【脉证】 脉沉,渴欲饮水,小便不利,皆发黄。脉沉乃阳明蓄热,喜自汗。汗
出入水
,热郁身肿,发热不渴,名黄汗。脉紧数,乃失饥发热,大食伤胃,食则腹满,名谷疸。数
为热,热则大食;紧为寒,寒则腹满。脉浮紧,乃因暴热浴冷水,热伏胸中,身面目悉如金
色,名黄胆。阳明病,脉迟者,食难用饱,饱则发烦、头眩者,必小便难,欲作谷疸。脉沉
弦或紧细,因饮酒百脉热,当风入水,懊 心烦足热,名酒疸。其脉浮欲呕者,先吐之;沉
弦者,先下之。脉浮紧,乃大热交接入水,肾气虚流入于脾,额黑,日晡热,小腹急,足下
热,大便黑,时溏,名女劳疸。腹如水状,不治。脉寸口近掌无脉,口鼻冷,不治。其病身
热,一身尽痛,发黄便涩。
【因】 内热入水,湿热内郁,冲发胃气。病虽有五,皆湿热也。
【治】 诸黄家,但利其小便愈。假令脉浮,以汗解之;如便通汗自,当下之愈
。当以
十八日为期,治之十日以上为差,反剧者难治。治法以疏湿、利小便、清热或汗之,五苓加
茵陈、连类。
茵陈栀子汤 茵陈(一两,去茎) 大黄(半两) 山栀(十个)
豆豉汤下
五苓散 热加苦参;渴加栝蒌根;便涩加葶苈;素热加黄连。
茵陈蒿汤 治黄胆,寒热不食,食则头眩,心胸不安者是。
滑石石膏丸 治女劳疸。证见题下。
滑石石膏
研末下,粥饮,例利则止。
[Pulse and Symptoms] A deep pulse, thirst with desire to drink water, and difficult urination all lead to jaundice. A deep pulse indicates heat accumulation in the Yangming channel, accompanied by spontaneous sweating. If one enters water immediately after sweating, heat becomes constrained within the body causing edema, fever without thirst; this condition is named Huanghan (Yellow Sweat). A tight and rapid pulse indicates fever following starvation or stomach injury due to overeating, leading to abdominal fullness after meals; this is called Gujdan (Grain Jaundice). "Rapid" indicates heat, which increases appetite; "tight" indicates cold, which causes abdominal fullness. A floating and tight pulse results from bathing in cold water while suddenly overheated, where heat lies concealed in the chest, causing the whole body and eyes to turn golden yellow; this is named Huangdan (Jaundice). In Yangming disease, a slow pulse suggests that one cannot eat until full; if fullness leads to irritability and dizziness, accompanied by difficult urination, it indicates impending Gujdan (Grain Jaundice). A deep, wiry, or tight-thin pulse, caused by alcohol consumption generating heat in all vessels followed by exposure to wind or water, resulting in mental restlessness and heat in the soles of the feet, is called Jiudan (Alcohol Jaundice). If the pulse is floating with nausea, induce vomiting first; if deep and wiry, purge first. A floating and tight pulse, occurring after intercourse during extreme heat followed by entering water, where Kidney Qi deficiency allows cold to flow into the Spleen, presenting with black forehead, afternoon fever, lower abdominal urgency, heat in the soles, black stool, and occasional loose stools, is called Nulaodan (Female Labor Jaundice). Abdominal distension resembling ascites is intractable. Absence of pulse at the Cun Kou (Radial artery) and cold nose and mouth are also intractable. The disease presents with body heat, generalized pain, jaundice, and dysuria.
[Etiology] Internal heat combined with water exposure causes damp-heat to stagnate internally, stirring up Stomach Qi. Although there are five types of jaundice, they are all caused by damp-heat.
[Treatment] For all patients with jaundice, recovery is achieved primarily by promoting diuresis. If the pulse is floating, resolve via sweating; if stool is unobstructed and spontaneous sweating occurs, treat via purgation. The expected duration is eighteen days; improvement should occur within ten days. If symptoms worsen, it is difficult to treat. Therapeutic methods include dispersing dampness, promoting diuresis, clearing heat, or inducing sweating. Wuling San (Five-Ling Powder) added with Yinchen Hao (Artemisiae Scopariae Herba) is used, along with similar formulas.
Yinchen Zhizi Tang (Inula and Gardenia Decoction): Yinchen (30g, stems removed), Dahuang (15g), Shanzhi (10 fruits). Take with Douchi Tang (Fermented Soybean Decoction).
Wuling San (Five-Ling Powder): Add Kushen (Sophorae Flavescentis Radix) for severe heat; add Gualougen (Trichosanthis Radix) for thirst; add Tingli (Descurainiae Semen) for dysuria; add Huanglian (Coptidis Rhizoma) for inherent heat.
Yinchen Hao Tang (Artemisia Decoction): Treats jaundice characterized by alternating chills and fever, anorexia, dizziness after eating, and discomfort in the heart and chest.
Huashi Shigao Wan (Talcum and Gypsum Pill): Treats Nulaodan (Female Labor Jaundice). See symptoms described above. Grind Huashi (Talcum) and Shigao (Gypsum Fibrosum) into powder, take with rice broth. Stop when bowel movement becomes smooth.