Library

The treatment for jaundice uses Yinchen (Artemisiae Scopariae Herba) as the sovereign drug, assisted by Dahuang (Rhei Radix et Rhizoma), and guided by Zhizi (Gardeniae Fructus), allowing damp-heat to be discharged through the large and small intestines. Consequently, the yellowing of the body and abdominal fullness will naturally resolve.

[Collected Annotations] Tang Buyan stated: Xunhuang refers to Yin Jaundice (dark-yellow jaundice); Juzihuang refers to Yang Jaundice (bright-yellow jaundice).
Cheng Zhi stated: This is a method to expel dampness and remove heat. In Shanghan (Cold Damage) disease after seven or eight days, it is the time when purgation may be used; difficulty in urination and slight abdominal fullness are indications that purgation is appropriate. With the addition of bright yellow coloration, it is undoubtedly pathogenic factors from the Three Yang channels entering the interior. Therefore, Yinchen is used to dispel dampness, Zhizi to clear heat, and Dahuang to assist in expulsion. Although this condition allows for purgation, the primary focus must be on dispelling dampness; it does not rely solely on aggressive purgation, which is precisely the point.

Yinchen Hao Tang Formula
Yinchen Hao (Six liang) Zhizi (Broken open, fourteen pieces) Dahuang (Bark removed, two liang)
Take these three ingredients, add one dou and two sheng of water, first decoct Yinchen until the volume reduces by six sheng, then add the other two ingredients. Decoct until three sheng remain, strain off the dregs, and divide into three doses. If urination becomes free, with urine resembling the juice of soap pods and appearing reddish, the abdomen will reduce after one night, and the yellow color will exit via the urine.

In Shanghan disease presenting with yellowing of the body and fever, Zhizi Bopi Tang should be administered.

[Annotation] In Shanghan disease with yellowing of the body and fever, if there is a exterior syndrome of anhidrosis (absence of sweating), Mahlian Lianqiao Chixiaodou Tang should be used to induce sweating; if there is an interior excess syndrome, Yinchenshao Tang can be used to purge. Currently, since there is no exterior syndrome suitable for sweating nor an interior syndrome suitable for purging, only Zhizi Bopi Tang should be used to clear the heat.

[Collected Annotations] Lin Lan stated: In Shanghan disease with yellowing of the body, there is stagnant heat in the Stomach requiring purgation. Here, because there is fever but the heat has not yet solidified, Zhizi Bopi Tang is appropriate to resolve it.
Wang Hu stated: Yellowing of the body accompanied by fever is the fever associated with jaundice syndromes, not the fever seen in Mahuang or Guizhi syndromes. Since heat is constrained and causes yellowing, although there is an exterior component, it is not a pure exterior syndrome. One should only clear the constrained heat to retreat the jaundice, at which point the fever will heal itself.
Wei Litong stated: Although these three clauses all describe conditions where exterior cold combines with dampness, stagnating into heat, one must pay special attention to whether the pathogen is in the exterior or interior, and whether dampness or heat predominates. How can one generally consider them interior syndromes and indiscriminately use purgation?

Zhizi Bopi Tang Formula
Zhizi (Broken open, fifteen pieces) Gancao (Honey-fried, one liang) Huangbai (Phellodendri Cortex, two liang)
Take these three ingredients, add four sheng of water, decoct until one and a half sheng remain, strain off the dregs, and divide into two warm doses.

[Note] The Gancao (Licorice Root) in this formula should likely be Yinchenshao (Artemisiae Scopariae Herba); this is certainly a transcription error.

In Yangming disease treated with fire therapy, if there is slight sweating on the forehead and difficulty in urination, yellowing of the body will inevitably occur.

[Annotation] In Yangming disease with anhidrosis, instead of using Gegen Tang to induce sweating, fire therapy was used to force sweat. This resulted in excessive heat and dryness of fluids. Drinking water led to fluid retention, and heat steamed upward, causing slight sweating on the forehead while the rest of the body remained without sweat. If urination were free, the condition would transform towards dryness, resulting in vexation and thirst, treated with Baihu Tang. Since urination is difficult, it transforms towards dampness, resulting in yellowing, treated with Yinchenshao Tang.

[Collected Annotations] Yu Chang stated: In Yangming disease, with dampness stagnating and heat constrained, vexation and thirst worsen, inevitably leading to yellowing. However, if sweating occurs, heat escapes outward, avoiding yellowing; if urination is frequent, heat drains downward, avoiding yellowing. If mistakenly purged, the heat sinks deeper, fluids are further damaged, and both sweat and urination become impossible. If mistakenly treated with fire, heat becomes more intense, fluids rush upward; although there is slight sweating on the forehead, sweat and urination elsewhere become impossible. How can one avoid the transformation of yellowing?
Cheng Zhi stated: Jaundice in Taiyang disease arises from cold constraining dampness, preventing its resolution. Jaundice in Yangming disease arises from dampness constraining heat, preventing its release. Therefore, treatment must distinguish between meridians.

In Yangming disease, with anhidrosis, difficulty in urination, and inner restlessness (Xinzhong Aonao), yellowing of the body will inevitably occur.

[Annotation] Anhidrosis in Yangming disease means heat cannot escape outward. Difficulty in urination means dampness cannot drain downward. Inner restlessness indicates dampness and heat constrained within the interior. Thus, yellowing is inevitable. Malign Lianqiao Chixiaodou Tang should be used to release externally and drain internally. If, after sweating, vomiting, or purging, or if urination is free but inner restlessness persists, it is due to heat constraint, not dampness constraint. If stools are hard, Tiaowei Chengqi Tang should be used to purge; if stools are soft, Zhizi Chi Tang should be used to induce emesis.

[Collected Annotations] Fang Youzhi stated: Anhidrosis and difficulty in urination lead to dampness stagnation and inner restlessness. With dampness stagnating and heat constrained, yellowing is certain.
Zhang Lu stated: Unable to sweat externally or urinate downward, damp-heat is constrained in the chest and cannot vent, inevitably steaming the body to become yellow.

In Yangming disease, if the entire face appears red, purgation must not be used. It will inevitably result in fever, yellowing, and difficulty in urination.

[Annotation] In Yangming meridian disease, facial redness indicates heat still constrained in the meridian, not yet entering the interior to form excess. Therefore, even if there is constipation, purgation is contraindicated. If purged, the heat constrained in the meridian will not resolve, inevitably causing fever and yellowing. If the patient has interior dryness and free urination, it transforms towards dryness, so yellowing will not occur, but stools will become hard.

[Collected Annotations] Fang Youzhi stated: "He" means corresponding. "Chi" means red, the color of heat. Stomach heat rises, causing facial redness. Purging destroys fluids, leading to fever and yellowing due to difficulty in urination.
Cheng Zhi stated: This states that heat in the Yangming meridian cannot be purged. Heat in the meridian means Yang Qi is constrained at the exterior. Purging prevents the heat in the meridian from being released, inevitably causing fever and yellowing due to difficulty in urination.
Cheng Yingmao stated: Heat obstructs between the skin and muscles, causing fever and difficulty in urination, constraining into yellowing.

In Yangming disease, fever and sweating indicate heat venting outward, so yellowing cannot occur. If there is only sweating on the head, no sweating on the body, stopping at the neck, difficulty in urination, and thirst for liquids, this indicates stagnant heat in the interior, inevitably causing yellowing. Yinchenshao Tang should be administered.

[Annotation] Fever and sweating in Yangming disease indicate heat venting outward. If urination is free and stools become hard due to dryness, yellowing cannot occur. Only head sweating with no body sweating indicates Yangming heat cannot vent outward but steams upward. Difficulty in urination indicates dampness accumulating in the Bladder. Thirst for liquids indicates heat scorching the Stomach. This is damp-heat stagnant in the interior, pressing on the skin and muscles, inevitably causing yellowing. Yinchenshao Tang is used to unblock the large and small bowels, allowing damp-heat to exit via the lower orifices.

[Collected Annotations] Fang Youzhi stated: "Yue" means dispersing. Head sweating, stagnant heat, and yellowing are noted in the Taiyang chapter. Yinchen drives out damp-stagnant yellow, Zhizi removes Stomach heat, and Dahuang pushes away obstructive stasis. These three herbs use bitterness to drain heat; draining heat disperses the yellow.
Cheng Yingmao stated: Head sweating, no body sweating, stopping at the neck, proves Yang heat qi is constrained internally and cannot vent, thus only steaming the head, as the head is the summit of all Yang meridians. Qi fails to descend, causing difficulty in urination; Fu organ qi is overly dry, causing thirst for liquids. "Stagnant heat in the interior" refers to anhidrosis. Anhidrosis with free urination belongs to cold; anhidrosis with difficulty in urination belongs to damp-heat. Two pathogens intertwine and cannot vent, hence yellowing. To resolve heat and dispel dampness, nothing surpasses Yinchen and Zhizi clearing the upper, and Dahuang cleansing the lower. Once the heat of the whole body is vented, how can the yellow not disperse?

In Shanghan disease, if the pulse is floating and slow, and the hands and feet are naturally warm, this indicates the disease is related to Taiyin. In Taiyin disease, the body should yellow; however, if urination is naturally free, yellowing cannot occur. By the seventh or eighth day, if stools become hard, it has become Yangming disease.

[Annotation] This is a Taiyin condition transferring to Yangming. Shanghan with floating-slow pulse and hot hands/feet is Taiyang. Now, with naturally warm hands/feet, it is not a Taiyang syndrome, but related to Taiyin. However, Taiyin pulse should be sinking-slow; the current floating-slow pulse is Taiyang. A Taiyin syndrome with a Taiyang pulse indicates pathogenic factors transmitting from Taiyang to Taiyin, hence "related to Taiyin." If urination is free, it does not transform via Taiyin dampness to cause yellowing. By the seventh or eighth day, hard stools indicate transformation via dryness, becoming Yangming disease.

[Collected Annotations] Cheng Yingmao stated: Yangming disease originates from Stomach Excess. Stomach excess is caused not only by pathogenic factors in the Three Yang channels transferring to Yangming, but also by factors in the Three Yin channels transferring to Yangming. Taking Taiyin as an example: Floating-slow pulse is a surface pulse, but without exterior symptoms like fever, headache, or aversion to cold, and with only warm hands/feet, the pathogen is in the interior, not the exterior. Interior transmission has Yin-Yang distinctions, distinguished by urination. Difficulty in urination leads to steaming dampness and stagnant heat causing yellowing, because the person lacks dryness in the Stomach originally. Free urination leads to dry Stomach and hard stools forming excess, because the person possesses dryness in the Stomach originally. Although the disease manifests after seven or eight days, the initial signs of floating-slow pulse and warm hands/feet truly represent a transfer from Taiyin. Extending this logic from Taiyin and Yangming, the Three Da Chengqi cases in Shaoyin and the Xiao Chengqi case in Jueyin are all diseases transferring to Yangming!
Wei Litong stated: When disease is in Taiyang, heat constrained by dampness gathers in the interior and must have a destination. If it cannot cause yellowing and urination is free, where does the pathogen go? It must return to the Stomach, the destination of all things. By the seventh or eighth day, increased urination and hard stools constitute Yangming disease.

When Shanghan transfers to involve Yangming, the patient exhibits continuous mild sweating (Jieran Han Chu).

[Annotation] In all Shanghan diseases, regardless of Three Yin or Three Yang channels, if they transfer to involve Yangming, the patient must exhibit continuous mild sweating to confirm the transfer to Yangming.

If Taiyang disease is treated with emesis, and although Taiyang disease should present with aversion to cold, now there is no aversion to cold and a desire to remove clothing, this is internal vexation caused by emesis.

[Annotation] If Taiyang disease is treated with emesis and the exterior resolves, there should be no aversion to cold; if the interior resolves, there should be no aversion to heat. Now, the absence of aversion to cold and the desire to remove clothing indicate aversion to heat. This is due to the exterior resolving but the interior remaining unresolved after emesis, generating internal vexation and heat. Vexation and heat without sweating, with heat in the exterior, is Da Qinglong Tang syndrome. Vexation and heat with sweating, with heat in the interior, is Baihu Tang syndrome. After emesis and purging, with inner restlessness, no sweating, and vexation/heat, even if stools are hard, heat remains in the interior, indicating Zhizi Chi Tang syndrome. Vexation and heat with sweating and hard stools, with heat fully entering the Fu organs, indicates Tiaowei Chengqi Tang syndrome. Now, following emesis, internal vexation arises, representing deficiency vexation due to damage of Qi and fluids, not excess vexation before sweating/purging. None of the above methods apply; only Zhuye Shigao Tang should be used to benefit Qi, generate fluids, clear heat, and calm vexation.

[Collected Annotations] Zhang Lu stated: Emesis damages fluids in the Stomach, causing internal vexation and desire to remove clothing. Although manifesting deficiency vexation, it is slightly milder than deficiency heat with fine-rapid Guan pulse damaging Spleen and Stomach. It does not lead to reversal, but is still the fault of mistaken emesis.

Taiyang disease should present with aversion to cold and fever. Now, spontaneous sweating occurs, with no aversion to cold or fever, and the Guan pulse is fine and rapid. This is the fault of the physician's emesis. If emesis is used on the first or second day, the patient feels hungry in the abdomen but cannot eat. If used on the third or fourth day, the patient dislikes congee and desires cold food. If used on the fifth or sixth day, morning food is vomited in the evening. This is caused by the physician's emesis and is considered a minor deviation (Xiao Ni).

[Note] Under "desires cold food," the phrase "if emesis is used on the fifth or sixth day" should exist. Without this sentence, the text regarding disliking congee/desiring cold food and morning food/evening vomiting is disjointed. Careful examination of the first-second and third-fourth day texts reveals the necessity of the "fifth-sixth day" clause, representing progression from shallow to deep.

[Annotation] Unresolved Taiyang disease should have aversion to cold and fever. Now, spontaneous sweating with no aversion to cold or fever indicates the exterior has resolved. Fine-rapid Guan pulse indicates Stomach disharmony. Fine indicates deficient Stomach Qi; rapid indicates hot Stomach Qi. The mismatch between syndrome and pulse, upon inquiry, reveals the fault of physician-emesis. On days one or two, disease is in Taiyang, Zheng Qi is not depleted; emesis causes shallow Stomach injury, so the patient feels hungry but cannot eat. On days three or four, disease is in Yangming, Stomach is already hot; emesis further damages fluids, so the patient dislikes congee and desires cold food. On days five or six, disease is about to enter Yin channels, Zheng Qi is depleted; emesis causes cold deficiency in the Stomach, so morning food is vomited in the evening. All are caused by physician-emesis but remain treatable. Hence, "minor deviation."

[Collected Annotations] Cheng Zhi stated: Original Taiyang disease treated with emesis allows exterior pathogens to enter Yangming via deficiency, disturbing Stomach Qi, resulting in fine-rapid Guan pulse.
Cheng Yingmao stated: Yangming Qi descends smoothly; ascending is reversal. Caused by physician-emesis, this is not the original pathology of Spleen and Stomach, hence "minor deviation." Do not mistreat it, lest minor deviation becomes major reversal.

Food intake triggering desire to vomit belongs to Yangming; Wuzhuyu Tang should be administered. If symptoms worsen after taking the decoction, it belongs to the Upper Jiao.

[Annotation] Desire to vomit upon eating belongs to Yangming because the Stomach governs reception. Current cold in the Stomach prevents grain reception, causing desire to vomit. Wuzhuyu Tang warms the middle and directs rebellious Qi downward to stop vomiting. If symptoms worsen after ingestion, this is not Middle Jiao Yangming interior cold, but Upper Jiao Taiyang exterior heat. Wuzhuyu is hot in nature and flavor, mismatching the pathology, hence worsening. Treatment should follow the principle of Taiyang-Yangming combined disease with vomiting but no diarrhea, using Gegen Banxia Tang.

[Collected Annotations] Fang Youzhi stated: Desire to vomit upon eating indicates Stomach cold, hence belonging to Yangming, distinguishing it from aversion-to-cold vomiting. Upper Jiao refers to the diaphragm.

If a patient has a rapid pulse, rapid indicates heat, and digestion should be efficient with good appetite, yet vomiting occurs instead, this is because sweating made Yang Qi weak and Diaphragm Qi deficient, causing the rapid pulse. Rapid here indicates guest heat, which cannot digest food; vomiting occurs due to cold deficiency in the Stomach.

[Annotation] Patient has rapid pulse, indicating heat, so digestion should be efficient. Yet vomiting occurs after eating. This is because fever and rapid pulse were mistaken for exterior heat, leading to sweating, which weakened Yang Qi and Diaphragm Qi. The rapid pulse is due to external guest heat, not interior Stomach excess heat. Inability to digest food and vomiting result from original Stomach cold deficiency.

[Collected Annotations] Cheng Zhi stated: This describes post-sweating rapid pulse and vomiting of food, attributing it to Stomach Yang deficiency. Yang receives Qi from the Chest; excessive sweating weakens Yang Qi and Diaphragm Qi, causing guest heat to escape outward, resulting in rapid pulse. Guest heat cannot digest food, causing vomiting; this must be attributed to Stomach cold deficiency. Using Stomach-clearing herbs based on the rapid pulse would be erroneous.
Cheng Yingmao stated: Seeing rapid pulse but vomiting: rapid is a heat pulse, but if forceless, it is a deficiency pulse. Deficient Yang guests in the upper region cannot warm downward, causing Stomach cold deficiency. Heat is guest heat; cold is true cold. Ultimately, the root is sweating weakening Yang Qi. How precious is Yang Qi, and how can one rashly sweat?

In Yangming disease, inability to eat, attacking the heat will inevitably cause hiccups (Yue). The reason is cold deficiency in the Stomach. Because the person is originally deficient, attacking the heat will inevitably cause hiccups.

[Annotation] Inability to eat in Yangming disease indicates Middle Cold. Even if there is a rapid pulse with guest heat, the previous clause warned against sweating; this adds that purging is also contraindicated. Attacking heat will chill Stomach Yang, inevitably causing hiccups. The reason is that although guest heat is removed, the Stomach remains cold-deficient. Because the person is originally Stomach deficient, attacking heat causes hiccups. Yue refers to dry heaving.

[Collected Annotations] Fang Youzhi stated: Heat-purging herbs are cold, hence hiccups are inevitable. Stomach deficiency described as inability to eat serves as a warning.
Lin Lan stated: Yangming delirium and tidal fever with inability to eat can be purged due to dry stool in the interior. However, some cases involve Stomach cold deficiency causing inability to eat; these must be carefully distinguished. One cannot simply assume inability to eat indicates excess. Mistaken purging removes heat but triggers hiccups. Thus, one cannot generalize that Yangming always requires purgation!

If Stomach cold deficiency causes inability to eat, drinking water will trigger hiccups.

[Annotation] This continues the meaning of the previous clause that hiccups occur even without purging. If Stomach cold deficiency causes inability to eat, drinking water will trigger hiccups because the cold-deficient Stomach encounters cold water. Lizhong Tang plus Dingxiang (Caryophylli Flos) and Wuzhuyu (Evodiae Fructus) should be used to warm and direct downward.

[Collected Annotations] Yu Chang stated: Exterior heat with interior cold requires saving the interior first. SiNi Tang is used in Taiyang; how much more so in Yangming? This clause presents more severe cold deficiency than the previous one; thus, not only does attacking heat cause hiccups, but drinking water also causes them.
Wang Hu stated: If Stomach cold deficiency causes inability to eat, drinking water causes water and cold to clash, rebellious Qi rises, causing hiccups. Treatment requires strong warming.

Fuyang pulse is floating; floating indicates deficiency. Floating and deficiency interacting causes belching (Qi Yi), indicating exhaustion of Stomach Qi. Pulse slippery indicates hiccups; this is the physician's fault, treating deficiency as excess, guarding emptiness while forcing blood. If pulse is floating and nose is dry, epistaxis (Nu) will occur.

[Annotation] Mistaken purging or drinking cold water can cause belching, certainly. Now, Fuyang Stomach pulse is floating but not large, forceless and deficient, indicating Stomach deficiency interacting with pathogen. Even without mistaken purging or cold drinks, belching occurs. If Fuyang Stomach pulse is slippery, hiccups occur; this is belching due to heat congestion, not Stomach Qi exhaustion. How can the physician treat excess as deficiency, taking blame upon themselves? If Fuyang Stomach pulse is floating and nose is dry, heat occupies the Ying level, Ying heat forces blood to move recklessly, causing epistaxis. Some confuse Yue (dry heave) with hiccup (E Ni). Yue is dry heave, named for its sound. Modern hiccups (E Ni) involve air rushing from below the navel upwards after drinking cold water, making grunting sounds. Long pauses indicate excess, treatable; short, incessant sounds indicate deficiency, difficult to treat.

[Collected Annotations] Fang Youzhi stated: This introduces Fuyang pulse, discussing hiccups and epistaxis, both caused by forced sweating failing to produce sweat. Jiu means fault. Ze Xu means seeking disease in deficiency. Qu Shi means wrongly treating deficiency as excess. Blood belongs to Yin and guards inwardly, hence "guarding emptiness." Po Xue means coercing sweat.

Cunkou pulse is floating and large, yet the physician mistakenly uses purgation; this is a major reversal. Floating indicates lack of blood; large indicates cold. Cold qi interacting causes borborygmus. The physician fails to recognize this and instead gives cold water to induce heavy sweating. Water meeting cold qi causes cold interaction, inevitably causing belching in the patient.

[Note] The four characters "ling han da chu" (causing heavy sweating) are likely interpolations.

[Annotation] Cunkou floating-large pulse refers to all six pulses being floating and large. Six pulses floating-large are not the large pulse of Yangming palpable under pressure, but the large pulse of Taiyang not palpable under pressure. Mistaken purgation is a major reversal. The former floating pulse transforms into deficiency lacking blood; the large pulse transforms into slow pulse of Stomach cold. Deficiency and cold interact, causing borborygmus. The physician fails to recognize this and gives cold water. The patient receives cold-water qi; cold and deficiency interact in the Stomach, inevitably causing belching. Yi refers to qi knotting with sound, i.e., modern hiccup.

[Collected Annotations] Cheng Zhi stated: This describes the transformation of mistaken purgation when pathogen is in the exterior. Cunkou floating-large without hardness/fullness or interior heat syndromes should be treated with sweating. If