虽然，余走笔至此，窃不禁凛然有所俱焉。所惧者何？曰：人将以本案为根据，而伸其温病伏少阴之说，盖所谓少阴云者，指足少阴经肾言也。余曰：肾精亏耗者，全身津液不足，一旦外受邪风之侵，无能祛邪，反易化热，此犹为抽象之言，差近于是，犹曰：平素肠胃虚寒者易患桂枝汤证，同不失为平正之论。若必欲一口咬定温病之邪气久伏于肾，则犹曰中风证之邪气必久伏于肠胃，其可通乎？不特此也，小儿天真烂漫，肾精不耗，为何患味疹等一类温病特多？盖为其纯阳之体，长育之日，需津既亟，化热自易，初不关肾家事也。奈何温病伏于少阴，发于他经之说，竟亦风行医林，斯乃不可解者。
镇江赵锡庠，章次公门人也，诊所在曹家渡，尝治康脑脱路忻康里四十八号蔡姓女孩，约一周岁，先病百日咳，月余未痊，忽股背间隐约有红点，咳甚剧，目赤多泪，惟身热不扬，手足逆冷，常自汗出，皮肤宽缓，颜面淡白，无出疹状。锡庠告其母曰，瘄疹欲出，表阳虚而不足以达之，此即俗所称白面痧也。方用葛根三钱桂枝一钱杭芍钱半生草一钱姜一片枣二枚因其咳也，加前胡钱半，射干钱半，桔梗八分，象贝三钱，复加牛蒡子三钱以助其提达出表。明日复诊，颜面红疹渐显。神色虽佳，而手足尚冷，遂令再进一剂。二日后，手足温和，周身红疹透达。越二日而回。一切平安，趸咳亦愈。
【按】学者既已知中风伤寒温病各为太阳病之一纲矣，然此犹为未足。吾今当为学者作进一步言。曰，所谓中风，所谓伤寒，所谓温病，所谓太阳病，推而至十六经病，是皆非疾病之真名，不过疾病之代名耳。更细晰言之，六经病方为疾病之代名，所谓中风伤寒温病，尚为疾病中一证之代名耳。病犹戏剧之全部，证犹戏剧之一幕，故病之范围大，而证之范围小。更详尽言之，谓中风伤寒温病等为一证之代名，犹不切，毋宁谓之曰一证之通名。何者，知此等通名病证之方治，将可以泛应万病故也。例如吾人知太阳温病之方治，可以泛治痉病，可以泛冶麻疹，可以泛治一切类似之病。所谓痉病，所谓麻疹，方是疾病之真名。仲景之所以为圣，即在先教人以病证之通名通治（指《伤寒》），后教人以病证之专名专治（指《金匮》）。后人不晓病证之通名通治，独龂龂于伤寒温病等代名之争。
既不知疾病之通名通治，更不晓何者为证。而余之所欲大声疾呼者，亦即在使学者知仲圣通名通治之大道。柯氏曰：因知仲景方可通治百病，与后人分门证类，使无下手处者，可同年而语耶？是柯氏宁非得道之深者。
余谓吾人既知太阳温病之方治，即可以泛治麻疹者，犹曰用葛根汤方可以治麻疹之初起也（麻疹之顺者可勿服药，服药而误，反易偾事）。阅者将疑麻桂之决不可治疹病者乎，则吾师遇麻疹病之遏伏甚而不透发者，且用麻黄汤。服汤已，疹乃畅发。惟窃细心考察，间有透发之后，引起灼热者，是正所谓若发汗已，身灼热者，名曰风温。但余早已言及，此所谓灼热并非不得了之谓，其轻者将自已，其重者亦可以补治。惟窃意与其补治于后，宁早用葛根预防于前，故余之治小儿麻疹，葛根乃为第一味要药。回观本案赵先生方中，既用前胡牛蒡桔梗等开发之品，即可以代麻黄之司。故谓本方为桂枝汤加葛根加味，毋宁谓葛根汤加味，与余之方治乃密合无间也。
余用麻黄常由八分至二钱，用桂枝常由钱半至三钱，用葛根常由二钱至四钱，若吾师之用此三药，则更倍蓗于是。故三药之中，以葛根最为和平。奈何今之医尚多不敢下笔，徒知拾前人之唾余，曰葛根是阳明药，若邪未入阳明而早用之，将引邪入内,曰葛根竭胃汁，是可慨也。
曹颖甫曰：世之论者动称温病无主方，而伤寒论一书几疑为专治伤寒而设。不知越人言伤寒有五，温病即在其中。今姜生能于大论中发明葛根汤为太阳温病之主方，真能发前人所未发。盖葛根汤证与伤寒不同者，原以津液不足之故，故于桂枝汤中加麻黄而君葛根。中风证而津液不足者即用桂枝汤本方而加葛根。太阳标热内陷而下利者即用葛根芩连汤，以清热生津为主。盖人体中水分多于血分，则易从寒化，故藏于精者，春不病温。血分多于水分，则易从热化，故冬不藏精，春必病温。从寒化者，伤寒不愈，寖成痰饮，虽天时转阳，犹宜小青龙汤。从热化者，中风误治即成热病，为其津液少也。即此意以求之，则葛根为太阳温病主药，葛根汤为太阳温病主方，不益可信乎？
住三角街梅寄里屠人吴某之室，病起四五日，脉大身热，大汗，不谵语，不头痛，惟口中大渴。时方初夏，思食西瓜，家人不敢以应，乃延予诊。予曰：此白虎汤证也。随书方如下：生石膏一两肥知母八钱生甘草三钱洋参一钱粳米一小杯服后，渴稍解。知药不误，明日再服原方。至第三日，仍如是，惟较初诊时略安，本拟用犀角地黄汤，以其家寒，仍以白虎原剂，增石膏至二两，加赤芍一两，丹皮一两，生地一两，大小蓟五钱，并令买西瓜与食，二剂略安，五剂全愈。
【按】本案方原为白虎加人参汤，却标作白虎汤证者，盖为求说解便利，示学者以大范故耳。石膏所以清热，人参所以养阴，养阴所以佐清热之不逮，同属于里，非若白虎加桂枝汤，桂枝加大黄汤之兼有表里者，故今姑一并及之。后人于白虎汤中加元参生地麦冬之属，即是人参之变味，不足异也。
江阴缪姓女，予族侄子良妇也，自江阴来上海，居小西门寓所，偶受风寒，恶风自汗，脉浮，两太阳穴痛，投以轻剂桂枝汤，计桂枝二钱，芍药三钱，甘草一钱，生姜二片，大枣三枚。汗出，头痛差，寒热亦止。不料一日后，忽又发热，脉转大，身烦乱，因与白虎汤。
生石膏八钱知母五钱生草三钱粳米一撮服后，病如故。次日，又服白虎汤，孰知身热更高，烦躁更甚，大渴引饮，汗出如浆。又增重药量，为石膏二两，知母一两，生草五钱，梗米二杯，并加鲜生地二两，天花粉一两，大小蓟各五钱，丹皮五钱。令以大锅煎汁，口渴即饮。共饮三大碗，神志略清，头不痛，壮热退，并能自起大小便。尽剂后，烦躁亦安，口渴大减。翌日停服，至第三日，热又发，且加剧，周身骨节疼痛，思饮冰凉之品，夜中令其子取自来水饮之，尽一桶。因思此证乍发乍止，发则加剧，热又不退，证大可疑。适余子湘人在，曰，论证情，确系白虎，其势盛，则用药亦宜加重。第就白虎汤原方，加石膏至八两，余仍其旧。仍以大锅煎汁冷饮。服后，大汗如注，湿透衣襟，诸恙悉除，不复发。惟大便不行，用麻仁丸二钱，芒硝汤送下，一剂而瘥。
【按】白虎汤证有由直中天时之热而起者，有由自身积热而起者，若前案所引是也。有非直起于热，而由寒化热者，即由桂枝汤证转为白虎汤证者，若本案所言是也。仲圣曰，服桂枝汤，大汗出后，大烦渴不解，脉洪大者，白虎加人参汤主之。是即由寒化热之明证。本条之意若曰：有患桂枝汤证者于此，医者认证不误，予以桂枝汤。服汤已，应热退病除，但病者忽大汗出后，反大烦渴不解，脉且转为洪大。是盖其人素有蕴热，因药引起，或药量过剂所致，但勿惧，可以白虎加人参汤一剂愈之。其属有蕴热者可以顺便除之，其属药量过剂者，此即补救祛也。本条即示桂枝汤证化为白虎汤证之一例。
人多以桂枝麻黄二汤齐称，我今且撇开麻黄，而以白虎合桂枝二汤并论之。余曰桂枝汤为温和肠胃（若以其重要言，当曰胃肠）之方，白虎汤则为凉和肠胃之方。桂枝证之肠胃失之过寒，故当温之，温之则能和。白虎证之肠胃失之过热，故当凉之，凉之则亦能和。和者，平也，犹今人所谓水平，或标准也。失此标准则病，故曰太过等于不及，犹言其病一也。桂枝汤证肠胃之虚寒，或由于病者素体积弱使然，或由于偶受风寒使然，或更合二因而兼有之。白虎汤证肠胃之实热，容吾重复言之，或由于病者素体积热使然，或由于由寒化热使然，或竟由直受热邪使然，或竟合诸因而兼有之。来路不一，证状参差，而医者予以方，求其和则同。方药不一，而方意则同。桂枝汤有桂芍以激血，生姜以止呕，同是温胃。白虎汤之石膏知母同是凉胃。大枣免胃液之伤，粳米求胃津之凝。余下甘草一味，同是和肠，防其下传。两相对勘，一无遁形。
吾师治白虎汤证之直起于热者，用白虎汤，治白虎汤证之由寒化热者，亦用白虎汤。无所谓伤寒，无所渭温热，是乃仲圣之正传。乃温热家硬欲分伤寒温热为尔我彼此，明由寒化热者是伤寒，由热直起者是温热。然则治伤寒之白虎汤证用白虎汤，治温热之白虎汤证，曷不用其他神汤妙药，而终不脱石膏知母耶？是故温热伤寒之争，甚无谓也。
友人郁祖安君之女公子，方三龄，患消渴病。每夜须大饮十余次，每饮且二大杯，勿与之，则吵闹不休，小便之多亦如之，大便不行，脉数，别无所苦。时方炎夏，尝受治于某保险公司之西医，盖友人也。
逐日用灌肠法，大便方下，否则不下。医诫勿与多饮，此乃事实上所绝不可能者。累治多日，迄无一效。余诊之，曰：是白虎汤证也。方与：生石膏四钱知母二钱生草钱半粳米一撮加其他生津止渴之品，如洋参花粉茅根之属，五剂而病痊。顾余热未楚，孩又不肯服药，遂止服。越五日，旧恙复发，仍与原方加减，连服十五日，方告全愈，口不渴，而二便如常。先后计服石膏达半斤之谱。
鍾右住圣母院路初诊十一月初三日伤寒七日，发热无汗，微恶寒，一身尽疼，咯痰不畅，肺气闭塞使然也。痰色黄，中已化热，宜麻黄杏仁甘草石膏汤加浮萍。
【按】据史惠甫师兄言，钟姓少妇先因外出探望其父病，心滋优戚，归途白雪纷飞，到家即病。曾经中西医师杂治未痊，又因身怀六甲，家人忧俱万分。耳师名，叩请出诊，惠甫兄随侍焉。初诊时，病者面赤气喘，频频呼痛，脸都尤甚，按脉浮紧。师谓此证易治，不足忧，径疏本方。
二诊十一月初四日昨进麻杏甘石汤加浮萍，汗泄而热稍除，惟咳嗽咯痰不畅，引胸腹而俱痛，脉仍浮紧，仍宜前法以泄之。
净麻黄三钱五分生甘草二钱生石膏六钱薄荷末一钱同打光杏仁四钱苦桔梗五钱生薏仁一两中川朴二钱苏叶五钱
【按】据史惠甫兄言，二诊时患者已能与师对语，神情爽适，不若初诊时之但呼痛矣。稔知服药后，微汗出，一身尽疼者悉除。惟于咳嗽时，胸腹部尚觉牵痛耳。师谓本可一剂全愈，适值天时阴雨，故稍缠绵，乃加苡仁、厚朴、苏叶等与之。
自服第二方后，又出微汗，身热全除，但胸背腹部尚有微痛，游移不居。又越一日，病乃全瘥，起床如常人。
冯衡荪嵩山路萼庐帐房十月廿九日始而恶寒，发热，无汗，一身尽痛。
发热必在暮夜，其病属营，而恶寒发热无汗，则其病属卫，加以咳而咽痛，当由肺热为表寒所束，正以开表为宜。
净麻黄三钱光杏仁四钱生石膏五钱青黛四分同打生甘草二钱浮萍三钱
【按】本案脉案中所谓营卫，盖本《内经》营气夜行于阳，昼行于阴，卫气昼行于阳，夜行于阴之说。余则谓本案乃麻黄汤证化热而为麻杏石甘汤证耳。
观其恶寒发热无汗身疼，非麻黄汤证而何？观其咳而咽痛，非由寒邪化热，热邪灼津而何？方依证转，病随药除。
桂枝汤证，或以服药故，或以病能自然传变故，可一变而为白虎汤证。同理，麻黄汤证可一变而为麻杏石甘汤证。此可证之以大论。曰：发汗后不可更行桂枝汤，汗出，而喘，无大热者，可与麻黄杏仁甘草石膏汤。此言本属麻黄汤证，予麻黄汤发汗，孰知药剂太重，竟致肺部转热，虽汗出，而仍喘。浅人无知，见无汗变为有汗，疑麻黄汤证转为桂枝汤证。初不知身无大热，热反聚于肺藏，而肺藏之邪，并非传于肠胃也。经文俱在，可以覆按。
余前谓白虎汤为桂枝汤之反面，今当续曰，麻杏甘石汤为麻黄汤之反面。此说当更易明了。何者？二汤中三味相同，所异者，一为桂枝，一为石膏。而后知麻黄汤证为寒实，麻杏甘石汤证为热实。攻实虽同，寒热不一。麻黄汤证有喘，麻杏甘石汤证亦有喘。其喘虽同，而其喘之因不一。喘为肺闭，而其所以闭之因不一。人当健时，肺都寒温调匀，启阖合度，无所谓闭。及其受寒，则闭，受热，则亦闭。闭者当开，故均用麻杏以开之，甘草以和之，而以桂枝石膏治其原。于是因寒而闭者开，因热而闭者亦开，仲圣制方之旨，于焉大明！
Although so, as I write to this point, I cannot help but feel a sense of solemn awe. What is it that I fear? I say: People may take this medical case as a basis to promote their theory of "warm diseases lying latent in the Shaoyin." The term "Shaoyin" refers to the Foot-Shaoyin meridian and the Kidney. I hold that: In cases where Kidney essence is depleted, there is a deficiency of fluids throughout the body. Once invaded by external pathogenic wind, the body lacks the strength to expel the pathogen, making it prone to transformation into heat. This is still an abstract statement, which roughly approximates the truth; it is akin to saying that those with chronic deficiency-cold of the intestines and stomach are prone to Guizhi Tang syndrome, which remains a moderate and sound argument. However, if one insists that the pathogenic factor of warm diseases lies latent in the Kidney for a long time, it would be like insisting that the pathogenic factor of Wind-stroke must lie latent in the intestines and stomach for a long time. Is this logical? Moreover, children are innocent and their Kidney essence is not depleted. Why do they suffer from warm diseases such as measles particularly often? It is because they possess a "pure Yang" constitution. During their growth and development, their demand for fluids is urgent, so they easily transform into heat. This has nothing to do with the affairs of the Kidney. Why does the theory that "warm diseases lie latent in the Shaoyin and manifest in other meridians" prevail in the medical community? This is truly incomprehensible.
Case 4 of Gegen Tang Syndrome (Including Treatment Experiences of Disciples)
Zhao Xixiang from Zhenjiang was a disciple of Zhang Cigong. His clinic was located at Caojiadu. He once treated a girl surnamed Cai, approximately one year old, living at No. 48 Xinkangli, Kangnaotuo Road. She initially suffered from whooping cough, which had not resolved after more than a month. Suddenly, faint red spots appeared on her thighs and back. Her cough became severe, her eyes were red and watery, yet her body fever was not prominent. Her hands and feet were cold, she sweated spontaneously, her skin was loose, and her face was pale without signs of rash eruption. Zhao Xixiang told her mother, "The measles are about to erupt. The exterior Yang is deficient and insufficient to push the toxin out. This is commonly known as 'White-faced Sha'." The prescription used Gegen (Puerariae Radix) 3 qian, Guizhi (Cinnamomi Ramulus) 1 qian, Hangshao (Paeoniae Radix Alba) 1.5 qian, Shengcaoshao (Glycyrrhizae Radix et Rhizoma Preparatum) 1 qian, Shengjiang (Zingiberis Rhizoma Recens) 1 slice, and Dazao (Jujubae Fructus) 2 pieces. Due to her cough, Qianhu (Peucedani Radix) 1.5 qian, Shegan (Belamcandae Rhizoma) 1.5 qian, Jiegeng (Platycodonis Radix) 0.8 fen, and Xiangbei (Fritillariae Thunbergii Bulbus) 3 qian were added. Niubangzi (Arctii Fructus) 3 qian was further added to assist in lifting and releasing the pathogen to the exterior. On the next day's follow-up, facial red rashes gradually appeared. Although her spirit was good, her hands and feet remained cold, so she was instructed to take another dose. Two days later, her hands and feet became warm, and the red rashes on her entire body fully emerged. She returned two days later, safe and sound, and her whooping cough had also healed.
[Commentary] Scholars already know that Wind-stroke, Cold Damage, and Warm Diseases each constitute a major category of Taiyang Disease. However, this is still insufficient. I now wish to elaborate further for scholars. I say: The terms Wind-stroke, Cold Damage, Warm Disease, and Taiyang Disease, extending up to the Sixteen Meridian Diseases, are not the true names of diseases but merely aliases. More precisely, the Six Meridian Diseases are aliases for diseases, while Wind-stroke, Cold Damage, and Warm Diseases are aliases for specific syndromes within diseases. A disease is like a complete play, while a syndrome is like a scene in that play. Thus, the scope of a disease is larger, while the scope of a syndrome is smaller. To be more detailed, calling Wind-stroke, Cold Damage, and Warm Diseases aliases for a single syndrome is still not precise enough; it is better to call them generic names for syndromes. Why? Because knowing the treatment methods for these generic disease-syndromes allows one to broadly address various illnesses. For example, if we know the treatment for Taiyang Warm Disease, we can broadly treat Spasm Disease, measles, and all similar conditions. Spasm Disease and measles are the true names of diseases. Zhang Zhongjing's sainthood lies in first teaching people to treat diseases based on generic syndrome names (as in *Shanghan Lun*), and later teaching them to treat based on specific disease names (as in *Jingui Yaolue*). Later generations, failing to understand the principle of treating by generic names, obsess over the debate regarding aliases like Cold Damage and Warm Disease.
Since they do not understand the universal treatment of diseases by generic names, nor do they understand what constitutes a syndrome, my loud appeal is to make scholars aware of Zhang Zhongjing's great principle of universal treatment via generic names. Ke Qin stated: "From this, we know that Zhongjing's formulas can universally treat hundreds of diseases. How can this be compared to later generations who categorized diseases into compartments, leaving doctors with no entry point?" It seems Ke Qin was indeed one who deeply grasped the Dao.
I said that since we know the treatment for Taiyang Warm Disease, we can broadly treat measles. This is akin to saying that Gegen Tang can treat the initial stage of measles (Measles in a favorable course may not require medication; improper medication may instead cause harm). Readers might suspect that Mahuang Tang or Guizhi Tang absolutely cannot treat rash diseases. Yet, when my teacher encountered measles cases where the pathogen was severely suppressed and failed to erupt, he even used Mahuang Tang. After taking the decoction, the rash erupted smoothly. However, upon careful observation, occasionally after the rash erupted, burning heat ensued. This is exactly what is meant by: "If after sweating, the body becomes burning hot, it is named Fengwen (Wind-Warmth)." But I have already stated that this "burning heat" does not mean a dire situation; mild cases will resolve themselves, and severe cases can be remedied. Nevertheless, I believe it is better to prevent with Gegen beforehand rather than remedy afterwards. Therefore, in my treatment of pediatric measles, Gegen is the primary essential herb. Looking back at Mr. Zhao's prescription in this case, since it used Qiankaifai (developing and dispersing) herbs such as Qianhu, Niubangzi, and Jiegeng, these could substitute for the function of Mahuang. Thus, describing this formula as Guizhi Tang plus Gegen and modifications is less accurate than describing it as Gegen Tang plus modifications, which aligns perfectly with my treatment method.
I typically use Mahuang from 0.8 fen to 2 qian, Guizhi from 1.5 qian to 3 qian, and Gegen from 2 qian to 4 qian. If my teacher uses these three herbs, the dosage is doubled. Among these three, Gegen is the most gentle. Why do many modern physicians dare not prescribe it, content only to repeat previous authorities, claiming Gegen is a Yangming herb? They argue that using it early before the pathogen enters Yangming will draw the pathogen inward, or that Gegen depletes stomach fluids. This is lamentable.
Cao Yingfu said: Critics often claim that Warm Diseases have no principal formula, leading some to suspect *Shanghan Lun* was designed solely for Cold Damage. They fail to realize that Bian Que (Yue Ren) stated there are five types of Cold Damage, including Warm Disease within them. Now, Jiang Sheng has elucidated in the Great Treatise that Gegen Tang is the principal formula for Taiyang Warm Disease, truly uncovering what predecessors had not revealed. The difference between Gegen Tang syndrome and Cold Damage lies originally in the deficiency of fluids. Therefore, Mahuang is added to Guizhi Tang, with Gegen as the sovereign herb. For Wind-stroke syndrome with fluid deficiency, Guizhi Tang itself plus Gegen is used. For Taiyang superficial heat sinking inward causing diarrhea, Gegen Qinlian Tang is used, focusing on clearing heat and generating fluids. Generally, when bodily fluids exceed blood components, pathology tends to transform towards cold; thus, those who preserve their essence will not suffer Warm Disease in spring. When blood components exceed fluids, pathology tends to transform towards heat; thus, those who fail to preserve essence in winter will inevitably suffer Warm Disease in spring. Those transforming from cold, if Cold Damage persists, gradually become Phlegm-Fluid retention; even if weather warms, Xiao Qinglong Tang is still appropriate. Those transforming from heat, if Wind-stroke is mistreated, becomes Heat Disease due to fluid deficiency. Based on this reasoning, it is highly credible that Gegen is the principal herb and Gegen Tang the principal formula for Taiyang Warm Disease.
Case 1 of Baihu Tang Syndrome
The wife of Wu, a resident of Meiji Lane, Sanjiao Street, fell ill for four or five days. Her pulse was large, body hot, with profuse sweating. She did not delirium, nor did she have a headache, only extreme thirst in the mouth. It was early summer, and she craved watermelon, but her family dared not give it to her. They invited me to diagnose. I said, "This is Baihu Tang syndrome." I prescribed as follows: Sheng Shigao (Gypsum Fibrosum) 1 liang, Fei Zhimu (Anemarrhenae Rhizoma) 8 qian, Sheng Caoshao (Glycyrrhizae Radix et Rhizoma Preparatum) 3 qian, Yangshen (Panacis Quinquefolii Radix) 1 qian, Jingmi (Oryzae Semen) one small cup. After taking it, her thirst slightly relieved. Knowing the medicine was correct, she took the original prescription again the next day. By the third day, the condition remained similar, though slightly better than the initial visit. Originally intending to use Xijiao Dihuang Tang, but due to their poverty, I stuck with the original Baihu Tang, increasing Shigao to 2 liang, adding Chishao (Paeoniae Radix Rubra) 1 liang, Danpi (Moutan Cortex) 1 liang, Shengdi (Rehmanniae Radix) 1 liang, and Da Xiao Ji (Cirsii Herba et Radix) 5 qian. I also instructed them to buy watermelon for her to eat. After two doses, she felt slightly better; after five doses, she fully recovered.
[Commentary] The formula in this case was originally Baihu Jia Renshen Tang, but it is labeled as Baihu Tang syndrome for the sake of convenient explanation, showing scholars the broad category. Shigao clears heat, Renshen nourishes Yin. Nourishing Yin assists in compensating for the insufficiency of heat-clearing. Both belong to interior patterns, unlike Baihu Jia Guizhi Tang or Guizhi Jia Dahuang Tang which involve both exterior and interior. Therefore, I mention them together here. Later additions of Xuanshen (Scrophulariae Radix), Shengdi, and Maidong (Ophiopogonis Radix) to Baihu Tang are variations of Renshen's function, which is not surprising.
Case 2 of Baihu Tang Syndrome
Ms. Miu from Jiangyin was the wife of my clan nephew Liang. She came from Jiangyin to Shanghai, residing in a lodging near Xiaoximen. Accidentally exposed to wind-cold, she experienced aversion to wind, spontaneous sweating, floating pulse, and pain in both temporal regions. She was given a light dose of Guizhi Tang: Guizhi 2 qian, Shaoyao 3 qian, Caoshao 1 qian, Shengjiang 2 slices, Dazao 3 pieces. After sweating, her headache improved, and chills/fever ceased. Unexpectedly, one day later, she suddenly developed fever again, her pulse turned large, and she felt restless. Therefore, Baihu Tang was administered.
Shigao 8 qian, Zhimu 5 qian, Sheng Caoshao 3 qian, Jingyi (a pinch of rice). After taking it, the illness remained unchanged. The next day, she took Baihu Tang again. Who knew her body heat would rise higher, restlessness worsen, extreme thirst with desire to drink ensue, and sweat pour like syrup. The dosage was increased further: Shigao 2 liang, Zhimu 1 liang, Sheng Caoshao 5 qian, Jingmi 2 cups, plus fresh Shengdi 2 liang, Tianhuafen (Trichosanthis Radix) 1 liang, Da Xiao Ji 5 qian each, Danpi 5 qian. Instructed to boil in a large pot and drink whenever thirsty. She drank a total of three large bowls. Her consciousness cleared slightly, headache stopped, high fever subsided, and she could get up to urinate and defecate. After finishing the dose, restlessness calmed, and thirst greatly reduced. Medication stopped the next day. By the third day, fever recurred and intensified, with pain in all bone joints. She desired cold drinks. At night, she asked her son to fetch tap water, drinking a whole bucket. Thinking that this condition came and went, intensified upon recurrence, and fever did not subside, the case seemed suspicious. Fortunately, my son Xiangren was present. He said, "Based on the symptoms, it is indeed Baihu Tang syndrome. Since the pathogen is strong, the medication should also be heavy. Starting from the original Baihu Tang formula, increase Shigao to 8 liang, keeping the rest unchanged. Still boil in a large pot and drink cold." After taking it, profuse sweating poured down, soaking her clothes. All ailments disappeared, with no recurrence. Only constipation remained. She took Maren Wan (Ephedrae Semen Pill) 2 qian, delivered with Mangxiao Tang (Natrii Sulfatis Decoction). One dose cured her.
[Commentary] Baihu Tang syndrome arises either directly from seasonal heat, as in the previous case, or from accumulated internal heat. Some do not arise directly from heat but transform from cold, i.e., transitioning from Guizhi Tang syndrome to Baihu Tang syndrome, as described in this case. Zhang Zhongjing stated: "After taking Guizhi Tang, if profuse sweating occurs followed by extreme vexation and unquenchable thirst with a洪大 (Surging-Large) pulse, Baihu Jia Renshen Tang governs." This is clear evidence of transformation from cold to heat. The meaning of this clause is: Here is a patient with Guizhi Tang syndrome. The doctor diagnoses correctly and prescribes Guizhi Tang. After taking it, heat should retreat and illness remove. But suddenly, after profuse sweating, the patient experiences extreme vexation and unquenchable thirst, and the pulse turns Surging-Large. This is likely due to pre-existing latent heat triggered by the medicine, or excessive dosage. Do not fear; one dose of Baihu Jia Renshen Tang will cure it. Pre-existing latent heat can be cleared simultaneously; excessive dosage is remedied by this approach. This clause demonstrates an example of Guizhi Tang syndrome transforming into Baihu Tang syndrome.
People often group Guizhi Tang and Mahuang Tang together. I will now set aside Mahuang Tang and discuss Baihu Tang alongside Guizhi Tang. I say Guizhi Tang is a formula to gently warm the intestines and stomach (or gastrointestinal tract, emphasizing its importance), while Baihu Tang cools and harmonizes the intestines and stomach. Guizhi Tang syndrome involves intestinal/stomach deficiency-cold, so it requires warming to achieve harmony. Baihu Tang syndrome involves intestinal/stomach excess-heat, so it requires cooling to achieve harmony. "Harmony" means balance, like the level of water or a standard. Deviating from this standard causes disease; thus, excess is equivalent to deficiency, meaning the disease state is similar. Guizhi Tang syndrome's deficiency-cold may result from inherent weak constitution, accidental wind-cold exposure, or a combination. Baihu Tang syndrome's excess-heat may result from inherent hot constitution, transformation from cold, direct heat pathogen invasion, or a combination. Origins differ, symptoms vary, but the physician's goal to achieve "harmony" is the same. Formulas differ, but the intent is identical. Guizhi Tang uses Guizhi and Shaoyao to stimulate blood, Shengjiang to stop vomiting, all warming the stomach. Baihu Tang uses Shigao and Zhimu to cool the stomach. Dazao prevents damage to gastric fluids, Jingmi seeks condensation of stomach fluids. I leave Caoshao alone, which harmonizes the intestines and prevents downward transmission. Comparing the two, nothing is hidden.
My teacher uses Baihu Tang for cases arising directly from heat, and also uses Baihu Tang for cases transforming from cold. There is no distinction between Cold Damage and Warm Disease; this is the orthodox transmission of Zhang Zhongjing. However, Warm Disease proponents insist on dividing Cold Damage and Warm Disease into opposing camps. Clearly, Cold Damage transforming to heat is Cold Damage, while heat arising directly is Warm Disease. Then, why, when treating Baihu Tang syndrome in Cold Damage, use Baihu Tang, and when treating Baihu Tang syndrome in Warm Disease, not use other miraculous formulas, but ultimately rely on Shigao and Zhimu? Thus, the debate between Warm Disease and Cold Damage is meaningless.
Case 3 of Baihu Tang Syndrome (Including Disciple's Treatment Experience)
The daughter of my friend Mr. Yu Zu'an, aged three, suffered from Xiao Ke (Wasting-Thirst). Every night she needed to drink heavily more than ten times, each time two large cups. If not given, she would cry incessantly. Urination was equally frequent. Bowels were dry, pulse rapid, with no other discomfort. It was midsummer. She had been treated by a Western doctor friend from an insurance company.
Daily enemas were used; bowels moved only then, otherwise not. The doctor advised against giving too much water, which was practically impossible. After many days of treatment with no effect, I diagnosed her, saying, "This is Baihu Tang syndrome." Prescribed: Sheng Shigao 4 qian, Zhimu 2 qian, Sheng Caoshao 1.5 qian, Jingmi a pinch, plus other fluids-generating and thirst-quenching herbs like Yangshen, Huafen, and Maogen. Five doses cured the illness. However, residual heat remained, and the child refused further medicine, so treatment stopped. Five days later, old symptoms recurred. Using the original formula with modifications, she took it continuously for fifteen days until full recovery. Thirst ceased, bowel and bladder functions normalized. Total Shigao consumption reached approximately half a jin.
Case 1 of Mahuang Xingren Gancao Shigao Tang Syndrome
Ms. Zhong, residing on Shengmu Yuan Road. First visit: November 3rd. Seven days of Shanghan (Cold Damage), fever, no sweat, slight aversion to cold, body ache throughout, difficulty expectorating phlegm due to Lung Qi obstruction. Phlegm color yellow, indicating internal heat transformation. Suitable for Mahuang Xingren Gancao Shigao Tang plus Fuping.
Jing Mahuang 3 qian, Guang Xingren 5 qian, Sheng Shigao 4 qian, Qingdai 0.4 fen (ground together), Sheng Caoshao 3 qian, Fuping 3 qian.
[Commentary] According to senior brother Shi Huifu, Ms. Zhong, a young woman, had gone out to visit her sick father, feeling deep sorrow. On the return journey, snow fell heavily. Upon arriving home, she fell ill. Treated by various Chinese and Western doctors without success. Being pregnant, her family was extremely worried. Hearing of the Master's reputation, they requested a consultation, with Brother Huifu attending. At the first visit, the patient had a red face, panting, frequently crying out in pain, especially on the face. Pulse was floating and tight. The Master said this case was easy to treat and not to worry, prescribing this formula directly.
Second visit: November 4th. Yesterday, Mahuang Xingren Gancao Shigao Tang plus Fuping was taken. Sweat released, heat slightly reduced. However, cough and difficult expectoration persisted, pulling pain in chest and abdomen. Pulse still floating and tight. Continue previous method to vent.
Jing Mahuang 3.5 qian, Sheng Caoshao 2 qian, Sheng Shigao 6 qian, Bohe Mo 1 qian (ground together), Guang Xingren 4 qian, Ku Jiegeng 5 qian, Sheng Yiren 1 liang, Zhong Chuanpu 2 qian, Su Ye 5 qian.
[Commentary] According to Brother Huifu, at the second visit, the patient could converse with the Master, looking refreshed, unlike the first visit where she only cried in pain. It is known that after taking the medicine, slight sweating occurred, and body aches completely resolved. Only pulling pain in chest and abdomen during cough remained. The Master said one dose could have cured it, but due to rainy weather, the condition lingered slightly. Thus, Yiren, Houpo, and Su Ye were added.
After taking the second prescription, slight sweating occurred again, body heat completely removed. However, slight pain remained in chest, back, and abdomen, migrating and unsettled. One day later, the illness fully resolved, and she got up like a normal person.
Case 2 of Mahuang Xingren Gancao Shigao Tang Syndrome
Mr. Feng Hongsun, Accountant at Elu, Songshan Road. Started on October 29th with aversion to cold, fever, no sweat, body ache throughout.
Fever always occurs at dusk; the disease belongs to Ying (Nutrient) level. Aversion to cold, fever, and no sweat belong to Wei (Defensive) level. Added cough and sore throat indicate Lung Heat constrained by Exterior Cold. Opening the exterior is appropriate.
Jing Mahuang 3 qian, Guang Xingren 4 qian, Sheng Shigao 5 qian, Qingdai 0.4 fen (ground together), Sheng Caoshao 2 qian, Fuping 3 qian.
[Commentary] The Ying and Wei mentioned in the pulse record of this case likely stem from the *Neijing* theory that Ying Qi travels in Yang during night and Yin during day, while Wei Qi travels in Yang during day and Yin during night. I, however, consider this case to be Mahuang Tang syndrome transforming into heat, becoming Mahuang Xingren Gancao Shigao Tang syndrome.
Looking at his aversion to cold, fever, no sweat, and body ache, is this not Mahuang Tang syndrome? Looking at his cough and sore throat, is this not Cold Pathogen transforming into Heat, scorching fluids? The formula follows the syndrome change, and the illness removes with the medicine.
Guizhi Tang syndrome, either due to medication or natural progression, can transform into Baihu Tang syndrome. Similarly, Mahuang Tang syndrome can transform into Mahuang Xingren Gancao Shigao Tang syndrome. This is proven by the Great Treatise: "After sweating, do not use Guizhi Tang again. If sweating occurs with panting and no significant heat, Mahuang Xingren Gancao Shigao Tang may be given." This refers to a case originally belonging to Mahuang Tang syndrome. Given Mahuang Tang to induce sweating, who knew the dosage was too heavy, causing Lung heat transformation. Although sweating occurred, panting persisted. Ignorant people, seeing no sweat turn to sweat, suspected Mahuang Tang syndrome transformed into Guizhi Tang syndrome. They did not realize that although the body lacked significant heat, heat gathered in the Lung organ, and the pathogen in the Lung did not transmit to the intestines and stomach. The classic text is available for verification.
I previously stated that Baihu Tang is the reverse of Guizhi Tang. Now I should continue: Mahuang Xingren Gancao Shigao Tang is the reverse of Mahuang Tang. This concept should be easier to understand. Why? Three ingredients are the same in both formulas; the difference is one contains Guizhi, the other Shigao. Thus, we know Mahuang Tang syndrome is Cold Excess, while Mahuang Xingren Gancao Shigao Tang syndrome is Heat Excess. Attacking excess is the same, but Cold and Heat differ. Both Mahuang Tang syndrome and Mahuang Xingren Gancao Shigao Tang syndrome feature panting. Although the panting is similar, the causes differ. Panting is due to Lung obstruction, but the reasons for obstruction differ. In health, Lung temperature is balanced, opening and closing are regulated, so there is no obstruction. When exposed to Cold, it obstructs; when exposed to Heat, it also obstructs. Obstruction requires opening, so both use Mahuang and Xingren to open, Caoshao to harmonize, and Guizhi or Shigao to treat the root. Thus, obstruction due to Cold opens, and obstruction due to Heat opens. The intent of Zhang Zhongjing's formula creation is thereby clearly illuminated!
Case 3 of Mahuang Xingren Gancao Shigao Tang Syndrome (Including Disciple's Treatment Experience)