（仲景）
治伤寒脉浮滑，表有热，里有寒（浮为在表，滑为在里。里寒指伤寒，即病热之本因也）；
及三阳合病，脉浮大，腹满身重，难以转侧，口不仁而面垢， 语遗尿，发汗则 语，下之
则头
遗尿
气下
热）；通治阳明病脉洪大而长，不恶寒，反恶热，头痛，自汗，口渴，舌胎，目痛，鼻干，
不得卧，心烦躁乱，日晡潮热；或阳毒发斑，胃热诸病（邪热盛，故脉洪大；热在表而浅，
邪恶正，故恶寒；热入里而深，邪甚无畏，故不恶寒，反恶热；中风有汗，伤寒无汗，传入
阳明，则有汗，谓之热越，故阳明病法多汗；里热故作渴；阳明主肌肉，故肌热；脉交额中，
故目痛；脉夹鼻，金燥故鼻干；胃不和，故卧不安。人之阳气，昼日行阳二十五度，平旦属
少阳，
石膏（一斤） 知母（六两） 甘草（二两） 粳米（六合。）先煮石膏数十沸味淡难
出，再投
此足阳明、手太阴药也。热淫于内，以苦发之，故以知母苦寒为君；热则伤气，必以甘
寒为助，故以石膏为臣（石膏、滑石，味皆甘寒，凡药带甘者，皆泻中有补）；津液内烁，
故以甘草、粳米甘平益气缓之为使，不致伤胃也。又烦出于肺，躁出于肾，石膏清肺而泻胃
火，知母清肺而泻肾火，甘草和中而泻心脾之火，或泻其子肺，或泻其母心，不专治阳明气
分热也（石膏、甘草不但清里，兼能发表，然必实热方可用。或有血虚身热，脾虚发热，及
阴盛格阳，面赤烦躁，类白虎汤证，误投之不可救也。按∶白虎证脉洪大有力，类白虎证脉
大而虚，以此为辨。又按∶阴盛格阳，阳盛格阴，二证至为难辨。盖阴盛极而格阳于外，外
热而内寒；阳盛极而格阴于外，外冷而内热；经所谓重阴必阳，重阳必阴，重寒则热，重热
则寒是也。当于小便分之∶便清者外虽燥热，而中必寒；便赤者外虽厥冷，而内实热。再看
口中燥润及舌苔浅深，盖舌为心苗，应南方火，邪在表则未生胎，邪入里津液搏结则生胎；
而滑胎白者，丹田有热，胸中有寒，邪在半表半里也；热入渐深，则燥而涩，热聚于胃则黄，
宜承气及白虎；若热病口干舌黑，乃肾水刑于心火，热益深而病笃矣。然亦有胎黑属寒者，
舌无芒刺，口有津液也，又当用温补之剂，尤其细辨。李东垣曰∶邪在阳明，肺受火克，故
用辛寒以清肺，所以有白虎之名，白虎，西万金神也。吴鹤皋曰∶如秋金之令行，则夏火之
炎退。成氏曰∶立秋后不可服，为大寒之剂。易老曰∶有是病则投是药，苟拘于时，何以措
手。若以白虎为大寒，承气又何以行于冬令乎。太阳发热无汗而渴，忌白虎，表未解也，阳
明汗多而渴，忌五苓、猪苓，津液大耗也）。
本方加人参三两，名人参白虎汤（仲景）∶治伤寒渴欲饮水，无表证者（白虎解热，人
参生津。凡身发热为热在表，渴欲饮水为热在里，身热饮水，表里俱有热，身凉不渴，表里
俱无热。欲饮水者，不可不与，不可过与，恣饮则有水结胸、心下悸、喘咳、哕噎、肿胀、
癃秘、下利诸变证；亦治伤寒无大热，口澡渴，心烦，背微恶寒者背为阳，背恶寒、口中和
者，少阴病也，宜附子汤；今热未退而微恶寒，为表未全罢，尚属太阳，然燥渴心烦为里热
已炽，与白虎汤解表邪，清里热，加人参补气生津。太阳病在表故恶寒，少阳在半表半里亦
微恶寒，阳明在里故不恶寒，反恶热，间有恶寒者，与太阳合病也。许叔微曰∶仲景云∶伤
寒吐下后，七八日不解，表里俱热，大渴烦躁者，白虎加人参汤主之。又云∶脉浮滑，此表
有热，里有寒，白虎加人参汤主之。又云∶伤寒脉浮，发热无汗，其表不解，不可与白虎。
林亿校正谓；于此表里差矣，余谓不然，大抵白虎能除伤寒中渴，表里发热，前后二证，或
云表里俱热，或云表热里寒，皆可服之。一种发热无汗，其表不解，全是麻黄与葛根证，安
可行白虎也）；亦治太阳中 （音谒。暑也），身热，汗出，恶寒，足冷，脉微而渴（身热恶
寒，为在表；足冷脉微，又不可表）；亦治火伤肺胃，传为膈消（喻嘉言曰∶肺消以地黄丸
治其血分，肾消以白虎汤治其气分，病不能除，医之罪也）。本方加苍术，名白虎加苍术汤∶
治湿温脉（沉细者沉细属湿，先受暑，后受湿，暑湿相搏，名湿温。其证胫冷，腹满，头痛，
身痛，多汗，渴而谵语。李东垣曰∶动而伤暑，火热伤气，辛苦之人多得之，宜人参白虎汤；
静而伤暑，湿胜身重，安东之人多得之，宜白虎苍术汤）。本方加桂枝，名桂枝白虎汤（《金
匮》）∶治温疟，但热无寒，骨节疼痛，时呕。本方加柴胡、黄芩、半夏，名柴胡石膏汤∶治
暑嗽喘渴。本方除粳米，加人参，名化斑汤∶治胃热发斑脉虚者。
（张仲景）主治伤寒脉象浮滑，表有热，里有寒（浮脉主病在表，滑脉主病在里。这里的“里寒”指的是伤寒，即产生内热的根本原因）；以及三阳合病，脉象浮大，腹部胀满，身体沉重，难以翻身转侧，口舌麻木不知味且面色污垢，胡言乱语并遗尿，若误用发汗法则会导致胡言乱语加重，误用攻下法则会导致气陷而遗尿）；通治阳明病脉象洪大而长，不恶寒，反而恶热，头痛，自汗，口渴，舌苔厚，目痛，鼻干，无法安卧，心中烦乱躁动，下午申时左右定时发热；或者阳毒发斑，胃热引起的各种疾病（邪热亢盛，所以脉象洪大；热在体表且浅，正气与邪气相争，所以恶寒；热入体内且深，邪气强盛无所畏惧，所以不恶寒，反而恶热；中风证有汗，伤寒证无汗，传入阳明经后则有汗，这叫做热邪外越，所以阳明病通常多汗；体内有热故口渴；阳明经主管肌肉，所以肌肉发热；经脉交汇于额中，所以目痛；经脉夹行于鼻旁，肺金燥热所以鼻干；胃气不和，所以睡眠不安。人的阳气，白天运行于阳分二十五度，平旦时分属于少阳经，石膏（一斤）知母（六两）甘草（二两）粳米（六合）。先煮石膏数十沸，味道淡了难出，再投入其他药物。这是足阳明、手太阴经的药物。热邪淫溢于内，用苦味药发散它，所以用苦寒的知母为君药；热邪会耗伤气，必须用甘寒药作为辅助，所以用石膏为臣药（石膏、滑石，味道都是甘寒，凡是带甘味的药，都是在泻中有补）；津液在内被灼烧，所以用甘草、粳米的甘平之性益气缓急为使药，以免损伤胃气。另外，烦出于肺，躁出于肾，石膏清肺而泻胃火，知母清肺而泻肾火，甘草调和中间而泻心脾之火，或者是泻其子脏肺，或者是泻其母脏心，并不专门治疗阳明气分的热（石膏、甘草不但能清里热，兼能解表，但必须是实热证方可使用。如果有血虚身热，脾虚发热，以及阴盛格阳，面赤烦躁，类似白虎汤证的情况，误投此药则不可救。按：白虎汤证的脉象洪大有力，类白虎汤证的脉象大而虚，以此作为辨别。又按：阴盛格阳和阳盛格阴两种证候极难辨别。因为阴气极盛而格拒阳气于外，表现为外热内寒；阳气极盛而格拒阴气于外，表现为外冷内热；这就是《内经》所说的重阴必阳，重阳必阴，重寒则热，重热则寒的道理。应当通过小便来区分：小便清长的，虽然外表燥热，但内部一定是寒；小便短赤的，虽然外表厥冷，但内部确实是热。再看口中干燥湿润及舌苔的深浅，因为舌是心的苗窍，对应南方的火，邪气在表则未生舌苔，邪气入里津液搏结则生舌苔；而舌苔滑白的，是丹田有热，胸中有寒，邪气在半表半里之间；热邪侵入渐深，则变得干燥涩滞，热聚于胃则舌苔发黄，适宜用承气汤及白虎汤；如果是热病导致口干舌黑，这是肾水克制心火，热邪更深而病情危笃了。然而也有舌苔黑属于寒证的，舌上没有芒刺，口中有津液的，又应当用温补的药剂，尤其需要仔细辨别。李东垣说：邪气在阳明，肺受火克，所以用辛寒的药以清肺，因此有白虎之名，白虎是西方的金神。吴鹤皋说：如同秋季金气当令，则夏季火气的炎势退去。成无己说：立秋后不可服用，因为是大寒的药剂。易老说：有病则投相应的药，如果拘泥于时令，如何施治。如果把白虎汤看作大寒之剂，那么承气汤又凭什么在冬季使用呢？太阳病发热无汗而口渴，忌用白虎汤，因为表证未解；阳明病汗多而口渴，忌用五苓散、猪苓散，因为津液已经大量消耗）。本方加入人参三两，称为人参白虎汤（张仲景）：主治伤寒口渴想喝水，没有表证的人（白虎汤解除热邪，人参生津液。凡是身体发热是热在表，口渴想喝水是热在里，身热且饮水，说明表里都有热，身凉且不渴，说明表里都没有热。想喝水的人，不能不给喝，也不能过量给喝，恣意饮水则会导致水结胸、心下悸动、喘咳、呃逆噎塞、肿胀、小便不通、下利等各种变证；也治疗伤寒没有大热，口燥渴，心烦，背部微微恶寒的人（背为阳，背部恶寒且口中平和的，是少阴病，适宜用附子汤；现在热未退而轻微恶寒，说明表证未完全解除，仍属于太阳病，然而燥渴心烦说明里热已经炽盛，给予白虎汤解除表邪，清里热，加入人参补气生津。太阳病在表所以恶寒，少阳病在半表半里也轻微恶寒，阳明病在里所以不恶寒，反而恶热，间或有恶寒的，是与太阳病合病。许叔微说：张仲景说：伤寒吐下之后，七八天不解，表里俱热，大渴烦躁的，用白虎加人参汤主治。又说：脉浮滑，这是表有热，里有寒，用白虎加人参汤主治。又说：伤寒脉浮，发热无汗，其表证未解，不可给予白虎汤。林亿校正认为：这里关于表里的论述有差异，我认为不是这样，大体上白虎汤能去除伤寒中的口渴，表里发热，前后两个证候，或者说表里俱热，或者说表热里寒，都可以服用。一种发热无汗，其表证未解，完全是麻黄汤与葛根汤的证候，哪里可行用白虎汤呢）；也治疗太阳中暍（音谒，即暑邪），身体发热，汗出，恶寒，脚冷，脉微而渴（身热恶寒，说明病在表；脚冷脉微，又不宜发汗解表）；也治疗火邪损伤肺胃，传变为膈消（喻嘉言说：肺消用地黄丸治疗其血分，肾消用白虎汤治疗其气分，病不能除除，是医生的罪过）。本方加入苍术，名为白虎加苍术汤：治疗湿温脉象沉细（沉细脉属湿，先感受暑邪，后感受湿邪，暑湿相搏，称为湿温。其症状小腿冷，腹胀满，头痛，身痛，多汗，口渴且胡言乱语。李东垣说：活动后伤暑，火热伤气，辛苦劳作的人多得此病，适宜用人参白虎汤；静止时伤暑，湿气胜导致身体沉重，安逸之人多得此病，适宜用白虎加苍术汤）。本方加入桂枝，名为桂枝白虎汤（《金匮要略》）：治疗温疟，只有热没有寒，骨节疼痛，时常呕吐。本方加入柴胡、黄芩、半夏，名为柴胡石膏汤：治疗暑邪咳嗽气喘口渴。本方除去粳米，加入人参，名为化斑汤：治疗胃热发斑且脉虚的人。
(Zhang Zhongjing) Treats Shanghan (Cold Damage) with a floating and slippery pulse, heat in the exterior and cold in the interior (A floating pulse indicates disease in the exterior, a slippery pulse indicates disease in the interior. "Cold in the interior" here refers to Shanghan, which is the root cause of generating internal heat); as well as San Yang He Bing (Combined Disease of the Three Yang), with a floating and large pulse, abdominal fullness, body heaviness, difficulty in turning over, numbness of the mouth and face with greasy complexion, delirium and urinary incontinence. If sweating is induced, delirium worsens; if purgation is used, Qi sinks leading to urinary incontinence); it generally treats Yangming Bing (Yangming Disease) with a surging and long pulse, aversion to cold absent but aversion to heat present, headache, spontaneous sweating, thirst, thick tongue coating, eye pain, nasal dryness, inability to sleep, mental restlessness and irritability, tidal fever around Shen hour (3-5 PM); or Yang Du Fa Ban (Yang Toxin causing macules), and various diseases caused by Stomach Heat (Evil heat is flourishing, hence the surging pulse; heat is in the exterior and shallow, Zheng Qi struggles with evil, hence aversion to cold; heat enters the interior and is deep, evil is strong and fearless, hence no aversion to cold but aversion to heat; Feng Zhong (Wind Strike) has sweating, Shanghan has no sweating; upon transmission to Yangming, there is sweating, called Re Yue (Heat venting out), hence Yangming Bing usually involves much sweating; internal heat causes thirst; Yangming governs muscles, hence muscle heat; meridians intersect at the forehead, hence eye pain; meridians flank the nose, Lung Metal dryness causes nasal dryness; Stomach Qi disharmony causes restless sleep. Human Yang Qi travels through the Yang aspects 25 times during the day, starting from Shaoyang (Lesser Yang) at dawn. Shigao (Gypsum Fibrosum, 1 jin), Zhi Mu (Anemarrhenae Rhizoma, 6 liang), Gancao (Licorice Root, 2 liang), Jingmi (Oryza Sativa, 6 he). Boil Shigao for dozens of boils until the taste is faint and difficult to extract, then add other herbs. This is a formula for the Foot-Yangming and Hand-Taiyin meridians. When heat invades internally, bitter drugs are used to disperse it, so Zhi Mu (Anemarrhenae Rhizoma), bitter and cold, is used as the Sovereign drug; heat injures Qi, so sweet and cold drugs are needed as assistants, hence Shigao (Gypsum Fibrosum) is used as the Minister drug (Shigao and Huashi (Pyrrhosiae Folium) are both sweet and cold; any drug with a sweet taste contains tonification within purgation); fluids are scorched internally, so Gancao (Licorice Root) and Jingmi (Oryza Sativa) with their sweet and neutral nature are used as Guides to tonify Qi and moderate urgency, preventing stomach injury. Furthermore, Fan (Vexation) originates from the Lung, Zao (Restlessness) from the Kidney. Shigao clears the Lung and drains Stomach Fire; Zhi Mu clears the Lung and drains Kidney Fire; Gancao harmonizes the middle and drains Heart and Spleen Fire, either draining its child organ (Lung) or its mother organ (Heart), not specifically treating only Yangming Qi-level heat (Shigao and Gancao can clear the interior and release the exterior, but must be used only for excess heat. If there is blood deficiency causing body heat, Spleen deficiency causing fever, or Yin excess repelling Yang causing red face and restlessness resembling Baihu Tang syndrome, misusing this drug is incurable. Note: Baihu Tang syndrome presents with a surging and forceful pulse, while similar conditions present with a large but deficient pulse, which serves as the differentiation. Also note: Yin excess repelling Yang and Yang excess repelling Yin are extremely difficult to differentiate. When Yin is extremely excessive, it repels Yang to the exterior, presenting as external heat and internal cold; when Yang is extremely excessive, it repels Yin to the exterior, presenting as external cold and internal heat. This is what the Classics refer to as "Extreme Yin becomes Yang, extreme Yang becomes Yin; extreme cold becomes heat, extreme heat becomes cold." Differentiate by urine: clear urine indicates internal cold despite external dryness/heat; dark urine indicates internal heat despite external cold limbs. Observe oral moisture and tongue coating depth: the tongue is the sprout of the Heart, corresponding to Southern Fire. Evil in the exterior does not produce coating; evil entering the interior condenses fluids to produce coating. A slippery white coating indicates heat in the Dantian and cold in the chest, with evil in the half-exterior/half-interior. As heat penetrates deeper, it becomes dry and rough; heat gathering in the Stomach produces yellow coating, suitable for Chengqi Tang and Baihu Tang. If heat disease causes black tongue and dry mouth, it is Kidney Water punishing Heart Fire, indicating deeper heat and critical illness. However, black coating can also belong to cold patterns, characterized by no thorns on the tongue and saliva in the mouth, requiring warm tonification, demanding careful differentiation. Li Dongyuan said: Evil in Yangming, Lung suffers fire suppression, so acrid-cold drugs are used to clear the Lung, hence the name Baihu (White Tiger), the Divine God of the West. Wu Hegao said: Just as the command of Autumn Metal arrives, the flare-up of Summer Fire recedes. Cheng Shi said: It should not be taken after Start of Autumn, as it is a major cold agent. Yi Lao said: Prescribe the drug for the disease; if constrained by time, how can one practice? If Baihu is considered major cold, why is Chengqi used in winter? Taiyang fever with no sweat and thirst contraindicates Baihu, as the exterior is unresolved; Yangming sweating with thirst contraindicates Wuling San and Zhuling San, as fluids are greatly depleted). Adding Renshen (Ginseng Radix et Rhizoma) 3 liang to this formula creates Ren Shen Bai Hu Tang (Zhang Zhongjing): Treats Shanghan with thirst wanting to drink water, without exterior signs (Baihu resolves heat, Renshen generates fluids. Body heat indicates heat in the exterior; thirst wanting to drink indicates heat in the interior; body heat with drinking indicates heat in both exterior and interior; cool body without thirst indicates no heat in either. Those wanting to drink should be given water, but not excessively; excessive drinking leads to Shui Jie Xiong (Water accumulation in the chest), Xin Xia Ji (Palpitations below the heart), Chuan Ke (Wheezing and cough), Yue Ye (Hiccups and choking), Zhang Zhong (Swelling), Long Mi (Dysuria), and Xia Li (Diarrhea) complications; it also treats Shanghan without high fever, oral dryness/thirst, mental irritability, and slight aversion to cold on the back (The back is Yang; aversion to cold on the back with a normal mouth indicates Shaoyin Bing, suitable for Fuzi Tang; now heat remains with slight aversion to cold, indicating the exterior is not fully resolved, still belonging to Taiyang, yet dry thirst and irritability indicate blazing interior heat. Give Baihu Tang to resolve exterior evil and clear interior heat, adding Renshen to tonify Qi and generate fluids. Taiyang disease is in the exterior, hence aversion to cold; Shaoyang is half-exterior/half-interior, hence slight aversion to cold; Yangming is in the interior, hence no aversion to cold but aversion to heat. Occasional aversion to cold indicates combination with Taiyang. Xu Shuwei said: Zhang Zhongjing stated: After vomiting/purging in Shanghan, unresolved after 7-8 days, with exterior-interior heat, great thirst and irritability, treat with Baihu Jia Renshen Tang. Also: Floating-slippery pulse, exterior heat interior cold, treat with Baihu Jia Renshen Tang. Also: Shanghan floating pulse, fever no sweat, exterior unresolved, do not give Baihu. Lin Yi corrected: There is a discrepancy in the description of exterior/interior here. I disagree. Generally, Baihu removes thirst and exterior-interior heat in Shanghan. Both previous cases, whether described as exterior-interior heat or exterior heat interior cold, are applicable. One case of fever no sweat with unresolved exterior is purely Mahuang Tang and Gegen Tang indications, where can Baihu be used?) ; it also treats Taiyang Zhong Shuo (Summerheat Stroke, pronounced 'ye', meaning summerheat), with body heat, sweating, aversion to cold, cold feet, weak pulse and thirst (Body heat and aversion to cold indicate disease in the exterior; cold feet and weak pulse indicate that exterior-releasing methods are contraindicated); it also treats Fire injuring Lung and Stomach, transmitting into Ge Xiao (Yu Jiayan said: Fei Xiao (Lung Wasting) is treated with Dihuang Wan addressing the Blood aspect; Shen Xiao (Kidney Wasting) is treated with Baihu Tang addressing the Qi aspect. If the disease cannot be cured, it is the doctor's fault). Adding Cangzhu (Atractylodis Rhizoma) to this formula creates Baihu Jia Cangzhu Tang: Treats Shi Wen (Damp-Warmth) with a sinking and fine pulse (Sinking-fine pulse belongs to Dampness; first contracting Summerheat, then Dampness, Summerheat and Dampness contend, named Shi Wen. Symptoms include cold calves, abdominal fullness, headache, body pain, much sweating, thirst and delirium. Li Dongyuan said: Movement-injured Summerheat, Fire-Heat injures Qi, common among hard-working people, suitable for Ren Shen Bai Hu Tang; Stillness-injured Summerheat, Dampness wins causing body heaviness, common among idle people, suitable for Baihu Jia Cangzhu Tang). Adding Guizhi (Cinnamon Twig) to this formula creates Guizhi Baihu Tang (Jin Gui Yao Lue): Treats Wen Nue (Warm Malaria), with heat only without cold, joint pain, and occasional vomiting. Adding Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), and Banxia (Pinelliae Rhizoma) to this formula creates Chaihu Shigao Tang: Treats Summerheat cough, wheezing, and thirst. Removing Jingmi and adding Renshen to this formula creates Hua Ban Tang: Treats Wei Re Fa Ban (Stomach Heat causing macules) with a deficient pulse.