1. Qinghao Biejia Tang "Warm Disease Differentiation"

1. Qinghao Biejia Tang ("Warm Disease Differentiation")

[Composition] Qinghao 6 g, Turtle Shell 15 g, Anemarrhena asphodeloides 6 g, Rehmannia glutinosa 12 g, Moutan Cortex 9 g

[Administration] Decocted in water and taken orally.

[Indications] Yin deficiency fire is active, with residual pathogenic factors hidden inside.

[Symptoms] Nighttime fever and morning coolness, fever subsides without sweating, red tongue with little coating, fine and rapid pulse.

[Functions] Nourishing yin and dispersing heat.

[Formula Analysis] Although the major heat has subsided, yin fluids are depleted, and yin deficiency leads to excessive yin deficiency fire, hence the saying that heat comes from yin. Nighttime fever and morning coolness, red tongue with little coating, and fine, rapid pulse are all signs of yin deficiency fire; the fact that fever subsides without sweating indicates that residual pathogenic factors are still hidden in the yin aspect and cannot be expelled outward. This condition involves both yin deficiency fire and residual pathogenic factors hidden in the yin aspect—nourishing yin alone will leave pathogenic factors behind, while eliminating pathogenic factors alone will harm yin. In this formula, Qinghao opens the skin pores to expel pathogenic factors, while Turtle Shell enters the blood and nourishes yin while removing toxins, together achieving the effect of nourishing yin and dispersing heat as the principal herbs. Anemarrhena asphodeloides, Moutan Cortex, and Rehmannia glutinosa all have the function of nourishing yin and clearing heat as auxiliaries.

[Clinical Modifications] ① Omit Rehmannia glutinosa, add Mulberry leaves and pollen, still named Qinghao Biejia Tang ("Warm Disease Differentiation"). Indicated for "wiry left pulse, nighttime fever and morning coolness, sweating and thirst, with Shao Yang malaria leaning toward severe heat." ② This formula can be used to treat pulmonary tuberculosis with bone steaming; add Codonopsis pilosula and Eclipta prostrata to nourish yin and clear the lungs; add White Veil, Dendrobium, and Cortex Lycii to dispel deficient heat. ③ Add White Veil and Lotus Stem to treat summer heat in children, with symptoms of nighttime fever and morning coolness, indicating yin deficiency with heat. ④ Omit Moutan Cortex and Rehmannia glutinosa, add Silver Bupleurum, Coptis chinensis, and Honey-processed Licorice, named Qinggu San ("Standard for Diagnosis and Treatment"), indicated for deficiency-related bone steaming.

[Reference Materials] ① For nighttime fever and morning coolness, with fever subsiding without sweating, and heat originating from yin, Qinghao Biejia Tang is the primary choice. At night, heat resides in the yin aspect, while during the day it moves to the yang aspect and cools down; the deep-seated pathogenic factors in the yin aspect are evident. Fever subsides without sweating, indicating that the pathogenic factors have not yet been expelled outward and remain in the yin aspect—this further confirms that heat originates from yin. ("Warm Disease Differentiation") ② Qinghao Biejia Tang omits Moutan Cortex and Rehmannia glutinosa, adding Bupleurum, Uncaria rhynchophylla, Citrus peel, and Atractylodes macrocephala to treat 19 cases of vesicular conjunctivitis caused by lung meridian dry heat—some required only a few doses, while others needed more than ten before recovery. The cure rate was 100%. ("Beihai Science and Technology" January 1973)

[Commentary] This formula can be used for autonomic nervous system dysfunction in the late stage of febrile diseases, unexplained fever; it can also be used for low-grade fever due to tuberculosis, hematological diseases, and summer heat in children, among others.