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Treatment for cold-warm diseases where excess heat has entered the Yangming fu-organs, characterized by dry mouth and thirst with a strong desire to drink cold water, and a fine and rapid pulse.

Raw Gypsum (San liang, crushed into fine powder) Anemarrhenae Rhizoma (Yi liang) Ginseng Radix et Rhizoma (Liu qian) Dioscoreae Rhizoma (Liu qian) Glycyrrhizae Radix et Rhizoma preparata (San qian)

The above five herbs are decocted in five bowls of water until three bowls of clear liquid remain. Take one bowl warm initially. If the illness resolves, discontinue subsequent doses. If not fully resolved, wait two hours and take another bowl.
For detailed instructions on administration, refer to Xianlu Tang (Fairy Dew Decoction).

In the treatment principles of Shanghan Lun (Treatise on Cold Damage), it is stated that Renshen (Ginseng) should be added to Baihu Tang (White Tiger Decoction) after sweating, vomiting, or purging methods have been used. However, upon closer examination, if the pulse is deficient, Renshen (Ginseng) is appropriate regardless of whether these methods were employed previously. Since I began clinical practice, whenever I encountered Yangming heat blazing intensely in patients who had pre-existing internal injury or inherently weak Yuanqi (Original Qi), presenting with either a deficient-rapid or fine-weak pulse, I administered Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng). After long-term clinical verification, I found that replacing Jingmi (Rice) with Shanyao (Dioscorea Rhizome) makes the formula more stable and effective faster. This is because Jingmi (Rice) merely harmonizes Stomach Qi, whereas Shanyao (Dioscorea Rhizome) can secure the Yuanqi (Original Qi) of the Lower Jiao (Lower Burner), preventing patients with inherently deficient Yuanqi (Original Qi) from experiencing loose stools due to the cold nature of Shigao (Gypsum) and Zhimu (Anemarrhena Rhizome). Furthermore, Shanyao (Dioscorea Rhizome) contains abundant protein-rich juice, which is excellent at nourishing Yin. With Shanyao (Dioscorea Rhizome), Baihu Tang (White Tiger Decoction) can both purge excess fire and clear deficiency heat, resolving both internal injuries and external contractions rapidly. I have saved many lives using this formula. Below are several case records for reference.

An elderly man, nearly sixty years old. He was constitutionally frail and suffered from chronic cough (Laosou). After contracting a Shanghan (Cold Damage) syndrome, he fell into a coma and lost consciousness after three days. His pulse was extremely deficient and rapid, and his skin was burning hot, indicating definite excess heat. Recognizing this as a condition of deficient pulse and excess pathogen, with rampant evil fire and insufficient Yuanqi (Original Qi) to support him, although the disease transmission had not yet penetrated deeply, he became comatose. After much hesitation, I boldly prescribed this decoction. The medicine was decocted and administered slowly while hot, only two teaspoons at a time. After three hours, having administered two bowls, he suddenly woke up clearly. After finishing the remainder, he recovered.

Another elderly man, sixty years old. Also constitutionally frail and prone to illness, he contracted a Shanghan (Cold Damage) syndrome that persisted for over ten days. His tongue coating was thick, yellow, and dry; his chest felt hot and thirsty, with occasional irritability. When not irritable, he was drowsy and seemed asleep; when called, his eyes opened slightly, revealing extreme mental exhaustion. His pulse was fine and rapid, and powerless upon deep pressure. A cooling and moistening agent was prescribed. Due to the deficient pulse, Yetaishen (Wild Ginseng) was added as an assistant herb. Suddenly, he experienced loose stools (Huaxie), defecating several times a day. I reasoned that since even slight use of clearing-fire herbs caused loose stools, his Lower Jiao (Lower Burner) Qi transformation must be insecure. It is better to first secure the Lower Jiao (Lower Burner) with medication before clearing the Upper and Middle Jiao (Upper and Middle Burners). Thus, Shudihuang (Prepared Rehmannia Root) two liang and one sour pomegranate, crushed with peel, were decocted together in a large bowl of soup. Taken warm in three doses, the loose stools stopped. On alternate days, this formula was administered again, but with Shanyao (Dioscorea Rhizome) increased to one liang, and Shengdihuang (Raw Rehmannia Root) replacing Zhimu (Anemarrhena Rhizome). The decoction was taken warm slowly, one large sip at a time. After eight hours, one dose was completed, and the illness improved by half. The next day, the original formula was decocted and taken as directed, improving the condition by another half. On the third day, taking the full dose resulted in complete recovery.

Note: Shudihuang (Prepared Rehmannia Root) is not originally a herb for treating cold-warm diseases, but in critical conditions, it may be used to address immediate emergencies. Therefore, Zhang Zhongjing used Gancao Tang (Licorice Decoction) containing Dihuang (Rehmannia Root, i.e., Raw Rehmannia Root today) for Jiedai Mai (Knotted and Intermittent Pulse), which is also a dangerous pulse pattern. If sour pomegranate is unavailable, Longgu (Fossilized Mammal Bones, crushed) and Muli (Oyster Shell, crushed) five qian each can be substituted.

Yet another elderly man, over sixty years old. He habitually smoked opium and was frail and ill. In early winter, he caught wind-cold, presenting with a weak and floating pulse. I treated him with a few qian of Huangqi (Astragalus Root) combined with exterior-releasing herbs, and he recovered after sweating. Two days later, due to urgent business, he went out in the cold. After sweating, he caught cold again, worse than before. Bedridden in an inn, unable to return home, local doctors were consulted. At that time, he had fever and thirst, indicating the disease was in the Yangming fu-organs. Because his pulse was weak, the doctor switched to warming and tonifying herbs, worsening the condition. Another doctor diagnosed floating heat above and excess cold below, prescribing Fuzi (Aconite Lateralis Radix Preparata), Wuzhuyu (Evodia Fruit), and Huanglian (Coptidis Rhizoma). After taking it, his gums swelled completely and were very painful; he felt frequent irritability and drank water constantly without relief. Desperately, they summoned me. Upon examination, his pulse was fine and rapid, feeling slightly solid upon deep pressure. I prescribed this decoction plus Xuanshen (Scrophulariae Radix) six qian to dissipate the floating heat. After one dose, toothache resolved, and irritability and thirst lessened. The next day, using the original formula minus Xuanshen (Scrophulariae Radix), three raw chicken egg yolks were mixed into the decoction and taken warm in three doses. Bowel movement occurred, and he recovered.

A twenty-year-old man, constitutionally weak. He occasionally felt discomfort in the Qi level. Doctors used Sanleng (Sparganii Rhizoma) and Yanhusuo (Corydalis Rhizoma) to break stagnation. He felt shortness of breath and stopped taking the medicine. Two days later, he suddenly developed wheezing and rebellious Qi, muscle twitching, and mental confusion. His pulse was rapid, reaching six beats per respiration, trembling on superficial palpation, and seemingly absent on deep pressure. His skin was very hot, with hot sweat appearing frequently on the upper body. He complained that heat forced his heart, causing severe palpitations. His tongue had a thin white coating, yellowish in the center. Observing the sudden onset, his exposure to external pathogens had actually begun earlier when he felt Qi discomfort, though he was unaware then. Due to severe palpitations preventing him from fetching medicine, I urgently used four raw chicken egg yolks mixed with warm boiled water. The bowl was placed in a basin of hot water to keep it warm before administration. Wheezing stopped, and palpitations improved. Subsequently, this decoction was administered, decocted into a large bowl, with three raw chicken egg yolks mixed in, taken warm slowly. From 10 PM to 7 AM, one dose was consumed, and the illness vanished. Because previous medications damaged his Qi, he was given Xuanshen (Scrophulariae Radix) one liang and Luoshen (Codonopsis Radix) five qian for several doses to consolidate recovery.

A seventeen-year-old boy. In early summer, he contracted a Warm Disease. Within eight to nine days, he suffered from rapid breathing, frequent coughing and expectoration mixed with blood. Coughing caused pain radiating to the chest and hypochondrium, with mild oppression in the Upper Jiao (Upper Burner). His pulse indicated definite excess heat, rapid to seven beats per respiration, and rootless/trembling. Given his inherent weakness, mental labor from studying, and severe external contraction, the pulse was dangerously indicative. Due to chest/hypochondriac pain and hemoptysis, I reduced the Ginseng dosage by half and added Zhuru (Bambusae Caulis in Taeniam) and Sanqi (Notoginseng Radix et Rhizoma, crushed and taken with decoction) two qian each. Sanqi (Notoginseng Radix et Rhizoma) was chosen not only for hemoptysis but also for chest/hypochondriac pain. After one dose, bleeding ceased, and other symptoms improved. After a second dose, full recovery was achieved.

An eleven-year-old farm boy. During the busy wheat harvest, even children worked in the fields. Unable to withstand heavy labor, he contracted a Warm Disease. He exhibited restless limbs, inability to lie still, continuous delirium speaking only of labor tasks, and sleeplessness day and night. His pulse was solid but not surging and slippery. I intended to prescribe this decoction but worried that for a child's Shaoyang constitution with raging external pathogens, Ginseng might be inappropriate. Thus, I used Raw Gypsum one and a half liang and Chantui (Cicadae Periostracum) one qian. After decoction and administration, symptoms persisted. Upon return inquiry, he complained of difficulty swallowing medicine, having vomited half of the previous dose. I advised using Raw Gypsum two liang alone, decocted into clear liquid, taken warm slowly to prevent vomiting. Following this, the illness did not resolve. Re-examination showed faint pulse and subsided fever, but delirium worsened, mental state was lethargic, and he was unconscious. Urgently, Wild Ginseng one and a half liang and Raw Gypsum two liang were decocted into a large bowl and taken warm in multiple doses. Fever and pulse returned, eyes closed, limbs calmed, but delirium continued. To the remaining dregs, Raw Gypsum and Maidong (Ophiopogonis Radix) one liang each were added, decocted into two bowls, and taken warm in two doses. One black stool was passed, and the illness resolved.

Note: Had Ginseng been used earlier, the condition would hardly have been salvageable. Fortunately, awareness returned, allowing efforts to reverse it, though it was critical before stabilizing. I hope practitioners using Baihu Tang (White Tiger Decoction) will always consider adding Ginseng. Additionally, comparing this case with the previous one, indications for adding Ginseng to Baihu Tang (White Tiger Decoction) do not strictly require a deficient pulse. Whenever it is known that the patient has overworked mentally or physically, is elderly, has chronic diseases, or heat has entered the Yangming fu-organs, presenting with a solid pulse lacking surging/slippery qualities, or a pulse showing excess heat with extreme frequency, Ginseng should be酌情 (discretionarily) added.

For cold-warm diseases with deficiency in both interior and exterior, profuse sweating, and residual excess heat in the Yangming Stomach fu-organ, Longgu (Fossilized Mammal Bones) and Muli (Oyster Shell) should be added to this decoction. A sixteen-year-old boy contracted Shanghan (Cold Damage) in late winter. Excessive use of exterior-releasing drugs by a doctor caused constant sweating throughout the body. Despite this, significant interior/exterior heat remained, accompanied by palpitations and mental confusion. The pulse was surging and rapid, powerless on deep pressure. This decoction plus Longgu (Fossilized Mammal Bones) and Muli (Oyster Shell) (both uncalcined) one liang each was decocted into a large bowl and taken warm in multiple doses. Recovery occurred after one dose.

Zhang Zhongjing’s use of Zhi Gancao Tang (Honey-Fried Licorice Decoction) for Shanghan (Cold Damage) with Jiedai Mai (Knotted and Intermittent Pulse) is indeed excellent. In my treatment of cold-warm diseases, if external heat is not intense and such pulses appear, I follow Zhang Zhongjing’s method. However, if the pulse is knotted/intermittent but external fire is substantial, I use Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang (White Tiger Decoction Plus Ginseng with Dioscorea Rhizome Replacing Rice). I once treated an elderly man, over sixty, with Shanghan (Cold Damage) in early winter. After five to six days, I examined him. His pulse was surging and slippery, seemingly forceful on pressure. Both exterior and interior felt hot, with occasional groaning and mild wheezing. Baihu Tang (White Tiger Decoction) was prescribed; after one dose, high fever decreased slightly. Re-examination revealed pauses every seven to eight beats or ten to twelve beats in both hands, powerless on deep pressure. Eight qian of Ginseng were added to the original formula, following the principle of using Dihuang (Rehmannia Root) in Zhi Gancao Tang (Honey-Fried Licorice Decoction), substituting Shengdihuang (Raw Rehmannia Root) for Zhimu (Anemarrhena Rhizoma). Decocted into two bowls and taken warm in two doses, the pulse normalized and became stronger, but fever persisted. Raw Gypsum dosage was doubled from two liang to four liang, decocted into a large bowl, and taken warm slowly. Recovery followed completion of the dose.

Note: Initially, I was accustomed to using Baihu Tang (White Tiger Decoction) but not Baihu Jia Renshen Tang (White Tiger Decoction Plus Ginseng). Thereafter, for anyone over sixty, even with surging-solid pulses, I invariably add two to three qian of Ginseng to Baihu Tang (White Tiger Decoction).

Although Knotted (Jie) and Intermittent (Dai) pulses are discussed together, Knotted pulses are milder than Intermittent ones, so some Knotted pulses benefit from unblocking. I treated an elderly man, over sixty, with hematochezia. After thirty-plus days of treatment, the condition worsened. Defecating bloody stools with clots over ten times daily, he was mentally confused. Examination revealed an exceptionally surging-solid pulse, normal frequency, but stops in the right position without fixed intervals, identifying it as a Knotted pulse. Pure black tongue coating indicated severe Warm Disease excess syndrome. Previous doctors treated only the bleeding, ignoring the Warm Disease. I prescribed Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang (White Tiger Decoction Plus Ginseng with Dioscorea Rhizome Replacing Rice), increasing Gypsum to four liang, decocted into three bowls, taken warm in three doses. Each dose was accompanied by one qian of fine powder of Han Sanqi (Wild Notoginseng). Taking one dose daily, bleeding stopped in two days, but loose stools persisted. Surging-solid pulse halved, but Knotted pulse worsened, accompanied by abdominal distension. Inquiry revealed onset after anger. I switched to Laifuzi (Radish Seed) six qian assisted by Baishao (Paeoniae Radix Alba), Huashi (Talcum), Huafen (Trichosanthis Radix), Maogen (Imperatae Rhizoma), and Gancao (Licorice Root). Distension resolved after one dose. Pulse frequency normalized, slight surging-solid quality remained, and loose stools decreased. Zi Yin Qing Zao Tang (Nourish Yin Clear Dryness Decoction) stopped diarrhea and normalized the pulse.

Dry tongue is most taboo in cold-warm diseases. Thin-dry or dry-contracted tongue coatings are particularly dangerous. Causes vary: True Yin deficiency, Qi deficiency failing to ascend moisture, or Qi sinking. All can be treated with Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang (White Tiger Decoction Plus Ginseng with Dioscorea Rhizome Replacing Rice). Ginseng strongly tonifies Qi; robust ascending Yuanqi (Original Qi) prevents sinking. Combined with Gypsum, it treats True Yin deficiency in external contractions, aided by Shanyao (Dioscorea Rhizome) and Zhimu (Anemarrhena Rhizome) for moistening. For deficient-rapid pulses, increase Ginseng, reduce Gypsum by one liang, add Xuanshen (Scrophulariae Radix) and Shengdihuang (Raw Rehmannia Root) for Yin nourishment. Decoct into three or four tea bowls, take warm slowly, one large sip at a time, to prevent cold-induced loose stools. Ensure medicinal power ascends continuously to help Yuanqi (Original Qi) generate fluids. Finish one dose, decoct another, ensuring day-night continuity. Over several days, tongue moistens, fire retreats, and illness resolves. A man in his twenties, chronically overworked, felt Qi sinking. Cured three times within a year. Late autumn, he caught seasonal Qi, suffering chest烦热 (vexing heat) and fullness, dry-thirst with drinking, persistent loose stools, and mild wheezing. Tongue lacked coating, was bright red with grainy texture. Doctors used half-tonic half-breaking herbs to stop loose stools and relieve fullness. Two doses failed to stop diarrhea. My examination showed apparent excess heat but powerless deep pressure. First, I used my modified Tianshui San (Heavenly Water Powder) to stop diarrhea: Shanyao (Dioscorea Rhizome) one and a half liang, Huashi (Talcum) one liang. One dose stopped diarrhea. Subsequent Yin-nourishing and fire-clearing herbs resolved wheezing and reduced heat. However, tongue remained dry extending to throat, nearly speechless, frequent drinking provided no relief, chest fullness persisted. I realized this was seasonal Qi invasion reactivating old illness; thus, despite hot pulse, deep pressure was not solid. Tongue dryness resulted from Qi sinking failing to ascend fluids. Chest fullness was due to Qi sinking causing shortness of breath, misinterpreted by the patient as fullness. Constipation lasted five days. Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang (White Tiger Decoction Plus Ginseng with Dioscorea Rhizome Replacing Rice) cured seventy to eighty percent after one dose, reducing tongue dryness by half. A second dose restored bowel movement and near-complete recovery. Lingering tongue dryness was treated with Luoshen (Codonopsis Radix) one liang and Xuanshen (Scrophulariae Radix) one and a half liang daily. After three days, tongue moisture returned.

A thirteen-year-old boy contracted Shanghan (Cold Damage) in early winter. After seven to eight days, he exhibited panting, nasal flaring, mental confusion, and delirium discussing labor. Pulse was fine, weak, and rapid, powerless on pressure. Tongue was dry, shrunken, unable to extend; black spots appeared on tongue surface, resembling coating but not quite. Frequent cold water intake yielded no relief. I diagnosed Qi sinking of the Great Qi in the chest due to overwork, preventing fluid ascent and trapping fire, causing pulse obstruction. Otherwise, why would excessive cold water intake not cause loose stools? Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang (White Tiger Decoction Plus Ginseng with Dioscorea Rhizome Replacing Rice) was prescribed, decocted into a large bowl, taken warm slowly. Two doses within twenty-four hours resolved the illness.

Note: For deficient-rapid pulse and dry tongue, even with multi-day constipation, purgatives are contraindicated, even if tongue coating is yellow-black. Only the aforementioned method allows gradual bowel movement, which is safe. If fire remains intense and tongue dry after bowel movement, Luoshen (Codonopsis Radix) one liang and Xuanshen (Scrophulariae Radix) two liang decocted and taken slowly moistens the tongue and reduces fire. If improper medication causes loose stools post-bowel movement with rising deficiency fire and dry tongue, use my Zi Yin Gu Xia Tang (Nourish Yin Secure Lower Decoction) minus Huashi (Talcum), adding Shachen (Aucklandiae Radix). If prolonged external fire clears but tongue dryness, confusion, or sighing persists due to Qi sinking from medication, single Ginseng decoction (one liang) or with minor Chaihu (Bupleuri Radix) restores Great Qi (see Case under Sheng Xi Tang). Minor residual heat can be assisted with Xuanshen (Scrophulariae Radix).

When cold-warm diseases persist after purgation, doctors often despair. However, Shanghan Lun (Treatise on Cold Damage) provides a solution: Baihu Jia Renshen Tang (White Tiger Decoction Plus Ginseng). Article 168 states: "Shanghan disease, after vomiting or purging, unresolved after seven to eight days, heat結 (knots) internally, exterior and interior both hot, occasional aversion to wind, great thirst, dry tongue with vexation, desiring to drink several liters of water, is treated with Baihu Jia Renshen Tang (White Tiger Decoction Plus Ginseng)." Although I rarely encounter unresolved cases post-purgation in my experience (discussed under Xianlu Tang), patients referred after other doctors' purgations often present with unpassed stools and non-deficient pulses days later. In such cases, I follow the original Shanghan Lun (Treatise on Cold Damage) formula. If immediately post-purgation or with additional deficiency signs, I replace Jingmi (Rice) with Shanyao (Dioscorea Rhizome) or Zhimu (Anemarrhena Rhizome) with Shengdihuang (Raw Rehmannia Root), achieving prompt results. Post-purgation, bowels are unstable; sudden cold herbs risk loose stools. Shanyao (Dioscorea Rhizome) is astringent, Shengdihuang (Raw Rehmannia Root) is sticky-moistening; replacing Jingmi (Rice)/Zhimu (Anemarrhena Rhizome) secures the lower burner, especially suitable for deficient pulses. Both herbs nourish True Yin; post-purgation persistence often indicates inherent Yin deficiency. Sufficient Yin overcomes residual external heat.

After ten-plus days of cold-warm diseases, high fever may subside, revealing various critical signs. Some cases require single Ginseng treatment, not necessarily adding Ginseng to Baihu Tang (White Tiger Decoction). Wang Yutai stated: "I treat Shanghan/Warm diseases complicated by quacks' erroneous sweating/purging, critical and imminent death, using two liang of Ginseng decocted with urine from young boys, cooled in ice water, providing immediate effect." Zhang Zhihe treated a critical Shanghan complication with cold limbs and impending death using one liang Ginseng and one qian Fuzi (Aconite Lateralis Radix Preparata) decocted in stone pot, cooled in fresh water. One dose consumed, sweating ensued, moisture dripped from nose tip. Nose corresponds to Spleen; moisture here indicates salvageability due to Earth element pervading the body.

Additionally, I treated a Warm Disease case past twenty days, whole body cold, faint breath. Diagnosed Great Qi sinking from mis-treatment. Used one liang Ginseng and two qian Chaihu (Bupleuri Radix) decoction. Two doses achieved full recovery (see detailed case under Sheng Xi Tang).

Baihu Tang (White Tiger Decoction) plus Ginseng, with Shanyao (Dioscorea Rhizome) replacing Jingmi (Rice), supplements Qi to expel pathogens, generates fluids, stops thirst, nourishes Yin, and reduces fever. It is indeed a perfect formula. Occasionally, severe True Yin deficiency requires heavy Yin-nourishing herbs alongside. An elderly woman, over seventy, contracted Warm Disease in early summer. After five to six days, fever, dry-thirst, mental confusion, tongue lacking coating but with black patches, dry and shrunken. Pulse fine-rapid, powerless on pressure. High age and presentation suggested incurability. Yet, in my practice, even seemingly incurable cases demand diligent study and treatment attempts.