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。
白虎汤治结热在里之剂，先示所禁，后明所用，见白虎为重，则不可轻用也。脉浮、发热、无汗，麻黄证
尚在，即是表不解；更兼渴欲饮水，又是热入里。此谓有表里证，当用五苓，多服暖水发汗矣。若外热已解，是
无表证。但渴欲饮水，是邪热内攻。热邪与元气不两立，急当救里，故用白虎加人参以主之。若表不解而妄用之，
热退寒起，亡可立待矣。
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。
前条详证，此条详脉。全注见桂枝篇。
伤寒无大热，口燥渴，心烦，背微恶寒者，白虎加人参汤主之。
伤寒六七日，无大热，其人躁烦，为阳去入阴。此虽不躁而口渴心烦，阳邪入里明矣。无大热，指表言，
见微热犹在；背微恶寒，见恶寒将罢。此虽有表里证，而表邪已轻，里热已甚，急与白虎加人参汤，里和而表
自解矣。
伤寒若吐若下后，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，
白虎加人参汤主之。
伤寒七八日尚不解者，当汗不汗，反行吐下，是治之逆也。吐则津液亡于上，下则津液亡于下。表虽不解，
热已入于里矣。太阳主表，阳明主里，表里俱热，是两阳并病也。恶风为太阳表证未罢，然时时恶
风，则有时不恶，表将解矣，与背微恶寒同。烦躁、舌干、大渴为阳明证，欲饮水数升，里热结而不散，急当
救里以滋津液。里和表亦解，故不须两解之法。
阳明病，若渴欲饮水，口干舌燥者，白虎加人参汤主之。
白虎所治，皆阳明燥证，揭为阳明主方，信为有见。
三阳合病，腹满，身重，难以转侧，口不仁而面垢，遗尿。发汗则谵语，下之则额上汗出、手足冷。若自汗
出者，白虎汤主之。
此本阳明病，而略兼太、少也。胃气不通，故腹满。阳明主肉，无气以动，故身重。难以转侧者，少阳行
身之侧也。口者，胃之门户。胃气病，则津液不能上行，故不仁。阳明病则颜黑，少阳病则面微有尘，阳气不荣
于面，故垢。膀胱不约为遗溺遗尿者，太阳本病也。虽三阳合病，而阳明证多，则当独取阳明矣。无表证则不
宜汗，胃未实则不当下。此阳明半表里证也。里热而非里实，故当用白虎，而不当用承气。若妄汗则津竭而
谵语，误下则亡阳而额汗出、手足厥也。此自汗出，为内热甚者言耳，接遗尿句来。若自汗而无大烦大渴证，无洪
大浮滑脉，当从虚治，不得妄用白虎。若额上汗出、手足冷者，见烦渴、谵语等证与洪滑之脉，亦可用白虎汤。
三阳合病，脉浮大在关上，但欲睡眠，合目则汗。
上条言病状及治方，此条详病脉、探病情、究病机，必两条合参，而合病之大要始得。脉大为阳，关上阳
所治也，是为重阳矣。但欲睡眠，是阳入于阴矣。合目则卫气行阴，而兼汗出，热淫于内矣。与上文自汗同，与
少阴脉微细而但欲寐不同。
伤寒脉浮滑，此表有热、里有邪，白虎汤主之。
此条论脉而不及证，因有白虎汤证，而推及其脉也。勿只据脉而不审其证。脉浮而滑为阳，阳主热。《内
经》云∶“脉缓而滑曰热中”。是浮为在表，滑为在里。旧本作里有寒者误。此虽表里并言，而重在里热，所谓
结热在里，表里似热者也。
伤寒脉滑而厥者，里有热也，白虎汤主之。
脉微而厥为寒厥，脉滑而厥为热厥。阳极似阴之证，全凭脉以辨之。然必烦渴引饮，能食而大便难，乃为里有
热也。
白虎汤∶
石膏（一斤，碎绵裹） 知母（六两） 甘草（二两） 粳米（六合）
水一斗，煮米熟汤成，温服一升，日三服。
白虎加人参汤∶
前方加人参（三两）。余同前法。
《经》曰“火生苦。”又曰∶“以苦燥之”。又曰∶“味过于苦，脾气不濡，胃气乃浓。”以是知苦从火
化。火能生土，则土燥火炎，非苦寒之味所能治矣。《经》曰∶“甘先入脾。”又曰∶“以甘泻之。”又
曰∶“饮入于胃，输精于脾，上归于肺，水精四布，五经并行。”以是知甘寒之品，乃泻胃火生津液之上剂也。
石膏大寒，寒能胜热，味甘归脾，质刚而主降，备中土生金之体，色白通肺，质重而含脂，具金能生水之用，故
以为君。知母气寒主降，苦以泄肺火，辛以润肺燥，内肥白而外皮毛，肺金之象、生水之源也，故以为臣。甘
草皮赤中黄，能土中泻火，为中宫舟楫，寒药得之缓其寒，用此为佐，沉降之性，亦得留连于脾胃之间矣。粳米
稼穑作甘，气味温和，禀容平之性，为后天养生之资，得此为佐，阴寒之物，则无伤损脾胃之虑也。煮汤入胃，
输脾归肺，水精四布，大烦大渴可除矣。白虎主西方金也，用以名汤者，秋金得令，而暑清阳解，此四时之序也。
更加人参，以补中益气而生津，协和甘草、粳米之补，承制石膏、知母之寒，泻火而火不伤，乃操万全之术者。
伤寒脉象浮，发热且无汗，表证尚未解除的，不可使用白虎汤。若口渴想喝水，且没有表证的，用白虎加人参汤主治。
白虎汤是治疗热邪结聚在体内的方剂，先指出禁忌，再说明适用情况，表明白虎汤药力沉重，不可轻易使用。脉浮、发热、无汗，说明麻黄汤证（麻黄汤主治的表实证）仍在，这就是表未解；再加上口渴想喝水，又是热邪入里。这属于有表里证的情况，应当使用五苓散，多饮暖水以发汗。如果外热已解，就是无表证。只是口渴想喝水，说明邪热内攻。热邪与人体元气不能共存，急需救里，所以用白虎加人参汤来主治。如果表证未解而误用此方，热退后寒象起，死亡就在眼前了。
服用桂枝汤后，大汗出之后，出现严重烦躁、口渴不解，脉象洪大的，用白虎加人参汤主治。
前一条详细论述症状，这一条详细论述脉象。全篇注释见桂枝汤篇。
伤寒病热度不高，口燥渴，心烦，背部微微怕冷的，用白虎加人参汤主治。
伤寒六七天，热度不高，病人躁动烦乱，这是阳气离去进入阴经的表现。这里虽然不躁动但口渴心烦，说明阳邪入里很明显。所谓“无大热”，是指从体表来看，还有微热存在；背部微微怕冷，说明怕冷的症状即将消失。这里虽然有表里证，但表邪已经很轻，里热已经很盛，急需给予白虎加人参汤，里气调和则表证自然解除。
伤寒经过吐法或下法治疗后，七八天病情仍未解除，热邪结聚在体内，表里都发热，时时怕风，极度口渴，舌上干燥而烦，想要喝几升水的，用白虎加人参汤主治。
伤寒七八天仍不解除，本该发汗却未发汗，反而用了吐法或下法，这是治疗逆乱。吐则津液亡失于上，下则津液亡失于下。表证虽未解，但热邪已经入里。太阳主表，阳明主里，表里俱热，这是两阳并病。恶风是太阳表证未罢的表现，但如果是“时时”恶风，说明有时不怕风，表证即将解除，这与背微恶寒同理。烦躁、舌干、大渴是阳明证，想要喝几升水，说明里热结聚不散，急需救里以滋生津液。里气和则表也解，所以不需要表里双解的方法。
白虎汤所治疗的，都是阳明燥证，将其列为阳明主方，确实是有见识的。
三阳合病，腹部胀满，身体沉重，难以翻身转侧，口不知味且面色垢浊，遗尿。发汗则会出现谵语，误下则会出现额头出汗、手足冰冷。如果有自汗出的，用白虎汤主治。
这本来是阳明病，略微兼有太阴、少阳的症状。胃气不通畅，所以腹部胀满。阳明主肌肉，气虚无法推动，所以身体沉重。难以转侧，是因为少阳经脉行于身侧。口是胃的门户。胃气生病，津液不能上行，所以口不知味。阳明病面色发黑，少阳病面色微有尘垢，阳气不能荣润于面，所以面色垢浊。膀胱约束无力导致遗尿，这是太阳本病。虽然是三阳合病，但阳明证居多，就应当独取阳明。没有表证就不宜发汗，胃腑未实就不宜攻下。这是阳明半表里的证候。里热而非里实，所以应当用白虎汤，而不当用承气汤。如果误用发汗，则津液枯竭而出现谵语；误用攻下，则亡阳而导致额头出汗、手足厥冷。这里的自汗出，是说内热极盛，承接上一句遗尿而来。如果自汗但没有大烦大渴的症状，没有洪大浮滑的脉象，应当从虚证治疗，不得妄用白虎汤。如果出现额头出汗、手足冷，同时伴有烦渴、谵语等症状和洪滑的脉象，也可以用白虎汤。
三阳合病，脉象浮大且在关部，只想睡觉，闭上眼睛就出汗。
上一条讲病症及治法，这一条详细讲病脉、探究病情、研究病机，必须两条结合参考，才能掌握合病的要点。脉大为阳，关部是阳气所治的地方，这是重阳。只想睡觉，是阳气进入阴分。闭上眼睛时卫气行于阴分，兼有出汗，说明热邪淫溢于内。这与上文提到的自汗相同，但与少阴病脉微细且只想睡觉不同。
这一条讨论脉象而未涉及症状，因为已有白虎汤证，从而推及其脉象。不要仅凭脉象而不审查症状。脉浮而滑为阳，阳主热。《内经》说：“脉缓而滑称为热中”。这说明浮表示在表，滑表示在里。旧本作“里有寒”是错误的。这里虽然表里并提，但重在里热，所谓热邪结聚在体内，表里似乎都有热。
脉微而厥冷是寒厥，脉滑而厥冷是热厥。阳极似阴的证候，完全依靠脉象来辨别。但必须伴有烦渴引饮、能食而大便难，才是里有热。
白虎汤：
石膏（一斤，打碎，用绵布包裹） 知母（六两） 甘草（二两） 粳米（六合）
用水一斗，煮至米熟汤成，每次温服一升，每日三次。
《内经》说“火生苦”。又说“用苦味燥湿”。又说“味道过于苦，脾气不濡润，胃气就会浓烈”。由此可知苦味从火化。火能生土，则土燥火炎，不是苦寒的味道所能治疗的。《内经》说“甘味先入脾”。又说“用甘味泻之”。又说“水饮进入胃，精微输布到脾，向上归于肺，水精四布，五脏经脉并行”。由此可知甘寒的药物，是泻胃火、生津液的上等药剂。石膏大寒，寒能胜热，味甘归脾，质地刚硬而主降，具备中土生金的体性，色白通肺，质地重而含脂，具有金能生水的作用，所以作为君药。知母气寒主降，苦味以泄肺火，辛味以润肺燥，内里肥白外面有皮毛，是肺金的形象、生水的源头，所以作为臣药。甘草皮赤中黄，能在土中泻火，作为中宫的舟楫，寒药得到它就能缓和其寒性，用它作为佐药，沉降的药性也能留连在脾胃之间。粳米稼穑作甘，气味温和，禀受平和之性，是后天养生的资粮，得到它作为佐药，阴寒之物就不会损伤脾胃了。煮汤入胃，输脾归肺，水精四布，大烦大渴就可以消除了。白虎主西方金，用这个名字命名汤剂，是因为秋金得令，暑热清解，这是四时的次序。再加人参，以补中益气而生津，协和甘草、粳米的补益，制约石膏、知母的寒性，泻火而火不伤正，这才是万全之术。
Shaoyang disease (Disease of the Shaoyang channel) presents with a floating pulse, fever, and absence of sweating. If the exterior syndrome remains unresolved, Baihu Tang (White Tiger Decoction) must not be administered. 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.
Baihu Tang is a formula for treating heat binding in the interior. The text first indicates contraindications and then clarifies indications, demonstrating that Baihu Tang is potent and should not be used lightly. Floating pulse, fever, and absence of sweating indicate that Mahuang Tang syndrome (Exterior Excess Syndrome treated by Ephedra Decoction) persists; this constitutes an unresolved exterior. Coupled with thirst desire to drink, it signifies heat entering the interior. This situation involves both exterior and interior syndromes; Wuling San (Five-Ingredient Powder with Poria) should be used, along with drinking warm water to induce sweating. If external heat has resolved, there is no exterior syndrome. Thirst desire to drink alone indicates pathogenic heat attacking inward. Pathogenic heat and healthy Qi cannot coexist; urgent rescue of the interior is required, hence Baihu Jia Renshen Tang is indicated. If the exterior is unresolved and this formula is misused, heat may retreat causing cold to arise, leading to imminent death.
After taking Guizhi Tang (Cinnamon Twig Decoction), if profuse sweating occurs followed by severe restlessness, unrelenting thirst, and a flooding pulse, Baihu Jia Renshen Tang is the primary treatment.
The previous clause details symptoms; this clause details pulses. Full annotations are found in the Guizhi Tang chapter.
In Shaoyang disease, if there is no significant fever, dry mouth and thirst, mental irritability, and slight aversion to cold on the back, Baihu Jia Renshen Tang is the primary treatment.
In Shaoyang disease lasting six or seven days, absence of significant fever accompanied by restlessness and irritability indicates Yang departing and entering Yin. Although here there is no restlessness but rather thirst and irritability, it clearly shows Yang pathogen entering the interior. "No significant fever" refers to the exterior, indicating slight heat remains; "slight aversion to cold on the back" indicates aversion to cold is about to cease. Although there are exterior and interior signs, the exterior pathogen is light while interior heat is severe. Urgent administration of Baihu Jia Renshen Tang is needed; once the interior harmonizes, the exterior resolves spontaneously.
Following purgation or emesis in Shaoyang disease, if after seven or eight days the condition remains unresolved, with heat binding in the interior and heat present in both exterior and interior, occasional aversion to wind, extreme thirst, dry tongue with irritability, and desire to drink several liters of water, Baihu Jia Renshen Tang is the primary treatment.
If Shaoyang disease persists for seven or eight days without resolution, failing to sweat when one should, and instead undergoing emesis or purgation, this is incorrect treatment. Emesis causes loss of body fluids above; purgation causes loss below. Although the exterior remains unresolved, heat has entered the interior. Taiyang governs the exterior; Yangming governs the interior. Heat in both exterior and interior indicates concurrent illness of two Yang channels. Aversion to wind is an unresolving Taiyang exterior sign; however, "occasional" aversion implies periods without it, suggesting the exterior is resolving, similar to slight aversion on the back. Irritability, dry tongue, and extreme thirst are Yangming signs. Desire to drink several liters indicates interior heat binding and dispersion failure; urgent interior rescue to nourish fluids is required. Harmonizing the interior also resolves the exterior, so dual exterior-interior resolution is unnecessary.
In Yangming disease, if there is thirst desire to drink water, dry mouth, and dry tongue, Baihu Jia Renshen Tang is the primary treatment.
Baihu Tang treats all Yangming dryness syndromes; designating it as the principal formula for Yangming demonstrates profound insight.
In concurrent illness of the three Yang channels, presenting with abdominal fullness, heavy body, difficulty turning over, insensitivity around the mouth, greasy facial complexion, and urinary incontinence: inducing sweating leads to delirious speech; purging leads to sweating on the forehead and cold hands and feet. If spontaneous sweating occurs, Baihu Tang is the primary treatment.
This is fundamentally a Yangming disease slightly involving Taiyin and Shaoyang. Stomach Qi obstruction causes abdominal fullness. Yangming governs flesh; lack of Qi movement causes heaviness. Difficulty turning reflects Shaoyang channel distribution along the sides of the body. The mouth is the gateway of the stomach. Stomach pathology prevents fluid ascent, causing oral insensitivity. Yangming disease darkens the face; Shaoyang disease causes a dusty appearance due to lack of Yang Qi nourishment, resulting in a greasy look. Urinary incontinence due to bladder laxity is a fundamental Taiyang disease. Despite concurrent three-Yang illness, Yangming signs predominate, warranting exclusive focus on Yangming. Without exterior syndrome, sweating is inappropriate; without excess in the stomach, purging is inappropriate. This is a half-exterior/half-interior Yangming syndrome. Interior heat without interior excess requires Baihu Tang, not Chengqi Tang formulas. Incorrect sweating depletes fluids causing delirium; incorrect purging destroys Yang causing forehead sweating and cold extremities. Spontaneous sweating here refers to severe internal heat, following the mention of urinary incontinence. If spontaneous sweating exists without severe restlessness/thirst or flooding-floating-slippery pulse, treat as deficiency; do not misuse Baihu Tang. If forehead sweating and cold extremities occur alongside restlessness/thirst, delirium, and slippery-flooding pulse, Baihu Tang may still be used.
In concurrent illness of the three Yang channels, with floating-large pulse at the Guan position, drowsiness, and sweating upon closing eyes:
The previous clause discusses symptoms and treatment; this clause details pulse, probes pathology, and investigates mechanism. Both clauses must be referenced together to grasp the essence of concurrent illness. Large pulse indicates Yang; Guan position governs Yang, representing excessive Yang. Drowsiness indicates Yang entering Yin. Closing eyes allows Wei Qi to enter Yin, accompanied by sweating, indicating heat rampant within. This resembles the aforementioned spontaneous sweating but differs from Shaoyin disease's fine-weak pulse and drowsiness.
In Shaoyang disease, floating-slippery pulse indicates heat in the exterior and pathogen in the interior; Baihu Tang is the primary treatment.
This clause discusses pulse without symptoms, inferring pulse from Baihu Tang syndrome. Do not rely solely on pulse without examining symptoms. Floating-slippery pulse is Yang, governing heat. *Neijing* states: "Slow and slippery pulse indicates heat in the center." Floating indicates exterior; slippery indicates interior. Old texts stating "cold in interior" are erroneous. Although mentioning both exterior and interior, emphasis is on interior heat—heat binding in the interior, appearing as heat in both layers.
In Shaoyang disease, slippery pulse with cold extremities indicates heat in the interior; Baihu Tang is the primary treatment.
Micro-pulse with cold extremities is Cold Jue (Reversal); slippery pulse with cold extremities is Heat Jue. Extreme Yang resembling Yin syndromes are distinguished entirely by pulse. However, symptoms like irritability/thirst with drinking preference, ability to eat but difficult defecation must confirm interior heat.
Baihu Tang:
Shigao (Gypsum Fibrosum, 1 jin, crushed, wrapped in muslin) Zhimu (Anemarrhenae Rhizoma, 6 liang) Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang) Jingmi (Oryza Sativa, 6 he)
Boil in 10 dou of water until rice is cooked and decoction ready. Take 1 sheng warm, three times daily.
Baihu Jia Renshen Tang:
Add Renshen (Panacis Ginseng Radix, 3 liang) to the above formula. Preparation method same as above.
*Jing* states: "Fire generates bitter." Also: "Use bitter to dry dampness." Also: "Excessive bitterness impairs Spleen moisture and thickens Stomach Qi." Thus, bitter transforms via Fire. Fire generates Earth; if Earth is dry and Fire blazes, bitter-cold flavors cannot treat it. *Jing* states: "Sweet enters Spleen first." Also: "Use sweet to drain." Also: "Water entering Stomach, essence transported to Spleen, ascending to Lung, fluids distributed four directions, five meridians parallel." Thus, sweet-cold herbs are superior for draining Stomach Fire and generating fluids. Shigao is extremely cold, overcoming heat; sweet flavor enters Spleen; rigid nature descends; embodies Earth generating Metal; white color connects to Lung; heavy texture contains grease, possessing Metal generating Water function. Hence, it is the Sovereign herb. Zhimu is cold and descending; bitter drains Lung Fire; pungent moistens Lung dryness; inner white fleshy part with outer skin represents Lung Metal image and Water source. Hence, it is the Minister herb. Gancao has red skin and yellow center, draining fire in Earth, acting as a vessel in the Central Palace; combined with cold herbs, it moderates their chill. As Assistant, its sinking nature lingers in Spleen/Stomach. Jingmi is sweet from cultivation, mild-warm in aroma/flavor, possessing balanced nature, providing postnatal nourishment. As Assistant, it prevents cold herbs from damaging Spleen/Stomach. Decoction enters Stomach, transports to Spleen/Lung, distributes fluids, relieving severe restlessness/thirst. Baihu governs Western Metal; named after autumn metal season when summer heat clears, reflecting seasonal order. Adding Renshen tonifies Middle Qi and generates fluids, harmonizing Gancao/Jingmi tonification, controlling Shigao/Zhimu coldness, draining fire without injuring正气 (Zheng Qi), ensuring complete safety.