瘅者热也。黄胆俱因正气不宣郁而生。黄有如遏酱相似。其症有五。条分
缕析。脉症始得而详明也。一曰湿热发黄。小便如栀。染衣成黄。而面目身体之黄。不待言矣。此因茶酒汤水。
聚而不散。郁成壮火。故成此症。但有热多湿少者。有湿多热少者。有湿热全无者。不可以不辨也。热多
湿少者。脉来弦数。黄中带亮。宜用茵陈柴苓汤。若渴而饮水者。宜用柴胡芍药汤。加茵陈。泽泻。乃得三
焦气化行。津液通。渴解而黄退。金匮云。疸而渴者难治。虑其津液枯竭。初非不治之症也。湿多热少者。
脉来沉细而缓。其色黄而晦。宜用茵陈四苓汤。若大便自利。上气喘急。宜加参术。不可误用寒凉。伤
损脾气。至于湿热全无者。既无血食酒汗之症。又无黄赤小便。但见身黄倦怠。肢体无力。虚阳上泛为黄也。
宜用加减八物汤。今医治此。概用五苓套剂。岂能愈乎。
谷疸者。饮食郁结。正气不行。抑而成黄。其症胸膈不宽。四肢无力。身面俱黄。脉来洪滑者。症属于阳。合用二
陈消食之剂。但火热郁结。遏生苔衣。干涩难下。今人动用苍朴燥剂。但治其食。不治其热。疸之一字。置于何所。无
怪乎治之不痊也。更有粗工。专用针砂绿矾等药。不思积滞虽去。津液随亡。大失治疸之体。惟用养血健脾汤。大有殊
功。脉沉细缓者。症属于阴。其人四肢青冷。大便时溏。宜用香砂理中汤。加炮姜肉桂之类。不可概以热治也。然谷疸
之症。每兼发肿。初起见之无妨。日久气虚。多主危殆。
女劳疸者。身黄加以额黑也。其症脐下满闷。大便时黑。日晡寒热。皆蓄血
之所致也。男子勤于房事。血不化精。滞于小腹。故成此症。女子经水未净。
交合血滞。亦有此症。脉来弦芤者。宜用加减柴物汤。若脉来细缓无力。或涩而细者。元气大虚。虽有蓄血。不宜消导。
宜用十全补中。大扶元气正气盛则邪气自退。若用消导之剂。是促之使亡也。然女劳之血宜在小腹。若
大腹尽满。血散成臌。不治之症也。仲景云。腹满如水者不治。旨哉言乎。
酒为湿热之最。因酒而成疸者。其人小便必如栀汁。合用茵陈柴苓汤矣。若心中懊 。热不能食。时欲呕吐者。湿
热积于上焦。必有老痰在胃。宜用清热化痰汤。若头面目赤。身热足寒。脉来寸强尺弱。阳气不能下达。宜于前方加大
黄下之。如大便带黑。面色黄黑者。其人必有蓄血。盖嗜酒之人。多喜热饮荡死血脉积于胃中。隐而未发。亦宜加减柴
物汤。缓缓调治。酒疸之黑。与女劳之黑。相去一间。女劳为肾气所发。酒疸乃柴血腐败之色。柴物汤有半补半消之功。
若用大黄峻剂。荣血益趋于败而已。治者明之。黄汗者。汗如栀汁。染衣成黄。多因汗出浴水。水浸皮肤。壅遏本身。
荣卫郁而生黄也。亦有内伤茶酒。湿热走于皮毛。亦令发黄。初起身热恶寒。头疼身痛者。可用柴陈汤。加苏葛桑皮。
以微散之。日久津虚。宜用柴胡芍药汤。此症脉多洪大无力。或细缓不匀。不可误用补剂。以其发热不止。必生恶疮留
结痈脓也。
茵陈柴苓汤
柴胡 黄芩 半夏 甘草 猪苓 泽泻 赤茯 茵陈 麦冬 赤芍
湿少热多。固宜分利。使热从小便而去。佐以小柴胡。方有清热之功。湿蒸热郁。必先燥其肺
气。所以小水不行。茵陈辛凉清理肺热。肺金一润。其气
清肃下行。膀胱之壅热立通。小便利而黄退矣。（古云治湿不利小便非其治法尤宜慎审）
加减八物汤
人参 白术 白茯 甘草 当归 白芍 熟地 石斛 苡仁 远志 秦艽 陈皮
养血健脾汤
当归 白芍 麦冬 枳壳 浓朴 山楂 赤茯 杏仁 桔梗 陈皮
香砂理中汤 方见食门。
加减柴物汤
柴胡 黄芩 半夏 甘草 当归 川芎 白芍 熟地 香附 玄胡 丹皮 丹参
清热化痰汤
柴胡 黄芩 半夏 甘草 陈皮 白茯 杏仁 山栀 枳壳 桔梗 赤芍
柴胡芍药汤
柴胡 黄芩 花粉 甘草 白芍 麦冬 知母
“瘅”指的是热邪。黄疸病都是由于正气不宣通、郁结而生成的。黄色的表现就像酱色一样。它的症状主要有五种，需要条理分明地分析，才能详细明了地通过脉象和症状进行诊断。
第一种是湿热发黄。小便颜色像栀子染过一样，能染黄衣物，至于面目和身体的发黄，就不必多说了。这是因为茶、酒、汤水等积聚不散，郁结化为壮火，从而形成这种病症。其中又有热多湿少、湿多热少、以及湿热全无的区别，不可以不加以辨别。
如果是热多湿少的情况，脉象弦而数，黄色中带有光亮，适宜使用茵陈柴苓汤。如果口渴想喝水的，适宜使用柴胡芍药汤，加入茵陈、泽泻，这样才能使三焦的气化功能运行，津液通畅，口渴解除，黄疸消退。《金匮要略》说：“患疸病且口渴的难以治疗。”这是担心津液枯竭，但起初并不是不治之症。
如果是湿多热少的情况，脉象沉细而缓，黄色晦暗，适宜使用茵陈四苓汤。如果大便自利（腹泻），上气喘急，适宜加入人参、白术，不可误用寒凉药物，以免损伤脾气。
至于湿热全无的情况，既没有因血食、饮酒、汗出等引起的症状，也没有黄赤的小便，只见到身体发黄、倦怠、肢体无力，这是虚阳上浮导致的发黄。适宜使用加减八物汤。现在的医生治疗这种情况，一概使用五苓散类的方剂，怎么能治愈呢？
第二种是谷疸。这是由于饮食郁结，正气不行，压抑而成黄疸。其症状表现为胸膈不宽畅，四肢无力，身面都发黄，脉象洪滑的，属于阳证，应当合用二陈汤配合消食的药剂。但是如果有火热郁结，导致舌苔厚腻干涩难下，现在的人动不动就用苍术、厚朴等燥湿的药物，只治疗食积，不治疗火热，那么“疸”这个字放在哪里呢？难怪治疗不痊愈。更有粗劣的医生，专门使用针砂、绿矾等药物，不考虑虽然积滞去除了，但津液也随之亡失，这大大违背了治疗黄疸的根本原则。只有使用养血健脾汤，才有显著的疗效。如果脉象沉细缓，属于阴证，其人四肢青冷，大便时常溏薄，适宜使用香砂理中汤，加入炮姜、肉桂之类的药物，不可一概用热药来治（此处原文逻辑似有矛盾，通常阴证用热药，但前文提到“不可概以热治”，结合语境可能指不可单纯用热药而不顾其他，或指不可误用寒凉，此处依原文直译：不可一概用热药来治，需辨证）。然而谷疸的症状，常常兼带浮肿，初起时看见无妨，日久气虚，大多主危殆。
第三种是女劳疸。身体发黄加上额头发黑。其症状是脐下满闷，大便时常发黑，傍晚时分寒热往来，这都是蓄血所致。男子房事过度，精血不能化生，停滞在小腹，所以形成这种病症。女子月经未净时性交，血液停滞，也有这种病症。脉象弦芤的，适宜使用加减柴物汤。如果脉象细缓无力，或者涩而细，说明元气大虚，虽然有蓄血，也不宜使用消导攻伐的药物，适宜使用十全补中汤，大力扶持元气，正气旺盛则邪气自然退去。如果使用消导的药物，是促使病人死亡啊。然而女劳疸的血瘀应该在小腹，如果大腹全部胀满，血液散乱形成鼓胀，是不治之症。张仲景说：“腹部胀满像水一样的不治。”这话真深刻啊。
第四种是酒疸。酒是湿热之最，因为喝酒而得黄疸的，其人小便一定像栀子汁一样，应当合用茵陈柴苓汤。如果心中懊恼，发热不能进食，时时想要呕吐的，是湿热积于上焦，胃中必有老痰，适宜使用清热化痰汤。如果头面目赤，身热足寒，脉象寸强尺弱，阳气不能下达，适宜在前方的基础上加大黄攻下。如果大便带黑，面色黄黑的，其人必有蓄血。大概嗜酒的人，多喜欢热饮，烫死血脉积于胃中，隐伏而未发作，也适宜使用加减柴物汤，缓缓调治。酒疸的黑，与女劳疸的黑，相差无几。女劳疸是由肾气引发的，酒疸则是瘀血腐败的颜色。柴物汤有半补半消的功效，如果使用大黄峻猛的药物，营血只会更加趋向败坏罢了。治病的人要明白这一点。
第五种是黄汗。汗液像栀子汁，染衣成黄色。多因为出汗后洗澡，水浸皮肤，壅遏本身，营卫郁结而生黄。也有因为内伤茶酒，湿热走窜到皮毛，也令身体发黄。初起身热恶寒，头疼身痛的，可用柴陈汤，加入苏叶、葛根、桑白皮，以微微发散之。日久津液虚弱，适宜使用柴胡芍药汤。此症脉象多洪大无力，或细缓不匀，不可误用补剂，因为其发热不止，必定会生恶疮，留下痈脓。
茵陈柴苓汤
柴胡、黄芩、半夏、甘草、猪苓、泽泻、赤茯苓、茵陈、麦冬、赤芍。
湿少热多，固然适宜分利，使热从小便而去，佐以小柴胡汤，方有清热之功。湿蒸热郁，必先燥其肺气，所以小水不通。茵陈辛凉清理肺热，肺金一润，其气清肃下行，膀胱的壅热立刻通畅，小便利而黄疸消退。（古语说：治湿不利小便，非其治法，尤其应当审慎）
加减八物汤
人参、白术、白茯苓、甘草、当归、白芍、熟地黄、石斛、薏苡仁、远志、秦艽、陈皮。
养血健脾汤
当归、白芍、麦冬、枳壳、浓朴、山楂、赤茯苓、杏仁、桔梗、陈皮。
香砂理中汤 方见食门（在食积章节中有记载）。
加减柴物汤
柴胡、黄芩、半夏、甘草、当归、川芎、白芍、熟地黄、香附、玄胡索、丹皮、丹参。
"Dan" refers to heat pathogen. Jaundice arises from the stagnation and郁结 (stagnation) of healthy Qi due to its failure to circulate freely. The yellow color resembles that of soy sauce. There are five types of symptoms, which must be analyzed in detail through pulse and symptom differentiation for accurate diagnosis.
The first type is jaundice caused by damp-heat. The urine is like that stained by gardenia, capable of dyeing clothes yellow; naturally, the yellowing of the face, eyes, and body follows. This condition results from the accumulation and stagnation of tea, alcohol, soups, and water, which transform into fierce fire, leading to this syndrome. It is necessary to distinguish between cases with more heat than dampness, more dampness than heat, and those without any damp-heat.
In cases where heat exceeds dampness, the pulse is wiry and rapid, and the yellow hue is bright. Yinchen Chai Ling Tang (Yinchen Coptis and Poria Decoction) is appropriate. If thirst and desire to drink water are present, Chaihu Shaoyao Tang (Bupleurum and Peony Decoction) added with Yinchen (Artemisiae Scopariae Herba) and Zexie (Alismatis Rhizoma) should be used. This promotes the Qi transformation of the Sanjiao (Triple Burner), unblocks fluids, resolves thirst, and clears jaundice. The *Jingui Yaolue* states: "Jaundice accompanied by thirst is difficult to treat," fearing fluid exhaustion, but it is not initially incurable.
In cases where dampness exceeds heat, the pulse is deep, fine, and slow, and the yellow color is dull. Yichen Siling Tang (Yinchen Four-Poria Decoction) is suitable. If there is spontaneous diarrhea and wheezing/shortness of breath, Ginseng (Renshen) and Atractylodes (Baizhu) should be added. Cold-natured herbs must not be mistakenly used, as they damage Spleen Qi.
Regarding cases with neither dampness nor heat, there are no symptoms related to blood stasis, dietary excess, alcohol, or sweating, nor is there dark yellow urine. Only yellowing of the body, fatigue, and limb weakness are observed, indicating yellowing due to floating deficient Yang. Jiajian Bawu Tang (Modified Eight-Treasure Decoction) is indicated. Current physicians often indiscriminately use Wuling San (Five-Poria Powder) variants for this, which cannot cure the disease.
The second type is Grain Jaundice (Gu Dan). This arises from food stagnation obstructing the circulation of healthy Qi. Symptoms include chest and diaphragm fullness, limb weakness, and yellowing of the body and face. With a surging and slippery pulse, it belongs to the Yang aspect; Erchen Tang (Two-Aged Decoction) combined with digestive agents is appropriate. However, if fire-heat stagnation causes thick, dry, and difficult-to-swallow coating, physicians often rashly use drying agents like Cangzhu (Atractodis Rhizoma) and Houpo (Magnoliae Officinalis Cortex) to treat only the food stagnation while ignoring the heat. Where does the "jaundice" aspect go? No wonder treatment fails. More incompetent practitioners specifically use Zhen Sha (Magnetitum) and Lü Fan (Chalcanthite), failing to realize that although stagnation is removed, fluids are lost, violating the fundamental principle of treating jaundice. Xuejian Jianpi Tang (Blood-Nourishing and Spleen-Strengthening Decoction) yields significant results. If the pulse is deep, fine, and slow, it belongs to the Yin aspect. The patient has cold, blue limbs and loose stools. Xiangsha Lizhong Tang (Amomum and Cardamom Lizhong Decoction) with Pao Jiang (Prepared Ginger) and Rougui (Cinnamon Bark) is suitable. One must not simply apply hot treatments without differentiation. However, Grain Jaundice often accompanies edema. Early stages are manageable, but prolonged illness leads to Qi deficiency and danger.
The third type is Female Labor Jaundice (Nü Lao Dan). The body is yellow with a black forehead. Symptoms include umbilical fullness, black stools, and alternating chills and fever at dusk, all caused by blood stasis. In men, excessive sexual activity prevents blood from transforming into essence, causing stagnation in the lower abdomen. In women, intercourse during menstruation causes blood stagnation. With a wiry and hollow pulse, Jiajian Chaiwu Tang (Modified Bupleurum and Blood-Decoction) is appropriate. If the pulse is fine, slow, and weak, or choppy and fine, Yuanqi (Original Qi) is severely deficient. Although blood stasis exists, purgative/digestive methods are contraindicated. Shiquan Buzhong Tang (Ten Complete Middle-Supporting Decoction) should be used to strongly support Yuanqi; when healthy Qi is strong, pathogenic factors recede. Using purgatives would hasten death. The blood stasis of Nü Lao Dan is located in the lower abdomen. If the entire abdomen is distended with blood dispersing into drum-like swelling (Gu Zhang), it is incurable. Zhang Zhongjing stated: "Abdominal fullness resembling water is incurable." These words are profound.
The fourth type is Wine Jaundice (Jiu Dan). Alcohol is the most potent source of damp-heat. Jaundice caused by drinking results in urine like gardenia juice, requiring Yinchen Chai Ling Tang. If there is mental restlessness (Ao Nu), fever, inability to eat, and frequent vomiting, damp-heat accumulates in the Upper Jiao, likely with old phlegm in the Stomach. Qingre Huatan Tang (Clear-Heat and Resolve-Phlegm Decoction) is indicated. If the head, eyes, and face are red, the body is hot but feet are cold, and the pulse is strong at the Cun position and weak at the Chi position, indicating Yang Qi failing to descend, Dahuang (Rhei Radix et Rhizoma) should be added to the previous formula to purge. If stools are black and the complexion is yellow-black, blood stasis is present. Heavy drinkers often prefer hot drinks, damaging blood vessels and causing blood accumulation in the stomach, latent and unmanifested. Jiajian Chaiwu Tang should be used for gradual regulation. The blackness of Wine Jaundice differs slightly from that of Nü Lao Dan. Nü Lao Dan originates from Kidney Qi, while Wine Jaundice blackness is the color of corrupted blood. Chaiwu Tang has half-tonifying and half-purging effects. Using harsh Dahuang would further corrupt Ying Blood. Physicians must understand this.
The fifth type is Yellow Sweat (Huang Han). Sweat resembles gardenia juice, staining clothes yellow. It often occurs after bathing while sweating, where water penetrates the skin, obstructing the body, causing Ying and Wei Qi stagnation and yellowing. It can also result from internal injury from tea/alcohol, with damp-heat moving to the skin and hair follicles. Initially, with fever, aversion to cold, headache, and body pain, Chai Chen Tang (Bupleurum and Pinellia Decoction) added with Suzye (Perillae Folium), Gegen (Puerariae Radix), and Sangbaipi (Morus Alba Cortex) can be used to mildly disperse. After prolonged duration with fluid deficiency, Chaihu Shaoyao Tang is suitable. The pulse is typically surging and forceless, or fine, slow, and irregular. Tonics must not be mistakenly used, as persistent fever will lead to malignant sores and abscesses.
Yinchen Chai Ling Tang (Yinchen Coptis and Poria Decoction):
Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Zhuling (Polypori Umbellati), Zexie (Alismatis Rhizoma), Chifu (Poria cum Rhus), Yinchen (Artemisiae Scopariae Herba), Maidong (Ophiopogonis Tuber), Chishao (Paeoniae Radix Rubra).
When dampness is slight and heat is abundant, draining via urination is appropriate to expel heat through the bladder. Adding Xiao Chaihu Tang (Minor Bupleurum Decoction) aids heat-clearing. When damp steams and heat stagnates, Lung Qi must be dried/aerated first, hence the obstruction of urination. Yinchen is pungent and cool, clearing Lung heat. Once Lung Metal is moistened, its Qi descends clearly and turbidly, immediately unblocking bladder heat. Urine flows freely, and jaundice recedes. (Ancient saying: Treating dampness without promoting urination is incorrect; caution is required.)
Jiajian Bawu Tang (Modified Eight-Treasure Decoction):
Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Bai Fu (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Shudi (Rehmanniae Radix Preparata), Shihu (Dendrobii Caulis), Yiren (Coicis Semen), Yuanzhi (Polygalae Radix), Qinjiao (Gentianae Macrophyllae Radix), Chenpi (Citri Reticulatae Pericarpium).
Xuejian Jianpi Tang (Blood-Nourishing and Spleen-Strengthening Decoction):
Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Maidong (Ophiopogonis Tuber), Zhike (Aurantii Fructus Immaturus), Nongpu (Magnoliae Officinalis Cortex), Shanzha (Crataegi Fructus), Chifu (Poria cum Rhus), Xingren (Armeniacae Semen Amarum), Jiegeng (Platycodonis Radix), Chenpi (Citri Reticulatae Pericarpium).
Xiangsha Lizhong Tang (Amomum and Cardamom Lizhong Decoction): See Food Chapter.
Jiajian Chaiwu Tang (Modified Bupleurum and Blood-Decoction):
Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baishao (Paeoniae Radix Alba), Shudi (Rehmanniae Radix Preparata), Xiangfu (Cyperi Rhizoma), Yanhu (Corydalis Rhizoma), Danpi (Moutan Cortex), Danshen (Salviae Miltiorrhizae Radix et Rhizoma).
Qingre Huatan Tang (Clear-Heat and Resolve-Phlegm Decoction):
Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Bai Fu (Poria), Xingren (Armeniacae Semen Amarum), Shanzhi (Gardeniae Fructus), Zhike (Aurantii Fructus Immaturus), Jiegeng (Platycodonis Radix), Chishao (Paeoniae Radix Rubra).
Chaihu Shaoyao Tang (Bupleurum and Peony Decoction):
Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Huafen (Trichosanthis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Baishao (Paeoniae Radix Alba), Maidong (Ophiopogonis Tuber), Zhimu (Anemarrhenae Rhizoma).