous by Doctor Xu Lingtai) is one-sided — Doctor Zhang Zhongjing used ginseng liberally in the Shang Han Za Bing Lun. In a plague, those who fall ill are precisely those whose upright qi is deficient; and because plague qi can plunge straight inward instead of following the six-channel sequence, the earlier you support the upright with ginseng, the better — the replenished zheng qi then commands the other nine herbs to walk each into its own channel and drive the pathogen out.
• Doctor Yu Jiayan’s three-dynasty battle record proves it. Jiajing reign: doubled ginseng, qian hu and du huo removed — ‘everyone who took it recovered, essentially no failures.’ Wanli reign: taken at onset to disperse the exterior — ‘not one failed to survive.’ Chongzhen reign of war and famine: adding ginseng to sweat-and-harmonize formulas dramatically raised survival. He also used it for dysentery, creating the ‘rowing the boat upstream’ (ni liu wan zhou) method.
• Practical indications: caught a chill, dampness heavy, tongue coating thick and greasy, tongue body not bright red — expel wind, disperse the pathogen, support the upright. If there is heat inside, add huang qin (baical skullcap) and jin yin hua (honeysuckle). It proved its worth in the Wuhan epidemic, when TCM doctors used it with excellent fever-breaking results — yet, regrettably, almost no ready-made patent medicine of this classic formula exists today.