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Liaoning patient Ma XX, aged fifty-one, suffered from Taiyang disease (Taiyang disorder) complicated with latent heat syndrome.

Etiology: Due to financial losses in business and a sudden deterioration of family finances, he was filled with remorse, which generated internal heat. In early winter, he contracted wind-pathogen, resulting in cough with phlegm, slight wheezing, difficult urination, and generalized edema. I cured him of this condition. More than ten days later, he contracted an external pathogen again, leading to the current syndrome.

Clinical Manifestations: Severe heat in both exterior and interior, restlessness and irritability, distending pain in the head, bowel movements once every few days with extreme dryness, white and thick tongue coating with a slightly yellow center, and extremely surging and solid pulse on both left and right wrists. This is a manifestation of Yangming Fu-organ excess syndrome. Typically, the pulse for Yangming Fu-organ excess appears predominantly on the right side. The fact that the pulse here is surging and solid on both sides is due to his frequent remorse causing accumulation of internal heat in the Heart and Liver. The distending pain in the head is caused by the heat of the Heart and Liver combining with Yangming heat to attack upwards. Treatment should employ a large dose of cold-natured herbs with mild exterior-dispersing properties to clear the heat of the Yangming Stomach-Fu organ, while simultaneously clearing the heat of the Heart and Liver.

Prescription: Shigao (Calcitrum, Raw Gypsum) [4 liang, crushed fine], Zhi Mu (Anemarrhenae Rhizoma, Zhi Mu) [1 liang], Gancao (Glycyrrhizae Radix et Rhizoma, Licorice Root) [4 qian], Jingmi (Oryza Sativa, Rice) [6 qian], Qing Lianqiao (Forsythiae Fructum, Forsythia Fruit) [3 qian].
Decoct together until the rice is cooked, obtain three portions of the decoction, and take warm orally in three divided doses. Discontinue medication upon recovery; do not necessarily finish the entire prescription.

Formula Analysis: This formula is Baihu Tang (White Tiger Decoction) plus Lianqiao. Baihu Tang is the principal formula for treating Yangming Fu-heat in Taiyang disease. Lianqiao is added because its green color enters the Liver meridian and its light aroma enters the Heart meridian, thereby guiding the efficacy of Baihu Tang to the Heart and Liver to clear heat.

Outcome: After completing three doses, the fever subsided slightly. However, the next day the condition reverted to its original state. Five consecutive doses were administered, increasing the dosage of Shigao to 8 liang, but the condition remained unchanged, and there was no loose stool. The family feared the case was incurable. I reassured them, stating: "Shigao is originally a mild herb, but it is more potent when taken as a fine powder. Please allow me to prescribe as I see fit without obstruction; this time will surely bring a cure." A new prescription was issued with Shigao still at 8 liang. After administering the decoction, an additional 2 liang of raw Shigao fine powder was prescribed to be chewed slowly with slices of pear. Upon consuming one and a half liang, the fever completely disappeared, and administration was stopped. The patient recovered thereafter without recurrence.

Postscript: This case was published in "Compilation of Verified Cases by Famous Doctors Nationwide." He Lianchen commented on this case: "A Japanese physician stated: 'If Shigao is not used in large doses, it is ineffective. Therefore, the dosages in Baihu Tang, Zhuye Shigao Tang, and other formulas containing Shigao exceed standard amounts. Uninformed physicians use small doses, akin to using a cup of water to extinguish a cartload of burning firewood; hence, they are ineffective.' Among Chinese physicians skilled in using Shigao, besides Zhang Zhongjing of Changsha in the Han Dynasty, there was Miao Zhongchun (Miao Xiyong) in the Ming Dynasty, and Gu Songyuan (Gu Song), Yu Shiyu, and Wang Mengying in the Qing Dynasty. All were famous for treating warm diseases and invariably used heavy doses of Shigao to treat Yangming excess-heat syndromes successfully. Increasing Shigao from 4 liang to 8 liang seems shocking, yet after five or six doses, the fever persisted despite normal bowel movements. Only after adding Shigao fine powder dipped in pear slices did the fever fully subside and the patient recover. This demonstrates that Shigao is a pure and excellent cooling herb. Those who fear Shigao as if it were a tiger can use it boldly without doubt."