白虎汤

nullbai hu tangbai hu tangWhite Tiger DecoctionSource: Discussion of Cold-induced Disorders (Shang han lun) nullThe name of this formula is probably derived from Chinese mythology where the white tiger is the metal spirit of the west which appears in the autumn and heralds the end of summer's heat. It is used here as a metaphor for the heat-clearing action of the formula.nullGypsum (shi gao) 30g Radix Anemarrhenae Asphodeloidis (zhi mu) 9g Honey-fried Radix Glycyrrhizae Uralensis(zhi gan cao) 3g Nonglutinous rice (jing mi) 9gIngredientsPreparation Preparation Decoct all drugs in water until the rice is well-done. Take the decoction warm orally after removal of the residue. nullActions Clearing heat and promoting fluid productionnullIndicationsSyndrome of heat exuberance in qi system null high fever with profuse sweating and an aversion to heat a red face severe thirst and irritability flooding, forceful or slippery, rapid pulse Symptomsnullsevere thirsthigh feverprofuse sweatflooding forceful pulsenullThis is blazing heat in the yang brightness channel-stage of the six stages of disease, or the qi level of the four levels of disease. The yang brightness channels contain an abundance of qi and blood. When a strong pathogenic influence attacks the yang brightness channels in a person of robust health, the result is a disorder of extreme ferocity characterized by the 'four greats': a great (high) fever, great thirst, great (profuse) sweating, and a great (flooding and big) pulse. nullBecause the yang brightness channels traverse the head and face, severe heat in these channels causes a red face. And because the heat has entered the interior, the simultaneous fever and chills which are the hallmark of exterior conditions is absent, replaced by the high fever which is characteristic of interior heat.nullAlthough this is regarded as an interior condition, it remains in the relatively superficial level of the channels. Therefore the heat primarily affects the superficial and upper aspects of the body. It forces out the fluids in the form of profuse sweating, and dries the fluids in the upper yang brightness organ (the Stomach). This leads to severe thirst, irritability, and a dry mouth and tongue. The flooding pulse reflects the presence of a strong pathogenic influence in the channels. There may also be a yellow, dry tongue coating, heavy, labored breathing, and in severe cases.ANALYSIS OF FORMULAANALYSIS OF FORMULA Shi gao-chief herb pungent，sweet and very cold clears pathogenic evil of the lung and stomach. expelling heat from the body promotes generation of body fluid for quenching thirst null Zhi mu--deputy drug bitter in taste and cold moist in nature helps Shigao to clear the excessive heat of the qi stage as well as replenishes the injured yin null Zhi gan cao and jing mi assistant and envoy drugs reinforce the function of the stomach and promote the generation of the fluid prevent the middle-warmer from being injured by bitter and cold drugsCOMMENTARY COMMENTARY Some physicians are overly cautious in prescribing this formula, and therefore use it only rarely. This is because of the belief that shi gao is very harmful to the yang qi. For this reason, shi hu is often used as a substitute. However, if the diagnosis is accurate this formula can be used without causing any unpleasant side-effects.nullA normal course of treatment is 2-4 doses; in some cases, only one dose is needed. If treatment is ineffective after 6-7 doses, the practitioner must carefully reevaluate the situation. Other than misdiagnosis, the primary cause of deleterious side-effects is an inordinately large dosage of shi gao. Side-effects of an overdose include icy-cold limbs, loss of appetite and other symptoms of spleen yang deficiency.nullWith the appropriate presentation, this formula may be used in treating such biomedically-defined infectious diseases as encephalitis, meningitis, and lobar pneumonia, as well as heat stroke, diabetes mellitus , and periodontitis.CAUTIONS & CONTRAINDICATIONS CAUTIONS & CONTRAINDICATIONS This formula is contraindicated in cases of fever due to Spleen and Stomach deficiency characterized by fever, spontaneous sweating, extreme fatigue, aversion to wind, and a deficient, floating pulse. It should also be avoided in cases of true cold and false heat characterized by fever with a desire for warmth, thirst with no desire to drink, and a flooding but weak pulse. Careful follow-up is advised. Use of this formula should immediately stop if signs of headache, stiffness of the neck, icy-cold limbs, subjective sensations of cold, or impairment of mental faculties occur.MODIFICATIONS MODIFICATIONS For concurrent Stomach qi deficiency, substitute shan yao for non-glutinous rice. For concurrent wind-cold in the exterior, add cong bai, dan dou chi and xi xin. For red, swollen eyes and excruciating headache, add huang lian and huang qin. For pain and swelling of the gums, headache, nosebleed, a dry mouth, thirst, and constipation due to Lung heat and Stomach fire, add da huang.nullFor wasting and thirsting disorder, or heat that severely injures the fluids resulting in thirst, irritability, and insatiable hunger, add tian hua fen, lu gen and mai men dong. For the subcutaneous blotches (petechiae), irritability and restlessness, and insomnia associated with febrile disease and heat toxin, take with Coptis Decoction to Relieve Toxicity (huang lian jie du tang).