主治烦渴也，旁治谵语、烦躁、身热。
考 证
白虎汤证曰∶谵语遗尿。
白虎加人参汤证曰∶大烦渴。
白虎加桂枝汤证曰∶身无寒、但热。
以上三方，石膏皆一斤。
越婢汤证曰∶不渴、续自汗出、无大热。（不渴，非全不渴之谓。无大热，非全无大热
之谓也，说在外传中）。
麻黄杏仁甘草石膏汤，证不具也。（说在《类聚方》）
以上二方，石膏皆半斤。
大青龙汤证曰∶烦躁。
木防己汤，证不具也（说在《类聚方》）
以上二方，石膏皆鸡子大也。为则按，鸡子大，即半斤也，木防己汤，石膏或为三枚，
或为十二枚，其分量难得而知焉。今从旁例，以为鸡子大也。
上历观此诸方，石膏主治烦渴也明矣。凡病烦躁者，身热者，谵语者，及发狂者，齿痛者，
头痛者，咽痛者，其有烦渴之证也，得石膏而其效核焉。
互 考
《伤寒论》曰∶伤寒脉浮、发热无汗，其表不解者，不可与白虎汤。渴欲饮水，无表证
者，白虎加人参汤主之。为则按，上云不可与白虎汤，下云白虎加人参汤主之。上下恐有错
误也。于是考诸《千金方》，揭《伤寒论》之全文。而白虎汤加人参汤，作白虎汤是也。今
从之。
《伤寒论》中，白虎汤之证不具也，《千金方》举其证也备矣，今从之。
辨 误
《名医别录》言∶石膏性大寒，自后医者怖之，遂至于置而不用焉。仲景氏举白虎汤之
证曰∶无大热。越婢汤之证亦云。而二方主用石膏。然则仲景氏之用药，不以其性之寒热也
可以见已。余也笃信而好古，于是乎为渴家而无热者，投以石膏之剂，病已而未见其害也。
方炎暑之时，有患大渴引饮而渴不止者，则使其服石膏末，烦渴顿止。而不复见其害也。石
膏之治渴而不足怖也，斯可以知已。
陶弘景曰∶石膏发汗，是不稽之说。而不可以为公论。仲景氏无斯言，意者陶氏用石膏，
而
在下则下。于是乎有非吐剂而吐，非下剂而下，非汗剂而汗者，是变而非常也。何法之为？
譬有盗于梁上，室人交索之。出于右，则顺而难逃。逾于左，则逆而易逃。然则虽逆乎？从
其易也，毒亦然。仲景曰∶与柴胡汤，必蒸蒸而振，却发热汗出而解。陶氏所谓石膏发汗，
盖亦此类也已。陶氏不知，而以为发汗之剂。不亦过乎？后世以石膏为峻药，而怖之太甚，
是不学之过也。仲景氏之用石膏，其量每多于他药；半斤至一斤，此盖以其气味之薄故也。
余尝治青山候臣蜂大夫之病。其证平素毒着脊上七椎至十一椎，痛不可忍，发则胸膈烦闷而
渴，甚则冒而不省人事，有年数矣。一日大发，众医以为大虚，为作独参汤，贴二钱，日三
服；六日未知也。医皆以为必死。于是家人召余诊之。脉绝如死状，但诊其胸，微觉有烦闷
状，乃作石膏黄连甘草汤与之。一剂之重三十五钱，以水一盏六分，煮取六分，顿服，自昏
至晓，令三剂尽，通计一百有五钱，及晓，其证犹梦而顿觉。次日余辞而归京师，病客曰∶
一旦诀别，吾则不堪。请与君行，朝夕于左右，遂俱归京师。为用石膏如故，居七八十许日
而告瘳。石膏之非峻药而不可怖也，可以见焉尔。
品 考
石膏 本邦处处出焉。加州、奥州最多。而有硬软二种。软者上品也。《别录》曰∶细
理白泽者良。雷 曰∶其色莹净如水精。李时珍曰∶白者洁净细文，短密如束针。为则曰∶
采石药之道，下底为佳，以其久而能化也。采石膏于其上头者，状如米糕。于其下底者，莹
净如水精，此其上品也。用之之法，唯打碎之已。近世火 用之，此以其性为寒故也。臆测
之为也，余则不取焉。大凡制药之法，制而倍毒则制之。去毒则不，是毒外无能也。诸药之
下，其当制者，详其制也，不制者不，下皆效之。
It primarily treats excessive thirst and irritability (Fan Ke), and secondarily treats delirium, restlessness, and body heat.
Textual Research:
The syndrome of Baihu Tang (White Tiger Decoction) presents with delirium and urinary incontinence.
The syndrome of Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) presents with severe excessive thirst and irritability.
The syndrome of Baihu Jia Guizhi Tang (White Tiger Decoction plus Cinnamon Twig) presents with no aversion to cold, only heat.
In the above three formulas, the dosage of Shigao (Gypsum Fibrosum) is one jin.
The syndrome of Yuespi Tang (Yuebi Decoction) presents with no thirst, continuous spontaneous sweating, and no significant heat. ("No thirst" does not mean absolutely no thirst; "no significant heat" does not mean absolutely no significant heat; see external commentary for details).
The syndrome description for Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) is incomplete. (See *Leiju Fang* for details).
In the above two formulas, the dosage of Shigao (Gypsum Fibrosum) is half a jin.
The syndrome of Daqinglong Tang (Major Blue Green Dragon Decoction) presents with restlessness.
The syndrome description for Mufangji Tang (Stephania Tetrandra Decoction) is incomplete (see *Leiju Fang* for details).
In the above two formulas, the dosage of Shigao (Gypsum Fibrosum) is the size of an egg. I have verified that the size of an egg is equivalent to half a jin. In Mufangji Tang (Stephania Tetrandra Decoction), Shigao (Gypsum Fibrosum) is recorded as either three pieces or twelve pieces, making its exact dosage difficult to ascertain. Following parallel examples, I consider it to be the size of an egg.
Having observed these formulas comprehensively, it is clear that Shigao (Gypsum Fibrosum) primarily treats excessive thirst and irritability. For any disease presenting with restlessness, body heat, delirium, mania, toothache, headache, or sore throat, if accompanied by symptoms of excessive thirst and irritability, Shigao (Gypsum Fibrosum) yields definitive efficacy.
Cross-Reference:
*Shanghan Lun* (Treatise on Cold Pathogenic Diseases) states: In cold damage with floating pulse, fever, and absence of sweating, if the exterior syndrome is unresolved, Baihu Tang (White Tiger Decoction) must not be given. If there is thirst desire to drink water, and no exterior syndrome, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is the primary treatment. I have verified that the upper text says "must not give Baihu Tang," while the lower text says "Baihu Jia Renshen Tang is the primary treatment." There may be errors between the upper and lower texts. Therefore, I consulted *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) to reveal the full text of *Shanghan Lun*. It shows that "Baihu Jia Renshen Tang" was written as "Baihu Tang," which is correct. I now follow this correction.
In *Shanghan Lun*, the syndrome description for Baihu Tang (White Tiger Decoction) is incomplete, whereas *Qianjin Fang* lists the syndromes comprehensively. I now follow *Qianjin Fang*.
Correction of Errors:
*Mingyi Bielu* (Secret Record of Famous Physicians) states: Shigao (Gypsum Fibrosum) has a major cold nature. Since then, physicians have feared it, leading to its abandonment and non-use. Zhang Zhongjing pointed out in the syndrome of Baihu Tang (White Tiger Decoction): "no significant heat." The syndrome of Yuespi Tang (Yuebi Decoction) also states this, yet both formulas primarily use Shigao (Gypsum Fibrosum). Thus, it can be seen that Zhang Zhongjing did not prescribe medication based solely on its cold or hot nature. I firmly believe in and cherish ancient methods. Consequently, for patients who are thirsty but lack heat signs, I administered Shigao (Gypsum Fibrosum) preparations; the illness resolved without adverse effects. During the intense heat of summer, there were cases of severe thirst with unquenchable drinking desire. Having them consume Shigao (Gypsum Fibrosum) powder stopped the excessive thirst and irritability immediately, without adverse effects. This demonstrates that Shigao (Gypsum Fibrosum) for treating thirst is not something to fear.
Tao Hongjing stated: "Shigao (Gypsum Fibrosum) induces sweating." This is an unsubstantiated claim and cannot serve as public consensus. Zhang Zhongjing made no such statement. It is likely that when Tao used Shigao (Gypsum Fibrosum), its action directed downwards causing purgation, thus creating situations where non-purgatives caused purgation, and non-diaphoretics caused sweating. This is a variation, not the norm. What principle is this? Imagine a thief on the beam; household members search everywhere. If he exits from the right, following the direction makes escape difficult; if he crosses to the left, going against the direction makes escape easy. Even if contrary, one follows the path of ease. The toxicity of drugs is similar. Zhang Zhongjing said: "When administering Chaihu Tang (Bupleurum Decoction), there will inevitably be shivering and trembling, followed by fever, sweating, and resolution." Tao's statement about Shigao (Gypsum Fibrosum) inducing sweating is likely of this same category. Tao did not understand this and considered it a diaphoretic agent, which is excessive. Later generations regarded Shigao (Gypsum Fibrosum) as a harsh drug and feared it excessively; this is the fault of ignorance. Zhang Zhongjing’s dosage of Shigao (Gypsum Fibrosum) was often greater than other herbs; half a jin to one jin. This is likely due to its thin flavor and qi.
I once treated the illness of Feng Dafu, a minister of the Aoyama domain. His condition involved toxins attaching to the seventh through eleventh vertebrae of the spine, causing unbearable pain. Upon onset, he experienced chest and diaphragm oppression with thirst; severely, he would faint and lose consciousness. This had persisted for years. One day, a severe attack occurred. Other physicians considered it a major deficiency and prescribed Dushen Tang (Single Ginseng Decoction), applying two qian, taken three times daily. After six days, there was no improvement. All physicians believed death was inevitable. The family summoned me to diagnose. The pulse was imperceptible, resembling death, but upon palpating the chest, I perceived slight oppression. I prepared Shigao Huanglian Gancao Tang (Gypsum, Coptis, and Licorice Decoction) for him. One dose weighed thirty-five qian. Boiled in one cup and six fen of water until reduced to six fen, it was taken all at once. From dusk till dawn, he completed three doses, totaling one hundred five qian. By dawn, his condition suddenly cleared as if waking from a dream. The next day, I bid farewell and returned to the capital. The patient said, "If we part now, I cannot bear it. Allow me to accompany you, serving you morning and night." We returned to the capital together. I continued using Shigao (Gypsum Fibrosum) as before. After residing for seventy to eighty days, he reported recovery. This shows that Shigao (Gypsum Fibrosum) is not a harsh drug and need not be feared.
Product Examination:
Shigao (Gypsum Fibrosum): Produced everywhere in our country. Most abundant in California and Aomori Prefecture. It exists in hard and soft varieties. The soft variety is superior. *Bi Lu* states: Those with fine texture and bright white luster are good. Lei Xiao stated: Its color is crystal clear like water essence. Li Shizhen stated: White ones are clean with fine, short, dense textures like bundled needles. I have verified: The method of mining stone medicines considers the bottom layer best, as it has been there longer and can transform. Mining from the top yields shapes like rice cakes; mining from the bottom yields crystals clear like water essence, which is the superior grade. The method of use is simply to crush it. In recent times, Fire Spirit School practitioners use it because they consider its nature cold. I do not accept this speculation. Generally, the method of processing medicine is: if processing doubles the toxicity, process it; if removing toxicity, do not process it, because outside of toxicity, there is no other effect. Among various medicines, those that should be processed have detailed processing instructions; those not processed remain so, and the following emulate this practice.