升麻葛根汤 治伤寒瘟疫风热，壮热头痛，肢体痛，疮疹已发未发并宜用之。
升麻 干葛（细锉） 芍药 甘草（锉炙各等分）
上同为粗末，每服四钱，水一盏半煎至一盏，量大小与之，温服无时。
张氏景岳曰∶麻疹之证多属阳明火毒。凡欲解表散邪但表实邪盛者最宜用此，然愚谓
以柴胡代升麻用之更妙，若血气稍虚而邪有未解者，惟柴归饮为最妥。
汪氏双池曰∶此阳明经药也，麻疹发于阳明故以此方为要药，升麻葛根以达阳气于外，
芍药甘草以和脾胃于中，加芫荽生姜以微汗之，使元腑润泽，则热毒不郁也。
柯氏曰∶此为阳明初病解表和里之剂。可用以散表热，亦可用以治里虚。一方而两擅其
其长也。此方仿仲景葛根汤去姜桂之辛热大枣之甘壅，以升麻代麻黄，便是阳明表剂，而
非太阳表剂矣。葛根甘凉可散表实，协升麻以上升，则使清阳达上而浊阴降下，可以托散本
经自病之肌热，并可以升提与太阳合病之自利也。芍药收敛脾阴，甘草缓急和里，治里仍
用表药者，以表实下利而非里实故也。痘疹自里达表，初起内外皆热故亦宜于凉散耳。若无
汗加麻黄，有汗加桂枝，渴热加石膏，咽痛加桔梗，头痛合芎芷，有少阳证加柴芩，火盛加
芩连。凡邪在三阳以此出入，无不利也。
德按∶闻人氏伯圜曰∶道有经有权，兵有正有奇，病有常有变。病之常者可必，病之变
者不可必。古人立升麻汤治小儿疮痘为一定之论，岂固而不通者哉。尝思古人之意，升麻
汤一方盖治疮痘之常，不治疮痘之变。常者何也，未有斑点之前均发热者常也，已结痂 后
之均有余热拂郁而肌表未清凉者亦常也，是以升麻汤方状云∶治疮疹未发，已发，未发者
谓未见斑点之前，已发者谓已作痂 之后，此升麻汤所以为治疮痘之常者也。若夫斑点既
见与夫痂 未结，其候千变万化，治法在随证参调，曾非定论之可拘。犹如伤寒之变异不一
也，当此之际安可执一药以应无穷之变哉。且升麻汤所用之药不过凉肌解表而已，未见斑
点之前，已结痂 之后，则可以凉肌可以解表，古人处方之意如此，曷尝令用之于疮疹正
作之时耶。今昧者不能究此，既见斑点尚令儿服饵，致肌寒表弱陷伏而危殆。吁读古人之书
而不能探古人之妙，不可以言医矣。
麻黄杏仁甘草石膏汤 治温热内发，表里俱热，头痛身疼，不恶寒反恶热，无汗而喘，
大烦大渴，脉阴阳俱浮者，用此发汗而清火，若脉浮弱、沉紧、沉细、恶寒，自汗出而不渴者，禁用。
麻黄（四两） 杏仁（五十个，炮去双仁去皮尖） 甘草（二两，炙） 石膏（八两，碎绵裹）
上四味，以水七升，先煮麻黄减一升，去上沫，内诸药，煮取二升，去滓，温服一升。本云黄耳杯。
王氏曰∶喘家作桂枝汤加浓朴杏仁治寒喘也，今以麻黄石膏加杏仁治热喘也，麻黄开
毛窍，杏仁下里气，而以甘草载石膏辛寒之性，从肺发泄，俾阳气出者出，降者降，分头解
散，喘虽忌汗，然此重在急清肺热以存阴，热清喘定汗即不辍，而阳亦不亡矣。观二喘一寒
一热，治法仍有营卫分途之义。
柯氏曰∶此温病发汗逐邪之主剂也，石膏为清火之重剂，青龙白虎皆赖以建功。然用之
不当适足以召祸，故青龙以无汗烦躁得姜桂，以宣卫外之阳也，白虎以有汗烦渴须粳米以
存胃中之液也，此但热无寒故不用姜桂喘不在胃而在肺，故不须粳米其意重在存阴，不必
虑其亡阳也。故以麻黄汤去桂枝之监制取麻黄之专开，杏仁之降，甘草之和，倍石膏之大
寒，除内外之实热，斯溱溱汗出，而内外之烦热喘渴悉除矣。
程氏扶生曰∶此治寒深入肺发为喘热也，汗即出矣，而喘是寒邪未尽，若身无大热，则
是热壅于肺，故以麻黄散邪，石膏除热，杏仁利肺，于青龙汤内减麻黄，去姜桂，稳为发散
除热清肺之剂也，石膏去热清肺故肺热亦可用。
德按∶程氏杏轩云∶予治出麻冒风，隐闭喘促，烦躁凶险急证，每用此方获效。
盖麻出于肺闭，则火毒内攻多致喘闷而殆。此方麻黄发肺邪，杏仁下肺气，甘草缓肺
急，石膏清肺热，药简功专，所以效速。杏轩着有《医述》。（已刊行世）
白虎汤
治阳明证汗自出，渴欲饮水，洪大浮滑，不恶寒反恶热。
石膏（一斤，碎绵裹） 知母（六两） 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。
王氏曰∶白虎汤治阳明经表里俱热，与调胃承气导阳明腑中热邪，白虎泄阳明经中热
邪，石膏泄阳，知母滋阴，粳米缓阳明之阳，甘草缓阳明之阴。因石膏性重知母性滑，恐期其
疾趋于下，另设煎法以米熟汤成，俾辛寒重滑之性，得粳米甘草载之于上，逗遛阳明成清化
之功，名曰白虎者，虎为兽，以明石膏知母之辛寒，整肃肺金则阳明之热自解，实则泻子之理也。
柯氏曰∶阳明邪从热化故不恶寒而反恶热，热蒸外越故热汗自出，热烁胃液故渴欲饮
水，邪盛而实故脉洪大，半犹在经故兼浮而滑
也。阳明属胃外主肌肉，虽有大热而未成实。然火炎土燥，终非苦寒之味所能治也。经曰∶
甘先入脾，又曰∶以甘泻之，由是知甘寒之品乃泻胃火生津液之上剂也。石膏辛寒，辛能解
肌，寒能胜热，味甘入脾，质刚而主降，备中土生金之体，色白通肺，性柔而含脂具金，能生
水之用，入以为君。知母气寒主降，苦以泄肺火，辛以润肾燥，故为臣。甘草为中宫舟楫，能
土中泻火，寒药得之缓其寒，使沉降之性皆得留连于胃。粳米气味温和禀容平之德，作甘稼
穑，为后天养命之资。得此二味为佐阴寒之物，庶无伤胃损脾之虑。煮汤入胃，输脾归肺，
水精四布，大烦大渴可除矣。白虎乃西方金神，取以名汤者，秋金得令而炎暑自解也。更
加人参以补，承制石膏知母之寒，泻火而土不伤，乃操万全之术者。
德按∶白虎本为达热出表，若其脉浮弦而细者不可与也，脉沉细而微者不可与也，凡病
虽有壮热而无烦渴，汗不出者，知不在阳明，切勿误与白虎，学人慎毋孟浪。
白虎加人参汤
石膏（一斤，碎绵裹） 知母（六两） 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。
王氏曰∶阳明热病化燥白虎加人参汤何也。石膏辛寒仅能散表热，知母甘苦仅能降里热，甘草粳米仅能
载药留于中焦，若胃经热久伤气，气虚不能生津者，必须人参养正回津而后，白虎汤乃能清化除燥。
柯氏曰∶更加人参者，以气为水母，邪之所凑，其气必虚。阴虚则无气，此大寒剂中必
得人参之力以大补真阴，阴气复而津液自生也。若壮热之人，元气未伤，津液未竭，不大渴
者，只须滋阴以抑阳，不必加参而益气。若元气已亏者，但用纯阴之剂，火去而气无由生，
惟加人参则火泻而土不伤，又使金能得气，斯立法之尽善欤。此方重在烦渴，是热已入里，
若无汗烦渴而表不解者，则是麻杏甘石证矣。
竹叶石膏汤
竹叶（三把） 石膏（一斤，碎绵裹） 麦门冬（一升） 人参（三两） 半夏（半升，洗） 甘草（
二两，炙） 粳米（半升）
上六味以水一斗，煮取六升，去滓，内粳米煮米熟汤成，去米，温服一升，日三服。
王氏曰∶此汤分走手足两经，而不悖于理者，以胃居中焦，分行津液于各脏，补胃泻肺，
有补母泻子之义也。竹叶石膏麦冬泻肺之热，人参半夏炙草平胃之逆，复以粳米缓于中，使
诸药得成清化之功，是亦白虎越婢麦门冬三汤之变方也。
钱氏天来曰∶竹叶性寒而止烦热，石膏入阳明而清胃热，半夏蠲饮而止呕吐，人参补病
后之虚，同麦冬而大添胃中之津液，又恐寒凉损胃，故用甘草和之，而又以粳米助其胃气也。
周氏禹载曰∶石膏最凉兼竹叶以清热，则胃与小肠之邪俱去矣，半夏豁痰以止呕，麦冬
清肺以除烦，则中上二焦之邪俱降矣，惟甘草可生肌肉，粳米可益胃气，正与虚羸少气者相
宜也。且伤寒，热病也。即云解后其内蕴之热未必全清，故以甘寒之品清热补虚，此正为热
邪未全退之证而设，若用此以治虚羸则不可也。
德按∶徐氏洄溪注曰∶此仲景先生治伤寒愈后调养之方也。其法专于滋养肺胃之阴气，
以复津液，盖伤寒虽六经传遍而汗吐下三者皆肺胃当之。又《内经》云∶人之伤于寒也，则为病热。故滋养
肺胃，歧黄以至仲景不易之法也。后之庸医则用温热之药峻补脾肾，而千圣相传之精义消亡尽矣。
升麻葛根汤 治疗伤寒、瘟疫及风热引起的壮热头痛、肢体疼痛，无论疮疹是否发出都适宜使用。
升麻 干葛（细切） 芍药 甘草（切碎并炙烤，各等分）
以上药材共同捣成粗末，每次服用四钱，加水一盏半煎煮至一盏，根据患者年龄大小给予服用，随时温服。
张氏景岳说：麻疹的证候多属于阳明火毒。凡是想要解表散邪，但表实邪盛的情况最适合用此方，然而我认为用柴胡代替升麻使用更妙，如果血气稍虚而邪气未解的，只有柴归饮最为妥当。
汪氏双池说：这是治疗阳明经的药物，麻疹发于阳明，所以以此方为要药，升麻和葛根能将阳气通达于外，芍药和甘草能在中焦调和脾胃，加上芫荽和生姜以微微发汗，使元腑润泽，那么热毒就不会郁结。
柯氏说：这是治疗阳明初病、解表和里的方剂。可以用来散表热，也可以用来治里虚。一方而兼擅两长。此方模仿仲景的葛根汤，去掉姜桂的辛热和大枣的甘壅，用升麻代替麻黄，就成了阳明的表剂，而不是太阳的表剂了。葛根甘凉可以发散表实，协助升麻向上提升，从而使清阳达于上而浊阴降于下，可以托散本经自病的肌热，并且可以升提与太阳合病引起的自利。芍药收敛脾阴，甘草缓急和里，治疗里证仍用表药，是因为这是表实导致的下利，而非里实。痘疹从里达表，初起时内外皆热，所以也适宜用凉散的方法。如果没有汗加麻黄，有汗加桂枝，口渴发热加石膏，咽痛加桔梗，头痛合用川芎白芷，有少阳证加柴胡黄芩，火盛加黄芩黄连。凡邪气在三阳经，以此方加减出入，没有不利的。
德按：闻人氏伯圜说：道有常规和权变，兵有正兵和奇兵，病有常证和变证。病的常证是可以预料的，病的变证是不可预料的。古人设立升麻汤治疗小儿疮痘是作为一定的定论，难道是固执不通吗？我曾经思考古人的用意，升麻汤这一方大概是治疗疮痘的常证，不治疗疮痘的变证。什么是常证呢？在斑点出现之前都发热是常证，结痂之后都有余热拂郁且肌表未清凉也是常证，所以升麻汤方状中说：治疗疮疹未发、已发。未发是指未见斑点之前，已发是指已作结痂之后，这就是升麻汤之所以成为治疗疮痘常证的原因。至于斑点已经见到以及痂皮未结的时候，其症状千变万化，治疗方法在于随证参调，绝不是定论可以拘泥的。就像伤寒的变异不一一样，在这个时候怎么可以执着一种药物来应对无穷的变化呢？而且升麻汤所用的药物不过是凉肌解表而已，在未见斑点之前、已结痂之后，可以凉肌可以解表，古人处方的意思如此，何曾让它用于疮疹正在发作的时候呢？现在愚昧的人不能探究这一点，既然看到斑点还让儿童服用，导致肌寒表弱、邪气陷伏而危殆。唉，读古人的书而不能探求古人的妙处，不可以称为懂医。
麻黄杏仁甘草石膏汤 治疗温热内发，表里俱热，头痛身疼，不恶寒反恶热，无汗而喘，大烦大渴，脉阴阳俱浮者，用此方发汗而清火，如果脉浮弱、沉紧、沉细、恶寒，自汗出而不渴的，禁用。
麻黄（四两） 杏仁（五十个，炮制去双仁去皮尖） 甘草（二两，炙） 石膏（八两，碎后用绵包裹）
以上四味药，用水七升，先煮麻黄减少一升，去掉上面的沫，加入其他药物，煮取二升，去渣，温服一升。原本说是黄耳杯。
王氏说：喘家发作时用桂枝汤加浓朴杏仁治疗寒喘，现在用麻黄石膏加杏仁治疗热喘，麻黄开泄毛窍，杏仁下气，而用甘草承载石膏辛寒之性，从肺发泄，使得阳气该出的出，该降的降，分头解散，虽然喘证忌用发汗，但这方重在急清肺热以保存阴液，热清喘定汗自然停止，而阳气也不会亡失。看这两种喘，一寒一热，治法仍有营卫分途的意义。
柯氏说：这是温病发汗逐邪的主剂，石膏是清火的重剂，青龙汤和白虎汤都依靠它建功。但是使用不当足以招致祸患，所以青龙汤因为无汗烦躁而得到姜桂，以宣通卫外的阳气；白虎汤因为有汗烦渴须粳米以保存胃中的津液。此方只有热没有寒，所以不用姜桂；喘不在胃而在肺，所以不需要粳米。其意重在保存阴液，不必担心亡阳。所以用麻黄汤去掉桂枝的监制，取麻黄的专开，杏仁的降，甘草的和，加倍石膏的大寒，清除内外的实热，于是溱溱汗出，而内外的烦热喘渴全部消除。
程氏扶生说：这是治疗寒气深入肺中引发喘热的，汗已经出了，但喘是因为寒邪未尽，如果身体没有大热，那就是热壅于肺，所以用麻黄散邪，石膏除热，杏仁利肺，在青龙汤内减去麻黄，去掉姜桂，是稳妥的发散除热清肺的方剂，石膏去热清肺所以肺热也可以用。
德按：程氏杏轩说：我治疗出麻疹冒风，隐闭喘促，烦躁凶险急证，每用此方获得疗效。大概麻出于肺闭，则火毒内攻多导致喘闷而危险。此方麻黄发肺邪，杏仁下肺气，甘草缓肺急，石膏清肺热，药简功专，所以见效快。杏轩著有《医述》。（已刊行于世）
白虎汤
治疗阳明证汗自出，渴欲饮水，脉洪大浮滑，不恶寒反恶热。
石膏（一斤，碎后用绵包裹） 知母（六两） 甘草（二两，炙） 粳米（六合）
以上四味药，用水一斗，煮米熟，汤成，去渣，温服一升，每日三次。
王氏说：白虎汤治疗阳明经表里俱热，与调胃承气汤导引阳明腑中热邪不同，白虎汤泄阳明经中热邪，石膏泄阳，知母滋阴，粳米缓和阳明之阳，甘草缓和阳明之阴。因为石膏性重知母性滑，恐怕它们急于趋于下行，另外设置煎法以米熟汤成，使得辛寒重滑之性，得粳米甘草承载于上，逗留于阳明形成清化的功效，名叫白虎，虎是兽，用以表明石膏知母的辛寒，整肃肺金则阳明之热自然解除，这是实则泻子的道理。
柯氏说：阳明邪气从热化所以不恶寒而反恶热，热蒸外越所以热汗自出，热烁胃液所以渴欲饮水，邪盛而实所以脉洪大，半犹在经所以兼浮而滑。阳明属胃外主肌肉，虽有大热但未成实。然而火炎土燥，终究不是苦寒的味道所能治疗的。经上说：甘先入脾，又说：以甘泻之，由此可知甘寒之品是泻胃火生津液的上剂。石膏辛寒，辛能解肌，寒能胜热，味甘入脾，质刚而主降，具备中土生金的体貌，色白通肺，性柔而含脂具金，能生水之用，入方作为君药。知母气寒主降，苦以泄肺火，辛以润肾燥，所以作为臣药。甘草是中宫的舟楫，能在土中泻火，寒药得到它缓和其寒性，使得沉降之性都能留连于胃。粳米气味温和禀容平之德，作甘稼穑，是后天养命的资粮。得到这两味作为佐药，对于阴寒之物，才没有伤胃损脾的忧虑。煮汤入胃，输脾归肺，水精四布，大烦大渴可以消除了。白虎是西方金神，取以命名汤剂，秋金得令而炎暑自然解除。再加上人参以补益，承接制约石膏知母的寒性，泻火而土不受伤，才是万全之术。
德按：白虎本是为了达热出表，如果脉浮弦而细的不可给与，脉沉细而微的不可给与，凡病虽然有壮热但没有烦渴，不出汗的，知道不在阳明，切勿误给白虎汤，学医者务必谨慎不要鲁莽。
白虎加人参汤
石膏（一斤，碎后用绵包裹） 知母（六两） 甘草（二两，炙） 粳米（六合） 人参（三两）
以上五味药，用水一斗，煮米熟汤成，去渣，温服一升，每日三次。
王氏说：阳明热病化燥为什么用白虎加人参汤呢？石膏辛寒仅能散表热，知母甘苦仅能降里热，甘草粳米仅能载药留于中焦，如果胃经热久伤气，气虚不能生津的，必须用人参养正回津之后，白虎汤才能清化除燥。
柯氏说：更加人参的原因，是因为气为水之母，邪气所凑集的地方，其气必虚。阴虚则无气，此大寒剂中必须得人参之力以大补真阴，阴气恢复而津液自然生成。如果是壮热之人，元气未伤，津液未竭，不大渴的，只需滋阴以抑阳，不必加参而益气。如果元气已亏的，只用纯阴之剂，火去而气无由生，只有加人参则火泻而土不伤，又使金能得气，这才是立法的尽善尽美吧。此方重在烦渴，是热已入里，如果没有汗烦渴而表不解的，那就是麻杏甘石证了。
竹叶石膏汤
竹叶（三把） 石膏（一斤，碎后用绵包裹） 麦门冬（一升） 人参（三两） 半夏（半升，洗） 甘草（二两，炙） 粳米（半升）
以上六味药用水一斗，煮取六升，去渣，加入粳米煮米熟汤成，去米，温服一升，每日三次。
王氏说：此汤分走手足两经，而不悖于理的原因，是因为胃居中焦，分行津液于各脏，补胃泻肺，有补母泻子的意义。竹叶石膏麦冬泻肺之热，人参半夏炙草平胃之逆，再用粳米缓和于中，使得诸药得以成就清化的功效，这也是白虎汤、越婢汤、麦门冬汤三个方剂的变方。
钱氏天来说：竹叶性寒而止烦热，石膏入阳明而清胃热，半夏蠲除痰饮而止呕吐，人参补病后之虚，同麦冬而大添胃中之津液，又恐寒凉损胃，所以用甘草调和它，而又以粳米助其胃气。
周氏禹载说：石膏最凉兼竹叶以清热，则胃与小肠之邪都去除了，半夏豁痰以止呕，麦冬清肺以除烦，则中上二焦之邪都下降了，只有甘草可生肌肉，粳米可益胃气，正与虚羸少气者相适宜。况且伤寒是热病。即使说解后其内蕴之热未必全清，所以用甘寒之品清热补虚，这正是为热邪未全退的证候而设的，如果用此来治疗虚羸则不可以。
德按：徐氏洄溪注说：这是仲景先生治疗伤寒愈后调养之方。其法专门于滋养肺胃之阴气，以恢复津液，大概伤寒虽然六经传遍而汗吐下三者皆由肺胃承受。又《内经》说：人之伤于寒也，则为病热。所以滋养肺胃，是从歧黄到仲景不易之法。后来的庸医则用温热之药峻补脾肾，而千圣相传的精义消亡尽了。
Shengma Gegen Tang (Cinnamon Twig and Pueraria Decoction) treats febrile diseases caused by Cold Damage, plague, and wind-heat, characterized by high fever, headache, and limb pain. It is suitable for use whether the skin eruptions have appeared or not.
Shengma (Rhizoma Cimicifugae), Gan Ge (Radix Puerariae Lobatae, finely chopped), Shaoyao (Radix Paeoniae Rubra or Radix Paeoniae Alba), Gancao (Radix Glycyrrhizae Uralensis, chopped and roasted, equal parts).
Grind the above ingredients into a coarse powder. Take four qian per dose, decoct with one and a half sheng of water until reduced to one sheng. Administer according to age, taking warm at any time.
Zhang Jingyue stated: The syndrome of measles mostly belongs to Fire-Toxin of the Yangming channel. Whenever one wishes to release the exterior and scatter pathogens, this formula is most suitable for cases where the exterior is excess and pathogens are abundant. However, I believe it is even more effective to substitute Chaihu (Radix Bupleuri) for Shengma. For those with slightly deficient Qi and Blood while pathogens remain unresolved, Chaigui Yin (Bupleurium and Angelica Decoction) is the most appropriate.
Wang Shuangchi stated: This is a medicine for the Yangming channel. Since measles originates in the Yangming, this formula is essential. Shengma and Gegen deliver Yang Qi to the exterior, while Shaoyao and Ganhe harmonize the Spleen and Stomach in the middle. Adding Yuanxu (Coriandrum Sativum) and Shengjiang (Rhizoma Zingiberis Recens) induces slight sweating, moistening the primordial organs so that Heat-Toxin does not stagnate.
Ke stated: This is a formula for resolving the exterior and harmonizing the interior in the initial stage of Yangming disease. It can be used to scatter exterior Heat or treat interior deficiency. One formula excels in both aspects. This formula imitates Zhang Zhongjing's Gegen Tang (Kudzu Root Decoction), removing the acrid-warm nature of Jiang (Rhizoma Zingiberis Recens) and Gui (Ramulus Cinnamomi Cassiae) and the cloying sweetness of Dazao (Fructus Jujubae), and substituting Shengma for Mahuang (Herba Ephedrae). Thus, it becomes an exterior-releasing formula for the Yangming channel, not the Taiyang channel. Gegen is sweet and cool, capable of dispersing exterior excess; assisting Shengma in ascending, it directs Clear Yang upward and turbid Yin downward. It can support and disperse the muscular heat inherent to its own channel and lift prolapse associated with concurrent Taiyang disease. Shaoyao astringes Spleen Yin, and Gancao moderates urgency and harmonizes the interior. Using exterior-releasing medicines to treat interior conditions is because the diarrhea is due to exterior excess rather than interior excess. Eruptions originate from the interior and reach the exterior; in the early stage, both interior and exterior are hot, so cooling and dispersing methods are appropriate. If there is no sweat, add Mahuang; if there is sweat, add Guizhi (Ramulus Cinnamomi Cassiae); if thirsty and hot, add Shigao (Gypsum Fibrosum); if sore throat, add Jiegeng (Radix Platycodonis); if headache, combine with Xiong (Radix Ligustici Chuanxiong) and Zhizi (Flos Chrysanthemi Indici); if Shaoyang symptoms exist, add Chaihu and Huangqin (Radix Scutellariae); if Fire is excessive, add Huangqin and Huanglian (Radix Coptidis). For pathogens in the three Yang channels, adjusting this formula yields favorable results.
De noted: Wenren Bohuan said: The Dao has constancy and flexibility; warfare has orthodox and unorthodox tactics; diseases have constant and variable patterns. Constant disease patterns can be predicted, but variable ones cannot. The ancients established Shengma Tang as a fixed rule for treating pediatric smallpox and measles. Is this rigid and inflexible? I have pondered the ancients' intent: Shengma Tang treats the constant pattern of eruptions, not the variable one. What is the constant pattern? Fever before spots appear is constant; residual heat and stagnation with uncooled skin after crusting is also constant. Hence, Shengma Tang states it treats eruptions before appearance and after appearance. "Before appearance" means before spots are seen; "after appearance" means after crusting. This is why Shengma Tang is for the constant pattern of eruptions. When spots have appeared or crusts have not yet formed, symptoms vary infinitely, and treatment must be adjusted according to the syndrome, not bound by fixed rules. Just as Cold Damage varies, how can one stick to a single medicine to address infinite variations? Moreover, the herbs in Shengma Tang merely cool the muscles and release the exterior. Before spots appear and after crusting, cooling and releasing are appropriate. Did the ancients intend to use it when eruptions are actively erupting? Ignorant people today fail to investigate this; seeing spots, they still administer it to children, causing cold muscles, weak exterior, sinking pathogens, and danger. Alas, reading ancient texts without exploring their subtleties disqualifies one from practicing medicine.
Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) treats internal onset of Warmth, simultaneous exterior and interior Heat, headache, body pain, aversion to cold absent but aversion to heat present, absence of sweat with wheezing, severe restlessness and thirst, and floating pulse on both Cun and Chi positions. Use this to induce sweating and clear Fire. Contraindicated if the pulse is floating and weak, deep and tight, deep and fine, accompanied by aversion to cold, spontaneous sweating, and absence of thirst.
Mahuang (Four liang), Xingren (Fifty seeds, processed to remove double kernels, skin, and tips), Gancao (Two liang, roasted), Shigao (Eight liang, crushed and wrapped in silk).
Take the four ingredients, decoct in seven sheng of water. First boil Mahuang to reduce by one sheng, skim off the foam, then add other herbs. Boil to obtain two sheng, strain, and take one sheng warm. Originally called Huang'er Bei.
Wang stated: For asthmatics, Guizhi Tang plus Houpo (Cortex Magnolia Officinalis) and Xingren treats cold asthma. Now, Mahuang and Shigao plus Xingren treat hot asthma. Mahuang opens hair follicles, Xingren descends interior Qi, and Gancao carries the acrid-cool nature of Shigao to vent from the Lung, allowing Yang Qi to ascend and descend appropriately, dispersing separately. Although sweating is contraindicated for asthma, this formula focuses on urgently clearing Lung Heat to preserve Yin. Once Heat clears and wheezing stops, sweating ceases naturally, and Yang is preserved. Comparing these two asthmas—one cold, one hot—the treatments reflect the separation of Ying and Wei pathways.
Ke stated: This is the main formula for inducing sweating and expelling pathogens in Warm Diseases. Shigao is a heavy agent for clearing Fire; both Qinglong Tang (Blue Dragon Decoction) and Baihu Tang (White Tiger Decoction) rely on it for success. However, improper use invites disaster. Qinglong Tang uses Jiang and Gui to unblock Exterior Yang for cases with no sweat and irritability; Baihu Tang uses Jingmi (Semen Oryzae Sativum) to preserve Stomach fluids for cases with sweat, irritability, and thirst. This formula has only Heat, no Cold, so Jiang and Gui are omitted. Wheezing is in the Lung, not the Stomach, so Jingmi is unnecessary. The focus is preserving Yin, not worrying about loss of Yang. Thus, using Mahuang Tang minus Guizhi (to remove restraint), utilizing Mahuang's specific opening, Xingren's descending, Gancao's harmonizing, and doubling Shigao's great coldness clears interior and exterior excess Heat. Profuse sweating ensues, eliminating interior/exterior restlessness, heat, wheezing, and thirst.
Cheng Fusheng stated: This treats cold penetrating deeply into the Lung causing wheezing and heat. Sweat has occurred, but wheezing persists due to incomplete expulsion of cold pathogens. If there is no significant heat, it indicates Heat congestion in the Lung. Thus, Mahuang scatters pathogens, Shigao removes heat, and Xingren benefits the Lung. Reducing Mahuang and removing Jiang/Gui from Qinglong Tang makes it a stable formula for dispersing, removing heat, and clearing the Lung. Shigao clears Lung Heat, so it is usable for Lung Heat.
De noted: Cheng Xuanxuan said: I treat acute, dangerous syndromes of measles obscured by wind, resulting in lung closure, wheezing, and irritability, often using this formula with success. Measles originating from Lung closure leads to internal attack of Fire-Toxin, often causing wheezing and danger. This formula: Mahuang releases Lung pathogens, Xingren descends Lung Qi, Gancao moderates Lung urgency, Shigao clears Lung Heat. Simple herbs with focused efficacy yield rapid results. Xuanxuan authored *Yi Shu* (Medical Compendium), now published.
Baihu Tang (White Tiger Decoction)
Treats Yangming syndrome with spontaneous sweating, thirst desire for drinking water, surging-large-floating-slippery pulse, no aversion to cold but aversion to heat.
Shigao (One jin, crushed and wrapped in silk), Zhimu (Radix Anemarrhenae Asphodeloides, Six liang), Gancao (Two liang, roasted), Jingmi (Six he).
Take the four ingredients, decoct in ten sheng of water until rice is cooked and soup is ready. Strain, take one sheng warm, three times daily.
Wang stated: Baihu Tang treats simultaneous exterior-interior Heat of the Yangming channel. Unlike Tiaowei Chengqi Tang which guides Heat from the Yangming Fu organ, Baihu Tang drains Heat from the Yangming Jing channel. Shigao drains Yang, Zhimu nourishes Yin, Jingmi moderates Yangming Yang, and Gancao moderates Yangming Yin. Since Shigao is heavy and Zhimu slippery, fearing they rush downward, a special decoction method ensures that when rice is cooked, the acrid-cool-heavy-slippery properties are carried upward by Jingmi and Gancao, lingering in Yangming to achieve clearing and transforming effects. Named "White Tiger," the tiger represents the acrid-cool nature of Shigao and Zhimu, rectifying Metal (Lung) so Yangming Heat resolves naturally, following the principle of draining the child.
Ke stated: Yangming pathogens transform via Heat, hence no aversion to cold but aversion to heat. Heat steaming outward causes spontaneous sweating. Heat consuming Stomach fluids causes thirst. Pathogen abundance and excess cause surging pulse. Half remaining in the channel causes floating and slippery qualities. Yangming belongs to the Stomach and governs muscles externally. Despite high heat, it has not formed solid excess. However, Fire blazing and Earth drying cannot be treated solely with bitter-cold substances. The Classics state: Sweet enters the Spleen first; also: Use sweet to drain. Thus, sweet-cold substances are superior for draining Stomach Fire and generating fluids. Shigao is acrid-cool; acrid resolves muscles, cold overcomes heat. Sweet enters Spleen, substance is firm and descending, embodying Earth generating Metal. White color connects to Lung, soft texture contains fat resembling Metal, enabling Water generation. It serves as the Sovereign herb. Zhimu is cold and descending; bitter drains Lung Fire, acrid moistens Kidney dryness, serving as Minister. Gancao is the vessel of the Central Palace, draining Fire in Earth. With cold herbs, it moderates their coldness, keeping sinking properties lingering in the Stomach. Jingmi is mild and warm, possessing balanced virtue, sweet and agricultural, providing post-heaven life sustenance. These two serve as Assistant herbs, preventing injury to Stomach and Spleen by yin-cold substances. Soup entering the Stomach transports to Spleen and Lung, distributing fluid essence, eliminating severe restlessness and thirst. "White Tiger" refers to the Western Metal Spirit; naming the formula thus implies that when Autumn Metal commands, summer heat resolves. Adding Renshen (Radix Ginseng) supplements and controls the cold of Shigao and Zhimu, draining Fire without injuring Earth, ensuring absolute safety.
De noted: Baihu Tang originally aims to radiate Heat to the exterior. It is contraindicated if the pulse is floating, string-tight, and fine, or deep, fine, and faint. Even with high fever, if there is no restlessness/thirst or sweating, the pathology is not in Yangming. Do not mistakenly prescribe Baihu Tang. Students must be cautious and not reckless.
Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction)
Shigao (One jin, crushed and wrapped in silk), Zhimu (Six liang), Gancao (Two liang, roasted), Jingmi (Six he), Renshen (Three liang).
Take the five ingredients, decoct in ten sheng of water until rice is cooked and soup is ready. Strain, take one sheng warm, three times daily.
Wang stated: Why use Baihu Tang plus Renshen for Yangming Heat disease transforming into dryness? Shigao's acrid-cool only disperses exterior Heat; Zhimu's sweet-bitter only descends interior Heat; Gancao and Jingmi only carry drugs to linger in the Middle Jiao. If long-standing Heat injures Qi in the Stomach channel, and Qi deficiency fails to generate fluids, Renshen is required to nourish Righteousness and restore fluids before Baihu Tang can clear and transform dryness.
Ke stated: Adding Renshen is because Qi is the mother of Water; where pathogens gather, Qi is necessarily deficient. Yin deficiency leads to Qi deficiency. In this great cold formula, Renshen's power is needed to greatly tonify True Yin. Once Yin Qi recovers, fluids generate spontaneously. For those with high fever but undamaged Yuan Qi and unexhausted fluids, without severe thirst, merely nourishing Yin to suppress Yang suffices; adding Renshen for Qi tonification is unnecessary. If Yuan Qi is already depleted, using purely Yin-cold formulas removes Fire but leaves no source for Qi generation. Only adding Renshen drains Fire without injuring Earth and allows Metal to receive Qi, achieving perfect legislative design. This formula focuses on restlessness and thirst, indicating Heat has entered the interior. If there is no sweat, restlessness, thirst, and unresolved exterior, it is Mahuang Xingren Gancao Shigao Tang syndrome.
Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction)
Zhuye (Leaf of Bambusa Textilis, three handfuls), Shigao (One jin, crushed and wrapped in silk), Maimendong (Radix Ophiopogonis Japonici, one sheng), Renshen (Three liang), Banxia (Rhizoma Pinelliae Ternatae, half sheng, washed), Gancao (Two liang, roasted), Jingmi (Half sheng).
Take the six ingredients, decoct in ten sheng of water to obtain six sheng. Strain, add Jingmi, cook until rice is done and soup is ready. Remove rice, take one sheng warm, three times daily.
Wang stated: This soup travels through both Hand and Foot channels without violating principles because the Stomach resides in the Middle Jiao, distributing fluids to various organs. Tonifying Stomach and draining Lung follows the meaning of tonifying the Mother and draining the Child. Zhuye, Shigao, and Maimendong drain Lung Heat; Renshen, Banxia, and roasted Gancao calm Stomach rebellion; Jingmi moderates in the middle, allowing all herbs to achieve clearing and transforming effects. It is a variation of Baihu Tang, Yuebi Tang (Ma Huang, Shi Gao, Sheng Jiang, Da Zao, Gan Cao, Xing Ren), and Maimendong Tang.
Qian Tianlai stated: Zhuye is cold and stops restlessness/heat; Shigao enters Yangming and clears Stomach Heat; Banxia eliminates phlegm-fluids and stops vomiting; Renshen tonifies post-illness deficiency; together with Maimendong, it greatly adds fluids to the Stomach. Fearing cold damages the Stomach, Gancao harmonizes, and Jingmi assists Stomach Qi.
Zhou Yuzai stated: Shigao is coldest; combined with Zhuye to clear Heat, pathogens in Stomach and Small Intestine are removed. Banxia resolves phlegm to stop vomiting; Maimendong clears Lung to remove restlessness, lowering pathogens in Upper and Middle Jiao. Only Gancao generates flesh, and Jingmi benefits Stomach Qi, suitable for emaciation and shortness of breath. Cold Damage is a Heat disease. Even after resolution, internal Heat may not be fully cleared. Thus, sweet-cold substances clear Heat and tonify deficiency, designed for syndromes where Heat pathogens are not fully retreated. Using this for emaciation is inappropriate.
De noted: Xu Huixi annotated: This is Mr. Zhang Zhongjing's formula for convalescence after Cold Damage recovery. Its method specifically nourishes Lung and Stomach Yin Qi to restore fluids. Although Cold Damage traverses all six channels, sweating, vomiting, and purgation all affect Lung and Stomach. The *Neijing* states: Injury by Cold results in Heat disease. Thus, nourishing Lung and Stomach is an unchanging method from Qibo/Huangdi to Zhang Zhongjing. Later mediocre doctors use warm-hot medicines to aggressively tonify Spleen and Kidney, causing the refined essence passed down through thousands of sages to vanish completely.