寸口脉浮而缓。浮则为风。缓则为痹。痹（者。风与湿合而不去。）非（若疼痛之）
中风。（所以然者。风得湿而变热。湿应脾而内行。是以）四肢（不疼痛而）苦烦。脾
（病者。）色必黄。（脾以其所）瘀（之）热以（外）行。（则肢体面目尽黄矣。）
此以寸口脉而言黄瘅初时之病因也。
趺阳脉紧而数。数则为热。（胃）热则消谷。紧则为寒。（脾寒遇）食即为满。（
满者必生湿。是胃热而脾湿。为黄瘅之病源也。）尺脉浮为（风）伤（于）肾。趺阳脉
紧为（寒）伤（于）脾。（是肾得风生热。脾得寒生湿。为黄瘅之病源也。凡）风（
热与）寒（湿）相搏。（其气必归脾胃。脾胃者。仓廪之官也。）食谷即（助其热而
为）眩。谷气（瘀而）不消。（则）胃
中苦浊。浊气（自当）下流。（若小便通。则浊随溺而去。今）小便不通。（则浊虽
下流。而不外出。于是）阴（脏）被
其寒。（而客）热流（入）膀胱。（膀胱为太阳。统主一身之肌表。故）身体尽黄。名曰谷瘅。
（以病虽始于风寒。而实成于谷气也。）
此言趺阳脉以明胃热脾寒郁而成瘅。又言肾脉浮。趺阳脉紧。为肾热脾寒。亦能郁
而成瘅。又归于膀胱之不化气。以膀胱主一身之肌表。不化气。则湿热无去路。而亦成
瘅。其病虽有各经之不同。而总以脾胃为主。故以谷瘅结之。
额上（心之部也。肾邪重而水色见于火部。故）黑。（肾热上行。而通于心。则）
微汗出。（手心名劳宫。属心。足心名涌泉。属肾。肾虚不能配火。水火未济。则）手足中
热。（酉主肾。肾虚。则其热）薄暮即发。膀胱（为肾外腑。肾病。则外腑必）急。（
肾虚不能摄水。则）小便自利。（此得之房劳过度。热从肾出。故）。名曰女劳瘅。（
至）腹（满）如水状。（脾肾两败。）不治。
此为女劳瘅而另言其证也。
（脾虽黄色。有因于酒者。酒多湿而性阳。故伤在上焦。心为酒所困。则）心中懊
而热。（热内蓄。则）不能食。（热上冲。则时）时欲吐。（酒气熏心。而味归脾胃
而作黄。）名曰酒瘅。
此言酒瘅之证也。
（瘅病属实者多。而属虚亦复不少。）阳明病（实者脉必数。今竟）脉迟。（其胃
弱可知。胃弱则化谷不速。）食难用饱。饱则（不运。火聚而）发烦。（胃中填塞。上
下俱阻。清者阻于上升。则）头眩。（浊者阻于下降。则）小便必难。此（因谷气郁而
生热。而非胃有实热。察其病势。）欲作谷瘅。虽下之。腹满如故。所以然者。（以）
脉迟（为虚）故也。
此言胃虚欲作谷瘅之证也。
（上言心中懊 等证。酒瘅之证。犹未备也。今且历陈之。）夫病酒黄瘅。（固属
上焦之病。而实不止于上焦也。水出高原。上焦湿热既盛。其下）必小便不利。（然）
其（有确切不可易之）候（曰）心中热。（从心热来。其小便不利。自不等于谷瘅之小便
不通。其）足下热。（又不等于女劳瘅之手足中热也。）是其（为酒瘅之的）证也。
酒黄瘅者。（以心中热为正候。亦）或（有热去于心。而）无热。（无热则心靖。
心）靖（则其）言了了。（然亦有心中无热。邪竟注于阳明。为）腹满（为）欲吐。
（又验之）鼻燥。（则知其为阳明证无疑。夫腹满宜下。欲吐宜越。因势而利导之法也。
今既腹满。而且欲吐。则可下而亦可吐。必须审）其脉浮者。（为邪近上。而）先吐
之。沉弦者。（为邪近下。而）先下之。（亦在乎临证而消息也。）
（上言无热。吐下尚未可定也。若）酒瘅心中热。（而且有）欲吐（之意）者。（
乘机）吐之（则）愈。
（上言可下。为无热而腹满者言也。若）酒瘅（而心中热。病在上而误）下之。（
则伤其下。其阳明之邪。乘下之虚。从支别入少阴。积渐而肾伤。故）久久为黑瘅。
（乙癸同源。肝病而）目青（肾病而）面黑。（然虽曰黑瘅。而其原则仍是酒家。故）
心中（热气熏烁。）如啖蒜齑状。（此于变证中。露出酒瘅真面目也。肾虚。则阴火熬
血。而为瘀血。瘀于里。则）大便正黑。（血不荣于表。则）皮肤爪之不仁。（此绝类女劳
瘅。何以知其为酒瘅也。然酒脉必浮。此虽因下而弱。要辨）其脉浮（中带）弱（其色）
虽黑（黑中仍带）微黄。故知之。
此四节。言酒瘅之相因为病。以补二条懊 等证所未备也。
师曰。病黄瘅。（湿热也。湿淫于内。则烦喘胸满。热淫于内。则发热口燥。今）
发热烦渴。胸满口燥者。以病发时。（不用汗解之正法。而以）火劫（逼）其汗。（以
热攻热。）两热（相搏）所得。然（使热不与湿合。必不作黄。凡）黄家所得。从湿得
之。（原不可以一下尽其法也。须审其）一身尽发热而黄。（而）肚热。（视一身之热
为尤甚。是因火劫。而令火）热（尽）在（于）里。（法）当下之。
此概言黄瘅有因误火而得之证。又辨其湿热相合者。为瘅病之常。独热在里者。为
瘅病之变。使人分别论治也。
（瘅病将成未成。必先见有一二证。而可卜之。凡病在里。则）脉沉。（里热。则）
渴欲饮水。（饮水多而）小便不利者。（水无去路。则郁于里而为湿。湿与热合。交相
蒸郁。）皆（可卜其）发黄。（脾之部位在腹。脾之脉络连舌本散舌下。若）腹满舌痿
黄。（是脾有湿而不行矣。又胃不和。则卧不安。若）躁不得睡。（是胃有热而不和矣。
湿热相合。为）属黄家。
此三节。言黄之将成。欲人图之于早。不俟其既成而药之。意含言外。
（黄者。土之色也。土无定位。寄王于四季之末各十八日。故）黄瘅之病。当以十
八日为期。（盖谓十八日脾气王。而虚者当复。即实者亦当通也。）治之（者。当使其
）十日以上（即）瘥。（不逾乎十八日之外。乃妙也。若逾十八日。不瘥。而）反剧为
（土气不能应期而王）难治。
此言黄瘅之愈有定期。欲医者期前而速治也。
按沈自南云、此取阳病阴和。阴病阳和为大纲也。十八乃三六。阴数之期也。十日
二五。阳土之数也。黄瘅乃湿热郁蒸。阳邪亢极。脾阴大衰。故治之须候一六二六三
六。阴气来复制火之期。而为定期。若至十日以上。土阴气复则当瘥。而反剧者。乃脾
阳亢极。阴气化灭。故为难治。此虽非正解。亦互相发明。
（瘅病是郁热外蒸之象。）瘅而渴者。（内热更甚。内外交病。）其瘅难治。瘅而不渴
者。（热从外宣。内之正气自运。）其瘅可治。发于阴部。（里为阴。里气之逆。）
其人必呕。（发于）阳部。（表为阳。表邪之盛。）其人振寒而发热也。
此以渴不渴别瘅之难治可治。以呕与寒热。辨黄之在表在里也。
（今试为瘅病出其方。）谷瘅之病。（其初多病寒热。其）寒热（作时。则）不食。
（寒热止时。即或时食。）食即（热上冲而）头眩。（内滞塞而）心胸不安。（湿瘀
热郁不解。）久久（身面）发黄。为谷瘅。（以）茵陈蒿汤主之。
此为谷瘅证而出其方也。
徐忠可云、前第一段论谷瘅。不言寒热。而有小便不通。第二段论谷瘅。不言心胸
不安。而有小便必难。此独不言及小便。盖谷瘅证亦有微甚不同。前所云小便不通。此
势之甚急者也。所云阳明病脉迟者。小便必难。乃既见阳明证。而因脉迟挟虚。以致不
运。此表病中之间有者也。若此云寒热。则非二三日之病矣。不食。食即头眩。则虽眩
而食未尝断。可知矣。故曰久久发黄。见迟之又久。乃相因而为病。其势渐而缓。则小
便亦未至不通耳。然观方下注云。一宿腹减。此亦必小便不快。而腹微胀可知。但不必专
责之耳。谷瘅三证。止出一方。盖阳明病一至发黄。则久暂皆宜开郁解热。故此方实为
主方。若阴黄。则后人以附子合茵陈。乃此方之变也。按心胸不安。与酒瘅之心中懊
亦不同。彼因心中热。至有无可奈何之象。此言不安。仅微烦也。即阳明脉迟证所谓发
烦头眩耳。
茵陈蒿汤方
茵陈蒿（六两） 栀子（十四枚） 大黄（二两）
上三味。以水一斗。先煮茵陈。减六升。纳二味。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。
（凡发热而不恶寒。为阳明病。若）黄家。（当申酉之时。名曰）日晡所（应其时
）发热。而反恶寒。此（非阳明热证。）为女劳得之。（以女劳之病在肾。肾之腑为膀
胱。申时气血注于膀胱。酉时气血注于肾也。肾为热逼。则）膀胱（必）急。（膀胱既
急。则）少腹（亦）满。（其一）身（虽）尽黄。（而）额上（独）黑。（一身虽尽热。
而）足下（尤）热。因（此病势浸淫。肾邪遍于周身。不独额上。而身上俱）作黑瘅。
（然其中犹有可疑者。腹胀便溏。证同脾湿。然究）其腹胀（非水。而）如水状。大便
必（变）黑。（而）时溏。此女劳之病。（肾热而气内结。）非（脾湿而）水（不行之
为）病也。（但证兼）腹满者（为阳气并伤。较为）难治。（以）硝石矾石散主之。
此为女劳瘅出其方治也。立论独详。所以补前之未备也。
硝石矾石散方
硝石（熬黄） 矾石（烧等分）
上二味为散。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。
是其候也。酒瘅。（前论已详。似可毋庸再赘矣。而）心中懊 。（为此证第一的据。
）或热痛。（为此证中之更甚者。以）栀子大黄汤主之。
此为酒瘅而出其方治也。
栀子大黄汤方
栀子（十四枚） 大黄（二两） 枳实（五枚） 豉（一升）
上四味。以水六升。煮取二升。分温三服。
诸（凡）病黄家。（概属湿热交郁而成。小便为气化之主。）但利其小便。（下
窍气通。则诸气自不能久郁。）假令脉浮。（则气病全滞于表分。徒利其小便。无益也。
）当以汗解之。宜桂枝加黄 汤主之。
此以下皆治正黄瘅方也。
徐忠可云、黄瘅家。不独谷瘅。酒瘅女劳瘅有分别。即正黄瘅。病邪乘虚。所着不
同。予治一黄瘅。百药不效而垂毙者。见其偏于上。令服鲜射干一味斤许而愈。又见有
偏于阴者。令服鲜益母草一味数斤而愈。其凡有黄瘅初起。非系谷瘅酒瘅女劳瘅者。辄
令将车前根叶子合捣。取自然汁。酒服数碗而愈。甚有卧床不起者。令将车前一味自然
汁数盂。置床头。随意饮之而愈。然则汗下之说。亦设言以启悟。其可无变通耶。
桂枝加黄 汤（见水气）
诸黄。（缘湿热经久。变为坚燥。譬如罨面。湿合热郁而成黄。热久则湿去而干也。
以）猪膏发煎主之。
此言黄瘅中另有一种燥证。饮食不消。胃胀有燥屎者。而出其方治也。徐氏谓为谷
气实所致。并述治友人骆天游黄瘅。腹大如鼓。百药不效。服猪膏发灰各四两。一剂而
愈。
按此条师止言诸黄二字。而未详其证。余参各家之说而注之。实未惬意。沈自南注。
浮浅又极附会。余素不喜。惟此条确有悟机。姑录而互参之。其云、此黄瘅血分通治
之方也。寒湿入于血分。久而生热。郁
蒸气血不利。证显津枯血燥。皮肤黄而暗晦。即为阴黄。当以猪脂润燥。发灰入血和阴。
俾脾胃之阴得其和。则气血不滞。而湿热自小便去矣。盖瘅皆因湿热郁蒸。相延日久
阴血必耗。不论气血二分。皆宜兼滋其阴。故云诸黄主之。
猪膏发煎方
猪膏（半斤） 乱发（如鸡子大三枚）
上二味。和膏中煎之。发消药成。分再服。病从小便出。
黄瘅病。（审其当用表里两解法者。以）茵陈五苓散主之。（若夫脉沉腹满在里。
则为大黄硝石汤证。脉浮无汗在表。则为桂枝加黄 汤证矣。当知此方非治黄通用之
方。）
此为黄瘅而出表里两解之方也。徐云、治黄瘅不贵补。存此以备虚证耳。
茵陈五苓散方
茵陈（十分末） 五苓散（五分）
上二味和。先食饮服方寸匕。日三服。
黄瘅。腹满。小便不利而赤。（里实也。黄瘅最难得汗。若）自汗出。（表和也。）
此为表和里实。（实者）当下之。宜大黄硝石汤。
此为黄瘅而出其里实之方也。视栀子大黄及茵陈蒿汤较峻。
大黄硝石汤方
大黄 黄柏 硝石（各四两） 栀子（十五枚）
上四味。以水六升。煮取二升。去滓。内硝更煮。取一升。顿服。
黄瘅病。（实热者。小盒饭赤短。若）小便色不变。（而且）欲自利。（其无内热。
确凿有据。可知其）腹满而喘。（非里实气盛。乃为虚满虚喘也。虽有瘅热。亦）不
可（以寒下之药）除（其）热。热除（则胃）必（寒而作）哕。哕者。（宜先调其胃降
其逆。然后消息治之。以）小半夏汤主之。
此为黄瘅之虚证。误治增病。而出其救治之方。非谓小半夏汤即能治黄瘅也。后人
以理中汤加茵陈蒿。颇有意义。
小半夏汤方（见痰饮）
诸黄腹痛而呕者。（少阳之木邪克土也。）宜柴胡汤。
The pulse at the Cun Kou (Cun position of the radial artery) is floating and slow. Floating indicates Wind, and slow indicates Bi syndrome (obstruction syndrome caused by wind-cold-dampness). (Bi here refers to the combination of Wind and Dampness that lingers and does not depart.) This is not Zhong Feng (Wind Stroke, typically characterized by limb pain). (The reason for this is that when Wind encounters Dampness, it transforms into Heat; Dampness corresponds to the Spleen and moves inward. Therefore, the four limbs do not hurt but suffer from vexation. When the Spleen is diseased, the complexion must be yellow. The Heat stagnated in the Spleen moves outward, causing the entire body, limbs, face, and eyes to turn yellow.) This explains the etiology of early-stage Huang Dan (Jaundice) based on the Cun Kou pulse.
The pulse at the Fu Yang (Dazu point, ST42) is tight and rapid. Rapid indicates Heat; Stomach Heat promotes digestion. Tight indicates Cold; Spleen Cold causes fullness after eating. (Fullness generates Dampness; thus, Stomach Heat and Spleen Dampness are the source of Huang Dan disease.) A floating pulse at the Chi position (distal radial pulse) indicates Wind injuring the Kidney. A tight pulse at the Fu Yang position indicates Cold injuring the Spleen. (This means the Kidney generates Heat due to Wind, and the Spleen generates Dampness due to Cold, which is also a source of Huang Dan. Generally, when Wind-Heat and Cold-Dampness contend, their Qi returns to the Spleen and Stomach. The Spleen and Stomach are the officials of granaries.) Eating grains assists the Heat and causes dizziness. Grain Qi stagnates and fails to digest, causing the Stomach to suffer from turbid Qi. Turbid Qi should flow downward. If urination is unobstructed, turbidity leaves with urine. Now, if urination is obstructed, although turbidity flows downward, it cannot exit externally. Thus, Yin organs are affected by Cold, and guest Heat flows into the Bladder. (The Bladder belongs to the Taiyang channel and governs the muscle layer of the whole body; therefore, the entire body turns yellow. This is called Gu Dan [Grain Jaundice].) (Although the disease starts with Wind-Cold, it actually forms due to grain Qi stagnation.)
Here, the Fu Yang pulse clarifies that Stomach Heat and Spleen Cold stagnating form jaundice. It also mentions that a floating Kidney pulse and a tight Fu Yang pulse indicate Kidney Heat and Spleen Cold, which can also stagnate to form jaundice, ultimately attributing it to the failure of the Bladder's Qi transformation. Since the Bladder governs the body's surface, failure to transform Qi leaves no outlet for Damp-Heat, leading to jaundice. Although diseases vary by meridian, they generally center on the Spleen and Stomach, hence summarized as Gu Dan.
The forehead is the area of the Heart. If Kidney pathogen is severe, Water color (black) appears in the Fire area (forehead), so the forehead turns black. (Kidney Heat ascends and connects to the Heart, causing slight sweating.) The palm is named Laogong (PC8), belonging to the Heart; the sole is named Yongquan (KI1), belonging to the Kidney. Kidney deficiency fails to control Fire, resulting in disharmony between Water and Fire, causing heat in the hands and feet. (You hour corresponds to the Kidney; with Kidney deficiency, its heat manifests at dusk.) The Bladder is the exterior腑 (Fu organ) of the Kidney; Kidney disease causes the exterior腑 to become urgent. (Kidney deficiency fails to control water, causing spontaneous urination.) This results from excessive sexual exertion, with Heat emerging from the Kidney, hence named Nü Lao Dan [Female Labor Jaundice]. (If it progresses to abdominal fullness resembling water accumulation, indicating both Spleen and Kidney failure, it is incurable.)
This describes additional symptoms of Nü Lao Dan.
(Although the Spleen's color is yellow, some cases are caused by alcohol. Alcohol is damp and yang in nature, injuring the Upper Jiao. Confined by wine, the Heart suffers from vexation and heat. (Heat stored internally prevents eating. (Heat rushing upward causes occasional desire to vomit. (Wine vapor confuses the Heart, and flavors return to the Spleen and Stomach to cause yellowing. This is called Jiu Dan [Alcohol Jaundice].)
This describes the symptoms of Jiu Dan.
(Jaundice diseases are mostly excess patterns, but deficiency patterns are also common.) Yangming disease (if excess) has a rapid pulse; now the pulse is slow, indicating weak Stomach Qi. Weak Stomach Qi digests grain slowly. One cannot eat until full; being full leads to poor transport, fire aggregation, and vexation. (Stomach blockage obstructs both upper and lower; clear Qi blocked from ascending causes dizziness; turbid Qi blocked from descending causes difficult urination. This is heat generated by grain Qi stagnation, not Stomach excess heat. Observing the disease trend, it desires to become Gu Dan. Even with purgation, abdominal fullness remains. The reason is that a slow pulse indicates deficiency.)
This describes the symptoms of Stomach deficiency desiring to develop Gu Dan.
(Above, symptoms like heart vexation were mentioned, but Jiu Dan symptoms were incomplete. Now listed comprehensively.) In Wine Yellow Jaundice, although it belongs to the Upper Jiao, it is not limited there. Water originates from the High Source (Lungs); if Upper Jiao Damp-Heat is flourishing, there must be difficult urination. (However, there is an invariant symptom: heat in the Heart. Coming from Heart heat, difficult urination differs from Gu Dan's urinary obstruction. Heat under the feet differs from Nü Lao Dan's hand-foot heat. These are the specific signs of Jiu Dan.)
For Jiu Dan, heat in the Heart is the primary sign. Sometimes heat leaves the Heart, resulting in no heat. (No heat means the Heart is calm, and speech is clear.) However, sometimes there is no Heart heat, but evil injects into the Yangming, causing abdominal fullness and desire to vomit. (Checking for dry nose confirms Yangming syndrome. Abdominal fullness requires purgation; desire to vomit requires emesis, following the momentum. Now with both fullness and vomiting, either method may apply. Must examine the pulse: if floating, evil is near the upper part, use emesis first; if deep and string-taut, evil is near the lower part, use purgation first. This depends on clinical judgment.)
(Above, without heat, emesis/purgation was undecided. If Jiu Dan has Heart heat and desire to vomit, take the opportunity to emesis, and it will heal.)
(Above, purgation was for no heat and abdominal fullness. If Jiu Dan has Heart heat, the disease is upper, and mistaken purgation damages the lower. Yangming evil, taking advantage of post-purgation weakness, enters Shaoyin via branches, gradually damaging the Kidney, eventually becoming Hei Dan [Black Jaundice]. (Yi and Gui share the same source; Liver disease causes green eyes, Kidney disease causes black face. Although called Black Jaundice, the principle remains wine-related. Thus, Heart heat scorching feels like eating minced garlic. This reveals the true face of Jiu Dan among complications. Kidney deficiency allows Yin Fire to boil blood, forming stasis. Stasis inside causes black stool. Blood failing to nourish the exterior causes numb skin and nails. This resembles Nü Lao Dan. How to know it is Jiu Dan? Wine pulses are always floating. Here, weakened by purgation, yet floating with weakness, and color black but with slight yellow undertones, we know it is Jiu Dan.)
These four sections discuss the interrelated pathology of Jiu Dan, supplementing the incomplete description of vexation symptoms earlier.
The Master said: Jaundice disease involves Damp-Heat. Dampness flooding internally causes vexation, panting, and chest fullness; Heat flooding internally causes fever and dry mouth. Now, with fever, vexation, thirst, chest fullness, and dry mouth, it is because at onset, (instead of using proper sweating methods,) Fire coercion (forced sweating. (Attacking heat with heat.) Two heats contending result. However, (if heat does not combine with dampness, yellowing will not occur. All) Huang family diseases arise from Dampness. (Purgation alone cannot exhaust all methods. One must assess if the whole body is hot and yellow, especially abdominal heat, which is more severe than general heat, indicating Fire coercion trapped Heat entirely inside. The method requires purgation.)
This generally discusses jaundice caused by mistaken Fire therapy. It distinguishes combined Damp-Heat as the normal pattern of Dan disease, while isolated Heat inside as a variant pattern, guiding differential treatment.
(Jaundice about to form shows initial signs for prediction. Disease in the interior implies deep pulse. Interior Heat implies thirst for water. Drinking much but with difficult urination means water has no outlet, stagnating as Dampness. Dampness combining with Heat steaming together predicts yellowing. (Spleen location is abdomen; Spleen meridians connect to tongue base. Abdominal fullness, flaccid tongue, and yellowing indicate Spleen Dampness failing to move. Also, Stomach disharmony causes sleeplessness. Restlessness preventing sleep indicates Stomach Heat disharmony. Damp-Heat combined belongs to the Huang family.)
These three sections warn of impending jaundice, urging early intervention before formation, implying advice beyond words.
(Yellow is Earth's color. Earth has no fixed position, thriving in the last 18 days of each season. Thus, Huang Dan disease has an 18-day prognosis. (Meaning Spleen Qi thrives on day 18, restoring deficiency or resolving excess.) Treatment should resolve within 10 days. (Not exceeding 18 days is ideal. If exceeding 18 days, worsening indicates Earth Qi failing to thrive, making it difficult to treat.)
This states jaundice recovery has a set period, urging timely treatment.
Shen Zinan notes: This follows the principle of Yin-Yang harmony. 18 is 3x6, an Yin number period. 10 is 2x5, an Yang-Earth number. Jaundice is Damp-Heat steaming, Yang evil extreme, Spleen Yin severely deficient. Treatment waits for 1, 6, 2, 6, 3, 6 periods where Yin Qi controls Fire. If resolving after 10 days, Spleen Yin recovers. Worsening indicates Spleen Yang extreme, Yin Qi extinguished, hence difficult. Though not orthodox, it elucidates further.
(Dan disease is image of stagnant Heat steaming outward.) Jaundice with thirst indicates severe internal heat, internal and external disease, difficult to treat. Jaundice without thirst indicates Heat venting outward, internal Zheng Qi moving, treatable. Emission from Yin parts (Interior is Yin, interior Qi rebellion) causes vomiting. Emission from Yang parts (Exterior is Yang, exterior evil prosperity) causes chills and fever.
This differentiates treatability by thirst/non-thirst and location by vomiting/chills-fever.
(Now prescribing formulas for Dan disease.) Gu Dan disease often begins with chills and fever. During chills/fever, appetite is lost. When chills/fever cease, eating causes Heat rushing up and dizziness, internal blockage and chest discomfort, unresolved Damp-Stagnant Heat. Over time, body and face yellow, termed Gu Dan. Treat with Yin Chen Hao Tang.
This prescribes a formula for Gu Dan syndrome.
Xu Zhongke says: Previous section 1 discussed Gu Dan without chills/fever but with urinary obstruction. Section 2 discussed Gu Dan without chest discomfort but with difficult urination. This section omits urination issues, implying varying severity. Urinary obstruction is acute; Yangming slow pulse/difficult urination is intermediate with deficiency. Chills/fever imply longer duration. Not eating, then dizziness upon eating implies intermittent intake. "Long time to yellow" implies gradual progression, so urination isn't fully obstructed. Note "abdomen reduces overnight," implying mild bloating/uncomfortable urination. Gu Dan syndromes use one main formula because once Yangming jaundice occurs, opening stagnation and resolving heat is key regardless of duration. For Yin Jaundice, later practitioners add Fuzi to Yinchen, a variation. Note: Chest discomfort differs from Jiu Dan's heart vexation; here it is mild annoyance, akin to Yangming slow pulse vexation/dizziness.
Yin Chen Hao Tang Formula
Yin Chen Hao (Artemisiae Scopariae Herba, 6 liang) Zhi Zi (Gardeniae Fructus, 14 pieces) Da Huang (Rhei Radix et Rhizoma, 2 liang)
Boil these three ingredients in 1 dou of water. First decoct Yin Chen Hao until reduced by 6 sheng. Add the other two. Decoct to 3 sheng. Strain. Divide into three warm doses. Beneficial urination occurs, urine looks like soapberry juice, red color. Overnight abdominal reduction indicates yellow qi exiting via urine.
(Fever without aversion to cold is Yangming disease. If Huang family patient has fever at Shen-You hours (3-7 PM), called Ribu Suo, but has aversion to cold, this is not Yangming Heat syndrome. It is caused by Nü Lao [Female Labor]. (Nü Lao disease affects Kidney; Kidney Fu is Bladder. Shen hour Qi enters Bladder; You hour Qi enters Kidney. Kidney forced by Heat makes Bladder urgent. Bladder urgency causes lower abdominal fullness. Whole body yellow, but forehead specifically black. Whole body hot, but soles especially hot. Pathogen permeates body, Kidney evil spreads, causing Hei Dan [Black Jaundice] beyond just forehead. Doubtful aspect: abdominal fullness/loose stool resembles Spleen Dampness, but fullness is not water retention, stool turns black/tarry intermittently. This is Nü Lao disease, Kidney Heat with internal Qi knotting, not Spleen Dampness water retention. If accompanied by abdominal fullness, Yang Qi damaged, difficult to treat. Treat with Xiao Shi Fan Shi San.)
This prescribes treatment for Nü Lao Dan, supplementing previous details.
Xiao Shi Fan Shi San Formula
Xiao Shi (Natrii Sulfas, roasted yellow) Fan Shi (Alumen, calcined, equal parts)
Grind to powder. Mix with barley porridge juice. Take one cun-bi dose. Three times daily. Disease exits via stool/urine. Urine turns yellow, stool turns black, indicating efficacy.
Jiu Dan was detailed earlier, seemingly redundant. However, heart vexation is the primary sign. Heat pain is more severe. Treat with Zhi Zi Da Huang Tang.
This prescribes treatment for Jiu Dan.
Zhi Zi Da Huang Tang Formula
Zhi Zi (Gardeniae Fructus, 14 pieces) Da Huang (Rhei Radix et Rhizoma, 2 liang) Zhi Shi (Aurantii Fructus Immaturus, 5 pieces) Chi Dou (Sojae Semen Praeparatum, 1 sheng)
Decoct these four in 6 sheng water to 2 sheng. Divide into three warm doses.
All Huang family diseases result from Damp-Heat entanglement. Urination is master of Qi transformation. Promoting urination opens lower orifices, allowing Qi to disperse stagnation. If pulse is floating, Qi stagnates in exterior; promoting urination is useless. Use sweating method. Gui Zhi Jia Huang Qi Tang is indicated.
Below are formulas for Zheng Huang Dan [Standard Jaundice].
Xu Zhongke says: Huang Dan varies not only by Gu/Jiu/Nü Lao types but also by Zheng Huang Dan depending on empty pathogen location. I treated a critical jaundice case ineffective with many herbs; seeing upper bias, prescribed fresh She Gan (Belamcandae Rhizoma) 1 jin, cured. Another Yin-biased case cured with fresh Yi Mu Cao (Leonuri Herba). Early stage non-specific jaundice cured with Che Qian Gen Ye (Plantaginis Radix et Herba) juice mixed with wine. Bedridden cases cured by drinking Che Qian natural juice. Thus, sweating/purgation theories are illustrative; flexibility is needed.
Gui Zhi Jia Huang Qi Tang (See Shui Qi chapter)
Various jaundices, due to long-standing Damp-Heat turning dry/hard (like dough fermentation), require Zhu Gao Fa Jian.
This addresses a dry-type jaundice with undigested food, stomach distension, and dry feces. Xu attributes it to Gu Qi excess, citing a friend Luo Tianyou cured by Zhu Gao (Porci Adeps) and Fa Hui (Capillaris Carbonisata) 4 liang each, one dose cured.
Note: Master only said "Various Jaundice" without details. I referenced others' notes but remain unsatisfied. Shen Zinan's note is superficial/apocryphal, disliked by me. This entry has insight: It treats Blood-level jaundice. Cold-Damp entering Blood level generates Heat over time, stagnating Qi/Blood, showing fluid depletion and Blood dryness, dark yellow skin (Yin Jaundice). Zhu Gao moistens dryness; Fa Hui enters Blood to harmonize Yin. Harmonizing Spleen/Stomach Yin stops Qi/Blood stagnation, allowing Damp-Heat to exit via urine. Jaundice stems from Damp-Heat steaming depleting Yin Blood over time; nourishing Yin is suitable for both Qi/Blood levels, hence "Various Jaundice."
Zhu Gao Fa Jian Formula
Zhu Gao (Porci Adeps, half jin) Luan Fa (Capillaris, three pieces size of chicken egg)
Simmer together in fat until hair dissolves. Divide into two doses. Disease exits via urine.
Huang Dan disease requiring simultaneous exterior-interior resolution uses Yin Chen Wu Ling San. Deep pulse/abdominal fullness (interior excess) indicates Da Huang Xiao Shi Tang. Floating pulse/no sweat (exterior) indicates Gui Zhi Jia Huang Qi Tang. Know this formula is not universal for jaundice.
This prescribes simultaneous exterior-interior resolution for Huang Dan. Xu notes: Treating jaundice doesn't prioritize tonification; keep this for deficiency cases.
Yin Chen Wu Ling San Formula
Yin Chen (Artemisiae Scopariae Herba, 10 parts powder) Wu Ling San (Poria Powder, 5 parts)
Mix. Take one cun-bi dose before meals with water. Three times daily.
Jaundice with abdominal fullness, difficult red urination indicates interior excess. Jaundice rarely sweats; spontaneous sweating indicates exterior harmony. Exterior harmonized, interior excess exists. Excess requires purgation. Da Huang Xiao Shi Tang is indicated.
This prescribes interior excess formula for jaundice, stronger than Zhi Zi Da Huang or Yin Chen Hao Tang.
Da Huang Xiao Shi Tang Formula
Da Huang (Rhei Radix et Rhizoma) Huang Bo (Phellodendri Cortex) Xiao Shi (Natrii Sulfas) (each 4 liang) Zhi Zi (Gardeniae Fructus, 15 pieces)
Decoct first three in 6 sheng water to 2 sheng. Strain. Add Xiao Shi, boil to 1 sheng. Take once.
Huang Dan disease with excess-heat usually has red/scanty urine. If urine color unchanged and desire for spontaneous diarrhea, lack of internal heat is confirmed. Abdominal fullness and panting indicate deficiency-fullness/deficiency-panting, not excess Qi.虽有瘅热 (Though Dan heat exists), do not use cold purgatives to remove heat. Removing heat causes Stomach cold and hiccups. For hiccups, first regulate Stomach and descend rebellious Qi, then treat conditionally. Xiao Ban Xia Tang is indicated.
This prescribes rescue formula for jaundice deficiency/mistreatment error, not claiming Xiao Ban Xia Tang treats jaundice directly. Later practitioners adding Yinchen to Lizhong Tang have merit.
Xiao Ban Xia Tang Formula (See Tan Yin chapter)
Various jaundice with abdominal pain and vomiting indicates Shaoyang Wood evil attacking Earth. Chai Hu Tang is indicated.