Library

(Wang Shuhe's Yangming Chapter, Mr. Haicang said: A yellow complexion resembling smoked tobacco indicates dampness disease, accompanied by pain throughout the body. A yellow complexion resembling an orange indicates jaundice disease, without pain throughout the body.)

Cheng Wuji commented: When damp-heat is excessive, the body turns yellow. In Shaoyang diseases progressing to jaundice, the condition has become severe. Pathogenic wind subjected to fire therapy causes two Yang energies to scorch each other, inevitably leading to a yellow body. If Yangming disease is treated with fire therapy, sweating on the forehead and difficulty in urination will inevitably lead to jaundice. These are all caused by internal heat being aggravated by fire therapy. In Yangming disease, absence of sweat, difficulty in urination, and mental restlessness (Ao Nao) inevitably lead to jaundice due to excessive Yangming heat. After sweating in Shaoyang disease, if the body and eyes turn yellow, it is because cold-dampness remains unresolved internally. This condition should not be treated with purgatives; instead, one should seek methods for treating cold-dampness. Thus, it is known that not only damp-heat causes jaundice, but cold-dampness also does. However, jaundice from cold-dampness presents as dark and dull like smoke, whereas jaundice from excessive heat presents bright orange-yellow, staining clothes, similar to cypress bark juice. Generally, jaundice belongs to the Taiyin channel. Taiyin jaundice results from steaming by damp-heat. The classic states: "Taiyin should manifest as body jaundice," which refers to this. If the pulse is deep and knotted, the lower abdomen is hard, urination is free, and the person appears manic, this is jaundice caused by blood stasis in the Lower Jiao. Jaundice is untreatable if the pulse at Cun is weak or absent, breath from the nose is cold, or if the body looks smoked, eyes stare fixedly, and head shakes (Heart exhaustion), or if the mouth corners are black, sweat is soft/cold, and jaundice occurs (Spleen exhaustion).

Shaoyang Disease: Body jaundice, pulse deep and knotted, lower abdomen hard, free urination, manic appearance indicate blood stasis; use Didang Tang (see Blood Stasis chapter). Six or seven days after onset, if the pulse is slow, floating, and weak, aversion to wind and cold, warm hands and feet, and the physician repeatedly uses purgatives leading to inability to eat, fullness and pain in the hypochondrium, neck stiffness, difficulty urinating, and yellow face/body, use Yinchen Wuling San (see Hypochondriac Pain chapter). In Shaoyang disease, if the pulse is floating and rapid, with headache, fever, slight night sweats, yet aversion to cold indicating the exterior is not resolved, and the physician incorrectly uses purgatives causing pathogenic qi to disturb the diaphragm, if there is no chest binding but only head sweating and difficulty urination, the body will inevitably turn yellow; use Zhizi Bopi Tang (see Head Sweating chapter). In Shaoyang Wind Strike, using fire therapy to induce sweating causes two Yang energies to scorch each other, leading to jaundice. Excess Yang desires epistaxis, Yin deficiency leads to difficult urination, both Yin and Yang are deficient, and the body becomes dry and withered; use Fangji Huangqi Tang and Zhizi Bopi Tang (see Head Sweating chapter).

Zhizi Bopi Tang Formula: Zhizi (15 pods, broken), Gancao (1 liang, roasted), Huangbai (2 liang). Boil these three ingredients in 4 sheng of water to obtain 1.5 sheng, remove dregs, and take warm in two doses.

If after sweating the body feels burning hot, it is called Fengwen. The pulse is floating in both Yin and Yang positions, spontaneous sweating, heavy body, excessive sleepiness, snoring breath, and difficulty speaking. If subjected to fire therapy, slight yellowing may occur. In Shaoyang disease, if after sweating fever and aversion to cold recur, followed by purgation making interior and exterior deficient, and then moxibustion/needling is added causing chest irritability, blue face, and skin spots, it is difficult to treat. If the color is slightly yellow and hands/feet are warm, recovery is easy (slight yellowing here is not a disease but a sign of easy recovery).

Yangming Disease: In Shanghan, if stagnant heat is in the interior, the body will inevitably turn yellow; use Mahuang Lianqiao Chixiaodou Tang.

Mahuang Lianqiao Chixiaodou Tang Formula: Mahuang (remove joints), Shengjiang (sliced), Lianyao (root of Lianqiao), Gancao (roasted, 2 liang each of the above four), Xingren (40 seeds, soaked, skin and tips removed), Dazao (12 pieces, broken), Shengzi Baipi (1 sheng, sliced), Chixiaodou (1 sheng). Boil these eight ingredients in 1 dou of rainwater. First boil Mahuang, skim foam upon boiling, add remaining herbs, boil to obtain 3 sheng, remove dregs, and take warm in three doses, finishing within half a day. (*Neijing* states: "For dampness rising with heat, treat with bitter-warm, assist with sweet-acrid, aiming for sweating." This applies. Rainwater is used because its thin taste does not aid dampness.)

In Yangming disease, if there is fever, only head sweating, difficulty urinating, thirst for fluids, this indicates stagnant heat in the interior, inevitably leading to jaundice; use Yinchenshao Tang. In Shanghan, after seven or eight days, if the body is yellow like gardenia color, with difficulty urinating and slight abdominal fullness, use Yinchenshao Tang. (Cheng Wuji commented: At peak heat, body yellow like orange indicates heat toxin venting externally. *Neijing* states: "The Bladder is the official of the reservoir, storing fluids; qi transformation allows them to exit." Difficulty urinating and lower abdominal fullness indicate heat excess externally preventing fluid descent. Yinchenshao Tang promotes urination, reduces jaundice, and removes heat.)

Yinchenshao Tang Formula: Yinchenshao (6 liang), Dahuang (2 liang, peeled), Fei Zhizi (14 pods, broken). Boil these three in 1 dou of water. First boil Yinchenshao until reduced by 6 sheng, add remaining two herbs, boil to obtain 3 sheng, remove dregs, and take warm in three doses. Urine should resemble soy sauce juice color (red); after one night, abdominal fullness decreases, and yellow exits via urine. (Cheng Wuji commented: Mild heat is harmonized with cool agents; severe heat is taken with cold agents. Jaundice is extreme heat, requiring strong cold agents to clear it. Sour and bitter induce vomiting and purging (Yin). Yinchenshao is sour-bitter and serves as the sovereign herb. Heart corresponds to South Fire and Heat; bitter-cold overcomes extreme heat, so Zhizi is the minister. Acid supplements, bitter purges; Dahuang assists in clearing evil heat. Though heat-toxin is severe, it is cleared through anterior/posterior elimination, resolving via bowel movement.)

In Yangming disease, absence of sweat, difficulty urinating, and mental restlessness inevitably lead to jaundice. Yangming Wind Strike: pulse stringy, floating, large, shortness of breath, abdominal fullness, pain in hypochondrium and heart region, dry nose, inability to sweat, lethargy, complete yellowing of body and eyes, difficulty urinating, tidal fever, occasional hiccups, swelling around ears. If illness persists ten days and pulse remains floating, give Xiaochaihu Tang; if pulse is only floating without other symptoms, give Mahuang Tang. If there is no urination, abdominal fullness, and increased hiccups, it is untreatable. In Yangming disease, if the face is red, do not purge; fever and jaundice with difficulty urination indicate use of Zhizi Bopi Tang. If Yangming disease is treated with fire therapy, slight forehead sweating and difficulty urination inevitably lead to jaundice (use Wuling San, Zhizi Bopi Tang). After sweating in Shanghan, if body and eyes turn yellow, it is because cold-dampness remains unresolved internally. Do not purge; seek treatment for cold-dampness. (Cheng Wuji commented: *Jingui Yaolue* states jaundice arises from dampness. If sweat releases heat, jaundice does not form. Post-sweat jaundice means wind-pathogen left, dampness remains. Spleen dislikes dampness; internal dampness steals Spleen color, causing jaundice. If blood stasis causes jaundice, purging is allowed; here, cold-dampness prevents purging, so treat as cold-dampness.)

Taiyin Disease: In Shanghan, if pulse is floating and slow, hands and feet are naturally warm, it relates to Taiyin. Taiyin should manifest as body jaundice. If urination is free, jaundice will not form because the Spleen is full (Shi), allowing rotting filth to exit. (Floating-slow is similar to large. For difficulty urinating, use Wuling San plus Yinchenshao; for free urination, use Jupi Tang.)

Lou Quanshan commented: Upper body jaundice, free urination, hard lower abdomen, mania, black stool indicate blood stasis; use Didang Tang to purge. If lower abdomen is not hard, no mania, normal stool, despite free urination, it is not blood stasis. There are three patterns: 1. Zhizi Bopi Tang and Mahuang Lianqiao Chixiaodou Tang treat jaundice with free urination and no body pain (Haicang's "Dry Jaundice"). 2. Guizhi Fuzi Tang removing Guizhi adding Baizhu Tang treats jaundice with free urination and whole-body pain (Huoren's "Dampness Strike").

Zhang Yuansu commented: Some ask why only Yangming and Taiyin channels cause jaundice in Shanghan, stating free urination prevents it. Yellow is the proper color of Earth; since Taiyin and Yangming belong to Earth, jaundice forms. The mechanism: external inability to sweat, internal inability to urinate, Earth of Spleen/Stomach steamed by heat, showing yellow externally. Free urination prevents heat accumulation, thus no jaundice. Other channels causing jaundice also stem from Spleen/Stomach Earth receiving pathogen.

Zhao Sizhen commented: Differentiate stagnant heat jaundice from blood stasis jaundice by signs and pulse. Head sweating stopping at neck, slight abdominal fullness, difficulty urinating, thirst indicate stagnant heat. Urgent lower abdomen, manic appearance, hard lower abdomen, free urination, black stool indicate blood stasis. Pulses differ: blood stasis is subtle/deep/knotted; stagnant heat is floating/slips/tight/rapid. Only the yellow color is similar. Also, wind-warmth with fire therapy, Shaoyang fire-induced sweating, Yangming fire-induced forehead sweating all cause yellowing via fire pathogen. Is there dissimilar yellow? Yes, dampness patients' smoked-yellow is different. One must distinguish based on similarity.

Attached Formulas:
Wuling Yinchensan Formula: Mix Yinchen decoction with Wuling San (2 qian), take 3-4 times daily. Jaundice exits via urine until urine clears.
Jupi Tang Formula: Jupi (1 liang), Shengjiang (2 liang), finely cut, boil in 1.5 sheng water to 0.7 sheng, remove dregs, take warm in two doses. Repeat if unhealed.
Yinchenshao Dahuang Tang: Treats Shanghan jaundice with complete yellowing of face/eyes and red urine. Ingredients: Yinchenshao, Shanzhiren, Chaihu, Huangbai (honey-roasted), Longdancao (each 0.5 liang), Huangqin (cleaned), Shengma, Dahuang (stir-fried, each 1 liang). Crush, take 5 qian per dose with 1.5 sheng water, boil to 1 sheng, take warm after meals morning and evening.
Maogen Tang: Treats Shanghan jaundice with golden-yellow body. Maogen (cleaned/cut), Shanzhiren, Yinchenshao, Digupi, Gancao (roasted, each 0.5 liang). Crush, take 5 qian per dose with 1.5 sheng water, 3 slices ginger, 6-7 grains Douchi, boil to 1 sheng, take warm far from meals.

Attached: Yin Jaundice
Cold body, sweating, deep pulse with yellowing indicates Yin Jaundice, dampness in Taiyin. May have body pain and fever, body yellow like smoke, but not bright orange like Yang Jaundice. Check urination. Free urination: Shufu Tang. Difficulty urinating, loose stool: Wuling San.

Li Dongyuan commented: In Shanghan, during Sun/Yin ruling periods, excessive purging often causes Yin Jaundice. Reason 1: Cold Water excess attacks Earth. Reason 2: Earth deficiency allows Water invasion. Treatments: 1. Yinchenshengfu Tang + Danggui, Guizhi; 2. Yinchenchupi Tang + Jiang, Zhu, Banxia; 3. Yinchenshuzi Tang; 4. Yinchensini Tang; 5. Yinchenshangfu Tang; 6. Yinchenswuzhuyu Tang. Details below: Jaundice with difficulty urinating, irritability, thirst: Yinchenshao Tang + Fuling, Zhuling, Huashi, Danggui, Guigui (Han's Yinchenshengfu Tang). Jaundice with irritability, wheezing, vomiting, no thirst: Yinchenshao Tang + Chenpi, Baizhu, Shengjiang, Banxia, Fuling (Han's Yinchenchupi Tang). Jaundice with cold limbs/body: Yinchenshao Tang + Fuzi, Gancao (Han's Yinchenshuzi Tang). Jaundice with cold limbs, waist sweating: Yinchenshao Tang + Fuzi, Ganjiang, Gancao (Han's Yinchenshangfu Tang). Jaundice with continuous cold sweat: Yinchenshao Tang + Fuzi, Ganjiang (Han's Yinchenshangfu Tang). Jaundice after ginger/fuzi meds, slow pulse: Yinchenshao Tang + Wuzhuyu, Fuzi, Ganjiang, Mutong, Danggui (Han's Yinchenswuzhuyu Tang). Zhao Zongyan developed jaundice from excessive purging, deep/slow/weak pulse; sequential use of Yinchenshuzi Tang was effective. Haicang's sequence: Han's Yinchenshengfu -> Yinchenchupi -> Yinchenshuzi. Scholar Zhao followed this.

Scholar Zhao had jaundice, Cun/Ruo pulse, cold body; sequential use of Yinchensini Tang was effective. Cold injury, weak pulse/qi, Yin Jaundice: Zhang Zhongjing's Lizhong Tang + Yinchenshao.

Li Dongyuan commented: Alternating chills/fever with whole-body jaundice: Xiao Chaihu Tang + Zhizi.

Yanyi Commentary: A monk with Shanghan had incomplete sweating, residual heat, yellow face/body, fever lasting a year. Misdiagnosed as food stagnation. Given formula: Yinchenshao, Zhizi (each 3 fen), Qinjiao, Shengma (each 4 qian), powdered. Take 3 qian with 4 he water, boil to 2 he, strain, take warm after meals. Recovered in 30 days.

Huoren Commentary: Wuling San + Yinchenshao Tang: Treats jaundice with thirst and difficulty urinating. Yinchenshao Tang (10 parts), Wuling Tang (5 parts). Mix, take 3 qian 3 times daily with water.
Another method: For impending jaundice, use Guiti powder insufflated into nose with water in mouth to expel yellow water. Then take Yinchenshao Tang mixed with Wuling San.

Bencao Commentary: Treats head damp-heat jaundice, Dan Guiti San. Guiti (20), Chixiaodou, Shumi (each 14 grains). Powder fine. Insert one grain-sized amount into nose to expel yellow water. Do not blow in.

Yunqizi Commentary: Chest-binding jaundice attaches to Shaoyang (treat as chest-binding); Pi-energy jaundice attaches to Taiyin (treat as Pi).

Huoren Commentary: Q: Baihu syndrome has fever, thirst, difficulty urinating, why no jaundice? A: Baihu has full-body sweating (heat vents); Jaundice has only head/face sweating, no sweat below neck.