2. Shigao Tang from "Waitai Mi Yao"

2. Shigao Tang from "Waitai Mi Yao"

[Composition]

Fermented soybeans 9 grams (one sheng), gardenia 6 grams (ten pieces), ephedra 9 grams (three liang), scutellaria, phellodendron, coptis, and raw gypsum each 6 grams (one liang).

[Administration]

Decoct in water and take orally.

[Indications]

Exterior heat combined with interior heat.

[Symptoms] Headache without sweat, chills and fever, red face and red eyes, dry nose and thirst, restlessness and delirium, nosebleeds, and a slippery, rapid pulse.

[Functions] Harmonize the exterior and purge the interior.

[Formula Analysis]

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The Sun Channel remains unresolved, with intense internal heat accumulating; this formula is used in such cases. Headache without sweating and fever with chills indicate that the exterior pattern of Shaoyang cold injury has not yet been resolved; while flushed face, red eyes, dry nose, thirst, irritability, and delirium suggest that the interior heat is particularly severe. Among the exterior syndrome and interior heat, the interior heat is more prominent and urgent. In this formula, gypsum, with its pungent, sweet, and extremely cold nature, primarily clears fire and reduces heat internally; ephedra, with its pungent and warm nature, promotes sweating and disperses cold from the exterior, serving as a secondary ingredient. When heat is trapped internally and persists for a long time, it can transform into fire and even toxic conditions; therefore, the three yellow herbs and gardenia both have the effects of clearing fire and detoxifying, making them suitable for concurrent treatment; fermented soybeans, with their sweet and cool nature, act on the exterior to prevent wind-heat from invading the body, embodying the principle of treating disease before it manifests, and are also appropriate for concurrent treatment.

[Clinical Modifications]

① Remove ephedra, fermented soybeans, and gypsum, add burdock seed and forsythia fruit, forming Huanglian Detoxification Decoction (from "Orthodox Surgery"), which has the effect of clearing fire and detoxifying, suitable for treating fire syndromes in the three burners, such as boils and sores.

② Add ginger, jujube, and fine tea, forming Three Yellow Gypsum Decoction (from "Six Books on Cold Damage"), mainly indicated for simultaneous heat in all three burners, with pain in the body and eyes.

[References]

① Used to treat persistent high fever in the exterior, interior, and three burners, or symptoms such as severe irritability and thirst, flushed face, dry nose, fiery eyes, stiff body, inability to sweat, and six pulse points being full and rapid, as well as symptoms like Yang toxin-induced rash. ("Convenient Readings on Formulas")

② Since both exterior and interior pathogenic heat are severe, Huangqin is used to clear upper burner fire, Huanglian to clear middle burner fire, Huangbo to clear lower burner fire, and Zhizi to clear fire throughout the three burners, while ephedra and fermented soybeans disperse exterior pathogens, and gypsum, being heavy in weight, clears fire and lightens qi to release muscle tension—these are all medicines that disperse exterior and interior simultaneously. ("Practical Application of Prescriptions")

[Commentary]

This formula is often used for various acute and subacute infections, such as boils, erysipelas, sepsis, etc.; inflammatory diseases of the gallbladder, pancreas, appendix, pelvic cavity, and other areas can also be treated with modifications of this formula.

III. Dispersing Exterior and Warming Interior

Applicable when there is an exterior syndrome combined with interior cold. Compared with the exterior syndrome, the interior cold is the primary factor, while the exterior syndrome is secondary; if the exterior syndrome is dominant and the interior cold is secondary, then it falls under the category of exterior-dispelling formulas.