疸分阴阳,而总以湿得之。阳疸者,湿从火化,瘀热在里,胆热液泄,与胃之浊气相并,
上不得越,下不得泄,熏蒸遏郁,侵于肺则身目俱黄,热流膀胱溺变赤,其色明,阳主明,治
在胃。阴黄者,湿从寒水,脾阳不能化热,胆液为湿所阻,渍于脾,浸淫肌肉,蕴于皮肤,黄如
熏,其色晦,阴主晦,治在脾。黄胆者,身黄、目黄、溺黄之谓也。
黄胆分五名固有,黄汗女劳湿热酒。总归湿热相郁蒸,脾胃兼虚为日久。茵陈五苓散主
之,随病增减方堪施。病久腹胀兼黑色。此为不治先当知。
谷疸(不宜下犯足太阴,防变胀)
猪肚丸 猪肚 苦参 白术 牡蛎
又方 绵茵陈 茯苓皮 蔻仁 花粉 枳实 苦桔梗
疸后郁伤心脾
用归脾丸
酒疸
四君子汤加陈皮 白芍 当归 柴胡 生姜 大枣
陈参曰∶酒客多蕴热,宜先清中分利,后顾脾阳。
湿热郁蒸黄胆
湿在上宜辛散法,取以风胜,防己、大豆卷、苡仁、银花、滑石、生牡蛎、枳实、法半夏、姜汁。
湿在下宜苦泄法,取以淡渗,黄柏、赤小豆、石膏、杏仁、山栀、连翘、通草、花粉。
疸变肿胀
大腹皮 海金沙 粉猪苓 鸡肫皮 紫川朴 川通草
黄胆,脉络瘀热,此与水谷气交蒸
河间金铃子散加枳实 柴胡 半夏 黄芩 山栀 谷芽
黄胆脾液外越(夏热泄气。脾虚为黄,非湿热之疸)
人参 白扁豆 茯神 炙草 怀山药 米仁
何书田曰∶脉弦胁痛少阳未罢,仍主和。渴饮水浆阳明化燥,急当泻热。如狂蓄血主
攻,汗后溺血主补。表虚者实卫,里虚者建中。女劳有秽浊,始以解毒,继之滑窍,终当峻补肾之真阴。
黄疸分为阳黄和阴黄两类,但总归都是由湿邪引起的。阳黄,是湿邪从火化热,瘀滞的热邪蕴结在体内,胆热导致津液外泄,与胃中的浊气相合并,向上不能宣发,向下不能排泄,熏蒸郁遏,侵犯肺脏则身体和眼睛都发黄,热邪流入膀胱使小便变红,其颜色鲜明,阳主明亮,治疗重点在胃。阴黄,是湿邪从寒水而来,脾阳不能运化产生热量,胆液被湿邪阻滞,浸渍于脾,渗透肌肉,蕴积皮肤,黄色像被烟熏过一样,其颜色晦暗,阴主晦暗,治疗重点在脾。所谓黄疸,是指身体、眼睛、小便都发黄的症状。
黄疸分为五种名称,分别是谷疸、女劳疸、酒疸以及湿热疸等(注:原文“黄汗女劳湿热酒”指代几种类型,结合下文具体方剂及论述,主要涵盖谷疸、女劳疸、酒疸及湿热郁蒸之证)。这些病症总归是湿热相互郁结熏蒸所致,若脾胃兼有虚弱且病程日久,则更为复杂。茵陈五苓散是主治方剂,需根据病情增减药物才能施用得当。如果病久出现腹胀且面色发黑,这属于难治之症,应当预先知晓。
【谷疸】(不宜使用攻下法,以免损伤足太阴脾经,防止变为胀满)
猪肚丸:猪肚、苦参、白术、牡蛎。
又一方:绵茵陈、茯苓皮、蔻仁、天花粉、枳实、苦桔梗。
【酒疸】
四君子汤加陈皮、白芍、当归、柴胡、生姜、大枣。
陈修园说:经常饮酒的人多蕴藏热邪,应当先清利中焦,随后顾护脾阳。
【湿热郁蒸导致的黄疸】
湿邪在上部,宜用辛散法,取风胜湿之意,用药如防己、大豆卷、薏苡仁、金银花、滑石、生牡蛎、枳实、法半夏、姜汁。
湿邪在下部,宜用苦泄法,取淡渗利湿之意,用药如黄柏、赤小豆、石膏、杏仁、山栀、连翘、通草、天花粉。
【黄疸转变为肿胀】
大腹皮、海金沙、粉猪苓、鸡肫皮、紫川朴(厚朴)、川通草。
【黄疸,脉络瘀热,此与水谷之气交蒸】
河间金铃子散加枳实、柴胡、半夏、黄芩、山栀、谷芽。
【黄疸脾液外越】(夏季炎热耗伤气机。脾虚导致发黄,并非湿热之疸)
人参、白扁豆、茯神、炙甘草、怀山药、米仁(薏苡仁)。
何书田说:脉弦且胁痛,说明少阳病未愈,仍应以和解为主;口渴饮水,说明阳明化燥,急当泻热;如狂且有蓄血症状,主攻逐瘀血;发汗后出现尿血,主补益;表虚者应实卫气,里虚者应建中气。女劳疸伴有秽浊之气,开始以解毒为主,继之以滑窍通淋,最终应当峻补肾之真阴。
Jaundice is divided into Yang Jaundice and Yin Jaundice, but it is generally caused by Dampness (Shi). Yang Jaundice occurs when Dampness transforms into Fire (Huo), with Stagnant Heat (Yu Re) accumulating in the interior. Gallbladder heat causes fluid leakage, which merges with turbid Qi of the Stomach. Unable to ascend and vent out or descend and excrete, it steams and stagnates. Invading the Lung (Fei), it causes both the body and eyes to turn yellow; heat flowing into the Bladder (Pang Guang) turns urine red. The color is bright, as Yang governs brightness, so treatment focuses on the Stomach (Wei). Yin Jaundice occurs when Dampness stems from Cold Water (Han Shui); Spleen Yang (Pi Yang) fails to transform heat. Gallbladder fluid is obstructed by Dampness, soaking the Spleen, infiltrating muscles, and accumulating in the skin. The yellow color resembles smoke staining, appearing dull, as Yin governs dullness, so treatment focuses on the Spleen. Jaundice refers to the condition where the body, eyes, and urine are all yellow.
Jaundice is classified into five names: Grain Jaundice (Gu Dan), Female Labor Jaundice (Nu Lao Dan), Wine Jaundice (Jiu Dan), and those related to Damp-Heat (Shi Re). Ultimately, these归结 to Damp-Heat mutually stagnating and steaming. If accompanied by Spleen and Stomach deficiency over a long duration, the condition becomes chronic. Yinchen Wuling San (Artemisia Capillaris and Five-Ingredient Poria Pill) is the primary formula, which must be modified according to the specific disease presentation. If the disease persists for a long time, leading to abdominal distension and black complexion, this is considered incurable and should be known in advance.
[Grain Jaundice] (Purging methods should not be used to avoid damaging the Foot-Taiyin Spleen Meridian, preventing transformation into distension.)
Zhudu Wan (Pig Stomach Pill): Pig Stomach (Sus scrofa domesticus Ventriculus), Sophora Flavescens Root (Kushen, 苦参), Atractylodes Macrocephala Rhizome (Baizhu, 白术), Oyster Shell (Muli, 牡蛎).
Another Prescription: Milfoil Mugwort Herb (Mian Yinchen, 绵茵陈), Poria Skin (Fuling Pi, 茯苓皮), Areca Seed (Kouren, 蔻仁), Trichosanthes Root (Huafen, 花粉), Immature Bitter Orange (Zhishi, 枳实), Bitter Platycodon Root (Ku Jiegeng, 苦桔梗).
[Post-Jaundice Depression Affecting Heart and Spleen]
Use Guipi Wan (Restore the Spleen Pill).
[Wine Jaundice]
Sijunzi Tang (Four Gentlemen Decoction) plus Tangerine Peel (Chenpi, 陈皮), White Peony Root (Baishao, 白芍), Chinese Angelica Root (Danggui, 当归), Bupleurum Root (Chaihu, 柴胡), Fresh Ginger (Shengjiang, 生姜), Jujube (Dazao, 大枣).
Chen Xiuyuan stated: Frequent drinkers often harbor internal heat; one should first clear and separate the Middle Jiao, then attend to Spleen Yang.
[Damp-Heat Stagnation and Steaming Causing Jaundice]
When Dampness is in the Upper Jiao, use Acrid Dispersing Method, employing Wind to overcome Dampness. Herbs include: Stephania Tetrandra Stem (Fangji, 防己), Soybean Sprout (Dadou Juan, 大豆卷), Coix Seed (Yiren, 薏苡仁), Honeysuckle Flower (Yinhua, 银花), Talcum (Huashi, 滑石), Raw Oyster Shell (Sheng Muli, 生牡蛎), Immature Bitter Orange (Zhishi, 枳实), Processed Pinellia Tuber (Fa Banxia, 法半夏), Ginger Juice (Jiangzhi, 姜汁).
When Dampness is in the Lower Jiao, use Bitter Draining Method, employing Light Percolation. Herbs include: Phellodendron Bark (Huangbai, 黄柏), Adzuki Bean (Chixiaodou, 赤小豆), Gypsum Fibrosum (Shigao, 石膏), Apricot Kernel (Xingren, 杏仁), Gardenia Fruit (Shanzhi, 山栀), Forsythia Fruit (Lianqiao, 连翘), Tongcao Pith (Tongcao, 通草), Trichosanthes Root (Huafen, 花粉).
[Jaundice Transforming into Swelling]
Greater Burdock Fruit (Dafupi, 大腹皮), Gold Sand Herb (Haijinsha, 海金沙), Polished Poria (Fen Zhuling, 粉猪苓), Chicken Gizzard Membrane (Jizhupi, 鸡肫皮), Magnolia Bark (Zi Chuanpu/Houpo, 紫川朴/厚朴), River Reed Pith (Chuan Tongcao, 川通草).
[Jaundice, Collateral Stagnant Heat, Interacting with Food and Drink Qi]
Hejian Jinlingzi San (Jin Ling Zi Powder) plus Immature Bitter Orange (Zhishi, 枳实), Bupleurum Root (Chaihu, 柴胡), Pinellia Tuber (Banxia, 半夏), Scutellaria Root (Huangqin, 黄芩), Gardenia Fruit (Shanzhi, 山栀), Rice Sprout (Guya, 谷芽).
[Jaundice with Spleen Fluid Leakage] (Summer heat drains Qi. Spleen deficiency causes yellowing, not Damp-Heat Jaundice.)
Ginseng Radix (Renshen, 人参), White Hyacinth Bean (Baibian Dou, 白扁豆), Poria with Hostwood (Fushen, 茯神), Prepared Licorice Root (Zhigancao, 炙草), Chinese Yam (Huai Shanyao, 怀山药), Coix Seed (Miren/Yiren, 米仁).
He Shutian stated: If the pulse is wiry and there is hypochondriac pain, Shaoyang disease has not resolved; continue with Harmonizing methods. If thirsty and drinking fluids, Yangming has transformed into Dryness; urgently purge the heat. If manic with blood stasis, attack vigorously. If hematuria occurs after sweating, tonify. For Exterior Deficiency, solidify the Defensive Qi; for Interior Deficiency, build the Middle Jiao. Female Labor Jaundice involves turbid filth; initially detoxify, then unblock orifices, and finally vigorously tonify the True Yin of the Kidney.