栀子十四枚 大黄一两 枳实五枚 豉一升
右四味,以水六升,煮取三升,分温二服。
【集解】
魏荔彤曰:酒黄疸,心中懊□或热甚而痛,栀子大黄汤主之,盖为实热之邪立法也。
酒家积郁成热,非此不除也。
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酒疸下之,久久为黑疸,目青面黑,心中如啖蒜齑状,大便正黑,皮肤抓之不仁,其
脉浮弱,虽黑微黄,故知之。
【注】
酒疸,心中懊□,或心中热痛,脉沉实者,当下之。若心中热欲吐,脉浮弱者,当吐
之,而反下之则为逆也。若其人素有劳倦,下之则热入于脾,顷时腹满如故,则成谷
疸也。若其人素有女劳,下之则热入于肾,虽黄微黑,久久必变为黑疸也。目青者精
伤也,面黑者肾伤也,心中如啖蒜齑状胃伤也,大便黑色血伤也,皮肤不仁血痹也,
此等证皆因酒疸,脉浮弱者,应吐而反下之之误使然也。
【集注】
赵良曰:酒疸之黑,非女劳疸之黑也,盖女劳之黑,肾气所发也;酒疸之黑,败血之
黑也。因酒之湿热伤脾胃,脾胃不和,阳气不化,阴气不运,若更下之,久久则运化
之用愈耗矣。气耗血积故腐瘀,浊色越出面为黑,味变于心咽作嘈杂,心辣如啖蒜齑
状。荣血衰而不行于皮肤,抓之不仁,输于大肠,便如黑漆,其目青与脉浮弦,皆血
病也。
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诸黄,猪膏发煎主之。
【按】
诸黄,谓一切黄也。皆主猪膏发煎,恐未必尽然。医者审之,此必有脱简也。
【集注】
程林曰:扁鹊有『黄经』、『明堂』有烙三十六黄法,皆后人所未见,唯『圣济总录
』载三十六黄,方论详明,治法始备。今猪膏发煎,能治诸黄,当是黄之轻者,可从
小便而去,至若阴黄、急黄、女劳之属,岂猪膏发煎所能治乎?医者审之。
Zhi Zi (Fructus Gardeniae) fourteen pieces, Da Huang (Radix et Rhizoma Rhei), one tael, Zhi Shi (Fructus Aurantii Immaturus), five pieces, Chi Xiao Dou (Faber Semen Preparatum), one sheng.
The above four ingredients are boiled in six sheng of water until three sheng remain; divide into two warm doses.
[Collected Explanations]
Wei Litong states: For Jiu Huang Dan (Alcohol-induced Jaundice), characterized by Xin Zhong Ao Nao (mental restlessness and discomfort) or severe heat with pain, Zhi Zi Da Huang Tang (Gardenia and Rhubarb Decoction) is the primary treatment. This formula is established to address pathogenic excess-heat.
For individuals habitually consuming alcohol, accumulation and stagnation transform into heat; without this formula, it cannot be eliminated.
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If Jiu Huang Dan is incorrectly treated with purgation, over time it may transform into Hei Dan (Black Jaundice). Symptoms include bluish eyes, black complexion, a sensation in the heart as if eating minced garlic, normal black stool, skin numbness where scratching does not elicit pain, a floating and weak pulse, and although the complexion is black, a faint yellow hue remains, allowing for identification.
[Annotation]
In Jiu Huang Dan, if there is mental restlessness or heat-pain in the heart with a deep and solid pulse, purgation should be employed. If there is heat in the heart accompanied by the desire to vomit, with a floating and weak pulse, emesis should be employed; conversely using purgation constitutes an erroneous counter-treatment. If the patient has a history of physical exhaustion, purgation causes heat to enter the Spleen; shortly thereafter, abdominal fullness persists, resulting in Gu Huang Dan (Grain-induced Jaundice). If the patient has a history of sexual exhaustion, purgation causes heat to enter the Kidney; although the yellowing is slightly black, over time it will inevitably transform into Hei Dan (Black Jaundice). Bluish eyes indicate injury to essence; black complexion indicates injury to the Kidney; the sensation of eating minced garlic indicates injury to the Stomach; black stool indicates injury to blood; skin numbness indicates Blood Bi (Blood Stasis obstruction); these syndromes are all caused by the error of applying purgation instead of emesis when the pulse of Jiu Huang Dan is floating and weak.
[Collected Notes]
Zhao Liang states: The blackness of Jiu Huang Dan differs from that of Nu Lao Dan (Sexual Exhaustion Jaundice). The blackness of Nu Lao Dan originates from Kidney Qi pathology; the blackness of Jiu Huang Dan stems from corrupted and stagnant blood. Alcohol-damp-heat injures the Spleen and Stomach, causing disharmony where Yang Qi fails to transform and Yin Qi fails to circulate. Further incorrect purgation depletes transformation and transportation functions. Qi depletion and blood stasis lead to corruption and瘀 (stasis); turbid colors manifest on the face as black; flavors change in the heart and throat causing zao za (discomfort and hunger pangs), with a burning sensation in the heart like eating minced garlic. Ying Blood (Nutritive Blood) declines and fails to circulate to the skin, causing numbness upon scratching; it flows into the Large Intestine, making stool black as lacquer. Bluish eyes and a floating, wiry pulse are both manifestations of Blood pathology.
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For various types of jaundice, Zhu Gao Fa Jian (Pig Fat and Hair Decoction) is indicated.
[Commentary]
"Various jaundices" refers to all types of jaundice. To claim that Zhu Gao Fa Jian treats all cases is likely not entirely accurate. Physicians must examine this carefully; there must be missing text here.
[Collected Notes]
Cheng Lin states: Bian Que had the "Huang Jing" (Classic of Jaundice), and the "Ming Tang" contains methods for cauterizing thirty-six types of jaundice, which are unseen by later generations. Only the "Sheng Ji Zong Lu" records thirty-six jaundices, with detailed formulas and theories, making treatments complete. That Zhu Gao Fa Jian can treat various jaundices likely applies only to mild cases, which can be expelled via urination. As for Yin Huang (Yin-type Jaundice), Ji Huang (Acute Jaundice), and Nu Lao Dan, can they truly be treated by Zhu Gao Fa Jian? Physicians must examine this carefully.