《内经》发黄,分上中下三条。有谓目黄曰黄胆;有谓黄胆暴病久逆之所生者,及少阴厥阴司
天之政溽暑皆发黄胆,悉是上焦湿热也,宜用一清饮等宣发;有谓食已如饥曰胃疸,与脾风
发痹、腹中热出黄者,有脾脉搏坚而长其色黄者,《灵枢》谓脾所生病,皆中焦湿热也,栀连
茵陈汤治者;有谓溺黄赤安卧者,必黄胆,及肾脉搏坚而长其色黄,《灵枢》谓肾生病,皆下
焦湿热也,栀子柏皮汤治者。仲景根据此诸条,发明黄胆于《金匮》门,复发明发黄于《伤寒论》。
或以表邪未解,下之太早,热邪内陷而发黄;或以血蓄下焦,小腹硬满,其人如狂而发黄;
或以火劫汗,两阳相薰而发黄;或渴饮水浆,湿热浸淫而发黄。另有发汗,已热气已泄,反
发黄者,非瘀热发黄,当于寒湿中求之。然则《金匮》疸黄与伤寒热病发黄,又有分别。夫发黄
之症,通用茵陈汤,如小便不利,烦躁而渴,五苓散合茵陈二苓汤。发黄烦躁,呕而不渴,
茵陈平胃散。热重凝结有下症者,栀子大黄汤、大黄硝石汤。酒积积热喘呕而渴者,济生葛
根汤。若伤寒发黄,身热无汗,表症不解,脉浮而紧,冬月仲景用麻黄汤,今家秘用羌活防
风汤。若表解里热者,宝鉴黄连散。以上皆湿热发黄也。另有身不发热,冷汗自出,脉沉而
迟,乃太阴经阴黄也。内间有身痛亦发热者,然脉必沉迟,色必熏黄而晦,口必干,不饮
水,与阳明湿热发黄,脉数消水,色如橘黄大相异。伤寒病,遇寒水湿土司天,往往变成阴
黄。治阴黄之症,小便利者,术附汤。小便不利者,五苓散。遍身手足逆冷,冷汗自汗,茵
陈汤加姜附。脉弱气虚者,理中汤重加茵陈。以上皆阴黄也。至淤热发黄与淤血发黄,又宜
细辨。如头汗出,遍身无汗,腹微满,小便不利,渴欲饮水,为淤热发黄。若小腹硬满,小
便不利,大便或结或黑,如狂喜忘,渴不饮水,为淤血发黄,此症之分别也。淤热发黄,脉
必数大沉实;淤血发黄,脉见沉细芤结,此脉之分别也。白虎症,烦渴饮水,不发黄者,遍
身多汗,湿热发泄。若但头汗,身上汗少,邪热不得外泄,故发黄。余按发黄症,惟阳明太
阴脾胃二经者多。以黄色属土,土中湿热,则发黄色。至阴黄,乃内伤寒湿症也。
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,阳气内陷,若不
结胸,但头汗出,小便不利,身必发黄。
脉浮动数之表症,反下之,热邪内陷,应变结胸。若不结胸,但头有汗,小便不利,瘀热
无从出路,身必黄。详注头汗、结胸。
太阳病,身黄,脉沉结,小腹硬,小便自利,其人如狂者,血也,抵当汤。
太阳病身黄,脉当数大。今沉结,小腹硬实,如狂,小便自利,此非热结膀胱,的是蓄血发黄。
太阳中风,以火劫汗,邪风被火热,血气流溢,两阳相薰灼,其身发黄。阳盛欲衄,阴虚小
便难,阴阳俱虚,身体枯燥,但头汗出。
中风乃阳邪,以火劫汗,两阳相薰灼而身发黄。火伤上,阳分热盛,故欲衄;火伤下,阴
分受热,故小便难。气血两伤,则津液竭,血燥而身体枯燥。详注头汗。
若发汗已身灼热者,名风温。脉阴阳俱浮,自汗身重,多眠睡,鼻必鼾,语言难出,若被火
者,微发黄色。
风温,即春令发热,不恶寒而渴之温病,复以火劫汗,必发黄。
阳明病,发热汗出者,此为热越,不能发黄。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,身黄如橘子色,小便不利,腹微满者,茵陈蒿汤。
阳明发热,本汗出。今头上出,余处无汗,则热邪不得外解,且渴饮水浆,小便不利,则
湿热不得下泄而身黄。又云伤寒七八日,身黄如橘色,小便不利,腹微满,亦是湿热发
黄,故二条同欲茵陈汤。
阳明病,无汗,小便不利,心中懊 ,身必发黄。
阳明之热,外不得汗解,内不得小便泄,故懊 身黄。虽不立方,然栀子豆豉加茵陈症也。
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,耳前后肿,刺之瘥。病过十日,脉续浮者,与小柴胡汤;脉但浮无余
症者,与麻黄汤;若不屎,腹满加哕者,不治。
此条详注呃逆。
阳明病,面合赤色,不可攻。必发热色黄者,小便不利也。
阳明病,合面皆赤色,此表症不可攻。若误攻之,则表汗不出,必见黄色,淤热内结,而
小便不利也。
阳明病,被火,额上微汗,小便不利者,必发黄。
阳明病,畏火,今反以火熏灼,上攻头额,止得额上微汗,则热邪外不得汗泄,下不得便
出,而必发黄。此条不立方,然猪苓茵陈汤症也。
伤寒发汗已,身目为黄。所以然者,以寒湿在里不解故也。不可下,于寒湿中求之。
伤寒汗不得出发黄,今发汗已,身目反黄,此非淤热,乃阴黄病,当于寒湿门求治。
一清饮
柴胡 赤茯苓 桑白皮 黄芩 川芎 甘草
治发黄症,一惟清湿热,故以柴胡、川芎清表邪;桑白皮、黄芩清肺气;赤茯苓清小便。
栀连茵陈汤
栀子 川连 茵陈
一清饮,双解表里湿热者。此方清在里湿热者,故曰湿热内结,分利甚捷。
栀子柏皮汤
栀子 柏皮 甘草
湿热在表,用一清饮;湿热在里,用栀连茵陈汤;湿热在下焦,故以山栀、黄柏佐甘草,
缓肝急而专施泄。
茵陈汤
茵陈 栀子 大黄
湿热症,宜利小便。仲景妙在大黄与茵陈同用,则大黄不出大便,随茵陈、山栀迳从膀胱
而出。故曰当验其黄从小便而出,色如皂荚汁是也。
五苓散
猪苓 白茯苓 白术 泽泻 桂枝 茵陈
五苓散,止利水湿,今加茵陈,并利湿热矣。
茵陈二苓汤
茵陈 栀子 大黄 茯苓 猪苓
茵陈山栀大黄汤,仲景使黄从小便而出。后人善体仲景,故用二苓,专走小便。
茵陈平胃散 即平胃散加茵陈一味。
食滞发黄,名谷疸,故以平胃散散湿热,加茵陈则清热散黄。若食重不消,加白豆蔻、莱
菔子、神曲、枳实。
栀子大黄汤
栀子 豆豉 枳实 大黄 茵陈
仲景治懊 ,用栀子豆豉汤;治心下热痛,用大黄、枳实。今以懊 又兼心下热痛,故以
四味合治。今家秘加入茵陈者,以其散湿热,能治黄耳。
济生葛根汤
葛根 栀子 豆豉 枳实 甘草
酒湿之热,积于肠胃,必发黄发热,此方以栀子豆豉汤,加枳实、干葛,则宣发阳明湿
热,从表而散。
羌活防风汤
羌活 防风 白芷 苍术 川芎 甘草
风湿伤太阳,发热发黄,脉浮无汗,仲景用麻黄汤。后人恐南方辛热,故以此方代之。
宝鉴黄连散
黄连 黄芩 大黄 甘草
湿热在表发黄,用前方散;表湿热在里发黄,又当用此方。加生甘草泻心火,制苦寒。
金匮大黄硝石汤
大黄 黄柏 硝石 栀子
同一清热治黄,前方栀子大黄汤加豆豉、枳实,治懊 热结在上者;此方加黄柏、硝石,
治热结在下者。盖大黄得硝石则直走大肠。茵陈大黄汤内无枳实,如调胃承气。栀子大黄
汤加枳实,如小承气。大黄硝石汤,如大承气汤。立此三法,无太过不及。
术附汤
熟附子 白术
阴症发黄,皆是太阴寒湿,此方补土中之火。
《黄帝内经》中关于发黄的论述,分为上、中、下三焦三条。有一种说法认为眼睛发黄称为黄疸;还有一种说法认为黄疸是由于暴病或久病气逆所产生,以及少阴、厥阴司天之时,遇到潮湿暑热的气候也会发生黄疸,这些都属于上焦湿热证,适宜使用一清饮等方剂来宣散透发;另一种说法认为进食后感觉像饥饿一样(但又不想吃)称为胃疸,还有脾风导致肢体麻木、腹中发热且排出黄色粪便的情况,以及脾脉搏动坚实而长、面色发黄的情况,《灵枢》称之为脾脏所生的疾病,这些都属于中焦湿热证,适宜用栀连茵陈汤治疗;还有一种说法认为小便黄赤、嗜睡的人,必定会患黄疸,以及肾脉搏动坚实而长、面色发黄,《灵枢》称之为肾脏所生的疾病,这些都属于下焦湿热证,适宜用栀子柏皮汤治疗。张仲景依据上述诸条,在《金匮要略》中阐明了黄疸的病症,又在《伤寒论》中阐明了发黄的病症。有的因为表邪未解,过早使用泻下法,导致热邪内陷而发黄;有的因为瘀血蓄积在下焦,小腹硬满,患者神志如狂而发黄;有的因为用火法强迫发汗,两阳(风邪与火邪)相互熏灼而发黄;有的因为口渴饮水过多,湿热浸淫体内而发黄。另外,有的虽然已经发汗,热气已泄,反而发黄的,这不是瘀热发黄,应当在寒湿证中寻找原因。既然如此,《金匮要略》中的疸黄与《伤寒论》中的热病发黄,又有区别。对于发黄的病症,通用茵陈汤;如果小便不利,烦躁且口渴,用五苓散合茵陈二苓汤;如果发黄伴烦躁、呕吐但不口渴,用茵陈平胃散;如果热重凝结且有里实证的,用栀子大黄汤、大黄硝石汤;如果是酒积蕴热,伴有气喘、呕吐和口渴的,用济生葛根汤。如果是伤寒发黄,身体发热无汗,表证未解,脉象浮紧,冬季张仲景使用麻黄汤,现在各家秘传使用羌活防风汤。如果表证已解而里热盛的,用宝鉴黄连散。以上这些都是湿热发黄。另外有身体不发热,冷汗自出,脉象沉迟的,这是太阴经的阴黄证。其中间或有身体疼痛也发热的,但脉象必然沉迟,肤色必然熏黄而晦暗,口必然干燥但不想喝水,这与阳明湿热发黄(脉数、消渴、色如橘黄)大不相同。伤寒病,如果遇到寒水湿土司天的年份,往往变成阴黄。治疗阴黄证,如果小便通利的,用术附汤;如果小便不利的,用五苓散;如果遍身手足逆冷,冷汗自出的,用茵陈汤加干姜、附子;如果脉弱气虚的,用理中汤重加茵陈。以上都是阴黄证。至于瘀热发黄与瘀血发黄,又需要仔细辨别。如头部出汗,遍身无汗,腹部微满,小便不利,口渴想喝水,这是瘀热发黄。如果小腹硬满,小便不利,大便或者干结或者黑色,神志如狂或健忘,口渴但不想喝水,这是瘀血发黄,这是症状上的区别。瘀热发黄的脉象必然数大沉实;瘀血发黄的脉象见沉细芤结,这是脉象上的区别。白虎汤证,烦渴饮水,不发黄的,是因为遍身多汗,湿热得以发泄。如果只是头部出汗,身上汗少,邪热不能向外发泄,所以发黄。我按:发黄的病症,多见于阳明、太阴脾胃二经。因为黄色属土,土中湿热,则发黄色。至于阴黄,乃是内伤寒湿证。
太阳病,脉象浮动数,头痛发热,微微盗汗,反而恶寒,说明表证未解。医生反而使用泻下法,阳气内陷,如果不形成结胸证,只是头部出汗,小便不利,身体必定发黄。
脉象浮动数的表证,反而被泻下,热邪内陷,应当转变为结胸证。如果不形成结胸证,只是头部有汗,小便不利,瘀热没有出路,身体必定发黄。详细注释头汗、结胸。
太阳病,身体发黄,脉象沉结,小腹硬,小便自利,患者神志如狂的,是蓄血证,用抵当汤。
太阳病身体发黄,脉象应当数大。现在脉象沉结,小腹硬实,神志如狂,小便自利,这并非热结膀胱,确实是蓄血发黄。
太阳中风,用火法强迫发汗,邪风被火热之气侵袭,气血流溢,两阳相互熏灼,身体发黄。阳气盛欲致鼻衄,阴虚导致小便困难,阴阳俱虚,身体枯燥,只有头部出汗。
中风乃阳邪,用火法强迫发汗,两阳相互熏灼而身体发黄。火邪伤上,阳分热盛,所以欲致鼻衄;火邪伤下,阴分受热,所以小便困难。气血两伤,则津液枯竭,血燥而身体枯燥。详细注释头汗。
如果发汗后身体灼热的,名为风温。脉象寸关尺俱浮,自汗身体沉重,多眠睡,鼻子必然打鼾,语言难出,如果被火法治疗的,轻微发黄。
风温,即春季发热,不恶寒而口渴的温病,如果再被火法强迫发汗,必定发黄。
阳明病,发热汗出的,这叫热邪外越,不能发黄。只有头部出汗,小便不利,口渴饮水浆,这是瘀热在里,身体必定发黄,用茵陈蒿汤。伤寒七八日,身体黄如橘子色,小便不利,腹部微满的,用茵陈蒿汤。
阳明发热,本来应该汗出。现在只有头上出汗,其余地方无汗,则热邪不能向外解除,况且口渴饮水浆,小便不利,则湿热不能向下排泄而身体发黄。又说伤寒七八日,身体黄如橘色,小便不利,腹部微满,也是湿热发黄,所以这两条都想要茵陈汤。
阳明之热,向外不能通过汗解,向内不能通过小便泄,所以懊恼身黄。虽然没有列出方剂,但这属于栀子豆豉加茵陈的证候。
阳明中风,脉象弦浮大,短气腹满,胁下及心痛,鼻子干燥不得汗。嗜卧,全身及面目都黄,小便难,有潮热时时呃逆,耳前后肿胀,针刺后可好转。病过十日,脉象继续浮的,给小柴胡汤;脉象只浮没有其他症状的,给麻黄汤;如果不排便,腹满加重呃逆的,不治。
此条详细注释呃逆。
阳明病,满面皆红,这是表证不可攻下。如果误攻,则表汗不出,必定出现黄色,瘀热内结,而小便不利。
阳明病,畏火,现在反而用火熏灼,热气上攻头额,只得额头微汗,则热邪向外不能通过汗泄,向下不能从小便出,而必定发黄。此条不列方剂,但这属于猪苓茵陈汤的证候。
伤寒发汗后,身体眼睛发黄。之所以这样,是因为寒湿在里不解的缘故。不可泻下,应当在寒湿证中寻求治疗方法。
伤寒汗不得出发黄,现在发汗后,身体眼睛反而黄,这不是瘀热,乃是阴黄病,应当在寒湿门中求治。
一清饮
柴胡 赤茯苓 桑白皮 黄芩 川芎 甘草
治疗发黄症,一概清除湿热,所以用柴胡、川芎清解表邪;桑白皮、黄芩清肺气;赤茯苓清利小便。
栀连茵陈汤
栀子 川连 茵陈
一清饮,双解表里湿热者。此方清除在里湿热者,所以说湿热内结,分利非常快捷。
栀子柏皮汤
栀子 柏皮 甘草
湿热在表,用一清饮;湿热在里,用栀连茵陈汤;湿热在下焦,所以用山栀、黄柏佐以甘草,缓和肝急而专门施泄。
茵陈汤
茵陈 栀子 大黄
湿热症,宜利小便。张仲景的妙处在于大黄与茵陈同用,则大黄不通过大便排出,而是随着茵陈、山栀直接从膀胱而出。所以说应当验证黄色从小便而出,颜色像皂荚汁那样。
五苓散
猪苓 白茯苓 白术 泽泻 桂枝 茵陈
五苓散,只利水湿,现在加上茵陈,并利湿热了。
茵陈二苓汤
茵陈 栀子 大黄 茯苓 猪苓
茵陈山栀大黄汤,张仲景使黄色从小便而出。后人善于体会张仲景的心意,所以用二苓,专门走小便。
茵陈平胃散 即平胃散加茵陈一味。
食滞发黄,名叫谷疸,所以用平胃散散湿热,加茵陈则清热散黄。如果食重不消,加白豆蔻、莱菔子、神曲、枳实。
栀子大黄汤
栀子 豆豉 枳实 大黄 茵陈
张仲景治疗懊恼,用栀子豆豉汤;治疗心下热痛,用大黄、枳实。现在因为懊恼又兼心下热痛,所以用四味合治。现在家秘加入茵陈的,是因为它能散湿热,能治黄。
济生葛根汤
葛根 栀子 豆豉 枳实 甘草
酒湿之热,积于肠胃,必定发黄发热,此方用栀子豆豉汤,加枳实、干葛,则宣发阳明湿热,从表而散。
羌活防风汤
羌活 防风 白芷 苍术 川芎 甘草
风湿伤太阳,发热发黄,脉浮无汗,张仲景用麻黄汤。后人恐怕南方辛热,所以以此方代替。
宝鉴黄连散
黄连 黄芩 大黄 甘草
湿热在表发黄,用前方散;表湿热在里发黄,又应当用此方。加生甘草泻心火,制约苦寒。
金匮大黄硝石汤
大黄 黄柏 硝石 栀子
同一清热治黄,前方栀子大黄汤加豆豉、枳实,治疗懊恼热结在上者;此方加黄柏、硝石,治疗热结在下者。盖大黄得硝石则直走大肠。茵陈大黄汤内无枳实,如同调胃承气汤。栀子大黄汤加枳实,如同小承气汤。大黄硝石汤,如同大承气汤。立此三法,无太过不及。
In the *Huangdi Neijing* (Yellow Emperor's Inner Canon), jaundice is categorized into three sections based on the Upper, Middle, and Lower Jiao. One view states that yellowing of the eyes is called "Huangdan" (Jaundice). Another view suggests that Huangdan arises from acute illness or chronic qi rebellion, and occurs during the reigns of Shaoyin and Jueyin when damp-heat weather prevails; these are all attributed to damp-heat in the Upper Jiao, suitable for treatment with formulas like Yiqing Yin to ventilate and disperse. A third view describes "Weijian" (Stomach Jaundice) as a sensation of hunger after eating, along with symptoms such as numbness from Pi Wind, abdominal heat with yellow stool, and a Spleen pulse that is firm and long with a yellow complexion; the *Lingshu* classifies these as diseases of the Spleen, representing damp-heat in the Middle Jiao, treatable with Zhilian Yinchenshao Tang. Another perspective notes that dark yellow urine combined with lethargy indicates impending jaundice, and a Kidney pulse that is firm and long with a yellow complexion signifies Kidney disease per the *Lingshu*; these represent damp-heat in the Lower Jiao, treatable with Zhizi Baipi Tang. Zhang Zhongjing, based on these passages, elucidated jaundice in the *Jingui Yaolue* and further elaborated on jaundice manifestations in the *Shanghan Lun*. Jaundice may arise if exterior pathogens remain unresolved and purgatives are used too early, causing heat to sink inward; or due to blood stasis accumulating in the Lower Jiao, presenting with hardness and fullness in the lower abdomen and manic behavior; or from forced sweating via fire therapy, where wind and fire mutually scorch the body; or from excessive water intake leading to damp-heat infiltration. Conversely, if jaundice appears after sweating has already occurred and heat has dissipated, it is not due to stagnant heat but should be sought within cold-damp patterns. Thus, jaundice in the *Jingui Yaolue* differs from heat-induced jaundice in the *Shanghan Lun*. Generally, Yinchenshao Tang is used for jaundice; if accompanied by difficult urination, irritability, and thirst, Wuling San combined with Er Ling Yinchen Tang is indicated; for jaundice with irritability, vomiting, but no thirst, Yinchen Pingwei San is used; for severe heat with condensation and excess signs, Zhizi Dahuang Tang or Dahuang Xiaoshi Tang are appropriate; for alcohol accumulation with heat, wheezing, vomiting, and thirst, Jisheng Gegen Tang is employed. For Shanghan jaundice with fever, anhidrosis, unresolved exterior signs, and a floating-tight pulse, Zhang Zhongjing used Mahuang Tang in winter, while modern practitioners often use Qianghuo Fangfeng Tang. If the exterior is resolved but interior heat persists, Baojian Huanglian San is used. These all address damp-heat jaundice. Alternatively, non-feverish jaundice with spontaneous cold sweat and a deep-slow pulse indicates Yin Jaundice of the Taiyin channel. Although some cases present with body pain and fever, the pulse remains deep-slow, the complexion is dull yellow, and there is dry mouth without desire to drink, distinguishing it significantly from Yangming damp-heat jaundice (rapid pulse, polydipsia, orange-yellow hue). During years governed by Cold-Water-Damp-Earth, Shanghan often transforms into Yin Jaundice. Treatment for Yin Jaundice: if urination is free, Shu Fu Tang is used; if urination is difficult, Wuling San is used; for cold extremities and spontaneous cold sweat, Yinchenshao Tang with Ginger and Aconite is prescribed; for weak pulse and Qi deficiency, Lizhong Tang with heavy doses of Yinchenshao is used. These constitute Yin Jaundice patterns. Differentiation between Stagnant Heat Jaundice and Blood Stasis Jaundice is crucial. Head sweating only, with no body sweat, slight abdominal fullness, difficult urination, and thirst for water indicate Stagnant Heat Jaundice. Hardness/fullness in the lower abdomen, difficult urination, constipation or black stools, manic behavior or forgetfulness, and thirst without desire to drink indicate Blood Stasis Jaundice. Pulse differentiation: Stagnant Heat presents with rapid, large, deep, and solid pulses; Blood Stasis presents with deep, fine, hollow, or knotted pulses. Baihu Tang syndrome involves thirst and polydipsia without jaundice because profuse sweating allows damp-heat to vent. If only the head sweats and the body remains dry, heat cannot escape externally, resulting in jaundice. In my analysis, jaundice most commonly affects the Yangming and Taiyin Spleen-Stomach meridians, as yellow corresponds to Earth, and damp-heat in Earth manifests as yellowing. Yin Jaundice stems from internal Cold-Damp.
Taiyang Disease, characterized by a floating-numerous pulse, headache, fever, slight nocturnal sweating, and aversion to cold, indicates unresolved exterior pathology. If a physician erroneously applies purgation, Yang Qi sinks inward. If this does not result in Jie Xiong (Chest Binding), but rather head sweating and difficult urination, jaundice will inevitably develop.
A floating-numerous exterior pulse subjected to purgation causes heat to sink inward, typically transforming into Jie Xiong. If Jie Xiong does not form, but head sweating and difficult urination persist, stagnant heat lacks an exit route, inevitably causing jaundice. See detailed notes on head sweating and Jie Xiong.
Taiyang Disease presenting with jaundice, a deep-knotted pulse, hard lower abdomen, free urination, and manic behavior indicates Blood Stasis, treated with Didang Tang.
In Taiyang Disease with jaundice, the pulse should typically be rapid and large. A deep-knotted pulse, hard lower abdomen, manic behavior, and free urination confirm Blood Stasis Jaundice rather than Heat Binding in the Bladder.
Taiyang Wind Strike treated with fire-induced sweating causes wind pathogens to merge with fire, agitating Qi and Blood. The mutual scorching of two Yang forces leads to jaundice. Excess Yang may cause epistaxis; Yin deficiency leads to difficult urination. With both Yin and Yang depleted, fluids exhaust, blood dries, and the body becomes emaciated, manifesting only as head sweating.
Wind Strike is a Yang pathogen; fire-induced sweating merges two Yangs, causing jaundice. Fire injuring the upper Jiao creates excess Yang heat, predisposing to epistaxis; fire injuring the lower Jiao heats Yin fluids, causing difficult urination. Damage to both Qi and Blood exhausts Jingye, drying blood and causing physical emaciation. See detailed notes on head sweating.
If sweating results in burning heat, it is named Fengwen (Wind Warmth). Pulses are floating at all positions, with spontaneous sweating, heavy body, somnolence, nasal snoring, and difficulty speaking. If treated with fire, mild jaundice may occur.
Fengwen refers to spring febrile diseases with fever, no aversion to cold, and thirst. Repeated fire-induced sweating guarantees jaundice.
Yangming Disease with fever and sweating indicates heat venting outward, preventing jaundice. However, if only the head sweats, urination is difficult, and there is thirst for fluids, stagnant heat resides in the interior, causing jaundice, treated with Yinchenshao Tang. In Shanghan lasting seven to eight days, jaundice resembling orange peel color, with difficult urination and slight abdominal fullness, is also treated with Yinchenshao Tang.
Yangming fever usually involves sweating. If only the head sweats while the body remains dry, heat cannot resolve externally. Combined with thirst and difficult urination, damp-heat cannot drain downward, causing jaundice. The mention of seven-to-eight-day Shanghan with orange-yellow jaundice, difficult urination, and abdominal fullness also indicates damp-heat jaundice; hence both scenarios warrant Yinchenshao Tang.
Yangming Disease with anhidrosis, difficult urination, and mental restlessness (Ao Nao) inevitably leads to jaundice.
Yangming heat cannot resolve via sweat or urination, causing mental restlessness and jaundice. Although no formula is listed, this corresponds to Zhizi Chidou Chi Tang added with Yinchenshao.
Yangming Wind Strike presents with a string-taut-floating-large pulse, shortness of breath, abdominal fullness, hypochondriac and cardiac pain, dry nose, anhidrosis, somnolence, generalized and facial jaundice, difficult urination, tidal fever, occasional hiccups, and swelling around the ears. Acupuncture alleviates these. If symptoms persist beyond ten days with a continuing floating pulse, Xiao Chaihu Tang is given; if only floating pulse without other symptoms, Mahuang Tang is given; if constipation worsens abdominal fullness with hiccups, the condition is incurable.
This passage details hiccups.
Yangming Disease with a completely red face should not be purged. Erroneous purgation will cause fever and yellowing due to difficult urination.
A red face in Yangming Disease indicates an exterior pattern unsuitable for purgation. Mistaken purgation prevents exterior sweating, leading to yellowing as stagnant heat binds internally and urination becomes difficult.
Yangming Disease treated with fire therapy, resulting in slight forehead sweating and difficult urination, inevitably causes jaundice.
Yangming patients fear fire; applying fire moxibustion drives heat upward to the forehead, allowing only slight sweating there. Heat cannot vent externally via sweat nor exit downward via urination, causing jaundice. No formula is listed, but this fits Zhuling Yinchenshao Tang.
After Shanghan sweating, if the body and eyes turn yellow, it is because Cold-Damp lingers in the interior unresolved. Purgation is contraindicated; treatment must seek resolution within Cold-Damp patterns.
Shanghan should not cause jaundice through sweating. If jaundice appears post-sweating, it is not Stagnant Heat but Yin Jaundice, requiring treatment within the Cold-Damp category.
Yiqing Yin
Chai Hu, Chi Fu Ling, Sang Bai Pi, Huang Qin, Chuan Xiong, Gan Cao.
To treat jaundice by clearing damp-heat, Chai Hu and Chuan Xiong clear exterior pathogens; Sang Bai Pi and Huang Qin clear Lung Qi; Chi Fu Ling clears the bladder.
Zhilian Yinchenshao Tang
Zhi Zi, Chuan Lian, Yin Chen.
Yiqing Yin resolves both exterior and interior damp-heat. This formula targets interior damp-heat, offering rapid separation and drainage.
Zhizi Baipi Tang
Zhi Zi, Bo Pi, Gan Cao.
For exterior damp-heat, use Yiqing Yin; for interior damp-heat, use Zhilian Yinchenshao Tang; for Lower Jiao damp-heat, Zhi Zi and Huang Bo assist Gan Cao to soothe Liver urgency and promote drainage.
Yinchenshao Tang
Yin Chen, Zhi Zi, Da Huang.
For damp-heat, promoting urination is key. Zhang Zhongjing’s brilliance lies in combining Da Huang with Yin Chen, directing Da Huang not through the bowels but alongside Yin Chen and Zhi Zi out through the bladder. The cure is verified when yellow urine resembles soapberry juice.
Wuling San
Zhu Ling, Bai Fu Ling, Bai Zhu, Ze Xie, Gui Zhi, Yin Chen.
Wuling San drains water-dampness; adding Yin Chen addresses damp-heat.
Er Ling Yinchen Tang
Yin Chen, Zhi Zi, Da Huang, Fu Ling, Zhu Ling.
While Zhang Zhongjing’s Yinchenshao Tang directs yellowing out via urine, later practitioners refined this by using Er Ling (Fu Ling and Zhu Ling) to specifically target urination.
Yinchenshao Pingwei San
Pingwei San plus one ingredient: Yin Chen.
Food stagnation jaundice, known as Gu Dan (Grain Jaundice), is treated with Pingwei San to scatter damp-heat; adding Yin Chen clears heat and disperses yellowing. For severe indigestion, add Bai Dou Kou, Lai Fu Zi, Shen Qu, and Zhi Shi.
Zhizi Dahuang Tang
Zhi Zi, Dou Chi, Zhi Shi, Da Huang, Yin Chen.
Zhang Zhongjing used Zhizi Chidou Chi Tang for Ao Nao (mental restlessness) and Da Huang/Zhi Shi for epigastric heat/pain. Combining these four treats concurrent Ao Nao and epigastric heat. Adding Yin Chen helps scatter damp-heat and treat jaundice.
Jisheng Gegen Tang
Ge Gen, Zhi Zi, Dou Chi, Zhi Shi, Gan Cao.
Alcohol-damp heat accumulating in the intestines/stomach causes jaundice and fever. This formula uses Zhizi Chidou Chi Tang plus Zhi Shi and Ge Gen to vent Yangming damp-heat from the exterior.
Qianghuo Fangfeng Tang
Qiang Huo, Fang Feng, Bai Zhi, Cang Zhu, Chuan Xiong, Gan Cao.
For Wind-Damp attacking Taiyang with fever, jaundice, floating pulse, and anhidrosis, Zhang Zhongjing used Mahuang Tang. Later practitioners substituted this formula to avoid overly acrid-hot herbs in southern regions.
Baojian Huanglian San
Huang Lian, Huang Qin, Da Huang, Gan Cao.
For exterior damp-heat jaundice, use the previous dispersing formula; for interior damp-heat jaundice, use this formula. Raw Gan Cao clears Heart fire and moderates bitter-cold properties.
Jingui Dahuang Xiaoshi Tang
Da Huang, Huang Bo, Xiao Shi, Zhi Zi.
Both formulas clear heat for jaundice. Zhizi Dahuang Tang with Dou Chi and Zhi Shi treats upper Jiao heat binding with Ao Nao; this formula with Huang Bo and Xiao Shi treats lower Jiao heat binding. Da Huang combined with Xiao Shi moves directly to the Large Intestine. Yinchenshao Tang without Zhi Shi resembles Tiaowei Chengqi Tang; Zhizi Dahuang Tang with Zhi Shi resembles Xiao Chengqi Tang; Dahuang Xiaoshi Tang resembles Da Chengqi Tang. These three methods ensure balance without excess or deficiency.
Shu Fu Tang
Shu Fu Zi, Bai Zhu.
Yin syndrome jaundice stems from Taiyin Cold-Damp. This formula tonifies Fire within Earth.