Chronic Dry Cough, Breathless at the Slightest Effort, Always Short of Breath? Zhang Xichun’s Shen Mai Tang (Ginseng and Ophiopogon Decoction): Tonify Qi and Nourish Yin Together to Cure Deficiency Cough

What people search for: constant dry cough with yin deficiency / dry cough with phlegm / breathless on any exertion / short of breath and drained / long-term fatigue / tuberculosis exhaustion / a cough that never gets better

Medical terms for this pattern: yin-deficiency consumptive cough (yin xu lao sou) · lung yin deficiency · deficiency wheezing (xu lao chuan) · tuberculosis exhaustion

Opening: Zhang Xichun’s formulas — today we reach Shen Mai Tang

Doctor Luo Dalun has been taking everyone through Zhang Xichun’s Medical Records Integrated Chinese and Western Medicine (Yi Xue Zhong Zhong Can Xi Lu) piece by piece, moving from case studies to formulas in order, front to back. Today’s formula is called Shen Mai Tang (Ginseng and Ophiopogon Decoction).

💬 Note from Doctor Luo: The two characters shen-mai should sound familiar — I wrote an article about Shen Mai Yin (Ginseng and Ophiopogon Drink) before, and there is a formula by that name. But the Shen Mai Tang we are discussing today is Zhang Xichun’s own formula.

The name sounds familiar — but how is the formula actually used? Zhang Xichun’s indication in the book is only one sentence: “When the yin aspect has been depleted for a long time, gradually reaching the point where the lungs are deficient with phlegm.” That one sentence carries a great deal of information: the person has been yin-deficient for a long time — it is their constitution; the yin deficiency has grown more and more severe, gradually dragging the lungs down too, until phlegm, cough and constant wheezing appear.

💬 Note from Doctor Luo: From this line we know what kind of person this is — a yin-deficient constitution. As the yin deficiency becomes severe, the lungs gradually weaken a great deal: phlegm, coughing, constant wheezing — deficiency-type wheezing, or in some cases accompanied by tuberculosis. Zhang Xichun writes this very clearly. If there is tuberculosis with yin-deficient symptoms, it can also be treated; ordinary cough caused by yin deficiency can be treated as well.

Ingredient one: ren shen three qian — why does Zhang Xichun write ginseng instead of dang shen this time?

The first ingredient on the list is ren shen (ginseng), three qian (9 g). Everyone knows ginseng tonifies upright qi. But there is a detail here: Zhang Xichun usually preferred dang shen (codonopsis) in his prescriptions — yet in this formula he deliberately writes ren shen, by which he means the ginseng from northeastern China.

💬 Note from Doctor Luo: Dang shen is a bit more gentle; northeastern ginseng carries some heat. The main action of ginseng is to greatly tonify primordial qi. Tonifying primordial qi, restoring the pulse and rescuing collapse — for instance, if your upright qi is insufficient and your pulse has already become extremely faint, taking ginseng can restore the pulse to its original state and make the upright qi sufficient. “Rescuing collapse” means: when a person’s qi is about to desert the body, usually in a critical condition, ginseng is used to lift the upright qi and immediately gather back that qi which was on the verge of escaping.

Where does ginseng’s tonifying power land most? On the spleen and lungs — greatly tonifying the spleen and lungs. That is ginseng’s home turf.

The finer points of ginseng: sun-dried, red, garden-grown, wild — and some from Russia

Ginseng has an enormous number of varieties, and Doctor Luo takes this opportunity to introduce them all.

First, processing: garden-grown ginseng dug up and dried directly in the sun turns white — that is sun-dried ginseng (sheng shai shen) — mainly tonifying qi; if it is steamed first and then dried, the color turns red, and that is red ginseng (hong shen) — carrying a mild blood-nourishing action as well, greatly tonifying qi and blood.

Then, origin and variety: yuan shen (garden-grown ginseng) is simply cultivated ginseng — but even cultivated, it has grown for five, six or seven years, so its medicinal strength is considerable; for ordinary people’s daily use, garden-grown ginseng is enough. Wild mountain ginseng (ye shan shen) has much stronger power — a friend in the ginseng business told Doctor Luo that after taking wild ginseng, your qi is so full that your head feels swollen.

💬 Note from Doctor Luo: People with high blood pressure should not take it casually — it must be used under a doctor’s guidance; some people’s blood pressure goes up after taking it. Wild mountain ginseng is becoming rarer and rarer; the wild ginseng of the Changbai Mountains in northeastern China is now almost impossible to dig up. Much of the “wild ginseng” you see on the market comes from Russia — the great forests of the Russian Far East also contain mountain ginseng, nobody harvests it, so a great deal has been imported. Its action is roughly the same and its strength is also considerable. With wild ginseng scarce, people use yi shan shen (transplanted mountain ginseng), lin xia shen (forest-understory ginseng) and the like — these may be a bit stronger. But I remind everyone not to look down on garden-grown ginseng: although it is cultivated, it has still grown five, six or seven years, and its medicinal strength is fairly strong.

In the past, people were afraid that eating ginseng would make them “hot,” and many dared not take it. But Doctor Luo states plainly: people with qi deficiency are extremely numerous today — especially ordinary white-collar workers. Once you truly replenish the qi, you see your whole state of life differently.

💬 Note from Doctor Luo: What does qi deficiency feel like? It feels like being perpetually exhausted and driven. So you should tonify qi.

Emperor Qianlong’s longevity formula: ginseng with mai dong — the emperor who ate his way to first place

When talking about using ginseng to tonify qi, one cannot avoid the most famous figure of all — Emperor Qianlong. Doctor Luo says this is recorded in the historical documents; the palace archives record it clearly.

💬 Note from Doctor Luo: Emperor Qianlong ate ginseng from his forties all the way to age 89. His lifespan ranks first among Chinese emperors and second among emperors worldwide. A man as busy as he was, living to 89 was no small feat. Why? Because he ate ginseng every day — according to the imperial physicians’ records, in a year of 365 days, he ate ginseng on more than 350 of them. This is not idle talk; the Qing palace kept meticulous archives: the imperial physicians recorded every pulse-taking, and everything the emperor ate and in what quantity was recorded.

So how did Qianlong eat ginseng every day without getting “heated”? The secret is in the pairing — his physicians paired it with mai dong (Ophiopogon root): ginseng with mai dong is called Shen Mai Yin (Ginseng and Ophiopogon Drink).

💬 Note from Doctor Luo: Ginseng is warm and tonifies qi; mai dong nourishes yin and moistens dryness, especially tonifying lung yin and generating fluids. Ginseng and mai dong together are neither cold nor hot — they tonify qi and nourish yin at the same time. Emperor Qianlong used this formula, ginseng with mai dong every day, sometimes adding a little wu wei zi (schisandra) — that version is called Sheng Mai Yin (Pulse-Engendering Powder). He took the two formulas alternately. What dosage? One qian of ginseng is three grams, one qian of mai dong is also three grams — exactly equal proportions — taken daily, neither cold nor hot, tonifying qi and generating fluids: tonifying both qi and yin. That is why this formula is so famous.

This is the origin of the shen-mai pairing.

Mai dong with the core, four qian; sheng shan yao, six qian: nourishing yin comes first, and the spleen is the mother of the lungs

Back to Zhang Xichun’s Shen Mai Tang. The second ingredient is mai dong with the core, four qian (12 g) — note that it is one qian more than the ginseng.

💬 Note from Doctor Luo: Why? Because Zhang Xichun regarded this condition as yin deficiency at its core, so the yin-nourishing medicine weighs slightly heavier. Ginseng paired with mai dong — that is shen-mai.

The third ingredient is an old friend: sheng shan yao (raw Chinese yam), six qian (18 g) — the largest dose in the whole formula.

💬 Note from Doctor Luo: Chinese yam greatly tonifies the lungs, spleen and kidneys — its lung- and spleen-tonifying actions are especially strong. On top of ginseng and mai dong tonifying the lungs and nourishing yin, yam adds lung- and spleen-tonifying power — the spleen is the mother of the lungs; once I fill the spleen, lung qi can be sufficient. So you see, whenever he treats lung disease, he uses spleen-tonifying medicines. These three — ginseng, mai dong and yam — are the main melody of the formula; they are the tonics.

Qing ban xia, two qian: all four preparations of ban xia, learned in one go

Next comes qing ban xia (alum-processed Pinellia), two qian (6 g). Ban xia is processed in a bewildering number of ways, and Doctor Luo walks through all four preparations one by one — so that when you go to the pharmacy and see the name, you know exactly what the doctor intends.

💬 Note from Doctor Luo: Ban xia comes in four preparations: qing ban xia, jiang ban xia, fa ban xia and sheng ban xia (raw). Raw ban xia is somewhat toxic and fierce, and is generally not used nowadays — though some doctors are especially skilled with raw ban xia and get excellent results, especially in severe, critical cases. But that is that doctor’s personal expertise; the rest of us should not copy it — if you don’t know how to pair it, don’t use it casually. Fa ban xia is raw ban xia processed with licorice and slaked lime; its warm-drying nature is softened, and it excels at drying dampness and transforming phlegm while also harmonizing the spleen and stomach — when phlegm-dampness is heavy and has impaired the spleen and stomach, it works very well, which is why I often prescribe fa ban xia. Jiang ban xia is soaked in ginger juice, which makes it warmer, so it warms the middle and transforms phlegm — when the phlegm is cold phlegm, use it; the old saying goes “phlegm will not transform without warmth.” When the body is deficient-cold, the spleen is weak and dampness prevails, and phlegm-drool is causing trouble, jiang ban xia is especially good, and it also has the action of directing rebellious qi downward and stopping vomiting. Qing ban xia is raw ban xia soaked through in an alum solution; the pungent-drying nature is tempered somewhat while its phlegm-transforming action is strengthened — so qing ban xia is used for coughs caused by phlegm-dampness, especially when phlegm-dampness in the respiratory system is heavy. In this formula Zhang Xichun uses qing ban xia.

Now, after building the foundation with tonics, why add a single phlegm-drying, dampness-transforming ban xia?

💬 Note from Doctor Luo: Zhang Xichun explains it this way — ginseng is the main lung tonic, but in this kind of yin-deficient situation, ginseng often brings heat once it is used; and what does heat do? It ends up injuring the lungs. So mai dong is used to moderate it: you have heat? I nourish yin. Ginseng paired with mai dong can actually retreat heat — it can drive away deficiency heat. And mai dong is the main lung-moistening medicine, but moistening things are apt to feel greasy and clogging; what to do? Ban xia is added to moderate it, and it actually turns into cough-suppressing power — you’re a little too moist? I use ban xia’s pungent-drying nature to match you, so you can moisten without becoming cloying. Moreover, yam has an astringent action that helps ginseng tonify qi; and fresh yam is rich in sap, which helps mai dong moisten. So these medicines work together as a set.

Niu bang zi and su zi — both stir-fried and crushed: Zhang Xichun’s dispensing wisdom

Next come niu bang zi (burdock seed) and su zi (perilla seed), each three qian (9 g), and Zhang Xichun specifically notes: stir-fry them, then crush them. Doctor Luo says this is Zhang Xichun’s hard-won insight, and everyone should remember it.

💬 Note from Doctor Luo: Nowadays when we use niu bang zi or su zi, we rarely crush them — but remember, they must be crushed. The pharmacy hands you round, perfectly smooth seeds; the best approach is to crush them with a stone garlic-and-mortar pestle. Why? So the medicinal power can be extracted. Big hospital pharmacies rarely bother, but some small clinics and shops do it — why? Because they have to survive on results. If they don’t get results, the doctor cannot stand. For the sake of effectiveness, he considers every detail of the medicine — that is what responsibility looks like: results first.

What does niu bang zi do? Clears heat, resolves toxins, benefits the throat, stops cough. And su zi? Su zi is the seed of the purple perilla plant — the leaves (zi su ye) disperse cold, release the exterior, harmonize the middle and counter the toxins of fish and crab; the stem (su geng) regulates qi and harmonizes the middle, useful when qi stagnation in the chest or middle burner blocks the movement of qi; the seed is su zi — it directs qi downward, transforms phlegm, stops cough, directs rebellious qi downward and stops vomiting, and it also frees the large intestine — the lungs and large intestine are interior-exterior paired, so when lung qi descends, the qi of the large intestine opens too.

💬 Note from Doctor Luo: Zhang Xichun said: all these tonics before — I fear that if you use them long, they will create stagnation; they are all tonics. This niu bang zi has a slippery, freeing action — it unblocks. You tonify over there, and I help you open up over here, so niu bang zi clears toxins on one side while on the other it keeps the tonics from becoming cloying — every link fits into the next. Su zi directs qi downward and transforms phlegm, just like ban xia; its power moves downward. Why does this formula have so many qi-descending medicines? Because in this kind of lung disease with cough and wheezing, the qi tends to escape upward beyond control, and Zhang Xichun tries his best to bring it down. Sometimes, when the condition has not reached that point, a Chinese doctor will use ascending and descending medicines together — a bit up, a bit down — to restore normalcy. These are different situations, calling for different angles of prescribing.

Bai shao with gan cao: beyond generating yin from sour and sweet, a hidden layer of “managing the liver”

Toward the end of the formula come sheng hang shao (bai shao, white peony), three qian (9 g) and gan cao (licorice), one and a half qian (4.5 g) — together they form Shao Yao Gan Cao Tang (Peony and Licorice Decoction). That formula on its own nourishes yin: peony is sour, licorice is sweet, and sour plus sweet generates yin (suan gan hua yin) — generating fluids and replenishing body fluids. But Zhang Xichun’s use of bai shao here has a deeper purpose.

💬 Note from Doctor Luo: He is thinking about the relationship between the liver and the lungs — this is where the formula shows its depth. The liver is wood, the lungs are metal; normally metal controls wood — lung metal restrains liver wood, so the liver wood does not turn excessively violent. When your liver fire is especially blazing and liver qi erupts violently, lung metal can restrain it. But once the lungs become diseased? Nothing controls the liver fire anymore, so it grows fiercer and flares upward — first, it bullies lung metal, making the lung disease worse; second, with nothing restraining liver wood, liver fire flares upward and creates disorder, causing problems elsewhere in the body, such as chaotic qi and blood. So in this state, when you treat lung disease, you must consider the organs connected to the lungs: earlier, ginseng and yam tonify the spleen to generate lung qi — that is thinking of the mother of the lungs; on the other side, lung metal governs liver wood — once the lung channel is deficient, liver fire is left unmanaged, so you must also adjust the liver: bai shao can restrain and soften the liver, lightening the pressure on the lungs and letting them recover. That is the true purpose of bai shao in this formula.

This “treat one organ while adjusting its related organs” approach is the big-picture vision of a master prescriber. Doctor Luo notes it is exactly like treating liver disease, as discussed in earlier lectures — whenever you encounter liver disease you must tonify the spleen; while tonifying the spleen with yam, bai zhu and the like, you also add a little bai shao to restrain and soften the liver and some sheng mai ya (sprouted barley) to let liver qi flow freely — tonifying the spleen on one side and softening the liver on the other; only then can the liver slowly recover.

The cough of liver fire invading the lungs: why no patent medicine helps

Speaking of cough, Doctor Luo flags one of the most common types among modern people: emotion-related cough, where liver fire invades the lungs.

💬 Note from Doctor Luo: Many people today have troubled emotions; after that, liver fire invades the lungs and causes coughing. Look at an external contraction — it seems simple: the person catches a cold and coughs. But this cough will not get better no matter how you treat it. Do you think an external contraction is only caused by external pathogens? That is what the textbook says — but people never get sick according to the textbook. Very often, during this period the person’s liver qi was constrained and liver fire was blazing — they got angry, felt depressed, and that led liver fire to invade the lungs; the constrained liver qi also ran sideways and attacked spleen earth, the spleen and stomach weakened, and lung metal’s function declined further. With the body in this kind of disorder, a cold wind blows from outside, and only then do they catch a cold and cough; the external pathogen enters the interior and turns to heat. So this kind of cough presents as a mix of cold and heat, deficiency and excess. For a cough like this, simply dispersing cold by the textbook will not work — inside there is also interior heat. Where does the interior heat come from? On one side, the external pathogen enters the interior and turns to heat; on the other, liver fire invading the lungs also carries fire. So clearing the external cold, dispersing the interior heat, draining the liver fire and tonifying spleen earth — that is one integrated sequence.

Doctor Luo tells a case he personally treated: a few days ago a patient came in with a cough; he had tried every patent medicine, every cough remedy on the shelf — it simply would not get better.

💬 Note from Doctor Luo: I asked what was going on. I analyzed it: constrained liver qi. I prescribed a formula to drain liver fire — I used liver-softening medicines, and also dan pi (moutan bark), zhi zi (gardenia fruit), chai hu (bupleurum) and so on — everything to soothe the liver and drain liver fire — plus a little phlegm-transforming medicine and a little spleen-tonifying medicine. Three doses and it was cured. If you don’t realize that the person’s earlier stress created liver fire, that liver fire then invaded the lungs, and the external pathogen produced this cough — if you never think of liver fire invading the lungs, that illness is extremely hard to treat. So all the patent medicines in the world had no effect, and in the end one round of draining liver fire fixed it.

Closing: when you study a formula, you study the thinking

Look back at the seven ingredients of Shen Mai Tang — ginseng, mai dong and yam tonify; qing ban xia transforms phlegm, directs qi downward and stops rebellious vomiting; niu bang zi resolves toxins; su zi directs qi downward and transforms phlegm; bai shao softens the liver; gan cao harmonizes the medicines — every single one has its own assignment. That is Zhang Xichun’s level.

💬 Note from Doctor Luo: Why do these formulas look roughly similar, with a few ingredients added or subtracted? That is Zhang Xichun’s understanding of medicines on display. When we study a formula, we are not memorizing it — we are studying the thinking inside it: what is the doctor trying to accomplish, and you need to understand that clearly. A formula like this one is mainly for cough caused by deficiency and weakness, insufficient upright qi, weak spleen qi, accompanied by yin deficiency and a little residual external pathogen — in that situation it can be used. By going through Zhang Xichun’s book this way, from cases to formulas, one by one, in fine detail, you can begin to feel where this man’s level lies. As I always say, I don’t mind spending the words — a passage every day, a little for everyone to absorb, and you will understand Chinese medicine a bit more, step by step walking into the culture of Chinese medicine.

Shen Mai Tang teaches this principle: tonify qi and nourish yin together, tonify while keeping things moving, and when treating the lungs never forget the spleen and the liver.

Compiled from Doctor Luo Dalun’s commentary on Zhang Xichun’s case records; the original case is from Medical Records Integrated Chinese and Western Medicine.