黃連三兩甘草三兩（炙）乾薑三兩桂枝三兩（去皮）人參二兩大棗十二枚（擘）半夏半升（洗）上七味，以水一鬥，煮取六升，去渣，溫服，晝三夜二。疑非仲景方。
【方解及其應用範圍】本方寒熱並用，以黃連清胃中之熱，乾薑以溫胃中之寒，桂枝通調營衛，半夏降逆，佐黃連嘔吐可止，人參、甘草、大棗和胃安中，但得寒熱平調，嘔吐腹痛自愈。筆者常用此方治胸腹胃中之寒熱錯雜諸證，療效卓著。
十六、傷寒腹滿譫語，寸口脈浮而緊，此肝乘脾也，名曰（橫）〔縱〕①，刺期門②。原文108
①縱：是五行順次反克的形式。
②期門：穴名，位在乳直下二寸處。
鄭論：按腹滿譫語，陽明之腑證也；脈浮而緊，太陽之表證也。此名曰（橫）〔縱〕，甚不解，定有錯誤。
【闡釋】鄭氏疑原文定有錯誤。筆者參閱諸家之注，而為匯解，或可釋鄭氏之疑。傷寒腹滿譫語而無潮熱，手足漐漐汗出等為陽明之實證，脈浮而緊獨見寸口，自與太陽、陽明之見證有別。《脈經》雲：“浮而緊者名曰弦，弦為肝脈”。《內經》雲：“脾主腹”“諸腹脹大，皆屬於熱。”又雲：“肝主語”。以此推之，肝木旺則侮脾土，則腹滿譫語，侮其所勝，故名曰縱。治法當刺期門，因期門為肝之募，故刺之以泄肝邪。邪去則腹滿譫語自愈。
十七、傷寒發熱，嗇嗇惡寒，大渴欲飲水，其腹必滿，自汗出，小便利，其病欲解，此肝乘（脾）〔肺〕也，名曰橫③，刺期門。原文109
④表不解：即太陽表證，還沒有解除。
鄭論：按發熱惡寒，太陽之表證也，大渴飲水，此由寒水逆中，阻其脾中升騰之機，真水不得上升，故大渴，其腹滿者，水溢於中也，幸而自汗與小便利，上下分消，邪有出路，故知其必解也。設若不自汗，不小便，未可言欲解也。原文言肝乘（脾）〔肺〕，不知從何看出，餘甚不解。
【闡釋】鄭氏說：“原文言肝乘肺，不知從何處看出，餘甚不解。”筆者亦從上例為之匯解，以釋鄭氏之疑，是否有當，高明正之。肺主皮毛，肺受肝邪則毛竅閉塞，所以發熱，嗇嗇惡寒；木火刑金，津液劫爍，故渴欲飲水；肺失通調水道之功能，所以小便不利而腹滿。肝邪乘肺，侮其所不勝，故名曰“橫”，刺期門，則肝邪得泄，肺不受侮，毛竅通暢，則自汗出，水道通調則小便利，故病可愈。
十八、傷寒表不解④，心下有水氣，幹嘔，發熱而咳，或渴、或利、或噎①、或小便不利，少腹滿，〔或喘者〕，小青龍湯主之。原文40
鄭論：按傷寒既稱表不解，心下有水氣，以致一切病情，緣由寒水逆中，阻滯氣機，理應發汗行水，水邪一去，則氣機流通，諸症立失。學者切不可執病執方，執一己之見，總要窺透病機，當何下手，治之為是。若原文之青龍湯，重在發汗行水，而諸症立失，可知非見咳治咳，見嘔治嘔也。
【闡釋】本條是傷寒表不解心下有水氣的證治。鄭氏說：“切不可執病執方，執一己之見，總要窺透病機，當何下手，治之為是。”此屬其治病之經驗，殊堪寶貴。故對治傷寒表不解，心下有水氣，所以用外散寒邪，內蠲水飲之小青龍湯治之，則幹嘔，發熱而咳等諸證自愈。教人不可見咳治咳，見嘔止嘔。
小青龍湯方（校補）
麻黃三兩（去節）芍藥三兩乾薑三兩五味子半升甘草三兩（炙）桂枝三兩（去皮）細辛三兩半夏半升（洗）上八味，以水一鬥，先煮麻黃減二升，去上沫，內諸藥，取三升，去渣，溫服一升。若渴，去半夏加栝萎根三兩，若微利，去麻黃加芫花，如一雞子大，熬令赤色，若噎者，去麻黃加附子一枚（炮），若小便不利，少腹滿者，去麻黃加茯苓四兩，若喘，去麻黃加杏仁半升去皮尖。且芫花不治利，麻黃主喘，今此語反之，疑非仲景意。
【方解及其應用範圍】本方即麻黃湯、桂枝湯合方，減去杏仁、生薑、大棗，而加乾薑、五味、細辛、半夏。考所增四藥功能：乾薑主溫中，治胸滿咳逆上氣。細辛辛溫，配麻黃能祛痰利水，散風寒外出而治咳逆上氣。五味收納肺氣以入腎，故治咳逆合乾薑同用，一開一閡，咳之來路去路，均告肅清，故仲景治咳，皆姜、辛、五味同用。半夏燥痰，降水氣，和胃，止咳逆嘔吐。麻黃湯辛溫發表，逐邪之峻劑。桂枝湯和營衛以祛風。合用之肌表可開散，然不去水飲停蓄之邪，非特不能廓清其源，即麻桂之功力，亦必被停聚之水飲所阻撓也。筆者常用本方治療外感寒邪，內挾水飲之咳喘，亦治水飲溢於皮膚而浮腫腹滿，小便不利之咳喘，與夫痰飲咳嗽，哮喘之偏於寒性者，療效卓著。近人則多以本方治療呼吸系統疾病，屢見於報導。
十九、傷寒心下有水氣，咳而微喘，發熱不渴，服湯已渴者，此寒去欲解也，小青龍湯主之。原文41
鄭論：按心下有水氣，阻其呼吸之氣，上觸而咳，以致微喘，發熱不渴，服湯已渴者，水氣去，而中宮升騰之機，仍舊轉輸，故知其欲解也。以小青龍湯主之，是隨機而導之意也。
【闡釋】本條是指服小青龍湯以後口渴的，此寒去疾病自愈的表現，非調解後仍用小青龍湯也。故曹穎甫訂正此條，在“發熱不渴”下，即移原文“小青龍主之”。則其義更為明白了然。
二十、服桂枝湯，大汗出後，大煩渴不解①脈洪大者，白虎加入參湯主之。原文26
①大煩渴不解：煩是心煩，渴是口渴，大是形容煩渴的厲害，不解是病未愈的意思。
鄭論：按服桂枝湯以致大汗，其人大渴者，由汗出過多，血液被奪，傷及胃中津液故也。原文主以人參白虎湯，取人參以救津液，取石膏以清內熱，的確之法也。
【闡釋】服桂枝湯後，只要微微有汗即得，現在汗出太多，肌表之邪雖去，而胃中津液反為耗傷，胃燥化熱，病已由太陽傳至陽明，出現心煩、渴飲的症狀，故用白虎湯以清陽明熾盛之熱，加人參以救胃中耗傷之液，此為不易之法也。
白虎加人參湯方知母六兩石膏一斤（碎，綿裹）甘草二兩（炙）粳米六合人參三兩上五味，以水一鬥，煮米熟，湯成去渣，溫服一升，日三服。
【方解及其應用範圍】本方即白虎加人參湯，乃滅火救陰之神劑。有清熱、生津、止渴的作用。石膏辛寒，清三焦火熱，生津止渴；知母苦潤、泄火滋燥；甘草，梗米調和中宮；人參有補虛救逆，又有生津止渴之功。此方並非專為傷寒之陽明症立法，凡屬內裏之燥熱為病者，皆可服也。時人過畏石膏而不用，往往誤事。前人少有用本方治目疾者，今人加以推廣，不僅治赤、熱、腫、痛，外障、瘀滯較甚之目疾用之取效，並用以治肺炎、腦炎、糖尿病，尤其對夏月小兒高熱、多渴、多尿綜合症療效最好。一般認為凡屬裏熱傷津，氣陰兩虧之老年及諸不足者，皆可用白虎加人參湯治療，而本方的退熱作用，主要在於適當配伍了石膏。現將近代名醫張錫純用石膏的經驗，及筆者對本方的推廣應用附後。張著《醫學衷中參西錄》謂：“石膏其性涼而能散，有透表解肌之力，為清陽明胃腑實熱之聖藥，無論內傷、外感用之皆效，即他臟腑之實熱者用之亦效。……石膏醫者多誤認為大寒而煆用之，則宣散之性變為收斂，以治外感有實熱，竟將其痰火斂住，凝結不散，用至一兩即足傷人，是變金丹為鴆毒也。迨至誤用煆石膏僨事，流俗之見，不知其咎在煆不在石膏，轉謂石膏煆用之其猛烈猶足傷人，而不煆者更可知矣。於是一倡百和，遂視用石膏為畏途。……餘用以治外感實熱，輕症亦必用至兩許，若實熱熾盛，又恒重用至四、五兩或七、八兩。……蓋石膏生用以治外感實熱，斷無傷人之理，且放膽用之，亦斷無不退熱之理。惟熱實脈虛者，其人必實熱兼有虛熱，仿白虎加人參之義，以人參佐石膏，亦必能退熱。”又雲：“且嘗曆觀方書，前哲之用石膏，有一證而用十四斤者（見《筆花醫鏡》）；有一證而用至數十斤者（見吳鞠通醫案）；有產後亦重用石膏者（見徐靈胎醫案，然須用白虎加人參湯，以玄參代知母，生山藥代梗米）。然所用皆生石膏也。”筆者三十年來，對治外感風熱之邪，無論成人或小孩，身大熱（體溫39`以上），雖注射青、鏈黴素而身熱不退，即用白虎加人參湯治療，屢用屢驗。又治傷暑咳嗽，因高熱、煩渴、津傷、汗多，舌質鮮紅，舌上乾燥，苔幹黃，治以此方面獲效。又曾治尿崩證，患者一日一夜飲水達五十磅，石膏用量初服100克，一劑而飲水量減少五磅；二劑石膏增至200克，飲水又有所減少。其後石膏用量增至300克，連服五劑而痊癒。
二十一、傷寒脈浮滑，此裏有（熱）〔寒〕，表有（寒）〔熱〕，白虎湯主之。原文176
鄭論：按《脈象篇》雲：浮主風邪，滑主痰濕。此條只據二脈，即以白虎湯主之，實屬不當。況又未見有白虎症形，指為裏熱表寒，即果屬表寒裏熱，理應解表清裏，何獨重裏熱一面，而遺解表一面乎？疑有誤。
【闡釋】本條歷代注家，爭論極多，有認為此處表裏二字錯簡，亦有認為未錯簡，亦有認為寒字當邪解，亦熱也。但類皆自圓其說，不能使人信服。白虎湯證的病理，總歸是表裏俱熱，必須是陽明經熱熾盛的見證，才能用白虎湯。不能只憑脈以定病，而須結合證狀來定，如發熱汗出，煩渴引飲，此為陽明表裏俱熱之證，白虎湯乃對證之方。鄭氏疑有誤，值得深思考慮。
白虎湯方（校補）
知母六兩石膏一斤（碎）甘草二兩（炙）粳米六合上四味，以水一鬥，煮米熟，湯成，去渣，溫服一升，日三服。
【方解及其應用範圍】白虎湯《傷寒論》原文共三條，分見於太陽、陽明及厥陰三篇。其方解可參閱前條白虎加人參湯條。其治療目標是壯熱、大汗出、大煩渴、脈洪大、無表證。
因熱盛傷津灼陰，故汗渴飲冷。但邪初入陽明，熱而未實，急需滅火清熱以救陰，故以本方治之。鄭氏在《醫法圓通》中說：“此陽明腑分主方也。”隨即舉出其圓通應用法五條：（l）治上消證：（2）治心下一寸間發生瘡疾，紅腫痛甚；（3）治牙眼紅腫痛甚，飲冷；（4）治兩乳紅腫痛甚；（5）治譫語、遺尿、口不仁而面垢。此外有白虎湯證而挾濕者，則加蒼朮；挾風者，則加桂枝，亦極有效驗。筆者用此方治療傷熱咳嗽、哮喘，取得滿意效果。其症狀為咽喉幹痛，鼻孔出熱氣，口臭氣粗。咳嗽而痰難出，色黃且稠，有時成塊成沱，或帶血腥臭，面赤身熱，更兼煩燥不安，舌質紅絳，舌苔幹黃，脈洪大有力，全係熱盛之象，故以白虎湯治之而愈。現在白虎湯廣泛應用於各種急性熱病，更有用於挾熱之眼疾、痢疾亦獲良效，可見其應用範圍之廣泛。
二十二、傷寒脈浮，發熱無汗，其表不解（者），不可與白虎湯；渴欲飲水，無表證者，白虎加人參湯主之。原文170
鄭論：按發熱無汗，本應解表，原非白虎所宜，至於大渴飲冷，陽明症具，則以人參白虎施之，的確不易法也。
【闡釋】傷寒脈浮，發熱無汗，為傷寒麻黃湯證。若渴欲飲水，無表證者，是惡寒已罷，裏熱已熾，熱盛足以津傷，白虎人參湯以泄熱救陰。誠如鄭氏所言：大渴飲冷，陽明症具，則以人參白虎施之，是的確不易法也。
二十三、傷寒無大熱，口燥渴，心煩，背微惡寒者，白虎加人參湯主之。原文169
鄭論：按寒邪本由太陽而起，至背惡寒，亦可雲表未解，何得即以白虎湯主之。條中既稱無大熱，雖有燥渴心煩，未必即是白虎湯證。法中原有熱極邪伏，背心見冷，而用此方，但學者于此症，務要留心討究，相其舌之乾燥與不燥，氣之蒸（乎）〔手〕不蒸（乎）〔手〕，口渴之微盛，二便之利與不利，則得矣。
【闡釋】傷寒背微惡寒，可雲表未解，雖有燥渴心煩，但無大熱，即不能用白虎湯治療。鄭氏曰；“法中原有熱極邪伏，背心見冷，而用此方。”但必其舌乾燥，氣粗蒸手，口渴盛，二便不利，則可用白虎加人參湯治之。
二十四、傷寒若吐若下後，七八日不解，熱結在裏，表裏俱熱，（而）時時惡風，大渴，舌上乾燥而煩，欲飲水數升者，白虎加人參湯主之。原文168
鄭論：按吐下後而表不解，蓋吐則亡陽，下則亡陰，陰陽兩虛，更不能俾邪外出，故不解。以致表邪趨入陽明地界，遂隨陽明之氣化，而轉為熱邪，故現一切症形，全是白虎湯對症之法。至飲水多者，是由下而津液大傷，故乞水以為援也。主以白虎加人參，以救欲亡之陰，實的確不易之法也。
【闡釋】傷寒吐下後，津液被奪，以致表邪趨入陽明地界，轉為熱結在裏之證。裏熱大盛，所以表裏俱熱，時時惡風，舌上乾燥而煩，欲飲水以自救。此為陽明經證傷津，法當清泄裏熱，兼生津液。如鄭氏所言：主以白虎加人參，實的確不易之法也。
傷寒恒論卷四
陽明上篇
外邪初入陽明，太陽尚有未盡者，謂之太陽陽明，列於此篇計三十九法（據舒本較增）。
Huanglian (Coptidis Rhizoma) 3 liang, Gancao (Glycyrrhizae Radix et Rhizoma) 3 liang (roasted with honey), Ganjiang (Zingiberis Rhizoma) 3 liang, Guizhi (Cinnamomi Ramulus) 3 liang (bark removed), Renshen (Ginseng Radix) 2 liang, Dazao (Jujubae Fructus) 12 pieces (split open), Banxia (Pinelliae Rhizoma) half sheng (washed). The above seven herbs are decocted in one dou of water, reduced to six sheng, dregs removed, taken warm. Taken three times during the day and twice at night. Suspected not to be an original formula by Zhang Zhongjing.
[Formula Analysis and Scope of Application] This formula combines cold and hot properties. Huanglian clears heat in the stomach, Ganjiang warms cold in the stomach, Guizhi regulates Ying and Wei (Nutritive and Defensive Qi), Banxia directs rebellious Qi downward, assisting Huanglian to stop vomiting. Renshen, Gancao, and Dazao harmonize the Stomach and stabilize the Middle Jiao. Once cold and heat are balanced, vomiting and abdominal pain will resolve spontaneously. The author frequently uses this formula to treat various syndromes of mixed cold and heat in the chest, abdomen, and stomach, achieving remarkable efficacy.
16. In Shaoyang disease (Cold Damage), abdominal fullness and delirium occur; the pulse at Cun Kou (Radial artery location) is floating and tight. This is Liver Wood overacting on Spleen Earth, named "Zong" (Vertical/Reverse Subjugation)①. Treat by puncturing Qimen (LR-14)②. Original Text 108
① Zong: Refers to the form of reverse subjugation in the sequential order of the Five Elements.
② Qimen: Acupoint name, located two cun directly below the nipple.
Zheng's Commentary: Abdominal fullness and delirium constitute a Yangming Fu organ syndrome; a floating and tight pulse indicates a Taiyang exterior syndrome. The term "Zong" here is incomprehensible and likely contains an error.
[Explanation] Zheng suspected an error in the original text. The author has consulted various commentaries to provide a synthesis, which may resolve Zheng's doubts. In Cold Damage, abdominal fullness and delirium without tidal fever or sweating on the hands and feet indicate a Yangming excess syndrome. A floating and tight pulse appearing only at Cun Kou distinguishes it from typical Taiyang or Yangming presentations. The *Mai Jing* states: "Floating and tight is called Xian (Wiry); Xian is the Liver pulse." The *Nei Jing* states: "The Spleen governs the abdomen" and "All abdominal distensions and enlargements belong to Heat." It also states: "The Liver governs speech." Inferring from this, when Liver Wood is hyperactive, it insults Spleen Earth, causing abdominal fullness and delirium. Since it insults what it normally controls, it is named "Zong." The treatment method is to puncture Qimen, as Qimen is the Front-Mu point of the Liver, thereby draining Liver pathogenic factors. Once pathogens are expelled, abdominal fullness and delirium resolve spontaneously.
17. In Cold Damage, fever occurs with aversion to cold (se se e han), intense thirst desiring water, abdominal fullness, spontaneous sweating, and free urination. The disease is about to resolve. This is Liver invading Lung Metal, named "Heng" (Horizontal/Reverse Subjugation)③. Treat by puncturing Qimen. Original Text 109
③ Heng: Refers to the form of reverse subjugation in the reverse order of the Five Elements.
④ Biao bu jie: Indicates that the Taiyang exterior syndrome has not yet resolved.
Zheng's Commentary: Fever and aversion to cold are Taiyang exterior symptoms. Intense thirst for water results from cold-water counterflow obstructing the ascending mechanism of the Spleen, preventing True Water from rising, hence the intense thirst. Abdominal fullness is due to water overflowing into the interior. Fortunately, spontaneous sweating and free urination allow the pathogen to exit via upper and lower dispersion, indicating resolution. If there were no sweating or urination, resolution could not be claimed. The original text mentions Liver invading Lung; it is unclear how this is determined, leaving the author very puzzled.
[Explanation] Zheng stated: "The original text mentions Liver invading Lung, but I do not see how this is derived; I am very puzzled." The author provides a synthesis based on the previous example to address Zheng's doubt, awaiting correction from experts. The Lung governs skin and hair. When Lung is invaded by Liver pathogenic factors, pores close, causing fever and aversion to cold. Wood-Fire attacking Metal depletes body fluids, leading to thirst. Loss of Lung's function in regulating water passages results in difficult urination and abdominal fullness. Liver pathogenic factors invading Lung insult what it cannot normally control, hence named "Heng." Puncturing Qimen drains Liver pathogens, sparing the Lung from insult. With unblocked pores, spontaneous sweating occurs; with regulated water passages, urination becomes free, leading to recovery.
18. In Cold Damage, if the exterior is not resolved④, and there is fluid retention in the epigastrium (Xin Xia), causing dry retching, fever with cough, or thirst, diarrhea, choking sensation①, difficulty in urination with hypogastric fullness, [or wheezing], Xiao Qing Long Tang (Minor Blue Dragon Decoction) is indicated. Original Text 40
① Ye: Choking sensation with air reflux during eating.
Zheng's Commentary: Given that the exterior is unresolved and there is fluid retention in the epigastrium, all symptoms arise from cold-water counterflow obstructing Qi dynamics. Sweating and promoting water metabolism should be employed. Once water pathogens are eliminated, Qi flows freely, and symptoms vanish immediately. Scholars must not rigidly adhere to diseases or formulas based on personal views; one must penetrate the disease mechanism to determine the approach. Xiao Qing Long Tang focuses on sweating and moving water, eliminating symptoms instantly, proving it does not merely treat cough or vomiting symptomatically.
[Explanation] This section addresses the syndrome and treatment of Cold Damage with unresolved exterior and fluid retention in the epigastrium. Zheng said: "Do not rigidly adhere to diseases or formulas; always penetrate the disease mechanism to determine the approach." This valuable experience teaches treating Cold Damage with unresolved exterior and fluid retention using Xiao Qing Long Tang to disperse cold externally and eliminate water internally, resolving dry retching, fever, and cough. It instructs against treating cough only with antitussives or vomiting only with antiemetics.
Xiao Qing Long Tang Formula (Corrected Supplement)
Mahuang (Ephedrae Herba) 3 liang (nodes removed), Shaoyao (Paeoniae Radix Alba) 3 liang, Ganjiang (Zingiberis Rhizoma) 3 liang, Wuweizi (Schisandrae Fructus) half sheng, Gancao (Glycyrrhizae Radix et Rhizoma) 3 liang (roasted with honey), Guizhi (Cinnamomi Ramulus) 3 liang (bark removed), Xixin (Asari Radix et Rhizoma) 3 liang, Banxia (Pinelliae Rhizoma) half sheng (washed). The above eight herbs are decocted in one dou of water. First boil Mahuang to reduce volume by two sheng, remove foam, add remaining herbs, reduce to three sheng, remove dregs, take one sheng warm. For thirst, remove Banxia and add Gualougen (Trichosanthis Radix) 3 liang. For mild diarrhea, remove Mahuang and add Yuanhua (Kadsurae Flos) the size of a chicken egg, roasted until red. For choking, remove Mahuang and add Fuzi (Aconiti Lateralis Radix Praeparata) one piece (prepared). For difficult urination with hypogastric fullness, remove Mahuang and add Fuling (Poria) 4 liang. For wheezing, remove Mahuang and add Xingren (Armeniacae Semen Amarum) half sheng (skin and tips removed). Note: Yuanhua does not treat diarrhea, and Mahuang treats wheezing; the current text contradicts this, suspected not to be Zhang Zhongjing's intent.
[Formula Analysis and Scope of Application] This formula combines Ma Huang Tang and Gui Zhi Tang, removing Xingren, Shengjiang, and Dazao, adding Ganjiang, Wuwei, Xixin, and Banxia. The functions of the added four herbs are: Ganjiang warms the Middle, treating chest fullness and rebellious Qi with cough. Xixin is acrid and warm; combined with Mahuang, it resolves phlegm, promotes water metabolism, disperses wind-cold, and treats rebellious Qi with cough. Wuweizi gathers Lung Qi into the Kidney, treating rebellious Qi with cough; combined with Ganjiang, one opens and one closes, clearing both incoming and outgoing paths of cough, hence Zhang Zhongjing always uses Ginger, Asarum, and Schisandra together for cough. Banxia dries phlegm, descends water Qi, harmonizes the Stomach, and stops rebellious Qi with vomiting. Ma Huang Tang is an acrid-warm exterior-releasing harsh agent. Gui Zhi Tang harmonizes Ying and Wei to dispel wind. Combined, they open the muscle layer, but without eliminating stagnant water, neither can clear the source nor utilize the power of Mahuang and Guizhi, as it would be blocked by stagnant water. The author frequently uses this formula for cough and asthma caused by external cold with internal water retention, edema with abdominal fullness and difficult urination due to water overflowing into skin, and cold-type phlegm-fluid cough and asthma, achieving remarkable efficacy. Modern practitioners often use it for respiratory system diseases, frequently reported.
19. In Cold Damage, fluid retention in the epigastrium causes cough with slight wheezing, fever without thirst. After taking the decoction, if thirst occurs, this indicates cold is departing and the disease is about to resolve. Xiao Qing Long Tang is indicated. Original Text 41
Zheng's Commentary: Fluid retention in the epigastrium obstructs respiratory Qi, touching upwards causing cough and slight wheezing. Fever without thirst; after taking the decoction, thirst indicates water qi is gone, and the ascending mechanism of the Middle Palace resumes transport, indicating resolution. Using Xiao Qing Long Tang follows the principle of guiding according to circumstances.
[Explanation] This section refers to thirst occurring after taking Xiao Qing Long Tang, indicating cold departure and spontaneous disease resolution, not continuing Xiao Qing Long Tang after regulation. Therefore, Cao Yingfu corrected this section by moving "Xiao Qing Long Tang is indicated" under "fever without thirst," making the meaning clearer.
20. After taking Gui Zhi Tang, if heavy sweating occurs followed by severe restlessness and thirst that does not resolve, and the pulse is flooding (Hong Da), Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is indicated. Original Text 26
① Severe restlessness and thirst not resolving: Restlessness refers to mental agitation, thirst refers to dry mouth, severe describes the intensity, not resolving means the disease is not cured.
Zheng's Commentary: Taking Gui Zhi Tang leading to heavy sweating, resulting in intense thirst, is due to excessive sweating depriving blood and damaging Stomach fluids. The original text prescribes Renshen Bai Hu Tang, using Renshen to save fluids and Shigao to clear internal heat, a precise method.
[Explanation] After taking Gui Zhi Tang, slight sweating is sufficient. Now, excessive sweating removes exterior pathogens but consumes Stomach fluids. Stomach dryness transforms into heat, and the disease transmits from Taiyang to Yangming, presenting with mental agitation and thirst. Thus, Bai Hu Tang clears blazing Yangming heat, and Renshen saves consumed Stomach fluids, an unchangeable method.
Bai Hu Jia Ren Shen Tang Formula
Zhimu (Anemarrhenae Rhizoma) 6 liang, Shigao (Gypsum Fibrosum) 1 jin (crushed, wrapped in cloth), Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang (roasted with honey), Jingmi (Oryza Sativa Germ) 6 he, Renshen (Ginseng Radix) 3 liang. The above five herbs are decocted in one dou of water. Boil until rice is cooked, decoction ready, remove dregs, take one sheng warm, three times daily.
[Formula Analysis and Scope of Application] This formula, Bai Hu Jia Ren Shen Tang, is a divine agent for extinguishing fire and saving Yin. It clears heat, generates fluids, and stops thirst. Shigao is acrid and cold, clearing San Jiao fire, generating fluids, and stopping thirst; Zhimu is bitter and moist, draining fire and nourishing dryness; Gancao and Jingmi harmonize the Middle Palace; Renshen tonifies deficiency, rescues collapse, generates fluids, and stops thirst. This formula is not exclusively for Yangming syndrome of Cold Damage but applies to any internal dry-heat pathology. People today fear Shigao too much and avoid it, often causing errors. Few predecessors used this formula for eye diseases; modern practitioners have expanded its use, effective for red, hot, swollen, painful eye diseases with significant external obstruction and stasis, pneumonia, encephalitis, and diabetes. Especially effective for summer pediatric high fever, polydipsia, and polyuria syndrome. Generally, for elderly patients with Yin and Qi deficiency due to interior heat damaging fluids, Bai Hu Jia Ren Shen Tang is applicable. The antipyretic effect mainly lies in the appropriate combination of Shigao. Below attaches the experience of modern famous doctor Zhang Xichun using Shigao and the author's expanded application. Zhang's *Yi Xue Zhong Zhong Can Xi Lu* states: "Shigao is cool and dispersing, possessing the power to penetrate the exterior and resolve the muscle layer, being the holy medicine for clearing excess heat in the Yangming Stomach Fu organs. Effective for both internal injuries and external infections, and even excess heat in other Zang-Fu organs... Many doctors mistakenly consider it extremely cold and calcine it for use, changing its dispersing nature to astringent. Treating external excess heat with calcined Shigao traps phlegm-fire, causing condensation. One liang is enough to harm people, turning golden elixir into poison. When calcined Shigao causes failure, vulgar views blame calcination rather than Shigao itself, assuming raw Shigao is even more harmful. Thus, using Shigao became a taboo... For external excess heat, I use at least one liang for mild cases, and heavily use four, five, or seven, eight liang for blazing heat... Raw Shigao for external excess heat certainly does not harm people; bold use surely reduces fever. Only when heat is excess and pulse is deficient, indicating concurrent deficiency heat, following the principle of Bai Hu Jia Ren Shen Tang, assisting Shigao with Renshen can also reduce fever." He also said: "Observing medical texts, predecessors used Shigao up to fourteen jin for one syndrome (see *Bi Hua Yi Jing*), dozens of jin for one syndrome (see Wu Jutong's medical records), and even postpartum women used heavy doses (see Xu Lingtai's medical records, requiring Bai Hu Jia Ren Shen Tang, replacing Zhimu with Xuanshen, and Jingmi with raw Shan Yao). All used raw Shigao." For thirty years, the author has treated external wind-heat in adults and children with high fever (above 39°C), unresponsive to penicillin/streptomycin injections, using Bai Hu Jia Ren Shen Tang with consistent success. Also effective for summerheat cough with high fever, restlessness, thirst, fluid damage, and profuse sweating, presenting with bright red tongue, dry coating, and yellow dry fur. Treated diabetes insipidus where a patient drank fifty pounds of water daily; initial Shigao dose 100g reduced intake by five pounds per dose; second dose increased Shigao to 200g, further reducing intake; later increased to 300g, curing after five doses.
21. In Cold Damage, pulse is floating and slippery. This indicates heat inside and cold outside (or vice versa depending on textual variant), Bai Hu Tang is indicated. Original Text 176
Zheng's Commentary: The *Mai Xiang Pian* states: Floating indicates wind pathogen, slippery indicates phlegm-dampness. Prescribing Bai Hu Tang based solely on these two pulses is inappropriate. Moreover, without typical Bai Hu syndrome manifestations, labeling it interior heat and exterior cold—if indeed exterior cold and interior heat—should require releasing the exterior and clearing the interior. Why focus only on interior heat while neglecting the exterior? Suspected error.
[Explanation] Commentators have debated this section extensively. Some believe "interior/exterior" characters are misplaced, others say they are correct, some interpret "cold" as "pathogen" or "heat." All arguments are self-consistent but unconvincing. The pathology of Bai Hu Tang syndrome is essentially interior and exterior heat. It requires evidence of blazing Yangming channel heat to use Bai Hu Tang. Disease cannot be determined by pulse alone but must combine symptoms. For example, fever, sweating, mental agitation, and thirst for drinking indicate Yangming interior-exterior heat syndrome; Bai Hu Tang is the corresponding formula. Zheng's suspicion of error warrants deep consideration.
Bai Hu Tang Formula (Corrected Supplement)
Zhimu (Anemarrhenae Rhizoma) 6 liang, Shigao (Gypsum Fibrosum) 1 jin (crushed), Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang (roasted with honey), Jingmi (Oryza Sativa Germ) 6 he. The above four herbs are decocted in one dou of water. Boil until rice is cooked, decoction ready, remove dregs, take one sheng warm, three times daily.
[Formula Analysis and Scope of Application] Bai Hu Tang appears in three original texts in *Shang Han Lun*, found in Taiyang, Yangming, and Jueyin chapters. Formula analysis refers to the previous Bai Hu Jia Ren Shen Tang section. Treatment targets are high fever, profuse sweating, severe thirst, flooding pulse, and absence of exterior syndrome.
Due to heat damaging fluids and burning Yin, sweating and thirst for cold drinks occur. However, since pathogens just entered Yangming, heat exists without accumulation, urgently requiring fire-extinguishing and heat-clearing to save Yin, hence this formula. Zheng in *Yi Fa Yuan Tong* said: "This is the main formula for Yangming Fu branch." He listed five flexible applications: (1) Treating Upper Xiao syndrome; (2) Treating sores arising one cun below the heart, with severe redness, swelling, and pain; (3) Treating severely red, swollen, painful gums desiring cold drinks; (4) Treating severely red, swollen, painful breasts; (5) Treating delirium, urinary incontinence, oral insensitivity, and facial dirtiness. Additionally, for Bai Hu Tang syndrome with dampness, add Cangzhu; with wind, add Guizhi, both highly effective. The author used this formula for heat-injury cough and asthma with satisfactory results. Symptoms included dry sore throat, hot breath from nostrils, foul breath, difficult expectoration of thick yellow sputum forming clumps or bloody odor, red face, body heat, restlessness, crimson tongue, dry yellow coating, and strong flooding pulse, all indicating heat excess, cured by Bai Hu Tang. Currently, Bai Hu Tang is widely applied in acute febrile diseases, and effectively for eye diseases and dysentery with heat, showing broad application scope.
22. In Cold Damage, pulse is floating, fever without sweating, if exterior is not resolved, Bai Hu Tang is contraindicated; if desiring water to drink without exterior syndrome, Bai Hu Jia Ren Shen Tang is indicated. Original Text 170
Zheng's Commentary: Fever without sweating should be treated by releasing the exterior, originally unsuitable for Bai Hu. Regarding intense thirst for cold drinks with complete Yangming syndrome, applying Renshen Bai Hu is indeed an unchangeable method.
[Explanation] Cold Damage with floating pulse, fever, and no sweating constitutes Ma Huang Tang syndrome. If desiring water to drink without exterior syndrome, aversion to cold has ceased, interior heat is blazing, and heat severity damages fluids. Bai Hu Jia Ren Shen Tang drains heat and saves Yin. As Zheng stated: Intense thirst for cold drinks with complete Yangming syndrome makes Renshen Bai Hu an indeed unchangeable method.
23. In Cold Damage, no high fever, dry mouth and thirst, mental agitation, slight aversion to cold on the back, Bai Hu Jia Ren Shen Tang is indicated. Original Text 169
Zheng's Commentary: Cold pathogens originate from Taiyang. Aversion to cold on the back suggests exterior unresolved. How can Bai Hu Tang be prescribed? Although calling it "no high fever," despite dry thirst and agitation, it may not necessarily be Bai Hu Tang syndrome. Methods include extreme heat with hidden pathogens causing cold sensation on the back, using this formula. But scholars must carefully investigate: check tongue dryness, whether breath steams hands, severity of thirst, and bowel/bladder function.
[Explanation] Cold Damage with slight back aversion to cold suggests exterior unresolved. Despite dry thirst and agitation, without high fever, Bai Hu Tang cannot be used. Zheng said: "Methods include extreme heat with hidden pathogens causing cold sensation on the back, using this formula." But tongue must be dry, breath steaming hands, intense thirst, and difficult urination/bowel movements must be present to use Bai Hu Jia Ren Shen Tang.
24. In Cold Damage, after purging or vomiting, unresolved after seven to eight days, heat binds in the interior, interior and exterior both hot, occasional aversion to wind, intense thirst, dry tongue with agitation, desiring several sheng of water, Bai Hu Jia Ren Shen Tang is indicated. Original Text 168
Zheng's Commentary: After vomiting and purging, if exterior remains unresolved, vomiting loses Yang, purging loses Yin, dual deficiency prevents pathogen expulsion, hence unresolved. Exterior pathogens enter Yangming territory, transforming into heat pathogens following Yangming Qi transformation, presenting all symptoms matching Bai Hu Tang indications. Excessive drinking is due to massive fluid loss from purging/vomiting, seeking water as support. Prescribing Bai Hu Jia Ren Shen Tang saves impending Yin loss, truly an unchangeable method.
[Explanation] After vomiting and purging in Cold Damage, fluids are deprived, exterior pathogens enter Yangming territory, transforming into interior heat binding. Interior heat is blazing, causing interior-exterior heat, occasional aversion to wind, dry tongue with agitation, desiring water for self-rescue. This is Yangming channel syndrome damaging fluids; method requires clearing interior heat and generating fluids. As Zheng stated: Prescribing Bai Hu Jia Ren Shen Tang is truly an unchangeable method.
Shang Han Heng Lun Volume Four
Yangming Upper Chapter
When external pathogens first enter Yangming, if Taiyang remnants remain, it is called Taiyang-Yangming, listed in this chapter totaling thirty-nine methods (increased according to Shu edition).
1. Yangming disease, pulse is slow, sweating is profuse, slight aversion to cold, exterior is unresolved, can induce sweating, Gui Zhi Tang is suitable. Original Text 234