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Yinchen (Er Liang, approx. 90g) Fuzi (One piece, processed) Ganjiang (Liang Ban, approx. 75g) Zhigancao (Liang, approx. 30g, honey-fried)

For symptoms of jaundice (yellowing of skin and eyes), pulse that is deep and slow, cold extremities with reversal of cold, and spontaneous sweating above the waist, this formula should be taken cold.

This is jaundice due to a Yin syndrome. When Yin-cold is excessive in the lower part, it forces Yang to float upwards, thus the upper body manifests Yang syndrome signs, while the lower body manifests Yin syndrome signs. Because Yin is excessive in the lower part, a deep and slow Yin pulse is seen, accompanied by the Yin syndrome sign of cold extremities; because Yang floats on top, yellowing of the body (jaundice) characteristic of Yang syndrome and spontaneous sweating of the upper body are seen. Yinchen (Artemisiae Scopariae Herba) is an essential herb for treating jaundice, therefore it is used regardless of whether the condition is cold or hot. Fuzi (Aconiti Lateralis Radix Praeparata), Ganjiang (Zingiberis Rhizoma), and Zhigancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) are key items for restoring Yang, therefore they are used whenever there is Yin-cold. However, the reason for taking them cold is to prevent the acrid-hot nature of Ginger and Aconite from dispersing in the upper Jiao where Yang is abundant, leaving the Yin-cold region in the lower part insufficiently warmed. This formula was used by Han Zhihe, Li Sixun, and Zhu Fengyi (Zhu Gong). If one were to follow Danxi Weng's statement that "there is no need to distinguish among the Five [types], as all are damp-heat," and stubbornly use this formula to treat such cases, would not the medicine contradict the syndrome? The deeds of Han and Li are recorded in *Tangye Bencao*, and those of Zhu Fengyi are found in *Huren Shu*.

Xiaoshi (Niter, calcined, equal parts) Fanshi (Alumen, calcined, equal parts)

Grind both into powder. Mix with barley porridge soup and take one Fangcunbi (approx. 2-3 grams) per dose, three times daily.

Zhang Zhongjing stated in *Jingui Yaolue*: "In patients with jaundice, fever occurs at dusk, yet there is contrary aversion to cold; this is called Nulao Dan (Jaundice due to sexual exhaustion)." It arises from bladder urgency, abdominal fullness, blackening of the forehead, and heat in the soles of the feet, thereby forming Heidan (Black Jaundice). If the abdomen is distended resembling water accumulation, the stool must be black and occasionally loose. This is the disease of Nulao, not Water Disease. Abdominal fullness indicates a difficult-to-treat case. This formula governs it.

When Yang pathogenic factors transmit to the Stomach, heat has no outlet to vent outwards, the color of Earth (yellow) becomes visible, resulting in jaundice, and thus fever necessarily occurs at dusk. The reason for this is that the Qi of Earth flourishes at dusk. Now, since there is contrary aversion to cold, we know this is due to deficiency caused by sexual exhaustion. Deficiency due to sexual exhaustion is attributed to the Kidney. The Bladder is the Interior-Exterior pair of the Kidney. The anterior yin orifice is the opening of the Kidney. When Kidney deficiency allows Yang pathogens to invade, it causes bladder urgency and lower abdominal fullness. Black is the color of Kidney Water in the North. Blackening of the forehead indicates that Kidney disease manifests its true color. Heat in the soles of the feet occurs because the Kidney meridian originates at Yongquan (KI1); when Kidney Water is deficient, Ministerial Fire gathers there, causing heat in the soles. The formation of Black Jaundice occurs because Yang pathogens have completely sunk into the Kidney, and the color of the Kidney fully manifests externally. Abdominal distension occurs because the Kidney meridian runs inside the abdomen, and pathogenic qi occupies it, causing distension resembling water, though it is actually not water. If it were a Water Disease, the stool would be clear and watery diarrhea. Since this is a Kidney disease, the stool must be black and occasionally loose. Generally, the Kidney governs the two excretions; upon illness, the stool becomes black and loose, losing its normal state. This allows us to distinguish it as Nulao disease rather than Water Disease. The reason abdominal fullness is difficult to treat is that abdominal fullness differs from abdominal distension. Abdominal distension is due to the Kidney meridian running in the abdomen, causing external distension. Abdominal fullness is due to the Spleen and Stomach receiving pathogens, failing to transport and transform, leading to internal fullness. The Spleen and Stomach belong to Earth, which can overcome Kidney Water; therefore, it is said to be difficult to treat. Xiaoshi (Natrii Sulfas) and Fanshi (Alumen) are salty and cold. Salty enters the Kidney, and cold overcomes heat; thus, these two substances are used as the main treatment. Mixing with barley porridge soup is done to prevent these two substances from damaging the Stomach Qi. Alas! Master Zhongjing’s exposition of syndromes and formulation of prescriptions is exquisite and precisely appropriate, mostly like this. It is like selecting generals and training soldiers: knowing people and assigning them well leads to success in every attempt, achieving merit without fail. Those who use formulas incompatible with syndromes are like launching a campaign without just cause. Those who use medicines without understanding their properties are like generals who do not know their troops; few among them avoid losing their army and bringing shame to the state. How can they achieve merit?