High Fever, Thirst, and Exhaustion? Song Dynasty Formula Master Doctor Xu Shuwei Uses Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction) to Clear Heat and Nourish Qi — Both Patients Fully Recovered
Patient search words: high fever / fever that will not come down / fever with thirst / thirsty and wanting water / exhausted by the fever / fever with delirium / fever with urinary incontinence / fever in the elderly and children
Corresponding medical terms: yang ming heat exuberance (yang ming re sheng) · dual injury of qi and yin (qi yin liang shang) · externally contracted high fever · three yang combined pattern (san yang he bing) · Bai Hu Jia Ren Shen Tang pattern (bai hu jia ren shen tang zheng)
The opening: meet “Scholar Xu” — the trailblazer of the classical formula school
Today we continue the stories of Doctor Xu Shuwei, the great formula master of the Song dynasty, using the formulas of the Treatise on Cold Damage to cure disease.
Doctor Xu Shuwei, courtesy name Zhike, was a celebrated physician of the transition between the Northern and Southern Song dynasties, known as “Scholar Xu” (Xu Xueshi). He was one of the founders of the classical formula school (jing fang pai) in Chinese medicine. Everyone knows the formulas in Zhang Zhongjing’s Treatise on Cold Damage — but in ancient times they were actually not used very widely. Even the King of Medicine, Sun Simiao, had never seen the Treatise on Cold Damage in his early years; the book did not circulate widely, and he only came across it late in life — and found it so precious. It was in later generations that Doctor Xu Shuwei and this group of physicians began to apply the formulas of the Treatise widely in treatment; everyone studied after them and gradually mastered the classical formulas. That is why Xu Shuwei and his colleagues are counted as the founders of the classical formula school.
💬 Note from Doctor Luo: Doctor Xu Shuwei’s story is truly remarkable. In his later years he practiced medicine at Mashan in Wuxi, Jiangsu. Early in life he had held high office, then he resigned and returned home, devoting himself to treating ordinary people. He was a close friend of Han Shizhong, the great general who fought against the Jin invaders — think about it: only a man of genuine integrity could have been friends with Han Shizhong!
What we are discussing today is the Bai Hu Jia Ren Shen Tang pattern (White Tiger Plus Ginseng Decoction pattern). Yesterday I talked about Bai Hu Tang (White Tiger Decoction), and some of you may already be eager to use it. But I must tell you: Bai Hu Tang’s range of application is far narrower than Bai Hu Jia Ren Shen Tang’s — Bai Hu Jia Ren Shen Tang is the easier one to apply, so today’s lesson is worth listening to closely.
Case one: a soldier who vomited and was purged for eight or nine days, burning up inside and out
Let’s start with the first case. The patient was a soldier — a man serving in the army, actually on campaign — named Wang Wujing.
He fell ill. It began with vomiting. A physician judged there was heat, so he gave him a purgative to drain it. But after eight or nine days, he still had not recovered — instead he was hot inside and out (nei wai fa re): hot on the inside and hot on the surface, burning up badly.
At this point Doctor Xu Shuwei was called in to diagnose. He took one look and said: Bai Hu Jia Ren Shen Tang should be used.
💬 Note from Doctor Luo: Notice that someone nearby immediately objected: this man has already vomited, and he has already been purged — the interior must be quite deficient by now, interior deficiency (li xu)! Bai Hu Jia Ren Shen Tang is built on Bai Hu Tang — can it really be used?
The bystanders panicked: he has been purged and vomited, the interior is empty — can this formula be used?
The objection sounded reasonable: after vomiting and purging, the upright qi has been wounded; using the cooling Bai Hu Tang would only add frost to snow, wouldn’t it?
How did Doctor Xu Shuwei answer? He opened his mouth and recited the Treatise on Cold Damage from memory — the masters of the classical formula school always explained things with Zhang Zhongjing’s own words:
“Zhang Zhongjing said: ‘If after purging, the disease is not resolved after seven or eight days, and the heat binds in the interior, with heat in both the exterior and the interior, then Bai Hu Jia Ren Shen Tang governs.’”
What does that mean? If after purging, the illness is still not resolved after seven or eight days, with the heat pathogen bound in the interior and heat in both the exterior and the interior — this is exactly the indication for Bai Hu Jia Ren Shen Tang. This patient’s symptoms matched the “pattern” (zheng) of the formula, so it could be used.
💬 Note from Doctor Luo: Why was he vomiting? Because the heat pathogen was in the stomach region (wei wan) — heat in the stomach sends qi upward in rebellion, so he vomited. And the pulse? After all that vomiting and purging, his pulse was large but empty (xu da) — it looked big, but it was actually deficient. In exactly this situation, Bai Hu Jia Ren Shen Tang is the right call.
So Wang Wujing was given the decoction three times, and he recovered.
Bai Hu Tang vs. Bai Hu Jia Ren Shen Tang: only one herb differs — why does it matter so much?
This small case points us in a direction. Now comes the key lesson: what is Bai Hu Jia Ren Shen Tang?
As I explained before, Bai Hu Tang has a wide range of application. When there is a heat pattern in the body — a genuine heat pattern caused by external pathogens — the usual approach is to clear the heat outward. Bai Hu Tang is an excellent formula for this; its principal ingredient is sheng shi gao (raw gypsum).
Raw gypsum has the action of transmitting heat outward (tou re). Doctor Zhang Xichun placed special emphasis on this — when he lectured on the individual herbs, gypsum was the one he wrote about most and at greatest length. Doctor Zhang Xichun believed raw gypsum could even transmit the heat of the blood outward, letting it be resolved through sweating from the body surface; and when no sweat broke, it quietly dissolved the heat internally, and the heat was cleared. So raw gypsum is an outstanding herb for resolving heat.
💬 Note from Doctor Luo: Raw gypsum is a very strange herb. Its main active ingredient is hydrous calcium sulfate — and here is the marvel: hydrous calcium sulfate does not dissolve in water! When you boil it, only a trace amount comes out. By rights, 30 grams and 100 grams should yield no significant difference in what dissolves — yet in Chinese medicine we hold that 10 grams, 30 grams, and 100 grams of raw gypsum differ enormously in effect. Why? Even today it is a puzzle — researchers study how it lowers fever, what pathways it uses, and perhaps other components are helping to resolve the heat. But what has been proven through Doctor Zhang Xichun’s exposition and practice is this: raw gypsum is quite mild — not nearly as fearsome as people imagine. Still, caution is required.
The wonder of raw gypsum: it does not dissolve in water, yet the dosage makes a world of difference
Using raw gypsum — especially inside Bai Hu Tang — has one very important characteristic: it is no problem at all for robust people — middle-aged and young adults. But with children and the elderly, special caution is needed; and with people who are genuinely weak, caution too. Occasionally side effects really do occur, and I want to be clear about this.
💬 Note from Doctor Luo: It is not the case that anyone who drinks Bai Hu Tang should take as much as possible — “let me drink 100 grams” — that is not how it works. Some weak people feel unwell after taking it; there are even recorded cases of people becoming dazed and talking nonsense — their upright qi simply could not bear it. Exactly how it works still awaits research. So the ancients devised a method — this is Zhang Zhongjing’s method: pair it at the same time with herbs that support the upright qi.
What do you use to support upright qi? Ren shen (ginseng). Add ren shen to Bai Hu Tang, and you have Bai Hu Jia Ren Shen Tang.
So for whom do you add ginseng? For those with insufficient upright qi — and above all, in my experience, the elderly and children: whenever you see upright qi deficiency, adding ginseng is foolproof — no more side effects. Used alone, raw gypsum occasionally causes reactions in certain individuals; for a very weak person, once ginseng is added, there is no problem. Doctor Zhang Xichun had even more experience — he used this formula constantly and saved countless lives. This is the accumulated experience of Chinese medicine.
Why did Zhang Zhongjing add ginseng? The secret of profuse sweating, great thirst, and a surging pulse
Zhang Zhongjing did not spell it out as “add ginseng when the person is deficient” — he taught it through symptoms.
Bai Hu Jia Ren Shen Tang is Bai Hu Tang — sheng shi gao, zhi mu (anemarrhena), gan cao (licorice), jing mi (rice) — with ginseng added: the ginseng supports upright qi. The preparation is simple: decoct the soup; when the rice is cooked, strain out the dregs and drink.
💬 Note from Doctor Luo: What does Zhang Zhongjing’s original text say? “After taking Gui Zhi Tang, when profuse sweating occurs, followed by great vexation and unrelieved thirst, with a large surging pulse (mai hong da), Bai Hu Jia Ren Shen Tang governs.” — Sweating too much wounds the upright qi. At this point the heat is still inside — you see the surging, powerful pulse; and the thirst — what does thirst indicate? The body’s fluids (jin ye) are insufficient. So ren shen has the actions of supplementing qi and generating fluids.
There is another clause — the one Doctor Xu Shuwei just recited: “In cold damage, if after vomiting or purging… seven or eight days pass unresolved, with heat bound in the interior and heat in both the exterior and the interior.” Doctor Xu Shuwei had memorized the Treatise on Cold Damage thoroughly — as soon as the symptoms were described, he “snapped” and matched them to the original text of the Treatise.
That clause also says: shi shi e feng — always afraid of wind, which indicates insufficient fluids; she shang gan zao er fan — dry tongue and vexation, the fluids are wounded; yu yin shui shu sheng — wanting to drink several liters of water, always thirsty, drinking a great deal. At this point the upright qi is insufficient, there is heat inside, and the fluids are injured — hence Bai Hu Jia Ren Shen Tang: Bai Hu Tang clears the heat of the yang ming qi aspect, while ren shen supports upright qi and generates fluids — it is there to repair the damage.
💬 Note from Doctor Luo: Zhang Zhongjing was extremely clear: when the person has insufficient upright qi, with dual injury of qi and yin, and there is heat inside — the external pathogen has arrived and made the body very hot — then Bai Hu Tang can be used to regulate. But note: in cold damage, when the pulse is floating, there is fever without sweating, and the exterior is not yet resolved, Bai Hu Tang must not be given — because at this point you must release the exterior, using something like Ma Huang Tang to resolve the surface first; you cannot clear the interior heat alone; even if you use Bai Hu Tang, it must be combined with exterior-releasing herbs. And when there is thirst with desire to drink water and no exterior pattern — extremely thirsty and wanting water, but the exterior chills of the external contraction are already gone — then Bai Hu Jia Ren Shen Tang governs.
Doctor Zhang Xichun put it this way: when one’s learning has not reached the level, one omits ginseng where it should be used — when there is no obvious thirst, and there is still heat, Bai Hu Tang alone can be used; but when thirst is genuine, the fluids are already injured, and ginseng must be added.
So Bai Hu Jia Ren Shen Tang is the formula for yang ming heat exuberance that consumes qi and yin (heat disease causing dual injury of qi and yin).
Case two: the woman south of the city wall who could not hold her urine — the other doctors declared “kidney exhaustion”!
The second case is another story of Doctor Xu Shuwei — and again Bai Hu Jia Ren Shen Tang.
A woman living south of the city wall had contracted an external illness. She developed abdominal fullness and a heavy body (fu man shen zhong) — her belly was distended and oppressive, her body heavy, and turning over was a struggle; yi niao (enuresis) — when urine came, it simply leaked out by itself; and speech disorder (yan yu shi chang) — even her speech was wrong.
💬 Note from Doctor Luo: What is going on? You should understand: this is because of heat pathogen — the heat pathogen disrupts the functioning of the nervous system, which is why she lost control of her urine; and the disordered speech is heat disturbing the heart-spirit (re nao xin shen) — the heart-spirit in turmoil. These are manifestations of the heat pathogen.
The other physicians were called in. They declared: “Untreatable — kidney exhaustion (shen jue)!” Look — the urine is leaking out, beyond control; the kidney qi must already be exhausted; the kidneys are gone; there is no saving this person!
The family was terrified: a mere external illness, and suddenly “kidney exhaustion” and death? The whole household was in a panic, frightened out of their wits — and they secretly summoned Doctor Xu Shuwei.
When Doctor Xu Shuwei arrived, the other physician was still sitting there. After examining the patient, Doctor Xu asked: “What do you mean by kidney exhaustion?”
💬 Note from Doctor Luo: Doctor Xu Shuwei had a bit of a temper — great skill, but a temper. With people who could not diagnose clearly, he could be a little blunt. He asked: explain to me — how is this patient kidney exhaustion?
The other doctor replied: both functions below are out of control — incontinence of urine and stool; her speech is foggy and nonsensical; mu fan zhi shi — the eyes roll straight upward. That is kidney exhaustion; she cannot live.
Doctor Xu Shuwei rebuts on the spot: you read only half the book — this is a three yang combined pattern
What did Doctor Xu Shuwei say? He said: this is reading only half the book — you looked at the case but missed the key point!
He said: the pulse is full, large, and long (shi da er chang) — kidney exhaustion should show weakness and loss of power, but this pulse is full, large, and long. This is a three yang combined pattern (san yang he bing)! Tai yang, shao yang, and yang ming are all involved, with yang ming predominating — we discussed this when we talked about Bai Hu Tang. How can a three yang combined pattern be called kidney exhaustion?
Then Doctor Xu Shuwei quoted Zhang Zhongjing again: “Abdominal fullness, heavy body, difficulty turning over, loss of taste in the mouth, delirium, enuresis. If sweating is induced, delirium; if purging is used, sweat breaks out on the forehead and the hands and feet turn cold.”
💬 Note from Doctor Luo: What does this mean? Abdominal fullness, difficulty turning the body, no taste in the mouth, talking nonsense (delirium), enuresis — in this condition, if you sweat when you should not, the fluids are wounded, heat disturbs the heart-spirit, and the patient raves; and if you then purge, the upright qi collapses, sweat appears on the forehead, and the hands and feet turn icy. So this is not the life-threatening crisis of raving and eyes rolling upward that “kidney exhaustion” would show — don’t misread it! In this condition, if there is spontaneous sweating, it is a Bai Hu Tang pattern.
Now, because this woman’s body was already weak, Doctor Xu Shuwei did not use Bai Hu Tang — see how careful he was — what did he use? Bai Hu Jia Ren Shen Tang. After a few doses, the illness was completely cured.
💬 Note from Doctor Luo: Everyone, this is a master at work! See how precisely he identified the pattern. When the heat inside is exuberant and needs to be transmitted outward, use Bai Hu Tang; but when the upright qi is already deficient, add ginseng — supporting upright qi and generating fluids on one side, transmitting the heat outward on the other. With this approach, failure is basically impossible.
Doctor Luo’s field experience: for fever in the elderly and children, remember to add ginseng to Bai Hu Tang
Finally, Doctor Luo sums up his practical experience:
First, think before using Bai Hu Tang. Whenever you observe that the person has insufficient upright qi, dual injury of qi and yin — especially the elderly, children, or the frail — my advice when you want to use Bai Hu Tang is: add ginseng. Even if you don’t add Northeast ginseng, dang shen (Codonopsis) will do — it helps support upright qi, and the raw gypsum in Bai Hu Tang works all the better. This is the voice of experience.
Second, the opportunities for application. In everyday life, when an external illness develops into heat in both the exterior and the interior with a high fever that will not break — think about it: how many people have ample upright qi? Very few. So Bai Hu Jia Ren Shen Tang is used far more often than Bai Hu Tang. For the elderly you can add more — use Northeast ginseng, and watch them more closely.
💬 Note from Doctor Luo: Third, the rice can be replaced with Huai shan yao (Chinese yam). In the past I used rice and Huai shan yao together — I think each has its own action, and keeping both in does no harm. Doctor Zhang Xichun said to remove the rice and substitute Huai shan yao, for better nourishing action; I think keeping both is fine too — decoct more soup and drink it; there is no risk. Some people say that after the start of autumn the weather turns cool and Bai Hu Tang should not be used — actually that is not so: if the pattern genuinely calls for it, you can use it.
Bonus: how to use raw gypsum? Start at 15 grams, stop when the fever breaks
So how is raw gypsum generally used? In externally contracted high fever:
For adults, about 15 to 30 grams is enough. In truly high fever, when you urgently want to bring the temperature down, you can go up to 50 or 60 grams without a problem; some practitioners use over 100 grams. Generally I find 15 to 30 grams safe, and with a little ginseng added, the effect should be excellent. The usual approach: if the fever does not break, add a bit more; if it still does not break, add a bit more — and generally stop once the fever breaks. Doctor Zhang Xichun accumulated vast experience with raw gypsum — you can study it in his writings.
💬 Note from Doctor Luo: I have used raw gypsum a great deal myself — for my family and for patients, plenty of it. I find it genuinely very safe, with excellent heat-transmitting action. Here is a secret of nature discovered by the ancients: if someone is physically weak, whatever you do for them, they lack the strength to run it, to bear it, and the effect may be less good — so ginseng is paired in, and it becomes Bai Hu Jia Ren Shen Tang. Unless your fever is not caused by the heat pathogen — fever from qi deficiency, fever from yin or blood deficiency, fever from depressed liver fire — those are not suitable. For most external contraction illnesses, as long as the disease is at the qi aspect (qi fen) level, it can be used, and the effect is excellent. During external contraction illnesses and epidemics, raw gypsum is applied especially widely.
Also, Doctor Zhang Xichun had a Shi Gao Jing Mi Tang (Gypsum and Rice Decoction) — raw gypsum with some Huai shan yao and some ginseng — I have spoken about this many times. If you really meet a high fever, you can try it.
💬 Note from Doctor Luo: Some patent medicines also contain raw gypsum — for example Kang Bing Du oral liquid (antiviral oral liquid) and others; many contain it — but none is as good as what you decoct yourself, because one little glass vial has far too small an amount. You can combine them: decoct your own, and also drink some antiviral oral liquid — that works. When a practitioner finds exuberant heat in the body, he commonly adds a little raw gypsum to the prescription, plus some other herbs that diffuse and transmit, to help the heat out — this is our approach to treating external contraction illnesses.
Closing: don’t drive your car into the emergency room — the confidence that comes from keeping some Chinese medicine at home
Finally, a story from everyday life.
💬 Note from Doctor Luo: Some parents — when a child has a febrile seizure and is convulsing from the fever — how frantic is the father? He drives straight into the hospital emergency room and smashes through the glass doors, shouting “Save my child! Give my child an IV drip!” — At that level of desperation, you would be better off spending that energy learning a little Chinese medicine instead. Keep some Jiao San Xian (a digestive trio of charred hawthorn, malt, and Shen Qu) and some raw gypsum at home — what are you afraid of? Do you really need to drive into the ER lobby and smash the glass doors? When you learn some Chinese medicine in daily life, your whole attitude toward illness changes, and you stop panicking.
Understand the wisdom of the ancient Chinese: not a single herb in Bai Hu Tang kills bacteria or viruses — raw gypsum, zhi mu, jing mi, gan cao: which of these kills viruses? None. Yet it can bring down a fever and let the body slowly return to normal.
💬 Note from Doctor Luo: I do not directly annihilate bacteria or viruses. You have heat — how do you clear the heat? You will find the body recovers by itself: the heat has congested the body, high and blocked, so it cannot exert itself; clear the heat away, and the body begins to run normally and expels the external pathogen. This is the thinking of the ancient Chinese, and the charm of Chinese medicine: change the configuration of the body, and let the body solve the problem itself. This is the wisdom we learn when we study Chinese medicine.
Compiled from Doctor Luo Dalun’s commentary on Doctor Xu Shuwei’s case record; the case comes from Discussion of Ninety Cases of Cold Damage (Shang Han Jiu Shi Lun), by Doctor Xu Shuwei.