候也。（候上。徐沈尤。有其字。○外台云。大麦则须是无皮麦者。）
〔程〕内经曰。中满者泄之于内。润下作咸。硝石之苦咸。矾石之酸咸。皆所以泄中满。而润下。使
其小便黄。而大便黑也。然硝石。主胃胀闭。涤蓄结。矾石主热在骨髓。而经言劳者温之。是方得无太峻欤。
然所服者。方寸匕耳。和以大麦粥汁。正所以宽胃而益脾也。（案硝石。即火硝。时珍辨之。
详矣。下大黄硝石汤同。）
喻氏法律云。硝石矾石散。从来不解用硝石之义。方书俱改为滑石矾石散。且并改大黄硝石汤。为大
黄滑石汤。医学之陋。一至此乎。夫男子血化为精。精动则一身之血俱动。以女劳而硕其精。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。甚者血瘀之久。大腹尽满。
而成血蛊。尤为极重。而难治矣。味仲景之文。及制方之意。女劳疸。非亟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。故以为君。矾石。本草。谓其能除痼热在骨髓。用以清肾及膀胱脏腑之热。并建消瘀除浊之功。此方之
极妙者也。以陈无择之贤。模棱两可。其说谓无发热恶寒。脉滑者用此汤。若发热恶寒。其脉浮紧。则以滑石
石膏治之。青天白日。梦语喃喃。况其他乎。世岂有血蓄下焦。反见浮滑且紧之脉者乎。妄矣
妄矣。何氏医碥云。伤寒阳明证。发热者。必不恶寒。乃湿与热瘀痹于内。表阳不宣。故恶寒也。此乃辨证
之法。额最高。火气之所熏。故黑。先则额黑。后则周身皆黑。故作黑
疸。硝石。咸寒除热。矾石。除痼热在骨髓。大麦粥调服。恐伤胃也。然此方难用。
肘后方云。女劳疸。身目皆黄。发热恶寒。小腹满急。
小便难。由大劳大热交接后入水所致。治之方。（即本方。）
又治交接劳复。阴卵肿。或缩入腹。腹中绞痛。或便绝。（即本方。）
千金云。湿疸之为病。始得之一身尽疼。发热面色黑黄。
七八日后壮热。热在里。有血当下。去之如豚肝状。其小腹
满者。急下之。亦治一身尽黄。目黄腹满。小便不利方。
于本方。硝石。代滑石。（王氏准绳。载滑石散。治女劳疸。即此方。注
云。按此即前硝石方。硝与滑字形相近。未知孰是。两存之。）
又黄胆之为病。日晡所发热恶寒。小腹急。身体黄额黑。
大便溏黑。足下热。此为女劳。腹满者难治。治之方。
滑石 石膏（各等分） 服法与本方同（外台。引千金翼云。短剧。千金。备急。文仲并同。）
千金翼。泻肾散。主男女诸虚不足。肾气之方。
即本方。不用大麦粥。用粳米粥。
酒黄胆。心中懊 。或热痛。栀子大黄汤主之。
〔徐〕前酒疸正条。尚有不能食欲吐。后各变证。如小便不利。足下热。腹满不一。此独举心中懊 。
为酒疸第一的据也。
〔魏〕为实热之邪立法也。栀子大黄。大苦寒之品。以泄之。枳实以开破之。香豉
以升散之。酒家积郁成热。非此不当其施也。
喻氏法律云。此治酒热内结。昏惑懊 之剂。然伤寒证中有云。阳明病。无汗。小便不利。心中懊 者。
身必发黄。是则诸凡热甚于内者。皆足致此。非独酒也。
栀子大黄汤方（外台。引仲景伤寒论云。肘后。千金同。名栀子枳实豉大黄汤。千金翼。名栀子汤。）
栀子（十四枚） 大黄（一两） 枳实（五枚） 豉（一升）
上四味。以水六升。煮取二升。分温三服。
肘后云。酒疸者。心懊痛。足胫满。小便黄。饮酒发赤斑黄黑。由大醉当风。入水所致。治之方。（即本方。）
千金。枳实大黄汤。治伤寒饮酒。食少饮多。痰结发黄。
酒疸心中懊 。而不甚热。或干呕方。（即本方。）
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。（方见水气病中。○千金。载本方。用黄 五两。）
〔沈〕此风多湿少。邪机向表。通治之方也。诸病黄家。乃胃中湿热酿成。而湿性下流。当从下驱为顺。
故但利小便。而为常法。假令脉浮。则湿少风多。而风性通扬。邪机在表。当以汗解。不可拘利小便为常矣。
故用桂枝汤。和营卫而解肌表之邪。风为表虚。加黄 而实腠理。啜热稀粥为助。使周身微微小汗。则肌表之
邪去。而虽有里湿。亦从下渗矣。
徐云。黄胆家。不独谷疸酒疸女劳疸有分别。即正黄胆病邪。乘虚所着不同。予治一黄胆。百药不效。
而垂毙者。见其偏于上。令服鲜射干一味。斤许而愈。又见一偏于阴者。令服鲜益母草一味。数斤而愈。其
凡黄胆初起。非系谷疸酒疸女劳疸者。辄令将车前根叶子。合捣取自然汁。酒服数碗而愈。甚有卧床不起者。
令将车前一味。自然汁数盂。置床头。随意饮之而愈。然则汗下之说。亦设言以启悟。其可无
变通耶。案此等治法。出于绳墨之外。所谓草头药者。亦有效验。故附载之。
外台。许仁则。疗急黄。始得大类天行病。经三两日。宜合麻黄等五味汤服之。发汗以泄黄势方。
麻黄（三两） 葛根（五两） 石膏（八两） 生姜（六两） 茵陈（二两）
上以水八升。煮取二升七合。去滓。分温三服。覆被微
取汗以散之。案黄家脉浮热盛者。桂枝加黄 汤非所宜。此方有大青龙之意。当随证撰用。故附于此。
诸黄。猪膏发煎主之。
〔程〕扁鹊有疗黄经。明堂。有烙三十六黄法。皆后人所未见。唯圣济总录。载三十六黄。方论详
明治法始备。今猪膏发煎。能治诸黄。当是黄之轻者。可从小便而去。至若
阴黄急黄女劳之属。岂猪膏发煎。所能治乎。医者审之。
〔尤〕此治黄胆。不湿而燥者之法。按伤寒类要云。
男子女人。黄胆饮食不消。胃胀。热生黄衣在胃中。有燥屎使然。猪膏煎服则愈。盖湿热经久。变为坚燥。譬
如盒曲。热久则湿去而干也。本草猪脂利血脉。解风热。乱发消瘀开关格。利水道。故曰病从小便出。
猪膏发煎方（外台。引仲景伤寒论云。肘后。备急。文仲。千金。古今录验。深师。范汪同。）
猪膏（半斤○外台。作八两。） 乱发（如鸡子大三枚○肘后外台作一枚）
上二味。和膏中煎之。发消药成。分再服。病从小便出。（味下。外台有内发二字。药成。作尽
研绞去膏细滓七字。方后云。大医校尉史脱家婢再病。胃中干粪下。便瘥。神验。）
案外台。引肘后。疗黄胆者。一身面目悉黄。如橘柚。暴得热。外以冷迫之。热因留胃中。生黄衣。
热熏上所致方。猪脂一斤。上一味。煎成者。温令热。尽服之。日三。燥屎当下。下则稍愈便止。证类本草。
引伤寒类要。尤则采之于证类也。今本肘后无考。外台。又引近效。主疗亦同。
肘后。女劳疸者。身目皆黄。发热恶寒。小腹满急。小便难。由大劳大热。交接后入水所致治之方。（即
本方○喻氏法律引肘后云。盖女劳疸。血瘀膀胱。非直入血分之药。必不能开。然虻蛭过峻。矾石过燥。明
是治血燥矣。）
徐云。予友骆天游黄胆腹大如鼓。百药不效。用猪膏四两。发灰四两。一剂而愈。仲景岂欺我哉。
黄胆病。茵陈五苓散主之。（〔原注〕一本云。茵陈汤。及五苓散并主之。）
〔徐〕此表里两解之方。然五苓中有桂术。乃为稍涉虚者设也。
〔尤〕此正治湿热成疸者之法。茵陈散结热。五苓利水去湿也。
〔鉴〕黄胆病之下。当有小便不利者之五字。茵陈五苓散方有着落。必传写之遗。
茵陈五苓散方（外台。引仲景伤寒论。文同。云短剧。古今录验。张文仲。经心录同。）
茵陈蒿末（十分） 五苓散（五分○方见痰饮中）
上二味和。先食饮方寸匕。日三服。（外台。作上二味和。先食白饮和方寸匕。服之日三。）
外台。又五苓散。利小便。治黄胆方。（即本方。不用茵陈。云千金。深师。范汪同。）
三因方。五苓散。治伏暑郁发黄。小便不利烦渴。用茵陈煎汤调下。
严氏济生方。加减五苓散。治饮食伏暑。郁发黄。烦渴小便不利。○于本方。去桂枝加茵陈。
准绳。茵陈五苓散。治伤寒温湿。热病感冒。后发为黄胆。小便黑赤。烦渴发热。不得安宁。此盖汗下太
早。服药不对证。因感湿热病。以致遍身发黄。○上用生料五苓散一两。加入茵陈半两。车前子一钱。木通
柴胡各一钱半。酒后得证。加干葛二钱。灯心五十茎。水一碗。煎八分。连进数服。小便清利为愈。
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。（宋本。硝石。作滑石。下同。非。脉经。作大黄黄柏栀子芒硝汤。）
〔鉴〕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。用栀子清上焦
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。
大黄硝石汤方（千金。名大黄黄柏汤。翼。名大黄汤。外台。引仲景伤寒论。
名大黄黄柏皮栀子硝石汤。短剧。千金翼。深师。范汪并同。）
大黄 黄柏 硝石（各四两） 栀子（十五枚）
上四味。以水六升。煮取二升。去滓。内消。更煮取一升。顿服。
喻氏法律云。湿热郁蒸。而发黄。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。以疸证多夹内伤。不得不回护之耳。
外台。必效大黄汤。疗急黄胆内等黄方。
大黄（三两） 芒硝（二两）
上二味。以水二升。生渍大黄。一宿。平旦绞汁一升半。内芒硝。搅服。须臾当快利瘥。
圣惠。治黄病腹胀满。小便涩而赤少。
于本方中。加冬葵子。
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。（方见痰饮中○外台。引仲景伤寒论云。范汪同。）
〔尤〕便清自利。内无热征。则腹满非里实。喘非气盛矣。虽有疸热。亦不可以寒药攻之。热气虽除。
阳气则伤。必发为哕。哕。呃逆也。魏氏谓胃阳为寒药所坠。欲升而不能者是也。小半夏。温胃止哕。哕止
然后温理中脏。使气盛而行健。则喘满除。黄病去。非小半夏能治疸也。
圣惠。小半夏散。阴黄小便色不变。欲自利而不利。腹满而喘者。必哕；哕者宜服此方。
半夏（一两） 人参（二两） 葛根（二两）
上件药。捣粗罗为散。每服四钱。以水一中盏。入生姜半分。煎至六分。去滓。不计时候温服。
诸黄。腹痛而呕者。宜柴胡汤。（〔原注〕必小柴胡汤。方见呕吐中。○
原本。黄。作劳。今据诸本改定。魏作劳解之。非。）
〔程〕经曰。呕而腹满。视其前后。知何部不利。利之则愈。今黄家腹痛而呕。应内有实邪。当是大
柴胡以下之。若小柴胡。则可止呕。未可疗腹痛也。明者详之。
〔鉴〕呕而腹痛。胃实热也。然必有潮热便
硬。始宜大柴胡汤两解之。若无潮热。便软则当用小柴胡汤。去黄芩。加芍药和之可也。（
案玉机。小柴胡汤。加栀子。）
男子黄。小便自利。当与虚劳小建中汤。（方见虚劳中。）
〔鉴〕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。
〔尤〕小便利者。不能发黄。以热从小便去也。今小便利。而
黄不去。知非热病。乃上虚而色外见。宜补中。而不可除热者也。夫黄胆之病。湿热所郁也。故在表者汗而
发之。在里者攻而去之。此大法也。乃亦有不湿而燥者。则变清利为润导。如猪膏发煎之治也。不热而寒。不
实而虚者。则变攻为补。变寒为温。如小建中之法也。其有兼证错出者。则先治兼证。而后治本证。
如小半夏。及小柴胡之治也。仲景论黄胆一证。而于正变虚实之法。详尽如此。其心可谓尽矣。
王氏阴证略例云。内感伤寒。劳役形体。饮食失节。中州变寒之病。生黄非伤寒坏之而得。只用建中。
理中大建中。足矣。不必用茵陈也。何氏医碥曰。阴黄。小便清白。大便
不实。喜静能卧。脉迟弱无力。身冷自汗。当以虚寒治之。
仲景所谓男子黄。小便自利。与小建中汤。王海藏谓中州寒生黄。用大小建中。不必茵陈。皆气虚之阴黄也。
气虚则脾不运。久瘀于里。则脾败而色外见。故黄。其黄色必淡。戴复庵谓失血后多令面黄。或遍身黄。血
不荣也。如竹木春夏叶润则绿。至秋则干黄。宜养荣汤。十全大补汤。此血虚之阴血也。此为干黄。小便利。
候证。（“候”字在上文。徐灵胎、沈明宗、尤在泾认为原文有“候”字。《外台秘要》记载：大麦必须使用去皮的麦粒。）
〔程知〕《内经》说：“中焦气满的，用泄法从内部疏导。”“润下作咸”，硝石的苦咸味，矾石的酸咸味，都是用来疏导中焦气满，并发挥润下的作用，使小便变黄，大便变黑。然而硝石主要治疗胃胀闭塞，涤荡积滞结聚；矾石主要治疗骨髓中的热邪。而经文又说“劳损的病要用温补法”，这个方子难道太过峻猛吗？但是服用的量只有一方寸匕，并且用大麦粥汁调和，这正是为了宽缓胃气并补益脾脏的缘故。（按语：硝石即火硝，李时珍对此辨析得很详细。下文的大黄硝石汤与此相同。）
喻嘉言在《医门法律》中说：硝石矾石散，历来没有人解释使用硝石的用意。方书都将其改为滑石矾石散，并且连大黄硝石汤也改成了大黄滑石汤。医学的陋习，竟然到了这种地步！男子血液化为精液，精液发动则全身血液随之而动。因为女劳（房事过度）耗损精液，血液必然继之受损。所以因女劳导致尿血的，其血尚能运行，还容易治疗；因女劳而成黄疸的，则是血瘀不行，就难以治疗了。更严重的，血瘀日久，导致大腹全部胀满，形成血蛊，更是极重且难治的疾病。体味张仲景的文意及制方的本意，女劳疸如果不急需去除膀胱和少腹部位的瘀血，万无生路。在伤寒病热邪瘀结膀胱的证候中，患者如果下血就会痊愈；如果血不下行，就用抵当汤攻下。这也是因为血是暂时凝结，可以峻猛攻伐。而这个女劳疸，蓄积的瘀血必定不是朝夕之间形成的，峻猛攻伐没有益处。只能取用石药的悍烈之性，使其快速趋行，直达病所。硝石，味咸寒，走血分，可以消除驱逐热瘀之血，所以作为君药。矾石，《本草》记载它能清除骨髓中的顽固热邪，用来清泻肾脏及膀胱脏腑的热邪，并建立消瘀除浊的功效。这是此方极其精妙的地方。以陈无择的贤能，却模棱两可，他的说法是：如果没有发热恶寒、脉滑的症状，就用这个方子；如果有发热恶寒、脉浮紧的症状，就用滑石石膏治疗。这简直是青天白日里的梦话喃喃自语，何况其他的说法呢？世上哪有血蓄积在下焦，反而出现浮滑且紧的脉象的呢？真是荒谬啊荒谬！何秀山在《医碥》中说：伤寒阳明证，发热的，一定不恶寒。这是湿与热瘀痹于内，表阳不能宣通，所以才恶寒。这是辨证的方法。额头最高，是火气熏蒸的地方，所以发黑。先是额头黑，后来周身都黑，所以称为黑疸。硝石，咸寒除热；矾石，清除骨髓中的顽固热邪。用大麦粥调服，是担心损伤胃气。然而这个方子很难使用。
《肘后备急方》说：女劳疸，身体和眼睛都发黄，发热恶寒，小腹满急，小便困难。这是由于在大疲劳、大热状态下行房事后入水所致。治疗方剂。（即本方：硝石矾石散。）
又治疗房事后的劳复症，阴囊肿胀，或者缩入腹中，腹中绞痛，或者大便不通。（即本方：硝石矾石散。）
《千金方》说：湿疸这种病，刚开始时全身疼痛，发热，面色黑黄。七八天后壮热，热在体内，有瘀血应当下行排出，排出的血像猪肝一样。如果小腹满胀的，紧急攻下。也治疗全身发黄、眼睛黄、腹部满胀、小便不利的方剂。在本方中，用硝石代替滑石。（《准绳》记载滑石散，治疗女劳疸，就是此方。注解说：按此即是前文的硝石方，硝与滑字形相近，不知哪个正确，两者并存。）
又黄疸这种病，傍晚时分发热恶寒，小腹急迫，身体黄、额头黑，大便溏黑，脚心发热。这是女劳疸。如果腹部满胀的，难以治疗。治疗方剂：滑石、石膏（各等分）。服法与本方相同。（《外台秘要》引用《千金翼》、《短剧》、《千金》、《备急》、《文仲》均相同。）
《千金翼方》：泻肾散，主治男女各种虚损不足，肾气的方剂。即本方，不用大麦粥，改用粳米粥。
〔徐灵胎〕前面的酒疸正条文中，还有不能进食、欲吐的症状，后述的各种变证，如小便不利、脚心发热、腹满等不一而足。这里单独举出心中懊恼，作为酒疸最确切的依据。
〔魏荔彤〕这是为实热之邪立法的方子。栀子和大黄是大苦大寒的药物，用来泄热；枳实用来开破气滞；香豉用来升散郁热。酒客积郁成热，非此方不当施用。
喻嘉言在《医门法律》中说：这是治疗酒热内结，昏惑懊恼的方剂。然而在伤寒证中有说：“阳明病，无汗，小便不利，心中懊恼的，身体一定会发黄。”那么凡是热邪盛于内部的，都足以导致这种情况，不仅仅是饮酒引起的。
栀子大黄汤方（《外台秘要》引用《仲景伤寒论》说：《肘后方》、《千金方》相同，名为栀子枳实豉大黄汤。《千金翼方》名为栀子汤。）
以上四味药，用水六升，煮取二升，分三次温服。
《肘后方》说：酒疸，心中懊恼疼痛，足胫肿胀，小便黄，饮酒后出现赤斑、黄黑斑。这是由于大醉当风、入水所致。治疗方剂。（即本方：栀子大黄汤。）
酒疸心中懊恼，而不甚热，或者干呕的方剂。（即本方：栀子大黄汤。）
所有患黄疸的人，只要通利小便即可。假如脉浮，应当用发汗法解除，宜用桂枝加黄芪汤主治。（方见水气病篇中。○《千金方》记载本方，用黄芪五两。）
〔沈明宗〕这是风多湿少，病机趋向体表的通治方。各种黄疸病，都是胃中湿热酿成，而湿性向下流注，应当从下面驱除为顺。所以通利小便是常法。假如脉浮，则湿少风多，而风性轻扬向上，病机在表，应当用发汗法解除，不可拘泥于通利小便为常法。所以用桂枝汤，调和营卫并解肌表之邪。风邪导致表虚，加黄芪来充实腠理。喝热稀粥以助药力，使周身微微出汗，则肌表之邪去除，即使有里湿，也会从下面渗利而出。
徐灵胎说：黄疸病家，不仅谷疸、酒疸、女劳疸有区别，即使是正黄疸病，邪气乘虚侵袭的部位也不同。我治疗一个黄疸病人，百药无效，濒临死亡。见他病势偏于上部，令其服用鲜射干一味药，一斤多就好了。又见到一个病势偏于阴分的，令其服用鲜益母草一味药，几斤就好了。那些初起黄疸，不属于谷疸、酒疸、女劳疸的，我就令他们将车前草根叶合捣取自然汁，用酒送服数碗就好了。甚至有卧床不起的，令他将车前草一味，取自然汁数盆，放在床头，随意饮用就好了。然而，发汗和攻下的说法，也是设言以启发领悟，怎么可以没有变通呢？案：这些治法，出于常规法度之外，所谓“草头药”（民间草药），也有疗效，所以附载于此。
《外台秘要》：许仁则治疗急黄，开始很像天行病（传染病）。经过两三天，适宜合用麻黄等五味汤服用，发汗以泄黄势方。
麻黄（三两） 葛根（五两） 石膏（八两） 生姜（六两） 茵陈（二两）
以上五味药，用水八升，煮取二升七合，去渣，分三次温服。盖被微取汗以散之。案：黄疸病患者若脉浮热盛，桂枝加黄芪汤就不适宜了。此方有大青龙汤的意思，应当随证选用，所以附于此。
〔程知〕扁鹊有治疗黄疸的经书，《明堂》有烙三十六黄的疗法，都是后人所未见的。只有《圣济总录》记载了三十六黄，方论详细，治疗方法始备。现在猪膏发煎能治疗各种黄疸，应当是较轻的黄疸，可以从大小便而去。至于阴黄、急黄、女劳疸之类，难道是猪膏发煎所能治疗的吗？医生们要审慎判断。
〔尤在泾〕这是治疗黄疸，不湿而燥的治疗方法。按《伤寒类要》说：男人女人，黄疸饮食不消，胃胀，热生黄衣在胃中，有燥屎导致如此。猪膏煎服则愈。大概湿热经久，变为坚燥，譬如做曲，热久了湿气去而变干。本草记载猪脂能利血脉，解风热；乱发能消瘀，开关格，利水道。所以说病从小便出。
猪膏发煎方（《外台秘要》引用《仲景伤寒论》说：《肘后方》、《备急方》、《文仲》、《千金方》、《古今录验》、《深师方》、《范汪方》相同。）
猪膏（半斤○《外台秘要》作八两。） 乱发（如鸡蛋大三枚○《肘后方》、《外台秘要》作一枚）
以上两味药，和入膏中煎煮，发消药成，分两次服。病从小便出。（《外台秘要》在“味下”后有“内发”二字，“药成”后作“尽研绞去膏细滓”七字。方后记载：大医校尉史脱家的婢女再次患病，胃中干粪排出，病愈，神效。）
案：《外台秘要》引用《肘后方》，治疗黄疸者，一身面目悉黄，如橘柚，暴得热，外以冷迫之，热因留胃中，生黄衣，热熏上所致方。猪脂一斤，上一味药，煎成者，温令热，尽服之，日三服。燥屎当下，下则稍愈便止。《证类本草》引用《伤寒类要》，尤在泾是采之于《证类本草》的。今本《肘后方》无法考证。《外台秘要》又引用《近效方》，主疗也相同。
《肘后方》：女劳疸，身体和眼睛都发黄，发热恶寒，小腹满急，小便困难。由于大劳大热，交接后入水所致。治疗方剂。（即本方○喻嘉言《医门法律》引用《肘后方》说：大概女劳疸，血瘀膀胱，如果不是直入血分的药物，一定不能开通。然而虻虫、水蛭过于峻猛，矾石过于干燥，明明是治疗血燥的了。）
徐灵胎说：我的朋友骆天游患黄疸，腹大如鼓，百药无效。用猪膏四两，发灰四两，一剂而愈。仲景难道欺骗我吗？
黄疸病，用茵陈五苓散主治。（〔原注〕另一版本说：茵陈汤，以及五苓散都主治。）
〔徐灵胎〕这是表里两解的方子。然而五苓散中有桂枝、白术，是为稍微涉及虚证的病人设立的。
〔尤在泾〕这是正治湿热成疸的方法。茵陈散结热，五苓散利水去湿。
〔鉴〕黄疸病之下，应当有“小便不利者”这五个字，茵陈五苓散方才有着落。必然是传写遗漏。
茵陈五苓散方（《外台秘要》引用《仲景伤寒论》，文字相同，说《短剧》、《古今录验》、《张文仲方》、《经心录》相同。）
以上两味药混合，饭前用开水送服一方寸匕，每日三次。（《外台秘要》作：以上两味药混合，饭前用白饮和一方寸匕，服之日三次。）
《外台秘要》又载五苓散，利小便，治黄疸方。（即本方，不用茵陈，说《千金方》、《深师方》、《范汪方》相同。）
《三因方》：五苓散，治疗伏暑郁发黄，小便不利烦渴，用茵陈煎汤调下。
《严氏济生方》：加减五苓散，治疗饮食伏暑，郁发黄，烦渴小便不利。○在本方中，去桂枝加茵陈。
《准绳》：茵陈五苓散，治疗伤寒温湿，热病感冒后发为黄疸，小便黑赤，烦渴发热，不得安宁。这大概是汗下太早，服药不对证，因感湿热病，以致遍身发黄。○上方用生料五苓散一两，加入茵陈半两，车前子一钱，木通、柴胡各一钱半。酒后得证，加干葛二钱，灯心五十茎，水一碗，煎至八分。连进数服，小便清利为愈。
黄疸腹满，小便不利而赤，自汗出，这是表和里实，应当攻下，宜用大黄硝石汤。（宋本中，硝石作滑石，下同，非。《脉经》作大黄黄柏栀子芒硝汤。）
〔鉴〕李梴说：腹满，小便不利而赤，是里病。自汗出，是和。里病者，湿热内甚。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，有燥烈发散之意，使药力无所不至，而湿热悉消散矣。
大黄硝石汤方（《千金方》名大黄黄柏汤，《千金翼方》名大黄汤。《外台秘要》引用《仲景伤寒论》，名大黄黄柏皮栀子硝石汤。《短剧》、《千金翼方》、《深师方》、《范汪方》相同。）
以上四味药，用水六升，煮取二升，去渣，内入硝石，再煮取一升，顿服。
喻嘉言在《医门法律》中说：湿热郁蒸而发黄，其应当从下面夺下，也必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，如同大承气汤的例子。稍轻则用栀子大黄汤，清解而兼下夺，如同三黄汤的例子。更轻则用茵陈蒿汤，清解为君，微加大黄为使，如同栀豉汤中加大黄，如博棋子大的例子。那么汗法固然不敢轻用，下法也在所慎重施用，因为疸证多夹内伤，不得不回护之耳。
大黄（三两） 芒硝（二两）
以上两味药，用水二升，生渍大黄，一夜，平旦绞汁一升半，内入芒硝，搅服。须臾当快利瘥。
《圣惠方》：治疗黄病腹胀满，小便涩而赤少。
在本方中，加冬葵子。
黄疸病，小便颜色不变，想自行腹泻，腹满而喘，不可除热。
热除必发哕（呃逆）。哕者，用小半夏汤主治。（方见痰饮篇中○《外台秘要》引用《仲景伤寒论》说：《范汪方》相同。）
〔尤在泾〕便清自利，内无热征，则腹满非里实，喘非气盛。虽有疸热，也不可以用寒药攻之。热气虽除，阳气则伤，必发为哕。哕，就是呃逆。魏氏说胃阳为寒药所坠，欲升而不能，是对的。小半夏汤温胃止哕。哕止然后温理中脏，使气盛而行健，则喘满除，黄病去。并非小半夏汤能治疸。
《圣惠方》：小半夏散，阴黄小便色不变，想自行腹泻而不利，腹满而喘的，必发哕；哕者宜服此方。
以上药材，捣粗罗为散。每服四钱，用水一中盏，入生姜半分，煎至六分，去渣，不计时候温服。
各种黄疸，腹痛而呕的，宜用柴胡汤。（〔原注〕必是小柴胡汤，方见呕吐篇中。○原本，黄，作劳。今据诸本改定。魏荔彤作劳解之，非。）
〔程知〕经文说：“呕而腹满，视其前后，知何部不利，利之则愈。”现在黄疸家腹痛而呕，应内有实邪，应当是大柴胡汤以下之。若是小柴胡汤，则可止呕，未可疗腹痛。明者详之。
〔鉴〕呕而腹痛，是胃实热。然而必有潮热便硬，始宜大柴胡汤两解之。若无潮热，便软则当用小柴胡汤，去黄芩，加芍药和之可也。（案《玉机真藏论》，小柴胡汤，加栀子。）
〔鉴〕高世栻说：女为阴，男为阳。阴主血，阳主气。男子黄，是阳气虚。黄，是土之色。阳气虚，而土色外呈，中无湿热，故小便自利。此为虚证。
〔尤在泾〕小便利者，不能发黄，因为热从小便去了。现在小便利，而黄不去，知道不是热病，乃是上虚而色外见，宜补中，而不可除热。夫黄疸之病，是湿热所郁。所以在表者汗而发之，在里者攻而去之，这是大法。但也有不湿而燥的，则变清利为润导，如猪膏发煎的治疗。不热而寒，不实而虚的，则变攻为补，变寒为温，如小建中的方法。其有兼证错出的，则先治兼证，而后治本证，如小半夏，及小柴胡的治疗。仲景论黄疸一证，而对于正变虚实之法，详尽如此，其心可谓尽矣。
王好古《阴证略例》说：内感伤寒，劳役形体，饮食失节，中州变寒之病，生黄非伤寒坏之而得。只用建中、理中、大建中，足矣，不必用茵陈。何秀山《医碥》说：阴黄，小便清白，大便不实，喜静能卧，脉迟弱无力，身冷自汗，当以虚寒治之。
仲景所谓男子黄，小便自利，与小建中汤。王海藏谓中州寒生黄，用大小建中，不必茵陈，都是气虚之阴黄。气虚则脾不运，久瘀于里，则脾败而色外见，故黄。其黄色必淡。戴复庵说失血后多令面黄，或遍身黄，血不荣也。如竹木春夏叶润则绿，至秋则干黄，宜养荣汤、十全大补汤。此为血虚之阴血。此为干黄，小便利。
Prognostic signs. ("Hou" [signs/prognosis] is in the preceding text. Xu Lingtai, Shen Mingzong, and You Zaijing believe the original text contains the character "Hou". *Waitai Miyao* records: Barley must be hulled barley.)
[Cheng Zhi] The *Neijing* states: "For fullness in the middle jiao, use purgation from within." "Moistening and descending produces saltiness." The bitter-salty nature of Nuxiaoshi (Natrii Sulfas) and the sour-salty nature of Fanshi (Alumen) are all used to drain middle jiao fullness and promote moistening and descending, causing urine to turn yellow and stool to turn black. However, Nuxiaoshi primarily treats stomach distension and closure, cleansing accumulated stagnation; Fanshi primarily treats heat in the bone marrow. Yet the classic states, "Lao diseases should be treated with warming and tonifying." Is this prescription too harsh? Nevertheless, the dosage taken is only one fangcun bi (a square-inch measure), and it is harmonized with barley porridge juice, which precisely serves to soothe the stomach and benefit the spleen. (Note: Nuxiaoshi is fire saltpeter; Li Shizhen has辨析ed this in detail. The Dahuang Nuxiaoshi Tang below is the same.)
Yu Jiayan in *Yimen Falü* says: Regarding Xiaoshi Fansan Powder, no one has ever explained the meaning of using Nuxiaoshi. Medical texts have all changed it to Huashi Fansan Powder (Talcum and Alumen Powder), and even changed Dahuang Nuxiaoshi Tang to Dahuang Huashi Tang. How has the vulgarity of medicine reached such a point! In men, blood transforms into essence. When essence moves, the blood of the whole body moves. Due to female labor (sexual exhaustion) depleting the essence, the blood must subsequently be damaged. Therefore, hematuria caused by female labor involves blood that still flows and is relatively easy to treat. Jaundice resulting from female labor involves stagnant blood that does not flow, making it difficult to treat. In severe cases, long-standing blood stasis causes the entire abdomen to become distended, forming Blood Gu (blood accumulation disorder), which is extremely severe and difficult to treat. Reflecting on Zhang Zhongjing's text and the intent of his prescriptions, for female labor jaundice, if one does not urgently remove the blood stasis in the bladder and lower abdomen, there is absolutely no hope of survival. In Taiyang disease where heat and stasis bind in the bladder, the patient recovers upon passing blood; if blood does not pass, Didang Tang is used to purge it. This is because the blood is temporarily congealed and can be aggressively attacked. However, the accumulated blood in female labor jaundice has likely formed over days or weeks, so aggressive purging is of no benefit. One must rely on the fierce nature of mineral drugs to quickly reach the site of disease. Nuxiaoshi, salty and cold, enters the blood level and can eliminate and drive out heat-stasis blood, thus serving as the sovereign drug. Fanshi, according to Bencao, can eliminate stubborn heat in the bone marrow; it is used to clear heat in the Kidney and Bladder organs and establish the function of eliminating stasis and turbidity. This is the extreme subtlety of this formula. Chen Wuzhe, despite his virtue, was ambiguous. He stated: If there is no fever, aversion to cold, and the pulse is slippery, use this decoction. If there is fever, aversion to cold, and the pulse is floating and tight, use Huashi and Shigao (Gypsum). This is merely babbling dreams in broad daylight, let alone other statements. How could there be blood accumulation in the lower jiao presenting with a floating, slippery, and tight pulse? Absurd, absurd! He Xiushan in *Yipian* states: In Yangming syndrome of Cold Damage, fever implies no aversion to cold. Here, dampness and heat are bound internally, preventing the venting of exterior Yang, hence the aversion to cold. This is a method of differentiation. The forehead is the highest point, where Fire Qi steams, hence it turns black. Initially, only the forehead turns black; later, the whole body turns black, thus called Black Jaundice. Nuxiaoshi, salty and cold, clears heat; Fanshi clears stubborn heat in the bone marrow. Taking it with barley porridge avoids damaging the stomach. However, this formula is difficult to use.
*Zhouhou Beiji Fang* states: Female labor jaundice presents with yellowing of the body and eyes, fever, aversion to cold, abdominal fullness and urgency, and difficult urination. It is caused by sexual intercourse after severe fatigue and heat, followed by exposure to water. The treatment formula is (this formula: Xiaoshi Fansan Powder).
It also treats relapse due to sexual exertion, with swelling of the scrotum or retraction into the abdomen, colicky abdominal pain, or constipation. (This formula: Xiaoshi Fansan Powder).
*Qianjin Fang* states: Wet jaundice initially presents with generalized body pain, fever, and a dark-yellow complexion. After seven or eight days, high fever occurs, with heat in the interior and blood stasis that should be expelled downward; the expelled blood resembles pig liver. If the lower abdomen is full, urgent purging is required. It also treats generalized yellowing, yellow eyes, abdominal fullness, and difficult urination. In this formula, replace Huashi with Nuxiaoshi. (*Zhunsheng* records Huashi San treating female labor jaundice, which is this formula. The note says: This is the previous Xiaoshi formula; 'Xiao' and 'Hua' look similar, uncertainty remains. Both are preserved.)
Another type of jaundice presents with fever and aversion to cold at dusk, lower abdominal urgency, generalized yellowing with a black forehead, loose black stools, and hot soles. This is female labor jaundice. If the abdomen is full, it is difficult to treat. The treatment formula is: Huashi and Shigao (equal parts). Administration is the same as the main formula. (*Waitai Miyao* cites *Qianjin Yi*, *Duanju*, *Qianjin*, *Beiji*, and *Wenzhong* as identical.)
*Qianjin Yi*: Xieshen San treats various deficiencies in men and women, targeting Kidney Qi. It is this formula, but uses rice porridge instead of barley porridge.
Wine jaundice presents with mental restlessness (Ao Nu) or painful heat, treated with Zhizi Dahuang Tang.
[Xu Lingtai] The main clause for wine jaundice previously mentioned inability to eat and desire to vomit. The subsequent variable syndromes include difficult urination, hot soles, abdominal fullness, etc. Here, mental restlessness (Ao Nu) is singled out as the primary diagnostic indicator for wine jaundice.
[Wei Liting] This formula establishes legislation for pathogenic excess-heat. Zhizi and Dahuang are greatly bitter and cold, used to drain heat; Zhishi opens and breaks stagnation; Chidou (Fermented Soybean) lifts and disperses. Wine drinkers accumulate depression transforming into heat; this formula is appropriate for their condition.
Yu Jiayan in *Yimen Falü* states: This is a formula for treating internal binding of wine-heat causing mental confusion and restlessness. However, in Cold Damage syndromes, it is stated: "Yangming disease, with no sweat, difficult urination, and mental restlessness, will result in jaundice." Thus, any condition with intense internal heat can cause this, not just wine.
Zhizi Dahuang Tang Formula (*Waitai Miyao* cites *Zhongjing Shanghan Lun*: *Zhouhou* and *Qianjin* are the same, named Zhizi Zhishi Chi Dahuang Tang. *Qianjin Yi* names it Zhizi Tang.)
Zhizi (14 seeds) Dahuang (1 liang) Zhishi (5 pieces) Chi Dou (1 sheng)
The above four ingredients are boiled in 6 sheng of water to obtain 2 sheng. Divide into three warm doses.
*Zhouhou* states: Wine jaundice presents with painful mental restlessness, swollen calves, yellow urine, red spots, and yellow-black discoloration after drinking. It is caused by drunkenness exposed to wind and entering water. The treatment formula is (this formula: Zhizi Dahuang Tang).
*Qianjin*: Zhishi Dahuang Tang treats Cold Damage from drinking alcohol, where food intake is low but fluid intake is high, leading to phlegm binding and jaundice.
Wine jaundice with mental restlessness but little heat, or dry vomiting, is treated with (this formula: Zhizi Dahuang Tang).
For all patients with jaundice, promoting diuresis is sufficient. If the pulse is floating, release via sweating is indicated; Guizhi Jia Huangqi Tang is appropriate. (Formula seen in Water Qi chapter. ○ *Qianjin* records this formula using Huangqi 5 liang.)
[Shen Mingzong] This is a general formula for conditions with more Wind than Dampness, where the pathogen trends toward the exterior. All types of jaundice are brewed from Damp-Heat in the Stomach. Since Dampness tends to flow downward, driving it out from below is the smooth approach. Thus, promoting diuresis is the standard method. If the pulse is floating, there is less Dampness and more Wind. Wind is light and ascending; the pathogen is in the exterior. Release via sweating is indicated. One should not rigidly adhere to diuresis as the constant method. Therefore, use Guizhi Tang to harmonize Ying and Wei and resolve exterior muscle pathogens. Wind causes exterior deficiency; add Huangqi to solidify the couli (pores). Drink hot thin porridge to assist, inducing slight generalized sweating. Then exterior pathogens are removed, and even if interior Dampness exists, it渗 (seeps) downward.
Xu Lingtai says: Jaundice patients differ not only in Grain Jaundice, Wine Jaundice, and Female Labor Jaundice, but even in regular Jaundice, the pathogen attaches differently depending on deficiency. I treated a jaundice patient who failed hundred medicines and was near death. Seeing the pathology biased upward, I ordered fresh Shegan (Belamcanda Rhizome) alone. After consuming over a jin, he recovered. I saw another case biased toward Yin, ordered fresh Yimucao (Motherwort Herb) alone. After consuming several jin, he recovered. For early-stage jaundice not classified as Grain, Wine, or Female Labor Jaundice, I ordered Cheqian genye (Plantain Root and Leaf) crushed for natural juice, taken with wine. Several bowls cured him. Even bedridden patients were cured by placing cups of Plantain natural juice by the bedside for free consumption. Thus, the theories of sweating and purging are hypothetical to inspire understanding; how can there be no flexibility? Note: These treatments are outside conventional methods, known as "grass-head medicines" (folk herbs), yet effective. Hence appended.
*Waitai Miyao*: Xu Renze treats Ji Huang (Urgent Jaundice), which initially resembles epidemic disease. After two or three days, administer Mahuang Wuwei Tang (Mahuang and five other herbs) to induce sweating and dissipate jaundice momentum.
Mahuang (3 liang) Gegen (5 liang) Shigao (8 liang) Shengjiang (6 liang) Yinchen (2 liang)
The above five ingredients are boiled in 8 sheng of water to obtain 2.7 sheng. Strain and divide into three warm doses. Cover with blankets to induce slight sweating to dissipate. Note: For jaundice patients with floating pulse and intense heat, Guizhi Jia Huangqi Tang is unsuitable. This formula has the intent of Da Qinglong Tang and should be used according to syndrome. Hence appended.
For all jaundices, Zhigao Fa Jian (Pork Fat and Hair Decoction) is indicated.
[Cheng Zhi] Bianque had a classic on treating jaundice; *Mingtang* had methods for cauterizing thirty-six yellows, unseen by later generations. Only *Shengji Zonglu* records thirty-six yellows with detailed formulas and methods. Now, Zhigao Fa Jian can treat various jaundices, implying these are mild cases expellable via urine/stool. As for Yin Huang, Ji Huang, and Female Labor Jaundice, can Zhigao Fa Jian treat them? Physicians must deliberate.
[You Zaijing] This is the method for treating jaundice that is dry rather than damp. According to *Shanghan Leiyao*: Men and women with jaundice, indigestion, stomach distension, and yellow coating in the stomach due to heat and dry feces. Boiling pork fat cures it. Generally, long-standing Damp-Heat becomes hard and dry, like yeast dough losing moisture after prolonged heat. Bencao records Pig Fat benefits vessels and resolves Wind-Heat; human hair eliminates stasis, opens blockages, and promotes urination. Thus, the disease exits via urine.
Zhigao Fa Jian Formula (*Waitai Miyao* cites *Zhongjing Shanghan Lun*: *Zhouhou*, *Beiji*, *Wenzhong*, *Qianjin*, *Gujin Luyian*, *Shenshi*, *Fanwang* are the same.)
Zhigao (Pork Fat) (0.5 jin ○ *Waitai* makes 8 liang) Luannian (Human Hair) (size of three chicken eggs ○ *Zhouhou* and *Waitai* make one piece)
Boil the two ingredients together in the fat until the hair dissolves and the medicine is ready. Take in two doses. The disease exits via urine. (*Waitai* adds "add hair" under ingredients, and "grind thoroughly, strain off residue" after cooking. Post-formula note: The maid of Grand Physician Xiaowei Shi fell ill again; dry feces passed from the stomach, and she recovered. Miraculous.)
Note: *Waitai* cites *Zhouhou* treating jaundice with generalized yellowing of body and eyes like orange peel, acute heat, external cold forcing heat into the stomach, generating yellow coating, steaming upward. Pork fat 1 jin, boil until ready, warm and drink completely, three times daily. Dry feces will pass; once passed, improvement occurs, then stop. *Zhenglei Bencao* cites *Shanghan Leiyao*; You Zaijing extracted this from *Zhenglei*. Current *Zhouhou* cannot be verified. *Waitai* also cites *Jinxiao*, with identical indications.
*Zhouhou*: Female labor jaundice presents with yellowing of body and eyes, fever, aversion to cold, lower abdominal fullness/urgency, difficult urination. Caused by severe fatigue/heat, sexual intercourse followed by water exposure. Treatment formula (this formula ○ Yu Jiayan *Yimen Falü* cites *Zhouhou*: Female labor jaundice involves blood stasis in the bladder; only drugs entering the blood level can open it. However, Macheng and Lizhi are too harsh, Fanshi too drying; clearly treating blood dryness.)
Xu Lingtai says: My friend Luo Tianyou had jaundice with a drum-like abdomen, failing hundred medicines. Using 4 liang pork fat and 4 liang hair ash, one dose cured him. Does Zhongjing deceive me?
Jaundice disease is treated with Yichen Wuling San. ([Original Note] Another version says: Yichen Tang and Wuling San both treat.)
[Xu Lingtai] This is a formula resolving both exterior and interior. However, Wuling San contains Guizhi and Baizhu, intended for those slightly deficient.
[You Zaijing] This is the standard method for treating Damp-Heat jaundice. Yichen dissipates constrained heat; Wuling San promotes urination and removes dampness.
[Jian] Under "Jaundice Disease," the phrase "with difficult urination" should exist for Yichen Wuling San to have a basis. Likely a transcription omission.
Yichen Wuling San Formula (*Waitai Miyao* cites *Zhongjing Shanghan Lun*, text same, saying *Duanju*, *Gujin Luyian*, *Zhang Wenzhong*, *Jingxin Lu* are the same.)
Yichen Hao Mo (10 parts) Wuling San (5 parts ○ Formula seen in Phlegm-Fluids chapter)
Mix the two ingredients. Take one fangcun bi before meals with water, three times daily. (*Waitai* makes: Mix two ingredients, take one fangcun bi before meals with white drink, three times daily.)
*Waitai Miyao* also records Wuling San promoting diuresis for jaundice (this formula without Yichen, saying *Qianjin*, *Shenshi*, *Fanwang* are the same).
*Sanyin Fang*: Wuling San treats latent summerheat causing jaundice, difficult urination, irritability, and thirst. Administer with Yichen decoction.
*Yanshi Jisheng Fang*: Modified Wuling San treats dietary latent summerheat causing jaundice, irritability, difficult urination. ○ Remove Guizhi and add Yichen to this formula.
*Zhunsheng*: Yichen Wuling San treats Cold Damage/Warm-Damp, post-respiratory infection jaundice with dark-red urine, irritability, fever, restlessness. Likely due to premature sweating/purging or incorrect medication, contracting Damp-Heat causing generalized yellowing. ○ Use raw material Wuling San 1 liang, add Yichen 0.5 liang, Cheqianzi 1 qian, Mutong and Chaihu 1.5 qian each. If contracted after drinking, add Gegen 2 qian, Dengxin 50 stems. Boil 1 bowl of water to 0.8 bowl. Advance several doses until urine clears and flows freely, indicating cure.
Jaundice with abdominal fullness, difficult and red urine, spontaneous sweating indicates Exterior Harmonious and Interior Excess. Purge is indicated; Dahuang Nuxiaoshi Tang is appropriate. (Song edition changes Nuxiaoshi to Huashi, below same, incorrect. *Maijing* makes it Dahuang Huangbai Zhizi Mangxiao Tang.)
[Jian] Li Chan says: Abdominal fullness and difficult red urine indicate interior disease. Spontaneous sweating indicates exterior harmony. Interior disease implies severe internal Damp-Heat. Zhizi clears upper jiao Damp-Heat; Dahuang drains middle jiao Damp-Heat; Huangbai clears lower jiao Damp-Heat. Nuxiaoshi, amidst bitter-cold heat draining, has a drying and dispersing intent, ensuring medicinal power reaches everywhere, dissipating all Damp-Heat.
Dahuang Nuxiaoshi Tang Formula (*Qianjin* names it Dahuang Huangbai Tang; *Yi* names it Dahuang Tang. *Waitai* cites *Zhongjing Shanghan Lun* naming it Dahuang Huangbipi Zhizi Nuxiaoshi Tang. *Duanju*, *Qianjin Yi*, *Shenshi*, *Fanwang* are the same.)
Dahuang Huangbai Nuxiaoshi (each 4 liang) Zhizi (15 seeds)
Boil the above four ingredients in 6 sheng of water to obtain 2 sheng. Strain, add Nuxiaoshi, boil again to obtain 1 sheng. Take in one dose.
Yu Jiayan in *Yimen Falü* states: When Damp-Heat steams and causes jaundice, purging from below is necessary, following Cold Damage methods. Only usable for interior heat. Severe cases use Dahuang Nuxiaoshi Tang to scour Damp-Heat, like Da Chengqi Tang. Mild cases use Zhizi Dahuang Tang to clear and mildly purge, like Sanhuang Tang. Lighter cases use Yichen Hao Tang with clearing as sovereign and slight Dahuang as assistant, like adding Dahuang to Zhichi Tang. Thus, sweating methods dare not be used lightly, and purging methods must be applied cautiously, as jaundice often involves internal injury, requiring protection.
*Waitai Miyao*: Bixiao Dahuang Tang treats Urgent Jaundice and internal yellowing.
Dahuang (3 liang) Mangxiao (2 liang)
Soak Dahuang in 2 sheng of water overnight. At dawn, squeeze juice (1.5 sheng), add Mangxiao, stir and drink. Rapid relief follows shortly.
*Shenghui Fang*: Treats jaundice with abdominal fullness, scanty red涩 (astringent) urine.
Add Dongkuizi to this formula.
Jaundice disease with unchanged urine color, desire for spontaneous diarrhea, abdominal fullness, and wheezing should not be treated with heat-clearing drugs. Clearing heat will必 (necessarily) cause hiccups (Yue). Hiccups are treated with Xiaobanxia Tang. (Formula seen in Phlegm-Fluids chapter ○ *Waitai Miyao* cites *Zhongjing Shanghan Lun*: *Fanwang* is the same.)
[You Zaijing] Clear stool and spontaneous diarrhea indicate no interior heat. Thus, abdominal fullness is not interior excess, and wheezing is not Qi hyperactivity. Even with jaundice heat, cold drugs should not be used to attack. Clearing heat damages Yang Qi, inevitably causing hiccups. Yue means hiccup. Wei states that Stomach Yang is depressed by cold drugs, unable to ascend. Xiaobanxia Tang warms the Stomach and stops hiccups. Once hiccups stop, warm and regulate the Middle Jiao, allowing Qi to prosper and move vigorously, removing wheezing/fullness and curing jaundice. Xiaobanxia Tang does not treat jaundice itself.
*Shenghui Fang*: Xiaobanxia San treats Yin Jaundice with unchanged urine color, desire for diarrhea but difficulty, abdominal fullness, and wheezing, inevitably causing hiccups; hiccups should be treated with this formula.
Banxia (1 liang) Renshen (2 liang) Gegen (2 liang)
Grind the above herbs into coarse powder. Take 4 qian per dose with 1 zhong of water and 0.5 fen of Shengjiang. Boil to 0.6 zhong. Strain and take warm at any time.
All jaundices with abdominal pain and vomiting should use Chaihu Tang. ([Original Note] Must be Xiaochaihu Tang, formula seen in Vomiting chapter. ○ Original text has "Lao" instead of "Huang". Corrected based on all editions. Wei interprets as "Lao", incorrect.)
[Cheng Zhi] The classic states: "Vomiting with abdominal fullness, check anterior and posterior orifices to know which is obstructed; unblocking cures it." Now, jaundice patients with abdominal pain and vomiting should have interior excess. Da Chaihu Tang should be used to purge. If Xiaochaihu Tang is used, it stops vomiting but does not treat abdominal pain. Discerning physicians should examine this carefully.
[Jian] Vomiting with abdominal pain indicates Stomach excess-heat. However, tidal fever and hard stool must be present before using Da Chaihu Tang to resolve both. Without tidal fever and with soft stool, use Xiaochaihu Tang, remove Huangqin, add Shaoyao to harmonize. (Note *Yuji*: Add Zhizi to Xiaochaihu Tang.)
Men's Jaundice with spontaneous free urination should be given Xulao Xiaojianzhong Tang. (Formula seen in Deficiency Consumption chapter.)
[Jian] Gao Shishi says: Women are Yin, Men are Yang. Yin governs Blood, Yang governs Qi. Men's Jaundice indicates Qi deficiency. Yellow is the color of Earth. Qi deficiency allows Earth color to manifest externally; with no interior Damp-Heat, urine flows freely. This is deficiency.
[You Zaijing] Free urination prevents jaundice formation as heat exits via urine. Now, with free urination but persistent jaundice, it is known not to be a heat disease, but Upper Deficiency causing external color manifestation. Tonify the Middle; do not clear heat. Jaundice is caused by Damp-Heat constraint. Thus, exterior cases are released via sweating, interior cases via purging—this is the major principle. But some are dry not damp; change clearing/diuresis to moistening/guiding, like Zhigao Fa Jian. Some are cold not heat, empty not excess; change purging to tonifying, cold to warm, like Xiaojianzhong. Some have mixed concurrent syndromes; treat concurrent first, then root, like Xiaobanxia and Xiaochaihu. Zhongjing’s discussion of jaundice details orthodox, variable, excess, and deficiency methods exhaustively. His mind was truly thorough.
Wang Haocang *Yin Zheng Lueli* states: Internal Cold Damage, physical exhaustion, dietary irregularity causing Middle Jiao cold transformation generates jaundice, not from deteriorated Cold Damage. Only Jianzhong, Lizhong, and Dajianzhong are sufficient; Yichen is unnecessary. He Xiushan *Yipian* states: Yin Jaundice presents with clear/white urine, loose stools, preference for quiet/rest, slow/weak pulse, cold body, spontaneous sweating. Treat as deficiency-cold.
Zhongjing’s "Men's Jaundice, free urination, give Xiaojianzhong Tang" and Wang Haicang’s "Middle Jiao cold generates jaundice, use Da/Xiao Jianzhong, no Yichen" both refer to Qi-deficiency Yin Jaundice. Qi deficiency leads to Spleen failure to transport; long-term stagnation causes Spleen collapse and external color manifestation, hence yellow. The yellow color must be pale. Dai Fu'an states post-hemorrhage often causes facial or generalized yellowing due to Blood failing to nourish. Like bamboo/wood leaves green when moist in spring/summer, turning dry/yellow in autumn. Use Yangrong Tang or Shiquan Dabu Tang. This is Blood-deficiency Yin Blood. This is dry jaundice, with free urination.