阳明病。无汗。小便不利。心中懊 者。身必发黄。
此言发黄之由。皆因无汗及小便不利之所致也。邪入阳明之经。本当身热汗自出。及入阳明之腑。亦必潮热自汗。
若无汗。则邪不得外泄而热郁于内。小便不利。则水不得下泻而湿停于里。湿气郁热。瘀热在胃。不得发泄。故心中
懊而知其必发黄也。黄者。中央脾土之色也。胃为脾之腑。脾乃胃之脏。脾胃以膜相连而为一合。
胃实郁蒸。故脾病而现黄色也。脾本恶湿。况湿热并郁乎。
阳明病。面合赤色。不可攻之。必发热黄色。小便不利也。
此言表邪未解。误下而致色黄也。面合赤色。成注谓合。通也。阳明病面色通赤。热在经也。方氏云。合。应也。
面应赤色。攻之则亡津液。其说非也。当以成说为是。盖阳明居身之前。其脉起于鼻之交 中。
灵枢邪气脏腑病形篇云。诸阳之会。皆在于面。其中人也。方乘虚时。及新用力。若饮食汗出。腠理开而中于邪。
中于面。则下阳明。故热在阳明之经。皆现于面。所以面色通赤。此时邪方在经。尚未入里。不可攻之。
攻之则胃虚邪陷。热郁于里。其所以必发热色黄者。以小便不利。湿与热并。郁蒸于里故也。若小便利。
必不能发黄矣。
阳明病。发热汗出者。此为热越。不能发黄也。但头汗出。身无汗。剂颈而还。小便不利。渴饮水浆者。
此为瘀热在里。身必发黄。茵陈蒿汤主之。
此又详言发黄与不发黄。皆由汗之有无。小便利与不利。以反复互明前义也。然此条又当与太阳中风脉浮动数
之末证参看。谓邪气虽在太阳。误下则邪陷入里。湿热即可入胃郁蒸而发黄。非有阳明太阳之别也。言邪在阳明
而发热汗出。乃其本证。若此者。为热邪已经随汗发越于外。虽或另有他证。然必不能发黄也。若但头汗出。则阳邪
独盛于上。身无汗。则热邪不得外泄。剂颈而还者。三阳之经络皆上至头。三阴之经络皆至颈而还。足
见邪热固闭。阴阳离异。营卫不行。腠理不通也。邪热炽盛而三焦不运。气化不行。故小便不利。水湿不得下泻。
且胃热枯燥而渴饮水浆。则水湿又从上入。其湿蒸郁热。瘀蓄在里。故身必发黄。其湿热之邪。急宜攘逐。
故以茵陈蒿汤主之。
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。
茵陈性虽微寒。而能治湿热黄胆。及伤寒滞热。通身发黄。小便不利。栀子苦寒。泻三焦火。除胃热时
疾黄病。通小便。解消渴心烦懊 。郁热结气。更入血分。大黄苦寒下泄。逐邪热。通肠胃。三者皆能蠲湿热。
去郁滞。故为阳明发黄之首剂云。
阳明病。被火。额上微汗出。小便不利者。必发黄。
此言阳明无汗。而以火劫之。反增火邪。以致小便不利而发黄也。阳明被火。即太阳中风。以火劫汗之属也。
以中风之阳邪被火。是亦两阳相熏灼也。若能通身得汗。则热越而不能发黄矣。今云额上微汗。则周身无汗
可知。更小便不利。则湿气又不得下泄。是与上文但头汗出。身无汗。剂颈而还之证同。而更增火邪矣。故必湿
热壅滞。郁蒸而发黄也。
伤寒七八日。身黄如橘子色。小便不利。腹微满者。茵陈蒿汤主之。
此言阳明发黄之色。状与阴黄如烟熏之不同也。伤寒至七八日。邪气入里已深。身黄如橘子色者。
湿热之邪在胃。独伤阳分。故发阳黄也。小便不利。则水湿内蓄。邪食壅滞而腹微满也。以湿热实于胃。
故以茵陈蒿汤主之。
伤寒身黄发热者。栀子柏皮汤主之。
发黄本由乎湿热。此以伤寒而不言无汗。更不曰小便不利。但曰身黄发热者。是热胜于湿。无形之邪
郁蒸而发黄也。故不必茵陈大黄。而以栀子柏皮汤主之。
栀子柏皮汤方
栀子（十五个） 甘草（一两） 黄柏（二两）
上三味。以水四升。煮取一升半。去滓。分温再服。
栀子苦寒。解见前方。黄柏苦寒。神农本经治五脏肠胃中结热黄胆。泻膀胱相火。故用之以泻热邪。
又恐苦寒伤胃。故以甘草和胃保脾。而为调剂之妙也。
伤寒瘀热在里。身必发黄。麻黄连轺赤小豆汤主之。
瘀。留蓄壅滞也。言伤寒郁热。与胃中之湿气。互结湿蒸。如淖泽中之淤泥。水土粘泞而不分也。
故成注引经文云。湿热相交。民多病瘅。盖以湿热胶固。壅积于胃。故曰瘀热在里。身必发黄也。麻黄之
用。非热在里而反治表也。赤小豆之用。所以利小便也。翘根梓皮。所以解郁热也。上文云。无汗而
小便不利者。身必发黄。故治黄之法。无如汗之。则湿
热从毛窍而散。利其小便。则湿热由下窍而泄。故以麻黄连轺赤小豆汤主之。
麻黄连轺赤小豆汤方
麻黄（二两去节） 赤小豆（一升即今赤豆之小者） 连轺（二两连翘根也） 杏仁（四十个去皮）
生梓白皮（一升） 甘草（一两炙） 生姜（二两切） 大枣（十二枚）
以上八味。以潦水一斗。先煮麻黄再沸。去上沫。内诸药。煮取三升。分温再服。
赤小豆非今一头红黑者。古人以黑豆黄豆为大豆。绿豆赤豆白豆 豆皆为小豆。以小豆中之赤者。
故曰赤小豆。李时珍曰。以紧小而赤黯色者入药。稍大而鲜红淡红者。并不治病。花似豇豆而小。淡银
褐色。荚长二三寸。比绿豆荚稍大。三青二黄时即收之。可煮可炒。可作粥饭。馄饨馅并佳也。
麻黄汤。麻黄桂枝杏仁甘草也。皆开鬼门而泄汗。汗泄则肌肉腠理之郁热湿邪皆去。减桂枝而不
用者。恐助瘀热也。素问至真要大论云。湿上甚而热。以汗为故而止。王冰注云。身半以上。湿气有余。
火气复郁。郁湿相薄。以苦温甘辛之药。解表流汗而祛之是也。赤小豆除湿散热。下水肿而利小便。李
时珍云。赤小豆。小而色赤。心之谷也。其性下行。通乎小肠。能入阴分。治有形之病。故行津液利小便。
消胀除肿。止吐治痢。解酒病寒热。疗痈肿。通乳汁。下胞衣。产难服之。降令太过。津血渗泄。所以
令人肌瘦身重也。吹鼻瓜蒂散及辟瘟疫用之。亦取其通气除湿散热耳。梓白皮。性苦寒。能散温热之邪。
其治黄无所考据。连翘根。陶弘景云。方药不用。人无识者。王好古云。能下热气。故仲景治伤寒瘀热
用之。李时珍云。潦水乃雨水所积。韩退之诗云。潢潦无根源。朝灌夕已除。盖谓其无根而易涸。故成氏谓莫
味薄不助湿气而利热也。
伤寒脉浮而缓。手足自温者。是为系在太阴。太阴身当发黄。若小便自利者。不能发黄。至七八日大便
硬者。为阳明病也。
伤寒脉浮而缓。与太阳下编大青龙汤第二条相同。然邪在太阳。为伤寒而见中风之脉。则有发热恶寒之表证。
此条不言表证者。以邪不在三阳也。夫缓者。脾之本脉。故在太阳则浮缓为中风。而有发热恶寒之表证。
在太阴则浮缓为伤寒。而无发热恶寒之表证。此阴阳经络之分也。然同曰伤寒脉浮而缓。何以别其为太阳太
阴乎。但观手足自温。则知通身无热矣。即所谓无热恶寒。为发于阴也。况脾主四肢。手足本关足太阴者乎。
曰自温。则又知非少阴厥阴之四肢厥冷矣。非太阴而何。故曰是为系在太阴也。然太阴湿土之邪郁蒸。当发身黄。
若小便利者。其湿气已从水道而去。故不能发黄也。湿气已去。至七八日。大便硬者。为太阴复转阳明。胃实
而成可下之症也。此条当细加体认。上半节与太阴篇无异。此以七八日大便反硬。为转属阳明。彼以七八日后
暴烦下利。为脾家实。一症而各阴阳。一源而分泾渭。病情之变化如此。故入阳则为阳邪而成阳症。入阴则为
阴邪而成阴症矣。宁有一定之可拟哉。
阳明病。无汗。小便不利。心中懊 者。身必发黄。
这是说发黄的成因，都是由于无汗以及小便不利所导致的。邪气侵入阳明经，本应当身体发热、自然出汗；等到邪气传入阳明腑，也必定会出现潮热和自汗。
如果没有汗，那么邪气就无法向外宣泄，导致热邪郁结在体内；如果小便不通利，那么水湿就无法向下排泄，导致湿气停滞在体内。湿气与郁热相互搏结，瘀积的热邪停留在胃中，无法发泄，所以心中感到烦闷不安，据此可以推断身体一定会发黄。黄色，是中央脾土的颜色。胃是脾的腑，脾是胃的脏，脾胃通过膜相连而构成一个整体。
胃中实热郁蒸，所以脾病而显现出黄色。脾本性厌恶湿气，何况是湿热并郁呢？
阳明病。面合赤色。不可攻之。必发热黄色。小便不利也。
这是说表邪尚未解除，误用下法而导致面色发黄。面部通现红色，成无己注解说“合”意为通。阳明病面色通红，说明热邪在经络。方有执说，“合”意为应。面部呈现红色，若此时攻下则会耗伤津液，这种说法是不对的。应当以成无己的说法为正确。大概因为阳明经位于人体前面，其脉起于鼻翼两侧交于鼻根之中。
《灵枢·邪气脏腑病形》篇说：诸阳经的会合，都在面部。当邪气中人时，正值人体虚弱之时，或者刚用力过度，如饮食后出汗，腠理开泄而中受邪气。
邪气从面部侵入，则下行至阳明经。所以热邪在阳明经，都会表现在面部，因此面色通红。此时邪气尚在经络，尚未入里，不可使用攻下法。
若误用攻下，则胃气虚弱，邪气内陷，热邪郁结在体内。之所以必然出现发热、面色发黄，是因为小便不利，湿与热相并，郁蒸于体内的缘故。如果小便通利，
就一定不会发黄了。
阳明病。发热汗出者。此为热越。不能发黄也。但头汗出。身无汗。剂颈而还。小便不利。渴饮水浆者。
此为瘀热在里。身必发黄。茵陈蒿汤主之。
这里又详细论述发黄与不发黄，都取决于是否有汗、小便是否通利，以此反复阐明前面的意义。然而这一条还应当与太阳中风证见脉浮、动、数等末段症状参看。意思是说，邪气虽然在太阳经，若误用下法，则邪气陷入体内，湿热即可进入胃中郁蒸而发黄，并非有阳明病和太阳病的严格区别。说邪气在阳明经而见发热、汗出，是其本证。像这种情况，是因为热邪已经随着汗液发散到体外，虽然可能另有其他症状，但一定不会发黄。如果只是头部出汗，
则阳邪独盛于上部；身体无汗，则热邪无法向外宣泄。“剂颈而还”（汗水仅到颈部即止），是因为三阳经的经络都上行至头部，三阴经的经络都上行至颈部即回返。足见邪热固闭，阴阳分离异常，营卫运行不畅，腠理闭塞不通。邪热炽盛而三焦气化功能失常，故小便不利，水湿无法向下排泄。
且胃中热盛干燥而口渴，想喝水或汤浆，则水湿又从上面摄入。这样湿热蒸腾郁结，瘀蓄在体内，所以身体一定会发黄。对于这种湿热之邪，急宜驱除，
所以用茵陈蒿汤主治。
茵陈蒿汤方
茵陈蒿（六两） 栀子（十四枚） 大黄（二两）
以上三味药，用水一斗，先煮茵陈蒿，水量减少六升后，加入另外两味药，煮取三升药液，去渣，分三次温服。小便利，尿色像皂角汁一样，
颜色正红，一夜之后腹部胀满减轻，黄色从小便排出。
茵陈性虽微寒，但能治疗湿热黄疸，以及伤寒滞热、全身发黄、小便不利。栀子苦寒，泻三焦之火，除胃热及时行病引起的黄病，通利小便，消除消渴、心烦、懊 、郁热结气，更入血分。大黄苦寒，下行泄热，驱逐邪热，通利肠胃。这三者都能清除湿热，去除郁滞，所以作为治疗阳明发黄的首选方剂。
阳明病。被火。额上微汗出。小便不利者。必发黄。
这是说阳明病无汗，却用火法劫汗，反而增加火邪，以致小便不利而发黄。阳明病被火法治疗，即属于太阳中风证用火法劫汗的情况。
以中风证的阳邪遭遇火法，这也是两阳相熏灼。如果能全身出汗，则热邪发散而不能发黄。现在说只有额头微微出汗，则可知周身无汗。
再加上小便不利，则湿气又无法向下排泄。这与上文所述“但头汗出，身无汗，剂颈而还”的症状相同，而且更增加了火邪。所以必然导致
湿热壅滞，郁蒸而发黄。
伤寒七八日。身黄如橘子色。小便不利。腹微满者。茵陈蒿汤主之。
这是说阳明发黄的色泽，状如橘子色，与阴黄如烟熏色不同。伤寒至七八日，邪气入里已深。身体黄如橘子色的，
是湿热之邪在胃，独伤阳分，所以发阳黄。小便不利，则水湿内蓄，邪气食滞壅塞而导致腹部轻微胀满。因湿热实于胃，
所以用茵陈蒿汤主治。
伤寒身黄发热者。栀子柏皮汤主之。
发黄本由湿热引起，此处提到伤寒却不提无汗，也不说小便不利，只说身黄发热，说明热胜于湿，无形之邪
郁蒸而发黄。所以不必用茵陈、大黄，而以栀子柏皮汤主治。
栀子柏皮汤方
栀子（十五个） 甘草（一两） 黄柏（二两）
以上三味药，用水四升，煮取一升半药液，去渣，分两次温服。
栀子苦寒，功效见前方。黄柏苦寒，《神农本草经》记载其治五脏肠胃中结热黄疸，泻膀胱相火，所以用它来泻热邪。
又担心苦寒伤胃，所以用甘草调和胃气、保护脾气，起到调剂的作用。
伤寒瘀热在里。身必发黄。麻黄连轺赤小豆汤主之。
“瘀”，指留蓄壅滞。是说伤寒郁热，与胃中的湿气，互相结合湿热蒸腾，如同沼泽中的淤泥，水土粘腻而不分。
所以成无己引用经文说：湿热相交，百姓多患疸病。大概因为湿热胶固，壅积于胃，所以说瘀热在里，身体一定会发黄。麻黄
的使用，并非热在里而反治表。赤小豆的使用，是为了利小便。连翘根梓白皮，是为了疏散郁热。上文说：无汗而
小便不利者，身体一定会发黄。所以治黄的方法，没有比发汗更好的，则湿热从毛孔散发；通利小便，则湿热由下窍排泄。所以用麻黄连轺赤小豆汤主治。
麻黄连轺赤小豆汤方
麻黄（二两去节） 赤小豆（一升即今赤豆之小者） 连轺（二两连翘根也） 杏仁（四十个去皮）
生梓白皮（一升） 甘草（一两炙） 生姜（二两切） 大枣（十二枚）
以上八味药，用潦水（雨水）一斗，先煮麻黄再次沸腾，去掉上面的沫，加入其余药物，煮取三升药液，分两次温服。
赤小豆不是现在一头红黑的那种。古人以黑豆、黄豆为大豆，绿豆、赤豆、白豆、菉豆皆为小豆。以小豆中红色的，
所以叫赤小豆。李时珍说：以紧小而赤黯色的入药，稍大而鲜红淡红的，并不治病。花似豇豆而小，淡银
褐色，荚长二三寸，比绿豆荚稍大，三青二黄时即采收。可煮可炒，可做粥饭，做馄饨馅也很好。
麻黄汤，由麻黄、桂枝、杏仁、甘草组成，都是开鬼门（发汗）而泄汗。汗泄则肌肉腠理的郁热湿邪皆去。减去桂枝而不
用的原因，是恐怕助长瘀热。《素问·至真要大论》说：湿在上部甚而热，以汗解而止。王冰注解说：身半以上，湿气有余，
火气复郁，郁湿相薄，用苦温甘辛的药物，解表流汗而祛之，就是这个意思。赤小豆除湿散热，下水肿而利小便。李
时珍说：赤小豆，小而色赤，是心之谷。其性下行，通乎小肠，能入阴分，治有形之病，所以行津液利小便，
消胀除肿，止吐治痢，解酒病寒热，疗痈肿，通乳汁，下胞衣，难产服用它。因其降令太过，津血渗泄，所以
令人肌瘦身重。吹鼻瓜蒂散及辟瘟疫用之，也是取其通气除湿散热耳。梓白皮，性苦寒，能散温热之邪。
其治黄无所考据。连翘根，陶弘景说：方药不用，无人认识。王好古说：能下热气，所以张仲景治伤寒瘀热
用它。李时珍说：潦水是雨水所积，韩愈诗云：潢潦无根源，朝灌夕已除。是说它无根而易干涸，所以成无己说它味薄不助湿气而利热。
伤寒脉浮而缓。手足自温者。是为系在太阴。太阴身当发黄。若小便自利者。不能发黄。至七八日大便
硬者。为阳明病也。
伤寒脉浮而缓，与太阳病误用大青龙汤的第二条相同。然而邪在太阳，为伤寒而见中风的脉象，则有发热恶寒的表证。
此条不言表证，是因为邪不在三阳经。夫缓脉，是脾的本脉。所以在太阳经则浮缓为中风，而有发热恶寒的表证。
在太阴经则浮缓为伤寒，而无发热恶寒的表证。这是阴阳经络的区别。然而同样说是伤寒脉浮而缓，如何辨别其为太阳还是太阴呢？
只要观察手足自温，就知道全身无热了。即所谓无热恶寒，为发于阴证。况且脾主四肢，手足本来关联足太阴脾经吗？
说“自温”，又知道不是少阴、厥阴的四肢厥冷。不是太阴是什么？所以说这是系在太阴。然而太阴湿土之邪郁蒸，应当发身黄。
如果小便通利，其湿气已从水道而去，所以不能发黄。湿气已去，至七八日，大便变硬的，是太阴转属阳明，胃实
而成可下的病症。这一条应当仔细体会。上半节与太阴篇无异，此处以七八日大便反硬，为转属阳明；彼处以七八日后
暴烦下利，为脾家实。同一症状却分属阴阳，同源而分泾渭，病情变化如此。所以入阳则为阳邪而成阳症，入阴则为
阴邪而成阴症了。岂有一定不变的规律可循哉。
Yangming disease. Absence of sweating, difficulty in urination, and mental restlessness (Xin Zhong Ao Nao) indicate that the body will inevitably develop jaundice.
This explains that the cause of jaundice is due to the absence of sweating and difficulty in urination. When pathogenic factors invade the Yangming meridian, one should naturally experience fever and spontaneous sweating; when they enter the Yangming fu-organ, tidal fever and spontaneous sweating are also inevitable.
If there is no sweating, pathogenic factors cannot be released outward, leading to heat stagnation internally; if urination is difficult, water-dampness cannot drain downward, causing dampness to accumulate internally. Dampness and stagnant heat interact, with stasis-heat lodging in the stomach and unable to vent. Thus, mental restlessness occurs, indicating that jaundice will inevitably develop. Yellow is the color of the Spleen-Earth in the center. The Stomach is the fu-organ of the Spleen, and the Spleen is the zang-organ of the Stomach; they are connected by membranes and function as a unified pair.
Stagnant heat steaming in the Stomach causes Spleen pathology to manifest as yellow discoloration. The Spleen inherently dislikes dampness, especially when damp-heat is combined and stagnant.
In Yangming disease, if the face appears entirely red, purgative therapy must not be used. It will inevitably lead to fever, yellow discoloration, and difficulty in urination.
This states that if exterior pathogenic factors are unresolved and purgatives are mistakenly used, jaundice results. A face appearing entirely red: Cheng Wuji notes that "he" means permeating or general. In Yangming disease, a generally red face indicates heat in the meridians. Fang Youzhi says "he" means corresponding. If the face corresponds to redness, using purgatives will deplete body fluids; this view is incorrect. Cheng’s interpretation should be adopted. Generally, the Yangming meridian is located at the front of the body, originating from the sides of the nose meeting at the root.
The *Ling Shu: Pathogenic Factors and Zang-Fu Disease Manifestations* chapter states: All yang meridians converge on the face. When pathogenic factors attack, it often happens during periods of deficiency or after physical exertion, such as sweating after eating, when pores are open and pathogens enter.
If pathogens enter via the face, they descend into the Yangming meridian. Therefore, heat in the Yangming meridian manifests on the face, resulting in a generally red complexion. At this time, pathogens are still in the meridians and have not entered the interior; purgatives must not be used.
Purgatives will weaken the Stomach Qi, allowing pathogens to sink inward, with heat stagnating internally. The reason for inevitable fever and yellow discoloration is that difficulty in urination causes dampness and heat to combine and steam internally. If urination were free,
jaundice would certainly not develop.
In Yangming disease, if there is fever and sweating, this is called "heat venting," and jaundice will not develop. However, if only the head sweats, the body has no sweat, stopping at the neck, accompanied by difficulty in urination and thirst for drinks,
this indicates stasis-heat lodged in the interior, and the body will inevitably develop jaundice. Yinchen Hao Tang (Mugwort and Gardenia Decoction) is indicated.
This further details why jaundice develops or does not, depending on the presence or absence of sweating and the freedom or obstruction of urination, repeatedly clarifying the previous meaning. This clause should also be cross-referenced with the terminal symptoms of Taiyang wind-strike with floating, rapid, or wiry pulses. It implies that although pathogens are in the Taiyang stage, mistaken purgation allows pathogens to sink inward, where damp-heat can enter the Stomach, steam, and cause jaundice; there is no strict distinction between Yangming and Taiyang here. Fever and sweating in Yangming disease represent its primary syndrome. In such cases, heat pathogens have already vented outward through sweat; even if other symptoms exist, jaundice will not develop. If only the head sweats,
yang pathogens are exclusively abundant in the upper part; the lack of body sweat means heat cannot vent outward. "Stopping at the neck" occurs because all three yang meridians ascend to the head, while all three yin meridians ascend only to the neck before returning. This shows that pathogenic heat is sealed, yin and yang are disconnected, Ying and Wei circulation is obstructed, and pores are blocked. Intense pathogenic heat disrupts Sanjiao Qi transformation, leading to difficulty in urination and inability of water-dampness to drain downward.
Furthermore, dryness and heat in the Stomach cause thirst for drinks, introducing more water-dampness from above. Steamy damp-heat accumulates stasis internally, causing inevitable jaundice. For this damp-heat pathogen, urgent expulsion is required;
therefore, Yinchen Hao Tang (Mugwort and Gardenia Decoction) is indicated.
Yinchen Hao Tang (Mugwort and Gardenia Decoction) Formula
Artemisiae Scopariae Herba (6 liang), Gardeniae Fructus (14 pieces), Rhei Radix et Rhizoma (2 liang).
These three ingredients are boiled in 10 dou of water. First, boil Artemisiae Scopariae Herba until the volume reduces by 6 dou. Then add the other two ingredients, boil to obtain 3 sheng of liquid, strain, and divide into three warm doses. Urination will become free, urine will resemble soapberry juice,
and appear bright red. After one night, abdominal fullness will decrease, and jaundice will exit via urination.
Although Mugwort (Yin Chen) is slightly cold, it treats damp-heat jaundice, as well as stagnant heat in Shanghan, generalized jaundice, and difficulty in urination. Gardenia (Zhi Zi) is bitter and cold, draining fire from the Sanjiao, removing Stomach heat and epidemic jaundice, promoting urination, and resolving thirst, irritability, mental restlessness, and stagnant heat qi accumulation; it also enters the blood level. Rhubarb (Da Huang) is bitter and cold, descending to drain heat, expel pathogenic heat, and unblock the intestines and stomach. All three clear damp-heat and remove stagnation, making this the primary formula for Yangming jaundice.
In Yangming disease, if subjected to fire therapy, with slight sweating on the forehead and difficulty in urination, jaundice will inevitably develop.
This states that in Yangming disease without sweating, applying fire therapy to force sweat instead increases fire pathogens, leading to difficulty in urination and jaundice. Fire therapy on Yangming disease belongs to the category of forcing sweat in Taiyang wind-strike.
Subjecting the yang pathogen of wind-strike to fire therapy constitutes the burning of two yangs. If the whole body sweated, heat would vent and jaundice would not develop. Now, since only the forehead sweats slightly, it is known that the body has no sweat.
Combined with difficulty in urination, dampness cannot drain downward. This is identical to the previous condition of "head sweating only, no body sweat, stopping at the neck," but with added fire pathogens. Thus, damp-heat congestion and steaming inevitably cause jaundice.
After seven or eight days of Shanghan, if the body is yellow like an orange peel, accompanied by difficulty in urination and mild abdominal fullness, Yinchen Hao Tang (Mugwort and Gardenia Decoction) is indicated.
This describes the color of Yangming jaundice, which resembles an orange peel, differing from Yin jaundice which looks like smoke. By the seventh or eighth day of Shanghan, pathogens have deeply entered the interior. A body yellow like an orange peel indicates
damp-heat pathogens in the Stomach affecting only the yang aspect, thus causing yang jaundice. Difficulty in urination leads to internal accumulation of water-dampness, and pathogenic food stagnation causes mild abdominal fullness. Since damp-heat is excess in the Stomach,
Yinchen Hao Tang (Mugwort and Gardenia Decoction) is indicated.
In Shanghan, if there is jaundice and fever, Zhizi Bopi Tang (Gardenia and Phellodendron Decoction) is indicated.
Jaundice originates from damp-heat. Here, Shanghan is mentioned without noting absence of sweat or difficulty in urination, only stating jaundice and fever, indicating that heat exceeds dampness, and formless pathogens
steam and cause jaundice. Therefore, Mugwort and Rhubarb are unnecessary; Zhizi Bopi Tang (Gardenia and Phellodendron Decoction) is indicated.
Zhizi Bopi Tang (Gardenia and Phellodendron Decoction) Formula
Gardeniae Fructus (15 pieces), Glycyrrhizae Radix et Rhizoma (1 liang), Phellodendri Cortex (2 liang).
These three ingredients are boiled in 4 sheng of water to obtain 1.5 sheng of liquid. Strain and divide into two warm doses.
Gardenia is bitter and cold; its effects are seen in the previous formula. Phellodendron is bitter and cold; *Shennong Bencao Jing* records it treats internal结热 (knot-heat) in the five zang and six fu organs and jaundice, draining bladder ministerial fire. Thus, it is used to drain heat pathogens.
Fearing that bitter-cold herbs may damage the Stomach, Licorice (Gan Cao) is used to harmonize the Stomach and protect the Spleen, serving as a妙 (wonderful) adjustment.
In Shanghan, if stasis-heat is lodged in the interior, jaundice will inevitably develop. Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia Root, and Red Bean Decoction) is indicated.
"Yu" (stasis) refers to retention and congestion. It means Shanghan stagnant heat interacts with dampness in the Stomach, steaming together like silt in a marsh, where water and soil stick indistinguishably.
Thus, Cheng Wuji cites the classic: "When dampness and heat intersect, many people suffer from dan disease." Because damp-heat is glued and congested in the Stomach, it is said that stasis-heat is in the interior, causing inevitable jaundice. The use of Ephedra
does not treat the exterior when heat is in the interior. Red Bean is used to promote urination. Forsythia root and Catalpa bark disperse stagnant heat. As stated earlier: "Absence of sweat and difficulty in urination lead to jaundice." Therefore, the method for treating jaundice involves sweating to disperse damp-heat through hair follicles, and promoting urination to drain damp-heat through the lower orifice. Thus, Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia Root, and Red Bean Decoction) is indicated.
Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia Root, and Red Bean Decoction) Formula
Ephedrae Herba (2 liang, nodes removed), Phaseoli Semen Rubrum (1 sheng, i.e., small red beans), Forsythiae Radix (2 liang), Armeniacae Semen Amarum (40 pieces, skin removed), Catalpae Cortex (1 sheng), Glycyrrhizae Radix et Rhizoma (1 liang, roasted), Zingiberis Rhizoma Recens (2 liang, sliced), Jujubae Fructus (12 pieces).
These eight ingredients are boiled in 10 dou of rainwater. First, boil Ephedra until boiling again, remove the foam on top, then add the remaining herbs. Boil to obtain 3 sheng of liquid, divide into two warm doses.
Red Bean is not the variety that is black on one end and red on the other. Ancients considered black beans and soybeans as large beans, while mung beans, red beans, white beans, and adzuki beans were considered small beans. Among small beans, the red ones are
called Red Bean. Li Shizhen states: Use those that are tight, small, and dark red for medicine; larger ones that are bright red or pale red do not treat disease. Flowers resemble cowpeas but are smaller, pale silver-brown, pods are 2-3 cun long, slightly larger than mung bean pods. Harvest when pods are three parts green and two parts yellow. They can be boiled, fried, made into porridge, rice, or wonton filling.
Mahuang Tang consists of Ephedra, Cinnamon Twig, Apricot Kernel, and Licorice, all opening the "ghost gate" (pores) to induce sweat. When sweat is released, stagnant heat and dampness in muscles and pores are eliminated. Cinnamon Twig is reduced and omitted
to avoid aggravating stasis-heat. *Suwen: Treatise on the Most Essential Truths* states: "When dampness is excessive in the upper part and heat follows, resolve it by sweating." Wang Bing notes: "Above the waist, if dampness is excessive and fire qi is stagnant, interacting with dampness, use bitter-warm, sweet, and acrid-sweet herbs to release the exterior, induce sweat, and dispel it." Red Bean removes dampness, dissipates heat, reduces edema, and promotes urination. Li Shizhen says: Red Bean is small and red, the grain of the Heart. Its nature descends, connecting to the Small Intestine, entering the yin level, treating tangible diseases, thus moving fluids, promoting urination, reducing distension, eliminating swelling, stopping vomiting and dysentery, resolving alcohol-induced cold/heat, treating abscesses, promoting lactation, delivering the placenta, and assisting in difficult labor. Excessive descending action causes fluid and blood leakage, leading to emaciation and heaviness. It is used in blowing powder with Melon Seed for plague prevention to ventilate qi, remove dampness, and dissipate heat. Catalpa bark is bitter and cold, dispersing warm-heat pathogens.
Its efficacy for jaundice lacks documentation. Forsythia root: Tao Hongjing says it is not used in prescriptions and unrecognized. Wang Haogu says it drains heat, so Zhang Zhongjing uses it for Shanghan stasis-heat. Li Shizhen says: Rainwater is accumulated rain. Han Yu's poem says: "Rainwater has no source, irrigated in the morning, dried by evening." Meaning it is rootless and dries easily, so Cheng Shi says it is flavor-light, does not aid dampness, and promotes heat clearance.
In Shanghan, if the pulse is floating and moderate, and hands and feet are naturally warm, this is linked to Taiyin. Taiyin typically presents with jaundice. If urination is free, jaundice will not develop. By the seventh or eighth day, if stool becomes hard, it becomes Yangming disease.
Shanghan with a floating and moderate pulse is similar to the second clause of the Taiyang section regarding mistaken use of Da Qing Long Tang. However, when pathogens are in Taiyang, presenting with a wind-strike pulse in Shanghan, there are exterior symptoms of fever and aversion to cold.
This clause omits exterior symptoms because pathogens are not in the three yang meridians. The moderate pulse is the fundamental pulse of the Spleen. Thus, in Taiyang, floating-moderate indicates wind-strike with fever and aversion to cold.
In Taiyin, floating-moderate indicates Shanghan without fever and aversion to cold. This distinguishes yin and yang meridians. How to distinguish between Taiyang and Taiyin given both present with floating-moderate pulses in Shanghan?
Observing naturally warm hands and feet reveals no whole-body heat, aligning with "no heat, aversion to cold, originating from yin." Moreover, the Spleen governs the four limbs, linking to Foot-Taiyin.
Saying "naturally warm" excludes cold extremities of Shaoyin and Jueyin. If not Taiyin, what else? Hence, it is linked to Taiyin. However, Taiyin damp-earth pathogen steaming should cause jaundice.
If urination is free, dampness exits via the water pathway, so jaundice does not develop. Once dampness is gone, by the seventh or eighth day, hard stool indicates Taiyin transforming into Yangming, with Stomach excess requiring purgation. This clause requires careful consideration. The first half is identical to the Taiyin chapter; here, hard stool after seven/eight days indicates transformation to Yangming, whereas previously, sudden irritability and diarrhea after seven/eight days indicated Spleen excess. One symptom divides into yin and yang, same source but distinct paths. Disease progression varies thus. Entering yang makes it yang pathogen and yang syndrome; entering yin makes it yin pathogen and yin syndrome. Can there be fixed rules?