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The substance of Gypsum Fibrosum (Shigao, 石膏) is originally formed by the combination of sulfur, oxygen, and light calcium. Its nature is cool and dispersing, possessing the power to penetrate the exterior and release the muscle layer. It is the supreme medicine for clearing excess heat in the Yangming Stomach Fu organ. Whether used for internal injury or external contraction, it is effective; even if there is excess heat in other Zang-Fu organs, it remains effective. The *Shennong Bencao Jing* (Divine Farmer's Materia Medica) originally states that it is slightly cold. Its cooling power is far inferior to that of Coptidis Rhizoma (Huanglian, 黄连), Gentianae Radix (Longdancao, 龙胆草), Anemarrhenae Rhizoma (Zhimu, 知母), and Phellodendri Cortex (Huangbai, 黄柏), yet its efficacy in reducing fever far surpasses these herbs. The statement in the *Shennong Bencao Jing* that it is "slightly cold" indicates that its nature is not severely cold. Furthermore, its suitability for postpartum women ("chan ru") reveals that its nature is particularly pure and mild.

This implies that because its nature is not excessively cold, it can be used during the postpartum period. However, later commentators on the *Shennong Bencao Jing*, failing to understand that the character "ru" (milk/nursing) in "chan ru" was originally interpreted as "sheng" (birth), absurdly claimed that Gypsum Fibrosum treats women with insufficient lactation. One must realize that if there is no external heat contraction after childbirth, Gypsum Fibrosum should originally not be used. If there is indeed external excess heat, while other cooling herbs might be contraindicated, Gypsum Fibrosum is uniquely not forbidden because its nature is not severely cold but slightly cold. Therefore, in Zhang Zhongjing's *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) from the late Han Dynasty, there is a formula called Zhupi Dawan (Bamboo Peel Large Pill) for treating women with deficiency during childbirth, accompanied by restlessness and vomiting/reversal. This formula contains Gypsum Fibrosum. "Ru zhong" refers to the time of childbirth; the restlessness and vomiting at this time must be due to external excess heat. This actually formulates a prescription based on the meaning in the *Shennong Bencao Jing* that Gypsum Fibrosum governs postpartum birth conditions.

Many physicians mistakenly believe Gypsum Fibrosum is severely cold and thus hesitate to use it. If used improperly, its dispersing nature becomes astringent (calcium sulfate is used to coagulate tofu, taking advantage of its astringent property). When treating external excess heat, it may trap phlegm-fire, causing it to condense and stagnate. Using just one liang (approx. 30-50g depending on era/region, here implying a significant dose relative to misconception) can injure the patient, turning a golden elixir into poison. After mishaps caused by improper use of Gypsum Fibrosum, common opinion fails to identify whether the fault lies in the herb itself or its misuse. Instead, they claim that even when used correctly, Gypsum Fibrosum is too fierce and harmful, making non-use seem safer. Thus, one voice leads to hundred echoes, and using Gypsum Fibrosum becomes a dreaded path. Even those who dare to use it limit themselves to seven or eight qian (approx. 20-30g). Given the heavy density of Gypsum Fibrosum, seven or eight qian is merely a large handful. How can a small handful of a slightly cold herb extinguish the raging fire-like heat of a Hanwen (warm disease)? Therefore, when I use raw Gypsum Fibrosum to treat external excess heat, even for mild cases, I must use at least one liang. If excess heat is blazing, I often use heavy doses of four to five liang, or seven to eight liang. It may be used alone or combined with other herbs, decocted into three or four teacups of liquid, taken in four to five portions slowly and warm. Once the fever subsides, the entire dose need not be consumed. Decocting heavily and administering slowly aims to alleviate the patient's suspicion and fear, and to ensure the medicinal power remains in the Upper and Middle Jiao, preventing the cold nature from descending and causing loose stools. Raw Gypsum Fibrosum used for external excess heat absolutely does not injure the body, and bold usage absolutely ensures fever reduction. Only in cases where heat is excess but the pulse is deficient—indicating excess heat combined with deficiency heat—one should follow the principle of Baihu Tang with Ginseng (Baihu Jia Renshen Tang, White Tiger Decoction plus Ginseng), adding Ginseng to assist Gypsum Fibrosum in reducing fever. Generally, herbs reduce fever by overcoming heat with cold, whereas Gypsum Fibrosum reduces fever by driving heat outwards. After decocting and taking Gypsum Fibrosum, the internally accumulated heat escapes gradually through the pores. Because it contains sulfur, oxygen, and light calcium, it inherently has exterior-releasing properties. Decocted, it resembles clear water; after ingestion, its cooling power exits along with the exterior-releasing action, leaving no viscous residue in the middle to damage the Spleen and Stomach. Thus, when facing the raging heat of severe warm diseases, boldly administering a large dose of Baihu Tang yields immediate results. For patients with excess pathogen and deficient healthy qi, Baihu Tang with Ginseng is also effective.

The reason Gypsum Fibrosum excels in treating warm diseases relies on the sulfur, oxygen, and light calcium in its original substance. If calcined (burnt), these components dissipate, and the remaining calcium changes quality upon calcination. Misuse of calcined Gypsum Fibrosum can congeal external phlegm-fire and block all blood vessels in the body. Cases have been seen where taking a few qian of calcined Gypsum Fibrosum led to knotted and intermittent pulses, progressing to speech impediments and limb flaccidity; where it transformed the condition into Jie Xiong (chest binding) with extreme fullness and obstruction; or where muscles seemed to have distinct boundaries and protruded. Since the claim arose that calcined Gypsum Fibrosum does not hurt the stomach, many physicians have blindly trusted this and caused fatal errors, which are countless. Therefore, when using raw Gypsum Fibrosum, one should buy whole, bright pieces and supervise the grinding process oneself (mineral drugs must be ground finely to extract fully). If bought from a pharmacy, it is hard to distinguish raw from calcined. If, after decoction, the gypsum solidifies at the bottom of the pot and cannot be poured out, it is definitely calcined Gypsum Fibrosum, and the decoction must not be taken.

I have observed ancient medical texts where predecessors used Gypsum Fibrosum: one case used fourteen jin (approx. 6-7 kg); another used dozens of jin (*Wu Juzhong Medical Cases*); some postpartum cases also used heavy doses (*Xu Lingtai Medical Cases*, using Baihu Tang with Ginseng, substituting Scrophulariae Radix for Anemarrhenae Rhizoma and raw Dioscorea Rhizome for Rice). In all these cases, raw Gypsum Fibrosum was used.

[Attached Case] My son XX, at age seven, contracted wind-cold. After four to five days, he had high fever, with a yellow tongue coating tinged with black. The child suffered from taking medicine; forcing it caused incessant vomiting. So, I used only about one liang of raw Gypsum Fibrosum, decocted to obtain clear liquid, divided into three doses taken warm. The illness improved slightly. Then, two liang of raw Gypsum Fibrosum were decocted and taken slowly warm; the illness improved further. Then, three liang were decocted and taken similarly; the illness completely resolved. A seven-year-old child consuming six liang of raw Gypsum Fibrosum in roughly one day and night, recovering with increased appetite and no signs of cold-damage to the middle, proves: Is Gypsum Fibrosum severely cold or slightly cold? This was my first experience of using heavy doses. The first dose was only one liang, divided into three parts, as I was still uncertain of its nature. Why do people today dare not use heavy doses? They might as well test it more extensively to exhaust its capabilities, as I did.

The wife of my fellow townsman Zhao XX, nearly sixty years old, contracted a warm disease. Her pulse was rapid, surging, and solid; her tongue coating was yellow and dry; she vomited upon smelling medicine. I instructed her to take six liang of fine raw Gypsum Fibrosum powder, decocted in a small rice-cooking pot (not a medicine steamer, to avoid medicinal odor triggering vomiting) to yield one large bowl of clear soup. To prevent vomiting, she took only one mouthful warm at a time. After swallowing, she felt extremely restless, and the family suspected the prescription was incorrect. I said, "No, the disease is severe and the medication light." After three doses, the restlessness ceased. Four hours later, having finished the dose, she recovered.

Mao XX's third son, XX, aged thirty-two, had a history of phlegm-fluid retention. He contracted a cold injury, treated and cured. Relapsed due to overeating, cured again. Relapsed again days later due to overeating; treatment failed. I consulted him after four to five days. His pulse was surging, long, and forceful, but his tongue coating was pale white, not dry, and he did not feel thirsty. Eating one bite of pear made him feel very cold; eating one pomegranate seed made his heart feel cold. Discarding symptoms for the pulse, I prescribed a large dose of Baihu Tang (White Tiger Decoction). Due to his phlegm-fluid retention, I added several qian of prepared Pinellia Tuber (Qing Banxia, 清半夏). His cousin, Gao XX, present and a senior physician in the county, questioned suspiciously: "This patient feels no thirst or heat in the chest and fears cold foods so much. In my view, even clearing and resolving herbs are unsuitable. What is your basis for using several liang of raw Gypsum Fibrosum?" I replied: "The surging and solid pulse indicates Yangming excess heat. The absence of thirst and heat sensation is due to his chronic phlegm-fluid retention and dampness dominance. His aversion to cold food is because the gastric phlegm-fluid interacts with external heat, causing the Stomach Fu to transform according to this mixture and oppose cold." Mao XX understood medicine and trusted me. He took the medicine over ten times in two nights, consuming over one jin of raw Gypsum Fibrosum, until his pulse became peaceful. I returned home. Two days later, he came to welcome me, reporting severe relapse with abnormal symptoms, fearing imminent death. I wondered how such a definitively cured case could relapse so drastically. Upon arrival (three li away), I saw excessive phlegm-saliva, continuous coughing and spitting,恍惚 mental state, confused speech, and body tremors. His pulse was peaceful and normal, except for slightly weak Stomach Qi at the Right Guan position. I suddenly realized and urgently told his family: "There is absolutely no danger here. Previously, he relapsed due to overeating; now he relapses due to under-eating/starvation." His family confirmed they had given very little food for days to avoid repeating past mistakes. I said: "No medicine is needed; eating will cure him." They worried he couldn't eat given his state. I said: "Do not worry. If the illness is caused by hunger, he will naturally desire food." Following my advice, from 8 PM until dawn, he ate three times, with controlled portions each time, and recovered.

Friend Mao XX's wife, nearly seventy, contracted cold injury in mid-January with no sweating. Originally a Mahuang Tang (Ephedra Decoction) pattern. Mistakenly treated with Guizhi Tang (Cinnamon Twig Decoction); sweat did not emerge. Suddenly, upper Jiao felt hot and nauseous; vomiting occurred upon smelling medicine. Even drinking plain water boiled with Gypsum Fibrosum or boiled water caused vomiting. Only swallowing small ice cubes throughout day and night prevented vomiting. Despite consuming considerable ice over two days, the heat and irritability persisted. Her pulse at the Guan position before was exceptionally surging and slippery. I instructed her to chew fresh pear slices dipped in fine raw Gypsum Fibrosum powder. She then tolerated the medicine without vomiting. After finishing two liang, she recovered.

A man with syphilis was treated in a Japanese hospital for over twenty days. His head and face were swollen, lower body ulcerated, body had high fever, and he delirious and unconscious. The Japanese doctors said the toxin had spread to Dan (erysipelas) and was incurable. His friend Sun XX invited me to diagnose him in the hospital. Suspecting the condition involved a concurrent warm disease, I used half a jin of fine raw Gypsum Fibrosum, boiled in a large bottle of water, disguised as wine to enter the hospital under the pretext of visiting a friend, so the Japanese staff wouldn't know I was treating him. Upon seeing the patient, his head and face were swollen and red. His pulse was surging and solid, confirming concurrent warm disease. I instructed him to drink the Gypsum water slowly and warm. The next day, his swelling and redness subsided, the surging/solid pulse halved but became faster, and he remained delirious and unconscious. Half the Gypsum water remained. I advised buying five qian of Radix Codonopsis Pilosae (Ludangshen, 潞党参), decocting it, and mixing it with the remaining Gypsum water. The next day, his consciousness cleared, and his pulse normalized. He decided to leave the hospital for recovery elsewhere. Ten days later, his syphilis also healed. Codonopsis was used for its neutral, non-heating nature.

A fifty-year-old man felt cold all over, with pain in both legs. Doctors administered warming and tonifying medicines, worsening the cold, leading to chills. His pulse was deep and hidden, but forceful upon heavy pressure. Tongue coating was thick and yellow; urination was red and difficult. It was mid-spring; I knew this was Spring-Warmth heat depressed in Yangming, not yet erupted, presenting as a false sign. I wanted to use Baihu Tang with Forsythiae Fructum (Lianqiao, 连翘). The patient was terrified. I said: "Just pre-purchase four liang of raw Gypsum Fibrosum. When the heat becomes unbearable, decoct and drink it, okay?" Patient: "It won't happen." I said: "If you decoct fresh Imperata Rhizome (Baimaogen, 白茅根) and drink it, the cold will turn to heat, even severe heat." Still skeptical, he tried it to verify. He peeled fresh Imperata Rhizome, chopped a large bowl, boiled it, and drank the soup as tea. Soon, heat erupted, becoming unbearable. Re-checking the pulse, it was extremely surging and large. I decocted the pre-purchased four liang of raw Gypsum Fibrosum, divided into three warm doses. The heat subsided.

Gypsum Fibrosum's nature also excels at clearing heat from epidemic rashes (see attached case after Qingzhen Tang), clearing heat from the head and face (see attached case after Qingyu Tang), and clearing heat from the throat (see case of Dong XX from Cangzhou in 'Detailed Discussion on Throat Disease Treatment').

For external contraction with phlegm-wheezing, Jin Gui Xiao Qinglong Jia Shigao Tang (Minor Green Dragon Decoction plus Gypsum Fibrosum) is appropriate. If the external heat has entered the Yangming Fu, the Ephedra, Cinnamon Twig, Ginger, and Asarum in Xiao Qinglong Tang are truly unsuitable. I once treated Liu XX, aged eight. In early autumn, he contracted a warm disease. After ten days of treatment, the condition worsened. Exterior and interior had high heat, wheezing was urgent, pulse was surging and rapid, forceful upon heavy pressure. Knowing it was still treatable, I asked about bowel movements; none for two days. I prescribed a large dose of Baihu Tang, using heavy dose of two and a half liang raw Gypsum Fibrosum, replacing rice with one liang raw Dioscorea Rhizome (Shanyao, 山药). Due to urgent wheezing and latent pathogen in the lungs, I added one and a half qian Mentha Haplocalyx (Boheye, 薄荷叶) to clear it. Decocted into two teacups, taken warm in two doses. One dose improved the condition significantly; a second dose cured it completely.

Traditionally, postpartum conditions strictly forbid cold herbs. But if it is truly a postpartum warm disease with dry heat in the chest, yellow thick tongue coating, and surging solid pulse, cold herbs are not forbidden. However, cold herbs must be chosen carefully, not thrown in randomly. For mild postpartum warm cases where heat enters Yangming but the pulse is not strongly surging/solid, I often use heavy doses of Scrophulariae Radix (Xuan Shen, 玄参), one to two liang, achieving immediate results. For severe cases, Baihu Tang with Ginseng is necessary. Use raw Dioscorea Rhizome instead of rice, and Scrophulariae Radix instead of Anemarrhenae Rhizoma for safety. See the verified case under Baihu Tang with Ginseng substituting Yam for Rice in the Medical Formulas section. Both Gypsum Fibrosum and Scrophulariae Radix are explicitly stated in the *Shennong Bencao Jing* to treat postpartum conditions, whereas Anemarrhenae Rhizoma is not mentioned in its entry. I dare not act arbitrarily.

Friend Mao XX once treated a young woman, ten-plus days postpartum, with high fever all over, no sweat, hot chest, and thirst. Medical treatment worsened the condition, becoming critical. Mao XX diagnosed a surging, solid pulse; yellow tongue coating turning black; grasping at empty air and touching the bed, indicating internal wind stirring. He treated with three liang raw Gypsum Fibrosum, one liang Scrophulariae Radix, five qian wild ginseng (Yetaishen, 野台参), two qian Licorice Root (Gancao, 甘草). Due to frequent vomiting, following the principle of Zhupi Dawan, he added two qian Bamboo Shavings (Zhuru, 竹茹), decocted in one large bowl, taken slowly warm. Finished the dose and recovered. Looking at this case, external heat raging like a wildfire, even postpartum, how can one treat it leisurely? Sun Simiao said: "Wisdom should be round, conduct square; courage should be great, caution small." Secular doctors encounter such cases with only caution, lacking courage. How can they remain indifferent to the patient's critical state?

In women, external heat pressing inward can cause persistent bleeding. Baihu Tang with Ginseng can be used heavily. Li family's wife from a neighboring village, a few days postpartum, lochia had stopped. On day seven or eight, sudden bleeding resumed. Medicine taken for twenty-plus days failed. Pulse surging, slippery, forceful; hot chest and thirst. Suspected concurrent external contraction; she felt no body heat, tongue had no coating, color slightly white. Suspected blood-heat reckless movement; cooled blood and stopped bleeding meds failed; heat and thirst persisted. Concluded definitely concurrent external contraction. Switched to Baihu Tang with Ginseng, using three liang raw Gypsum Fibrosum, raw Dioscorea Rhizome instead of rice, decocted in three bowls, taken warm in three doses. Heat and thirst resolved, bleeding stopped. Later switched to blood-cooling and hemostatic meds for final cure.

Dysentery with unceasing fever, unresponsive to all fire-clearing herbs, is often deemed untreatable in texts. If the treatment matches the syndrome, why would the fever not cease? This is because dysentery involves concurrent external contraction; the external heat pathogen sinks deep with the dysentery, filling the Lower Jiao meridines with no exit, aiding the dysentery, worsening daily without end. Diseases with concurrent syndromes require concurrent treatments. Heavy use of Gypsum Fibrosum supplemented with Ginseng to clear external heat is essential (See verified case of Wang XX after Tongbian Baihu Jia Renshen Tang).

Gao Shi, wife of cousin Zhang XX, over fifty, chronically ill. Early summer morning, started passing white dysentery; by evening, ten-plus times. After candlelight, suddenly high fever all over, unconscious, picking at clothes, unresponsive. Pulse surging but weak, skin hot to touch. Diagnosed as Qi-level heat dysentery with summerheat invasion; frail body could not sustain it, hence confusion. Urgently prescribed three liang raw Gypsum Fibrosum, four qian wild Codonopsis (Yedangshen, 野党参), decocted in one large bowl, taken slowly warm. Woke up at midnight after finishing the dose; dysentery also stopped. Decocted dregs next morning; recovered completely.

All the above dysentery cases involved concurrent external heat. Hence, heavy Gypsum Fibrosum was used. It is not a general dysentery formula. In my book *Zhongzhong Canxi Lu*, there are seven formulas for dysentery, used flexibly based on syndrome, with certainty. The formula used in the previous case is one of them. I have used this formula on many people; if pulse and syndrome match, there is no error.

Malaria, though in Shaoyang, if Yangming has concurrent excess heat, heavy Gypsum Fibrosum is suitable. I treated neighbor Li XX, around forty, malaria every other day. During fever, burning hot; even on non-fever days, felt heat in exterior and interior, dry tongue/mouth, pulse string-like and long, solid upon heavy pressure. This is Shaoyang pathogen excess, Yangming heat excess, malaria concurrent with warm disease pulse. Prescribed large dose Baihu Tang plus three qian Bupleurum Root (Chaihu, 柴胡). Felt refreshed immediately. Next morning, malaria did not recur. Took half the previous dose plus three qian Ginger, warm malaria cured thereafter. For cases where pulse is not strongly solid but forceful upon pressure, with constant feeling of fever and poor appetite, I add about one liang raw Gypsum Fibrosum to malaria prescriptions, always effective.

Gypsum Fibrosum's nature also excellently treats nasal discharge (naozhou). Texts often use Xin Yi Hua (Magnolia Flower) and Cang Er Zi (Xanthium Fruit). Etiology varies: wind attacking the brain, or liver transferring heat to the brain. If wind attack, early stage might use these acrid-warm herbs to disperse. If heat develops over time, acrid-warm herbs are unsuitable. If liver transfers heat to brain, acrid-warm herbs are strictly contraindicated. Recently treated Guo XX from Fengtian, suffering for half a year. Nose flows turbid mucus, foul smell, hot heart, confusion, frequent dizziness. Pulses left and right string-like and forceful; stool often dry. Diagnosed liver transferring heat to brain, stomach also transferring heat to brain. Fearing initial etiology was wind, first gave Aspirin to induce sweat; head/eyes felt refreshed. Then prescribed: one and a half liang raw Gypsum Fibrosum, four qian Gentianae Radix (Longdancao, 龙胆草), raw Paeoniae Radix Alba (Sheng Baishao, 生杭芍), Scrophulariae Radix (Xuan Shen, 玄参), Anemarrhenae Rhizoma (Zhimu, 知母), Trichosanthis Radix (Guafen, 花粉) each four qian; Forsythiae Fructum (Lianqiao, 连翘), Honeysuckle Flower (Jinyinhua, 金银花), Licorice Root (Gancao, 甘草) each two qian; Mint Leaf (Boheye, 薄荷叶) one qian. Taken ten doses consecutively. Gypsum Fibrosum maintained at one and a half liang; other herbs adjusted slightly. Recovered completely.