白虎汤之外，又有白虎加人参汤，以辅白虎汤之所不逮。其
方五见于《伤寒论》，今试约略录其数节以为研究之数据。
《伤寒论》原文∶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。
【白虎加人参汤方】知母六两，石膏一斤碎绵裹，甘草二两炙，粳米六合，人参三两。
上五味，以水一斗，煮米熟汤成，去滓，温服一升，日三服。
服桂枝汤原取微似有汗，若汗出如水流漓，病必不解，此谓服桂枝汤而致大汗出，是汗出如水流漓也。
因汗出过多，大伤津液，是以大烦大渴、脉洪大异常，以白虎汤解其热，加人参以复其津液而病可愈矣。
《伤寒论》原文∶伤寒病若吐若下后，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。
所谓若吐、若下者，实因治失其宜，误吐、误下，是以吐下后而病不愈也。且误吐则伤其津液，误下则
伤其气分，津液伤损可令人作渴，气分伤损，不能助津液上潮更可作渴，是以欲饮水数升也。白虎汤中
加人参，不但能生津液，且能补助气分以助津液上潮，是以能立建奇功也。
《伤寒论》原文∶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。
凡服白虎汤之脉，皆当有滑象脉，滑者中有热也。此节之脉象但浮，虽曰发热，不过其热在表，其不
可与以白虎汤之实际，实在于此。乃因节中有无汗及表不解之文，而后世之治伤寒者，或谓汗不出者，不可
用白虎汤，或谓表不解者，不可用白虎汤，至引此节之文以为征据，而不能连上数句汇通读之，以重误古人。
独不思太阳篇中白虎汤证，其脉浮滑，浮非连于表乎？又不思白虎汤证三见于《伤寒论》，惟阳明篇白虎汤
证，明言汗出，而太阳篇与厥阴篇之所载者，皆未言有汗乎？至于其人欲饮水数升，且无寒束之表证，是
其外感之热皆入于里，灼耗津液，令人大渴，是亦宜急救以白虎加人参汤而无可迟疑也。
白虎加人参汤所主之证，或渴、或烦、或舌干，固由内陷之热邪所伤，实亦由其人真阴亏损也。人参，
补气之药，非滋阴之药，
而加于白虎汤中，实能于邪火炽盛之时立复真阴，此中盖有化合之妙也。曾治一人，患伤寒热入阳明之府，
脉象有力而兼硬，时作谵语，按此等脉原宜投以白虎加人参汤，而愚时当少年，医学未能深造，竟与以大剂
白虎汤，俾分数次温饮下，翌日视之热已见退，而脉搏转数，谵语更甚。乃恍然悟会，改投以白虎加人参
汤煎一大剂，分三次徐徐温饮下，尽剂而愈。盖白虎汤证其脉宜见滑象，脉有硬象即非滑矣，此中原有阴亏
之象，是以宜治以白虎加人参汤，而不可但治以白虎汤也。自治愈此案之后，凡遇其人脉数或弦硬，或年过五
旬，或在劳心劳力之余，或其人身形素羸弱，即非在汗吐下后，渴而心烦者，当用白虎汤时，皆宜加人
参，此立脚于不败之地，战则必胜之师也。
同邑友人李××，曾治一阳明府实证，其脉虽有力而数逾六至，李××先投以白虎汤不效，继因其脉
数加玄参、沙参以滋其阴分仍不效，询方于愚。答曰∶此白虎加人参汤证也。李××谓，此证非在汗吐下后，
且又不渴不烦，何为用白虎加人参汤？愚曰∶用古人之方，当即古人立方之意而推展变通之，凡白虎汤所
主之证，其渴与烦者，多因阴分虚损，而脉象数者独非阴分虚损乎？李××闻愚言而心中会悟，改投以白
虎加人参汤一剂而愈。
推展白虎加人参汤之用法，不必其人身体虚弱或有所伤损也。忆愚年三旬时，曾病伏气化热，五心烦热，
头目昏沉，舌苔白浓欲黄，且多芒刺，大便干燥，每日用生石膏数两煮水饮之，连饮数日，热象不退，因思
或药轻不能胜病，乃于头午用生石膏五两煮水饮下，过午又用生石膏五两煮水饮下，一日之间共服生
石膏十两，而心中分毫不觉凉，大便亦未通下。踌躇再四，精思其理，恍悟此必伏气之所入甚深，原当补助
正气，俾吾身之正气壮旺，自能逐邪外出也。于斯欲仿白虎加人参汤之义，因无确实
把握，犹不敢遽用大剂，就已所预存之药，用生石膏二两，野台
参二钱，甘草钱半，适有所轧生怀山药粗渣又加少许，煎汤两蛊，分三次温饮下，饮完晚间即觉清爽，一夜
安睡，至黎明时少腹微疼，连泻三次，自觉伏气之热全消，再自视舌苔，已退去一半，而芒刺全无矣。夫
以常理揆之，加人参于白虎汤中，必谓能减石膏之凉力，而此次之实验乃知人参反能助石膏之凉力，其理
果安在乎？盖石膏煎汤，其凉散之力皆息息由毛孔透达于外，若与人参并用，则其凉散之力，与人参补益之
力互相化合，能旋转于脏腑之间，以搜剔深入之外邪使之净尽无遗，此所以白虎加人
参汤，清热之力远胜于白虎汤也。
愚生平治寒温实热，用白虎加人参汤时，恒多于用白虎汤时，而又恒因证制宜，即原方少有通变，凡
遇脉过六至者，恒用生怀山药一两以代方中粳米，盖以山药含蛋白质甚多，大能滋阴补肾，而其浓郁之汁浆
又能代粳米调胃也。若遇阳明之热既实，而其人又兼下痢者，恒用生杭芍一两以代方中知母，因芍药善清
肝热以除痢疾之里急后重，而其凉润滋阴之性又近于知母也。若妇人产后患寒温实热者，亦以山药代粳米，
又必以玄参八钱，以代方中知母，因山药既可补产后之肾虚，而玄参主产乳余疾，《神农本草经》原有
明文也（《神农本草经》中石膏、玄参皆主产乳，知母未言治产乳，不敢师心自用、轻以苦寒之药施于产后也）。
且玄参原非苦寒之品，实验之原甘而微苦（《神农本草经》谓其味苦者，当系后世传写之误），是
以虽在产后可放胆用之无碍也。
愚治寒温之证，于阳明肠实大便燥结者，恒投以大剂白虎汤，或白虎加人参汤，往往大便得通而愈，且
无下后不解之虞。间有服药之后大便未即通下者，而少投以降下之品，或用玄明粉二三钱和蜜冲服，其大便即
可通下。盖因服白虎汤及服白虎加人参汤后，壮热已消，燥结已润，自易通下也。
有外感之实热日久不退，致其人气血两亏，危险迫于目前，
急救以白虎加人参汤，其病只愈一半，必继服他种补益之药始能
全愈者，今试详述一案以征明之∶
一幼女年九岁，于季春上旬感受温病，医者以热药发之，服后分毫无汗，转觉表里大热，盖已成白虎汤
证也。医者不知按方施治，迁延二十余日，身体 羸，危险之朕兆歧出，其目睛上窜，几至不见，筋惕肉 ，
周身颤动，时作嗳声，间有喘时，精神昏愦，毫无知觉，其肌肤甚热，启其齿见舌缩而干，苔薄微黄，其脉
数逾六至，左部弦细而浮，不任重按，右部亦弦细而重诊似有力，大便旬日未行，此久经外感之热灼耗，致
气血两虚，肝风内动，真阴失守，元气将脱之候也。宜急治以白虎加人参汤，再辅以滋阴固气之品，庶可
救愈，特虑病状若此，汤药不能下咽耳。其家人谓偶与以勺水或米汤犹知下咽，想灌以药亦如下
咽也，于斯遂为疏方。
【处方】生石膏细末二两，野台参三钱，生怀山药六钱，生
怀地黄一两，生净萸肉一两，甘草二钱，共煎汤两大盅，分三次温饮下。
此方即白虎加人参汤以生地黄代知母，生山药代粳米，而又加山萸肉也。此方若不加萸肉，为愚常用之方，
以治寒温证当用白虎加人参汤而体弱阴亏者。今重加山萸肉一两者，诚以人当元气不固之时，恒因肝脏之疏泄
而上脱，此证目睛之上窜，乃显露之朕兆（当属于肝），重用萸肉以收敛肝脏之疏泄，元气即可不脱。且
喻嘉言谓上脱之证，若但知重用人参，转令人气高不返，重用萸肉为之辅弼，自无斯弊，可稳重建功。将药
三次服完，目睛即不上窜，身体安稳，嗳声已止，气息已匀，精神较前明了，而仍不能言，大便犹未通下，肌
肤犹热，脉数已减，不若从前之浮弦，右部重诊仍似有力，遂即原方略为加减，俾再服之。
【第二方】生石膏细末两半，野台参三钱，生怀地黄一两，生净萸肉六钱，天冬六钱，甘草二钱，
煎汤两盅，分两次温饮
下，每饮一次，调入生鸡子黄一枚。
目睛已不上窜而犹用萸肉者，诚以此证先有嗳气之病，是其气难于上达也。凡气之难于上达者，须防
其大便通后，气或下脱，故用萸肉以预防之。至于鸡子黄，化学家谓其含有副肾髓
质，即善滋真阴，生用之又善润大便是以加之。
此药日服一剂，服两日热已全退，精神之明了似将撤消，而仍不能言，大便仍未通下，间有努力欲便
之状。诊其脉热象已静且微弱，拟用灌肠法通其大便。先用野台参三钱，萸肉、天冬各四钱，煎汤服下。然
后用灌肠法以通其大便，安然通下。仍不能言，细诊其脉微弱益甚，右部关前之脉几至不见。乃恍悟其所以
不能言者，胸中大气下陷也，升补其胸中大气，使之上达于舌本必能言矣。
【第三方】生箭 三钱，野台参三钱，生怀山药一两，大甘枸杞一两，北沙参一两，天冬六钱，寸
冬带心六钱，升麻一钱，桔梗钱半，共煎汤一盅半，分两次温服下。此方连服两剂，遂能
言语，因方中重用滋阴之药以培养其精神，而精神亦复常矣。
除了白虎汤之外，还有白虎加人参汤（Baihu Jia Renshen Tang, White Tiger Decoction with Ginseng），用来辅助白虎汤所不能顾及之处。该方在《伤寒论》（Shanghan Lun, Treatise on Cold Pathogenic Diseases）中出现了五次，现在试着简要摘录其中几段作为研究的资料。
《伤寒论》原文：服用桂枝汤（Guizhi Tang, Cinnamon Twig Decoction）后大汗出，出现严重烦躁、口渴且症状不缓解，脉象洪大者，以白虎加人参汤主治。
【白虎加人参汤方】知母（Anemarrhenae Rhizoma, Zhimu）六两，石膏（Gypsum Fibrosum, Shigao）一斤（捣碎，用棉布包裹），甘草（Glycyrrhizae Radix et Rhizoma, Gancao）二两（炙烤），粳米（Oryza Sativa, Jingmi）六合，人参（Ginseng Radix, Renshen）三两。
以上五味药，用水一斗，煮至米熟汤成，滤去药渣，每次温服一升，每日三次。
服用桂枝汤原本是为了取微汗，如果汗出如水流漓，病必然不解，这叫做服用桂枝汤导致大汗出，即汗出如水流漓的状态。
因为出汗过多，严重损伤津液（Jinye, Body Fluids），所以出现严重的烦躁和口渴，脉象异常洪大，用白虎汤解除其热邪，加入人参来恢复津液，病就可以痊愈了。
《伤寒论》原文：伤寒病经过呕吐或泻下治疗后，七八天病情未解，热邪结聚在体内，表里都发热，时常怕风，极度口渴，舌面干燥且烦躁，想要喝几升水者，以白虎加人参汤主治。
所谓“若吐、若下”，实际上是治疗不当，误用吐法或下法，所以在吐下之后病没有好。而且误用吐法会损伤津液，误用下法会损伤气分（Qifen, Qi Level），津液受损会让人产生渴感，气分受损，不能帮助津液上潮到口腔，更会导致口渴，所以想要喝几升水。在白虎汤中加入人参，不仅能生津液，还能补助气分以帮助津液上潮，所以能建立奇效。
《伤寒论》原文：伤寒脉浮，发热无汗，表证未解者，不可给予白虎汤。若有口渴想喝水，且无表证者，以白虎加人参汤主治。
凡是服用白虎汤的脉象，都应该有滑脉（Hua Mai, Slippery Pulse）的特征，滑脉代表中有热邪。这一节的脉象只是浮（Fu Mai, Floating Pulse），虽然说是发热，但热邪仅在体表，这正是不能用白虎汤的实际原因。然而因为节文中提到了无汗及表不解的文字，后世治疗伤寒的人，有的说不出汗者不可用白虎汤，有的说表不解者不可用白虎汤，甚至引用这一节文字作为证据，却不能将上面的几句连贯起来通读理解，从而重重地误解了古人。
难道没考虑到太阳篇中的白虎汤证，其脉象是浮滑的，浮脉难道不是关联于表吗？又不考虑白虎汤证在《伤寒论》中出现三次，只有阳明篇的白虎汤证明确提到出汗，而太阳篇与厥阴篇所载的，都没有提到出汗吗？至于这个人想要喝几升水，且没有寒邪束表的证候，说明外感的热邪全部入里，灼烧消耗津液，让人极度口渴，这也是应该紧急使用白虎加人参汤救治而不容迟疑的情况。
白虎加人参汤所主治的证候，无论是口渴、烦躁还是舌干，固然由内陷的热邪所伤，实际上也是由于人体真阴（Zhenyin, True Yin）亏损所致。人参是补气（Buqi, Tonifying Qi）的药，不是滋阴（Ziyin, Nourishing Yin）的药，但加入白虎汤中，实在能在邪火炽盛之时立即恢复真阴，这其中大概有药物化合的奥妙。
曾治疗一个人，患伤寒热邪进入阳明之腑，脉象有力且兼硬，时常说胡话（谵语）。按照这种脉象本来适宜投以白虎加人参汤，但我当时年轻，医学造诣不深，竟然给了大剂量的白虎汤，让他分几次温饮下去。第二天看时，热势已退，但脉搏转快，说胡话更严重。这才恍然大悟，改投白虎加人参汤煎一大剂，分三次徐徐温饮下，喝完药后痊愈。大概白虎汤证的脉象宜见滑象，脉有硬象就不是滑脉了，这中间原有阴亏的迹象，所以适宜治以白虎加人参汤，而不能只治以白虎汤。自治愈此案之后，凡遇到病人脉数或弦硬，或年龄超过五十岁，或在劳心劳力之后，或其人身形素来羸弱，即使不是在汗、吐、下之后，只要口渴心烦，当用白虎汤时，都适宜加入人参，这是立于不败之地，作战必胜的军队。
同乡友人李××，曾治疗一个阳明腑实证，其脉虽然有力但数超过六至（每呼吸一次脉搏跳动次数），李××先投以白虎汤无效，接着因脉数加入玄参（Scrophulariae Radix, Xuanshen）、沙参（Glehniae Radix, Shashen）以滋其阴分仍然无效，向我请教。我回答说：这是白虎加人参汤证。李××说，此证并非在汗、吐、下之后，而且也不渴不烦，为什么要用白虎加人参汤？我说：使用古人的方子，应当根据古人立方的意思去推展变通，凡是白虎汤所主的证候，那些口渴与烦躁的，多因阴分虚损，而脉象数的难道不是阴分虚损吗？李××听了我的话心中领悟，改投白虎加人参汤一剂而愈。
推展白虎加人参汤的用法，不必其人身体虚弱或有所伤损才用。回忆我三十岁时，曾患伏气化热，五心烦热（Wuxin Fanre, Five-palm Heat），头目昏沉，舌苔白厚欲黄，且多有芒刺，大便干燥，每天用生石膏数两煮水喝，连喝数日，热象不退，心想或许是药力轻不能胜病，于是在上午用生石膏五两煮水喝下，下午又用生石膏五两煮水喝下，一天之内共服生石膏十两，但心中丝毫不觉得凉，大便也未通下。犹豫再三，精思其理，恍悟这必定是伏气侵入很深，原本应当补助正气，使我的正气壮旺，自然能将邪气驱逐外出。于是想仿照白虎加人参汤的意义，因为没有确切把握，还不敢贸然用大剂量，就用预先存有的药，用生石膏二两，野台参二钱，甘草钱半，恰好有一些轧碎的怀山药粗渣又加少许，煎汤两大盅，分三次温饮下，喝完晚上就觉得清爽，一夜安睡，到黎明时小腹部微疼，连泻三次，自觉伏气的热全消，再看舌苔，已退去一半，且芒刺全无了。按常理推测，在人参加入白虎汤中，必谓能减少石膏的凉力，而这次的实验却知道人参反而能助长石膏的凉力，其中的道理在哪里呢？大概石膏煎汤，其凉散之力都是通过毛孔透达于外，若与人参并用，则其凉散之力与人参补益之力互相化合，能在脏腑之间旋转，搜剔深入的外邪使之净尽无遗，这就是白虎加人参汤清热之力远胜于白虎汤的原因。
我生平治疗寒温实热，用白虎加人参汤的时候，往往多于用白虎汤的时候，而又恒因证制宜，即原方少有变动。凡遇到脉超过六至者，恒用生怀山药一两代替方中的粳米，大概因为山药含有蛋白质甚多，大能滋阴补肾，而其浓郁的汁浆又能代替粳米调和胃气。如果遇到阳明之热既实，而其人又兼下痢者，恒用生杭芍一两代替方中的知母，因为芍药善清肝热以消除痢疾的里急后重，而其凉润滋阴的性质又接近知母。如果妇人产后患寒温实热者，也以山药代替粳米，又必须以玄参八钱代替方中的知母，因为山药既可补产后之肾虚，而玄参主治产乳余疾，《神农本草经》原有明文记载（《神农本草经》中石膏、玄参皆主治产乳，知母未言治产乳，不敢主观自用，轻易用苦寒的药施于产后）。而且玄参原本不是苦寒之品，实验发现其味甘而微苦（《神农本草经》谓其味苦者，应当是后世传写的错误），所以在产后可放心使用无碍。
我治疗寒温之证，对于阳明肠实大便燥结者，恒投以大剂白虎汤，或白虎加人参汤，往往大便得通而愈，且无泻下后病不解的担忧。间或有服药之后大便未立即通下的，而少投以降下之品，或用玄明粉二三钱和蜜冲服，其大便即可通下。大概因为服白虎汤及服白虎加人参汤后，壮热已消，燥结已润，自然容易通下。
有外感实热日久不退，致使其人气血两亏，危险迫在眉睫，急救以白虎加人参汤，病只愈了一半，必须继服其他补益之药才能全愈的，现在试着详细叙述一案以证明这一点：
一个九岁幼女，在季春上旬感受温病，医生用热药发汗，服后分毫无汗，转而觉得表里大热，这已成白虎汤证。医生不知按方施治，拖延二十余日，身体羸弱，危险的征兆歧出，其眼睛上窜，几乎看不见，筋惕肉瞤（肌肉跳动），周身颤动，时常打嗝，间有喘息，精神昏愦，毫无知觉，肌肤很热，张开牙齿看到舌缩而干，苔薄微黄，脉数超过六至，左部弦细而浮，不耐重按，右部也弦细而重诊似有力，大便十天未行，这是久经外感之热灼烧消耗，致气血两虚，肝风内动（Liver Wind Stirring Internally），真阴失守，元气将脱的征候。适宜紧急治以白虎加人参汤，再辅以滋阴固气之品，或许可以救愈，特别担心病状如此，汤药不能下咽。其家人说偶尔给勺水或米汤尚知下咽，想灌药也应该能下咽，于是遂为其开方。
【处方】生石膏细末二两，野台参三钱，生怀山药六钱，生怀地黄一两，生净萸肉一两，甘草二钱，共煎汤两大盅，分三次温饮下。
此方即白虎加人参汤以生地黄（Rehmanniae Radix, Sheng Dihuang）代知母，生山药代粳米，而又加山萸肉（Corni Fructus, Shanzhuyu）。此方若不加萸肉，为我常用的方，以治寒温证当用白虎加人参汤而体弱阴亏者。今重加山萸肉一两，诚因为人当元气不固之时，恒因肝脏的疏泄而上脱，此证眼睛的上窜，乃显露的征兆（当属于肝），重用萸肉以收敛肝脏的疏泄，元气即可不脱。且喻嘉言说上脱之证，若只知道重用人参，反令人气高不返，重用萸肉为之辅弼，自然无此弊病，可稳重建功。将药分三次服完，眼睛即不上窜，身体安稳，嗳声已止，气息已匀，精神较前明了，但仍不能说话，大便仍未通下，肌肤犹热，脉数已减，不像从前那样浮弦，右部重诊仍似有力，于是就在原方略为加减，让其再服。
【第二方】生石膏细末一两半，野台参三钱，生怀地黄一两，生净萸肉六钱，天冬（Asparagi Radix, Tiandong）六钱，甘草二钱，煎汤两盅，分两次温饮下，每次饮用时，调入生鸡蛋黄一枚。
眼睛已不上窜而犹用萸肉者，诚以此证先前有嗳气的病，是其气难于上达。凡气难于上达者，须防其大便通后，气或下脱，故用萸肉以预防之。至于鸡蛋黄，化学家谓其含有副肾髓质，即善滋真阴，生用之又善润大便，所以加上它。
此药日服一剂，服两日热已全退，精神的明了似乎将要消失，而仍不能说话，大便仍未通下，间有努力想排便的样子。诊其脉热象已静且微弱，拟用灌肠法通其大便。先用野台参三钱，萸肉、天冬各四钱，煎汤服下。然后用灌肠法以通其大便，安然通下。仍不能说话，细诊其脉微弱更甚，右部关前之脉几乎不见。这才恍悟其所以不能说话的原因，是胸中大气（Zhongqi/Daqi, Chest Qi）下陷，升补其胸中大气，使其上达于舌本，必能说话了。
【第三方】生箭芪三钱，野台参三钱，生怀山药一两，大甘枸杞一两，北沙参一两，天冬六钱，寸冬带心六钱，升麻一钱，桔梗钱半，共煎汤一盅半，分两次温服下。此方连服两剂，遂能言语，因方中重用滋阴之药以培养其精神，而精神亦复常矣。
Besides Baihu Tang (White Tiger Decoction), there is also Baihu Jia Renshen Tang (White Tiger Decoction with Ginseng), which serves to supplement the deficiencies of Baihu Tang. This formula appears five times in *Shanghan Lun* (*Treatise on Cold Pathogenic Diseases*). Now, I will briefly excerpt a few sections from it as data for study.
Original text from *Shanghan Lun*: After taking Guizhi Tang (Cinnamon Twig Decoction) and experiencing profuse sweating, if severe irritability and thirst persist without relief, and the pulse is flooding (Hong Mai, Large Pulse), Baihu Jia Renshen Tang should be administered.
[Formula for Baihu Jia Renshen Tang] Anemarrhenae Rhizoma (Zhimu, 知母) six liang, Gypsum Fibrosum (Shigao, 石膏) one jin (crushed, wrapped in cotton cloth), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) two liang (prepared by roasting), Oryza Sativa (Jingmi, 粳米) six he, Ginseng Radix (Renshen, 人参) three liang.
Take the above five ingredients, add ten dou of water, and boil until the rice is cooked and the decoction is ready. Strain out the dregs, and take one sheng warm each time, three times a day.
The original purpose of taking Guizhi Tang was to induce a slight sweat. If the sweat flows like water, the disease will certainly not resolve; this is referred to as causing profuse sweating after taking Guizhi Tang, meaning the sweat flows like water.
Because excessive sweating severely damages body fluids (Jinye), severe irritability and thirst occur, and the pulse becomes abnormally flooding. Using Baihu Tang to clear the heat, and adding Renshen to restore the body fluids, the disease can be cured.
Original text from *Shanghan Lun*: In cold damage disease, if vomiting or purging has been performed, and after seven or eight days the condition remains unresolved, with heat accumulating internally, manifesting as heat in both the interior and exterior, occasional aversion to wind, extreme thirst, dryness and irritability on the tongue, and a desire to drink several sheng of water, Baihu Jia Renshen Tang should be administered.
The phrase "if vomiting, if purging" actually refers to improper treatment, i.e., mistaken use of emetic or purgative methods, resulting in the failure of the disease to resolve after these treatments. Moreover, mistaken vomiting damages body fluids, while mistaken purging damages the qi level (Qifen). Damage to body fluids causes thirst, and damage to the qi level impairs its ability to assist body fluids in rising to the mouth, further causing thirst; hence the desire to drink several sheng of water. Adding Renshen to Baihu Tang not only generates body fluids but also supplements the qi level to help body fluids rise, thereby achieving remarkable results.
Original text from *Shanghan Lun*: In cold damage, if the pulse is floating (Fu Mai), with fever and no sweat, and the exterior syndrome is not resolved, Baihu Tang should not be given. If there is a desire to drink water and no exterior syndrome exists, Baihu Jia Renshen Tang should be administered.
For any case where Baihu Tang is indicated, the pulse should exhibit a slippery quality (Hua Mai, Slippery Pulse), which indicates heat within. The pulse in this section is merely floating. Although there is fever, the heat is located at the exterior; this is the practical reason why Baihu Tang cannot be used. However, because the text mentions "no sweat" and "exterior not resolved," later practitioners of cold damage have claimed that those without sweat or with an unresolving exterior cannot use Baihu Tang, citing this section as evidence. They fail to read the preceding sentences together to understand the context, thus greatly misunderstanding the ancients.
Have they not considered that in the Taiyang chapter, the Baihu Tang syndrome presents with a floating-slippery pulse? Is the floating pulse not connected to the exterior? Have they not considered that the Baihu Tang syndrome appears three times in *Shanghan Lun*, and only in the Yangming chapter is sweating explicitly mentioned, whereas in the Taiyang and Jueyin chapters, sweating is not mentioned? As for the person desiring to drink several sheng of water, and having no exterior syndrome constrained by cold, it means the external pathogenic heat has entered the interior, scorching and consuming body fluids, causing extreme thirst. In such cases, urgent rescue with Baihu Jia Renshen Tang is appropriate without hesitation.
The syndromes treated by Baihu Jia Renshen Tang, whether characterized by thirst, irritability, or dry tongue, are indeed injured by internalized pathogenic heat, but essentially stem from a deficiency of true yin (Zhenyin). Renshen is a herb that tonifies qi (Buqi) rather than nourishes yin (Ziyin). Yet, when added to Baihu Tang, it can rapidly restore true yin even when pathogenic fire is blazing fierce; there must be a subtle chemical interaction involved.
I once treated a patient suffering from cold damage where heat had entered the Yangming fu organs. The pulse was forceful and hard, accompanied by delirium. According to this pulse, Baihu Jia Renshen Tang was originally indicated. However, being young and lacking deep medical cultivation at the time, I prescribed a large dose of Baihu Tang alone, instructing the patient to drink it warm in divided doses. The next day, the fever had subsided, but the pulse became rapid, and the delirium worsened. It suddenly dawned on me, so I switched to Baihu Jia Renshen Tang, prepared a large decoction, and instructed the patient to drink it slowly in three doses. Upon finishing the medication, the patient recovered. Generally, the pulse for Baihu Tang syndrome should be slippery; a hard pulse indicates it is not slippery, revealing signs of yin deficiency within. Therefore, it should be treated with Baihu Jia Renshen Tang, not solely with Baihu Tang. Since curing this case, whenever I encounter patients with a rapid or wiry-hard pulse, those over fifty years old, those exhausted from mental or physical labor, or those constitutionally weak, even if not post-emesis/purgation, if they present with thirst and irritability requiring Baihu Tang, I always add Renshen. This ensures standing on unassailable ground, like an army destined to win.
A friend from my hometown, Li XX, once treated a Yangming fu excess syndrome. Although the pulse was forceful, it was rapid, exceeding six beats per respiration. Li XX first prescribed Baihu Tang without effect, then added Scrophulariae Radix (Xuanshen, 玄参) and Glehniae Radix (Shashen, 沙参) to nourish the yin level due to the rapid pulse, still without effect. He consulted me. I replied: This is a Baihu Jia Renshen Tang syndrome. Li XX said, this syndrome did not follow emesis, purgation, or sweating, nor is there thirst or irritability; why use Baihu Jia Renshen Tang? I said: When using ancient formulas, one must infer and adapt based on the intent of the ancient physicians. For syndromes treated by Baihu Tang, those with thirst and irritability often result from yin deficiency. Does a rapid pulse not also indicate yin deficiency? Li XX understood upon hearing my words, switched to Baihu Jia Renshen Tang, and the patient recovered after one dose.
Expanding the usage of Baihu Jia Renshen Tang does not require the patient to be physically weak or damaged. Recalling when I was thirty, I suffered from latent qi transforming into heat, experiencing heat in the five centers (Wuxin Fanre), dizziness and heaviness of the head and eyes, white thick tongue coating turning yellow, covered with prickles, and dry stool. I boiled several liang of raw Gypsum Fibrosum daily to drink, continuing for several days, but the heat did not subside. Thinking perhaps the dosage was too light to overcome the disease, I took five liang of raw Gypsum Fibrosum boiled in water at noon, and another five liang in the afternoon, totaling ten liang in one day. Yet, I felt no coolness internally, and my stool remained unpassed. After much deliberation and deep thought, I realized the latent qi had penetrated deeply. Originally, supporting the righteous qi (Zhengqi) was necessary so that strong righteous qi could naturally expel the pathogen. Thus, intending to imitate the principle of Baihu Jia Renshen Tang, but lacking confidence to use a large dose immediately, I used herbs I had stored: two liang of raw Gypsum Fibrosum, two qian of wild Taishen (Wild Ginseng), one and a half qian of Gancao, and added some coarse residue of processed Huai Shan Yao (Dioscoreae Rhizoma, Chinese Yam). I decocted this in two large bowls of water, drinking it warm in three doses. By evening, I felt refreshed and slept peacefully through the night. At dawn, I had mild lower abdominal pain and passed stool three times. I felt the latent heat had completely dissipated. Inspecting my tongue, the coating had receded by half, and the prickles were gone. By common logic, adding Renshen to Baihu Tang should reduce the cooling power of Gypsum Fibrosum. However, this experiment showed that Renshen actually enhances the cooling power of Gypsum Fibrosum. What is the rationale? When Gypsum Fibrosum is decocted, its cooling and dispersing power radiates outward through the pores. When used with Renshen, its cooling power combines with Renshen's tonifying power, circulating within the zang-fu organs to thoroughly eliminate deep-seated external pathogens. This is why Baihu Jia Renshen Tang clears heat far more effectively than Baihu Tang alone.
In my lifetime, treating exogenous febrile diseases with substantial heat, I often used Baihu Jia Renshen Tang more frequently than Baihu Tang, adapting the original formula slightly according to the syndrome. Whenever the pulse exceeded six beats per respiration, I consistently replaced the Jingmi in the formula with one liang of raw Huai Shan Yao. This is because Shan Yao contains abundant protein, strongly nourishing yin and tonifying the kidney, and its rich mucilage can replace Jingmi to harmonize the stomach. If Yangming heat is substantial and the patient also suffers from dysentery, I consistently replace Anemarrhenae Rhizoma (Zhimu) with one liang of raw Hang Shaoyao (Paeoniae Radix Alba, White Peony Root), because Shaoyao clears liver heat to relieve tenesmus in dysentery, and its cooling, moistening, and yin-nourishing nature is close to Zhimu. If a woman suffers from exogenous febrile disease with substantial heat postpartum, I also replace Jingmi with Shan Yao, and must replace Zhimu with eight qian of Xuanshen. This is because Shan Yao tonifies kidney deficiency postpartum, and Xuanshen treats residual disorders after childbirth, as explicitly stated in *Shennong Bencao Jing* (*Divine Farmer's Materia Medica*) (Both Gypsum Fibrosum and Xuanshen are stated to treat postpartum conditions in *Shennong Bencao Jing*; Zhimu is not stated to treat postpartum conditions. I dare not act subjectively and lightly administer bitter-cold herbs to postpartum women). Moreover, Xuanshen is not inherently bitter-cold; experiments show it is sweet with a slight bitterness (The statement in *Shennong Bencao Jing* that it is bitter is likely a transcription error by later generations). Therefore, it can be used boldly postpartum without harm.
When treating exogenous febrile diseases with Yangming intestinal excess and dry stool, I often prescribe large doses of Baihu Tang or Baihu Jia Renshen Tang. Often, the bowel movement becomes free, and the patient recovers, without the risk of unresolved disease after purgation. Occasionally, after taking the medicine, the bowel movement does not immediately pass. In such cases, administering a small amount of purgatives, or mixing two to three qian of Mirabilite (Xuanmingfen) with honey and water, allows the bowel to pass smoothly. This is because after taking Baihu Tang or Baihu Jia Renshen Tang, the high fever has subsided, and the dryness has been moistened, making passage easy.
There are cases where exogenous substantial heat persists for a long time, leading to dual deficiency of qi and blood, with danger imminent. Emergency treatment with Baihu Jia Renshen Tang may cure only half the illness; subsequent administration of other tonic medicines is required for full recovery. I will now detail a case to demonstrate this:
A nine-year-old girl contracted a warm disease in early spring. The physician used hot herbs to induce sweating. After ingestion, there was no sweat, and she developed severe interior and exterior heat, constituting a Baihu Tang syndrome. The physician failed to treat according to the formula, delaying for over twenty days. Her body became emaciated, and various signs of danger emerged: her eyes rolled upward, nearly blind; muscles twitched (Jinti Rourun); her whole body trembled; she belched frequently; occasionally wheezed; her spirit was confused and unconscious; her skin was very hot. Opening her teeth revealed a retracted, dry tongue with a thin, slightly yellow coating. The pulse was rapid, exceeding six beats per respiration. The left side was wiry, fine, and floating, unable to withstand heavy pressure. The right side was also wiry and fine, but seemed forceful under heavy pressure. She had not passed stool for ten days. This was due to prolonged burning by exogenous heat, causing dual deficiency of qi and blood, stirring of liver wind (Ganfeng Neidong), loss of true yin control, and impending collapse of yuan qi (Primordial Qi). Urgent treatment with Baihu Jia Renshen Tang, supplemented by herbs to nourish yin and secure qi, might save her. However, I feared that given her condition, she could not swallow decoctions. Her family said she could swallow spoonfuls of water or rice soup if offered, so administering medicine orally should be possible. Thus, I prescribed the following:
[Prescription] Raw Gypsum Fibrosum (fine powder) two liang, Wild Taishen three qian, Raw Huai Shan Yao six qian, Raw Rehmanniae Radix (Sheng Dihuang, Prepared Rehmannia Root) one liang, Raw Corni Fructus (Sheng Shanzhuyu, Dogwood Fruit) one liang, Gancao two qian. Decoct together in two large bowls of water, divide into three doses, drink warm.
This formula is Baihu Jia Renshen Tang with Raw Rehmanniae Radix replacing Anemarrhenae Rhizoma, Raw Huai Shan Yao replacing Oryza Sativa, plus added Corni Fructus. Without Corni Fructus, this is my commonly used formula for exogenous febrile diseases requiring Baihu Jia Renshen Tang in patients who are weak and yin-deficient. Today, I heavily added one liang of Corni Fructus because when primordial qi is insecure, it often ascends and collapses due to the liver's dispersing function. The upward rolling of the eyes is a manifest sign (belonging to the liver). Heavy use of Corni Fructus converges the liver's dispersing function, preventing qi collapse. Furthermore, Yu Jiayan stated that for ascending collapse syndromes, relying solely on heavy Renshen may cause qi to rise uncontrollably. Adding heavy Corni Fructus as an assistant prevents this drawback, ensuring steady success. After completing three doses, her eyes stopped rolling upward, her body stabilized, belching ceased, breathing normalized, and her spirit became clearer, though she still could not speak. Her stool remained unpassed, skin still hot, pulse rate decreased and less wiry-floating than before, but the right side still seemed forceful under heavy pressure. I slightly modified the original formula for continued use.
[Second Prescription] Raw Gypsum Fibrosum (fine powder) one and a half liang, Wild Taishen three qian, Raw Rehmanniae Radix one liang, Raw Corni Fructus six qian, Asparagi Radix (Tiandong, Asparagus Tuber) six qian, Gancao two qian. Decoct in two bowls of water, divide into two doses, drink warm. Add one raw chicken egg yolk to each dose.
Corni Fructus is still used despite the eyes no longer rolling upward because this patient previously suffered from belching, indicating difficulty in qi ascending. For qi difficult to ascend, one must guard against qi collapsing downward after bowel movement. Thus, Corni Fructus is used for prevention. Regarding the chicken egg yolk, chemists state it contains adrenal medullary substances, which nourish true yin well. Raw application also moistens the bowels well, hence its addition.
Taking one dose daily, after two days the heat completely subsided. Her clarity of spirit seemed to fade, and she still could not speak. Stool remained unpassed, with occasional straining. Palpating the pulse, the heat signs had quieted and become weak. I planned to use enema to facilitate bowel movement. First, I gave Wild Taishen three qian, Corni Fructus and Asparagi Radix four qian each, decocted in water. Then, I used an enema to facilitate bowel movement, which passed smoothly. She still could not speak. Fine palpation revealed the pulse was even weaker; the pulse at the cun position on the right side was almost imperceptible. It suddenly dawned on me that her inability to speak was due to sinking of the great qi in the chest (Zhong Daqi Xiaxian). Lifting and tonifying the great qi in the chest, allowing it to reach the root of the tongue, would enable speech.
[Third Prescription] Raw Atractylodis Macrocephalae Rhizoma (Sheng Jianqi, Astragalus Root) three qian, Wild Taishen three qian, Raw Huai Shan Yao one liang, Large Sweet Lycii Fructus (Gouqizi, Goji Berry) one liang, Glehniae Radix (Beishashen, North Glehnia Root) one liang, Asparagi Radix six qian, Ophiopogonis Japonici Bulbus with heart (Cundong Daixin, Lily Tuber) six qian, Cimicifugae Rhizoma (Shengma, Black Cohosh Root) one qian, Platycodonis Radix (Jiegeng, Balloon Flower Root) one and a half qian. Decoct in one and a half bowls of water, divide into two doses, drink warm. After taking two doses of this formula, she could speak. This is because the formula heavily uses yin-nourishing herbs to cultivate her spirit, and her spirit returned to normal.