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(Zhang Zhongjing) Treats Shanghan (Cold Damage) with a floating and slippery pulse, heat in the exterior and cold in the interior (A floating pulse indicates disease in the exterior, a slippery pulse indicates disease in the interior. "Cold in the interior" here refers to Shanghan, which is the root cause of generating internal heat); as well as San Yang He Bing (Combined Disease of the Three Yang), with a floating and large pulse, abdominal fullness, body heaviness, difficulty in turning over, numbness of the mouth and face with greasy complexion, delirium and urinary incontinence. If sweating is induced, delirium worsens; if purgation is used, Qi sinks leading to urinary incontinence); it generally treats Yangming Bing (Yangming Disease) with a surging and long pulse, aversion to cold absent but aversion to heat present, headache, spontaneous sweating, thirst, thick tongue coating, eye pain, nasal dryness, inability to sleep, mental restlessness and irritability, tidal fever around Shen hour (3-5 PM); or Yang Du Fa Ban (Yang Toxin causing macules), and various diseases caused by Stomach Heat (Evil heat is flourishing, hence the surging pulse; heat is in the exterior and shallow, Zheng Qi struggles with evil, hence aversion to cold; heat enters the interior and is deep, evil is strong and fearless, hence no aversion to cold but aversion to heat; Feng Zhong (Wind Strike) has sweating, Shanghan has no sweating; upon transmission to Yangming, there is sweating, called Re Yue (Heat venting out), hence Yangming Bing usually involves much sweating; internal heat causes thirst; Yangming governs muscles, hence muscle heat; meridians intersect at the forehead, hence eye pain; meridians flank the nose, Lung Metal dryness causes nasal dryness; Stomach Qi disharmony causes restless sleep. Human Yang Qi travels through the Yang aspects 25 times during the day, starting from Shaoyang (Lesser Yang) at dawn. Shigao (Gypsum Fibrosum, 1 jin), Zhi Mu (Anemarrhenae Rhizoma, 6 liang), Gancao (Licorice Root, 2 liang), Jingmi (Oryza Sativa, 6 he). Boil Shigao for dozens of boils until the taste is faint and difficult to extract, then add other herbs. This is a formula for the Foot-Yangming and Hand-Taiyin meridians. When heat invades internally, bitter drugs are used to disperse it, so Zhi Mu (Anemarrhenae Rhizoma), bitter and cold, is used as the Sovereign drug; heat injures Qi, so sweet and cold drugs are needed as assistants, hence Shigao (Gypsum Fibrosum) is used as the Minister drug (Shigao and Huashi (Pyrrhosiae Folium) are both sweet and cold; any drug with a sweet taste contains tonification within purgation); fluids are scorched internally, so Gancao (Licorice Root) and Jingmi (Oryza Sativa) with their sweet and neutral nature are used as Guides to tonify Qi and moderate urgency, preventing stomach injury. Furthermore, Fan (Vexation) originates from the Lung, Zao (Restlessness) from the Kidney. Shigao clears the Lung and drains Stomach Fire; Zhi Mu clears the Lung and drains Kidney Fire; Gancao harmonizes the middle and drains Heart and Spleen Fire, either draining its child organ (Lung) or its mother organ (Heart), not specifically treating only Yangming Qi-level heat (Shigao and Gancao can clear the interior and release the exterior, but must be used only for excess heat. If there is blood deficiency causing body heat, Spleen deficiency causing fever, or Yin excess repelling Yang causing red face and restlessness resembling Baihu Tang syndrome, misusing this drug is incurable. Note: Baihu Tang syndrome presents with a surging and forceful pulse, while similar conditions present with a large but deficient pulse, which serves as the differentiation. Also note: Yin excess repelling Yang and Yang excess repelling Yin are extremely difficult to differentiate. When Yin is extremely excessive, it repels Yang to the exterior, presenting as external heat and internal cold; when Yang is extremely excessive, it repels Yin to the exterior, presenting as external cold and internal heat. This is what the Classics refer to as "Extreme Yin becomes Yang, extreme Yang becomes Yin; extreme cold becomes heat, extreme heat becomes cold." Differentiate by urine: clear urine indicates internal cold despite external dryness/heat; dark urine indicates internal heat despite external cold limbs. Observe oral moisture and tongue coating depth: the tongue is the sprout of the Heart, corresponding to Southern Fire. Evil in the exterior does not produce coating; evil entering the interior condenses fluids to produce coating. A slippery white coating indicates heat in the Dantian and cold in the chest, with evil in the half-exterior/half-interior. As heat penetrates deeper, it becomes dry and rough; heat gathering in the Stomach produces yellow coating, suitable for Chengqi Tang and Baihu Tang. If heat disease causes black tongue and dry mouth, it is Kidney Water punishing Heart Fire, indicating deeper heat and critical illness. However, black coating can also belong to cold patterns, characterized by no thorns on the tongue and saliva in the mouth, requiring warm tonification, demanding careful differentiation. Li Dongyuan said: Evil in Yangming, Lung suffers fire suppression, so acrid-cold drugs are used to clear the Lung, hence the name Baihu (White Tiger), the Divine God of the West. Wu Hegao said: Just as the command of Autumn Metal arrives, the flare-up of Summer Fire recedes. Cheng Shi said: It should not be taken after Start of Autumn, as it is a major cold agent. Yi Lao said: Prescribe the drug for the disease; if constrained by time, how can one practice? If Baihu is considered major cold, why is Chengqi used in winter? Taiyang fever with no sweat and thirst contraindicates Baihu, as the exterior is unresolved; Yangming sweating with thirst contraindicates Wuling San and Zhuling San, as fluids are greatly depleted). Adding Renshen (Ginseng Radix et Rhizoma) 3 liang to this formula creates Ren Shen Bai Hu Tang (Zhang Zhongjing): Treats Shanghan with thirst wanting to drink water, without exterior signs (Baihu resolves heat, Renshen generates fluids. Body heat indicates heat in the exterior; thirst wanting to drink indicates heat in the interior; body heat with drinking indicates heat in both exterior and interior; cool body without thirst indicates no heat in either. Those wanting to drink should be given water, but not excessively; excessive drinking leads to Shui Jie Xiong (Water accumulation in the chest), Xin Xia Ji (Palpitations below the heart), Chuan Ke (Wheezing and cough), Yue Ye (Hiccups and choking), Zhang Zhong (Swelling), Long Mi (Dysuria), and Xia Li (Diarrhea) complications; it also treats Shanghan without high fever, oral dryness/thirst, mental irritability, and slight aversion to cold on the back (The back is Yang; aversion to cold on the back with a normal mouth indicates Shaoyin Bing, suitable for Fuzi Tang; now heat remains with slight aversion to cold, indicating the exterior is not fully resolved, still belonging to Taiyang, yet dry thirst and irritability indicate blazing interior heat. Give Baihu Tang to resolve exterior evil and clear interior heat, adding Renshen to tonify Qi and generate fluids. Taiyang disease is in the exterior, hence aversion to cold; Shaoyang is half-exterior/half-interior, hence slight aversion to cold; Yangming is in the interior, hence no aversion to cold but aversion to heat. Occasional aversion to cold indicates combination with Taiyang. Xu Shuwei said: Zhang Zhongjing stated: After vomiting/purging in Shanghan, unresolved after 7-8 days, with exterior-interior heat, great thirst and irritability, treat with Baihu Jia Renshen Tang. Also: Floating-slippery pulse, exterior heat interior cold, treat with Baihu Jia Renshen Tang. Also: Shanghan floating pulse, fever no sweat, exterior unresolved, do not give Baihu. Lin Yi corrected: There is a discrepancy in the description of exterior/interior here. I disagree. Generally, Baihu removes thirst and exterior-interior heat in Shanghan. Both previous cases, whether described as exterior-interior heat or exterior heat interior cold, are applicable. One case of fever no sweat with unresolved exterior is purely Mahuang Tang and Gegen Tang indications, where can Baihu be used?) ; it also treats Taiyang Zhong Shuo (Summerheat Stroke, pronounced 'ye', meaning summerheat), with body heat, sweating, aversion to cold, cold feet, weak pulse and thirst (Body heat and aversion to cold indicate disease in the exterior; cold feet and weak pulse indicate that exterior-releasing methods are contraindicated); it also treats Fire injuring Lung and Stomach, transmitting into Ge Xiao (Yu Jiayan said: Fei Xiao (Lung Wasting) is treated with Dihuang Wan addressing the Blood aspect; Shen Xiao (Kidney Wasting) is treated with Baihu Tang addressing the Qi aspect. If the disease cannot be cured, it is the doctor's fault). Adding Cangzhu (Atractylodis Rhizoma) to this formula creates Baihu Jia Cangzhu Tang: Treats Shi Wen (Damp-Warmth) with a sinking and fine pulse (Sinking-fine pulse belongs to Dampness; first contracting Summerheat, then Dampness, Summerheat and Dampness contend, named Shi Wen. Symptoms include cold calves, abdominal fullness, headache, body pain, much sweating, thirst and delirium. Li Dongyuan said: Movement-injured Summerheat, Fire-Heat injures Qi, common among hard-working people, suitable for Ren Shen Bai Hu Tang; Stillness-injured Summerheat, Dampness wins causing body heaviness, common among idle people, suitable for Baihu Jia Cangzhu Tang). Adding Guizhi (Cinnamon Twig) to this formula creates Guizhi Baihu Tang (Jin Gui Yao Lue): Treats Wen Nue (Warm Malaria), with heat only without cold, joint pain, and occasional vomiting. Adding Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), and Banxia (Pinelliae Rhizoma) to this formula creates Chaihu Shigao Tang: Treats Summerheat cough, wheezing, and thirst. Removing Jingmi and adding Renshen to this formula creates Hua Ban Tang: Treats Wei Re Fa Ban (Stomach Heat causing macules) with a deficient pulse.