茵陈蒿六两 栀子十四枚 大黄二两
右三味，以水一斗，先煮茵陈，减六升，内二味，煮取三升，去滓，分温三服，小便
当利，尿如皂角汁状，色正赤，一宿腹减，黄从小便去也。
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阳明病，脉迟者，食难用饱，饱则发烦，头眩，小便必难，此欲作谷疸，虽下之，腹
满如故，所以然者，脉迟故也。
【注】
谷疸属胃热，脉当数，今脉迟，脾藏寒也。寒不化谷，所以虽饥欲食，食难用饱，饱
则烦闷，胃中填塞健运失常也。清者阻于上升，故头眩；浊者阻于下降，故小便难也
，此皆欲作谷疸之征。其证原从太阴寒湿郁黩而生，若误以为阳明热湿发黄，下之虽
腹满暂减，顷复如故，所以然者，脉迟寒故也。此发明欲作谷疸，属脾阴寒化而不可
下者也。
【集注】
程林曰：脉迟为寒，寒不杀谷，故食难用饱，饱则谷气不消，胃中若浊，浊气蕴蓄则
发烦，熏蒸则作眩也。小便难者，以脉迟则无阳以施化浊气，但留于胃而不宣，是以
欲作谷疸。若下之，徒虚其胃而腹满如故也，所以然者，以脉迟为寒之故也。
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黄家，日晡所发热，而反恶寒，此为女劳。得之，膀胱急，少腹满，身尽黄，额上黑
，足下热，因作黑疸，其腹胀如水状，大便必黑，时溏，此女劳之病，非水也。腹满
者难治，硝石矾石散主之。
【注】
此详申女劳疸之为病。黄疸日晡所发热，乃阳明热症，当不恶寒也；而反恶寒者，非
阳明热症，此或为女劳得之也。女劳得之疸证，虽膀胱急，少腹满，而小便自利，身
虽尽黄，而额上则黑，虽发热，惟足下甚，此少阴热因作黑疸也。故腹胀如水状，而
大便必黑时溏，知非水胀病，乃为女劳得之疸胀病也。时溏黑色者，亦藏病及血之征
也。血病者颜必变，岂有色黑而血不病者乎？女劳疸腹满者为难治，以其脾肾两败也
。以硝石入血消坚，矾石入气胜湿，然此方治标固宜，非图本之治，世久书□，姑辨
其理也。
【集注】
尤怡曰：黄家，日晡所本当发热，今发热而反恶寒者，此为女劳得之疸也。热在胃浅
而肾深，故热深则先反恶寒也。膀胱急，额上黑，足下热，大便黑，皆肾热之征，虽
少腹满胀有如水状，而实为肾气不行，非脾湿而水不行也。惟是证兼腹满，则脾肾并
伤，而其治为难耳！硝石咸寒除热，矾石除痼热在骨髓，骨与肾合，用以清肾热也。
大麦粥和服，恐伤胃也。
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，水量减少六升后，加入另外两味药，继续煎煮至剩余三升药液，滤去药渣，分三次温服。服药后小便应当通利，尿液颜色像皂角汁一样，呈深红色，过一夜腹部胀满减轻，黄疸通过小便排出。
@@@
阳明病（阳明经受邪所致的病证），脉象迟缓的，进食难以吃饱，吃饱了就感到心烦、头晕目眩，小便必然困难，这是将要发生谷疸（因饮食不节导致的黄疸）的表现。即使使用攻下法治疗，腹部胀满依然如故，之所以这样，是因为脉迟（主寒）的缘故。
【注】
谷疸属于胃热，脉象应当数（快），现在脉象迟缓，说明脾脏有寒。寒气不能运化水谷，所以虽然饥饿想吃东西，但难以吃饱，吃饱后就会烦闷，这是因为胃中食物填塞，导致脾胃健运功能失常。清气受阻无法上升，所以头晕目眩；浊气受阻无法下降，所以小便困难。这些都是将要发生谷疸的征象。这种病症原本是由太阴寒湿郁滞而生的，如果误认为是阳明湿热发黄而使用攻下法，虽然腹部胀满暂时减轻，但很快又恢复原状，之所以这样，是因为脉迟代表寒证的缘故。此处阐明了欲作谷疸属于脾阴寒化生，不可使用攻下法。
【集注】
程林说：脉迟表示有寒，寒邪不能消化水谷，所以进食难以吃饱，吃饱后谷气不能消散，胃中如同浑浊之气蕴蓄，从而引发心烦，熏蒸头部则产生眩晕。小便困难，是因为脉迟导致阳气不足，无法气化浊气，浊气只停留在胃中而不能宣散，因此想要形成谷疸。如果使用攻下法，只会使胃气虚弱而腹部胀满依旧，之所以这样，是因为脉迟代表寒证的缘故。
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患有黄疸的人，在日晡时（下午3-5点）发热，反而出现恶寒症状，这是女劳疸（因房劳过度导致的黄疸）。此病表现为膀胱拘急，少腹（小腹）胀满，全身发黄，额头颜色发黑，脚心发热，因此形成黑疸（黄疸的一种，色黑晦暗）。其腹部胀大如水状，大便必然发黑且时而稀溏，这是女劳疸的病证，不是水胀病。如果腹部胀满严重则难治，用硝石矾石散主治。
【注】
此处详细阐述女劳疸这一疾病。黄疸患者在日晡时发热，本是阳明热症，应当不恶寒；但现在反而恶寒，说明这不是阳明热症，这可能是由女劳引起的。由女劳引起的疸证，虽然膀胱拘急、少腹胀满，但小便自利（通畅）；身体虽然全部发黄，但额头发黑；虽然发热，但只有脚心发热严重，这是少阴热邪导致黑疸。所以腹部胀大像水状，大便必黑且时而稀溏，可知这不是水胀病，而是由女劳引起的疸胀病。大便时而稀溏且黑色，也是脏腑病变波及血分的征象。血分有病面色必然改变，哪有面色发黑而血分没有病的呢？女劳疸出现腹部胀满的为难治之症，因为脾肾两败。硝石入血分消除坚积，矾石入气分胜湿，然而此方治疗标症固然适宜，并非治本之法，世传书籍中有缺漏，姑且辨析其中的医理。
【集注】
尤怡说：黄疸患者，日晡时本当发热，现在发热反而恶寒，这是由女劳引起的疸证。热邪在胃较浅而在肾较深，所以热邪深入时先出现反常的恶寒。膀胱拘急、额头发黑、脚心发热、大便发黑，都是肾热的征象，虽然少腹满胀像有水状，但实际上是肾气运行不畅，并非脾湿导致的水液不行。只是此证兼有腹部胀满，则脾肾同时受伤，治疗就比较困难！硝石咸寒以清除热邪，矾石清除骨髓中的顽固热邪，骨与肾相合，用来清泄肾热。用大麦粥送服，是为了防止损伤胃气。
Yinchen Hao Tang (Capillaris Decoction) consists of Yinchen Hao (Artemisiae Scopariae Herba, 茵陈蒿) six liang, Zhizi (Gardeniae Fructus, 栀子) fourteen pieces, and Dahuang (Rhei Radix et Rhizoma, 大黄) two liang.
The above three ingredients are boiled in ten dou of water. First, boil Yinchen Hao until the volume reduces by six dou. Then add the remaining two ingredients and continue boiling until three sheng of liquid remain. Strain the decoction and divide it into three warm doses. After administration, urination should become unobstructed, and the urine will resemble the juice of a soap pod, appearing dark red. Overnight, abdominal distension will subside, and the jaundice will be expelled through urination.
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In Yangming disease (disease of the Yangming channel), if the pulse is slow (Chi, 迟), the patient finds it difficult to eat to fullness. Upon eating to satiety, they experience irritability and dizziness, and urination will inevitably be difficult. This indicates the impending onset of Gu Dan (Grain Jaundice). Even if purgative therapy is applied, abdominal fullness remains unchanged. The reason for this is the presence of a slow pulse, which indicates cold.
[Annotation]
Gu Dan typically belongs to Stomach heat, where the pulse should be rapid (Shu, 数). A slow pulse here indicates Spleen cold. Cold fails to transform food; thus, although the patient feels hungry and desires to eat, they cannot consume large amounts. Satiety leads to stifling sensation because the stomach is filled with undigested food, impairing the healthy transport and transformation functions. Clear qi is obstructed from ascending, causing dizziness; turbid qi is obstructed from descending, causing difficulty in urination. These are all signs of impending Gu Dan. This condition originally arises from the stagnation of Taiyin cold-dampness. If mistakenly treated as Yangming damp-heat jaundice with purgatives, abdominal fullness may temporarily decrease but will quickly return. This occurs because the slow pulse signifies cold. This passage elucidates that impending Gu Dan due to Spleen-Yin cold transformation should not be treated with purgatives.
[Collected Annotations]
Cheng Lin stated: A slow pulse indicates cold. Cold fails to digest grain, so one cannot eat to fullness. Upon satiety, grain qi fails to dissipate, creating turbidity in the stomach. Accumulated turbid qi causes irritability, and its steaming effect causes dizziness. Difficulty in urination occurs because the slow pulse implies a lack of Yang qi to transform turbid qi; the turbid qi remains stagnant in the stomach without dispersing, leading to the formation of Gu Dan. Purgatives would only weaken the Stomach qi while leaving abdominal fullness unchanged, precisely because the slow pulse indicates cold.
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Patients with jaundice who experience fever at dusk (ribang suo, 日晡所) but paradoxically feel aversion to cold have contracted Nü Lao Dan (Female Labor Jaundice). Symptoms include urgency of the bladder, fullness of the lower abdomen, yellowing of the entire body, blackening of the forehead, and heat in the soles of the feet, resulting in Hei Dan (Black Jaundice). The abdomen becomes distended like water retention, stools are invariably black and sometimes loose. This is Nü Lao disease, not water retention disease. If abdominal fullness is severe, it is difficult to treat; Xiaoshi Fanshi San (Niter and Alum Powder) is indicated.
[Annotation]
This section elaborates on Nü Lao Dan. Fever at dusk is characteristic of Yangming heat syndrome, which should not present with aversion to cold. The presence of aversion to cold indicates this is not Yangming heat but rather Nü Lao-induced jaundice. In Nü Lao jaundice, despite bladder urgency and lower abdominal fullness, urination is free. Although the body is yellow, the forehead is black, and although there is fever, it is most intense in the soles of the feet; this represents Shaoyin heat transforming into Black Jaundice. Consequently, the abdomen is distended like water, and stools are black and loose, confirming this is not water retention but Nü Lao-induced jaundice distension. Loose, black stools indicate pathological changes affecting the blood level. Blood pathology manifests in facial color; how can one have a black complexion without blood pathology? Nü Lao jaundice with abdominal fullness is difficult to treat because both the Spleen and Kidney are depleted. Xiaoshi (Niter, 硝石) enters the blood level to resolve hardness, and Fanshi (Alumen, 矾石) enters the qi level to overcome dampness. While this formula treats the branch symptoms effectively, it is not a root cure. Due to textual gaps in ancient books, we merely clarify the underlying principles here.
[Collected Annotations]
You Yi stated: Patients with jaundice should naturally experience fever at dusk. The presence of fever accompanied by aversion to cold indicates Nü Lao-induced jaundice. Heat is shallow in the Stomach but deep in the Kidney; thus, when heat penetrates deeply, aversion to cold appears first. Bladder urgency, black forehead, hot soles, and black stools are all signs of Kidney heat. Although the lower abdomen is full and distended resembling water retention, this is actually due to impaired Kidney qi movement, not Spleen dampness causing water stagnation. However, since this condition involves abdominal fullness, both the Spleen and Kidney are injured, making treatment difficult. Xiaoshi is salty and cold, clearing heat; Fanshi clears stubborn heat in the marrow. Since bone corresponds to the Kidney, these are used to clear Kidney heat. Taking the powder with Barley Porridge (Damai Zhou, 大麦粥) prevents damage to the Stomach qi.