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Sun XX from Wuqing County, aged thirty-three, contracted warm disease (Wen Bing) in early autumn.

Etiology Before the onset of illness, he often felt heat in his heart. Subsequently, after a meal, he sweated and did not have time to rest. Suddenly having urgent business, he went out exposing himself to wind, which led to the contraction of warm disease.

Symptoms He felt intense fever both on the exterior and interior. He craved cold water and cool foods. His tongue coating was thick and white, with the center already turning yellow. His stool was dry, and his urine was scanty and dark red. His pulse was surging (Hong), long, and forceful, identical on both left and right sides, beating seventy-eight times per minute.

Diagnosis This condition arose because latent heat had already transformed within the body prior to the onset, or summer-heat pathogen was internally latent. Slightly stimulated by an external contraction, it caused sudden intense fever throughout the interior and exterior. Within one or two days, Yangming Fu-organ heat became solidified; the surging, long, and forceful pulse is clear evidence of this. I proposed administering a large dose of Baihu Tang (White Tiger Decoction), supplemented with a small amount of dispersing herbs.

Prescription Sheng Shigao (Raw Gypsum Fibrosum, 4 liang, crushed) Zhi Mu (Anemarrhenae Rhizoma, 1 lian) Xian Maogen (Fresh Imperatae Rhizoma, 6 qian) Qing Lianqiao (Forsythiae Fructum, 3 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 3 qian) Jingmi (Oryza Sativa, 3 qian)

Decoct together to make three bowls of soup, taken warm in three divided doses.

Second Visit After completing the three doses, the fever on the exterior and interior remained unchanged, and the surging, long, and forceful pulse persisted. The stool had not yet passed. This was not due to incorrect prescription, but rather that the medication was too mild for the severity of the disease; the medicinal power could not overcome the pathogen. The *Shennong Bencao Jing* originally states that the nature of Shigao (Gypsum Fibrosum) is slightly cold. However, when encountering severe Yangming heat syndromes, one should use it boldly. I planned to remove Lianqiao (Forsythiae Fructum) from the original formula, add Huatifen (Trichosanthis Radix), and increase the dosage of Shigao (Gypsum Fibrosum).

Prescription Sheng Shigao (Raw Gypsum Fibrosum, 6 liang) Zhi Mu (Anemarrhenae Rhizoma, 1 liang) Huatifen (Trichosanthis Radix, 1 liang) Xian Maogen (Fresh Imperatae Rhizoma, 6 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 4 qian) Jingmi (Oryza Sativa, 4 qian)

Decoct together to make three large bowls of soup, taken warm in three divided doses.

Third Visit After completing the three doses, several pieces of dry feces were passed, but the fever on the exterior and interior still did not recede, and the pulse remained forceful. I said to Sun XX: "In my lifetime treating excess heat syndromes of cold and warm diseases, if the fever does not recede after multiple treatments with large doses of Baihu Tang (White Tiger Decoction), I usually grind the Shigao (Gypsum Fibrosum) in the formula into an extremely fine powder and administer it using the decoction of the other herbs. This can achieve efficacy. This case is precisely suitable for this method." Sun XX agreed.

Prescription Sheng Shigao (Raw Gypsum Fibrosum, 2 liang, ground to an extremely fine powder) Sheng Huaishanyao (Dioscoreae Rhizoma, 2 liang) Gancao (Glycyrrhizae Radix et Rhizoma, 6 qian)

Decoct the Huaishanyao (Dioscoreae Rhizoma) and Gancao (Glycyrrhizae Radix et Rhizoma) to make one large bowl of soup, taken warm in multiple divided doses. Each time, take about 2 qian of Shigao powder with the soup. If the fever subsides, there is no need to finish the entire dose. Even if the fever has not completely subsided, if the stool passes again once, the medication should be stopped.

Outcome After drinking the herbal soup in six divided doses and taking nearly half of the prescribed Shigao powder, the fever still did not recede, and the stool had not passed. I then decocted the dregs to obtain two bowls of liquid, which were taken in divided doses along with Shigao powder. Immediately after finishing, the intensity of the fever on the exterior and interior suddenly increased significantly. It was late at night, making it inconvenient to invite a doctor. Sun XX palpated his own pulse and found it wiry (Xuan) and hard (Ying) abnormally. Having frequently read *Yixue Zhongzhong Canxi Lu*, he knew that when the pulse is forceful but lacks a surging and slippery quality, Ren Shen (Ginseng Radix) should be added when using Baihu Tang (White Tiger Decoction). He hurriedly bought 5 qian of Gaolishen (Korean Ginseng), decocted it into a soup, and drank it in one go. His pulse gradually became harmonious and slow, and the fever gradually receded. By dawn, the illness was completely cured.

Commentary According to the standard rules for Shanghan (Cold Damage), whenever Baihu Tang (White Tiger Decoction) is used after sweating, vomiting, or purging, or when thirst is present, Ren Shen (Ginseng Radix) should be added. Upon detailed inquiry into the course of this illness, it was learned that he had sweated profusely once. Although the medicine taken this time was not the original Baihu Tang (White Tiger Decoction) formula, it essentially functioned as such by substituting Jingmi (Oryza Sativa) with Huaishanyao (Dioscoreae Rhizoma) and employing a specific method of administering Shigao (Gypsum Fibrosum) where its potency was sufficient to render Zhi Mu (Anemarrhenae Rhizoma) unnecessary. If Dangshen (Codonopsis Radix) had been added earlier, along with Huaishanyao (Dioscoreae Rhizoma) and Gancao (Glycyrrhizae Radix et Rhizoma) decocted to send the Shigao powder, the patient would likely have recovered peacefully. Due to a momentary oversight, this was not considered. Fortunately, the patient's own knowledge of medical principles salvaged the situation at the last moment. Although Baihu Tang (White Tiger Decoction) and Ren Shen (Ginseng Radix) were administered sequentially here, it is equivalent to simultaneous administration. Adding Ren Shen (Ginseng Radix) to Baihu Tang (White Tiger Decoction) in this case offers three benefits: First, after sweating, the body's Zheng Qi (Upright Qi) is often deficient. Ren Shen (Ginseng Radix) greatly tonifies Zheng Qi (Upright Qi); when Zheng Qi (Upright Qi) becomes robust, it can naturally transform and utilize the medicinal power to overcome the pathogen. Second, sweating easily damages Jin Ye (Body Fluids). When Jin Ye (Body Fluids) are damaged, the Yin aspect of the body is often depleted. The combination of Ren Shen (Ginseng Radix) and Shigao (Gypsum Fibrosum) can nourish Jin Ye (Body Fluids) and restore True Yin during periods of blazing pathogenic heat. When Jin Ye (Body Fluids) are nourished and Yin is restored, pathogenic heat retreats easily. Third, regarding the method of medication, heat is often treated with cold, and cold with heat, as described in the *Neijing* ("subduing the root cause"). In this case, after administering Shigao (Gypsum Fibrosum) with a decoction of Huaishanyao (Dioscoreae Rhizoma) and Gancao (Glycyrrhizae Radix et Rhizoma), the disease presented as pure heat, while the medicine was pure cold. This creates a dynamic similar to ice and charcoal being incompatible, thereby further exciting and agitating the heat. Adding Ren Shen (Ginseng Radix), which has a warm nature, serves as a guide. This embodies the principle of "using heat to facilitate cold treatment." The warm herb acts as a guide within the cold formula to dissipate heat, preventing rejection and allowing chemical integration between the heat and the cold medicine. Once integrated, the heat is eliminated. Considering these three benefits, it becomes clear why this illness healed, further marveling at the ingenuity of Zhang Zhongjing's formula creation. Even approximate application of this principle can salvage critical conditions.