秦子曰∶黄胆者,身目皆黄,色如橘皮,湿气胜,则黄而晦,热气胜,则黄而明,故爪
甲皮肤,悉见黄色,即是黄胆。若汗出染衣,色如柏汁,名曰黄汗,身肿者,入肿症门,身
不肿者,入疸症门,其间治法大同,而从肿从疸,则各异也。
【黄汗之症】眼白黄,面皮黄,汗出染衣,如黄柏汁,发热而渴,状如风水,身疼烦重
,小便不利,此黄汗之症也。
【黄汗之因】脾胃素热,汗出逢风,或汗出入水,水渍汗孔,湿热内蒸,热气外现,而
【黄汗之脉】洪大者愈易,细涩者瘥难。
【黄汗之治】《金匮》于水肿门,则立黄 芍药桂酒汤,以治身重发热,两胫自冷,
症,又立桂枝加黄 汤,以治身发热,足胫热,盗汗,汗出反发热之症,又于黄胆门,亦立
桂枝加黄 汤,以治诸黄家脉浮当汗之症,详见水肿门黄汗中。
黄 芍药桂酒汤 治身重发热,汗出而渴,黄汗染衣,脉自沉。
黄 芍药 桂枝
桂枝加黄 汤
桂枝 芍药 甘草 生姜 黄 大枣
【正黄胆之症】食已即饥,遍身俱黄,小便或赤,或不利,憎寒壮热,身体如肿,此黄
疸之症也。
【正黄胆之因】脏腑积热,并于脾胃之间,外因风湿相搏,闭郁腠理,湿热熏蒸,HT 而
成黄,则诸黄胆之症乃作。
【正黄胆之脉】寸脉浮缓,缓则伤风,趺阳紧数,数则为热,紧则伤脾,尺脉本沉,浮
则肾伤,阳明脉迟,迟则忌下。
【正黄胆之治】假令脉浮,当以汗解,桂枝黄 汤。若寒热,胸满,烦呕,小柴胡汤。
恶寒身痛,表不解者,麻黄醇酒汤。若腹满,小便不利而赤,自汗出,此表解里实热,宜下,大黄
硝石汤、茵陈汤。小便不利,加减五苓散。胸满呕吐,小半夏汤。黄结上焦者,权用瓜蒂散
吐之,然不若吹鼻出黄水。
桂枝加黄 汤 治黄胆脉浮,宜汗者;若腹满,欲呕吐懊 ,宜吐不宜汗。
桂枝 白芍 生姜 黄 甘草 大枣
上水煮温服,须臾饮热稀粥以助药力,取微汗。
小柴胡汤 见后酸软。
麻黄醇酒汤
用麻黄,冬月酒煮,春月水煮。
大黄硝石汤
大黄 黄柏 硝石 栀子
茵陈大黄汤
茵陈 大黄 栀子
小半夏汤
半夏 广皮 加姜煎。
茵陈五苓散 即五苓散加茵陈。
秦子说:黄疸病,表现为身体和眼睛都发黄,颜色像橘皮一样。如果湿气偏胜,黄色就会晦暗;如果热气偏胜,黄色就会鲜明。因此,指甲和皮肤全部呈现黄色,这就是黄疸。如果汗液流出染在衣服上,颜色像黄柏汁一样,称为黄汗。身体浮肿的,归入水肿症门类;身体不浮肿的,归入疸症门类。这两者之间的治疗方法大体相同,但根据是否浮肿归属于水肿或疸症,则具体治法各异。
【黄汗的症状】眼白发黄,面部皮肤发黄,出汗染衣,颜色如黄柏汁,伴有发热和口渴,症状类似风水病(一种以头面浮肿、恶风为主的风水证),身体疼痛且沉重烦扰,小便不通利,这是黄汗的症状。
【黄汗的病因】脾胃素来有热,出汗时受风邪侵袭,或者出汗后进入水中,水湿浸渍汗孔,导致湿热在内蒸腾,热气向外发散,从而形成黄汗。
【黄汗的脉象】脉象洪大者容易治愈,脉象细涩者难愈。
【黄汗的治疗】《金匮要略》在水肿门类中,设立黄芪芍药桂酒汤,用于治疗身体沉重发热、两小腿自冷等症状;又设立桂枝加黄芪汤,用于治疗身体发热、足胫发热、盗汗、出汗后反而发热的症状;又在黄疸门类中,同样设立桂枝加黄芪汤,用于治疗各种黄疸患者脉浮应当发汗的症状,详细内容详见水肿门中的黄汗部分。
黄芪芍药桂酒汤 治疗身体沉重发热,出汗而口渴,黄汗染衣,脉象自沉。
方药组成:黄芪、芍药、桂枝。
【正黄疸的症状】进食后立即感到饥饿,全身都发黄,小便有时发红,有时不通利,憎恶寒冷且壮热,身体感觉像浮肿一样,这是黄疸的症状。
【正黄疸的病因】脏腑积热,汇聚于脾胃之间,外因风湿相搏结,闭塞郁阻腠理,湿热熏蒸,蕴结而成黄色,于是各种黄疸的症状就产生了。
【正黄疸的脉象】寸脉浮缓,缓脉表示伤风;趺阳脉紧数,数脉表示有热,紧脉表示伤脾;尺脉本应沉,若见浮脉则表示肾受伤;阳明脉迟,迟脉表示忌用攻下法。
【正黄疸的治疗】假如脉浮,应当用发汗法解表,使用桂枝加黄芪汤。如果有寒热往来、胸胁胀满、心烦呕吐,使用小柴胡汤。如果恶寒身痛,表证未解,使用麻黄醇酒汤。如果腹部胀满,小便不利且色赤,自汗出,这是表证已解、里实热盛,适宜用攻下法,可用大黄硝石汤、茵陈汤。如果小便不利,用加减五苓散。如果胸满呕吐,用小半夏汤。如果湿热结聚在上焦,权且使用瓜蒂散催吐,然而不如吹鼻引出黄水的方法好。
桂枝加黄芪汤 治疗黄疸脉浮,适宜发汗者;如果出现腹部胀满,想要呕吐、懊恼,适宜催吐而不适宜发汗。
方药组成:桂枝、白芍、生姜、黄芪、甘草、大枣。
煎服法:以上药物用水煎煮,温服,服药片刻后喝热稀粥以助药力,取微汗。
小柴胡汤 参见后文酸软症。
Qin Zi said: Jaundice is characterized by yellowing of both the body and the eyes, with a color resembling orange peel. If dampness predominates, the yellow color will be dull; if heat predominates, the yellow color will be bright. Therefore, when the fingernails and skin all exhibit a yellow hue, it is identified as jaundice. If sweat stains the clothing with a color like the juice of Phellodendri Cortex (Huangbai), it is termed "Yellow Sweat" (Huanghan). Cases with bodily edema are classified under the category of Edema Syndromes, while those without edema fall under the category of Dan Syndromes. Although the treatment methods between these two categories are largely similar, specific approaches differ depending on whether they are categorized as edema or dan syndromes.
[Symptoms of Yellow Sweat] The whites of the eyes and facial skin turn yellow; sweat stains clothes with a color like Phellodendri Cortex juice; accompanied by fever and thirst; symptoms resemble Fengshui syndrome (a wind-water syndrome characterized by edema of the head and face and aversion to wind); body pain with heaviness and irritability; and difficult urination. These constitute the symptoms of Yellow Sweat.
[Etiology of Yellow Sweat] The spleen and stomach possess inherent heat. When sweating occurs followed by exposure to wind, or entering water while sweating, water moisture infiltrates the sweat pores. This leads to internal steaming of damp-heat, with heat qi manifesting externally, resulting in Yellow Sweat.
[Pulse of Yellow Sweat] A洪大 (Hongda, surging and large) pulse indicates easier recovery, whereas a细涩 (Xise, fine and choppy) pulse indicates difficulty in recovery.
[Treatment of Yellow Sweat] In the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), within the Edema section, Huangqi Shaoyao Guijiu Tang (Astragalus, Peony, and Cinnamon Twig Wine Decoction) is established to treat symptoms of heavy body and fever with spontaneous coldness in both calves. Additionally, Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus) is established to treat symptoms of body fever, heat in the feet and calves, night sweats, and fever that persists despite sweating. Furthermore, within the Jaundice section, Guizhi Jia Huangqi Tang is also established to treat various jaundice cases where the pulse is floating and diaphoresis is indicated. For details, refer to the Yellow Sweat section in the Edema chapter.
Huangqi Shaoyao Guijiu Tang treats heavy body and fever, sweating with thirst, yellow sweat staining clothes, and a self-deep pulse.
Ingredients: Huangqi (Astragali Radix), Shaoyao (Paeoniae Radix), Guizhi (Cinnamomi Ramulus).
Guizhi Jia Huangqi Tang
Ingredients: Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), Huangqi (Astragali Radix), Dazao (Jujubae Fructus).
[Symptoms of Typical Jaundice] Hunger immediately after eating; yellowing of the entire body; urine may be red or difficult to pass; aversion to cold with high fever; sensation of bodily swelling. These constitute the symptoms of jaundice.
[Etiology of Typical Jaundice] Accumulated heat in the zang-fu organs converges between the spleen and stomach. Externally, wind and dampness interact, closing and stagnating the couli (pores and interstices). Damp-heat steams and熏蒸 (fumes/steams), condensing into yellow, thereby generating various jaundice symptoms.
[Pulse of Typical Jaundice] The Cun (inch) pulse is floating and slow; a slow pulse indicates wind injury. The Yuyang (foot Yangming) pulse is tight and rapid; a rapid pulse indicates heat, and a tight pulse indicates spleen injury. The Chi (cubit) pulse should naturally be deep; if floating, it indicates kidney injury. The Yangming pulse is slow; a slow pulse contraindicates purgation.
[Treatment of Typical Jaundice] If the pulse is floating, resolution via diaphoresis is indicated, using Guizhi Jia Huangqi Tang. If there are alternating chills and fever, chest fullness, irritability, and vomiting, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used. If there is aversion to cold, body pain, and unresolved exterior syndrome, Mahuang Chunjiu Tang (Ephedra and Mellow Wine Decoction) is used. If there is abdominal fullness, difficult and red urination, and spontaneous sweating, this indicates resolved exterior and excess heat in the interior, requiring purgation; Dahuang Xiaoshi Tang (Rhubarb and Niter Decoction) or Yinchen Tang (Artemisiae Scopariae Decoction) are appropriate. If urination is difficult, Jiawu Wuling San (Modified Five-Ingredient Powder with Poria) is used. If there is chest fullness and vomiting, Xiao Banxia Tang (Minor Pinellia Decoction) is used. If damp-heat knots in the Upper Jiao, Gouti San (Melon Sepal Powder) is temporarily used for emesis, though blowing powder into the nose to induce discharge of yellow fluid is preferable.
Guizhi Jia Huangqi Tang treats jaundice with a floating pulse, suitable for diaphoresis; if abdominal fullness, desire to vomit, and anguish occur, emesis is indicated rather than diaphoresis.
Ingredients: Guizhi (Cinnamomi Ramulus), Baishao (Paeoniae Radix Alba), Shengjiang (Zingiberis Rhizoma Recens), Huangqi (Astragali Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Dazao (Jujubae Fructus).
Preparation: Decoct the above ingredients in water and take warm. Shortly after ingestion, drink hot thin porridge to assist the medicinal power, aiming for slight sweating.
Xiao Chaihu Tang See later under Soreness and Weakness.
Mahuang Chunjiu Tang
Usage: Use Mahuang (Ephedrae Herba); decoct in wine during winter months, and in water during spring months.
Dahuang Xiaoshi Tang
Ingredients: Dahuang (Rhei Radix et Rhizoma), Huangbai (Phellodendri Cortex), Xiaoshi (Natrii Sulfas), Zhizi (Gardeniae Fructus).
Yinchen Dahuang Tang
Ingredients: Yinchen (Artemisiae Scopariae Herba), Dahuang (Rhei Radix et Rhizoma), Zhizi (Gardeniae Fructus).
Xiao Banxia Tang
Ingredients: Banxia (Pinelliae Rhizoma Preparatum), Guangpi (Citri Reticulatae Pericarpium), add Shengjiang (Zingiberis Rhizoma Recens) for decoction.
Yinchen Wuling San Is Wuling San (Five-Ingredient Powder with Poria) added with Yinchen (Artemisiae Scopariae Herba).