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Original text from *Shanghan Lun*: When cold damage results in yellowing of the body and fever, Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Decoction) is the primary treatment.

This section indicates to practitioners that if one observes yellowing of the body and fever, even in the absence of symptoms such as abdominal fullness and difficulty urinating, it can be directly diagnosed as a disease caused by damp-heat.

[Formula: Zhi Zi Bai Pi Tang]
Zhi Zi (Fructus Gardeniae) fifteen pieces (broken open), Gan Cao (Radix Glycyrrhizae) one liang (roasted), Huang Bo (Cortex Phellodendri) two liang.

Take these three ingredients, add four sheng of water, boil to obtain one and a half sheng, remove the dregs, and take warm in two divided doses.

The intent of this formula is to separately dissipate heat in the Upper, Middle, and Lower Jiao. Therefore, Zhi Zi is good at clearing heat in the Upper Jiao, Huang Bo is good at clearing heat in the Lower Jiao, and adding Gan Cao allows the herbs to guide each other to the Middle Jiao to clear heat there. Furthermore, since Zhi Zi and Huang Bo are overly bitter and cold, the sweetness of Gan Cao is used to moderate them, slightly altering their bitter-cold nature so as not to injure the Stomach Qi.

Original text from *Shanghan Lun*: In cold damage, stagnant heat trapped inside will inevitably cause yellowing of the body; Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction) is the primary treatment.

[Formula: Ma Huang Lian Qiao Chi Xiao Dou Tang]
Ma Huang (Herba Ephedrae) two liang (nodes removed), Chi Xiao Dou (Semen Phaseoli Angularis) one sheng, Lian Yao (Radix Forsythiae) two liang, Xing Ren (Semen Armeniacae Amarum) forty pieces (skin and tips removed), Da Zao (Fructus Jujubae) twelve pieces, Sheng Zi Bai Pi (Cortex Catalpae Viridis) one sheng, Sheng Jiang (Rhizoma Zingiberis Recens) two liang (sliced), Gan Cao (Radix Glycyrrhizae) two liang (roasted).

Take these eight ingredients, add ten dou of rainwater (Liao Shui), first boil Ma Huang until it boils again, skim off the foam on top, then add the remaining herbs, boil to obtain three sheng, and take warm in three divided doses, finishing within half a day.

Note: Lian Yao is not Lian Qiao (Forsythia Fruit), but rather the root of Forsythia. Its nature is cool and capable of draining heat, and it is also good at promoting diuresis to resolve dampness; using Lian Qiao in later generations changes its nature. Chi Xiao Dou refers to the small beans used for cooking, shaped like mung beans but red in color, not the red beans imported from the South. Zi Bai Pi (Cortex Catalpae) is not sold in pharmacies; if there are Catalpa trees nearby, one can harvest it themselves. Chen Xiuyuan stated that if Zi Bai Pi is unavailable, Yin Chen (Herba Artemisiae Scopariae) can be used as a substitute.

Yellowing of the body differs from Jaundice (Huang Dan). Jaundice involves bile flowing recklessly into the blood. Although Zhang Zhongjing did not explicitly state this in his writings, Yu Jiayan elucidated this point in the case of Qian Xiaolu in *Yi Yi Cao* (Meaningful Grass); at that time, the Western theory of "bile overflowing into the blood" had not yet entered China. As for diseases causing yellowing of the body, which develop suddenly within one or two days, it is evident that they are not caused by bile overflowing into the blood level. Yin Chen is a key herb for treating heat-binding jaundice, clearly recorded in *Shennong Ben Cao Jing*. Zhang Zhongjing also used it for treating yellowing of the body because both conditions arise from damp-heat. If damp-heat accumulates gradually, it becomes Jaundice; if damp-heat is constrained by external pathogens and forms abruptly, it becomes yellowing of the body. Thus, both can be treated with Yin Chen Hao Tang (Artemisia Scoparia Decoction).

Not all cases of yellowing of the body are due to damp-heat. Section 76 of the Yangming Chapter states: "After cold damage has been treated with sweating, if the body and eyes become yellow, the reason is that cold-dampness remains unresolved internally. It should not be treated with purgatives; instead, seek the treatment within the context of cold-dampness."

Wang He'an said: Yellow is the color of oily heat. Oil contains fluid and envelops vessels, nurturing blood. When fluid is deficient and blood is dry, heat becomes severe, resulting in Yang Jaundice, which corresponds to the Zhi Zi Bai Pi Tang pattern of yellowing body and fever. When oily dampness and blood heat are equal and steaming together, causing difficulty urinating and a body yellow like an orange peel, this corresponds to the Yin Chen Hao Tang pattern. When oil is cold and membranes are damp,郁 blood transforms into heat, leading to severe cold-dampness and becoming Yin Jaundice, corresponding to the Yin Chen Wu Ling San pattern. The disease presents with heat signs but is treated according to cold-dampness principles. Reflecting on these two sentences reveals the flexibility of the language. Essentially, saying "do not use purgatives" implies that there are heat-type yellows that could be purged; saying "seek treatment within cold-dampness" implies seeking methods for cold-dampness, indicating that yellow patterns are not purely cold-damp. For any syndrome with two causes, treatment follows the more severe aspect, as seen in these two statements.

Mr. Wang's discussion above is very refined, but I have another understanding of this section's text. I will cite two previous cured cases to illustrate this.

I once treated a patient who contracted a common cold, experienced aversion to cold and no sweat, and had whole-body yellowing. I used Ma Huang Tang (Ephedra Decoction) to induce sweating, but the yellowing did not recede after sweating. Upon careful pulse diagnosis, the left pulse was wiry and weak, and the right pulse was soggy and weak. This indicated that the Yang Qi of the Liver and Gallbladder was not vigorous, and the Spleen and Stomach were deficient and cold. The Spleen and Stomach belong to Earth, whose natural color is yellow. When diseased, they manifest their true color. Thus, if the pathology is damp-heat, the yellow may appear bright; if it is damp-cold, the yellow may appear dull. Observing the yellow presented here, although seemingly dull, it was not extremely dull because reckless bile flow was involved. This was likely due to the invigoration of Liver-Gallbladder Yang being insufficient, preventing the transformation and transportation of Qi, so bile could not reach the Small Intestine to aid digestion. Consequently, the bile duct became blocked, bile accumulated excessively and flowed recklessly, overflowing into the blood level and permeating to show yellow. Since the roots of the yellowing were different, they manifested together, making the yellowing appear dull but not truly dull. Having accurately diagnosed the condition, I prescribed a formula to treat the left and right sides separately.

Sheng Huang Qi (Radix Astragali) six qian, Gui Zhi Jian (Ramulus Cinnamomi Cum Gemmis) two qian, Gan Jiang (Rhizoma Zingiberis Secatus) three qian, Hou Po (Cortex Magnoliae Officinalis) half a qian, Chen Pi (Pericarpium Citri Reticulatae) half a qian, Yin Chen (Herba Artemisiae Scopariae) two qian.

Boil these six herbs in a large cup of water and take warm.

Rationale of the formula: Huang Qi is used to assist the Yang Qi of the Liver and Gallbladder, assisted by the acrid-warm nature of Gui Zhi, which provides opening power. Gan Jiang is used to eliminate cold-dampness in the Spleen and Stomach; Hou Po assists in directing the warming heat downward. Chen Pi further assists in directing the heat sideways. When the warming heat spreads throughout the body, the cold-dampness of the Spleen and Stomach is naturally eliminated. Yin Chen is used because of its ascending and dispersing nature, which effectively opens the blockage of the bile duct. Moreover, it promotes diuresis to resolve dampness. Combined with Ginger and Cinnamon Twig, although it is bitter and cold, its cold nature is not felt. Additionally, the Liver and Gallbladder harbor Ministerial Fire (Xiang Huo). Even if the Liver and Gallbladder are cool, the ministerial fire remains. Ministerial fire is originally Dragon-Lei fire; it cannot be triggered by purely acrid-hot agents. Adding a small amount of Yin Chen actually incorporates the principle of "treating heat with cold."

I also treated another person during mid-autumn. He had alternating chills and fever, whole-body yellowing, mental restlessness and heat, and a sensation of cold in the abdomen. Food was not digesting well. His pulse was wiry and hard on the left, and deep and soggy on the right. I was very suspicious and asked about the origin of his illness. He replied that he did not know. After asking about his daily diet and lifestyle, I learned that due to narrow living quarters, he had slept outdoors between June and July, and the area was humid with heavy night dew. I suddenly realized that long-term exposure to dampness had affected the viscera. The Spleen belongs to Earth (Taiyin); prolonged damp stagnation generates cold, leading to indigestion. The Liver and Gallbladder belong to Wood (Shaoyang); prolonged damp stagnation generates heat, compounded by the steaming effect of the harbored ministerial fire. This caused swelling and blockage of the bile duct, leading to reckless bile flow overflowing into the blood and causing yellowing. There was a slight white coating on the tongue, indicating a mild external contraction invading the Triple Burner. The Triple Burner consists of the Hand Shaoyang and Foot Shaoyang, forming a continuous pathway where Qi flows freely, thus explaining the alternating chills and fever. Originally, Chai Hu (Radix Bupleuri) should have been used to harmonize, which would have resolved the chills and fever. Since Yin Chen has properties similar to Chai Hu and is also a Shaoyang herb, and given the yellowing, I used three qian of Yin Chen to replace Chai Hu. I added three qian each of Lian Qiao (Fructus Forsythiae), Bo He Ye (Folium Menthae Haplocalycis), and Sheng Jiang, along with two qian of Gan Cao. After taking the decoction, the patient sweated profusely (Foot Shaoyang should not be induced to sweat, whereas Hand Shaoyang should). The alternating chills and fever ceased, but the yellowing remained. At this point, considering the distinct difference in cold and heat between the left and right pulses, I formulated another prescription.

Yin Chen (Herba Artemisiae Scopariae) three qian, Zhi Zi (Fructus Gardeniae) three qian, Gan Jiang (Rhizoma Zingiberis Secatus) three qian, Bai Zhu (Rhizoma Atractylodis Macrocephalae) three qian (stir-fried), Hou Po (Cortex Magnoliae Officinalis) two qian, Yan Xiao (Natrii Sulfas Calcined) five fen (finely ground).

Decoct the first five herbs in a large cup of water. While hot, dissolve the Yan Xiao powder and take orally.

Rationale of the formula: Zhi Zi and Yin Chen are used to clear heat from the Liver and Gallbladder. Gan Jiang, Bai Zhu, and Hou Po are used to eliminate cold from the Spleen and Stomach. Although the medicinal properties are distinctly cooling and warming, combining them in one formula allows for separate therapeutic actions. Yan Xiao is used because bile duct blockage is often caused by gallstones obstructing the flow of bile into the Small Intestine. Yan Xiao has a dissolving nature; even if gallstones are present in the bile duct, it is not difficult to dissolve them with this herb.