典藏书目

Treats cases of Shanghan (Cold Damage) presenting with jaundice and fever, where there are no exterior or interior syndromes.

Zhi Zi (Gardeniae Fructus, broken open) 15 pieces; Gan Cao (Licorice Root) 1 liang; Huang Bo (Phellodendri Cortex) 1 liang. These three ingredients are decocted in 4 sheng of water to obtain 1.5 sheng. Strain the dregs, and take half warm, twice a day.

[Annotation] In cases of Shanghan with jaundice and fever: If there is an exterior syndrome characterized by anhidrosis (absence of sweating), treat it with Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia, and Red Bean Decoction) to induce sweating. If there is an interior excess syndrome, treat it with Yinchen Hao Tang (Artemisiae Scopariae Decoction) to purge. Currently, there are no exterior signs suitable for sweating, nor interior signs suitable for purging; there is only jaundice and heat. It is appropriate to clear the heat using Zhizi Bopi Tang (Gardenia and Phellodendron Decoction). The Gan Cao (Licorice Root) in this formula should actually be Yin Chen (Artemisiae Scopariae Herba); this is a transcription error.

In Yangming disease, if there is fever, sweating only on the head, no sweating on the body, difficulty in urination, and thirst for drinking fluids, this indicates stasis-heat trapped inside. The body will inevitably develop jaundice. For those with slight abdominal fullness, this formula is indicated.

Yin Chen Hao (Artemisiae Scopariae Herba) 6 liang; Zhi Zi (Gardeniae Fructus, broken open) 14 pieces; Da Huang (Rhei Radix et Rhizoma) 2 liang. These three ingredients are decocted in 2 dou of water. First, decoct Yin Chen Hao until the volume decreases by 6 sheng. Then add the other two ingredients and decoct until 3 sheng remains. Strain the dregs, and take one-third warm, three times a day. Urination should become smooth, resembling the juice of soap pods, with a bright red color. After one night, abdominal fullness decreases, and the yellow pigment is expelled via urination.

[Collected Annotations] Ke Qin stated: Both Taiyang (Greater Yang) and Yangming diseases can present with jaundice. However, if there is sweating only on the head and no sweating on the body, the heat cannot vent outward; if urination is difficult, the heat cannot drain downward. Thus, stasis-heat becomes trapped inside. Nevertheless, the location of the interior pathology differs: The muscles belong to the interior of Taiyang and should be dispersed via sweating; therefore, Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia, and Red Bean Decoction) is used as a cooling dispersal method. The chest and heart belong to the interior of both Taiyang and Yangming and should be treated with cold-natured herbs to overcome the heat; thus, Zhizi Bopi Tang (Gardenia and Phellodendron Decoction) is used as a fire-clearing method. The intestines and stomach belong to the interior of Yangming and should be purged from within; therefore, this formula (Yinchen Hao Tang) is established as a method to eliminate turbidity. Yin Chen inherits the Qi of the North, does not wither in winter, braves frost and snow, and absorbs excessive cold Qi. Therefore, it can remove lingering heat pathogens. Guiding Zhi Zi to open the water source and Da Huang to regulate gastric excess allows all stasis-heat inside and outside the body to exit via urination. Abdominal fullness naturally subsides, and the intestines and stomach are unharmed. This conforms to the principle of "drawing out and exhausting," making it a sacred remedy for promoting diuresis in Yangming disease. He further stated: Zhang Zhongjing employed four methods to treat thirst and fluid intake in Yangming disease: For cases transferred from Taiyang, Wuling San (Five-Ingredient Powder with Poria) is used to mildly induce sweating and disperse water qi; for severe irritability, thirst, and spontaneous urination, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is used to clear fire and generate fluids; for floating pulse, fever, and difficulty in urination, Zhuling Tang (Poria Decoction) is used to nourish yin and promote diuresis; for difficulty in urination and abdominal fullness, Yinchen Hao Tang (Artemisiae Scopariae Decoction) is used to relieve fullness. Now that the yellow pigment exits via urine, the pathology and treatment strategy are clear. Whenever I reflect on Zhang Zhongjing’s prescriptions, he always uses herbs that promote Qi transformation for difficulty in urination, and Chengqi-class herbs for constipation. Therefore, for difficulty in urination, Fu Ling (Poria) must be added, and Zhu Ling (Polyporus) added in severe cases, because these two fungi facilitate Qi transformation, which is essential for urination. Why were Zhu Ling and Fu Ling not used here? The text states: In Yangming disease, if there is profuse sweating and thirst, Zhuling Tang (Poria Decoction) must not be given, because profuse sweating causes dryness in the stomach, and Zhuling Tang would further deplete fluids by promoting urination. From this, we know that if it is contraindicated when sweating is profuse, it is even more contraindicated when sweating is absent but thirst exists, as the body fluids are already deficient. Here, Yin Chen, which pushes out the old and generates the new, is assisted by Zhi Zi, which directs flow downward. Without Zhi Mu or Hou Po to assist the Chengqi formula, or Mang Xiao (Mirabilite) for harsh purgation, Da Huang serves only to moisten gastric dryness, indicating that bowel movements will not occur immediately. Thus, abdominal fullness subsides only after one night, and the yellow pigment exits via urine rather than the large intestine. Zhang Zhongjing’s legislative ingenuity is miraculous and beyond imagination.