Bái Hŭ Tāng

Question 1

Method of Preparation

Answer 1

Cook until rice is done, then strain and ingest liquid.

Question 2

Actions

Answer 2

Clears qi-level heat, drains Stomach fire, generates fluids, and alleviates thirst

Question 3

Indications

Answer 3

high fever with profuse sweating and an aversion to heat
red face
severe thirst and irritability
may also include:
headache
toothache
bleeding of the gums and nose
heavy, labored breathing
severe: delirious speech

P: flooding, forceful or slippery, rapid
T: red with either a dry white or yellow coat

Question 4

Herbs

Answer 4

shí gāo
zhī mŭ
zhì gān căo
jīng mĭ

clear severe heat from interior without damaging qi dynamic
support generation of body fluids without inhibiting the venting of pathogenic heat

Question 5

shí gāo

Answer 5

acrid, sweet, extremely cold
- clear heat from interior
- vent pathogenic heat to the exterior and release heat constraint from the muscle layer and skin
- moisten and enrich the yin to support the generation of body fluids

Question 6

zhī mŭ

Answer 6

bitter, cold, moistening
assists chief: clearing heat from Lungs and Stomach to alleviate irritability, moistens dryness, enriches the yin

Question 7

zhì gān căo
jīng mĭ

Answer 7

benefit the Stomach, protect the fluids
prevent extremely cold properties of other ingredients from injuring middle burner

Question 8

Cautions and Contraindications

Answer 8

Systematic Differentiation of Warm Pathogen Diseases lists four primary contraindications for the use of this formula:
1. A pulse that is floating, wiry, and thin. Fever with a floating and wiry pulse indicates that the pathogen is located predominantly in the exterior, from which it must be dispersed. A thin, floating, or deficient pulse accompanied by fever, sweating, and an aversion to wind, on the other hand, indicates yin fire due to Spleen and Stomach deficiency that must be treated with sweet and warm herbs.
2. A submerged pulse. If this pulse is strong, it indicates that the pathogen has already moved into the yang organs and must be purged. If the submerged pulse is thin and weak, it reflects yang deficiency with false heat. The appropriate treatment strategy here is to augment the yang.
3. The absence of thirst. This can occur in the course of a damp-warmth disorder, where fever is due to obstruction of the yang qi by dampness. It also occurs when a warm pathogen disorder transforms from the qi into the nutritive level. In the former case,
inappropriate use of White Tiger Decoction would further obstruct the yang qi, while in the latter case, it would prevent a venting of pathogenic heat from the nutritive into the qi level.
4. The absence of sweating. Within the context of feverish disorders, this will most likely occur either when the body fluids have been exhausted or where the exterior is obstructed by wind-cold. In the first case, one should enrich the yin, and in the second, release the exterior through sweating.

Zhang Xi-Chun argued that only the first two of these four points constitute absolute contraindications. In his personal experience, only about 20 percent of all cases for which White Tiger Decoction is indicated present with both sweating and thirst. In all other cases, there will still be some obstruction in the exterior, causing a lack of sweating, or the fluids will not yet have been damaged so that the patient is not thirsty. Zhang Xi Chun’s experience resonates with Cheng Guo-Peng’s analysis of the formula and is an important pointer in clinical practice.

Careful follow-up is advised in any case. 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

Question 9

Diagnostic Pattern

Answer 9

Blazing heat in the yang brightness-channel warp of the six warps (yang ming channel pattern in the six stages) of disease or the qi level of the four levels of disease.