寸口脉浮而缓。浮则为风。缓则为痹。痹（者。风与湿合而不去。）非（若疼痛之）
中风。（所以然者。风得湿而变热。湿应脾而内行。是以）四肢（不疼痛而）苦烦。脾
（病者。）色必黄。（脾以其所）瘀（之）热以（外）行。（则肢体面目尽黄矣。）
此以寸口脉而言黄瘅初时之病因也。
趺阳脉紧而数。数则为热。（胃）热则消谷。紧则为寒。（脾寒遇）食即为满。（
满者必生湿。是胃热而脾湿。为黄瘅之病源也。）尺脉浮为（风）伤（于）肾。趺阳脉
紧为（寒）伤（于）脾。（是肾得风生热。脾得寒生湿。为黄瘅之病源也。凡）风（
热与）寒（湿）相搏。（其气必归脾胃。脾胃者。仓廪之官也。）食谷即（助其热而
为）眩。谷气（瘀而）不消。（则）胃
中苦浊。浊气（自当）下流。（若小便通。则浊随溺而去。今）小便不通。（则浊虽
下流。而不外出。于是）阴（脏）被
其寒。（而客）热流（入）膀胱。（膀胱为太阳。统主一身之肌表。故）身体尽黄。名曰谷瘅。
（以病虽始于风寒。而实成于谷气也。）
此言趺阳脉以明胃热脾寒郁而成瘅。又言肾脉浮。趺阳脉紧。为肾热脾寒。亦能郁
而成瘅。又归于膀胱之不化气。以膀胱主一身之肌表。不化气。则湿热无去路。而亦成
瘅。其病虽有各经之不同。而总以脾胃为主。故以谷瘅结之。
额上（心之部也。肾邪重而水色见于火部。故）黑。（肾热上行。而通于心。则）
微汗出。（手心名劳宫。属心。足心名涌泉。属肾。肾虚不能配火。水火未济。则）手足中
热。（酉主肾。肾虚。则其热）薄暮即发。膀胱（为肾外腑。肾病。则外腑必）急。（
肾虚不能摄水。则）小便自利。（此得之房劳过度。热从肾出。故）。名曰女劳瘅。（
至）腹（满）如水状。（脾肾两败。）不治。
此为女劳瘅而另言其证也。
（脾虽黄色。有因于酒者。酒多湿而性阳。故伤在上焦。心为酒所困。则）心中懊
而热。（热内蓄。则）不能食。（热上冲。则时）时欲吐。（酒气熏心。而味归脾胃
而作黄。）名曰酒瘅。
此言酒瘅之证也。
（瘅病属实者多。而属虚亦复不少。）阳明病（实者脉必数。今竟）脉迟。（其胃
弱可知。胃弱则化谷不速。）食难用饱。饱则（不运。火聚而）发烦。（胃中填塞。上
下俱阻。清者阻于上升。则）头眩。（浊者阻于下降。则）小便必难。此（因谷气郁而
生热。而非胃有实热。察其病势。）欲作谷瘅。虽下之。腹满如故。所以然者。（以）
脉迟（为虚）故也。
此言胃虚欲作谷瘅之证也。
（上言心中懊 等证。酒瘅之证。犹未备也。今且历陈之。）夫病酒黄瘅。（固属
上焦之病。而实不止于上焦也。水出高原。上焦湿热既盛。其下）必小便不利。（然）
其（有确切不可易之）候（曰）心中热。（从心热来。其小便不利。自不等于谷瘅之小便
不通。其）足下热。（又不等于女劳瘅之手足中热也。）是其（为酒瘅之的）证也。
酒黄瘅者。（以心中热为正候。亦）或（有热去于心。而）无热。（无热则心靖。
心）靖（则其）言了了。（然亦有心中无热。邪竟注于阳明。为）腹满（为）欲吐。
（又验之）鼻燥。（则知其为阳明证无疑。夫腹满宜下。欲吐宜越。因势而利导之法也。
今既腹满。而且欲吐。则可下而亦可吐。必须审）其脉浮者。（为邪近上。而）先吐
之。沉弦者。（为邪近下。而）先下之。（亦在乎临证而消息也。）
（上言无热。吐下尚未可定也。若）酒瘅心中热。（而且有）欲吐（之意）者。（
乘机）吐之（则）愈。
（上言可下。为无热而腹满者言也。若）酒瘅（而心中热。病在上而误）下之。（
则伤其下。其阳明之邪。乘下之虚。从支别入少阴。积渐而肾伤。故）久久为黑瘅。
（乙癸同源。肝病而）目青（肾病而）面黑。（然虽曰黑瘅。而其原则仍是酒家。故）
心中（热气熏烁。）如啖蒜齑状。（此于变证中。露出酒瘅真面目也。肾虚。则阴火熬
血。而为瘀血。瘀于里。则）大便正黑。（血不荣于表。则）皮肤爪之不仁。（此绝类女劳
瘅。何以知其为酒瘅也。然酒脉必浮。此虽因下而弱。要辨）其脉浮（中带）弱（其色）
虽黑（黑中仍带）微黄。故知之。
此四节。言酒瘅之相因为病。以补二条懊 等证所未备也。
师曰。病黄瘅。（湿热也。湿淫于内。则烦喘胸满。热淫于内。则发热口燥。今）
发热烦渴。胸满口燥者。以病发时。（不用汗解之正法。而以）火劫（逼）其汗。（以
热攻热。）两热（相搏）所得。然（使热不与湿合。必不作黄。凡）黄家所得。从湿得
之。（原不可以一下尽其法也。须审其）一身尽发热而黄。（而）肚热。（视一身之热
为尤甚。是因火劫。而令火）热（尽）在（于）里。（法）当下之。
此概言黄瘅有因误火而得之证。又辨其湿热相合者。为瘅病之常。独热在里者。为
瘅病之变。使人分别论治也。
（瘅病将成未成。必先见有一二证。而可卜之。凡病在里。则）脉沉。（里热。则）
渴欲饮水。（饮水多而）小便不利者。（水无去路。则郁于里而为湿。湿与热合。交相
蒸郁。）皆（可卜其）发黄。（脾之部位在腹。脾之脉络连舌本散舌下。若）腹满舌痿
黄。（是脾有湿而不行矣。又胃不和。则卧不安。若）躁不得睡。（是胃有热而不和矣。
湿热相合。为）属黄家。
此三节。言黄之将成。欲人图之于早。不俟其既成而药之。意含言外。
（黄者。土之色也。土无定位。寄王于四季之末各十八日。故）黄瘅之病。当以十
八日为期。（盖谓十八日脾气王。而虚者当复。即实者亦当通也。）治之（者。当使其
）十日以上（即）瘥。（不逾乎十八日之外。乃妙也。若逾十八日。不瘥。而）反剧为
（土气不能应期而王）难治。
此言黄瘅之愈有定期。欲医者期前而速治也。
按沈自南云、此取阳病阴和。阴病阳和为大纲也。十八乃三六。阴数之期也。十日
二五。阳土之数也。黄瘅乃湿热郁蒸。阳邪亢极。脾阴大衰。故治之须候一六二六三
六。阴气来复制火之期。而为定期。若至十日以上。土阴气复则当瘥。而反剧者。乃脾
阳亢极。阴气化灭。故为难治。此虽非正解。亦互相发明。
（瘅病是郁热外蒸之象。）瘅而渴者。（内热更甚。内外交病。）其瘅难治。瘅而不渴
者。（热从外宣。内之正气自运。）其瘅可治。发于阴部。（里为阴。里气之逆。）
其人必呕。（发于）阳部。（表为阳。表邪之盛。）其人振寒而发热也。
此以渴不渴别瘅之难治可治。以呕与寒热。辨黄之在表在里也。
（今试为瘅病出其方。）谷瘅之病。（其初多病寒热。其）寒热（作时。则）不食。
（寒热止时。即或时食。）食即（热上冲而）头眩。（内滞塞而）心胸不安。（湿瘀
热郁不解。）久久（身面）发黄。为谷瘅。（以）茵陈蒿汤主之。
此为谷瘅证而出其方也。
徐忠可云、前第一段论谷瘅。不言寒热。而有小便不通。第二段论谷瘅。不言心胸
不安。而有小便必难。此独不言及小便。盖谷瘅证亦有微甚不同。前所云小便不通。此
势之甚急者也。所云阳明病脉迟者。小便必难。乃既见阳明证。而因脉迟挟虚。以致不
运。此表病中之间有者也。若此云寒热。则非二三日之病矣。不食。食即头眩。则虽眩
而食未尝断。可知矣。故曰久久发黄。见迟之又久。乃相因而为病。其势渐而缓。则小
便亦未至不通耳。然观方下注云。一宿腹减。此亦必小便不快。而腹微胀可知。但不必专
责之耳。谷瘅三证。止出一方。盖阳明病一至发黄。则久暂皆宜开郁解热。故此方实为
主方。若阴黄。则后人以附子合茵陈。乃此方之变也。按心胸不安。与酒瘅之心中懊
亦不同。彼因心中热。至有无可奈何之象。此言不安。仅微烦也。即阳明脉迟证所谓发
烦头眩耳。
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。纳二味。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。
（凡发热而不恶寒。为阳明病。若）黄家。（当申酉之时。名曰）日晡所（应其时
）发热。而反恶寒。此（非阳明热证。）为女劳得之。（以女劳之病在肾。肾之腑为膀
胱。申时气血注于膀胱。酉时气血注于肾也。肾为热逼。则）膀胱（必）急。（膀胱既
急。则）少腹（亦）满。（其一）身（虽）尽黄。（而）额上（独）黑。（一身虽尽热。
而）足下（尤）热。因（此病势浸淫。肾邪遍于周身。不独额上。而身上俱）作黑瘅。
（然其中犹有可疑者。腹胀便溏。证同脾湿。然究）其腹胀（非水。而）如水状。大便
必（变）黑。（而）时溏。此女劳之病。（肾热而气内结。）非（脾湿而）水（不行之
为）病也。（但证兼）腹满者（为阳气并伤。较为）难治。（以）硝石矾石散主之。
此为女劳瘅出其方治也。立论独详。所以补前之未备也。
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。（前论已详。似可毋庸再赘矣。而）心中懊 。（为此证第一的据。
）或热痛。（为此证中之更甚者。以）栀子大黄汤主之。
此为酒瘅而出其方治也。
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（凡）病黄家。（概属湿热交郁而成。小便为气化之主。）但利其小便。（下
窍气通。则诸气自不能久郁。）假令脉浮。（则气病全滞于表分。徒利其小便。无益也。
）当以汗解之。宜桂枝加黄 汤主之。
此以下皆治正黄瘅方也。
徐忠可云、黄瘅家。不独谷瘅。酒瘅女劳瘅有分别。即正黄瘅。病邪乘虚。所着不
同。予治一黄瘅。百药不效而垂毙者。见其偏于上。令服鲜射干一味斤许而愈。又见有
偏于阴者。令服鲜益母草一味数斤而愈。其凡有黄瘅初起。非系谷瘅酒瘅女劳瘅者。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。
桂枝加黄 汤（见水气）
诸黄。（缘湿热经久。变为坚燥。譬如罨面。湿合热郁而成黄。热久则湿去而干也。
以）猪膏发煎主之。
此言黄瘅中另有一种燥证。饮食不消。胃胀有燥屎者。而出其方治也。徐氏谓为谷
气实所致。并述治友人骆天游黄瘅。腹大如鼓。百药不效。服猪膏发灰各四两。一剂而
愈。
按此条师止言诸黄二字。而未详其证。余参各家之说而注之。实未惬意。沈自南注。
浮浅又极附会。余素不喜。惟此条确有悟机。姑录而互参之。其云、此黄瘅血分通治
之方也。寒湿入于血分。久而生热。郁
蒸气血不利。证显津枯血燥。皮肤黄而暗晦。即为阴黄。当以猪脂润燥。发灰入血和阴。
俾脾胃之阴得其和。则气血不滞。而湿热自小便去矣。盖瘅皆因湿热郁蒸。相延日久
阴血必耗。不论气血二分。皆宜兼滋其阴。故云诸黄主之。
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。
黄瘅病。（审其当用表里两解法者。以）茵陈五苓散主之。（若夫脉沉腹满在里。
则为大黄硝石汤证。脉浮无汗在表。则为桂枝加黄 汤证矣。当知此方非治黄通用之
方。）
此为黄瘅而出表里两解之方也。徐云、治黄瘅不贵补。存此以备虚证耳。
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。（里实也。黄瘅最难得汗。若）自汗出。（表和也。）
此为表和里实。（实者）当下之。宜大黄硝石汤。
此为黄瘅而出其里实之方也。视栀子大黄及茵陈蒿汤较峻。
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。（实热者。小盒饭赤短。若）小便色不变。（而且）欲自利。（其无内热。
确凿有据。可知其）腹满而喘。（非里实气盛。乃为虚满虚喘也。虽有瘅热。亦）不
可（以寒下之药）除（其）热。热除（则胃）必（寒而作）哕。哕者。（宜先调其胃降
其逆。然后消息治之。以）小半夏汤主之。
此为黄瘅之虚证。误治增病。而出其救治之方。非谓小半夏汤即能治黄瘅也。后人
以理中汤加茵陈蒿。颇有意义。
小半夏汤方（见痰饮）
诸黄腹痛而呕者。（少阳之木邪克土也。）宜柴胡汤。
寸口脉象浮而缓。浮脉主风邪，缓脉主湿痹。（所谓痹，是指风邪与湿邪结合而滞留不去。）这并不是通常所说的中风（即肢体疼痛的中风证）。（之所以这样，是因为风邪遇到湿气会转化为热，湿气对应脾脏并向体内运行。因此四肢并不疼痛，而是感到烦闷不适。脾脏患病时，面色必然发黄。这是因为脾脏将郁积的热邪向外散发，就会导致全身皮肤、肢体和面目都变黄。）这是从寸口脉的角度来说明黄疸病初期的病因。
趺阳脉象紧而数。数脉主热，胃中有热则能消化食物；紧脉主寒，脾脏受寒后进食就会感到胀满。（胀满必然产生湿气，这就是胃热脾湿，是黄疸病的根源。）尺部脉象浮，表示风邪伤肾；趺阳脉象紧，表示寒邪伤脾。（这说明肾脏因风而生热，脾脏因寒而生湿，这也是黄疸病的根源。大凡风热与寒湿相互搏结，其病气必然归于脾胃。脾胃是负责受纳运化的器官。）进食后就会助长热邪导致头晕目眩，谷气郁滞不能消散，就会使胃中苦于浊气内停。浊气本应向下流注，如果小便通畅，浊气就会随尿液排出；如今小便不通畅，那么浊气虽然向下流注，却无法从体外排出。于是阴脏受到寒邪侵袭，客热流入膀胱。（膀胱属太阳经，统管全身的肌表，所以身体全部发黄，这种病名叫谷瘅。）（因为疾病虽然起始于风寒，但实际上是由谷气郁滞而成的。）
这里通过趺阳脉来阐明胃热脾寒郁结而成黄疸的道理。又提到肾脉浮、趺阳脉紧，说明肾热脾寒也能郁结而成黄疸，最后归结于膀胱气化功能失常。因为膀胱主管一身肌表，若不能化气，湿热就没有出路，从而形成黄疸。这些病症虽然涉及不同的经络，但总以脾胃为主，所以用“谷瘅”来总结。
额头部位属于心脏反射区。如果肾邪严重，水色（黑色）出现在火部（额头），所以额头发黑。（肾热上行并通于心，就会出现微汗出。）手心名为劳宫穴，属心；足心名为涌泉穴，属肾。肾虚不能制约心火，水火不济，就会出现手足心发热。（酉时对应肾脏，肾虚时，其热在傍晚时分发作。）膀胱是肾脏的外腑，肾脏有病，外腑必然拘急。（肾虚不能摄纳水液，就会出现小便自利。）这是由于房劳过度，热邪从肾脏发出，所以名叫女劳瘅。（如果发展到腹部胀满像有水状，说明脾肾两败，属于不治之症。）
这是针对女劳瘅另外论述其症状。
（脾脏本色为黄色，但也有因饮酒引起的。酒多湿气且性质阳热，所以伤害上焦。心被酒气所困，就会心中懊恼烦热。（热邪内蓄，就不能进食。（热邪上冲，就会时常想呕吐。（酒气熏蒸心脏，味道归入脾胃而发黄。）这名叫酒瘅。
这是论述酒瘅的症状。
（黄疸病大多属实证，但也不少见虚证。）阳明病如果是实证，脉象必定数，现在竟然脉迟，可知胃气虚弱。胃弱则消化谷物缓慢，难以吃饱，吃饱了就运化不动，火聚而发烦。（胃中填塞，上下阻滞，清气受阻不能上升，就会头晕；浊气受阻不能下降，小便必然困难。这是因谷气郁滞而生热，而不是胃有实热。观察其病势，想要发作成谷瘅。即使使用下法，腹满也不会消除。之所以这样，是因为脉迟代表虚证。）
（上面提到的心中懊恼等症状，酒瘅的症状还不完备。现在逐一陈述。）患酒黄瘅的病，固然属于上焦的病，但实际上不止于上焦。水来源于肺（高原），上焦湿热既盛，必然小便不利。（然而有一个确切不可改变的症状叫心中发热。从心热而来，其小便不利，自然不等于谷瘅的小便不通。其足下发热，又不等于女劳瘅的手足心发热。）这是酒瘅的确切症状。
酒黄瘅，以心中发热为主要症状，或者也有热邪离开心脏而没有热的情况。（没有热，则心神安宁，说话清楚明白。）然而也有心中无热，邪气竟注入阳明经，出现腹部胀满想呕吐的情况。（再验证鼻燥，就知道这是阳明证无疑了。腹部胀满应当用下法，想呕吐应当用吐法，这是顺应病势引导的方法。现在既然腹部胀满，而且想呕吐，既可以下也可以吐。必须仔细辨别，如果脉象浮，表示邪气靠近上部，先采用吐法；脉象沉弦，表示邪气靠近下部，先采用下法。这也取决于临证时的斟酌。）
（上面说没有热，吐法和下法尚未确定。如果酒瘅心中发热，而且有想呕吐的意思，乘机采用吐法就能痊愈。）
（上面说可以下，是针对没有热而腹部胀满的情况说的。如果酒瘅心中发热，病在上部却误用下法，就会损伤下部。阳明经的邪气，乘下法后的虚弱，从分支进入少阴，逐渐损伤肾脏，所以久而久之变成黑瘅。（乙癸同源，肝病则眼睛发青，肾病则面色发黑。虽然叫做黑瘅，但其原则仍然是酒家所致，所以心中热气熏灼，感觉像吃了蒜泥一样辛辣难受。这是在变证中显露出酒瘅的真面目。肾虚，则阴火煎熬血液，形成瘀血。瘀滞在体内，大便就呈黑色。血液不能荣养体表，皮肤和指甲就麻木不仁。这非常像女劳瘅，怎么知道它是酒瘅呢？酒的脉象必定浮，这里虽然因为误下而脉弱，但要辨别其脉浮中带弱，其色虽黑但黑中仍带微黄，所以知道它是酒瘅。）
这四节文字，论述酒瘅相互关联的病变，以补充前面两条关于懊恼等症状的不完备之处。
老师说：患黄疸病，是湿热为患。湿气淫溢于内，就会烦闷气喘胸满；热邪淫溢于内，就会发热口燥。现在发热烦渴、胸满口燥，是因为发病时（没有用发汗解表的正法，而是用）火劫法逼迫出汗。（以热攻热。）两热相搏所得的结果。然而（如果热不与湿结合，必然不会发黄。凡是）黄家所得的病，都是从湿得来的。（原本不可以用一下法穷尽所有治法。必须审视如果全身都发热而且发黄，而且肚脐周围发热，比全身的热更甚，这是因火劫导致火热完全在体内。按照法则应当用下法。）
这是概括论述黄疸病有因误用火法而得的证候。又辨析湿热相合者，是黄疸病的常法；独热在里者，是黄疸病的变法，让人分别论治。
（黄疸病将要形成而未形成时，必须先见到一两个症状，就可以推测它。凡是病在里，脉象就沉。里有热，就想喝水。如果喝水多而小便不利，水没有去路，就会郁滞在里成为湿气，湿气与热邪结合，互相蒸郁。）都可以推测其会发黄。（脾的部位在腹部，脾的脉络连接舌根散布在舌下。如果腹部胀满、舌体萎软且发黄，这是脾有湿气而不运行。另外胃不和，睡眠就不安稳。如果烦躁不能入睡，这是胃有热而不和。湿热相合，属于黄家病。）
这三节文字，论述黄疸即将形成，希望人们在早期采取措施，不要等到已经形成再去治疗，意思包含在言外。
（黄色是土的颜色。土没有固定的位置，寄旺于四季末各十八天。所以）黄疸病，应当以十八天为期限。（大概意思是十八天脾气旺盛，虚弱的应当恢复，即使是实证也应当通畅。）治疗的话，应当在十日以上就好了。（不超过十八天之外，才是妙策。如果超过十八天，不好反而加重，就是土气不能应期而旺盛，难治。）
这是论述黄疸病的痊愈有定期，希望医生在期限前迅速治疗。
按沈自南说：这是取阳病阴和、阴病阳和为大纲。十八是三六，是阴数的期限。十日是二五，是阳土之数。黄疸是湿热郁蒸，阳邪亢极，脾阴大衰，所以治疗须等候一六、二六、三六，阴气来克制火的时期，作为定期。如果到十日以上，土阴气恢复就应该痊愈，反而加重的，是脾阳亢极，阴气化灭，所以难治。这虽然不是正统解释，但也互相发明。
（黄疸病是郁热外蒸的现象。）黄疸而口渴的，内热更甚，内外交病，其黄疸难治。黄疸而不口渴的，热从外部宣散，内部的正气自然运转，其黄疸可治。发于阴部（里为阴，里气逆乱），其人必然呕吐。发于阳部（表为阳，表邪盛），其人恶寒而发热。
这是以渴与不渴来区别黄疸的难治与可治，以呕吐与寒热来辨别黄疸在表还是在里。
（现在试着为黄疸病开出方剂。）谷瘅病，初期多伴有寒热，寒热发作时，不能进食；寒热停止时，即使有时进食，进食后就热邪上冲导致头晕，内部滞塞导致心胸不安，湿气郁积热邪不解。久而久之身面发黄，称为谷瘅。用茵陈蒿汤主治。
这是针对谷瘅证开出方剂。
徐忠可说：前第一段论述谷瘅，不说寒热，而有小便不通；第二段论述谷瘅，不说心胸不安，而有小便必难。这里唯独没提小便的问题，大概谷瘅证也有轻重不同。前面所说的小便不通，是病情最紧急的情况；所说阳明病脉迟者，小便必难，是已经见到阳明证，但因脉迟挟带虚证，以致运化不力，这是表病中间的情况。如果说这里有寒热，那就不是二三天内的病了。不吃东西，吃东西就头晕，说明虽然头晕但饮食未曾断绝，可知矣。所以说“久久发黄”，见其时间很久，才相继致病，其势渐缓，所以小便也未至不通。然而看方剂下的注释说，“一宿腹减”，这也必然小便不快，腹部微胀可知。但不必专门责怪这一点。谷瘅三种证候，只出一个方子，大概阳明病一到发黄，无论久暂都适宜开郁解热，所以这个方子实际上是主方。如果是阴黄，后人用附子合茵陈，就是这个方子的变方。按：心胸不安，与酒瘅的心中懊恼也不同。那是因心中热，到了无可奈何的地步；这里说不安，仅是轻微烦闷。也就是阳明脉迟证所说的发烦头眩。
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，尿如皂角汁状，颜色正红，一夜之后腹部减轻，黄气从小便排出去。
（凡是发热而不恶寒，是阳明病。如果黄家，在申酉之时，名叫日晡所，应该在这个时候发热，反而恶寒，这不是阳明热证。）这是女劳病引起的。（因为女劳的病在肾，肾的腑是膀胱，申时气血注入膀胱，酉时气血注入肾。肾被热逼迫，膀胱必然拘急。膀胱既已拘急，少腹也就胀满。其全身虽然都发黄，但额头特别黑。全身虽然都热，但足下尤其热。因为这个病势浸淫，肾邪遍布周身，不仅额头，身上都作黑瘅。然而其中还有可疑的地方，腹胀便溏，证候同脾湿，然而究其腹胀并非水饮，而是像水状，大便必然变黑，时而稀溏。这是女劳的病，肾热气内结，不是脾湿水不行的病。但如果兼有腹满，是为阳气并伤，较为难治。用硝石矾石散主治。）
这是针对女劳瘅开出方剂治法。立论详细，是为了补充前面的不足。
硝石矾石散方
硝石（熬黄） 矾石（烧，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。病随着大小便排出，小便正黄，大便正黑，这是见效的征候。
酒瘅，前面论述已经很详细，似乎不需要再赘述了。但是心中懊恼，是这个证的第一确切依据。或者热痛，是这个证中更严重的，用栀子大黄汤主治。
这是针对酒瘅开出方剂治法。
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。
凡是患黄家病，概属湿热交郁而成，小便为气化之主。只要通利小便，下窍气通，则诸气自然不能久郁。假如脉浮，则气病全滞于表分，徒然利小便，没有益处，应当用汗法解表。宜用桂枝加黄芪汤主治。
这以下都是治疗正黄瘅的方剂。
徐忠可说：黄瘅家，不只是谷瘅、酒瘅、女劳瘅有分别，即使是正黄瘅，病邪乘虚，所着部位不同。我治疗一个黄瘅，百药不效濒临死亡的人，见他病偏于上部，让他服鲜射干一味药一斤多而痊愈。又见有偏于阴部的，让他服鲜益母草一味药几斤而痊愈。那些凡是有黄瘅初起，不是属于谷瘅、酒瘅、女劳瘅的，就让用车前草根叶合捣，取自然汁，酒送服几碗而痊愈。甚至有卧床不起的，让用车前一味的自然汁几杯，放在床头，随意饮用而痊愈。然而汗法和下法的说法，也是设言以启发领悟，难道可以没有变通吗？
桂枝加黄芪汤（见水气篇）
各种黄疸，因为湿热经久，变为坚燥，譬如敷面，湿合热郁而成黄，热久了则湿去而干。用猪膏发煎主治。
这是论述黄疸病中另有一种燥证，饮食不消，胃胀有燥屎的情况，而出其方剂治法。徐氏说是谷气实所致，并叙述治疗友人骆天游的黄瘅，腹大如鼓，百药不效，服用猪膏发灰各四两，一剂而愈。
按：这一条老师只说了“诸黄”二字，而没有详细说明症状。我参考各家之说进行注解，实在不满意。沈自南的注解浮浅又极附会，我素来不喜欢。只有这一条确有悟机，姑且录下来互相参考。他说：这是黄瘅血分通治的方子。寒湿进入血分，久了而生热，郁蒸气血不利，证候显现津枯血燥，皮肤黄而暗晦，就是阴黄。应当用猪脂润燥，发灰入血和阴，使得脾胃之阴得到调和，则气血不滞，而湿热自然从小便排出去。大概黄疸都是因为湿热郁蒸，拖延日久阴血必耗，不论气血二分，都适宜兼滋其阴，所以说诸黄主之。
猪膏发煎方
猪膏（半斤） 乱发（如鸡子大三枚）
以上两味药，和膏中煎之，发消药成，分两次服。病从小便排出。
黄瘅病，审察其应当用表里两解法的，用茵陈五苓散主治。如果脉沉腹满在里，则是大黄硝石汤证；脉浮无汗在表，则是桂枝加黄芪汤证。应当知道这个方子不是治疗黄疸通用的方子。
这是针对黄瘅开出表里两解的方剂。徐云：治疗黄瘅不贵在补，保留此方以备虚证之用。
茵陈五苓散方
茵陈（十分末） 五苓散（五分）
以上两味药混合，饭前用开水送服一方寸匕，每天三次。
黄瘅，腹部胀满，小便不利且色赤，这是里实证。黄瘅最难出汗，如果自汗出，说明表和。这是表和里实。实证应当用下法。宜用大黄硝石汤。
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，实热者，小便应当赤短。如果小便颜色不变，而且想自利（腹泻），其无内热，确凿有据，可知其腹满而喘，不是里实气盛，乃是虚满虚喘。虽然有瘅热，也不可以用寒下药去除热。热除则胃必寒而作哕（打嗝）。哕者，应当先调其胃降其逆，然后斟酌治疗。用小半夏汤主治。
这是针对黄瘅的虚证，误治增病，而出其救治的方剂。并不是说小半夏汤就能治黄瘅。后人用理中汤加茵陈蒿，颇有意义。
小半夏汤方（见痰饮篇）
The pulse at the Cun Kou (Cun position of the radial artery) is floating and slow. Floating indicates Wind, and slow indicates Bi syndrome (obstruction syndrome caused by wind-cold-dampness). (Bi here refers to the combination of Wind and Dampness that lingers and does not depart.) This is not Zhong Feng (Wind Stroke, typically characterized by limb pain). (The reason for this is that when Wind encounters Dampness, it transforms into Heat; Dampness corresponds to the Spleen and moves inward. Therefore, the four limbs do not hurt but suffer from vexation. When the Spleen is diseased, the complexion must be yellow. The Heat stagnated in the Spleen moves outward, causing the entire body, limbs, face, and eyes to turn yellow.) This explains the etiology of early-stage Huang Dan (Jaundice) based on the Cun Kou pulse.
The pulse at the Fu Yang (Dazu point, ST42) is tight and rapid. Rapid indicates Heat; Stomach Heat promotes digestion. Tight indicates Cold; Spleen Cold causes fullness after eating. (Fullness generates Dampness; thus, Stomach Heat and Spleen Dampness are the source of Huang Dan disease.) A floating pulse at the Chi position (distal radial pulse) indicates Wind injuring the Kidney. A tight pulse at the Fu Yang position indicates Cold injuring the Spleen. (This means the Kidney generates Heat due to Wind, and the Spleen generates Dampness due to Cold, which is also a source of Huang Dan. Generally, when Wind-Heat and Cold-Dampness contend, their Qi returns to the Spleen and Stomach. The Spleen and Stomach are the officials of granaries.) Eating grains assists the Heat and causes dizziness. Grain Qi stagnates and fails to digest, causing the Stomach to suffer from turbid Qi. Turbid Qi should flow downward. If urination is unobstructed, turbidity leaves with urine. Now, if urination is obstructed, although turbidity flows downward, it cannot exit externally. Thus, Yin organs are affected by Cold, and guest Heat flows into the Bladder. (The Bladder belongs to the Taiyang channel and governs the muscle layer of the whole body; therefore, the entire body turns yellow. This is called Gu Dan [Grain Jaundice].) (Although the disease starts with Wind-Cold, it actually forms due to grain Qi stagnation.)
Here, the Fu Yang pulse clarifies that Stomach Heat and Spleen Cold stagnating form jaundice. It also mentions that a floating Kidney pulse and a tight Fu Yang pulse indicate Kidney Heat and Spleen Cold, which can also stagnate to form jaundice, ultimately attributing it to the failure of the Bladder's Qi transformation. Since the Bladder governs the body's surface, failure to transform Qi leaves no outlet for Damp-Heat, leading to jaundice. Although diseases vary by meridian, they generally center on the Spleen and Stomach, hence summarized as Gu Dan.
The forehead is the area of the Heart. If Kidney pathogen is severe, Water color (black) appears in the Fire area (forehead), so the forehead turns black. (Kidney Heat ascends and connects to the Heart, causing slight sweating.) The palm is named Laogong (PC8), belonging to the Heart; the sole is named Yongquan (KI1), belonging to the Kidney. Kidney deficiency fails to control Fire, resulting in disharmony between Water and Fire, causing heat in the hands and feet. (You hour corresponds to the Kidney; with Kidney deficiency, its heat manifests at dusk.) The Bladder is the exterior腑 (Fu organ) of the Kidney; Kidney disease causes the exterior腑 to become urgent. (Kidney deficiency fails to control water, causing spontaneous urination.) This results from excessive sexual exertion, with Heat emerging from the Kidney, hence named Nü Lao Dan [Female Labor Jaundice]. (If it progresses to abdominal fullness resembling water accumulation, indicating both Spleen and Kidney failure, it is incurable.)
This describes additional symptoms of Nü Lao Dan.
(Although the Spleen's color is yellow, some cases are caused by alcohol. Alcohol is damp and yang in nature, injuring the Upper Jiao. Confined by wine, the Heart suffers from vexation and heat. (Heat stored internally prevents eating. (Heat rushing upward causes occasional desire to vomit. (Wine vapor confuses the Heart, and flavors return to the Spleen and Stomach to cause yellowing. This is called Jiu Dan [Alcohol Jaundice].)
This describes the symptoms of Jiu Dan.
(Jaundice diseases are mostly excess patterns, but deficiency patterns are also common.) Yangming disease (if excess) has a rapid pulse; now the pulse is slow, indicating weak Stomach Qi. Weak Stomach Qi digests grain slowly. One cannot eat until full; being full leads to poor transport, fire aggregation, and vexation. (Stomach blockage obstructs both upper and lower; clear Qi blocked from ascending causes dizziness; turbid Qi blocked from descending causes difficult urination. This is heat generated by grain Qi stagnation, not Stomach excess heat. Observing the disease trend, it desires to become Gu Dan. Even with purgation, abdominal fullness remains. The reason is that a slow pulse indicates deficiency.)
This describes the symptoms of Stomach deficiency desiring to develop Gu Dan.
(Above, symptoms like heart vexation were mentioned, but Jiu Dan symptoms were incomplete. Now listed comprehensively.) In Wine Yellow Jaundice, although it belongs to the Upper Jiao, it is not limited there. Water originates from the High Source (Lungs); if Upper Jiao Damp-Heat is flourishing, there must be difficult urination. (However, there is an invariant symptom: heat in the Heart. Coming from Heart heat, difficult urination differs from Gu Dan's urinary obstruction. Heat under the feet differs from Nü Lao Dan's hand-foot heat. These are the specific signs of Jiu Dan.)
For Jiu Dan, heat in the Heart is the primary sign. Sometimes heat leaves the Heart, resulting in no heat. (No heat means the Heart is calm, and speech is clear.) However, sometimes there is no Heart heat, but evil injects into the Yangming, causing abdominal fullness and desire to vomit. (Checking for dry nose confirms Yangming syndrome. Abdominal fullness requires purgation; desire to vomit requires emesis, following the momentum. Now with both fullness and vomiting, either method may apply. Must examine the pulse: if floating, evil is near the upper part, use emesis first; if deep and string-taut, evil is near the lower part, use purgation first. This depends on clinical judgment.)
(Above, without heat, emesis/purgation was undecided. If Jiu Dan has Heart heat and desire to vomit, take the opportunity to emesis, and it will heal.)
(Above, purgation was for no heat and abdominal fullness. If Jiu Dan has Heart heat, the disease is upper, and mistaken purgation damages the lower. Yangming evil, taking advantage of post-purgation weakness, enters Shaoyin via branches, gradually damaging the Kidney, eventually becoming Hei Dan [Black Jaundice]. (Yi and Gui share the same source; Liver disease causes green eyes, Kidney disease causes black face. Although called Black Jaundice, the principle remains wine-related. Thus, Heart heat scorching feels like eating minced garlic. This reveals the true face of Jiu Dan among complications. Kidney deficiency allows Yin Fire to boil blood, forming stasis. Stasis inside causes black stool. Blood failing to nourish the exterior causes numb skin and nails. This resembles Nü Lao Dan. How to know it is Jiu Dan? Wine pulses are always floating. Here, weakened by purgation, yet floating with weakness, and color black but with slight yellow undertones, we know it is Jiu Dan.)
These four sections discuss the interrelated pathology of Jiu Dan, supplementing the incomplete description of vexation symptoms earlier.
The Master said: Jaundice disease involves Damp-Heat. Dampness flooding internally causes vexation, panting, and chest fullness; Heat flooding internally causes fever and dry mouth. Now, with fever, vexation, thirst, chest fullness, and dry mouth, it is because at onset, (instead of using proper sweating methods,) Fire coercion (forced sweating. (Attacking heat with heat.) Two heats contending result. However, (if heat does not combine with dampness, yellowing will not occur. All) Huang family diseases arise from Dampness. (Purgation alone cannot exhaust all methods. One must assess if the whole body is hot and yellow, especially abdominal heat, which is more severe than general heat, indicating Fire coercion trapped Heat entirely inside. The method requires purgation.)
This generally discusses jaundice caused by mistaken Fire therapy. It distinguishes combined Damp-Heat as the normal pattern of Dan disease, while isolated Heat inside as a variant pattern, guiding differential treatment.
(Jaundice about to form shows initial signs for prediction. Disease in the interior implies deep pulse. Interior Heat implies thirst for water. Drinking much but with difficult urination means water has no outlet, stagnating as Dampness. Dampness combining with Heat steaming together predicts yellowing. (Spleen location is abdomen; Spleen meridians connect to tongue base. Abdominal fullness, flaccid tongue, and yellowing indicate Spleen Dampness failing to move. Also, Stomach disharmony causes sleeplessness. Restlessness preventing sleep indicates Stomach Heat disharmony. Damp-Heat combined belongs to the Huang family.)
These three sections warn of impending jaundice, urging early intervention before formation, implying advice beyond words.
(Yellow is Earth's color. Earth has no fixed position, thriving in the last 18 days of each season. Thus, Huang Dan disease has an 18-day prognosis. (Meaning Spleen Qi thrives on day 18, restoring deficiency or resolving excess.) Treatment should resolve within 10 days. (Not exceeding 18 days is ideal. If exceeding 18 days, worsening indicates Earth Qi failing to thrive, making it difficult to treat.)
This states jaundice recovery has a set period, urging timely treatment.
Shen Zinan notes: This follows the principle of Yin-Yang harmony. 18 is 3x6, an Yin number period. 10 is 2x5, an Yang-Earth number. Jaundice is Damp-Heat steaming, Yang evil extreme, Spleen Yin severely deficient. Treatment waits for 1, 6, 2, 6, 3, 6 periods where Yin Qi controls Fire. If resolving after 10 days, Spleen Yin recovers. Worsening indicates Spleen Yang extreme, Yin Qi extinguished, hence difficult. Though not orthodox, it elucidates further.
(Dan disease is image of stagnant Heat steaming outward.) Jaundice with thirst indicates severe internal heat, internal and external disease, difficult to treat. Jaundice without thirst indicates Heat venting outward, internal Zheng Qi moving, treatable. Emission from Yin parts (Interior is Yin, interior Qi rebellion) causes vomiting. Emission from Yang parts (Exterior is Yang, exterior evil prosperity) causes chills and fever.
This differentiates treatability by thirst/non-thirst and location by vomiting/chills-fever.
(Now prescribing formulas for Dan disease.) Gu Dan disease often begins with chills and fever. During chills/fever, appetite is lost. When chills/fever cease, eating causes Heat rushing up and dizziness, internal blockage and chest discomfort, unresolved Damp-Stagnant Heat. Over time, body and face yellow, termed Gu Dan. Treat with Yin Chen Hao Tang.
This prescribes a formula for Gu Dan syndrome.
Xu Zhongke says: Previous section 1 discussed Gu Dan without chills/fever but with urinary obstruction. Section 2 discussed Gu Dan without chest discomfort but with difficult urination. This section omits urination issues, implying varying severity. Urinary obstruction is acute; Yangming slow pulse/difficult urination is intermediate with deficiency. Chills/fever imply longer duration. Not eating, then dizziness upon eating implies intermittent intake. "Long time to yellow" implies gradual progression, so urination isn't fully obstructed. Note "abdomen reduces overnight," implying mild bloating/uncomfortable urination. Gu Dan syndromes use one main formula because once Yangming jaundice occurs, opening stagnation and resolving heat is key regardless of duration. For Yin Jaundice, later practitioners add Fuzi to Yinchen, a variation. Note: Chest discomfort differs from Jiu Dan's heart vexation; here it is mild annoyance, akin to Yangming slow pulse vexation/dizziness.
Yin Chen Hao Tang Formula
Yin Chen Hao (Artemisiae Scopariae Herba, 6 liang) Zhi Zi (Gardeniae Fructus, 14 pieces) Da Huang (Rhei Radix et Rhizoma, 2 liang)
Boil these three ingredients in 1 dou of water. First decoct Yin Chen Hao until reduced by 6 sheng. Add the other two. Decoct to 3 sheng. Strain. Divide into three warm doses. Beneficial urination occurs, urine looks like soapberry juice, red color. Overnight abdominal reduction indicates yellow qi exiting via urine.
(Fever without aversion to cold is Yangming disease. If Huang family patient has fever at Shen-You hours (3-7 PM), called Ribu Suo, but has aversion to cold, this is not Yangming Heat syndrome. It is caused by Nü Lao [Female Labor]. (Nü Lao disease affects Kidney; Kidney Fu is Bladder. Shen hour Qi enters Bladder; You hour Qi enters Kidney. Kidney forced by Heat makes Bladder urgent. Bladder urgency causes lower abdominal fullness. Whole body yellow, but forehead specifically black. Whole body hot, but soles especially hot. Pathogen permeates body, Kidney evil spreads, causing Hei Dan [Black Jaundice] beyond just forehead. Doubtful aspect: abdominal fullness/loose stool resembles Spleen Dampness, but fullness is not water retention, stool turns black/tarry intermittently. This is Nü Lao disease, Kidney Heat with internal Qi knotting, not Spleen Dampness water retention. If accompanied by abdominal fullness, Yang Qi damaged, difficult to treat. Treat with Xiao Shi Fan Shi San.)
This prescribes treatment for Nü Lao Dan, supplementing previous details.
Xiao Shi Fan Shi San Formula
Xiao Shi (Natrii Sulfas, roasted yellow) Fan Shi (Alumen, calcined, equal parts)
Grind to powder. Mix with barley porridge juice. Take one cun-bi dose. Three times daily. Disease exits via stool/urine. Urine turns yellow, stool turns black, indicating efficacy.
Jiu Dan was detailed earlier, seemingly redundant. However, heart vexation is the primary sign. Heat pain is more severe. Treat with Zhi Zi Da Huang Tang.
This prescribes treatment for Jiu Dan.
Zhi Zi Da Huang Tang Formula
Zhi Zi (Gardeniae Fructus, 14 pieces) Da Huang (Rhei Radix et Rhizoma, 2 liang) Zhi Shi (Aurantii Fructus Immaturus, 5 pieces) Chi Dou (Sojae Semen Praeparatum, 1 sheng)
Decoct these four in 6 sheng water to 2 sheng. Divide into three warm doses.
All Huang family diseases result from Damp-Heat entanglement. Urination is master of Qi transformation. Promoting urination opens lower orifices, allowing Qi to disperse stagnation. If pulse is floating, Qi stagnates in exterior; promoting urination is useless. Use sweating method. Gui Zhi Jia Huang Qi Tang is indicated.
Below are formulas for Zheng Huang Dan [Standard Jaundice].
Xu Zhongke says: Huang Dan varies not only by Gu/Jiu/Nü Lao types but also by Zheng Huang Dan depending on empty pathogen location. I treated a critical jaundice case ineffective with many herbs; seeing upper bias, prescribed fresh She Gan (Belamcandae Rhizoma) 1 jin, cured. Another Yin-biased case cured with fresh Yi Mu Cao (Leonuri Herba). Early stage non-specific jaundice cured with Che Qian Gen Ye (Plantaginis Radix et Herba) juice mixed with wine. Bedridden cases cured by drinking Che Qian natural juice. Thus, sweating/purgation theories are illustrative; flexibility is needed.
Gui Zhi Jia Huang Qi Tang (See Shui Qi chapter)
Various jaundices, due to long-standing Damp-Heat turning dry/hard (like dough fermentation), require Zhu Gao Fa Jian.
This addresses a dry-type jaundice with undigested food, stomach distension, and dry feces. Xu attributes it to Gu Qi excess, citing a friend Luo Tianyou cured by Zhu Gao (Porci Adeps) and Fa Hui (Capillaris Carbonisata) 4 liang each, one dose cured.
Note: Master only said "Various Jaundice" without details. I referenced others' notes but remain unsatisfied. Shen Zinan's note is superficial/apocryphal, disliked by me. This entry has insight: It treats Blood-level jaundice. Cold-Damp entering Blood level generates Heat over time, stagnating Qi/Blood, showing fluid depletion and Blood dryness, dark yellow skin (Yin Jaundice). Zhu Gao moistens dryness; Fa Hui enters Blood to harmonize Yin. Harmonizing Spleen/Stomach Yin stops Qi/Blood stagnation, allowing Damp-Heat to exit via urine. Jaundice stems from Damp-Heat steaming depleting Yin Blood over time; nourishing Yin is suitable for both Qi/Blood levels, hence "Various Jaundice."
Zhu Gao Fa Jian Formula
Zhu Gao (Porci Adeps, half jin) Luan Fa (Capillaris, three pieces size of chicken egg)
Simmer together in fat until hair dissolves. Divide into two doses. Disease exits via urine.
Huang Dan disease requiring simultaneous exterior-interior resolution uses Yin Chen Wu Ling San. Deep pulse/abdominal fullness (interior excess) indicates Da Huang Xiao Shi Tang. Floating pulse/no sweat (exterior) indicates Gui Zhi Jia Huang Qi Tang. Know this formula is not universal for jaundice.
This prescribes simultaneous exterior-interior resolution for Huang Dan. Xu notes: Treating jaundice doesn't prioritize tonification; keep this for deficiency cases.
Yin Chen Wu Ling San Formula
Yin Chen (Artemisiae Scopariae Herba, 10 parts powder) Wu Ling San (Poria Powder, 5 parts)
Mix. Take one cun-bi dose before meals with water. Three times daily.
Jaundice with abdominal fullness, difficult red urination indicates interior excess. Jaundice rarely sweats; spontaneous sweating indicates exterior harmony. Exterior harmonized, interior excess exists. Excess requires purgation. Da Huang Xiao Shi Tang is indicated.
This prescribes interior excess formula for jaundice, stronger than Zhi Zi Da Huang or Yin Chen Hao Tang.
Da Huang Xiao Shi Tang Formula
Da Huang (Rhei Radix et Rhizoma) Huang Bo (Phellodendri Cortex) Xiao Shi (Natrii Sulfas) (each 4 liang) Zhi Zi (Gardeniae Fructus, 15 pieces)
Decoct first three in 6 sheng water to 2 sheng. Strain. Add Xiao Shi, boil to 1 sheng. Take once.
Huang Dan disease with excess-heat usually has red/scanty urine. If urine color unchanged and desire for spontaneous diarrhea, lack of internal heat is confirmed. Abdominal fullness and panting indicate deficiency-fullness/deficiency-panting, not excess Qi.虽有瘅热 (Though Dan heat exists), do not use cold purgatives to remove heat. Removing heat causes Stomach cold and hiccups. For hiccups, first regulate Stomach and descend rebellious Qi, then treat conditionally. Xiao Ban Xia Tang is indicated.
This prescribes rescue formula for jaundice deficiency/mistreatment error, not claiming Xiao Ban Xia Tang treats jaundice directly. Later practitioners adding Yinchen to Lizhong Tang have merit.
Xiao Ban Xia Tang Formula (See Tan Yin chapter)
Various jaundice with abdominal pain and vomiting indicates Shaoyang Wood evil attacking Earth. Chai Hu Tang is indicated.