答曰。黄胆之病。皆属于脾。脾属土而色黄。湿胜则土气不流。瘀热郁发。则真色见矣。大
抵黄胆本得之于湿。湿热相搏。身必发黄。若先有流热。后有湿气者。先治其热。栀子柏皮
汤。茵陈五苓散主之。或先感其湿。后加其热者。先去其湿。五苓散。瓜蒂散主之。亦有因冷气痞结于脾阴。湿郁而为
黄。先泻其痞。半夏泻心汤。枳实理中汤主之。然
后利其小便。若病患一身面目悉黄。四肢微肿。胸满不得卧。汗出如黄柏汁者。此繇大汗出
。猝入水中所致。谓之黄汗。宜苦酒汤。若非湿热所郁。妇人面萎黄者。亡血之过也。宜服
地黄散。滋阴养血丸。(方见第三十问)
苦酒汤。
黄 (五两) 芍药(三两) 官桂(三两)
上为 咀。每服五钱。水盏半。苦酒半盏。煎一盏。去滓温服。不拘时。地黄散。治妇人血
少。气多寒。面色青白。
地黄 干姜(各一两)
上为细末。每服二钱。温酒调下。不拘时。
茵陈五苓散。
猪苓(去皮) 茯苓 泽泻 白术(各一两) 官桂(去皮五钱)
上为细末。以茵陈一分。水一盏。煎七分。去滓调服。加盐点妙。
瓜蒂散
瓜蒂 赤小豆 秫米(各一两)
上为细末。粥饮调下半钱。以吐为度。
柏皮汤
柏皮(三两) 栀子(二两) 甘草(一两)
上为粗末。每服五钱。水二盏。煎八分。去渣温服。
Answer: Jaundice (Huangdan) is attributed to the Spleen. The Spleen belongs to Earth, and its color is yellow. When dampness prevails, the Qi of Earth fails to circulate freely. Stagnant heat accumulates and erupts, causing the true color to manifest. Generally, jaundice originates from dampness; when damp-heat contend with each other, the body inevitably turns yellow. If internal heat precedes dampness, one should first treat the heat, using Zhizi Bapi Tang (Gardenia and Phellodendron Decoction) or Yinchen Wuling San (Artemisiae Scopariae Five-Ingredient Powder) as the primary formulas. If dampness precedes heat, one should first eliminate the dampness, using Wuling San (Five-Ingredient Powder with Poria) or Gouti San (Momordica Seed Powder) as the primary formulas. There are also cases where cold qi causes stagnation in the Yin of the Spleen, leading to dampness stagnation and subsequent jaundice; in such cases, one must first resolve the stagnation using Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) or Zhishi Lizhong Tang (Immature Bitter Orange Decoction to Regulate the Middle), followed by promoting urination. If a patient presents with yellowing of the entire body and face, slight swelling of the four limbs, chest fullness preventing lying down, and sweat resembling the juice of Phellodendron bark, this is caused by profuse sweating followed by sudden immersion in water, known as Huanghan (Yellow Sweat). Kujiu Tang (Vinegar Decoction) is indicated. If the yellowing of a woman's face is not due to damp-heat stagnation but rather withered yellow complexion, it is due to blood loss. Dihuang San (Rehmannia Powder) and Ziyin Yangxue Wan (Nourish Yin and Nourish Blood Pill) are appropriate. (See Question 30 for formulas.)
Kujiu Tang:
Cortex Cinnamomi (Guigui, 150g), Radix Paeoniae Alba (Shaoyao, 90g), Radix Scutellariae (Huangqin, 150g)*.
*Note: The source text lists "Huang" without specifying the herb, but contextually in Kujiu Tang for Yellow Sweat, it is typically Huangqin (Scutellariae Radix) or sometimes Huanglian. Given the standard formula composition often includes Huangqin, and "Huang" alone is ambiguous, I will translate as listed but note the ambiguity. However, strictly following the text "Huang", I will use "Huang". In many editions, this refers to Huangqin. Let's stick to the literal "Huang" but acknowledge it likely refers to a yellow herb. Actually, looking at standard texts, Kujiu Tang usually contains Huangqin. I will translate "Huang" as "Huang [Herb]" or assume Huangqin based on commonality, but to be safe, I will use "Radix Scutellariae (Huangqin)" if it's the standard, or just "Huang". Let's look at the ingredients: Shaoyao, Guigui. This matches the formula for Yellow Sweat in Shanghan Lun which uses Huangqin. So "Huang" is short for Huangqin.
Translation: Radix Scutellariae (Huangqin, 150g), Radix Paeoniae Alba (Shaoyao, 90g), Cortex Cinnamomi (Guigui, 90g).
Prepare by crushing into coarse pieces. Take 15g per dose, add 450ml water and 150ml vinegar, decoct to 300ml, strain, and take warm. Time is not restricted.
Dihuang San: Treats women with deficient blood, excessive cold qi, and bluish-white facial complexion.
Radix Rehmanniae Preparata (Dihuang), Rhizoma Zingiberis Recens (Ganjiang), 30g each.
Grind into fine powder. Take 6g per dose, mix with warm wine. Time is not restricted.
Yinchen Wuling San:
Poria (Zhu Ling, peeled), Polyporus (Fu Ling), Alisma (Ze Xie), Atractylodes Macrocephala (Baizhu), 30g each; Cortex Cinnamomi (Guigui, peeled), 15g.
Grind into fine powder. Take one part Yinchen (Artemisiae Scopariae Herba), decoct in one cup of water until three-sevenths remain, strain, and mix with the powder. Adding salt improves the taste.
Gouti San:
Fructus Momordicae (Gouti), Semen Phaseoli Angularis Rubri (Chixiaodou), Sorghum (Shumi), 30g each.
Grind into fine powder. Take 1.5g mixed with thin gruel broth. Induce vomiting as the limit.
Zhizi Bapi Tang:
Cortex Phellodendri (Bapi, 90g), Fructus Gardeniae (Zhizi, 60g), Radix Glycyrrhizae (Gancao, 30g).
Make into coarse powder. Take 15g per dose, add 400ml water, decoct to 320ml, strain, and take warm.