五疸实热，脉必洪数。涩微属虚，最忌发渴。
疸者，黄胆也，谓湿疸、谷疸、女劳疸、酒疸及黄汗也。名虽分五，实脾胃为
之总司，湿热为之原始。夫脾胃属土，合肌肉而主四肢。其化湿，其性滞着，其色
黄，其脉迟缓。所畏者风木，而复喜风之燥。能制者寒水，而反恶水之湿。人之病
也，若内无脾胃之郁，外无风湿之搏，虽有外邪，气机自利，热不 蒸，黄又何自
而成乎？故《金匮要略》论湿疸曰∶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。盖言风之独行者，乃名中风。中风则腠理空
疏，皮毛开泄，汗出热越，不能发黄。今则脉浮而缓，浮固为风，缓为土湿。湿则
痹着，非若风之疏利，必郁瘀成热。脾土所主之四肢，亦苦烦闷，而黄色则蒸行于
表也。其论谷疸，则曰∶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。夫人饮
食入胃，胃主消纳，脾主运输。脾胃温和，两称其职。今胃热而过于强，则徒能消
纳。脾寒而失之弱，则不能运输。既寒且弱，肝木得以乘之。木者，风也。风与寒
搏，脾愈不运。更加以食，气愈不消。搏于寒，则中为满。搏于风，则上为眩。气
既不消，胃中自浊。浊则不能清升，而反下流。下流则脾之紧寒乘肾，胃之数热乘
膀胱。（《尚书》洪范曰∶土爰稼穑。稼穑作甘。夫万物藉土以生，人赖稼穑以养。稼穑者，谷也。
谷气下流，而必归之肾与膀胱者，亦土乘水义。《难经》三十七难曰∶脾气通于口，口和则知谷味矣。
脾主五味，食味之归于脾者不可胜数，而独言一谷味者，正稼穑作甘之义也。）膀胱者，州都之官，主
藏津液。肾者水脏，主通二阴。热流膀胱，而小便又复不利。水与热郁，未有不蒸 而成黄者。
以膀胱太阳主表，故黄
遍于周身也。（或兼寒热不食，食即头眩，心胸不安，久久发黄为谷疸。宜茵陈汤加减主之。）其论女
劳疸，则曰额上黑，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。此言女劳而成疸，则黄不言可知矣。细察仲景文义，是亦谷气郁蒸之
变证也。盖人过劳于房室则伤精，精伤则肾虚，肾虚则真水不足，真水不足则相火
炽炎。于是胃中浊热之气，不流于膀胱而竟归之肾。一以乘不足之水虚，一以就同
类之火炽。火炽则君火亦因而动。况子午同气，心肾交通，故不惟肾经之足心热，
而心经之掌心亦热也。薄暮气降而属阴，乘其已虚之阴，助其下流之势，无如此际，
故薄暮病即发也。膀胱虽虚急，而热不内蓄，故小便自利也。若湿热相火郁甚，久
而不愈，则脾气积而不运，肾气散而不藏，致腹胀如有水状者，是脾肾两败，故不
治也。《金匮》又云∶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，宜硝矾散主之。其论酒疸，则曰∶心中懊 而热，不能
食，时欲吐，名曰酒疸。酒疸者，过饮而病黄，亦谷气郁蒸之变证也。《灵枢》论勇
篇云∶酒者，水谷之精，熟谷之液也。熟则已经酝酿，拔其精微，蜕其糟粕，纯阳
气胜之物。其性 悍，多升而少降。（今人饮少酒即头面先红，此多升少降之明验也。）非上所云谷气，
未经腐熟酝酿者比。故湿热不流于下，但积于中焦，郁胃熏心，令人外发黄而内烦
懊，不能食而时欲吐也。又云∶酒疸诸证，小便不利，心中热，足下热，又或无热，
谵语，小腹满，欲吐，鼻燥。其脉浮者，先吐之。沉弦者，先下之。心中热，欲呕
者，吐之愈。酒疸下之，久久为黑疸，目青面黑，心中如啖蒜齑状，大便正黑，皮
肤抓之不仁，其脉浮弱，虽黑微黄，故知之。酒疸心中懊 ，或热痛，栀子大黄汤
主之。黄汗一证，仲景《金匮要略》收入水气病中，其主治与治疸亦自悬绝。后人
以其汗黄，遂列为五疸之一，实非疸也。今本文既云五疸，则黄汗在其中，似不可
移去，姑从之，而论治仍从《要略》。在圆机者，自为识别可也。《要略》曰∶黄汗之
为病，身体重，发热汗出而渴，状如风水，汗沾衣，色正黄如柏汗，脉自沉，从何
得之？师曰∶以汗出入水中浴，水从汗孔入得之，宜黄 芍桂酒汤主之，此黄汗之
病因也。盖人作劳汗出，阳气动张，阴液妄泄。此时玄府未闭，荣卫两虚，即浴于
水。水寒之邪，未有不乘虚而入者。入则水湿内侵，浮阳外拒，郁搏于肌肉之间。
肌肉者，脾土之合，故身则发热，而汗则见黄色也。原以荣卫虚而受邪，邪入则愈
虚，而阳仍不固，阴液仍泄。即仲景所云阳浮者热自发，阴弱者汗自出之义。以汗
液出多，故渴。以水气在表，故状如风水。水性就下，故脉沉。治以黄 芍桂酒汤
者，所以和荣固卫，托里建中，则黄从汗减，水从汗消，与治疸之发汗利小便者，
固不可同日语也。又云∶黄汗之病，两胫自冷。假令发热，此属历节。食已汗出，
又身常暮盗汗出者，此荣气也。若汗出已，反发热者，久久其身必甲错。发热
不止者，必生恶疮。若身重，汗出已辄轻者，久久必身 。 即胸中痛。又从腰以
上汗出，下无汗，腰髋弛痛，如有物在皮中状，剧者不能食，身疼重，烦躁，
小便不利，此为黄汗，桂枝加黄 汤主之。此黄汗之变证也。黄汗既为阴阳两虚，
阳则浮散于表，阴则脱根于下。两胫逆冷者其常也。今不冷而反发热，是热为湿郁
所成，乘阴之虚，流注下焦，以及于胫。而胫以上之诸节，历遍而痛，不言可知。
此黄汗之传为历节者如此。卫者，阳气也。劳则阳动，阳动则卫气张散。卒逢食谷，
胃阳骤升。张散之虚阳不能羁谷气之 悍，故与之俱出而为汗也。又暮为阳衰之时，
劳动衰耗之阳，暮则愈衰。衰则不能外固，而汗因盗出矣。此黄汗之挟劳气者如此。
凡热随汗而解者，理之常也。今汗已，反更发热，如是久久，则津液续亡，肌肤枯
涩，身体又安得不甲错乎？甲错而热仍不止，不但浅灾肌肤，亦将祸延肉理。恶疮
之生，势所必然。（如流注痈毒之类，故云恶。）身重者，水湿之邪也。汗出辄轻，似乎邪解，
今云久久者，必轻而复重，重而复轻。亡散卫阳，耗竭津液，不知其几。而邪仍不
去，则必转为身 ，而胸中痛矣。《灵枢》本藏篇云∶卫气和，则分肉解利，皮肤调
柔，腠理致密。又云∶卫气者，所以温分肉，充皮肤，肥腠理，司开阖。《素问》痹
论又云∶卫气循皮肤之中，分肉之间，熏于肓膜，散于胸腹。调经论亦云∶阳受气
于上焦，以温皮肤分肉之间。观诸篇论，则知人身分肉腠理，皆卫气之所充实。上
焦胸腹，皆卫阳之所布输。今卫气亡散，分肉腠理不能致密，而反空虚，空虚故
而动。上焦胸腹不得受其熏布，亦随 而为虚痛也。（痛必欲按。）荣气既虚，卫复不固。
况腰以上为阳，阳主开，故汗出。腰以下为阴，阴主阖，荣卫虚而邪复滞着，故无
汗。惟其无汗，邪不松解，故如有物在皮中，而腰 为之弛痛也。剧则三焦皆无所
御，荣卫不能相将。气不将于上，则不能食。气不将于中，则生烦躁。气不将于下，
则小便不利。治以桂枝加黄 汤者，与上条黄 芍桂酒汤之义亦同。但此条云食已
汗出，常暮盗汗，汗已反热，汗出辄轻而不解，汗上出而下无，皆似病在汗处，故
加姜、枣、甘草，盖欲助脾胃以行津液，益辛甘以别取正汗耳。诸病黄家，但利其
小便。假令脉浮，宜以汗解之，宜桂枝加黄 汤主之。（治疸利小便，固一定之法。然脉浮者郁在
表，又宜以汗解也。）诸黄，猪膏发煎主之。黄胆病，茵陈五苓散主之。（二皆通治之方。）黄胆腹
满，小便不利而赤，自汗出，此为表和里实，当下之，宜大黄硝石汤。（汗出为表和，腹
满、便实为里实。里实者宜下之。）黄胆病，小便色不变，欲自利，腹满而喘，不可除热，热除
必哕。哕者，小半夏汤主之。（小便色不变，大便欲自利，里无热也，则喘满为虚象。若认为热而除之，必胃
寒作哕矣。）诸黄腹痛而呕者，宜柴胡汤。（腹痛而呕，半表半里。柴胡汤即小柴胡汤也。）男子黄，小便
自利，当与虚劳小建中汤。（黄而小便自利，知非湿郁，乃男子劳役伤脾所致。脾伤则见土色。）病黄胆，
发热烦喘，胸满口燥者，以病发时，火劫其汗，两热所得。然黄家所得，从湿得之。
一身尽发热而黄，肚热。热在里，当下之。（凡病肚热者，热在腹，不独疸也。手按则知。）脉沉，
渴欲饮水，小便不利者，皆发黄。（沉为在里，渴为里热。热则多饮，而小便复不利，必郁为黄。）腹满，
舌痿黄燥，不得睡，属黄家。（胃土郁则水液不分布，故腹满、舌燥。经云∶胃不和则睡不安，
皆黄家之先驱也。）
黄胆之病，当以十八日为期。治之十日以上瘥，反剧为难治。（土旺于四时各十八日，湿土之病
期亦应之。十日以上则旺气渐衰，邪宜渐退。反剧者则正不胜邪，故云难治。）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。（湿土郁而成疸，
内关脾胃。发于脾阴则呕，发于胃阳则振寒发热，皆二经是动之病。）正文云∶五疸实热，以疸皆湿与热郁。
外不得通，内不得泄， 蒸成黄。虚松而有通泄处，则不能成黄，故曰实热，若是
则脉自应洪数。涩微者，自应为虚黄也。渴为里热，黄为表蒸。表里热亢，阴何以
堪？又疸既湿郁，汗溺不通，可复加之饮乎？渴则多饮，故最忌也。（丹溪云∶黄胆不必分
五。总是湿热不分。则何以处治，是失之太简。巢氏广为九疸，亦先之太繁。惟《金匮》论证处方，
言言中的。学人宗之，自无过不及之偏也。）
五疸（五种黄疸病）属于实热证，脉象必定是洪大且数急的。若脉象涩而微弱则属于虚证，最忌讳出现口渴症状。
疸，就是黄胆病，包括湿疸、谷疸、女劳疸、酒疸以及黄汗这五种。名称虽然分为五种，但实际上脾胃是总的主管，湿热是产生的根源。脾胃属土，合于肌肉并主宰四肢。其气化功能主司湿气，性质黏滞附着，颜色为黄色，脉象表现为迟缓。它所畏惧的是风木之气，却又喜欢风的燥性。能够制约它的是寒水之气，但却厌恶水的湿性。人之所以生病，如果体内没有脾胃的郁结，体外没有风湿的搏击，即使有外邪入侵，气机自然通畅，热气不致蒸腾，黄疸又从何产生呢？所以《金匮要略》论述湿疸时说：寸口脉浮而缓，浮脉代表风邪，缓脉代表痹阻。这种痹阻并非中风，而是四肢感到烦闷不适，脾的颜色必然发黄，瘀积的热邪随之运行。这是说风邪单独行走的情况，才叫中风。中风会导致腠理空疏，皮毛开泄，出汗后热邪发散，不能形成黄疸。现在则是脉象浮而缓，浮固然是风，缓则是土湿。湿气导致痹阻黏着，不像风那样疏利，必定会郁结瘀滞而成热邪。脾土所主的四肢，也会感到烦闷，而黄色就会蒸腾行散于体表。
关于谷疸的论述，则说：趺阳脉紧而数，数脉代表热，热则能消化食物。紧脉代表寒，进食后就感到胀满；尺脉浮，代表伤肾。趺阳脉紧，代表伤脾。风寒相互搏击，进食后就头晕目眩。谷气不能消化，胃中苦于浊气。浊气向下流注，小便不通畅。阴分受寒，热邪流入膀胱，身体全部发黄，名叫谷疸。人饮食进入胃中，胃主消纳，脾主运输。脾胃温和，两者各司其职。现在胃热过于强盛，则只能消纳而不能运化；脾寒而失之虚弱，则不能运输。既寒且弱，肝木得以乘虚侵袭。木对应风。风与寒搏击，脾更加不运化。再加上进食，气更加不消。搏结于寒，则中焦胀满；搏结于风，则上头眩晕。气既然不能消散，胃中自然浑浊。浊气不能清升，反而下流。下流则脾的紧寒之气乘袭肾脏，胃的数急热邪乘袭膀胱。（《尚书·洪范》说：土的特性是稼穑。稼穑产生甘味。万物依靠土生长，人依靠谷物养育。稼穑就是谷。谷气下流，必定归于肾与膀胱，这也是土乘克水的义理。《难经》第三十七难说：脾气通于口，口调和就能知道谷物的味道。脾主管五味，食味归于脾的不可胜数，但唯独说一谷味，正是稼穑作甘的含义。）膀胱是州都之官，主要储藏津液。肾是水脏，主管前后二阴。热邪流入膀胱，而小便又不通畅。水与热郁结，没有不蒸腾而成黄的。因为膀胱太阳经主表，所以黄色遍布周身。（有时兼有寒热、不能进食，进食即头晕，心胸不安，久久发黄成为谷疸。适宜茵陈汤加减主治。）
关于女劳疸的论述，则说：额头发黑，微微出汗，手足心发热，傍晚时分发作，膀胱拘急，小便自利，名叫女劳疸。腹部像有水状，无法治愈。这是说因房劳过度而成疸，那么黄色不言可知。仔细考察张仲景的文义，这也是谷气郁蒸的变证。大概人如果在房事上过度劳累就会伤精，精伤则肾虚，肾虚则真水不足，真水不足则相火炽盛炎上。于是胃中浊热之气，不流于膀胱而竟归于肾。一方面乘袭不足的水虚，一方面就同类之火炽盛。火炽盛则君火也因而动摇。况且子午同气，心肾交通，所以不仅肾经的足心热，心经的掌心也热。傍晚时气降而属阴，乘袭已经虚弱的阴气，助长其下流的趋势，无此际遇，所以傍晚病即发作。膀胱虽然虚急，但热不内蓄，所以小便自利。如果湿热相火郁结严重，久治不愈，则脾气积聚而不运，肾气散失而不藏，导致腹胀好像有水状，这是脾肾两败，所以无法治愈。《金匮要略》又说：黄疸病患者在日晡时（下午3-5点）发热，反而恶寒，这是女劳疸所致。膀胱拘急，少腹满，全身发黄，额头黑，脚底热，因此形成黑疸。其腹胀如水状，大便必定黑，时而溏薄。这是女劳的病，不是水气病。腹满者难治，适宜硝矾散主治。
关于酒疸的论述，则说：心中懊憹（烦闷不安）且热，不能进食，时常想吐，名叫酒疸。酒疸，是因为过量饮酒而病黄，也是谷气郁蒸的变证。《灵枢·论勇篇》说：酒，是水谷的精微，是熟谷的液体。经过酝酿，提取了精微，蜕去了糟粕，是纯阳气盛的物体。其性悍烈，多升而少降。（现代人喝少量酒即头面先红，这是多升少降的明显验证。）不同于上面所说的未经腐熟酝酿的谷气。所以湿热不流于下，只积聚在中焦，郁结熏蒸胃和心，让人外表发黄而内心烦闷懊恼，不能进食且时常想吐。又说：酒疸的各种症状，小便不利，心中热，脚底热，或者无热，谵语，小腹满，想吐，鼻干。脉象浮的，先用吐法。脉象沉弦的，先用下法。心中热，想呕吐的，用吐法可愈。酒疸如果用下法，久久会变成黑疸，眼睛青黑，面色黑，心中像吃蒜泥一样的感觉，大便正黑，皮肤抓之不仁，脉象浮弱，虽然是黑色但微带黄色，所以可以知晓。酒疸心中懊憹，或者热痛，用栀子大黄汤主治。
黄汗这一证候，张仲景将其收入《金匮要略》的水气病篇中，其主治方法与治黄疸截然不同。后人因为其汗黄，遂列为五疸之一，其实并不是疸。现在本文既然说五疸，那么黄汗在其中，似乎不可移去，姑且遵从，但论治仍从《要略》。在圆融机变的人看来，自然会识别区分。《要略》说：黄汗这个病，身体沉重，发热出汗且口渴，状如风水病，汗沾衣服，颜色正黄如柏汁，脉象自沉，从哪里得来的呢？医生说：因为出汗时进入水中洗澡，水从汗孔进入而得病，适宜黄耆芍药桂枝酒汤主治，这是黄汗的病因。大概人劳作出汗，阳气动荡张开，阴液妄泄。此时玄府未闭，营卫两虚，立即在水中洗浴。水寒之邪，没有不乘虚而入的。进入体内则水湿内侵，浮阳在外抗拒，郁搏于肌肉之间。肌肉是脾土所合，所以身发热，而汗见黄色。原本是因为营卫虚而受邪，邪入则更虚，而阳仍不固，阴液仍泄。就是张仲景所说的阳浮者热自发，阴弱者汗自出的义理。因为汗液出得多，所以渴。因为水气在表，所以状如风水。水性就下，所以脉沉。治疗用黄耆芍药桂枝酒汤，是为了调和营卫，固护卫气，托里建中，则黄从汗减，水从汗消，这与治黄疸的发汗利小便的方法，本来不可同日而语。
又说：黄汗的病，两小腿自冷。假如发热，这属于历节病。吃饭后出汗，又身体常在傍晚盗汗出，这是营气的问题。如果出汗后，反而发热，久久身体必定甲错（皮肤粗糙如鳞甲）。发热不止者，必生恶疮。如果身体重，出汗后随即减轻，久久必身瞤动（肌肉跳动），甚至胸中痛。又从腰以上出汗，下身无汗，腰髋弛痛，好像有物在皮中，严重者不能食，身疼重，烦躁，小便不利，这是黄汗，用桂枝加黄耆汤主治。这是黄汗的变证。黄汗既然是阴阳两虚，阳则浮散于表，阴则脱根于下。两小腿逆冷是其常态。现在不冷反而发热，是热被湿郁结成，乘阴之虚，流注下焦，以至于小腿。而小腿以上的诸关节，遍行而痛，不言可知。这就是黄汗传变为历节的情形。卫气，是阳气。劳作则阳动，阳动则卫气张散。突然遇到进食，胃阳骤升。张散的虚阳不能羁留谷气的悍烈，所以与之俱出而为汗。又傍晚是阳气衰弱的时候，劳动耗损了衰弱的阳，傍晚则更衰。衰则不能外固，所以汗因盗出。这就是黄汗挟带劳气的情形。凡是热随汗而解的，是常理。现在汗已出，反而更发热，如是久久，则津液续亡，肌肤枯涩，身体又怎能不甲错呢？甲错而热仍不止，不但浅灾肌肤，也将祸延肉理。恶疮的产生，势所必然。（如流注痈毒之类，所以称恶。）身重者，是水湿之邪。汗出辄轻，似乎邪解，现在说久久者，必轻而复重，重而复轻。亡散卫阳，耗竭津液，不知有多少次。而邪仍不去，则必转为身瞤动，而胸中痛了。《灵枢·本藏篇》说：卫气和，则分肉解利，皮肤调柔，腠理致密。又说：卫气，是用来温养分肉，充实皮肤，肥厚腠理，司职开阖的。《素问·痹论》又说：卫气循行于皮肤之中，分肉之间，熏蒸于肓膜，散布于胸腹。《调经论》也说：阳受气于上焦，以温养皮肤分肉之间。观诸篇论述，则知人身分肉腠理，都是卫气所充实。上焦胸腹，都是卫阳所布输。现在卫气亡散，分肉腠理不能致密，反而空虚，空虚故而动。上焦胸腹不得受其熏布，也随动而为虚痛。（疼痛一定想要按压。）荣气既虚，卫复不固。况且腰以上为阳，阳主开，所以汗出。腰以下为阴，阴主阖，荣卫虚而邪复滞着，所以无汗。正因为无汗，邪不松解，所以如有物在皮中，而腰髋为之弛痛。严重时三焦皆无所抵御，荣卫不能相将。气不将于上，则不能食。气不将于中，则生烦躁。气不将于下，则小便不利。治疗用桂枝加黄耆汤，与上一条黄耆芍药桂枝酒汤的意义相同。但此条说食已汗出，常暮盗汗，汗已反热，汗出辄轻而不解，汗上出而下无，都像病在汗处，所以加姜、枣、甘草，大概是想要帮助脾胃以行津液，益辛甘以别取正汗罢了。
所有患黄疸病的人，只要利其小便。假如脉浮，适宜用汗法解之，适宜桂枝加黄耆汤主治。（治黄疸利小便是固定之法。然而脉浮者郁在表，又适宜用汗法解。）所有黄疸，猪膏发煎主治。黄疸病，茵陈五苓散主治。（这两个都是通治之方。）黄疸腹满，小便不利而赤，自汗出，这是表和里实，当下之，宜大黄硝石汤。（汗出为表和，腹满、便实为里实。里实者宜下之。）黄疸病，小便色不变，欲自利，腹满而喘，不可除热，热除必哕。哕者，小半夏汤主治。（小便色不变，大便欲自利，里无热也，则喘满为虚象。若认为热而除之，必胃寒作哕矣。）所有黄疸腹痛而呕者，宜柴胡汤。（腹痛而呕，半表半里。柴胡汤即小柴胡汤也。）男子黄，小便自利，当与虚劳小建中汤。（黄而小便自利，知非湿郁，乃男子劳役伤脾所致。脾伤则见土色。）病黄疸，发热烦喘，胸满口燥者，因为发病时，火劫其汗，两热所得。然而黄家所得，从湿得之。一身尽发热而黄，肚热。热在里，当下之。（凡病肚热者，热在腹，不独疸也。手按则知。）脉沉，渴欲饮水，小便不利者，皆发黄。（沉为在里，渴为里热。热则多饮，而小便复不利，必郁为黄。）腹满，舌痿黄燥，不得睡，属黄家。（胃土郁则水液不分布，故腹满、舌燥。经云：胃不和则睡不安，皆黄家之先驱也。）
黄疸病，应当以十八天为期。治疗十天以上痊愈，反而加重则难治。（土旺于四季各十八日，湿土之病期也应之。十日以上则旺气渐衰，邪宜渐退。反剧者则正不胜邪，故云难治。）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。（湿土郁而成疸，内关脾胃。发于脾阴则呕，发于胃阳则振寒发热，皆二经是动之病。）正文说：五疸实热，因为疸都是湿与热郁结。外不得通，内不得泄，蒸腾成黄。虚松而有通泄处，则不能成黄，所以说实热，若是则脉自应洪数。涩微者，自应为虚黄也。渴为里热，黄为表蒸。表里热亢，阴何以堪？又疸既湿郁，汗溺不通，可复加之饮乎？渴则多饮，所以最忌。（丹溪说：黄疸不必分五。总是湿热不分。则何以处治，是失之太简。巢氏广为九疸，亦先之太繁。惟《金匮》论证处方，言言中的。学人宗之，自无过不及之偏也。）
Wu Dan (Five Types of Jaundice) belongs to the excess-heat syndrome, and the pulse must be surging (Hong) and rapid (Shuo). If the pulse is choppy (Se) and faint (Wei), it indicates a deficiency syndrome; thirst is strictly contraindicated.
Dan refers to Huang Dan (Jaundice), which includes Shi Dan (Dampness Jaundice), Gu Dan (Grain Jaundice), Nü Lao Dan (Female Exhaustion Jaundice), Jiu Dan (Alcohol Jaundice), and Huang Han (Yellow Sweat). Although named as five types, in reality, the Spleen and Stomach are the general managers, and Damp-Heat is the origin. The Spleen and Stomach belong to Earth, combine with muscles, and govern the four limbs. Their transformation governs dampness, their nature is sticky and adherent, their color is yellow, and their pulse is slow (Chi) and moderate (Huan). They fear Wood (Wind), yet prefer the dryness of Wind. They can be controlled by Water (Cold), yet dislike the dampness of Water. When humans fall ill, if there is no internal stagnation of the Spleen and Stomach, and no external confrontation of Wind and Dampness, even if external pathogens invade, the Qi mechanism remains smooth, heat does not steam, and how could jaundice form? Therefore, *Jin Gui Yao Lue* discusses Shi Dan saying: The Cun Kou pulse is floating (Fu) and slow (Huan). Floating indicates Wind, slow indicates Bi obstruction. This Bi is not Zhong Feng (Wind Stroke); the four limbs suffer from vexation, the color of the Spleen must be yellow, and stagnant heat circulates. This means that when Wind moves alone, it is called Zhong Feng. Zhong Feng causes the Cou Li (pores) to be loose, the skin and hair follicles to open, sweat to flow, and heat to dissipate, preventing jaundice. Now, however, the pulse is floating and slow; floating is indeed Wind, but slow is Earth-Dampness. Dampness causes Bi obstruction, unlike Wind which is dispersing; it must stagnate and become heat. The four limbs governed by Spleen-Earth also suffer from vexation, and the yellow color steams and spreads on the surface.
Regarding Gu Dan, it says: The Fu Yang pulse is tight (Jin) and rapid (Shuo). Rapid indicates Heat, Heat digests grain. Tight indicates Cold, food intake leads to fullness. The Chi pulse floating indicates Kidney injury. The tight Fu Yang pulse indicates Spleen injury. Wind and Cold contend, dizziness occurs after eating grain. Grain Qi fails to digest, the Stomach suffers from turbid Qi. Turbid Qi flows downward, urination is blocked. Yin is affected by Cold, Heat flows into the Bladder, the whole body turns yellow, named Gu Dan. When food enters the Stomach, the Stomach governs digestion and reception, the Spleen governs transportation. When Spleen and Stomach are warm and mild, they perform their duties. Now, if Stomach Heat is excessive, it only digests but cannot transform; if Spleen Cold is weak, it cannot transport. Being both cold and weak, Liver-Wood takes advantage to invade. Wood corresponds to Wind. Wind contending with Cold makes the Spleen even less functional. Adding food makes Qi even less digestible. Contending with Cold causes middle-fullness; contending with Wind causes upper dizziness. Since Qi does not digest, the Stomach becomes turbid. Turbidity cannot ascend clearly but flows downward. Downward flow allows Spleen's tight Cold to attack the Kidney, and Stomach's rapid Heat to attack the Bladder. (*Shang Shu Hong Fan* states: Earth's nature is planting and harvesting. Planting and harvesting produce sweetness. All things rely on Earth to grow, humans rely on grains for nourishment. Planting and harvesting refer to grain. Grain Qi flowing downward returns to the Kidney and Bladder, which is the meaning of Earth overcoming Water. *Nan Jing* Chapter 37 states: Spleen Qi connects to the mouth; when the mouth is harmonious, one knows the taste of grain. The Spleen governs the five flavors; countless food flavors return to the Spleen, yet only one grain flavor is mentioned, reflecting the meaning of planting and harvesting producing sweetness.) The Bladder is the official of the reservoir, mainly storing fluids. The Kidney is the Water organ, governing the two yin openings. Heat flowing into the Bladder, while urination is difficult, causes water and heat to stagnate, inevitably steaming into yellow. Since the Bladder Tai Yang governs the exterior, the yellow covers the whole body. (Sometimes accompanied by chills, fever, anorexia, dizziness after eating, chest discomfort, turning yellow over time into Gu Dan. Yin Chen Tang with modifications is indicated.)
Regarding Nü Lao Dan, it says: The forehead is black, slight sweating, heat in the hands and feet, onset at dusk, bladder urgency, spontaneous urination, named Nü Lao Dan. Abdomen looks like it contains water, untreatable. This implies that jaundice caused by sexual exhaustion results in yellowing, which is self-evident. Carefully examining Zhang Zhongjing's text, this is also a variation of stagnant grain Qi steaming. Generally, excessive sexual activity injures Essence; essence injury leads to Kidney deficiency; Kidney deficiency leads to insufficiency of True Water; insufficiency of True Water leads to blazing Minister Fire. Thus, turbid heat Qi in the Stomach does not flow to the Bladder but returns to the Kidney. It attacks the deficient Water and joins the blazing Fire. Blazing Fire agitates Lord Fire. Moreover, Zi and Wu share the same Qi, Heart and Kidney communicate, so not only is the sole of the foot hot (Kidney meridian), but the palm is also hot (Heart meridian). At dusk, Qi descends and belongs to Yin, attacking the already deficient Yin and aiding its downward trend, hence the disease manifests at dusk. Although the bladder is urgently deficient, heat does not accumulate internally, so urination is spontaneous. If Damp-Heat and Minister Fire are severely stagnant and chronic, Spleen Qi accumulates without transporting, Kidney Qi scatters without storing, leading to abdominal distension as if containing water; this is failure of both Spleen and Kidney, hence untreatable. *Jin Gui* further states: Jaundice patients have fever at dusk (You Shi) but paradoxically feel aversion to cold; this is caused by Nü Lao. Bladder urgency, lower abdomen fullness, whole body yellow, black forehead, hot soles, thus forming Hei Dan (Black Jaundice). Abdominal distension like water, stool must be black, sometimes loose. This is a disease of Nü Lao, not Water Qi. Abdominal fullness is difficult to treat; Xiao Fan San is indicated.
Regarding Jiu Dan, it says: Vexation (Ao Nao) and heat in the heart, inability to eat, frequent desire to vomit, named Jiu Dan. Jiu Dan is jaundice caused by excessive drinking, also a variation of stagnant grain Qi steaming. *Ling Shu: Lun Yong* states: Wine is the essence of water and grain, the fluid of cooked grain. After fermentation, extracting the subtle essence and shedding the dregs, it is a substance with pure Yang Qi prevailing. Its nature is fierce, rising more than descending. (The fact that modern people's faces turn red after drinking small amounts of wine is clear evidence of rising more than descending.) It differs from the unfermented grain Qi mentioned above. Thus, Damp-Heat does not flow downward but accumulates in the Middle Jiao, stagnating and steaming the Stomach and Heart, causing external yellowing and internal vexation, inability to eat, and frequent desire to vomit. It also states: Symptoms of Jiu Dan include difficult urination, heat in the heart, heat in the soles, or no heat, delirium, lower abdomen fullness, desire to vomit, dry nose. If the pulse is floating, induce vomiting first. If sinking and string-taut, induce purgation first. If heat in the heart and desire to vomit, vomiting cures it. If Jiu Dan is treated with purgatives, it eventually becomes Hei Dan, with blue-black eyes, black face, sensation of eating minced garlic in the heart, black stool, insensate skin upon scratching, floating-weak pulse; although black, slightly yellow, thus recognizable. For Jiu Dan with heart vexation or painful heat, Zhi Zi Da Huang Tang is indicated.
Huang Han (Yellow Sweat) is included in the Water Qi disease chapter of *Jin Gui Yao Lue*; its treatment is distinct from jaundice. Later authors classified it as one of the Five Dans due to yellow sweat, but it is not truly Dan. Since this text mentions Five Dans, Huang Han is included here and should not be removed; we follow it tentatively, but the treatment discussion follows *Yao Lue*. Those with flexible understanding will distinguish them. *Yao Lue* states: Huang Han disease presents with heavy body, fever, sweating, and thirst, resembling Feng Shui disease. Sweat stains clothes yellow like cypress sap, pulse is naturally sunken. How is it acquired? The Master says: Bathing in water while sweating, water enters through the pores. Huang Qi Shao Gui Jiu Tang is indicated. This is the etiology of Huang Han. Generally, labor causes sweating, Yang Qi moves and expands, Yin fluids leak recklessly. At this time, Xuan Fu (pores) are not closed, Ying and Wei are both deficient; bathing in water allows cold-damp pathogens to enter via deficiency. Water-damp invades internally, floating Yang repels externally, stagnating and contending between muscles. Muscles combine with Spleen-Earth, so the body feels hot, and sweat appears yellow. Originally, deficiency of Ying and Wei invites pathogens; pathogen entry increases deficiency, Yang remains insecure, Yin fluids continue to leak. This aligns with Zhongjing's principle: floating Yang causes spontaneous heat, weak Yin causes spontaneous sweat. Excessive sweat causes thirst. Water Qi on the exterior resembles Feng Shui. Water tends downward, so the pulse is sunken. Treatment with Huang Qi Shao Gui Jiu Tang harmonizes Ying and Wei, secures Wei, supports the interior, and establishes the center; thus yellow reduces via sweat, water dissipates via sweat. This cannot be compared to treating jaundice with diaphoresis and diuresis.
It also states: Huang Han disease presents with cold calves. If feverish, it belongs to Li Jie (Joint Bi). Sweating after eating, and night sweats in the evening, relate to Ying Qi. If fever persists after sweating, eventually the body becomes Jia Cuo (rough, scaly skin). Continuous fever generates evil sores. If heavy body, lightening after sweat, eventually muscle twitching (Shun) and chest pain. Sweating above the waist, no sweat below, flaccid pain in loins and hips, sensation of foreign body in skin, severe cases anorexia, body ache/heaviness, irritability, difficult urination; this is Huang Han, Gui Zhi Jia Huang Qi Tang is indicated. This is a variant of Huang Han. Huang Han involves both Yin and Yang deficiency; Yang floats outward, Yin detaches downward. Cold calves are normal. Now, instead of cold, there is fever; heat is formed by damp stagnation, attacking deficient Yin, flowing to the Lower Jiao and calves. Joints above the calves become painful throughout, which is self-evident. This is how Huang Han transmits to Li Jie. Wei Qi is Yang Qi. Labor moves Yang, Yang movement expands Wei Qi. Suddenly eating raises Stomach Yang rapidly. Expanded deficient Yang cannot restrain the fierce Grain Qi, so they exit together as sweat. Dusk is when Yang declines; labor depletes declining Yang, making it weaker at dusk. Weakness fails to secure the exterior, causing night sweats. This is Huang Han accompanying labor Qi. Normally, heat resolves with sweat. Now, fever persists after sweat; over time, fluids perish, skin becomes dry and rough, leading to Jia Cuo. Persistent heat beyond skin affects flesh layers, inevitably generating evil sores (such as abscesses). Heavy body is damp-wind pathogen. Lightening after sweat seems like pathogen resolution, but "over time" implies alternating lightness and heaviness. Loss of Wei Yang and depletion of fluids occur repeatedly. Pathogen remains, transforming into muscle twitching and chest pain. *Ling Shu: Ben Cang* states: Harmonious Wei Qi makes intermuscular spaces smooth, skin soft, Cou Li dense. Wei Qi warms muscles, fills skin, thickens Cou Li, controls opening/closing. *Su Wen: Bi Lun* states: Wei Qi circulates in skin and muscles, steams Huo membranes, scatters in chest/abdomen. *Tiao Jing Lun* states: Yang receives Qi from Upper Jiao to warm skin and muscles. From these texts, intermuscular spaces and Cou Li are filled by Wei Qi. Upper Jiao chest/abdomen are distributed by Wei Yang. Now, Wei Qi scatters, Cou Li becomes loose and empty, moving vacuously. Upper Jiao lacks warming distribution, becoming vacuous pain (relieved by pressure). Ying is deficient, Wei is insecure. Waist-up is Yang, Yang opens, so sweating. Waist-down is Yin, Yin closes; Ying-Wei deficiency and pathogen stagnation cause no sweat. No sweat means pathogen doesn't resolve, feeling like a foreign body in skin, causing flaccid loin/hip pain. Severe cases, Three Jiao has no defense, Ying-Wei cannot support each other. Qi failing to ascend causes anorexia; failing to mid-level causes irritability; failing to descend causes difficult urination. Gui Zhi Jia Huang Qi Tang shares the meaning of Huang Qi Shao Gui Jiu Tang. But this clause mentions post-prandial sweating, night sweats, persistent fever after sweat, partial sweating, suggesting pathology at the sweat site; thus adding Ginger, Jujube, Licorice to assist Spleen/Stomach in distributing fluids and obtain proper sweat via Pungent-Sweet synergy.
All jaundice patients should promote urination. If pulse is floating, use diaphoresis; Gui Zhi Jia Huang Qi Tang is indicated. (Promoting urination is fixed for jaundice, but floating pulse indicates exterior stagnation, requiring diaphoresis.) All jaundice may be treated with Zhu Gao Fa Jian. Jaundice disease may be treated with Yin Chen Wu Ling San. (Both are general formulas.) Jaundice with abdominal fullness, difficult/cherry-red urination, spontaneous sweating indicates Exterior Harmonious and Interior Excess; purge with Da Huang Xiao Shi Tang. (Sweating indicates Exterior Harmony; fullness/hard stool indicates Interior Excess requiring purgation.) Jaundice with unchanged urine color, desire for loose stools, abdominal fullness/wheezing should not have heat cleared; clearing heat causes hiccups. Hiccups are treated with Xiao Ban Xia Tang. (Unchanged urine/desire for loose stools indicates no Interior Heat; wheezing/fullness is deficiency. Clearing heat wrongly causes Stomach Cold hiccups.) Jaundice with abdominal pain and vomiting should use Chai Hu Tang. (Pain/vomiting indicates Half-Exterior/Half-Interior; Chai Hu Tang is Xiao Chai Hu Tang.) Male jaundice with spontaneous urination should receive Xu Lao Xiao Jian Zhong Tang. (Jaundice with spontaneous urination indicates not damp-stagnation, but Spleen injury from labor; Spleen injury reveals Earth color.) Jaundice with fever, vexation/wheezing, chest fullness/dry mouth results from fire-coercing sweat during onset, combining two heats. However, jaundice originates from dampness. Whole-body fever/yellowing, abdominal heat indicates Interior Heat requiring purgation. (Abdominal heat indicates Interior heat, palpable.) Sunken pulse, thirst with desire to drink, difficult urination all lead to yellowing. (Sunken indicates Interior, thirst indicates Interior Heat; heat causes drinking, difficult urination causes stagnation into yellow.) Abdominal fullness, tongue withered/yellow/dry, insomnia belong to Huang Jia. (Stomach Earth stagnation prevents fluid distribution, causing fullness/dry tongue. Classics state: Disharmonious Stomach leads to restless sleep; these are precursors of jaundice.)
Jaundice disease has an 18-day prognosis. Healing within 10+ days is good; worsening is difficult. (Earth prospers for 18 days in each season; damp diseases follow this. After 10 days, prosperous Qi declines, pathogen should retreat. Worsening means righteous Qi cannot overcome pathogen.) Jaundice with thirst is difficult; without thirst is treatable. Manifesting in Yin parts causes vomiting; manifesting in Yang parts causes chills and fever. (Damp-Earth stagnation affecting Spleen/Stomach. Manifesting in Spleen Yin causes vomiting; manifesting in Stomach Yang causes chills/fever; both are meridian activation diseases.) Text states: Five Dans are Excess Heat because damp and heat stagnate, unable to vent externally or drain internally, steaming into yellow. Deficient/loose conditions with drainage prevent yellowing, hence Excess Heat implies surging-rapid pulse. Choppy-faint pulses indicate Deficient Yellow. Thirst indicates Interior Heat, yellow indicates Exterior Steaming. Excess Exterior-Interior Heat overwhelms Yin. With damp stagnation blocking sweat/urine, adding fluids (drinking) is forbidden. Thirst leads to drinking, hence strictly contraindicated. (Danxi stated: Jaundice need not be divided into five; it is always Damp-Heat indistinguishable. His view was too simple. Chao Yuanfang expanded to Nine Dans, too complex. Only *Jin Gui* arguments and prescriptions hit the mark. Students following it avoid excess/deficiency biases.)