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The pulse at the Cun Kou (radial artery proximal crease) is floating and slow. Floating indicates wind, while slow indicates bi-syndrome (obstruction syndrome). This bi-syndrome is not wind-stroke. The patient suffers from vexation in the four limbs. The color of the spleen manifests as yellow, and stagnant heat circulates throughout the body.

The pulse at the Fu Yang (dorsalis pedis artery) is tight and rapid. Rapid indicates heat; heat consumes grain (causing hunger), so the patient can eat much. Tight indicates cold; cold causes fullness immediately after eating. A floating pulse at the Chi position (radial artery distal crease) indicates kidney injury. A tight pulse at the Fu Yang position indicates spleen injury. Wind and cold pathogens contend with each other. After eating, dizziness occurs. Grain qi fails to digest. The stomach suffers from turbid qi accumulation. Turbid qi flows downward into the bladder, causing urinary obstruction. Yin is affected by cold, while heat flows into the bladder. The entire body turns yellow. This is named Gu Dan (Grain Jaundice). If the forehead is black, there is slight sweating, heat in the hands and feet, onset in the evening, bladder urgency, but spontaneous urination, this is named Nu Lao Dan (Female Labor Jaundice). If the abdomen is swollen like water retention, it is incurable. If there is mental restlessness and heat (Ao Nao), inability to eat, and occasional desire to vomit, this is named Jiu Dan (Wine Jaundice).

[Annotation]
A floating and slow pulse at Cun Kou, where floating indicates wind and slow indicates bi-syndrome, and bi-syndrome is not wind-stroke, has been discussed in detail previously. Now, with a tight and rapid pulse at Fu Yang and a floating pulse at Chi, along with vexation in the four limbs and yellowing of the body and face, this is jaundice. Yellow is the color of Earth. Earth disease manifests here. Earth corresponds to the Spleen and Stomach. The Spleen is Yin Earth governing dampness; the Stomach is Yang Earth governing heat. Therefore, all cases of jaundice are due to dampness stagnation and heat depression. When circulating externally, it necessarily causes vexation in the four limbs and yellowing of the body and face. Generally, if the person has pre-existing damp-heat, combined externally with wind-cold contention, or injured internally by sexual exhaustion, or through improper diet and alcohol consumption, interacting with dampness or heat, all can cause this disease. If the Stomach pulse is rapid, heat exceeds dampness, transforming via Stomach Yang heat. Heat consumes grain, so the patient can eat; this is called Yang Huang (Yang Jaundice). If the Stomach pulse is tight, dampness exceeds heat, transforming via Splein Yin cold. Cold prevents eating, causing fullness upon eating; this is called Yin Huang (Yin Jaundice). Yang Huang includes Re Dan (Heat Jaundice) and Jiu Dan (Wine Jaundice). Yin Huang includes Nu Lao Dan (Female Labor Jaundice) and Gu Dan (Grain Jaundice). If the Chi pulse is not deep but floating, it indicates kidney injury. Kidney disease causing jaundice is also Nu Lao Dan. If the Stomach pulse is not slow but tight, it indicates spleen injury. Spleen disease causing jaundice is also Gu Dan. Gu Dan presents with fullness upon eating, failure of grain qi to digest, suffering from turbid qi in the stomach, obstruction of essence qi from ascending, causing dizziness; turbid qi flows to the bladder, causing urinary obstruction. Nu Lao Dan presents with a black forehead (color of kidney disease); slight sweating indicates dampness is not stagnant; heat in the five centers (palms, soles, chest) occurring in the evening indicates kidney yin heat; bladder urgency with free urination indicates lower jiao deficiency. Abdominal fullness resembling water retention indicates dual failure of spleen and kidney, hence termed incurable. If there is mental restlessness and heat, inability to eat, occasional vomiting, lower abdominal fullness, and urinary difficulty, even if the eyes appear greenish-black and the face black, it must be Jiu Dan (Wine Jaundice).

If the pulse is deep, there is thirst with desire to drink water, and urinary difficulty, jaundice will ensue.

[Annotation]
A deep pulse indicates interior syndrome. Thirst with desire to drink indicates heat stagnation. Urinary difficulty indicates dampness depression. Heat stagnation and dampness depression within the interior cause jaundice. The first clause states that floating, slow, tight, and rapid pulses all cause jaundice, indicating an external etiology. This clause states that a deep pulse also causes jaundice, indicating an internal etiology. Thus, treating jaundice involves two methods: diaphoresis (sweating) and purgation.

[Collected Annotations]
Li [Name Redacted] said: With a deep pulse and thirst, desiring to drink, and urinary difficulty, damp-heat accumulates internally without a way to dissipate, causing jaundice.

If jaundice is accompanied by thirst, it is difficult to treat; if jaundice is not accompanied by thirst, it is treatable. If originating from the Yin aspect, the patient will certainly vomit; if originating from the Yang aspect, the patient will experience chills and fever.

[Annotation]
Before jaundice forms, urinary difficulty with thirst indicates impending jaundice. After jaundice forms, persistent thirst indicates deep-seated heat, making it difficult to treat. Lack of thirst indicates shallow heat即将 resolving, making it treatable. Jaundice originating from Yin causes vomiting/reversal of Qi, due to interior Yin pathology. Jaundice originating from Yang causes chills and fever, due to exterior Yang pathology. Here, thirst versus no thirst distinguishes between difficult and treatable jaundice; vomiting versus chills/fever distinguishes between jaundice in the exterior and interior.

[Collected Annotations]
Cheng Lin said: In jaundice cases, damp-heat contends. There may be dry mouth and nose but not reaching thirst. Thirst implies internal consumption of fluids and dominance of pathogenic factors. No thirst implies fluids are not exhausted and healthy Qi is not weak, distinguishing the ease or difficulty of treatment. Yin governs the interior; dampness dominating the interior causes vomiting. Yang governs the exterior; heat dominating the exterior causes chills and fever. This clause differentiates jaundice based on thirst, indicating differences in severity and location (exterior/interior).
You Yi said: Jaundice with thirst means heat is blazing and dampness increases daily, hence difficult to treat. No thirst means heat has subsided and dampness naturally dissipates, hence treatable. "Yin parts" refer to interior zang-fu organs related to Qi, hence vomiting. "Yang parts" refer to exterior body shell related to form, hence chills and fever. This is a differentiation of Yin/Yang, interior/exterior, shallow/deep, and mild/severe.

Abdominal fullness, flaccid yellow body, restlessness preventing sleep, belongs to the category of jaundice patients.

[Commentary]
The character "tongue" (She) in "flaccid yellow tongue" should be "body" (Shen), likely a transcription error.

[Annotation]
Flaccid yellow body, abdominal fullness, and restlessness preventing sleep belong to the disease of jaundice patients. It is an interior condition and should be treated with purgation.

[Collected Annotations]
Xu Bin said: Abdominal fullness is an interior sign. If abdominal fullness is accompanied by a flaccid yellow body and restlessness preventing sleep, this is stagnant heat moving outward, a precursor to jaundice. Hence, it says: belongs to jaundice patients.

For all jaundice patients, promoting urination is the primary method. However, if the pulse is floating, it should be resolved through diaphoresis. Gui Zhi Jia Huang Qi Tang (Cinnamon Twig Decoction plus Astragalus) should be administered.

[Annotation]
"All jaundice patients" refers to all cases of jaundice. Jaundice does not have distinct exterior or interior signs initially. If heat is excessive with thirst, clear heat. If dampness is excessive with urinary difficulty, promote urination. If the pulse is floating, the pathogen is in the exterior, requiring diaphoresis. Gui Zhi Jia Huang Qi Tang is indicated. From this, we can infer that if the pulse is deep, the pathogen is in the interior, requiring purgation.

[Collected Annotations]
Gao Shishi said: Promoting urination is the fixed method for jaundice, hence "all jaundice patients, only promote urination." However, some cases suit diaphoresis, hence "if the pulse is floating, it is in the exterior, resolve via sweating." The method for diaphoresis is Gui Zhi Jia Huang Qi Tang. Use Gui Zhi Tang (Cinnamon Twig Decoction) to release the muscle layer; once the muscle layer is released, sweat occurs naturally. Add Huang Qi (Astragali Radix) to assist the exterior. When the exterior harmonizes, Ying and Wei (Nutritive and Defensive Qi) also flow smoothly.