寇窃发，原易扑灭，若直逼京师重地，乃可危耳。）
子和治一妇，水肿，四肢不举，令以草贮布囊，高支两足而卧，乃服上涌汗
下泄泻之药，自腰以上水觉下行，自足跗以上水觉上行，会于脐下，泄泻而出，病
大减。此法宜知，胜于升提也。
诊法∶内水脉沉，外水脉浮，气胀浮沉无定，（气时外行，时内聚故也。）总以有神（和缓有
力也。）为佳，最忌弦细微弱。
水肿鼓胀死证。腹胀身热（阳盛也）而失血，（则阴亡矣。）四末清（冷也）脱，（瘦也，阴盛可知。）泻
数行，（中亦脱矣。）肿先四肢后入腹，（见前。）利旋肿满，（服下利之药，而旋消旋胀。）
腹筋青，（青胀高
起。）唇黑，（肝伤。）脐突，（脾伤。）阴囊腐，（肾伤。）缺盆、脊背、足心平，（缺盆平心伤，
背平肺伤，足
平肾伤。）掌肿无纹，（心伤。）脉虚涩，（虚涩为血气败。）肿胀逢之总可惊。
病由湿热蒸发，如罨曲相似，遍身头目爪甲皆黄，小便黄赤不利，（有色如姜黄者。）
有外感郁热与素有之湿相蒸，或外感于湿与素有之热相蒸，而发黄者，宜从汗解，
详《伤寒论》。有内生之湿热相蒸者，在上则吐之，在下则下之，利之。然有阳黄阴
黄之分，盖热胜则为阳黄，湿胜而寒则为阴黄，不可概用寒药。内因有由于停食者，
仲景所谓谷疸，寒热不食，（言其人先有寒热之病，则胃不和，故不能食也。）食即头眩，（
强食不化，
浊气上升使然。）心胸不安，久之发黄，（食郁成热，蒸湿而发。）茵陈蒿汤主之。又谓，谷气不消，
胃中苦浊，浊气下流，小便不通，（湿热瘀矣。）身体尽黄是也，（《内经》谓∶已食而饥者
胃疸，乃热
盛湿少，故能消谷，乃胃热非食滞也，与此不同。）此阳黄也。又谓，阳明病脉迟，（胃寒。）食难用饱，
饱则发烦，（饱则不消而烦。）头眩，小便难，此欲作谷疸，（始虽寒，久亦成郁热。）虽下之，腹满
如故，以脉迟故也，（详《伤寒论》·《阳明篇》中。）此阴黄也。有因于酒者，酒性热而质湿，
湿热内瘀，多发黄，仲景所谓鼻燥心中热，脉浮欲吐者，吐之愈。（病属上焦。）又谓，
心中懊 或热痛，不能食，栀子大黄汤主之。（病在中焦。）又谓，或无热，（无外热也，观或
字知有外热者矣。）谵语，小腹满，脉沉者下之。（病在下焦。）又谓，酒疸下之，久久为黑疸，
（病在上焦者应吐，若误下则伤其血分，故血败而见黑色。）目青面黑，（举面目以该周身也。）
心中如淡
蒜状，（辛味刺心。）大便黑，（瘀血之色。）皮肤爪之不仁（血痹于皮肤也。）是也。有由于房劳者，
致肾水虚，相火炎，不特蒸湿成黄，并瘀血变黑，仲景所谓黄家日晡发热，（湿属
脾土，故热发日晡所。）而反恶寒，（伤寒阳明证发热者必不恶寒，乃湿与热瘀痹于内，表阳不宣，
故恶寒也。此
乃辨证之法。）此为女劳得之。膀胱急，少腹满，身尽黄，额上黑，（额最高，火气之所熏故黑。）
足下热，因作黑疸。（先则额黑，后则周身皆黑。）其腹胀如水状，大便必黑，时溏，此女劳
病，非水也，腹满者，难治，（脾肾皆病矣，故难治。）消石矾石散主之。（消石咸寒除热，矾石除痼
热在骨髓，大麦粥调服，恐伤胃也，然此方难用。）又谓，额上黑，微汗出，（湿欲外泄。）手足中热，薄
暮即发，（阴热故暮发。）膀胱急，（血瘀急痛。）小便自利，（可知膀胱之急乃由血瘀。）曰女劳疸是也。
其余所因尚多，而古人止分谷疸、酒疸、女劳疸，及总名之黄胆，与五水中之黄汗
（详水肿篇。）为五，然不必泥，当推展之。仲景谓疸而渴者难治，（热盛。）不渴易治。发于
阴部，其人必呕，（阴者里也，里气逆故呕。）发于阳部，（表也。）其人振寒而热。（湿胜则寒，热胜则热。）
又谓，腹满舌痿，（湿痰壅塞舌本之筋，不得转掉也。或曰舌当作身，湿热伤筋故痿。）躁不得睡。又谓，
诸黄胆，但利其小便，茵陈五苓散主之；脉浮当汗解，桂枝加黄 汤主之。（此方不可
轻用。）又谓肚热，热在里，当下之。又谓腹满，小便不利而赤，自汗出，为表和里实，
当下之，大黄消石丸，此皆言阳黄也。又谓，小便色不变，欲自利，腹满而喘，（此
为寒气痞满，浮热上壅。）不可除热，除热必哕，（干呕也，虚阳为寒所闭，上哕而有声。）小半夏汤主之，
（散寒降逆。）此言阴黄也。阴黄小便清白，大便不实，喜静能卧，脉迟弱无力，身冷自
汗，当以虚寒治之。仲景所谓男子黄，小便自利，与小建中汤。（见劳倦。）王海藏谓，
中州寒生黄，用大小建中，（见劳倦。）不必茵陈，皆气虚之阴黄也。（气虚则脾不运，久
瘀于里，则脾败而色外见，故黄，其黄色必淡。）戴复庵谓，失血后多面黄，或遍身黄，（但不及耳目。）
血不荣也，如竹木春夏叶润则绿，至秋则干黄，宜养荣汤、（见虚损。）十全大补汤，（见
虚损。）妨食者，四君子（见气。）加黄 、扁豆。此血虚之阴黄也。（此为干黄，小便利，四肢不沉重
也。）以上所论黄胆证，《准绳》谓是暴病，（言其黄骤然而见也。）故仲景以十八日为期。
（仲景谓治之十日以上瘥，反剧者难治。十八日乃脾土寄旺于四季之期，十者土之成数，逾十日不瘥，
则旺气就衰，故难愈也。然可不泥。）另有一种病黄者，（其黄以渐见，久而不愈者。）名食劳疳黄，（或由食
积，或由劳倦，或由疳积所致，或名黄胖，胖者，肿也。）大小温中丸、枣矾丸、暖中丸。上前三方，
以针砂、醋之类伐肝，以术、米之类助脾，后一方以矾醋之酸泻肝，（湿热蒸而发胖，如
馒头蒸而起发，矾醋收敛，使之瘦缩，凡收敛即属伐肝。）以枣肉之甘补脾，虚人佐以补剂。按此即
今人所谓黄肿，与黄胆分别处在肿而色带白，眼目如故，不如黄胆之眼目皆黄，（湿
盛则但黄而不亮，热盛则鲜明如橘子，干黄则枯槁不润。盖色润者属水，色光者属火。若色如烟熏，
黄黑晦滞，枯
槁无光，为危证。旧说湿胜如熏黄黑晦，存参。按黑晦即不亮也，然未必枯，若并不润，则是瘀败之
死水，难治矣。）
而不带白，且无肿状，似不必以暴渐分。又黄肿多有虫与食积，有虫必吐黄水，毛
发皆直，或好食生米茶叶之类，用使君子、槟榔、川练、雷丸之类。食积则用消食
药，剂中不可无针砂，消积平肝，其功最速，治法亦与黄胆有别也。又有温疫发黄，
详温疫门。又有瘀血发黄，身热小便利，大便黑，脉涩，桃仁承气汤（见血），下尽黑物
愈。又有身不黄，独目黄者，《经》云∶风气自阳明入胃，循脉而上至目 ，
其人肥，风气不得外泄，则为热中而目黄。青龙散主之。（按此亦举隅之论耳。）
治法∶丹溪谓，五疸不必细分，概以湿热治之。养胃化疸汤∶茵陈、苍术、木
通、泽泻、猪苓、山栀、白茯苓、薏苡仁。食滞加神曲、山楂、麦芽。酒疸加苜蓿、
葛根。女劳疸加当归、红花活血。有神验方∶黄蜡、香油摊膏，长六寸，箸头
卷，湿面二指浓，大如掌，中以指穿一孔，对脐贴，将膏卷入孔，燃火熏，最久者
九条立愈。谷疸，红丸子（见伤饮食）、《宝鉴》茵陈栀子汤、谷疸丸。酒疸，栀子大黄
汤、葛根煎汤，或栀子仁煎汤调五苓散，（见伤湿。）或生料五苓散加干葛一钱，或葛花
解酲汤。（见伤饮食。）酒疸变成腹胀，渐至面目周身俱肿，霍脾饮加木香、麦芽各五分。
女劳疸，加味四君子汤、（大便不健者宜。）滑石散、（小便不利者宜。）肾疸汤。病后脾气虚而
黄者，异功散（见气）加黄 、扁豆各一钱。黑疸多危，急用土瓜根一斤，捣碎，绞汁六
合，顿服，当有黄水从小便出再服之。目黄不除，瓜蒂散（见伤饮食）搐鼻取黄水。
(When bandits first rise, they are originally easy to suppress; however, if they directly threaten the capital, a critical danger arises.)
Zihe treated a woman suffering from edema, whose limbs were immobile. He instructed her to lie supine with her feet elevated high on bags filled with grass, and then administered emetic, diaphoretic, and purgative medicines. She perceived the fluid in her upper body (waist and above) flowing downward, and the fluid in her lower body (dorsum of foot and above) flowing upward, converging below the navel, and being expelled through diarrhea. Her condition improved significantly. This method is worth knowing and is superior to simple lifting therapies.
Diagnostic Methods: The pulse for internal water retention is deep (Chen); for external water retention, it is floating (Fu). For Qi distension, the pulse varies between floating and deep without fixed pattern (because Qi moves outward at times and gathers inward at others). Generally, a pulse with "Shen" (spirit/vitality, meaning gentle and forceful) is auspicious. Pulses that are string-taut (Xian), fine (Xi), minute (Wei), or weak (Ruo) are most taboo.
Edema and Drum Distension are fatal when presenting as follows: Abdominal distension with body fever (excess Yang) accompanied by hemorrhage (indicating Yin collapse); cold extremities and emaciation (cold indicates excess Yin); frequent diarrhea (Middle Qi collapse); swelling starting in the four limbs and then entering the abdomen (see previous text); swelling subsiding and re-accumulating immediately after purgatives (服下利之药，而旋消旋胀); exposed and raised abdominal veins (Qing Zhang); black lips (Liver injury); protruding umbilicus (Spleen injury); rotting scrotum (Kidney injury); flat supraclavicular fossa, back, and sole of foot (flat supraclavicular fossa indicates Heart injury; flat back indicates Lung injury; flat sole indicates Kidney injury); swollen palms with no creases (Heart injury); deficient and choppy pulse (Xu Se indicates blood and Qi exhaustion). Encountering these signs in swelling diseases is always alarming.
Jaundice arises from damp-heat evaporation, similar to fermenting qu. The whole body, head, eyes, and nails turn yellow; urine is yellow-red and difficult to pass (color like turmeric). If caused by external constrained heat steaming with inherent dampness, or external dampness steaming with inherent heat, treatment should focus on resolving via sweating (Han Jie); see *Shanghan Lun*. If caused by internally generated damp-heat steaming each other, treat those above by vomiting, and those below by purging or promoting urination. However, Jaundice is divided into Yang Jaundice and Yin Jaundice. Heat dominance leads to Yang Jaundice; dampness dominance with cold leads to Yin Jaundice. Cold medicines cannot be used indiscriminately.
Internal causes include food stagnation, known by Zhang Zhongjing as Grain Jaundice (Gu Dan). Symptoms include alternating chills and fever, anorexia (meaning the patient had prior chills/fever causing stomach disharmony, hence inability to eat), dizziness upon eating (forced ingestion leads to indigestion and turbid Qi rising), chest discomfort, and eventual yellowing after time (food stagnation generates heat, steaming dampness). The main formula is Yinchen Hao Tang. It is also stated: When grain Qi fails to digest, the stomach suffers from turbidity; turbid Qi flows downward, urine becomes obstructed (damp-heat stasis), and the whole body turns yellow. (*Neijing* states: feeling hungry after eating is Stomach Jaundice, due to excess heat and little dampness, allowing digestion; this is Stomach Heat, not food stagnation, and differs from the above). This is Yang Jaundice.
Also stated: In Yangming disease, a slow pulse (Chi) indicates Stomach Cold. One cannot eat to fullness; feeling full causes irritability (indigestion causes vexation), dizziness, and difficulty urinating. This suggests impending Grain Jaundice (initially cold, but long-term stagnation generates heat). Even if purged, abdominal fullness remains due to the slow pulse (see *Shanghan Lun · Yangming Chapter*). This is Yin Jaundice.
Caused by alcohol: Alcohol is hot in nature and damp in substance. Internal damp-heat stasis often causes yellowing. Zhang Zhongjing states: nasal dryness, heart vexation/heat, floating pulse, and desire to vomit indicate upper Jiao pathology; treat by vomiting. Also: heart vexation or painful heat, anorexia; main formula Zhi Zi Da Huang Tang (pathology in Middle Jiao). Also: or no external heat (the word "or" implies presence of external heat in other cases), delirium, lower abdominal fullness, deep pulse; treat by purging (pathology in Lower Jiao). Also: Purging Wine Jaundice improperly leads to Black Jaundice over time (Upper Jiao pathology should be vomited; improper purging damages Blood aspect, leading to blood decay and black appearance). Blue eyes, black face (representing the whole body), sensation of raw garlic in the heart (pungent taste irritating the Heart), black stool (color of blood stasis), skin numbness to pinprick (Blood Bi in skin).
Caused by sexual exhaustion: Leads to Kidney Water deficiency and Ministerial Fire flaring. Not only does it steam dampness to cause yellowing, but blood stasis turns black. Zhang Zhongjing states: Jaundice patients having afternoon fevers (Dampness belongs to Spleen Earth, so heat manifests at Shen hour 3-5 PM), yet paradoxically fearing cold (Yangming heat usually does not fear cold; here damp-heat blocks interior, preventing exterior Yang from venting, hence fearing cold. This is a differentiation method). This is Female Labor Jaundice (Nu Lao Dan). Urgency in bladder, fullness in lower abdomen, whole body yellow, black forehead (forehead is highest, steamed by fire Qi so it turns black), hot soles, resulting in Black Jaundice (first forehead black, then whole body black). Abdomen looks like water accumulation, stool must be black, occasionally loose. This is Female Labor Disease, not Water Disease. If abdominal fullness exists, it is difficult to treat (Spleen and Kidney both diseased). Main formula: Xiaoshi Fanshi San (Xiaoshi is salty/cold to remove heat; Fanshi removes stubborn heat in marrow; taken with Barley Porridge to protect Stomach, though this formula is hard to use). Also: Black forehead, slight sweating (dampness trying to exit), heat in hands/feet, evening onset (Yin heat manifests at dusk), bladder urgency (blood stasis pain), free urination (bladder urgency is due to blood stasis). This is Female Labor Jaundice.
Other causes are numerous, but ancients only classified Grain Jaundice, Wine Jaundice, Female Labor Jaundice, and the general term Yellow Dan, along with Yellow Sweat from the Five Waters (see Edema chapter), totaling five. However, one should not be rigid but expand understanding. Zhang Zhongjing says: Jaundice with thirst is difficult to treat (excess heat); without thirst, easy to treat. Manifesting in Yin parts (Interior), the person vomits (Yin means Interior, Interior Qi rebels causing vomiting). Manifesting in Yang parts (Exterior), the person shivers with cold then has fever (Damp dominance causes cold, Heat dominance causes heat). Also: Abdominal fullness, tongue flaccidity (damp-phlegm blocks tendons at base of tongue; some say tongue should be body, damp-heat injures tendons causing flaccidity), restlessness unable to sleep. Also: All Jaundices, primarily promote urination; main formula Yinchen Wuling San. If pulse is floating, resolve via sweating; main formula Guizhi Jia Huangqi Tang (do not use lightly). Also: Belly heat, heat in Interior, purge. Also: Abdominal fullness, difficult/chief urine, spontaneous sweating, indicates Exterior harmonious and Interior excess, purge; main formula Dahuang Xiaoshi Wan. These all refer to Yang Jaundice.
Also: Urine color unchanged, desire for spontaneous diarrhea, abdominal fullness with wheezing (Cold Qi obstruction with floating heat rushing up). Do not clear heat; clearing heat will cause hiccups (dry retching, deficient Yang blocked by cold, rushing up with sound). Main formula Xiao Banxia Tang (dispel cold, descend rebellion). This refers to Yin Jaundice. Yin Jaundice features clear/white urine, loose stools, preference for quiet/rest, slow/weak/powerless pulse, cold body with spontaneous sweating. Treat as Deficient-Cold. Zhang Zhongjing states: Male Yellow, free urination; use Xiao Jianzhong Tang (see Fatigue/Labor). Wang Haicang states: Cold in Central Jiao produces Yellow; use Da/Xiao Jianzhong Tangs (see Fatigue/Labor), no need for Yinchen. These are all Qi-deficient Yin Jaundice (Qi deficiency leads to Spleen failure to transport; long-term stasis in Interior leads to Spleen failure and color manifesting externally as yellow, which must be pale). Dai Fu'an states: After blood loss, many have yellow face or whole body yellow (excluding eyes/ears), due to Blood failing to nourish. Like bamboo/wood leaves green/moist in spring/summer, but dry/yellow in autumn. Use Yangrong Tang (see Deficiency Damage), Shiquan Dabu Tang (see Deficiency Damage). If appetite hindered, use Sijunzi Tang (see Qi) plus Huangqi, Bian Dou. This is Blood-deficient Yin Jaundice (this is Dry Yellow, free urination, limbs not heavy).
Regarding the above discussed Jaundice syndromes, *Zhunsuo* calls it an acute disease (yellow appears suddenly), so Zhang Zhongjing sets a limit of 18 days. (Zhang says: if cured within 10 days, good; if worsening after 10 days, difficult. 18 days is the period when Spleen Earth thrives in the four seasons; 10 is the completion number of Earth. Beyond 10 days without cure, thriving Qi declines, hence difficult. But do not be rigid.)
Another type of "Yellow" disease (yellow appears gradually, persists long): Named Food-Labor Gai Yellow (caused by food stagnation, labor fatigue, or Gai accumulation; also called Huang Pang, where Pang means swelling). Use Da/Xiao Wenzhong Wan, Zaofan Wan, Nuanzhong Wan. The first three formulas use Zhen Sha (Needle Sand) and Vinegar to subdue Liver, and Baizhu/Rice to assist Spleen. The last formula uses Fanshi/Vinegar acid to drain Liver (damp-heat steams causing swelling like rising dough; vinegar/fanshi astringe to shrink it; astringing is subduing Liver), and Jujube flesh sweetness to tonify Spleen. For deficient persons, add tonics. This corresponds to modern "Huangzhong" (Yellow Swelling). Difference from Huangdan: Huangzhong is swollen with white-tinged hue, eyes remain normal, unlike Huangdan where eyes are fully yellow (Damp excess is dull yellow; Heat excess is bright like orange; Dry yellow is withered/dry. Moist color belongs to Water; Lustrous color belongs to Fire. If color is like smoke-stained, dark/black/dull/withered/lusterless, it is critical. Old theory says damp excess like smoked yellow/black/dull; keep for reference. Dark/dull means not bright, but not necessarily withered; if also not moist, it is dead stagnant water, difficult to treat), and lacks whiteness/swelling. Perhaps distinction by acute vs gradual is unnecessary.
Furthermore, Huangzhong often involves parasites and food stagnation. Parasites cause vomiting of yellow water, straight hair, craving raw rice/tea. Use Shijunzi, Binglang, Chuanlian, Leiwan. Food stagnation uses digestive herbs; Zhen Sha must be included to reduce accumulation and calm Liver, acting fastest. Treatment differs from Huangdan.
There is also Warm Epidemic Yellowing (see Warm Epidemic section). There is Blood Stasis Yellowing: body heat, free urination, black stool, choppy pulse; use Tao Ren Chengqi Tang (see Blood), until black material is passed, then cured. There is case where body is not yellow, only eyes are yellow. *Jing* says: Wind Qi enters Stomach from Yangming, follows meridian up to eye corner. Obese people cannot vent wind Qi externally, leading to Heat in Middle and yellow eyes. Main formula Qinglong San (note: this is merely an illustrative example).
Treatment Methods: Danxi states: Five Jaundices need not be finely distinguished; generally treat damp-heat. Yangwei Huadan Tang: Yinchen, Cangzhu, Mutong, Zexie, Zhuling, Shanzhi, Baifuling, Yiyiren. Add Shenqu, Shanzha, Maiya for food stagnation. Add Muxu, Gegen for Wine Jaundice. Add Danggui, Honghua for blood circulation in Female Labor Jaundice.
Divine Efficacy Formula: Beeswax and Sesame Oil made into plaster, 6 cun long, rolled around chopstick, wet flour two fingers thick, palm-sized, hole poked in center. Apply to umbilicus, roll plaster into hole, ignite and fumigate. Max 9 strips for immediate cure.
Grain Jaundice: Hong Wanzi (see Food Injury), *Baojian* Yinchen Zhizi Tang, Gudan Wan.
Wine Jaundice: Zhi Zi Da Huang Tang, Gegen decoction, or Zhiren decoction mixed with Wuling San (see Damp Injury), or Raw Material Wuling San plus Gan Ge 1 qian, or Gehua Jieying Tang (see Food Injury).
If Wine Jaundice turns to abdominal distension, gradually swelling face/body: Huopi Yin plus Muxiang, Maiya 5 fen each.
Female Labor Jaundice: Jiawei Sijunzi Tang (for loose stools), Huashi San (for difficult urination), Shendan Tang.
Post-illness Spleen Qi deficiency causing yellow: Yigong San (see Qi) plus Huangqi, Bian Dou 1 qian each.
Black Jaundice is critical. Urgently use Tugua Gen 1 jin, crush, juice 6 he, take in one dose. Yellow water should pass via urine, then repeat. If eye yellow persists, use Guiti San (see Food Injury) insufflated into nose to extract yellow water.