Unconscious After a Fever, Ice-Cold All Over, Tongue Dry as a Stone? How Ginseng Turned the Tide — Doctor Zhang Xichun’s Wisdom on Using Ren Shen (Ginseng)
Opening: no one used ginseng better than Doctor Zhang Xichun
Everyone knows ginseng — so well, in fact, that nobody quite knows how to use it. Doctor Luo Dalun says that if you really want to learn how ginseng is used, look at Doctor Zhang Xichun. The acknowledged greatest physician of the Republic era, Zhang Xichun handled ginseng with effortless mastery — in one famous case he used it to pull back a patient another doctor had already written off as “waiting to die,” in just two doses.
💬 Note from Doctor Luo: Hello, friends. Today we’re going to talk about a Chinese herb — which one? Ren shen (ginseng). Everyone is very familiar with ginseng, but how did Zhang Xichun use it? Let me tell you. Ginseng comes in many varieties, so let’s first get clear on what ginseng actually is.
Ginseng’s family tree: the ginseng in ancient medical books was not Northeast ginseng
The ginseng we know today is mostly Northeast ginseng. But Doctor Luo says there’s a piece of little-known history here — the ginseng written about in ancient medical books was not Northeast ginseng at all.
💬 Note from Doctor Luo: When we say ginseng today, most people mean Northeast ginseng, right? But the ginseng in ancient medical books was not Northeast ginseng. Northeast ginseng only entered the rest of China in the late Ming dynasty — before that it stayed in the Northeast. So what was the ginseng in the ancient books? It was the codonopsis (dang shen) from Shangdang in today’s Shanxi province — and that ancient codonopsis may now be extinct. It’s gone.
In other words, the “ginseng” that Zhang Zhongjing used, and that every medical classic refers to, was mostly Shangdang codonopsis from Shanxi — not the Northeast root we know today.
Codonopsis comes in several varieties: Tai dang shen, wild tai shen, Lu dang shen
Codonopsis itself has subtypes, and Zhang Xichun knew them thoroughly —
💬 Note from Doctor Luo: Codonopsis divides into a few kinds. One kind grows on Mount Wutai and is called tai dang shen — Zhang Xichun simply called it tai shen. There’s also a wild version, called wild tai shen. The kind that grows in Luzhou, in the Taihang mountains — Mount Zituan — is called Lu dang shen. Comparing the two: tai dang shen has more power; Lu dang shen is mild and even in nature — it doesn’t heat you up.
Remember this: tai dang shen is powerful, Lu dang shen is mild and non-heating — that detail will matter in the story in a moment.
What did the Shennong Bencao Jing say about ginseng? — Tonify the five organs, settle the spirit, calm the soul
So what is ginseng actually for? The most authoritative answer comes from the Shennong Bencao Jing (Divine Husbandman’s Classic of the Materia Medica).
💬 Note from Doctor Luo: Ginseng tonifies qi, and tonifying qi can generate fluids. That’s why the Shennong Bencao Jing says: ginseng tonifies the five organs, settles the spirit, calms the soul, stops palpitations, expels pathogenic qi, brightens the eyes and opens the heart-mind. Why so many effects? Simply because qi and blood become sufficient — it replenishes your qi and blood. Once qi is tonified, qi generates blood; once qi and blood are full, the organs, limbs and hundred bones are nourished, and these symptoms disappear. So ginseng is an especially important herb for tonifying qi.
One sentence — “tonify the five organs, settle the spirit, calm the soul” — says it all. Ginseng isn’t a drug for any one disease; it tops up the upright qi and lets the body restore itself.
Zhang Xichun’s personal approach: wild ginseng is mild, cultivated ginseng is hot — pair it with mai dong
Zhang Xichun had his own principles for using ginseng.
💬 Note from Doctor Luo: Zhang Xichun said that Northeast wild mountain ginseng is quite mild — he considered it especially gentle. The Northeast ginseng available today is all cultivated, and he believed cultivated ginseng is much hotter in nature than wild mountain ginseng. So how do you control that heat? You pair it with a little yin-nourishing medicine — mai dong (ophiopogon) and the like. Used together, he said, you achieve the effect of tonifying both qi and blood. That’s why Zhang Xichun was so skilled with ginseng.
Ginseng is warm, even hot — and cultivated roots are hotter still. So pair it with cool, moist, yin-nourishing herbs like mai dong: one warm, one cool, tonifying both qi and blood. That was Zhang Xichun’s compounding wisdom.
The case begins: Mr. Gao of Bozhuang Village, and the epidemic that terrified his family
Background done — now the story. In Zhang Xichun’s hometown village of Bozhuang lived a Mr. Gao, in his forties.
💬 Note from Doctor Luo: This is a case from Zhang Xichun’s hometown. Mr. Gao, in his forties, caught an epidemic febrile disease in spring. After continual treatment by the doctors, the great heat had subsided — the high fever broke. But had he been cured? No. He became increasingly exhausted — to the point where his spirit was failing and he was nearly unconscious. The doctor took one look and washed his hands of it: “I can’t treat this anymore.”
The fever broke, but the man grew weaker by the day, on the verge of losing consciousness — and the doctor quit. The family assumed he was gasping his last and would die any day now; they simply waited out the days.
The turning point: ten days with no change, and someone remembered Zhang Xichun in the next village
By rights he should have gotten worse. But oddly, after ten-odd days, Mr. Gao’s condition neither improved nor deteriorated — it simply stayed the same.
💬 Note from Doctor Luo: After ten-odd days, everyone noticed his condition hadn’t changed — it was exactly as before. Had he improved? No. Did that mean there might still be a chance? Maybe, right? Maybe he could still be saved. So people said: Zhang Xichun in the next village has real skill — send for him. And so Zhang Xichun was called in.
What Zhang Xichun saw: eyes drained of fire, unconscious, tongue dry as a stone
Zhang Xichun arrived and first examined the patient. One look, and he already knew.
💬 Note from Doctor Luo: What did the patient look like? Both eyes clear without fire — that state where the eyes take on a bluish cast. Then he was utterly unconscious, unaware of his surroundings — half-comatose; you spoke to him and he couldn’t hear. His mouth was pried open to look at the tongue: it was dry as a stone slab, with no coating at all — not a trace of fluid. Ask him a question, and he couldn’t answer. Touching him, his whole body was cold. Observing his breathing, Zhang Xichun noticed: he breathed five or six breaths, then always heaved one long sigh — then breathed again, five or six breaths, another long sigh — the qi just wouldn’t rise. Taking the pulse: both hands weak and faint, with a slightly slow rate — it beat a bit slowly.
You’ll notice Zhang Xichun rarely wrote about the tongue in his cases — but does that mean he didn’t look? Of course he looked. He examined the eyes, the tongue, the body temperature, the breathing — nothing was skipped, and his diagnosis was crystal clear. Bluish eyes, unconsciousness, tongue dry as stone, body ice-cold, a long sigh every half-dozen breaths, faint and slow pulse — line up this string of signs and Zhang Xichun’s diagnosis was already settled.
The diagnostic highlight: this was sinking of the great qi in the chest
Zhang Xichun took the pulse, and the picture was complete in his mind — sinking of the great qi in the chest (da qi xia xian).
💬 Note from Doctor Luo: Friends, we’ve talked about sinking of the great qi before. When the great qi sinks, qi can no longer rise — it can’t reach the brain, so you become unconscious, right? That’s the coma. When the great qi can’t vaporize fluids up to the tongue, the tongue dries out. When the great qi sinks and can’t distribute nutritive and defensive qi and blood throughout the body, the body turns cold. Breathing five or six breaths and then heaving one long sigh — that’s the classic shortness of breath inside the chest in sinking of the great qi; you must take one long breath to reset your breathing. The earlier prescriptions used clearing, heat-reducing and purging herbs too aggressively, which drove the qi mechanism downward — and so the great qi could no longer rise.
So that was it: it wasn’t that his fluids were dried up — it was that there wasn’t enough qi to vaporize them upward. The previous doctor’s fierce clearing and purging had knocked the qi mechanism down — one of the easiest steps to misdiagnose in a critical emergency.
The prescription, unpacked: why wild tai shen instead of raw huang qi?
The mechanism was clear — time to prescribe. You might say: shouldn’t this be the classic Sheng Xian Tang (Lift the Sinking Decoction)? — the formula built on raw huang qi (astragalus). Yet Zhang Xichun deliberately didn’t use it.
💬 Note from Doctor Luo: You’d say, shouldn’t he use Sheng Xian Tang? Zhang Xichun didn’t. Why? Sheng Xian Tang uses raw huang qi. In this situation the patient’s upright qi was insufficient, so raw huang qi could be considered — but his fluids were insufficient as well. What single herb can both tonify qi AND generate fluids? At that moment Zhang Xichun thought of one herb: wild tai shen — the wild codonopsis of Mount Wutai. The difference between codonopsis and ginseng: codonopsis also tonifies qi — not as powerfully — but it also isn’t as hot as Northeast ginseng.
This is where the earlier groundwork on “tai dang shen, wild tai shen” pays off: raw huang qi only tonifies qi; wild tai shen both tonifies qi and generates fluids — and this patient was missing both, so it was exactly right.
💬 Note from Doctor Luo: Ginseng tonifies qi and generates fluids. He used one liang (about 30 g) of wild tai shen and two qian (about 6 g) of chai hu (bupleurum). You see — he paired the qi-tonifying herb with chai hu. What for? To lift it upward. The intent is the same as Sheng Xian Tang, but he didn’t use raw huang qi — raw huang qi only tonifies qi; at this moment he used codonopsis, which both tonifies qi and generates fluids. Then he decocted it and poured it in.
One liang of wild tai shen underneath to tonify qi and generate fluids, two qian of chai hu above to lift — the intent of Sheng Xian Tang, with a flexible swap of the leading herb. That is a master at work.
The result: one dose improved, two doses cured
The medicine went in. What happened?
💬 Note from Doctor Luo: One dose improved, two doses cured! What does that tell you? It shows Zhang Xichun diagnosed accurately and handled the medication with extraordinary precision. An ordinary doctor would have reached for the original Sheng Xian Tang formula. He adapted flexibly — in the presence of external contraction he changed his approach, using wild tai shen instead of raw huang qi, one liang paired with two qian of chai hu, and in two doses this patient was restored.
The earlier doctor had pronounced “waiting to die.” Zhang Xichun brought him back with two doses — that is the weight of the phrase accurate diagnosis.
What to take away: ren shen, dang shen and huang qi can all turn the tide in a crisis
What can we learn from this case?
💬 Note from Doctor Luo: Today’s case — what can everyone learn from it? You can learn that ren shen (ginseng) and dang shen (codonopsis) both tonify qi. Remember this: in some critical situations, when qi is deficient, ginseng and codonopsis can both turn the tide — exactly like huang qi — they can both turn the tide and replenish the qi for you. That’s all for today. In the next few days I’ll take this herb — ren shen, one we meet constantly in daily life — and explain it piece by piece, thoroughly, so that everyone understands what it does.
Doctor Luo says ren shen, dang shen and huang qi — these three great qi-tonifying generals — can all turn the tide at the critical moment. And Zhang Xichun’s genius lay in which one to use, at what dose, and how to pair it — judged to perfection.
💬 Note from Doctor Luo: Tomorrow we’ll continue with how Zhang Xichun used ren shen. Thank you all, and see you tomorrow.
One herb — from its family tree to its usage — Zhang Xichun left posterity a treasure trove of ginseng wisdom. Next time, we’ll hear more.
Compiled from Doctor Luo Dalun’s lecture series on Doctor Zhang Xichun’s cases. The medical cases come from Yi Xue Zhong Zhong Can Xi Lu (Records of Integrating Chinese and Western Medicine, 《医学衷中参西录》), published in installments between 1918 and 1934.