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A woman surnamed Zhang from Tianjin, nearly thirty years old, was pregnant and suffered from a warm disease (Wenbing) complicated by dysentery.

Etiology She had been pregnant for six months and constantly felt heat in the heart region. Subsequently, due to her husband's sudden unemployment, emotional agitation stirred up Liver Fire, making the internal heat even more severe. Additionally, constrained by external pathogenic factors, she developed a warm disease complicated by dysentery.

Symptoms There was high fever on both the exterior and interior without sweating, extreme heat in the heart region, and a desire to drink ice water, which her family dared not give her. The tongue coating was dry and yellow; frequent drinking of water did not moisten the mouth. She often felt pain and a bearing-down sensation in the abdomen. Her stools consisted of dysentery with more red than white, mixed with fresh blood, occurring more than ten times a day. The pulse was wiry and long on the left side, and surging and slippery on the right side, both forceful upon heavy pressure, beating five times per breath.

Diagnosis A wiry, long, and forceful pulse on the left indicates blazing fire of the Liver and Gallbladder. Because this Liver-Gallbladder fire is blazing and pressing downward, it causes not only dysentery with red and white discharge but also fresh blood, along with abdominal pain and a bearing-down sensation. A surging and slippery forceful pulse on the right indicates that the warm-heat has entered the Yangming Fu organs, resulting in a dry yellow tongue coating. The heart is pressed by heat, causing a desire to drink ice water. Fortunately, although the pulse indicates heat, it is not excessively rapid, and flows smoothly without stagnation, suggesting the fetal qi can be preserved safely. It is appropriate to treat with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) to resolve the heat of the warm disease, and to heavily use Shaoyao (Paeoniae Radix Alba) to replace Zhimu (Anemarrhenae Rhizoma) in the formula. This will clear the Liver heat and cure the dysentery.

Prescription Sheng Shigao (Raw Gypsum Fibrosum, 3 liang, crushed), Dalu Shen (Large Radix Codonopsis Pilosulae, 5 qian), Sheng Hangshao (Raw Paeoniae Radix Alba, 1 liang), Jingmi (Oryza Sativa, 5 qian), Gancao (Radix Glycyrrhizae Uralensis, 3 qian).
Decoct together to make three bowls of decoction, taken warm in three divided doses.

Follow-up Visit After completing the three doses, the heat on both the exterior and interior had receded by more than half, the dysentery improved by seventy to eighty percent, and the abdominal pain and bearing-down sensation were significantly alleviated. The tongue coating changed from yellow to white, and fluids returned. The pulse remained forceful but was more moderate compared to before. Therefore, modifications were made to the original formula for continued administration.

Prescription Sheng Shigao (Raw Gypsum Fibrosum, 2 liang, crushed), Dalu Shen (Large Radix Codonopsis Pilosulae, 3 qian), Sheng Huai Shanyao (Raw Dioscoreae Oppositae Rhizoma, 8 qian), Sheng Hangshao (Raw Paeoniae Radix Alba, 6 qian), Baitouweng (Radix Pulsatillae, 4 qian), Qinpi (Cortex Fraxini, 3 qian), Gancao (Radix Glycyrrhizae Uralensis, 2 qian).
Decoct together to make three bowls of decoction, taken warm in three divided doses.

Formula Analysis This formula combines Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) and Baitouweng Tang (Pulsatilla Decoction). Because the formula contains Shaoyao (Paeoniae Radix Alba) and Shanyao (Dioscoreae Oppositae Rhizoma), Zhimu (Anemarrhenae Rhizoma) and Jingmi (Oryza Sativa) can be omitted from Baihu Jia Renshen Tang. Since Shigao (Gypsum Fibrosum) in Baihu Jia Renshen Tang can substitute for Huanglian (Coptidis Rhizoma) and Huangbai (Phellodendri Cortex), only Baitouweng (Radix Pulsatillae) and Qinpi (Cortex Fraxini) are used from Baitouweng Tang. Combined, half treats the warm disease and half treats the dysentery. The arrangement is meticulous and coordinated, likely to achieve efficacy.

Outcome Following the prescription for two doses, the illness was completely cured.

Interrogation: In Shanghan Lun (Treatise on Cold Damage), the fixed rule for using Baihu Tang (White Tiger Decoction) is to add Renshen (Ginseng) after sweating, vomiting, or purging, and to add Renshen if there is thirst. In this case, the symptoms did not follow sweating, vomiting, or purging, nor was thirst mentioned. Why was Renshen added twice when using Baihu Tang? Answer: This case involves dysentery, which is a form of "downward" discharge. The dry yellow tongue coating lacking fluids is analogous to thirst. Furthermore, the heat of the warm disease not only enters the Stomach but sinks into the Lower Jiao due to dysentery, leaving no outlet. Only the combination of Renshen (Radix Ginseng) and Shigao (Gypsum Fibrosum) can effectively lift the sunken warm-heat and clear/dissipate it, preventing it from lingering in the Lower Jiao and consuming True Yin. Moreover, since the warm disease and dysentery exacerbate each other, threatening the fetal qi to the point of near collapse, adding Renshen to Baihu Tang serves to protect the fetal qi and prevent unexpected mishaps.