典藏书目

Cinnamon Twig (Guizhi) 1 liang, White Peony Root (Shaoyao) 4 liang, Licorice Root (Gancao) 2 liang, Ginseng Root (Renshen) 3 liang, Fresh Ginger (Shengjiang) sliced 4 liang, Jujube (Dazao) pitted 12 pieces.
The above six ingredients are boiled with 12 sheng of water over a gentle fire until reduced to 3 sheng of liquid. The dregs are removed, and the decoction is taken in three divided warm doses, following the administration method of Guizhi Tang (Cinnamon Twig Decoction).

[Formula Analysis]
This formula is essentially Guizhi Tang (Cinnamon Twig Decoction) with increased dosages of Shaoyao (White Peony Root) and Shengjiang (Fresh Ginger), plus the addition of Renshen (Ginseng Root). Body pain after sweating indicates deficiency and disharmony of Ying (Nutritive Qi) and Wei (Defensive Qi); therefore, Guizhi Tang (Cinnamon Twig Decoction) is used to harmonize Ying (Nutritive Qi) and Wei (Defensive Qi). The dosage of Shengjiang (Fresh Ginger) is doubled because the pulse is deep and slow, indicating cold in the Ying (Nutritive Qi) level; the dosage of Shaoyao (White Peony Root) is doubled because of insufficient Ying (Nutritive Qi) and blood deficiency; Renshen (Ginseng Root) is added to tonify various deficiencies. When Guizhi (Cinnamon Twig) combines with Renshen (Ginseng Root), the Zong Qi (Pectoral Qi) circulates throughout the body, and sufficient Qi and Blood regulate the bones and muscles; when Renshen (Ginseng Root) combines with Guizhi (Cinnamon Twig), it connects the interior and exterior, tonifies Ying Yin (Nutritive Yin) and benefits Wei Yang (Defensive Yang). There is no case of body pain due to Exterior Deficiency that cannot be cured.

If the patient presents with fever, headache, and a pulse that is unexpectedly deep, and if the condition does not improve accompanied by body pain, the Interior should be warmed, and Sini Tang (Frigid Extremities Decoction) is indicated.

[Commentary]
Under the phrase "body pain," the four characters "diarrhea with undigested food" (xiali qinggu) should likely appear to align with the text "the Interior should be warmed." As stated in the Taiyin Chapter: In cold damage, if a physician incorrectly uses purgatives, resulting in persistent diarrhea with undigested food and body pain, one must urgently rescue the Interior using Sini Tang (Frigid Extremities Decoction). Although here there was no purgative treatment, the unexpectedly deep pulse indicates Interior Cold, suggesting a textual omission.

[Annotation]
Fever and headache are signs of a Taiyang Exterior syndrome. The pulse should be floating; its unexpected depth indicates a Taiyang Exterior syndrome presenting with a Shaoyin Interior pulse. For diseases involving both Taiyang and Shaoyin where both Exterior and Interior are cold and there is no sweat, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is suitable for inducing sweating. If the condition persists without diarrhea, Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) is used to harmonize; if diarrhea with undigested food occurs, even if Exterior symptoms like body pain remain, sweating should not be induced again. Instead, the Interior should be warmed using Sini Tang (Frigid Extremities Decoction) to prevent Yang from transforming into Yin, which could lead to reversal conditions such as cold extremities, palpitations, and collapse of Yang. One must never argue that because the disease is in Taiyang, warming is inappropriate.

See Shaoyin Chapter.

In cold damage, if vomiting or purging has been performed and the disease remains unresolved after seven or eight days, with heat accumulating in the Interior, causing fever in both Exterior and Interior, occasional aversion to wind, extreme thirst, dryness and irritability on the tongue, and a desire to drink several sheng of water, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) should be administered.

[Commentary]
After the term "cold damage," the words "if sweating" (ruohan) should likely be present, as sweating injures Jin Ye (Body Fluids) more severely than vomiting or purging. "Occasional aversion to wind" should read "occasional sweating with aversion to wind." Without the character "sweating," "occasional aversion to wind" would indicate an unresolved Exterior syndrome, making Baihu Tang (White Tiger Decoction) contraindicated. The text states: For fever without sweat and unresolved Exterior syndrome, Baihu Tang is forbidden; for thirst with desire to drink water and no Exterior syndrome, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated. Readers will understand upon careful study of the original text.

[Annotation]
After cold damage is treated with sweating, vomiting, or purging, if the disease remains unresolved after seven or eight days, leading to heat accumulation in the Interior, occasional sweating with aversion to wind indicates that the accumulated heat in the Exterior has not yet resolved; extreme thirst, dryness and irritability on the tongue, and desire to drink several sheng of water indicate that the accumulated heat in the Interior is manifest. Thus, it is said that both Exterior and Interior are hot, and Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated. Baihu Tang (White Tiger Decoction) can release muscle-heat from the Exterior and clear Interior heat. Renshen (Ginseng Root) is added because sweating, vomiting, and purging deplete Jin Ye (Body Fluids) and weaken Qi; this ingredient is used to tonify Qi and generate fluids.

[Commentary]
Da Qinglong Tang (Major Green Dragon Decoction) treats Taiyang syndrome with heat in both Exterior and Interior, where Exterior heat predominates over Interior heat, hence there is no thirst. Baihu Tang (White Tiger Decoction) treats Yangming syndrome with heat in both Exterior and Interior, where Interior heat predominates over Exterior heat, hence extreme thirst. Now, with extreme thirst, dryness, irritability, occasional sweating, and aversion to wind, the heat is in Yangming combined with Taiyang. Baihu Tang (White Tiger Decoction) is used because Yangming Interior heat patterns are more prevalent than Taiyang Exterior heat patterns. If there is no sweat and slight thirst, Taiyang Exterior patterns predominate; even with severe heat in both Exterior and Interior, Da Qinglong Tang (Major Green Dragon Decoction) should be used.

[Collected Annotations]
Yu Chang stated: Examining this clause, "heat accumulating in the Interior, heat in both Exterior and Interior" allows for self-judgment. Precisely because heat accumulates in the Interior, Exterior heat cannot dissipate. Moreover, with extreme thirst and desire to drink water, clearing heat must be urgent!
Cheng Zhi stated: Exterior heat refers to body heat; Interior heat refers to internal heat. Because the disease remained unresolved after sweating, vomiting, and purging, pathogenic factors took advantage of deficiency to accumulate as Interior heat. Precisely because heat accumulates in the Interior, Exterior heat does not dissipate, accompanied by aversion to wind. Extreme thirst indicates blazing Interior heat; how can one not use Baihu Tang (White Tiger Decoction) to urgently resolve it? Shi Gao (Gypsum) is pungent and cold, capable of clearing Interior heat and dispersing Exterior heat. Precisely because this follows sweating, vomiting, and purging, Renshen (Ginseng Root) must be added to protect Zheng Qi (Upright Qi).
Wang Hu stated: Administering Baihu Tang (White Tiger Decoction) with Renshen (Ginseng Root) supports Zheng Qi (Upright Qi) to resolve pathogenic heat inside and outside. Essentially, this formula is suitable only for cases where Zheng Qi (Upright Qi) is weak and pathogenic factors are mild; if pathogenic factors are severe, adding Renshen (Ginseng Root) lightly is inadvisable.