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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the body aches and the complexion is slightly yellow, the dental plaque is yellow, and the nails are yellow, this is Huangdan (Jaundice). Lethargy, dark yellow urine, a pulse that is small and choppy, and loss of appetite indicate Huangdan. Lethargy with dark yellow urine is called Huangdan; feeling hungry immediately after eating is called Weidan (Stomach Jaundice); yellowing of the eyes is called Huangdan.

The *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) states: For all patients suffering from jaundice, promoting urination is sufficient. If the pulse is floating, sweating should be used to resolve the exterior; Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus) is appropriate.

This syndrome of jaundice generally arises from water-dampness. The primary method for treating dampness is to promote urination. However, if the pulse is floating, it indicates that the dampness is not in the interior but on the exterior, and sweating should be used to resolve it. If exterior dampness enters the interior due to deficiency and causes urinary retention (Longbi), then promoting urination is required. Thus, the next clause states: For Huangdan disease, Yinchen Wuling San (Artemisiae Scopariae Decoction with Five Ingredients) is indicated. Treatment requires flexibility of mind; one cannot be rigid. For Huangdan disease, Yinchen Wuling San is indicated.

In cases of Jiudan (Alcoholic Jaundice), there must be difficulty in urination. The symptoms include heat in the heart and heat under the feet; this is its presentation.

In Jiudan, some cases have no fever, with the patient quiet and lucid, yet experiencing abdominal fullness, desire to vomit, and dry nose. If the pulse is floating, induce vomiting first; if the pulse is deep and wiry, purge first. For Jiudan with heat pain or mental restlessness (Aonao) in the heart, Zhizi Dahuang Tang (Gardenia and Rhubarb Decoction) is indicated.

This formula is a variation of Zhishi Zhizi Chitang (Mature Buckwheat Fruit, Gardenia, and Fermented Soybean Decoction). After a major illness, recurrence due to overexertion causing fever is treated with Zhishi, Zhizi, and Chiren (Fermented Soybeans); covering the patient to induce slight sweating allows residual heat to resolve from the exterior. If there is retained food, Dahuang (Rhubarb) is added to resolve from the interior. This treats Jiudan with a deep-wiry pulse using purgation. If the pulse is floating and vomiting is indicated, Zhizi Chitang is used, which goes without saying. Since Jiudan damages the stomach leading to yellowing, involving formless damp-heat, inducing vomiting with Zhizi Chitang is suitable. This differs distinctly from Gudan (Grain Jaundice), which requires Yinchen Hao Tang (Artemisiae Scopariae and Yellow Gentian Root Decoction). Even this decoction treats dampness stagnation caused by combined injury from alcohol and food, hence purgation can be used. Observing the addition of Dahuang to Zhishi Zhizi Chitang also depends on retained food. Furthermore, Zhizi Bapi Tang (Gardenia and Phellodendri Bark Decoction) treats yellowing with fever by using bitter-drying herbs to unblock the fluid passages. By analogy, the methods for treating jaundice are comprehensive.

If Jiudan is treated with purgation for too long, it may transform into Heidan (Black Jaundice). Symptoms include yellow eyes, black complexion, a sensation in the heart like eating minced garlic, black stools, and skin numbness (Buren). The pulse is floating and weak; although the complexion is black with a hint of yellow, this confirms Heidan. The *Jingui Yaolue* treats Jiudan with either emesis or purgation; though the methods appear mixed, the principle is consistent. Generally, accumulated heat from alcohol entering the Bladder impedes Qi mechanism, causing urinary difficulty; accumulating in the Upper Jiao causes heart heat; accumulating in the Lower Jiao causes foot heat. Those without heart or foot heat remain lucid and unconscious-free. Seeing only abdominal fullness, desire to vomit, and dry nose indicates simultaneous pathology in the diaphragm and abdomen, requiring sequential treatment. One must distinguish between floating and deep pulses to determine the order of emesis or purgation. If only heart heat and desire to vomit exist, the disease is entirely in the Upper Jiao, and emesis suffices; why use purgation? If internal binding of alcohol-heat causes mental confusion, Aonao, and pain, purgation is necessary. Thus, Zhizi and Xiangchi (Fermented Soybeans) treat heart Aonao; Dahuang purges excess heat; Zhishi breaks stagnation and expels retained waste. However, such aggressive methods should not be used long-term. Long-term purgation injures Spleen and Lung Yang, failing to control Yin blood, leading to blood degeneration and blackening. However, the blackness of Jiudan differs from Nulao Dan (Female Labor Jaundice). Nulao Dan’s blackness stems from Kidney Qi pathology; Jiudan’s blackness is the color of degenerated blood. Alcohol-damp-heat damages the Spleen and Stomach; disharmony prevents Yang transformation and Yin blood circulation. Further purgation exhausts transformation functions. Qi depletion and blood stasis lead to corruption and turbidity, manifesting as blackness on the skin and face, and a spicy sensation in the heart like eating garlic. Ying blood fails to circulate, causing skin numbness; transmission to the Large Intestine results in pitch-black stools. Yellow eyes and floating-weak pulses indicate blood-level pathology. Zhang Zhongjing details the sequential treatment for Jiudan with such precision.

Gudan (Grain Jaundice) presents with aversion to cold, fever, anorexia, dizziness upon eating, chest discomfort, and eventual yellowing. Yinchen Hao Tang is indicated.

Black forehead, slight sweating, heat in hands and feet, evening onset, bladder urgency, and normal urination constitute Nulao Dan. Abdominal distension resembling water accumulation is incurable.

Nulao Dan mentions only a black forehead, omitting body yellowing, implying brevity. Black is the color of Northern Yin obscurity, appearing on the Southern Li Brightness position (face/heart) due to excessive sexual activity causing Spleen turbidity to descend into the Kidney, mixing Earth and Water colors. Slight sweat follows fire to the forehead, losing Heart fluids. Heat in palms and soles is common in internal injury. At dusk, Yangming governs, closing and gathering damp-heat downward to the Bladder. Normal urination and occasional black loose stools verify Bladder blood stasis. Abdominal water-like distension actually refers to blood stasis, hence incurable.

Jaundice patients fevers at sunset (Shiwu) with paradoxical aversion to cold indicate Nulao origin. Bladder urgency, abdominal fullness, generalized yellowing, black forehead, and foot heat constitute Heidan. Abdominal water-like distension and black loose stools confirm Nulao disease, not water retention. Abdominal fullness is difficult to treat; Xiaoshi Fanshi San (Niter and Alumen Powder) is indicated.

This is an emergency formula for Nulao Dan. Male essence movement mobilizes blood; excessive female labor depletes essence and blood. Hematuria from female labor is easier to treat as blood still flows. Jaundice from female labor involves stagnant blood; urgent removal of Bladder/Lower Abdomen stasis is vital. Xiaoshi (Niter) clears stasis; Fanshi (Alumen) breaks accumulation. These two work synergistically, sharp but not fierce, representing the formula’s efficacy.

For Jaundice with abdominal fullness, dark/scanty urination, and spontaneous sweating, the exterior is harmonious while the interior is excess; purgation is required using Dahuang Xiaoshi Tang (Rhubarb and Niter Decoction).

Jaundice rarely induces sweating; spontaneous sweating resolves the exterior, confirming "Exterior Harmonious, Interior Excess." Dahuang and Xiaoshi resolve interior blood binding; Huangbai (Phellodendri Cortex) clears Lower Jiao damp-heat; Zhizi (Gardeniae Fructus) is light and floating, allowing interior heat to drain via fluid passages.

For various jaundices, Zhaogao Faxian Jian (Pig Fat and Human Hair Decoction) is indicated.

This is a mild formula for jaundice due to blood stasis. Although most jaundices involve damp-heat, chronic meridian disease inevitably involves stasis. *Zhouhou Fang* uses this for Nulao Dan with generalized yellowing, fever, chills, lower abdominal fullness, and difficult urination, caused by extreme heat/cold from sexual activity followed by water exposure. Renmao (Human Hair Ash) disperses stasis; pig fat moistens meridians and bowels. Compared to Xiaoshi Fanshi San, it is milder but shares the goal of dispersing stasis.

Jaundice with thirst is difficult to treat; without thirst, it is curable. Disease originating in Yin parts causes vomiting; in Yang parts, chills and fever. Jaundice involves solidified damp-heat blocking fluid pathways; thirst indicates blockage, lack thereof indicates flow. Vomiting indicates Stomach/Intestine pathology; chills/fever indicate Meridian injury. This distinguishes Exterior/Interior and Yin/Yang for treatment.

Huangdan with smoky-yellow color and body pain is Wet Disease. Orange-yellow color without pain is Dan Disease. Dan divides into five: Huanghan (Yellow Sweat), Huangdan, Gudan, Jiudan, Nulao Dan. Huanghan presents with cold calves, sweating above waist, no sweat below, loins/hips pain, sensation of foreign body in skin, severe cases anorexia, heavy body pain, irritability, and scanty urination. Shaoyao Guizhi Kujiu Tang (Peony, Cinnamon Twig, and Vinegar Decoction) is indicated. Add Fangfeng (Saposhnikoviae Radix) for daytime heat; Danggui (Angelicae Sinensis Radix) for night heat; Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria) for poor appetite. Huangdan has Dry and Wet types. Dry Huang (Lung dryness): normal urination, non-heavy limbs, thirst for drinks; Zhizi Bapi Tang is indicated. Wet Huang (Spleen dampness): scanty urination, heavy limbs, false thirst without desire to drink; Mazi Lianqiao Chixiaodou Tang (Ephedra, Loranthus, and Red Adzuki Bean Decoction) is indicated. Orange-yellow skin, scanty urination, mild abdominal fullness: Yinchen Hao Tang. With thirst: Yinchen Wuling San. Gudan: dizziness after eating, chest oppression, generalized yellowing; Xiao Chaihu Tang modified with Baizhu, Paoshengjiang (Prepared Ginger), Danshen (Gentiana Scabra), Zhishi. Constipation: Yinchen Hao Tang. Weidan: hunger after eating, stomach heat consuming grain, sallow thin face, chest/hypochondriac fullness, scanty red urine; Buzhong Yiqi Tang modified with Pig Bile-fried Huanglian (Coptidis Rhizoma), Jiuhuangbai (Wine-processed Phellodendri Cortex), Zexie (Alismatis Rhizoma). Jiudan: yellow eyes/skin, water-like abdomen, heart Aonao/heat, anorexia, frequent vomiting, swollen calves, yellow urine, red spots on face; caused by drinking while hungry, getting drunk in wind/water; Zhizi Dahuang Tang is indicated. If Jiudan purged leads to Heidan, remove Dahuang from previous formula, add Xijiao (Rhinocerotis Cornu - substitute with Niujiao/Bovis Cornu clinically), Dihuang (Rehmanniae Radix). If ineffective, remove Dihuang, add Guixin (Cinnamomi Ramulus), Taoren (Pruni Semen), Shanjiajia (Manis Squama). Se Dan: yellow body, slightly black forehead, normal urination, black stool; caused by excessive intercourse, blood stasis in lower abdomen causing yellowing and lower back/abdominal pain; Dahuang Fuzi Tang modified (remove Xixin, add Rougui) is indicated. If mental fatigue, heavy head, poor Spleen transport, loose stools: Sijunzi Tang with Xiaoshi Fanshi Wan. Yin Huang: cold limbs, deep pulse, or caused by excessive cold herbs/diet; cold skin, epigastric hardness, dry eyes, spontaneous diarrhea, curled posture; Yinchen Fuzi Ganjiang Tang or Yinchen Sini Tang plus Baizhu. For cold food indigestion, abdominal cramping: remove Gancao, add Zhishi, Baizhu, Caodoukou (Black Cardamom). For scanty urination: add Guizhi, Fuling, Zexie. Jaundice with blood stasis: black stool, abdominal/flank mass/bloating, deep/wiry pulse, constipation, pulse slightly firm not weak: Taohhe Chengqi Tang. Discharge black material to resolve. Post-hemorrhage or post-miscarriage, general post-illness with great Spleen/Stomach/Lung Qi deficiency, sallow or pale complexion: all deficiency, treat as internal injury, do not mistake for Jaundice. Shi Lao Gan Huang (Food/Labor Malnutrition Jaundice), vulgarly "Yellow Puffiness": Huangdan is acute; Gan Huang is chronic. For persistent cases: Wenzhong Wan, Zaofan Wan. Only for robust individuals or laborers; delicate persons should not use. Dai Shi says: Food-stagnation jaundice requires purging based on deficiency/excess; otherwise, promote urination. Clear urine resolves jaundice. Yu Jiayan says: Summer heat and earth dampness combine; humans absorb these, forming internal knots causing jaundice, like fermenting sauce. Must use exterior-releasing, emetic, or purgative methods to clear damp-heat. However, summer has exterior Yang and interior Yin, unlike winter Cold where Qi hides. Gudan, Jiudan, Nulao Dan are purely internal injuries, unrelated to exterior pathogens. Zhang Zhongjing supplemented the *Neijing*, detailing subtleties. Regarding Yin Dan, Zhang’s formulas are lost; only Luo Qianfu’s Yinchen Sini Tang remains, treating Yang Dan transformed to Yin by excessive cold herbs, following ancient precedent. Moderns say Yang Dan is bright, Yin Dan is dull; this confuses Qi/Blood differentiation and misleads. E.g., Jiudan turning black or Nulao Dan black forehead—does black imply Yin Dan treatable with Fuzi/Ganjiang? Nulao Dan: True Yang blocked by blood, not severely damaged; once blood moves, Yang restores. Yin Dan: True Yang deficient; damp-heat/turbid blood accumulate; Yang must be restored to break stagnation. Without sun illuminating darkness, how can hidden things be reached? Exterior-derived Jaundice treated with tonics is "Solidifying Solid" (Shi Shi); Internal-derived Jaundice treated with purgatives is "Emptying Empty" (Xu Xu). Treating Yin Dan as Yang with bitter-cold herbs kills patients.

In half-Yin half-Yang syndromes, initially restore Yang to retreat Yin; only then treat Yang. Combining Fuzi and Huanglian is harmful; using bitter-cold for pure Yin without Yang is worse.

Shiwan stated: Among jaundices, Heidan is most severe, caused by alcohol indulgence allowing dampness to enter marrow stores, signaling Spleen failure and Kidney collapse. Early stage with intact spirit/form has damp-heat to attack, guiding jaundice removal. Late stage with muscle wasting indicates Yuan Qi exhaustion, unable to nourish dried-up sources.

Official Wang suffered jaundice; Yinchen Wuling San failed. August diagnosis: pulse string-large-empty, indicating Kidney injury with stasis and accumulation. Urgently use Jingui Xiaoshi Fanshi San combined with Guiling Wan formulation to cleanse while Yuan Qi permits; delay makes it difficult. Wang’s physician deemed drugs too harsh. Soon after, Wang’s son passed provincial exams, causing mental distraction, delaying treatment. New Year’s Day 2nd: pulse string-tough-leather, Yuan Qi exhausted. Daily Ginseng doses failed like water on stone. Late January inquiry: I predicted safety after imperial exams. Wang succeeded, returned early, proving my words correct. Simultaneously, an actor with Heidan took Xiaoshi Fanshi San pills (5 morning/evening). Day 4: lower abdominal colic, bloody urine first, then black loose stools. Day 11: stasis cleared. Followed by Guiling/Danggui/Shaoyao for 15 days to recover. Question: Moderns use herbal folk remedies for jaundice; acceptable in remote areas, but urban fools imitate them. Is this not painful for benevolent men? I have seen deaths from Shanglu (Veratrum), Kugua (Bitter Melon), Guoshanlong, Xueliqing, Luchong juices causing vomiting/diarrhea and Qi collapse. Pregnant woman with jaundice used Genti (Momordica seed) nasal insufflation, causing vomiting, asthma, fetal distress, and death. How to save her? Answer: Like moths to flame. To save lives, publish warnings to prevent future errors, preserving benevolence. Saving overturned carts is impossible.

Eye Jaundice: Eye yellowing is Huangdan. Some have yellow eyes but non-yellow body. *Neijing*: Wind-Qi and Yangming enter Stomach, ascend via meridians to inner canthus. In obese people, wind cannot escape, causing Heat-Middle and eye yellowing, thirst. Xuanming used Qinglong San, missing the canon’s intent. Use Yebipi Jia Zhu Tang or Guizhi Er Yebipi Yi Tang appropriately. Chronic deficiency: Liling Tang doubled Guizhi/Fuling. For persistent eye jaundice or heavy head: Genti San nasal insufflation, followed by Yinchen Wuling San to clear/drain.

[Diagnosis] Deep pulse, thirst for water, scanty urination: all indicate jaundice. Surging pulse, free stool, thirst: death. Tiny pulse, free urination, no thirst: survival. For all jaundice patients, if radial pulse near palm is absent, and mouth/nose breath is cold: incurable. Jaundice toxin entering abdomen with wheezing/fullness: critical. Young/robust with slippery/firm stool: easy recovery. Elderly/weak with empty/choppy pulse and free stool: difficult cure.