伤寒病。若吐若下后。六七日不解。热结在里。表里俱热。时时恶风。大渴。舌上干燥而烦。欲
饮水数升者。白虎加人参汤主之。
以下三条。王叔和本在太阳篇中。今移置此。
伤寒若下若吐后。至七八日不解。而燥渴转增者。邪气去太阳之经。而入阳明之腑也。阳明经
为表。而腑为里。故曰热结在里。腑中之热。自内际外。为表里俱热。热盛于内。阴反居外。为时时
恶风。而胃者。津液之原也。热盛而涸。则舌上干燥。故既以白虎除热。必加人参以生津。尚从善
所谓邪热结而为实者。则无大渴。邪气散漫。熏蒸焦膈。故舌上干燥而烦。大渴欲饮水数升是也。是以白虎承气。并
为阳明腑病之方。而承气苦寒。逐热荡实。为热而且实者设。白虎甘寒。逐热生津。为热而不实者
设。乃阳明邪热入腑之两大法门也。故从太阳分出三条。并列于此云。
白虎加人参汤 方见太阳斡旋法。
伤寒无大热。口燥渴。心烦。背微恶寒者。白虎加人参汤主之。
无大热。表无大热也。口燥渴心烦。里热极盛也。背微恶寒。与时时恶风同意。盖亦太阳经邪
传入阳明胃腑。熏蒸焦膈之证。故宜白虎加人参。以彻热而生津也。
伤寒脉浮。发热无汗。其表不解者。不可与白虎汤。渴欲饮水。无表证者。白虎加人参汤主之
。
前二条既着白虎之用。此条复示白虎之戒。谓邪气虽入阳明之腑。而脉证犹带太阳之经者。则
不可便与白虎汤。与之则适以留表邪。而伤胃气也。而又申之曰、渴欲饮水。无表证者。白虎加人
参汤主之。其丁宁反复之意。可谓至矣。
Shanghan disease. If after emesis or purgation, the condition remains unresolved after six or seven days, with heat accumulating in the interior, manifesting as fever both in the exterior and interior, occasional aversion to wind, severe thirst, dryness of the tongue accompanied by irritability, and a desire to drink several liters of water, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) should be administered.
The following three clauses were originally located in the Taiyang Chapter in Wang Shuhe's edition. They are now relocated here.
After Shanghan disease is treated with purgation or emesis, if the condition remains unresolved after seven or eight days, and dryness and thirst intensify, it indicates that the pathogenic factor has left the Taiyang channel and entered the Yangming fu-organ. The Yangming channel governs the exterior, while its fu-organ governs the interior; hence, it is said that heat accumulates in the interior. The heat within the fu-organ steams outward from the inside, resulting in fever both in the exterior and interior. When heat is excessive in the interior, yin is repelled to the exterior, causing occasional aversion to wind. The stomach is the source of body fluids. When excessive heat depletes these fluids, the tongue becomes dry. Therefore, since Baizhu Tang is used to clear heat, Renshen (Ginseng Radix et Rhizoma) must be added to generate fluids. Shang Congshan stated that if evil heat accumulates to form excess patterns, there will not be severe thirst. However, when the pathogenic factor is diffuse and steams the diaphragm, it causes dryness of the tongue, irritability, and severe thirst with a desire to drink several liters of water. Thus, Baihu Tang and Chengqi Tang are both formulas for treating Yangming fu-diseases. Chengqi Tang is bitter and cold, aiming to purge heat and eliminate excess accumulation, designed for patterns characterized by both heat and excess. Baihu Tang is sweet and cold, aiming to purge heat and generate fluids, designed for patterns characterized by heat without excess. These constitute the two major approaches for treating evil heat entering the fu-organs in Yangming. Therefore, these three clauses are extracted from the Taiyang section and placed together here for explanation.
Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction). See the formula in the "Taiyang Manipulation Method" section.
In Shanghan disease, if there is no significant external heat, but mouth dryness and thirst, irritability, and slight aversion to cold on the back are present, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) should be administered.
"No significant external heat" refers to the absence of marked fever on the body surface. "Mouth dryness, thirst, and irritability" indicate extreme internal heat. "Slight aversion to cold on the back" shares the same meaning as "occasional aversion to wind." This likely represents a pattern where pathogenic factors from the Taiyang channel have transmitted into the Yangming stomach fu-organ, steaming the diaphragm. Therefore, Baihu Jia Renshen Tang is appropriate to thoroughly clear heat and generate fluids.
In Shanghan disease, if the pulse is floating, there is fever without sweating, and the exterior syndrome is not resolved, Baihu Tang should not be given. If there is thirst with a desire to drink water, and no exterior syndrome is present, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) should be administered.
The previous two clauses illustrate the application of Baihu Tang. This clause reiterates the contraindications for using Baihu Tang. It states that although the pathogenic factor has entered the Yangming fu-organ, if the pulse and symptoms still carry characteristics of the Taiyang channel, Baihu Tang should not be hastily administered. Doing so would merely retain the exterior pathogen and damage stomach qi. It further emphasizes: if there is thirst with a desire to drink water and no exterior syndrome, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) should be administered. This repeated caution demonstrates utmost thoroughness.