天津张氏妇，年近三旬，怀妊，受温病兼下痢。
病因 受妊已六个月，心中恒觉发热，继因其夫骤尔赋闲，遂致
激动肝火，其热益甚，又薄为外感所束，遂致温而兼痢。
证候 表里俱壮热无汗，心中热极，思饮冰水，其家人不敢予。舌苔干而黄，频饮水不濡润，腹中常
觉疼坠，下痢赤多白少，间杂以鲜血，一昼夜十余次。其脉左部弦长，右部洪滑，皆重诊有力，一息五至。
诊断 其脉左部弦长有力者，肝胆之火炽盛也。惟其肝胆之火炽
盛下迫，是以不但下痢赤白，且又兼下鲜血，腹疼下坠。为其右部洪滑有力，知温热已入阳明之府，
是以舌苔干黄，心为热迫，思饮冰水。所犹喜者脉象虽热，不至甚数，且又流利无滞，胎气可保无恙
也。宜治以白虎加人参汤以解温病之热，而更重用芍药以代方中知母，则肝热能清而痢亦可愈矣。
处方 生石膏（三两捣细） 大潞参（五钱） 生杭芍（一两） 粳米（五钱） 甘草（三钱）
共煎汤三盅，分三次温饮下。
复诊 将药分三次服完，表里之热已退强半，痢愈十之七八，腹中疼坠亦大轻减，舌苔由黄变白，已有津
液，脉象仍然有力
而较前则和缓矣。遂即原方为之加减俾再服之。
处方 生石膏（二两捣细） 大潞参（三钱） 生怀山药（八钱） 生杭芍（六钱）
白头翁（四钱） 秦皮（三钱） 甘草（二钱）
共煎汤三盅，分三次温饮下。
方解 按此方即白虎加人参汤与白头翁汤相并为一方也。为方中有芍药、山药，是以白虎加
人参汤中可省去知母、粳米；为白虎加人参汤中之石膏，可抵黄连、黄柏，是以白头翁汤中止
用白头翁、秦皮，合用之则一半治温，一半治痢，安排周匝，步伍整齐，当可奏效。
效果 将药如法服两剂，病遂全愈。
或问 《伤寒论》用白虎汤之方定例，汗吐下后加人参，渴者加人参。此案之证非当汗吐
下后，亦未言渴，何以案中两次用白虎皆加人参乎？答曰∶此案证兼下痢，下痢亦下之类也。
其舌苔干黄毫无津液，舌干无液亦渴之类也。且其温病之热，不但入胃，更随下痢陷至下焦永无
出路。惟人参与石膏并用，实能升举其下陷之温热而清解消散之，不至久留下焦以耗真阴。况
此证温病与下痢相助为虐，实有累于胎气，几至于莫能支，加人参于白虎汤中，亦所以保其胎气
使无意外之虞也。
天津张氏的一位妇女，年龄接近三十岁，怀孕，感染了温病并伴有痢疾。
病因 怀孕已有六个月，心中经常感觉发热，接着因为丈夫突然失业，导致情绪激动引发肝火，体内的热势更加严重，又受到外感邪气的束缚，于是导致温病兼夹痢疾。
证候 表里都出现高热且无汗，心中极度烦热，想喝冰水，但她的家人不敢给她喝。舌苔干燥且发黄，频繁喝水也不能使口腔湿润，腹部经常感到疼痛和下坠感，大便下痢赤多白少，间杂有鲜血，一昼夜腹泻十多次。其脉象左部弦长，右部洪滑，重按都有力，一息跳动五次。
诊断 其脉象左部弦长有力，是肝胆之火炽盛的表现。正因为肝胆之火炽盛并向下逼迫，所以不仅下痢赤白相间，而且还夹杂下鲜血，伴有腹痛和下坠感。因为其右部脉象洪滑有力，知道温热之邪已经传入阳明腑，所以舌苔干黄，心被热邪逼迫，想要喝冰水。所庆幸的是脉象虽然显示热盛，但并不十分急促，而且流利无滞涩，胎气可以保全无恙。适宜用白虎加人参汤来解除温病的热邪，并且更重用芍药来代替方中的知母，这样肝热就能清除，痢疾也可以痊愈了。
处方 生石膏（三两，捣碎） 大潞参（五钱） 生杭芍（一两） 粳米（五钱） 甘草（三钱）
共同煎煮成三碗汤，分三次温服。
复诊 将药物分三次服完后，表里的热势已退去大半，痢疾好了十之七八，腹部的疼痛和下坠感也大大减轻，舌苔由黄色变为白色，已有津液，脉象仍然有力，但比之前和缓了。于是就在原方基础上进行加减，让她继续服用。
处方 生石膏（二两，捣碎） 大潞参（三钱） 生怀山药（八钱） 生杭芍（六钱）
白头翁（四钱） 秦皮（三钱） 甘草（二钱）
共同煎煮成三碗汤，分三次温服。
方解 按照此方，就是白虎加人参汤与白头翁汤合并为一个方剂。因为方中有芍药、山药，所以在白虎加人参汤中可以省去知母、粳米；因为白虎加人参汤中的石膏，可以抵得上黄连、黄柏的作用，所以在白头翁汤中只使用白头翁、秦皮，合用之后，一半治疗温病，一半治疗痢疾，安排周密严谨，步调整齐，应当能够奏效。
效果 按照方法服药两剂后，疾病完全痊愈。
有人问：《伤寒论》中使用白虎汤的固定法则是，发汗、催吐、泻下之后加用人参，口渴者加用人参。这个病例的症状并非在发汗、催吐、泻下之后，也没有提到口渴，为什么案中两次使用白虎汤都要加人参呢？回答说：这个病例的症状兼有痢疾，痢疾也是“下”的一类表现。其舌苔干黄毫无津液，舌干无液也是“渴”的一类表现。而且其温病的热邪，不但进入胃腑，更随着痢疾陷入下焦，永远没有出路。只有人参和石膏并用，确实能升举那些下陷的温热之邪并清解消散它，不至于长久留在下焦消耗真阴。况且这个病例中温病与痢疾互相助长为害，实际上累及胎气，几乎到了无法支撑的地步，在白虎汤中加入人参，也是为了保护胎气，使其没有意外的危险。
A woman surnamed Zhang from Tianjin, nearly thirty years old, was pregnant and suffered from a warm disease (Wenbing) complicated by dysentery.
Etiology She had been pregnant for six months and constantly felt heat in the heart region. Subsequently, due to her husband's sudden unemployment, emotional agitation stirred up Liver Fire, making the internal heat even more severe. Additionally, constrained by external pathogenic factors, she developed a warm disease complicated by dysentery.
Symptoms There was high fever on both the exterior and interior without sweating, extreme heat in the heart region, and a desire to drink ice water, which her family dared not give her. The tongue coating was dry and yellow; frequent drinking of water did not moisten the mouth. She often felt pain and a bearing-down sensation in the abdomen. Her stools consisted of dysentery with more red than white, mixed with fresh blood, occurring more than ten times a day. The pulse was wiry and long on the left side, and surging and slippery on the right side, both forceful upon heavy pressure, beating five times per breath.
Diagnosis A wiry, long, and forceful pulse on the left indicates blazing fire of the Liver and Gallbladder. Because this Liver-Gallbladder fire is blazing and pressing downward, it causes not only dysentery with red and white discharge but also fresh blood, along with abdominal pain and a bearing-down sensation. A surging and slippery forceful pulse on the right indicates that the warm-heat has entered the Yangming Fu organs, resulting in a dry yellow tongue coating. The heart is pressed by heat, causing a desire to drink ice water. Fortunately, although the pulse indicates heat, it is not excessively rapid, and flows smoothly without stagnation, suggesting the fetal qi can be preserved safely. It is appropriate to treat with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) to resolve the heat of the warm disease, and to heavily use Shaoyao (Paeoniae Radix Alba) to replace Zhimu (Anemarrhenae Rhizoma) in the formula. This will clear the Liver heat and cure the dysentery.
Prescription Sheng Shigao (Raw Gypsum Fibrosum, 3 liang, crushed), Dalu Shen (Large Radix Codonopsis Pilosulae, 5 qian), Sheng Hangshao (Raw Paeoniae Radix Alba, 1 liang), Jingmi (Oryza Sativa, 5 qian), Gancao (Radix Glycyrrhizae Uralensis, 3 qian).
Decoct together to make three bowls of decoction, taken warm in three divided doses.
Follow-up Visit After completing the three doses, the heat on both the exterior and interior had receded by more than half, the dysentery improved by seventy to eighty percent, and the abdominal pain and bearing-down sensation were significantly alleviated. The tongue coating changed from yellow to white, and fluids returned. The pulse remained forceful but was more moderate compared to before. Therefore, modifications were made to the original formula for continued administration.
Prescription Sheng Shigao (Raw Gypsum Fibrosum, 2 liang, crushed), Dalu Shen (Large Radix Codonopsis Pilosulae, 3 qian), Sheng Huai Shanyao (Raw Dioscoreae Oppositae Rhizoma, 8 qian), Sheng Hangshao (Raw Paeoniae Radix Alba, 6 qian), Baitouweng (Radix Pulsatillae, 4 qian), Qinpi (Cortex Fraxini, 3 qian), Gancao (Radix Glycyrrhizae Uralensis, 2 qian).
Decoct together to make three bowls of decoction, taken warm in three divided doses.
Formula Analysis This formula combines Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) and Baitouweng Tang (Pulsatilla Decoction). Because the formula contains Shaoyao (Paeoniae Radix Alba) and Shanyao (Dioscoreae Oppositae Rhizoma), Zhimu (Anemarrhenae Rhizoma) and Jingmi (Oryza Sativa) can be omitted from Baihu Jia Renshen Tang. Since Shigao (Gypsum Fibrosum) in Baihu Jia Renshen Tang can substitute for Huanglian (Coptidis Rhizoma) and Huangbai (Phellodendri Cortex), only Baitouweng (Radix Pulsatillae) and Qinpi (Cortex Fraxini) are used from Baitouweng Tang. Combined, half treats the warm disease and half treats the dysentery. The arrangement is meticulous and coordinated, likely to achieve efficacy.
Outcome Following the prescription for two doses, the illness was completely cured.
Interrogation: In Shanghan Lun (Treatise on Cold Damage), the fixed rule for using Baihu Tang (White Tiger Decoction) is to add Renshen (Ginseng) after sweating, vomiting, or purging, and to add Renshen if there is thirst. In this case, the symptoms did not follow sweating, vomiting, or purging, nor was thirst mentioned. Why was Renshen added twice when using Baihu Tang? Answer: This case involves dysentery, which is a form of "downward" discharge. The dry yellow tongue coating lacking fluids is analogous to thirst. Furthermore, the heat of the warm disease not only enters the Stomach but sinks into the Lower Jiao due to dysentery, leaving no outlet. Only the combination of Renshen (Radix Ginseng) and Shigao (Gypsum Fibrosum) can effectively lift the sunken warm-heat and clear/dissipate it, preventing it from lingering in the Lower Jiao and consuming True Yin. Moreover, since the warm disease and dysentery exacerbate each other, threatening the fetal qi to the point of near collapse, adding Renshen to Baihu Tang serves to protect the fetal qi and prevent unexpected mishaps.