Always Tired, Sweating at the Slightest Effort, Heart Always Fluttering? How Ginseng Tonifies Qi — the Ming-Dynasty Master Doctor Zhang Jingyue Explained It All (Ren Shen · The Four Pillars of Medicine)

What people search for: always tired and weak / sweating at the slightest movement / heart always fluttering and anxious / qi deficiency symptoms list / how to tonify qi / ginseng benefits and how to take it / when ginseng should and should not be used / deficiency fire vs excess fire / red ginseng vs sun-dried ginseng / how much ginseng a day / Zhang Jingyue ginseng / Qianlong ginseng longevity

Medical terms for this condition: qi deficiency (qi xu) · qi failing to govern fluids (qi bu she shui) · xu er jing ji (fluttering heart from deficiency) · xu er duan qi (shortness of breath from deficiency) · essence gate failing to hold (jing guan bu gu) · qi failing to consolidate (qi bu gu tuo) · qi as commander of blood (qi wei xue zhi shuai) · yao zhong si wei (the four pillars of medicine: ginseng, prepared rehmannia, aconite, rhubarb) · long lei zhi huo (dragon-thunder fire) · ge yang (yin exuberance repelling yang) · tonifying qi to generate fluids (bu qi yi sheng jin ye)

Opening: the four pillars that hold up the tent

💬 Note from Doctor Luo: Dear friends, good morning everyone. Today we continue with the medication experience of the famous Ming-dynasty doctor Zhang Jingyue. He called ginseng (ren shen), prepared rehmannia (shu di huang), aconite (fu zi) and rhubarb (da huang) the four pillars of medicine (yao zhong si wei) — the character wei means dimension. What does that mean? Just as a tent has to be held up by four corners, if you master these four directions your way of seeing illness becomes much clearer: ginseng tonifies qi; prepared rehmannia tonifies kidney essence (tonifies true yin, yin and blood); aconite warms yang; rhubarb clears heat and drains heat. Grasp these four big directions and you will be right eight or nine times out of ten. Today we talk about the one he valued especially — ginseng.

One herb, the first pillar of the four directions

The first herb Zhang Jingyue valued was prepared rehmannia; the second was ginseng. What is ginseng’s nature? Sweet in taste, slightly bitter, slightly warm — a little warm, with a thick aroma, yang with a touch of yin inside. So it can tonify qi deficiency, blood deficiency, and yang deficiency too. He also added a warning: ginseng is antagonistic to veratrum (li lu) — some herbs cannot be used together with others, and you must be cautious when prescribing.

💬 Note from Doctor Luo: Zhang Jingyue knew the Book of Changes (I Ching) extremely well and deeply understood the principle that yin and yang are mutually rooted and mutually generative — yin is born within yang, yang is born within yin. That is why he said: when tonifying qi you must add a little blood-nourishing medicine, and when tonifying blood you must use a little qi-tonifying medicine — only then can qi and blood generate each other. His most brilliant sentence is: when yang qi is exhausted to the point of collapse, this herb can pull it back from the land of nothingness (wu he you zhi xiang). What is the “land of nothingness”? It is a state of utter emptiness, where nothing is left. When yang qi is almost gone and the whole system is about to collapse, ginseng can forcefully drag that qi back! And another: when yin blood collapses, it can plug the breach after the dike has already burst — when yin blood suddenly collapses and the blood is about to scatter away, when a big problem has already broken out, ginseng can block it up for you.

What does a qi-deficient person look like? Zhang Jingyue listed a long string of signs

Zhang Jingyue described the many faces of qi deficiency in extraordinary detail. Let us go through them one by one and check ourselves:

Sweating all over at the slightest movement. Qi governs the body fluids — when qi is sufficient, fluids and blood circulate normally in their channels; when qi is deficient it cannot hold them, the fluids escape the channels, and the person starts to sweat spontaneously. Zhang Jingyue put it vividly: fine when sitting still, but the moment you move — a body full of sweat, a head full of sweat. That is qi deficiency.

Dizziness the moment you get tired. When qi deficiency reaches a certain degree, dizziness appears; with the slightest busyness the brain “swims for a moment” — this is called dizziness from deficiency (xu er xuan yun).

Whole-body weakness, as if the sinews had been pulled out. Weakness and weariness from deficiency (xu er kun juan) — soft as noodles, no desire to do anything, unable to get up in the morning. Doctor Luo says this is exactly how so many people felt after the epidemic — the qi had not recovered.

A heart that is always fluttering and afraid. This is called a fluttering, startled heart from deficiency (xu er jing ji): a firecracker goes off outside, other people are fine, but your heart goes “thump”; or you are always vaguely uneasy, always feeling that something is about to happen.

💬 Note from Doctor Luo: Why does heart-qi deficiency cause a fluttering, startled heart? Because the heart governs the spirit (xin zhu shen) — when qi is deficient, the spirit and mind become disordered. That is why the ancients said ginseng can settle the spirit and anchor the soul (an shen zhi, ding hun po) — this is the reason. At such times, what is the lead herb for calming the heart? It is ginseng! Once the upright qi is tonified enough, this condition passes — dragon bone and oyster shell cannot replace it, because the root is insufficient upright qi.

Panting after two steps. Shortness of breath from deficiency (xu er duan qi) — people with qi deficiency breathe fast; they always feel that breathing a little faster is more comfortable; with any exertion they pant far harder than others.

💬 Note from Doctor Luo: Did the ancient Chinese know how to run experiments? They did — it is recorded! They found two people of roughly similar build and had them run together, one holding a piece of ginseng in the mouth, the other not. After several kilometers: the one with ginseng was fine, no shortness of breath; the one without was panting hard. The ancients used exactly this experimental method to determine that ginseng tonifies qi.

Seminal emission and premature ejaculation. Zhang Jingyue said “emission from deficiency” (xu er yi xie) — in ancient terms this is the essence gate failing to hold (jing guan bu gu). Deficient qi cannot consolidate and restrain; the gate cannot hold, and at the slightest stirring of desire it fails. In old movies, that pale-faced, sedentary scholar was the classic sufferer.

Chronic loose stools. Diarrhea from deficiency (xu er xie li) — diarrhea has many patterns, and one of them is qi deficiency failing to consolidate: the qi sinks downward and cannot be lifted up, so the person easily has loose stools. At such times you need ginseng to tonify the qi.

Headache. Headache from deficiency (xu er tou tong) — qi and blood cannot rise to the top, the head is nearly empty — how could it not hurt? This is linked with the dizziness above.

Abdominal pain that feels better when pressed and warmed. Abdominal pain from deficiency (xu er fu tong) — when qi is deficient the qi mechanism does not move, dampness and cold congeal, and that produces abdominal pain. This kind of pain feels better when you press on it and better with a hot-water bottle — so the correct treatment is tonifying qi and warming yang.

Food stuck in the stomach after meals. Food not moving from deficiency (xu er yin shi bu yun) — when a qi-deficient person finishes a meal, the food suddenly lodges in the stomach, the belly bulges at once, and half a day later it still has not gone down — stifling, suffocating, sometimes even making it hard to breathe. This is qi deficiency unable to move and transform food, and you need ginseng to tonify the qi.

Profuse phlegm and edema. Phlegm flooding from deficiency (xu er tan xian yong sheng) — when qi is deficient it cannot move things, dampness stagnates and cannot be excreted, and qi-deficient people are especially prone to edema.

💬 Note from Doctor Luo: Remember, heavy dampness and qi deficiency are basically two sides of the same coin — they usually appear together. Dampness gradually gathers and condenses into phlegm, which is why qi-deficient people so easily produce phlegm. When you truly treat phlegm, you should consider tonifying qi properly; if you only resolve phlegm without tonifying qi, the phlegm will leave — and then come back again.

Coughing blood, spitting blood, very heavy periods. Blood from deficiency (xu er ke xue tu xue) — qi is the commander of blood and blood is the mother of qi (qi wei xue zhi shuai, xue wei qi zhi mu); qi is what pushes the blood along. When qi is deficient it cannot push, its consolidating power is lost, and the blood starts to run wild: upward it becomes coughing blood and spitting blood; downward it becomes very heavy periods in women, dripping metrorrhagia, and blood in the stool — Zhang Jingyue said “blood below and dampness from deficiency” — all of these are qi-deficiency signs.

Dribbling urine, and constipation. Dribbling from deficiency (xu er lin li) — urine drips out drop by drop because deficient qi cannot consolidate the fluids; constipation from deficiency (xu er bian bi) — there is no strength to push the waste through the intestines. This qi-deficiency constipation is very common in the elderly: you work up a sweat on the toilet and still nothing comes out — you have to tonify the qi before it will pass.

💬 Note from Doctor Luo: Zhang Jingyue basically walked through the whole of qi deficiency — fever (fever from deficiency; Doctor Li Dongyuan discussed it in detail), spontaneous sweating, dizziness, weariness, fluttering heart, shortness of breath, emission, diarrhea, headache, abdominal pain, food not moving, phlegm flooding, coughing and spitting blood, dribbling, constipation, blood below… when you meet these symptoms, you should consider bringing in ginseng to tonify the qi.

If ginseng tonifies qi, how can it also tonify blood?

Dividing by qi and blood, Zhang Jingyue said ginseng’s aroma and taste are quite light, and it belongs more to yang: when it tonifies qi it reaches the qi aspect six parts and the blood aspect four parts — in short, it never loses its status as a qi-aspect herb, yet it is indispensable to the blood aspect.

💬 Note from Doctor Luo: Why does tonifying qi tonify blood? Zhang Jingyue explained it in one sentence: there has never been a case where qi is left untreated yet blood is cured on its own — no one has ever heard of blood being replenished while qi remains insufficient. Qi and blood always generate each other and keep each other in balance; if qi deficiency reaches a certain degree, how could the blood possibly be nourished sufficiently? So you must nourish blood while tonifying qi. Because ginseng tonifies both qi and blood, it is an especially fine herb.

Where did red ginseng come from? The Nurhaci steaming legend

Today’s ginseng comes in sun-dried (sheng shai shen), white (bai shen) and red (hong shen) forms. Doctor Luo says: sun-dried and white ginseng tonify qi a little more strongly; red ginseng tonifies both qi and blood, with stronger blood-nourishing power. And red ginseng appeared only later — in Zhang Jingyue’s era they basically used white and sun-dried ginseng.

💬 Note from Doctor Luo: How did red ginseng come about? Nurhaci and his people sold ginseng to the Central Plains and to the Ming dynasty, and the ginseng often spoiled. So someone came up with an idea: steam it first, then sell it — and it becomes red ginseng. So red ginseng appeared in Nurhaci’s time, a little later than Zhang Jingyue.

Is ginseng warm or cool? What kind of ginseng did the ancients use?

Zhang Jingyue said ginseng is warm in nature, but some argue it is cool — and the root of the argument is: what kind of ginseng was the ginseng of antiquity?

💬 Note from Doctor Luo: The medical world is still debating this. Some people (Doctor Zhang Xichun held this view) say the ginseng of antiquity was actually dang shen (Codonopsis pilosula); others say it was a local ginseng of Shangdang (in Shanxi province) that was dug out completely by the Ming dynasty, after which the Northeastern ginseng entered the interior widely. Whether that herb was a true Panax ginseng or a Codonopsis, nobody has ever seen it. As for the claim that ginseng is cool — obviously that does not refer to Northeastern ginseng. There are also TCM practitioners today who believe Northeastern ginseng is not hot, that the more you eat it the cooler you feel. But I think Northeastern ginseng is still warm — I am from the Northeast myself, and I have eaten ginseng; I eat it casually, and the nature is genuinely warm.

The great test: deficiency fire vs. excess fire — when to use ginseng boldly, when never to touch it

Doctor Li Dongyuan said ginseng and astragalus are the holy herbs for retiring fire, and Doctor Zhu Danxi said deficiency fire can be tonified — they were speaking of deficiency fire. Zhang Jingyue put it even more finely: true cold inside with false heat outside — false heat pushed out by real cold within is the genuine deficiency fire, and at that point you may boldly use ginseng; but if it is true essence exhaustion — kidney essence deficiency causing yin deficiency, with evil fire and restless spirit both inside and out, heat both within and without — that is genuine yin-deficiency fire-blazing, and ginseng really can feed the heat. Never misuse it.

💬 Note from Doctor Luo: Deficiency fire and excess fire, excess within deficiency and deficiency within excess, yang within yin and yin within yang — you must investigate, and do not cling stubbornly to your own opinion in good faith — saying “it must be so, this is how I treat it” will not do either. Face east and you never see the western wall — you may never find the truth inside it.

So how exactly do you distinguish deficiency fire? Zhang Jingyue used two metaphors that explain it beautifully:

💬 Note from Doctor Luo: There is a kind of deficiency fire called dragon-thunder fire (long lei zhi huo) — it blazes when watered and scatters when sunned: pour cold water on it (nourish yin, clear heat) and it burns even more fiercely; give it sunshine (warm yang) and it disperses. This is the yin exuberance repelling yang (ge yang) pattern of kidney essence deficiency, with yang qi rejected to the exterior. At this point nourishing yin will not do and clearing heat will not do — you must add yang-warming herbs on a foundation of tonifying kidney essence, and the fire disperses — this is how Zhang Jingyue always tonified yang. But conversely, if it is yang excess with yin exhaustion (kang yang yin xu) — like a great drought with the scorched earth bare for a thousand li, not a drop of water — then can you tonify yang to generate yin? No, you cannot!

Excess fire and deficiency fire call for completely different herbs:

Excess fire — like a sky scorching hot, the heat of the season at its height — must be cleared and drained with cold herbs: gypsum, rhubarb and the like, to unload the excess fire;
Deficiency fire — like a river run dry, the earth parched — must be nourished with yin and fluids: rehmannia, glehnia, ophiopogon and the like, to nourish yin and fluids;
Sometimes the two must be used together, but you must weigh which is heavier — mainly judging whether excess fire or deficiency fire predominates. When you cannot decide (Niu Huang Jie Du to drain fire, or Liu Wei Di Huang Wan to nourish yin — which is right, how much of each), that is where diagnostic skill comes in.

Zhang Jingyue’s exclusive insight: even when nourishing yin, add ginseng

This is an insight later generations basically lost — Zhang Jingyue said: when yin is deficient but fire is not raging, ginseng should naturally be the sovereign herb; when yin is deficient and fire is raging hard, ginseng is the assistant.

💬 Note from Doctor Luo: When Zhang Jingyue nourished yin, he would often add ginseng as well — ginseng tonifies qi to generate fluids. Today, when we meet yin deficiency we have a better option: use American ginseng (xi yang shen) (American ginseng only came into wide use in China in the Qing dynasty — Doctor Wang Mengying loved it), and it was not yet popular in Zhang Jingyue’s era. So his unique insight of adding ginseng when nourishing yin — later generations stopped using it, we basically lost it all. These things of Zhang Jingyue’s, we can slowly ponder and recover.

Ginseng and history: the Manchu war chest, Run Run Shaw’s longevity, Qianlong’s Ba Zhen Gao

In those days ginseng was extremely precious, basically all wild. The rise of the Manchus had a great deal to do with selling ginseng — they sold Northeastern ginseng to the Ming dynasty, the Ming commoners bought enormous quantities, the Manchus grew richer and richer, spent the money on their war chest, and in the end destroyed the Ming. By the Qing dynasty the mountain ginseng was all sealed off, reserved for the emperor.

💬 Note from Doctor Luo: Sir Run Run Shaw of Hong Kong — how far did he take eating ginseng? One wild ginseng a day — that was HK$20,000 in the 1980s! Whenever a wild ginseng reached Hong Kong, Sir Run Run was the number-one buyer. There really was a Hong Kong businessman who went to Changbai Mountain and married the daughter of a local ginseng farmer — those people know ginseng; where the ginseng grows in the mountains, they know it exactly. The newspapers reported that after marrying, that businessman’s wealth poured in and his company grew bigger and bigger. How old did Run Run Shaw live? Past one hundred! That is the result of tonification. The Qianlong Emperor holds first place among Chinese emperors for lifespan — 89 years old — and second among the world’s monarchs (first is an Egyptian pharaoh, 90). Why was Qianlong so long-lived? He took ginseng seriously: Shen Mai Yin (ginseng and ophiopogon drink) every day (ginseng with ophiopogon — the same idea as Sheng Mai San), and the Ba Zhen Gao (Eight Treasures Cake) he ate also contained ginseng, eaten daily. Other emperors were gone at twenty or thirty; he lived to 89.

The way of nourishing: a slice or two a day — learn from the emperor and the tycoon

Why does ginseng sell best in Guangdong, Hong Kong and Southeast Asia — with the biggest consuming region actually not the Northeast?

💬 Note from Doctor Luo: I understood only after going to Sanya (Hainan): heat consumes qi! When it is very hot, summer heat consumes qi, sweating consumes qi, the upright qi disperses — some people get foggy-headed and dizzy the moment the weather turns hot. At such times you need to tonify upright qi and restrain the fluids; ginseng can generate fluids. Notice they do not eat American ginseng there — they eat ginseng, and I think they have a point. I also eat ginseng in Sanya myself and clearly feel more comfortable. Northeasterners feel that in cold weather the qi mechanism is sealed tight and there is no need to tonify, and they fear “getting heated up” — but actually the heating-up is nowhere near as bad as they fear. So tonification has its reasoning.

How to take it? Not much — a little every day. Doctor Luo’s own recommendation: astragalus and wolfberry steeped in water, with a slice or two of ginseng added — if you are yang-deficient (usually afraid of cold, qi deficiency leaning toward yang deficiency) use ginseng; if yin-deficient, use a slice or two of American ginseng.

💬 Note from Doctor Luo: Tonifying does no harm — what harm did Sir Run Run Shaw’s one hundred-plus years do? Ordinary people now have the means; just learn from these tycoons and the emperor: you do not need HK$20,000 a day — two slices a day is enough, and it truly is not expensive. Everyone should take the chance to learn a little about the way of nourishing.

What to take away

The four pillars of medicine (yao zhong si wei): ginseng tonifies qi, prepared rehmannia tonifies essence, aconite warms yang, rhubarb clears heat — grasp these four directions and most prescribing decisions become clear.
Ginseng is sweet, slightly bitter, slightly warm — yang with a touch of yin: it tonifies qi deficiency, blood deficiency and yang deficiency; and it is antagonistic to veratrum (li lu) — never combine them.
The many faces of qi deficiency: sweating at the slightest movement, dizziness when tired, whole-body weakness, a fluttering frightened heart, panting after two steps, seminal emission, loose stools, headache, abdominal pain that likes pressure and warmth, food stuck in the stomach, phlegm and edema, bleeding (coughing/spitting blood, heavy periods, blood in stool), dribbling urine, and the elderly’s qi-deficiency constipation.
For a fluttering, anxious heart, the lead herb is ginseng, not dragon bone and oyster shell — the root is insufficient upright qi; once the qi is tonified, the spirit settles.
Tonifying qi generates blood: “there has never been a case where qi is left untreated yet blood is cured on its own” — blood deficiency must be treated through qi, and ginseng covers both.
Know your fire before using ginseng: true cold inside with false heat outside (ge yang) → use ginseng boldly; genuine yin-deficiency with blazing fire → never misuse it. The dragon-thunder fire blazes when watered and scatters when sunned — tonify kidney essence and warm yang instead. Excess fire is drained with cold herbs; deficiency fire is nourished with yin.
Zhang Jingyue’s lost insight: even when nourishing yin, add ginseng (tonifying qi to generate fluids) — when yin is deficient and fire mild, ginseng is the sovereign; when fire rages, ginseng is the assistant. Later generations lost this; consider American ginseng in modern practice.
The everyday way to take it: a slice or two a day in astragalus-wolfberry water — ginseng for yang deficiency, American ginseng for yin deficiency. The tycoon ate a wild ginseng a day and passed 100; the emperor drank Shen Mai Yin daily and reached 89.

Compiled from Doctor Luo Dalun’s lecture on Doctor Zhang Jingyue’s herbal strategies (medication insights); the source case material comes from Jing Yue Quan Shu (The Complete Works of Jingyue).