发黄之证，多成于湿热，诸治发黄之方，皆治湿热之方也。
乃有本阳明病，其人蕴有湿热而不发黄者，自当另议治法，而阳明篇中亦曾载其治方矣。
《伤寒论》原文∶若脉浮发热，渴欲饮水，小便不利者，猪苓汤主之。
此节所谓脉浮者，乃病入阳明，而犹连太阳之府也。盖太阳之病，在经脉浮，在府亦脉浮，此因太阳
之府蕴有实热，以致小便不利，而热之入于阳明者，不能由太阳之府分消其热下行，转上逆而累及于肺，是
以渴欲饮水也。治以猪苓汤，是仍欲由太阳之府分消其热也。
【猪苓汤方】猪苓去皮、茯苓、阿胶、滑石、泽泻各一两。
上五味，以水四升，先煮四味取二升，去滓，纳下阿胶，烊消，温服七合，日三服。
猪苓、茯苓，皆为渗淡之品，而猪苓生于枫下，得枫根阴柔之气，以其性善化阳，以治因热小便不利
者尤宜，故用之为主药。用泽泻者，因其能化水气上升以止渴，而后下降以利小便也。用滑石者，其性可
代石膏，以清阳明之实热，又能引其热自小便出也。用阿胶者，因太阳之府原与少阴相连，恐诸利水之
药或有损于少阴，故加阿胶大滋真阴之品，以助少阴之气化也。
总计阳明篇中之病证，大抵燥而且热也，其有不燥而转湿者，此阳明之变证也。于治发黄诸方，曾发
明之矣。更有不热而反寒者，此亦阳明之变证也。夫病既寒矣，必须治以热剂，方为
对证之药，是则温热之剂，又宜讲求矣。
《伤寒论》原文∶脉浮而迟，表热里寒，下利清谷者，四逆汤主之。
外感之着人，恒视人体之禀赋为转移，有如时气之流行，受病者或同室、同时，而其病之偏凉、偏热，
或迥有不同。盖人之脏腑素有积热者，外感触动之则其热益甚；其素有积寒者，外感触动
之则其寒亦益甚也。明乎此则可与论四逆汤矣。
【四逆汤方】甘草二两炙，干姜两半，附子一枚生用去皮破八片。
上三味以水三升，煮取一升二合，去滓，分温再服，强人可大附子一枚、干姜三两。
干姜为温暖脾胃之主药，伍以甘草，能化其猛烈之性使之和平，更能留其温暖之力使之常久也。然
脾胃之温暖，恒赖相火之壮旺，附子色黑入肾，其非常之热力，实能补助肾中之相火，以浓脾胃温暖之本
源也。方名四逆者，诚以脾主四肢，脾胃虚寒者，其四肢常觉逆冷，服此药后，而四肢之厥逆可回也。
方中附子，注明生用，非剖取即用也。因附子之毒甚大，种附子者，将附子剖出，先以盐水浸透，至
药局中又几经泡制，然后能用，是知方中所谓附子生用者，特未用火炮熟耳。
发黄（皮肤、巩膜及尿液变黄）的病证，大多由湿热引起，治疗发黄的方剂，都是治疗湿热的方剂。
然而，有的患者原本患有阳明病，体内蕴藏湿热却没有出现发黄症状的，自然应当另外讨论治法，而《伤寒论》阳明篇中也确实记载了相应的治疗方剂。
《伤寒论》原文说：如果脉象浮、发热，口渴想喝水，小便不通利的，用猪苓汤主治。
这一节所说的“脉浮”，是指病邪传入阳明，但仍然牵连太阳之腑（膀胱）。大概太阳的病，在经脉则脉浮，在腑也是脉浮，这是因为太阳之腑蕴含有实热，导致小便不利，而热邪传入阳明的部分，不能通过太阳之腑分散消除并下行，反而上逆波及到肺，所以出现口渴想喝水的症状。用猪苓汤治疗，仍然是希望通过太阳之腑来分散消除热邪。
【猪苓汤方】猪苓（去皮）、茯苓、阿胶、滑石、泽泻各一两。
以上五味药，用水四升，先煮前四味药，取二升药液，去掉药渣，加入阿胶，使其烊化溶解，每次温服七合，每天服用三次。
猪苓和茯苓，都是淡渗利湿的药物，但猪苓生长在枫树下，吸收了枫根阴柔之气，因其性质善于化解阳气阻滞，用来治疗因热导致的小便不利尤其适宜，所以作为主药使用。使用泽泻，是因为它能引导水气上升以止渴，随后下降以利小便。使用滑石，是因为它的性质可以代替石膏，以清泄阳明经的实热，又能引导热邪从小便排出。使用阿胶，是因为太阳之腑原与少阴肾相连，担心各种利水药物可能会损伤少阴，所以加入阿胶这种大滋真阴的药物，以辅助少阴的气化功能。
总计阳明篇中的病证，大体上是燥而且热的，其中有不燥转而变成湿的，这是阳明病的变证。在治疗发黄的诸方中，已经阐明了这一点。更有不热反而寒的，这也是阳明病的变证。既然病已属寒，必须用热性药物治疗，才是对症的药，那么温热性质的药剂，又应该加以研究探讨了。
《伤寒论》原文说：脉象浮而迟，表热里寒，下利排出未消化食物（完谷不化）的，用四逆汤主治。
外感病邪侵袭人体，往往随着人体体质的不同而发生转化，就像时行疫气的流行一样，同处一室或同时受邪的人，其病情偏凉或偏热，可能截然不同。大概人的脏腑素有积热的，外邪触动它则热势更盛；素有积寒的，外邪触动它则寒势也更盛。明白这个道理，就可以讨论四逆汤了。
【四逆汤方】甘草（炙）二两，干姜一两半，附子（生用，去皮，破成八片）一枚。
以上三味药，用水三升，煮取一升二合药液，去掉药渣，分两次温服，体格强壮的人可用大附子一枚、干姜三两。
干姜是温暖脾胃的主药，配合甘草，能缓和其猛烈之性使之平和，更能保留其温暖之力使之持久。然而脾胃的温暖，常常依赖命门之火（相火）的壮旺，附子色黑入肾，其非凡的热力，实际上能补助肾中的相火，以巩固脾胃温暖的根本源头。方名“四逆”，诚然因为脾主四肢，脾胃虚寒的人，其四肢常感觉逆冷，服用此药后，四肢的厥逆症状即可恢复。
方中附子注明“生用”，并非剖开立即使用。因为附子的毒性很大，种植附子的人，将附子剖出后，先用盐水浸透，到了药局中又经过多次炮制，然后才能使用，由此可知方中所说的“附子生用”，特指未经过火烤熟制罢了。
The syndrome of jaundice (yellowing of the skin, sclera, and urine) mostly arises from damp-heat. All formulas for treating jaundice are formulas for treating damp-heat.
However, there are cases where a patient originally suffers from Yangming disease, harbors damp-heat internally but does not develop jaundice; in such instances, a different treatment approach is naturally required. The Yangming chapter of *Shanghan Lun* indeed records a formula for this condition.
Original text from *Shanghan Lun*: "If the pulse is floating, accompanied by fever, thirst with desire to drink water, and difficult urination, Zhu Ling Tang should be administered."
The "floating pulse" mentioned in this section refers to the pathogen having entered the Yangming stage but still involving the Bladder Fu organ (Bladder). Generally, Taiyang disease presents with a floating pulse whether it affects the meridians or the Fu organs. This occurs because the Bladder Fu contains excess heat, leading to difficult urination. The heat that has entered the Yangming stage cannot be dispersed and eliminated downward through the Bladder Fu; instead, it rebels upward and affects the Lung, resulting in thirst and desire to drink water. Treating with Zhu Ling Tang aims to disperse and eliminate the heat through the Bladder Fu.
[Zhu Ling Tang Formula] Polyporus (with skin removed), Poria, Donkey-hide Gelatin, Talcum, Alisma rhizome, each 1 liang.
Take the above five herbs. Add four sheng of water. First decoct the first four herbs until two sheng remains. Remove the dregs. Add the Donkey-hide Gelatin and melt it. Take seven he of the warm decoction per dose, three times daily.
Polyporus and Poria are both diuretic and leaching agents. However, Polyporus grows under maple trees, absorbing the yin and soft qi of maple roots. Its nature is good at resolving yang obstruction, making it particularly suitable for treating difficult urination caused by heat; thus, it is used as the principal herb. Alisma rhizome is used because it can guide fluid qi upward to relieve thirst, and subsequently descend to promote urination. Talcum is used because its nature can substitute for Gypsum to clear excess heat in the Yangming stage, and it can also guide heat out through urination. Donkey-hide Gelatin is used because the Bladder Fu is originally connected to the Shaoyin Kidney. Fearing that various diuretic herbs might damage the Shaoyin, Donkey-hide Gelatin, a substance that greatly nourishes true yin, is added to assist the Qi transformation of the Shaoyin.
In summary, the syndromes in the Yangming chapter are generally dry and hot. Cases that are not dry but turn damp represent a variant syndrome of Yangming. This has been elucidated in the formulas for treating jaundice. Furthermore, cases that are not hot but become cold are also variant syndromes of Yangming. Since the disease is now cold, it must be treated with hot-natured medicines to be symptomatic; therefore, warm and hot agents require further study.
Original text from *Shanghan Lun*: "If the pulse is floating and slow, with exterior heat and interior cold, and diarrhea with undigested food, Si Ni Tang should be administered."
Exogenous pathogens affecting humans often transform according to the individual's constitution, similar to the spread of seasonal epidemics. Individuals exposed to the same pathogen in the same room or time may present with conditions that are distinctly cool or hot. Generally, if a person's zang-fu organs harbor accumulated heat, external pathogens will exacerbate the heat; if they harbor accumulated cold, external pathogens will exacerbate the cold. Understanding this allows for a discussion on Si Ni Tang.
[Si Ni Tang Formula] Licorice root (roasted) 2 liang, Dried ginger 1.5 liang, Aconite root (raw, skin removed, broken into eight pieces) one piece.
Take the above three herbs. Add three sheng of water. Decoct until one sheng and two he remain. Remove the dregs. Divide into two warm doses. For robust individuals, use one large Aconite root and 3 liang of Dried ginger.
Dried ginger is the principal herb for warming the Spleen and Stomach. Combined with Licorice root, it moderates its fierce nature to make it mild, and preserves its warming power for longevity. However, the warmth of the Spleen and Stomach relies heavily on the vigor of Mingmen Fire (Ministerial Fire). Aconite root, being black and entering the Kidney, possesses extraordinary heat that effectively supplements the Ministerial Fire in the Kidney, thereby consolidating the root source of Spleen and Stomach warmth. The formula is named "Si Ni" (Four Rebellions/Cold Extremities) because the Spleen governs the four limbs; those with Spleen-Stomach deficiency-cold often feel cold extremities. After taking this medicine, the coldness of the limbs can reverse.
The note "raw" for Aconite root in the formula does not mean using it immediately after excavation. Because Aconite root is highly toxic, growers soak the excavated root in salt water, and pharmacies undergo multiple processing steps before it is usable. Thus, "raw" in the formula specifically means unroasted/uncooked by fire.