心热则烦，骨热则躁。〕左手脉洪大盛。
柴胡〔肝胆主药，又为心包、三焦引经之药，故以为君。三钱。〕 丹皮〔清热，心包引经
报使之药，故以为臣。一钱。〕 独活〔七分。〕 防风〔一钱。〕 川芎〔七分。〕 淡豉〔
三钱。〕 生香附〔皆疏表之药，君以柴胡，臣以丹皮，则能同入心包而散风热之邪。二钱。〕 苏叶
〔固无汗，用以开腠。一钱。〕 炙甘草〔和中五分。〕引用姜枣。〔温服，服后取吐，微汗
出愈。若未吐而不愈，服之三。四剂自效。〕心中动甚而烦躁者，加生地、麦冬、丹参、玄参。发疹加葛
根、薄荷、荆芥、牛蒡子。
按此方治三、四、五月感冒时令温邪，疏表之剂。表症未解，而复见里症者，皆当以本方柴胡、丹皮
为主，余任去留，另加对症之药治之。治热病之法亦如是，但以柴胡、丹皮为主。
柴胡骨皮汤 治芒种以后，手少阳相火司令，感冒热邪，三焦经络受病，头痛发热恶风。〔邪气壅
逆故头痛。手经发
热，不似足经，惟显忽热忽不热，即是温热之病。邪风在于表，故恶风。〕自汗，〔风火侵入，扰乱阴
气故也。〕目锐 连耳后痛，耳鸣耳聋，晕眩咽痛，〔三焦脉从耳后入耳中，却出至目锐 。因热气
为之拂郁，故为痛为鸣，为聋为眩。火气搏结，故咽痛。〕肩 肘臂外廉皆痛。〔经脉所过，皆为不
利。〕或烦躁发斑。〔三焦脉络心包，故发烦躁。〕右手脉洪而盛。
柴胡〔三焦药也。三钱，〕 骨皮〔清热，三焦引经报使之药。一钱五分。〕 防风〔一
钱。〕 川芎〔七分。〕 淡豆豉〔三钱。〕 生香附〔君以柴胡，臣以丹皮，亦遂同入三焦，
解散热邪，二钱。〕 甘草〔五分，炙。服后以指探取吐，春夏阳气在上，因其高而越之也，如未愈，
连服二、三剂。〕汗多，去生香附，加白芍，不止，再加生黄 。〔如兼烦躁发斑等症，则大忌之。〕耳
聋，加连翘。〔直入三焦清热。〕眩晕，加天麻。咽痛，加元参、薄荷、桔梗，甚者，再加山豆根。
烦躁、加知母、花粉、元参，更甚者，再加犀角。烦闷咳呕足冷，是热邪传于肺胃，发斑之候。若欲出而
未出者，加葛根、薄荷、荆芥、牛蒡。〔以升发之，已见斑者，不宜再发。〕若里热炽盛，再加犀角、
石膏。胸中满痞闷，〔邪与痰合，壅塞气道故也。凡外邪传里，必先胸次胁，而入胃矣，〕加枳、桔，未
效，合小陷胸汤治之。呕吐，〔火邪挟木乘胃，气逆故也。〕宜以竹茹、枇杷叶，甚者，再加芦根汁。如
挟痰饮而呕吐者、则加半夏、黄连、竹茹。腹痛，加枳实、橘红。自利，去淡豆豉，合天水散，加芩、
连、葛根之属。或热甚渴甚，加寒水石。〔仲景云，此
症往往夏末秋初，沿门阁境，患者头痛发热，烦躁口渴 下利溺涩，甚者昼夜百行，或兼发斑疹。世人
妄称漏底，殊不知此肠脾胃素蕴湿热，复与时令热邪相合所致，法宜清热解毒表散，切忌下行破气
收涩，犯者不救。〕
按此方治夏至前后各一月，感冒时令热邪，需散表之剂。以上所列症，因表邪未解，故于疏表方
中，加以对症之药，如表解而见某症，即用某症之药治之。又如温病时令，而见热症，热病时令，而
见温症，有温热症并见者，或应热反凉，感冒风寒，而见风寒症者，或天阴久雨，外感湿气，而见湿症
者，或酷暑横流，触冒暑邪，而见暑症者，必审察明白，即随所见之症，用药施治。全在活法，不可固
执。
葛根汤〔自制〕治正阳明经病，头痛额痛，〔胃脉循发际至额颅。〕壮热，〔胃主肌肉，故身
热尤甚。〕目痛鼻干，〔胃脉挟鼻络于目故也。〕不得卧，〔胃不和则卧不安。〕无汗。〔津液燔灼，故
汗难于达外。〕 葛根〔甘平，阳明解表之主药。二、三钱。不呕无汗可用，呕则邪火上逆，不宜
升散也。〕 淡豆豉〔三、五钱。〕 薄荷〔豉之苦甘，荷之辛凉，皆能解肌发汗。钱许。〕 麦冬
〔三、五钱。〕 知母〔生津，二、三钱。〕 黄芩〔清热。佐以三味，庶葛根无大开肌肉之患。
三钱。〕 甘草〔八分。〕
此方辛凉解表之剂，乃养汗以开玄府，与开玄府以出汗之法，迥乎不同。盖邪入皮毛，即玄府
闭，内气不得泄而生热，非风寒能变热也。但风寒初客，热未久而经中津液未伤，宣其皮毛则玄府开而邪
随汗散。若表不解，入客肌肉经
络之中，是谓邪在中，壅热日久，经中津液燔灼，汗难达外，昧者徒用风热之药发表，益助热耗
阴，而不得汗。仲景解肌和解之法，只用辛凉清解热邪，津液充而汗自涌出肌表。况阳明禁汗，若大开
其肌肉，津液尽从外泄，则胃气愈燥而阴立亡矣。
竹叶石膏汤〔即白虎汤加竹叶、麦冬。〕治足阳明胃腑受病，喜凉恶热，自汗烦躁，〔邪入于
内，故不恶寒而反恶热，热蒸腾达，故自汗。热盛于表，则手足躁扰；热盛于里，则神志烦躁。〕口渴
饮冷，〔胃热炽盛，津液耗竭故也。〕咽燥唇裂，〔胃中热极所致。〕舌苔芒刺，〔舌为心苗，胃热
冲心，心热则舌上津液结而苔。〕谵语潮热，〔热极神昏，故发谚语。潮热者，以潮水之有信，独于申
酉戌为阳明旺时发热也，〕甚则发呃，〔热气壅郁，气不得通而成。〕发厥，〔厥谓手足逆冷也。阳厥
必小便短赤，口渴饮冷。〕发斑发狂，脉洪大者。大便不硬，或虽硬而腹无所苦，此汤主之。〔解热止渴
生津而退胃热。若兼上症而不大便六、七日，绕脐痛，或腹满痛，手不可按，转矢气者，此胃家实
之的据，有燥粪也，当以承气汤下之。〕
石膏〔最清脾胃之火，欲借其大寒之性，行西方金神白虎清肃之令，而除其炎热。一两至四
两。〕 知母〔除烦躁，止消渴。三钱至一两五钱。〕 甘草〔缓其速下。八分至三钱。〕 粳
米〔培其胃气，恐大寒则伤胃气也。〕 麦冬〔生其津液，热极必伤津液也。五钱至二两。〕 竹叶
〔涤除烦热，五十片至二百片。〕人虚脉弱者，可加人参。〔助胃中
天真之气。〕心下硬满，〔邪未入腹不可攻之。〕加桔梗、枳壳、黄连、蒌实。烦躁谵语，加犀角。
甚者再加黄连。舌苔亦如之。发呃加竹茹。呕者，加竹茹、枇粑叶，芦根汁。
此甘寒清热之剂。仲景以白虎汤加人参，治服表药大汗出后，大烦渴不解，脉洪大者。大汗出则
津液外亡，大烦渴，内热极。又治渴欲次水，无表症者，谓无头痛发热恶寒身疼无汗等症也。又治伤
寒无大热，口燥渴心烦，背微恶寒者，无大热，表热已少；燥渴心烦，是里热偏多；背微恶寒，是表
邪将罢，比通身恶寒不同。里热炽盛，急当清解。又治伤寒吐下后七、八日不解，热结在里，表里俱
热，时时恶风，大渴，舌上干燥而烦，欲饮水数升者。里热炽盛，不急清解，则津液立竭，所以在表
微风，不必拘泥；况表风原不禁白虎汤也。但此汤必渴欲饮冷者方服之。饮冷之法，不可不与，亦不可
过与。〔梨汁、藕汁、蔗浆、西瓜皆可与之〕。不大渴者，里热尚微，不能消水，不可服也。若失血
家发热微汗，口渴心烦，甚至目赤面红，六脉豁大空虚，谓之血虚发热，当以六味地黄汤加减治之，
误服白虎者死。仲淳云∶伤寒温热，时疫诸病，三阳症中，往往多带阳明者，以手阳明大肠与肺为表
里，同开窍于鼻，足阳明胃与脾为表里，同开窍于口，凡邪气必从口鼻而入，故兼阳明症者独多，不
可不知。此方投之得当，其效如神。按∶吴又可言阴症为罕有之病，阳症似阴者，比比皆是。盖伤寒温
热瘟疫
诸病，传入胃家，阳气内郁，不能外布，即便四逆。若肥盛之体，尤易壅闭；亢阳已极，遂通身
如冰；因热极气道壅闭，遂脉微欲绝，所谓阳厥也。仲景云∶热深者厥亦深，热微者厥亦微。故微
者但手足冷，深者冷过肘膝，脉沉而微。更剧则通身冰冷，甚或指甲青黑，肌肤血凝，青紫成片，六
脉无力，或微或绝。以上脉症，悉似真阴，审其内症，必气喷如火，咽干口臭，舌苔芒刺，渴欲冷
饮，谵语太息，喜凉恶热，心腹胀满，按之痛甚，大便燥结，或协热下利，或热结傍流，必臭秽殊常，
小便赤涩作痛，若误引节庵冷过肘膝，便是阴症，及脉有力为阳，无力为阴之说，而竟投附子
理中四逆等汤，下咽必毙。夫温热瘟疫，热病也，从无感寒，阴自何来？即传经伤寒，亦系阴病，与
直中阴经不同，何得一见厥冷，便疑为冷症耶？
竹叶石膏汤加竹茹、芦根。治胃中热气壅郁，气逆发呃，或再加枳实、栝蒌。
此方以清胃热降逆气为主。按发呃一症，有因热因寒，因痰因食，因瘀血，因大虚之不同，须以别
症相参施治。如因胃中痰饮所阻，气逆而呃者，二陈汤加旋复代赭石治之。若因胃中饮食所阻，气逆而
呃者，沉、砂、枳、橘、青皮、槟榔之属。若因胃中实热，失下而呃，大便不通，脉来有力者，当用承
气汤下之。若因胃中热，瘀血而呃者，犀角地黄汤加降香、玉金、桃仁、羚羊角之属。如阴伤胃而
呃，或冷气逆上者，丁香、柿蒂、沉、砂、吴茱萸之属，甚
者，加桂，附，挟虚者再加人参。若因吐下后，及久病产后，老人虚人，阴气大亏，阳气暴逆，自脐
下直冲至胸嗌间而呃者，最凶之兆。在热病中，大概属热实者居多，或清或下，随宜用药，凡呃声重者
可治，呃声轻者不治。经曰∶病深者其声哕是也。
竹叶石膏化斑汤 治发疹发斑。疹属少阴，小红点行于皮肤之中，或不出者，或出而随没，又随
出者。班属少阳，大红点显于皮肤之上，势甚者，发热一、二日即出，六、七日乃退；势缓者，发热四、
五日方出，一、二日即退。有随出随退者，有发过再发者。有稀疏几点者为轻，有稠密如麸者为重。实时
令热邪，传于肺胃，而发为斑疹。盖斑重而疹轻也。斑疹已见者，通用此治之。
竹叶石膏汤〔清解肺胃之邪热。〕 加犀角〔散邪清热，凉血解毒。〕 元参〔壮水制
火。〕斑盛加青黛，热毒内盛，合黄连解毒汤。〔量症轻重制剂大小，中病即止，勿使太过。〕咳嗽加
贝母花粉，〔自初发以至发后，总以清热消痰为治。〕喘者〔热邪壅肺故也。〕加桑皮、茅根、栝蒌
实。
按斑疹及小儿痧痘，皆属肺胃火热，不必根据症施治，惟宜治本，解二经之邪热，则诸症自退，斑之
方萌，与蚊迹相似，发斑多见于胸腹，蚊迹多见于四肢。病患昏 ，先红后赤者斑也；病患安静，先红
后黄者，蚊迹也。须看斑色鲜红者吉，紫赤者险，淡白者危，黑色者死。斑既发出，须得脉洪数有力，身
温足温易治；若脉沉小足冷，元气虚弱者难医。滑伯仁曰∶脉者血气之波澜，发斑则血散于肌肤，故
脉小或绝无。凡斑欲出未出之时，治宜清凉辛散为主，最忌酸
收，误施温补，祸不旋踵。药用葛根散阳明之郁火，薄荷解太阴之风热，荆芥散风热，治疮毒，牛蒡
开毛窍，除热毒。总以透斑为主。如里热炽盛，可加犀角，寒而不滞，其性走散故也。或合白虎汤，
俟斑透，即以化斑汤加减治之。若人虚脉弱者少加人参，参本肺热所忌，不得已而用之，以扶元
气，而兼化斑。斑症慎勿发汗，汗则斑烂。又不可下，下则斑毒内陷，症反变剧。若大便燥结，以元
明粉润之，或用猪胆汁导之。凡发斑吐泻者多吉；以阳明之热得解，即表里分消之义也。治泻慎勿止
泻，惟用黄连、茯、甘、升、葛之属，则泻自止。如便脓血，是热邪下陷也，大忌止涩，宜芩
连以清热毒，茯、甘以调脾胃，升、葛以散热邪，加滑石末调服，取其行积滞，逐凝血也。
竹叶石膏汤加犀角、金汁 治热邪传胃冲心，神乱发狂，妄言骂詈，不避亲疏。〔神明昏乱故
也。〕甚则弃衣而走，〔热盛于身也。〕登高而歌，逾垣上屋，〔阳邪刚盛，故履步失常，〕目赤唇
焦，舌干齿燥，大渴饮水，小便短赤，〔皆里热炽盛之所致，〕大便不结者，〔肠胃热盛，而传化失
常也。〕急以此汤大剂频频灌之。
竹叶〔一百五十片。〕 石膏〔四两。〕 知母〔一两五钱。〕 甘草〔五钱。〕 麦
冬〔二两。〕 犀角尖〔凉心清热，一两。〕 金汁〔治阳毒发狂，陈久者一大杯。〕
此方治足阳明胃实发狂，便不结者用之。如大便不通，当用承气汤急下之。凡发狂难制，以醋泼火
炭上，烟冲入
鼻即安。一切热病热邪传里，亢极无解，用黄连一两，或芒硝煎水，井中顿冷，浸新青布搭胸上，热
即换之，热势稍退即除去，床前宜置冰水。行此法者，水可以灭火，寒可以除热，外可以安内。经曰∶
水行渍之，和其中和，可使毕已。此之谓也。
三黄石膏汤 治热病壮热，无汗烦躁，〔壮热无汗，表未解也。兼见烦躁渴炊等症，是表里热
盛，故津耗无汗。〕鼻干面红，〔阳明火邪，上行燎面。经云∶面热者胃病也。〕目赤唇焦，舌干齿
燥〔胃脉入上齿中故也。〕大渴饮水，狂叫欲走，脉洪而数。
When the Heart is hot, vexation (restlessness of mind) occurs; when the bones are hot, agitation (restlessness of body) occurs. The pulse on the left hand is surging (Hong), large, and vigorous.
Chai Hu (Bupleuri Radix): It is the principal herb for the Liver and Gallbladder, and also a guiding herb for the Pericardium and San Jiao (Triple Burner); therefore, it serves as the Sovereign (Jun). Dosage: 3 qian.
Dan Pi (Moutan Cortex): It clears heat and is a guiding messenger herb for the Pericardium; therefore, it serves as the Minister (Chen). Dosage: 1 qian.
Du Huo (Angelicae Pubescentis Radix): Dosage: 7 fen.
Fang Feng (Saposhnikoviae Radix): Dosage: 1 qian.
Chuan Xiong (Ligustici Chuanxiong Rhizoma): Dosage: 7 fen.
Dan Chi (Fermented Soybean): Dosage: 3 qian.
Sheng Xiang Fu (Cyperi Rhizoma): These are all herbs that disperse exterior pathogens. With Chai Hu as Sovereign and Dan Pi as Minister, they can jointly enter the Pericardium to dissipate wind-heat pathogens. Dosage: 2 qian.
Su Ye (Perillae Folium): If there is no sweating, it is used to open the cou li (pores and interstices). Dosage: 1 qian.
Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle): Harmonizes the Middle Jiao. Dosage: 5 fen.
Reference: Jiang Zao (Fresh Ginger and Jujube). Take warm. After ingestion, induce vomiting. Recovery occurs with slight sweating. If vomiting does not occur and the disease persists, take three or four doses, and efficacy will naturally follow. If there is severe palpitation in the heart accompanied by vexation and agitation, add Sheng Di Huang (Rehmanniae Radix), Mai Dong (Ophiopogonis Radix), Dan Shen (Salviae Miltiorrhizae Radix), and Xuan Shen (Scrophulariae Radix). If macules/papules appear, add Ge Gen (Puerariae Lobatae Radix), Bo He (Menthae Haplocalycis Herba), Jing Jie (Schizonepetae Spica), and Niu Bang Zi (Arctii Fructus).
Note: This formula treats seasonal warm pathogens contracted during the third, fourth, and fifth lunar months; it is an agent for dispersing the exterior. If the exterior syndrome remains unresolved but interior syndromes appear, one should primarily use Chai Hu and Dan Pi from this formula, retaining or discarding other herbs as appropriate, and adding specific symptomatic herbs. The method for treating febrile diseases is similar, prioritizing Chai Hu and Dan Pi.
Chai Hu Gu Pi Tang (Bupleurum and Moutan Decoction): Treats conditions after the Mang Zhong solar term, when the Shaoyang Ministerial Fire is in command. Contracting heat pathogens leads to disease in the Shaoyang San Jiao meridians, presenting with headache, fever, and aversion to wind. (Headache results from pathogenic qi stagnation and rebellion. Fever in the Hand meridians differs from Foot meridians, manifesting as intermittent fever, characteristic of warm-heat diseases. Wind-pathogen in the exterior causes aversion to wind.) Spontaneous sweating (caused by wind-fire invading and disturbing Yin qi). Pain connecting the outer canthus to behind the ear, tinnitus, deafness, dizziness, and sore throat. (The San Jiao meridian enters the ear from behind and emerges at the outer canthus. Heat qi stagnation causes pain, ringing, deafness, and dizziness. Fire qi binding causes sore throat.) Pain in the shoulder, elbow, and lateral arm. (Discomfort in areas traversed by the meridians.) Or vexation and appearance of macules (ban). (San Jiao meridians connect to the Pericardium, causing vexation.) The pulse on the right hand is surging (Hong) and vigorous.
Chai Hu (Bupleuri Radix): Herb for the San Jiao. Dosage: 3 qian.
Gu Pi (Moutan Cortex): Clears heat and is a guiding messenger herb for the San Jiao. Dosage: 1.5 qian.
Fang Feng (Saposhnikoviae Radix): Dosage: 1 qian.
Chuan Xiong (Ligustici Chuanxiong Rhizoma): Dosage: 7 fen.
Dan Dou Chi (Fermented Soybean): Dosage: 3 qian.
Sheng Xiang Fu (Cyperi Rhizoma): With Chai Hu as Sovereign and Dan Pi as Minister, they enter the San Jiao to resolve and dissipate heat pathogens. Dosage: 2 qian.
Gan Cao (Glycyrrhizae Radix et Rhizoma): 5 fen, prepared with honey. After taking, induce vomiting by probing the throat with fingers. In spring and summer, Yang qi is superior;顺应 its high position to vent it. If not cured, take two or three consecutive doses. If sweating is excessive, remove Sheng Xiang Fu and add Bai Shao (Paeoniae Radix Alba); if sweating persists, add Sheng Huang Qi (Astragali Radix). (Contraindicated if accompanied by vexation and macules.) For deafness, add Lian Qiao (Forsythiae Fructus), which directly enters the San Jiao to clear heat. For dizziness, add Tian Ma (Gastrodiae Rhizoma). For sore throat, add Yuan Shen (Scrophulariae Radix), Bo He (Menthae Haplocalycis Herba), and Jie Geng (Platycodonis Radix); for severe cases, add Shan Dou Gen (Sophorae Tonkinensis Radix). For vexation, add Zhi Mu (Anemarrhenae Rhizoma), Hua Fen (Trichosanthis Radix), and Yuan Shen (Scrophulariae Radix); for more severe cases, add Xi Jiao (Rhinocerotis Cornu). Vexation, oppression, cough, vomiting, and cold feet indicate heat pathogen transmitting to the Lung and Stomach, a precursor to macules. If macules desire to emerge but have not, add Ge Gen (Puerariae Lobatae Radix), Bo He (Menthae Haplocalycis Herba), Jing Jie (Schizonepetae Spica), and Niu Bang Zi (Arctii Fructus) to promote emergence. Once visible, do not force emergence again. If interior heat is blazing, add Xi Jiao (Rhinocerotis Cornu) and Shi Gao (Gypsum Fibrosum). Chest fullness and oppression result from pathogen combining with phlegm, blocking airways. Exterior pathogens transmitting inward first block the chest and hypochondrium before entering the Stomach. Add Zhi Shi (Aurantii Fructus Immaturus) and Jie Geng (Platycodonis Radix); if ineffective, combine with Xiao Xian Xiong Tang (Minor Sinking Thorax Decoction). Vomiting results from fire pathogen and Wood overacting on Stomach, causing rebellious Qi. Use Zhu Ru (Bambusae Caulis in Taenia) and Pi Pa Ye (Loquat Leaf); for severe cases, add Lu Gen Juice (Reed Rhizome Juice). If vomiting is due to phlegm-fluids, add Ban Xia (Pinelliae Rhizoma), Huang Qin (Scutellariae Radix), and Zhu Ru (Bambusae Caulis in Taenia). For abdominal pain, add Zhi Shi (Aurantii Fructus Immaturus) and Ju Hong (Citri Reticulatae Pericarpium). For spontaneous diarrhea, remove Dan Dou Chi (Fermented Soybean), combine with Tian Shui San (Heavenly Water Powder), and add Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), and Ge Gen (Puerariae Lobatae Radix). For severe heat and thirst, add Han Shui Shi (Halloysit Rubra). Zhang Zhongjing stated: This condition often occurs in late summer and early autumn, spreading through neighborhoods. Patients suffer headache, fever, vexation, thirst, diarrhea, and dysuria. Severe cases may have hundreds of bowel movements daily or develop macules/rashes. Laypeople mistakenly call this "leaky bottom," not realizing it is caused by pre-existing damp-heat in the intestines, stomach, and spleen combined with seasonal heat pathogens. Treatment should clear heat, detoxify, and disperse the exterior. Avoid downward-draining, Qi-breaking, or astringent herbs; violating this leads to death.
Note: This formula treats seasonal heat pathogens contracted around the Summer Solstice (one month before and after). It is a dispersing exterior agent. The listed symptoms arise because the exterior pathogen is unresolved; thus, symptomatic herbs are added to the exterior-dispersing base. If the exterior resolves and specific symptoms appear, treat those symptoms. Similarly, if warm disease season presents with heat symptoms, or heat disease season presents with warm symptoms, or both appear together, or if cooling follows heating (wind-cold contraction with wind-cold symptoms), or if rainy weather brings dampness (damp symptoms), or if extreme heat brings summerheat (summerheat symptoms), one must examine carefully and treat according to observed symptoms. Flexibility is key; do not be rigid.
Ge Gen Tang (Pueraria Decoction) [Self-made]: Treats Zheng Yangming Meridian disease, with headache and frontal pain. (Stomach meridian runs along hairline to forehead.) High fever. (Stomach governs muscles, so body heat is especially severe.) Eye pain and dry nose. (Stomach meridian flanks nose and connects to eyes.) Inability to sleep. (When Stomach is disharmonious, sleep is uneasy.) No sweating. (Fluids are scorched, making sweat difficult to reach the exterior.)
Ge Gen (Puerariae Lobatae Radix): Sweet and neutral, principal herb for resolving Yangming exterior. Dosage: 2-3 qian. Suitable for no vomiting and no sweating. If vomiting occurs, pathogenic fire rebels upward, so ascending/dispersing is unsuitable.
Dan Dou Chi (Fermented Soybean): Dosage: 3-5 qian.
Bo He (Menthae Haplocalycis Herba): The bitter-sweet of Dou Chi and pungent-cool of Bo He both resolve muscle layer and induce sweating. Dosage: approx. 1 qian.
Mai Dong (Ophiopogonis Radix): Dosage: 3-5 qian.
Zhi Mu (Anemarrhenae Rhizoma): Generates fluids. Dosage: 2-3 qian.
Huang Qin (Scutellariae Radix): Clears heat. Adding these three prevents Ge Gen from excessively opening muscles. Dosage: 3 qian.
Gan Cao (Glycyrrhizae Radix et Rhizoma): Dosage: 8 fen.
This is a pungent-cool exterior-resolving agent. It nourishes sweat to open the xuan fu (pores), differing significantly from methods that open pores to induce sweating. When pathogen enters skin/hair, xuan fu closes, internal Qi cannot vent, generating heat; this is not wind-cold turning into heat. Initially, when wind-cold invades briefly and meridional fluids are undamaged, dispersing skin opens xuan fu, allowing pathogen to scatter with sweat. If exterior remains unresolved, pathogen enters muscle/meridians ("pathogen in middle"), stagnating heat burns meridional fluids, preventing sweat. Ignorant practitioners using pungent-warm herbs to release exterior only assist heat and consume Yin, failing to produce sweat. Zhang Zhongjing’s method of resolving muscle and harmonizing uses only pungent-cool herbs to clear heat; when fluids are sufficient, sweat naturally涌s out. Yangming prohibits sweating; excessively opening muscles drains fluids, drying Stomach Qi and destroying Yin instantly.
Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) [White Tiger Decoction plus Zhu Ye and Mai Dong]: Treats Zu Yangming Stomach Fu disease, characterized by preference for coolness and aversion to heat, spontaneous sweating, and vexation. (Pathogen enters interior, so no aversion to cold but aversion to heat; steaming heat causes sweating. Heat excess in exterior causes limb restlessness; heat excess in interior causes mental vexation.) Thirst for cold drinks. (Blazing Stomach heat consumes fluids.) Dry throat and cracked lips. (Extreme Stomach heat.) Thorny tongue coating. (Tongue is sprout of Heart; Stomach heat rushes to Heart, Heart heat coagulates tongue fluids forming coating.) Delirium and tidal fever. (Extreme heat causes confusion and delirium. Tidal fever refers to fever occurring at specific times—Shen, You, Xu hours—when Yangming is prosperous.) Severe cases may have hiccups. (Heat qi stagnation blocks Qi flow.) Jue (cold extremities). (Jue means reverse cold of hands/feet. Yang jue presents with short dark urine and thirst for cold drinks.) Macules, mania, and surging pulse. If stool is not hard, or even if hard but abdomen is painless, this decoction is indicated. (Resolves heat, stops thirst, generates fluids, reduces Stomach heat. If accompanied by above symptoms and constipation for 6-7 days, periumbilical pain, abdominal fullness/pain, tenderness to touch, and passing gas, this indicates Stomach excess with dry feces; use Cheng Qi Tang to purge.)
Shi Gao (Gypsum Fibrosum): Most effective at clearing Stomach/Spleen fire. Uses its great cold nature to execute the White Tiger’s metal-clearing decree. Dosage: 1-4 liang.
Zhi Mu (Anemarrhenae Rhizoma): Relieves vexation, stops thirst. Dosage: 3 qian - 1.5 liang.
Gan Cao (Glycyrrhizae Radix et Rhizoma): Slows rapid purgation. Dosage: 8 fen - 3 qian.
Jing Mi (Oryza Sativa): Nourishes Stomach Qi, fearing great cold damages Stomach Qi.
Mai Dong (Ophiopogonis Radix): Generates fluids, as extreme heat damages fluids. Dosage: 5 qian - 2 liang.
Zhu Ye (Bambusae Folium): Clears vexation-heat. Dosage: 50-200 leaves.
If patient is deficient with weak pulse, add Ren Shen (Ginseng Radix et Rhizoma) to assist True Qi of Stomach.
For sub-xiphoid hardness/fullness (pathogen has not entered abdomen, do not purge), add Jie Geng (Platycodonis Radix), Zhi Ke (Aurantii Fructus), Huang Lian (Coptidis Rhizoma), and Gua Lou Shi (Trichosanthis Fructus). For vexation and delirium, add Xi Jiao (Rhinocerotis Cornu); for severe cases, add Huang Lian (Coptidis Rhizoma). Tongue coating treated similarly. For hiccups, add Zhu Ru (Bambusae Caulis in Taenia). For vomiting, add Zhu Ru (Bambusae Caulis in Taenia), Pi Pa Ye (Loquat Leaf), and Lu Gen Juice (Reed Rhizome Juice).
This is a sweet-cold heat-clearing agent. Zhang Zhongjing used White Tiger Decoction plus Ren Shen to treat post-excessive sweating from exterior-resolving herbs, presenting with great vexation/thirst and surging pulse. Excessive sweating loses fluids; great vexation/thirst indicates extreme interior heat. Also treats thirst for water without exterior syndrome (no headache, fever, aversion to cold, body ache, or anhidrosis). Also treats Shanghan with little heat, dry mouth/thirst, vexation, and slight back aversion to cold. Little heat means exterior heat is subsiding; dry mouth/thirst/vexation indicates predominant interior heat; slight back aversion to cold means exterior pathogen is fading (different from whole-body aversion). Blazing interior heat requires urgent clearing. Also treats Shanghan after vomiting/purging, unresolved after 7-8 days, heat結 in interior, exterior-interior heat, occasional aversion to wind, great thirst, dry tongue with vexation, desire to drink several liters of water. Interior heat blazing requires urgent clearing to prevent fluid exhaustion; slight exterior wind need not constrain treatment, as exterior wind does not contraindicate White Tiger Decoction. However, this decoction is only for those desiring cold drinks. Cold drink intake should be moderate (pear juice, lotus root juice, sugarcane syrup, watermelon are suitable). Those not greatly thirsty have mild interior heat unable to process water; do not administer. For blood-loss patients with fever, slight sweat, thirst, vexation, red eyes/face, and empty/surging pulses (Blood Deficiency Fever), use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) modified. Misuse of White Tiger Decoction is fatal. Chen Xiuyuan noted: In Shanghan, warm diseases, and epidemics, Yangming syndrome often accompanies Taiyang, Yangming, and Shaoyang syndromes because Hand Yangming Large Intestine pairs with Lung (opening at nose), and Foot Yangming Stomach pairs with Spleen (opening at mouth); pathogens enter via mouth/nose, hence frequent Yangming involvement. Proper use of this formula is miraculous. Note: Wu Youke stated Yin syndromes are rare; Yang syndromes mimicking Yin are common. When Shanghan/warm diseases/epidemics transmit to Stomach, Yang Qi is internally depressed, unable to distribute outward, causing Jue (cold limbs). In obese individuals, obstruction is easier; extreme Yang causes whole-body coldness; extreme heat blocks Qi channels, causing faint pulse, called Yang Jue. Zhang Zhongjing said: Deeper heat, deeper Jue; milder heat, milder Jue. Mild cases have cold hands/feet; deep cases have cold past elbows/knees, deep/faint pulse. Worse cases have whole-body coldness, black/blue nails, coagulated blood, purple patches, powerless pulse. These resemble true Yin syndrome, but interior signs show fiery breath, dry mouth/bad odor, thorny tongue, thirst for cold, delirium, sighing, preference for cool/aversion to heat, abdominal fullness/tenderness, dry stool, or heat-induced diarrhea/marginal flow (foul-smelling), dark painful urine. Mistaking this for Yin syndrome based on cold limbs or pulse strength (strong=Yang, weak=Yin) and administering Fu Zi Li Zhong Tang or Si Ni Tang leads to death. Warm diseases are heat pathogens; how can Yin come? Even transmitted Shanghan is Yin disease, different from direct transmission to Yin meridians. Why suspect cold syndrome upon seeing cold limbs?
Zhu Ye Shi Gao Tang plus Zhu Ru and Lu Gen: Treats Stomach heat stagnation causing rebellious Qi and hiccups. May add Zhi Shi (Aurantii Fructus Immaturus) and Gua Lou (Trichosanthis Fructus).
This formula primarily clears Stomach heat and directs rebellious Qi downward. Hiccups vary by cause: heat, cold, phlegm, food, blood stasis, or severe deficiency. Differentiate and treat accordingly. Phlegm-fluid obstruction: Er Chen Tang plus Xuan Fu Dai Zhe Shi Tang. Food obstruction: Chen Xiang, Sha Ren, Zhi Shi, Ju Pi, Qing Pi, Bing Lang. Stomach excess heat with constipation and strong pulse: Cheng Qi Tang. Stomach heat with blood stasis: Xi Jiao Di Huang Tang plus Jiang Xiang, Yu Jin, Tao Ren, Ling Yang Jiao. Yin deficiency with cold Qi rebellion: Ding Xiang, Shi Di, Chen Xiang, Sha Ren, Wu Zhu Yu; severe cases add Gui Zhi, Fu Zi; deficiency adds Ren Shen. Hiccups rising from umbilicus to chest/throat after vomiting/purging, chronic illness, postpartum, or in elderly/deficient patients, indicating severe Yin deficiency and sudden Yang rebellion, is a dire sign. In heat diseases, most hiccups are heat-excess; treat with clearing or purging. Loud hiccups are treatable; quiet hiccups are untreatable. Classic says: Deep disease manifests as hiccups.
Zhu Ye Shi Gao Hua Ban Tang (Bamboo Leaf and Gypsum Macule-Resolving Decoction): Treats rashes and macules. Rash belongs to Shaoyin, appearing as small red dots within skin, sometimes not emerging, or emerging/disappearing/re-emerging. Macule (Ban) belongs to Shaoyang, appearing as large red spots on skin surface. Severe cases emerge 1-2 days after fever starts, recede 6-7 days later; mild cases emerge 4-5 days after fever, recede 1-2 days later. Some emerge and recede quickly; some recur. Sparse few dots are mild; dense like bran is severe. This is seasonal heat pathogen transmitting to Lung/Stomach, causing macules/rashes. Macules are heavier than rashes. For existing macules/rashes, use this formula generally.
Zhu Ye Shi Gao Tang (Clears Lung/Stomach heat pathogens).
Add Xi Jiao (Rhinocerotis Cornu): Disperses pathogen, clears heat, cools blood, detoxifies.
Add Yuan Shen (Scrophulariae Radix): Nourishes Water to control Fire.
For severe macules, add Qing Dai (Indigo Naturalis). For intense internal heat toxin, combine with Huang Lian Jie Du Tang (Coptis Detoxification Decoction). Adjust dosage based on severity; stop when illness is addressed, avoid excess.
For cough, add Bei Mu (Fritillariae Bulbus) and Hua Fen (Trichosanthis Radix). From onset to resolution, always clear heat and eliminate phlegm.
For wheezing (heat pathogen congesting Lung), add Sang Bai Pi (Mori Cortex), Mao Gen (Imperatae Rhizoma), and Gua Lou Shi (Trichosanthis Fructus).
Note: Macules, rashes, and pediatric measles/smallpox belong to Lung/Stomach fire. Do not treat symptoms alone; treat the root by clearing heat pathogens of these two meridians. Early macules resemble mosquito bites; macules favor chest/abdomen, mosquito bites favor limbs. Drowsy patient with red-to-dark-red progression has macules; quiet patient with red-to-yellow progression has mosquito bites. Prognosis: Bright red is auspicious; purple-red is dangerous; pale white is critical; black is fatal. After emergence, surging-rapid-strong pulse and warm body/feet indicate easy treatment; sunken-small pulse and cold feet with weak Yuan Qi indicate difficult treatment. Hua Bolin said: Pulse is wave of blood/Qi; macules scatter blood into skin, so pulse becomes small or absent. While macules desire to emerge but have not, treat with cool-pungent dispersal. Strictly avoid astringents; mistaken warm-tonics bring swift disaster. Use Ge Gen (Puerariae Lobatae Radix) to disperse Yangming郁 fire, Bo He (Menthae Haplocalycis Herba) to resolve Taiyin wind-heat, Jing Jie (Schizonepetae Spica) to disperse wind-heat and treat sores, Niu Bang Zi (Arctii Fructus) to open pores and remove heat toxin. Main goal is to vent macules. If interior heat is blazing, add Xi Jiao (Rhinocerotis Cornu); it is cool but not stagnant, moving freely. Or combine with Bai Hu Tang (White Tiger Decoction); once macules vent, modify Hua Ban Tang. If deficient with weak pulse, add small amount of Ren Shen (Ginseng Radix et Rhizoma); although Ren Shen is contraindicated for Lung heat, use reluctantly to support Yuan Qi while resolving macules. Strictly avoid sweating in macule cases; sweating causes macule rot. Avoid purging; purging drives toxin inward, worsening condition. For dry stool, use Yuan Ming Fen (Mirabilite) to moisten, or Pig Bile enema. Vomiting/diarrhea with macules is auspicious; Yangming heat resolves, distributing exterior-interior. Do not stop diarrhea; use Huang Lian, Fu Ling, Gan Cao, Sheng Ma, Ge Gen to stop diarrhea naturally. For pus/blood in stool, heat pathogen has sunk; strictly avoid astringents. Use Qin-Lian to clear heat toxin, Fu-Gan to harmonize Spleen/Stomach, Sheng-Ge to dissipate heat, plus Hua Shi powder to move stagnation and expel congealed blood.
Zhu Ye Shi Gao Tang plus Xi Jiao and Jin Zhi (Gold Juice): Treats heat pathogen transmitting to Stomach and rushing to Heart, causing mental chaos, mania, inappropriate speech/cursing regardless of kinship. (Spirit is confused.) Severe cases discard clothes and run, climb high, sing, jump walls/roofs. (Yang pathogen is vigorous, causing abnormal movement.) Red eyes, scorched lips, dry tongue/tooth, great thirst for water, short dark urine. (All due to blazing interior heat.) Stool not bound. (Intestinal/Stomach heat excess disrupts transportation.) Urgently administer large doses frequently.
Zhu Ye (Bamboo Leaf): 150 leaves.
Shi Gao (Gypsum Fibrosum): 4 liang.
Zhi Mu (Anemarrhenae Rhizoma): 1.5 liang.
Gan Cao (Glycyrrhizae Radix et Rhizoma): 5 qian.
Mai Dong (Ophiopogonis Radix): 2 liang.
Xi Jiao Jian (Tip of Rhinoceros Horn): Cools Heart, clears heat. 1 liang.
Jin Zhi (Gold Juice): Treats Yang toxicity and mania; aged is best, 1 large cup.
This formula treats Yangming Stomach excess causing mania with unbound stool. If stool is bound, urgently use Cheng Qi Tang to purge. For uncontrollable mania, pour vinegar on hot charcoal; smoke entering nose calms immediately. For all heat diseases with interior-transmitted heat, extreme and unresolvable, use 1 liang Huang Lian (Coptidis Rhizoma) or Mang Xiao (Natrii Sulfas) boiled in well-water, cooled, soak fresh blue cloth, apply to chest, replace when hot. Remove when heat subsides slightly. Place ice water near bed. Water extinguishes fire, cold removes heat, external application calms internal state. Classic says: Water immersion harmonizes neutrality, bringing completion. This is the meaning.
San Huang Shi Gao Tang (Three Yellows and Gypsum Decoction): Treats heat disease with high fever, no sweating, and vexation. (High fever/no sweating indicates unresolved exterior. Accompanied by vexation/thirst, indicating exterior-interior heat excess, consuming fluids causing no sweat.) Dry nose, red face. (Yangming fire pathogen rises to face. Classic: Face heat indicates Stomach disease.) Red eyes, scorched lips, dry tongue/tooth. (Stomach meridian enters upper teeth.) Great thirst for water, screaming, desire to run, surging-rapid pulse.