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Yu Jiayan stated: The *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) mentions: If the Duyang pulse (foot dorsalis pedis artery, reflecting Spleen and Stomach Qi) is tight and rapid, rapid indicates heat, and heat consumes grain (causing hunger); tight indicates cold, and cold causes abdominal fullness after eating. A floating Chi pulse (wrist radial pulse position reflecting Kidney Qi) indicates Kidney injury, and a tight Duyang pulse 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 stagnation, turbid qi flows downward, causing urinary obstruction. The Yin aspect is invaded by cold, while heat knots in the Bladder, resulting in whole-body yellowing, termed Grain Jaundice (jaundice caused by dietary internal injury). This discussion on the pathogenesis of jaundice due to internal injury is truly pioneering.

Generally, the human Spleen and Stomach reside in the central Earth element. The Spleen's Earth has a Yin substance but Yang function; the Stomach's Earth has a Yang substance but Yin function. When harmonized, they are neither rigid nor soft; the Stomach receives grain food, the Spleen transports grain qi, regulates water passages, and irrigates all vessels. Only when excessive internal injuries—such as emotional excess, irregular diet, or sexual exhaustion—occur do the Yin and Yang of the Spleen and Stomach fail to harmonize. If the Stomach leans toward Yang without Spleen Yin to harmonize it, like nature having summer without winter, it gathers heat alone and consumes grain; if the Spleen leans toward Yin without Stomach Yang to harmonize it, like nature having winter without summer, it gathers cold alone and causes abdominal fullness. In such cases, the patient's Duyang pulse will show tightness (cold) and rapidity (heat), providing clear evidence. Palpating only tight or only rapid pulses reveals whether the disease is governed separately by the Spleen or Stomach; palpating both tight and rapid together reveals joint involvement. The medical principle is exquisite.

More subtly, palpating a floating Chi pulse indicates concurrent Kidney injury. Since the Kidney pulse should normally be deep, why does it float? Because the Kidneys store Essence, which is generated from grain. If the Spleen fails to transport Stomach grain qi into the Kidneys, Essence lacks support and the Kidneys are injured, causing the pulse to change from deep to floating. Knowing that a floating Chi pulse indicates Kidney injury allows one to know that a tight Duyang pulse indicates Spleen injury. However, a tight pulse is characteristic of the Liver pulse, just as Zhang Zhongjing stated that tight equals wiry, resembling a bowstring. The Spleen pulse is naturally relaxed; when subjected to Liver Wood overacting, it becomes tight. Liver wind qi attacks the cold gathered in the Spleen, contending with each other, causing dizziness upon eating. This means grain entering the Stomach fails to nourish Stomach Yang but instead disturbs Spleen Yin. The heat gathered in the Stomach for digestion merely steams into foul qi rather than essence-clear qi. Turbid qi from Stomach heat flows down into the Bladder, heating it, stopping Qi transformation, causing urinary obstruction, and turning the body yellow. Turbid qi from Spleen cold flows down into the Kidneys, injuring them with cold, and combined with the residual effect of Liver overacting, causes abdominal fullness.

Ultimately, Grain Jaundice is mostly caused by Stomach heat injuring the Bladder; cases caused by Spleen cold injuring the Kidneys account for only two or three out of ten. If dietary injury affects the Spleen compounded by sexual exhaustion injuring the Kidneys, symptoms will inevitably include abdominal fullness and be difficult to treat.

Jaundice arises from damp-heat of Fire (Heart/Heat) and Earth (Spleen/Dampness). If combined with the dryness of the Hand-Yangming Large Intestine meridian, dampness, heat, and dryness contend to produce jaundice, and the patient will likely feel thirsty and desire water. With this symptom, moistening herbs must be added to the damp-heat clearing formula so that Sanjiao Qi transformation can proceed, fluids can circulate, thirst resolves, and jaundice recedes. If thirst persists, dryness remains. However, this is not a death omen. It is also said that jaundice with thirst is difficult to treat, implying fear of depletion of the lower source (Kidney water), not just middle Jiao fluid deficiency.

Zhang Zhongjing stated that for most jaundice cases, promoting urination is sufficient. If the pulse is floating, sweating should be used to release the exterior, suitable for Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus). Thus, the general rule is to promote urination; only when the pulse is floating can exterior release be considered. However, jaundice pulses often show Ying and Wei Qi deficiency with damp-heat taking advantage to cause floating. Therefore, Guizhi Jia Huangqi Tang is used to harmonize Ying and Wei, and Xiaochaihu Tang (Minor Bupleurum Decoction) to harmonize interior and exterior. Taking harmonization as the method for exterior release is Zhang Zhongjing's subtle intent.

When damp-heat stagnation and steaming cause jaundice, purgation from below may be indicated, following Shaoyang/Shanghan methods, applicable only for interior heat excess. For severe cases, Dahuang Xishi Tang (Rhubarb and Niter Decoction) sweeps away damp-heat, similar to Dachengqi Tang; for milder cases, Zhizi Dahuang Tang (Gardenia and Rhubarb Decoction) clears and purges slightly, similar to Sanhuang Tang; for the mildest, Yinchenshao Tang (Artemisiae Scopariae Decoction) uses clearing as the primary action with slight rhubarb as an assistant, similar to adding rhubarb pieces to Zhizi Chitang. Thus, sweating is certainly not to be used lightly, nor is purgation to be applied carelessly, because jaundice often involves internal injury requiring protection.

However, jaundice varies: some have more dampness than heat, some more heat than dampness, some no damp-heat at all. These must be distinguished. Zhang Zhongjing feared internal injury in jaundice, hence cautioning against sweating, vomiting, and purging. He used Xiao Jianzhong Tang (Minor Construct the Middle Decoction) for men with jaundice and spontaneous urination, indicating no interior damp-heat, but rather damage to Yang from frequent intercourse causing deficient Yang to float upward. Thus, he did not treat the jaundice directly but harmonized Ying and Wei to gather Yang, allowing jaundice to resolve spontaneously, akin to treating Shanghan with little pathogen and much deficiency causing palpitations and irritability using Jianzhong methods.

If urine is originally yellow-red and lightens after treatment, recognize that latent heat was minimal. If stool tends toward diarrhea with abdominal fullness and upper body wheezing, recognize that Spleen dampness was originally abundant. If cold herbs were overused, urgently use Xiaobanxia Tang (Minor Pinellia Decoction) to warm the Stomach and dry dampness. Further clearing heat would remove non-existent heat, causing Stomach cold and hiccups. This is another scenario.

Jaundice patients often experience fever during the Ding hour (3-5 PM) with aversion to cold, indicating Female Labor Jaundice (jaundice from sexual exhaustion). Bladder urgency, abdominal fullness, whole-body yellowing, black forehead, and hot soles constitute Black Jaundice. If abdominal distension resembles water accumulation, stools are black and loose, this is Female Labor disease, not water retention. Abdominal fullness is difficult to treat. Men transform blood into essence; essence movement moves all blood. Sexual exhaustion depletes essence, leading to blood loss. Hematuria from sexual labor is easier to treat as blood still flows; jaundice from sexual labor involves stagnant blood, making it difficult. Severe long-term blood stasis forms Blood Distortion (Xue Gu), extremely critical. Urgent removal of bladder and lower abdominal blood stasis is essential for survival. However, accumulated blood from Female Labor Jaundice is not formed overnight; harsh attack is useless. *Jingui Yaolue* uses Xiaoshi Fanshi San (Niter and Alum Powder), utilizing the fierce nature of minerals to reach the disease site quickly. Niter is cold, salty, enters blood, and drives out stasis (Chief herb); Alum clears entrenched heat in marrow, cleanses Kidney and Bladder organs, and eliminates stasis and turbidity. This is the brilliance of this formula.

Zhu Danxi stated: Jaundice need not be divided into five types; all are damp-heat. Add Huangqin and Huanglian for more heat; otherwise, prioritize promoting urination. Once urination flows, jaundice recedes.

Zhao Yuhuang stated: Regarding jaundice, the Classics say: Central color is yellow, connecting to the Spleen. Spleen belongs to Earth, color yellow, extending to muscles, corresponding to damp transformation. Now, if Taiyin pathogenic qi is rampant, damp stagnation and heat steaming,郁结 not releasing, like yeast fermenting, results in yellow color, which is the pathology. Treatment differs between sweating/purging and tonifying/draining. Modern practitioners use Pingwei San, Wuling San, or Yinchenshao Tang, focusing only on clearing heat and draining dampness. While effective for damp-heat in intestines/stomach, if damp-heat is trapped in skin/muscles unable to vent, overuse of draining herbs causes damp-heat to sink inward.

Zhang Zhongjing treated body heat with jaundice using Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Adzuki Bean Decoction), aiming to urgently release the exterior so heat dissipates outward. Critics who only see descending properties in formulas but miss ascending ones misunderstand the theory.

For those with chronic Spleen deficiency, excessive cold herbs, clear urine, loose stools, fatigue, weak spirit, fine pulse, and poor appetite, these are signs of extreme Taiyin Spleen Qi deficiency with true color appearing externally. Use Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) with minor additions of Cheqianzi and Fuling. For heat excess, Lianli Tang (Scutellaria and Ginger Decoction) is suitable.

Currently, practitioners often fail to distinguish deficiency/excess or interior/exterior, indiscriminately using cold and draining herbs. They do not realize that deficient Spleen/Stomach cannot tolerate cold, which further damages Middle Qi; weak Spleen/Stomach cannot tolerate descending, which loses Yin through excessive downward flow. Whether attacking or tonifying, ascending or descending, flexibility according to circumstances is key.