【纲】仲景曰。病发于阳。而反下之。热入。因作结胸。但头汗出。余处无汗。至颈而还。小便
不利。身必发黄也。伤寒瘀热在里。身必发黄。麻黄连翘赤小豆汤主之。
【目】朱肱曰。头汗出而身发黄者。茵陈蒿汤十分。五苓散五分。拌和。每服一钱。水下。日
三服。
张云岐曰。寒气侵人。人即发热以拒之。是为发阳。助阳散寒。一汗而寒热解矣。不汗而反下。
故热内陷而成结胸。炎上而但头有汗。且小便不利。致湿热内蒸。黄色外见也。解表清火利水。
麻黄连翘赤小豆汤一剂而三善备。且以见太阳发热之治。与阳明迥别也。
【纲】仲景曰。太阳病。身黄。脉沉结。少腹硬。小便不利者。为无血也。小便自利。其人如
狂者。血结症也。抵当汤主之。
【目】朱震亨曰。寒热在里不散。热蓄于脾胃。腠理不开。瘀热与宿谷相薄。郁蒸不消化。故
发黄。发黄与瘀血外症及脉俱相似。但小便不利为发黄。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。若瘀血症即如狂。大便必硬。此异耳。
楼全善曰。此蓄血在下焦而发黄者也。
柯琴曰。太阳病发黄与狂。有气血之分。小便不利而发黄者。病在气分。麻黄连翘赤小豆症也。
小便自利而如狂。病在血分。抵当汤症也。
【纲】仲景曰。太阳病。中风。以火劫发汗。邪风被火热。血气流溢。失其常度。两阳相熏灼。
身体则枯燥。但头汗出。齐颈而还。其身发黄。
【目】朱肱曰。病患服汤。得小便利。如皂荚汁赤。一宿腹减。则黄从小便中出也。古人云。治
湿不利小便。非其治也。麻黄连翘赤小豆汤、栀子柏皮汤。可选用之。
陶华曰。内经云。湿热相交。民多病瘅。发黄是也。谓单阳而无阴也。太阴脾土为湿热所蒸。
色见于外。曰发黄。湿胜则如熏黄而晦。热胜则如橘黄而明。伤寒至于发黄。热势已极。且如蓄血。
大抵相类。设或寸口无脉。鼻出冷气。与夫形如烟熏。摇头直视。环口黧黑。举体发黄。是皆真
脏气绝也。
【纲】仲景曰。太阳病。脉浮而动数。浮则为风。数则为热。动则为痛。数则为虚。头痛发热。
微盗汗出。而反恶寒者。表未解也。医反下之。动数变迟。膈内拒痛。胃中空虚。客气动膈。短
气烦躁。心中懊 。阳气内陷。心下因硬。则为结胸。大陷胸汤主之。若不结胸。但头汗出。余无
汗。齐颈而还。小便不利。身必发黄也。
【目】方中行曰。此条本言结胸之症。叙其由。绘其状。而明其治也。若不结胸以下。乃就变症
之轻者言之。但头汗出者。乃诸阳之本。阳健故汗出也。余无汗者。阴脉上不过颈也。小便不利者。
阳不下通。阴不任事。化不行而湿停也。湿停不行。必更渗土而入胃。胃土本湿。得渗则盛。既
盛且停。热气郁蒸。发为身黄也。
【纲】仲景曰。伤寒发汗已。身目为黄。所以然者。以寒湿在里不解故也。以为不可下也。于
寒湿中求之。
【目】魏荔彤曰。伤寒发汗。已得治而表邪可愈矣。何以身目为黄。知非寒邪在表为患。而外
感寒邪挟在里之湿邪为患也。故仲师明示以寒湿在里不解之故。见人当于里求治也。喻氏以里为躯
壳之里。与脏腑无涉。盖此症非在表。亦非在里。特在表之里。而不在脏腑之里。故仲师又以为里
而不可下也。于寒湿中求之。不出方者。方不外麻黄
连翘赤小豆汤、茵陈蒿汤、栀子柏皮汤。可选用也。夫寒湿俱阴邪。二阴相搏于里。何以不发青
白色。而成黄色。则寒邪郁而变为热邪。合之湿邪相蒸而见于外也。故总无治寒之药。学人详焉。
陶华曰。湿家之为病。一身尽痛。发热身虽似熏黄。小便不利。五苓散。小便自利。术附汤。
身头痛。麻黄汤加苍术。脉浮身重汗出恶风。防己黄 汤。初发黄。以瓜蒂末。口噙水。搐鼻中。黄水出愈。
【纲】仲景曰。伤寒六七日。身黄如橘子色。小便不利。腹微满者。茵陈蒿汤主之。伤寒身黄
发热者。栀子柏皮汤主之。
【目】喻昌曰。黄色鲜明。其为三阳之热邪无疑。小便不利腹微满。乃湿家之本症。不得因此
指为伤寒之里症也。方用大黄佐茵陈、栀子。建中驱湿除热之功。以利小便。非用下也。热已发出于外。自与内瘀不同。
正当随热势清解其黄。使不留于肌表间也。前条热瘀。故用麻
黄。此条发热。反不用麻黄者。盖寒湿之症难于得热。热则其势外出而不内入矣。所谓于寒湿中求
之。不尽泥伤寒定法也。
【纲】仲景曰。风湿为病。脉阴阳俱浮。若被火者。微发黄色。
【目】朱肱曰。中湿一身尽痛。发热身黄小便不利。病患中湿。因而伤风。风湿相搏。一身痛
重。是名中湿。亦当于风湿中求之。
李中梓曰。小便不利。四肢沉重。似疟。若不饮而发黄。茵陈五苓散。伤寒脉虚。小便如常。
变为阴黄。理中加茵陈汤。如下之太过。脾虚津竭。饮水自伤。此阴湿变黄。茵陈茯苓汤、茵陈四逆
汤。
鳌按。风湿相抟于内而以火劫之。受火气之轻者。湿不得越。必因热而发黄。
[General Principle] Zhang Zhongjing stated: When a disease originates in the Yang (exterior-heat syndrome) and is mistakenly treated with purgation, heat enters inward, resulting in Jie Xiong (chest binding). The symptoms include sweating only on the head, no sweating elsewhere, stopping at the neck; difficulty in urination, and the body will inevitably become jaundiced. In Shang Han (Cold Damage), when stagnant heat accumulates inside, the body will inevitably become jaundiced; this should be treated with Mahlian Liao Chixiaodou Decoction (Mahuang, Forsythia, and Red Bean Decoction).
[Commentary] Zhu Gong said: For cases of head sweating accompanied by jaundice, mix Yinchen Hao Tang (Artemisiae Scopariae Decoction) in a proportion of ten parts and Wuling San (Five-Ingredient Powder with Poria) in five parts. Take one qian per dose, washed down with water, three times daily.
Zhang Yunqi said: When cold qi invades the human body, the body generates fever to resist it, which is called Fa Yang (releasing Yang). By assisting Yang to scatter cold, once sweating occurs, the cold and heat are resolved. If sweating does not occur but purgation is used instead, heat sinks inward forming Jie Xiong. Since fire flares upward, there is only head sweating. Coupled with difficulty in urination, damp-heat steams internally, causing yellow color to appear externally. Using methods to release the exterior, clear fire, and promote urination, one dose of Mahlian Liao Chixiaodou Decoction achieves all three benefits. This also demonstrates that the treatment for fever in Taiyang disease is distinct from that in Yangming disease.
[General Principle] Zhang Zhongjing stated: In Taiyang disease, if the body is yellow, the pulse is deep and knotted, and the lower abdomen is hard, but urination is difficult, this indicates no blood stasis. If urination is normal and the patient exhibits mania-like behavior, this is Blood Stasis Syndrome; treat with Didang Tang (Echinopsite and Ground Beetle Decoction).
[Commentary] Zhu Zhenheng said: When cold and heat accumulate inside without dispersing, heat stores in the Spleen and Stomach. With closed pores, stagnant heat clashes with retained food, leading to depression and steaming that impairs digestion, resulting in jaundice. The external signs and pulse of jaundice resemble those of blood stasis. However, difficulty in urination indicates jaundice, while normal urination indicates blood stasis. Generally, patients with jaundice have accumulated damp-heat in the Heart and Spleen, experience fever and thirst, and have a floating, slippery, tight, and rapid pulse. In contrast, blood stasis presents with mania-like behavior and hard stools. These are the differences.
Lou Quanshan said: This is jaundice caused by blood accumulation in the Lower Jiao.
Ke Qin said: Jaundice and mania in Taiyang disease differ between Qi level and Blood level. Jaundice with difficulty in urination is a disease of the Qi level, corresponding to Mahlian Liao Chixiaodou Decoction. Normal urination with mania is a disease of the Blood level, corresponding to Didang Tang.
[General Principle] Zhang Zhongjing stated: In Taiyang disease with Wind Strike, if forced sweating is induced by Fire Therapy, the wind pathogen is subjected to intense heat. The flow of blood and Qi overflows its normal limits. The two Yangs (wind and fire) scorch each other, causing the body to become dry and withered. There is only head sweating, stopping at the neck; the body becomes jaundiced.
[Commentary] Zhu Gong said: After the patient takes the decoction, if urination becomes smooth and the urine is red like soap pod juice, and abdominal distension decreases overnight, the jaundice will exit through the urine. The ancients said: To treat dampness without promoting urination is incorrect treatment. One may choose Mahlian Liao Chixiaodou Decoction or Zhizi Bapi Tang (Gardenia and Phellodendron Bark Decoction).
Tao Hua said: The Neijing states: "When dampness and heat intersect, people often suffer from dan (jaundice)." Jaundice is such a case, referring to excess Yang without Yin. When the Earth of the Taiyin Spleen is steamed by damp-heat, the yellow color appears externally, called jaundice. If dampness prevails, the yellow is dull like smoke-stained cloth; if heat prevails, the yellow is bright like an orange. When Shang Han progresses to jaundice, the heat intensity is extreme, largely similar to blood accumulation. If the radial pulse is absent, cold air comes from the nose, the form looks like smoke-stained, the head shakes, eyes stare straight, the ring around the mouth is dark, and the whole body is yellow, these are all signs of the extinction of the True Zang Qi (death).
[General Principle] Zhang Zhongjing stated: In Taiyang disease, if the pulse is floating, moving, and rapid: floating indicates Wind, rapid indicates Heat, moving indicates Pain, and rapid also indicates Deficiency. Headache, fever, slight night sweats, yet paradoxical aversion to cold indicate the exterior is unresolved. If the physician mistakenly uses purgation, the moving/rapid pulse changes to slow. There is resistance and pain in the diaphragm interior. The Stomach is empty, and hostile Qi disturbs the diaphragm, causing shortness of breath, irritability, and mental restlessness. As Yang Qi sinks inward, the epigastrium becomes hard, forming Jie Xiong; treat with Da Xiexiong Tang (Major Downward Draining Chest Decoction). If Jie Xiong does not form, but there is only head sweating, no other sweating, stopping at the neck, and difficulty in urination, the body will inevitably become jaundiced.
[Commentary] Fang Zhongxing said: This clause originally discusses the symptoms of Jie Xiong, describing its origin, manifestations, and treatment. The section "If Jie Xiong does not form..." refers to milder variant syndromes. Head sweating alone occurs because the head is the source of all Yang; robust Yang causes sweating. No other sweating occurs because Yin meridians do not ascend above the neck. Difficulty in urination occurs because Yang cannot descend and circulate, and Yin cannot perform its functions; transformation fails and dampness stagnates. Stagnant dampness seeps into the Spleen Earth and enters the Stomach. Since Stomach Earth is naturally damp, receiving more dampness makes it excessive. Excess and stagnant dampness, combined with郁蒸 (depressive steaming) of heat, results in body jaundice.
[General Principle] Zhang Zhongjing stated: After treating Shang Han with sweating, if the body and eyes turn yellow, it is because Cold-Dampness remains unresolved inside. It is stated that purgation should not be used; instead, seek treatment within the context of Cold-Dampness.
[Commentary] Wei Litong said: After treating Shang Han with sweating, if treated correctly, exterior pathogens should be cured. Why do the body and eyes turn yellow? This indicates that the pathology is not due to cold pathogens in the exterior, but rather external cold pathogens combining with internal dampness. Thus, Zhong Jing explicitly points out the cause as unresolved Cold-Dampness inside, instructing practitioners to seek treatment in the interior. Yu Chang interpreted "interior" as the space within the shell, unrelated to Zang-Fu organs. Essentially, this syndrome is neither purely exterior nor purely interior, but lies in the deeper layer of the exterior, not involving the Zang-Fu interior. Therefore, Zhong Jing says although it is considered interior, purgation is contraindicated; seek treatment in Cold-Dampness. No specific formula is given because the options are Mahlian Liao Chixiaodou Decoction, Yinchen Hao Tang, or Zhizi Bapi Tang. Both Cold and Damp are Yin pathogens. Why do two Yins clashing inside produce yellow rather than green or white? Because the cold pathogen depresses and transforms into heat, which combines with dampness to steam outward. Therefore, the general treatment principle does not include herbs specifically for cold; students should examine this carefully.
Tao Hua said: Patients with dampness diseases suffer from generalized pain and fever. Although the body appears dull yellow like smoke-stained cloth, if urination is difficult, use Wuling San. If urination is normal, use Shu Fu Tang. If there is headache and body pain, use Mahuang Tang plus Cangzhu. If the pulse is floating, body heavy, sweating, and aversion to wind, use Fangji Huangqi Tang. For early-stage jaundice, use Gengti powder, hold water in the mouth, and insufflate into the nose; discharge of yellow fluid indicates cure.
[General Principle] Zhang Zhongjing stated: In Shang Han, after six or seven days, if the body is yellow like an orange color, urination is difficult, and the abdomen is slightly full, treat with Yinchen Hao Tang. If Shang Han presents with body jaundice and fever, treat with Zhizi Bapi Tang.
[Commentary] Yu Chang said: Bright yellow color undoubtedly indicates Heat pathogens of the Three Yang meridians. Difficulty in urination and slight abdominal fullness are fundamental symptoms of dampness diseases; they should not be mistaken for interior syndromes of Shang Han. The formula uses Dahuang (Rhubarb) to assist Yinchen (Artemisia) and Zhizi (Gardenia) to establish middle Qi, drive out dampness, and remove heat, aiming to promote urination, not to purge. Since heat has already emerged outward, it differs from internal stagnation. One should follow the heat trend to clear and resolve the jaundice, preventing it from lingering in the muscle and skin layers. The previous clause used Mahuang because of heat stagnation; this clause involves fever but avoids Mahuang because Cold-Damp syndomas rarely generate heat; if heat arises, the pathogen tends to move outward rather than inward. This illustrates "seeking treatment in Cold-Dampness," not rigidly adhering to fixed Shang Han methods.
[General Principle] Zhang Zhongjing stated: In Wind-Damp disease, if the pulses at both Yin and Yang positions are floating, and Fire Therapy is applied, mild jaundice will result.
[Commentary] Zhu Gong said: Zhong Shi (contracting dampness) causes generalized pain, fever, jaundice, and difficulty in urination. If a patient contracts dampness and then catches a cold, Wind and Damp clash, causing heavy and painful limbs. This is named Zhong Shi, and treatment should be sought within the context of Wind-Damp.
Li Zhongzi said: If there is difficulty in urination, heavy limbs, and symptoms resembling malaria, but no thirst with jaundice, use Yinchen Wuling San. If Shang Han presents with a deficient pulse and normal urination, transforming into Yin Jaundice, use Lizhong Tang plus Yinchen. If purgation was excessive, leading to Spleen deficiency and fluid exhaustion, where drinking water harms the body, this is Yin-Damp transforming into jaundice; use Yinchen Fuling Tang or Yinchen Sini Tang.
Shen Jin'ao's Note: When Wind-Damp clashes internally and is subjected to Fire Therapy, those who receive lighter fire energy find that dampness cannot vent out and must transform into heat, resulting in jaundice.