(Wang Shuhe's Yangming Chapter: Haizang stated that a yellow complexion resembling smoke indicates dampness disease, accompanied by pain throughout the body. A yellow complexion resembling orange peel indicates jaundice disease, without pain throughout the body.)

Cheng Wuji commented: When damp-heat is excessive, the body turns yellow. In Shanghan (Cold Damage), the progression to jaundice indicates a severe condition. The combination of pathogenic wind and fire therapy causes two yang pathogens to scorch each other, inevitably leading to yellowing of the body. In Yangming disease, if treated with fire therapy, sweating on the forehead combined with difficulty in urination will certainly cause jaundice. These cases all result from internal heat exacerbated by fire therapy. In Yangming disease, absence of sweating, difficulty in urination, and mental restlessness (Ao Nao) certainly lead to jaundice due to excessive Yangming heat. After sweating treatment for Shanghan, if the body and eyes turn yellow, it is because cold-dampness remains unresolved internally. This condition should not be treated with purgatives; instead, one should seek methods suitable for cold-dampness. Thus, it is known that not only damp-heat but also cold-dampness can cause jaundice. However, jaundice caused by cold-dampness appears dark and dull like smoke, whereas jaundice caused by excess heat appears bright orange, with heat radiating out enough to stain clothes, resembling the color of cypress bark. Generally, jaundice diseases are associated with the Taiyin channel. Taiyin disease leads to jaundice due to steaming by damp-heat, as stated in the classics: "Taiyin should manifest as body jaundice." If the pulse is deep and knotted, the lower abdomen is hard, urination is spontaneous, and the patient exhibits mania, this is jaundice caused by blood stasis in the Lower Jiao. Jaundice accompanied by a faint pulse at the Cun position near the palm, cold breath from the nose, is an untreatable condition. Similarly, a body appearance like smoke, fixed gaze, and shaking head indicate Heart Qi exhaustion; blackening around the mouth, soft sweating, and jaundice indicate Spleen Qi exhaustion. All these are untreatable conditions.

Taiyin Disease: Body jaundice, pulse deep and knotted, lower abdomen hard, spontaneous urination, and mania indicate blood stasis; treat with Didang Tang (see Blood Stasis chapter). Six or seven days after onset, with a slow, floating, weak pulse, aversion to wind and cold, and warm hands and feet, if the physician repeatedly uses purgatives, leading to inability to eat, fullness and pain in the hypochondrium, neck stiffness, difficulty in urination, and yellowing of the face and body, treat with Yinchen Wuling San (see Hypochondriac Pain chapter). In Taiyang disease, if the pulse is floating and rapid, with headache, fever, slight night sweats, and aversion to cold, the exterior syndrome is unresolved. If the physician incorrectly uses purgatives, disturbing the diaphragm with pathogenic qi, and if chest binding does not form but only head sweating and difficulty in uritation occur, the body will surely turn yellow; treat with Zhizi Bopi Tang (see Head Sweating chapter). In Taiyang Wind Strike, if forced sweating via fire therapy causes two yang pathogens to scorch each other, resulting in jaundice; with excess yang leading to epistaxis, yin deficiency causing difficult urination, and both yin and yang deficient leading to dryness and roughness of the body, treat with Fangji Huangqi Tang or Zhizi Bopi Tang (see Head Sweating chapter).

Zhizi Bopi Tang Formula: Zhizi (Gardeniae Fructus, 15 pods, broken), Gancao (Licorice Root, 1 liang, honey-fried), Huangbai (Phellodendron Bark, 2 liang). Boil these three ingredients in 4 sheng of water to obtain 1.5 sheng, remove dregs, and take half warm twice.

If after sweating the body feels burning hot, it is called Fengwen (Wind-Warmth). The pulse is floating in both yin and yang positions, with spontaneous sweating, heavy body, excessive sleepiness, snoring nasal breathing, and difficulty speaking. If subjected to fire therapy, slight yellowing may occur. In Taiyang disease, if sweating fails to resolve fever and aversion to cold, and purgatives are subsequently used, causing interior and exterior deficiency, followed by moxibustion leading to chest irritability, blueish face, and skin ecchymosis, the prognosis is poor. If the complexion is slightly yellow and hands and feet are warm, recovery is likely (slight yellowing here is not pathological but a sign of easy recovery).

Yangming Disease: In Shanghan, if stagnant heat is trapped inside, the body will surely turn yellow; treat with Mahuang Lianqiao Chixiaodou Tang.

Mahuang Lianqiao Chixiaodou Tang Formula: Mahuang (Ephedrae Herba, de-stemmed), Shengjiang (Zingiberis Rhizoma Recens, sliced), Lianqiao Gen (Forsythiae Radix, also known as Lian Yao), Gancao (Licorice Root, fried, 2 liang each for the first four herbs), Xingren (Prunus Armeniaca Seed, 40 seeds, soaked, skin and tips removed), Dazao (Jujubae Fructus, 12 pieces, broken), Shengzi Baipi (Broussonetiae Cortex, 1 sheng, sliced), Chixiaodou (Phaseoli Semen Rubrum, 1 sheng). Boil these eight ingredients in 1 dou of rainwater (Liao Shui). First boil Mahuang, skim off foam upon boiling, then add remaining herbs. Boil to obtain 3 sheng, remove dregs, and take warm in three doses over half a day. (The Neijing states: "For dampness rising with heat, use bitter-warm herbs assisted by sweet-acrid herbs, aiming for sweating." This applies here. Rainwater is used because its thin nature does not aid dampness.)

Yangming Disease: Fever, only head sweating, difficulty in urination, thirst for fluids, indicating stagnant heat trapped inside, will surely cause jaundice; treat with Yinchenshao Tang. In Shanghan lasting seven or eight days, if the body is yellow like Gardenia fruit, with difficulty in urination and mild abdominal fullness, treat with Yinchenshao Tang. (Cheng Wuji commented: When heat is extreme, the body turns yellow like an orange, indicating heat toxin venting outward. The Neijing states: "The Bladder is the official of the capital, storing fluids; only through qi transformation can they exit." Difficulty in urination and lower abdominal fullness indicate excessive external heat preventing fluid descent. Yinchenshao Tang promotes urination, reduces jaundice, and clears heat.)

Yinchenshao Tang Formula: Yinchenshao (Artemisiae Scopariae Herba, 6 liang), Dahuang (Rhei Radix et Rhizoma, 2 liang, peeled), Fei Zhizi (Gardeniae Fructus, 14 pods, broken). Boil these three ingredients in 1 dou of water. First boil Yinchenshao until reduced by 6 sheng, then add the other two. Boil to obtain 3 sheng, remove dregs, and take warm in three doses. Urine should resemble soy sauce juice color (dark red); after one night, abdominal fullness decreases, and jaundice exits via urine. (Cheng Wuji commented: Mild heat is harmonized with cool herbs; extreme heat is conquered with cold herbs. Jaundice represents extreme heat, requiring strong cold herbs to penetrate. Sour and bitter induce vomiting and purging (yin action). Yinchenshao and Hao (Artemisiae Argyi Folium) are sour and bitter, serving as sovereign herbs. Heart corresponds to South Fire and Heat; thus, bitter-cold Zhi Zi acts as minister herb. Acid supplements, bitter purges; Dahuang acts as assistant herb to purge evil heat. Even severe fire-toxin can be cleared, dividing output through anterior and posterior orifices, resolving the disease through bowel movement.)

Yangming Disease: Absence of sweating, difficulty in urination, and mental restlessness certainly lead to jaundice. Yangming Wind Strike presents with wiry, floating, large pulse, shortness of breath, abdominal fullness, hypochondriac and heart pain, dry nose, inability to sweat, lethargy, generalized jaundice of body and eyes, difficult urination, tidal fever, occasional hiccups, and swelling around ears. If symptoms persist beyond ten days and the pulse remains floating, administer Xiaochaihu Tang. If the pulse is only floating without other symptoms, administer Mahuang Tang. If there is no urination, abdominal fullness, and added hiccups, the condition is untreatable. Yangming disease with facial redness should not be treated with purgatives; if fever, yellowing, and difficulty in urination occur, use Zhizi Bopi Tang. Yangming disease treated with fire therapy, presenting with slight forehead sweating and difficulty in urination, will surely cause jaundice; use Wuling San or Zhizi Bopi Tang. After sweating in Shanghan, if body and eyes turn yellow, it is because cold-dampness remains unresolved internally. Purgatives are contraindicated; seek treatment within the framework of cold-dampness. (Cheng Wuji commented: Jingui Yaolue states jaundice originates from dampness. If heat leaves with sweat, jaundice does not form. Post-sweat jaundice indicates wind has left but dampness remains. Spleen dislikes dampness; internal dampness obscures Spleen color, causing jaundice. Jaundice from blood stasis can be purged, but this case involves cold-dampness, so purgatives are contraindicated; treat according to cold-dampness principles.)

Taiyin Disease: Shanghan with floating, slow pulse and warm hands/feet relates to Taiyin. Taiyin should manifest as jaundice. However, if urination is spontaneous, jaundice will not form because Spleen Qi is sufficient to expel rotting filth. (Floating-slow pulse is similar to large pulse. For difficulty in urination, use Wuling San plus Yinchenshao. For spontaneous urination, use Jupi Tang.)

Lou Quanshan commented: Upper body jaundice, spontaneous urination, hard lower abdomen, mania, and black stool indicate blood stasis; treat with Didang Tang. If lower abdomen is not hard, no mania, normal stool color despite spontaneous urination, it is not blood stasis. There are three types of such syndromes: 1. Zhizi Bopi Tang; 2. Mahuang Lianqiao Chixiaodou Tang; both treat jaundice with spontaneous urination and no body pain, referred to by Haizang as "Dry Jaundice." 3. Guizhi Fuzi Tang minus Guizhi plus Baizhu Tang; treats jaundice with spontaneous urination and whole-body pain, referred to in Huoren Shu as "Dampness Invasion."

Zhang Yuansu commented: Some say jaundice in Shanghan occurs only in Yangming and Taiyin channels, noting that spontaneous urination prevents jaundice. Why? Yellow is the proper color of Earth. Since Taiyin and Yangming belong to Earth, jaundice occurs. The mechanism is that externally, sweating is impossible; internally, urination is blocked. Earth of Spleen/Stomach is steamed by heat, causing yellow color to appear externally. If urination is free, heat does not accumulate internally, so jaundice does not form. Jaundice in other channels also results from Earth (Spleen/Stomach) receiving pathogenic influence.

Zhao Xianke commented: Differentiate between jaundice from stagnant heat and jaundice from blood stasis. Externally, signs and pulses differ. Head sweating stopping at the neck, mild abdominal fullness, difficult urination, and thirst indicate stagnant heat. Urgent lower abdomen, mania, hard lower abdomen, spontaneous urination, and black stool indicate blood stasis. Pulses also differ: blood stasis shows subtle/deep or deep-knotted pulse; stagnant heat shows floating/slippery/tight/rapid pulse. The only similarity is the yellow color. Similarity extends to other conditions: Fengwen with fire therapy causes slight yellowing; Taiyang fire-forced sweating causes yellowing; Yangming fire therapy causes forehead sweating and jaundice. These involve fire pathogens. Are there dissimilar yellows? Yes, the smoky yellow of dampness patients differs. One must distinguish based on similarities and differences.

Attached Formulas:
Wuling Yinchensan Formula: Mix Yinchen decoction with Wuling San (2 qian). Take 3-4 times daily. Jaundice exits via urine; stop when urine clears.
Jupi Tang Formula: Jupi (Citri Reticulatae Pericarpium, 1 liang), Shengjiang (Zingiberis Rhizoma Recens, 2 liang). Cut finely, boil in 1.5 sheng water to 0.7 sheng, remove dregs. Take warm in two doses. Repeat if necessary.
Yinchenshao Dahuang Tang: Treats Shanghan jaundice with generalized yellowing and red urine. Ingredients: Yinchenshao, Shanzhiren (Gardeniae Fructus), Chaihu (Bupleuri Radix), Huangbai (Phellodendri Cortex, honey-fried), Longdancao (Gentianae Radix, 0.5 liang each), Huangqin (Scutellariae Radix, cleaned), Shengma (Cimicifugae Rhizoma), Dahuang (Rhei Radix et Rhizoma, stir-fried, 1 liang each). Chop coarsely. Take 5 qian per dose, boil in 1.5 sheng water to 1 sheng. Strain and take warm after meals morning and evening.
Maogen Tang: Treats Shanghan jaundice with golden-yellow body. Maogen (Imperatae Rhizoma, washed and chopped), Shanzhiren, Yinchenshao, Digupi (Lycii Cortex, 0.5 liang each). Chop coarsely. Take 5 qian per dose with 1.5 sheng water, 3 slices of ginger, 6-7 grains of Douchi (Sojae Semen Praeparatum). Boil to 1 sheng. Strain and take warm long after meals.

Attached: Yin Jaundice
Cold limbs, sweating, deep pulse, and yellow complexion indicate Yin Jaundice, caused by dampness in Taiyin channel. Some present with body pain and fever, appearing smoky-yellow, distinct from Yang Jaundice's bright orange hue. Determine urination status. Spontaneous urination: Zhufu Tang. Difficult urination with loose stools: Wuling San.

Haizang commented: In Shanghan, during Taiyang or Taiyin ruling periods, excessive purgation often transforms into Yin Jaundice. Reasons: 1. Excessive Cold Water attacks Earth; 2. Weak Earth allows Water invasion. Treatments: 1. Yinchenshenling Tang plus Danggui, Guizhi; 2. Yinchenchupi Tang plus Jiang, Baizhu, Banxia; 3. Yinchenshuzi Tang; 4. Yinchensini Tang; 5. Yinchenshengfu Tang; 6. Yinchenswuzhuyu Tang. Details below: Jaundice with difficult urination, irritability, and thirst: Yinchenshao Tang plus Fuling, Zhuling, Huashi, Danggui, Guigui (Han Shi name: Yinchenshenling Tang). Jaundice with irritability, wheezing, vomiting, no thirst: Yinchenshao Tang plus Chenpi, Baizhu, Shengjiang, Banxia, Fuling (Han Shi name: Yinchenchupi Tang). Jaundice with cold limbs/body: Yinchenshao Tang plus Fuzi, Gancao (Han Shi name: Yinchenshuzi Tang). Jaundice with cold extremities and waist sweating: Yinchenshao Tang plus Fuzi, Ganjiang, Gancao (Han Shi name: Yinchenshengfu Tang). Jaundice with continuous cold sweat: Yinchenshao Tang plus Fuzi, Ganjiang (Han Shi name: Yinchenshengfu Tang). Jaundice unresponsive to previous ginger/aconite formulas with slow pulse: Yinchenshao plus Wuzhuyu, Fuzi, Ganjiang, Mutong, Danggui (Han Shi name: Yinchenswuzhuyu Tang). Case: Zhao Zongyan developed jaundice from excessive purgation, with deep, fine, slow, weak pulse. Sequentially administered formulas up to Yinchenshuzi Tang with great effect. Zhao Xiucai developed jaundice with superficially weak and deeply weak pulse, cold body. Sequentially administered up to Yinchensini Tang with great effect. Cold damage with weak pulse and Qi deficiency transforming into Yin Jaundice: Zhang Zhongjing's Lizhong Tang plus Yinchenshao.

Haizang commented: Alternating chills and fever with generalized jaundice: Xiao Chaihu Tang plus Zhizi.

Yanyi Commentary: A monk with Shanghan had incomplete sweating, leaving residual heat causing yellow face/body and fever for a year. Misdiagnosed as food stagnation. After confirming diet was normal, prescribed: Yinchenshao, Zhizi (3 fen each), Qinjiao, Shengma (4 qian each). Powdered. Take 3 qian with 4 he of water, boiled to 2 he. Strain and take warm after meals until cured.

Huoren Commentary: Wuling San plus Yinchenshao Tang: Treats jaundice with thirst and difficult urination. Yinchenshao Tang (10 parts), Wuling Tang (5 parts). Mix well. Take 3 qian 3 times daily with water.
Another Method: For impending jaundice in Shanghan, urgently insert Guoti powder (1 zi) into nostrils with water in mouth to discharge yellow fluid. Then take Yinchenshao Tang mixed with Wuling San. Effective.

Bencao Commentary: Treats head damp-heat jaundice with Dan Guoti San. Guoti (20 pieces), Chixiaodou, Shumi (14 grains each). Powder finely. Insert one grain-sized amount into nostril; yellow fluid should discharge. Do not blow powder in.

Yunqi Commentary: Chest-binding jaundice attaches to Taiyang (treat as chest binding). Pi-energy jaundice attaches to Taiyin (treat as pi syndrome).

Huoren Q&A: Question: Baihu Syndrome has fever, thirst, drinking preference, and difficult urination, why no jaundice? Answer: Baihu and Jaundice are similar. Generalized sweating indicates heat venting (Baihu). Head/facial sweating only, no sweat below neck, indicates Jaundice.