@@@
寸口脉浮而缓，浮则为风，缓则为痹，痹非中风，四肢苦烦，脾色必黄，瘀热以行。
趺阳脉紧而数，数则为热，热则消谷，紧则为寒，食即为满。尺脉浮为伤肾，趺阳脉
紧为伤脾。风寒相搏，食谷即眩，谷气不消，胃中苦浊，浊气下流，小便不通，阴被
其寒，热流膀胱，身体尽黄，名曰谷疸。额上黑，微汗出，手足中热，薄暮即发，膀
胱急，小便自利，名曰女劳疸，腹如水状，不治。心中懊□而热，不能食，时欲吐，
名曰酒疸。
【注】
寸口脉浮而缓，浮则为风，缓则为痹，痹非中风，前已详言之矣。今趺阳紧数而尺脉
浮，四肢苦烦，身面色黄，乃疸病也。黄，土色也，土病则见之，土属脾胃，脾为阴
土主湿，胃为阳土主热，故凡病疸，皆为湿瘀热郁也，行于外则必四肢苦烦身面发黄
也。盖其人素有湿热，外被风寒相搏，内为女劳所伤，乃食谷饮酒，或与湿瘀，或与
热郁，皆能为是病也。若胃脉数，是热胜于湿，则从胃阳热化，热则消谷，故能食而
谓之阳黄。若胃脉紧，是湿胜于热，则从脾阴寒化，寒则不食，故食即满而谓之阴黄
也。阳黄则为热疸、酒疸，阴黄则为女劳疸、谷疸也。若尺脉不沉而浮，则为伤肾，
肾伤病疸，亦为女劳疸也。胃脉不缓而紧，则为伤脾，脾伤病疸，亦为谷疸也。谷疸
则食谷即满，谷气不消，胃中苦浊，精气阻于上行，故头眩也，浊气流于膀胱，故小
便不通也。女劳疸则额上黑，肾病色也；微汗出，湿不瘀也；五心热，薄暮发，肾阴
热也；膀胱急，小便利，下焦虚也。腹满如水状，脾肾两败，故谓不治也。若心中懊
□而热，不能食，时欲吐，小腹满，小便不利，虽见目青面黑，必是酒疸病也。
@@@
脉沉，渴欲饮水，小便不利者，皆发黄。
【注】
脉沉，主里也，渴欲饮水，热瘀也；小便不利，湿郁也，热瘀湿郁于里，故发黄也。
首条谓脉浮缓紧数皆令发黄，是得之于外因也；此条脉沉亦令发黄，是得之于内因也
，故治黄有汗、下二法也。
【集注】
李□曰：脉沉而渴，渴欲饮水，小便不利，则湿热内蓄，无从分消，故发黄也。
@@@
疸而渴者，其疸难治；疸而不渴者，其疸可治。发于阴部，其人必呕；发于阳部，其
人振寒而发热也。
【注】
未成疸前，小便不利而渴者，是欲作疸病也。已成疸后而渴者，是热深不已，故难治
也；不渴者是热浅将除，故可治也。疸发于阴者，人必呕逆，呕逆者，阴里为之也。
发于阳者，人必振寒发热，寒热者，阳表为之也。此以渴不渴，别疸之难治、可治；
以呕逆寒热，辨黄之在表、在里也。
【集注】
程林曰：黄家以湿热相搏，有口燥、鼻燥而未至于渴，渴则津液内消，邪气独胜；不
渴则津液未竭，正气未衰，治之所以分难易也。阴主里，湿胜于里则呕；阳主表，热
胜于表则振寒发热也。此条辨疸证之渴与不渴，有轻重表里之分也。
尤怡曰：疸而渴，则热方炽，而湿且日增，故难治；不渴则热已减，而湿亦自消，故
可治。阴部者，里之藏府，关于气，故呕；阳部者，表之躯壳，属于形，故振寒而发
热。此阴阳内外浅深微甚之辨也。
@@@
腹满，舌痿黄，躁不得眠，属黄家。
【按】
舌痿黄之「舌」字，当是「身」字，必传写之□。
【注】
舌痿而黄，腹满而躁不得睡者，属黄家之病，在里，当下之也。
【集注】
徐彬曰：腹满里证也，乃有腹满而加身痿黄，躁不得眠，瘀热外行，此发黄之渐也
。故曰：属黄家。
@@@
诸黄家病，但利其小便，假令脉浮者，当以汗解之，宜桂枝加黄耆汤主之。
【注】
诸黄家病，谓一切黄家病也。黄病无表里证，热盛而渴者，当清之，湿盛小便不利者
，但当利其小便。假令脉浮则为在表，当以汗解之，宜桂枝加黄耆汤。于此推之，可
知脉沉在里，当以下解之也。
【集注】
高世栻曰：利小便，乃黄家一定之法，故曰诸病黄家，但利小便。然亦自有宜汗者，
故又曰：假令脉浮为在表，当以汗解之。汗解之法，宜桂枝加黄耆汤，用桂枝汤以解
肌，肌解则汗自出，加黄耆以助表，表和则荣卫亦通矣。
寸口脉象浮而缓，浮脉主风邪，缓脉主湿痹，这种湿痹并非中风病，患者四肢感到烦扰不适，脾的色泽表现为黄色，瘀滞的热邪随气血运行周身。
趺阳脉象紧而数，数脉主热，热盛则消谷善饥；紧脉主寒，寒盛则进食后脘腹胀满。尺脉浮表示伤肾，趺阳脉紧表示伤脾。风寒之邪相互搏结，进食后即感头晕目眩，水谷之气不能正常运化，胃中苦于浊气内停，浊气下流注于膀胱，导致小便不通；阴分受寒邪侵袭，热邪流入膀胱，致使全身发黄，这种病症称为谷疸（因饮食不当引起的黄疸）。若见额头颜色发黑，微微出汗，手足心发热，傍晚时分发作，伴有膀胱拘急但小便自利，这种病症称为女劳疸（因房劳过度引起的黄疸）；若腹部胀大如水肿状，则属难治之症。若心中烦闷懊恼且伴有热感，不能进食，时常想呕吐，这种病症称为酒疸（因饮酒过多引起的黄疸）。
【注解】
寸口脉浮而缓，浮主风，缓主痹，痹非中风，前文已详细论述过。现在趺阳脉紧数而尺脉浮，四肢烦扰，身面颜色发黄，这是黄疸病。黄色是土的颜色，土病则显现于此，土对应脾胃，脾为阴土主湿，胃为阳土主热，所以凡是患黄疸病，都是由于湿邪瘀滞、热邪郁结所致，行于体表则必然出现四肢烦扰、身面发黄的症状。大概是因为患者素来体内有湿热，外受风寒相搏，内因房劳所伤，或是饮食不节、饮酒过度，或与湿邪瘀结，或与热邪郁结，都能导致此病。如果胃脉数，说明热胜于湿，则从胃阳热化，热盛则消谷，所以能进食，这称为阳黄。如果胃脉紧，说明湿胜于热，则从脾阴寒化，寒盛则不食，所以进食即胀满，这称为阴黄。阳黄包括热疸和酒疸，阴黄包括女劳疸和谷疸。如果尺脉不沉反浮，则是伤肾，肾病导致的黄疸，也是女劳疸。如果胃脉不缓反紧，则是伤脾，脾病导致的黄疸，也是谷疸。谷疸表现为进食后即感胀满，水谷之气不消，胃中苦于浊气，精气受阻不能上行，所以头部眩晕；浊气流注膀胱，所以小便不通。女劳疸表现为额头发黑，这是肾病的色征；微微出汗，说明湿邪未瘀结；五心烦热，傍晚发作，这是肾阴虚热；膀胱拘急但小便通利，这是下焦虚损。腹部胀满如水肿状，是脾肾两败，所以称为不治之症。如果心中烦闷懊恼且热，不能进食，时常想吐，小腹胀满，小便不利，即使见到眼睛青黑、面色黑，也一定是酒疸病。
脉象沉，口渴想喝水，小便不利的，都会发黄。
【注解】
脉沉，主里证；口渴想喝水，是热邪瘀结；小便不利，是湿邪郁滞。热瘀湿郁在体内，所以发黄。第一条说脉浮、缓、紧、数都会导致发黄，这是由外因引起的；这一条说脉沉也会导致发黄，这是由内因引起的，所以治疗黄疸有发汗和攻下两种方法。
【集注】
李□说：脉沉而渴，渴欲饮水，小便不利，则湿热内蓄积，无法从上下分消，所以发黄。
黄疸而口渴的，其病难治；黄疸而不口渴的，其病可治。病发于阴分的，患者必定呕吐；病发于阳分的，患者必定恶寒战栗并发热。
【注解】
尚未形成黄疸之前，小便不利且口渴的，是即将发生黄疸病。已经形成黄疸之后仍然口渴的，是热邪深重不已，所以难治；不口渴的是热邪浅表将要消除，所以可治。黄疸发于阴分的，人必定呕吐逆乱，呕吐逆乱是因为阴里受病。发于阳分的，人必定恶寒战栗并发热，寒热症状是因为阳表受病。这里通过是否口渴来辨别黄疸的难治与可治；通过呕吐、恶寒发热来辨别黄疸是在表还是在里。
【集注】
程林说：黄疸病患者多有湿热相搏，有口燥、鼻燥但未至于渴，若口渴则津液内耗，邪气独盛；若不渴则津液未竭，正气未衰，治疗因此分为难易两类。阴主里，湿邪胜于里则呕吐；阳主表，热邪胜于表则恶寒战栗并发热。这一条辨析黄疸证的渴与不渴，有轻重、表里的区别。
尤怡说：黄疸而口渴，则热势正炽，且湿邪日益增加，所以难治；不渴则热势已减，湿邪也会自行消退，所以可治。阴部指体内的脏腑，关乎气机，所以呕吐；阳部指体表的躯壳，关乎形体，所以恶寒战栗并发热。这是对阴阳、内外、浅深、微甚的辨析。
腹部胀满，身体萎黄，烦躁不得睡眠，属于黄疸病范畴。
【按语】
“舌痿黄”中的“舌”字，应当是“身”字，必然是传抄过程中的错误。
【注解】
身体萎黄且腹部胀满，烦躁不得入睡的，属于黄疸病，病位在里，应当用攻下法治疗。
【集注】
徐彬说：腹满是里证，如果有腹满且加上身体萎黄，烦躁不得睡眠，这是瘀热外行的表现，这是发黄的征兆。所以说：属于黄疸病家。
各种黄疸病患者，只要通利小便即可；假如脉象浮的，应当用发汗法解除，适宜用桂枝加黄芪汤主治。
【注解】
各种黄疸病患者，指一切黄疸病。黄疸病没有明显的表里证候区分，热盛且口渴的，应当清热；湿盛且小便不利的，只应当通利小便。假如脉浮则表示病在表，应当用发汗法解除，适宜用桂枝加黄芪汤。由此推断，可知脉沉表示病在里，应当用攻下法解除。
【集注】
高世栻说：通利小便是治疗黄疸病的固定法则，所以说“诸病黄家，但利小便”。然而也有适宜发汗的情况，所以又说：“假如脉浮为在表，当以汗解之。”发汗的方法，适宜用桂枝加黄芪汤，用桂枝汤来解肌发表，肌表得解则汗自出，加入黄芪以助卫气，表气和顺则营卫也能通畅了。
The pulse at the Cun Kou (radial artery proximal crease) is floating and slow. Floating indicates wind, while slow indicates bi-syndrome (obstruction syndrome). This bi-syndrome is not wind-stroke. The patient suffers from vexation in the four limbs. The color of the spleen manifests as yellow, and stagnant heat circulates throughout the body.
The pulse at the Fu Yang (dorsalis pedis artery) is tight and rapid. Rapid indicates heat; heat consumes grain (causing hunger), so the patient can eat much. Tight indicates cold; cold causes fullness immediately after eating. A floating pulse at the Chi position (radial artery distal crease) indicates kidney injury. A tight pulse at the Fu Yang position indicates spleen injury. Wind and cold pathogens contend with each other. After eating, dizziness occurs. Grain qi fails to digest. The stomach suffers from turbid qi accumulation. Turbid qi flows downward into the bladder, causing urinary obstruction. Yin is affected by cold, while heat flows into the bladder. The entire body turns yellow. This is named Gu Dan (Grain Jaundice). If the forehead is black, there is slight sweating, heat in the hands and feet, onset in the evening, bladder urgency, but spontaneous urination, this is named Nu Lao Dan (Female Labor Jaundice). If the abdomen is swollen like water retention, it is incurable. If there is mental restlessness and heat (Ao Nao), inability to eat, and occasional desire to vomit, this is named Jiu Dan (Wine Jaundice).
[Annotation]
A floating and slow pulse at Cun Kou, where floating indicates wind and slow indicates bi-syndrome, and bi-syndrome is not wind-stroke, has been discussed in detail previously. Now, with a tight and rapid pulse at Fu Yang and a floating pulse at Chi, along with vexation in the four limbs and yellowing of the body and face, this is jaundice. Yellow is the color of Earth. Earth disease manifests here. Earth corresponds to the Spleen and Stomach. The Spleen is Yin Earth governing dampness; the Stomach is Yang Earth governing heat. Therefore, all cases of jaundice are due to dampness stagnation and heat depression. When circulating externally, it necessarily causes vexation in the four limbs and yellowing of the body and face. Generally, if the person has pre-existing damp-heat, combined externally with wind-cold contention, or injured internally by sexual exhaustion, or through improper diet and alcohol consumption, interacting with dampness or heat, all can cause this disease. If the Stomach pulse is rapid, heat exceeds dampness, transforming via Stomach Yang heat. Heat consumes grain, so the patient can eat; this is called Yang Huang (Yang Jaundice). If the Stomach pulse is tight, dampness exceeds heat, transforming via Splein Yin cold. Cold prevents eating, causing fullness upon eating; this is called Yin Huang (Yin Jaundice). Yang Huang includes Re Dan (Heat Jaundice) and Jiu Dan (Wine Jaundice). Yin Huang includes Nu Lao Dan (Female Labor Jaundice) and Gu Dan (Grain Jaundice). If the Chi pulse is not deep but floating, it indicates kidney injury. Kidney disease causing jaundice is also Nu Lao Dan. If the Stomach pulse is not slow but tight, it indicates spleen injury. Spleen disease causing jaundice is also Gu Dan. Gu Dan presents with fullness upon eating, failure of grain qi to digest, suffering from turbid qi in the stomach, obstruction of essence qi from ascending, causing dizziness; turbid qi flows to the bladder, causing urinary obstruction. Nu Lao Dan presents with a black forehead (color of kidney disease); slight sweating indicates dampness is not stagnant; heat in the five centers (palms, soles, chest) occurring in the evening indicates kidney yin heat; bladder urgency with free urination indicates lower jiao deficiency. Abdominal fullness resembling water retention indicates dual failure of spleen and kidney, hence termed incurable. If there is mental restlessness and heat, inability to eat, occasional vomiting, lower abdominal fullness, and urinary difficulty, even if the eyes appear greenish-black and the face black, it must be Jiu Dan (Wine Jaundice).
If the pulse is deep, there is thirst with desire to drink water, and urinary difficulty, jaundice will ensue.
[Annotation]
A deep pulse indicates interior syndrome. Thirst with desire to drink indicates heat stagnation. Urinary difficulty indicates dampness depression. Heat stagnation and dampness depression within the interior cause jaundice. The first clause states that floating, slow, tight, and rapid pulses all cause jaundice, indicating an external etiology. This clause states that a deep pulse also causes jaundice, indicating an internal etiology. Thus, treating jaundice involves two methods: diaphoresis (sweating) and purgation.
[Collected Annotations]
Li [Name Redacted] said: With a deep pulse and thirst, desiring to drink, and urinary difficulty, damp-heat accumulates internally without a way to dissipate, causing jaundice.
If jaundice is accompanied by thirst, it is difficult to treat; if jaundice is not accompanied by thirst, it is treatable. If originating from the Yin aspect, the patient will certainly vomit; if originating from the Yang aspect, the patient will experience chills and fever.
[Annotation]
Before jaundice forms, urinary difficulty with thirst indicates impending jaundice. After jaundice forms, persistent thirst indicates deep-seated heat, making it difficult to treat. Lack of thirst indicates shallow heat即将 resolving, making it treatable. Jaundice originating from Yin causes vomiting/reversal of Qi, due to interior Yin pathology. Jaundice originating from Yang causes chills and fever, due to exterior Yang pathology. Here, thirst versus no thirst distinguishes between difficult and treatable jaundice; vomiting versus chills/fever distinguishes between jaundice in the exterior and interior.
[Collected Annotations]
Cheng Lin said: In jaundice cases, damp-heat contends. There may be dry mouth and nose but not reaching thirst. Thirst implies internal consumption of fluids and dominance of pathogenic factors. No thirst implies fluids are not exhausted and healthy Qi is not weak, distinguishing the ease or difficulty of treatment. Yin governs the interior; dampness dominating the interior causes vomiting. Yang governs the exterior; heat dominating the exterior causes chills and fever. This clause differentiates jaundice based on thirst, indicating differences in severity and location (exterior/interior).
You Yi said: Jaundice with thirst means heat is blazing and dampness increases daily, hence difficult to treat. No thirst means heat has subsided and dampness naturally dissipates, hence treatable. "Yin parts" refer to interior zang-fu organs related to Qi, hence vomiting. "Yang parts" refer to exterior body shell related to form, hence chills and fever. This is a differentiation of Yin/Yang, interior/exterior, shallow/deep, and mild/severe.
Abdominal fullness, flaccid yellow body, restlessness preventing sleep, belongs to the category of jaundice patients.
[Commentary]
The character "tongue" (She) in "flaccid yellow tongue" should be "body" (Shen), likely a transcription error.
[Annotation]
Flaccid yellow body, abdominal fullness, and restlessness preventing sleep belong to the disease of jaundice patients. It is an interior condition and should be treated with purgation.
[Collected Annotations]
Xu Bin said: Abdominal fullness is an interior sign. If abdominal fullness is accompanied by a flaccid yellow body and restlessness preventing sleep, this is stagnant heat moving outward, a precursor to jaundice. Hence, it says: belongs to jaundice patients.
For all jaundice patients, promoting urination is the primary method. However, if the pulse is floating, it should be resolved through diaphoresis. Gui Zhi Jia Huang Qi Tang (Cinnamon Twig Decoction plus Astragalus) should be administered.
[Annotation]
"All jaundice patients" refers to all cases of jaundice. Jaundice does not have distinct exterior or interior signs initially. If heat is excessive with thirst, clear heat. If dampness is excessive with urinary difficulty, promote urination. If the pulse is floating, the pathogen is in the exterior, requiring diaphoresis. Gui Zhi Jia Huang Qi Tang is indicated. From this, we can infer that if the pulse is deep, the pathogen is in the interior, requiring purgation.
[Collected Annotations]
Gao Shishi said: Promoting urination is the fixed method for jaundice, hence "all jaundice patients, only promote urination." However, some cases suit diaphoresis, hence "if the pulse is floating, it is in the exterior, resolve via sweating." The method for diaphoresis is Gui Zhi Jia Huang Qi Tang. Use Gui Zhi Tang (Cinnamon Twig Decoction) to release the muscle layer; once the muscle layer is released, sweat occurs naturally. Add Huang Qi (Astragali Radix) to assist the exterior. When the exterior harmonizes, Ying and Wei (Nutritive and Defensive Qi) also flow smoothly.