伤寒发汗已，身目为黄。所以然者，以表有寒里有湿未解也。夫表寒里湿，郁而发黄
，自非热湿内瘀，郁而成黄者比，故不可下。惟当于表寒里湿中求其治法，宜发其表
寒，利其里湿可也。
【集注】
喻昌曰：伤寒发汗已，热邪解矣，何由反蒸身目为黄？所以然者，寒湿搏聚，适在躯
壳之里，故尔发黄也。里者，在内之通称，非谓寒湿深入在里，盖身目正属躯壳，与
藏府无关也。于寒湿中求之，求其寒湿中之治法也。
程应旄曰：其人素有湿邪在里，表寒虽经发汗，而其为里湿所持者，终在里而无从解
散也。发汗后之寒，与湿郁蒸为热，非实热也，故不可下。仍当于寒湿中，责其或浅
或深而治之可也。
@@@
伤寒瘀热在里，身必发黄，麻黄连轺赤小豆汤主之。
【注】
伤寒表邪未解，适遇其人阳明素有湿邪，热入里而与湿合，湿热蒸瘀，外薄肌表，身
必发黄也。若其人头有汗，小便不利，大便□，则或清、或下、或利小便，自可愈也
。今乃无汗小便利，是里之瘀热未深，表之郁遏犹甚，故用麻黄连轺赤小豆汤，外发
其表，内逐其湿也。
【集注】
喻昌曰：伤寒之邪，得湿而不行，所以热瘀身中而发黄，设泥「里」字，岂有邪在里
而反治其表之理哉！
程应旄曰：凡伤寒瘀热在里者，由湿蒸而来，故身必发黄。此之瘀热未深，祗从表一
边开其郁滞，而散除湿热，麻黄连轺赤小豆汤是其主也。
林澜曰：麻黄连轺一证，虽曰在里，必因邪气在表之时，有失解散，今虽发黄，犹宜
兼汗解以治之也。
汪琥曰：夫寒邪自外而来，若挟内湿瘀于经络之中，则郁而变热，故令其人身目发黄
也。此条乃是太阳经传来者，太阳伤寒，理宜用麻黄汤，只因邪传阳明，热瘀于里，
里非胃府，以阳明经居太阳之里，即『尚论篇』所云躯壳之里是也。惟其里有热，所
以方中用麻黄汤而去桂枝之辛热，更加赤小豆、姜、枣之甘辛，以祛散在表之寒湿，
复加连轺、生梓白皮之苦寒，以清解肌里之瘀热也。
After treating Taiyang disease (Taiyang disorder) with sweating therapy, the body and eyes turn yellow. The reason for this is that cold pathogen remains at the exterior while dampness lingers within, neither having been resolved. Since it is cold at the exterior and dampness within, leading to yellowing through stagnation and constraint, it differs from cases where heat-dampness stasis internally causes yellowing; therefore, purgative methods are contraindicated. One should seek treatment principles within the pattern of exterior cold and interior dampness: it is appropriate to release the exterior cold and promote diuresis to drain the interior dampness.
[Collected Annotations]
Yu Chang stated: After sweating therapy for Taiyang disease, the heat pathogen should be resolved. Why does the body and eyes then turn yellow? This occurs because cold and dampness bind and gather within the "shell" of the body (the superficial layers), causing yellowing. Here, "interior" refers generally to the inside, not implying that cold-dampness has deeply penetrated the Zang-Fu organs. The body and eyes belong to the shell, unrelated to the Zang-Fu. Treatment must be sought within the context of cold-dampness, specifically targeting the therapeutic approach for cold-dampness.
Cheng Yingmao stated: The patient inherently possesses dampness pathogen within. Although the exterior cold was addressed by sweating, it remains constrained by the interior dampness and cannot dissipate. The residual cold after sweating combines with dampness to stagnate and transform into heat, but this is not excess-heat; thus, purgatives are contraindicated. Treatment should still address the cold-dampness, adjusting based on whether the pathology is shallow or deep.
@@@
When stagnant heat in Taiyang disease resides within, the body will inevitably turn yellow; Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia Root, and Red Bean Decoction) is the primary formula.
[Annotation]
The exterior pathogen of Taiyang disease has not yet resolved, coinciding with the patient's inherent dampness in the Yangming channel. Heat enters the interior and combines with dampness; the steaming and stagnation of heat-dampness presses outward upon the muscle surface, causing the body to turn yellow. If the patient has sweat on the head, difficulty urinating, and normal bowel movements, one may use clearing heat, purging, or promoting urination methods to achieve recovery. However, in this case, there is no sweat and urination is free, indicating that the interior stagnant heat is not yet deep, but the exterior constraint is severe. Therefore, Ma Huang Lian Qiao Chi Xiao Dou Tang is used to release the exterior and expel dampness from within.
[Collected Annotations]
Yu Chang stated: The Taiyang pathogen, when encountering dampness, cannot circulate freely, causing heat to stagnate in the body and result in yellowing. If one rigidly interprets "interior," how could one treat the exterior when the pathogen is supposedly in the interior?
Cheng Yingmao stated: Cases of stagnant heat in the interior due to Taiyang disease arise from dampness steaming, inevitably causing yellowing. Since this stagnant heat is not deep, one should open the stagnation from the exterior side to disperse the heat-dampness; Ma Huang Lian Qiao Chi Xiao Dou Tang is the principal formula.
Lin Lan stated: Although this syndrome of Ma Huang Lian Qiao is described as "in the interior," it originates from a failure to resolve the pathogen while it was at the exterior. Even though yellowing has occurred, sweating and releasing the exterior should still be combined in treatment.
Wang Hu stated: Cold pathogen enters from outside; if it carries internal dampness to stagnate in the meridians, it transforms into heat through stagnation, causing jaundice of the body and eyes. This clause describes transmission from the Taiyang channel. Taiyang Taiyang disease typically requires Ma Huang Tang (Ephedra Decoction). However, since the pathogen transmitted to Yangming and heat stagnated in the "interior," this "interior" does not refer to the Stomach Fu organ, but rather the interior of the Yangming channel relative to Taiyang, which is what *Shanglun Pian* calls the "interior of the shell." Because there is heat within, the formula uses Ma Huang Tang but removes Gui Zhi (Cinnamon Twig) for its acrid-warm nature, adds Chi Xiao Dou (Adzuki Bean), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube) for their sweet-acrid properties to dispel exterior cold-dampness, and further adds Lian Qiao (Forsythia Fruit/Root) and Sheng Zi Bai Pi (Catalpa Bark) for their bitter-cold properties to clear stagnant heat in the muscle layer.