天津苏媪，年六十六岁，于仲春得黄胆证。
病因 事有拂意，怒动肝火，继又薄受外感，遂遍身发黄成疸证。
证候 周身黄色如橘，目睛黄尤甚，小便黄可染衣，大便色白而
干，心中发热作渴，不思饮食。其脉左部弦长有力且甚硬，右部脉亦有力而微浮，舌苔薄而白无津液。
诊断 此乃肝中先有蕴热，又为外感所束，其热益甚，致胆管肿胀，不能输其胆汁于小肠，而
溢于血中随血运遍周身，是以周身无处不黄。迨至随血营运之余，又随水饮渗出归于膀胱，
是以小便亦黄。至于大便色白者，因胆汁不入小肠以化食，大便中既无胆汁之色也。《金匮》有硝
石矾石散，原为治女劳疸之专方，愚恒借之以概治疸证皆效，而煎汤送服之药须
随证更改。其原方原用大麦粥送服，而此证肝胆之脉太盛，当用泻肝胆之药煎汤送之。
处方 净火硝（一两研细） 皂矾（一两研细） 大麦面（二两焙热，如无可代以小麦面）
水和为丸，桐子大，每服二钱，日两次。此即硝石矾石散而变散为丸也。
汤药 生怀山药（一两） 生杭芍（八钱） 连翘（三钱） 滑石（三钱）
栀子（二钱） 茵陈（二钱） 甘草（二钱）
共煎汤一大盅，送服丸药一次，至第二次服丸药时，仍煎此汤药之渣送之。再者此证舌苔犹白，右
脉犹浮，当于初次服药后迟一点钟，再服西药阿斯匹林一瓦，俾周身得微汗以解其未罢之表证。
复诊 将药连服四剂，阿斯匹林服一次已周身得汗，其心中已不若从前之渴热，能进饮食，大便
已变黑色，小便黄色稍淡，周身之黄亦见退，脉象亦较前和缓。俾每日仍服丸药两次，
每次服一钱五分，所送服之汤药方则稍为加减。
汤药 生怀山药（一两） 生杭芍（六钱） 生麦芽（三钱）
茵陈（二钱） 鲜茅根（三钱，茅根无鲜者可代以鲜芦根） 龙胆草（二钱） 甘草（钱半）
共煎汤，送服丸药如前。
效果 将药连服五剂，周身之黄已减三分之二，小便之黄亦日见清减，脉象已和平如常。遂俾停
药勿服，日用生怀山药、生薏米等分轧细，煮作茶汤，调入鲜梨、鲜荸荠自然汁，当点
心服之，阅两旬病遂全愈。
或问 黄胆之证，中法谓病发于脾，西法谓病发于胆。今此案全从病发于胆论治，将勿中法谓
病发于脾者不可信欤？答曰∶黄胆之证有发于脾者有发于胆者，为黄胆之原因不同，是以仲圣治
黄胆之方各异，即如硝石矾石散，原治病发于胆者也。其矾石若用皂矾，固为平肝胆要药，至硝石确
系火硝，其味甚辛，辛者金味，与矾石并用更可相助为理也。且西人谓有因胆石成黄胆者，而
硝石矾石散，又善消胆石。有因钩虫成黄胆者，而硝石矾石散，并善除钩虫，制方之妙诚不可
令人思议也。不但此也，仲圣对于各种疸证多用茵陈，因最善入少阳之府以清热、舒郁、消肿、
透窍，原为少阳之主药。仲圣若不知黄胆之证兼发于胆，何以若斯喜用少阳之药乎？是以至
明季南昌喻氏出，深窥仲圣用药之奥旨，于治钱小鲁酒疸一案，直谓胆之热汁溢于外，以渐渗于经络
则周身俱黄云云，不已显然揭明黄胆有发于胆经者乎？
A sixty-six-year-old woman surnamed Su in Tianjin contracted jaundice during the second month of spring.
Etiology: Due to dissatisfaction with events, anger stirred up liver fire, followed by a mild external contraction, resulting in generalized yellowing of the body and the formation of jaundice syndrome.
Symptoms: The skin of the entire body was yellow like an orange peel, with the sclera being particularly yellow. Urine was dark yellow, capable of staining clothes. Stools were white and dry. There was a sensation of heat in the heart accompanied by thirst, and a lack of appetite. The pulse on the left side was wiry, long, forceful, and very hard; the pulse on the right side was also forceful but slightly floating. The tongue coating was thin and white, lacking fluids.
Diagnosis: This condition arises from pre-existing accumulated heat in the liver, which is constrained by external pathogens, causing the heat to intensify. This leads to swelling of the bile ducts, preventing the transport of bile into the small intestine. Bile overflows into the blood and circulates throughout the body, causing generalized yellowing. As this excess bile is metabolized via blood circulation, it exudes through water metabolism back into the bladder, resulting in yellow urine. The whiteness of the stools occurs because bile does not enter the small intestine to aid digestion, leaving the stools devoid of bile color. *Xiaoshi Fanshi San* (Niter and Alum Powder) from the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) is originally a specific formula for treating female labor jaundice. I frequently borrow it to treat various types of jaundice effectively, but the decoction used to deliver the pills must be modified according to the specific syndrome. The original prescription used barley porridge for delivery; however, since this case presents with excessive liver and gallbladder pulses, a decoction clearing and purging the liver and gallbladder should be used instead.
Prescription: Jing Huoxiao (Refined Niter, 1 liang, finely ground); Zaofan (Alum, 1 liang, finely ground); Damai mian (Barley flour, 2 liang, baked hot; wheat flour may substitute if unavailable). Mix with water to form pills the size of tung tree seeds. Take 2 qian per dose, twice daily. This is essentially *Xiaoshi Fanshi San* converted from powder to pill form.
Decoction: Sheng Huaishanyao (Raw Chinese Yam, 1 liang); Sheng Hangshao (Raw Paeonia Radix Alba, 8 qian); Lianqiao (Forsythiae Fructus, 3 qian); Huashi (Talcum, 3 qian); Zhizi (Gardeniae Fructus, 2 qian); Yinchen (Artemisiae Scopariae Herba, 2 qian); Gancao (Licorice Root, 2 qian). Decoct together in one large cup. Administer once with the pills. For the second dose of pills, use the residue of this decoction, re-decocted, for delivery. Furthermore, since the tongue coating remains white and the right pulse is still floating, administer one grain of Aspirin (Western medicine) about one hour after the first dose of herbs. This induces slight sweating to resolve the lingering exterior syndrome.
Follow-up Visit: After four doses of the medication and one dose of Aspirin, the patient sweated profusely. The intense thirst and heat in the chest subsided, appetite returned, stools turned black, urine became less yellow, and the generalized yellowing began to recede. The pulse became more relaxed and moderate compared to before. Instructed to continue taking the pills twice daily, reducing the dose to 1.5 qian per time, with slight modifications to the accompanying decoction.
Modified Decoction: Sheng Huaishanyao (Raw Chinese Yam, 1 liang); Sheng Hangshao (Raw Paeonia Radix Alba, 6 qian); Sheng Maiya (Raw Sprouted Hordeum Vulgare, 3 qian); Yinchen (Artemisiae Scopariae Herba, 2 qian); Xian Maogen (Fresh Imperata Rhizome, 3 qian; fresh Arundo Rhizome may substitute if Imperata is unavailable); Longdancao (Gentianae Radix, 2 qian); Gancao (Licorice Root, 1.5 qian). Decoct together and administer with the pills as before.
Outcome: After five doses, the generalized yellowing decreased by two-thirds, urine became progressively clearer, and the pulse normalized. Medication was discontinued. Instead, the patient consumed a tea made from equal parts of raw Chinese Yam and Coicis Semen (Job's Tears), finely ground and boiled. Fresh pear juice and fresh Eleocharis Tubers juice were added to this tea, taken as snacks. The disease was completely cured within twenty days.
Q&A: Regarding jaundice, Traditional Chinese Medicine (TCM) attributes the pathology to the Spleen, while Western Medicine attributes it to the Gallbladder. This case treats the condition entirely based on the Gallbladder origin. Does this imply that the TCM view of spleen-origin jaundice is unreliable? A: Jaundice can originate from either the Spleen or the Gallbladder, depending on different etiologies. Therefore, Zhang Zhongjing employed different formulas for different types of jaundice. For instance, *Xiaoshi Fanshi San* is originally intended for jaundice originating in the Gallbladder. If Zao Fan (Green Vitriol/Alum) is used, it is indeed a key herb for calming the Liver and Gallbladder. Huoxiao (Niter) is pungent, corresponding to the Metal element flavor; combined with Alum, it enhances therapeutic efficacy. Western medicine notes that gallstones can cause jaundice, and *Xiaoshi Fanshi San* is effective in dissolving gallstones. Hookworm infection can also cause jaundice, and this formula helps eliminate hookworms. The ingenuity of this prescription is truly remarkable. Moreover, Zhang Zhongjing frequently used Yinchen (Artemisiae Scopariae Herba) for various jaundice syndromes because it enters the Shaoyang organ system to clear heat, relieve stagnation, reduce swelling, and open orifices, making it a primary herb for the Shaoyang channel. If Zhang Zhongjing did not recognize that jaundice involves the Gallbladder, why would he so preferentially use Shaoyang herbs? Thus, when Yu Jia Yan (Yu Chang) emerged in the late Ming Dynasty, he deeply understood Zhang’s pharmacological principles. In treating Qian Xiaolu’s alcohol-induced jaundice case, Yu explicitly stated that "hot bile juices overflow externally and gradually seep into the collaterals, causing whole-body yellowing." This clearly elucidates that jaundice can originate from the Gallbladder channel.