辽宁马××，年五十一岁，得伤寒兼有伏热证。
病因 因买卖赔钱，家计顿窘，懊悔不已，致生内热；孟冬时因受风，咳嗽有痰微喘，小便不利，
周身漫肿。愚为治愈，旬日之外，又重受外感，因得斯证。
证候 表里大热，烦躁不安，脑中胀疼，大便数日一行甚干燥，舌苔白浓，中心微黄，脉极洪实，
左右皆然，此乃阳明腑实之证。凡阳明腑实之脉，多偏见于右手，此脉左右皆洪实
者，因其时常懊悔，心肝积有内热也，其脑中胀疼者，因心
与肝胆之热挟阳明之热上攻也。当用大剂寒凉微带表散，清其阳明胃腑之热，兼以清其心肝之热。
处方 生石膏（四两捣细） 知母（一两） 甘草（四钱） 粳米（六钱） 青连翘（三钱）
共作汤煎至米熟，取汤三盅，分三次温服下，病愈勿尽剂。
方解 此方即白虎汤加连翘也，白虎汤为伤寒病阳明腑热之正药，加连翘者取其色青入肝，气
轻入心，又能引白虎汤之力达于心肝以清热也。
效果 将药三次服完，其热稍退，翌日病复还原，连服五剂，将生石膏加至八两，病仍如故，大
便亦不滑泻，病家惧不可挽救，因晓之曰∶石膏原为平和之药，惟服其细末则较有力，听吾用
药勿阻，此次即愈矣。为疏方，方中生石膏仍用八两，将药煎服之后，又用生石膏细末二两，俾蘸梨
片徐徐嚼服之，服至两半，其热全消，遂停服，从此病愈，不再反复。
附记 此案曾登于《全国名医验案类编》，何廉臣评此案云∶“日本××××谓∶‘石膏非大
剂则无效，故白虎汤、竹叶石膏汤及其他石膏诸方，其量皆过于平剂。世医不知此意为小剂
用之，譬如一杯水救一车薪之火，宜乎无效也。’吾国善用石膏者，除长沙汉方之外，
明有缪氏仲淳，清有顾氏松园、余氏师愚、王氏孟英，皆以善治温热名，凡治阳明实热之证，
无不重用石膏以奏功。今用石膏由四两加至八两，似已骇人听闻，然连服五、六剂热仍如故，大
便亦不滑泻，迨外加石膏细末梨片蘸服又至两半，热始全消而病愈，可见石膏为凉药中纯
良之品，世之畏石膏如虎者，可以放胆而不必怀疑也。”
病因：因买卖亏损，家境顿时窘迫，懊悔不已，导致产生内热；初冬时节又因受风邪侵袭，出现咳嗽、有痰、轻微气喘、小便不利、全身弥漫性浮肿的症状。我将其治愈后，过了十几天，再次感受外邪，因而得了这个病证。
证候：表里俱大热，烦躁不安，头脑胀痛，大便数日一行且非常干燥，舌苔白厚，中心微黄，脉象极洪大有力，左右手皆如此，这是阳明腑实证的表现。凡是阳明腑实的脉象，多偏见于右手，此脉左右皆洪大有力，是因为他时常懊悔，心肝积有内热所致；其头脑胀痛，是因为心与肝胆之热挟带阳明之热上攻头部所致。应当使用大剂量的寒凉药，微带解表散邪之功，以清泄阳明胃腑之热，兼以清泄心肝之热。
处方：生石膏（四两，捣细） 知母（一两） 甘草（四钱） 粳米（六钱） 青连翘（三钱）
共煎汤，煎至米熟，取药汁三盅，分三次温服，病愈即停服，不必服完全部药剂。
方解：此方即白虎汤加连翘组成。白虎汤是治疗伤寒病阳明腑热的正药，加入连翘，取其色青入肝经，气轻入心经，又能引导白虎汤的药力达于心肝以清热。
效果：将药分三次服完，热度稍退，第二天病情恢复原状，连续服用五剂，并将生石膏用量增加至八两，病情仍无变化，大便也未滑泻。病家害怕无法挽救，我便开导他们说：“石膏原本是平和的药物，但服用其细末则效力更强，请听从我用药，不要阻拦，这次一定能痊愈。”于是重新开具处方，方中生石膏仍用八两，将药煎服之后，又用生石膏细末二两，让病人蘸着梨片慢慢咀嚼服用，服至一两半时，热度完全消退，随即停止服用，从此病愈，不再反复。
附记：此案曾刊登于《全国名医验案类编》，何廉臣评价此案说：“日本××××认为：‘石膏若非大剂量则无效，所以白虎汤、竹叶石膏汤及其他含石膏的诸方，其用量都超过常规剂量。世俗医生不懂这个道理，用小剂量使用，譬如一杯水去救一车柴草的火，当然无效了。’我国善于使用石膏的医生，除了长沙张仲景汉方之外，明代有缪希雍缪氏仲淳，清代有顾松园顾氏、余师愚余氏、王孟英王氏，都以善于治疗温热病闻名，凡治疗阳明实热之证，无不重用石膏以奏效。如今用石膏由四两加至八两，似乎已骇人听闻，然而连续服用五六剂，热度仍如故，大便也未滑泻，等到外加石膏细末蘸梨片服用又至一两半，热度才完全消退而病愈，可见石膏是凉药中纯良之品，世上那些畏惧石膏如老虎的人，可以放心大胆地使用而无需怀疑。”
Liaoning patient Ma XX, aged fifty-one, suffered from Taiyang disease (Taiyang disorder) complicated with latent heat syndrome.
Etiology: Due to financial losses in business and a sudden deterioration of family finances, he was filled with remorse, which generated internal heat. In early winter, he contracted wind-pathogen, resulting in cough with phlegm, slight wheezing, difficult urination, and generalized edema. I cured him of this condition. More than ten days later, he contracted an external pathogen again, leading to the current syndrome.
Clinical Manifestations: Severe heat in both exterior and interior, restlessness and irritability, distending pain in the head, bowel movements once every few days with extreme dryness, white and thick tongue coating with a slightly yellow center, and extremely surging and solid pulse on both left and right wrists. This is a manifestation of Yangming Fu-organ excess syndrome. Typically, the pulse for Yangming Fu-organ excess appears predominantly on the right side. The fact that the pulse here is surging and solid on both sides is due to his frequent remorse causing accumulation of internal heat in the Heart and Liver. The distending pain in the head is caused by the heat of the Heart and Liver combining with Yangming heat to attack upwards. Treatment should employ a large dose of cold-natured herbs with mild exterior-dispersing properties to clear the heat of the Yangming Stomach-Fu organ, while simultaneously clearing the heat of the Heart and Liver.
Prescription: Shigao (Calcitrum, Raw Gypsum) [4 liang, crushed fine], Zhi Mu (Anemarrhenae Rhizoma, Zhi Mu) [1 liang], Gancao (Glycyrrhizae Radix et Rhizoma, Licorice Root) [4 qian], Jingmi (Oryza Sativa, Rice) [6 qian], Qing Lianqiao (Forsythiae Fructum, Forsythia Fruit) [3 qian].
Decoct together until the rice is cooked, obtain three portions of the decoction, and take warm orally in three divided doses. Discontinue medication upon recovery; do not necessarily finish the entire prescription.
Formula Analysis: This formula is Baihu Tang (White Tiger Decoction) plus Lianqiao. Baihu Tang is the principal formula for treating Yangming Fu-heat in Taiyang disease. Lianqiao is added because its green color enters the Liver meridian and its light aroma enters the Heart meridian, thereby guiding the efficacy of Baihu Tang to the Heart and Liver to clear heat.
Outcome: After completing three doses, the fever subsided slightly. However, the next day the condition reverted to its original state. Five consecutive doses were administered, increasing the dosage of Shigao to 8 liang, but the condition remained unchanged, and there was no loose stool. The family feared the case was incurable. I reassured them, stating: "Shigao is originally a mild herb, but it is more potent when taken as a fine powder. Please allow me to prescribe as I see fit without obstruction; this time will surely bring a cure." A new prescription was issued with Shigao still at 8 liang. After administering the decoction, an additional 2 liang of raw Shigao fine powder was prescribed to be chewed slowly with slices of pear. Upon consuming one and a half liang, the fever completely disappeared, and administration was stopped. The patient recovered thereafter without recurrence.
Postscript: This case was published in "Compilation of Verified Cases by Famous Doctors Nationwide." He Lianchen commented on this case: "A Japanese physician stated: 'If Shigao is not used in large doses, it is ineffective. Therefore, the dosages in Baihu Tang, Zhuye Shigao Tang, and other formulas containing Shigao exceed standard amounts. Uninformed physicians use small doses, akin to using a cup of water to extinguish a cartload of burning firewood; hence, they are ineffective.' Among Chinese physicians skilled in using Shigao, besides Zhang Zhongjing of Changsha in the Han Dynasty, there was Miao Zhongchun (Miao Xiyong) in the Ming Dynasty, and Gu Songyuan (Gu Song), Yu Shiyu, and Wang Mengying in the Qing Dynasty. All were famous for treating warm diseases and invariably used heavy doses of Shigao to treat Yangming excess-heat syndromes successfully. Increasing Shigao from 4 liang to 8 liang seems shocking, yet after five or six doses, the fever persisted despite normal bowel movements. Only after adding Shigao fine powder dipped in pear slices did the fever fully subside and the patient recover. This demonstrates that Shigao is a pure and excellent cooling herb. Those who fear Shigao as if it were a tiger can use it boldly without doubt."