（论二首脉证十四条方七首）
寸口脉浮而缓。浮则为风。缓则为痹。痹非中风。四肢苦烦。脾色必黄。瘀热以行。
〔衍义〕脾胃者。主四肢。合肌肉。其色黄。其气化湿。其性痞着。其脉迟缓。所畏风木。
风者。善行数变。若中风而风独行者。开则泄皮毛而出汗。闭则热肌肉以闷乱。
今风与湿相搏则成痹。所以痹之风则不能中。风之善行数变。内郁为瘀。热郁
极。乃发风。风性动。挟脾胃之积热以行。从而走四肢。欲散不散。为之苦烦。出肌
肤。为之色黄。缘风所致。故脉浮。因取痹。故脉缓也。
趺阳脉紧而数。数则为热。热则消谷。紧则为寒。食则为满。尺脉浮则伤肾。趺阳脉
紧则伤脾。风寒相搏。食谷即眩。谷气不消。胃中苦浊。浊气下流。小便不通。阴被其
寒。热流膀胱。身体尽黄。名曰谷疸。
额上黑。微汗出。手足中热。薄暮即发。膀胱急。小便自利。名曰女劳疸。腹如水状。不治。
〔衍义〕谷疸症。趺阳脉紧数者。何寒而致紧。何热而致数。尺浮何为伤肾。趺阳紧
何为伤脾。风从何生。不详其源。莫知其所治矣。盖天之六气。感人脏腑而应于
脉诊。因以数为热。紧为寒矣。然人脏腑气化。亦有风寒湿热燥火。与天气同其
名。寒热湿温凉同其性。阴阳表里同其情。浮沉迟数同其病。将何以别天与人
之气乎。天气从八风之变。邪自外入。人气从七情食色劳役之伤。邪自内出。谷
疸由脏气所化之淫邪为病。非天气也。盖脾胃之土有阴阳。脾阴而胃阳。阴阳
离决。二气不合。则胃独聚其阳以成热。为病消谷。脾独聚其阴以成寒。为腹满。
于是寒热见紧数之脉。而紧又为之伤脾者。乃肝木挟肾寒乘虚克土。故曰风
寒相搏。食入于胃。长气于阳。肝木之风。得阳则动。故食谷则头目眩晕也。肾属
水。藏精。实则脉沉。虚则脉浮。而精生于谷。谷不化。则精不生。精不生。则肾无所
受。虚而反受下流之脾邪。故曰尺浮伤肾。又曰阴被其寒。阴谓肾。寒谓脾也。此
谷气不化。所积之瘀浊。属于脾之寒者。不流则伤肾。属于胃之热者。下流则伤
膀胱。由是小便不通。身体尽黄。生于胃热食谷之浊。故曰谷疸。陈无择谓是症
用苦参丸方。苦参用龙胆除胃中伏热。本草以二药能益肝胆。平胃气。以猪胆
为使。此退胃之木火。用大麦者。五谷之长。脾胃所宜。将苦参龙胆入脾土也。本
草又曰破冷气去腹满。此疗脾阴寒结。
〔衍义〕女劳疸。惟言额上黑。不言身黄。简文也。后人虽曰交接水中所致。特其一
端耳。然以此连谷疸之后。必胃先有谷气之浊热。下伤于肾而后黑。黑疸因黄
而发也。二脏并病。安得不交见其色乎。盖胃阳明也。阳明与宗筋合于气街。饮
食入内。宗筋通用。阴精泄脱。而阳明之湿热。乘虚下流于肾之中。肾中之火。亦
乘阳明。上下交驰。胃土发越而色黄。相火入炎水中而色黑。二脏并病。故二色
并见。其黑色先见于额者。膀胱脉上巅交鼻额。火性炎上。故肾火从膀胱上越。
额为神庭。属心部。心、火之主也。心肾子午同化。足经之火。炎就手经。亦必出于
额。额、火之巅也。心主汗。火越于此。汗亦出此。所以额黑微汗也。手足心热者。手
心乃包络荥穴。足心乃肾之井穴。心肾火盛则应之。薄暮即发。膀胱急。小便自
利。乃阳明主阖。日暮阳明收敛。湿热下流。膀胱之气虽满急。其气降。故小便自
利。若湿热火郁甚。肾水之气不行。停积于腹。胀如水状者。则肾衰矣。故难治。
此以气受病者言之。若血病而黑。则如下条女劳疸云。
心中懊 而热。不能食。时欲吐。名曰酒疸。
〔衍义〕此饮之过当所致也。酒为五谷所致。酝而成。湿热有毒。其气归心。味归脾
胃。胃阳主升。脾阴主降。胃得之。则热甚。脾得之。则阴伤。阴伤则不能降。不降则
所饮停而不去。气熏于心。心神不宁。而作懊 。气痞中焦。故不能食。蓄极乃发。故时欲呕而为疸也。
阳明病脉迟者。食难用饱。饱则发烦头眩。小便必难。此欲作谷疸。虽下之。腹满如
故。所以然者。脉迟故也。
〔衍义〕伤寒阳明证注。阳明病脉迟。邪方入里。热未为实。食入于胃。长气于阳。胃
中有热。食难饱。饱则微烦而目眩者。谷气与热气相击。两热合。消搏津液。若小
便利者。不发黄。热得泄也。小便不利。则热不得泄。身必发黄。以其发于谷气之
热。故名谷疸。热实者下之。脉迟为热气未实。虽下之。腹满亦不减也。经曰。脉迟。尚未可
攻。且脉迟不但为热未实。脉经曰。关脉迟滞而弱者。无胃气而有热。则胃虚而脉迟。尤不可攻也。
夫病酒黄胆。必小便不利。其候心中热。足下热。是其证也。
〔衍义〕酒为湿热之最。膀胱者。清净之府。津液藏焉。气化所出。若过于酒。伤其气
化。小便必难。积气于中。则心热。流于肾则足下热。积成瘀热。发于外而为黄胆也。
酒黄胆者。或无热。清言了了。腹满欲吐。鼻燥。其脉浮者。先吐之。沉弦者。先下之。
〔衍义〕酒入胃而不伤心。则无心热。故神不昏而其言清朗也。不伤肾。则无足热。
但酒停于膈。欲吐。阳明气郁。成腹满。阳明脉上入额中作鼻燥。脉浮者。在膈上。
积多在阳。先吐上焦。而后治其中满。沉弦者。在膈下。积多在阴。先下其中满。而后治其上焦也。
酒疸。心中热。欲呕者。吐之愈。
酒停胃上脘。则心中热而后呕。必吐之乃愈。
酒疸。下之。久久为黑疸。目青面黑。心中如啖蒜齑状。大便正黑。皮肤爪之不仁。其
脉浮弱。虽黑微黄。故知之。
〔衍义〕酒疸之黑。非女劳疸之黑也。女劳之黑。肾气所发也。酒疸之黑。败血之黑
也。因酒之湿。热伤脾胃。脾胃不利。阳气不化。阴血不运。若更下之。久久则运化
之用愈耗矣。气耗血积。故腐瘀浊色。越肌面为黑。味变于心。咽作嘈杂。心辣如
啖蒜齑状。荣血衰而行于皮肤。爪之不仁。输于大肠。便如黑漆。其目青与脉浮弦。皆血病也。
师曰。病黄胆。发热烦喘。胸满口燥者。以病发时。火劫其汗。两热相得。然黄家所得。
从湿得之。一身尽发热而黄。肚热。热在里。当下之。
〔衍义〕黄胆必由湿热所发。湿有天地之湿。有人气之湿。有饮食之湿。三者皆内
应脾胃。郁而成热。郁极乃发。则一身热。而土之黄色。出见于表。为黄胆也。此证
先因外感湿邪。大法。湿宜缓取微汗。久久乃解。今因火劫其汗。汗纵出而湿不
去。火热反与内之郁热相并。客于足阳明经。故发热烦喘胸满。热仍在。故燥。此
际宜寒凉之剂。如肚热入腑。则当下之矣。
脉沉。渴欲饮水。小便不利者。皆发黄。
〔衍义〕大抵黄胆。俱属太阳阳明。热蒸其土而然也。而阳明又属金。金得火则
郁燥渴。燥与湿热相搏。则津液不化。故上焦渴而欲饮。下焦约而小便难。上下
不通。郁极而发于皮肤。故作黄。此条在里之热甚。故脉沉。伤寒论阳明病。有发
热头汗出。身无汗。渴饮水浆。小便不利者。茵陈汤主之。
黄胆之病。当以十八日为期。治之十日以上瘥。反剧者难治。
疸而渴者。其疸难治。疸而不渴者。其疸可治。发于阴部。其人必呕。发于阳部。其人振寒而发热也。
〔衍义〕疸即瘅也。单阳而无阴。湿热甚。脾胃之津液乏竭无阴。热蒸不已。孤阳能
独生乎。内经曰。刚其刚。阴气破散。阳气消亡。其难治为此。若不渴。则阴气犹存。
故可治。阴部者。脾太阴也。阳部者。胃阳明也。热甚于里则呕。热在于表。则发热
振寒。灵枢曰。脾是动者呕。阳明是静者。洒洒振寒也。伤寒发黄渴。亦茵陈汤主之。
谷疸之为病。寒热不食。食即头眩。心胸不安。久久发黄为谷疸。茵陈蒿汤主之。
茵陈蒿汤方
茵陈蒿（六两） 栀子（十四枚炒） 大黄（三两）
上三味。以水一斗。先煮茵陈。减六升。内二味。煮取三升。去滓。分温三服。小盒饭
利。尿如皂角汁状。色正赤。一宿腹减。黄从小便去也。
〔衍义〕此汤治阳明瘀热在里。身黄发热。但头汗出。身无汗。剂颈而还。小便不利。
渴饮水浆者。又伤寒七八日。身黄如橘子色。小便不利。腹微满者。今又治是证。
三者尽属里热。但务去其邪。病状之异弗论矣。此寒热不在表。脾胃内热。达于
外而成肌肤寒热者。亦不能食。灵枢曰。肌肤热者。取三阳于下。补足太阴。以出
其汗。皆因脾胃热。故不解其表。而遽治其里也。盖茵陈汤治热结发黄。佐栀子
去胃热。通小便。更以大黄为使。荡涤之。虽然。治疸不可不分轻重。如栀子柏皮
汤。解身热发黄内热之未实者。麻黄连翘赤小豆汤。治表寒湿。内有瘀热而黄
者。大黄硝石汤。下内热之实者。栀子大黄汤次之。茵陈蒿汤又次之。又必究其
受病之因有同异。既病之人有劳逸。若得之膏粱食肥者。气滞血壅。得之先贵
后贱。前富后贫。与脱势惭愧。离愁忧患者。虽皆郁积成热。气血失损。不可与食
肥者同治。若始终贫贱。不近水冒雨。即残羹冷汁。久卧湿地。多挟寒湿。致阴雨
乖隔而病。又可与上二者同治乎。故攻邪同。而先后调治。亦不可不审也。
腹满。舌痿黄。躁不得卧。属黄家。（一作身痿）
〔衍义〕瘀热内积为腹满。外连肌表成痿黄。身热气烦。血少荣微。夜不入阴。故不
睡。属黄家者。以其虽不似黄胆之黄。亦由积渐所致也。黄胆之黄深。实热之黄。
痿黄之黄浅。虚热之黄。若舌痿黄燥者。亦有说。心脾脉络舌上下。凡舌本黄燥
即是内热。况舌痿乎。湿热结积。虽不行肌表。然已见于舌。即属黄家也。
黄家。日晡所发热。而反恶寒。此为女劳得之。膀胱急。少腹满。身尽黄。额上黑。足下
热。因作黑疸。其腹胀如水状。大便必黑。时溏。此女劳之病。非水也。腹满者难治。硝石矾石散主之。
硝石矾石散方
硝石 矾石（烧等分）
上二味为散。以大麦粥汁。和服方寸匕。日三服。病随大小便去。小便正黄。大便
正黑。是候也。
〔衍义〕肾者。阴之主也。为五脏之根。血尽属之。血虽化于中土。生之于心。藏之于
肝。若肾阴病。则中土莫得而化。心莫得而生。肝莫得而藏。荣卫莫得而行。其血
败矣。将与湿热凝瘀于肠胃之间。肾属水。其味咸。其性寒。故治之之药。必用咸
寒。补其不足之水。泻其所客之热。荡涤肠胃。推陈致新。用硝石为君。本草矾石
能除固热在骨髓者。骨与肾合。亦必能治肾热可知也。大麦粥汁为之使。引入
肠胃。下泄郁气。大便属阴。瘀血由是而出。其色黑。小便属阳。热液从是而利。其色黄也。
酒疸病心中懊 。或热痛。栀子大黄汤主之。
栀子大黄汤方
栀子（十四枚） 大黄（一两） 枳实（五枚） 香豉（一升）
上四味。以水六升。煮取三升。分温三服。
〔衍义〕酒热内结。心神昏乱。作懊 。甚则热痛。栀子、香豉。皆能治心中懊 。大黄
荡涤实热。枳实破结逐停。去宿积也。伤寒论阳明病无汗。小便不利。心中懊
者。身必发黄。是知热甚于内者。皆能成是病。非独酒也。
诸病黄家。但利其小便。假令脉浮。当以汗解之。宜桂枝加黄 汤主之。
〔衍义〕黄家大约从水湿得之。经虽云。治湿不利小便。非其治也。然脉浮者。湿不
在里而在表。表热乘虚入里。亦作癃闭。故须以脉别之。汗解攻下。各有所宜也。
而攻下之法。既有浅深轻重。利小便与发汗之方。何独不然乎。是方所主。惟和
荣卫。非有发汗峻剂。必表之虚者用之。连翘赤小豆汤。又是里之虚者用之。利
小便亦然。是宜知其大略也。
诸黄。猪膏发煎主之。
附方
猪膏（半斤） 乱发（如鸡子大三枚）
上二味。和膏发中共煎。发消药成。分再服。病从小便出。
〔衍义〕此但言诸黄无他证。必将谓证有变态。不可悉数。及方云女劳疸。身目尽
黄。发热恶寒。小腹满。小便难。以大热大寒。女劳交接。从而入水所致。用是汤。又
云。五疸。身体四肢微肿。胸满。不得汗。汗出如黄柏汁。由大汗出。入水所致。猪脂
一味服。伤寒类略亦云男子女人黄胆。饮食不消。胃中胀热生黄衣。胃中有燥
屎使然。猪脂煎服则愈。因明此方。乃治血燥者也。诸黄所感之邪。与所变之脏
虽不同。然至郁成湿热。则悉干于脾胃。胃之阳明经。更属于肺金。金主燥。若湿
热胜。则愈变枯涩。血愈耗干。故诸黄起于血燥者。皆得用之。考之本草。猪脂利
血脉。解风热。润肺痿热毒。五疸身肿不得卧者。非燥之在上欤。胃中黄衣干屎。
非燥之在中欤。小腹满。小便难。非燥之在下欤。三焦之燥。皆将猪脂润之。而燥
在下。小便难者。又须乱发消瘀。开关格。利水道。故用为佐。此与前条硝石矾石
散。同治膀胱小腹满之血病。然一以除热去瘀。一以润燥。矾石之性燥走血。安
(Two treatises, fourteen pulse and symptom patterns, seven prescriptions)
The pulse at the cunkou (radial artery) is floating and slow. Floating indicates wind; slow indicates bi-syndrome (obstruction syndrome). This bi-syndrome is not wind-stroke. The patient suffers from vexation in the four limbs. The color of the spleen must be yellow; stagnant heat circulates throughout the body.
[Commentary] The spleen and stomach govern the four limbs and unite with the muscles. Their color is yellow, their qi generates dampness, their nature is stagnation and adherence, and their pulse is slow and moderate. They fear wind-wood. Wind is agile and changeable. If it is wind-stroke and wind acts alone, when the pores open, sweat exits from the skin and hair; when closed, heat stagnates in the muscles causing restlessness. Now, wind combats with dampness to form bi-syndrome. Therefore, the wind in bi-syndrome cannot strike the body like wind-stroke. The agile and changeable nature of wind, when internally stagnant, becomes blood stasis. When heat stagnates to an extreme, it triggers wind movement. Wind moves actively, carrying the accumulated heat of the spleen and stomach to circulate, flowing into the four limbs. Unable to disperse, it causes vexation; emerging on the skin and flesh, it causes yellowing. Because it is caused by wind, the pulse is floating; because it involves bi-syndrome, the pulse is slow.
The pulse at the fuyang (dorsalis pedis artery) is tight and rapid. Rapid indicates heat; heat digests food. Tight indicates cold; after eating, there is fullness. A floating pulse at the chi position indicates kidney injury. A tight pulse at the fuyang position indicates spleen injury. Wind and cold combat each other; dizziness occurs immediately after eating. Grain qi does not digest; the stomach suffers from turbid qi. Turbid qi flows downward, causing urinary obstruction. Yin is affected by cold, while heat flows into the bladder. The entire body turns yellow, named Grains Jaundice (Gu Dan).
If the forehead is black, with slight sweating, heat in the hands and feet, occurring at dusk, urgency in the bladder, and spontaneous urination, it is named Female Labor Jaundice (Nv Lao Dan). If the abdomen is distended like water, it is difficult to treat.
[Commentary] In Grains Jaundice, why does a tight fuyang pulse indicate cold? Why does a rapid pulse indicate heat? Why does a floating chi pulse injure the kidney? Why does a tight fuyang pulse injure the spleen? Where does the wind come from? Without knowing the source, one cannot know the treatment. Generally, the six qi of heaven invade the internal organs and manifest in pulse diagnosis, hence rapid is heat and tight is cold. However, the qi transformation of human internal organs also has wind, cold, damp, heat, dryness, and fire, sharing names with heavenly qi. Cold, heat, damp, warm, and cool share natures; yin, yang, interior, and exterior share states; floating, sinking, slow, and rapid share pathologies. How to distinguish heavenly qi from human qi? Heavenly changes come from the eight winds, with evil entering from outside; human damage comes from the seven emotions, diet, sex, and labor, with evil arising from inside. Grains Jaundice is caused by excessive pathogens transformed by organ qi, not by heavenly qi. Spleen and stomach earth have yin and yang; spleen is yin, stomach is yang. If yin and yang separate and the two qi do not harmonize, the stomach gathers yang to form heat, causing digestion of food; the spleen gathers yin to form cold, causing abdominal fullness. Thus, cold and heat appear with tight and rapid pulses. The tight pulse injuring the spleen is due to liver wood carrying kidney cold to attack earth in deficiency. Hence, wind and cold combat. Food enters the stomach, nourishing yang. Liver wind moves when aided by yang, causing dizziness upon eating. Kidney belongs to water, stores essence; excess pulse is deep, deficiency pulse is floating. Essence is born from grain. If grain is not digested, essence is not generated; if essence is not generated, the kidney receives nothing. Deficient, it receives the downward-flowing spleen pathogen. Hence, floating chi pulse injures the kidney. "Yin is affected by cold": yin refers to kidney, cold refers to spleen. Undigested grain accumulates as turbidity belonging to spleen cold; if it does not flow, it injures the kidney. Belonging to stomach heat, it flows downward to injure the bladder. Thus, urinary obstruction and whole-body yellowing occur. Originating from stomach heat and grain turbidity, it is called Grains Jaundice. Chen Wuzhe stated this condition uses Kushen Wan. Kushen combined with Longdan clears latent heat in the stomach. Materia Medica says these two herbs benefit liver and gallbladder and calm stomach qi, using pig bile as an envoy to retreat stomach wood-fire. Barley is used because it is the chief of five grains, suitable for spleen and stomach, guiding Kushen and Longdan into spleen earth. Materia Medica also says they break cold qi and remove abdominal fullness, treating spleen yin cold accumulation.
[Commentary] Female Labor Jaundice mentions only a black forehead, not body yellowing, which is concise text. Later generations said it was caused by intercourse in water, but this is only one aspect. Since it follows Grains Jaundice, it implies the stomach first had grain turbid heat, damaging the kidney below, leading to blackening. Black Jaundice develops from yellow jaundice. With both organs diseased, how can colors not intermingle? Stomach is Yangming, uniting with sinews at Qichuan. Food enters, sinews act together. If yin essence leaks, Yangming damp-heat flows down to the kidney. Kidney fire rises to meet Yangming. Upper and lower rush together, stomach earth emits yellow color, ministerial fire inflames water turning black. Both organs diseased, so both colors appear. Blackness appears first on the forehead because Bladder meridian goes to vertex, crosses nose and forehead. Fire nature flares upward, so kidney fire surges from bladder. Forehead is Shenting, belonging to heart region. Heart is master of fire. Heart and kidney transform together via Zi-Wu axis. Foot meridian fire rises to hand meridian, exiting at forehead. Forehead is the peak of fire. Heart governs sweat; fire surges here, sweat exits here. Hence, black forehead with slight sweat. Heat in palms and soles: palm is Pericardium Ying point, sole is Kidney Jing point. Heart and kidney fire excess responds here. Occurring at dusk: Bladder urgency, spontaneous urination. Yangming governs closing; at dusk Yangming converges, damp-heat flows down. Although bladder qi is full and urgent, its qi descends, so urination is spontaneous. If damp-heat stagnation is severe, kidney water qi fails to move, accumulating in abdomen causing water-like distension, indicating kidney decline, thus difficult to treat. This speaks of qi disease. If blood disease causes blackness, see next paragraph on Female Labor Jaundice.
Vexation in the heart with heat, inability to eat, occasional desire to vomit, is named Wine Jaundice (Jiu Dan).
[Commentary] This is caused by improper drinking. Wine is brewed from five grains, containing damp-heat toxicity. Its qi returns to the heart, its flavor returns to spleen and stomach. Stomach yang ascends, spleen yin descends. Stomach receiving wine causes intense heat; spleen receiving wine damages yin. Damaged yin cannot descend; undescended wine stagnates. Qi steams the heart, disturbing spirit causing vexation. Qi stagnates in middle jiao, causing inability to eat. Accumulation reaches extremity then erupts, causing occasional vomiting and jaundice.
In Yangming disease, if the pulse is slow, one cannot eat to fullness. Fullness causes vexation and dizziness. Urination will be difficult. This is about to become Grains Jaundice. Even if purged, abdominal fullness remains. The reason is the slow pulse.
[Commentary] Commentary on Yangming Syndrome in Shanghan Lun: Yangming disease with slow pulse means evil just entered interior, heat not yet solid. Food enters stomach, nourishes yang. Heat in stomach makes full eating difficult. Fullness causes slight vexation and dizziness because grain qi strikes heat qi. Two heats combine, consuming fluids. If urine is clear, no yellowing occurs because heat vents. If urine is difficult, heat cannot vent, body must yellow. Because it originates from grain heat, it is named Grains Jaundice. If heat is solid, purge it. Slow pulse means heat not solid; even if purged, fullness won't decrease. Classic says: Slow pulse, not yet ready to attack. Also, slow pulse not only means heat not solid. Pulse Classic says: Guan pulse slow, stagnant, weak means no stomach qi but has heat, i.e., stomach deficiency with slow pulse, especially unattackable.
Wine Yellow Jaundice must have urinary difficulty. Symptoms are heat in heart, heat under feet. This is the pattern.
[Commentary] Wine is the utmost of damp-heat. Bladder is pure mansion, storing fluids, output via qi transformation. Excessive wine damages qi transformation, causing urinary difficulty. Qi accumulates in middle causing heart heat; flows to kidney causing foot heat. Accumulated into stagnant heat, emitting externally as jaundice.
Wine Jaundice may have no heat, speech clear, abdominal fullness, desire to vomit, dry nose. If pulse is floating, use emesis first. If sinking and wiry, use purgation first.
[Commentary] Wine enters stomach without hurting heart, so no heart heat, spirit not confused, speech clear. Does not hurt kidney, so no foot heat. Wine stops in diaphragm, causing desire to vomit. Yangming qi stagnates, forming abdominal fullness. Yangming meridian enters forehead causing dry nose. Floating pulse indicates above diaphragm, accumulation mostly in yang. Emesis upper jiao first, then treat middle fullness. Sinking/wiry pulse indicates below diaphragm, accumulation mostly in yin. Purge middle fullness first, then treat upper jiao.
Wine Jaundice with heart heat and desire to vomit: emesis cures it.
Wine stopping in upper stomach causes heart heat then vomiting. Must emesis to cure.
Wine Jaundice, if purged, eventually becomes Black Jaundice. Eyes blue-black, face black, heart feels like eating garlic paste, stool black, skin numb to scratching. Pulse floating and weak. Though black, faint yellow is visible, thus known.
[Commentary] Blackness in Wine Jaundice differs from Female Labor Jaundice. Female Labor blackness is kidney qi emission; Wine Jaundice blackness is blood corruption. Damp-heat of wine damages spleen and stomach. Spleen/stomach dysfunction, yang qi not transforming, yin blood not moving. Further purging exhausts transformation function. Qi exhausted, blood accumulates, corrupt turbid color emerges on skin/face as black. Flavor changes in heart, throat feels restless, heart burns like garlic paste. Nutritive blood declines, circulating in skin, scratching causes numbness. Transfusing to large intestine, stool like black lacquer. Blue eyes and floating/wiry pulse are all blood diseases.
Master said: Jaundice with fever, vexation, panting, chest fullness, mouth dryness. At onset, fire coercion induced sweating. Two heats combined. However, Jaundice arises from dampness. Whole body fever and yellowing, belly heat, heat in interior, must be purged.
[Commentary] Jaundice must originate from damp-heat. Dampness includes heaven-earth dampness, human qi dampness, diet dampness. All three internalize to spleen/stomach, stagnate into heat, erupt at extreme causing whole body fever and earth-yellow surface manifestation. Initially due to external damp evil, major method is slow mild sweating to resolve. Now, fire coercion induces sweat; sweat exits but damp remains. Fire heat combines with internal stagnant heat, lodging in Foot Yangming meridian, causing fever, vexation, panting, chest fullness. Heat remains, causing dryness. Use cold-cool agents. If belly heat enters fu, purge it.
Pulse deep, thirst wanting to drink, urinary difficulty: all lead to yellowing.
[Commentary] Generally, Jaundice belongs to Taiyang-Yangming, heat steaming earth. Yangming belongs to metal; metal gets fire, becoming stagnant, dry, thirsty. Dryness combats damp-heat, fluids fail to transform. Upper jiao thirsty wanting to drink; lower jiao constrained, urinary difficulty. Upper/lower blocked, stagnation erupts on skin as yellow. This line indicates severe interior heat, hence deep pulse. Shanghan Lun Yangming disease: fever, head sweat, no body sweat, thirst wanting fluids, urinary difficulty: treated with Yinchen Decoction.
Jaundice disease has an eighteen-day period. Treatment over ten days should improve; if worsening, difficult to treat.
Jaundice with thirst is difficult to treat; jaundice without thirst is treatable. Disease originating in yin parts causes vomiting; disease originating in yang parts causes chills and fever.
[Commentary] Dan is equivalent to Dian, single yang without yin, severe damp-heat. Spleen/stomach fluids exhausted without yin. Heat steams endlessly, can lone yang survive? Neijing says: Rigidity breaks yin, yin qi scatters, yang qi perishes. This is why difficult. No thirst means yin qi remains, thus treatable. Yin part is Spleen Taiyin; Yang part is Stomach Yangming. Heat severe in interior causes vomiting; heat in exterior causes fever/chills. Ling Shu says: Splei moving disease causes vomiting; Yangming quiet disease causes shivering chills. Shanghan yellowing with thirst also treated with Yinchen Decoction.
Grains Jaundice disease: chills/fever, inability to eat, dizziness upon eating, heart/chest unrest, eventually yellowing becomes Grains Jaundice. Treated with Yinchen Hao Tang.
Yinchen Hao Tang Formula
Yin Chen Hao (6 liang), Zhi Zi (14 seeds, fried), Da Huang (3 liang).
Three ingredients. Water 1 dou. Boil Yin Chen Hao first, reduce by 6 sheng. Add remaining two, boil to 3 sheng. Remove dregs. Divide into three warm doses. Small boxian (urination) will be smooth. Urine like soap pod juice, red. Overnight abdominal reduction. Yellow leaves via urine.
[Commentary] This decoction treats Yangming stagnant heat in interior, body yellowing/fever, only head sweat, no body sweat, sweat stopping at neck, urinary difficulty, thirst wanting fluids. Also treats Shanghan 7-8 days, body yellow like orange peel, urinary difficulty, slight abdominal fullness. These three belong to interior heat. Just remove evil, ignore symptom differences. Chills/fever not in exterior, but spleen/stomach interior heat reaching exterior causing skin chills/fever, unable to eat. Ling Shu says: Skin heat, take San Yang below, tonify Taiyin to induce sweat. All due to spleen/stomach heat, so do not release exterior, but treat interior directly. Yinchen Hao Tang treats heat-binding yellowing. Zhi Zi assists to clear stomach heat, promote urination. Da Huang acts as envoy to scour. However, treating jaundice requires distinguishing severity. Zhizi Bopi Tang clears body heat/yellowing interior heat not solid. Mahlian Qiaochi Xiaodou Tang treats exterior cold-damp, interior stagnant heat yellowing. Dahuang Xiaoshi Tang purges interior heat solid. Zhizi Dahuang Tang is secondary. Yinchen Hao Tang is tertiary. Investigate cause similarity/difference. Patient labor/rest status. Diet rich/fatty causes qi stagnation/blood congestion. Former noble/poor, former rich/poor, loss of power/shame, separation/sorrow cause heat accumulation, qi/blood damage. Cannot treat same as fatty diet patients. Poor/humble, rain exposure, cold leftovers, damp bed causes cold-damp, yin-yang disruption illness. Can these be treated same as above? Attack evil same, but sequential regulation must be examined.
Abdominal fullness, tongue flaccid yellow, restlessness unable to lie down, belongs to Jaundice Family (Huang Jia). (Variant: Body flaccid).
[Commentary] Stagnant heat interior accumulation causes abdominal fullness. Exterior connecting muscle surface forms flaccid yellow. Body heat/qi vexation, blood deficient/nutritive micro, night not entering yin, thus sleepless. Belonging to Huang Jia, though not as yellow as Jaundice, results from gradual accumulation. Jaundice yellow is deep, solid heat yellow. Flaccid yellow is shallow, deficiency heat yellow. Tongue flaccid yellow dry: explanation exists. Heart/Spleen meridians connect tongue top/bottom. Tongue root yellow dry indicates interior heat, let alone tongue flaccidity. Damp-heat accumulation, though not on muscle surface, seen on tongue, belongs to Huang Jia.
Huang Jia, afternoon fever, counter-intuitively chills, caused by Female Labor. Bladder urgency, lower abdominal fullness, whole body yellowing, forehead black, foot heat, thus forming Black Jaundice. Abdominal distension like water, stool must be black, occasionally loose. This is Female Labor disease, not water. Abdominal fullness is difficult to treat. Treated with Xiaoshi Fanshi San.
Xiaoshi Fanshi San Formula
Xiaoshi, Fanshi (burned, equal parts).
Two ingredients powdered. Mix with barley porridge juice. Take 1 cunbi dose. Three times daily. Disease leaves via stool/urine. Urine turns yellow, stool turns black. This is the sign.
[Commentary] Kidney is master of yin, root of five zang. Blood belongs to it. Blood transforms in middle earth, generated in heart, stored in liver. If kidney yin diseased, middle earth cannot transform, heart cannot generate, liver cannot store, ying/wei cannot circulate. Blood corrupts. Combines with damp-heat stasis in intestines/stomach. Kidney belongs to water, salty flavor, cold nature. Treatment drugs must be salty-cold, supplement insufficient water, drain guest heat, scour intestines/stomach, push old bring new. Xiaoshi is sovereign. Materia Medica says Fanshi removes fixed heat in bone marrow. Bone unites with kidney, thus treats kidney heat. Barley porridge juice is envoy, introducing to intestines/stomach, draining stagnant qi. Stool is yin, blood stasis exits via it, color black. Urine is yang, heat fluid exits via it, color yellow.
Wine Jaundice disease, heart vexation or heat pain. Treated with Zhizi Dahuang Tang.
Zhizi Dahuang Tang Formula
Zhi Zi (14 seeds), Da Huang (1 liang), Zhi Shi (5 pieces), Xiang Chi (1 sheng).
Four ingredients. Water 6 sheng. Boil to 3 sheng. Divide into three warm doses.
[Commentary] Wine heat interior binding, spirit confusion, causing vexation. Severe heat pain. Zhi Zi, Xiang Chi treat heart vexation. Da Huang scours solid heat. Zhi Shi breaks knots, drives stagnation, removes old accumulation. Shanghan Lun Yangming disease no sweat, urinary difficulty, heart vexation, body must yellow. Thus heat severe inside causes this disease, not only wine.
All Huang Jia diseases, merely promote urination. If pulse floating, resolve via sweating. Gui Zhi Jia Huang Qi Tang is indicated.
[Commentary] Huang Jia generally from water-damp. Classic says: Treat damp without promoting urination is incorrect. But if pulse floating, damp not in interior but exterior. Exterior heat invading interior via deficiency causes strangury. Thus distinguish by pulse. Sweating and purging have respective suitability. Purging methods have depth/severity. Promoting urination and sweating formulas, why different? This formula harmonizes ying/wei, not harsh sweating agent. Use for exterior deficiency. Lianqiao Xiaodou Tang is for interior deficiency. Promoting urination similarly. Know the general principle.
All Jaundices, Zhigao Fa Jian is indicated.
Attached Formula
Zhi Gao (half jin), Luan Fa (three pieces size of chicken egg).
Two ingredients. Boil together in fat until hair dissolves and medicine forms. Divide into two doses. Disease exits via urine.
[Commentary] This states all Jaundices without other symptoms, implying variable manifestations. Formula mentions Female Labor Jaundice, body/eyes yellow, fever/chills, lower abdominal fullness, urinary difficulty. Caused by extreme heat/cold, intercourse, entering water. Use this decoction. Also mentions Five Jaundices, body/limbs slight swelling, chest fullness, no sweat, sweat like yellow bark juice. Caused by heavy sweating entering water. Pig fat alone taken. Shanghan Leilue says men/women jaundice, indigestion, stomach胀热 generating yellow coat, dry feces in stomach. Pig fat decoction cures. Thus understand this formula treats blood dryness. Various Jaundices feel different evils and change different organs, but ultimately damp-heat affects spleen/stomach. Stomach Yangming meritus connects to Lung Metal. Metal governs dryness. If damp-heat wins, becomes dry/astringent, blood consumes. Thus all Jaundices starting from blood dryness can use it. Materia Medica: Pig fat benefits vessels, resolves wind-heat, moistens lung/flaccidity heat-toxin. Five Jaundices body swelling unable to lie down: isn't this dryness above? Stomach yellow coat dry feces: isn't this dryness middle? Lower abdominal fullness, urinary difficulty: isn't this dryness below? Three Jiao dryness, all moistened by pig fat. Dryness below, urinary difficulty, requires Luan Fa to dissolve stasis, open blockage, benefit water passage, thus used as assistant. This and previous Xiaoshi Fanshi San both treat bladder/lower abdominal fullness blood disease. One removes heat/dissolves stasis, one moistens dryness. Fanshi nature dry moves blood, safe...