黄胆,由脾胃湿热郁蒸,渐自身目如金,汗溺皆黄。经谓湿热相交,民病瘅也。丹溪云
∶此
如曲酱相似,湿热久 ,其黄乃成。海藏云∶凡病当汗不汗,当利小便不利,皆生黄。内
治以清热泄湿主之。
分阴阳,(二百遍。)推三关,(一百遍。)退六腑,(一百遍。)推补脾土,(三百遍。)抱
肚揉,(一百遍。)揉脐左右旋。(各一百遍。)凡推用葱汤香麝水。
按∶黄胆宜辨阴阳,湿热
阳黄多瘀热,烦渴大汗,脉必滑数,系胃腑湿热薰蒸,与胆液泄越,上而侵肺,则发黄
。其
色明如橘子。治在胃。且有表实里实之分,表实则无汗,治宜疏表,使黄从表解;里实则二
便必秘,腹必满,治宜下夺,使黄从里解。若表里无证,则不可汗下,惟利小便而已。
阴黄,身冷汗出,脉必沉微,系脾脏寒湿不通,与胆液浸淫,外渍肌肉则发黄,其色晦
如烟
薰,治在脾,或宜温脾,以理中加茵陈主之。或宜温肾,以四逆加茵陈主之。且阴黄亦有体
痛发热者,但身如薰黄,终不似阳黄如橘子色也。海藏治阴黄小便不利,烦躁而渴者,茵陈
茯苓汤主之。
疸∶黄病也。疸有五,身目皆黄,寒热体倦者为黄胆;食已如饥,头眩,烦热身黄者为
谷疸
;大醉当风入水,心中懊 ,不食欲吐,面黄赤斑者,为酒疸;房劳,小腹满急,额上黑,
手足心热,薄暮发热者为女劳疸;汗出染衣,色如柏汁,因身热汗出澡浴,水入毛孔而成者
,为黄汗。方书治法具在,则无庸赘述,若徒以按摩诸法施之,则拘矣。(惕厉子)
黄疸,是由于脾胃湿热郁结蒸腾,逐渐导致全身和眼睛像金子一样黄,汗液和小便都变黄。《内经》说湿热相互交结,百姓就会发生疸病。朱丹溪说:这就像曲酱相似,湿热时间久了,黄色才形成。张元素(海藏)说:凡是疾病应当发汗而不发汗,应当利小便而不利小便的,都会产生黄疸。内治法以清热利湿为主。
分阴阳穴(二百遍)。推三关穴(一百遍)。退六腑穴(一百遍)。推补脾土穴(三百遍)。抱肚揉(一百遍)。揉脐部左右旋转(各一百遍)。凡是用推拿手法时,使用葱汤或香麝水。
按语:黄疸应当辨别阴阳。湿热导致的阳黄多伴有瘀热,表现为烦躁、口渴、大汗,脉象必定滑数,这是胃腑湿热熏蒸,与胆液外泄有关,向上侵犯肺脏,则发黄。其颜色明亮如橘子皮。治疗重点在胃。并且有表实和里实的区别,表实则无汗,治疗宜疏解表邪,使黄疸从体表解除;里实则二便必然闭塞,腹部必然胀满,治疗宜攻下夺实,使黄疸从体内解除。如果表里都没有实证,则不可用发汗或攻下法,只需利小便即可。
阴黄,身体冷汗出,脉象必定沉微,这是脾脏寒湿不通,与胆液浸淫有关,向外渍入肌肉则发黄,其颜色晦暗如烟熏,治疗重点在脾,或者宜温补脾脏,以理中汤加茵陈为主方。或者宜温补肾阳,以四逆汤加茵陈为主方。而且阴黄也有身体疼痛发热的情况,但身体颜色像被烟熏的黄,终究不像阳黄那样像橘子色。张元素治疗阴黄小便不利、烦躁且口渴的患者,以茵陈茯苓汤为主方。
疸:是黄色的病。疸有五种,身体和眼睛都黄的,伴有寒热、身体疲倦的是黄胆;吃完饭后感觉像饥饿,头晕目眩,烦热身体发黄的是谷疸;大醉后受风或入水,心中懊恼,不想吃东西且想吐,面部黄赤有斑点的,是酒疸;房事劳累,小腹胀满急迫,额头发黑,手足心热,傍晚发热的是女劳疸;出汗染衣,颜色像柏树汁,因为身体热出汗洗澡,水进入毛孔而形成的,是黄汗。方书中的治疗方法都在那里,就不用赘述了,如果仅仅用按摩的各种方法来施治,那就局限了。(惕厉子)
Jaundice (Huangdan) arises from the stagnation and steaming of damp-heat in the Spleen and Stomach, gradually causing the whole body and eyes to turn yellow like gold, with sweat and urine both becoming yellow. The Classics state that when damp-heat interacts, the people suffer from Dan disease. Zhu Danxi said: This is similar to fermenting paste; after damp-heat persists for a long time, the yellow color forms. Zhang Yuansu (Haizang) said: For any disease where sweating should be induced but is not, or where promoting urination should occur but does not, jaundice will result. Internal treatment focuses on clearing heat and draining dampness.
Divide Yin and Yang points (200 times). Push San Guan point (100 times). Retreat Liu Fu point (100 times). Push and tonify Pi Tu point (300 times). Embrace the belly and knead (100 times). Knead the navel rotating left and right (100 times each). All pushing techniques should use scallion soup or musk-infused water.
Note: Jaundice should be differentiated into Yin and Yang types. Damp-heat leading to Yang Jaundice often involves stasis-heat, presenting with irritability, thirst, and profuse sweating; the pulse is invariably slippery and rapid. This is due to damp-heat steaming in the Stomach fu organ, combined with the leakage of bile fluid, which moves upward to invade the Lung, resulting in yellowing. The color is bright like an orange peel. Treatment focuses on the Stomach. There are also distinctions between exterior excess and interior excess. Exterior excess presents with no sweating; treatment should release the exterior to resolve jaundice through the skin. Interior excess presents with constipation and urinary retention, along with abdominal fullness; treatment should purge the interior to resolve jaundice from within. If there are no exterior or interior excess signs, neither sweating nor purging should be used; only promoting urination is appropriate.
Yin Jaundice presents with cold sweat and a pulse that is deep and faint. This is caused by cold-dampness obstructing the Spleen zang organ, interacting with bile fluid, which infiltrates outward into the muscles, causing yellowing. The color is dull and dark like smoke-stained material. Treatment focuses on the Spleen; one may warm the Spleen using Lizhong Tang (Regulate the Middle Decoction) added with Yinchen (Artemisiae Scopariae Herba). Alternatively, one may warm the Kidney using Sini Tang (Frigid Extremities Decoction) added with Yinchen. Furthermore, Yin Jaundice may present with body pain and fever, but the body color resembles smoke-stained yellow, distinctly different from the orange-peel hue of Yang Jaundice. Zhang Yuansu treated Yin Jaundice with difficulty in urination, irritability, and thirst using Yinchin Fuling Tang (Artemisia and Poria Decoction).
Dan: A disease characterized by yellowing. There are five types of Dan. When the body and eyes are yellow, accompanied by chills, fever, and fatigue, it is called Huangdan (Yellow Jaundice); when one feels hungry shortly after eating, experiences dizziness, irritability, and yellowing of the body, it is called Gu Dan (Grain Jaundice); when heavy drinking followed by exposure to wind or entering water causes mental restlessness, anorexia with nausea, and a yellow-red mottled face, it is called Jiu Dan (Wine Jaundice); when sexual exhaustion leads to lower abdominal fullness and urgency, blackening of the forehead, hot palms and soles, and evening fever, it is called Nulao Dan (Female Labor Jaundice); when sweat stains clothes with a color like cypress juice, resulting from bathing while the body is hot and sweating, allowing water to enter the pores, it is called Huanghan (Yellow Sweat). Methods of treatment found in medical formularies are already documented, so no further elaboration is needed. Relying solely on various massage techniques would be too restrictive. (Tili Zi)