Library

Treats conditions where pathogenic factors from Shanghan (Cold Damage) or Wenbing (Warm Diseases) have transmitted to the Stomach Fu organ, presenting with extreme dryness and thirst, body heat, and all symptoms characteristic of Baihu Tang syndrome. Additionally, if the patient experiences rebellious Qi in the Stomach and fullness/stuffiness in the epigastrium (Xin Xia).

Prescription: Sheng Shigao (Calcitum, Raw Gypsum, 3 liang, finely crushed), Zhi Mu (Anemarrhenae Rhizoma, 1.5 liang), Qing Banxia (Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine, 8 qian), Zhuru Fen (Bambusae Caulis in Taenia Pulvis, 6 qian).

Use five zhong of water, decoct to obtain three zhong of liquid. First, take one zhong warm. If the illness is cured, discontinue subsequent doses. If not fully cured, after two hours, take another zhong warm. Baihu Tang (White Tiger Decoction) from the *Shanghan Lun* is a sacred medicine for treating Yangming Fu heat. Generally, when external pathogens are vigorous, spreading like a prairie fire, the fluids in the Stomach are immediately depleted. Therefore, the acrid-cold nature of Shigao is used to dispel external pathogens, and the cool-moistening nature of Zhimu is used to nourish the internally consumed Yin. However, since Shigao has a heavy substance quality (even when decocted into a soup, its nature remains descending), and Zhi Mu has a bitter taste, the combination of bitter descent and heavy sinking creates a rapid downward force, which may make it difficult to completely eliminate the heat in the Stomach Fu. Furthermore, there is a fear that the medicine will rush directly to the Lower Jiao causing diarrhea. Thus, the thick juice of Jingmi (Oryza Sativa Grain) and the sweet flavor of Gancao (Glycyrrhizae Radix et Rhizoma) are borrowed to slow down this downward momentum. This allows the minute blood vessels in the Stomach to slowly absorb the medicinal power, which then rises via the Lung to become Qi, exudes through the skin as sweat, and the remainder enters the Bladder to become urine. The internally entangled pathogenic heat is thereby cleared along with it. This is the subtlety of Zhang Zhongjing's formula formulation. However, diseases often have concurrent syndromes, so medication cannot be rigidly bound by established formulas. Even if it is a Baihu Tang syndrome, because the patient has rebellious Stomach Qi and epigastric distension, Jingmi and Gancao should not be reused. Instead, Banxia and Zhuru are substituted to utilize their ability to descend rebellious Qi, assisting Shigao and Zhimu in achieving therapeutic success.

A woman, over thirty years old, contracted a Warm Disease. Initially, she vomited. Between the fifth and sixth day, she experienced epigastric fullness and stuffiness, accompanied by fever and thirst. Her pulse was surging, slippery, and forceful; her tongue coating was yellow, thick, and dense. It was reported that before falling ill, she had suffered from unexpressed depression and anger, leading to this condition, commonly known as "Jia Nao Shanghan" (Cold Damage complicated by emotional constraint). However, it was late spring, and upon contracting the disease, she did not feel aversion to cold; thus, it was a Warm Disease, not Cold Damage. I prescribed this formula. A physician present doubted and asked: "This syndrome causes distension and fullness due to rebellious Stomach Qi, so the Baihu Tang formula was modified. Why does the formula not include herbs that open the Qi mechanism, such as Houpo (Magnoliae Officinalis Cortex) and Zhishi (Immaturus Citri Reticulatae Fructus) used in Chengqi Tang, but only uses Banxia and Zhuru?" I replied: "The intent of Baihu Tang is vastly different from Chengqi Tang. Chengqi Tang is a medicine that guides pathogens downward for expulsion, whereas Baihu Tang is a medicine that lifts pathogens outward for release. Therefore, after taking Baihu Tang, most patients resolve through sweating. Occasionally, patients do not sweat immediately after ingestion, but once the high fever subsides, during meals, they often experience slight sweating, and residual heat is thereby completely resolved. If, due to Qi rebellion and distension, one recklessly uses Qi-breaking herbs, damaging the Zheng Qi (Upright Qi), the ability to lift pathogens outward is lost, causing pathogens to sink deeper, making distension impossible to resolve or even worsening it. Observe that in the *Shanghan Lun*, there are many cases where improper purgation damaged the Qi mechanism, resulting in Jie Xiong (Chest Binding) or Xin Xia Pi Ying (Epigastric Fullness and Hardness) syndromes; these must be understood. Furthermore, observe that various Xiexin Tang (Drain the Epigastrium Decoctions) rarely use Qi-breaking substances, yet Banxia Xiexin Tang exists. Additionally, Zhang Zhongjing treated 'after resolution of Cold Damage, rebellious Qi desires vomiting' with Zhuye Shigao Tang, using Banxia together with Shigao; and treated 'women with deficiency in the breast and middle jiao, irritability, restlessness, and vomiting' with Zhupi Da Wan, using Zhuru together with Shigao. This demonstrates that Banxia and Zhuru are effective in descending rebellious Qi. Now, following the intent of these two formulas, I use them to replace Gancao and Jingmi in Baihu Tang. This descends rebellious Qi without damaging righteous Qi. After ingestion, it can still lift pathogens outward for resolution through sweat, and the distension syndrome will also dissipate completely. I have used this formula frequently, never failing to achieve immediate effect." Hearing this, the physician realized his error and accepted my prescription. After the patient took the medicine, she felt as though her distended area was being pushed downward by hand, and the illness was subsequently cured.