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。跗阳脉紧而数，数则为热，热则消谷；紧则为寒，食即为满。尺脉浮为伤肾，跗阳
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，名曰女劳疽，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，痹非中凤，前已详言之矣。今跗阳紧数
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，及食谷饮酒，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，清气阻于上行，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 ，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，里之脏腑，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，躁不得睡，属黄家。
【按】舌痿黄之“舌”字，当是“身”字，必传写之讹。
【注】身痿而黄，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 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 汤。于此推之，可
知脉沉在里，当以下解之也。
【集注】高世 曰∶利小便，及黄家一定之法，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 汤，用桂枝
汤以解肌，肌解则汗自出，加黄 以助表，表和则营卫亦通矣。
桂枝加黄 汤方（见水气病中）
师曰∶病黄胆，发热、烦喘、胸满、口燥者，以病发时，火劫其汗，两热相得，然
黄家所得，从湿得之，一身尽发热而黄，肚热，热在里，当下之。
【注】此详申黄胆误用火汗之为病也。病疸者，湿热也。今湿淫于内，则胸满烦喘；热
淫于内，则发热口燥。若病发时，复以火劫其汗，则为两热相合。盖黄家所得，由湿得
之，则一身必尽热，而身面即发黄也。今因火劫误汗而发黄，虽有表热，则不当汗也，但
扪其肚热，其热在里，当下之以去其热也。
【集注】程林曰∶湿淫于内，则烦喘胸满；热淫于内，则发热口燥；复以火迫劫其汗，反
致两热相搏。殊不知黄家之病，必得之湿热瘀于脾土，故一身尽发热而黄，正以明火劫
之误也。若肚有热，则热在腹，可下之以去其湿热。
黄病腹满，小便不利而赤，自汗出，此为表和里实，当下之，宜大黄硝石汤。
【注】此承上条，互详其证，以明其治也。腹满、小便不利而赤，是热在里，其人自汗
出，此为表和里实也，宜大黄硝石汤下之。
大黄硝石汤方
大黄 黄柏 硝石（各四两） 栀子（十五枚）
上三味，以水六升，煮取二升，去滓，内硝更煮，取一升，顿服。
【集解】李 曰∶腹满、小便不利而赤，里病也。自汗出，表和也。里病者，湿热内
甚，用桅子清上焦湿热，大黄泻中焦湿热，黄柏清下焦湿热，硝石则于苦寒泻热之中，而
有燥烈发散之意，使药力无所不至，而湿热悉消散矣。
黄胆病，茵陈五苓散主之（一本云∶茵陈汤及五苓散并主之。）
【按】黄胆病之下，当有“小便不利者”五字，茵陈五苓散方有着落，必传写之遗。
【注】
黄胆病，脉沉腹满在里者，以大黄硝石汤下之；脉浮无汗在表者，以桂枝加黄 汤
汗之；小便不利者，不在表里，故以茵陈五苓散主之。
茵陈五苓散方
茵陈蒿末（十分） 五苓散（五分，方见痰饮中）
上二味和，先食饮服方寸匕，日三服。
【集解】尤怡曰∶此正治湿热成疸者之法，茵陈散热郁，五苓利湿瘀也。
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。
【注】黄胆病小盒饭赤，今不赤而白，且欲自利，虽腹满而喘，是湿盛无热，阴黄证
也。切不可除热，若除热以凉药下之，则胃必寒而作哕。哕者主之以小半夏汤，以止哕
也。
【集注】李 曰∶小便色不变欲自利，里无实可知，腹满而喘，脾气虚而肺气不利耳！
用苦寒药攻里除热，则胃寒而虚气上逆，故哕，宜小半夏汤散逆止哕。
高世 曰∶小便色不变，非赤也；欲自利，非下利也。若腹满而喘，虽似里实，不
可投寒剂以除热，如大黄硝石汤，不可用也。若投寒剂而除热，则必哕。哕，呃逆也。半
夏生姜辛温散寒，故哕者，当以小半夏汤主之也。
小半夏汤方（见痰饮中）
黄胆之病，当以十八日为期，治之十日以上瘥，反剧为难治。
【注】疸病属脾，脾主土，土无定位，寄旺于四季之末，各十八日。期之十八日者，土
旺之日也，故治十日以上当瘥，而不逾十八日之外也。若逾十八日不瘥而反剧者，则土
衰矣。故曰∶难治。
【集注】高世 曰∶十八日，乃脾土寄旺于四季之期，十日，土之成数也，黄胆之病
在于脾土，故当以十八日为期。然治之宜先，故治之十日以上即当瘥。至十日以上不瘥，而
疸病反剧者，是谓难治，谓土气虚败不可治也。
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。
【注】此详申谷疸之为病也。未成谷疸之时，其人多病寒热。寒热作时，则不能食；寒
热止时，则或能食，虽能食，然食后即头晕目眩，心烦不安。此为湿瘀热郁而内蒸，将
作谷疸之征也。久久身面必发黄，为谷疸矣。宜茵陈蒿汤利下，使从大、小二便而出之。
茵陈蒿汤方
茵陈蒿（六两） 桅子（十四枚） 大黄（二两）
上三味，以水一斗，先煮茵陈，减六升，内二味，煮取三升，去滓，分温三服。小便
当利，尿如皂角汁状，色正赤，一宿腹减，黄从小便去也。
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。
【注】谷疸属胃热，脉当数，今脉迟，脾脏寒也。寒不化谷，所以虽饥欲食，食难用
饱，饱则烦闷，胃中填塞健运失常也。清者阻于上升，故头眩；浊者阻于下降，故小便
难也。此皆欲作谷疸之征。其证原从太阴寒湿郁黩而生，若误以为阳明热湿发黄，下之
虽腹满暂减，顷复如故，所以然者，脉迟寒故也。此发明欲作谷疸，属脾阴寒化而不可
下者也。
【集注】程林曰∶脉迟为寒，寒不杀谷，故食难用饱。饱则谷气不消，胃中苦浊，浊
气蕴蓄则发烦，熏蒸则作眩也。小便难者，以脉迟则无阳以施化浊气，但留于胃而不宣，是
以欲作谷疸。若下之，徒虚其胃而腹满如故也，所以然者，以脉迟为寒之故也。
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。
【注】此详申女劳疸之为病，黄胆日晡所发热，乃阳明热症，当不恶寒也；而反恶寒
者，非阳明热症，此或为女劳得之也。女劳
得之疸证，虽膀胱急，少腹满，而小便自利；身虽尽黄，而额上则黑；虽发热，惟足下甚。
此少阴热因作黑疸也。故腹胀如水状，而大便必黑，时溏，知非水胀病，乃为女劳得之
疸胀病也。时溏黑色者，亦脏病及血之征也。血病者颜必变，岂有色黑而血不病者乎？女
劳疸腹满者为难治，以其脾肾两败也。以硝石入血消坚，矾石入气胜湿，然此方治标固
宜，非图本之治。世久书讹，姑辨其理也。
【集注】尤怡曰∶黄家，日晡所本当发热，今发热而反恶寒者，此为女劳得之疸也。热
在胃浅而肾深，故热深则先反恶寒也。膀胱急，额上黑，足下热，大便黑，皆肾热之征。
虽少腹满胀有如水状，而实为肾气不行，非脾湿而水不行也。惟是证兼腹满，则脾肾并
伤，而其治为难耳！硝石咸寒除热，矾石除痼热在骨髓，骨与肾合，用以清肾热也。大
麦粥和服，恐伤胃也。
硝石矾石散方
硝石 矾石（烧，等分）
上二味为散，以大麦粥汁和，服方寸匕，日三服。病随大小便去，小便正黄，大便正
黑，是候也。
男子黄，小便自利，当与虚劳小建中汤。
【注】妇人产后经崩，发黄色者，乃脱血之黄色，非黄胆也。今男子黄而小便自利，则
知非湿热发黄也。询知其人必有失血亡血之故，以致虚黄之色外现。斯时汗、下、渗、利
之法俱不可施，惟当与虚劳失血同治，故以小建中汤调养营卫，黄自愈矣。
【集注】高世 曰∶女为阴，男为阳，阴主血，阳主气，男子黄，阳气虚也。黄者土
之色，阳气虚而土色外呈。中无湿热，故小便自利。此为虚也，故当以小建中汤和其阴
阳，调其血气也。本论《血痹虚劳篇》有小建中汤主治虚劳，故曰∶虚劳小建中。意谓
此男子黄而小便利，亦为虚劳之证云尔。
小建中汤方（见虚劳中）
酒黄胆者，或无热谵言，小腹满欲吐，鼻燥。其脉浮者，先吐之；沉弦者，先下之。
【注】此详申酒疸之为病也。酒体湿而性热，过饮之人必生湿热为疸病也。无热，无
外热也；谵语、鼻燥，有内热也；小腹满，湿热蓄于膀胱也；欲吐，湿热酿于胃中也。其
脉浮者，酒热在经，先吐之以解外也；沉弦者酒饮在里，先下之以解内也。
【集注】李 曰∶胃足阳明之脉，起于鼻之交 中，故鼻燥也。
夫病酒黄胆，必小便不利，其候心中热，足下热，是其证也。
【注】此详酒疸之病。湿热生也，必小便不利。其候心中热，胃腑热也；足下热，胃
经热也。是其酒疸之证也。
【集注】程林曰∶夫小便利则湿热行，不利则湿留于胃，胃脉贯膈下足跗，上熏胃脘
则心中热，下注足跗，则足下热也。
酒疸，心中热，欲吐者，吐之愈。
【注】此详申酒疸宜吐之治也。酒疸，心中热、欲吐者，谓胃中烦乱懊 欲吐，非吐
之不能愈也。
【集注】程林曰∶后证热深则懊 欲吐，今微热则心中热亦欲吐。病属上焦，故吐之
可愈也。
酒黄胆，心中懊 ，或热痛，桅子大黄汤主之。
【注】此详申酒疸宜下之治也。酒黄胆，谓因饮酒过度而成黄胆也。心中懊 欲吐，或
自吐之而愈，或服栀子豉汤吐之而愈，皆可也。若心中懊 不欲吐，或心中热痛，皆非
吐之可愈，故以栀子大黄汤下之愈也。
栀子大黄汤方
寸口脉象浮而缓，浮脉主风邪，缓脉主湿痹，但这种痹证并非中风。患者四肢感到烦扰不适，脾的色泽必现于面部发黄，这是由于瘀滞的热邪随气血运行所致。跗阳脉象紧而数，数脉主热，热能消谷；紧脉主寒，寒则进食后腹部胀满。尺部脉象浮表示伤肾，跗阳脉象紧表示伤脾。风寒之邪相互搏结，进食后即感头晕目眩，水谷之气不能正常消化，胃中苦于浊气内停，浊气向下流注，导致小便不通，阴分受寒邪侵袭，热邪流入膀胱，全身皮肤尽皆发黄，这种病称为谷疸。若见额头颜色发黑，微汗出，手足心发热，傍晚时分发作，膀胱拘急但小便自利，这种病称为女劳疸；若腹部胀大如水肿状，属于难治之症。心中烦闷懊恼且发热，不能进食，时常想呕吐，这种病称为酒疸。
【注释】寸口脉浮而缓，浮为风，缓为痹，痹非中风，前文已详细论述过。如今跗阳脉紧数而尺脉浮，四肢烦扰，身面发黄，这是黄疸病。黄色是土的颜色，土病则显现此色。土归属于脾胃，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，内因房劳过度所伤，以及饮食谷物和饮酒，或与湿邪相瘀，或与热邪相郁，都能导致这种疾病。如果胃脉数，说明热胜于湿，则从胃阳热化，热则能消谷，所以能进食而称为阳黄。如果胃脉紧，说明湿胜于热，则从脾阴寒化，寒则不能进食，所以食后即胀满而称为阴黄。阳黄包括热疸、酒疸，阴黄包括女劳疸、谷疸。如果尺脉不沉反浮，则为伤肾，肾病导致的黄疸，也是女劳疸。胃脉不缓反紧，则为伤脾，脾病导致的黄疸，也是谷疸。谷疸表现为进食后即胀满，水谷之气不消，胃中苦于浊气，清气受阻不能上行，所以头眩；浊气流注膀胱，所以小便不通。女劳疸表现为额头发黑，这是肾病的颜色；微汗出，说明湿邪未瘀滞；五心烦热，傍晚发作，这是肾阴虚热；膀胱拘急，小便通利，这是下焦虚损。腹部胀满如水状，是脾肾两败，所以称为不治之症。如果心中烦闷懊恼，发热不能进食，时常想吐，小腹满，小便不利，即使见到眼睛青、面色黑，必定是酒疸病。
脉象沉，口渴想喝水，小便不利的，都会发黄。
【注释】脉沉，主里证；口渴想喝水，是热邪瘀滞；小便不利，是湿邪郁结；热瘀湿郁结在体内，所以发黄。首条说脉浮缓、紧数都会导致发黄，这是由外因引起的；这一条脉沉也会导致发黄，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】李氏说：脉沉而渴，渴欲饮水，小便不利，则是湿热内蓄，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伴有发热。
【注释】未形成黄疸之前，小便不利且口渴的，是想作黄疸病。已经形成黄疸之后而口渴的，是热邪深重不已，所以难治；不口渴的是热邪浅即将除，所以可治。黄疸发于阴分的，人必定呕吐逆气。呕吐逆气，是因为阴里（脏腑）受病。发于阳分的，人必定恶寒战栗并伴有发热。寒热症状，是因为阳表（躯壳）受病。这里通过渴与不渴，来辨别黄疸的难治与可治；通过呕吐逆气和寒热，来辨别黄疸是在表还是在里。
【集注】程林说：黄疸患者多有湿热相搏，有口燥、鼻燥但未至于渴，若渴则津液内消，邪气独盛；不渴则津液未竭，正气未衰，因此治疗上有难易之分。阴主里，湿胜于里则呕吐；阳主表，热胜于表则恶寒战栗发热。这一条辨析黄疸证的渴与不渴，有轻重表里的区别。尤怡说：黄疸而渴，则热正炽盛，且湿邪日益增加，所以难治；不渴则热已减退，湿邪也自然消退，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，属于形体，所以恶寒战栗发热。这是阴阳内外、浅深、微甚的区别。
腹部胀满，身体萎黄，烦躁不得入睡，属于黄疸病患者。
【按语】“舌痿黄”中的“舌”字，应当是“身”字，必然是传抄时的错误。
【注释】身体萎黄，腹部胀满且烦躁不得入睡的，属于黄疸病，病位在里，应当用攻下法治疗。
【集注】徐彬说：腹部胀满是里证，现在又有腹部胀满加上身体萎黄，烦躁不得眠，这是瘀热外行的表现，这是发黄的征兆。所以说：属于黄疸病患者。
所有黄疸病患者，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。
【注释】所谓诸黄家病，指一切黄疸病。黄疸病没有明显的表里证区分，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，可知脉沉在里的，应当用攻下法解除。
【集注】高世栻说：利小便是治疗黄疸的一定法则，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：假如脉浮表示在表，应当用发汗法解除。发汗的方法，适宜用桂枝加黄芪汤，用桂枝汤解肌，肌解则汗自出，加黄芪以助表气，表气和顺则营卫也通畅了。
老师说：患黄疸病，出现发热、烦躁气喘、胸满、口燥等症状，是因为发病时，用火法强迫出汗，导致两热相合。然而黄疸病的成因，是从湿邪得来的，全身尽发热而发黄，肚腹热，热在里，应当用攻下法。
【注释】此处详细阐述黄疸误用火法发汗导致的病症。患黄疸者，是湿热之邪。如今湿邪淫溢于内，则胸满烦躁气喘；热邪淫溢于内，则发热口燥。如果在发病时，再用火法强迫发汗，就会导致两热相合。大概黄疸病是由湿邪得来的，则全身必然尽发热，而身面即发黄。如今因火法误汗而发黄，虽然有表热，也不应当发汗，只需触摸其肚腹发热，可知热在里，应当用攻下法以去除热邪。
【集注】程林说：湿邪淫溢于内，则烦躁气喘胸满；热邪淫溢于内，则发热口燥；再用火迫劫发汗，反而导致两热相搏。殊不知黄疸病，必定是湿热瘀结于脾土，所以全身尽发热而发黄，这正是为了指明火法发汗的错误。如果肚腹有热，则热在腹部，可以用攻下法以去除湿热。
黄疸病腹部胀满，小便不利且色赤，自汗出，这是表气和里实，应当用攻下法，适宜用大黄硝石汤。
【注释】此处承接上条，互相详述其证候，以阐明其治法。腹部胀满、小便不利且色赤，是热在里，其人自汗出，这是表气和里实的表现，适宜用大黄硝石汤攻下。
大黄硝石汤方
大黄 黄柏 硝石（各四两） 栀子（十五枚）
以上三味药，用水六升，煮取二升，去滓，加入硝石再煮，取一升，一次顿服。
【集解】李氏说：腹部胀满、小便不利且色赤，是里病。自汗出，是表和。里病者，是湿热内盛，用栀子清上焦湿热，大黄泻中焦湿热，黄柏清下焦湿热，硝石则在苦寒泻热之中，具有燥烈发散之意，使药力无所不至，而湿热全部消散。
黄疸病，茵陈五苓散主治（另一版本说：茵陈汤及五苓散并主之。）
【按语】“黄疸病”之下，应当有“小便不利者”五个字，茵陈五苓散方才有依据，必然是传抄时的遗漏。
【注释】
黄疸病，脉沉腹部胀满在里的，用大黄硝石汤攻下；脉浮无汗在表的，用桂枝加黄芪汤发汗；小便不利的，不在表里，所以用茵陈五苓散主治。
茵陈五苓散方
茵陈蒿末（十分） 五苓散（五分，方见痰饮篇中）
以上两味药混合，饭前用米汤送服一方寸匕，每日三次。
【集解】尤怡说：这是治疗湿热成疸的正治之法，茵陈散热郁，五苓散利湿瘀。
黄疸病，小便颜色不变（正常），想要自利（腹泻），腹部胀满且气喘，不可清除热邪，清除热邪必定会导致呃逆。呃逆者，用小半夏汤主治。
【注释】黄疸病的小便应当色赤，如今不赤而白，且想要自利，虽然腹部胀满且气喘，这是湿盛无热，属于阴黄证。切不可清除热邪，如果用凉药攻下除热，则胃必寒而引发呃逆。呃逆者，主以小半夏汤，以止呃逆。
【集注】李氏说：小便色不变且想要自利，可知里没有实证，腹部胀满且气喘，是脾气虚而肺气不利！用苦寒药攻里除热，则胃寒而虚气上逆，所以呃逆，适宜用小半夏汤散逆止呃。
高世栻说：小便色不变，不是色赤；想要自利，不是下利。如果腹部胀满且气喘，虽然看似里实，不可投寒剂以除热，如大黄硝石汤，不可使用。如果投寒剂而除热，则必定呃逆。呃逆，即打嗝。半夏生姜辛温散寒，所以呃逆者，应当用小半夏汤主治。
黄疸病，病程当以十八天为期，治疗十天以上痊愈，如果反而加重则难治。
【注释】黄疸病属脾，脾主土，土无固定位置，寄旺于四季之末，各十八天。定为十八天为期，是土气旺盛的日子，所以治疗十天以上应当痊愈，而不超过十八天之外。如果超过十八天不愈反而加重的，则是土气衰败了。所以说：难治。
【集注】高世栻说：十八天，是脾土寄旺于四季的周期，十天，是土的成数，黄疸病在于脾土，所以当以十八天为期。然而治疗应当尽早，所以治疗十天以上即应当痊愈。到了十天以上不愈，而黄疸病反而加重的，这叫做难治，谓土气虚败不可治。
谷疸这种病，恶寒发热，不能进食，进食后即头晕目眩，心胸不安，久久发黄，称为谷疸，用茵陈蒿汤主治。
【注释】此处详细阐述谷疸的病症。未形成谷疸之时，此人多患有寒热病。寒热发作时，则不能进食；寒热停止时，则或许能进食，虽然能进食，但食后即头晕目眩，心烦不安。这是因为湿瘀热郁而内蒸，是将要作谷疸的征兆。久久之后身面必然发黄，成为谷疸了。适宜用茵陈蒿汤利下，使邪气从大小二便排出。
茵陈蒿汤方
茵陈蒿（六两） 栀子（十四枚） 大黄（二两）
以上三味药，用水一斗，先煮茵陈，减去六升，加入另外两味药，煮取三升，去滓，分三次温服。小便应当通利，尿如皂角汁状，颜色正红，一夜之后腹部胀满减轻，黄色从小便而去。
阳明病，脉迟的，进食难以吃饱，饱则发烦，头晕目眩，小便必定困难，这是将要作谷疸。即使攻下，腹部胀满依旧，之所以这样，是因为脉迟的缘故。
【注释】谷疸属胃热，脉应当数，如今脉迟，是脾脏寒。寒不能消化谷物，所以虽然饥饿想吃，但进食难以吃饱，饱则烦闷，胃中填塞健运失常。清气受阻不能上升，所以头晕目眩；浊气受阻不能下降，所以小便困难。这些都是将要作谷疸的征兆。其证原本从太阴寒湿郁遏而生，如果误以为是阳明热湿发黄，攻下后虽然腹部胀满暂时减轻，片刻后又恢复原状，之所以这样，是因为脉迟寒的缘故。此处阐明了将要作谷疸，属于脾阴寒化而不可攻下的情况。
【集注】程林说：脉迟为寒，寒不能杀谷（消化食物），所以进食难以吃饱。饱则谷气不消，胃中苦于浊气，浊气蕴蓄则发烦，熏蒸则作眩。小便难，是因为脉迟则无阳气以施化浊气，浊气只留在胃中而不宣散，所以欲作谷疸。如果攻下，徒然使胃虚而腹部胀满依旧，之所以这样，是因为脉迟为寒的缘故。
黄疸病患者，下午申时发热，反而恶寒，这是女劳疸所致，膀胱拘急，少腹满，全身发黄，额头发黑，足下发热，因而形成黑疸，其腹部胀大如水状，大便必定黑，时而溏泄，这是女劳疸病，不是水胀病，腹部胀满的难治，用硝石矾石散主治。
【注释】此处详细阐述女劳疸的病症。黄疸病在申时发热，本是阳明热症，应当不恶寒；却反而恶寒的，不是阳明热症，这可能是女劳疸所致。女劳疸证，虽然膀胱拘急，少腹满，但小便自利；身体虽尽黄，但额头则黑；虽然发热，只有足下甚。这是少阴热邪导致黑疸。所以腹部胀大如水状，而大便必黑，时而溏泄，知道不是水胀病，乃是女劳疸胀病。时而溏泄黑色，也是脏病及血的征象。血病者颜面必变色，岂有色黑而血不病的呢？女劳疸腹部胀满的难治，因为脾肾两败。用硝石入血分消除坚积，矾石入气分胜湿，然而此方治标固然适宜，并非图本的治疗。世间书籍长久讹误，姑且辨析其理。
【集注】尤怡说：黄疸病患者，申时本当发热，如今发热而反恶寒的，这是女劳疸。热在胃浅而肾深，所以热深则先反恶寒。膀胱拘急，额头发黑，足下发热，大便黑，都是肾热的征象。虽然少腹满胀有水状，实为肾气不行，不是脾湿而水不行。只是证兼腹满，则脾肾并伤，而其治疗为难耳！硝石咸寒除热，矾石消除骨髓中的痼热，骨与肾相合，用以清肾热。大麦粥调和服用，是恐伤胃气。
硝石矾石散方
硝石 矾石（烧，等分）
以上两味药研为散，用大麦粥汁调和，服一方寸匕，每日三次。病随大小便而去，小便正黄，大便正黑，这是见效的征候。
【注释】妇人产后经崩，发黄色的，是脱血之黄色，不是黄疸。如今男子发黄而小便自利，则知不是湿热发黄。询问得知此人必有失血亡血的原因，以致虚黄之色外现。此时汗、下、渗、利诸法都不可施用，只应当与虚劳失血同治，所以用小建中汤调养营卫，黄色自然痊愈。
【集注】高世栻说：女为阴，男为阳，阴主血，阳主气，男子发黄，是阳气虚。黄色是土的颜色，阳气虚而土色外呈。中没有湿热，所以小便自利。此为虚证，所以应当用小建中汤调和阴阳，调其血气。本论《血痹虚劳篇》有小建中汤主治虚劳，所以说：虚劳小建中。意思是说此男子黄而小便利，也是虚劳的证候。
酒黄疸，或者无外热而谵语，小腹满欲吐，鼻燥。其脉浮的，先用吐法；脉沉弦的，先用下法。
【注释】此处详细阐述酒疸的病症。酒体湿而性热，过饮之人必生湿热为疸病。无外热，指没有体表发热；谵语、鼻燥，有内热；小腹满，湿热蓄于膀胱；欲吐，湿热酿于胃中。其脉浮的，酒热在经，先用吐法以解外；沉弦的，酒饮在里，先用下法以解内。
凡患酒黄疸，必定小便不利，其征候是心中热，足下热，这就是其证候。
【注释】此处详述酒疸的病。湿热生也，必定小便不利。其征候心中热，是胃腑热；足下热，是胃经热。这就是酒疸的证候。
【集注】程林说：小便利则湿热行，不利则湿留于胃，胃脉贯膈下足跗，上熏胃脘则心中热，下注足跗，则足下热也。
【注释】此处详细阐述酒疸宜用吐法的治疗。酒疸，心中热、想呕吐的，是指胃中烦乱懊恼想吐，不用吐法不能痊愈。
【集注】程林说：后证热深则懊恼欲吐，今微热则心中热亦欲吐。病属上焦，所以吐之可愈。
【注释】此处详细阐述酒疸宜用下法的治疗。酒黄疸，谓因饮酒过度而成黄疸。心中懊恼想吐，或者自行吐出而愈，或者服栀子豉汤吐出而愈，都可以。如果心中懊恼不想吐，或者心中热痛，都不是吐法可愈，所以用栀子大黄汤攻下而愈。
The pulse at the cunkou (radial artery) is floating and slow. Floating indicates wind, while slow indicates bi-syndrome (obstruction syndrome). However, this bi-syndrome is not wind-stroke. The patient suffers from vexation in the four limbs; the color of the spleen must manifest as yellow on the face, with stagnant heat circulating through the body. The Fuyang pulse is tight and rapid. Rapid indicates heat, which consumes food; tight indicates cold, causing fullness after eating. A floating pulse at the chi position indicates kidney injury, while a tight Fuyang pulse indicates spleen injury. Wind and cold fight each other; upon eating, dizziness occurs. Grain qi fails to digest, the stomach suffers from turbid qi, which flows downward, blocking urination. Yin is affected by cold, while heat flows into the bladder. The entire body turns yellow, named Grice Jaundice (Gu Dan). If the forehead is black, with slight sweating, heat in the hands and feet occurring at dusk, urgency in the bladder but free urination, it is named Female Labor Jaundice (Nv Lao Ju). If the abdomen is distended like water accumulation, it is difficult to treat. Vexation and heat in the heart, inability to eat, and occasional desire to vomit indicate Wine Jaundice (Jiu Dan).
[Annotation] The floating and slow pulse at cunkou, where floating indicates wind and slow indicates bi-syndrome (not wind-stroke), has been discussed in detail previously. Now, with a tight and rapid Fuyang pulse, a floating chi pulse, vexation in the four limbs, and yellowing of the body and face, this is jaundice. Yellow is the color of Earth; Earth pathology manifests this way. Earth belongs to the Spleen and Stomach. The Spleen is Yin Earth governing dampness, and the Stomach is Yang Earth governing heat. Therefore, all jaundice cases involve dampness stagnating and heat郁 (depressing). Manifesting externally, it causes vexation in the four limbs and yellowing of the body and face. Generally, if the person has pre-existing damp-heat, combined with external wind-cold fighting, internal injury from sexual exhaustion, and consumption of grain and alcohol, 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, termed Yang Jaundice. If the stomach pulse is tight, dampness exceeds heat, transforming via Spleen Yin cold; cold prevents eating, causing fullness after eating, termed Yin Jaundice. Yang Jaundice includes Heat Jaundice and Wine Jaundice; Yin Jaundice includes Female Labor Jaundice and Grice Jaundice. If the chi pulse is floating instead of deep, it indicates kidney injury; kidney injury leading to jaundice is also Female Labor Jaundice. If the stomach pulse is tight instead of slow, it indicates spleen injury; spleen injury leading to jaundice is also Grice Jaundice. Grice Jaundice presents with fullness after eating, undigested grain qi, stomach suffering from turbid qi. Clear qi is blocked from ascending, causing dizziness; turbid qi flows to the bladder, causing urinary obstruction. Female Labor Jaundice presents with a black forehead (kidney color); slight sweating indicates dampness is not stagnant; five-center heat occurring at dusk indicates Kidney Yin heat; bladder urgency with free urination indicates lower jiao deficiency. Abdominal distension like water indicates failure of both spleen and kidney, hence untreatable. If there is vexation in the heart, heat, inability to eat, occasional vomiting, abdominal fullness, and urinary difficulty, even with blue eyes and black face, it is definitely Wine Jaundice.
A deep pulse, thirst with desire to drink, and urinary difficulty all lead to yellowing.
[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 in the interior cause yellowing. The first clause states that floating-slow and tight-rapid pulses cause yellowing, originating from external factors; this clause states a deep pulse also causes yellowing, originating from internal factors. Thus, treating jaundice involves sweating and purging methods.
[Ji Zhu - Collected Annotations] Li says: Deep pulse with thirst, desire to drink, and urinary difficulty means damp-heat accumulates internally without a way to dissipate, causing yellowing.
Jaundice with thirst is difficult to treat; jaundice without thirst is treatable. Onset in Yin parts causes vomiting; onset in Yang parts causes chills and fever.
[Annotation] Before jaundice forms, urinary difficulty with thirst indicates impending jaundice. After jaundice forms, thirst indicates deep heat, making it difficult to treat; absence of thirst indicates shallow heat about to resolve, making it treatable. Jaundice arising from Yin causes vomiting/reversal of Qi. Vomiting/reversal is due to interior Yin pathology. Jaundice arising from Yang causes chills and fever. Chills/fever are due to exterior Yang pathology. Thirst vs. no thirst distinguishes difficult vs. treatable jaundice; vomiting vs. chills/fever distinguishes exterior vs. interior jaundice.
[Ji Zhu - Collected Annotations] Cheng Lin says: In jaundice, damp-heat fights. There may be dry mouth/nose but not thirst. Thirst implies fluid depletion and pathogen dominance; no thirst implies fluids intact and righteous Qi strong, distinguishing treatment difficulty. Yin governs interior; dampness exceeding in interior causes vomiting. Yang governs exterior; heat exceeding in exterior causes chills and fever. This clause distinguishes severity and exterior/interior based on thirst. You Yi says: Thirst in jaundice means heat is blazing and dampness increasing, hence difficult. No thirst means heat subsiding and dampness dissipating, hence treatable. Yin parts refer to interior organs affecting Qi, causing vomiting. Yang parts refer to exterior body affecting Form, causing chills and fever. This distinguishes Yin/Yang, interior/exterior, shallow/deep.
Abdominal fullness, flaccid yellow body, restlessness preventing sleep, belongs to the Jaundice family.
[Commentary] The character "tongue" in "flaccid yellow tongue" should be "body," likely a transcription error.
[Annotation] Flaccid yellow body, abdominal fullness, and restlessness preventing sleep belong to Jaundice family diseases, located in the interior, requiring purging.
[Ji Zhu - Collected Annotations] Xu Bin says: Abdominal fullness is an interior sign. With flaccid yellow body and restlessness, stagnant heat moves outward, indicating the beginning of yellowing. Hence, it belongs to the Jaundice family.
For all Jaundice family diseases, promoting urination is sufficient. If the pulse is floating, resolve via sweating, using Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus).
[Annotation] "All Jaundice family diseases" refers to all types. Jaundice lacks distinct exterior/interior signs. If heat is excessive with thirst, clear it. If dampness is excessive with urinary difficulty, promote urination. If the pulse is floating, the pathogen is in the exterior, resolve via sweating, using Guizhi Jia Huangqi Tang. By inference, a deep pulse indicates interior location, requiring purging.
[Ji Zhu - Collected Annotations] Gao Shishi says: Promoting urination is the fixed method for jaundice. However, sweating is sometimes appropriate. If the pulse is floating indicating exterior, use sweating. Guizhi Jia Huangqi Tang uses Guizhi Tang to release the muscle layer, inducing sweat. Adding Huangqi (Astragalus) assists the exterior; harmonizing the exterior unites Ying and Wei.
Guizhi Jia Huangqi Tang formula (see Water Qi Disease chapter).
The Master said: In jaundice with fever, vexation, panting, chest fullness, and dry mouth, these symptoms arise because fire therapy was used to force sweating during onset, causing two heats to combine. Jaundice originates from dampness. Whole-body fever and yellowing, with abdominal heat (heat in the interior), require purging.
[Annotation] This details the pathology of misusing fire therapy for jaundice. Jaundice involves damp-heat. Damp flooding the interior causes chest fullness, vexation, and panting. Heat flooding the interior causes fever and dry mouth. Using fire to force sweat combines two heats. Since jaundice comes from dampness, whole-body fever and yellowing occur. Although there is exterior heat from misused sweating, do not sweat. Palpate abdominal heat to confirm interior heat, then purge to remove heat.
[Ji Zhu - Collected Annotations] Cheng Lin says: Damp in interior causes vexation/panting/fullness; heat in interior causes fever/dry mouth. Fire forcing sweat causes heat conflict. Jaundice results from damp-heat stagnating in Spleen Earth, causing whole-body fever and yellowing, highlighting the error of fire therapy. Abdominal heat indicates heat in the abdomen, removable by purging damp-heat.
Jaundice with abdominal fullness, urinary difficulty with red urine, and spontaneous sweating indicates harmonious exterior and solid interior, requiring purging, preferably Da Huang Xiao Shi Tang (Rhubarb and Niter Decoction).
[Annotation] Following the previous clause, this details symptoms and treatment. Abdominal fullness, difficult red urination indicate interior heat. Spontaneous sweating indicates harmonious exterior and solid interior. Use Da Huang Xiao Shi Tang to purge.
Da Huang Xiao Shi Tang Formula
Da Huang (Rhubarb Root and Rhizome), Huangbai (Phellodendron Bark), Xiaoshi (Niter) (4 liang each), Zhizi (Gardenia Fruit) (15 pieces).
Boil the first three ingredients in 6 sheng of water to obtain 2 sheng, strain, add Xiaoshi, boil again to obtain 1 sheng, take once.
[Ji Jie - Collected Explanations] Li says: Abdominal fullness and difficult red urination are interior diseases. Spontaneous sweating indicates exterior harmony. For interior disease with severe damp-heat, Zhizi clears upper jiao damp-heat, Da Huang drains middle jiao damp-heat, Huangbai clears lower jiao damp-heat. Xiaoshi has drying and dispersing properties within bitter-cold heat-draining actions, ensuring drug efficacy reaches everywhere, dissipating all damp-heat.
For Jaundice Disease, Yinchen Wuling San (Yinchen and Five-Ingredient Powder with Poria) is indicated (another version says: Yinchen Tang and Wuling San both indicated).
[Commentary] The phrase "urinary difficulty" is missing after "Jaundice Disease"; its inclusion provides basis for the formula, likely a transcription omission.
[Annotation]
For Jaundice Disease: If pulse is deep with abdominal fullness (interior), purge with Da Huang Xiao Shi Tang. If pulse is floating with no sweat (exterior), sweat with Guizhi Jia Huangqi Tang. If urinary difficulty exists (neither purely exterior nor interior), use Yinchen Wuling San.
Yinchen Wuling San Formula
Yinchen Hao End (10 parts), Wuling San (5 parts, formula see Phlegm-Fluid Disease chapter).
Mix the two powders. Take one fangcunbi before meals with rice soup, three times daily.
[Ji Jie - Collected Explanations] You Yi says: This is the standard treatment for damp-heat jaundice. Yinchen disperses heat stagnation; Wuling San promotes dampness stagnation.
In Jaundice Disease, if urine color does not change, there is desire for spontaneous diarrhea, abdominal fullness, and panting, do not clear heat. Clearing heat will inevitably cause hiccups. Hiccups are treated with Xiaobanxia Tang (Minor Ginger and Pinellia Decoction).
[Annotation] Jaundice urine should be red; now it is white, and there is desire for spontaneous diarrhea. Despite abdominal fullness and panting, this is dampness excess without heat, a Yin Jaundice pattern. Do not clear heat. Using cold/laxative drugs to clear heat will chill the stomach, causing hiccups. Treat hiccups with Xiaobanxia Tang.
[Ji Zhu - Collected Annotations] Li says: Unchanged urine color and desire for spontaneous diarrhea indicate no interior excess. Abdominal fullness and panting indicate Spleen Qi deficiency and Lung Qi obstruction. Using bitter-cold drugs to purge/clear heat chills the stomach, causing reverse Qi and hiccups. Use Xiaobanxia Tang to scatter reverse Qi and stop hiccups.
Gao Shishi says: Unchanged urine color is not red; desire for spontaneous diarrhea is not dysentery. Although abdominal fullness and panting seem like interior excess, do not use cold agents to clear heat (e.g., Da Huang Xiao Shi Tang). Using cold agents to clear heat causes hiccups. Hiccups are eructation/belching. Banxia and Shengjiang are acrid-warm and disperse cold; thus, use Xiaobanxia Tang for hiccups.
Xiaobanxia Tang formula (see Phlegm-Fluid Disease chapter).
Jaundice Disease has an eighteen-day prognosis. Treatment for over ten days should result in recovery; worsening after ten days is difficult to treat.
[Annotation] Jaundice belongs to the Spleen, which governs Earth. Earth has no fixed position but thrives at the end of each season for eighteen days. The eighteen-day period corresponds to Earth's thriving days. Recovery should occur within ten to eighteen days. If not recovered after eighteen days and worsening, Earth Qi is deficient. Hence, difficult to treat.
[Ji Zhu - Collected Annotations] Gao Shishi says: Eighteen days is the cycle of Spleen Earth thriving in the four seasons. Ten days is the completion number of Earth. Since jaundice lies in Spleen Earth, the period is eighteen days. Early treatment is preferred; recovery should occur after ten days. If not recovered after ten days and worsening, it is difficult to treat, meaning Spleen Qi failure is incurable.
Grice Jaundice presents with chills and fever, inability to eat, dizziness after eating, mental unrest, and eventual yellowing. It is named Grice Jaundice, treated with Yinchenshao Tang (Yinchen and Gardenia Decoction).
[Annotation] This details Grice Jaundice. Before formation, patients often have chills and fever. During chills/fever, they cannot eat; when resolved, they might eat, but dizziness and mental unrest follow eating. This indicates damp-heat stagnation steaming internally, signaling impending Grice Jaundice. Eventually, the body and face turn yellow. Use Yinchenshao Tang to drain via urination and defecation.
Yinchenshao Tang Formula
Yinchen Hao (6 liang), Zhizi (14 pieces), Da Huang (2 liang).
Boil the three ingredients in 1 dou of water. First boil Yinchen Hao, reducing by 6 sheng. Add the other two, boil to obtain 3 sheng. Strain, divide into three warm doses. Urination should increase, urine resembling soapberry juice, bright red. After one night, abdominal fullness decreases, and yellow exits via urine.
In Yangming Disease, a slow pulse, inability to eat until full, vexation and dizziness after fullness, and difficult urination indicate impending Grice Jaundice. Even if purged, abdominal fullness remains. This is due to the slow pulse.
[Annotation] Grice Jaundice usually involves Stomach Heat with a rapid pulse. Here, the slow pulse indicates Spleen Cold. Cold fails to transform grain; thus, despite hunger, one cannot eat much. Fullness causes vexation and stagnation, impairing transport. Clear Qi fails to ascend (dizziness); turbid Qi fails to descend (difficult urination). These signal impending Grice Jaundice. The condition arises from Taiyin cold-damp stagnation. Mistaking it for Yangming damp-heat jaundice and purging may temporarily reduce fullness, but it returns quickly due to cold (slow pulse). This clarifies that impending Grice Jaundice due to Spleen Yin cold transformation is not suitable for purging.
[Ji Zhu - Collected Annotations] Cheng Lin says: Slow pulse indicates cold; cold fails to digest grain, so one cannot eat much. Fullness leads to undigested grain qi, stomach turbidity, vexation, and dizziness. Difficult urination occurs because slow pulse lacks Yang Qi to transform turbidity, leaving it in the Stomach. Purging only empties the Stomach while fullness persists due to cold.
Jaundice patients experiencing afternoon fever with contrary chills, caused by female labor, present with bladder urgency, lower abdominal fullness, whole-body yellowing, black forehead, and foot heat, forming Black Jaundice. Abdominal distension resembles water, stools are black and loose. This is Female Labor Jaundice, not water swelling. Abdominal fullness is difficult to treat; use Xiaoshi Fanshi San (Niter and Alum Powder).
[Annotation] This details Female Labor Jaundice. Afternoon fever is typically Yangming heat (no chills). Contrary chills indicate Female Labor Jaundice. Symptoms include bladder urgency and lower abdominal fullness with free urination; whole-body yellowing with black forehead; foot heat. This is Shaoyin heat causing Black Jaundice. Abdominal distension like water and black loose stools indicate blood involvement from organ disease, not water swelling. Blood disease changes complexion; black color implies blood pathology. Abdominal fullness in Female Labor Jaundice is difficult to treat due to Spleen-Kidney failure. Xiaoshi enters blood to dissolve hardness; Fanshi enters Qi to overcome dampness. This formula treats symptoms, not root. Textual errors exist; reasoning is clarified here.
[Ji Zhu - Collected Annotations] You Yi says: Afternoon fever with chills indicates Female Labor Jaundice. Heat is shallow in Stomach but deep in Kidney; deep heat causes initial chills. Bladder urgency, black forehead, foot heat, black stools are Kidney heat signs. Lower abdominal fullness resembles water but is due to Kidney Qi failure, not Spleen damp-water. Combined abdominal fullness injures both Spleen and Kidney, making treatment difficult. Xiaoshi is salty-cold to clear heat; Fanshi clears stubborn heat in bone marrow (Kidney association) to clear Kidney heat. Take with Barley Porridge to protect the Stomach.
Xiaoshi Fanshi San Formula
Xiaoshi (Niter), Fanshi (Alum) (calcined, equal parts).
Powder the two ingredients. Mix with Barley Porridge juice. Take one fangcunbi, three times daily. Disease exits via stool and urine; normal yellow urine and black stool indicate effectiveness.
Male jaundice with free urination should be treated with Xulao Xiaojianzhong Tang (Deficiency Consumption Minor Constructive Middle Decoction).
[Annotation] Postpartum women with bleeding who turn yellow suffer from blood loss, not jaundice. Male jaundice with free urination indicates non-damp-heat origin. Inquiry reveals blood loss history causing deficiency yellow. Sweating, purging,渗 (percolating), and diuretic methods are contraindicated. Treat as deficiency consumption with blood loss. Use Xiaojianzhong Tang to nourish Ying and Wei; yellow resolves spontaneously.
[Ji Zhu - Collected Annotations] Gao Shishi says: Female is Yin/Blood; Male is Yang/Qi. Male jaundice indicates Yang Qi deficiency. Yellow is Earth color; Yang deficiency allows Earth color to manifest externally. No damp-heat in middle, hence free urination. This is deficiency; use Xiaojianzhong Tang to harmonize Yin/Yang and regulate Blood/Qi. The text references Xiaojianzhong Tang for Deficiency Consumption, implying male jaundice with free urination is a Deficiency Consumption pattern.
Xiaojianzhong Tang formula (see Deficiency Consumption chapter).
Wine Jaundice may present with no exterior heat but delirium, lower abdominal fullness, desire to vomit, and dry nose. If the pulse is floating, induce vomiting first; if deep and string-taut, purge first.
[Annotation] This details Wine Jaundice. Wine is damp and hot; excess drinking generates damp-heat jaundice. No exterior heat but delirium and dry nose indicate interior heat. Lower abdominal fullness indicates damp-heat in Bladder. Desire to vomit indicates damp-heat fermenting in Stomach. Floating pulse indicates wine-heat in meridians; induce vomiting to resolve exterior. Deep-string pulse indicates wine-damp in interior; purge to resolve interior.
[Ji Zhu - Collected Annotations] Li says: Foot-Yangming Stomach Meridian starts at the nose, explaining dry nose.
Patients with Wine Jaundice always have urinary difficulty. Signs include heat in the heart and heat under the feet.
[Annotation] This details Wine Jaundice pathology. Damp-heat generation causes urinary difficulty. Heat in the heart indicates Stomach Fu heat; heat under the feet indicates Stomach Meridian heat. These are Wine Jaundice signs.
[Ji Zhu - Collected Annotations] Cheng Lin says: Free urination allows damp-heat to exit; difficulty retains dampness in Stomach. Stomach Meridian passes through diaphragm to sole. Heat steaming Stomach causes heart heat; flowing to sole causes foot heat.
Wine Jaundice with heart heat and desire to vomit resolves with vomiting.
[Annotation] This details vomiting treatment for Wine Jaundice. Heart heat and desire to vomit indicate gastric vexation and nausea. Vomiting is necessary for cure.
[Ji Zhu - Collected Annotations] Cheng Lin says: Deep heat causes vexation/nausea; mild heat causes heart heat/nausea. Pathogen is in Upper Jiao, so vomiting cures it.
Wine Jaundice with heart vexation or heat pain is treated with Zhizi Dahuang Tang (Gardenia and Rhubarb Decoction).
[Annotation] This details purging treatment for Wine Jaundice. Wine Jaundice from excessive drinking. Heart vexation/nausea may resolve by spontaneous vomiting or Zhizi Chi Tang-induced vomiting. If heart vexation without desire to vomit, or heart heat pain, vomiting is ineffective; use Zhizi Dahuang Tang to purge.
Zhizi Dahuang Tang Formula