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Yangming disease. Absence of sweating, difficulty in urination, and mental restlessness (Xin Zhong Ao Nao) indicate that the body will inevitably develop jaundice.
This explains that the cause of jaundice is due to the absence of sweating and difficulty in urination. When pathogenic factors invade the Yangming meridian, one should naturally experience fever and spontaneous sweating; when they enter the Yangming fu-organ, tidal fever and spontaneous sweating are also inevitable.
If there is no sweating, pathogenic factors cannot be released outward, leading to heat stagnation internally; if urination is difficult, water-dampness cannot drain downward, causing dampness to accumulate internally. Dampness and stagnant heat interact, with stasis-heat lodging in the stomach and unable to vent. Thus, mental restlessness occurs, indicating that jaundice will inevitably develop. Yellow is the color of the Spleen-Earth in the center. The Stomach is the fu-organ of the Spleen, and the Spleen is the zang-organ of the Stomach; they are connected by membranes and function as a unified pair.
Stagnant heat steaming in the Stomach causes Spleen pathology to manifest as yellow discoloration. The Spleen inherently dislikes dampness, especially when damp-heat is combined and stagnant.

In Yangming disease, if the face appears entirely red, purgative therapy must not be used. It will inevitably lead to fever, yellow discoloration, and difficulty in urination.
This states that if exterior pathogenic factors are unresolved and purgatives are mistakenly used, jaundice results. A face appearing entirely red: Cheng Wuji notes that "he" means permeating or general. In Yangming disease, a generally red face indicates heat in the meridians. Fang Youzhi says "he" means corresponding. If the face corresponds to redness, using purgatives will deplete body fluids; this view is incorrect. Cheng’s interpretation should be adopted. Generally, the Yangming meridian is located at the front of the body, originating from the sides of the nose meeting at the root.
The *Ling Shu: Pathogenic Factors and Zang-Fu Disease Manifestations* chapter states: All yang meridians converge on the face. When pathogenic factors attack, it often happens during periods of deficiency or after physical exertion, such as sweating after eating, when pores are open and pathogens enter.
If pathogens enter via the face, they descend into the Yangming meridian. Therefore, heat in the Yangming meridian manifests on the face, resulting in a generally red complexion. At this time, pathogens are still in the meridians and have not entered the interior; purgatives must not be used.
Purgatives will weaken the Stomach Qi, allowing pathogens to sink inward, with heat stagnating internally. The reason for inevitable fever and yellow discoloration is that difficulty in urination causes dampness and heat to combine and steam internally. If urination were free,
jaundice would certainly not develop.

In Yangming disease, if there is fever and sweating, this is called "heat venting," and jaundice will not develop. However, if only the head sweats, the body has no sweat, stopping at the neck, accompanied by difficulty in urination and thirst for drinks,
this indicates stasis-heat lodged in the interior, and the body will inevitably develop jaundice. Yinchen Hao Tang (Mugwort and Gardenia Decoction) is indicated.
This further details why jaundice develops or does not, depending on the presence or absence of sweating and the freedom or obstruction of urination, repeatedly clarifying the previous meaning. This clause should also be cross-referenced with the terminal symptoms of Taiyang wind-strike with floating, rapid, or wiry pulses. It implies that although pathogens are in the Taiyang stage, mistaken purgation allows pathogens to sink inward, where damp-heat can enter the Stomach, steam, and cause jaundice; there is no strict distinction between Yangming and Taiyang here. Fever and sweating in Yangming disease represent its primary syndrome. In such cases, heat pathogens have already vented outward through sweat; even if other symptoms exist, jaundice will not develop. If only the head sweats,
yang pathogens are exclusively abundant in the upper part; the lack of body sweat means heat cannot vent outward. "Stopping at the neck" occurs because all three yang meridians ascend to the head, while all three yin meridians ascend only to the neck before returning. This shows that pathogenic heat is sealed, yin and yang are disconnected, Ying and Wei circulation is obstructed, and pores are blocked. Intense pathogenic heat disrupts Sanjiao Qi transformation, leading to difficulty in urination and inability of water-dampness to drain downward.
Furthermore, dryness and heat in the Stomach cause thirst for drinks, introducing more water-dampness from above. Steamy damp-heat accumulates stasis internally, causing inevitable jaundice. For this damp-heat pathogen, urgent expulsion is required;
therefore, Yinchen Hao Tang (Mugwort and Gardenia Decoction) is indicated.

Yinchen Hao Tang (Mugwort and Gardenia Decoction) Formula
Artemisiae Scopariae Herba (6 liang), Gardeniae Fructus (14 pieces), Rhei Radix et Rhizoma (2 liang).
These three ingredients are boiled in 10 dou of water. First, boil Artemisiae Scopariae Herba until the volume reduces by 6 dou. Then add the other two ingredients, boil to obtain 3 sheng of liquid, strain, and divide into three warm doses. Urination will become free, urine will resemble soapberry juice,
and appear bright red. After one night, abdominal fullness will decrease, and jaundice will exit via urination.

Although Mugwort (Yin Chen) is slightly cold, it treats damp-heat jaundice, as well as stagnant heat in Shanghan, generalized jaundice, and difficulty in urination. Gardenia (Zhi Zi) is bitter and cold, draining fire from the Sanjiao, removing Stomach heat and epidemic jaundice, promoting urination, and resolving thirst, irritability, mental restlessness, and stagnant heat qi accumulation; it also enters the blood level. Rhubarb (Da Huang) is bitter and cold, descending to drain heat, expel pathogenic heat, and unblock the intestines and stomach. All three clear damp-heat and remove stagnation, making this the primary formula for Yangming jaundice.

In Yangming disease, if subjected to fire therapy, with slight sweating on the forehead and difficulty in urination, jaundice will inevitably develop.
This states that in Yangming disease without sweating, applying fire therapy to force sweat instead increases fire pathogens, leading to difficulty in urination and jaundice. Fire therapy on Yangming disease belongs to the category of forcing sweat in Taiyang wind-strike.
Subjecting the yang pathogen of wind-strike to fire therapy constitutes the burning of two yangs. If the whole body sweated, heat would vent and jaundice would not develop. Now, since only the forehead sweats slightly, it is known that the body has no sweat.
Combined with difficulty in urination, dampness cannot drain downward. This is identical to the previous condition of "head sweating only, no body sweat, stopping at the neck," but with added fire pathogens. Thus, damp-heat congestion and steaming inevitably cause jaundice.

After seven or eight days of Shanghan, if the body is yellow like an orange peel, accompanied by difficulty in urination and mild abdominal fullness, Yinchen Hao Tang (Mugwort and Gardenia Decoction) is indicated.
This describes the color of Yangming jaundice, which resembles an orange peel, differing from Yin jaundice which looks like smoke. By the seventh or eighth day of Shanghan, pathogens have deeply entered the interior. A body yellow like an orange peel indicates
damp-heat pathogens in the Stomach affecting only the yang aspect, thus causing yang jaundice. Difficulty in urination leads to internal accumulation of water-dampness, and pathogenic food stagnation causes mild abdominal fullness. Since damp-heat is excess in the Stomach,
Yinchen Hao Tang (Mugwort and Gardenia Decoction) is indicated.

In Shanghan, if there is jaundice and fever, Zhizi Bopi Tang (Gardenia and Phellodendron Decoction) is indicated.
Jaundice originates from damp-heat. Here, Shanghan is mentioned without noting absence of sweat or difficulty in urination, only stating jaundice and fever, indicating that heat exceeds dampness, and formless pathogens
steam and cause jaundice. Therefore, Mugwort and Rhubarb are unnecessary; Zhizi Bopi Tang (Gardenia and Phellodendron Decoction) is indicated.

Zhizi Bopi Tang (Gardenia and Phellodendron Decoction) Formula
Gardeniae Fructus (15 pieces), Glycyrrhizae Radix et Rhizoma (1 liang), Phellodendri Cortex (2 liang).
These three ingredients are boiled in 4 sheng of water to obtain 1.5 sheng of liquid. Strain and divide into two warm doses.
Gardenia is bitter and cold; its effects are seen in the previous formula. Phellodendron is bitter and cold; *Shennong Bencao Jing* records it treats internal结热 (knot-heat) in the five zang and six fu organs and jaundice, draining bladder ministerial fire. Thus, it is used to drain heat pathogens.
Fearing that bitter-cold herbs may damage the Stomach, Licorice (Gan Cao) is used to harmonize the Stomach and protect the Spleen, serving as a妙 (wonderful) adjustment.

In Shanghan, if stasis-heat is lodged in the interior, jaundice will inevitably develop. Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia Root, and Red Bean Decoction) is indicated.
"Yu" (stasis) refers to retention and congestion. It means Shanghan stagnant heat interacts with dampness in the Stomach, steaming together like silt in a marsh, where water and soil stick indistinguishably.
Thus, Cheng Wuji cites the classic: "When dampness and heat intersect, many people suffer from dan disease." Because damp-heat is glued and congested in the Stomach, it is said that stasis-heat is in the interior, causing inevitable jaundice. The use of Ephedra
does not treat the exterior when heat is in the interior. Red Bean is used to promote urination. Forsythia root and Catalpa bark disperse stagnant heat. As stated earlier: "Absence of sweat and difficulty in urination lead to jaundice." Therefore, the method for treating jaundice involves sweating to disperse damp-heat through hair follicles, and promoting urination to drain damp-heat through the lower orifice. Thus, Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia Root, and Red Bean Decoction) is indicated.

Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia Root, and Red Bean Decoction) Formula
Ephedrae Herba (2 liang, nodes removed), Phaseoli Semen Rubrum (1 sheng, i.e., small red beans), Forsythiae Radix (2 liang), Armeniacae Semen Amarum (40 pieces, skin removed), Catalpae Cortex (1 sheng), Glycyrrhizae Radix et Rhizoma (1 liang, roasted), Zingiberis Rhizoma Recens (2 liang, sliced), Jujubae Fructus (12 pieces).
These eight ingredients are boiled in 10 dou of rainwater. First, boil Ephedra until boiling again, remove the foam on top, then add the remaining herbs. Boil to obtain 3 sheng of liquid, divide into two warm doses.

Red Bean is not the variety that is black on one end and red on the other. Ancients considered black beans and soybeans as large beans, while mung beans, red beans, white beans, and adzuki beans were considered small beans. Among small beans, the red ones are
called Red Bean. Li Shizhen states: Use those that are tight, small, and dark red for medicine; larger ones that are bright red or pale red do not treat disease. Flowers resemble cowpeas but are smaller, pale silver-brown, pods are 2-3 cun long, slightly larger than mung bean pods. Harvest when pods are three parts green and two parts yellow. They can be boiled, fried, made into porridge, rice, or wonton filling.
Mahuang Tang consists of Ephedra, Cinnamon Twig, Apricot Kernel, and Licorice, all opening the "ghost gate" (pores) to induce sweat. When sweat is released, stagnant heat and dampness in muscles and pores are eliminated. Cinnamon Twig is reduced and omitted
to avoid aggravating stasis-heat. *Suwen: Treatise on the Most Essential Truths* states: "When dampness is excessive in the upper part and heat follows, resolve it by sweating." Wang Bing notes: "Above the waist, if dampness is excessive and fire qi is stagnant, interacting with dampness, use bitter-warm, sweet, and acrid-sweet herbs to release the exterior, induce sweat, and dispel it." Red Bean removes dampness, dissipates heat, reduces edema, and promotes urination. Li Shizhen says: Red Bean is small and red, the grain of the Heart. Its nature descends, connecting to the Small Intestine, entering the yin level, treating tangible diseases, thus moving fluids, promoting urination, reducing distension, eliminating swelling, stopping vomiting and dysentery, resolving alcohol-induced cold/heat, treating abscesses, promoting lactation, delivering the placenta, and assisting in difficult labor. Excessive descending action causes fluid and blood leakage, leading to emaciation and heaviness. It is used in blowing powder with Melon Seed for plague prevention to ventilate qi, remove dampness, and dissipate heat. Catalpa bark is bitter and cold, dispersing warm-heat pathogens.
Its efficacy for jaundice lacks documentation. Forsythia root: Tao Hongjing says it is not used in prescriptions and unrecognized. Wang Haogu says it drains heat, so Zhang Zhongjing uses it for Shanghan stasis-heat. Li Shizhen says: Rainwater is accumulated rain. Han Yu's poem says: "Rainwater has no source, irrigated in the morning, dried by evening." Meaning it is rootless and dries easily, so Cheng Shi says it is flavor-light, does not aid dampness, and promotes heat clearance.

In Shanghan, if the pulse is floating and moderate, and hands and feet are naturally warm, this is linked to Taiyin. Taiyin typically presents with jaundice. If urination is free, jaundice will not develop. By the seventh or eighth day, if stool becomes hard, it becomes Yangming disease.
Shanghan with a floating and moderate pulse is similar to the second clause of the Taiyang section regarding mistaken use of Da Qing Long Tang. However, when pathogens are in Taiyang, presenting with a wind-strike pulse in Shanghan, there are exterior symptoms of fever and aversion to cold.
This clause omits exterior symptoms because pathogens are not in the three yang meridians. The moderate pulse is the fundamental pulse of the Spleen. Thus, in Taiyang, floating-moderate indicates wind-strike with fever and aversion to cold.
In Taiyin, floating-moderate indicates Shanghan without fever and aversion to cold. This distinguishes yin and yang meridians. How to distinguish between Taiyang and Taiyin given both present with floating-moderate pulses in Shanghan?
Observing naturally warm hands and feet reveals no whole-body heat, aligning with "no heat, aversion to cold, originating from yin." Moreover, the Spleen governs the four limbs, linking to Foot-Taiyin.
Saying "naturally warm" excludes cold extremities of Shaoyin and Jueyin. If not Taiyin, what else? Hence, it is linked to Taiyin. However, Taiyin damp-earth pathogen steaming should cause jaundice.
If urination is free, dampness exits via the water pathway, so jaundice does not develop. Once dampness is gone, by the seventh or eighth day, hard stool indicates Taiyin transforming into Yangming, with Stomach excess requiring purgation. This clause requires careful consideration. The first half is identical to the Taiyin chapter; here, hard stool after seven/eight days indicates transformation to Yangming, whereas previously, sudden irritability and diarrhea after seven/eight days indicated Spleen excess. One symptom divides into yin and yang, same source but distinct paths. Disease progression varies thus. Entering yang makes it yang pathogen and yang syndrome; entering yin makes it yin pathogen and yin syndrome. Can there be fixed rules?