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Like water distension. The stool must be black, sometimes loose. This is the disease of female labor jaundice (Nü Lao Dan), not water qi disease. If there is abdominal fullness, it is difficult to treat. Xiao Fan San (Magnesia and Alum Powder) is the main treatment.

Xiao Shi Fan Shi San Formula: Xiao Shi (Sodium Nitrate), Fan Shi (Alum) (calcined, equal parts).
The above two ingredients are ground into a powder. Mix with barley porridge juice, take one Fang Cun Bi (a measure approx. 2.7 cm square) per dose, three times a day. The pathogen exits via urination and defecation; when urine becomes normally yellow and stool becomes normally black, this is the sign of recovery.

This further elaborates on the symptoms and treatment principles of female labor jaundice. It states that among those who have yellowing, if they experience fever whenever evening approaches (around dusk), it resembles the syndrome of Yangming Stomach Excess. However, in cases of Stomach Excess, according to the method, one should fear heat, whereas here one fears cold instead. This is because Yin deficiency in the Yin aspect leads to Ministerial Fire (Xiang Huo) becoming hyperactive and blazing due to lack of attachment at that time, causing True Yin to fail to withstand the fierce heat, thus resulting in fever; Wei Qi (Defensive Qi) cannot overcome the pathogenic fire, thus resulting in aversion to cold. It is said that without contracting female labor jaundice, one would not reach this state. The twelve sentences mentioning "bladder urgency" etc., describe various symptoms; see the annotation for Article 3. Xiao Shi is salty and cold, descending and moistening; Fan Shi is sour and cool, astringent and suppressing. Using them to govern the condition of flying fire qi is indeed very appropriate. However, the nature of sour and salty tends to move downward, so using barley, which fills the heart and benefits Qi, as porridge juice to mix and take it, intends to make it linger slightly, allowing the scum-scraping and polishing nature of Fan Shi to slowly clarify and descend thoroughly. Then, heat follows the yellow and black colors, exiting together from urination and defecation. But Article 3 says abdominal distension like water is incurable, while this article says abdominal fullness is difficult to treat. This indicates that for female labor jaundice, if all symptoms are present but the abdomen is not full, life is preserved; if fullness is severe and resembles edema, death ensues; if the abdomen is already full, even if not severe, life and death are equally probable. This is Zhang Zhongjing's profound meaning in discussing female labor jaundice.

Article 17: Wine Jaundice (Jiu Huang Dan), with mental restlessness and vexation (Ao Nu) or hot pain, is mainly treated with Zhi Zi Da Huang Tang (Gardenia and Rhubarb Decoction).

Zhi Zi Da Huang Tang Formula: Zhi Zi (Gardeniae Fructus, 14 pieces), Da Huang (Rhei Radix et Rhizoma, 1 liang), Zhi Shi (Aurantii Fructus Immaturus, 5 pieces), Chi Shao Dou Chi (Fermented Soybean, 1 sheng).
The above four ingredients are boiled in 6 sheng of water to obtain 2 sheng, divided into three warm doses.

This further elaborates on the symptoms and treatment principles of wine jaundice. Mental restlessness and vexation with heat are seen in the annotation for Article 4. Pain indicates heat burning, leading to a sensation of suspension, rigidity, and tension in the chest cavity. As mentioned in the annotation for Article 6, heat appearing via a floating pulse indicates an upward flare-up of heat. Therefore, bitter-cold Zhi Zi is used to descend heat in the Epigastrium (Tan Zhong); bitter-cold Zhi Shi is used to dissipate stagnation in the Chest. Heavy use of Fermented Soybean (Chi Dou Chi) is to nourish Stomach fluids. Adding Da Huang is to purge Stomach heat. Ultimately, these are agents relying on high-source water nourishing the lower flow; most hot yellows exit via urination and defecation. Old annotations claiming this is an emetic formula are far off. Predecessors mistakenly believed Zhi Zi Dou Chi Tang could induce vomiting because Fermented Soybean was heavily used in Gua Di San (Melon Peduncle Powder), leading them to attribute emesis to the nature of Fermented Soybean. They did not realize that emesis comes from Melon Peduncle (Gua Di); Coix Seed (Chi Xiao Dou) merely guides Melon Peduncle, acting slightly as a descending messenger. Fermented Soybean is used to nourish Yin and calm the Stomach, fearing post-emesis irritability, thus preparing in advance. Refer to the original annotation of Gua Di San. I hope all colleagues pay attention and try it, jointly stripping away errors and correcting the truth, so that Zhang Zhongjing does not cry injustice and Zhi Zi Dou Chi does not suffer grievance. That would be fortunate.

Article 18: All patients with jaundice should benefit from promoting urination. If the pulse is floating, it should be resolved by sweating; Gui Zhi Jia Huang Qi Tang (Cinnamon Twig Decoction plus Astragalus) is suitable. (Formula see Water Disease section.)

From here to the end of the chapter, there are seven articles in total, broadly discussing treatment principles for various yellows based on jaundice. All patients with jaundice involve damp-heat. When urination is free, dampness leaves and heat follows, so promoting urination is the method. If the pulse is floating, damp-heat is in the upper and exterior layers, requiring resolution by sweating as a convenient pathway. Gui Zhi Tang itself induces sweating to resolve heat; adding Huang Qi (Astragali Radix) assists Wei Qi to send dampness out to the exterior, hence it is suitable. Promoting urination includes not only Article 15's Yin Chen Hao Tang (Artemisiae Scopariae Decoction), Article 19's Gao Fa Jian (Pig Fat and Hair Decoction), and Article 20's Yin Chen Wu Ling San (Artemisiae Scopariae and Five-Ingredient Poria Pill), but also all seeping and draining formulas in the Fluid Retention section. A student asked: Jaundice symptoms arise from heat and dampness, so formulas for jaundice mostly use bitter-cold, salty-cold, and purgative items. Having heard the rationale, this article says "all patients with jaundice," implying jaundice is included, yet it uniquely advocates the acrid-warm and hot Gui Zhi Tang, plus Qi-tonifying Huang Qi, for floating pulses. Is there no concern about heat aiding heat? Please explain. The answer is: In Zhang Zhongjing's book, each article has its main symptom and perspective. If one does not seek the intent of the statement and the precise correspondence between formula and pathology, there is no way to enter. This article addresses a condition where exterior Wei Qi deficiency first attracts damp-water. Damp-water generates heat; damp-heat stagnates in skin and collaterals causing yellowing. Thus, Wei Qi deficiency is the first layer of disease, dampness is the second, and heat is the third. Would Wei Qi deficiency not suit Gui Zhi's acrid-warmth and Huang Qi's tonification? Moreover, heat exists within dampness; dampness is the root, and heat is a false branch. Following the sweating example to remove dampness treats the root, leaving no room for heat. Subsequent Article 19 deals with yellow caused by heat generated from fluid-blood deficiency; Article 20 deals with yellow where chest heat first attracts internal water, or long-standing retention transforms into heat; Article 21 deals with middle-jiao heat-excess, ascending and descending blockage; Article 23 deals with middle-jiao heat-excess attacking the flanks rather than the stomach; Articles 22 and 24 deal with upper-jiao Zong Qi deficiency and consumption, inability to transport, leading to difficulty in defecation and gradual upward-floating yellow. Etiologies differ, so main treatments differ.

Article 19: Various yellows are mainly treated with Zhu Gao Luan Fa Jian (Pig Fat and Loose Hair Decoction).

Zhu Gao Luan Fa Jian Formula: Zhu Gao (Pig Fat, half jin), Luan Fa (Loose Hair, three pieces the size of a chicken egg).
The above two ingredients are boiled together in the fat until the hair dissolves and the medicine is ready. Divide into two doses. The disease exits via urination.

Among various yellows, there is a type where fluid-blood is short and Yang Qi is excessive. Short fluid-blood retains water qi generating dampness; excessive Yang Qi stagnates and steams fire qi generating heat. Here, damp-heat takes fluid-blood exhaustion as the root disease. Nourishing fluid-blood replaces dampness, allowing dampness to descend naturally; nourishing Yin blood moistens Qi, allowing Qi to circulate freely. Once damp-heat is removed, yellow will dissipate naturally. Zhu Goo generates fluids; Luan Fa supplements blood. Using them is appropriate.

Article 20: Jaundice disease is mainly treated with Yin Chen Wu Ling San (Artemisiae Scopariae and Five-Ingredient Poria Pill).

Yin Chen Wu Ling San Formula: Yin Chen Hao Mo (Artemisiae Scopariae Herba Powder, ten parts), Wu Ling San (Five-Ingredient Poria Pill, five parts).
Mix the above two ingredients. Take one Fang Cun Bi before eating, three times a day.

Among various yellows, there is a type where heat initially causes water retention, followed by water accumulation transforming into more heat. Since it starts from heat, it is called jaundice following jaundice cases, and treated with Yin Chen following jaundice methods. This is a combined syndrome of heat-yellow and water-yellow, hence treated by both aspects. The meanings of Yin Chen and Wu Ling San are seen elsewhere.

Article 21: Jaundice with abdominal fullness, dysuria with red urine, and spontaneous sweating indicates exterior harmony and interior disease. Purge internally; Da Huang Xiao Shi Tang (Rhubarb and Sodium Nitrate Decoction) is suitable.

Da Huang Xiao Shi Tang Formula: Da Huang (Rhei Radix et Rhizoma), Xiao Shi (Sodium Nitrate), Huang Bo (Phellodendri Cortex, four liang each), Zhi Zi (Gardeniae Fructus, fifteen pieces).
Boil the above four ingredients in 6 sheng of water to obtain 2 sheng. Remove dregs, add Xiao Shi, boil again to obtain 1 sheng. Take once in one dose.

All jaundice cases involve closed pores and dysuria, caused by intense damp-heat interacting inside and outside, above and below. Only damp-yellow and water-yellow present this way: sweating releases damp-water upwards and externally; free urination releases damp-water downwards and internally. For jaundice arising from heat, internal heat is vigorous; even with sweating, internal heat does not decrease, so yellow persists. There is a type of jaundice that does not spread horizontally to the exterior, but whose heat stays in the Middle Jiao, invading the chest/diaphragm upwards and penetrating liver/kidneys downwards, presenting vertically. Abdominal fullness is a response of interior dampness; dysuria with red urine is a response of interior heat—this is interior disease. Interior damp-heat should theoretically transmit to the exterior. Now, with spontaneous sweating, meridians and skin/hair have no stagnant heat, indicating exterior harmony. For exterior harmony and interior disease, purging internally is the correct treatment. The reason for this formula is excess-heat in the Middle Jiao; thus, bitter-cold Da Huang and salty-cold Xiao Shi follow the Cheng Qi method of purging downward. Heat in the middle must熏 (smoke/ascend) to Yang positions, so Zhi Zi, which travels well to the Epigastrium, is added to descend it. Heat in the middle must penetrate to Yin, so Huang Bo, which moistens liver/kidneys, is added to firm it. Salty overcomes heat, bitter dries dampness—these are residual implications.

Article 22: Jaundice disease with unchanged urine color, desire for spontaneous diarrhea, abdominal fullness, and wheezing should not have heat removed. Removing heat will cause hiccups. Hiccups are mainly treated with Xiao Ban Xia Tang (Minor Ginger and Pinellia Decoction). (Formula see Phlegm-Fluid section.)

This describes a type of jaundice where there is no heat in the Lower Jiao, so urine remains unchanged and pale white; no heat in the Middle Jiao, so stool desires spontaneous diarrhea and is unformed. It is solely due to heavy Spleen Qi dampness causing abdominal fullness, and Diaphragm Qi labor-heat causing Lung wheezing. Labor-heat mingling with dampness eventually forms jaundice. However, this arises from labor causing Divine Fire to float, generating false heat, different from true heat-excess. Thus, purging to remove heat is contraindicated. Removing heat makes the Diaphragm deficient and Stomach cold; attacking deficiency with cold guarantees hiccups. Hiccups are treated with Xiao Ban Xia Tang because it fills the chest, warms the Stomach, descends rebellion, removes cold, and calms hiccups. See Phlegm-Fluid section for decoction details.

Article 23: Various yellows with abdominal fullness and vomiting should use Chai Hu Tang (Bupleurum Decoction). (Major and Minor Chai Hu Tang formulas are seen elsewhere.)

"Various yellows" refers to both jaundice disease and yellow-family conditions. "Suitable for Chai Hu Tang" refers to both Major and Minor Chai Hu Tangs. This generally discusses syndromes and treatments flowing through Shaoyang for jaundice where heat precedes dampness, and yellow where dampness precedes heat. Abdominal fullness is seen previously. Shaoyang receiving heat reverses upward from the hypochondrium, causing frequent vomiting. Both heat-jaundice and damp-yellow have this symptom. Heat-attracting-damp jaundice often has Spleen/Stomach heat-excess; Spleen/Stomach heat-excess qi biases towards the sides of the abdomen, ascending to the hypochondrium, which is the Shaoyang region. Damp-generating-heat yellow often has chest/diaphragm damp-heat; chest/diaphragm damp-heat qi biases towards the sides of the chest, overflowing horizontally to the hypochondrium, also the Shaoyang region. Hence both can cause vomiting. Saying "suitable for Chai Hu Tang" without specifying Major or Minor is because jaundice takes heat as root and damp as branch; treating heat suits purging, hence Major Chai Hu; yellow takes damp as root and heat as branch; treating damp suits sweating, hence Minor Chai Hu. Waiting for people's divine understanding. Meanings of Major and Minor Chai Hu Tangs are seen elsewhere.

Article 24: Male yellow with free urination should be given Xu Lao Xiao Jian Zhong Tang (Deficiency Consumption Minor Constructive Middle Decoction). (Formula see Deficiency Consumption section.)

This supplements because the previous Article 22 only established rescue-for-error formulas without standard formulas. Free urination implies the meaning of unchanged color from the previous article. Generally, Bladder receiving heat causes strangury with yellow-red color; free urination implies the unchanged state. But if urination is free, heat drains and dampness reduces; how can yellow appear? Thus, this yellow is caused by Zong Qi deficiency leading to consumption,幻 (illuding) false heat. It suits Xiao Jian Zhong Tang's acrid-warmth to fill Heaven's Qi. Then Sun shines brightly, and Dragon-Lei Yin Fire, Lanqi Yin Dampness, naturally hide and dissipate. Female yellow with free urination is mostly postpartum or metrorrhagia/metrostaxis cases, so it cannot be diagnosed as deficiency consumption. The yellow in this condition is pale, not scorched. Commonly known as "Fatigue Yellow." Women do not bear the burden of strenuous effort, so they do not have this disease.