仲景曰。脉浮而动数。医反下之。动数变迟。阳气内陷。心下因
硬。则为结胸。若不结胸。但头汗出。余处无汗。剂颈而还。小便不
利。身必发黄。常氏云。发黄者。与茵陈煎浓汁。调五苓散亦可。雍
曰。凡黄皆用二药。重者茵陈蒿汤。轻者五苓散。
又曰。伤寒脉浮而缓。手足自温者。是为系在太阴。太阴者身当
发黄。若小便自利者。不能发黄。治在阳明证中。
又曰。阳明病。无汗。小便不利。心中懊 者。身必发黄。
又曰。阳明病。被火。额上微汗出。而小便不利者。必发黄。常氏
云。可与茵陈汤、五苓散。
又曰。阳明病。发热汗出者。此为热越。不能发黄。但头汗出。身
无汗。剂颈而还。小便不利。渴饮水浆者。此为瘀热在里。身必发黄。
宜下之。茵陈汤主之。
又曰。伤寒六七日。身黄如橘子色。小便不利。腹微满者。茵陈
汤主之。
又曰。伤寒身黄发热。栀子柏皮汤主之。
又曰。伤寒瘀热在里。身必发黄。麻黄连翘赤小豆汤主之。
又曰。伤寒发汗已。身目为黄。所以然者。以寒湿在里故也。以
为不可下也。于寒湿中求之。常氏云。可五苓散。
又曰。伤寒头痛。翕翕发热。形象中风。下之。益烦心。发汗。则
致。熏之。则发黄。雍曰。治在不可汗证中。发黄。则茵陈蒿汤也。
又曰。阳明病。脉迟。食难用饱。饱则微烦。头眩。必小便难。此
欲作谷疸。虽下之。腹满如故。所以然者。脉迟故也。常氏云。可茯苓
汤、五苓散。雍曰。宜千金方谷疸丸。
又曰。太阳中风。以火劫发汗。两阳相熏灼。其身发黄。阳盛则
欲衄。阴虚则小便难。阴阳俱虚竭。身体则枯燥。但头汗出。剂颈而
还。小便利者。其人可治。雍曰。治法在不可火证中。身黄者。茵陈
汤。小便难者。五苓散。
又曰。寸口脉。阳浮而阴濡弱。阳浮则为风。阴濡弱为少血。浮
虚受风。少血发热。医以火熏熨令汗出。恶寒遂甚。客热因火而发。
身因为黄。小便难。鼻中出血。复下之。热瘀在膀胱。蓄结成积聚。状
如肝。当下不下。心乱狂走赴水。蓄血若去。目明心了。此皆医所
为。轻者得愈。剧者不治。雍曰。详治在不可火证中。先下积血。次身
黄。小便难。治如前证。
又曰。阳明中风。脉弦浮大而短气。腹都满。胁下及心痛。久按
之气不通。鼻干不得汗。嗜卧。一身及面目悉黄。小便难。雍曰。治在
阳明证中。身目黄。茵陈蒿汤。小便难者。五苓散。
又曰。伤寒发热。口中勃勃气出。头痛目黄。衄不可制。雍曰。治
在不可下证中。目黄。如前法治。
又曰。得病六七日。脉迟浮弱。恶风寒。手足温。医二三下之。不
能食而胁下满痛。面目及身黄。颈项强。小便难。雍曰。治在吐下后
证中。身黄小便难。治如前法。
千金方曰。诸病黄胆。宜利其小便。假令脉浮。当以汗解。宜桂
枝黄 汤。
又曰。伤寒。热出表。发黄胆。麻黄醇酒汤。冬用宜酒。春用宜水。
又曰。治黄胆。鼻中取黄汁。宜瓜蒂、赤小豆、秫米末。名瓜丁散。
又曰。时行病。急黄。并瘴疠疫气 疟。宜茵陈丸。余见千金十
卷。（今千金三十四卷）
巢氏曰。伤寒阳明病。无汗。小便不利。心中懊 。必发黄。被
火。额上微汗出而小便不利。亦发黄。其人黄如橘色。或如桃枝色。
腹微满。此由寒湿气不散。瘀热在脾胃也。又时气发黄候曰。湿气
盛。蓄于脾胃。脾胃有湿。则新谷郁蒸。不能消化。大小便结涩。故发
黄。又温病候曰。发汗不解。温毒瓦斯瘀结在内。小便为之不利。故发
黄。雍曰。巢氏所论。即仲景阳明懊 被火二证。及寒湿一证而已。
亦甚略也。言简多不尽意。大抵瘀热在里不解。必为黄。热在膀胱。
亦为黄也。桃枝色者。孙真人云。久则变作桃皮色也。
又巢氏黄病论曰。黄病一身尽痛。发热。面色深黄。七八日后。
热结在里。有血当下。如豚肝状。（庞氏云。有血。抵当汤。狂者。血下
必自愈。）其人少腹满急。若眼睛涩痛。鼻骨疼。两膊及项强。腰背
急。则是黄候。大便涩。但得小便利。则不虑死矣。不用大便多。多则
心腹胀不住。此由寒湿在里。则热蓄于脾胃。腠理不开。瘀热与宿谷
相搏。郁蒸不得消散。则大小便不通。故身体面背变黄色。凡黄候。
其寸口近掌无脉。鼻口气冷。并死不治。
活人书曰。病患寒湿在里不散。热蓄于脾胃。腠理不开。瘀热与
宿谷相搏。郁蒸不消化。故发黄。此皆巢氏之言。惟改一表里字。
又曰。发黄与瘀血。外证及脉俱相似。但小便不利为黄。小便自
利为瘀血。要之发黄之人。心脾蕴积。发热引饮。脉必浮滑而紧数。
若瘀血证发狂。大便必黑。此为异耳。凡病患身体发热。头面汗出。
身无汗。剂颈而止。渴引水浆。小便不利。如此必发黄。茵陈蒿汤、五
苓散加茵陈主之。
又曰。茵陈蒿汤十分。五苓散五分。二药拌匀。每服三钱。温酒
调服。日三服。即以茵陈蒿汤调五苓散服之最良。病患服汤。得小便
利如皂角色赤。一宿腹减。则黄从小便中出也。栀子柏皮汤、麻黄连
翘赤小豆汤。皆可选用。
又曰。伤寒欲发黄者。急用瓜蒂末。口含水。搐一字许入鼻中。
出黄水。甚验。
又曰。太阳病。一身尽痛。发热。身如熏黄者。何也。太阳中湿
也。雍曰。宜五苓散。（太阳下宜有一病字。中湿原本是温字。）
又曰。白虎证与发黄相近。遍身汗出。此为热越。白虎证也。头
面汗出。
颈以下都无汗。发黄证也。雍曰。白虎证遍身汗出。安能发
黄。故仲景言阳明热越。不得发黄也。
雍曰。巢氏黄病一论。未为该通。而诸家伤寒论中多从之。夫致
黄之由非一。或误下。或火熏。皆能成黄。非止寒热谷气而已。大抵寒
邪中人。久不能去。变为热毒。假春风发动表为可出之时。既动则不
可复回。而腠理不开。无由作汗而出。郁而在里。终不能散。淫邪泮
衍。血脉传流。其毒之重者。遇血相搏不能胜。为之变结。或如豚肝。
或如墨色。此为邪气所败之血也。无以泄其邪。则血枯而人死。其轻
者鼓血而上。随衄可出。涩者因促滑气而下。随溺可去。既不能与血
相搏。又不能开腠理而生汗。上不可出。下不可去。乃散于毛窍之际。
已失所舍。而无可定止。进退不能。郁为至黄之色。以待汗与溺而后
通。此毒非不欲出也。犹人之行及门而无路也。医者疏通其道而指示
之。不为汗。则为溺。未有不去之理。然毒在腠理之内。与正气争持。
正邪相窒。毛孔亦不可开。是以不能作汗。必从开窍利小便而出。此
所以毒瓦斯在里不能出者。必成黄血二证。虽轻重上下不同。其理一
也。有可汗而出者乎。曰。脉浮甚者。其表必疏。可汗而出之也。
庞氏曰。孙真人云。凡遇天行热病。多内热发黄。但用瓜丁散纳
鼻中。黄水出乃愈。即后不复病患黄矣。常须谨候病患。四肢身面。
微似有黄气。即速行瓜丁散。不可令散漫失候。必大危矣。特忌酒面
色欲。犯者不治。（瓜丁细辛含水搐一字许千金方三味不同）
Zhang Zhongjing said: The pulse is floating, dynamic, and rapid. If the physician erroneously applies purgation, the dynamic and rapid pulse changes to a slow one. Yang qi sinks inward, causing hardness in the epigastrium, resulting in Jie Xiong (Chest Binding). If Jie Xiong does not form, but there is sweating only on the head with no sweat elsewhere, stopping at the neck, and urination is difficult, jaundice will inevitably occur. Chang Shi stated: For treating jaundice, decoct Yin Chen (Artemisiae Scopariae Herba) into a thick juice and mix it with Wu Ling San (Five-Ingredient Powder with Poria). Guo Yong stated: For all cases of jaundice, both remedies may be used; for severe cases, use Yin Chen Hao Tang (Artemisia Scoparia Decoction); for mild cases, use Wu Ling San.
He also said: In Shang Han (Cold Damage), if the pulse is floating and slow, and the hands and feet are naturally warm, this indicates the disease is related to the Tai Yin (Greater Yin) channel. Patients affected by Tai Yin should develop jaundice; however, if urination is free and easy, jaundice will not occur. Treatment should follow the patterns of Yang Ming (Bright Yang) syndrome.
He also said: In Yang Ming disease, if there is no sweat, urination is difficult, and the patient experiences mental restlessness and distress (Ao Nao), jaundice will inevitably occur.
He also said: In Yang Ming disease, if treated with fire therapy, leading to slight sweating on the forehead but difficulty in urination, jaundice will certainly occur. Chang Shi stated: Yin Chen Tang (Artemisia Decoction) or Wu Ling San may be given.
He also said: In Yang Ming disease, fever accompanied by sweating indicates that heat is venting outward, so jaundice will not occur. However, if there is only sweating on the head, no sweat on the body, stopping at the neck, difficulty in urination, and thirst for fluids, this indicates stagnant heat trapped inside. Jaundice will inevitably occur, and purgation is indicated, primarily using Yin Chen Tang.
He also said: In Shang Han, after six or seven days, if the body is yellow like an orange peel, urination is difficult, and the abdomen is slightly full, treat primarily with Yin Chen Tang.
He also said: For Shang Han presenting with jaundice and fever, treat primarily with Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction).
He also said: For Shang Han with stagnant heat trapped inside, where jaundice inevitably occurs, treat primarily with Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction).
He also said: After treating Shang Han with diaphoresis, if the body and eyes turn yellow, it is because cold-dampness resides in the interior. This condition should not be treated with purgation; instead, seek treatment within the methods for cold-dampness. Chang Shi stated: Wu Ling San may be used.
He also said: In Shang Han with headache, mild fever resembling wind-stroke, erroneous purgation increases mental distress; erroneous diaphoresis leads to [text missing]; erroneous fire fumigation causes jaundice. Guo Yong stated: Treatment should follow protocols for conditions where diaphoresis is contraindicated. If jaundice has already occurred, use Yin Chen Hao Tang.
He also said: In Yang Ming disease, if the pulse is slow, the patient cannot eat to fullness, feeling slight mental distress and dizziness after eating, and experiencing difficulty in urination, this is about to become Gu Dan (Grain Jaundice). Even if purged, abdominal fullness remains because of the slow pulse. Chang Shi stated: Fu Ling Tang (Poria Decoction) or Wu Ling San may be used. Guo Yong stated: Gu Dan Wan (Grain Jaundice Pill) from *Qian Jin Fang* is appropriate.
He also said: In Tai Yang Wind Strike, if fire coercion is used to induce sweating, the combination of wind and fire scorches the body, causing jaundice. Excess Yang leads to epistaxis; Yin deficiency leads to difficult urination. With both Yin and Yang exhausted, the body becomes dry and rough. There is only head sweating stopping at the neck. If urination is free, the patient can be cured. Guo Yong stated: Treatment follows protocols for conditions where fire therapy is contraindicated. For jaundice, use Yin Chen Tang; for difficult urination, use Wu Ling San.
He also said: At the Cun Kou (inch position) pulse, the Yang aspect is floating and the Yin aspect is soggy and weak. Floating Yang indicates wind; soggy-weak Yin indicates blood deficiency. Due to floating deficiency contracting wind and blood-deficiency fever, if the physician uses fire fumigation to induce sweating, aversion to cold worsens, and pathogenic heat ignites due to fire, causing jaundice, difficult urination, and epistaxis. If the physician then erroneously purges, heat stagnates in the Bladder, forming accumulations resembling the liver. Failure to purge when necessary leads to mental confusion, mania, and running toward water. If blood stasis is removed, vision clears and the mind settles. These errors are caused by physicians. Mild cases recover; severe cases are incurable. Guo Yong stated: Detailed treatment follows protocols for conditions where fire therapy is contraindicated. First purge blood stasis, then treat jaundice and difficult urination as previously described.
He also said: In Yang Ming Wind Strike, if the pulse is wiry, floating, large, accompanied by shortness of breath, generalized abdominal fullness, pain in the hypochondrium and chest, obstruction of Qi upon prolonged pressure, dry nose without sweat, lethargy, generalized jaundice of the body and face, and difficult urination: Guo Yong stated: Treatment follows Yang Ming patterns. For jaundice of the body and eyes, use Yin Chen Hao Tang; for difficult urination, use Wu Ling San.
He also said: In Shang Han with fever, hot air rushing from the mouth, headache, yellow eyes, and uncontrollable epistaxis: Guo Yong stated: Treatment follows protocols for conditions where purgation is contraindicated. For yellow eyes, treat as previously described.
He also said: On the sixth or seventh day of illness, if the pulse is slow, floating, and weak, with aversion to wind and cold, and warm hands and feet, but the physician purges two or three times, leading to inability to eat, fullness and pain in the hypochondrium, jaundice of the face, eyes, and body, stiff neck, and difficult urination: Guo Yong stated: Treatment follows protocols for post-emesis/purgation conditions. For jaundice and difficult urination, treat as previously described.
*Qian Jin Fang* states: For various jaundice diseases, promoting urination is suitable. If the pulse is floating, release via sweating is indicated, preferably Gui Zhi Jia Huang Qi Tang (Astragalus Added to Cinnamon Twig Decoction).
He also said: For Shang Han where heat exits the exterior causing jaundice, use Ma Huang Chun Jiu Tang (Ephedra in Malt Wine Decoction). Use wine in winter and water in spring.
He also said: To treat jaundice, extract yellow fluid from the nose using powder of Gua Di (Thladianthae Fructus), Chi Xiao Dou (Adzuki Bean), and Shu Mi (Broomcorn Millet), named Gua Ding San.
He also said: For epidemic diseases, acute jaundice, and miasma/malaria, use Yin Chen Wan (Artemisia Pill). See Volume 10 of *Qian Jin Fang* (currently Volume 34).
Chao Yuan-fang stated: In Shang Han Yang Ming disease, lack of sweat and difficult urination with mental distress lead to jaundice. Fire therapy causing slight forehead sweating and difficult urination also leads to jaundice. The skin color may be like an orange or peach branch, with slight abdominal fullness. This is due to unresolved cold-dampness and stagnant heat in the Spleen and Stomach. Regarding "Qi Jaundice": excessive dampness accumulates in the Spleen and Stomach; dampness hinders digestion of new food, causing constipation in stool and urine, leading to jaundice. Regarding "Warm Disease": failure to resolve after sweating causes warm toxins to stagnate internally, hindering urination and causing jaundice. Guo Yong stated: Chao’s discussion covers Zhang Zhongjing’s Yang Ming distress/fire therapy patterns and the cold-damp pattern, which is quite brief. Generally, unresolved internal stagnant heat causes jaundice; heat in the Bladder also causes jaundice. Sun Simiao noted that peach-branch color turns into peach-skin color over time.
Chao Yuan-fang further discussed jaundice: Generalized pain, fever, and deep yellow complexion indicate jaundice. After seven or eight days, heat knots internally, requiring blood evacuation resembling pig liver. Pang An-chang noted: For blood stasis, use Di Dang Tang (Water Bug Decoction); for mania, evacuation of blood leads to self-healing. Fullness and urgency in the lower abdomen, sore eyes, nasal bone pain, stiffness in shoulders/neck/back indicate jaundice signs. Constipation is present, but if urination is free, death is avoidable. Excessive stool causes abdominal distension. This is due to internal cold-dampness heating the Spleen/Stomach, closing pores, and stagnant heat clashing with old food, blocking stool and urine, turning the body yellow. If the pulse disappears near the palm and breath from the nose is cold, it is fatal.
*Huo Ren Shu* stated: Unresolved internal cold-dampness heats the Spleen/Stomach, closing pores, clashing with old food, causing jaundice. This echoes Chao Yuan-fang, merely changing "exterior-interior." It also stated: Jaundice and blood stasis have similar external signs and pulses; difficult urination indicates jaundice, while free urination indicates blood stasis. Jaundice patients have accumulated heat in Heart/Spleen, fever, thirst, and a floating-slippery-tight-rapid pulse. Blood stasis mania presents with black stool. For fever, head sweating only, thirst, and difficult urination, use Yin Chen Hao Tang or Wu Ling San added with Yin Chen.
It also stated: Mix Yin Chen Hao Tang (10 parts) and Wu Ling San (5 parts). Take 3 qian with warm wine, three times daily. Mixing Yin Chen Hao Tang with Wu Ling San is best. Effective urination resembling soap-color red reduces abdominal fullness overnight, expelling jaundice via urine. Zhi Zi Bai Pi Tang and Ma Huang Lian Qiao Chi Xiao Dou Tang are also options.
It also stated: For impending jaundice in Shang Han, quickly use Gua Ding powder. Hold water in mouth, insufflate a character's amount into the nose to discharge yellow fluid; this is very effective.
It also stated: Tai Yang disease with generalized pain, fever, and smoky-yellow body indicates Tai Yang Dampness. Guo Yong stated: Use Wu Ling San. ("Zhong Shi" was originally "Wen").
It also stated: Bai Hu (White Tiger) syndrome resembles jaundice. Generalized sweating indicates heat venting (Bai Hu). Head/face sweating only, with no sweat below the neck, indicates jaundice. Guo Yong stated: Bai Hu involves generalized sweating, so jaundice cannot occur. Zhang Zhongjing stated Yang Ming heat venting prevents jaundice.
Guo Yong stated: Chao Yuan-fang’s theory is incomplete, yet widely followed. Jaundice arises from various causes: erroneous purgation or fire fumigation, not just cold-heat/grain issues. Cold pathogens lingering transform into toxic heat. When spring winds move the exterior, if pores do not open, heat cannot sweat out, stagnating internally. Pathogens spread through vessels. Severe toxicity clashes with blood, forming clots like pig liver or ink (defeated blood). Without excretion, blood dries and death ensues. Mild cases vent via epistaxis; sluggish cases exit via urine. Unable to clash with blood or sweat, pathogens scatter in hair follicles, stagnating into yellow color, waiting for sweat/urine to clear. Doctors must guide this path. Internal toxins competing with healthy Qi block pores, preventing sweat, thus exiting via urine/openings. This explains why internal toxins cause jaundice or blood syndromes. For floating pulses indicating loose exterior, sweating is possible.
Pang An-chang stated: Sun Simiao said: Epidemic febrile diseases often cause internal heat jaundice. Use Gua Ding San nasally; discharge of yellow fluid cures it, preventing recurrence. Monitor for slight yellow hue on limbs/face immediately. Avoid alcohol, wheat products, and sexual desire; violation is incurable. (Note: Gua Ding San composition differs in *Qian Jin Fang*).