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Background Information:
Book: Zabing Guangyao (Comprehensive Requirements for Miscellaneous Diseases)
Author: Danbo Yuanjian (Japanese, Qing Dynasty)
Chapter: Jaundice (Part 2 of 3)
Category: Comprehensive

Yang-Rong Decoction is indicated for the Chinese text [context missing], and one should refer to the subsequent formulas for tonifying deficiency. Known as "Deficiency Jaundice" in *Mingyi Zhizhang* (Clear Instructions from Famous Physicians), it is suitable to swallow Bawei Wan (Eight-Ingredient Pill with Rehmannia) with Sijunzi Tang (Four Gentlemen Decoction). Wuweizi (Schisandra Fruit) and Fuzi (Prepared Aconite Root) may also be used. One must not overuse cooling agents or forcibly promote urination, lest Kidney Water (Kidney Yin/Essence) become depleted. Over time, a blackish-yellow complexion will appear, which is difficult to treat. After various hemorrhages, a yellow complexion often results. Blood constitutes Ying (Nutritive Qi); a ruddy complexion indicates abundant Ying blood. When blood is lost, the face appears yellow. It is like plants and trees: leaves are green in spring and summer but turn yellow in autumn, due to the difference between moisture and dryness. Suitable formulas include Yangrong Tang (Nourish Ying Decoction), Zhi Gui Tang (Citrus Aurantium and Angelica Decoction - formula missing), and Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction). For those with poor appetite, add Huangqi (Astragalus Root) and Bian Dou (Lablab Bean) each at one qian to Sijunzi Tang, creating Huangqi Sijunzi Tang; adding Chenpi (Tangerine Peel) creates Yigong San (Extraordinary Power Powder); adding these two ingredients is also acceptable. There are also cases of generalized body yellowing, but the yellow does not extend to the eyes and ears. (*Yaojue*)

Yin Jaundice is entirely unrelated to Damp-Heat, but rather stems from the failure of Blood and Qi. Since Qi fails to generate Blood, Blood deteriorates; since Blood fails to nourish the complexion, the color deteriorates. Any case of Jaundice presenting without any Yang symptoms or Yang pulses is classified as Yin Jaundice. How does Yin Jaundice arise? It is invariably caused by emotional injuries damaging the Zang organs, or fatigue and overwork injuring the形体 (physical form), leading to severe damage of Middle Qi. The Spleen fails to transform Blood, thus the color of Spleen Earth manifests externally. In this disease, the patient prefers stillness and dislikes movement, prefers darkness and fears light. Symptoms such as mental confusion and fatigue, faint speech, palpitations and dizziness, aversion to cold, reduced food intake, weakness in the four limbs, loose stools, urine resembling gruel, and weak pulses are all signs of Yang Deficiency. This stands in stark contrast to Jaundice caused by Damp-Heat, like ice and charcoal. Unless Yuan Qi (Original Qi) is rapidly rescued and the Spleen and Kidney are greatly tonified, there is no hope of recovery. Moreover, this pattern is very common. If one merely sees yellow skin, fails to examine the pulse and symptoms, and claims that Jaundice is always Damp-Heat, treating it with Yinchen (Artemisia Capillaris), Zhizi (Gardenia Fruit), fire-clearing, and diuretic agents, patients will inevitably die following medication. (*Jingyue*) (Note: This is Deficiency Jaundice, distinct from Cold-Damp.)

Yin Jaundice presents with clear white urine, loose stools, preference for stillness and lying down, slow and weak pulses, cold body, and spontaneous sweating. It should be treated as Deficient-Cold. Zhang Zhongjing stated that for men with Jaundice and free urination, Xiaojianzhong Tang (Minor Construct the Middle Decoction) is indicated. Wang Haicang said that Cold in the Middle Jiao generates Yellow, using Da or Xiao Jianzhong, without needing Yinchen. These are all Qi-Deficient Yin Jaundice (Qi deficiency leads to Spleen failure to transport; long-term stasis inside causes Spleen failure, causing its color to appear externally, hence the yellow, which must be pale). Dai Fu'an said that after blood loss, the face is often yellow, or the whole body is yellow (but not the eyes and ears), because Blood fails to nourish. Like bamboo and wood, leaves are moist and green in spring and summer, but dry and yellow in autumn. Suitable formulas are Yangrong Tang and Shiquan Dabu Tang. For those with poor appetite, add Huangqi and Bian Dou to Sijunzi Tang. This is Blood-Deficient Yin Jaundice (this is Dry Yellow, with free urination and no heaviness in the four limbs). (*Yique*)

Jaundice due to Stasis-Blood: The external symptoms and pulses of Jaundice and Stasis-Blood are similar. However, obstructed urination indicates Jaundice, while free urination indicates Stasis-Blood. Generally, those with Jaundice have accumulated Heat in the Heart and Spleen, fever with desire for drinks, and pulses that are floating, slippery, tight, and rapid. In contrast, Stasis-Blood cases present with mania-like behavior and black stools. This is the difference. (*Huo Ren Shu*)

When Damp-Heat stasis injures Blood, this is another type of Blood-pattern Jaundice. How do we know? In Jaundice patterns, urination is obstructed; in Blood-pattern Jaundice, urination is free. (*Zhizhi*)

Summer-Toxicity causing Jaundice: External Summer-Toxicity damages the Spleen, causing obstructed urination, which can also lead to Jaundice. Decoct Maohua Hua Tang (Reed Flower Decoction) to mix with Wuling San (Five-Ingredient Powder with Poria). (*Yaojue*)

Sun Zhuye returned to Zhejiang, contracted Summer-Toxicity on the journey, and was further injured by alcohol and wheat flour, leading to vomiting and chest/diaphragm fullness. Contemporary physicians used digestion-promoting agents that dried out and stirred Spleen Fire, causing thirst, epigastric discomfort, restlessness, golden eyes, and full-body yellowing, constituting a Jaundice syndrome. Pulse examination revealed only the right Cun position was slippery, large, and forceful. Initially, Wendan Tang (Warm the Gallbladder Decoction) was used, doubling Xiangru (Elsholtzia), Huashi (Talcum), and Gegen (Kudzu Root) to resolve Summer-Toxicity and stop vomiting as the Sovereign herbs; Huanglian (Coptis Rhizome) and Maidong (Ophiopogon Tuber) were added to clear Heat and stop thirst as Minister herbs, so that when Damp-Heat disperses, the Jaundice heals spontaneously. Given for three doses, vomiting stopped, appetite returned, and yellowing stabilized. Then, Wuling San was given with Qinghao (Artemisia Annua), Gegen, Huashi, Huanglian, and Zhishi (Immature Bitter Orange) for eight doses, resulting in complete resolution of the yellowing. (*Chuishui*)

Post-Malaria Jaundice: Many develop yellowing after Malaria. Malaria is called Spleen-Cold; since the Spleen is diseased, its color appears on the face. Regulating the Spleen should be prioritized. Yigong San with half a qian each of Huangqi and Bian Dou is suitable; this is also appropriate for yellowing after other diseases. (*Yaojue*)

Pi-Huang (Mass Jaundice): Qi and fluid retention accumulate into masses (Pi). Due to conflict with Heat Qi, stagnation and steaming fail to dissipate, causing fullness and pain in the hypochondrium and yellowing of the body, named Pi-Huang. (*Bingyuan Lun*)

Dan-Huang (Gallbladder Jaundice): Dan-Huang syndrome occurs in cases of great fright, terror, and combat injuries. I have seen cases of sudden fright from tigers, wolves, or wild beasts, where the Gallbladder spirit is suddenly lost and Jaundice develops; the onset is acute. I have also seen cases of enduring cruel officials or fearing disaster, where endless terror leads to Jaundice; the onset is gradual. For example, in the 11th year of Yongming in the Qi Dynasty (Southern and Northern Dynasties), a Grand Student named Wei Zhun died of panic and fear, his entire body turning blue. People at the time thought his Gallbladder had ruptured; this is of that category. I have also seen cases of gradual yellowing after combat, caused by Gallbladder injury. The symptoms show no Fire or Dampness; the person is lethargic and fatigued; the color is pure yellow like dyed fabric. All these cases are due to Gallbladder injury. When the Gallbladder is injured, Gallbladder Qi fails and Gallbladder Fluid leaks, causing this syndrome. The Classics state: "When Gallbladder Fluid leaks, there is bitter taste in the mouth; when Stomach Qi rebels, there is vomiting of bitterness." Thus it is called "Vomiting Gallbladder," with meaning similar to this. Furthermore, the Gallbladder attaches to the Liver and governs the Spring-generating Qi of Shaoyang. With life comes life, without life comes death. Hence the Classics say: "All eleven Zang organs depend on the Gallbladder," precisely because the Qi generated in the Gallbladder is the origin of all transformations. If these syndromes are all due to Gallbladder injury, and Gallbladder injury causes the failure of generating Qi, how can life continue? Therefore, those suffering from this often prove incurable. However, if one examines the severity of the injury and rapidly rescues the root, recovery is still possible. The power to "smelt stones to mend the sky" lies in the hands of wise physicians. (*Jingyue*) (Note: Original treatment formulas exist; *Bianzheng Lu* also records this syndrome, and reference is advised.)

Shu-Dan (Mouse Jaundice): Mice steal food grains and leave feces inside. Humans do not select carefully and accidentally ingest them, leading to Jaundice. When all medicines fail, use Cat Saliva mixed with Jiedu Dan (Detoxification Pill) for administration. (* Shibing Jiefa*) (Note: In *Bencao* under Qinjiao, *Tujing* cites Cui Yuanliang's *Jiyi Fang*: "Accidentally eating mouse feces at night also causes yellowing." Also, Jiedu Dan refers to Shenxian Jiedu Wanbing Wan.)

Abdominal Distension: When the Spleen is affected by Damp-Heat, stagnation and obstruction occur, often leading to abdominal distension. The general principle of treatment is to guide Damp-Heat out through the large and small intestines. People merely see that Yinchen Tang, Wuling San, Huanglian Wan, and Sanhuang Wan work immediately upon trial, and regard them as ordinary. They fail to consider that when Yang is excessive and Yin is absent, the disease is extreme. If Jaundice exists without thirst, treatment can still be attempted; if Jaundice is accompanied by thirst, or if the abdomen is bloated, few recover completely. (*Zhizhi*)

Overuse of Cold/Cooling agents damages the Spleen and Stomach, leading to swelling/distension, with extraordinary harm. (*Yidu*) (Note: This view also appears in *Zhuzheng Bianyi*.)

Life and Death Rules: For any Jaundice, if the Cun Kou pulse near the palm is absent, and the mouth and nose are cold, it is untreatable. (*Maijing*)

In severe cases, absence of Cun Kou pulse, cold air from the nose, body appearance like smoke-staining, head shaking, and fixed staring indicate Heart Exhaustion. Blackness around the mouth and oily sweat turning yellow indicate Spleen Exhaustion. These are sights that Cang Fei would gaze upon in astonishment. Who says Black Jaundice can be cured? (*Zhizhi*)

If Jaundice toxin enters the abdomen and causes wheezing and fullness, the condition is critical (Note: *Rumen* adds symptoms of excessive thirst and black face). If the pulse is洪大 (Surging-Large), with free stools and thirst, death ensues. If the pulse is small, with free urination and no thirst, survival is likely. (*Qixiao*)

Generally, those who are young and vigorous with Surging-Large pulses recover easily; those who are aged and deficient with fine and choppy pulses are difficult to cure. Those over fifty who contract the disease due to sexual exhaustion, alcohol consumption, and unresolved emotions, presenting with black forehead, vomiting/hiccups, free stools, cold hands and feet, inability to eat, and limb fatigue, who do not respond to Jianzhong, Lizhong, or Damp-draining medicines, cannot be saved. (*Zhuanshen*)

For Jaundice, turning black like smoke/dust indicates death; urine resembling gruel indicates death; abdominal distension indicates death; insufficient food intake indicates death. If the eyes gradually turn white and urination becomes prolonged, the disease is receding. (*Yu'an*)

Complexion like smoke-staining, dark and dull eye spirit indicates fatal Yang Jaundice. Unremitting wheezing, fullness, thirst, and vexation, with stabbing pain in the heart/chest like eating garlic, and Jaundice toxin entering the abdomen, indicates fatal syndrome. Dark black complexion, cold sweat, indicates fatal Yin Jaundice. (*Jinjian*)

Method to verify life/death in Jaundice: Press heavily on the Shanzhong acupoint on the chest with two fingers, then separate the two fingers left and right. If there is blood color in the middle, it is treatable. (*Yizong Shuoyue*)

General Discussion on Treatment Methods: Treatment methods should investigate the cause. Promoting separation and drainage is primary; detoxification is secondary. (*Dacheng*)

Zhongjing's Yinchen Zhizi Dahuang Tang treats Damp-Heat. Zhizi Baipi Tang treats Dry-Heat. Like seedlings: waterlogged seedlings become Damp-Yellow, drought-stricken seedlings become Dry-Yellow. Dampness is purged, Dryness is moistened. These two formulas treat Yang Jaundice. Han Zhihe and Li Sixun treat Yin Jaundice with Yinchen Fuzi Tang, generally using Yinchen as Sovereign, assisted by Dahuang and Fuzi, according to Cold or Heat. (*Tangye Bencao*)

The method of treatment primarily involves guiding Damp-Heat out through the large and small intestines (Note: This originates from *Zhizhi*). Yinchen, Wuling, Huanglian, and Sanhuang agents are all key medicines. (*Pudu Cihang*)

Spleen-Stomach Disharmony Jaundice, with fatigue and poor appetite: Weiling Tang. Add Huashi if urine is red. Damp-Heat Jaundice, with red and obstructed urine: Yinchen Wuling San. Cold-Damp Jaundice, Spleen-Stomach disharmony, anorexia, deep-fine pulse, clear and free urination: Lizhong Tang. In severe cases, add Fuzi; this is what is called Yin Jaundice. Spleen-Damp accumulation Jaundice, with heart/abdominal pain: Weiling Tang. Damp-Heat, due to reversed Stomach Qi, taking purgatives leading to diarrhea: Renshen, Baizhu, etc., plus Yinchen, Zhizi, Gancao. Yellow complexion, limb fatigue, clear urine: Wood overcoming Earth, Middle Qi moving outward (Note: Character 'Zhong' suspected error), Huangqi Jianzhong Tang. (*Danxi*)

General principles favor promoting urination to remove Damp-Heat. Floating pulse, harmonious abdomen: induce sweating. Floating pulse, heat in heart, abdominal fullness with desire to vomit: induce vomiting. Deep pulse, vexation in heart, or heat/pain with abdominal fullness, obstructed urination, red face with spontaneous sweating: purge. Neither floating nor deep, slightly wiry pulse, abdominal pain with vomiting: harmonize. Deep-fine and weak pulse, spontaneous sweating and diarrhea, clear white urine indicating Deficiency, body/eye yellowing, free stools: tonify. Injury from hunger/fullness and labor, internal damage to Middle Jiao, not external contraction: tonify. (*Liuyao*)

Avoid breaking Qi, closing Qi, purging, salty, slippery/laxative, cloying/greasy, moistening, and drying-hot substances. For those with Stasis-Blood, additionally avoid sour-cold. Favor clearing Heat, promoting urination, removing Dampness, and nourishing Stomach Qi. For stagnation, favor resolving accumulations. For Stasis-Blood, favor moving Blood. (*Bencao Jingshu*)

Two Ends of Treatment: Li Sixun discusses miscellaneous disease yellowing as Spleen Deficiency. Yellowing that persists for a long time indicates accumulation. Tonifying the Spleen and grinding away accumulation is acceptable; cooling purgatives must not be used. (*Yuanrong*)

Dan disease must be treated differently based on newness or chronicity. New disease at onset should be resolved and drained, such as Yinchen Tang, Yinchen Wuling San, Fuling Shenshi Tang, etc., which should be effective. Chronic disease requires changed methods. Long-term Spleen-Stomach injury leads to weak Blood and Qi, requiring tonification, such as Shenzhu Jianpi Tang (Note: Yigong San plus Danggui, Shaoyao) or Danggui Qinjiao San (Note: Bawu Tang minus Renshen, plus Qinjiao, Chenpi, Banxia Qu), so that when Righteous Qi is strong, Pathogenic Qi retreats, and success may be achieved. For those with inherently weak Yuan Qi contracting this Dan, fearing that draining agents will further weaken their Yuan, they instead receive tonifying agents. Little do they know that tonifying before eliminating pathogens causes Dampness to increase and Heat to rise, gradually worsening yellowing of eyes and body. Although one wishes to retreat it, years are needed for healing. Those unable to treat it well ultimately die. (*Tongzhi*)

Jaundice disease mostly arises from Spleen-Stomach disharmony, combined Damp-Heat steaming and郁 (stagnating) to form Yellow, similar to fermentation. *Neijing* states: "Urine yellow-red, lying down much, is Jaundice." Yellow-red urine is a sign of Heat; lying down much is a sign of Dampness. Zhongjing states: "Yangming disease, no sweat, obstructed urination, vexation in heart, body must yellow." Because Yangming Damp-Heat pathogens cannot escape via sweat to the exterior, nor drain via urination downward, reaching vexation in the heart indicates that Damp-Heat cannot reach the exterior but instead knots internally, and cannot descend but instead rebels upward. Thus Zhongjing has Yinchen Hao Tang, using Yinchen and Zhizi to clear and resolve Heat, slightly adding Dahuang to guide it downward. *Qianjin Fang* has Mahuang Chunjiu Tang, using only Mahuang to open knots and scatter pathogens, plus strong wine to assist external release. Thus, interior and exterior are dispersed separately, Dampness retreats, Heat removes, and Yellow heals itself. This specifically speaks of external contraction yellowing, not internal injury. Zhongjing states: "Men with yellowing, free urination, Xiaojianzhong Tang governs." Free urination means Damp pathogen is gone, and yellowing should heal. If it does not heal, there is no Damp-Heat inside, but rather insufficient Middle Qi and floating Deficient Yang. Thus Xiaojianzhong Tang is used to construct Middle Qi and gather Deficient Yang, fitting the treatment. Unlike cases with no Heat pathogen (clearing harms Yang) or no Damp pathogen (draining harms Yin). Alas! Must one not be cautious? (*Bingji Huilun*)

Zhao Yuhuang says: Treatment methods differ in sweating/purging and tonifying/draining. Today, people treat this merely with Pingwei, Wuling, Yinchen Tang, etc., outside of clearing Heat and draining, having no other theory. Although for severe Damp-Heat in Intestines/Stomach, purging might be possible; if constrained between skin/flesh and cannot vent, overusing draining agents causes Damp-Heat to sink inward and not exit. Zhongjing's method for body heat with yellowing is Mahlian Lianqiao Chixiaodou Tang, solely to urgently resolve the exterior, allowing Heat pathogens to scatter from outside. Formulas discuss only descending, not ascending; this is illogical. As for those with inherent Spleen Deficiency, excessive cold/cooling, or clear white urine with slightly loose stools, fatigue, weak pulse, poor appetite, these are signs of extreme Taiyin Spleen Qi deficiency with True Color manifesting externally. Only Buyi Zhongqi Tang, slightly adding Cheqian and Fuling, or Lianli Tang for Heat dominance, is suitable. Now, encountering this syndrome, they do not distinguish excess/deficiency or exterior/interior, generally using cold/cooling and draining agents. Do they not know that deficient Spleen/Stomach should not be cooled; cooling makes Middle Qi worse; weak Spleen/Stomach should not be descended; descending causes Yin loss from below. Whether attacking or tonifying, ascending or descending, one must adapt to circumstances. (*Mingyi Huicui*)

Treatment Should Break the Sac: Zhongjing originally had decoction formulas for Jaundice. Why do they work for mild cases but fail for severe ones? Because in severe Jaundice, there is a sac in the hypochondrium wrapping Yellow Water. This sac has no outlet. Medications stay outside the sac, not entering it. Taken medications either tonify the pathogen or injure Righteous Qi, thus causing harm. In mild cases, the sac has not yet formed, so medication works; once the sac forms, none work. One must use penetrating formulas, either breaking the sac or dissolving the water (or extracting Yellow Water completely), with secret recipes transmitted, not treatable by general decoctions or pills. (*Yuanliu Lun*) (Note: This view is quite strange, kept for record.)

Sweating Formula: Acute Yellow resembles epidemic diseases initially. After two or three days, combine Mahuang and five other herbs in a decoction to take, inducing sweating to drain Yellow potential.
Mahuang (3 liang, nodes removed), Gan Ge (5 liang), Shigao (8 liang), Shengjiang (6 liang), Yinchen (2 liang).
Cut herbs, boil in 8 sheng water to obtain 2.7 sheng, strain, divide into three warm doses. Take doses spaced by distance of ten li. After finishing, cover with blanket to induce slight sweating to disperse. (*Waitai* citing Xu Renze)

Heat-Clearing Formulas: *Duanju* treats Jaundice with yellow body/eyes and dust-like skin eruption, using Sanwu Yinchen Hao Tang.
Yinchen Hao (6 liang), Zhizi (24 seeds), Shigao (1 jin) (*Qianjin Fang* adds Dahuang 3 liang).
Three ingredients, boil in 8 sheng water to obtain 2.5 sheng, strain. Burn Shigao fiercely until red hot, throw into decoction, wait for boiling to settle, take clear juice. At moderate temperature, take 1 sheng, cover self to induce full-body sweating, apply warm powder. Then healed. If no sweat, take another 1 sheng; sweating heals it. (*Waitai*)

Formula for Jaundice, skin/eyes golden, red urine, governs both.
Yinchen, Ziqin (each 4 fen), Huang Gualou, Qinjiao, Shengma (each 6 fen), Zhizi (5 seeds).
Boil in 2 sheng water to obtain 8 he, take long after meals, divide into three frequent doses. Two courses heal it. (*Qianjin Yueling*)

Cui Yuanliang's *Jiyi Fang* for Yellow: Use Qinjiao 1 da liang, finely cut into two packets. Use 1 sheng good wine, half sheng per packet, squeeze juice, strain, take empty stomach in two doses, stop if stool/urine moves. Good drinkers are easier to treat. There are several types of Yellow: Alcohol-injury is Jiu Huang. Nighttime accidental mouse feces ingestion also causes Yellow. Labor-induced yellowing has much phlegm/nasal discharge, red veins in eyes, daily emaciation, or red face/nausea. Cui Yuanliang used it and treated people effectively, extremely efficacious. (*Bencao Tujing* citation) (Note: Also cites *Zhengyuan Guangli Fang* for Jaundice: heart vexation/heat, dry mouth, yellow skin/flesh, Qinjiao boiled with cow milk, attributed to Xu Renze. *Waitai* also cites Xu, saying Wenzhong and *Bixiao* agree, Western Regions method.)

Gegen Tang, treats Wine Jaundice.
Gegen (2 liang), Zhishi (pulp removed, bran-fried), Zhizi Ren, Chi (each 1 liang), Gancao (roasted 0.5 liang).
Cut, take 4 qian per dose, 1.5 sheng water, decoct to 0.8 sheng, strain, take warm, any time. (*Jisheng*)

Shen's Black Jaundice Formula.
Yinchen Hao 4 liang, crush to obtain 1 he juice. Gualou Gen 1 jin, crush to obtain 6 he juice. Mix and drink at once. Must have Yellow Water pass via urination. If not, take again. This is Jin Ao's self-made formula. *Jianbian Fang* uses single Gualou Gen juice to drain Heat-Toxin, a good formula for Black Jaundice. I added Yinchen juice as guidance for Damp Pathogen, more precise, thus effective. (*Zunsheng Shu*)

Treat Labor Yellow, Chaihu San Formula.
Chaihu (1 liang, buds removed), Yinchen (0.5 liang), Xijiao Xie (0.5 liang), Maidong (1 liang, heart removed), Gancao (0.5 liang, roasted slightly red, cut), Biejia (2 liang, coated with butter, roasted slightly yellow, skirt removed)