上所论有葛根诸方，皆治阳明在经之病者也。至阳明在府之
病，又当另议治法，其治之主要，自当以白虎汤为称首也。
《伤寒论》原文∶伤寒脉浮滑，此表有热里有寒，白虎汤主之。（此节载太阳篇）
此脉象浮而且滑，夫滑则为热入里矣，乃滑而兼浮，是其热未尽入里，半在阳明之府，半在阳明之经
也。在经为表，在府为里，故曰表有热里有寒。《内经》谓热病者皆伤寒之类也。又谓人之伤于寒也，则为病
热。此所谓里有寒者，盖谓伤寒之热邪已入里也。陈氏之解原如斯，愚则亦以为然。至他注疏家有谓此寒热二
字，宜上下互易，当作外有寒里有热者，然其脉象既现浮滑，其外表断不至恶寒也。有谓此寒字当系痰之误，
因痰寒二音相近，且脉滑亦为有痰之征也。然在寒温，其脉有滑象，原主阳明之热已实，且足征病者气血
素充，治亦易愈。若因其脉滑，而以为有痰，则白虎汤岂为治痰之剂乎。
《伤寒论》原文∶三阳合病，腹满身重，难以转侧，口不仁
而面垢，谵语，遗尿。发汗则谵语，下之则额上生汗，手足逆冷。若自汗出者，白虎汤主之。（此节载阳明篇）
证为三阳合病，乃阳明外连太阳内连少阳也。由此知三阳会合以阳明为中间，三阳之病会合，即以
阳明之病为中坚也。是以其主病之方，仍为白虎汤，势若帅师以攻敌，以全力捣其中坚，
而其余者自瓦解。
《伤寒论》原文∶伤寒脉滑而厥者，里有热也，白虎汤主之。（此节载厥阴篇）
脉滑者阳明之热传入厥阴也。其脉滑而四肢厥逆者，因肝主疏泄，此证乃阳明传来之热郁于肝中，致肝
失其所司，而不能疏泄、是以热深厥亦深也。治以白虎汤，热消而厥自回矣。
或问∶伤寒传经之次第，原自阳明而少阳，三传而后至厥阴，今言阳明之热传入厥阴，将勿与经旨有
背谬乎？答曰∶白虎汤原为治阳明实热之正药，其证非阳明之实热者，仲景必不用白虎汤。此盖因阳明在经
之热，不传于府（若入府则不他传矣）而传于少阳，由少阳而为腑脏之相传（如由太阳传少阴，即腑脏相传，
《伤寒论》少阴篇∶麻黄附子细辛汤所主之病是也），则肝中传入阳明实热矣。究之，此等证其左右两关必皆
现有实热之象，盖此阳明在经之热，虽由少阳以入厥阴，必仍有余热入于阳明之府，俾其府亦蕴有实热，故
可放胆投以白虎汤，而于胃府无损也。
【白虎汤方】知母六两，石膏一斤打碎，甘草二两炙，粳米六合。
上四味，以水一斗，煮米熟汤成，去滓，温服一升，日三服。
方中重用石膏为主药，取其辛凉之性，质重气轻，不但长于清热，且善排挤内蕴之热息息自毛孔达出也。
用知母者，取其凉润滋阴之性，既可佐石膏以退热，更可防阳明热久者之耗真阴也。用甘草者，取其甘缓之
性，能逗留石膏之寒凉不至下趋也。用粳米者，取其汁浆浓郁能调石膏金石之药使之与胃相宜也。药
止四味，而若此相助为理，俾猛悍之剂归于和平，任人放胆用之，以挽回人命于垂危之际，真无尚之良方也。
何犹多畏之如虎而不敢轻用哉？
白虎汤方，三见于《伤寒论》。一在太阳篇，治脉浮滑；一在阳明篇，治三阳合病自汗出者，一
在厥阴篇，治脉滑而厥。注
家于阳明条下，谓苟非自汗，恐表邪抑塞，亦不敢卤莽而轻用白虎汤。自此说出，医者遇白虎汤证，恒因其
不自汗出即不敢用，此误人不浅也。盖寒温之证，邪愈深入则愈险。当其由表入里，阳明之府渐实，急投以大
剂白虎汤，皆可保完全无虞。设当用而不用，由胃实以至肠实而必须降下者，已不敢保其完全无虞也。
况自汗出之文惟阳明篇有之，而太阳篇但言脉浮滑，厥阴篇但言脉滑而厥，皆未言自汗出也。由是知其脉
但见滑象，无论其滑而兼浮，滑而兼厥，皆可投以白虎汤。经义昭然，何医者不知尊经，而拘于注家之谬说也？
白虎汤所主之病，分载于太阳阳明厥阴篇中，惟阳明所载未言其脉象何如，似令人有未惬意之处。
然即太阳篇之脉浮而滑及厥阴篇之脉滑而厥推之，其脉当为洪滑无疑，此当用白虎汤之正脉也。故治伤寒者，临
证时若见其脉象洪滑，知其阳明之府热已实，放胆投以白虎汤必无差谬，其人将药服后，或出凉汗而愈，或
不出汗其热亦可暗消于无形。若其脉为浮滑，知其病犹连表，于方中加薄荷叶一钱，或加连翘、蝉蜕各一钱，
服后须臾即可由汗解而愈。其脉为滑而厥也，知系厥阴肝气不舒，可用白茅根煮汤以之煎药，服后须臾厥回，
其病亦遂愈。此愚生平经验所得，故敢确实言之，以补古书所未备也。
近世用白虎汤者，恒恪守吴氏四禁。所谓四禁者，即其所着《温病条辨》白虎汤后所列禁用白虎汤之
四条也。然其四条之中，显有与经旨相反之两条，若必奉之为金科玉律，则此救颠扶
危挽回人命之良方，几将置之无用之地。
吴鞠通原文∶白虎本为达热出表，若其人脉浮弦而细者，不
可与也；脉沉者，不可与也；不渴者，不可与也；汗不出者，不可与也，常须识此，勿令误也。
按∶前两条之不可与，原当禁用白虎汤矣。至其第三条谓不
渴者不可与也，夫用白虎汤之定例，渴者加人参，其不渴者即服白虎汤原方，无事加参可知矣。吴氏以为不
渴者不可与，显与经旨相背矣。且果遵吴氏之言，其人若渴即可与以白虎汤，而亦无事加参矣，不又显与渴
者加人参之经旨相背乎？至其第四条谓汗不出者不可与也，夫白虎汤三见于《伤寒论》，惟阳明篇中所主
之三阳合病有汗，其太阳篇所主之病及厥阴篇所主之病，皆未见有汗也。仲圣当日未见有汗即用白虎汤，而
吴氏则于未见有汗者禁用白虎汤，此不又显与经旨相背乎？且石膏原具有发表之性，其汗不出者不正可借
以发其汗乎？且即吴氏所定之例，必其人有汗且兼渴者始可用白虎汤，然阳明实热之证，渴而兼汗出者，十
人之中不过一二人，是不几将白虎汤置之无用之地乎？夫吴氏为清季名医，而对于白虎汤竟误设禁忌若此，
彼盖未知石膏之性也。及至所着医案，曾治何姓叟，手足拘挛，因误服热药所致，每剂中用生石膏八两，服
近五十日始愈，计用生石膏二十余斤。又治赵姓中焦留饮，上泛作喘，每剂药中皆重用生石膏，有一剂
药中用六两八两者，有一剂中用十二两者，有一剂中用至一斤者，共服生石膏近百斤，其病始愈。以观其《温
病条辨》中，所定白虎汤之分量生石膏止用一两，犹煎汤三杯分三次温饮下者，岂不天壤悬殊哉？盖吴氏先
着《温病条辨》，后着《吴氏医案》，当其着《温病条辨》时，因未知石膏之性，故其用白虎汤慎重若
此；至其着《吴氏医案》时，是已知石膏之性也，故其能放胆重
用石膏若此，学问与年俱进，故不失其为名医也。
人之所以重视白虎汤而不敢轻用者，实皆未明石膏之性也。夫自古论药之书，当以《神农本草经》为
称首，其次则为《名医别录》。《神农本草经》创于开天辟地之圣神，洵堪为论药性之正宗，至《名医别录》
则成于前五代之陶弘景，乃取自汉以后及五代以前名医论药之处而集为成书，以为《神农本草经》之辅翼
（弘景曾以朱书本经、墨书别录为一书），今即《神农本草经》及《名医别录》之文而细为研究之。
《神农本草经》石膏原文∶气味辛，微寒，无毒，主治中风
寒热、心下逆气、惊喘、口干、舌焦、不能息、腹中坚痛、除邪鬼、产乳、金疮。
按∶后世本草，未有不以石膏为大寒者，独《神农本草经》以为微寒，可为万古定论。为其微寒，
是以白虎汤中用至一斤，至《吴氏医案》治痰饮上泛作喘，服石膏近百斤而脾胃不伤也。其言主中风者，夫中
风必用发表之药，石膏既主之则性善发表可知，至其主寒热、惊喘、口干、舌焦、无事诠解。至其能治心下逆
气、腹中坚痛，人或疑之，而临证细心品验，自可见诸事实也。曾治一人，患春温阳明府热已实，心下胀满
异常，投以生石膏二两、竹茹碎末五钱，煎服后，顿觉药有推荡之力，胀满与温病皆愈。又尝治一人，少腹
肿疼甚剧，屡经医治无效，诊其脉沉洪有力，投以生石膏三两、旱三七二钱（研细冲服）、生蒲黄三钱，煎
服两剂全愈。此证即西人所谓盲肠炎也，西人恒视之为危险难治之病，而放胆重用生石膏即可随手奏效。至
谓其除邪鬼者，谓能治寒温实热证之妄言妄见也。治产乳者，此乳字当作生字解（注疏家多以乳字作乳汁解者非是），
谓妇人当生产之后，偶患寒温实热，亦不妨用石膏，即《金匮》谓妇人乳中虚烦乱、呕逆、安中益气，竹皮大
丸主之者是也（竹皮大丸中有石膏）。治金疮者，人若为刀斧所伤，掺以生石膏细末，立能止血且能消肿愈疼也。
《名医别录》石膏原文∶石膏除时气、头疼身热、三焦大
热、肠胃中结气、解肌发汗、止消渴、烦逆、腹胀暴气、咽痛，亦可作浴汤。
按∶解肌者，其力能达表，使肌肤松畅，而内蕴之热息息自
毛孔透出也。其解肌兼能发汗者，言解肌之后，其内蕴之热又可
化汗而出也。特是，后世之论石膏者，对于《神农本草经》之微寒既皆改为大寒，而对于《名医别录》之解
肌发汗，则尤不相信。即如近世所出之本草，若邹润安之《本经疏证》、周伯度之《本草思辨录》，均可为卓
卓名著，而对于《名医别录》谓石膏能解肌发汗亦有微词。
愚浮沉医界者五十余年，尝精细体验白虎汤之用法，若阳明之实热，一半在经，一半在府，或其热虽入
府而犹连于经，服白虎汤后，大抵皆能出汗，斯乃石膏之凉与阳明之热化合而为汗以达于表也。若犹虑其或
不出汗，则少加连翘、蝉蜕诸药以为之引导，服后复杯之顷，其汗即出，且汗出后其病即愈，而不复有外
感之热存留矣。若其阳明之热已尽入府，服白虎汤后，大抵出汗者少，不出汗者多，其出汗者热可由汗而解，
其不出汗者其热亦可内消。盖石膏质重气轻，其质重也可以逐热下行，其气轻也可以逐热上出，俾胃府之
气化升降皆湛然清肃，外感之热自无存留之地矣。
石膏之发汗，原发身有实热之汗，非能发新受之风寒也。曾治一人，年近三旬，于春初得温病，医者以
温药发其汗，汗出而病益加剧，诊其脉洪滑而浮，投以大剂白虎汤，为加连翘、蝉蜕各钱半，服后遍体得凉
汗而愈。然愈后泄泻数次，后过旬日又重受外感，其脉与前次相符，乃因前次服白虎汤后作泄泻，遂改用
天花粉、玄参各八钱，薄荷叶、甘草各二钱，连翘三钱，服后亦汗出遍体，而其病分毫不减，因此次所出
之汗乃热汗非凉汗也。不得已遂仍用前方，为防其泄泻，以生怀山药八钱代方中粳米，服后仍遍体出凉
汗而愈。由此案观之，则石膏之妙用，有真令人不可思议者矣。
重用石膏以发汗，非仅愚一人之实验也。邑中友人刘××，
肺热劳喘，热令尤甚，时当季夏，病犯甚剧，因尝见愚重用生石
膏治病，自用生石膏四两，煎汤一大碗顿饮下，周身得凉汗，劳喘骤见轻，隔一日又将石膏如前煎饮，病又
见轻，如此隔日一饮石膏汤，饮后必然出汗，其病亦随之降序，饮过六次，而百药难愈之痼疾竟霍然矣。
后刘××与愚相遇，因问石膏如此凉药，何以能令人发汗？愚曰∶石膏性善发汗，《名医别录》载有明文，
脏腑蕴有实热之人，服之恒易作汗也。此证因有伏气化热，久留肺中不去，以致肺受其伤，屡次饮石膏汤
以逐之，则久留之热不能留，遂尽随汗出而消解无余矣。
用石膏以治肺病及劳热，古人早有经验之方，因后世未知石膏之性，即见古人之方亦不敢信，是以后
世无用者。其方曾载于王焘《外台秘要》，今特详录于下，以备医界之采取。
《外台秘要》原文∶治骨蒸劳热久嗽，用石膏纹如 针者一斤，粉甘草一两，研细如面，日以水调三、
四服，言其无毒有大益，乃养命上药，不可忽其贱而疑其寒。《名医别录》言陆州杨士丞女，
病骨蒸，内热外寒，众医不能瘥，处州吴医用此方而体遂凉。
按∶书中所载杨氏女亦伏气化热病。凡伏气化热之病，原当治以白虎汤，脉有数象者，白虎加人参汤，
医者不知如此治法，是以久不瘥。吴医治以石膏、甘草粉，实为白虎汤之变通用法。乃有其证非如此变通用之而
不能愈者（必服石膏面始能愈），此愚治伏气化热临证之实验，爰录一案于下，以明用古方者原宜因证变通也。
一人年近四旬，身形素强壮，时当暮春，忽觉心中发热，初未介意，后渐至大小便皆不利，屡次延医
服药，病转加剧，腹中胀满，发热益甚，小便犹可通滴沥，而大便则旬余未通矣，且又觉其热上逆，无论所服
何药，下咽即吐出，因此医皆束手无策。后延愚为诊视，其脉弦长有力，重按甚实，左右皆然，视其舌苔浓
而已黄，且多芒刺，知为伏气化热，因谓病者曰，欲此病愈非治
以大剂白虎汤不可。病者谓我未受外感何为服白虎汤？答曰，此
上文所论述的葛根汤等方剂，都是治疗阳明经病（邪气在阳明经络）的方法。至于阳明腑病（邪气在阳明胃肠），则应当另外讨论治法，其治疗的主要方剂，自然首推白虎汤。
《伤寒论》原文：伤寒脉浮滑，此表有热里有寒，白虎汤主之。（这一节记载在太阳篇）
这种脉象既浮又滑，滑脉代表热邪入里，但滑兼见浮脉，说明热邪尚未完全入里，一半在阳明腑，一半在阳明经。在经属于表，在腑属于里，所以说“表有热里有寒”。《内经》说热病都属于伤寒一类。又说人受寒邪侵袭，就会发生热病。这里所说的“里有寒”，大概是指伤寒的热邪已经传入体内。陈氏的解释原本就是这样，我也认为是对的。至于其他注疏家认为这里的“寒”、“热”二字应该上下互换，当作“外有寒里有热”，然而既然脉象呈现浮滑，体表断然不会恶寒。又有认为这个“寒”字是“痰”字的误写，因为“痰”和“寒”读音相近，且滑脉也是有痰的征象。然而在寒温病中，脉象出现滑象，原本就主阳明热邪已实，并且足以证明患者气血素来充盛，治疗也容易痊愈。如果因为脉滑就认为有痰，那么白虎汤难道是治疗痰证的方剂吗？
《伤寒论》原文：三阳合病，腹满身重，难以转侧，口不仁而面垢，谵语，遗尿。发汗则谵语，下之则额上生汗，手足逆冷。若自汗出者，白虎汤主之。（这一节记载在阳明篇）
证候为三阳合病，即阳明外连太阳、内连少阳。由此可知三阳会合以阳明为中心，三阳的病会合，就以阳明病为中坚。所以其主要治疗的方剂，仍然是白虎汤，这就像统帅军队攻打敌人，集中全力捣毁其中坚力量，其余部分自然瓦解。
《伤寒论》原文：伤寒脉滑而厥者，里有热也，白虎汤主之。（这一节记载在厥阴篇）
脉滑，是阳明热邪传入厥阴的表现。脉滑而且四肢厥冷，是因为肝主疏泄，此证是阳明传来之热郁结在肝中，导致肝失去其主管功能，不能疏泄，所以热越深，厥冷也就越深。用白虎汤治疗，热邪消除，厥冷自然回复。
有人问：伤寒传经的顺序，原本是从阳明传到少阳，经过三次传变后才到厥阴，现在说阳明热邪传入厥阴，岂不是与经典旨意相违背吗？回答说：白虎汤原本是治疗阳明实热的正药，如果不是阳明实热的证候，张仲景一定不用白虎汤。这是因为阳明在经的热邪，没有传入腑（如果入腑就不会再传其他经了），而是传给了少阳，由少阳进而发生脏腑之间的相传（比如由太阳传少阴，就是脏腑相传，《伤寒论》少阴篇中麻黄附子细辛汤所主治的病就是这种情况），这样肝中就传入了阳明实热。总之，这类证候左右两关脉必然都现出实热的象，因为这种阳明在经的热邪，虽然由少阳传入厥阴，但必定仍有残余热邪进入阳明之腑，使得其腑也蕴积有实热，所以可以放心大胆地投用白虎汤，而对胃腑没有损害。
【白虎汤方】知母六两，石膏一斤（打碎），甘草二两（炙），粳米六合。
以上四味药，用水一斗，煮至米熟汤成，去渣，温服一升，每日三次。
方中重用石膏为主药，取其辛凉的性质，质地重而气味轻，不仅擅长清热，而且善于将内蕴的热邪通过毛孔排出。用知母，是取其凉润滋阴的性质，既可以辅助石膏退热，更可以防止阳明热久耗伤真阴。用甘草，是取其甘缓的性质，能留住石膏的寒凉之气，使其不至于向下趋走。用粳米，是取其汁浆浓郁，能调和石膏金石类药物的性质，使之与胃相适宜。药只有四味，却如此相互配合调理，使猛烈的药剂归于平和，让人敢于放心使用，在危重时刻挽回生命，真是无与伦比的良方。为什么还有人像怕老虎一样畏惧它而不敢轻易使用呢？
白虎汤方，在《伤寒论》中出现三次。一次在太阳篇，治疗脉浮滑；一次在阳明篇，治疗三阳合病自汗出的；一次在厥阴篇，治疗脉滑而厥的。注家对阳明篇条文下说，如果不是自汗出，恐怕表邪被抑制堵塞，也不敢鲁莽轻用白虎汤。自从这种说法出现后，医生遇到白虎汤证，常常因为患者不自汗出就不敢使用，这误人不浅啊。大概寒温病证，邪气越深入就越危险。当邪气由表入里，阳明之腑逐渐充实时，急投以大剂量白虎汤，都可以保全身体无虞。如果该用而不用，从胃实发展到肠实而必须用攻下法时，就已经不能保证完全无虞了。况且“自汗出”的文字只在阳明篇中有，而太阳篇只说脉浮滑，厥阴篇只说脉滑而厥，都没有提到自汗出。由此可知，只要脉象见到滑象，无论它是浮滑还是滑而兼厥，都可以投用白虎汤。经文意义昭然，为什么医生不知道尊重经文，反而拘泥于注家的谬说呢？
白虎汤所主治的病，分载于太阳、阳明、厥阴篇中，只有阳明篇所载没有说明脉象如何，似乎让人有些不满足的地方。然而根据太阳篇的脉浮而滑及厥阴篇的脉滑而厥来推断，其脉象应当是洪滑无疑，这是应当用白虎汤的正脉。所以治疗伤寒的人，临证时如果见到脉象洪滑，知道阳明腑热已实，放心大胆地投用白虎汤一定不会出错，病人服药后，或者出凉汗而愈，或者不出汗，热邪也可以暗中消散于无形。如果脉象是浮滑，知道病还连着表，可以在方中加入薄荷叶一钱，或者加入连翘、蝉蜕各一钱，服用后不久即可通过出汗而愈。脉象是滑而厥的，知道是厥阴肝气不舒，可以用白茅根煮汤来煎药，服用后不久厥冷回复，病也就好了。这是我生平经验所得，所以敢确切地说出来，以补充古书所未具备的内容。
近代使用白虎汤的人，常常恪守吴鞠通的四条禁忌。所谓四条禁忌，就是他所著的《温病条辨》白虎汤后面所列出的禁用白虎汤的四条内容。然而这四条之中，明显有两条与经文旨意相反，如果一定要把它们奉为金科玉律，那么这个挽救危急、挽回生命的良方，几乎将被置于无用的境地。
吴鞠通原文：白虎本为达热出表，若其人脉浮弦而细者，不可与也；脉沉者，不可与也；不渴者，不可与也；汗不出者，不可与也，常须识此，勿令误也。
按：前两条的不可与，原本应当禁用白虎汤了。至于第三条说不渴者不可与，使用白虎汤的定例是，口渴者加人参，不渴者就直接服用白虎汤原方，不需要加人参，这是显而易见的。吴氏认为不渴者不可与，明显与经文旨意相背。而且如果遵从吴氏的话，其人若渴就可以给白虎汤，也不需要加人参了，这不又明显与“渴者加人参”的经文旨意相背吗？至于第四条说汗不出者不可与，白虎汤在《伤寒论》中出现三次，只有阳明篇中所主的三阳合病有汗，其太阳篇所主的病及厥阴篇所主的病，都没有见到有汗的情况。张仲景当日在没有看到有汗的情况下就用白虎汤，而吴氏却在没有看到有汗的情况下禁用白虎汤，这不又明显与经文旨意相背吗？而且石膏原本具有发表的性质，对于汗不出的人，不正可以利用它来发汗吗？况且即使按照吴氏定的例子，必须是人既有汗又兼口渴才可以开始使用白虎汤，然而阳明实热的证候，口渴兼汗出的，十个人中不过一两个人，这不简直是将白虎汤置于无用的境地了吗？吴鞠通是清末名医，而对于白虎汤竟然错误地设立这样的禁忌，那是因为他不了解石膏的性质。等到他后来所著的医案中，曾治疗一位何姓老人，手足拘挛，因误服热药所致，每剂药中使用生石膏八两，服用近五十天才痊愈，共计使用生石膏二十多斤。又治疗一位赵姓患者中焦留饮，上泛作喘，每剂药中都重用生石膏，有一剂药中使用六两八钱的，有一剂中使用十二两的，有一剂中使用至一斤的，共服用生石膏近百斤，病才痊愈。看他在《温病条辨》中，所定白虎汤的分量生石膏只用一两，还要煎汤三杯分三次温饮下，这岂不是天壤之别吗？大概吴氏先著《温病条辨》，后著《吴氏医案》，当他著《温病条辨》时，因为不了解石膏的性质，所以他使用白虎汤如此慎重；到了他著《吴氏医案》时，已经是了解石膏的性质了，所以他能够放心大胆地重用石膏如此之多，学问随着年纪增长而进步，所以不失其为名医。
人们之所以重视白虎汤而不敢轻用，实际上都是因为不明白石膏的性质。自古以来论述药物的书，当以《神农本草经》为首选，其次则是《名医别录》。《神农本草经》创始于开天辟地的圣神，确实是论述药性的正宗，而《名医别录》则由前五代的陶弘景完成，是选取汉代以后及五代以前名医论述药物的内容汇编而成，作为《神农本草经》的辅翼（弘景曾用红笔抄写本经，黑笔抄写别录为一本书），现在就依据《神农本草经》及《名医别录》的文本进行细致研究。
《神农本草经》石膏原文：气味辛，微寒，无毒，主治中风寒热、心下逆气、惊喘、口干、舌焦、不能息、腹中坚痛、除邪鬼、产乳、金疮。
按：后世的本草书籍，没有不把石膏视为大寒的，唯独《神农本草经》认为它是微寒，这可以作为万古不变的定论。正因为它是微寒，所以在白虎汤中使用至一斤，到了《吴氏医案》治疗痰饮上泛作喘，服用石膏近百斤而脾胃不受损伤。文中说主治中风，中风必须用发表的药物，石膏既然主治中风，那么它的性质善于发表是可以知道的。至于它主治寒热、惊喘、口干、舌焦，无需解释。至于它能治疗心下逆气、腹中坚痛，有人可能会怀疑，但在临证时细心体验验证，自然可以看到事实。曾治疗一个人，患春温病，阳明腑热已实，心下胀满异常，投以生石膏二两、竹茹碎末五钱，煎服后，顿时觉得药有推荡之力，胀满与温病都痊愈了。又曾治疗一个人，少腹肿疼非常剧烈，多次医治无效，诊其脉沉洪有力，投以生石膏三两、旱三七二钱（研细冲服）、生蒲黄三钱，煎服两剂全愈。这个证候就是西医所谓的盲肠炎，西医常视之为危险难治的病，而放心大胆重用生石膏即可随手奏效。至于说它能“除邪鬼”，是指能治疗寒温实热证出现的妄言妄见。说它能治“产乳”，这个“乳”字应当作“生”解（注疏家多以“乳”字作乳汁解是不对的），指妇人在生产之后，偶然患寒温实热，也不妨使用石膏，这就是《金匮要略》所说妇人乳中虚烦乱、呕逆、安中益气，用竹皮大丸主治的情况（竹皮大丸中含有石膏）。说它能治“金疮”，人如果被刀斧所伤，掺上生石膏细末，立刻能止血且能消肿止痛。
《名医别录》石膏原文：石膏除时气、头疼身热、三焦大热、肠胃中结气、解肌发汗、止消渴、烦逆、腹胀暴气、咽痛，亦可作浴汤。
按：“解肌”，是指其力量能达到体表，使肌肤松畅，而内蕴的热邪通过毛孔透出。“解肌兼能发汗”，是说解肌之后，内蕴的热邪又可以化为汗液排出。只是后世的论石膏者，对于《神农本草经》的微寒都改为了大寒，而对于《名医别录》的解肌发汗，更是表示不相信。就像近代出版的本草，如邹润安的《本经疏证》、周伯度的《本草思辨录》，都可谓卓越著名的著作，但对于《名医别录》谓石膏能解肌发汗也有微词。
我浮沉医界五十多年，曾经精细体验白虎汤的用法，如果是阳明实热，一半在经，一半在腑，或者热邪虽入腑但仍连着经，服用白虎汤后，大抵都能出汗，这是石膏的凉性与阳明之热化合而为汗以达于体表。如果还担心其不出汗，则少量加入连翘、蝉蜕等药物作为引导，服用后片刻之间，汗即发出，且汗出后病即愈，不再有外感的热邪存留。如果阳明之热已经完全入腑，服用白虎汤后，大抵出汗的少，不出汗的多，出汗的热可由汗而解，不出汗的热也可以在内消散。因为石膏质地重而气味轻，其质重可以驱逐热邪下行，其气轻可以驱逐热邪上出，使得胃腑的气化升降都清澈肃静，外感的热邪自然没有存留之地。
石膏的发汗，原本是针对身上有实热的人发的汗，不是能发新感受的风寒之汗。曾治疗一个人，年近三十，在初春得温病，医生用温药发其汗，汗出后病更加严重，诊其脉洪滑而浮，投以大剂量白虎汤，加入连翘、蝉蜕各一钱半，服用后遍体得到凉汗而痊愈。然而痊愈后腹泻数次，过后十多天又再次感受外邪，脉象与前次相符，但因为上次服用白虎汤后发生腹泻，于是改用天花粉、玄参各八钱，薄荷叶、甘草各二钱，连翘三钱，服用后也遍体出汗，但病分毫不减，因为这次出的汗是热汗而非凉汗。不得已遂仍用前方，为了防止其腹泻，用生怀山药八钱代替方中的粳米，服用后仍遍体出凉汗而痊愈。从这个医案来看，石膏的妙用，确实令人不可思议。
重用石膏来发汗，不仅仅是我一个人的实验。县里的朋友刘某某，肺热劳喘，热势尤其严重，当时正值盛夏，病情非常剧烈，因为曾见我重用生石膏治病，便自己用生石膏四两，煎汤一大碗顿服，周身得到凉汗，劳喘骤然减轻，隔一天又将石膏如前煎服，病又减轻，如此隔日饮用一次石膏汤，饮后必然出汗，病也随之按顺序下降，饮用过六次，这个百药难愈的痼疾竟然霍然而愈。
后来刘某某与我相遇，问我石膏如此凉的药，怎么能让人发汗？我说：石膏性质善于发汗，《名医别录》有明确记载，脏腑蕴有实热的人，服用后容易出汗。这个证候是因为有伏气化热，长久留在肺中不去，以致肺受到损伤，屡次饮用石膏汤来驱逐它，那么长久留下的热邪不能留存，于是全部随汗出而消解无余。
用石膏来治疗肺病及劳热，古人早有经验的方子，但因为后世不了解石膏的性质，即使见到古人的方子也不敢相信，所以后世无人使用。这个方子曾记载在王焘的《外台秘要》中，现在特别详细记录如下，以备医界采取。
《外台秘要》原文：治疗骨蒸劳热久嗽，用纹如针状的石膏一斤，粉甘草一两，研细如面粉，每天用水调服三、四次，说它无毒有大益，是养命的上品药，不要因为它的贱而怀疑它的寒。《名医别录》记载陆州杨士丞的女儿，患骨蒸病，内热外寒，众医不能治愈，处州吴医用此方而身体随即凉爽。
按：书中记载的杨氏女也是伏气化热的病。凡是伏气化热的病，原本应当用白虎汤治疗，脉有数象的，用白虎加人参汤，医生不知道如此治疗方法，所以长久不愈。吴医用石膏、甘草粉治疗，实际上是白虎汤的变通用法。但是有其证非如此变通使用而不能痊愈的（必须服用石膏粉才能痊愈），这是我治疗伏气化热临证的实验，于是记录一个医案在下面，以说明使用古方原本应当因证变通。
一个人年近四十，身形素来强壮，当时正值暮春，忽然觉得心中发热，起初没在意，后来渐渐大小便都不利，多次延请医生服药，病转加剧，腹中胀满，发热更甚，小便还可以通滴沥，而大便则十多天未通了，而且又觉得热气上逆，无论服用什么药，下咽即吐出，因此医生都束手无策。后来延请我为其诊治，其脉弦长有力，重按甚实，左右皆然，看其舌苔浓而且黄，且多芒刺，知道是伏气化热，于是对病人说，想要这个病痊愈非用大剂量白虎汤不可。病人说我未受外感为何服白虎汤？回答说，这
The formulas discussed above, such as Gegen Tang (Kudzu Decoction), are all used to treat diseases of the Yangming channel (pathogenic factors in the Yangming meridians). As for diseases of the Yangming fu-organ (pathogenic factors in the Yangming stomach and intestines), a different treatment method should be discussed. The primary formula for its treatment is naturally Baihu Tang (White Tiger Decoction).
Original text from *Shanghan Lun* (Treatise on Cold Pathogenic Diseases): "In cold damage, if the pulse is floating and slippery, this indicates heat at the exterior and cold at the interior; Baihu Tang (White Tiger Decoction) should govern it." (This section is recorded in the Taiyang chapter.)
This pulse condition is both floating and slippery. A slippery pulse indicates that heat has entered the interior. However, since it is slippery combined with floating, it means the heat has not fully entered the interior; half is in the Yangming fu-organ, and half is in the Yangming channel. Being in the channel belongs to the exterior, and being in the fu-organ belongs to the interior; therefore, it is said that there is heat at the exterior and cold at the interior. *Neijing* (Inner Canon) states that febrile diseases all belong to the category of cold damage. It also states that when humans are injured by cold pathogens, they develop febrile diseases. The "cold at the interior" mentioned here likely refers to the fact that the heat pathogen from cold damage has already entered the interior. Chen's interpretation was originally like this, and I also agree with it. As for other commentators who suggest that the characters "cold" and "heat" in these two positions should be swapped, making it "cold at the exterior and heat at the interior," however, since the pulse presents as floating and slippery, the exterior certainly would not present with aversion to cold. Others have suggested that the character "cold" here is a typo for "phlegm," because "phlegm" and "cold" sound similar, and a slippery pulse is also a sign of phlegm. However, in warm diseases, a slippery pulse originally indicates that Yangming heat is solidified, and it sufficiently proves that the patient's qi and blood were originally abundant, making treatment easy to succeed. If one assumes phlegm presence solely based on a slippery pulse, then is Baihu Tang (White Tiger Decoction) a formula for treating phlegm?
Original text from *Shanghan Lun*: "In combined disease of the three yang channels, there is abdominal fullness, heaviness of the body, difficulty in turning over, insensitivity in the mouth, greasy face, delirious speech, and urinary incontinence. If sweating is induced, delirium worsens; if purgation is used, sweat appears only on the forehead, and the hands and feet become cold. If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) should govern it." (This section is recorded in the Yangming chapter.)
The syndrome is a combined disease of the three yang channels, meaning Yangming connects externally with Taiyang and internally with Shaoyang. From this, we know that when the three yang channels converge, Yangming serves as the center. When diseases of the three yang channels converge, the disease of Yangming acts as the core strength. Therefore, the primary governing formula remains Baihu Tang (White Tiger Decoction). This is like a commander attacking an enemy, concentrating all strength to strike the core, causing the rest to collapse spontaneously.
Original text from *Shanghan Lun*: "In cold damage, if the pulse is slippery and there is jue (cold extremities), there is heat at the interior; Baihu Tang (White Tiger Decoction) should govern it." (This section is recorded in the Jueyin chapter.)
A slippery pulse indicates that Yangming heat has transmitted to Jueyin. When the pulse is slippery and accompanied by cold extremities, it is because the Liver governs free flow and drainage. In this syndrome, the heat transmitted from Yangming is constrained within the Liver, causing the Liver to lose its regulatory function and fail to perform free flow and drainage. Thus, the deeper the heat, the deeper the jue (cold extremities). Treating with Baihu Tang (White Tiger Decoction), once the heat dissipates, the jue will naturally resolve.
One might ask: The sequence of transmission in cold damage originally proceeds from Yangming to Shaoyang, and after three transmissions, it reaches Jueyin. Now, saying that Yangming heat transmits to Jueyin seems to contradict the canonical principles. The answer is: Baihu Tang (White Tiger Decoction) is originally the correct medicine for treating Yangming excess heat. If the syndrome is not Yangming excess heat, Zhang Zhongjing would definitely not use Baihu Tang (White Tiger Decoction). This is because the heat of Yangming in the channel did not transmit to the fu-organ (if it entered the fu-organ, it would not transmit elsewhere), but rather transmitted to Shaoyang. From Shaoyang, it underwent zang-fu transmission (such as transmission from Taiyang to Shaoyin, which is zang-fu transmission; the disease governed by Mahuang Fuzi Xixin Tang in the Shaoyin chapter of *Shanghan Lun* is an example). Thus, excess heat from Yangming was transmitted into the Liver. Ultimately, in such syndromes, the guan pulses on both left and right sides must exhibit signs of excess heat. Although this heat from Yangming in the channel entered Jueyin via Shaoyang, there must still be residual heat entering the Yangming fu-organ, causing the fu-organ to accumulate excess heat. Therefore, one can boldly administer Baihu Tang (White Tiger Decoction) without harming the stomach fu-organ.
[Baihu Tang Formula] Zhi Mu (Anemarrhenae Rhizoma) 6 liang, Shigao (Gypsum Fibrosum) 1 jin (crushed), Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang (honey-fried), Jingmi (Oryza Sativa) 6 he.
Take the above four ingredients, add 10 dou of water, boil until the rice is cooked and the decoction is ready, strain, and take 1 sheng warm, three times a day.
In this formula, Shigao (Gypsum Fibrosum) is heavily used as the chief drug, taking advantage of its acrid-cool nature, heavy texture, and light aroma. It not only excels at clearing heat but also effectively expels internal heat through the pores. Zhi Mu (Anemarrhenae Rhizoma) is used for its cool-moistening and yin-nourishing properties; it can assist Shigao (Gypsum Fibrosum) in reducing fever and prevent the consumption of true yin due to prolonged Yangming heat. Gancao (Glycyrrhizae Radix et Rhizoma) is used for its sweet-slowing property, which retains the cooling nature of Shigao (Gypsum Fibrosum) so it does not descend too quickly. Jingmi (Oryza Sativa) is used for its rich juice, which harmonizes the mineral nature of Shigao (Gypsum Fibrosum) to make it compatible with the stomach. With only four ingredients, they cooperate so well to moderate the fierce nature of the prescription, allowing people to use it boldly to save lives in critical moments. It is truly an unparalleled excellent formula. Why do some fear it like a tiger and dare not use it lightly?
Baihu Tang (White Tiger Decoction) appears three times in *Shanghan Lun*. Once in the Taiyang chapter, treating floating and slippery pulses; once in the Yangming chapter, treating spontaneous sweating in combined disease of the three yang channels; and once in the Jueyin chapter, treating slippery pulses with jue. Commentators under the Yangming clause state that if there is no spontaneous sweating, fearing that exterior pathogens might be suppressed and blocked, one dares not rashly use Baihu Tang (White Tiger Decoction). Since this statement emerged, doctors encountering Baihu Tang (White Tiger Decoction) syndromes often refrain from using it if there is no spontaneous sweating, which misleads people significantly. Generally, in cold and warm diseases, the deeper the pathogen penetrates, the more dangerous it becomes. When the pathogen moves from exterior to interior and the Yangming fu-organ gradually becomes solid, urgently administering a large dose of Baihu Tang (White Tiger Decoction) can ensure complete safety. If it should be used but is not, progressing from stomach solidity to intestinal solidity requiring purgation, one can no longer guarantee complete safety. Moreover, the text mentioning "spontaneous sweating" exists only in the Yangming chapter. The Taiyang chapter only mentions floating and slippery pulses, and the Jueyin chapter only mentions slippery pulses with jue; neither mentions spontaneous sweating. Thus, it is known that whenever a slippery pulse is seen, whether floating and slippery or slippery with jue, Baihu Tang (White Tiger Decoction) can be administered. The scriptural meaning is clear. Why do doctors not respect the scriptures and instead adhere to erroneous commentaries?
The diseases governed by Baihu Tang (White Tiger Decoction) are distributed among the Taiyang, Yangming, and Jueyin chapters. Only the Yangming chapter does not specify the pulse condition, which may leave one unsatisfied. However, inferring from the floating and slippery pulse in the Taiyang chapter and the slippery pulse with jue in the Jueyin chapter, the pulse should undoubtedly be洪滑 (hong-hua: surging and slippery), which is the correct pulse for using Baihu Tang (White Tiger Decoction). Therefore, when treating cold damage, if one observes a surging and slippery pulse, knowing that Yangming fu-organ heat is solid, one can boldly administer Baihu Tang (White Tiger Decoction) without error. After taking the medicine, the patient may recover with cool sweating, or even without sweating, the heat may dissipate invisibly. If the pulse is floating and slippery, knowing the disease still involves the exterior, one can add 1 qian of Bohe Ye (Menthae Haplocalycis Folium) or 1 qian each of Lianqiao (Forsythiae Fructus) and Chantui (Cicadae Periostracum) to the formula. After taking it, recovery through sweating occurs shortly. If the pulse is slippery with jue, knowing it is due to stagnation of Jueyin Liver qi, one can use Baimaogen (Imperatae Rhizoma) decoction to decoct the herbs. After taking it, jue resolves shortly, and the disease heals. This is my lifelong experience, so I dare to state it firmly to supplement what ancient books lack.
In recent times, those using Baihu Tang (White Tiger Decoction) often strictly adhere to Wu Juztong's Four Prohibitions. The so-called Four Prohibitions refer to the four conditions listed after Baihu Tang (White Tiger Decoction) in his book *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases) where Baihu Tang (White Tiger Decoction) is contraindicated. However, two of these four conditions clearly contradict the canonical principles. If they are treated as golden rules, this excellent formula for saving crises and rescuing lives would be rendered useless.
Wu Juztong's original text: "Baihu Tang is originally for venting heat out to the exterior. If the pulse is floating, wiry, and thin, it should not be given; if the pulse is deep, it should not be given; if there is no thirst, it should not be given; if there is no sweating, it should not be given. Always keep this in mind to avoid errors."
Analysis: The first two prohibitions originally meant Baihu Tang (White Tiger Decoction) should be banned. Regarding the third point, stating that those without thirst should not receive it: the standard rule for using Baihu Tang (White Tiger Decoction) is to add Renshen (Ginseng Radix) if thirsty; if not thirsty, one takes the original Baihu Tang (White Tiger Decoction) formula without adding ginseng, which is obvious. Wu's assertion that those without thirst should not receive it clearly contradicts the canonical principles. Furthermore, if one follows Wu's words, those who are thirsty could receive Baihu Tang (White Tiger Decoction) without adding ginseng, which again contradicts the canonical principle of "adding ginseng for thirst." Regarding the fourth point, stating that those without sweating should not receive it: Baihu Tang (White Tiger Decoction) appears three times in *Shanghan Lun*. Only the combined disease of the three yang channels in the Yangming chapter presents with sweating. The diseases governed in the Taiyang and Jueyin chapters do not show sweating. Zhang Zhongjing used Baihu Tang (White Tiger Decoction) when sweating was not observed, yet Wu prohibits it when sweating is not observed. Does this not clearly contradict the canonical principles? Moreover, Shigao (Gypsum Fibrosum) originally possesses dispersing properties. For those without sweating, can it not be used to induce sweating? Even according to Wu's own rules, one must have both sweating and thirst to use Baihu Tang (White Tiger Decoction). However, in cases of Yangming excess heat, those with both thirst and sweating account for only one or two out of ten people. Does this not essentially render Baihu Tang (White Tiger Decoction) useless? Wu Juztong was a famous doctor in the late Qing Dynasty, yet he mistakenly set such prohibitions for Baihu Tang (White Tiger Decoction) because he did not understand the nature of Shigao (Gypsum Fibrosum). Later, in his medical cases, he treated an elderly surnamed He who suffered from limb spasms caused by taking hot medicines incorrectly. Each dose contained 8 liang of raw Shigao (Gypsum Fibrosum), taken for nearly fifty days until recovery, totaling over twenty jin of raw Shigao (Gypsum Fibrosum). He also treated a middle-aged surnamed Zhao with retained fluid in the middle jiao causing wheezing. Each dose heavily used raw Shigao (Gypsum Fibrosum); one dose used 6.8 liang, another 12 liang, and another up to 1 jin. He consumed nearly 100 jin of raw Shigao (Gypsum Fibrosum) before recovering. Looking at *Wenbing Tiaobian*, where the dosage of Shigao (Gypsum Fibrosum) in Baihu Tang (White Tiger Decoction) was only 1 liang, decocted into three cups to be taken warm in three doses, the difference is indeed vast. Probably, Wu wrote *Wenbing Tiaobian* first and *Wu's Medical Cases* later. When writing *Wenbing Tiaobian*, he did not understand the nature of Shigao (Gypsum Fibrosum), hence his caution with Baihu Tang (White Tiger Decoction). By the time he wrote *Wu's Medical Cases*, he understood the nature of Shigao (Gypsum Fibrosum), allowing him to boldly use large doses. His knowledge advanced with age, thus remaining a famous doctor.
People value Baihu Tang (White Tiger Decoction) but dare not use it lightly because they do not understand the nature of Shigao (Gypsum Fibrosum). Among ancient books discussing herbs, *Shennong Bencao Jing* (Divine Farmer's Materia Medica) is the foremost, followed by *Mingyi Bielu* (Record of Famous Physicians). *Shennong Bencao Jing* was created by sage gods at the beginning of creation and is indeed the orthodox source for discussing herb properties. *Mingyi Bielu* was compiled by Tao Hongjing during the Five Dynasties period, collecting discussions on herbs by famous physicians from the Han Dynasty to before the Five Dynasties, serving as an appendix to *Shennong Bencao Jing* (Hongjing once copied the former in red ink and the latter in black ink into one book). Now, let us study the texts of *Shennong Bencao Jing* and *Mingyi Bielu* carefully.
*Shennong Bencao Jing* original text on Shigao (Gypsum Fibrosum): "Nature is acrid, slightly cold, non-toxic. It treats wind-stroke with cold and heat, rebellious qi below the heart, frightful panting, dry mouth, scorched tongue, inability to breathe, firm pain in the abdomen, removes evil spirits, treats childbirth issues, and metal wounds."
Analysis: Later materia medica books all regard Shigao (Gypsum Fibrosum) as greatly cold, but *Shennong Bencao Jing* considers it slightly cold, which can be established as a permanent conclusion. Because it is slightly cold, 1 jin is used in Baihu Tang (White Tiger Decoction). In *Wu's Medical Cases*, treating wheezing from phlegm-fluid rising, nearly 100 jin of Shigao (Gypsum Fibrosum) was taken without damaging the spleen and stomach. The text says it treats wind-stroke. Wind-stroke requires dispersing drugs; since Shigao (Gypsum Fibrosum) treats it, its nature is good at dispersing. Its treatment of cold/heat, frightful panting, dry mouth, and scorched tongue needs no explanation. Its ability to treat rebellious qi below the heart and firm abdominal pain may cause doubt, but careful clinical verification reveals facts. I once treated a person suffering from Spring Warmth with solidified Yangming fu-organ heat, experiencing extreme abdominal fullness. I administered 2 liang of raw Shigao (Gypsum Fibrosum) and 5 qian of crushed Zhuru (Bambusae Caulis in Taeniam) decocted. After taking it, he immediately felt a pushing force, and both the fullness and warmth disease healed. I also treated a person with severe swelling and pain in the lower abdomen, unresponsive to multiple treatments. His pulse was deep, surging, and forceful. I administered 3 liang of raw Shigao (Gypsum Fibrosum), 2 qian of Zansanqi (Notoginseng Radix, finely ground and taken with decoction), and 3 qian of Puhuang (Typhae Pollen) decocted. Two doses resulted in complete recovery. This syndrome is what Western medicine calls appendicitis, often viewed as dangerous and difficult to treat. Boldly using large doses of raw Shigao (Gypsum Fibrosum) yields immediate results. Regarding "removing evil spirits," it refers to treating delusions and hallucinations caused by excess heat in cold/warm diseases. Regarding "treating childbirth," the character "ru" (nipple/milk) should be interpreted as "birth" (commentators interpreting it as milk are incorrect). It means that if a woman suffers from excess heat in cold/warm diseases after giving birth, Shigao (Gypsum Fibrosum) can be used. This corresponds to *Jingui Yaolue* stating that for women with deficiency in the breast area causing vexation, confusion, vomiting, and reversal, Anzhong Yiqi (Nourishing the Center and Boosting Qi) is needed, governed by Zhupi Dawan (Bamboo Peel Large Pill), which contains Shigao (Gypsum Fibrosum). Regarding "treating metal wounds," if a person is injured by knives or axes, applying fine powder of raw Shigao (Gypsum Fibrosum) stops bleeding immediately and reduces swelling and pain.
*Mingyi Bielu* original text on Shigao (Gypsum Fibrosum): "Shigao (Gypsum Fibrosum) eliminates seasonal epidemics, headache, body heat, great heat in the three jiao, knotting of qi in the intestines and stomach, releases the muscle layer and induces sweating, stops thirst, irritability and reversal, abdominal distension and sudden qi, sore throat, and can also be used for bathing."
Analysis: "Releasing the muscle layer" means its power reaches the exterior, relaxing the skin and muscles, allowing internal heat to escape through the pores. "Releasing the muscle layer and inducing sweating" means that after releasing the muscle layer, the internal heat transforms into sweat. However, later commentators on Shigao (Gypsum Fibrosum) changed "slightly cold" from *Shennong Bencao Jing* to "greatly cold" and especially disbelieved "releasing the muscle layer and inducing sweating" from *Mingyi Bielu*. For example, modern materia medica works like Zou Run'an's *Benjing Shuzheng* and Zhou Bodu's *Bencao Sibianlu* are renowned, yet they also criticize *Mingyi Bielu*'s claim that Shigao (Gypsum Fibrosum) can release the muscle layer and induce sweating.
I have been active in the medical field for over fifty years and have carefully experienced the usage of Baihu Tang (White Tiger Decoction). If it is Yangming excess heat, half in the channel and half in the fu-organ, or if the heat has entered the fu-organ but still connects to the channel, after taking Baihu Tang (White Tiger Decoction), sweating usually occurs. This is because the coolness of Shigao (Gypsum Fibrosum) combines with Yangming heat to form sweat reaching the exterior. If worried about lack of sweating, adding small amounts of Lianqiao (Forsythiae Fructus) and Chantui (Cicadae Periostracum) as guides causes sweating within moments of ingestion, after which the disease heals, leaving no residual exterior heat. If Yangming heat has completely entered the fu-organ, after taking Baihu Tang (White Tiger Decoction), few sweat, while many do not. Those who sweat resolve heat through sweat; those who do not sweat see heat dissipate internally. Because Shigao (Gypsum Fibrosum) is heavy in texture and light in aroma, its heaviness drives heat downward, and its lightness drives heat upward, keeping the qi transformation of the stomach fu-organ clear and pure, leaving no room for exterior heat to remain.
Shigao's (Gypsum Fibrosum) induction of sweating originally targets sweating from existing excess heat in the body, not new wind-cold pathogens. I once treated a man near thirty who contracted a warmth disease in early spring. A doctor used warm medicines to induce sweating, but sweating worsened the condition. His pulse was surging, slippery, and floating. I administered a large dose of Baihu Tang (White Tiger Decoction) with 1.5 qian each of Lianqiao (Forsythiae Fructus) and Chantui (Cicadae Periostracum). After taking it, he sweated profusely with cool sweat and recovered. However, he had several episodes of diarrhea afterward. Ten days later, he caught another exterior pathogen. His pulse matched the previous one. Because of the previous diarrhea after taking Baihu Tang (White Tiger Decoction), I switched to Tianhuafen (Trichosanthis Radix) and Xuanshen (Scrophulariae Radix) 8 qian each, Bohe Ye (Menthae Haplocalycis Folium) and Gancao (Glycyrrhizae Radix et Rhizoma) 2 qian each, and Lianqiao (Forsythiae Fructus) 3 qian. After taking it, he sweated all over, but the disease did not improve at all, because the sweat produced was hot sweat, not cool sweat. Reluctantly, I returned to the previous formula. To prevent diarrhea, I replaced Jingmi (Oryza Sativa) with 8 qian of Sheng Huai Shanyao (Dioscoreae Hypoglaucae Rhizoma). After taking it, he sweated profusely with cool sweat and recovered. From this case, the miraculous use of Shigao (Gypsum Fibrosum) is truly inconceivable.
Using large doses of Shigao (Gypsum Fibrosum) to induce sweating is not just my personal experiment. A friend in our county, Liu XX, suffered from lung heat and labor-induced asthma, with severe heat. It was mid-summer, and the illness was intense. Having seen me use large doses of raw Shigao (Gypsum Fibrosum) to treat diseases, he used 4 liang of raw Shigao (Gypsum Fibrosum) himself, decocted in a large bowl of water and drank it all at once. He obtained cool sweat all over his body, and his asthma and labor symptoms improved suddenly. A day later, he decocted and drank Shigao (Gypsum Fibrosum) as before, and the illness improved again. Drinking Shigao (Gypsum Fibrosum) decoction every other day always induced sweating, and the illness declined sequentially. After six doses, this chronic disease, difficult to cure with other medicines, was miraculously cured.
Later, Liu XX met me and asked, "How can such a cool medicine like Shigao (Gypsum Fibrosum) induce sweating?" I said, "Shigao (Gypsum Fibrosum) has a nature good at inducing sweating, as explicitly recorded in *Mingyi Bielu*. People with excess heat stored in their zang-fu organs easily sweat after taking it. This syndrome was caused by latent qi transforming into heat, lingering in the lungs for a long time, injuring the lungs. Repeatedly drinking Shigao (Gypsum Fibrosum) decoction drove out this lingering heat, which could not stay and dissipated entirely through sweat."
Using Shigao (Gypsum Fibrosum) to treat lung diseases and labor heat was an experienced method of ancients. Because later generations did not understand the nature of Shigao (Gypsum Fibrosum), they dared not believe ancient formulas even when seeing them, so no one used them later. This formula was recorded in Wang Tao's *Waitai Miyao* (Essential Prescriptions from the Imperial Library). I record it in detail below for medical practitioners to adopt.
*Waitai Miyao* original text: "To treat bone-steaming labor heat and chronic cough, use 1 jin of Shigao (Gypsum Fibrosum) with patterns like needles, 1 liang of Fen Gancao (Powdered Glycyrrhiza), grind finely like flour, mix with water and take three to four times daily. It is said to be non-toxic and highly beneficial, a supreme medicine for nourishing life. Do not ignore its cheapness or suspect its coolness." *Mingyi Bielu* records that the daughter of Yang Shicheng in Luzhou suffered from bone-steaming, internal heat and external cold. Many doctors failed to cure her. The doctor from Chuzhou used this formula, and her body cooled down.
Analysis: The girl surnamed Yang recorded in the book also suffered from latent qi transforming into heat. Diseases of latent qi transforming into heat should originally be treated with Baihu Tang (White Tiger Decoction). If the pulse shows rapidity, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) should be used. Doctors did not know this treatment method, hence the prolonged failure to heal. The doctor from Chuzhou treated her with Shigao (Gypsum Fibrosum) and Gancao (Glycyrrhizae Radix et Rhizoma) powder, which is actually a modified universal application of Baihu Tang (White Tiger Decoction). However, there are syndromes that cannot heal unless this modified version is used (must take Shigao powder to heal). This is my clinical experience in treating latent qi transforming into heat. I record a case below to illustrate that using ancient formulas should adapt to the syndrome.
A man near forty years old, originally strong, suddenly felt heat in his heart in late spring. He initially ignored it, but gradually his urination and defecation became obstructed. Multiple doctors and medicines worsened the condition. Abdominal fullness increased, and fever intensified. Urination was possible but dribbling, while defecation had not occurred for over ten days. He also felt heat rushing upward; whatever medicine he swallowed, he vomited immediately. Doctors were helpless. I was invited to examine him. His pulse was wiry, long, and forceful, very solid upon heavy pressure, on both sides. His tongue coating was thick and yellow, with many prickles. I knew it was latent qi transforming into heat. I told the patient, "To cure this disease, a large dose of Baihu Tang (White Tiger Decoction) is indispensable." The patient asked, "Why should I take Baihu Tang (White Tiger Decoction) if I haven't caught an exterior pathogen?" I replied, "This...