之。方用肉桂为君，余则胡卢巴、茯苓、泽泻、熟地、山萸、附子，夜服一剂。其气只冲至脐，加重肉桂，数
服全愈。（吴天士）
附方
治食瘕方 海蜇头二斤、荸荠二斤、烧酒二斤。共入砂锅，隔汤煮，至蜇化酒干，取荸荠阴干，空心吃五个。
治痞块方 松香二两、阿魏二钱、皮硝五钱、蓖麻子一两。共捣成膏，照痞形大小，摊于布上，贴时加麝
香五厘，痞消则膏自落。
经义
溺黄赤，安卧者，曰黄胆。○已食如饥者，曰胃疸。○目黄者，曰黄胆。（《素问》）
肾所生病为黄胆。○身痛而色微黄，齿垢黄，爪甲上黄，黄胆也。（《灵枢》）
哲言
黄胆之为病，当以十八日为期，治之以十日上瘥，反剧为难治。○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；阳部，其人振寒而发热也。（《金匮》）
古有五疸之辨∶曰黄汗，曰黄胆，曰谷疸，曰酒疸，曰女劳疸是也。汗出染衣如柏汁者，曰黄汗。身、
面、眼目黄如金色，小便黄而无汗者，曰黄胆。因饮食伤脾而得者，曰谷疸。因酒后伤湿而得者，曰酒疸。因
色欲伤阴而得者，曰女劳疸。虽其名目如此，然总不出阴、阳二证。大都阳证多实，阴证多虚，虚实弗失，得
其要矣。（张景岳）
干黄热胜，色黄而明，大便燥结。湿黄寒胜，色黄而晦，大便润利。（《医学入门》）
疸病，有阴、有阳。阳黄之作，湿从火化，瘀热在里，胆热液泄，与胃之浊气共并，上不得越，下不得泄，
熏蒸遏郁侵于肺，身目俱黄，流于膀胱，溺色变赤，黄如橘色。阳主明，治在胃。阴黄之作，湿从寒水，脾阳
不能化热，胆液为湿所阻。渍于脾，浸淫肌肉，溢于皮肤，色如熏黄。阴主晦，治在脾。伤寒发黄，（《金匮》）
黄胆立名虽异，治法多同。有辨证三十五条，出治一十二方。审黄之发与不发，在小便之利不利。疸之易治难
治，在口之渴与不渴。再察其瘀热入胃之因，或因外并，或因内发，或因食谷，或因酣酒，或因劳色，及随经
蓄血，入水黄汗。又有表虚里虚，热除作哕，火劫致黄。病有不一之因，治有不紊之法。脉弦胁痛，少阳未罢，
仍主以和。渴饮水浆，阳明化燥，急当泻热。湿在上，以辛散，以风胜。湿在下，以苦泄，以淡渗。如狂蓄血，
势所必攻。汗后溺白，自宜投补。酒客多蕴热，先用清利，后必顾其脾阳。女劳有秽浊，始以解毒，继之滑窍，
终当峻补肾阴。
表虚者实卫，里虚者建中。入水火劫，以及治逆变证，各立方论。若云寒湿在里之治，阳明篇中惟见一则，指
人于寒湿中求之。今阴黄一证，外不因于六淫，内不伤于嗜欲，惟寒惟湿，譬以卑监之土，须暴风日之阳，纯
阴之病，疗以辛热无疑矣。考诸家之说，丹溪云∶不必分五疸。总如 酱相似，为得治黄之扼要。殊不知是言
也，以之治阳黄虽不中窍，不致增剧；以之治阴黄，下咽则毙，何异操刃！惟谦甫罗氏具有卓识，力辨阴阳，
遵伤寒寒湿之旨，出茵陈四逆之治，继往开来，活人有术。喻氏谓阴黄，仲景方论亡失，无所遵从，不意其注
《伤寒》、《金匮》数千言，独于关键明文，反为蒙昧，虽云智者一失，亦未免会心之不远也。（《临证指南》）
仲景茵陈栀子大黄汤，治湿热也。栀子柏皮汤，治燥热也。如苗涝则湿黄，苗旱则燥黄。湿则泻之，燥则
润之。（王好古）
秦艽退黄极妙，以其性能退阳明经湿热邪气也。若无湿热则恐伤燥，又宜慎用。
阳黄
师曰∶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。○黄胆病，茵陈五苓散主之。○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。（《金匮》）
湿热郁蒸发黄，其当从下夺，亦须仿治伤寒之法，里热者始可用之。重则用大黄硝石汤，荡涤其湿热，如
大承气汤之例。稍轻则用栀子大黄汤，清解而兼下夺，如三黄汤之例。更轻则用茵陈蒿汤，清解为君，微加大
黄为使，如栀豉汤中加大黄，如博棋子大之例。是则汗法固不敢轻用，下法亦在所慎施。（喻嘉言）
阳黄者，因湿多成热，热则生黄，此即湿热证也。然其人必有身热烦渴，或消谷善饥，或小水赤涩，或大
便秘结，其脉必洪
滑有力。此证不拘表里，或风湿外感，或酒食内伤，皆能致之。但察其元气尚强，脾胃无损，而湿热果盛者，
宜清火邪，利小便，湿热去而黄自退。（《景岳全书》）
阴黄
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。（《金匮》）
黄胆病，为湿热之所酿矣，然有湿多热少者，有湿少热多者，有湿热全无者，不可不察。仲景虑疸病多夹
内伤，故尔慎用汗、吐、下之法。其用小建中汤，则因男子发黄，而小便自利，是其里无湿热，惟以入房数扰
其阳，致虚阳上泛为黄耳。故不治其黄，但和营卫以收拾其阳，听其黄之自去，即取伤寒建中之法以治之。又
有小便本赤黄，治之其色微减，即当识其蕴热原少；或大便欲自利，腹满上气喘急，即当识其脾湿原盛。或兼
寒药过当，宜急用小半夏汤温胃燥湿，倘更除其热，则无热可除，胃寒起而呃逆矣。○今人但云阳疸色明，阴疸
色晦，此不过气血之分。辨之不清，转足误人。如酒疸变黑，女劳疸额上黑，岂以其黑遂谓阴疸，可用附子、
干姜乎？夫女劳疸，真阳为血所壅闭，尚未大损，瘀血一行，阳气即通矣。阴疸则真阳衰微不振，一任湿热与
浊气败血团结不散，必复其阳，锢结始开。倘非离照当空，幽隐胡由毕达耶？（喻嘉言）
阴黄者，全非湿热，总由血气之败。盖气不生血，所以血败，血不华色，所以色败。凡病黄胆，而无阳
证阳脉者，便是阴黄。必以七情伤脏，或劳倦伤形，中气大伤，脾不化血，故脾色自见于外。其人必喜静恶动，
喜暗畏明，神倦言微，或怔忡眩晕，畏寒少食，或大便不实，小便如膏，及脉息无力等证，悉皆阳虚之候，
使非速救元气，大补脾肾，则无复元之理。若但见黄不察脉证，遂云湿热，治以泻火利水，则无不毙。（《景岳全书》）
下之太过生黄，脉沉细迟无力，次第用药，至茵陈附子汤而
效。（《己任编》）
劳役形体，饮食失节，中州变寒生黄，只宜理中、建中足矣，不必用茵陈。（王好古）
谷疸
谷疸之为病，寒热不食，食即头眩，心胸不安，久久发黄为谷疸，茵陈蒿汤主之。○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。（《金匮》）
问∶仲景云，谷疸下之，腹满如故，何不立一治法？余曰∶必用和法，先和其中，后乃下之。何以知之？
仲景云∶脉迟尚未可攻，味一尚字，其当攻之旨跃然。《金匮》又云∶诸黄，腹痛而呕者，用小柴胡汤。观此，
仍是治伤寒邪高痛下之法，是以知之耳。陈无择治谷疸，用谷芽枳实小柴胡汤，差识此意，但半消、半和、半
下三法并用，漫无先后，较诸仲景之丝丝必贯，相去远矣。（喻嘉言）
酒疸
心中懊 而热，不能食，时欲吐，名曰酒疸。○夫病酒黄胆，必小便不利，其候心中热，足下热，是其
证。○酒黄胆者，或无热，静言了了，腹满欲吐，鼻燥。其脉浮者，先吐之；沉弦者，先下之。○酒疸心中热，
欲吐者，吐之愈。○酒黄胆，心中懊 或热痛，栀子大黄汤主之。○酒疸下之，久久为黑疸，目青面黑，心中
如啖蒜齑状，大便正黑，皮肤爪之不仁，其脉浮弱，虽黑微黄，故知之。（《金匮》）
《金匮》治酒疸，用或吐、或下之法，言虽错出，义实一贯。盖酒之积热入于膀胱，则气不化，小便不
利。积于上焦，则心中热。积于下焦，则足下热。其无心中足下热者，则清言了了，而神不昏，但见腹满欲吐
鼻燥三证，可知其膈上与腹中，阴阳交病，须分先后治之。当辨脉之浮沉，以定吐下之先后。脉浮，病在膈上，
阳分居多，先吐上焦，而后治其中满。脉沉弦，病在腹中，阴分居多，先下其中满，而后治其上焦。若但心中
热欲呕，则病全在上焦，吐之即愈。其酒热内结，心神昏乱而作懊 ，及痛楚者，则不可不下。但下法劫病，
不可久用，久久下之，必脾肺之阳尽伤，不能统领其阴血，其血日趋于败而变黑耳。仲景于一酒疸，胪列先后
次第，以尽其治，精详若此。○酒疸之黑，与女劳疸之黑，殊不相同，女劳疸之黑，为肾气所发；酒疸之黑，
乃营血腐败之色。营者水谷之精气，为湿热所瘀而不行，其光华之色转为晦黯，心胸嘈杂如啖蒜齑，其芳甘之
味变为酸辣，乃至肌肤不仁，大便正黑，脉见浮弱，皆肺金治节之气不行而血瘀也。必复肺中清肃之气，乃可
驱营中瘀浊之血，较女劳疸之难治，特一间耳。方书但用白术汤理脾气解酒热，抑何庸陋之甚耶！（喻嘉言）
疸证，惟黑疸最剧，良由酒后不禁酒湿流入髓脏所致，土败水湮之兆。始病形神未槁，尚有湿热可攻，为
治疸之向导。若病久肌肤消烁，此真元告匮，不能回荣于竭泽也。（张路玉）
女劳疸
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。○诸黄，猪膏发煎主之。（《金匮》）
硝石矾石散，此治女劳疸之要方也，从来不解用硝石之义。夫男子血化为精，精动则一身之血俱动。以女
劳而倾其精，血必继之。故因女劳而尿血者，其血尚行，犹易治也。因女劳而成疸者，血瘀不行，为难治矣。
非去其膀胱少腹之瘀血，万无生路。在伤寒热瘀膀胱之证，其人下血乃愈。血不下者，用抵当汤下之，亦
因其血之暂结，可峻攻也。此女劳疸蓄积之血，必匪朝夕，峻攻无益，但取石药之悍，得以疾趋而下达病所。
硝石咸寒走血，可消逐其热瘀之血；矾石能除锢热在骨髓，用以清肾及膀胱脏腑之
热，并建消瘀除浊之功。○女劳疸，额上黑，谓身黄加以额黑也。黑为北方阴晦之色，加于南方离明之位，此
必先有胃热脾寒之浊气下流入肾，益以女劳无度而后成之。其由来自非一日，脾中之浊气下趋于肾，水土互显
之色，但于黄中见黑滞耳。若相火从水中上炎，而合于心之君火，其势燎原，烟焰之色先透于额，乃至微汗亦
随火而出于额，心之液且外亡矣。手足心热，内伤皆然。日暮阳明用事，阳明主阖，收敛一身之湿热疾趋而下，
膀胱因而告急。其小便自利，大便黑，时溏，又是膀胱蓄血之验，腹如水状，实非水也，正指蓄血而言，故不
治。○猪膏发煎，藉血余之力，引入血分而润其燥，并藉其力开膀胱瘀血，利其小水，小水一利，将湿与热且
俱除矣。《肘后方》云∶女劳疸，身目尽黄，发热恶寒，少腹满，小便难，以大热大劳交接，入水所致者用此
方。盖女劳疸，血瘀膀胱，非直入血分之药，必不能开。仲景取用虻虫、水蛭、矾石，无非此义。然虻虫过峻，
不可以治女劳；矾石过燥，又不可以治女劳之燥，故更立此方以济之。（喻嘉言）
表邪发黄
诸病黄家，但利其小便，假令脉浮，当以汗解之，宜桂枝加黄 汤主之。○诸黄，腹痛而呕者，宜柴胡汤。
○瓜蒂汤治诸黄。○千金麻黄醇酒汤治黄胆。（《金匮》）
仲景治伤寒，首用麻黄汤为表法。今观《金匮》治黄胆之表，主之以桂枝黄 汤、小柴胡汤，附之以《千
金》麻黄醇酒汤，明示不欲发表之意。故首云∶诸病黄家，但利小便，假令脉浮，当以汗解之。可见大法当利
小便，必脉浮始可言表。然疸证之脉，多有营卫气虚湿热乘之而浮，故用桂枝黄 汤和其营卫，用小柴胡汤和
其表里，但取和法为表法，而表实发黄之证，岂曰无之？再取麻黄醇酒汤一方附入，读此而治病之机，宛然心
目矣。○瓜蒂汤，吐药也。邪在膈上，浅而易治，用此汤吐去黄水，正《内经》因其高而越之之旨也。然此亦
仲景治伤寒之方易为治疸证，
但附于后，是亦不欲轻用之意也。（喻嘉言）
表邪发黄者，即伤寒证也。凡伤寒汗不能透，而风湿在表者，有黄证；或表邪不解，自表传里，而湿热郁
于阳明者，亦有黄证。表邪未解者，必发热身痛，脉浮少汗，宜从汗散，湿热内郁者，必烦热多汗，脉缓滑，
宜从分消。（《景岳全书》）
疫病发黄
疫病发黄者，邪热在阳明，脉数发热，口渴引饮，便秘溲赤，治宜生首乌、黑豆、扁豆、甘草、鲜黄土、
石斛、麦冬、赤苓、车前、神曲、谷茅、陈皮之属，解疫毒而救脾胃。俾邪从阳明解，而出表为顺也。若其人
平日脾肾素虚，虽邪热在阳明，而脉细无力，人倦少神，冷汗自出，大便不实，急救脾肾，庶不致内传厥少，
而有虚脱之险也。（《会心录》）
（前文未完，接）方剂以肉桂为君药，其余药物包括胡卢巴、茯苓、泽泻、熟地黄、山茱萸、附子，每晚服用一剂。患者感觉气只冲到肚脐部位，于是加重肉桂用量，经过几次服药后完全痊愈。（吴天士）
附方
治疗食瘕的方剂：海蜇头二斤、荸荠二斤、烧酒二斤。一起放入砂锅中，隔水炖煮，直到海蜇化开、酒液熬干，取出荸荠阴干，空腹吃五个。
治疗痞块的方剂：松香二两、阿魏二钱、皮硝五钱、蓖麻子一两。一起捣碎制成膏药，根据痞块的大小，摊在布上，贴敷时加入麝香五厘，痞块消退后膏药自然脱落。
经义
小便黄赤，身体嗜睡安卧的，称为黄疸。○进食后仍感觉像饥饿一样的，称为胃疸。○眼睛发黄的，称为黄疸。（《素问》）
肾脏所发生的疾病中有黄疸。○身体疼痛且面色微黄，牙齿垢腻发黄，指甲上发黄，这是黄疸。（《灵枢》）
哲言
黄疸这种疾病，病程以十八天为期，治疗十天内好转为顺证，如果反而加重则难治。○患黄疸且口渴的，其病难治；患黄疸且不口渴的，其病可治。病发于阴部的，患者必然呕吐；病发于阳部的，患者出现寒战而发热。（《金匮要略》）
古代有五种黄疸的辨别：即黄汗、黄疸、谷疸、酒疸、女劳疸。出汗染衣如柏树汁颜色的，称为黄汗。身体、面部、眼目黄如金色，小便黄且无汗的，称为黄疸。因饮食损伤脾胃而得的，称为谷疸。因酒后伤湿而得的，称为酒疸。因房事过度损伤阴精而得的，称为女劳疸。虽然名称如此，但总不出阴阳两证。大多阳证多为实证，阴证多为虚证，不偏离虚实辨证的关键，就掌握了要领。（张景岳）
干黄是热邪胜，颜色黄而鲜明，大便燥结。湿黄是寒邪胜，颜色黄而晦暗，大便润利。（《医学入门》）
黄疸病，有阴证、阳证之分。阳黄的发生，湿气从火化，瘀热蕴结在体内，胆热导致津液外泄，与胃中的浊气合并，向上不能发散，向下不能排泄，熏蒸郁遏侵犯肺脏，全身和眼睛都发黄，流注到膀胱，尿液变成红色，黄色像橘子色一样。阳主明亮，治疗重点在胃。阴黄的发生，湿气从寒水化，脾阳不能化热，胆汁被湿气阻滞。浸渍于脾，浸润肌肉，溢出皮肤，颜色像熏过的黄色。阴主晦暗，治疗重点在脾。伤寒导致的发黄，（《金匮要略》）
黄疸命名虽异，治疗方法大多相同。有辨证的三十五条，出自治疗的十二个方剂。审查黄疸的发与不发，关键在于小便的通利与否。黄疸的易治与难治，在于口是否口渴。再观察瘀热入胃的原因，或因外感并合，或因内发，或因饮食，或因酗酒，或因房劳色欲，以及随经络蓄血，入水导致的黄汗。又有表虚里虚，热除后出现呃逆，火劫疗法导致发黄。病因不一，治法不乱。脉弦胁痛，少阳证未罢，仍以和解为主。口渴饮水，阳明化燥，急需泻热。湿在上焦，用辛散法，用风药胜湿。湿在下焦，用苦泄法，用淡渗利湿法。如狂躁蓄血，势必要攻逐。发汗后小便白，适宜投补益剂。酒客多蕴藏湿热，先用清利法，之后必须顾护脾阳。女劳疸有秽浊，开始以解毒，接着滑窍，最终应当峻补肾阴。
表虚者实卫气，里虚者建中气。涉及水火劫疗，以及治疗逆变证，各有方论。如果说寒湿在里的治疗，在《伤寒论·阳明篇》中只见一则，指引人在寒湿中寻求治法。如今阴黄一证，外不因六淫侵袭，内不伤于嗜欲，只是寒湿，比喻为卑监之土，需要暴风日的阳气，纯阴的病，用辛热药物治疗无疑。考察诸家之说，朱丹溪说：不必分五种黄疸。总之像酱相似，这抓住了治黄的扼要。却不知道这话，用来治阳黄虽然不中肯，但不致加重；用来治阴黄，喝下去就会死，何异于操刀杀人！只有罗谦甫具有卓识，极力辨别阴阳，遵循伤寒寒湿的宗旨，提出茵陈四逆汤的治疗，继往开来，救人无数。喻嘉言认为阴黄，张仲景的方论亡失，无所遵从，没想到他注释《伤寒》、《金匮》数千言，唯独在关键明文处，反而蒙昧，虽说智者一失，也未免会心不远。（《临证指南医案》）
张仲景的茵陈蒿汤、栀子大黄汤，治疗湿热。栀子柏皮汤，治疗燥热。如禾苗涝灾则是湿黄，禾苗干旱则是燥黄。湿则泻之，燥则润之。（王好古）
秦艽退黄极妙，因为其性能退阳明经湿热邪气。如果没有湿热则恐怕伤燥，又宜慎用。
阳黄
老师说：患黄疸病，发热烦喘，胸满口燥的，是因为发病时用火劫法发汗，两热相合所致。然而黄家的病，从湿得之，全身尽发热而黄，肚子热，热在里，应当用下法。○黄疸病，茵陈五苓散主治。○黄疸，腹满，小便不利且赤，自汗出，此为表和里实，应当用下法，宜用大黄硝石汤。（《金匮要略》）
湿热郁蒸发黄，应当从下夺，也须仿照治疗伤寒的方法，里热者始可用之。重则用大黄硝石汤，荡涤其湿热，如大承气汤的例子。稍轻则用栀子大黄汤，清解兼下夺，如三黄汤的例子。更轻则用茵陈蒿汤，清解为君药，微加大黄为使药，如在栀豉汤中加入大黄，如博棋子大小的例子。这样看来，汗法固然不敢轻用，下法也在所慎重施用。（喻嘉言）
阳黄，因湿多成热，热则生黄，这就是湿热证。然而患者必有身热烦渴，或消谷善饥，或小水赤涩，或大便秘结，其脉必洪滑有力。此证不拘表里，或风湿外感，或酒食内伤，都能导致。只要察其元气尚强，脾胃无损，而湿热果盛者，宜清火邪，利小便，湿热去而黄自退。（《景岳全书》）
阴黄
黄疸病，小便颜色不变，想自利（腹泻），腹满而喘，不可除热，热除必哕（呃逆），哕者，小半夏汤主治。（《金匮要略》）
黄疸病，是由湿热酿成的，但有湿多热少的，有湿少热多的，有湿热全无的，不可不察。张仲景担心疸病多夹内伤，所以慎用汗、吐、下之法。他用小建中汤，是因为男子发黄，而小便自利，是其里没有湿热，只是因为入房多次扰动阳气，导致虚阳上泛为黄罢了。所以不治其黄，只和营卫以收拾其阳，听任其黄自行消退，即取伤寒建中之法来治疗。又有小便本赤黄，治疗后颜色微减，就应当知道其蕴热原少；或大便想自利，腹满上气喘急，就应当知道其脾湿原盛。或兼寒药过当，宜急用小半夏汤温胃燥湿，倘若再除其热，则无热可除，胃寒起而呃逆了。○今人只说阳疸色明，阴疸色晦，这不过是气血之分。辨别不清，反而误人。如酒疸变黑，女劳疸额上黑，岂能因其黑遂谓阴疸，可用附子、干姜吗？夫女劳疸，真阳为血所壅闭，尚未大损，瘀血一行，阳气即通矣。阴疸则真阳衰微不振，一任湿热与浊气败血团结不散，必复其阳，锢结始开。倘非离照当空，幽隐胡由毕达耶？（喻嘉言）
阴黄，全非湿热，总由血气之败。盖气不生血，所以血败，血不华色，所以色败。凡病黄疸，而无阳证阳脉者，便是阴黄。必以七情伤脏，或劳倦伤形，中气大伤，脾不化血，故脾色自见于外。其人必喜静恶动，喜暗畏明，神倦言微，或怔忡眩晕，畏寒少食，或大便不实，小便如膏，及脉息无力等证，悉皆阳虚之候，使非速救元气，大补脾肾，则无复元之理。若但见黄不察脉证，遂云湿热，治以泻火利水，则无不毙。（《景岳全书》）
下之太过生黄，脉沉细迟无力，次第用药，至茵陈附子汤而效。（《己任编》）
劳役形体，饮食失节，中州变寒生黄，只宜理中、建中足矣，不必用茵陈。（王好古）
谷疸
谷疸之为病，寒热不食，食即头眩，心胸不安，久久发黄为谷疸，茵陈蒿汤主治。○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。（《金匮要略》）
问：张仲景说，谷疸下之，腹满如故，为什么不立一治法？我说：必用和法，先和其中，后乃下之。何以知之？张仲景说：脉迟尚未可攻，味一“尚”字，其当攻之旨跃然。《金匮》又说：诸黄，腹痛而呕者，用小柴胡汤。观此，仍是治伤寒邪高痛下之法，是以知之耳。陈无择治谷疸，用谷芽枳实小柴胡汤，差识此意，但半消、半和、半下三法并用，漫无先后，较诸张仲景之丝丝必贯，相去远矣。（喻嘉言）
酒疸
心中懊憹而热，不能食，时欲吐，名曰酒疸。○夫病酒黄疸，必小便不利，其候心中热，足下热，是其证。○酒黄疸者，或无热，静言了了，腹满欲吐，鼻燥。其脉浮者，先吐之；沉弦者，先下之。○酒疸心中热，欲吐者，吐之愈。○酒黄疸，心中懊憹或热痛，栀子大黄汤主治。○酒疸下之，久久为黑疸，目青面黑，心中如啖蒜齑状，大便正黑，皮肤爪之不仁，其脉浮弱，虽黑微黄，故知之。（《金匮要略》）
《金匮》治酒疸，用或吐、或下之法，言虽错出，义实一贯。盖酒之积热入于膀胱，则气不化，小便不利。积于上焦，则心中热。积于下焦，则足下热。其无心中足下热者，则清言了了，而神不昏，但见腹满欲吐鼻燥三证，可知其膈上与腹中，阴阳交病，须分先后治之。当辨脉之浮沉，以定吐下之先后。脉浮，病在膈上，阳分居多，先吐上焦，而后治其中满。脉沉弦，病在腹中，阴分居多，先下其中满，而后治其上焦。若但心中热欲呕，则病全在上焦，吐之即愈。其酒热内结，心神昏乱而作懊憹，及痛楚者，则不可不下。但下法劫病，不可久用，久久下之，必脾肺之阳尽伤，不能统领其阴血，其血日趋于败而变黑耳。张仲景于一酒疸，胪列先后次第，以尽其治，精详若此。○酒疸之黑，与女劳疸之黑，殊不相同，女劳疸之黑，为肾气所发；酒疸之黑，乃营血腐败之色。营者水谷之精气，为湿热所瘀而不行，其光华之色转为晦黯，心胸嘈杂如啖蒜齑，其芳甘之味变为酸辣，乃至肌肤不仁，大便正黑，脉见浮弱，皆肺金治节之气不行而血瘀也。必复肺中清肃之气，乃可驱营中瘀浊之血，较女劳疸之难治，特一间耳。方书但用白术汤理脾气解酒热，抑何庸陋之甚耶！（喻嘉言）
疸证，惟黑疸最剧，良由酒后不禁酒湿流入髓脏所致，土败水湮之兆。始病形神未槁，尚有湿热可攻，为治疸之向导。若病久肌肤消烁，此真元告匮，不能回荣于竭泽也。（张路玉）
女劳疸
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，硝石矾石散主治。○诸黄，猪膏发煎主治。（《金匮要略》）
硝石矾石散，此治女劳疸之要方也，从来不解用硝石之义。夫男子血化为精，精动则一身之血俱动。以女劳而倾其精，血必继之。故因女劳而尿血者，其血尚行，犹易治也。因女劳而成疸者，血瘀不行，为难治矣。非去其膀胱少腹之瘀血，万无生路。在伤寒热瘀膀胱之证，其人下血乃愈。血不下者，用抵当汤下之，亦因其血之暂结，可峻攻也。此女劳疸蓄积之血，必匪朝夕，峻攻无益，但取石药之悍，得以疾趋而下达病所。硝石咸寒走血，可消逐其热瘀之血；矾石能除锢热在骨髓，用以清肾及膀胱脏腑之热，并建消瘀除浊之功。○女劳疸，额上黑，谓身黄加以额黑也。黑为北方阴晦之色，加于南方离明之位，此必先有胃热脾寒之浊气下流入肾，益以女劳无度而后成之。其由来自非一日，脾中之浊气下趋于肾，水土互显之色，但于黄中见黑滞耳。若相火从水中上炎，而合于心之君火，其势燎原，烟焰之色先透于额，乃至微汗亦随火而出于额，心之液且外亡矣。手足心热，内伤皆然。日暮阳明用事，阳明主阖，收敛一身之湿热疾趋而下，膀胱因而告急。其小便自利，大便黑，时溏，又是膀胱蓄血之验，腹如水状，实非水也，正指蓄血而言，故不治。○猪膏发煎，藉血余之力，引入血分而润其燥，并藉其力开膀胱瘀血，利其小水，小水一利，将湿与热且俱除矣。《肘后方》云∶女劳疸，身目尽黄，发热恶寒，少腹满，小便难，以大热大劳交接，入水所致者用此方。盖女劳疸，血瘀膀胱，非直入血分之药，必不能开。张仲景取用虻虫、水蛭、矾石，无非此义。然虻虫过峻，不可以治女劳；矾石过燥，又不可以治女劳之燥，故更立此方以济之。（喻嘉言）
表邪发黄
诸病黄家，但利其小便，假令脉浮，当以汗解之，宜桂枝加黄芪汤主治。○诸黄，腹痛而呕者，宜柴胡汤。○瓜蒂汤治诸黄。○千金麻黄醇酒汤治黄疸。（《金匮要略》）
张仲景治伤寒，首用麻黄汤为表法。今观《金匮》治黄疸之表，主之以桂枝加黄芪汤、小柴胡汤，附之以《千金》麻黄醇酒汤，明示不欲发表之意。故首云∶诸病黄家，但利小便，假令脉浮，当以汗解之。可见大法当利小便，必脉浮始可言表。然疸证之脉，多有营卫气虚湿热乘之而浮，故用桂枝加黄芪汤和其营卫，用小柴胡汤和其表里，但取和法为表法，而表实发黄之证，岂曰无之？再取麻黄醇酒汤一方附入，读此而治病之机，宛然心目矣。○瓜蒂汤，吐药也。邪在膈上，浅而易治，用此汤吐去黄水，正《内经》因其高而越之之旨也。然此亦张仲景治伤寒之方易为治疸证，但附于后，是亦不欲轻用之意也。（喻嘉言）
表邪发黄者，即伤寒证也。凡伤寒汗不能透，而风湿在表者，有黄证；或表邪不解，自表传里，而湿热郁于阳明者，亦有黄证。表邪未解者，必发热身痛，脉浮少汗，宜从汗散，湿热内郁者，必烦热多汗，脉缓滑，宜从分消。（《景岳全书》）
疫病发黄
疫病发黄者，邪热在阳明，脉数发热，口渴引饮，便秘溲赤，治宜生首乌、黑豆、扁豆、甘草、鲜黄土、石斛、麦冬、赤苓、车前、神曲、谷茅、陈皮之属，解疫毒而救脾胃。俾邪从阳明解，而出表为顺也。若其人平日脾肾素虚，虽邪热在阳明，而脉细无力，人倦少神，冷汗自出，大便不实，急救脾肾，庶不致内传厥少，而有虚脱之险也。（《会心录》）
(Continuing from previous text) The prescription uses Rougui (Cinnamon Twig) as the sovereign drug, with other ingredients including Halubala (Fenugreek Seed), Fuling (Poria), Zexie (Alisma), Shudi (Prepared Rehmannia Root), Shanzhuyu (Cornus Fruit), and Fuzi (Prepared Aconite Root). One dose is taken at night. The patient felt the Qi only rushing to the navel level; the dosage of Rougui was increased, and after several doses, full recovery was achieved. (Wu Tianshi)
Supplementary Prescriptions
Prescription for treating Shi Jia (Food Stagnation Mass): Hai Zhe Tou (Halophyte Rhizome) two jin, Bi Qi (Water Chestnut) two jin, Shao Jiu (Brewed Wine) two jin. Place all together in a clay pot, simmer over water bath until the Halophyte dissolves and the wine evaporates. Take the dried Water Chestnuts and consume five on an empty stomach.
Prescription for treating Pi Kuai (Stagnant Mass): Song Xiang (Rosin) two liang, A Wei (Asafoetida) two qian, Pi Xiao (Mirabilite) five qian, Bi Ma Zi (Castor Bean) one liang. Pound together into a paste. Apply onto cloth according to the size of the mass. Add She Xiang (Musk) five li when applying. The paste will naturally fall off when the mass disappears.
Classic Meanings
Yellow urine and excessive sleepiness indicate Huang Dan (Jaundice). ○ Feeling hungry shortly after eating indicates Wei Dan (Stomach Jaundice). ○ Yellow eyes indicate Huang Dan (Jaundice). (*Su Wen*)
Diseases occurring in the Kidney include Huang Dan (Jaundice). ○ Body pain with slightly yellow complexion, yellow dental plaque, and yellow nails indicate Huang Dan (Jaundice). (*Ling Shu*)
Philosophical Remarks
The course of Huang Dan (Jaundice) disease is set at eighteen days. If treated within ten days and improving, it is favorable; if it worsens instead, it is difficult to treat. ○ Jaundice accompanied by thirst is difficult to treat; jaundice without thirst is treatable. Disease originating in Yin parts causes vomiting; disease originating in Yang parts causes chills followed by fever. (*Jin Gui Yao Lue*)
Ancient texts distinguish five types of jaundice: Huang Han (Yellow Sweat), Huang Dan (Jaundice), Gu Dan (Grain Jaundice), Jiu Dan (Wine Jaundice), and Nu Lao Dan (Female Exhaustion Jaundice). Sweating that stains clothes like cypress juice is called Huang Han (Yellow Sweat). Body, face, and eyes turning golden yellow, with yellow urine but no sweating, is called Huang Dan (Jaundice). Acquired due to dietary injury to the Spleen is called Gu Dan (Grain Jaundice). Acquired due to dampness after drinking alcohol is called Jiu Dan (Wine Jaundice). Acquired due to sexual excess injuring Yin essence is called Nu Lao Dan (Female Exhaustion Jaundice). Although named thus, they ultimately fall into Yin or Yang syndromes. Generally, Yang syndromes are mostly Excess, while Yin syndromes are mostly Deficiency. Grasping this distinction between Excess and Deficiency captures the essence. (Zhang Jingyue)
Dry Jaundice results from Heat predominance, presenting with bright yellow color and dry constipation. Damp Jaundice results from Cold predominance, presenting with dull yellow color and loose stools. (*Yi Xue Ru Men*)
Jaundice disease has Yin and Yang types. Yang Jaundice arises when Dampness transforms into Fire, with stagnant Heat in the interior. Gallbladder Heat causes fluid leakage, combining with turbid Qi from the Stomach. Unable to vent upward or excrete downward, it steams and obstructs, invading the Lung, causing whole-body and eye yellowing. Flowing into the Bladder, urine turns red, yellow like orange peel. Yang governs brightness; treatment focuses on the Stomach. Yin Jaundice arises when Dampness follows Cold-Water. Spleen Yang fails to transform Heat, and bile fluid is blocked by Dampness. Soaking the Spleen, infiltrating muscles, overflowing skin, the color is like smoked yellow. Yin governs darkness; treatment focuses on the Spleen. Yellowing caused by Taiyang Cold Damage... (*Jin Gui Yao Lue*)
Although named differently, the treatment methods for various jaundices are largely similar. There are thirty-five diagnostic criteria derived from twelve therapeutic prescriptions. Examining whether jaundice appears or not depends on the free flow of urine. Whether jaundice is easy or difficult to treat depends on thirst. Further observe the cause of stagnant Heat entering the Stomach: whether due to external invasion, internal origin, food intake, heavy drinking, sexual exhaustion, collateral blood stasis, or water-induced yellow sweat. Also consider exterior deficiency and interior deficiency, where removing Heat leads to hiccups, or fire-therapy causes yellowing. Causes vary, but methods remain orderly. Wiry pulse with hypochondriac pain indicates Shaoyang syndrome unresolved; harmonize primarily. Thirst for fluids indicates Yangming drying; urgently purge Heat. Dampness in the Upper Jiao is dispersed with Pungent herbs and overcome with Wind herbs. Dampness in the Lower Jiao is drained with Bitter herbs and渗利 (permeated/drained) with Sweet/Diuretic herbs. Manic blood stasis requires aggressive attack. Post-sweating white urine indicates suitability for tonification. Alcohol drinkers often harbor latent Heat; clear and drain first, then protect Spleen Yang. Female Exhaustion Jaundice involves turbidity; detoxify initially, lubricate orifices next, and finally vigorously tonify Kidney Yin.
Exterior deficiency strengthens Wei Qi; Interior deficiency builds Middle Qi. For cases involving water/fire therapy or inverted transformations, specific formulas are provided. Regarding the treatment of Cold-Damp in the Interior, only one case is seen in the Yangming Chapter, guiding practitioners to seek treatment within Cold-Damp contexts. Today, Yin Jaundice occurs without external Six Evils or internal desires, solely due to Cold and Dampness. It is likened to low-lying muddy earth requiring strong sun and wind. For pure Yin diseases, pungent-hot drugs are undoubtedly appropriate. Reviewing various theories, Zhu Danxi said: "No need to distinguish five jaundices. All resemble soy sauce." This grasps the essence of treating yellowing. However, unknown to him, this applies to Yang Jaundice without worsening, but for Yin Jaundice, swallowing it would be fatal—like wielding a blade! Only Luo Qianfu had profound insight, vigorously distinguishing Yin and Yang, following the principle of Cold-Damp in Cold Damage, proposing Yinyin Chen Si Ni Tang (Inulin Four Reversal Decoction), carrying forward the past and opening the future, saving lives. Yu Jiayan stated that for Yin Jaundice, Zhang Zhongjing's formulas were lost, leaving no guidance. Unexpectedly, after annotating thousands of words on *Shang Han* and *Jin Gui*, he remained ignorant of key explicit statements. Though wise men make mistakes, his understanding fell short. (*Lin Zheng Zhi Nan*)
Zhang Zhongjing's Yinchen Hao Tang (Artemisia Capillaris Decoction) and Zhizi Dahuang Tang (Gardenia and Rhubarb Decoction) treat Damp-Heat. Zhizi Baipi Tang (Gardenia and Phellodendron Bark Decoction) treats Dry-Heat. Like crops flooding causing Damp-Yellow, or drought causing Dry-Yellow. Dampness is purged; Dryness is moistened. (Wang Haogu)
Qin Jiao (Gentiana Macrophylla Root) is excellent for resolving jaundice because it clears Damp-Heat pathogenic factors from the Yangming Meridian. Without Damp-Heat, it may injure Dryness, so use with caution.
Yang Jaundice
The Master said: Patients with jaundice experiencing fever, irritability, panting, chest fullness, and dry mouth suffer from two Heats combining due to fire-therapy inducing sweat during onset. However, jaundice originates from Dampness. Whole-body fever with yellowing and abdominal heat indicates Heat in the Interior; purge it. ○ Jaundice is primarily treated with Yinchen Wuling San (Artemisia Capillaris and Five Ingredient Poria Pill). ○ Jaundice with abdominal fullness, difficult and red urination, and spontaneous sweating indicates Exterior Harmony and Interior Excess; purge it using Dahuang Xiaoshi Tang (Rhubarb and Nitre Decoction). (*Jin Gui Yao Lue*)
When Damp-Heat stagnates and generates jaundice, purgation is required, mimicking Cold Damage treatment methods, applicable only when Interior Heat exists. Severe cases use Dahuang Xiaoshi Tang to scour Damp-Heat, similar to Dachengqi Tang (Major Order the Qi Decoction). Mild cases use Zhizi Dahuang Tang to clear and purge, similar to Sanhuang Tang (Three Yellow Decoction). Lighter cases use Yinchen Hao Tang, with clearing agents as sovereign and slight Rhubarb as minister, similar to adding Rhubarb to Zhichi Tang (Gardenia and Fermented Soybean Decoction). Thus, sweating methods are rarely used lightly, and purgative methods are applied cautiously. (Yu Jiayan)
Yang Jaundice arises when Dampness generates Heat, and Heat produces yellowing; this is the Damp-Heat syndrome. Patients typically exhibit body heat, irritability, thirst, rapid digestion with hunger, dark/scanty urine, or constipation. The pulse is typically surging, slippery, and forceful. This syndrome, regardless of exterior/interior status, can result from Wind-Damp external contraction or Wine/Food internal injury. Provided vital Qi is strong, Spleen/Stomach undamaged, and Damp-Heat is abundant, clear Fire pathogens and promote urination; once Damp-Heat leaves, yellowing recedes. (*Jing Yue Quan Shu*)
Yin Jaundice
Jaundice with unchanged urine color, desire for diarrhea, abdominal fullness, and wheezing should not have Heat removed; removing Heat causes hiccups. Hiccups are treated with Xiaobanxia Tang (Minor Pinellia Decoction). (*Jin Gui Yao Lue*)
Jaundice is brewed from Damp-Heat, but there are cases of more Damp than Heat, less Damp than Heat, and no Damp-Heat at all; these must be distinguished. Zhang Zhongjing feared jaundice often involves internal injury, hence cautiously using sweating, vomiting, and purging methods. His use of Xiaojianzhong Tang (Minor Construct the Middle Decoction) is for men with yellowing and free urination, indicating no Damp-Heat in the interior, but rather deficiency Yang floating upward due to frequent sexual activity. Thus, he does not treat the yellowing directly but harmonizes Ying and Wei to gather the Yang, allowing yellowing to resolve spontaneously, employing the Jianzhong method from Cold Damage. If urine was originally dark yellow but lightens after treatment, recognize little latent Heat; if diarrhea, abdominal fullness, and upper body wheezing occur, recognize strong Spleen Dampness. If cold medicines were overdosed, urgently use Xiaobanxia Tang to warm the Stomass and dry Dampness; further removing Heat would leave nothing to remove, causing Stomach Cold and hiccups. ○ Moderns say Yang Jaundice is bright and Yin Jaundice is dull, merely distinguishing Qi and Blood. Unclear differentiation misleads people. If Wine Jaundice turns black, or Female Exhaustion Jaundice shows black forehead, can we call it Yin Jaundice and use Fuzi (Aconite) and Ganjiang (Dried Ginger)? In Female Exhaustion Jaundice, True Yang is blocked by Blood Stasis but not severely damaged; once stasis moves, Yang flows. In Yin Jaundice, True Yang is weak and depressed, allowing Damp-Heat, turbid Qi, and敗血 (defeated blood) to knot together; Yang must be restored to break the knot. Without the sun shining brightly, how can darkness be dispelled? (Yu Jiayan)
Yin Jaundice is entirely unrelated to Damp-Heat but stems from the failure of Qi and Blood. Qi failing to generate Blood causes Blood failure; Blood failing to nourish color causes color failure. Any jaundice without Yang symptoms or Yang pulse is Yin Jaundice. Caused by Seven Emotions injuring organs or Labor/Fatigue injuring the form, leading to severe Middle Qi damage and Spleen inability to transform Blood, the Spleen's color manifests externally. Patients prefer stillness over movement, darkness over light, show mental fatigue, weak speech, palpitations, dizziness, aversion to cold, poor appetite, loose stools, creamy urine, and weak pulses—all signs of Yang Deficiency. Unless Yuan Qi is rapidly saved and Spleen/Kidney vigorously tonified, recovery is impossible. Merely seeing yellowing without examining pulse/symptoms and attributing it to Damp-Heat, treating with purging Fire and draining Water, leads inevitably to death. (*Jing Yue Quan Shu*)
Over-purging can cause jaundice; with deep, fine, slow, and forceless pulse, step-by-step medication eventually yields efficacy with Yinyin Chen Fuzi Tang (Artemisia Capillaris and Aconite Decoction). (*Ji Ren Bian*)
Physical labor and irregular diet cause Middle Jiao Cold and jaundice; Lizhong Tang (Regulate the Middle Decoction) or Jianzhong Tang suffice; Yinchen (Artemisia) is unnecessary. (Wang Haogu)
Grain Jaundice
Grain Jaundice presents with chills, fever, loss of appetite, dizziness upon eating, chest/heart discomfort, and eventual yellowing; treated with Yinchen Hao Tang. ○ Yangming disease with slow pulse, inability to eat full meals, irritability and dizziness after eating, and difficult urination indicates impending Grain Jaundice; even if purged, abdominal fullness remains because the pulse is slow. (*Jin Gui Yao Lue*)
Question: Zhang Zhongjing states that purging Grain Jaundice leaves abdominal fullness unchanged; why no specific formula? Answer: Harmonizing method is necessary; harmonize the center first, then purge. How do I know? Zhang Zhongjing says: "Slow pulse means attack is not yet appropriate." The word "yet" implies eventual attack. *Jin Gui* also says: "All jaundices with abdominal pain and vomiting are treated with Xiaochaihu Tang (Minor Bupleurum Decoction)." This follows the Cold Damage method of treating high pathogens and lower pain. Chen Wuze treated Grain Jaundice with Guya Zhishi Xiaochaihu Tang (Grain Sprout and Immature Bitter Orange Minor Bupleurum Decoction), grasping this intent, but combined half-digestion, half-harmonizing, and half-purging methods without sequence, differing greatly from Zhang Zhongjing's meticulous continuity. (Yu Jiayan)
Wine Jaundice
Heartfelt vexation with heat, inability to eat, occasional desire to vomit is named Jiu Dan (Wine Jaundice). ○ Wine Jaundice always features difficult urination; symptoms include heart heat and foot heat. ○ Wine Jaundice may present without heat, with clear speech but abdominal fullness, desire to vomit, and dry nose. Floating pulse indicates vomiting first; deep-wiry pulse indicates purging first. ○ Heart heat and desire to vomit in Wine Jaundice improve with vomiting. ○ Heartfelt vexation or heat/pain in Wine Jaundice is treated with Zhizi Dahuang Tang. ○ Purging Wine Jaundice leads to Hei Dan (Black Jaundice) over time: blue eyes, black face, sensation of eating minced garlic in the heart, black stool, insensate skin/nails, floating-weak pulse. Though black, slight yellow remains, confirming diagnosis. (*Jin Gui Yao Lue*)
*Jin Gui* treats Wine Jaundice with vomiting or purging. Though scattered, the meaning is consistent. Accumulated heat from wine enters the Bladder, preventing Qi transformation and causing difficult urination. Accumulating in Upper Jiao causes heart heat. Accumulating in Lower Jiao causes foot heat. Absence of heart/foot heat means clear speech and unconfused spirit; only abdominal fullness, vomiting desire, and dry nose appear, indicating Yin-Yang conflict in Diaphragm and Abdomen requiring sequential treatment. Differentiate floating/deep pulses to determine vomiting/purging order. Floating pulse indicates Diaphragm pathology (more Yang); vomit Upper Jiao first, then treat abdominal fullness. Deep-wiry pulse indicates Abdominal pathology (more Yin); purge abdominal fullness first, then treat Upper Jiao. Mere heart heat/vomiting indicates pathology entirely in Upper Jiao; vomiting cures it. Internal wine-heat knotting causing mental confusion, vexation, and pain requires purging. However, purging attacks the disease and cannot be used long-term; prolonged purging injures Spleen/Lung Yang, failing to control Yin-Blood, leading to daily blood deterioration and blackening. Zhang Zhongjing listed sequential steps for Wine Jaundice comprehensively. ○ Blackness in Wine Jaundice differs from Female Exhaustion Jaundice. Female Exhaustion blackness stems from Kidney Qi; Wine Jaundice blackness is the color of corrupted Ying-Blood. Ying is essence of food/water, stagnant by Damp-Heat, losing luster to become dull. Heart/mind clutter feels like eating garlic; sweet taste becomes sour/spicy. Skin insensitivity, black stool, floating-weak pulse all indicate Lung Metal governing Qi failing, causing blood stasis. Restoring Lung's clear/descending Qi drives out Ying turbid blood. Treatment difficulty is slightly less than Female Exhaustion Jaundice. Formulas merely using Baizhu Tang (Atractylodes Macrocephala Decoction) to regulate Spleen and resolve wine heat are profoundly mediocre! (Yu Jiayan)
Among jaundice syndromes, Hei Dan (Black Jaundice) is most severe, caused by wine dampness flowing into marrow/organs after drinking. It signals Earth failure and Water inundation. Early stage, form/spirit intact, Damp-Heat can be attacked, serving as a guide for jaundice treatment. Long-standing disease with emaciated skin indicates Yuan Essence depletion, unable to restore nutrition to exhausted waters. (Zhang Luyu)
Female Exhaustion Jaundice
Jaundice patients having fever at dusk but paradoxically fearing cold contracted this from female exhaustion. Urgent bladder, lower abdominal fullness, whole-body yellowing, black forehead, hot feet lead to Hei Dan (Black Jaundice). Abdominal distension like water, black stool, occasional looseness characterizes this Female Exhaustion disease, not water retention. Abdominal fullness is difficult to treat; Xiaoshi Fanshi San (Nitre and Alum Powder) is primary. ○ All jaundices are treated with Zhigao Fa Jian (Pig Fat and Hair Decoction). (*Jin Gui Yao Lue*)
Xiaoshi Fanshi San is the key formula for Female Exhaustion Jaundice; its use of Xiaoshi (Nitre) has never been understood. Men's blood transforms into essence; moving essence moves all blood. Female exhaustion depletes essence, causing blood to follow. Hematuria from female exhaustion is easier to treat as blood still flows. Jaundice from female exhaustion involves stagnant blood, making it difficult. Removing blood stasis from Bladder/lower abdomen is essential for survival. In Cold Damage Heat-Stasis in Bladder, bleeding cures the patient. If bleeding doesn't occur, Didang Tang (Hit the Palace Decoction) purges it, exploiting temporary blood clotting for aggressive attack. Here, accumulated blood in Female Exhaustion Jaundice persists for days/weeks; aggressive attack is useless. Use the fierce nature of stone drugs to reach the disease site quickly. Xiaoshi is salty/cold, entering Blood to eliminate Heat-Stasis; Fanshi removes entrenched Heat in bone marrow, clearing Kidney/Bladder Heat, building stasis-resolving and turbidity-clearing merit. ○ "Black forehead" in Female Exhaustion Jaundice means body yellow plus black forehead. Black is Northern Yin/Dark color added to Southern Li/Bright position. This indicates turbid Qi from Stomach Heat/Spleen Cold flowing down to Kidney, exacerbated by unrestrained sexual activity. Originating over time, Spleen turbid Qi sinks to Kidney, showing mixed Earth/Water colors, appearing as black stagnation within yellow. If Minister Fire flares from Water joining Heart Sovereign Fire, spreading like wildfire, smoke color penetrates forehead first, even slight sweat follows fire out forehead, Heart fluids escape. Hot palms/soles occur in internal injury. At dusk, Yangming takes command, closing and gathering whole-body Damp-Heat to rush downward, causing Bladder urgency. Free urination, black stool, occasional looseness verify Bladder blood stasis. Abdominal distension like water is actually blood stasis, hence untreated. ○ Zhigao Fa Jian uses hair power to enter Blood aspect, moisten dryness, open Bladder stasis, promote urination; once urination flows, Damp and Heat are removed. *Zhou Hou Bei Ji Fang* states: Female Exhaustion Jaundice with whole-body/eye yellowing, fever/chills, lower abdominal fullness, difficult urination caused by intense heat/labor intercourse followed by water immersion uses this formula. Female Exhaustion Jaundice involves Bladder blood stasis; only direct Blood-entering drugs can open it. Zhang Zhongjing used May Chong (Blue Bottle Fly), Shui Zhi (Leech), and Fanshi for this purpose. However, May Chong is too harsh for female exhaustion; Fanshi is too drying for female exhaustion dryness; thus, this formula was established to assist. (Yu Jiayan)
Exterior Pathogen Yellowing
All jaundice patients benefit from promoting urination. If pulse is floating, release via sweating using Guizhi Jia Huangqi Tang (Cinnamon Twig Plus Astragalus Decoction). ○ All jaundices with abdominal pain and vomiting are treated with Chaihu Tang (Bupleurum Decoction). ○ Gengti Tang (Melon Spittle Decoction) treats all jaundices. ○ Qianjin Mahuang Chunjiu Tang (Thousand Gold Ephedra and Mellow Wine Decoction) treats jaundice. (*Jin Gui Yao Lue*)
Zhang Zhongjing treats Cold Damage starting with Mahuang Tang (Ephedra Decoction) as exterior method. Observing *Jin Gui* treating exterior jaundice with Guizhi Jia Huangqi Tang and Xiaochaihu Tang, supplemented by Qianjin Mahuang Chunjiu Tang, clearly shows reluctance to induce sweating. Thus, it begins: "All jaundice patients, promote urination; if pulse floats, release via sweating." This shows the main rule is promoting urination; only with floating pulse can exterior be discussed. However, jaundice pulses often float due to Ying-Wei Qi deficiency allowing Damp-Heat to invade. Hence, Guizhi Jia Huangqi Tang harmonizes Ying-Wei, Xiaochaihu Tang harmonizes exterior-interior. Taking harmonization as the exterior method, are there no exterior-excess yellowing cases? Adding Mahuang Chunjiu Tang reveals the mechanism of treatment clearly. ○ Gengti Tang is a vomiting medicine. Pathogen in Diaphragm is shallow/easy to treat; vomiting removes yellow water, following *Nei Jing* principle of evacuating high pathogens. This is also a Zhang Zhongjing Cold Damage formula adapted for jaundice, attached later, showing reluctance to use lightly. (Yu Jiayan)
Exterior pathogen yellowing is essentially Cold Damage syndrome. When Cold Damage sweat cannot penetrate and Wind-Damp remains in exterior, yellowing occurs; or when exterior pathogen doesn't resolve, transmitting inward, Damp-Heat stagnates in Yangming, causing yellowing. Unresolved exterior pathogen features fever, body pain, floating pulse, scant sweat; disperse via sweating. Internally stagnant Damp-Heat features irritability, profuse sweating, slow-slippery pulse; resolve via separation/drainage. (*Jing Yue Quan Shu*)
Epidemic Yellowing
Epidemic yellowing features pathogenic Heat in Yangming, rapid pulse, fever, thirst with desire to drink, constipation, dark urine. Treat with Sheng Shouwu (Raw Polygonum Multiflorum), Heidou (Black Soybean), Biandou (Lablab Bean), Gancao (Licorice), Xian Huangtu (Fresh Yellow Earth), Shihu (Dendrobium), Maidong (Ophiopogon), Chiling (Red Poria), Cheqian (Plantago), Shenqu (Medicated Leaven), Gumao (Rice Sprout), Chenpi (Tangerine Peel) etc., to resolve epidemic toxin and save Spleen/Stomach. Allow pathogen to resolve from Yangming and exit exterior as smooth progression. If patient usually has Spleen/Kidney deficiency, despite Yangming Heat, with fine/forceless pulse, fatigue, low spirit, cold sweat, loose stools, urgently rescue Spleen/Kidney to prevent transmission to Jueyin/Shaoyin and risk collapse. (*Hui Xin Lu*)