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。
脉浮为风。脉缓为湿。云为痹者。风与湿合而痹也。然非风痹疼痛之谓。故又曰痹非中风。所以
然者。风得湿而变热。湿应脾而内行。是以四肢不疼而苦烦。脾脏瘀热而色黄。脾者四运之轴也。脾
以其所瘀之热。转输流布。而肢体面目尽黄矣。故曰瘀热以行。
趺阳脉紧而数。数则为热。热则消谷。紧则为寒。食即为满。尺脉浮为伤肾。趺阳脉紧为伤脾。
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。
名曰谷瘅。
趺阳脉数为热者。其热在胃。故消谷。脉紧为寒者。其寒在脾。故满。满者必生湿。胃热而脾湿。
亦黄病之原也。尺脉浮为伤肾者。风伤肾也。趺阳脉紧为伤脾者。寒伤脾也。肾得风而生热。脾得寒
而生湿。又黄病之原也。湿热相合。其气必归脾胃。脾胃者。仓廪之官也。谷入而助其热则眩。谷不
消而气以瘀。则胃中苦浊。浊气当出下窍。若小便通。则浊随溺去。今不通。则浊虽下流而不外出。
于是阴受其湿。阳受其热。转相流被而身体尽黄矣。曰谷瘅者。病虽始于风寒。而实成于谷气耳。
额上黑。微汗出。手足中热。薄暮即发。膀胱急。小便自利。名曰女劳瘅。腹如水状。不治。
肾劳而热。黑色上出。犹脾病而黄外见也。额于部为庭。灵枢云。庭者颜也。又云。肾病者。
颧与颜黑。微汗出者。肾热上行。而气通于心也。手足心热。薄暮即发者。病在里在阴也。膀胱急者。
肾热所逼也。小便自利。病不在腑也。此得之房劳过度。热从肾出。故名曰女劳瘅。若腹如水状。则
不特阴伤。阳亦伤矣。故曰不治。
心中懊 而热。不能食。时欲吐。名曰酒瘅。
懊 。郁闷不宁之意。热内蓄则不能食。热上冲则时欲吐。酒气熏心而味归脾胃也。此得之饮酒
过多所致。故名酒瘅。
阳明病。脉迟。食难用饱。饱则发烦头眩。小便必难。此欲作谷瘅。虽下之。腹满如故。所以然
者。脉迟故也。
脉迟胃弱。则谷化不速。谷化不速。则谷气郁而生热。而非胃有实热。故虽下之而腹满不去。伤
寒里实。脉迟者尚未可攻。况非里实者耶。
夫病酒黄瘅。必小便不利。其候心中热。足下热。是其证也。酒黄瘅者。或无热。静言了了。腹
满欲吐。鼻燥。其脉浮者先吐之。沉弦者先下之。酒瘅心中热。欲吐者吐之愈。
酒之湿热。积于中而不下出。则为酒瘅。积于中则心中热。注于下则足下热也。酒黄瘅者。心中
必热。或亦有不热。静言了了者。则其热不聚于心中。而或从下积为腹满。或从上冲为欲吐鼻燥也。
腹满者可下之。欲吐者可因其势而越之。既腹满且欲吐。则可下亦可吐。然必审其脉浮者。则邪近上。
宜先吐。脉
沉弦者。则邪近下。宜先下也。
酒瘅下之。久久为黑瘅。目青面黑。心中如啖蒜状。大便正黑。皮肤爪之不仁。其脉浮弱。虽黑
微黄。故知之。
酒瘅虽有可下之例。然必审其腹满脉沉弦者而后下之。不然。湿热乘虚陷入血中。则变为黑瘅。目
青面黑。皮肤不仁。皆血变而瘀之征也。然虽曰黑瘅。而其原则仍是酒家。故心中热气熏灼。如啖蒜
状。一如懊 之无奈也。且其脉当浮弱。其色虽黑当微黄。必不如女劳瘅之色纯黑而脉必沉也。
师曰。病黄瘅。发热烦渴。胸满口燥者。以病发时火劫其汗。两热所得。然黄家所得。从湿得之。
一身尽发热而黄。肚热。热在里。当下之。
烦满燥渴。病发于热。而复以火劫之。以热遇热。相得不解。则发黄瘅。然非内兼湿邪。则热与
热相攻。而反相散矣。何瘅病之有哉。故曰黄家所得。从湿得之。明其病之不独因于热也。而治此病
者。必先审其在表在里。而施或汗或下之法。若一身尽热而腹热尤甚。则其热为在里。里不可从表散。
故曰当下。
脉沉。渴欲饮水。小便不利者。皆发黄。腹满。舌痿黄。躁不得睡。属黄家。
脉沉者。热难外泄。小便不利者。热不下出。而渴饮之水。与热相得。适足以蒸郁成黄而已。脾
之脉。连舌本。散舌下。腹满舌痿。脾不行矣。脾不行者有湿。躁不得睡者有热。热湿相搏。则黄瘅
之候也。
黄瘅之病。当以十八日为期。治之十日以上瘥。反剧为难治。
土无定位。寄王于四季之末各十八日。黄者土气也。内伤于脾。故即以土王之数。为黄病之期。
盖谓十
八日脾气至而虚者当复。即实者亦当通也。治之十日以上瘥者。邪浅而正胜之则易治。否则邪反胜正
而增剧。所谓病胜脏者也。故难治。
瘅而渴者。其瘅难治。瘅而不渴者。其瘅可治。发于阴部。其人必呕。阳部。其人振寒而发热也。
瘅而渴。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。
谷瘅之病。寒热不食。食即头眩。心胸不安。久久发黄为谷瘅。茵陈蒿汤主之。
谷瘅为阳明湿热瘀郁之证。阳明既郁。营卫之源。壅而不利。则作寒热。健运之机。窒而不用。
则为不食。食入则适以助湿热而增逆满。为头眩心胸不安而已。茵陈、栀子、大黄。苦寒通泄。使湿
热从小便出也。
茵陈蒿汤方
茵陈蒿（六两） 栀子（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。小盒饭利。尿如
皂角汁状。色正赤。一宿腹减。黄从小便去也。
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。因作黑瘅。
其腹胀如水状。大便必黑。时溏。此女劳之病。非水病也。腹满者难治。硝石矾石散主之。
黄家日晡所本当发热。乃不发热而反恶寒者。此为女劳肾热所致。与酒瘅、谷瘅不同。酒瘅、谷
瘅热在
胃。女劳瘅热在肾。胃浅而肾深。热深则外反恶寒也。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。而实为肾热而气内蓄。非脾湿而水不行也。惟是证兼腹满。则阳气并伤。
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（熬黄） 矾石（烧等分）
上二味为散。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。是其候也。
酒瘅心中懊 。或热痛。栀子大黄汤主之。
酒家热积而成实。为心中懊 。或心中热痛。栀子、淡豉彻热于上。枳实、大黄除实于中。亦上
下分消之法也。
栀子大黄汤方
栀子（十四枚） 大黄（二两） 枳实（五枚） 豉（一升）
上四味。以水六升。煮取二升。分温三服。
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。
小便利。则湿热除而黄自已。故利小便为黄家通法。然脉浮则邪近在表。宜从汗解。亦脉浮者先
吐之之意。但本无外风而欲出汗。则桂枝发散之中。必兼黄 固卫。斯病去而表不伤。抑亦助正气以
逐邪气也。
桂枝加黄 汤方（见水气）
诸黄。猪膏发煎主之。
此治黄瘅不湿而燥者之法。按伤寒类要云。男子女人黄瘅。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HT 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
猪膏（半斤） 乱发（如鸡子大三枚）
上二味。和膏中煎之。发消药成。分再服。病从小便出。千金云。太医校尉史脱家婢黄病。服此。
胃中燥粪下。便瘥。神验。
黄瘅病。茵陈五苓散主之。
此正治湿热成瘅者之法。茵陈散结热。五苓利水去湿也。
茵陈五苓散方
茵陈（十分末） 五苓散（五分）
上二味和。先食饮服方寸匕。日三服。
黄瘅腹满。小便不利而赤。自汗出。此为表和里实。当下之。宜大黄硝石汤。
腹满小便不利而赤为里实。自汗出为表和。大黄硝石。亦下热去实之法。视栀子大黄及茵陈蒿汤
较猛也。
大黄硝石汤方
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。内硝更煮。取一升。顿服。
黄瘅病小便色不变。欲自利。腹满而喘。不可除热。热除必哕。哕者小半夏汤主之。
便清自利。内无热征。则腹满非里实。喘非气盛矣。虽有瘅热。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。非小半夏能治瘅也。
小半夏汤方（见痰饮）
诸黄。腹痛而呕者。宜柴胡汤。
腹痛而呕。病在少阳。脾胃病者。木邪易张也。故以小柴胡散邪气。止痛呕。亦非小柴胡能治诸
黄也。
柴胡汤方（即小柴胡汤见呕吐）
男子黄。小便自利。当与虚劳小建中汤。
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。乃土虚而色外见。宜补
中而不可除热者也。夫黄瘅之病。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
论黄瘅一证。而于正变虚实之法。详尽如此。其心可谓尽矣。
附方
瓜蒂散 治诸黄。（方见 ）
按删繁方云。服讫。吐出黄汁。亦治脉浮欲吐者之法也。
千金麻黄醇酒汤 治黄瘅。
麻黄（三两）
上一味。以美酒五升。煮取二升半。顿服尽。冬月用酒。春月用水煮之。
寸口脉象浮而缓。浮脉主风邪，缓脉主湿痹。这种痹证并非中风，而是四肢感到烦扰不适。脾脏的颜色本为黄色，当瘀积的热邪随气血运行周身时，身体就会发黄。
脉浮表示有风邪，脉缓表示有湿气。文中所说的“痹”，是指风邪与湿气结合导致的阻滞，但并不是指风痹那种疼痛的症状，所以说“痹非中风”。之所以这样，是因为风邪遇到湿气会化热，湿气对应脾脏并内行于体内。因此四肢不痛只是感到烦扰，脾脏因瘀热而呈现黄色。脾是全身气机运转的枢纽，它将瘀积的热邪转输流布到全身，导致肢体和面目都变黄，所以说“瘀热以行”。
趺阳脉紧而数。数脉主热，热则能消化食物；紧脉主寒，寒则进食后容易腹胀。尺脉浮表示肾受伤，趺阳脉紧表示脾受伤。风寒之邪相互搏结，进食后即感头晕目眩，谷气不能正常消化，胃中苦于浊气停滞，浊气向下流注，导致小便不通。阴分受寒邪影响，热邪流入膀胱，导致全身发黄，这称为谷瘅（由饮食不当引起的黄疸）。
趺阳脉数表示热在胃中，所以能消谷；脉紧表示寒在脾中，所以腹胀。胀满必然生湿，胃热而脾湿，这也是黄疸病的根源。尺脉浮表示伤肾，是因为风邪伤肾；趺阳脉紧表示伤脾，是因为寒邪伤脾。肾受风邪而生热，脾受寒邪而生湿，这又是黄疸病的根源。湿热相结合，其气必然归于脾胃。脾胃是仓廪之官，谷物进入后助长热邪则致眩晕，谷物不消化导致气机瘀滞，则胃中苦于浊气。浊气本应从下窍排出，如果小便通畅，浊气就随尿液排出；现在小便不通，浊气虽然下行但不能外出。于是阴分受湿邪困扰，阳分受热邪困扰，湿热互相流布浸淫，导致全身发黄。称为谷瘅，是因为病虽然始于风寒，但实际上是由谷气（饮食）郁滞而成的。
额头颜色发黑，微微出汗，手足心发热，傍晚时分发作，膀胱拘急，小便自利，这称为女劳瘅（房劳过度引起的黄疸）。腹部像有水状，属于难治之症。
这是肾劳导致内热，黑色上泛于面部，就像脾病黄色外现一样。额部称为庭，《灵枢》说：“庭就是颜面。”又说：“肾病的人，颧骨和颜面发黑。”微微出汗，是肾热上行，气通于心所致。手足心发热，傍晚发作，说明病位在里、属阴。膀胱拘急，是肾热逼迫所致。小便自利，说明病不在腑。这是由于房劳过度，热从肾出，所以叫女劳瘅。如果腹部胀大像有水状，那么不仅阴精受损，阳气也受损了，所以说难治。
心中郁闷烦热，不能进食，时常想吐，这称为酒瘅（饮酒过多引起的黄疸）。
懊憹，是郁闷不宁的意思。热邪内蓄导致不能进食，热邪上冲导致时常想吐。酒气熏蒸心脏，味道归于脾胃。这是由于饮酒过多所致，所以叫酒瘅。
阳明病，脉迟，吃东西难以吃饱，饱食后就发生心烦、头晕目眩，小便一定困难，这是将要发生谷瘅的表现。即使使用下法，腹满也不会消除。之所以这样，是因为脉迟的缘故。
脉迟说明胃气虚弱，谷物消化缓慢。谷物消化慢，谷气郁滞而生热，但这并不是胃中有实热，所以即使使用下法，腹满也不去。伤寒病如果是里实证，脉迟的还不可以攻下，何况这不是里实证呢？
凡是患酒黄瘅的病人，一定小便不利。其症状是心中发热，脚底发热，这就是它的证候。酒黄瘅病人，有的可能没有热象，神志安静清楚，但有腹满、想吐、鼻燥等症状。如果脉浮，先用吐法；如果脉沉弦，先用下法。酒瘅病人心中热，想吐的，用吐法可以痊愈。
酒的湿热积聚在中焦而不能下行排出，就成为酒瘅。积聚在中焦则心中热，注于下部则脚底热。酒黄瘅病人心中一定热，但也有的可能不热，神志安静清楚的，说明热邪没有聚积在心中，而是或从下部积聚导致腹满，或从上冲导致想吐、鼻燥。腹满的可以攻下，想吐的可以顺应病势用吐法。既腹满又想吐的，既可以攻下也可以催吐。但必须审察脉象，脉浮的，说明邪气偏上，宜先用吐法；脉沉弦的，说明邪气偏下，宜先用下法。
酒瘅如果用下法治疗，时间久了会变成黑瘅。出现眼睛青、面色黑，心中感觉像吃了大蒜一样的辛辣灼热感，大便正黑，皮肤麻木不仁。如果脉象浮弱，虽然面色黑但微带黄色，由此可以知道是黑瘅。
酒瘅虽然有可用下法的例子，但必须审察是否腹满且脉沉弦，然后才能用下法。否则，湿热乘虚陷入血中，就会变成黑瘅。眼睛青、面色黑、皮肤不仁，都是血液变化而瘀滞的征象。虽然说叫黑瘅，但其原则仍然是酒家病。所以心中热气熏灼，感觉像吃了大蒜一样，一如懊憹那样的无奈。而且其脉应当浮弱，其色虽然黑但应当微黄，必定不像女劳瘅那样色纯黑且脉必沉。
老师说：患黄瘅病，发热烦渴，胸满口燥的，这是因为发病时用火法强迫发汗，两热相合所致。然而黄疸病的发生，是从湿邪得来的。全身都发热而且发黄，肚子热，热在里，应当用下法。
烦闷、燥渴，病起于热，又用火法劫汗，以热遇热，相互纠缠不解，就会发黄瘅。但是如果不兼有湿邪，那么热与热相攻，反而相互消散，怎么会有瘅病呢？所以说黄疸病的发生，是从湿邪得来的，明确说明这个病不仅仅是因为热。治疗这个病的人，必须先审察病邪在表还是在里，从而施用汗法或下法。如果全身都发热而腹部热尤其严重，那么热就在里。里证不可从表散解，所以说应当用下法。
脉沉，口渴想喝水，小便不利的，都会发黄。腹满，舌体痿软色黄，烦躁不能睡觉，属于黄疸病范畴。
脉沉，说明热邪难以向外宣泄；小便不利，说明热邪不能向下排出。此时喝进去的水，与热邪相合，正好足以蒸郁而成黄。脾的经脉，连接舌根，散布在舌下。腹满、舌痿，说明脾的功能不行了。脾功能不行是因为有湿，烦躁不能睡觉是因为有热。热与湿相搏结，就是黄瘅的征候。
黄瘅病，以十八天为期限。治疗十天后以上痊愈的，容易治；如果反而加重，就难治。
土气没有固定的位置，寄旺于四季末各十八天。黄色代表土气。内伤于脾，所以就用土气王相的天数，作为黄病的期限。大概意思是说，十八天后脾气到来，虚者应当恢复，即使是实者也应该通泄。治疗十天后以上痊愈的，是因为邪气浅而正气胜邪，所以容易治。否则邪气反胜正气而病情加重，所谓病胜脏，所以难治。
黄疸伴有口渴的，难治；黄疸不伴有口渴的，可治。病发于阴部的，病人一定会呕吐；病发于阳部的，病人会恶寒而发热。
黄疸伴有口渴，说明热势正盛且湿气日益增加，所以难治。不口渴，说明热势已减且湿气自然消退，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，关乎形体，所以恶寒而发热。这是阴阳、内外、浅深、轻重程度的辨别。
谷瘅的病，表现为寒热交替、不能进食，进食即头眩，心胸不安，时间久了发黄成为谷瘅。用茵陈蒿汤主治。
谷瘅是阳明湿热瘀郁的证候。阳明气机郁结，营卫生成的源头壅塞而不通利，就会产生寒热；脾胃健运的机制窒塞而不发挥作用，就会导致不能进食。食物进入后恰好助长湿热而增加逆满，导致头眩和心胸不安。茵陈、栀子、大黄，味苦性寒，通泄湿热，使湿热从小便排出。
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，水量减少六升，加入另外两味药，煮取三升，去掉药渣，分三次温服。小便利，尿色像皂角汁一样红赤，一夜之后腹满减轻，黄色从小便去除。
黄疸病人到了下午申时（日晡所）发热却反而恶寒，这是女劳瘅引起的。膀胱拘急，少腹满，全身发黄，额头发黑，脚底发热，因此形成黑瘅。如果腹胀大像水状，大便一定黑，时而稀溏。这是女劳瘅的病，不是水气病。腹满的难治。用硝石矾石散主治。
黄疸病人到了下午申时本来应当发热，现在不发热反而恶寒，这是女劳瘅肾热所致。与酒瘅、谷瘅不同。酒瘅、谷瘅的热在胃，女劳瘅的热在肾。胃位浅而肾位深，热邪深伏则体表反而恶寒。膀胱拘急、额头发黑、脚底发热、大便黑，都是肾热的征象。虽然少腹满胀，像有水状，但实际上是肾热导致气机内蓄，不是脾湿导致水液不行。只是这个证兼有腹满，说明阳气也受损，治疗就比较困难。硝石咸寒除热，矾石除去骨髓中的痼热，骨与肾相合，用来清肾热。用大麦粥送服，是担心损伤胃气。
硝石矾石散方
硝石（熬至变黄） 矾石（烧制，等分）
以上两味药研成散剂，用大麦粥汁调和服用一方寸匕，每天三次。病邪随大小便排出，小便正黄，大便正黑，就是见效的征候。
酒家热积而成实，导致心中懊憹，或者心中热痛。栀子、淡豆豉清除上部的热，枳实、大黄清除中部的实邪。这也是上下分消的方法。
栀子大黄汤方
栀子（十四枚） 大黄（二两） 枳实（五枚） 豆豉（一升）
以上四味药，用水六升，煮取二升，分三次温服。
凡是患黄疸病的人，只要通利小便即可。假如脉浮，应当用汗法解表。适宜用桂枝加黄芪汤主治。
小便利，则湿热除而黄自退。所以利小便是治疗黄疸的通法。然而脉浮说明邪气近在表，宜从汗解。这也符合“脉浮者先吐之”的意思。但原本没有外风却要发汗，那么在桂枝发散之中，必须兼用黄芪固护卫气。这样病去而表不伤，也是借助正气来驱逐邪气。
这是治疗黄疸不湿而燥的方法。按《伤寒类要》记载，男人女人患黄疸，饮食不消，胃胀，热生黄衣，在胃中有燥屎所致。服用猪膏煎则愈。大概是湿热经久，变为坚燥，譬如酿酒曲热久了则湿去而干。本草记载猪脂能利血脉，解风热；乱发能消瘀，开关格，利水道。所以说病邪从小便出。
猪膏发煎方
猪膏（半斤） 乱发（如鸡蛋大三枚）
以上两味药，在膏中煎煮，发消药成，分两次服。病邪从小便出。《千金方》记载，太医校尉史脱家的婢女患黄病，服用此方，胃中燥粪排出，病愈，非常灵验。
茵陈五苓散方
茵陈（十分末） 五苓散（五分）
以上两味药混合，饭前用开水调服一方寸匕，每天三次。
黄瘅病，腹满，小便不利且色赤，自汗出，这是表和里实。应当用下法。适宜用大黄硝石汤。
腹满、小便不利且色赤是里实，自汗出是和。大黄、硝石也是下热去实的方法，比栀子大黄汤及茵陈蒿汤药力较猛。
大黄硝石汤方
大黄 黄柏 硝石（各四两） 栀子（十五枚）
以上四味药，用水六升，煮取二升，去掉药渣，加入硝石再煮，取一升，一次顿服。
黄瘅病，小便颜色不变，想要自利（腹泻），腹满而喘，不可清热。清热必致呃逆。呃逆用小半夏汤主治。
便清自利，内部没有热象，那么腹满就不是里实，喘也不是气盛。虽然有瘅热，也不可以用寒药攻伐。热气虽除，阳气则伤，必然发生呃逆。哕，就是呃逆。魏氏说胃阳被寒药坠落，欲升而不能，就是这个意思。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。并不是小半夏汤能治瘅病本身。
腹痛而呕，病在少阳。脾胃病者，木邪容易亢盛。所以用小柴胡汤散邪气，止痛止呕。也不是小柴胡汤能治诸黄。
小便利，通常不会发黄，因为热从小便去了。现在小便利而黄不退，知道不是热病，而是土虚而色外现。适宜补中焦而不可清热。夫黄瘅之病，是湿热郁结所致。所以在表的用汗法发散，在里的用攻法去除，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。如果有兼证错出的，则先治兼证而后治本证，如小半夏及小柴胡的治疗。仲景论述黄瘅一证，而对于正变虚实的方法，详尽如此，他的用心可谓尽矣。
The pulse at the cunkou (radial artery) is floating and slow. A floating pulse indicates wind, while a slow pulse indicates dampness obstruction (Bi syndrome). This obstruction is not stroke; rather, it causes distress in the four limbs. The color of the Spleen is yellow; when stagnant heat circulates throughout the body, jaundice occurs.
A floating pulse signifies wind, and a slow pulse signifies dampness. The term "obstruction" here refers to the combination of wind and dampness causing blockage, but it does not refer to the pain associated with wind-Bi syndrome; hence it is stated that "this obstruction is not stroke." The reason for this is that wind transforms into heat when combined with dampness, and dampness corresponds to the Spleen and moves inward. Therefore, the limbs do not hurt but feel distressed, and the Spleen presents with yellow discoloration due to stagnant heat. The Spleen is the axis of movement for the four extremities; it distributes the stagnant heat throughout the body, causing the limbs and face to turn yellow. Thus, it is said that "stagnant heat circulates."
The pulse at the Duzuyang point (on the dorsum of the foot) is tight and rapid. A rapid pulse indicates heat, which promotes digestion; a tight pulse indicates cold, which causes fullness after eating. A floating pulse at the Chi position (wrist) indicates injury to the Kidney, while a tight pulse at the Duzuyang point indicates injury to the Spleen. Wind and cold contend with each other; upon eating, dizziness ensues. Grain qi fails to digest, leading to turbid qi stagnating in the Stomach. This turbid qi flows downward, causing urinary difficulty. Yin is affected by cold, while heat flows into the Bladder, resulting in generalized yellowing of the body, known as Gu Dan (Grain Jaundice).
A rapid pulse at the Duzuyang point indicates heat in the Stomach, hence the ability to digest grain. A tight pulse indicates cold in the Spleen, hence abdominal fullness. Fullness inevitably generates dampness; stomach heat combined with spleen dampness is also a root cause of jaundice. A floating pulse at the Chi position indicates kidney injury caused by wind. A tight pulse at the Duzuyang point indicates spleen injury caused by cold. The Kidney generates heat when injured by wind, and the Spleen generates dampness when injured by cold; this is another root cause of jaundice. When damp-heat combines, its qi tends to gather in the Spleen and Stomach. The Spleen and Stomach are the officials of granaries; when food enters, it aids heat, causing dizziness. If food fails to digest, qi becomes stagnant, causing turbid qi to accumulate in the Stomach. Turbid qi should exit through the lower orifices. If urination is unobstructed, turbid qi leaves with urine. Now, since urination is obstructed, turbid qi flows downward but cannot exit externally. Consequently, Yin suffers from dampness, and Yang suffers from heat. As they circulate and permeate each other, the whole body turns yellow. It is called Gu Dan because, although the disease begins with wind-cold, it actually forms due to the stagnation of grain qi.
Blackening of the forehead, slight sweating, heat in the hands and feet, onset in the late afternoon, urgency of the Bladder, and spontaneous urination characterize Nu Lao Dan (Female Labor Jaundice). Abdominal distension resembling water accumulation is difficult to treat.
This condition arises from Kidney exhaustion generating internal heat, with black color manifesting on the face, similar to how yellow manifests externally in Spleen disease. The forehead is called the Ting area. The *Ling Shu* states: "Ting refers to the face." It also says: "In Kidney disease, the cheekbones and face turn black." Slight sweating indicates Kidney heat rising and connecting with the Heart. Heat in the palms and soles, occurring in the late afternoon, indicates the disease is interior and Yin. Urgency of the Bladder is forced by Kidney heat. Spontaneous urination indicates the disease is not in the Fu organs. This results from excessive sexual activity, with heat originating from the Kidney, hence named Nu Lao Dan. If the abdomen becomes distended like water, both Yin essence and Yang qi are damaged, making it difficult to treat.
Mental restlessness and heat, inability to eat, and frequent desire to vomit characterize Jiu Dan (Alcohol Jaundice).
"Ao Nao" refers to mental depression and restlessness. Internal accumulation of heat prevents eating, while upward rushing of heat causes frequent vomiting. Wine fumes affect the Heart, and flavors return to the Spleen and Stomach. This results from excessive drinking, hence named Jiu Dan.
In Yangming disease, if the pulse is slow, one cannot eat until full. Upon becoming full, vexation and dizziness occur, and urination will certainly be difficult. This indicates impending Gu Dan. Even if purgatives are used, abdominal fullness remains. The reason is the slow pulse.
A slow pulse indicates weak Stomach Qi, leading to slow digestion of grain. Slow digestion causes grain qi to stagnate and generate heat, but this is not excess heat in the Stomach. Therefore, even with purgatives, fullness persists. In Cold Damage diseases, even if there is interior excess, if the pulse is slow, attack methods should not yet be used; how much less so if there is no interior excess?
For patients with Alcohol Yellow Jaundice, urinary difficulty is always present. Symptoms include heat in the chest and heat under the feet. Some patients with Alcohol Jaundice may have no heat sensation, appearing calm and clear-minded, but exhibit abdominal fullness, desire to vomit, and dry nose. If the pulse is floating, use emetics first; if deep and wiry, use purgatives first. For Alcohol Jaundice with chest heat and desire to vomit, emesis leads to recovery.
The damp-heat of wine accumulates in the middle jiao without descending, causing Alcohol Jaundice. Accumulation in the middle causes chest heat; flow to the lower part causes heat under the feet. Patients with Alcohol Jaundice must have chest heat, though some may not feel it. Those who are calm and clear-minded indicate heat has not gathered in the chest but has either accumulated below causing fullness or rushed above causing vomiting and nasal dryness. Abdominal fullness can be treated with purgatives; desire to vomit can be treated by following the trend with emetics. If both fullness and vomiting exist, either method may be used. However, examine the pulse: if floating, pathogen is upper, prefer emetics; if deep and wiry, pathogen is lower, prefer purgatives.
If Alcohol Jaundice is treated with purgatives for too long, it may transform into Hei Dan (Black Jaundice). Symptoms include blue eyes, black face, a sensation in the heart like eating garlic, black stool, and skin insensitivity. If the pulse is floating and weak, and the complexion is black but slightly yellow, one can identify it as Black Jaundice.
Although Alcohol Jaundice may sometimes require purgatives, one must verify abdominal fullness and a deep-wiry pulse before using them. Otherwise, damp-heat may sink into the blood vessels due to deficiency, transforming into Black Jaundice. Blue eyes, black face, and skin insensitivity are signs of blood stasis. Although called Black Jaundice, the principle remains related to alcohol consumption. Thus, heat qi scorches the heart, feeling like eating garlic, similar to the helplessness of Ao Nao. The pulse should be floating and weak, and the color, though black, should be slightly yellow, unlike the pure black color and deep pulse of Nu Lao Dan.
The Master said: In Yellow Jaundice with fever, vexation, thirst, chest fullness, and dry mouth, these symptoms arise because sweat was forcibly induced by fire therapy during the onset, combining two heats. However, Jaundice originates from dampness. Generalized fever with yellowing and abdominal heat indicates heat in the interior, requiring purgation.
Vexation, fullness, dryness, and thirst originate from heat. If fire therapy is applied to induce sweat, heat meets heat, entangling without resolution, leading to Yellow Jaundice. But without internal dampness, heat would attack and dissipate each other, preventing Jaundice. Thus, Jaundice comes from dampness, clarifying that it is not solely due to heat. Treatment must first determine if the pathogen is exterior or interior, applying diaphoresis or purgation accordingly. If general fever is present but abdominal heat is severe, the heat is interior. Interior heat cannot be dispersed via the exterior; thus, purgation is indicated.
A deep pulse, thirst with desire to drink, and urinary difficulty all lead to yellowing. Abdominal fullness, flaccid tongue with yellow coating, irritability, and insomnia belong to the category of Jaundice.
A deep pulse indicates heat difficult to vent outward. Urinary difficulty indicates heat unable to exit downward. Water drunk combines with heat, steaming and condensing to cause yellowing. The Spleen meridian connects to the tongue base and spreads under the tongue. Abdominal fullness and tongue flaccidity indicate Spleen dysfunction. Spleen dysfunction implies dampness; irritability and insomnia imply heat. Heat and dampness contending constitute the signs of Yellow Jaundice.
Yellow Jaundice has a prognosis period of eighteen days. Recovery after ten days of treatment is easy; worsening after treatment is difficult to manage.
Earth element has no fixed position but reigns for eighteen days at the end of each season. Yellow represents Earth qi. Internal injury to the Spleen means the duration of the disease follows the number of days Earth reigns. Roughly speaking, after eighteen days, Spleen Qi arrives; if deficient, it should recover; if excess, it should be unblocked. Recovery after ten days indicates shallow pathogen and strong righteous Qi, making it easy to treat. Otherwise, pathogen overcomes righteous Qi, worsening the condition, known as "disease overcoming the Zang," making it difficult to treat.
Jaundice with thirst is difficult to treat; jaundice without thirst is treatable. Disease arising in the Yin aspect causes vomiting; disease arising in the Yang aspect causes chills and fever.
Thirst in jaundice indicates flourishing heat and increasing dampness, hence difficult to treat. Absence of thirst indicates reduced heat and self-resolving dampness, hence treatable. Yin aspect refers to interior Zang-Fu organs related to Qi, hence vomiting. Yang aspect refers to exterior body shell related to Form, hence chills and fever. This distinguishes Yin-Yang, interior-exterior, depth, and severity.
Gu Dan presents with alternating chills and fever, anorexia, dizziness upon eating, and mental unrest. Prolonged yellowing confirms Gu Dan. Treat with Yinchen Hao Tang.
Gu Dan is a syndrome of Yangming damp-heat stagnation. Yangming stagnation blocks the source of Ying and Wei, causing chills and fever. Obstruction of Spleen-Stomach transport causes anorexia. Food intake exacerbates damp-heat and increases rebellious fullness, causing dizziness and mental unrest. Yinchen, Zhizi, and Dahuang are bitter and cold, promoting drainage to expel damp-heat via urine.
**Yinchen Hao Tang Formula**
Yinchen Hao (6 liang), Zhizi (14 seeds), Dahuang (2 liang).
Boil the three ingredients in 10 dou of water. First boil Yinchen until reduced by 6 dou. Add the other two, boil to obtain 3 sheng. Remove dregs. Divide into three warm doses. Beneficial urination results in urine resembling soapberry juice, dark red. After one night, abdominal fullness decreases, and yellow exits via urine.
Jaundice patients experiencing fever at dusk but paradoxically feeling chills suffer from Nu Lao Dan. Symptoms include bladder urgency, lower abdominal fullness, generalized yellowing, black forehead, and heat under feet, forming Hei Dan. If abdominal distension resembles water accumulation and stool is black and loose, it is Nu Lao Dan, not water disease. Abdominal fullness makes it difficult to treat. Use Xiaoshi Fanshi San.
Jaundice patients typically experience fever at dusk. Paradoxical chills indicate Kidney heat from Nu Lao, differing from Jiu Dan and Gu Dan where heat is in the Stomach. Nu Lao Dan heat is in the Kidney. Stomach is superficial, Kidney is deep; deep heat manifests as external chills. Bladder urgency, black forehead, foot heat, and black stool are signs of Kidney heat. Lower abdominal fullness resembling water is due to internal Qi stagnation from Kidney heat, not Spleen dampness blocking water. Combined abdominal fullness indicates Yang damage, making treatment difficult. Xiaoshi is salty and cold, clearing heat. Fanshi clears entrenched heat in bone marrow; bones correspond to Kidneys, clearing Kidney heat. Take with Barley Porridge to protect the Stomach.
**Xiaoshi Fanshi San Formula**
Xiaoshi (roasted yellow), Fanshi (calcined, equal parts).
Grind into powder. Mix with Barley Porridge juice. Take one cun-bi dose three times daily. Pathogen exits via stool and urine. Yellow urine and black stool indicate efficacy.
Alcohol Jaundice with mental restlessness or painful heat is treated with Zhizi Dahuang Tang.
Accumulated heat in drinkers becomes excess, causing mental restlessness or painful heat. Zhizi and Danchi clear heat above; Zhishi and Dahuang remove excess below. This is a method of dispersing heat from upper and lower jiao.
**Zhizi Dahuang Tang Formula**
Zhizi (14 seeds), Dahuang (2 liang), Zhishi (5 pieces), Chi (1 sheng).
Boil four ingredients in 6 sheng of water to obtain 2 sheng. Divide into three warm doses.
For all Jaundice cases, promoting urination is primary. If the pulse is floating, resolve via sweating. Use Guizhi Jia Huangqi Tang.
Unobstructed urination removes damp-heat, resolving jaundice naturally. Promoting urination is the general method for Jaundice. Floating pulse indicates pathogen near the exterior, requiring sweating. This aligns with "floating pulse, use emetics first." Since there is no external wind but sweating is desired, Guizhi's dispersing action must be combined with Huangqi to secure the exterior. This expels pathogen without damaging the exterior, assisting righteous Qi to drive out evil.
**Guizhi Jia Huangqi Tang Formula** (See Water Qi section)
For all types of Jaundice, use Zhigao Fa Jian.
This treats dry, non-damp Jaundice. According to *Shanghan Leiyao*, men and women with Jaundice, indigestion, gastric distension, and yellow coating in the stomach caused by dry feces are cured by Zhigao. Long-standing damp-heat hardens and dries, like fermentation yeast drying out. Pig fat benefits blood vessels and resolves wind-heat; human hair dissolves stasis, opens obstructions, and benefits water passages. Thus, pathogen exits via urine.
**Zhigao Fa Jian Formula**
Zhigao (0.5 jin), Luannian (three pieces size of chicken egg).
Fry in pig fat until hair dissolves and medicine is ready. Divide into two doses. Pathogen exits via urine. *Qianjin Fang* records a maid cured by this formula, passing dry feces from the stomach.
For Yellow Jaundice, use Yichen Wuling San.
This directly treats damp-heat forming Jaundice. Yichen dissipates constrained heat; Wuling San promotes urination and removes dampness.
**Yichen Wuling San Formula**
Yichen (ten parts powder), Wuling San (five parts).
Mix. Take one cun-bi dose with water before meals, three times daily.
For Yellow Jaundice with abdominal fullness, difficult and dark urination, and spontaneous sweating, this indicates exterior harmony and interior excess. Use purgation. Da Huang Xiaoshi Tang is suitable.
Abdominal fullness and dark, difficult urination indicate interior excess. Spontaneous sweating indicates exterior harmony. Da Huang and Xiaoshi purge heat and excess, stronger than Zhizi Dahuang Tang or Yichen Hao Tang.
**Da Huang Xiaoshi Tang Formula**
Dahuang, Huangbai, Xiaoshi (each 4 liang), Zhizi (15 seeds).
Boil four ingredients in 6 sheng of water to obtain 2 sheng. Remove dregs, add Xiaoshi, boil to obtain 1 sheng. Take once.
For Yellow Jaundice with normal urine color, desire for spontaneous diarrhea, abdominal fullness, and wheezing, do not clear heat. Clearing heat will cause hiccups. Treat hiccups with Xiao Banxia Tang.
Clear stool and spontaneous diarrhea indicate no internal heat. Abdominal fullness is not interior excess; wheezing is not Qi hyperactivity. Even with Jaundice heat, cold medicines should not attack. Removing heat damages Yang Qi, causing hiccups. Hiccups (wei) result from Stomach Yang being suppressed by cold medicine. Xiao Banxia Tang warms the Stomach and stops hiccups. After hiccups cease, warm and regulate the Middle Jiao to restore Qi movement, resolving wheezing and fullness, eliminating Jaundice. Xiao Banxia Tang does not treat Jaundice itself.
**Xiao Banxia Tang Formula** (See Phlegm-Fluids section)
For all Jaundice with abdominal pain and vomiting, use Chaihu Tang.
Abdominal pain and vomiting indicate Shaoyang disease. In Spleen-Stomach disorders, Wood pathogen easily flourishes. Xiao Chaihu Tang disperses pathogen, stops pain and vomiting. It does not treat all Jaundice directly.
**Chaihu Tang Formula** (i.e., Xiao Chaihu Tang, see Vomiting section)
For men with yellow complexion and spontaneous urination, give Xu Lao Xiao Jianzhong Tang.
Spontaneous urination usually prevents Jaundice as heat exits via urine. Here, urination is free but yellowing persists, indicating not a heat disease but Spleen Earth deficiency manifesting color. Tonify the Middle; do not clear heat. Jaundice is caused by damp-heat stagnation. Exterior cases use sweating; interior cases use purging. This is the general principle. However, dry cases change clearing/draining to moistening/guiding, as in Zhigao Fa Jian. Cold/non-excess/deficient cases change attacking to tonifying, changing cold to warm, as in Xiao Jianzhong. Mixed syndromes require treating complications first, then the main syndrome, as in Xiao Banxia and Xiao Chaihu. Zhang Zhongjing's discussion on Jaundice thoroughly covers correct, variant, excess, and deficiency methods, showing great diligence.
**Appendix Formulas**
Gua Di San treats all Jaundice. (Formula seen elsewhere).
According to *Shanfan Fang*, taking this induces vomiting of yellow fluid. It is also a method for floating pulse with desire to vomit.
**Qianjin Mahuang Chunjiu Tang** treats Jaundice.
Mahuang (3 liang).
Boil one ingredient in 5 sheng of fine wine to obtain 2.5 sheng. Take once. Use wine in winter, water in spring.