于白虎汤方内加人参三两，余根据白虎汤方
@@@
伤寒脉浮滑，此以表有热，里有寒，白虎汤主之。
【按】
王三阳云：经文「寒」字，当邪字解，亦热也，其说甚是。若是「寒」字，非白虎汤
证矣。
【注】
此言伤寒太阳证罢，邪传阳明，表里俱热，而未成胃实之病也。脉浮滑者：浮为表有
热之脉，阳明表有热，当发热汗出；滑为里有热之脉，阳明里有热，当烦渴引饮，故
曰：表有热里有热也。此为阳明表里俱热之证，白虎乃解阳明表里俱热之药，故主之
也。不加人参者，以其未经汗、吐、下，不虚故也。
【集注】
程知曰：滑则里热，云浮滑则表里俱热矣。大热之气，得辛凉而解，犹之暑暍之令，
得金风而爽，故清凉之剂，以白虎名之。又曰：厥阴条中有伤寒，脉滑而厥者，里有
热也，白虎汤主之，可证此条之非里有寒矣。
魏荔彤曰：此里尚为经络之里，非藏府之里，亦如卫为表，荣为里，非指藏府而言也
。
知母六两 石膏（碎）一筋 甘草（炙）二两 粳米六合
右四味，以水一斗，煮米熟汤成去滓，温服一升，日三服。
【集解】
柯琴曰：阳明邪从热化，故不恶寒而恶热，热蒸外越，故热汗出，热烁胃中，故渴欲
饮水，邪盛而实，故脉滑，然犹在经，故兼浮也。盖阳明属胃，外主肌肉，虽内外大
热而未实，终非苦寒之味所宜也。石膏辛寒，辛能解肌热，寒能胜胃火，寒能沉内，
辛能走外，此味两擅内外之能，故以为君；知母苦润，苦以泻火，润以滋燥，故用为
臣；甘草、粳米调和于中宫，且能土中泻火，稼穑作甘，寒剂得之缓其寒，苦剂得之
平其苦，使二味为佐，庶大寒大苦之品，无伤损脾胃之虑也。煮汤入胃，输脾归肺，
水精四布，大烦大渴可除矣。白虎为西方金神，取以名汤，秋金得令，而炎暑自解。
方中有更加人参者，亦补中益气而生津也。用以协和甘草粳米之补，承制石膏知母之
寒，泻火而土不伤，乃操万全之术者也。
@@@
病人烦热，汗出则解，又如疟状，日晡所发热者，属阳明也。脉实者，宜下之；脉浮
虚者，宜发汗。下之与大承气汤，发汗宜桂枝汤。
【注】
病人，谓病太阳经中风、伤寒之人也。太阳病烦热，汗出则应解矣。今又寒热如疟状
，每至日晡所即发潮热，日晡者，乃申酉阳明王时，故曰：属阳明也。证虽如此，当
审其果尽归阳明耶？抑或尚兼太阳也？故又当以脉辨之：若脉实者，邪已入里，则汗
出潮热，为阳明下证，宜与大承气汤下之；若脉浮虚者，邪尚在表，则寒热如疟，仍
属太阳当汗之证也，宜与桂枝汤汗之。
【集注】
程知曰：病人得汗后，烦热解，太阳之邪，将尽未尽，其人复如疟状，日晡时发热，
则邪入阳明审矣。然虽已入阳明，尚恐未离太阳，故必重辨其脉，脉实者可下；若脉
浮虚者，仍是阳明兼太阳，便宜汗而不宜下也。
@@@
太阳病，若吐、若下、若发汗后，微烦小便数，大便因□者，与小承气汤和之愈。
【注】
太阳病，若吐、若下、若发汗后不解，入里微烦者，乃栀子豉汤证也。今小便数，大
便因□，是津液下夺也，当与小承气汤和之，以其结热未甚，入里未深也。
【集注】
喻昌曰：微烦小便数，大便因□，皆是邪渐入里之机，故用小承气汤和之。
程应旄曰：吐、下、汗后而见烦证，征之于大便□，固非虚烦者比。然烦既微而小便
数，当由胃家失润，燥气客之使然，胃虽实非大实也。以小承气汤取其和也，非大攻
也。
Add three liang of Ren Shen (Ginseng Radix et Rhizoma) to the Bai Hu Tang (White Tiger Decoction) formula; for the rest, follow the Bai Hu Tang (White Tiger Decoction) formula.
@@@
In Shang Han (Cold Damage), a floating and slippery pulse indicates that there is heat on the exterior and cold on the interior; Bai Hu Tang (White Tiger Decoction) should be used as the primary treatment.
[Commentary]
Wang Sanyang stated: The character "cold" in the classic text should be interpreted as "pathogenic factor," which also implies heat; this explanation is very correct. If it were truly "cold," it would not be an indication for Bai Hu Tang (White Tiger Decoction).
[Annotation]
This passage refers to the situation where the Tai Yang (Greater Yang) syndrome of Shang Han (Cold Damage) has ceased, and the pathogen has transmitted to the Yang Ming (Yang Brightness) channel. There is heat in both the interior and exterior, but gastric excess has not yet formed. A floating and slippery pulse: Floating indicates heat on the exterior; when Yang Ming has heat on the exterior, fever and sweating should occur. Slippery indicates heat on the interior; when Yang Ming has heat on the interior, mental irritability and thirst with desire to drink should occur. Therefore, it is said: heat on the exterior and heat on the interior. This is a syndrome of heat in both the interior and exterior of Yang Ming. Bai Hu Tang (White Tiger Decoction) is the medicine that resolves heat in both the interior and exterior of Yang Ming, hence it is indicated. Ginseng is not added because the patient has not undergone sweating, vomiting, or purging treatments, so there is no deficiency.
[Collected Notes]
Cheng Zhi said: Slippy indicates heat on the interior; floating and slippery together indicate heat in both the interior and exterior. Great heat is resolved by acrid-cool herbs, just as summer heat is relieved by cool winds; therefore, cooling agents are named "Bai Hu" (White Tiger). He further stated: In the Jue Yin (Terminal Yin) chapter, it mentions Shang Han (Cold Damage) with a slippery pulse and cold extremities, indicating heat on the interior, treated with Bai Hu Tang (White Tiger Decoction); this proves that this clause does not refer to cold on the interior.
Wei Litong said: Here, "interior" still refers to the interior of the channels and collaterals, not the interior of the zang-fu organs. Similarly, Wei Qi (Defensive Qi) is exterior, and Ying Qi (Nutritive Qi) is interior; this does not refer to the zang-fu organs.
Zhi Mu (Anemarrhenae Rhizoma) six liang, Shi Gao (Gypsum Fibrosum) (crushed) one jin, Gan Cao (Glycyrrhizae Radix et Rhizoma) (honey-fried) two liang, Jing Mi (Oryza Sativa) six he.
These four ingredients are boiled in ten dou of water until the rice is cooked and the decoction is ready. Strain the dregs, and take one sheng warm, three times a day.
[Collected Explanations]
Ke Qin said: Pathogens in the Yang Ming channel transform into heat, so there is aversion to cold replaced by aversion to heat. Heat steams outward, causing sweaty heat; heat scorches the stomach, causing thirst and desire to drink. When pathogens are abundant and excess, the pulse is slippery; however, since it is still in the channels, it also presents with floating. Generally, Yang Ming belongs to the Stomach and externally governs the muscles. Although there is great heat internally and externally without fullness/excess, bitter-cold flavors are ultimately not suitable. Shi Gao (Gypsum Fibrosum) is acrid and cold; acrid can resolve muscle heat, and cold can overcome stomach fire. Cold sinks inward, while acrid moves outward; this herb excels in both internal and external functions, thus serving as the Sovereign herb. Zhi Mu (Anemarrhenae Rhizoma) is bitter and moist; bitter clears fire, and moistens dryness, thus serving as the Minister herb. Gan Cao (Glycyrrhizae Radix et Rhizoma) and Jing Mi (Oryza Sativa) harmonize in the Middle Jiao (Middle Burner) and can drain fire from the Earth element. Sweetness arises from sowing and reaping; cold agents become milder with them, and bitter agents become balanced with them. Using these two as Assistant and Guide herbs ensures that potent cold and bitter substances do not damage the Spleen and Stomach. The decoction enters the Stomach, distributes to the Spleen and Lungs, spreads fluid essence throughout, and resolves great irritability and thirst. Bai Hu (White Tiger) is the Metal Spirit of the West; naming the decoction after it implies that when Autumn Metal is in command, summer heat naturally resolves. If Ren Shen (Ginseng Radix et Rhizoma) is added to the formula, it is to tonify the Middle and boost Qi to generate fluids. This harmonizes the tonifying effects of Gan Cao (Glycyrrhizae Radix et Rhizoma) and Jing Mi (Oryza Sativa), counteracts the cold nature of Shi Gao (Gypsum Fibrosum) and Zhi Mu (Anemarrhenae Rhizoma), drains fire without damaging Earth, and represents a foolproof method.
@@@
The patient feels irritable and hot; symptoms relieve after sweating. However, if it resembles malaria with tidal fever occurring around dusk (Shen and You hours), it belongs to Yang Ming. If the pulse is solid, purgation is appropriate; if the pulse is floating and deficient, diaphoresis is appropriate. For purgation, use Da Cheng Qi Tang (Major Order the Qi Decoction); for diaphoresis, use Gui Zhi Tang (Cinnamon Twig Decoction).
[Annotation]
"The patient" refers to someone suffering from Wind Strike or Cold Damage of the Tai Yang channel. Irritability and heat from Tai Yang syndrome should resolve after sweating. Now, if there is alternating cold and heat resembling malaria, with tidal fever occurring every evening during the Shen and You hours (which are the prosperous times of the Yang Ming channel), it is said to belong to Yang Ming. Although the syndrome appears thus, one must examine whether it has completely entered Yang Ming or still involves Tai Yang. Therefore, differentiation by pulse is necessary: If the pulse is solid, the pathogen has entered the interior; sweating and tidal fever constitute a Yang Ming purgative syndrome, and Da Cheng Qi Tang (Major Order the Qi Decoction) should be given to purge. If the pulse is floating and deficient, the pathogen remains on the exterior; alternating cold and heat resembling malaria still belong to the Tai Yang syndrome requiring diaphoresis, and Gui Zhi Tang (Cinnamon Twig Decoction) should be given to induce sweating.
[Collected Notes]
Cheng Zhi said: After the patient sweats, irritability and heat resolve. The pathogen of Tai Yang is nearly exhausted but not entirely gone. If the person again resembles malaria with fever at dusk, the pathogen entering Yang Ming is certain. However, although it has entered Yang Ming, one must fear it has not left Tai Yang; thus, the pulse must be re-examined. A solid pulse allows for purgation; a floating and deficient pulse indicates Yang Ming combined with Tai Yang, making diaphoresis appropriate and purgation inappropriate.
@@@
In Tai Yang syndrome, if after vomiting, purging, or inducing sweating, slight irritability, frequent urination, and consequently constipation occur, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) should be given to harmonize, leading to recovery.
[Annotation]
In Tai Yang syndrome, if after vomiting, purging, or inducing sweating the disease does not resolve and slight irritability due to pathogen entering the interior occurs, this is an indication for Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). Now, with frequent urination and consequently constipation, this represents the depletion of body fluids downward. Xiao Cheng Qi Tang (Minor Order the Qi Decoction) should be given to harmonize, because the accumulated heat is not severe, and the pathogen has not penetrated deeply into the interior.
[Collected Notes]
Yu Chang said: Slight irritability, frequent urination, and consequently constipation are all signs of the pathogen gradually entering the interior; therefore, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is used to harmonize.
Cheng Yingmao said: Irritability appearing after vomiting, purging, and sweating, combined with constipation, is certainly different from empty irritability. However, since the irritability is slight and urination is frequent, it is likely caused by the Stomach losing moisture and dryness invading. The Stomach is excess but not severely excess. Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is chosen for its harmonizing action, not for strong purgation.