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Ginseng (Renshen): Whether it is wild ginseng, transplanted wild ginseng, or cultivated seedling ginseng, its color when fresh is white; after sun-drying, it turns red. If soaked in white rock sugar water and then dried, it becomes slightly red; if soaked repeatedly several times, even after drying, it returns to white. For wild ginseng, the rhizome (the place where the sprout grows, also known as "Lu Tu") is long and thin, with the longest reaching two cun, as thin as a leek stalk, and often twisted; those with shorter rhizomes are slightly thicker. As for seedling ginseng, its rhizome is no more than seven or eight fen long, but its thickness exceeds that of a chopstick.

Fresh ginseng all have rough outer bark. During processing, seven or eight strands of thread are twisted into one strand to serve as a bowstring; this string is used like a saw blade, rubbing back and forth to remove the rough bark, so that the skin color becomes smooth and lustrous. Regarding the horizontal wrinkles on the skin, those that are fine, dense, and deep are considered superior. Wild ginseng has more than twenty wrinkles per cun, whereas seedling ginseng has no more than ten wrinkles per cun, and its wrinkle shapes are broken, resembling knife scratches, while the wrinkles of wild ginseng are completely unbroken. However, regardless of whether it is wild or seedling ginseng, these wrinkles are naturally formed and cannot be achieved by human effort.

The rootlets of ginseng are prized for their hardness, because wild ginseng grows in hard soil and endures many years, making its rootlets naturally hard. In contrast, seedling ginseng is artificially planted in loose soil for a short time, so its rootlets are very soft.

It is well known that wild ginseng has a mild nature, while seedling ginseng has a dry and hot nature. The reason for this is not merely due to the difference in the number of years. Because those who cultivate seedling ginseng often sprinkle arsenic powder in the beds to prevent damage from insects and ants, the ginseng absorbs the qi of arsenic, thus becoming very dry and hot. Therefore, when I use ginseng in formulas treating cold-heat diseases, I dare not use seedling ginseng, and always substitute it with wild Codonopsis (Dangshen), which can also immediately rescue critical patients. As for American ginseng (Xiyangshen), it is mostly counterfeit using seedling ginseng, which I witnessed personally in Fengtian; users should also exercise caution.

Codonopsis (Dangshen) from Shanxi is mostly cultivated, with few wild specimens. Those that are wild have horizontal wrinkles similar to Liaoning ginseng, while cultivated ones lack horizontal wrinkles, or have only a few near the rhizome. Cultivated Codonopsis has moist skin and plump flesh, whereas wild Codonopsis has rough skin and loose flesh; when cut horizontally, the center shows a chrysanthemum-shaped pattern. The rhizome is prized for being thick and large, named "Lion Head Codonopsis," because it has endured many years and sprouted repeatedly from the rhizome, forming this shape. Codonopsis growing on Mount Wutai is called Tai Dangshen, with a white color slightly tinged with yellow. Codonopsis growing on Zituan Mountain in Taihang, Luzhou, is called Lu Dangshen, also known as Zituan Shen, with a slightly reddish color and slender shape. Comparing these two, Tai Dangshen has slightly stronger efficacy, while Lu Dangshen has a neutral nature without heat, making it very suitable for treating Qi deficiency with heat. However, wild Lu Dangshen is rare, mostly cultivated. As for Codonopsis produced in Liaodong (named Dong Dangshen colloquially because its shape resembles Codonopsis), it resembles Tai Dangshen, is wild, and its efficacy is similar to that of wild Tai Dangshen from Shanxi.

[Attached Case 1] Gao, a resident of the county, was about forty years old when he contracted a warm disease in late spring. After treatment by several physicians, the high fever had subsided, but his spirit became increasingly exhausted. The physicians declared it incurable. The patient's family also believed he was gasping for breath and merely waiting for death. Ten days later, the condition remained unchanged, and they began to think perhaps it could still be salvaged. They invited me to examine him. His eyes were clear and white without signs of fire, yet he was confused and unconscious. His tongue was dry as if rubbed with pumice, with no coating. When asked questions, he could not speak. Touching his whole body, it was cold. Between every five or six breaths, he would take a long sigh. His pulse was weak and slow on both sides. I determined that his Upper Jiao Qi (Zhongqi/Chest Qi) had sunk due to excessive use of dispersing, breaking, and descending medicines. Since Upper Jiao Qi failing to reach the brain causes mental confusion, and failing to moisten the base of the tongue causes dryness, his confusion and dry tongue prevented him from speaking. His whole body was cold because, after the sinking of Upper Jiao Qi, it could no longer distribute Ying and Wei (Nutritive and Defensive Qi). He sighed deeply between breaths because, after the sinking of Upper Jiao Qi, he felt shortness of breath in the chest, so he sighed to relieve the Qi stagnation. I prescribed one liang of wild Tai Codonopsis and two qian of Bupleurum (Chaihu), decocted in water and administered orally. After one dose, he improved; after two doses, he was fully recovered.

[Nephew Wang XX], at age twenty, suffered from an illness for months without recovery. His spirit was confused, limbs were sore and lazy, and he felt slight shortness of breath. Repeated medical consultations and medications failed to identify the cause or produce effects. One day, he suddenly could not breathe, opening his mouth to exhale but the air did not rise up. The Qi accumulated excessively and pressed downward, causing the anus to protrude. It took about twenty breaths for his breathing to normalize. This happened eight or nine times during the day and night. Palpating his pulse, the position before the Guan (Cun) was weak and unrising. I diagnosed Sinking of Upper Jiao Qi, which failed to govern the pivot mechanism of lung respiration. I prescribed one liang of Ginseng, three qian of Bupleurum, and two qian of Anemarrhena (Zhimu). After one dose, his breathing smoothed out. I then reduced Bupleurum to two qian and increased Anemarrhena to four qian. After taking several more doses, his chronic illness was cured.

In my treatment of Sinking of Upper Jiao Qi, I heavily rely on raw Astragalus (Huangqi) for its ability to tonify Qi and lift it simultaneously. In these two cases, however, I heavily relied on Ginseng because: in the first case, following an external contraction, fluids were depleted, and Ginseng can nourish fluids; in the second case, following a prolonged illness, Yuan Qi (Original Qi) was damaged, and Ginseng can consolidate Original Qi.

For patients with massive hematemesis (vomiting blood), ancient formulas often treat them with Single Ginseng Decoction (Dushen Tang), stating that in cases of blood loss, one should first tonify Qi. However, after hematemesis, there is often rising deficient heat. Administering Single Ginseng Decoction might exacerbate this deficient heat, causing the bleeding to recur. In such cases, I often use Ginseng assisted by sedating, cooling, and moistening herbs (see the case of Baoyuan Hanjiang Tang for reference).

When used appropriately, Ginseng also effectively promotes urination (see the case following Ji Yin Tang for reference).