（王叔和阳明篇 海藏云色如烟熏黄乃湿病也一身尽痛色如橘黄乃黄病也一身不痛）
成 湿热俱甚则发身黄伤寒至于发黄为病亦已甚矣邪风被火两阳相熏其身必黄阳明病被火额上汗出小便不利必
发
身黄此皆由内有热而被火攻发黄者也阳明病无汗小便不利心中懊 必发黄者由阳明热盛而发黄也伤寒汗已身目为黄以
寒湿在里不解故也此不可下宜于寒湿中求之是知非特湿热发黄而寒湿亦发黄也但寒湿之黄身如熏黄色暗而不明也热盛
之黄黄如橘色气出染衣正黄如柏也大抵黄家属太阴太阴为湿热蒸之而致经曰太阴当发身黄是也一或脉沉结少腹硬小便
自利其人如狂者又为蓄血在下焦使之黄也发黄非止寸口近掌无脉鼻气出冷为不治之证又若形体如烟熏直视摇头为心绝
环口黧黑柔汗发黄为脾绝是皆不治之证也
太阳 病身黄脉沉结少腹硬小便自利其人如狂者血也抵当汤（详蓄血）得病六七日脉迟浮弱恶风寒手足温医数下之
不能食胁下满痛项强小便难面目及身黄（茵陈五苓散详胁痛）太阳病脉浮动数头痛发热微盗汗出反恶寒表未解也医反下
之客气动膈若不结胸但头汗出小便不利身必发黄（栀子柏皮汤详头汗）太阳中风以火劫汗两阳相熏其身发黄阳盛欲衄阴
虚小便难阴阳俱虚身体枯燥（防己黄 汤栀子柏皮汤详头汗）
栀子柏皮汤方
栀子（十五个擘） 甘草（一两炙） 黄柏（二两）上三味以水四升煮取一升半去滓分温再服
若发汗已身体灼热者名曰风温脉阴阳俱浮自汗身重多眠睡鼻息必鼾语言难出若被火者微发黄色太阳病已汗遂发热
恶寒复下之表里俱虚复加烧针因胸烦面青肤 者难治色微黄手足温者易愈（色微黄非病也所以验其病之易愈也）
阳明 伤寒瘀热在里身必发黄麻黄连轺赤小豆汤
麻黄连轺赤小豆汤方
麻黄（去节） 生姜（切） 连轺（连翘根也） 甘草（炙四味各二两） 杏仁（四十粒泡去皮尖） 大枣（十二
枚擘） 生梓白皮（一升切） 赤小豆（一升）上八味以潦水一斗先煮麻黄再沸去上沫纳诸药煮取三升去滓分温三服半
日服尽（内经曰湿上甚而热治以苦温佐以甘辛以汗为度正此之谓也又煎用潦水者亦取其水味薄则不助湿气）
阳明病发热但头汗出小便不利渴饮水浆此瘀热在里身必发黄茵陈蒿汤伤寒七八日身黄如栀子色小便不利腹微满者
茵陈蒿汤（成 当热甚之时身黄如橘子色是热毒发泄于外内经曰膀胱者州都之官津液藏焉气化则能出矣小便不利小腹满
者热气甚于外而津液不得下行也与茵陈蒿汤利小便退黄逐热）
茵陈蒿汤方
茵陈（六两） 大黄（二两去皮） 肥栀子（十四枚擘）上三味以水一斗先煮茵陈减六升纳二味煮取三升去滓分温
三服小盒饭利尿如皂角汁色正赤一宿腹减黄从小便去也（成 小热之气凉以和之大热之气寒以取之发黄者热之极也非大
寒之剂则不能彻其热酸苦涌泄为阴酸以涌之苦以泄之故以茵陈蒿酸苦为君心法南方火而主热大热之气必以苦寒胜之故
以栀子为臣宜补必以酸宜下必以苦荡涤邪热必假将军攻之故以大黄为佐虽甚热火毒必祛除分泄前后腹得利而解矣）
阳明病无汗小便不利心中懊 身必发黄阳明中风脉弦浮大而短气腹满胁下及心痛鼻干不得汗嗜卧一身及面目悉黄
小便难有潮热时哕耳前后肿病过十日脉续浮者与小柴胡汤脉但浮无余证者与麻黄汤若不尿腹满加哕者不治阳明病面合
赤色不可攻必发热色黄者小便不利也（栀子柏皮汤）阳明病被火额上微汗小便不利者必发黄（五苓散栀子柏皮汤）伤寒
发汗已身目皆黄所以然者以寒湿在里不解故也不可下于寒湿中求之（成 金匮要略谓黄家所起从湿得之汗出热去则不能
发黄发汗已身目为黄者风气去湿气在也脾恶湿湿气内着脾色外夺者身目为黄若瘀血在里发黄者则可下此以寒湿在里故
不可下当从寒湿法治之）
太阴 伤寒脉浮而缓手足自温系在太阴太阴当发身黄若小便自利者不能发黄以脾家实腐秽当去故也（浮缓亦大之类
小便不利者五苓散加茵陈主之小便自利者橘皮汤主之）
娄 上身黄小便自利小腹硬而狂大便黑者为蓄血则宜抵当汤下之若小腹不硬其人不狂大便不黑者虽小便利非蓄
血
也其为证有三一者栀子柏皮汤二者麻黄连翘赤小豆汤皆治身黄小便利而身不疼者海藏所谓干黄是也三者桂枝附子汤去
桂加白术汤皆治身黄小便利而一身尽痛者活人所谓中湿是也
张 或谓伤寒发黄惟阳明与太阴两经有之俱言小便利者不能发黄何也盖黄者土之正色以太阴与阳明俱属土故发
黄
也其黄之理外不能汗里不得小便脾胃之土为热所蒸故色见于外为黄也若小便利者热不内蓄故不能变黄也其有别经发黄
者亦由脾胃之土受邪故也
赵 明瘀热发黄与瘀血发黄外证及脉未尝相似且如头汗出剂颈而还腹微满小便不利渴饮水浆为瘀热证小腹急结
其
人如狂小腹硬满小便自利大便黑为瘀血证此外证之不似也瘀血脉微而沉或沉结瘀热脉则浮滑紧数此脉状之又不相似也
然则相似者但色黄耳若论黄色之相似非特瘀热与瘀血又如风温被火微发黄色太阳火劫发汗两阳相熏灼其身发黄阳明被
火额上微汗必发黄者是又挟火邪所致者外此亦有黄色之不相似者乎曰湿家之熏黄则异矣可不各以其似不似而明辨之欤
附
五苓茵陈散方
以茵陈浓煎汤调五苓散二钱服之日三四黄从小便下以小便清为度
橘皮汤方
橘皮（一两） 生姜（二两） 细锉水一升半煎七合去滓分二服稍热呷之未瘥再服
茵陈蒿大黄汤 治伤寒发黄面目悉黄小便赤宜服
茵陈蒿 山栀仁 柴胡 黄柏（蜜涂炙） 龙胆草（各半两） 黄芩（去黑心） 升麻 大黄（炒各一两）上 咀
每服五钱水一盏半煎至一盏去滓早晚食后温服
茅根汤 治伤寒发黄遍身如金色者
茅根（洗净锉） 山栀仁 茵陈蒿 地骨皮 甘草（炙各半两）上 咀每服五钱用水一盏半生姜三片豆豉六七粒同
煎至一盏去滓早晚食远温服
附
阴黄
身冷汗出脉沉而黄为阴黄乃太阴经中湿亦有体痛发热者身如熏黄终不如阳黄之明如橘子色也当叩其小便之
利与不利小便自利术附汤小便不利大便反快者五苓散
海 伤寒病遇太阳太阴司天若下之太过往往变成阴黄一则寒水太过水来犯土一则土气不及水来侵之多变此疾一
则
茵陈茯苓汤加当归桂枝二则茵陈橘皮汤加姜术半夏三则茵陈附子汤四则茵陈四逆汤五则茵陈姜附汤六则茵陈吴茱萸汤
方见如下发黄小便不利烦躁而渴茵陈汤加茯苓猪苓滑石当归官桂主之（韩氏名茵陈茯苓汤）发黄烦躁喘呕不渴茵陈汤加
陈皮白术生姜半夏茯苓主之（韩氏名茵陈陈皮汤）发黄四肢遍身冷者茵陈汤加附子甘草主之（韩氏名茵陈附子汤）发黄
肢体逆冷腰上自汗茵陈汤加附子干姜甘草主之（韩氏名茵陈姜附汤）发黄冷汗不止者茵陈汤加附子干姜主之（韩氏名茵
陈附子汤）发黄前服姜附诸药未已脉尚迟者茵陈加吴茱萸附子干姜木通当归主之（韩氏名茵陈茱萸汤）赵宗颜因下之太
过生黄脉沉细迟无力次第用药至茵陈附子汤大效按海藏次第用药者谓先投韩氏茵陈茯苓汤次投茵陈陈皮汤又次投茵陈
附子汤后赵秀才次第仿此
赵秀才得黄病脉寸微尺弱身冷次第用药至茵陈四逆汤大效伤冷中寒脉弱气虚变为阴黄仲景理中汤加茵陈服之
海 往来寒热一身尽黄者小柴胡加栀子汤主之
衍 一僧伤寒发汗不彻有留热身面皆黄多热期年不愈医作食黄治之治不对病不去问之食不减寻与此药服五日病
减
三分之一十日减三分之二三十日病悉去方用茵陈栀子各三分秦艽升麻各四钱末之每用三钱水四合煎及二合去渣食后温
服以愈为度
活 五苓加茵陈蒿汤 治发黄而渴小便不利
茵陈蒿汤（十分） 五苓汤（五分）上二剂拌匀每服三钱日三服水调下
又方伤寒欲发黄者急用瓜蒂末口含水搐一字许入鼻中出黄水甚验即用茵陈汤调五苓散服之甚效
本 治头中湿热发黄胆瓜蒂散
瓜蒂（二十枚） 赤小豆 黍米（各十四粒）上为细末如大豆许一粒纳鼻中缩入当出黄水慎不可吹入
云 结胸发黄太阳附本也（以结胸法治之）痞气发黄太阴附本也（以痞法治之）
活 问白虎证亦有身热烦渴引饮小便不利何以不发黄答曰白虎与发黄证相近遍身汗出此为热越白虎证也头面汗
出颈以下无汗发黄证也
（王叔和《伤寒论》阳明篇，海藏先生云：面色如烟熏般的黄色，是湿病；全身疼痛。面色如橘子般的黄色，是黄疸病；全身不痛。）
成无己注：湿热俱盛则发身黄。伤寒发展到发黄，病情已经很严重了。邪风被火法攻伐，两阳相互熏灼，身体必然发黄。阳明病被火法攻治，额头出汗，小便不利，必然发身黄。这些都是由于内有热邪而被火法攻伐导致发黄的缘故。阳明病无汗、小便不利、心中烦闷懊恼，必然发黄的，是由于阳明热盛而发黄。伤寒发汗后，身体和眼睛发黄，是因为寒湿在体内未解的缘故。这种情况不可用下法，应当在治疗寒湿的方法中寻求对策。由此可知，不仅是湿热会导致发黄，寒湿也会导致发黄。但寒湿之黄，身体像烟熏一样，色暗而不明亮；热盛之黄，黄色如橘色，气息能染衣，正黄如柏树汁。大抵黄疸病归属于太阴经，太阴经因湿热蒸腾而导致发黄。经文说：“太阴当发身黄”就是此意。如果脉象沉结，少腹硬满，小便自利，其人如狂的，又是下焦蓄血导致的发黄。发黄不止于寸口脉搏微弱或无脉、鼻气出冷为不治之证。又如形体如烟熏、直视摇头为心绝，口唇周围发黑、冷汗淋漓、发黄为脾绝，这些都不治。
太阳病：身黄，脉沉结，少腹硬，小便自利，其人如狂的，是蓄血证，用抵当汤（详见蓄血篇）。得病六七日，脉迟浮弱，恶风寒，手足温，医生多次误下，导致不能食、胁下满痛、项强、小便难、面目及身黄，用茵陈五苓散（详见胁痛篇）。太阳病，脉浮动数，头痛发热，微盗汗出，反而恶寒，表证未解。医生反而用下法，导致客气动膈，若不结胸，仅头部出汗，小便不利，身体必然发黄，用栀子柏皮汤（详见头汗篇）。太阳中风，用火劫法发汗，两阳相熏，身体发黄。阳盛欲衄血，阴虚小便难，阴阳俱虚，身体枯燥，用防己黄芪汤、栀子柏皮汤（详见头汗篇）。
栀子柏皮汤方：栀子（十五个，掰开），甘草（一两，炙），黄柏（二两）。以上三味，用水四升，煮取一升半，去渣，分两次温服。
若发汗后身体灼热的，名叫风温。脉象阴阳俱浮，自汗，身重，多眠睡，鼻息必鼾，语言难出。若被火法攻治，微发黄色。太阳病已发汗，随即发热恶寒，又用下法，表里俱虚，又加烧针，因胸烦、面青、皮肤出现瘀斑者难治；色微黄、手足温者易愈（色微黄不是病，是用来验证疾病易愈的标志）。
麻黄连轺赤小豆汤方：麻黄（去节），生姜（切），连轺（即连翘根），甘草（炙，以上四味各二两），杏仁（四十粒，泡去皮尖），大枣（十二枚，掰开），生梓白皮（一升，切），赤小豆（一升）。以上八味，用潦水一斗，先煮麻黄，沸腾后去掉上浮的沫，加入其他药物，煮取三升，去渣，分三次温服，半日内服完。（《内经》说：“湿上甚而热，治以苦温，佐以甘辛，以汗为度”，正是这个意思。另外煎药用潦水，也是取其水味淡薄，不助湿气的缘故。）
阳明病，发热，仅头部出汗，小便不利，口渴饮水浆，这是瘀热在里，身体必然发黄，用茵陈蒿汤。伤寒七八日，身黄如栀子色，小便不利，腹部微满的，用茵陈蒿汤。（成无己注：应当是在热盛之时，身黄如橘子色，是热毒发泄于外。《内经》说：“膀胱者，州都之官，津液藏焉，气化则能出矣。”小便不利，小腹满，是热气甚于外而津液不得下行。与茵陈蒿汤利小便，退黄，逐热。）
茵陈蒿汤方：茵陈（六两），大黄（二两，去皮），肥栀子（十四枚，掰开）。以上三味，用水一斗，先煮茵陈，减少六升，加入另外两味药，煮取三升，去渣，分三次温服。小便应像皂角汁颜色一样正红，一夜之后腹部减轻，黄从小便排出。（成无己注：小热之气，用凉药调和；大热之气，用寒药攻取。发黄是热之极，非大寒之剂不能彻底清除其热。酸苦涌泄为阴，酸以涌吐，苦以泄下，故以茵陈蒿酸苦为君药。心法南方火而主热，大热之气必以苦寒胜之，故以栀子为臣药。宜补必以酸，宜下必以苦，荡涤邪热必假借将军（大黄）攻之，故以大黄为佐药。虽热火毒甚，必祛除分泄前后，腹部得利而解。）
阳明病，无汗，小便不利，心中懊恼，身体必然发黄。阳明中风，脉弦浮大而短气，腹满，胁下及心痛，鼻干不得汗，嗜卧，一身及面目悉黄，小便难，有潮热，时时哕逆，耳前后肿。病过十日，脉续浮的，与小柴胡汤；脉但浮无余证的，与麻黄汤。若不尿，腹满加哕的，不治。阳明病，面合赤色，不可攻，必发热，色黄，小便不利也（用栀子柏皮汤）。阳明病被火法攻治，额头微汗，小便不利者，必发黄（用五苓散、栀子柏皮汤）。伤寒发汗后，身目皆黄，所以然者，以寒湿在里不解的缘故。也不可下，应当在寒湿中求之。（成无己注：《金匮要略》谓黄家所起从湿得之，汗出热去则不能发黄。发汗后身目为黄者，风气去湿气在也。脾恶湿，湿气内着，脾色外夺，故身目为黄。若瘀血在里发黄者则可下，此以寒湿在里，故不可下，当从寒湿法治之。）
太阴病：伤寒，脉浮而缓，手足自温，系在太阴。太阴当发身黄，若小便自利的，不能发黄，因为脾家实，腐秽当去，故也。（浮缓亦大之类。小便不利者，五苓散加茵陈主治；小便自利者，橘皮汤主治。）
娄全善注：上身黄，小便自利，小腹硬而狂，大便黑的，为蓄血，则宜用抵当汤下之。若小腹不硬，其人 not 狂，大便不黑的，虽然小便利，也不是蓄血。其为证有三：一者栀子柏皮汤，二者麻黄连翘赤小豆汤，皆治身黄、小便利而身不疼者，海藏所谓“干黄”是也。三者桂枝附子汤去桂加白术汤，皆治身黄、小便利而一身尽痛者，《活人书》所谓“中湿”是也。
张元素注：有人问伤寒发黄，惟阳明与太阴两经有之，且都说小便利者不能发黄，为什么呢？盖黄是土的正色，以太阴与阳明俱属土，故发黄也。其发黄的道理，外不能汗，里不得小便，脾胃之土为热所蒸，故色见于外为黄也。若小便利者，热不内蓄，故不能变黄也。其有别经发黄的，也由脾胃之土受邪的缘故。
赵嗣真注：明辨瘀热发黄与瘀血发黄，外证及脉未尝相似。且如头汗出，齐颈而还，腹微满，小便不利，渴饮水浆，为瘀热证；小腹急结，其人如狂，小腹硬满，小便自利，大便黑，为瘀血证。这是外证的不相似。瘀血脉微而沉，或沉结；瘀热脉则浮滑紧数。这是脉状的不相似。然而相似的，只是色黄耳。若论黄色之相似，不仅瘀热与瘀血，又如风温被火微发黄色，太阳火劫发汗两阳相熏灼其身发黄，阳明被火额上微汗必发黄，是又挟火邪所致者。此外也有黄色之不相似者乎？曰：湿家之熏黄则异矣。可不各以其似不似而明辨之欤？
附方：
五苓茵陈散方：以茵陈浓煎汤调五苓散二钱服，日三四次，黄从小便下，以小便清为度。
橘皮汤方：橘皮（一两），生姜（二两），细锉，水一升半，煎七合，去渣，分二服，稍热呷之，未瘥再服。
茵陈蒿大黄汤：治伤寒发黄，面目悉黄，小便赤，宜服。茵陈蒿、山栀仁、柴胡、黄柏（蜜涂炙）、龙胆草（各半两）、黄芩（去黑心）、升麻、大黄（炒，各一两）。上药捣碎，每服五钱，水一盏半，煎至一盏，去渣，早晚食后温服。
茅根汤：治伤寒发黄，遍身如金色者。茅根（洗净锉）、山栀仁、茵陈蒿、地骨皮、甘草（炙，各半两）。上药捣碎，每服五钱，用水一盏半，生姜三片，豆豉六七粒，同煎至一盏，去渣，早晚食远温服。
附：阴黄
身冷汗出，脉沉而黄，为阴黄，乃太阴经中湿。亦有体痛发热者，身如熏黄，终不如阳黄之明，如橘子色也。当叩其小便之利与不利。小便自利者，术附汤；小便不利，大便反快者，五苓散。
李东垣注：伤寒病遇太阳、太阴司天，若下之太过，往往变成阴黄。一则寒水太过，水来犯土；一则土气不及，水来侵之，多变此疾。一则茵陈茯苓汤加当归、桂枝；二则茵陈橘皮汤加姜、术、半夏；三则茵陈附子汤；四则茵陈四逆汤；五则茵陈姜附汤；六则茵陈吴茱萸汤。方见如下：发黄，小便不利，烦躁而渴，茵陈汤加茯苓、猪苓、滑石、当归、官桂主之（韩氏名茵陈茯苓汤）；发黄，烦躁喘呕不渴，茵陈汤加陈皮、白术、生姜、半夏、茯苓主之（韩氏名茵陈陈皮汤）；发黄，四肢遍身冷者，茵陈汤加附子、甘草主之（韩氏名茵陈附子汤）；发黄，肢体逆冷，腰上自汗，茵陈汤加附子、干姜、甘草主之（韩氏名茵陈姜附汤）；发黄，冷汗不止者，茵陈汤加附子、干姜主之（韩氏名茵陈附子汤）；发黄，前服姜附诸药未已，脉尚迟者，茵陈加吴茱萸、附子、干姜、木通、当归主之（韩氏名茵陈茱萸汤）。赵宗颜因下之太过生黄，脉沉细迟无力，次第用药至茵陈附子汤，大效。按海藏次第用药者，谓先投韩氏茵陈茯苓汤，次投茵陈陈皮汤，又次投茵陈附子汤。后赵秀才次第仿此。
赵秀才得黄病，脉寸微尺弱，身冷，次第用药至茵陈四逆汤，大效。伤冷中寒，脉弱气虚，变为阴黄，仲景理中汤加茵陈服之。
衍义注：一僧伤寒发汗不彻，有留热身面皆黄，多热，期年不愈。医作食黄治之，治不对，病不去。问之食不减。寻与此药，服五日病减三分之一，十日减三分之二，三十日病悉去。方用茵陈、栀子各三分，秦艽、升麻各四钱，末之。每用三钱，水四合，煎及二合，去渣，食后温服，以愈为度。
活人注：五苓加茵陈蒿汤：治发黄而渴，小便不利。茵陈蒿汤（十分），五苓汤（五分）。上二剂拌匀，每服三钱，日三服，水调下。
又方：伤寒欲发黄者，急用瓜蒂末，口含水搐一字许入鼻中，出黄水，甚验。即用茵陈汤调五苓散服之，甚效。
本草注：治头中湿热发黄，胆瓜蒂散。瓜蒂（二十枚），赤小豆，黍米（各十四粒）。上为细末，如大豆许，一粒纳鼻中，缩入当出黄水，慎不可吹入。
云岐子注：结胸发黄，太阳附本也（以结胸法治之）；痞气发黄，太阴附本也（以痞法治之）。
活人注：问：白虎证亦有身热烦渴引饮，小便不利，何以不发黄？答曰：白虎与发黄证相近，遍身汗出，此为热越，白虎证也；头面汗出，颈以下无汗，发黄证也。
(Wang Shuhe's Yangming Chapter, Mr. Haicang said: A yellow complexion resembling smoked tobacco indicates dampness disease, accompanied by pain throughout the body. A yellow complexion resembling an orange indicates jaundice disease, without pain throughout the body.)
Cheng Wuji commented: When damp-heat is excessive, the body turns yellow. In Shaoyang diseases progressing to jaundice, the condition has become severe. Pathogenic wind subjected to fire therapy causes two Yang energies to scorch each other, inevitably leading to a yellow body. If Yangming disease is treated with fire therapy, sweating on the forehead and difficulty in urination will inevitably lead to jaundice. These are all caused by internal heat being aggravated by fire therapy. In Yangming disease, absence of sweat, difficulty in urination, and mental restlessness (Ao Nao) inevitably lead to jaundice due to excessive Yangming heat. After sweating in Shaoyang disease, if the body and eyes turn yellow, it is because cold-dampness remains unresolved internally. This condition should not be treated with purgatives; instead, one should seek methods for treating cold-dampness. Thus, it is known that not only damp-heat causes jaundice, but cold-dampness also does. However, jaundice from cold-dampness presents as dark and dull like smoke, whereas jaundice from excessive heat presents bright orange-yellow, staining clothes, similar to cypress bark juice. Generally, jaundice belongs to the Taiyin channel. Taiyin jaundice results from steaming by damp-heat. The classic states: "Taiyin should manifest as body jaundice," which refers to this. If the pulse is deep and knotted, the lower abdomen is hard, urination is free, and the person appears manic, this is jaundice caused by blood stasis in the Lower Jiao. Jaundice is untreatable if the pulse at Cun is weak or absent, breath from the nose is cold, or if the body looks smoked, eyes stare fixedly, and head shakes (Heart exhaustion), or if the mouth corners are black, sweat is soft/cold, and jaundice occurs (Spleen exhaustion).
Shaoyang Disease: Body jaundice, pulse deep and knotted, lower abdomen hard, free urination, manic appearance indicate blood stasis; use Didang Tang (see Blood Stasis chapter). Six or seven days after onset, if the pulse is slow, floating, and weak, aversion to wind and cold, warm hands and feet, and the physician repeatedly uses purgatives leading to inability to eat, fullness and pain in the hypochondrium, neck stiffness, difficulty urinating, and yellow face/body, use Yinchen Wuling San (see Hypochondriac Pain chapter). In Shaoyang disease, if the pulse is floating and rapid, with headache, fever, slight night sweats, yet aversion to cold indicating the exterior is not resolved, and the physician incorrectly uses purgatives causing pathogenic qi to disturb the diaphragm, if there is no chest binding but only head sweating and difficulty urination, the body will inevitably turn yellow; use Zhizi Bopi Tang (see Head Sweating chapter). In Shaoyang Wind Strike, using fire therapy to induce sweating causes two Yang energies to scorch each other, leading to jaundice. Excess Yang desires epistaxis, Yin deficiency leads to difficult urination, both Yin and Yang are deficient, and the body becomes dry and withered; use Fangji Huangqi Tang and Zhizi Bopi Tang (see Head Sweating chapter).
Zhizi Bopi Tang Formula: Zhizi (15 pods, broken), Gancao (1 liang, roasted), Huangbai (2 liang). Boil these three ingredients in 4 sheng of water to obtain 1.5 sheng, remove dregs, and take warm in two doses.
If after sweating the body feels burning hot, it is called Fengwen. The pulse is floating in both Yin and Yang positions, spontaneous sweating, heavy body, excessive sleepiness, snoring breath, and difficulty speaking. If subjected to fire therapy, slight yellowing may occur. In Shaoyang disease, if after sweating fever and aversion to cold recur, followed by purgation making interior and exterior deficient, and then moxibustion/needling is added causing chest irritability, blue face, and skin spots, it is difficult to treat. If the color is slightly yellow and hands/feet are warm, recovery is easy (slight yellowing here is not a disease but a sign of easy recovery).
Yangming Disease: In Shanghan, if stagnant heat is in the interior, the body will inevitably turn yellow; use Mahuang Lianqiao Chixiaodou Tang.
Mahuang Lianqiao Chixiaodou Tang Formula: Mahuang (remove joints), Shengjiang (sliced), Lianyao (root of Lianqiao), Gancao (roasted, 2 liang each of the above four), Xingren (40 seeds, soaked, skin and tips removed), Dazao (12 pieces, broken), Shengzi Baipi (1 sheng, sliced), Chixiaodou (1 sheng). Boil these eight ingredients in 1 dou of rainwater. First boil Mahuang, skim foam upon boiling, add remaining herbs, boil to obtain 3 sheng, remove dregs, and take warm in three doses, finishing within half a day. (*Neijing* states: "For dampness rising with heat, treat with bitter-warm, assist with sweet-acrid, aiming for sweating." This applies. Rainwater is used because its thin taste does not aid dampness.)
In Yangming disease, if there is fever, only head sweating, difficulty urinating, thirst for fluids, this indicates stagnant heat in the interior, inevitably leading to jaundice; use Yinchenshao Tang. In Shanghan, after seven or eight days, if the body is yellow like gardenia color, with difficulty urinating and slight abdominal fullness, use Yinchenshao Tang. (Cheng Wuji commented: At peak heat, body yellow like orange indicates heat toxin venting externally. *Neijing* states: "The Bladder is the official of the reservoir, storing fluids; qi transformation allows them to exit." Difficulty urinating and lower abdominal fullness indicate heat excess externally preventing fluid descent. Yinchenshao Tang promotes urination, reduces jaundice, and removes heat.)
Yinchenshao Tang Formula: Yinchenshao (6 liang), Dahuang (2 liang, peeled), Fei Zhizi (14 pods, broken). Boil these three in 1 dou of water. First boil Yinchenshao until reduced by 6 sheng, add remaining two herbs, boil to obtain 3 sheng, remove dregs, and take warm in three doses. Urine should resemble soy sauce juice color (red); after one night, abdominal fullness decreases, and yellow exits via urine. (Cheng Wuji commented: Mild heat is harmonized with cool agents; severe heat is taken with cold agents. Jaundice is extreme heat, requiring strong cold agents to clear it. Sour and bitter induce vomiting and purging (Yin). Yinchenshao is sour-bitter and serves as the sovereign herb. Heart corresponds to South Fire and Heat; bitter-cold overcomes extreme heat, so Zhizi is the minister. Acid supplements, bitter purges; Dahuang assists in clearing evil heat. Though heat-toxin is severe, it is cleared through anterior/posterior elimination, resolving via bowel movement.)
In Yangming disease, absence of sweat, difficulty urinating, and mental restlessness inevitably lead to jaundice. Yangming Wind Strike: pulse stringy, floating, large, shortness of breath, abdominal fullness, pain in hypochondrium and heart region, dry nose, inability to sweat, lethargy, complete yellowing of body and eyes, difficulty urinating, tidal fever, occasional hiccups, swelling around ears. If illness persists ten days and pulse remains floating, give Xiaochaihu Tang; if pulse is only floating without other symptoms, give Mahuang Tang. If there is no urination, abdominal fullness, and increased hiccups, it is untreatable. In Yangming disease, if the face is red, do not purge; fever and jaundice with difficulty urination indicate use of Zhizi Bopi Tang. If Yangming disease is treated with fire therapy, slight forehead sweating and difficulty urination inevitably lead to jaundice (use Wuling San, Zhizi Bopi Tang). After sweating in Shanghan, if body and eyes turn yellow, it is because cold-dampness remains unresolved internally. Do not purge; seek treatment for cold-dampness. (Cheng Wuji commented: *Jingui Yaolue* states jaundice arises from dampness. If sweat releases heat, jaundice does not form. Post-sweat jaundice means wind-pathogen left, dampness remains. Spleen dislikes dampness; internal dampness steals Spleen color, causing jaundice. If blood stasis causes jaundice, purging is allowed; here, cold-dampness prevents purging, so treat as cold-dampness.)
Taiyin Disease: In Shanghan, if pulse is floating and slow, hands and feet are naturally warm, it relates to Taiyin. Taiyin should manifest as body jaundice. If urination is free, jaundice will not form because the Spleen is full (Shi), allowing rotting filth to exit. (Floating-slow is similar to large. For difficulty urinating, use Wuling San plus Yinchenshao; for free urination, use Jupi Tang.)
Lou Quanshan commented: Upper body jaundice, free urination, hard lower abdomen, mania, black stool indicate blood stasis; use Didang Tang to purge. If lower abdomen is not hard, no mania, normal stool, despite free urination, it is not blood stasis. There are three patterns: 1. Zhizi Bopi Tang and Mahuang Lianqiao Chixiaodou Tang treat jaundice with free urination and no body pain (Haicang's "Dry Jaundice"). 2. Guizhi Fuzi Tang removing Guizhi adding Baizhu Tang treats jaundice with free urination and whole-body pain (Huoren's "Dampness Strike").
Zhang Yuansu commented: Some ask why only Yangming and Taiyin channels cause jaundice in Shanghan, stating free urination prevents it. Yellow is the proper color of Earth; since Taiyin and Yangming belong to Earth, jaundice forms. The mechanism: external inability to sweat, internal inability to urinate, Earth of Spleen/Stomach steamed by heat, showing yellow externally. Free urination prevents heat accumulation, thus no jaundice. Other channels causing jaundice also stem from Spleen/Stomach Earth receiving pathogen.
Zhao Sizhen commented: Differentiate stagnant heat jaundice from blood stasis jaundice by signs and pulse. Head sweating stopping at neck, slight abdominal fullness, difficulty urinating, thirst indicate stagnant heat. Urgent lower abdomen, manic appearance, hard lower abdomen, free urination, black stool indicate blood stasis. Pulses differ: blood stasis is subtle/deep/knotted; stagnant heat is floating/slips/tight/rapid. Only the yellow color is similar. Also, wind-warmth with fire therapy, Shaoyang fire-induced sweating, Yangming fire-induced forehead sweating all cause yellowing via fire pathogen. Is there dissimilar yellow? Yes, dampness patients' smoked-yellow is different. One must distinguish based on similarity.
Attached Formulas:
Wuling Yinchensan Formula: Mix Yinchen decoction with Wuling San (2 qian), take 3-4 times daily. Jaundice exits via urine until urine clears.
Jupi Tang Formula: Jupi (1 liang), Shengjiang (2 liang), finely cut, boil in 1.5 sheng water to 0.7 sheng, remove dregs, take warm in two doses. Repeat if unhealed.
Yinchenshao Dahuang Tang: Treats Shanghan jaundice with complete yellowing of face/eyes and red urine. Ingredients: Yinchenshao, Shanzhiren, Chaihu, Huangbai (honey-roasted), Longdancao (each 0.5 liang), Huangqin (cleaned), Shengma, Dahuang (stir-fried, each 1 liang). Crush, take 5 qian per dose with 1.5 sheng water, boil to 1 sheng, take warm after meals morning and evening.
Maogen Tang: Treats Shanghan jaundice with golden-yellow body. Maogen (cleaned/cut), Shanzhiren, Yinchenshao, Digupi, Gancao (roasted, each 0.5 liang). Crush, take 5 qian per dose with 1.5 sheng water, 3 slices ginger, 6-7 grains Douchi, boil to 1 sheng, take warm far from meals.
Attached: Yin Jaundice
Cold body, sweating, deep pulse with yellowing indicates Yin Jaundice, dampness in Taiyin. May have body pain and fever, body yellow like smoke, but not bright orange like Yang Jaundice. Check urination. Free urination: Shufu Tang. Difficulty urinating, loose stool: Wuling San.
Li Dongyuan commented: In Shanghan, during Sun/Yin ruling periods, excessive purging often causes Yin Jaundice. Reason 1: Cold Water excess attacks Earth. Reason 2: Earth deficiency allows Water invasion. Treatments: 1. Yinchenshengfu Tang + Danggui, Guizhi; 2. Yinchenchupi Tang + Jiang, Zhu, Banxia; 3. Yinchenshuzi Tang; 4. Yinchensini Tang; 5. Yinchenshangfu Tang; 6. Yinchenswuzhuyu Tang. Details below: Jaundice with difficulty urinating, irritability, thirst: Yinchenshao Tang + Fuling, Zhuling, Huashi, Danggui, Guigui (Han's Yinchenshengfu Tang). Jaundice with irritability, wheezing, vomiting, no thirst: Yinchenshao Tang + Chenpi, Baizhu, Shengjiang, Banxia, Fuling (Han's Yinchenchupi Tang). Jaundice with cold limbs/body: Yinchenshao Tang + Fuzi, Gancao (Han's Yinchenshuzi Tang). Jaundice with cold limbs, waist sweating: Yinchenshao Tang + Fuzi, Ganjiang, Gancao (Han's Yinchenshangfu Tang). Jaundice with continuous cold sweat: Yinchenshao Tang + Fuzi, Ganjiang (Han's Yinchenshangfu Tang). Jaundice after ginger/fuzi meds, slow pulse: Yinchenshao Tang + Wuzhuyu, Fuzi, Ganjiang, Mutong, Danggui (Han's Yinchenswuzhuyu Tang). Zhao Zongyan developed jaundice from excessive purging, deep/slow/weak pulse; sequential use of Yinchenshuzi Tang was effective. Haicang's sequence: Han's Yinchenshengfu -> Yinchenchupi -> Yinchenshuzi. Scholar Zhao followed this.
Scholar Zhao had jaundice, Cun/Ruo pulse, cold body; sequential use of Yinchensini Tang was effective. Cold injury, weak pulse/qi, Yin Jaundice: Zhang Zhongjing's Lizhong Tang + Yinchenshao.
Li Dongyuan commented: Alternating chills/fever with whole-body jaundice: Xiao Chaihu Tang + Zhizi.
Yanyi Commentary: A monk with Shanghan had incomplete sweating, residual heat, yellow face/body, fever lasting a year. Misdiagnosed as food stagnation. Given formula: Yinchenshao, Zhizi (each 3 fen), Qinjiao, Shengma (each 4 qian), powdered. Take 3 qian with 4 he water, boil to 2 he, strain, take warm after meals. Recovered in 30 days.
Huoren Commentary: Wuling San + Yinchenshao Tang: Treats jaundice with thirst and difficulty urinating. Yinchenshao Tang (10 parts), Wuling Tang (5 parts). Mix, take 3 qian 3 times daily with water.
Another method: For impending jaundice, use Guiti powder insufflated into nose with water in mouth to expel yellow water. Then take Yinchenshao Tang mixed with Wuling San.
Bencao Commentary: Treats head damp-heat jaundice, Dan Guiti San. Guiti (20), Chixiaodou, Shumi (each 14 grains). Powder fine. Insert one grain-sized amount into nose to expel yellow water. Do not blow in.
Yunqizi Commentary: Chest-binding jaundice attaches to Shaoyang (treat as chest-binding); Pi-energy jaundice attaches to Taiyin (treat as Pi).
Huoren Commentary: Q: Baihu syndrome has fever, thirst, difficulty urinating, why no jaundice? A: Baihu has full-body sweating (heat vents); Jaundice has only head/face sweating, no sweat below neck.