[Source]

Treatise on Cold Damage Diseases

 [Composition]

Anemarrhena Rhizome, Gypsum Fibrosum, Licorice (honey-fried Licorice), Japonica Rice
(4)

 [Categorization]

<Tonifying Spleen and Middle Qi>: Licorice

<Clearing Heat and Purging Fire>: Anemarrhena Rhizome, Gypsum Fibrosum

<External Use and Others>: Japonica Rice

[Rationale]

From “Medical Formulas”: This formula is for the Yangming Channel and Taiyin of the Hand. (1) When pathogenic heat invades internally, it is dispelled by bitterness. Therefore, Anemarrhena Rhizome, with its bitter and cold nature, serves as the monarch herb. (2) Heat injures Qi, so it must be assisted by a sweet and cold substance. Thus, Gypsum Fibrosum acts as the minister herb. (3) When bodily fluids are depleted internally, Licorice and Japonica Rice, with their sweet and neutral properties, tonify Qi and moderate the formula, preventing harm to the Stomach. (4) Furthermore, restlessness arises from the Lung, and dryness from the Kidney. Gypsum Fibrosum clears the Lung and purges Stomach fire, while Anemarrhena Rhizome clears the Lung and purges Kidney fire. (5) Licorice harmonizes the middle Jiao and purges fire from the Heart and Spleen. (6) It can purge the ‘child’ or the ‘mother’ of heat, not solely treating heat in the Yangming Qi level. (7) Wang Sanyang states that the character ‘han’ (cold) in the phrase ‘li you han’ (there is cold internally) in the Classics should be interpreted as ‘xie’ (pathogen) and also refers to heat. This is because a floating and slippery pulse indicates external heat and internal heat, respectively. This statement pertains to cases where the Taiyang stage of a cold damage disease has passed, and the pathogen has transferred to the Yangming, causing both external and internal heat without a solidified Stomach condition. From “Shan Bu”: Gypsum Fibrosum is acrid and cold. Its acridity resolves external heat, and its coldness overcomes Stomach fire. Its cold nature descends, and its acridity penetrates externally, thus possessing both internal and external efficacy, making it the monarch herb. Anemarrhena Rhizome is bitter and moist. Its bitterness purges fire, and its moistness nourishes dryness, thus serving as the minister herb. Licorice and Japonica Rice are used to harmonize the middle Jiao and can purge fire from the earth. They are the “crops of the earth”; their sweetness moderates the coldness of the formula and the bitterness of other herbs, allowing the descending nature to linger in the taste. With these two herbs as assistants, the drastic coldness of the ingredients will not harm the Spleen and Stomach. When boiled into a decoction and entering the Stomach, it is transmitted to the Spleen and returns to the Lung. The essence of water is then distributed, resolving severe restlessness and thirst. Bai Hu (White Tiger) symbolizes the metal deity of the West. Naming the formula after it signifies that when autumn metal is in its prime, the scorching summer heat naturally subsides. If Ginseng is added to tonify the middle Jiao, benefit Qi, and generate fluids, it will assist the tonifying effects of Licorice and Japonica Rice. It also controls the coldness of Gypsum Fibrosum and Anemarrhena Rhizome, purging fire without harming the earth, representing a strategy of absolute safety. From “Han Dian”: In this formula, Anemarrhena Rhizome and Gypsum Fibrosum primarily serve to clear heat. Licorice and Japonica Rice act as harmonizing agents and assist Anemarrhena Rhizome and Gypsum Fibrosum.

 [Functions]

Clears heat, generates fluids, eliminates thirst, and relieves restlessness.

 [Indications]

(1) Excessive heat in the Yangming Channel, or excessive heat in the Qi level of febrile diseases, or excessive heat in the Qi level of exogenous febrile diseases, presenting with high fever, headache, dry mouth, dry throat, restlessness, thirst with a desire to drink, flushed face, aversion to heat, profuse sweating, yellow and dry tongue coating, and a forceful, large, or slippery and rapid pulse. (2) Cold damage disease with a floating and slippery pulse, indicating external heat and internal cold, or cold damage disease with a slippery pulse and cold extremities, indicating internal heat. (3) Symptoms of fever, aversion to heat, and restlessness, which are subjective sensations of burning, usually without chills. If a palm is used to test the patient’s skin, it will also feel hot. This formula is used when the Yangming disease has not yet progressed to the stage where Cheng Qi Tang is indicated. (4) Co-morbid disease of the three Yang channels, presenting with abdominal fullness, heavy body, difficulty turning over, numbness of the mouth, facial soiling, delirium, and involuntary urination. If sweating occurs, delirium may appear; if purgation is used, sweat may appear on the forehead, and the hands and feet may become cold. If there is spontaneous sweating, this formula is indicated. (5) Headache, toothache, epistaxis, and bleeding gums caused by excessive Stomach fire. From “Medical Formulas”: (1) Treats cold damage disease with a floating and slippery pulse, external heat, and internal cold. (2) Also treats co-morbid disease of the three Yang channels, with a floating and large pulse, abdominal fullness, heavy body, difficulty turning over, numbness of the mouth, facial soiling, delirium, and involuntary urination. If sweating occurs, delirium may appear; if purgation is used, sweat may appear on the forehead, and the hands and feet may become cold. If there is spontaneous sweating. (3) Generally treats Yangming disease with a prominent, long, and large pulse, aversion to heat instead of aversion to cold, headache, spontaneous sweating, thirst, dry tongue coating, eye pain, dry nose, inability to lie down, and restlessness. Also treats Yang poisoning with macules and various stomach fire conditions. From “Shan Bu”: Yangming pattern with sweating and thirst, desire to drink water, a floating, large, and slippery pulse, aversion to heat instead of aversion to cold.

 [Indications]

Acute febrile diseases, common cold, influenza, epidemic Japanese encephalitis, measles, erysipelas, scarlet fever, enteritis with fever, meningitis, pneumonia, diabetes, acute glomerulonephritis, rheumatic carditis, rheumatic arthritis, ophthalmopathy (external), skin diseases, itchy eczema with strong dampness, amenorrhea in gynecology, and high fever from various causes.

 [Contraindications]

(1) This formula is a representative formula for conditions of excessive heat in the Yangming and Qi levels, belonging to internal heat patterns. A significant dosage of Gypsum Fibrosum is recommended for its efficacy. (2) This formula treats Yang patterns, heat patterns, excess patterns, and internal patterns, all characterized by excessive heat in the Lung and Stomach. The indications for this formula are generally based on the “four greats” (great fever, great sweating, great thirst, and a large pulse). However, in actual clinical practice, it can be used for individuals with a rapid and forceful pulse, high fever, profuse sweating, and severe thirst. (3) This formula serves as the base, and modifications can be made by adding or subtracting herbs to create variations with similar names and expanded applications, such as Bai Hu Tang Jia Ren Shen Tang (Bai Hu Tang with added Ginseng), Bai Hu Jia Gui Zhi Tang (Bai Hu Tang with added Cassia Twig), and Bai Hu Jia Cang Zhu Tang (Bai Hu Tang with added Atractylodes Macrocephala). (4) Contraindicated in cases of fever without sweating due to unresolved external symptoms, absence of thirst, or a fine, weak, or deep pulse; in heat due to blood deficiency with a pulse that is large and forceful but cannot be pressed deeply; and in “yin excess obstructing yang” patterns characterized by true cold and false heat. (5) In cold damage disease with a floating pulse, fever without sweating, and unresolved external symptoms, it should not be used; if the pulse is floating, string-like, and fine, it should not be used; if the pulse is deep, it should not be used; if there is no thirst, it should not be used; if there is no sweating, it should not be used.

 [Mnemonics]

(1) Bai Hu Xing – Zhi Shi Gao Cao Mi (White Tiger Star – Knowledge, Gypsum, Licorice, Rice) # (2) Zhi Dao Mu Qin Chao Zhe Yao Chi Mi Gao (Know Mother, Mother is fussing, wants to eat rice cake) #

 [Modifications]

From “Han Dian”: For cases with severe thirst due to high fever consuming body fluids, add Ginseng. If a Bai Hu Tang pattern exhibits external symptoms and a tendency for upward surging, add Cassia Twig. (1) If heat is intense in the Qi level, injuring both Qi and fluids, presenting with persistent restlessness, thirst, profuse sweating, and a weak, large, floating pulse, add Ginseng or American Ginseng to tonify Qi and nourish Yin. This creates Bai Hu Jia Ren Shen Tang (Bai Hu Tang with added Ginseng) from “Treatise on Cold Damage Diseases.” Its functions are to clear heat, benefit Qi, and generate fluids. It is primarily indicated for the “four great” symptoms after sweating, vomiting, or purgation, with intense internal heat, or for Bai Hu Tang patterns with slight aversion to cold in the back, or inability to quench thirst with drinking, or a floating, large, and hollow pulse, as well as for summer heat diseases with significant body heat due to Qi and fluid damage. (2) If external pathogens are present, characterized by blocked meridians, body heat, and pain in the joints, add Cassia Twig to harmonize the Ying and Wei and unblock the meridians, creating Bai Hu Jia Gui Zhi Tang (Bai Hu Tang with added Cassia Twig) from “Synopsis of Golden Chamber.” Its functions are to clear heat, unblock collaterals, and harmonize Ying and Wei. It is primarily indicated for febrile malaria with a normal pulse, fever without chills, pain and distress in the joints, occasional vomiting, and wind-damp bi syndrome with high fever, coarse breathing, restlessness, swollen joints, thirst, white tongue coating, and a slippery and rapid pulse. (3) If it is wind-heat in the exterior, combine with Honeysuckle Flower, Forsythia Fruit, and Isatis Leaf to dispel wind, clear heat, and resolve the exterior, creating Yin Qiao Bai Hu Tang. (4) For early-stage measles with strong heat in both exterior and interior, and rash points that are about to emerge but have not, combine with Forsythia Fruit, Mint, Cicada Slough, and Bombyx Batryticatus to clear heat, detoxify, and promote rash eruption, creating Qing Zhen Tang. (5) If pathogenic damp-heat is in the Qi level, or damp-heat obstructs sinews and bones, presenting with joint pain and fever, add Atractylodes Macrocephala to expel dampness, creating Bai Hu Jia Cang Zhu Tang (Bai Hu Tang with added Atractylodes Macrocephala). (6) If pathogenic heat enters the Ying and Blood levels, presenting with high fever, thirst, red macules on the body, delirium, profuse sweating, and a large, forceful pulse, combine with Rhinoceros Horn, Scrophularia Root, and Rehmannia Root (prepared) to cool the blood, detoxify, and clear both Qi and blood, creating Hua Ban Tang. (7) For convulsions, combine with Gastrodia Rhizome, Rhinoceros Horn, Uncaria Hook, and Antelope Horn to cool the Liver, extinguish wind, and stop spasms, creating Xi Ling Bai Hu Tang. (8) Adding Bupleurum Root, Scutellaria Root, and fresh Lotus Leaf to this formula creates Chai Hu Bai Hu Tang from “Revised Vernacular Treatise on Cold Damage Diseases.” It is indicated for co-morbid Shao Yang and Yang Ming diseases, alternating chills and fever with mild chills and severe fever, restlessness, sweating, and thirst with a string-like, forceful, and rapid pulse. (9) Removing Japonica Rice and Licorice from this formula and adding Pinellia Tuber and Bamboo Shavings creates Zhen Ni Bai Hu Tang from “Medical Essentials Combining Chinese and Western Medicine.” It is indicated for cold damage disease where the pathogen enters the Stomach, causing dry thirst and fever, fulfilling the Bai Hu syndrome, with rebellious Stomach Qi, and fullness and distension below the heart.

 [Pharmacology]

It has antipyretic, antiviral, anti-inflammatory, and analgesic effects.