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Jaundice in Cold Damage. How to elucidate it? The Classic says: "When dampness and heat interact, the people will suffer from Dan jaundice." "Dan" means yellow; this refers to a syndrome characterized by excess Yang-heat without Yin-cold.

When Cold Damage progresses to manifest jaundice, it indicates that the disease is severe. Whether caused by dampness or heat, when either becomes excessive, jaundice ensues. If internal heat is already flourishing and fire therapy (such as moxibustion or fire fumigation) is applied subsequently, jaundice will also occur. When pathogenic wind is combined with fire-heat, the two Yang pathogens scorch each other, and the body must develop jaundice. In Yangming disease, if subjected to fire therapy, with only slight sweating on the forehead and difficulty in urination, jaundice is inevitable. This results from internal heat exacerbated by fire attack. In Yangming disease, if there is no sweating, difficulty in urination, and mental restlessness with regret (Ao Nao), jaundice is also inevitable. This results from flourishing heat in the Yangming channel.

After sweating treatment for Cold Damage, if the body remains yellow, the reason is that cold-dampness remains unresolved within. It is considered inadvisable to use purgation here; instead, one should seek treatment by resolving cold-dampness. This type of jaundice is caused by cold-dampness. Both dampness and heat can cause jaundice; can they be distinguished? Not only are their fundamental causes different, but their complexion colors also differ. In patients with dampness, the yellowing resembles smoke-staining; although yellow, the color is dull and obscure. In contrast, jaundice due to excessive heat presents with a skin color like orange peel; in severe cases, the brightness is striking, staining clothes a true yellow akin to Phellodendron bark. Thus, are not dampness and heat distinct?

Generally, jaundice belongs to the Taiyin system. Taiyin corresponds to the Spleen meridian. The Spleen corresponds to Earth, whose color is yellow. When the Spleen meridian is steamed by damp-heat, the yellow color manifests externally, resulting in generalized jaundice. The Classic states: "In Cold Damage, if the pulse is floating and slow, and the hands and feet are naturally warm, the disease is associated with Taiyin. Taiyin disease should manifest generalized jaundice." Although internal heat may be flourishing, if the patient has spontaneous sweating and free urination, jaundice will not occur. However, if there is sweating only on the head, no sweating on the body (stopping at the neck), difficulty in urination, and thirst for fluids, this indicates stagnant heat trapped inside, and jaundice is inevitable.

Although jaundice patients exhibit excessive heat, treatment methods vary. In Cold Damage lasting eight or nine days, if the body is orange-yellow, urination is difficult, and the lower abdomen is full, Yinchen Hao Tang (Artemisiae Scopariae Decoction) is the primary prescription. This aims to purge and wash away the heat. If Cold Damage presents with jaundice and fever, Zhizi Bopi Tang (Gardeniae Cortex Phellodendri Decoction) is used. This aims to dissipate the heat. If Cold Damage involves stagnant heat trapped inside leading to jaundice, Mahuang Lianqiao Xiaochidou Tang (Ephedra, Forsythia, and Red Bean Decoction) is used. This also aims to dissipate the heat. These prescriptions employ purging or dissipating methods; though different, they all belong to agents that clear fire and penetrate heat.

However, if the body is yellow, the pulse is deep and knotted, the lower abdomen is hard, urination is free, and the person appears manic-like, this indicates blood stasis in the Lower Jiao causing jaundice. Dandang Tang (Ephedra, Cinnamon Twig, Peony, and Ground Beetle Decoction) must be used to purge the condition for recovery. Since jaundice represents an extreme stage of disease, many cases are incurable. Not only are conditions such as the absence of pulse near the crease of the wrist and cold breath from the nose considered incurable; furthermore, if the body appears dark like smoke-stained, with fixed staring and head shaking, this indicates Heart Qi exhaustion. If the area around the mouth turns blackish and sweat is soft/clammy while jaundiced, this indicates Spleen Qi exhaustion. All these are incurable syndromes. Physicians must examine these details carefully.