白虎汤

3. Tongue and pulse

• Tongue: Red tongue body with dry yellow coating.
• Pulse: Surging and forceful, or slippery and rapid.

4. Common modifications

• Bai Hu Jia Ren Shen Tang (White Tiger Decoction Plus Ginseng): The original formula with Ren Shen (ginseng) added. Suitable for Bai Hu Tang patterns accompanied by dual damage to qi and fluids, presenting with profuse sweating, severe thirst, and a large but forceless pulse, or slight aversion to cold in the back.
• Bai Hu Jia Gui Zhi Tang (White Tiger Decoction Plus Cinnamon Twig): The original formula with Gui Zhi (cinnamon twig) added. Clears heat and unblocks the collaterals, harmonizes ying and wei. Suitable for warm malaria (heat without cold) or wind-damp-heat impediment (red, swollen, hot, and painful joints).
• Bai Hu Jia Cang Zhu Tang (White Tiger Decoction Plus Atractylodes Rhizome): The original formula with Cang Zhu (atractylodes rhizome) added. Clears heat and dries dampness. Suitable for damp-warmth disease presenting with generalized heat, chest oppression, profuse sweating, red tongue with a greasy white coating.
• When accompanied by combined burning of qi and blood, with macules and rashes: Add Shui Niu Jiao (water buffalo horn), Xuan Shen (scrophularia root), and Sheng Di (fresh rehmannia root) (i.e., the approach of Hua Ban Tang, Macule-Resolving Decoction) to clear qi-level heat and cool the blood.

5. Cautions and clinical notes

• Absolute contraindications (the four major contraindications):
  1. Fever without sweating due to unresolved exterior pattern. (This is a Ma Huang Tang pattern.)
  2. Fever due to yang deficiency or blood deficiency. (Pulse surging and large but forceless on heavy pressure, or thin and rapid pulse.)
  3. True cold with false heat, a pattern of yin excess repelling yang. (Although there is body heat, there is thirst with a preference for hot drinks, and a large but forceless pulse.)
  4. Pulse: This formula should not be used when the pulse is deep, thin, or slow.
• This formula is strongly cold in nature and can easily damage Spleen and Stomach yang qi; it should be discontinued once the condition resolves and not taken over a prolonged period.
• During administration, a bland diet is advisable, with plenty of warm water, avoiding spicy and greasy foods.

6. Granule conversion and dose

• Calculation of total raw herb weight in the original formula:
  • Sheng Shi Gao (raw gypsum) 50 g + Zhi Mu (anemarrhena rhizome) 18 g + Jing Mi (polished rice) 9 g + Zhi Gan Cao (honey-fried liquorice root) 6 g = 83 g.
• Conversion to 5:1 granules:
  • 83 g raw herbs ÷ 5 = 16.6 g granules.
• Recommended dose:
  • This is the daily dose. Take one dose per day, divided into 2-3 doses dissolved in warm water, about 6-8 g per dose.
  • Important note: Bai Hu Tang is commonly used for acute high fever; strict adherence to the practitioner's instructions is essential. The practitioner may, depending on the severity of the condition, advise taking multiple doses per day or adjusting the single dose. Once the fever subsides, the formula should be adjusted or discontinued.