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The pulse at the cunkou (radial artery) is floating and slow. Floating indicates wind, while slow indicates bi-syndrome (obstruction syndrome). However, this bi-syndrome is not wind-stroke. The patient suffers from vexation in the four limbs; the color of the spleen must manifest as yellow on the face, with stagnant heat circulating through the body. The Fuyang pulse is tight and rapid. Rapid indicates heat, which consumes food; tight indicates cold, causing fullness after eating. A floating pulse at the chi position indicates kidney injury, while a tight Fuyang pulse indicates spleen injury. Wind and cold fight each other; upon eating, dizziness occurs. Grain qi fails to digest, the stomach suffers from turbid qi, which flows downward, blocking urination. Yin is affected by cold, while heat flows into the bladder. The entire body turns yellow, named Grice Jaundice (Gu Dan). If the forehead is black, with slight sweating, heat in the hands and feet occurring at dusk, urgency in the bladder but free urination, it is named Female Labor Jaundice (Nv Lao Ju). If the abdomen is distended like water accumulation, it is difficult to treat. Vexation and heat in the heart, inability to eat, and occasional desire to vomit indicate Wine Jaundice (Jiu Dan).

[Annotation] The floating and slow pulse at cunkou, where floating indicates wind and slow indicates bi-syndrome (not wind-stroke), has been discussed in detail previously. Now, with a tight and rapid Fuyang pulse, a floating chi pulse, vexation in the four limbs, and yellowing of the body and face, this is jaundice. Yellow is the color of Earth; Earth pathology manifests this way. Earth belongs to the Spleen and Stomach. The Spleen is Yin Earth governing dampness, and the Stomach is Yang Earth governing heat. Therefore, all jaundice cases involve dampness stagnating and heat郁 (depressing). Manifesting externally, it causes vexation in the four limbs and yellowing of the body and face. Generally, if the person has pre-existing damp-heat, combined with external wind-cold fighting, internal injury from sexual exhaustion, and consumption of grain and alcohol, interacting with dampness or heat, all can cause this disease. If the stomach pulse is rapid, heat exceeds dampness, transforming via Stomach Yang heat; heat consumes grain, so the patient can eat, termed Yang Jaundice. If the stomach pulse is tight, dampness exceeds heat, transforming via Spleen Yin cold; cold prevents eating, causing fullness after eating, termed Yin Jaundice. Yang Jaundice includes Heat Jaundice and Wine Jaundice; Yin Jaundice includes Female Labor Jaundice and Grice Jaundice. If the chi pulse is floating instead of deep, it indicates kidney injury; kidney injury leading to jaundice is also Female Labor Jaundice. If the stomach pulse is tight instead of slow, it indicates spleen injury; spleen injury leading to jaundice is also Grice Jaundice. Grice Jaundice presents with fullness after eating, undigested grain qi, stomach suffering from turbid qi. Clear qi is blocked from ascending, causing dizziness; turbid qi flows to the bladder, causing urinary obstruction. Female Labor Jaundice presents with a black forehead (kidney color); slight sweating indicates dampness is not stagnant; five-center heat occurring at dusk indicates Kidney Yin heat; bladder urgency with free urination indicates lower jiao deficiency. Abdominal distension like water indicates failure of both spleen and kidney, hence untreatable. If there is vexation in the heart, heat, inability to eat, occasional vomiting, abdominal fullness, and urinary difficulty, even with blue eyes and black face, it is definitely Wine Jaundice.

A deep pulse, thirst with desire to drink, and urinary difficulty all lead to yellowing.

[Annotation] A deep pulse indicates interior syndrome; thirst with desire to drink indicates heat stagnation; urinary difficulty indicates dampness depression. Heat stagnation and dampness depression in the interior cause yellowing. The first clause states that floating-slow and tight-rapid pulses cause yellowing, originating from external factors; this clause states a deep pulse also causes yellowing, originating from internal factors. Thus, treating jaundice involves sweating and purging methods.

[Ji Zhu - Collected Annotations] Li says: Deep pulse with thirst, desire to drink, and urinary difficulty means damp-heat accumulates internally without a way to dissipate, causing yellowing.

Jaundice with thirst is difficult to treat; jaundice without thirst is treatable. Onset in Yin parts causes vomiting; onset in Yang parts causes chills and fever.

[Annotation] Before jaundice forms, urinary difficulty with thirst indicates impending jaundice. After jaundice forms, thirst indicates deep heat, making it difficult to treat; absence of thirst indicates shallow heat about to resolve, making it treatable. Jaundice arising from Yin causes vomiting/reversal of Qi. Vomiting/reversal is due to interior Yin pathology. Jaundice arising from Yang causes chills and fever. Chills/fever are due to exterior Yang pathology. Thirst vs. no thirst distinguishes difficult vs. treatable jaundice; vomiting vs. chills/fever distinguishes exterior vs. interior jaundice.

[Ji Zhu - Collected Annotations] Cheng Lin says: In jaundice, damp-heat fights. There may be dry mouth/nose but not thirst. Thirst implies fluid depletion and pathogen dominance; no thirst implies fluids intact and righteous Qi strong, distinguishing treatment difficulty. Yin governs interior; dampness exceeding in interior causes vomiting. Yang governs exterior; heat exceeding in exterior causes chills and fever. This clause distinguishes severity and exterior/interior based on thirst. You Yi says: Thirst in jaundice means heat is blazing and dampness increasing, hence difficult. No thirst means heat subsiding and dampness dissipating, hence treatable. Yin parts refer to interior organs affecting Qi, causing vomiting. Yang parts refer to exterior body affecting Form, causing chills and fever. This distinguishes Yin/Yang, interior/exterior, shallow/deep.

Abdominal fullness, flaccid yellow body, restlessness preventing sleep, belongs to the Jaundice family.

[Commentary] The character "tongue" in "flaccid yellow tongue" should be "body," likely a transcription error.

[Annotation] Flaccid yellow body, abdominal fullness, and restlessness preventing sleep belong to Jaundice family diseases, located in the interior, requiring purging.

[Ji Zhu - Collected Annotations] Xu Bin says: Abdominal fullness is an interior sign. With flaccid yellow body and restlessness, stagnant heat moves outward, indicating the beginning of yellowing. Hence, it belongs to the Jaundice family.

For all Jaundice family diseases, promoting urination is sufficient. If the pulse is floating, resolve via sweating, using Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus).

[Annotation] "All Jaundice family diseases" refers to all types. Jaundice lacks distinct exterior/interior signs. If heat is excessive with thirst, clear it. If dampness is excessive with urinary difficulty, promote urination. If the pulse is floating, the pathogen is in the exterior, resolve via sweating, using Guizhi Jia Huangqi Tang. By inference, a deep pulse indicates interior location, requiring purging.

[Ji Zhu - Collected Annotations] Gao Shishi says: Promoting urination is the fixed method for jaundice. However, sweating is sometimes appropriate. If the pulse is floating indicating exterior, use sweating. Guizhi Jia Huangqi Tang uses Guizhi Tang to release the muscle layer, inducing sweat. Adding Huangqi (Astragalus) assists the exterior; harmonizing the exterior unites Ying and Wei.

Guizhi Jia Huangqi Tang formula (see Water Qi Disease chapter).

The Master said: In jaundice with fever, vexation, panting, chest fullness, and dry mouth, these symptoms arise because fire therapy was used to force sweating during onset, causing two heats to combine. Jaundice originates from dampness. Whole-body fever and yellowing, with abdominal heat (heat in the interior), require purging.

[Annotation] This details the pathology of misusing fire therapy for jaundice. Jaundice involves damp-heat. Damp flooding the interior causes chest fullness, vexation, and panting. Heat flooding the interior causes fever and dry mouth. Using fire to force sweat combines two heats. Since jaundice comes from dampness, whole-body fever and yellowing occur. Although there is exterior heat from misused sweating, do not sweat. Palpate abdominal heat to confirm interior heat, then purge to remove heat.

[Ji Zhu - Collected Annotations] Cheng Lin says: Damp in interior causes vexation/panting/fullness; heat in interior causes fever/dry mouth. Fire forcing sweat causes heat conflict. Jaundice results from damp-heat stagnating in Spleen Earth, causing whole-body fever and yellowing, highlighting the error of fire therapy. Abdominal heat indicates heat in the abdomen, removable by purging damp-heat.

Jaundice with abdominal fullness, urinary difficulty with red urine, and spontaneous sweating indicates harmonious exterior and solid interior, requiring purging, preferably Da Huang Xiao Shi Tang (Rhubarb and Niter Decoction).

[Annotation] Following the previous clause, this details symptoms and treatment. Abdominal fullness, difficult red urination indicate interior heat. Spontaneous sweating indicates harmonious exterior and solid interior. Use Da Huang Xiao Shi Tang to purge.

Da Huang Xiao Shi Tang Formula
Da Huang (Rhubarb Root and Rhizome), Huangbai (Phellodendron Bark), Xiaoshi (Niter) (4 liang each), Zhizi (Gardenia Fruit) (15 pieces).
Boil the first three ingredients in 6 sheng of water to obtain 2 sheng, strain, add Xiaoshi, boil again to obtain 1 sheng, take once.

[Ji Jie - Collected Explanations] Li says: Abdominal fullness and difficult red urination are interior diseases. Spontaneous sweating indicates exterior harmony. For interior disease with severe damp-heat, Zhizi clears upper jiao damp-heat, Da Huang drains middle jiao damp-heat, Huangbai clears lower jiao damp-heat. Xiaoshi has drying and dispersing properties within bitter-cold heat-draining actions, ensuring drug efficacy reaches everywhere, dissipating all damp-heat.

For Jaundice Disease, Yinchen Wuling San (Yinchen and Five-Ingredient Powder with Poria) is indicated (another version says: Yinchen Tang and Wuling San both indicated).

[Commentary] The phrase "urinary difficulty" is missing after "Jaundice Disease"; its inclusion provides basis for the formula, likely a transcription omission.

[Annotation]
For Jaundice Disease: If pulse is deep with abdominal fullness (interior), purge with Da Huang Xiao Shi Tang. If pulse is floating with no sweat (exterior), sweat with Guizhi Jia Huangqi Tang. If urinary difficulty exists (neither purely exterior nor interior), use Yinchen Wuling San.

Yinchen Wuling San Formula
Yinchen Hao End (10 parts), Wuling San (5 parts, formula see Phlegm-Fluid Disease chapter).
Mix the two powders. Take one fangcunbi before meals with rice soup, three times daily.

[Ji Jie - Collected Explanations] You Yi says: This is the standard treatment for damp-heat jaundice. Yinchen disperses heat stagnation; Wuling San promotes dampness stagnation.

In Jaundice Disease, if urine color does not change, there is desire for spontaneous diarrhea, abdominal fullness, and panting, do not clear heat. Clearing heat will inevitably cause hiccups. Hiccups are treated with Xiaobanxia Tang (Minor Ginger and Pinellia Decoction).

[Annotation] Jaundice urine should be red; now it is white, and there is desire for spontaneous diarrhea. Despite abdominal fullness and panting, this is dampness excess without heat, a Yin Jaundice pattern. Do not clear heat. Using cold/laxative drugs to clear heat will chill the stomach, causing hiccups. Treat hiccups with Xiaobanxia Tang.

[Ji Zhu - Collected Annotations] Li says: Unchanged urine color and desire for spontaneous diarrhea indicate no interior excess. Abdominal fullness and panting indicate Spleen Qi deficiency and Lung Qi obstruction. Using bitter-cold drugs to purge/clear heat chills the stomach, causing reverse Qi and hiccups. Use Xiaobanxia Tang to scatter reverse Qi and stop hiccups.
Gao Shishi says: Unchanged urine color is not red; desire for spontaneous diarrhea is not dysentery. Although abdominal fullness and panting seem like interior excess, do not use cold agents to clear heat (e.g., Da Huang Xiao Shi Tang). Using cold agents to clear heat causes hiccups. Hiccups are eructation/belching. Banxia and Shengjiang are acrid-warm and disperse cold; thus, use Xiaobanxia Tang for hiccups.

Xiaobanxia Tang formula (see Phlegm-Fluid Disease chapter).

Jaundice Disease has an eighteen-day prognosis. Treatment for over ten days should result in recovery; worsening after ten days is difficult to treat.

[Annotation] Jaundice belongs to the Spleen, which governs Earth. Earth has no fixed position but thrives at the end of each season for eighteen days. The eighteen-day period corresponds to Earth's thriving days. Recovery should occur within ten to eighteen days. If not recovered after eighteen days and worsening, Earth Qi is deficient. Hence, difficult to treat.

[Ji Zhu - Collected Annotations] Gao Shishi says: Eighteen days is the cycle of Spleen Earth thriving in the four seasons. Ten days is the completion number of Earth. Since jaundice lies in Spleen Earth, the period is eighteen days. Early treatment is preferred; recovery should occur after ten days. If not recovered after ten days and worsening, it is difficult to treat, meaning Spleen Qi failure is incurable.

Grice Jaundice presents with chills and fever, inability to eat, dizziness after eating, mental unrest, and eventual yellowing. It is named Grice Jaundice, treated with Yinchenshao Tang (Yinchen and Gardenia Decoction).

[Annotation] This details Grice Jaundice. Before formation, patients often have chills and fever. During chills/fever, they cannot eat; when resolved, they might eat, but dizziness and mental unrest follow eating. This indicates damp-heat stagnation steaming internally, signaling impending Grice Jaundice. Eventually, the body and face turn yellow. Use Yinchenshao Tang to drain via urination and defecation.

Yinchenshao Tang Formula
Yinchen Hao (6 liang), Zhizi (14 pieces), Da Huang (2 liang).
Boil the three ingredients in 1 dou of water. First boil Yinchen Hao, reducing by 6 sheng. Add the other two, boil to obtain 3 sheng. Strain, divide into three warm doses. Urination should increase, urine resembling soapberry juice, bright red. After one night, abdominal fullness decreases, and yellow exits via urine.

In Yangming Disease, a slow pulse, inability to eat until full, vexation and dizziness after fullness, and difficult urination indicate impending Grice Jaundice. Even if purged, abdominal fullness remains. This is due to the slow pulse.

[Annotation] Grice Jaundice usually involves Stomach Heat with a rapid pulse. Here, the slow pulse indicates Spleen Cold. Cold fails to transform grain; thus, despite hunger, one cannot eat much. Fullness causes vexation and stagnation, impairing transport. Clear Qi fails to ascend (dizziness); turbid Qi fails to descend (difficult urination). These signal impending Grice Jaundice. The condition arises from Taiyin cold-damp stagnation. Mistaking it for Yangming damp-heat jaundice and purging may temporarily reduce fullness, but it returns quickly due to cold (slow pulse). This clarifies that impending Grice Jaundice due to Spleen Yin cold transformation is not suitable for purging.

[Ji Zhu - Collected Annotations] Cheng Lin says: Slow pulse indicates cold; cold fails to digest grain, so one cannot eat much. Fullness leads to undigested grain qi, stomach turbidity, vexation, and dizziness. Difficult urination occurs because slow pulse lacks Yang Qi to transform turbidity, leaving it in the Stomach. Purging only empties the Stomach while fullness persists due to cold.

Jaundice patients experiencing afternoon fever with contrary chills, caused by female labor, present with bladder urgency, lower abdominal fullness, whole-body yellowing, black forehead, and foot heat, forming Black Jaundice. Abdominal distension resembles water, stools are black and loose. This is Female Labor Jaundice, not water swelling. Abdominal fullness is difficult to treat; use Xiaoshi Fanshi San (Niter and Alum Powder).

[Annotation] This details Female Labor Jaundice. Afternoon fever is typically Yangming heat (no chills). Contrary chills indicate Female Labor Jaundice. Symptoms include bladder urgency and lower abdominal fullness with free urination; whole-body yellowing with black forehead; foot heat. This is Shaoyin heat causing Black Jaundice. Abdominal distension like water and black loose stools indicate blood involvement from organ disease, not water swelling. Blood disease changes complexion; black color implies blood pathology. Abdominal fullness in Female Labor Jaundice is difficult to treat due to Spleen-Kidney failure. Xiaoshi enters blood to dissolve hardness; Fanshi enters Qi to overcome dampness. This formula treats symptoms, not root. Textual errors exist; reasoning is clarified here.

[Ji Zhu - Collected Annotations] You Yi says: Afternoon fever with chills indicates Female Labor Jaundice. Heat is shallow in Stomach but deep in Kidney; deep heat causes initial chills. Bladder urgency, black forehead, foot heat, black stools are Kidney heat signs. Lower abdominal fullness resembles water but is due to Kidney Qi failure, not Spleen damp-water. Combined abdominal fullness injures both Spleen and Kidney, making treatment difficult. Xiaoshi is salty-cold to clear heat; Fanshi clears stubborn heat in bone marrow (Kidney association) to clear Kidney heat. Take with Barley Porridge to protect the Stomach.

Xiaoshi Fanshi San Formula
Xiaoshi (Niter), Fanshi (Alum) (calcined, equal parts).
Powder the two ingredients. Mix with Barley Porridge juice. Take one fangcunbi, three times daily. Disease exits via stool and urine; normal yellow urine and black stool indicate effectiveness.

Male jaundice with free urination should be treated with Xulao Xiaojianzhong Tang (Deficiency Consumption Minor Constructive Middle Decoction).

[Annotation] Postpartum women with bleeding who turn yellow suffer from blood loss, not jaundice. Male jaundice with free urination indicates non-damp-heat origin. Inquiry reveals blood loss history causing deficiency yellow. Sweating, purging,渗 (percolating), and diuretic methods are contraindicated. Treat as deficiency consumption with blood loss. Use Xiaojianzhong Tang to nourish Ying and Wei; yellow resolves spontaneously.

[Ji Zhu - Collected Annotations] Gao Shishi says: Female is Yin/Blood; Male is Yang/Qi. Male jaundice indicates Yang Qi deficiency. Yellow is Earth color; Yang deficiency allows Earth color to manifest externally. No damp-heat in middle, hence free urination. This is deficiency; use Xiaojianzhong Tang to harmonize Yin/Yang and regulate Blood/Qi. The text references Xiaojianzhong Tang for Deficiency Consumption, implying male jaundice with free urination is a Deficiency Consumption pattern.

Xiaojianzhong Tang formula (see Deficiency Consumption chapter).

Wine Jaundice may present with no exterior heat but delirium, lower abdominal fullness, desire to vomit, and dry nose. If the pulse is floating, induce vomiting first; if deep and string-taut, purge first.

[Annotation] This details Wine Jaundice. Wine is damp and hot; excess drinking generates damp-heat jaundice. No exterior heat but delirium and dry nose indicate interior heat. Lower abdominal fullness indicates damp-heat in Bladder. Desire to vomit indicates damp-heat fermenting in Stomach. Floating pulse indicates wine-heat in meridians; induce vomiting to resolve exterior. Deep-string pulse indicates wine-damp in interior; purge to resolve interior.

[Ji Zhu - Collected Annotations] Li says: Foot-Yangming Stomach Meridian starts at the nose, explaining dry nose.

Patients with Wine Jaundice always have urinary difficulty. Signs include heat in the heart and heat under the feet.

[Annotation] This details Wine Jaundice pathology. Damp-heat generation causes urinary difficulty. Heat in the heart indicates Stomach Fu heat; heat under the feet indicates Stomach Meridian heat. These are Wine Jaundice signs.

[Ji Zhu - Collected Annotations] Cheng Lin says: Free urination allows damp-heat to exit; difficulty retains dampness in Stomach. Stomach Meridian passes through diaphragm to sole. Heat steaming Stomach causes heart heat; flowing to sole causes foot heat.

Wine Jaundice with heart heat and desire to vomit resolves with vomiting.

[Annotation] This details vomiting treatment for Wine Jaundice. Heart heat and desire to vomit indicate gastric vexation and nausea. Vomiting is necessary for cure.

[Ji Zhu - Collected Annotations] Cheng Lin says: Deep heat causes vexation/nausea; mild heat causes heart heat/nausea. Pathogen is in Upper Jiao, so vomiting cures it.

Wine Jaundice with heart vexation or heat pain is treated with Zhizi Dahuang Tang (Gardenia and Rhubarb Decoction).

[Annotation] This details purging treatment for Wine Jaundice. Wine Jaundice from excessive drinking. Heart vexation/nausea may resolve by spontaneous vomiting or Zhizi Chi Tang-induced vomiting. If heart vexation without desire to vomit, or heart heat pain, vomiting is ineffective; use Zhizi Dahuang Tang to purge.

Zhizi Dahuang Tang Formula