Can You Take Tonic Herbs During a Cold? Doctor Yu Jiayan’s Answer: If Your Upright Qi (Zheng Qi) Is Weak, Ginseng in the Sweating Formula Is Exactly What You Need

Opening: the strange phenomenon every household has seen

Does your family keep a stock of Ejiao (donkey-hide gelatin), ginseng, and various nourishing herbal pastes? Have you noticed that almost all of these tonic products carry the same line in their instructions — “do not take during a cold”?

💬 Note from Doctor Luo: You see, many nourishing and tonic medicines write on the package: don’t take it while you have a cold. This seems to have become an unspoken rule — everyone seems to accept it. But in fact this claim is deeply problematic — if a person’s upright qi is very strong, it doesn’t matter whether you add tonics to the exterior-releasing formula or not; but if a person’s upright qi is insufficient, this is precisely when you NEED tonics! When you are in dire need of supplies, you’re told supplies are forbidden — does that make sense? I have always said: this is wrong.

The piece we discuss today is precisely the manifesto that the late-Ming, early-Qing medical master Doctor Yu Jiayan wrote on this very subject — the famous essay “On the Method of Readily Using Ginseng in Medicines for Cold Damage” (Lun Zhi Shang Han Yao Zhong Yi Yong Ren Shen Zhi Fa) from his book Yu Yi Cao (《寓意草》— Hidden Meanings) — written to sweep away what he called “the disaster of the four vulgar errors” (si su zhi huo).

Three great plagues: what saved countless lives was precisely “Ren Shen Bai Du San”

Why did Yu Jiayan write this essay? Because he had seen it with his own eyes and lived through it himself — using ginseng for external contraction saves lives.

💬 Note from Doctor Luo: Everyone knows that during the COVID pandemic, the formula Ren Shen Bai Du San (Ginseng Toxin-Expelling Powder) became very famous. Why? Because it was used in ancient plagues. In Yu Yi Cao, Yu Jiayan records: in the yiwei year of the Jiajing reign (1535), during the fifth, sixth, and seventh months, externally contracted illness swept through Jiangnan and the Huai River region — plague and febrile disease spread village by village along the borders, and the dead were countless. The local doctors used Ren Shen Bai Du San — with double the ginseng, removing Qian Hu (peucedanum root) and Du Huo (doubleteeth pubescent angelica root) — and the people who took it responded remarkably well, with not a single failure. Later, during the Wanli reign, plague raged again, and this formula again worked superbly — wu bu quan huo — every single one of them survived. Why? Who is it that gets caught by plague? People with weak bodies! For weak people, put ginseng in — it replenishes upright qi and then drives out the pathogen — and so they all lived.

By the Chongzhen reign, plague raged for another two or three years, and corpses lined the roads. At that time, among the patients treated by doctors with sweating and harmonizing medicines, those whose formulas contained ginseng all lived — this was seen and heard by everyone. Yet there were plenty of fools who insisted that external contraction meant no ginseng and no tonics whatsoever. Yu Jiayan could not stand it, so he wrote this essay to argue the point.

Yu Jiayan begins: cold damage disease sometimes calls for ginseng — the twist must be understood

Yu Jiayan says: this I must debate. When a person is struck by external pathogen, one must first induce sweating to drive it out, right? But the key question is — sweating also needs someone strong enough to push.

💬 Note from Doctor Luo: When it comes to sweating, only those whose original qi (yuan qi) is exceptionally strong and whose upright qi is very sufficient have the pathogen slip out along with the medicine — one sweat and they are well. But there are many others — whose yuan qi is inherently weak! Otherwise, why would they catch the contraction in the first place? People who catch a cold the moment the wind blows almost always have weak yuan qi. As Yu Jiayan puts it: the medicine may travel outward, but the qi fails from within — the medicine goes to the exterior, yet your own qi collapses from the middle (yao sui wai xing, qi que cong zhong nei). Your upright qi cannot keep up; it is supposed to carry the medicine out to expel the pathogen, but the upright qi gives out first. In mild cases, the pathogen half-leaves and half-stays, lingering and trapping the person in endless discomfort; in severe cases, the pathogen contracts together with the yuan qi, the fever never lets up, the illness drags on far worse, and the road to recovery grows long. Therefore, when a person of weak constitution catches an external contraction, one must use three, five, or seven fen of ginseng — just that tiny amount, less than even one qian by today’s reckoning — added to the exterior-releasing formula, slightly assisting the yuan qi, to serve as the commander that drives out the pathogen (shao zhu yuan qi, yi wei qu xie zhi zhu). The pathogen, receiving the medicine, surges out all at once: upright qi gives one push, and the pathogen is swept away.

Yu Jiayan stresses this emphatically: this is in no way meant to nourish and supplement weakness — it is not simply tonifying deficiency! What is it, then? This is releasing the exterior (jie biao). Using a tonic to release the exterior — that is the most core viewpoint of this essay.

Can Chinese yam expel pathogens? Gui Zhi Tang never sweated — so why did the disease resolve?

Speaking of “using a tonic to release the exterior,” Doctor Luo recalls being challenged when he talked about Chinese yam in the past:

💬 Note from Doctor Luo: When I discussed Chinese yam (huai shan yao), I said that yam can induce sweating and expel pathogens. People asked: how can yam possibly expel pathogens? Is that real? I said: it truly is. It supports upright qi — it tonifies the spleen and lungs; once the qi is made sufficient, the body begins to expel the pathogen, qi and blood start moving, and at that point there may be slight sweating, and the pathogen is resolved. This is in fact the method of supporting upright qi and dispelling pathogens (fu zheng qu xie). Once you understand this principle, you understand why, in the Shang Han Lun, Gui Zhi Tang (Cinnamon Twig Decoction) hardly made anyone sweat, and yet the pathogen was resolved all at once — it harmonizes the spleen and stomach, harmonizes the nutritive and defensive qi (ying wei), and only then can the pathogen be dispelled. This is the treatment method for people with exterior deficiency.

Yu Jiayan continues: even when harmonizing medicines are used — when the pathogen sits half in the exterior and half in the interior and cannot come out — it is also the great strength of ginseng sitting in the middle (ren shen zhi da li zhe ju jian). Ginseng, this herb of great strength, sits inside as the anchor; the external pathogen meets upright qi, and finding it cannot win, it retreats without a fight (bu zheng er tui she). But if there were no great strength present to receive it, the pathogen would be fully capable of defeating upright qi — and would that fierce, savage qi ever submit to a harmonizing medicine?

💬 Note from Doctor Luo: Look at Xiao Chai Hu Tang (Minor Bupleurum Decoction) — the famous harmonizing formula — it contains ginseng! Is ginseng used in externally contracted illness? Of course it is. It is thanks to the ginseng sitting as the anchor that Xiao Chai Hu Tang can harmonize and the external pathogen can retreat. So using ginseng in harmonizing treatment is merely borrowing it to achieve balance (jie zhi de qi ping) — it is absolutely not a matter of favoring one side with tonics. It sits in the center, and lets the pathogen retreat.

“No tonics for cold damage”? Yu Jiayan was so furious he swore a solemn oath on the spot

Those who do not understand this say: “cold damage admits no tonics” (shang han wu bu fa) — the more you supplement the pathogen, the more you pour oil on the fire! So they dare not touch ginseng. Yu Jiayan laments with deep pain:

💬 Note from Doctor Luo: The doctors say: not only the lingering sequelae of cold damage — even at the onset of chickenpox they dare not use it, at the onset of malaria they dare not use it, at the onset of dysentery they dare not use it; wind stroke, wind-phlegm, cold-stroke, heat-stroke, carbuncles, and the postpartum period — all of them, they dare not use it! Then when people with insufficient upright qi meet any of these serious illnesses, every possible chance of life is cast aside. This is no small matter. And look at that line on the package insert — “do not take if you have a cold.” Ejiao can’t be used during a cold? Who says so? In Beijing there was a TCM doctor who discussed exactly this: a child with a fever — when the doctor saw the child had blood deficiency, he gave Ejiao — a good amount of Ejiao — and after drinking it, the child’s fever broke! Why? Blood deficiency, insufficient lung fluids, lung dryness — you moisten the lungs with Ejiao and it works immediately. Who says it can’t be used? And yet every tonic product slaps on “avoid during external contraction” — it is frankly ridiculous. Nobody even knows where that rule came from.

Yu Jiayan, getting heated in this essay, even swore a solemn oath:

💬 Note from Doctor Luo: He said: I am now telling you with my blood poured out (li xue xiang gao) — laying my whole heart open to you — and I will swear and vow: if from now on anyone, when discussing sweating formulas or harmonizing medicines for externally contracted illness, says “ginseng is not appropriate” and thereby misleads people — that person is one who tips the scale for the pathogen (qing xie qi zhe)! Such a person, after death, will descend to the Plough-Tongue Hell (li she di yu) — talking nonsense, so go down there and take your punishment! You see what a character Yu Jiayan was — interesting, isn’t he? He was so furious he swore a terrible oath: if you keep talking nonsense, you’ll go to hell when you die.

From Doctor Zhang Zhongjing to today: no famous doctor treated external contraction without ginseng

Yu Jiayan also offers a clinical scenario: the pathogen enters a person of weak constitution; the doctor does induce sweating — but after the sweat, the fever does not recede; then harmonizing and purging are tried — and still the heat does not recede. The doctor is at his wit’s end and declares the case hopeless. Why is it hopeless?

💬 Note from Doctor Luo: As the Nei Jing says: “If sweating does not cause the illness to abate, death follows; if three purgations bring no response, death follows” (han chu bu wei han shuai ze si, san xia er bu ying ze si) — why? The patient’s yuan qi is already weakened, and the medicine cannot get a response. You try to induce sweating but no sweat comes, and the fever will not break — because the upright qi is insufficient; the more you force the sweat, the more you injure the upright qi! When a person first falls ill, the yuan qi is not yet depleted; the blazing heat burns the body fluids. This is the moment to put three, five, or seven fen of ginseng into the medicine from the start — to lead the medicine deep in to drive out the pathogen — and only then does the sweating do its work. This point is actually very important — many people don’t understand it: with a weak person, do you think sweating settles everything? No — sometimes the more you sweat, the sicker the person gets. Right after the Gui Zhi Tang formula, Doctor Zhang Zhongjing wrote: “do not let it flow like a river” (bu ke ling ru shui liu li) — if the patient sweats in torrents, the disease will certainly not leave. Why? Because sweating is not the goal! If you force the sweat, you injure the body fluids, the defense system grows even weaker, and the pathogen grows stronger. When the upright qi is sufficient and the qi and blood circulate freely, there will be a gentle, moist sweat (zhi zhi han chu) — and only then does the disease resolve. Sweating is only a result — the result of sufficient upright qi and open circulation of qi and blood.

So Yu Jiayan concludes: throughout ancient and modern formulas — for exterior sweating, Wu Ji San (Five Accumulations Powder), Shen Su Yin (Ginseng and Perilla Drink), and Bai Du San (Toxin-Expelling Powder); for harmonizing, Xiao Chai Hu Tang; and also Bai Hu Tang (White Tiger Decoction) and Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) — all of these formulas use ginseng, all of them borrowing the strength of ginseng to lead the internal pathogen out, so that it does not linger (jie ren shen zhi li ling chu zai nei zhi xie, bu shi jiu liu) — and that is why recovery comes quickly. Yet the vulgar world does not see it!

💬 Note from Doctor Luo: When Doctor Li Dongyuan treated internal damage combined with external contraction, he used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) plus one or two exterior-releasing herbs, taken hot to disperse the external pathogen — a practice of merit that has lasted a thousand ages. Yu Jiayan sets those aside and speaks only of the cold damage specialty — Zhang Zhongjing. From Zhongjing down to the present, the famous masters and the formula books — none of them failed to use ginseng! Which famous doctor treating cold damage did not use ginseng? None. Today’s people alone remove ginseng and write on every package that tonics cannot be taken during external contraction — this way of thinking is wrong. People who know nothing of medicine pass the word from mouth to mouth, urging patients not to take ginseng, watching their own sons, daughters, and relatives die off one by one — and never once asking whose doing this evil really is!

Those who had trouble with ginseng: where exactly did they go wrong?

Why are people so afraid of ginseng? Yu Jiayan acknowledges: yes, some people misused ginseng and things went wrong — but he points out the hidden mechanism:

💬 Note from Doctor Luo: Every case of ginseng causing problems involved mixing it with other tonics: Huang Qi (astragalus), Bai Zhu (atractylodes), Dang Gui (angelica sinensis), Gan Jiang (dried ginger), Rou Gui (cinnamon bark), Da Fu Zi (aconite), and so on — the trouble came from warming and nourishing treatment that should never have been given, in inappropriate doses. But used together with herbs like Qiang Huo (notopterygium), Du Huo (pubescent angelica), Chai Hu (bupleurum), Qian Hu (peucedanum), Chuan Xiong (ligusticum), Jie Geng (platycodon), Bai Zhi (angelica dahurica), and Huang Qin (scutellaria) to treat external contraction — ginseng used in this way has never in all history injured a single life (cong gu zhi jin wei ceng shang guo ren xing ming)! Legitimate use of ginseng has never caused a problem through all the ages. Yet nobody knows why everyone treats ginseng like poison — the moment there is an external contraction, ginseng is forbidden — Yu Jiayan says: this is utterly detestable.

Qing-dynasty doctors said tonics “lock the pathogen in”? Doctor Luo: that is pure speculation

As for Ren Shen Bai Du San itself, Doctor Luo discussed this formula specially during the pandemic — it is a very famous formula for plague:

💬 Note from Doctor Luo: Chai Hu and Qian Hu soothe the wind and clear heat; Qiang Huo and Du Huo dispel wind and disperse cold; and ginseng is placed inside — Yu Jiayan called this “leading the pathogen out” (ling xie wai chu): ginseng serves as the commanding general, sitting in the center and tonifying upright qi, while the other herbs drive the pathogen outward. During this pandemic, many doctors also used Ren Shen Bai Du San with excellent results. Why did ancient Chinese medicine value upright qi so highly? When the external pathogen arrives, some people fall ill and others do not — why do YOU fall ill? Your upright qi is insufficient. It is not enough to only drive out the pathogen — sometimes the body can recover on its own after expelling it; but sometimes it cannot, because expelling a pathogen consumes the body’s energy. At such times, adding a little tonic to support the upright qi makes the expelling work even better.

As for the claim made by some Qing-dynasty doctors that tonics “lock the pathogen in” (ba xie qi bu zhu) —

💬 Note from Doctor Luo: I believe this claim is pure speculation (yi xiang) — Doctor Xu Lingtai said it too, and it was speculation on his part as well. If you use tonics correctly in the course of an externally contracted illness — the person’s body really is deficient, whether yin deficiency, qi deficiency, yang deficiency, or blood deficiency — you nourish according to his actual problem while at the same time using pathogen-expelling medicine — that is twice the result with half the effort (shi ban gong bei). In fact, some Ming-dynasty doctors discussed this extremely well; by the Qing dynasty, some doctors clung to their own one-sided views (zhi yi ji zhi pian). Their rhetoric was beautiful, and they savagely satirized and attacked the Ming-dynasty doctors — who were long dead and could not rebut them. So the words left by the Qing doctors appear to have won the day, yet what they said may well be wrong. That is my objective assessment today: many Qing-dynasty doctors spoke with bias, and you should keep that in mind. Doctor Xu Lingtai in particular opposed ginseng; whereas Yu Jiayan’s position is comparatively objective — look at his argument: people with deficient upright qi CAN use it, and using it gives better results. And so many plagues verified it: in large-scale use, the people who took ginseng all lived and recovered — which shows the thinking was right.

Closing: the Yu Jiayan series is finished — who comes next?

This piece is one of Yu Jiayan’s short essays, and it closes the Yu Jiayan series — with this, the book Yu Yi Cao is complete.

💬 Note from Doctor Luo: Yu Jiayan wrote many medical books — Yi Men Fa Lü (Laws and Regulations of the Medical Profession) and others; if you are interested, you can look them up. Yu Jiayan was a great master; he had a profound influence on the study of the Shang Han Lun and on the treatment of externally contracted illness. Yu Yi Cao explains the cases one by one, with an enormous amount of content, and each case is analyzed in extraordinary detail — how the illness came, how it left. From ancient times to the present, there are probably very few doctors who analyzed case records this carefully. It is a pity we could not cover it all, but you have now had a taste of his style. Rest for two days, and then we begin the Shang Han Lun series — starting with Doctor Xu Shuwei (Xu Shu Wei). Xu Shuwei wrote books on the Shang Han Lun and was one of the founding fathers of the classical formula school (jing fang pai). We will discuss the formulas of the Shang Han Lun, and mainly the principles behind them. Once you understand the principles, you may not be able to write prescriptions yourself — but at least you will know what is going on.

Compiled from Doctor Luo Dalun’s lecture on the case records of Doctor Yu Jiayan; the cases come from Yu Yi Cao (Hidden Meanings, late Ming to early Qing).