黄,黄胖也。疸,五疸也。《金匮》原有诸黄、诸疸之别,特疸详而黄略,读者易混,
因误
认诸黄为即五疸中之黄胆耳!考《病源》黄病候,自黄病至治也,百四十六字,列症甚详,
必
本之《金匮》逸文。何以言之?一身尽疼,发热,目涩,鼻疼,两膊及项强,腰背急,乃太
阳阳明表证,而《金匮》有黄家脉浮,当以汗解,宜桂枝加黄 汤一条,证治相符。大便涩
,正阳阳明胃家实症也,而《金匮》有诸黄猪膏发煎主之一条,证治相符。《金匮》既详其
治,不应反阙其证,故疑巢说本《金匮》逸文。且以此推之,黄病固有与伤寒同法者,故伤
寒亦多病黄。若五疸中之黄胆,则与余疸同属杂病,自不若黄病初起可以伤寒法治之,此其
别也。巢于黄病外别有黄胆,与女劳疸、酒疸、谷疸、黑疸同列,而以《灵》、《素》所言
黄胆诸条,及《金匮》所言疸而渴者以下三十五字入之黄胆候,较之黄病论绝异,其分别甚
严,真善读仲景书者。后人误认《金匮》标目黄胆二字,即五疸中黄胆,因以篇中诸黄云云
,皆认为五疸中黄胆,而黄与五疸之治法淆矣。不效,必曰古方难用也,故读书须取其至是
者。
人但知黄胆之有阴阳,而不知阴阳之何所指也。一闻“阴”字,即确认为虚症而不疑。
此不
独于疸为然,而疸之害尤甚。盖疸本湿热所为,无问阴阳,皆当以治湿热为正。的系阴黄,
则
湿热入深,其候重于阳黄可知,一投补剂,收住湿热,当时虽瘥,而病根终身不拔矣。余见
甚多,而卒不可夺。噫!人亦思阴阳之论何自 哉?《金匮》云∶疸病发于阴部,其人必呕;
发于阳部,其人振寒而发热。然则二疸之别,别于症之浅深,不别于气之虚实。阴以五脏言
,谓肺也;阳以六经言,谓三阳经也。仲景书中固有此例。如伤寒发热恶寒发于阳,无热恶
寒发于阴;咽喉痛,面赤有斑为阳毒,面青身痛为阴毒。皆是也。后世不明此义,每遇阴症
之名,不以为寒而用热药,即以为虚而用补药。元明以来,比比然矣。景岳于阴黄多制补剂
,其意岂欲误人哉?良由误认一时之收住为功且速,而不知能料他日复发之真明且远也。《
大学》贵知至,信然!
"Huang" refers to a sallow and puffy complexion; "Dan" refers to the five types of jaundice. The *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) originally distinguished between "various Huang" and "various Dan," but the discussion on Dan is detailed while that on Huang is brief, leading readers to easily confuse them. Consequently, they mistakenly assume that all "Huang" corresponds to "Huang Dan" within the five types of Dan. Examining the disease manifestation section on yellow diseases in the *Zhu Bing Yuan Hou Lun* (Source Book of All Categories of Pathogenesis), which spans 146 characters from the name of the yellow disease to its treatment, lists symptoms very meticulously. This must be based on the lost texts of the *Jin Gui Yao Lue*. Why do I say so? Body ache, fever, dry eyes, nasal pain, stiffness in both upper arms and neck, and tightness in the lower back are exterior syndromes of the Taiyang and Yangming channels. In the *Jin Gui Yao Lue*, there is a clause stating: "For patients with jaundice whose pulse is floating, sweating should be induced, and Guizhi Jia Huangqi Tang (Cinnamon Twig plus Astragalus Decoction) is appropriate." The symptoms and treatment correspond perfectly. Dry and difficult defecation indicates a Yangming stomach-fullness excess syndrome. In the *Jin Gui Yao Lue*, there is another clause: "Various types of jaundice are treated with Zhigao Fa Jian (Pork Fat and Human Hair Decoction)." Here too, the symptoms and treatment correspond. Since the *Jin Gui Yao Lue* details the treatments, it should not omit the symptoms; thus, I suspect that Chao Yuanyuan's theory was based on the lost texts of the *Jin Gui Yao Lue*. Furthermore, inferring from this, Huang disease naturally shares therapeutic methods with Shanghan (Cold Damage), hence jaundice often occurs in Shanghan cases. If we consider "Huang Dan" among the five types of Dan, it belongs to miscellaneous diseases like the others, and certainly does not allow for the initial treatment using Shanghan methods as Huang disease does; this is the distinction. Chao Yuanyuan listed "Huang Dan" separately from Huang disease, grouping it with Nü Lao Dan (Jaundice due to Sexual Exhaustion), Jiu Dan (Alcoholic Jaundice), Gu Dan (Grain Jaundice), and Hei Dan (Black Jaundice). He incorporated passages regarding Huang Dan from the *Ling Shu* and *Su Wen*, along with 35 characters from the *Jin Gui Yao Lue* concerning "jaundice accompanied by thirst," into his description of Huang Dan. This differs significantly from the discussion on Huang disease, showing strict differentiation, proving he was indeed a skilled reader of Zhang Zhongjing's works. Later generations mistakenly identified the term "Huang Dan" in the title of the *Jin Gui Yao Lue* as referring specifically to the Huang Dan among the five types, thereby categorizing all mentions of "Huang" in the chapter as such, causing confusion between the treatments for Huang and the five types of Dan. When treatment fails, people claim ancient prescriptions are difficult to use; therefore, one must select the most accurate interpretations when studying classics.
People only know that Huang Dan has Yin and Yang types, but do not understand what Yin and Yang specifically refer to. Upon hearing the word "Yin," they immediately confirm it as a deficiency syndrome without doubt. This applies not only to jaundice but is particularly harmful in the context of jaundice. Jaundice is fundamentally caused by damp-heat; regardless of Yin or Yang type, the correct approach is to treat the damp-heat. If it is truly Yin-type jaundice, the damp-heat has penetrated deeply, indicating a condition more severe than Yang-type jaundice. Administering tonifying agents will trap the damp-heat inside. Although the patient may appear improved temporarily, the root cause of the disease will remain unremoved for life. I have seen many such cases, ultimately irretrievable. Alas! Have people ever considered where the theory of Yin and Yang originates? The *Jin Gui Yao Lue* states: "When jaundice arises from the Yin aspect, the person will vomit; when it arises from the Yang aspect, the person will experience chills followed by fever." Thus, the distinction between these two types of jaundice lies in the depth of the pathology, not in the deficiency or excess of Qi. "Yin" here refers to the Zang organs, specifically the Lung; "Yang" refers to the Six Channels, specifically the Three Yang channels. Zhang Zhongjing's writings contain such examples. For instance, in Shanghan, fever with aversion to cold arises from the Yang, while absence of fever with aversion to cold arises from the Yin; sore throat with facial redness and macules is Yang Du (Yang Toxin), while dark complexion with body pain is Yin Du (Yin Toxin). These are all instances of this principle. Later generations failed to comprehend this meaning. Whenever encountering the term "Yin Syndrome," they either treated it as Cold using Hot herbs or as Deficiency using Tonics. Since the Yuan and Ming dynasties, this has been common. Zhang Jingyue often formulated tonifying prescriptions for Yin-type jaundice. Did he intend to harm people? No, he merely mistook the temporary trapping of damp-heat for rapid efficacy, failing to foresee the true brilliance and foresight required to prevent future relapse. The *Da Xue* (Great Learning) emphasizes the pursuit of ultimate knowledge; this is indeed true.