《伤寒论》原文∶伤寒身黄发热，栀子柏皮汤主之。
此节示人，但见其身黄发热，即无腹满小便不利诸证，亦直可以湿热成病断之也。
【栀子柏皮汤方】栀子十五个擘，甘草一两炙，黄柏二两。
上三味，以水四升，煮取一升半，去滓，分温再服。
此方之用意，欲以分消上中下之热也。是以方中栀子善清上焦之热，黄柏善清下焦之热，加甘草与三药
并用，又能引之至中焦以清中焦之热也。且栀子、黄柏皆过于苦寒，调以甘草之甘，俾其苦寒之性味少变，
而不至有伤于胃也。
《伤寒论》原文∶伤寒瘀热在里，身必发黄，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，连轺二两，杏仁四十个去皮尖，大枣十二枚，
生梓白皮一升，生姜二两切，甘草二两炙。
上八味，以潦水一斗，先煮麻黄再沸，去上沫，纳诸药，煮取三升，分温三服，半日服尽。
按∶连轺非连翘，乃连翘根也。其性凉能泻热，兼善利湿，后世改用连翘则性不同矣。赤小豆，即
作饭之小豆，形如绿豆而色赤者，非南来之红豆也。梓白皮，药局无鬻者，有梓树处自加
之可也。陈修园云，若无梓白皮，可以茵陈代之。
身发黄与黄胆不同。黄胆为胆汁妄行于血中，仲景书中虽未明言，而喻嘉言《寓意草》于钱小鲁案中
曾发明之，彼时西人谓胆汁溢于血中之说，犹未入中国也。至身发黄之病，猝成于一两日间，其非胆汁溢于
血分可知矣。茵陈为治热结黄胆之要药，《神农本草经》载有明文，仲景治身发黄亦用之者，诚以二证之成，
皆由于湿热，其湿热由渐而成则为黄胆，其湿热因外感所束，仓猝而成则为身发黄，是以皆可以茵陈蒿治之也。
身发黄之证，不必皆湿热也。阳明篇七十六节云∶“伤寒发汗
已，身目为黄，所以然者，寒湿在里不解故也，以为不可下也，于寒湿中求之。”
王和安曰∶黄为油热色，油中含液而包脉孕血，液虚血燥则热甚为阳黄，身黄发热之栀子柏皮证也。油
湿血热相等而交蒸，为小便不利，身黄如橘之茵陈蒿证也。油寒膜湿，郁血为热，则寒湿甚而为阴黄，即茵
陈五苓证也。病有热而治从寒湿，玩以为二句，语气之活自可想见。盖以为不可下，明见有可下之热黄也，
在于寒湿中求之，言治法求之寒湿，明见黄证不纯为寒湿也。凡一证二因者，治从其甚，可于二语见之。
上王氏之论甚精细，而愚于此节之文则又别有会悟，试引从前治愈之两案以明之。
曾治一人受感冒，恶寒无汗，周身发黄，以麻黄汤发之，汗出而黄不退。细诊其脉，左部弦而无力，右
部濡而无力，知其肝胆之阳不振，而脾胃又虚寒也。盖脾胃属土，土色本黄，脾胃有病，现其本色，是以其病
湿热也，可现明亮之黄色，其病湿寒也，亦可现黯淡之黄色。观此所现之黄色，虽似黯淡而不甚黯淡者，
因有胆汁妄行在其中也。此盖因肝胆阳分不振，其中气化不能宣通胆汁达于小肠化食，以致胆管闭塞，胆
汁遂蓄极妄行，溢于血分而透黄色，其为黄色之根源各异，竟相并以呈其象，是以其发
黄似黯淡而非黯淡也。审病既确，遂为拟分治左右之方以治之。
生箭 六钱，桂枝尖二钱，干姜三钱，浓朴钱半，陈皮钱半，茵陈二钱。
上药六味，共煎汤一大盅温服。
方中之义∶用黄 以助肝胆之阳气，佐以桂枝之辛温，更有开通之力也。用干姜以除脾胃之湿寒，
辅以浓朴能使其热力下达。更辅以陈皮，能使其热力旁行，其热力能布 充周，脾胃之寒湿自除也。用茵
陈者，为其具有升发之性，实能打开胆管之闭塞，且其性能利湿，更与姜、桂同用，虽云苦寒而亦不觉其苦
寒也。况肝胆中寄有相火，肝胆虽凉，相火之寄者仍在，相火原为龙雷之火，不可纯投以辛热之剂以触发之，
少加茵陈，实兼有热因寒用之义也。
又治一人，时当仲秋，寒热往来，周身发黄，心中烦热，腹中又似觉寒凉，饮食不甚消化，其脉左部
弦硬，右部沉濡，心甚疑之，问其得病之由，答云，不知。因细问其平素之饮食起居，乃知因屋宇窄隘，六
七月间皆在外露宿，且其地多潮湿，夜间雾露尤多。乃恍悟此因脏腑久受潮湿，脾胃属土，土为太阴，湿郁
久则生寒，是以饮食不能消化。肝胆属木，木为少阳，湿郁久则生热，又兼有所寄之相火为之熏蒸，以致
胆管肿胀闭塞，是以胆汁妄行，溢于血中而身黄也。舌上微有白苔，知其薄受外感，侵入三焦，三焦原为手少
阳与足少阳并为游部，一气贯通，是以亦可作寒热，原当以柴胡和解之，其寒热自已，茵陈性近柴胡，同为少
阳之药，因其身发黄，遂用茵陈三钱以代柴胡，又加连翘、薄荷叶、生姜各三钱，甘草二钱，煎汤服后，周身
得汗（足少阳不宜发汗手少阳宜发汗），寒热往来愈，而发黄如故。于斯就其左右之脉寒热迥殊者，再拟一方治之。
茵陈三钱，栀子三钱，干姜三钱，白术三钱炒，浓朴二钱，
焰硝五分研细。
上六味，将前五味煎汤一大盅，乘热纳硝末融化服之。
方中之义∶用栀子、茵陈以清肝胆之热，用干姜、白术、浓朴以除脾胃之寒，药性之凉热迥然不同，
而汇为一方自能分途施治也。用焰硝者，因胆管之闭塞，恒有胆石阻隔，不能输其胆汁
于小肠，焰硝之性善消，即使胆管果有胆石，服之亦不难消融也，
这一节是告诉人们，只要见到身体发黄、发热，即使没有腹部胀满、小便不利等症状，也可以直接判断为湿热致病。
【栀子柏皮汤方】栀子十五个（掰开），甘草一两（炙烤），黄柏二两。
以上三味药，用水四升，煮取一升半，滤去药渣，分两次温服。
这个方子的用意，在于分别消除上、中、下三焦的热邪。因此方中栀子善于清上焦之热，黄柏善于清下焦之热，加入甘草与这三味药同用，又能引导药力到达中焦以清中焦之热。而且栀子、黄柏都过于苦寒，用甘草的甘味来调和，使它们的苦寒性质和味道稍微改变，从而不至于损伤胃气。
《伤寒论》原文：伤寒瘀滞的热邪在体内，身体必定发黄，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，连轺二两，杏仁四十个（去皮尖），大枣十二枚，生梓白皮一升，生姜二两（切），甘草二两（炙）。
以上八味药，用雨水一斗，先煮麻黄至再次沸腾，去掉上面的浮沫，再加入其他药物，煮取三升，分三次温服，半天内服完。
按语：连轺不是连翘，而是连翘的根。它的性质凉能泻热，兼善利湿，后世改用连翘则性质不同了。赤小豆，就是做饭用的那种小豆，形状像绿豆而颜色发红，不是从南方传来的红豆。梓白皮，药店里没有卖的，有梓树的地方可以自己采集使用。陈修园说，如果没有梓白皮，可以用茵陈代替。
身体发黄与黄疸病不同。黄疸病是胆汁妄行于血中，张仲景书中虽然没有明确说明，但喻嘉言在《寓意草》的钱小鲁医案中曾阐发过这一点，那时西方人关于“胆汁溢于血中”的说法还没有传入中国。至于身体发黄的病，突然在一两天内形成，这就知道它不是胆汁溢于血分造成的。茵陈是治疗热结黄疸的重要药物，《神农本草经》中有明确记载，张仲景治疗身体发黄也使用它，确实是因为这两种证候的形成，都是由于湿热，湿热逐渐形成则为黄疸病，湿热因外感束缚而仓促形成则为身体发黄，所以都可以用茵陈蒿汤来治疗。
身体发黄的证候，并不一定都是湿热。阳明篇第七十六节说：“伤寒发汗后，身体眼睛发黄，之所以这样，是因为里有寒湿不解的缘故，认为不可用攻下法，应当在寒湿中寻求治疗方法。”
王和安说：黄色是油热之色，油中含有液体并包裹血脉孕育血液，液虚血燥则热盛成为阳黄，即身体发黄发热的栀子柏皮汤证。油湿与血热相等而交蒸，导致小便不利、身体黄如橘子色，即茵陈蒿汤证。油寒膜湿，郁血化热，则寒湿严重成为阴黄，即茵陈五苓散证。病有热象却从寒湿治疗，玩味这两句话，语气的灵活自可想见。大概意思是说，认为不可攻下，是明见有可以攻下的热黄证；在寒湿中寻求治疗方法，是说治法要在寒湿中求索，明见黄证不纯粹是寒湿。凡是同一证候有两种病因的，治疗顺从其严重的方面，可以从这两句话看出来。
上面王先生的论述非常精细，而我对于这一节的文字又有别的领悟，试着引用从前治愈的两个医案来说明。
曾经治疗一个人，感受感冒，恶寒无汗，周身发黄，用麻黄汤发汗，汗出后黄不退。仔细诊察他的脉象，左部弦而无力，右部濡而无力，知道他是肝胆阳气不振，而脾胃又虚寒。大概脾胃属土，土的颜色本是黄色，脾胃有病，显现其本色，所以如果是湿热病，可呈现明亮的黄色；如果是湿寒病，也可呈现黯淡的黄色。观察他所呈现的黄色，虽然看似黯淡但并不十分黯淡，是因为其中有胆汁妄行在其中。这大概是因肝胆阳气不振，其中的气化不能宣通，胆汁不能达于小肠化食，以致胆管闭塞，胆汁蓄积至极而妄行，溢于血分而透出黄色，它们成为黄色的根源各不相同，竟然相并呈现其象，所以他的发黄看似黯淡而非真正黯淡。审察病情既然确切，于是为他拟定分别治疗左右两侧的方子来治疗。
生黄芪六钱，桂枝尖二钱，干姜三钱，厚朴钱半，陈皮钱半，茵陈二钱。
以上六味药，共煎一大盅汤，温服。
方中的意义：用黄芪来辅助肝胆的阳气，佐以桂枝的辛温，更有开通之力。用干姜来去除脾胃的湿寒，辅以厚朴能使热力下达。再辅以陈皮，能使热力旁行，热力能布散充盈周身，脾胃的寒湿自然除去。用茵陈，是因为它具有升发的性质，实在能打开胆管的闭塞，而且它能利湿，再加上与姜、桂同用，虽然是苦寒药也不觉得苦寒。况且肝胆中寄居有相火，肝胆虽然凉，寄居的相火仍在，相火原本是龙雷之火，不可纯投以辛热剂来触发它，少加茵陈，实在兼有热因寒用的意义。
又治疗一个人，时值仲秋，寒热往来，周身发黄，心中烦热，腹中又似乎觉寒冷，饮食不太消化，他的脉象左部弦硬，右部沉濡，心里很怀疑，问他是如何得病的，回答说不知道。于是细问他的平时饮食起居，才知道因为房屋窄小，六七月份都在外面露宿，而且那地方多潮湿，夜间雾露尤其多。这才恍然大悟，这是因为脏腑久受潮湿，脾胃属土，土为太阴，湿郁久则生寒，所以饮食不能消化。肝胆属木，木为少阳，湿郁久则生热，又兼有所寄居的相火为之熏蒸，以致胆管肿胀闭塞，所以胆汁妄行，溢于血中而身体发黄。舌上微有白苔，知道是轻微感受外感，侵入三焦，三焦原是手少阳与足少阳并为游部，一气贯通，所以也可以出现寒热，原本应当用柴胡和解，寒热自然会停止，茵陈的性质接近柴胡，同为少阳药，因为他身体发黄，于是用茵陈三钱来代替柴胡，又加连翘、薄荷叶、生姜各三钱，甘草二钱，煎汤服用后，周身得汗（足少阳不宜发汗，手少阳宜发汗），寒热往来停止了，但发黄依旧。在此时根据他左右脉象寒热迥然不同的情况，再拟定一方治疗。
茵陈三钱，栀子三钱，干姜三钱，白术三钱（炒），厚朴二钱，焰硝五分（研细）。
以上六味药，将前五味煎一大盅汤，趁热纳入硝末融化后服用。
方中的意义：用栀子、茵陈来清肝胆之热，用干姜、白术、厚朴来除脾胃之寒，药物的性质凉热截然不同，而汇合为一方便能分途施治。用焰硝，是因为胆管的闭塞，常有胆石阻隔，不能输送胆汁于小肠，焰硝的性质善于消融，即使胆管果真有胆石，服用它也不难消融。
Original text from *Shanghan Lun*: When cold damage results in yellowing of the body and fever, Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Decoction) is the primary treatment.
This section indicates to practitioners that if one observes yellowing of the body and fever, even in the absence of symptoms such as abdominal fullness and difficulty urinating, it can be directly diagnosed as a disease caused by damp-heat.
[Formula: Zhi Zi Bai Pi Tang]
Zhi Zi (Fructus Gardeniae) fifteen pieces (broken open), Gan Cao (Radix Glycyrrhizae) one liang (roasted), Huang Bo (Cortex Phellodendri) two liang.
Take these three ingredients, add four sheng of water, boil to obtain one and a half sheng, remove the dregs, and take warm in two divided doses.
The intent of this formula is to separately dissipate heat in the Upper, Middle, and Lower Jiao. Therefore, Zhi Zi is good at clearing heat in the Upper Jiao, Huang Bo is good at clearing heat in the Lower Jiao, and adding Gan Cao allows the herbs to guide each other to the Middle Jiao to clear heat there. Furthermore, since Zhi Zi and Huang Bo are overly bitter and cold, the sweetness of Gan Cao is used to moderate them, slightly altering their bitter-cold nature so as not to injure the Stomach Qi.
Original text from *Shanghan Lun*: In cold damage, stagnant heat trapped inside will inevitably cause yellowing of the body; Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction) is the primary treatment.
[Formula: Ma Huang Lian Qiao Chi Xiao Dou Tang]
Ma Huang (Herba Ephedrae) two liang (nodes removed), Chi Xiao Dou (Semen Phaseoli Angularis) one sheng, Lian Yao (Radix Forsythiae) two liang, Xing Ren (Semen Armeniacae Amarum) forty pieces (skin and tips removed), Da Zao (Fructus Jujubae) twelve pieces, Sheng Zi Bai Pi (Cortex Catalpae Viridis) one sheng, Sheng Jiang (Rhizoma Zingiberis Recens) two liang (sliced), Gan Cao (Radix Glycyrrhizae) two liang (roasted).
Take these eight ingredients, add ten dou of rainwater (Liao Shui), first boil Ma Huang until it boils again, skim off the foam on top, then add the remaining herbs, boil to obtain three sheng, and take warm in three divided doses, finishing within half a day.
Note: Lian Yao is not Lian Qiao (Forsythia Fruit), but rather the root of Forsythia. Its nature is cool and capable of draining heat, and it is also good at promoting diuresis to resolve dampness; using Lian Qiao in later generations changes its nature. Chi Xiao Dou refers to the small beans used for cooking, shaped like mung beans but red in color, not the red beans imported from the South. Zi Bai Pi (Cortex Catalpae) is not sold in pharmacies; if there are Catalpa trees nearby, one can harvest it themselves. Chen Xiuyuan stated that if Zi Bai Pi is unavailable, Yin Chen (Herba Artemisiae Scopariae) can be used as a substitute.
Yellowing of the body differs from Jaundice (Huang Dan). Jaundice involves bile flowing recklessly into the blood. Although Zhang Zhongjing did not explicitly state this in his writings, Yu Jiayan elucidated this point in the case of Qian Xiaolu in *Yi Yi Cao* (Meaningful Grass); at that time, the Western theory of "bile overflowing into the blood" had not yet entered China. As for diseases causing yellowing of the body, which develop suddenly within one or two days, it is evident that they are not caused by bile overflowing into the blood level. Yin Chen is a key herb for treating heat-binding jaundice, clearly recorded in *Shennong Ben Cao Jing*. Zhang Zhongjing also used it for treating yellowing of the body because both conditions arise from damp-heat. If damp-heat accumulates gradually, it becomes Jaundice; if damp-heat is constrained by external pathogens and forms abruptly, it becomes yellowing of the body. Thus, both can be treated with Yin Chen Hao Tang (Artemisia Scoparia Decoction).
Not all cases of yellowing of the body are due to damp-heat. Section 76 of the Yangming Chapter states: "After cold damage has been treated with sweating, if the body and eyes become yellow, the reason is that cold-dampness remains unresolved internally. It should not be treated with purgatives; instead, seek the treatment within the context of cold-dampness."
Wang He'an said: Yellow is the color of oily heat. Oil contains fluid and envelops vessels, nurturing blood. When fluid is deficient and blood is dry, heat becomes severe, resulting in Yang Jaundice, which corresponds to the Zhi Zi Bai Pi Tang pattern of yellowing body and fever. When oily dampness and blood heat are equal and steaming together, causing difficulty urinating and a body yellow like an orange peel, this corresponds to the Yin Chen Hao Tang pattern. When oil is cold and membranes are damp,郁 blood transforms into heat, leading to severe cold-dampness and becoming Yin Jaundice, corresponding to the Yin Chen Wu Ling San pattern. The disease presents with heat signs but is treated according to cold-dampness principles. Reflecting on these two sentences reveals the flexibility of the language. Essentially, saying "do not use purgatives" implies that there are heat-type yellows that could be purged; saying "seek treatment within cold-dampness" implies seeking methods for cold-dampness, indicating that yellow patterns are not purely cold-damp. For any syndrome with two causes, treatment follows the more severe aspect, as seen in these two statements.
Mr. Wang's discussion above is very refined, but I have another understanding of this section's text. I will cite two previous cured cases to illustrate this.
I once treated a patient who contracted a common cold, experienced aversion to cold and no sweat, and had whole-body yellowing. I used Ma Huang Tang (Ephedra Decoction) to induce sweating, but the yellowing did not recede after sweating. Upon careful pulse diagnosis, the left pulse was wiry and weak, and the right pulse was soggy and weak. This indicated that the Yang Qi of the Liver and Gallbladder was not vigorous, and the Spleen and Stomach were deficient and cold. The Spleen and Stomach belong to Earth, whose natural color is yellow. When diseased, they manifest their true color. Thus, if the pathology is damp-heat, the yellow may appear bright; if it is damp-cold, the yellow may appear dull. Observing the yellow presented here, although seemingly dull, it was not extremely dull because reckless bile flow was involved. This was likely due to the invigoration of Liver-Gallbladder Yang being insufficient, preventing the transformation and transportation of Qi, so bile could not reach the Small Intestine to aid digestion. Consequently, the bile duct became blocked, bile accumulated excessively and flowed recklessly, overflowing into the blood level and permeating to show yellow. Since the roots of the yellowing were different, they manifested together, making the yellowing appear dull but not truly dull. Having accurately diagnosed the condition, I prescribed a formula to treat the left and right sides separately.
Sheng Huang Qi (Radix Astragali) six qian, Gui Zhi Jian (Ramulus Cinnamomi Cum Gemmis) two qian, Gan Jiang (Rhizoma Zingiberis Secatus) three qian, Hou Po (Cortex Magnoliae Officinalis) half a qian, Chen Pi (Pericarpium Citri Reticulatae) half a qian, Yin Chen (Herba Artemisiae Scopariae) two qian.
Boil these six herbs in a large cup of water and take warm.
Rationale of the formula: Huang Qi is used to assist the Yang Qi of the Liver and Gallbladder, assisted by the acrid-warm nature of Gui Zhi, which provides opening power. Gan Jiang is used to eliminate cold-dampness in the Spleen and Stomach; Hou Po assists in directing the warming heat downward. Chen Pi further assists in directing the heat sideways. When the warming heat spreads throughout the body, the cold-dampness of the Spleen and Stomach is naturally eliminated. Yin Chen is used because of its ascending and dispersing nature, which effectively opens the blockage of the bile duct. Moreover, it promotes diuresis to resolve dampness. Combined with Ginger and Cinnamon Twig, although it is bitter and cold, its cold nature is not felt. Additionally, the Liver and Gallbladder harbor Ministerial Fire (Xiang Huo). Even if the Liver and Gallbladder are cool, the ministerial fire remains. Ministerial fire is originally Dragon-Lei fire; it cannot be triggered by purely acrid-hot agents. Adding a small amount of Yin Chen actually incorporates the principle of "treating heat with cold."
I also treated another person during mid-autumn. He had alternating chills and fever, whole-body yellowing, mental restlessness and heat, and a sensation of cold in the abdomen. Food was not digesting well. His pulse was wiry and hard on the left, and deep and soggy on the right. I was very suspicious and asked about the origin of his illness. He replied that he did not know. After asking about his daily diet and lifestyle, I learned that due to narrow living quarters, he had slept outdoors between June and July, and the area was humid with heavy night dew. I suddenly realized that long-term exposure to dampness had affected the viscera. The Spleen belongs to Earth (Taiyin); prolonged damp stagnation generates cold, leading to indigestion. The Liver and Gallbladder belong to Wood (Shaoyang); prolonged damp stagnation generates heat, compounded by the steaming effect of the harbored ministerial fire. This caused swelling and blockage of the bile duct, leading to reckless bile flow overflowing into the blood and causing yellowing. There was a slight white coating on the tongue, indicating a mild external contraction invading the Triple Burner. The Triple Burner consists of the Hand Shaoyang and Foot Shaoyang, forming a continuous pathway where Qi flows freely, thus explaining the alternating chills and fever. Originally, Chai Hu (Radix Bupleuri) should have been used to harmonize, which would have resolved the chills and fever. Since Yin Chen has properties similar to Chai Hu and is also a Shaoyang herb, and given the yellowing, I used three qian of Yin Chen to replace Chai Hu. I added three qian each of Lian Qiao (Fructus Forsythiae), Bo He Ye (Folium Menthae Haplocalycis), and Sheng Jiang, along with two qian of Gan Cao. After taking the decoction, the patient sweated profusely (Foot Shaoyang should not be induced to sweat, whereas Hand Shaoyang should). The alternating chills and fever ceased, but the yellowing remained. At this point, considering the distinct difference in cold and heat between the left and right pulses, I formulated another prescription.
Yin Chen (Herba Artemisiae Scopariae) three qian, Zhi Zi (Fructus Gardeniae) three qian, Gan Jiang (Rhizoma Zingiberis Secatus) three qian, Bai Zhu (Rhizoma Atractylodis Macrocephalae) three qian (stir-fried), Hou Po (Cortex Magnoliae Officinalis) two qian, Yan Xiao (Natrii Sulfas Calcined) five fen (finely ground).
Decoct the first five herbs in a large cup of water. While hot, dissolve the Yan Xiao powder and take orally.
Rationale of the formula: Zhi Zi and Yin Chen are used to clear heat from the Liver and Gallbladder. Gan Jiang, Bai Zhu, and Hou Po are used to eliminate cold from the Spleen and Stomach. Although the medicinal properties are distinctly cooling and warming, combining them in one formula allows for separate therapeutic actions. Yan Xiao is used because bile duct blockage is often caused by gallstones obstructing the flow of bile into the Small Intestine. Yan Xiao has a dissolving nature; even if gallstones are present in the bile duct, it is not difficult to dissolve them with this herb.