一条 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。
后贤辨黄症者。纷纷不一。而终未有确解。愚按内经。及伤寒本经之旨。大概由于湿热相搏。中宫脾土之气。
郁滞而不流贯四脏。则浮横如天地之雾。而其黄色。散漫于皮肤诸窍者也。但先从湿因、水因起。而后生热
者。则湿水为本。而热为标。故名湿黄、水黄。先从阴虚病热。其后因热而生风聚湿。及积水者。则热为本。而风
湿与水为标。故名疸。其意以治其本。而黄自已。故症同而名异耳。犹之水门之先病水。而后经断者。名水分。
先经断而后病水者。名血分之例也。故除却十一、十三、十八、二十四。四条泛论诸黄及黄家。另行方治外。其
本门所列谷、酒及女劳、三疸。所主诸方。凡茵陈汤、硝矾散、栀子大黄汤、膏发煎、茵陈五苓散、大黄硝石汤。大
概俱咸寒苦寒之品。则其用意在去热者。可见矣。若夫水湿生热而病黄者。其治例。宜发汗者。十之七。而宜
利小水者。十之三。此本篇各条。有但曰诸黄及黄家者。有直名某黄胆者。不可不细察也。首条、从脉而总
言诸黄之所由发也。头面皮肤之症。法当先诊寸口。以寸口上应头目。外应皮肤故也。若寸口脉浮而缓。浮、
为真阴不足。而邪热生风之诊。故浮、则为上行外骛之风。缓、为真阳不充。而亢火食气之诊。故缓、则为正气
卑弱之痹也。夫平常之所谓痹者。原以外中风邪。卫气沉削之症。此为内热生风。故非中风之比。但以水不
胜火。而四肢惟觉燥热而苦烦。于是内干。则召外湿。湿热相蒙。而热化偏发。有如亢旱之天。雨露不滋。土气
不摄。浮尘满空。黄埃飞布之象。故脾色之黄气。随瘀热而周行于躯壳间矣。
二条 趺阳脉紧而数。数则为热。热则消谷。紧则为寒。食即为满。尺脉浮。为伤肾。趺阳脉紧。为伤脾。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。
趺阳、主中土。脉宜优柔和平以象土德。若体紧而至数。数为热。趺阳热。则火邪盛而善于杀谷。故热则消谷。
紧为寒。趺阳寒。则真气衰而食气压火。故初食则满也。夫消谷则不宜满。满则不宜消谷。其所以互见者。盖
肾中精足。则火尝畏伏而不敢自见。尺脉浮。则精虚。而肾气有不固之象。故知伤肾。肾伤。故趺阳以数见矣。
又脾阳德健。则气尝温畅。而不致退出。趺阳脉紧。则阳衰。而脾气有凝敛之象。故知伤脾。脾伤。故趺阳以紧
见矣。二句。是自注上文之所以寒热互见也。风寒。非指外感。谓风、生于热。寒、生于虚之候。热风虚寒。两相搏
击。于是热风之性。喜于上炎。虚寒之气。力不下运。故食即晕眩。谷气不消。与上文热则消谷。非矛盾也。盖消
谷。就形质之易于腐化而言。不消。就谷气之不能分消而言。以邪火所杀之谷气。堆贮胃中。则胃不空灵。而
以秽浊为苦矣。浊气下流。则热瘀而化机壅滞。故小便不通。夫脾寒之气。内被少厥两阴。则分运谷气之权
愈微。胃热之邪。下流膀胱诸腑。则留闭水饮之候兼作。热湿交蒸。身体尽黄。名曰谷疸者。其因如此也。
三条 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。女劳疸。
固因房室
太过。精虚生热。为本候。然单系精虚。则常见血痹虚劳等症。而不得成疸也。惟多欲而兼勒精者。始有此病。
以多欲则膈气过劳。而火浮于上。勒精则肾气摇动。而火郁于下。邪火内炎。则真阳不布。真阳不布。则中土
之气、浮横散漫。而发为黄症。如本条及十六条之候矣。若谓单系精虚生热所致。则当不主犀利之硝矾散。
并散后不列滋阴补精之药者。概可思矣。额上。内应胸分。黑为肾色。肾火冲炽胸分。有烟煤之象。故黑。邪
热内蒸。故汗出。手足之心属少阴。少阴火盛。故手足中热。薄暮属阴分。阴火盛。故薄暮即发。热势下流膀胱。
故急。小便自利。故知系干热而非水也。名曰女劳疸。其意以腹不胀者为可治。脾胃尚有滋息之源故也。倘
非水。而腹如水状。是脾阳衰败而作胀。将真阴无精悍以奉之。而邪火不可息矣。故不治也。
四条 心中懊 而热。不能食。时欲吐。名曰酒疸。
酒性、热湿而浮。热湿浮于膈上。故心中液伤而懊 。热湿浮于中焦。故胃中气伤而不欲食。热湿浮于中焦。
而且欲上冲膈上。故时欲吐也。谓非因酒而致疸之症乎。故名酒疸。
五条 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。
此言谷疸之变脉变症也。阳明病。指阳明之腑病而言。如病风寒暑湿燥火之后。皆是。盖谓谷疸之脉。不止
趺阳紧数一种。凡阳明腑病之后。其脉迟者。以脾胃之阳气内虚。故其至也。不能连珠鱼贯。而见迟迟慢发
之状。倘减谷自节。则其气犹能胜食而渐化。故食难用饱。饱则食滞而生热。且将胃脘中之残液。渗入食中。
不能腐化以自还。故烦。烦热之气。浮于中者。必炎于上。故头眩。气机不下运。则水谷混停。故小便必难。夫热
烦湿滞之邪。团结胃中。脉虽异于二条之紧数者。而其胃中之苦浊。则同。故知亦欲作谷疸也。下之。指后文
十五条茵陈汤之谓。盖茵陈汤、虽下其热烦谷滞。而腹满如故者。以脉迟阳虚、而作虚胀也。愚鄙拟之。或于
本汤加干姜。以为反佐。则寒热标本。针锋互对。而无弊矣。
六条 夫病酒黄胆。必小便不利。其候心中热。足下热。是其症也。
病酒热而小便利。则热随便减。而不得成疸。故病酒黄胆者。必先以小便不利为候也。酒性热而浮且湿。热
从浮见。浮则上炎。故其候。心中热。热从湿见。湿多下趋。故其候。足下热。此三者。为酒疸之确症也。
七条 酒黄胆者。或无热。静言了了。腹满。欲吐。鼻燥。其脉浮者。先吐之。沉弦者。先下之。
此言酒疸之初症变症也。酒于酸、苦、甘、辛、咸中。无正味。其味屈曲。而性从木。故先入肝胆。肝胆受热而乘
其
所胜。故脾胃为酒黄胆之总根。但脾通于肺。胃浮于脘。而症从上见。故有上条之心中热。及本条之腹满、欲
吐、鼻燥等候。脾热满而还注少厥二阴。胃热满而下注大小肠、膀胱。故有上条之小便不利。及足下热。并二
十条之茵陈五苓散。十七条之栀子大黄汤等方。此条。特揭其总法耳。盖谓因酒而黄胆者。其上下固多
热候。然又有一种阳衰阴盛之人。伤酒之热湿。堆中土。因无阳气以搏之。故其初症。竟或上而心下。下而
足下。俱无热者。夫心下病热。则液短而生烦。烦则语言必冒突而急错。今静言了了。故知其无热也。湿自胜。
故腹满。热自胜。故欲吐、鼻燥。此皆上炎之症。上炎者脉必浮。脉症俱高。故宜吐以越之也。此句是主。若腹满
诸症虽具。加之足下热。小便不利。则热湿下逼。脉必以沉弦下应。脉症俱深。又宜导而下之之为便矣。曰先
吐、先下。则吐后再下。下后再吐。其随症施治之意。又在言外矣。但下药。则有栀子大黄汤。而吐药不列方者。
其意。或以吐惟瓜蒂一散。故不复赘耶。旧注。谓宜栀豉汤。若论主酒疸之本汤内。两用栀豉。主谷疸之茵陈
汤。并从主黄胆之大黄硝石汤。俱单用栀子。则主栀豉汤。似于本门为近理。殊不知栀豉。非吐剂。辨详伤寒
本汤注。岂服此而探以为吐乎。是有待于高明之鉴定焉。
八条 酒疸。心中热。欲呕者。吐之愈。
心中热。欲呕。为热湿上冲之应。故亦宜吐以越之。承上文。言不特无热而腹满、欲吐、鼻燥者。宜用吐法。即有
热而下部之症未见者。其例亦同。且与但见下部之症。而不见上症者。其当遵攻下之例。交相互发也。
九条 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。
此言酒疸所变之黑疸。与三条及十六条之女劳疸。黑虽同。而症自悬绝之辨也。酒疸。有宜吐、宜下两症。热
湿在心下者。当吐。而先下之。则徒伤其阴。而心下之热湿仍在也。且热邪以阴伤而愈炽。热极则血欲枯。而
其色渐黑。故久久则为黑疸。目为胆之果。胆热则蒸其汁于上。故目青。面为胃之应。胃热如焦其土于中。故
面黑。心中如啖蒜齑者。阳液不足供热邪之暴残。而刻削嘈杂似之。故借以为状也。大便正黑者。亢火夺中
土之化。故其所下者。有草灰木炭之象也。皮肤不仁者。热逼少阴。心主之神灵。中阻而不外贯也。其脉浮弱。
浮为热。为在上。浮而弱。为阴虚。夫阳分上热而阴分下虚。岂非宜吐之酒疸。而误下之所致乎。但额黑便黑。
分明女劳疸之候。而谓成于酒疸之变症者。以黄为酒疸。今虽黑而微有黄色。故知其非女劳也。
十条 师曰。病黄胆。发热。烦喘。胸满。口燥者。以病发时。火劫其汗。两热所得。然黄家所得。从湿得
之。一身尽发
热而黄。肚热。热在里。当下之。
此言黄胆之治例。以汗为逆以。下为顺也盖。疸症之热俱在内。故从内而蒸其黄于外。未有作表热者。今发
热。则非其症矣。加之心中热干而烦。肺中热湿而喘。湿热鼓塞于膈间。则胸满。津液不布于廉泉。则口燥。此
因病初发时。误认汗可解热。而火劫其汗。既伤其阴。而内外之两热交煽。且里热因汗而提之在表在上。故
得此发热等候矣。然单热不能成疸。故黄家必从热、而生湿得之。今一身尽发热而黄。是热湿在肚内。夫热
湿在里者。法当下。与湿黄在经表之宜汗者。不同也。
十一条 脉沉。渴欲饮水。小便不利者。皆发黄。
沉为水脉。内水拒饮。本不当渴。乃渴欲饮水。是其水饮化热。内烫上熏之所致也。然令小便自利。则热饮下
泄。其势不聚。若再不利。则湿热两胜。故皆发黄。此因疸、而泛论水饮之黄也。
十二条 腹满。舌萎黄。躁不得眠。属黄家。
此与谷疸相似。而实非谷疸者。以谷疸者。先热后湿。此则。先湿后热故也。腹满为湿。舌黄为实。湿而热实。则
津液下掣。故胞精短。而其舌且萎顿而黄也。又热实。则神机不能内伏。故躁不得眠。湿热相蒙。此发黄之可
必也。故属黄家。叙症。从腹满起。故知先湿后热。同是脾家寒湿。胃家热实。故曰与谷疸相似。而实非者也。
十三条 黄胆之病。当以十八日为期。治之十日以上瘥。反剧者。为难治。
黄胆为火土病。期者。生死之期也。土气分旺各十八日。官旺之时。真气犹在。故可乘其胜而攻去其亢热。则
愈。否则至其所不胜而死之理也。故以之为期。火生于二。而成于七。是九为火之合数也。治之十日以上。则
火为退气之候。故当瘥。反剧。则邪火成燎原之势。而反常矣。且真阴有不支之惧。故难治。然则中宫之土气。
惟恐其或衰。而亢烈之火威。但虞其不熄。是为治疸之要义也。
十四条 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。阳部。其人振寒而发热也。
疸而渴者。热甚。一也。阴虚。二也。湿重。三也。故难治。不渴之可治者。可想见矣。阴部。指中焦脾脏及下焦
肾脏
而言。阳部。指上焦胸中而言。发于脾肾。则热邪从中下而上冲胃脘。故其人必呕。发于胸中。则热邪从胸膈
而外犯卫气。故其人先振寒。而后发热也。此与上文二条。统论三疸之死生微甚。及其所发之上下不同也。
十五条 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） 大黄（二两）
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。（以栀子大黄利小便。真是奇制。）
此申言谷疸之症候治例也。寒热。注见上条。发于阳部。盖中焦胃浊。蒸于胸分。故其邪热先发于此。夫宗气
与卫外之气相贯。邪热逼伤宗气。则其卫气有自败之象。故寒。继则卫从热化。故寒而复热也。不食及食即
头眩。详二条注。心胸不安。即六条酒疸心下热之义。茵陈味苦性凉。而气最重。味苦。入心胸。性凉、除邪热。气
重。则为气分专药。以之主阳部之疸。是欲其走心肺之夹空。而消散其气分之瘀热也。但因热从膻中而上
蒸。故配苦寒降润之栀子。又因热从脾胃而中发。故加苦寒攻下之大黄。至栀子、大黄。本为溏泻之品。得茵
陈之走气分者。重用而先煮之。则栀黄俱从茵陈之性。而以清凉之气为化矣。故不利大便。而黄从小便去。
三味药中。恍如一天酷热。恰逢秋气半空。金风翼翼。玉露垂垂。而烦襟顿涤之象也。方药云乎哉。
十六条 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
Article 1 The Cun Kou (Inch Position) pulse is floating and slow. Floating indicates wind; slow indicates obstruction (Bi syndrome). This obstruction is not wind-stroke. The four limbs suffer from vexation and heat. The color of the Spleen must be yellow, as stagnant heat circulates throughout the body.
Later scholars have offered various interpretations of jaundice, yet none have provided a definitive explanation. In my view, based on the principles of the *Neijing* and the original text of the *Shanghan Lun*, it generally arises from the interplay of dampness and heat. The Qi of the Middle Jiao Spleen Earth becomes stagnant and fails to circulate to the other four Zang organs. Thus, like mist in heaven and earth, its yellow color scatters across the skin and orifices. If the condition originates from dampness or water retention first, followed by the generation of heat, then dampness and water are the root, and heat is the branch. Hence, it is named Damp Jaundice or Water Jaundice. If it begins with Yin deficiency generating heat, followed by the generation of wind and accumulation of dampness and water due to heat, then heat is the root, and wind-dampness and water are the branches. Hence, it is named Dan (Jaundice). The intent is to treat the root, after which the yellowing will naturally resolve. Thus, although symptoms are similar, the names differ. This is analogous to the cases where edema precedes amenorrhea, named "Water Division," versus amenorrhea preceding edema, named "Blood Division." Therefore, excluding Articles 11, 13, 18, and 24, which generally discuss various jaundices and jaundice patients with separate treatments, the formulas listed in this chapter for Grain Jaundice, Wine Jaundice, Female Labor Jaundice, and the three types of Dan—namely Yinchen Tang (Artemisia Capillaris Decoction), Xiaofen San (Magnesium Aluminum Powder), Zhizi Dahuang Tang (Gardenia and Rhubarb Decoction), Gaofa Jian (Hair and Fat Decoction), Yinchen Wuling San (Artemisia Capillaris and Five-Ingredient Poria Powder), and Dahuang Xishi Tang (Rhubarb and Gypsum Decoction)—are mostly salty-cold and bitter-cold substances. Their purpose in clearing heat is evident. As for jaundice caused by water-dampness generating heat, the treatment principle is that seventy percent should use sweating methods, and thirty percent should use diuretic methods. In the articles of this chapter, some merely say "various jaundices" and "jaundice patients," while others directly name specific jaundices; these must be carefully examined. The first article summarizes the causes of all jaundices from the pulse perspective. For symptoms of the head, face, and skin, one should first examine the Cun Kou (Inch Position) pulse because Cun Kou corresponds to the head and eyes above and the skin externally. If the Cun Kou pulse is floating and slow: floating indicates insufficiency of true Yin and the generation of wind by pathogenic heat, so floating represents wind moving upward and outward; slow indicates insufficiency of true Yang and the consumption of Qi by hyperactive fire, so slow represents Bi syndrome of weak righteous Qi. The common understanding of Bi syndrome originally refers to external wind-pathogen invasion causing sinking and weakening of Defensive Qi. This case, however, involves internal heat generating wind, so it cannot be compared to wind-stroke. It is simply that water fails to control fire, causing the four limbs to feel dry, hot, and vexed. Internally, this attracts external dampness; dampness and heat mutually obscure each other, with heat transformation prevailing. This resembles a sky in severe drought, where rain and dew do not nourish, and Earth Qi fails to hold, resulting in floating dust filling the air and yellow haze spreading. Thus, the yellow Qi of the Spleen color circulates with the stagnant heat throughout the body shell.
Article 2 The Fu Yang pulse is tight and rapid. Rapid indicates heat; heat consumes grain (increases appetite). Tight indicates cold; cold causes fullness after eating. The Chi (Cubit Position) pulse floating indicates Kidney injury. The Fu Yang pulse tight indicates Spleen injury. Wind and cold interact violently; after eating grain, dizziness occurs. Grain Qi does not digest; the Stomach suffers from turbidity. Turbid Qi flows downward; urination is blocked. The Yin aspect is affected by cold, while heat flows into the Bladder. The whole body turns yellow, named Grain Jaundice.
Fu Yang governs the Middle Earth. Its pulse should be gentle and peaceful to symbolize the virtue of Earth. If the pulse is tight and rapid: rapid indicates heat. Heat at Fu Yang means Fire Pathogen is abundant and good at digesting grain, hence heat leads to consuming grain. Tight indicates cold. Cold at Fu Yang means True Qi is deficient, and food pressure suppresses fire, hence fullness upon initial eating. Digestion of grain should not coexist with fullness, nor should fullness coexist with digestion of grain. The reason they appear together is that when Kidney Essence is sufficient, Fire usually fears concealment and dares not reveal itself. Chi pulse floating indicates Essence deficiency and an image of insecure Kidney Qi, thus knowing Kidney is injured. When Kidney is injured, Fu Yang manifests as rapid. Furthermore, when Spleen Yang virtue is robust, Qi is usually warm and smooth without retreating. Fu Yang pulse tight indicates Yang deficiency and an image of congealed Spleen Qi, thus knowing Spleen is injured. When Spleen is injured, Fu Yang manifests as tight. These two sentences self-annotate why cold and heat appear simultaneously above. "Wind and cold" here do not refer to external contraction but denote wind generated by heat and cold generated by deficiency. Hot wind and deficient cold strike each other. The nature of hot wind likes to flare upward; the energy of deficient cold fails to transport downward. Thus, dizziness occurs immediately after eating. Grain Qi does not digest, which contradicts "heat consumes grain" above? No. "Consuming grain" refers to the easy decomposition of physical substance; "not digesting" refers to the inability to distribute and dissipate Grain Qi. Grain Qi killed by evil fire piles up in the Stomach, making the Stomach not empty and agile, suffering from filth and turbidity. Turbid Qi flows downward, causing heat stasis and obstructed transformation mechanism, hence urination is blocked. The cold Qi of the Spleen is internally constrained by Shaoyin and Jueyin, making the power to distribute Grain Qi even weaker. The heat pathogen of the Stomach flows downward to the Bladder and other Fu organs, causing concurrent retention and closure of water drinks. Heat and dampness steam each other, turning the whole body yellow, named Grain Jaundice. Such is the cause.
Article 3 Forehead black, slight sweating, heat in hands and feet, onset at dusk, Bladder urgency, spontaneous urination, named Female Labor Jaundice. Abdomen like water status is incurable.
Female Labor Jaundice is indeed due to excessive sexual activity, with Essence deficiency generating heat as the basic symptom. However, simple Essence deficiency usually presents as Blood Bi or Deficiency Consumption, not forming jaundice. Only those who are overly desirous yet forcibly restrain ejaculation get this disease. Over-desire exhausts Diaphragm Qi, causing Fire to float upward; restraining ejaculation shakes Kidney Qi, causing Fire to stagnate downward. Evil Fire flares internally, preventing True Yang from distributing. When True Yang does not distribute, Middle Earth Qi floats and scatters, developing into jaundice, as seen in this article and Article 16. If it were solely due to Essence deficiency generating heat, one would not use the sharp Xiaofen San (Magnesium Aluminum Powder), nor list Yin-nourishing and Essence-supplementing herbs afterward, which can be contemplated. The forehead internally corresponds to the Chest region. Black is the Kidney color. Kidney Fire rushes fiercely into the Chest region, resembling smoke stains, hence black. Evil heat steams internally, hence sweating. Hands and feet centers belong to Shaoyin; Shaoyin Fire is abundant, hence heat in hands and feet. Dusk belongs to Yin aspect; Yin Fire is abundant, hence onset at dusk. Heat trend flows downward to Bladder, hence urgency. Spontaneous urination indicates Dry Heat rather than Water. Named Female Labor Jaundice. The meaning is that if the abdomen is not distended, it is treatable because Spleen and Stomach still have sources of nourishment. If not water, yet abdomen looks like water, this is Spleen Yang collapse causing distension, leading to True Yin lacking vigorous essence to support it, and evil fire cannot be extinguished. Hence, incurable.
Article 4 Vexation and heat in the heart, inability to eat, frequent desire to vomit, named Wine Jaundice.
Wine nature is hot, damp, and floating. Hot-damp floating above the Diaphragm injures Heart fluids causing vexation. Hot-damp floating in the Middle Jiao injures Stomach Qi causing anorexia. Hot-damp floating in the Middle Jiao tends to rush upward to the Diaphragm, causing frequent desire to vomit. Is this not a jaundice condition caused by wine? Hence named Wine Jaundice.
Article 5 Yangming Disease with slow pulse: difficult to eat until full; if full, develops vexation and dizziness; urination will certainly be difficult. This is about to become Grain Jaundice. Even if purged, abdominal fullness remains as before. The reason is the slow pulse.
This discusses variable pulses and symptoms of Grain Jaundice. Yangming Disease refers to Yangming Fu organ disease, such as after contracting wind-cold, summerheat, dampness, dryness, or fire. It means Grain Jaundice pulse is not only Fu Yang tight-rapid. After any Yangming Fu disease, if the pulse is slow, it is because Spleen-Stomach Yang Qi is internally deficient, so the arrival cannot be continuous like fish swimming in a row, but appears slow and delayed. If one reduces food intake, Qi can overcome food and gradually digest it, hence difficult to eat until full. Fullness causes food stagnation generating heat, and residual fluids in Stomach-Hu enter the food, unable to decompose and return, causing vexation. Vexation-heat floating in the middle must flare upward, causing dizziness. Qi mechanism failing to transport downward causes water-grain mixing, hence urination difficulty. Heat-vexation and damp-stagnation pathogens gather in the Stomach. Although the pulse differs from the tight-rapid of Article 2, the Stomach's suffering from turbidity is the same, thus knowing it is also about to become Grain Jaundice. "Purging" refers to Yinchen Hao Tang (Artemisia Capillaris, Gardenia, and Rhubarb Decoction) in Article 15. Although Yinchen Hao Tang purges heat-vexation and grain stagnation, abdominal fullness remains because the slow pulse indicates Yang deficiency causing false distension. I humbly propose adding Ganjiang (Dried Ginger) to this decoction as a counter-agent, so cold and heat, root and branch, oppose each other precisely without弊端.
Article 6 Those with Wine Yellow Jaundice must have difficult urination. Their symptoms are heat in the heart and heat under the feet. This is their sign.
If Wine Heat has free urination, heat decreases with urine flow and jaundice does not form. Thus, Wine Yellow Jaundice patients must first present with difficult urination. Wine nature is hot, floating, and damp. Heat reveals through floating; floating flares upward, hence heat in the heart. Heat reveals through dampness; dampness tends downward, hence heat under the feet. These three are definitive signs of Wine Jaundice.
Article 7 Wine Jaundice patients may have no heat, speak quietly and clearly, have abdominal fullness, desire to vomit, and dry nose. If the pulse is floating, use emesis first. If sinking and wiry, use purgation first.
This discusses initial and variable symptoms of Wine Jaundice. Wine has no pure flavor among sour, bitter, sweet, pungent, and salty; its flavor is crooked, and nature follows Wood, entering Liver and Gallbladder first. Liver-Gallbladder heat overacts on what it conquers, making Spleen-Stomach the total root of Wine Jaundice. But Spleen connects to Lung, Stomach floats at Wan, and symptoms appear from above, hence heat in the heart (Article 6) and abdominal fullness, desire to vomit, dry nose (this article). Spleen heat-fullness returns to Shaoyin-Jueyin; Stomach heat-fullness flows down to Large/Small Intestines and Bladder, hence difficult urination, heat under feet, Yinchen Wuling San (Article 20), Zhizi Dahuang Tang (Article 17). This article highlights the general method. It says jaundice from wine has much heat above and below, yet there is a type of person with Yang deficiency and Yin excess. Damaged by wine's hot-dampness accumulating in Middle Earth, lacking Yang Qi to combat it, initial symptoms may lack heat in chest-below or feet-below. Chest-below heat shortens fluids causing vexation, making speech erratic. Now speaking quietly and clearly shows no heat. Dampness prevails, hence abdominal fullness. Heat prevails, hence desire to vomit and dry nose. These are flaming-upward symptoms. Flaming-upward pulses must be floating. Pulse and symptoms both high, hence suitable to emesis to disperse them. This sentence is the main point. If abdominal fullness etc. exist, plus heat under feet and difficult urination, heat-dampness presses downward, pulse must respond with sinking-wiry below. Pulse and symptoms both deep, hence suitable to guide downward. "First emesis, first purgation" implies alternating treatments based on symptoms. However, purgative formula is Zhizi Dahuang Tang, while emetic formula is not listed. Perhaps because only Goudi San (Melon Rind Powder) exists for emesis, so no need to repeat? Old annotations suggest Zhichi Tang (Gardenia and Soybean Decoction). Considering the main Wine Jaundice formula uses Zhichi twice, Grain Jaundice Yinchen Hao Tang uses Zhizi alone, and major Jaundice Dahuang Xishi Tang uses Zhizi alone, advocating Zhichi Tang seems close to logic. Yet Zhichi is not an emetic. See detailed discussion in Shanghan Lun annotation. Does one take this and induce vomiting? This awaits identification by experts.
Article 8 Wine Jaundice with heat in the heart and desire to vomit: emesis cures it.
Heat in heart and desire to vomit indicate hot-damp rushing upward, hence suitable to emesis to disperse. Continuing from above, not only those without heat but with abdominal fullness, desire to vomit, and dry nose should use emesis, but also those with heat but without lower body symptoms follow the same rule. And this interacts with those having only lower symptoms without upper symptoms, who should follow purgation rules.
Article 9 Purging Wine Jaundice eventually leads to Black Jaundice: blue-black eyes, black face, sensation in heart like eating minced garlic, stool truly black, skin and nails numb. Pulse floating and weak. Though black, slightly yellow, thus known.
This discusses Black Jaundice transformed from Wine Jaundice, distinguishing it from Female Labor Jaundice in Articles 3 and 16, though both are black, symptoms are vastly different. Wine Jaundice has indications for emesis or purgation. If hot-damp is in chest-below, should emese. If purged first, it vainly injures Yin, leaving hot-damp in chest-below. Moreover, heat pathogen intensifies due to Yin injury. Extreme heat dries blood, color gradually turns black, thus eventually becoming Black Jaundice. Eyes are fruit of Gallbladder; Gallbladder heat steams juice upward, hence blue-black eyes. Face responds to Stomach; Stomach heat scorches Earth within, hence black face. Heart sensation like eating minced garlic: Yang fluids insufficient to supply violent destruction of heat pathogen, causing gnawing and discomfort, hence borrowed as description. Stool truly black: Hyperactive Fire steals Middle Earth transformation, so excrement resembles grass ash or charcoal. Skin numbness: Heat forces Shaoyin, Spirit of Heart Master is blocked internally, unable to penetrate externally. Pulse floating and weak: Floating is heat, is above; floating and weak is Yin deficiency. Yang aspect upper heat and Yin aspect lower deficiency, is this not Wine Jaundice suitable for emesis, mistakenly purged? But forehead black and stool black are clearly Female Labor Jaundice signs, yet said to result from Wine Jaundice transformation because yellow is Wine Jaundice; now although black, slightly yellow remains, thus knowing it is not Female Labor.
Article 10 Master said: Jaundice patient with fever, vexation, panting, chest fullness, and dry mouth: because at onset, fire coerced sweat, two heats combined. However, Jaundice family obtains disease from dampness. Whole body fully feverish and yellow, belly heat, heat in interior, should purge.
This discusses Jaundice treatment principle: sweating is adverse, purging is favorable. Jaundice heat is all internal, steaming yellow outward from inside, never manifesting as exterior heat. Now fever is not its symptom. Plus heat-dryness in heart causing vexation, heat-dampness in Lung causing panting, heat-dampness blocking Diaphragm causing chest fullness, fluids not distributing to Lianquan causing dry mouth. This is because at onset, mistaken belief that sweating resolves heat, using fire to coerce sweat, injuring Yin, causing internal-external heat interaction. Interior heat lifted to exterior-upper by sweat, thus getting these fever signs. However, single heat cannot form jaundice; Jaundice family must obtain from heat generating dampness. Now whole body feverish and yellow, heat-damp is in belly. Heat-damp in interior should be purged, differing from damp-jaundice in meridians/exterior suitable for sweating.
Article 11 Pulse sinking, thirst desiring to drink, difficult urination: all turn yellow.
Sinking is water pulse. Internal water rejects drinking, normally no thirst. Yet thirst desiring to drink indicates water-drink transforming into heat, internally scalding and steaming upward. However, if urination is free, heat-drink drains downward, momentum does not gather. If again difficult, heat-damp both prevail, thus all turn yellow. This discusses water-drink jaundice generally due to jaundice.
Article 12 Abdominal fullness, tongue withered and yellow, restlessness unable to sleep: belongs to Jaundice family.
This resembles Grain Jaundice but is not Grain Jaundice, because Grain Jaundice is heat then damp, this is damp then heat. Abdominal fullness is damp; tongue yellow is excess. Damp and heat-excess pull fluids downward, causing bladder essence short, tongue withered and yellow. Heat-excess prevents Spirit mechanism from hiding internally, causing restlessness unable to sleep. Heat-damp obscuring, this yellowing is certain. Thus belongs to Jaundice family. Symptoms narrated starting from abdominal fullness, thus knowing damp then heat. Same Spleen cold-damp and Stomach heat-excess, hence said resembles Grain Jaundice but is not.
Article 13 Jaundice disease should have eighteen days as period. Treat for ten days or more to recover; if worsening, difficult to treat.
Jaundice is Fire-Earth disease. Period is life-death deadline. Earth Qi prosperous for eighteen days. During official prosperity, True Qi remains, so can attack and remove hyperactive heat during its victory, thus healing. Otherwise, die when encountering its unconquerable element. Hence set as period. Fire born at two, completed at seven; nine is Fire's combined number. Treat for ten days or more, Fire enters declining phase, thus should recover. If worsening, Evil Fire becomes prairie-fire momentum, abnormal. True Yin fears collapse, thus difficult to treat. Thus Middle Earth Qi fears decline, Hyperactive Fire fears non-extinction, this is key to treating jaundice.
Article 14 Jaundice with thirst: difficult to treat. Jaundice without thirst: treatable. Originating in Yin part: person must vomit. Originating in Yang part: person chills and fevers.
Jaundice with thirst: heat severe (1); Yin deficient (2); damp heavy (3). Hence difficult. Non-thirsty treatable can be imagined. Yin part refers to Middle Jiao Spleen and Lower Jiao Kidney. Yang part refers to Upper Jiao Chest. Originating in Spleen-Kidney, heat pathogen rushes from middle-lower to Stomach-Hu upward, hence vomiting. Originating in Chest, heat pathogen attacks Wei Qi from chest-diaphragm outward, hence chills then fevers. This collectively discusses Articles 2, analyzing life/death severity of three Dan types and their upper/lower origins.
Article 15 Grain Jaundice disease: chills-fever, anorexia, dizziness upon eating, chest-heart unrest, long-term yellowing, named Grain Jaundice. Treated with Yinchen Hao Tang (Artemisia Capillaris, Gardenia, and Rhubarb Decoction).
Yinchen Hao Tang Formula: Yinchen Hao (Six taels), Zhizi (Fourteen seeds), Dahuang (Two taels).
These three ingredients, boil in ten dou of water. First boil Yinchen, reduce by six sheng, add remaining two, boil to three sheng. Remove dregs. Divide into three warm doses. Urination should be beneficial, urine like soapberry juice, color red. Overnight abdominal reduction, yellow leaves via urination. (Using Zhizi and Dahuang to promote urination is a unique formulation.)
This reiterates Grain Jaundice symptoms and treatment. Chills-fever noted in previous article. Originating in Yang part: Middle Jiao Stomach turbidity steams to Chest region, so evil heat starts here. Zong Qi and Exterior-Defensive Qi connect. Evil heat damages Zong Qi, Defensive Qi shows self-destruction, hence chills. Then Defense transforms with heat, hence chills then fever. Anorexia and dizziness upon eating detailed in Article 2 note. Chest-heart unrest is meaning of Article 6 Wine Jaundice chest-heat. Yinchen is bitter, cool nature, heaviest Qi. Bitter enters Heart-Chest; cool removes evil heat; heavy Qi makes it specific to Qi aspect. Using it for Yang-part jaundice aims to travel to interspace of Heart-Lung and dissipate Qi-aspect stagnant heat. Because heat steams upward from Danzhong, pair with bitter-cold descending-moistening Zhizi. Because heat originates mid-body from Spleen-Stomach, add bitter-cold attacking-purgative Dahuang. Zhizi and Dahuang are normally loose-stool inducing; obtaining Yinchen traveling Qi aspect, heavily used and boiled first, Zhizi-Dahuang follow Yinchen nature, transforming via cool Qi. Thus no bowel movement benefit, yellow leaves via urination. Among three herbs, like intense summer heat meeting autumn air halfway, golden wind fluttering, jade dew dripping, vexation instantly washed away. What can be said of formulas?
Article 16 Jaundice family, fever at dusk, contrary chills: obtained from Female Labor. Bladder urgency, lower abdomen full, whole body yellow, forehead black, heat under feet, thus making Black Jaundice, abdominal distension...