Shigao Tang (Gypsum Decoction) from Waitai Miyao for Severe Infectious Disease
The Waitai Miyao (Arcane Essentials from the Imperial Library) contains a Shigao Tang (Gypsum Decoction) for severe infectious disease, composed of: Shigao (Gypsum Fibrosum) 1 liang (30 g); Huanglian (Coptidis Rhizoma), Huangbo (Phellodendri Cortex), and Huangqin (Scutellariae Radix), each 2 qian (6 g); Xiangchi (fermented soybean, i.e., Douchi; wrapped in cotton) 3 qian (9 g); Zhizi (Gardeniae Fructus) 3 qian (9 g); Mahuang (Ephedrae Herba) 3 qian (9 g). These are adult doses; children’s doses should be reduced under a doctor’s guidance.The indications for this formula are: cold-damage illness of eight or nine days’ duration, with high fever and no sweating, heavy, rigid body, dry nose and thirst, vexation and inability to sleep, clouded consciousness, occasional groaning, and a slippery, rapid pulse. A formula verse runs: in Shigao Tang, Zhizi and the three Huangs, with Mahuang and Douchi decocted and taken; for cold-damage high fever with slippery rapid pulse, clearing the interior and resolving the exterior—a truly fine formula. This verse points to Shigao Tang’s main action of resolving the exterior and clearing the interior, i.e., what we commonly call clearing heat and draining fire, and sweating to release the exterior. This is the representative formula for severe TCM cold-damage (in practice also covering severe infectious disease in general) at the stage when the exterior pattern has not yet resolved but interior heat is already exuberant—that is, when the patient has both aversion to cold and fever and signs of raging fire.Shigao Tang is built on Huanglian Jiedu Tang (Coptis Detoxifying Decoction: Huanglian, Huangbo, Huangqin, Zhizi) with the addition of Douchi (fermented soybean), Mahuang (Ephedra), and Shigao (Gypsum). Huanglian Jiedu Tang treats fire-toxin syndrome of the sanjiao. The Zhizi Dan-douchi Tang of the Shanghan Lun pairs Zhizi with Dan-douchi to treat oppressive unease in the heart and vexatious insomnia; TCM holds this to be heat entering the qi aspect, and the present formula also incorporates that pairing. Shigao with Mahuang forms half of Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction); these two are key herbs for treating pathogen-heat obstructing the lung. Seen this way, Shigao Tang applies both the TCM principle of releasing constrained fire and the principle of clearing heat when it is exuberant.Shigao Tang is a vigorous formula for severe infectious disease, used in antiquity to rescue patients with critical infections. In modern medicine, severe cold, sepsis, pyosepticemia, dysentery, pneumonia, urinary tract infection, epidemic cerebrospinal meningitis, Japanese encephalitis, and similar conditions presenting as exuberant heat-toxin may all be treated with this formula. Such patients commonly show: high fever with vexation, dry mouth and throat, delirium and insomnia; or hematemesis and epistaxis in febrile disease; or intense heat producing macules, fever with diarrhea, and damp-heat jaundice; or surgical boils, ulcers, and ding-toxin with red, swollen, hot, painful lesions, yellow-red urine, a red tongue with yellow coating, and a rapid, forceful pulse. This formula may also be used when the patient has already developed critical signs such as coma.When infectious disease is treated improperly, interior heat usually appears alongside an unresolved exterior pattern. From a modern medical standpoint, this is a severe infection that has already invaded multiple body systems—the respiratory, circulatory, digestive, urinary, and nervous systems—and the condition is already serious and dangerous.TCM anti-infection formulas mainly follow the sweating, clearing, harmonizing, and purging methods; Shigao Tang employs the sweating, clearing, and purging methods simultaneously. This formula both promotes sweating and promotes urination. Mahuang, Shigao, and Dan-douchi together encourage the pathogen to be resolved through spontaneous sweating; Mahuang, Shigao, and Zhizi together have a strong diuretic effect—according to TCM, promoting urination is also a purging method, giving the pathogen an exit. Huanglian, Huangbo, Huangqin, Zhizi, and Shigao all clear heat and resolve toxin: TCM holds that Huangqin mainly clears heat of the upper jiao, Huanglian mainly clears heat of the middle jiao, Huangbo mainly clears heat of the lower jiao, Shigao clears heat of the qi aspect, and Zhizi clears heat of the blood aspect; used together, they clear heat from the sanjiao as well as the qi and blood aspects all at once.From a modern pharmacological perspective, Mahuang, Huanglian, Huangqin, Huangbo, Zhizi, and Shigao all have broad-spectrum anti-infective activity and some efficacy against infectious diseases caused by various viruses and bacteria; it is therefore no surprise that this formula treats so many infectious diseases. The author has used it to rescue critically ill patients admitted to the ICU, obtaining the classic effect of improvement after one dose and resolution after three.When treating critically ill patients with this formula, once it takes effect, two doses a day are advisable, each divided into two administrations taken every 1–2 hours. If the patient’s condition eases but has not fully resolved, another dose may be taken in the evening. If the patient sweats too much after taking it, dust on some baby powder to check the sweating. Usually, however, there will not be much sweating; in fact the patient needs to drink more hot water to assist diaphoresis. After taking this formula, the patient’s urine will clearly increase; when the urine changes from yellow-red to pale yellow or colorless and the clinical symptoms have basically eased, the formula may be stopped. Thereafter, drinking more water and making up sleep will allow spontaneous recovery, and further treatment is usually unnecessary. Patients with underlying disease, however, need a doctor to select other formulas for follow-up treatment based on their specific condition.This formula must not be used for long or in excess. When using such a vigorous formula, one should follow the principle of stopping once the disease is reached; once symptoms have basically eased, stop it or switch to another formula for convalescence.