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Besides Baihu Tang (White Tiger Decoction), there is also Baihu Jia Renshen Tang (White Tiger Decoction with Ginseng), which serves to supplement the deficiencies of Baihu Tang. This formula appears five times in *Shanghan Lun* (*Treatise on Cold Pathogenic Diseases*). Now, I will briefly excerpt a few sections from it as data for study.

Original text from *Shanghan Lun*: After taking Guizhi Tang (Cinnamon Twig Decoction) and experiencing profuse sweating, if severe irritability and thirst persist without relief, and the pulse is flooding (Hong Mai, Large Pulse), Baihu Jia Renshen Tang should be administered.

[Formula for Baihu Jia Renshen Tang] Anemarrhenae Rhizoma (Zhimu, 知母) six liang, Gypsum Fibrosum (Shigao, 石膏) one jin (crushed, wrapped in cotton cloth), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) two liang (prepared by roasting), Oryza Sativa (Jingmi, 粳米) six he, Ginseng Radix (Renshen, 人参) three liang.

Take the above five ingredients, add ten dou of water, and boil until the rice is cooked and the decoction is ready. Strain out the dregs, and take one sheng warm each time, three times a day.

The original purpose of taking Guizhi Tang was to induce a slight sweat. If the sweat flows like water, the disease will certainly not resolve; this is referred to as causing profuse sweating after taking Guizhi Tang, meaning the sweat flows like water.

Because excessive sweating severely damages body fluids (Jinye), severe irritability and thirst occur, and the pulse becomes abnormally flooding. Using Baihu Tang to clear the heat, and adding Renshen to restore the body fluids, the disease can be cured.

Original text from *Shanghan Lun*: In cold damage disease, if vomiting or purging has been performed, and after seven or eight days the condition remains unresolved, with heat accumulating internally, manifesting as heat in both the interior and exterior, occasional aversion to wind, extreme thirst, dryness and irritability on the tongue, and a desire to drink several sheng of water, Baihu Jia Renshen Tang should be administered.

The phrase "if vomiting, if purging" actually refers to improper treatment, i.e., mistaken use of emetic or purgative methods, resulting in the failure of the disease to resolve after these treatments. Moreover, mistaken vomiting damages body fluids, while mistaken purging damages the qi level (Qifen). Damage to body fluids causes thirst, and damage to the qi level impairs its ability to assist body fluids in rising to the mouth, further causing thirst; hence the desire to drink several sheng of water. Adding Renshen to Baihu Tang not only generates body fluids but also supplements the qi level to help body fluids rise, thereby achieving remarkable results.

Original text from *Shanghan Lun*: In cold damage, if the pulse is floating (Fu Mai), with fever and no sweat, and the exterior syndrome is not resolved, Baihu Tang should not be given. If there is a desire to drink water and no exterior syndrome exists, Baihu Jia Renshen Tang should be administered.

For any case where Baihu Tang is indicated, the pulse should exhibit a slippery quality (Hua Mai, Slippery Pulse), which indicates heat within. The pulse in this section is merely floating. Although there is fever, the heat is located at the exterior; this is the practical reason why Baihu Tang cannot be used. However, because the text mentions "no sweat" and "exterior not resolved," later practitioners of cold damage have claimed that those without sweat or with an unresolving exterior cannot use Baihu Tang, citing this section as evidence. They fail to read the preceding sentences together to understand the context, thus greatly misunderstanding the ancients.

Have they not considered that in the Taiyang chapter, the Baihu Tang syndrome presents with a floating-slippery pulse? Is the floating pulse not connected to the exterior? Have they not considered that the Baihu Tang syndrome appears three times in *Shanghan Lun*, and only in the Yangming chapter is sweating explicitly mentioned, whereas in the Taiyang and Jueyin chapters, sweating is not mentioned? As for the person desiring to drink several sheng of water, and having no exterior syndrome constrained by cold, it means the external pathogenic heat has entered the interior, scorching and consuming body fluids, causing extreme thirst. In such cases, urgent rescue with Baihu Jia Renshen Tang is appropriate without hesitation.

The syndromes treated by Baihu Jia Renshen Tang, whether characterized by thirst, irritability, or dry tongue, are indeed injured by internalized pathogenic heat, but essentially stem from a deficiency of true yin (Zhenyin). Renshen is a herb that tonifies qi (Buqi) rather than nourishes yin (Ziyin). Yet, when added to Baihu Tang, it can rapidly restore true yin even when pathogenic fire is blazing fierce; there must be a subtle chemical interaction involved.

I once treated a patient suffering from cold damage where heat had entered the Yangming fu organs. The pulse was forceful and hard, accompanied by delirium. According to this pulse, Baihu Jia Renshen Tang was originally indicated. However, being young and lacking deep medical cultivation at the time, I prescribed a large dose of Baihu Tang alone, instructing the patient to drink it warm in divided doses. The next day, the fever had subsided, but the pulse became rapid, and the delirium worsened. It suddenly dawned on me, so I switched to Baihu Jia Renshen Tang, prepared a large decoction, and instructed the patient to drink it slowly in three doses. Upon finishing the medication, the patient recovered. Generally, the pulse for Baihu Tang syndrome should be slippery; a hard pulse indicates it is not slippery, revealing signs of yin deficiency within. Therefore, it should be treated with Baihu Jia Renshen Tang, not solely with Baihu Tang. Since curing this case, whenever I encounter patients with a rapid or wiry-hard pulse, those over fifty years old, those exhausted from mental or physical labor, or those constitutionally weak, even if not post-emesis/purgation, if they present with thirst and irritability requiring Baihu Tang, I always add Renshen. This ensures standing on unassailable ground, like an army destined to win.

A friend from my hometown, Li XX, once treated a Yangming fu excess syndrome. Although the pulse was forceful, it was rapid, exceeding six beats per respiration. Li XX first prescribed Baihu Tang without effect, then added Scrophulariae Radix (Xuanshen, 玄参) and Glehniae Radix (Shashen, 沙参) to nourish the yin level due to the rapid pulse, still without effect. He consulted me. I replied: This is a Baihu Jia Renshen Tang syndrome. Li XX said, this syndrome did not follow emesis, purgation, or sweating, nor is there thirst or irritability; why use Baihu Jia Renshen Tang? I said: When using ancient formulas, one must infer and adapt based on the intent of the ancient physicians. For syndromes treated by Baihu Tang, those with thirst and irritability often result from yin deficiency. Does a rapid pulse not also indicate yin deficiency? Li XX understood upon hearing my words, switched to Baihu Jia Renshen Tang, and the patient recovered after one dose.

Expanding the usage of Baihu Jia Renshen Tang does not require the patient to be physically weak or damaged. Recalling when I was thirty, I suffered from latent qi transforming into heat, experiencing heat in the five centers (Wuxin Fanre), dizziness and heaviness of the head and eyes, white thick tongue coating turning yellow, covered with prickles, and dry stool. I boiled several liang of raw Gypsum Fibrosum daily to drink, continuing for several days, but the heat did not subside. Thinking perhaps the dosage was too light to overcome the disease, I took five liang of raw Gypsum Fibrosum boiled in water at noon, and another five liang in the afternoon, totaling ten liang in one day. Yet, I felt no coolness internally, and my stool remained unpassed. After much deliberation and deep thought, I realized the latent qi had penetrated deeply. Originally, supporting the righteous qi (Zhengqi) was necessary so that strong righteous qi could naturally expel the pathogen. Thus, intending to imitate the principle of Baihu Jia Renshen Tang, but lacking confidence to use a large dose immediately, I used herbs I had stored: two liang of raw Gypsum Fibrosum, two qian of wild Taishen (Wild Ginseng), one and a half qian of Gancao, and added some coarse residue of processed Huai Shan Yao (Dioscoreae Rhizoma, Chinese Yam). I decocted this in two large bowls of water, drinking it warm in three doses. By evening, I felt refreshed and slept peacefully through the night. At dawn, I had mild lower abdominal pain and passed stool three times. I felt the latent heat had completely dissipated. Inspecting my tongue, the coating had receded by half, and the prickles were gone. By common logic, adding Renshen to Baihu Tang should reduce the cooling power of Gypsum Fibrosum. However, this experiment showed that Renshen actually enhances the cooling power of Gypsum Fibrosum. What is the rationale? When Gypsum Fibrosum is decocted, its cooling and dispersing power radiates outward through the pores. When used with Renshen, its cooling power combines with Renshen's tonifying power, circulating within the zang-fu organs to thoroughly eliminate deep-seated external pathogens. This is why Baihu Jia Renshen Tang clears heat far more effectively than Baihu Tang alone.

In my lifetime, treating exogenous febrile diseases with substantial heat, I often used Baihu Jia Renshen Tang more frequently than Baihu Tang, adapting the original formula slightly according to the syndrome. Whenever the pulse exceeded six beats per respiration, I consistently replaced the Jingmi in the formula with one liang of raw Huai Shan Yao. This is because Shan Yao contains abundant protein, strongly nourishing yin and tonifying the kidney, and its rich mucilage can replace Jingmi to harmonize the stomach. If Yangming heat is substantial and the patient also suffers from dysentery, I consistently replace Anemarrhenae Rhizoma (Zhimu) with one liang of raw Hang Shaoyao (Paeoniae Radix Alba, White Peony Root), because Shaoyao clears liver heat to relieve tenesmus in dysentery, and its cooling, moistening, and yin-nourishing nature is close to Zhimu. If a woman suffers from exogenous febrile disease with substantial heat postpartum, I also replace Jingmi with Shan Yao, and must replace Zhimu with eight qian of Xuanshen. This is because Shan Yao tonifies kidney deficiency postpartum, and Xuanshen treats residual disorders after childbirth, as explicitly stated in *Shennong Bencao Jing* (*Divine Farmer's Materia Medica*) (Both Gypsum Fibrosum and Xuanshen are stated to treat postpartum conditions in *Shennong Bencao Jing*; Zhimu is not stated to treat postpartum conditions. I dare not act subjectively and lightly administer bitter-cold herbs to postpartum women). Moreover, Xuanshen is not inherently bitter-cold; experiments show it is sweet with a slight bitterness (The statement in *Shennong Bencao Jing* that it is bitter is likely a transcription error by later generations). Therefore, it can be used boldly postpartum without harm.

When treating exogenous febrile diseases with Yangming intestinal excess and dry stool, I often prescribe large doses of Baihu Tang or Baihu Jia Renshen Tang. Often, the bowel movement becomes free, and the patient recovers, without the risk of unresolved disease after purgation. Occasionally, after taking the medicine, the bowel movement does not immediately pass. In such cases, administering a small amount of purgatives, or mixing two to three qian of Mirabilite (Xuanmingfen) with honey and water, allows the bowel to pass smoothly. This is because after taking Baihu Tang or Baihu Jia Renshen Tang, the high fever has subsided, and the dryness has been moistened, making passage easy.

There are cases where exogenous substantial heat persists for a long time, leading to dual deficiency of qi and blood, with danger imminent. Emergency treatment with Baihu Jia Renshen Tang may cure only half the illness; subsequent administration of other tonic medicines is required for full recovery. I will now detail a case to demonstrate this:

A nine-year-old girl contracted a warm disease in early spring. The physician used hot herbs to induce sweating. After ingestion, there was no sweat, and she developed severe interior and exterior heat, constituting a Baihu Tang syndrome. The physician failed to treat according to the formula, delaying for over twenty days. Her body became emaciated, and various signs of danger emerged: her eyes rolled upward, nearly blind; muscles twitched (Jinti Rourun); her whole body trembled; she belched frequently; occasionally wheezed; her spirit was confused and unconscious; her skin was very hot. Opening her teeth revealed a retracted, dry tongue with a thin, slightly yellow coating. The pulse was rapid, exceeding six beats per respiration. The left side was wiry, fine, and floating, unable to withstand heavy pressure. The right side was also wiry and fine, but seemed forceful under heavy pressure. She had not passed stool for ten days. This was due to prolonged burning by exogenous heat, causing dual deficiency of qi and blood, stirring of liver wind (Ganfeng Neidong), loss of true yin control, and impending collapse of yuan qi (Primordial Qi). Urgent treatment with Baihu Jia Renshen Tang, supplemented by herbs to nourish yin and secure qi, might save her. However, I feared that given her condition, she could not swallow decoctions. Her family said she could swallow spoonfuls of water or rice soup if offered, so administering medicine orally should be possible. Thus, I prescribed the following:

[Prescription] Raw Gypsum Fibrosum (fine powder) two liang, Wild Taishen three qian, Raw Huai Shan Yao six qian, Raw Rehmanniae Radix (Sheng Dihuang, Prepared Rehmannia Root) one liang, Raw Corni Fructus (Sheng Shanzhuyu, Dogwood Fruit) one liang, Gancao two qian. Decoct together in two large bowls of water, divide into three doses, drink warm.

This formula is Baihu Jia Renshen Tang with Raw Rehmanniae Radix replacing Anemarrhenae Rhizoma, Raw Huai Shan Yao replacing Oryza Sativa, plus added Corni Fructus. Without Corni Fructus, this is my commonly used formula for exogenous febrile diseases requiring Baihu Jia Renshen Tang in patients who are weak and yin-deficient. Today, I heavily added one liang of Corni Fructus because when primordial qi is insecure, it often ascends and collapses due to the liver's dispersing function. The upward rolling of the eyes is a manifest sign (belonging to the liver). Heavy use of Corni Fructus converges the liver's dispersing function, preventing qi collapse. Furthermore, Yu Jiayan stated that for ascending collapse syndromes, relying solely on heavy Renshen may cause qi to rise uncontrollably. Adding heavy Corni Fructus as an assistant prevents this drawback, ensuring steady success. After completing three doses, her eyes stopped rolling upward, her body stabilized, belching ceased, breathing normalized, and her spirit became clearer, though she still could not speak. Her stool remained unpassed, skin still hot, pulse rate decreased and less wiry-floating than before, but the right side still seemed forceful under heavy pressure. I slightly modified the original formula for continued use.

[Second Prescription] Raw Gypsum Fibrosum (fine powder) one and a half liang, Wild Taishen three qian, Raw Rehmanniae Radix one liang, Raw Corni Fructus six qian, Asparagi Radix (Tiandong, Asparagus Tuber) six qian, Gancao two qian. Decoct in two bowls of water, divide into two doses, drink warm. Add one raw chicken egg yolk to each dose.

Corni Fructus is still used despite the eyes no longer rolling upward because this patient previously suffered from belching, indicating difficulty in qi ascending. For qi difficult to ascend, one must guard against qi collapsing downward after bowel movement. Thus, Corni Fructus is used for prevention. Regarding the chicken egg yolk, chemists state it contains adrenal medullary substances, which nourish true yin well. Raw application also moistens the bowels well, hence its addition.

Taking one dose daily, after two days the heat completely subsided. Her clarity of spirit seemed to fade, and she still could not speak. Stool remained unpassed, with occasional straining. Palpating the pulse, the heat signs had quieted and become weak. I planned to use enema to facilitate bowel movement. First, I gave Wild Taishen three qian, Corni Fructus and Asparagi Radix four qian each, decocted in water. Then, I used an enema to facilitate bowel movement, which passed smoothly. She still could not speak. Fine palpation revealed the pulse was even weaker; the pulse at the cun position on the right side was almost imperceptible. It suddenly dawned on me that her inability to speak was due to sinking of the great qi in the chest (Zhong Daqi Xiaxian). Lifting and tonifying the great qi in the chest, allowing it to reach the root of the tongue, would enable speech.

[Third Prescription] Raw Atractylodis Macrocephalae Rhizoma (Sheng Jianqi, Astragalus Root) three qian, Wild Taishen three qian, Raw Huai Shan Yao one liang, Large Sweet Lycii Fructus (Gouqizi, Goji Berry) one liang, Glehniae Radix (Beishashen, North Glehnia Root) one liang, Asparagi Radix six qian, Ophiopogonis Japonici Bulbus with heart (Cundong Daixin, Lily Tuber) six qian, Cimicifugae Rhizoma (Shengma, Black Cohosh Root) one qian, Platycodonis Radix (Jiegeng, Balloon Flower Root) one and a half qian. Decoct in one and a half bowls of water, divide into two doses, drink warm. After taking two doses of this formula, she could speak. This is because the formula heavily uses yin-nourishing herbs to cultivate her spirit, and her spirit returned to normal.