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Having passed the initial stage, if jaundice develops gradually, it is all due to injury of the Gallbladder (Dan, 胆). The syndrome presents without fire or dampness; the person appears drowsy and fatigued; the complexion is pure yellow as if dyed. This is because injury to the Gallbladder leads to the failure of vital Qi and leakage of body fluids.
The *Classic* states: "All eleven Zang-Fu organs depend on the Gallbladder for their decisions." If the Gallbladder is injured, the generating Qi fails; how can it generate? Therefore, those who suffer from this condition often prove incurable. (Zhang Jingyue)

Yu Huang (Jaundice due to Stagnation)
Jaundice should be treated by resolving stagnation. Anything that does not stagnate does not turn yellow. Yinchen Wuling San (Inula and Poria Decoction) is strictly prohibited; Xiaoyao San (Free and Easy Wanderer Powder) should be used. (Zhao Yangkui)

Xu Huang (Deficiency Jaundice)
For a man with sallow complexion and spontaneous free urination, one should administer Xiao Jianzhong Tang (Minor Construct the Middle Decoction) for deficiency consumption. (*Jin Gui Yao Lue*)
Regarding Xu Huang (Deficiency Jaundice), the symptoms include bland taste in the mouth, palpitations, tinnitus, weak legs, lethargy and lack of strength, slight alternating chills and fever, and turbid, difficult urination. Although the skin is yellow, the fingernails remain normal. This is caused by excessive labor leading to deficiency of both Qi and Blood. One must not recklessly use cold medicines; instead, one should regulate the Middle Jiao and cultivate the Earth (Spleen/Stomach). If the complexion is greenish-yellow with spontaneous free urination, it is called Wood overacting on Earth (Liver overacting on Spleen), and treatment should focus on fortifying the Spleen and suppressing the Liver. (*Zheng Hui Hui Bu*)
If jaundice persists despite prolonged use of exterior-resolving and pathogen-expelling drugs, it should be treated as a deficiency syndrome. Sizijunzi Tang (Four Gentlemen Decoction) should be taken, swallowed with Bawei Wan (Eight-Ingredient Pill). One must not indulge in clearing heat and promoting diuresis, which would ruin Spleen Qi and dry up Kidney Water, inevitably leading to a critical state. (Xu Donggao)
Jaundice caused by external pathogens disappears naturally once the heat resolves. Jaundice caused by internal injury recedes only when deficiency is restored. For exogenous onset in robust constitutions, cooling medications can cure it. For endogenous onset in depleted constitutions, tonification is essential for recovery. (*Hui Xin Lu*)

Post-Illness Jaundice
After various hemorrhages, the face often turns yellow. The human body relies on Blood for nourishment; a ruddy complexion indicates abundant Blood. When Blood is lost, the face reveals yellow, similar to bamboo or wood: green leaves in spring and summer, yellow leaves in autumn, representing the difference between moist and dry states. ○ Jaundice after malaria is common; this is the color of Spleen pathology manifesting on the face. Treatment should regulate the Spleen using Yigong San (Extraordinary Power Powder) added with Huangqi (Astragalus Root) and Bian Dou (Lablab Bean). This applies to jaundice following other illnesses as well, except that the body and face are yellow while the eyes remain unaffected. (Dai Fu'an)
Chronic epigastric pain transforming into jaundice indicates severe depletion of the Spleen and Stomach. Unless there is retained blood stasis internally, there is phlegm-fluid retention mixed within. In cases of deficient heat, saving Spleen Yin is urgent; in cases of deficient cold, saving Stomach Yang is paramount. (*Hui Xin Lu*)

Huang Pang (Yellow Puffy Syndrome / Anemia)
Huang Dan (Jaundice) and Huang Pang (Yellow Puffy Syndrome) are different. In Huang Dan, both eyes and sclera are yellow, with no swelling; Huang Pang involves swelling, the color is yellow mixed with white, the eyes remain normal, and the patient may appear listless. Although the root of both diseases lies in the Spleen, Huang Dan results from damp-heat steaming and stagnating in the Spleen channel; Huang Pang involves less severe damp-heat and is mostly caused by parasite infestation (Gan disease) and food accumulation. Symptoms necessarily include vomiting yellow water, erect hair, or craving raw rice, tea leaves, soil, or charcoal. ○ Laborers who suffer excessive physical strain may develop Huang Pang, commonly known as "Depleted Strength Jaundice," characterized by increased appetite with easy hunger, lethargy, and weakness. Treatment should use Zaofan Wan (Alum and Date Pill). (*Jian Wen Lu*)
Gan Huang (Parasitic Jaundice), commonly known as Huang Pang. Huang Dan is an acute disease; Gan Huang is a chronic disease. Even in persistent cases, although Zaofan Wan is available, it is only suitable for robust laborers. It should not be lightly tried on those accustomed to rich foods and delicate constitutions. (*Zhang Shi Yi Tong*)

Pulse Diagnosis
A deep pulse, thirst with desire to drink, and difficult urination all indicate impending jaundice. A surging pulse with free stool and thirst indicates death. A minute pulse with free urination and no thirst indicates survival. In all jaundice patients, examine the Cun Kou (radial artery); if the pulse is absent near the palm, and breath from mouth and nose is cold, the condition is incurable. Young individuals with strong Qi and robust constitutions, presenting with slippery pulses and firm stools, will recover easily. Elderly individuals with weak Qi, presenting with deficient and choppy pulses and free urination/stool, will be difficult to cure. (*Zhang Shi Yi Tong*)

Selected Cases
A patient suffered from Spleen deficiency abdominal distension and tidal fever at night after labor. Suddenly, his whole body and face turned yellow. After using clearing and draining herbs, the night fever worsened. The pulse was hard, strong, surging, and striking the finger, identified as a Ge Pulse (Leather Pulse). This indicates excess on the exterior but insufficiency on the interior; it cannot be treated as ordinary jaundice. Yellow is the true color of the Spleen. Since he had chronic Spleen deficiency, one should fortify the Spleen and support healthy Qi. Moreover, frequent urination distinguishes this from damp-heat syndromes. The prescription used Renshen (Ginseng Root), Bian Dou (Lablab Bean), Shanyao (Chinese Yam), Chenpi (Tangerine Peel), Fuling (Poria), Gancao (Licorice Root), and Wei Jiang (Baked Ginger). Due to night fever, Danggui (Angelica Sinensis Root) and Danpi (Moutan Bark) were added. Baizhu (Atractylodes Rhizome) was omitted because he previously felt uncomfortable taking it. After the first dose, fever lightened, spirit calmed, and symptoms decreased. Later, high fever returned. Renshen was added, and Banxia (Pinellia Tuber) removed. Fever subsided, but abdominal distension persisted, indicating Spleen deficiency. Baizhu was necessary, but feared to increase distension. Therefore, the mother element (Fire generates Earth) was tonified to promote circulation in the Three Jiao, digest grains, and enhance the action of Renshen and Baizhu. Rougui (Cinnamon Bark) and Fuzi (Prepared Aconite Root) were added. Saliva production resumed, appetite improved, abdomen softened significantly, and he recovered after conditioning. (Wu Tianshi)

Nv Lao Dan (Female Labor Jaundice) originates from Kidney Water deficiency. Water deficiency leads to Earth dryness, resulting in a withered black color. Treatment should strengthen Water (nourish Kidney Yin); when Water is sufficient, Earth is not dry. Yu Tianmin stated: Nv Lao Dan should be treated as Xu Lao (Deficiency Consumption). A patient with this condition was cured after 100 doses of Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) added with Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), Qinjiao (Gentiana Macrophylla Root), Yiren (Coix Seed), and Maidong (Ophiopogon Tuber).

Sun Qushi suffered from jaundice. The physician used Wuling San (Five-Ingredient Powder with Poria) and Yinchen Hao Tang (Artemisia Capillaris Decoction) without effect; switching to warming the Middle led to a critical condition. I reasoned: Yellowing of the eyes first indicates Liver Wood stagnation; black forehead indicates Kidney Water exhaustion; heavy pain in waist and abdomen are signs of extreme Liver-Kidney deficiency. Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) added with Chaihu (Bupleurum Root) and Danggui (Angelica Sinensis Root) showed improvement in four doses and resolution in ten doses. (Cheng Huazhong)

A patient suffered from jaundice with a black forehead and white feces. The physician used Bawei Wan (Eight-Ingredient Pill) to tonify Fire to generate Earth, but failed, and the patient died. I reflected: The forehead belongs to South Li Fire. Seeing black here is a sign of Kidney Water overcoming Heart Fire. Ultimately, it stems from weak Earth failing to control Water, causing Water pathogen to overflow upward into the Heart channel region. White feces belong to Metal, corresponding to Autumn, which governs killing/harvesting; hence death. Analyzing this case, it is衰弱 of Ji Earth (Spleen Earth). If Heart Yang were tonified, rescue might have been possible. (Fang Xingyan)

Prepared Formula
For Huang Pang (Yellow Puffy Syndrome): Hongzao (Red Dates) 4 liang, Zaofan (Alum) 2 liang, Guojiao (Scorched Rice Crust) 3 liang, Heye (Lotus Leaf) 2 liang, Huaimian (Ash Flour) 12 liang. Stir-fry the ash flour until yellow. Boil red dates until cooked, remove skin and pits, take the flesh. Boil scorched rice crust until soft. Decoct alum and lotus leaf in juice. Mash everything together to form pills. Take 3 qian per dose.