治寒温阳明证，表里俱热，心中热，嗜凉水，而不至燥渴，脉象洪滑，而不至甚实，舌苔白浓，或白而微
黄，或有时背微恶寒者。
生石膏（三两，捣细） 玄参（一两） 连翘（三钱） 粳米（五钱）
上四味，用水五盅，煎至米熟，其汤即成。约可得清汁三盅，先温服一盅。若服完一剂，病犹在者，可仍
煎一剂，服之如前。使药力昼夜相继，以病愈为度。然每次临服药，必详细问询病患，若腹中微觉凉，或欲大
便者，即停药勿服。候两三点钟，若仍发热未大便者，可少少与服之。若已大便，即非溏泻而热犹在者，亦可
少少与服。
《伤寒论》白虎汤，为阳明府病之药，而兼治阳明经病。此汤为阳明经病之药，而兼治阳明府病。为其
所主者，责重于经，故于白虎汤方中，以玄参之甘寒（《神农本草经》言苦寒，细嚼之实甘而微苦，古今药或
有不同），易知母之苦寒，又去甘草，少加连翘。欲其轻清之性，善走经络，以解阳明在经之热也。方中粳米，
不可误用糯米（俗名浆米）。粳米清和甘缓，能逗留金石之药于胃中，使之由胃输脾，由脾达肺，药力四布，
经络贯通。糯米质粘性热，大能固闭药力，留中不散，若错用之，即能误事。
一叟年七十有一，因感冒风寒，头疼异常，彻夜不寝。其脉
洪大有力，表里俱发热，喜食凉物，大便三日未行，舌有白苔甚浓。知系伤寒之热，已入阳明之府。因头疼甚
剧，且舌苔犹白，疑犹可汗解。治以拙拟寒解汤，加薄荷叶一钱。头疼如故，亦未出汗，脉益洪实。恍悟曰∶
此非外感表证之头疼，乃阳明经府之热，相并上逆，而冲头部也。为制此汤，分三次温饮下，头疼愈强半，夜
间能安睡，大便亦通。复诊之，脉象余火犹炽，遂用仲景竹叶石膏汤，生石膏仍用三两，煎汁一大碗，分三次
温饮下，尽剂而愈。
按∶竹叶石膏汤，原寒温大热退后，涤余热、复真阴之方。故其方不列于六经，而附载于六经之后。其所
以能退余热者，不恃能用石膏，而恃石膏与参并用。盖寒温余热，在大热铄涸之余，其中必兼有虚热。石膏得
人参，能使寒温后之真阴顿复，而余热自消，此仲景制方之妙也。又麦冬甘寒粘滞，虽能为滋阴之佐使，实能
留邪不散，致成劳嗽。而惟与石膏、半夏并用，则无忌，诚以石膏能散邪，半夏能化滞也。或疑炙甘草汤（亦
名复脉汤）中亦有麦冬，却无石膏、半夏。然有桂枝、生姜之辛温宣通者，以驾驭之，故亦不至留邪。彼惟知
以甘寒退寒温之余热者，安能援以为口实哉！
温病中，有当日得之，即宜服仙露汤者。一童子，年十六。暑日力田于烈日之中，午饭后，陡觉发热，无
汗，烦渴引饮。诊其脉，洪而长，知其暑而兼温也。投以此汤，未尽剂而愈。
按∶此证初得，而胃府之热已实。彼谓温病入手经，不入足经者，何梦梦也！
上焦烦热太甚者，原非轻剂所能疗。而投以重剂，又恐药过病所，而病转不愈。惟用重剂，徐徐饮下，乃
为合法。曾治一人，年四十余。素吸鸦片，于仲冬得伤寒，两三日间，烦躁无汗。原是大青龙汤证，因误服桂
枝汤，烦躁益甚。迎愚诊视，其脉关前洪滑，两尺无力。为开仙露汤，因其尺弱，嘱其徐徐饮下，一
次只饮药一口，防其寒凉侵下焦也。病家忽愚所嘱，竟顿饮之，遂致滑泻数次，多带冷沫。上焦益觉烦躁，鼻
如烟熏，面如火炙。其关前脉，大于前一倍，又数至七至。知其已成戴阳之证，急用人参一两，煎好兑童便半
茶蛊，将药碗置凉水盆中，候冷顿饮之。又急用玄参、生地、知母各一两，煎汤一大碗，候用。自服参后，屡
诊其脉，过半点钟，脉象渐渐收敛，至数似又加数。遂急将候用之药炖热，徐徐饮下，一次饮药一口，阅两点
钟尽剂，周身微汗而愈。此因病家不听所嘱，致有如此之失，幸而救愈，然亦险矣。审是，则凡药宜作数次服
者，慎勿顿服也。盖愚自临证以来，无论内伤、外感，凡遇险证，皆煎一大剂，分多次服下。此以小心行其放
胆，乃万全之策，非孤注之一掷也。
《伤寒论》阳明篇中，白虎汤后，继以承气汤，以攻下肠中燥结，而又详载不可攻下诸证。诚以承气力
猛，倘或审证不确，即足误事。愚治寒温三十余年，得一避难就易之法。凡遇阳明应下证，亦先投以大剂白虎
汤一两剂。大便往往得通，病亦即愈。即间有服白虎汤数剂，大便犹不通者，而实火既消，津液自生，肠中不
致干燥，大便自易降下。用玄明粉三钱，加蜂蜜或柿霜两许，开水冲调服下，大便即通。若仍有余火未尽，而
大便不通者，单用生大黄末一钱（若凉水调服生大黄末一钱，可抵煮服者一两），蜜水调服，通其大便亦可。
且通大便于服白虎汤后，更无下后不解之虞。盖下证略具，而脉近虚数者，遽以承气下之，原多有下后不解者，
以其真阴亏、元气虚也。惟先服白虎汤或先服白虎加人参汤，去其实火，即以复其真阴，培其元气，而后微用
降药通之，下后又何至不解乎。此亦愚百用不至一失之法也。
间有用白虎汤润下大便，病仍不解，用大黄降之而后解者，以其肠中有匿藏之结粪也。曾治一媪，年七十
余，季冬得伤寒证，七八日间，延愚诊视。其脉洪长有力，表里俱热，烦渴异常，
大便自病后未行。投以白虎加人参汤二剂，大便遂通，一日降下三次，病稍见愈，而脉仍洪长。细审病情，当
有结粪未下，遂单用大黄三钱，煮数沸服之，下结粪四五枚，病遂见愈，仍非脉净身凉，又用拙拟白虎加人参
以山药代粳米汤，服未尽剂而愈。然此乃百中之一二也。临证者，不可因此生平仅遇之证，遂执为成法，轻视
白虎，而重视承气也。
重用石膏以退火之后，大便间有不通者，即可少用通利之药通之。此固愚常用之法，而随证制宜，又不可
拘执成见。曾治一少年，伤寒已过旬日，阳明火实，大便燥结，投一大剂白虎汤，一日连进二剂，共享生石膏
六两，至晚九点钟，火似见退，而精神恍惚，大便亦未通行，再诊其脉，变为弦象，夫弦主火衰，亦主气虚。
知此证清解已过，而其大便仍不通者，因其元气亏损，不能营运白虎汤凉润之力也。遂单用人参五钱，煎汤俾
服之，须臾大便即通，病亦遂愈。盖治此证的方，原是白虎加人参汤，因临证时审脉不确，但投以白虎汤，遂
致病有更改。幸迷途未远，犹得急用人参，继所服白虎汤后以成功。诚以日间所服白虎汤，尽在腹中，得人参
以助之，始能运化。是人参与白虎汤，前后分用之，亦无异于一时同用之也。益叹南阳制方之神妙，诚有令人
不可思议者也。吴又可谓∶“如人方肉食而病适来，以致停积在胃，用承气下之，惟是臭水稀粪而已，于承气
汤中，单加人参一味，虽三四十日停积之物于是方下。盖承气借人参之力鼓舞胃气，宿物始动也。”又可此论，
亦即愚用人参于白虎汤后，以通大便之理也。
附录∶
湖北天门县崔××来函∶
丁卯仲夏，何某，身染温病。他医以香薷饮、藿香正气散治
之，不效。迎仆诊视，遵用清解汤，一剂而愈。时因温病盛行，以书中清解汤、凉解汤、寒解汤、仙露汤、从
龙汤、馏水石膏饮，有呕者，兼用代赭石。本此数方，变通而用，救愈三千余人，共享生石膏一千余斤，并未
偾事。
治疗寒温病中阳明证，表现为表里都发热，心中烦热，喜欢喝凉水，但还没有达到极度口渴的程度，脉象洪大滑利，但还没有到非常坚实有力的程度，舌苔白厚，或者白中带微黄，或者有时背部微微怕冷的情况。
生石膏（三两，捣碎成细粉） 玄参（一两） 连翘（三钱） 粳米（五钱）
以上四味药，用水五碗，煎煮直到米粒熟透，汤剂就做好了。大约能得到澄清的药汁三碗，先温热服用一碗。如果服完一剂药后，病邪仍在，可以再次煎煮一剂，像之前那样服用。使药力昼夜连续发挥作用，以病愈为停止标准。然而每次准备服药时，必须详细询问病人，如果腹中微微觉得凉，或者有便意的，就停药不要服用。等待两三个小时，如果仍然发热且没有大便，可以少量给予服用。如果已经大便，即使不是稀泻而热势仍在的，也可以少量给予服用。
《伤寒论》中的白虎汤，是治疗阳明腑病的药物，同时也兼治阳明经病。此仙露汤是治疗阳明经病的药物，同时也兼治阳明腑病。因为它主要侧重在经，所以责任重在经络，因此在白虎汤方中，用玄参的甘寒（《神农本草经》说它是苦寒，细细咀嚼实际上是甘而微苦，古今用药认识可能有所不同），替换知母的苦寒，又去掉甘草，稍微加入连翘。想要利用它轻清的性质，善于走窜经络，来解除阳明在经的热邪。方中的粳米，不可误用糯米（俗名浆米）。粳米性质清和甘缓，能使金石类药物在胃中停留，使其由胃输送到脾，由脾到达肺，药力散布全身，经络贯通。糯米质地粘腻性热，大大能固闭药力，留在体内不散，如果错用了，就会耽误病情。
有一位七十多岁的老人，因为感冒风寒，头痛异常，整夜无法入睡。他的脉象洪大有力，表里都发热，喜欢吃凉物，大便三天未行，舌上有很厚的白苔。知道这是伤寒的热邪，已经进入阳明的腑。因为头痛非常剧烈，而且舌苔还是白的，怀疑还可以用发汗法解表。用我拟定的寒解汤，加薄荷叶一钱。头痛依旧，也没有出汗，脉象更加洪实。恍然大悟说：这不是外感表证的头痛，而是阳明经腑的热邪，相互并合上逆，冲撞头部所致。于是配制此汤，分三次温热饮下，头痛减轻了一半多，夜间能够安睡，大便也通了。复诊时，脉象显示余火依然炽盛，于是用张仲景的竹叶石膏汤，生石膏仍然用三两，煎汁一大碗，分三次温热饮下，服完一剂而痊愈。
按语：竹叶石膏汤，原本是用于寒温病大热退去后，清除余热、恢复真阴的方子。所以它的方子不列在六经篇中，而是附载在六经之后。它能够退去余热的缘故，不在于单靠能用石膏，而在于依靠石膏与人参并用。大概寒温病的余热，在大热灼伤津液枯竭之后，其中必然兼有虚热。石膏得到人参，能使寒温病后的真阴顿时恢复，而余热自然消除，这是张仲景制方的精妙之处。另外麦冬甘寒粘滞，虽然能做滋阴的辅助，但实际上能留滞邪气不散，导致形成劳嗽。只有与石膏、半夏并用，才没有禁忌，确实是因为石膏能散邪，半夏能化滞。有人疑惑炙甘草汤（也叫复脉汤）中也有麦冬，却没有石膏、半夏。但是有桂枝、生姜的辛温宣通作用，来驾驭它，所以也不会留滞邪气。那些只知道用甘寒药来退寒温病余热的，怎么能引用这个作为借口呢！
温病中，有当天得病，就适宜服用仙露汤的情况。一个十六岁的童子，暑天在烈日下田间劳作，午饭后，突然觉得发热，无汗，烦躁口渴想喝水。诊察他的脉象，洪大而长，知道这是暑邪兼有温邪。投以此汤，还没服完一剂就痊愈了。
按语：此证刚得病，胃腑的热邪就已经结实。那些说温病只入手经，不入足经的人，真是糊涂啊！
上焦烦热太严重的，原本就不是轻剂所能治疗的。而投以重剂，又恐怕药力超过病所，反而病不能愈。只有用重剂，慢慢饮用，才是合法度。曾治疗一个人，四十多岁。平时吸鸦片，在仲冬时节得了伤寒，两三天间，烦躁无汗。原本是大青龙汤证，因为误服桂枝汤，烦躁更加严重。请我去诊治，他的脉象关前洪滑，两尺无力。为他开仙露汤，因为他尺脉弱，嘱咐他慢慢饮用，一次只喝一口药，防止寒凉之药侵扰下焦。病人家属忽视了我的嘱咐，竟然一次性顿服，于是导致滑泻几次，大多带有冷沫。上焦更加觉得烦躁，鼻子像烟熏一样，脸像火烤一样。他的关前脉，比前一倍还大，脉搏次数增加到七至。知道这已经成了戴阳证（虚阳上浮），急忙用人参一两，煎好后兑入童便半茶盅，将药碗放在凉水盆中，等凉了一次性喝下。又急忙用玄参、生地、知母各一两，煎汤一大碗，备用。自服人参后，多次诊察脉象，过了半个小时，脉象渐渐收敛，至数似乎又加快。于是急忙将备用的药炖热，慢慢饮用，一次喝一口药，经过两个小时服完一剂，周身微微出汗而痊愈。这是因为病人家属不听嘱咐，导致有这样的失误，幸好救回来了，但也险极了。由此看来，凡是应该分多次服用的药，千万不要一次性顿服。大概我自临证以来，无论是内伤、外感，凡遇到险证，都是煎一大剂药，分多次服下。这是以小心谨慎来执行大胆的治疗，是万全的策略，不是孤注一掷。
《伤寒论》阳明篇中，白虎汤之后，接着是承气汤，用来攻下肠中的燥结，而又详细记载了不可攻下的各种证候。确实因为承气汤药力猛烈，如果辨证不确切，就足以误事。我治疗寒温病三十多年，得到一种避难就易的方法。凡遇到阳明应当用下法的证候，也先投以大剂量的白虎汤一两剂。大便往往得以通畅，病也就好了。即使偶尔有服白虎汤几剂后，大便仍然不通的，而实火既然消除，津液自然产生，肠中不至于干燥，大便自然容易降下。用玄明粉三钱，加蜂蜜或柿霜二两，开水冲调服用，大便即通。如果还有余火未尽，而大便不通的，单用生大黄末一钱（如果用凉水调服生大黄末一钱，效果可抵得上煮服的一两），蜜水调服，通其大便也可以。而且在大便通畅后再服白虎汤，更没有下法后病不解的担忧。大概下证稍微具备，而脉象接近虚数的，立刻用承气汤攻下，原本多有下后病不解的，因为真阴亏损、元气虚弱。只有先服白虎汤或先服白虎加人参汤，去除其实火，同时恢复其真阴，培养其元气，然后轻微使用降下药通便，下后又怎么会不解呢。这也是我百用不失一的方法。
间或有使用白虎汤润下大便，病仍不解，用大黄降下后才解的，因为肠中有隐匿的结粪。曾治疗一位七十多岁的老妇人，季冬时节得了伤寒证，七八天后，请我去诊治。她的脉象洪长有力，表里都发热，烦躁口渴异常，从生病后大便未行。投以白虎加人参汤两剂，大便遂通，一天排便三次，病稍见好转，而脉象仍然洪长。仔细审察病情，应当有结粪未下，于是单用大黄三钱，煮几沸后服用，排出结粪四五枚，病遂见好转，仍然不是脉静身凉，又用我拟定的白虎加人参汤以山药代替粳米，服完不到一剂而痊愈。然而这是百中一二的情况。临证者，不可因此生平仅遇一次的证候，就固执为成法，轻视白虎汤，而重视承气汤。
重用石膏以退火之后，大便间有不通的，就可以少用通利之药来通便。这固然是我常用的方法，而随证制宜，又不可拘泥于成见。曾治疗一个少年，伤寒已过十天，阳明火实，大便燥结，投一大剂白虎汤，一天连进两剂，共用生石膏六两，到了晚上九点钟，火势似乎减退，而精神恍惚，大便也未通行，再诊其脉，变为弦象。夫弦脉主火衰，也主气虚。知道此证清解已过度，而其大便仍不通的原因，是因为元气亏损，不能运化白虎汤凉润的力量。于是单用人参五钱，煎汤让他服用，片刻大便即通，病也随之痊愈。大概治此证的方子，原是白虎加人参汤，因为临证时诊脉不确切，只投以白虎汤，致使病情发生变化。幸好迷途未远，还能急忙用人参，继所服的白虎汤之后取得成功。确实因为白天所服的白虎汤，都在腹中，得到人参的帮助，才能运化。是人参与白虎汤，前后分开服用，也无异于同时服用。更加感叹张仲景制方的神妙，确实有令人不可思议的地方。吴又可曾说：“如同人正在吃肉食而病恰好来了，以致停积在胃，用承气汤攻下，只是排出臭水稀粪而已，在承气汤中，单加人参一味，即使是三四十日停积之物也能在此方下。”吴又可的这个论述，也就是我用人参于白虎汤后，以通大便的道理。
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湖北天门县崔××来信：
丁卯年仲夏，何某，身体染上温病。其他医生用香薷饮、藿香正气散治疗，无效。请我去诊治，遵照使用清解汤，一剂而愈。当时因温病盛行，根据书中清解汤、凉解汤、寒解汤、仙露汤、从龙汤、馏水石膏饮，如果有呕吐的，兼用代赭石。依据这几个方子，变通而用，救治痊愈三千多人，共用生石膏一千多斤，并未出错。
Treatment for Yangming syndrome in cold-warm diseases, presenting with heat in both the exterior and interior, heat in the heart, desire to drink cold water but not reaching extreme thirst, pulse is surging and slippery but not extremely firm, tongue coating is thick white, or white with slight yellow, or sometimes slight aversion to cold on the back.
Sheng Shigao (Calcitrum Preparatum, Raw Gypsum) [3 liang, crushed into fine powder], Xuanshen (Scrophulariae Radix) [1 liang], Lianqiao (Forsythiae Fructus) [3 qian], Jingmi (Oryzae Semen Germine Exulatum) [5 qian].
The above four herbs are decocted with five bowls of water until the rice grains are cooked, then the decoction is ready. Approximately three bowls of clear liquid can be obtained. First, take one bowl warm. If after finishing one dose the disease persists, another dose may be decocted and taken as before. This ensures the medicinal power acts continuously day and night until recovery. However, before each administration, the patient must be carefully questioned. If the abdomen feels slightly cool or there is an urge for defecation, stop the medication. Wait two to three hours; if fever persists and no defecation has occurred, administer a small amount. If defecation has occurred, even if not diarrheal and heat remains, a small amount may still be administered.
Baihu Tang (White Tiger Decoction) from *Shanghan Lun* (*Treatise on Cold Damage*) is a formula for Yangming Fu-organ disease, but also treats Yangming Jing-meridian disease. This Xianlu Tang (Immortal Dew Decoction) is a formula for Yangming Jing-meridian disease, but also treats Yangming Fu-organ disease. Since its primary focus is on the meridian, responsibility lies heavier with the meridians. Therefore, in Baihu Tang, the bitter-cold Zhimu (Anemarrhenae Rhizoma) is replaced by the sweet-cold Xuanshen (noting that *Shennong Bencao Jing* describes it as bitter-cold, but tasting it reveals it is sweet with slight bitterness; herbal properties may differ between ancient and modern times), Gancao (Glycyrrhizae Radix et Rhizoma) is removed, and Lianqiao is added in small amounts. The intention is to utilize its light and clear nature, which travels well through the meridians, to resolve heat in the Yangming meridians. In this formula, Jingmi must not be confused with Nuomi (Glutinous Rice). Jingmi is clear, harmonious, sweet, and slow-acting; it retains metallic/mineral drugs in the stomach, allowing them to transmit from the stomach to the spleen, and from the spleen to the lungs, distributing medicinal power throughout and unblocking the meridians. Nuomi is sticky, viscous, and hot-natured; it strongly seals medicinal power, keeping it stagnant in the middle jiao without dispersing. Misuse will cause errors.
An elderly man, aged seventy-one, contracted wind-cold due to exposure, suffering from severe headache and insomnia all night. His pulse was surging, large, and forceful; exterior and interior were both hot; he desired cold foods; stool had not passed for three days; tongue coating was thick white. It was known that the heat of cold damage had entered the Yangming fu-organ. Because the headache was severe and the tongue coating remained white, it was suspected that sweating could still resolve the exterior. Treatment was prescribed using my formulated Hanjie Tang (Cold Resolution Decoction) with 1 qian of Boheye (Menthae Haplocalycis Folium). Headache persisted, no sweat appeared, and the pulse became more surging and solid. Suddenly realizing: "This is not a headache from exterior wind-cold, but heat from Yangming meridians and fu-organs merging and rushing upward to attack the head." I prepared this Xianlu Tang, divided into three doses taken warm. Headache reduced by half, sleep improved at night, and stool passed. On follow-up, residual fire in the pulse was still intense, so Zhongjing's Zhuye Shigao Tang (Schizonepetae Herba and Gypsum Decoction) was used, with Sheng Shigao still at 3 liang, decocted into one large bowl, divided into three warm doses. Recovery occurred after completing one dose.
Note: Zhuye Shigao Tang was originally intended to clear residual heat and restore true yin after the subsidence of high fever in warm diseases. Thus, it is not listed among the Six Channels but appended afterwards. Its ability to clear residual heat relies not solely on Shigao, but on the combination of Shigao and Renshen (Ginseng Radix et Rhizoma). Generally, residual heat in warm diseases, after being scorched and dried by high fever, inevitably involves deficient heat. Shigao combined with Renshen allows true yin to recover instantly after warm diseases, causing residual heat to vanish spontaneously. This is the brilliance of Zhang Zhongjing's formula design. Additionally, Maidong (Ophiopogonis Radix) is sweet, cold, sticky, and stagnant. Although it assists in nourishing yin, it tends to retain pathogenic factors, leading to consumptive cough. Only when used with Shigao and Banxia (Pinelliae Rhizoma) is there no contraindication, truly because Shigao dissipates pathogens and Banxia transforms stagnation. Some may doubt that Zhi Gancao Tang (also known as Fumai Tang) contains Maidong but lacks Shigao and Banxia. However, Guizhi (Cinnamomi Ramulus) and Shengjiang (Zingiberis Rhizoma Recens) provide acrid-warm dispersion and unblocking to control it, thus preventing pathogen retention. Those who only know to use sweet-cold herbs to clear residual heat in warm diseases cannot cite this as justification!
In warm diseases, there are cases where Xianlu Tang should be taken on the day of onset. A sixteen-year-old boy worked in fields under the scorching sun during summer. After lunch, he suddenly felt feverish, anhidrotic, irritable, and thirsty with excessive drinking. His pulse was surging and long, indicating summerheat combined with warm pathogen. This decoction was administered, and he recovered before finishing one dose.
Note: At the onset of this condition, heat in the Stomach fu-organ was already substantial. Those who claim warm diseases enter hand meridians but not foot meridians are utterly ignorant!
When upper jiao irritant heat is too severe, light formulas are ineffective. However, heavy formulas risk overshooting the target, potentially worsening the condition. The correct method is to use heavy formulas but administer them slowly. I once treated a man in his forties who habitually smoked opium. He contracted cold damage in mid-winter. For two to three days, he suffered from irritability and anhidrosis. Originally, this was a Daqinglong Tang (Major Green Dragon Decoction) pattern, but due to mistaken administration of Guizhi Tang (Cinnamon Twig Decoction), irritability worsened. Upon consultation, his pulse was surging and slippery at the Guan position, while the Chi positions were powerless. I prescribed Xianlu Tang. Noting his weak Chi pulse, I instructed him to drink slowly, taking only one mouthful at a time, to prevent cold-cooling herbs from invading the lower jiao. The family ignored my advice and administered the entire dose at once, resulting in several episodes of slippery diarrhea with cold froth. Upper jiao irritability increased; nose felt like smoke-stained, face felt like fire-burned. The Guan pulse doubled in size, beating seven times per breath. This indicated Daiyang syndrome (floating yang). Urgently, I used 1 liang of Renshen, decocted and mixed with half a teacup of Tongbian (Child's Urine). The medicine bowl was placed in a basin of cold water, cooled, and then consumed at once. Simultaneously, I urgently prepared a decoction of Xuanshen, Shengdi (Rehmanniae Radix), and Zhimu, each 1 liang, in one large bowl, ready for use. After taking Renshen, repeated pulse checks showed gradual convergence over half an hour, though the rate seemed faster. I urgently heated the prepared decoction and instructed slow administration, one mouthful at a time. Over two hours, one dose was completed. Slight general sweating occurred, and he recovered. This mishap resulted from the family ignoring instructions. Fortunately, rescue was successful, but it was perilous. Thus, for any medicine meant to be taken in multiple doses, never administer it all at once. Since beginning clinical practice, whether for internal injury or external contraction, for critical conditions, I always decoct one large dose and divide it into multiple administrations. This is exercising boldness with caution, a foolproof strategy, not gambling everything on one throw.
In the Yangming chapter of *Shanghan Lun*, Chengqi Tang follows Baihu Tang to purge dry accumulation in the intestines, yet detailed contraindications for purgation are recorded. Indeed, Chengqi Tang is potent; inaccurate diagnosis leads to error. Having treated cold-warm diseases for thirty years, I have developed a method of avoiding difficulty for ease. Whenever a Yangming pattern requiring purgation appears, I first administer a large dose of Baihu Tang for one to two doses. Often, stool passes, and the disease resolves. Even occasionally, after several doses of Baihu Tang, stool remains blocked; however, since excess fire is cleared and fluids generated, the intestines do not dry out, making stool passage easier. Using Xuanmingfen (Mirabilitum) 3 qian, mixed with 2 liang of Fengmi (Honey) or Shishuang (Diospyros Frost), dissolved in boiling water, results in immediate bowel movement. If residual fire remains and stool is blocked, using 1 qian of raw Dahuang (Rhei Radix et Rhizoma) powder alone (mixed with cold water, 1 qian raw powder equals the effect of 1 liang decocted herb), taken with honey water, can also open the bowels. Furthermore, opening stool after Baihu Tang eliminates the fear of post-purgation non-resolution. Generally, when purgation signs are slight and the pulse is near deficient-rapid, immediate purgation with Chengqi Tang often fails post-purgation due to true yin deficiency and yuan qi (original qi) weakness. By first taking Baihu Tang or Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), excess fire is removed, true yin is restored, and yuan qi is cultivated. Then, mild descending agents are used to open the bowels; why would post-purgation failure occur? This is my method, successful in nearly every instance.
Occasionally, Baihu Tang moistens and opens stool, but the disease persists, resolving only after Dahuang descends the pathogen, due to hidden fecal impaction in the intestines. I once treated a woman in her seventies who contracted cold damage in late winter. Seven to eight days later, she consulted me. Her pulse was surging, long, and forceful; exterior and interior were hot; irritability and thirst were extreme; no stool since illness onset. Two doses of Baihu Jia Renshen Tang were given, resulting in bowel movement, three stools in one day, slight improvement, yet the pulse remained surging and long. Careful examination suggested retained hardened stool. Single Dahuang 3 qian was boiled briefly and administered, expelling four or five pieces of hardened stool. Improvement followed. As the pulse was not yet calm and body temperature normal, my formulated Baihu Jia Renshen Tang with Shanyao (Dioscoreae Rhizoma) replacing Jingmi was used, recovering before finishing one dose. However, this is rare (one or two in a hundred). Clinicians should not generalize from such rare occurrences to establish rigid rules, despising Baihu Tang while overvaluing Chengqi Tang.
After heavily using Shigao to reduce fire, occasional stool blockage may occur, treatable with small amounts of laxatives. This is my common method, but one must adapt to the condition and not cling to preconceptions. I once treated a youth whose cold damage had lasted over ten days. Yangming fire was substantial, stool was dry and hard. One large dose of Baihu Tang was given, two doses in one day, totaling 6 liang of Sheng Shigao. By 9 PM, fire seemed reduced, but spirit was confused, and stool had not passed. Re-examination revealed a string-like (Xian) pulse. String-like pulse indicates fire decline or qi deficiency. Knowing the clearing/resolving phase had been excessive, and stool remained blocked due to yuan qi depletion failing to transport the cooling/moistening power of Baihu Tang, I prescribed single Renshen 5 qian decocted in water. Stool passed shortly after, and the disease resolved. The original formula for this condition should have been Baihu Jia Renshen Tang. Due to inaccurate pulse diagnosis, only Baihu Tang was given, altering the course. Fortunately, the deviation was minor, allowing urgent Renshen administration following Baihu Tang to succeed. Indeed, the Baihu Tang taken during the day remained in the abdomen; aided by Renshen, it could be transformed and transported. Administering Renshen and Baihu Tang sequentially is无异于 (no different from) administering them simultaneously. I deeply admire the divine efficacy of Zhang Zhongjing's formulas, which are truly inconceivable. Wu Youke stated: "Like a person eating meat when disease strikes, causing stagnation in the stomach; purging with Chengqi Tang yields only foul water and loose stool. Adding Renshen to Chengqi Tang allows expulsion of material stagnant for thirty to forty days. Chengqi Tang borrows Renshen's power to stimulate stomach qi, moving the old accumulation." Wu Youke's theory explains my rationale for using Renshen after Baihu Tang to open the bowels.
Appendix:
Letter from Cui XX, Tianmen County, Hubei Province:
In mid-summer of Dingmao year, He某人 contracted warm disease. Other physicians treated with Xiangru Yin (Elsholtzia Decoction) and Huoxiang Zhengqi San (Patchouli Powder for Regulating the Qi), without effect. I was invited to consult. Following Qingjie Tang (Clearing and Resolving Decoction), recovery occurred after one dose. During the prevalence of warm diseases, based on Qingjie Tang, Liangjie Tang (Cooling and Resolving Decoction), Hanjie Tang, Xianlu Tang, Conglong Tang (Following the Dragon Decoction), and Liu Shui Shigao Yin (Distilled Water Gypsum Drink) from the book, for patients with vomiting, Daizheshi (Haematitum) was added. Adapting these few formulas, I saved over three thousand people, consuming more than one thousand jin of Sheng Shigao, without any adverse events.