主治烦渴也，旁治谵语、烦躁、身热。
考 证
白虎汤证曰∶谵语遗尿。
白虎加人参汤证曰∶大烦渴。
白虎加桂枝汤证曰∶身无寒、但热。
以上三方，石膏皆一斤。
越婢汤证曰∶不渴、续自汗出、无大热。（不渴，非全不渴之谓。无大热，非全无大热
之谓也，说在外传中）。
麻黄杏仁甘草石膏汤，证不具也。（说在《类聚方》）
以上二方，石膏皆半斤。
大青龙汤证曰∶烦躁。
木防己汤，证不具也（说在《类聚方》）
以上二方，石膏皆鸡子大也。为则按，鸡子大，即半斤也，木防己汤，石膏或为三枚，
或为十二枚，其分量难得而知焉。今从旁例，以为鸡子大也。
上历观此诸方，石膏主治烦渴也明矣。凡病烦躁者，身热者，谵语者，及发狂者，齿痛者，
头痛者，咽痛者，其有烦渴之证也，得石膏而其效核焉。
互 考
《伤寒论》曰∶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。为则按，上云不可与白虎汤，下云白虎加人参汤主之。上下恐有错
误也。于是考诸《千金方》，揭《伤寒论》之全文。而白虎汤加人参汤，作白虎汤是也。今
从之。
《伤寒论》中，白虎汤之证不具也，《千金方》举其证也备矣，今从之。
辨 误
《名医别录》言∶石膏性大寒，自后医者怖之，遂至于置而不用焉。仲景氏举白虎汤之
证曰∶无大热。越婢汤之证亦云。而二方主用石膏。然则仲景氏之用药，不以其性之寒热也
可以见已。余也笃信而好古，于是乎为渴家而无热者，投以石膏之剂，病已而未见其害也。
方炎暑之时，有患大渴引饮而渴不止者，则使其服石膏末，烦渴顿止。而不复见其害也。石
膏之治渴而不足怖也，斯可以知已。
陶弘景曰∶石膏发汗，是不稽之说。而不可以为公论。仲景氏无斯言，意者陶氏用石膏，
而
在下则下。于是乎有非吐剂而吐，非下剂而下，非汗剂而汗者，是变而非常也。何法之为？
譬有盗于梁上，室人交索之。出于右，则顺而难逃。逾于左，则逆而易逃。然则虽逆乎？从
其易也，毒亦然。仲景曰∶与柴胡汤，必蒸蒸而振，却发热汗出而解。陶氏所谓石膏发汗，
盖亦此类也已。陶氏不知，而以为发汗之剂。不亦过乎？后世以石膏为峻药，而怖之太甚，
是不学之过也。仲景氏之用石膏，其量每多于他药；半斤至一斤，此盖以其气味之薄故也。
余尝治青山候臣蜂大夫之病。其证平素毒着脊上七椎至十一椎，痛不可忍，发则胸膈烦闷而
渴，甚则冒而不省人事，有年数矣。一日大发，众医以为大虚，为作独参汤，贴二钱，日三
服；六日未知也。医皆以为必死。于是家人召余诊之。脉绝如死状，但诊其胸，微觉有烦闷
状，乃作石膏黄连甘草汤与之。一剂之重三十五钱，以水一盏六分，煮取六分，顿服，自昏
至晓，令三剂尽，通计一百有五钱，及晓，其证犹梦而顿觉。次日余辞而归京师，病客曰∶
一旦诀别，吾则不堪。请与君行，朝夕于左右，遂俱归京师。为用石膏如故，居七八十许日
而告瘳。石膏之非峻药而不可怖也，可以见焉尔。
品 考
石膏 本邦处处出焉。加州、奥州最多。而有硬软二种。软者上品也。《别录》曰∶细
理白泽者良。雷 曰∶其色莹净如水精。李时珍曰∶白者洁净细文，短密如束针。为则曰∶
采石药之道，下底为佳，以其久而能化也。采石膏于其上头者，状如米糕。于其下底者，莹
净如水精，此其上品也。用之之法，唯打碎之已。近世火 用之，此以其性为寒故也。臆测
之为也，余则不取焉。大凡制药之法，制而倍毒则制之。去毒则不，是毒外无能也。诸药之
下，其当制者，详其制也，不制者不，下皆效之。
考证：
白虎汤证的表现为：谵语、遗尿。
白虎加人参汤证的表现为：极度烦渴。
白虎加桂枝汤证的表现为：身体不恶寒，只有发热。
以上三个方剂中，石膏的用量均为一斤。
越婢汤证的表现为：口不渴、持续自汗出、没有大热。（“口不渴”并非完全不渴的意思；“没有大热”并非完全没有大热的意思，详细解释见外传）。
麻黄杏仁甘草石膏汤的证候描述不完整。（详细解释见《类聚方》）
以上两个方剂中，石膏的用量均为半斤。
大青龙汤证的表现为：烦躁。
木防己汤的证候描述不完整（详细解释见《类聚方》）。
以上两个方剂中，石膏的用量均为鸡蛋大小。我按察认为，鸡蛋大小即相当于半斤。木防己汤中，石膏有的记载为三枚，有的记载为十二枚，其具体分量难以确切知晓。现在参照旁例，认定为鸡蛋大小。
综上所述观察这些方剂，石膏主治烦渴是显而易见的。凡是患有烦躁、身体发热、谵语、发狂、牙痛、头痛、咽痛的病症，如果伴有烦渴的症状，使用石膏就能取得确切疗效。
互考：
《伤寒论》中说：伤寒脉浮、发热无汗，表证未解者，不可给予白虎汤。口渴想喝水，且没有表证者，用白虎加人参汤主治。我按察认为，上文说不可与白虎汤，下文说用白虎加人参汤主治，上下文中恐怕有错误。于是考证《千金方》，揭示《伤寒论》的全文。发现其中将“白虎汤加人参汤”写作“白虎汤”，这是正确的。现在遵从这一说法。
《伤寒论》中，白虎汤的证候描述不完整，《千金方》列举其证候非常完备，现在遵从《千金方》。
辨误：
《名医别录》说：石膏性味大寒，从此以后医生们害怕它，以至于放置不用。张仲景指出白虎汤的证候时说：“没有大热”。越婢汤的证候也这样说，而这两个方剂主要使用石膏。由此可见，张仲景用药并不因其性味的寒热而定。我也笃信并喜好古法，于是对于那些只口渴而没有热象的患者，投以石膏制剂，病愈后并未见到害处。在酷热暑天，有人患大渴引饮而渴不止，让他服用石膏粉，烦渴立刻停止，并没有见到害处。由此可知，石膏治疗口渴并不可怕。
陶弘景说：石膏能发汗，这是不经考证的说法，不能作为公论。张仲景没有这种说法，推测陶氏在使用石膏时，药力下行则导致下利，于是产生了非泻下药却导致下利、非发汗药却导致发汗的情况，这是药效变异而非正常现象。这是什么道理呢？譬如梁上有盗贼，屋内的人四处搜寻。从右边出来，顺着方向很难逃脱；翻越到左边，逆着方向容易逃脱。那么，即使是逆势，也顺应容易逃脱的路径。药物的毒性也是如此。张仲景说：“给予柴胡汤，必定会蒸蒸然振栗，随后发热出汗而解。”陶氏所说的石膏发汗，大概也是这类情况吧。陶氏不知道这一点，而认为它是发汗剂，不是太过分了吗？后世把石膏当作峻猛药物，过于害怕它，这是不学习的过错。张仲景使用石膏，其剂量往往多于其他药物；半斤至一斤，这大概是因其气味淡薄的原因。
我曾经诊治青山侯臣蜂大夫的病。他的症状是平时毒素附着在脊柱第七椎至第十一椎之间，疼痛难忍，发作时胸膈烦闷而口渴，严重时昏迷不省人事，已有数年之久。一天突然大发，众医生认为是大虚证，为他配制独参汤，贴敷二钱，每日三次服用；六天后未见好转。医生们都认为必死无疑。于是家人召我去诊视。脉象微弱如死状，但诊察胸部，微微感觉有烦闷之状，于是配制石膏黄连甘草汤给他服用。一剂药重三十五钱，用水一盏六分，煮取六分，一次性服下，从黄昏到拂晓，令其服完三剂，总计一百零五钱。到了拂晓，他的症状如同梦境般突然觉醒。第二天我辞别返回京城，病人说：“一旦诀别，我无法承受。请允许我跟随您，朝夕在您身边侍奉。”于是我们一起回到京城。我继续像以前一样使用石膏，居住七八十天左右，他告知痊愈。由此可见，石膏并非峻猛药物，不必害怕。
品考：
石膏：我国各地都有出产。加州、奥州最多。分为硬和软两种。软的为上品。《名医别录》说：纹理细密、色泽洁白如玉的为良。雷敩说：其颜色晶莹洁净如水精。李时珍说：白色的洁净且有细密短促如束针般的纹理。我按察说：开采石药的方法，以下层为佳，因为年代久远能够化解。在上部开采的石膏，形状像米糕；在下层开采的，晶莹洁净如水精，这是上品。使用方法，只需打碎即可。近世火神派使用它，是因为认为其性寒的缘故。对此臆测，我不采纳。大凡制药的方法，炮制后加倍毒性则进行炮制；去除毒性则不炮制，这是因为毒性之外没有其他作用。在各种药物之下，应当炮制的，详细说明炮制方法；不炮制的就不炮制，下面都效法这种做法。
It primarily treats excessive thirst and irritability (Fan Ke), and secondarily treats delirium, restlessness, and body heat.
Textual Research:
The syndrome of Baihu Tang (White Tiger Decoction) presents with delirium and urinary incontinence.
The syndrome of Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) presents with severe excessive thirst and irritability.
The syndrome of Baihu Jia Guizhi Tang (White Tiger Decoction plus Cinnamon Twig) presents with no aversion to cold, only heat.
In the above three formulas, the dosage of Shigao (Gypsum Fibrosum) is one jin.
The syndrome of Yuespi Tang (Yuebi Decoction) presents with no thirst, continuous spontaneous sweating, and no significant heat. ("No thirst" does not mean absolutely no thirst; "no significant heat" does not mean absolutely no significant heat; see external commentary for details).
The syndrome description for Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) is incomplete. (See *Leiju Fang* for details).
In the above two formulas, the dosage of Shigao (Gypsum Fibrosum) is half a jin.
The syndrome of Daqinglong Tang (Major Blue Green Dragon Decoction) presents with restlessness.
The syndrome description for Mufangji Tang (Stephania Tetrandra Decoction) is incomplete (see *Leiju Fang* for details).
In the above two formulas, the dosage of Shigao (Gypsum Fibrosum) is the size of an egg. I have verified that the size of an egg is equivalent to half a jin. In Mufangji Tang (Stephania Tetrandra Decoction), Shigao (Gypsum Fibrosum) is recorded as either three pieces or twelve pieces, making its exact dosage difficult to ascertain. Following parallel examples, I consider it to be the size of an egg.
Having observed these formulas comprehensively, it is clear that Shigao (Gypsum Fibrosum) primarily treats excessive thirst and irritability. For any disease presenting with restlessness, body heat, delirium, mania, toothache, headache, or sore throat, if accompanied by symptoms of excessive thirst and irritability, Shigao (Gypsum Fibrosum) yields definitive efficacy.
Cross-Reference:
*Shanghan Lun* (Treatise on Cold Pathogenic Diseases) states: In cold damage with floating pulse, fever, and absence of sweating, if the exterior syndrome is unresolved, Baihu Tang (White Tiger Decoction) must not be given. 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. I have verified that the upper text says "must not give Baihu Tang," while the lower text says "Baihu Jia Renshen Tang is the primary treatment." There may be errors between the upper and lower texts. Therefore, I consulted *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) to reveal the full text of *Shanghan Lun*. It shows that "Baihu Jia Renshen Tang" was written as "Baihu Tang," which is correct. I now follow this correction.
In *Shanghan Lun*, the syndrome description for Baihu Tang (White Tiger Decoction) is incomplete, whereas *Qianjin Fang* lists the syndromes comprehensively. I now follow *Qianjin Fang*.
Correction of Errors:
*Mingyi Bielu* (Secret Record of Famous Physicians) states: Shigao (Gypsum Fibrosum) has a major cold nature. Since then, physicians have feared it, leading to its abandonment and non-use. Zhang Zhongjing pointed out in the syndrome of Baihu Tang (White Tiger Decoction): "no significant heat." The syndrome of Yuespi Tang (Yuebi Decoction) also states this, yet both formulas primarily use Shigao (Gypsum Fibrosum). Thus, it can be seen that Zhang Zhongjing did not prescribe medication based solely on its cold or hot nature. I firmly believe in and cherish ancient methods. Consequently, for patients who are thirsty but lack heat signs, I administered Shigao (Gypsum Fibrosum) preparations; the illness resolved without adverse effects. During the intense heat of summer, there were cases of severe thirst with unquenchable drinking desire. Having them consume Shigao (Gypsum Fibrosum) powder stopped the excessive thirst and irritability immediately, without adverse effects. This demonstrates that Shigao (Gypsum Fibrosum) for treating thirst is not something to fear.
Tao Hongjing stated: "Shigao (Gypsum Fibrosum) induces sweating." This is an unsubstantiated claim and cannot serve as public consensus. Zhang Zhongjing made no such statement. It is likely that when Tao used Shigao (Gypsum Fibrosum), its action directed downwards causing purgation, thus creating situations where non-purgatives caused purgation, and non-diaphoretics caused sweating. This is a variation, not the norm. What principle is this? Imagine a thief on the beam; household members search everywhere. If he exits from the right, following the direction makes escape difficult; if he crosses to the left, going against the direction makes escape easy. Even if contrary, one follows the path of ease. The toxicity of drugs is similar. Zhang Zhongjing said: "When administering Chaihu Tang (Bupleurum Decoction), there will inevitably be shivering and trembling, followed by fever, sweating, and resolution." Tao's statement about Shigao (Gypsum Fibrosum) inducing sweating is likely of this same category. Tao did not understand this and considered it a diaphoretic agent, which is excessive. Later generations regarded Shigao (Gypsum Fibrosum) as a harsh drug and feared it excessively; this is the fault of ignorance. Zhang Zhongjing’s dosage of Shigao (Gypsum Fibrosum) was often greater than other herbs; half a jin to one jin. This is likely due to its thin flavor and qi.
I once treated the illness of Feng Dafu, a minister of the Aoyama domain. His condition involved toxins attaching to the seventh through eleventh vertebrae of the spine, causing unbearable pain. Upon onset, he experienced chest and diaphragm oppression with thirst; severely, he would faint and lose consciousness. This had persisted for years. One day, a severe attack occurred. Other physicians considered it a major deficiency and prescribed Dushen Tang (Single Ginseng Decoction), applying two qian, taken three times daily. After six days, there was no improvement. All physicians believed death was inevitable. The family summoned me to diagnose. The pulse was imperceptible, resembling death, but upon palpating the chest, I perceived slight oppression. I prepared Shigao Huanglian Gancao Tang (Gypsum, Coptis, and Licorice Decoction) for him. One dose weighed thirty-five qian. Boiled in one cup and six fen of water until reduced to six fen, it was taken all at once. From dusk till dawn, he completed three doses, totaling one hundred five qian. By dawn, his condition suddenly cleared as if waking from a dream. The next day, I bid farewell and returned to the capital. The patient said, "If we part now, I cannot bear it. Allow me to accompany you, serving you morning and night." We returned to the capital together. I continued using Shigao (Gypsum Fibrosum) as before. After residing for seventy to eighty days, he reported recovery. This shows that Shigao (Gypsum Fibrosum) is not a harsh drug and need not be feared.
Product Examination:
Shigao (Gypsum Fibrosum): Produced everywhere in our country. Most abundant in California and Aomori Prefecture. It exists in hard and soft varieties. The soft variety is superior. *Bi Lu* states: Those with fine texture and bright white luster are good. Lei Xiao stated: Its color is crystal clear like water essence. Li Shizhen stated: White ones are clean with fine, short, dense textures like bundled needles. I have verified: The method of mining stone medicines considers the bottom layer best, as it has been there longer and can transform. Mining from the top yields shapes like rice cakes; mining from the bottom yields crystals clear like water essence, which is the superior grade. The method of use is simply to crush it. In recent times, Fire Spirit School practitioners use it because they consider its nature cold. I do not accept this speculation. Generally, the method of processing medicine is: if processing doubles the toxicity, process it; if removing toxicity, do not process it, because outside of toxicity, there is no other effect. Among various medicines, those that should be processed have detailed processing instructions; those not processed remain so, and the following emulate this practice.