已，日渐而病黄者，皆因伤胆而然。其证则无火无湿，其人则昏沉困倦，其色则正黄如染。盖胆伤则气败液泄。
《经》曰∶凡十一脏皆取决于胆。胆伤则生气败，其能生乎？所以凡患此者，多致不救。（张景岳）
郁黄
发黄当从郁治，凡物不郁则不黄，禁用茵陈五苓，当用逍遥散。（赵养葵）
虚黄
男子黄，小便自利，当与虚劳小建中汤。（《金匮》）
虚黄者，其证口淡，怔忡，耳鸣，脚软，怠惰无力，寒热微作，小便浊涩皮肤虽黄，而爪甲如常。此劳倦
太过，血气俱虚，不可妄用凉药，惟宜调中培土。若面色青黄，小便自利，谓之木乘土，又宜培脾抑肝。（《证治汇补》）
疸证，服解利之药，久而不愈，皆作虚论，宜四君子汤，吞八味丸。不可恣行清利，致脾气败坏，肾水枯
涸，必至危笃。（徐东皋）
外感之黄，热解而黄自消。内伤之黄，虚回而黄始退。外发体实者，投清凉可愈。内发元亏者，非补益不
痊。（《会心录》）
病后黄
诸失血后，多令人面黄。盖人身以血为荣，面色红润者。血之荣也。血去则面见黄色，譬之竹木，春夏叶
绿，遇秋叶黄，润与燥之别也。○疟后多黄者，脾病色见于面也，治宜理脾，异功散加黄 、扁豆。诸病后黄者
皆宜，然其证身面俱黄，不及眼目为异耳。（戴复庵）
胃脘久痛变黄，乃脾胃大亏，若非内蓄瘀血，即中挟痰饮。虚热者救脾阴为急，虚寒者救胃阳为先。（《会心录》）
黄胖
黄胆与黄胖不同。黄胆，眼目皆黄，无肿状；黄胖多肿，其色黄中带白，眼目如故，或洋洋少神。虽病
根都于脾，然黄胆则由脾经湿热蒸郁而成；黄胖则湿热未甚，多由虫疳与食积所致。其证必吐黄水，毛发皆直，
或好食生米、茶叶、土炭为异。○有种力作之人，劳苦过伤成黄胖病，俗名脱力黄，好食易饥，怠惰无力，治
宜枣矾丸。（《见闻录》）
疳黄，俗名黄胖。夫黄胆，暴病也，疳黄，宿病也。至有久不愈者，虽治有枣矾丸，然只可施于力作壮实
之人，若膏粱柔脆，未可轻试。（《张氏医通》）
脉候
脉沉，渴欲饮水，小便不利者皆发黄。脉洪大，大便利而渴
者死。脉微小，小便利，不渴者生。凡黄家候其寸口，近掌无脉，口鼻气冷，并不可治。凡年壮气实，脉滑便
坚者易愈。年衰气弱，脉虚涩而便利者难痊。（《张氏医通》）
选案
一人患脾虚腹胀，劳苦夜发潮热，忽浑身面目俱黄，用清利药，夜热更甚，脉坚劲，洪大搏指，乃革脉也，
是外有余而内不足，不可作寻常疸证治。盖黄者脾之本色，素患脾虚，当健脾辅正，况小便多，尤非湿热之证
可比。方用人参、扁豆、山药、陈皮、茯苓、甘草、煨姜，因其夜热，加当归、丹皮，平昔服术不安，故不用
术。初剂热轻神安，各证俱减。续复大热，加人参去半夏，服之热退而腹胀不消，此脾虚也。必须用术，又恐
增胀，当补其母，则能营运三焦，熟腐五谷，且行参、术之力。遂加桂、附，觉口有津液，饮食知味，腹软大
半，调理而起。（吴天士）
女劳疸，其原属于肾水亏虚，水虚则土燥，故见此枯黑之色，惟宜壮水，水滋则土不燥。虞天民云∶女劳
疸当作虚劳治。一人患此候，以六味汤加归、芍、秦艽、苡仁、麦冬，百剂而愈。
孙瞿士疸证，医用五苓、茵陈不效；改用温中，病势危笃。予谓两目先黄，肝木郁也；额黑，肾水枯也；
腰腹重痛，皆肝肾虚极之候。以六味汤加柴胡、当归，四剂知，十剂已。（程华仲）
一人病疸，额黑而便白粪，医用八味丸补火生土，不应而殁。予思额属南方离火，今见黑色，肾水克心火
之征，究由土虚不能制水，致水邪上溢于心经之部。矢白属金，金为秋，秋主杀故死。按此证，乃己土衰弱，
若能补心之阳，庶乎可救。（方星岩）
备方
黄胖药 红枣四两、皂矾二两、锅焦三两、荷叶二两、灰面十二两。灰面炒黄，红枣煮熟去皮核，取肉，
锅焦煮烂，皂矾、荷叶煎汁捣丸，每服三钱。
已经（指病程初期），逐渐出现身体发黄的症状，都是因为损伤了胆腑所致。其证候表现为没有火热也没有湿邪，患者精神昏沉困倦，肤色纯正如染般发黄。这是因为胆腑受伤导致元气败坏、津液外泄。
《黄帝内经》说：所有十一脏的功能都取决于胆。胆腑受伤则生发之气败坏，怎么可能还能生化万物呢？所以凡是患这种病的人，大多难以救治。（张景岳）
郁黄
发黄应当从“郁”（气机郁滞）的角度治疗，凡是不郁滞的东西就不会变黄，禁用茵陈五苓散，应当使用逍遥散。（赵养葵）
虚黄
男子面色萎黄，小便通畅自利，应当给予虚劳方剂小建中汤。（《金匮要略》）
所谓虚黄，其症状表现为口淡无味，心悸怔忡，耳鸣，双腿酸软，倦怠无力，寒热轻微发作，小便浑浊涩滞。虽然皮肤发黄，但指甲颜色正常。这是由于过度劳累，气血俱虚所致，不可妄用寒凉药物，只适宜调理中焦、培补脾胃。如果面色青黄，小便自利，这叫做木乘土（肝木克伐脾土），又适宜培补脾气、抑制肝木。（《证治汇补》）
黄疸证，服用解表祛邪药物的时间久了仍不痊愈，都当作虚证论治，适宜服用四君子汤，吞服八味丸。不可肆意使用清热利湿的药物，以免导致脾气败坏，肾水枯竭，必然发展到危重地步。（徐东皋）
外感引起的发黄，热邪解除后黄色自然消退。内伤引起的发黄，正气恢复后黄色才开始退去。外感发病且体质壮实者，投以清凉药物可以痊愈。内伤发病且元气亏损者，不使用补益药物无法治愈。（《会心录》）
病后黄
各种失血之后，多让人面色发黄。因为人体以血为荣（营养滋润），面色红润是血液充盈的表现。血液流失后，面部显现黄色，就像竹木一样，春夏季节叶子绿，到了秋天叶子黄，这是滋润与干燥的区别。○疟疾之后多出现发黄，是脾脏病变反映在面部的色泽上，治疗适宜理脾，用异功散加黄芪、扁豆。其他疾病之后出现的发黄也都适宜此法，只是其症状是身体和面部都发黄，唯独眼睛不发黄，这是不同之处罢了。（戴复庵）
胃脘部长期疼痛转变为发黄，这是脾胃严重亏损，如果不是内部蓄积瘀血，就是中间夹杂痰饮。属于虚热的，急救脾阴为当务之急；属于虚寒的，急救胃阳为先。（《会心录》）
黄胖
黄疸与黄胖是不同的。黄疸，眼睛和眼白都发黄，没有肿胀现象；黄胖多有肿胀，肤色黄中带白，眼睛如常，或者神情萎靡缺乏神采。虽然病根都在脾脏，但是黄疸是由脾经湿热蒸腾郁结而成；黄胖则是湿热并不严重，多由虫疳（寄生虫病）和食积所致。其症状必定呕吐黄水，毛发直立，或者喜欢吃生米、茶叶、泥土炭块等奇怪东西。○有种从事体力劳动的人，因劳苦过度损伤而成黄胖病，俗名叫脱力黄，好吃易饥，倦怠无力，治疗适宜用枣矾丸。（《见闻录》）
疳黄，俗名黄胖。黄疸是急性病，疳黄是慢性病。甚至有久治不愈的，虽然有枣矾丸可治，但也只能用于从事体力劳动的强壮之人，如果是饮食肥甘厚味、体质柔弱娇嫩的人，不可轻易尝试。（《张氏医通》）
脉候
脉象沉，口渴想喝水，小便不利的人都会发黄。脉象洪大，大便通畅而口渴的会死亡。脉象微小，小便通畅，不口渴的会生存。凡是黄疸患者，诊察其寸口脉，靠近手掌处无脉动，口鼻气息寒冷，都是不可治疗的死证。凡是年轻气盛、体质壮实，脉滑大便干结的容易痊愈。年老体衰、气弱，脉虚涩而大小便通畅的难以治愈。（《张氏医通》）
选案
有一人患有脾虚腹胀，劳累后夜间出现潮热，忽然全身面目都发黄，医生使用清热利湿药，夜间发热更严重，脉象坚硬强劲，洪大搏指，这是革脉，属于外有余而内不足，不能当作寻常的黄疸证治疗。因为黄色是脾的本色，素来患有脾虚，应当健脾扶助正气，况且小便多，尤其不是湿热证可比拟的。处方用人参、扁豆、山药、陈皮、茯苓、甘草、煨姜，因为夜间发热，加入当归、丹皮，平时服用白术感到不适，所以不用白术。第一服药后热势减轻，神志安宁，各症状都减少。后来再次出现大热，加入人参去掉半夏，服用后热退但腹胀不消，这是脾虚的缘故。必须使用白术，又担心增加胀满，应当补其母（火生土，即补心/脾之阳），这样能营运三焦，熟腐五谷，并且能行使人参、白术的药力。于是加入肉桂、附子，感觉口中有了津液，饮食知道味道，腹部变软大半，经过调理而康复。（吴天士）
女劳疸，其根源属于肾水亏虚，水虚则土燥，所以出现枯黑的颜色，只适宜壮水（滋补肾阴），水充足则土不燥。虞天民说：女劳疸应当当作虚劳来治疗。有一人患此症，用六味地黄汤加当归、芍药、秦艽、薏苡仁、麦冬，服用一百剂而痊愈。
孙瞿士患黄疸证，医生使用五苓散、茵陈蒿汤无效；改用温中药物，病情变得危重。我认为两目先黄，是肝木郁结；额头黑，是肾水枯竭；腰腹沉重疼痛，都是肝肾极度虚弱的征候。用六味地黄汤加柴胡、当归，四剂见效，十剂痊愈。（程华仲）
有一人患黄疸，额头黑而排出白色粪便，医生用八味丸补火生土，没有效果而死。我思考额头属南方离火，现在见到黑色，是肾水克制心火的征象，究其原因是脾土虚弱不能制约肾水，导致水邪上溢到心经所属的部位。白色粪便属金，金对应秋季，秋主肃杀，所以死亡。按此证分析，乃是己土（脾土）衰弱，如果能补益心之阳气，或许还可以救治。（方星岩）
备方
黄胖药 红枣四两、皂矾二两、锅焦三两、荷叶二两、灰面十二两。将灰面炒黄，红枣煮熟去皮核，取肉，锅焦煮烂，皂矾、荷叶煎汁捣碎制成丸药，每次服用三钱。
Having passed the initial stage, if jaundice develops gradually, it is all due to injury of the Gallbladder (Dan, 胆). The syndrome presents without fire or dampness; the person appears drowsy and fatigued; the complexion is pure yellow as if dyed. This is because injury to the Gallbladder leads to the failure of vital Qi and leakage of body fluids.
The *Classic* states: "All eleven Zang-Fu organs depend on the Gallbladder for their decisions." If the Gallbladder is injured, the generating Qi fails; how can it generate? Therefore, those who suffer from this condition often prove incurable. (Zhang Jingyue)
Yu Huang (Jaundice due to Stagnation)
Jaundice should be treated by resolving stagnation. Anything that does not stagnate does not turn yellow. Yinchen Wuling San (Inula and Poria Decoction) is strictly prohibited; Xiaoyao San (Free and Easy Wanderer Powder) should be used. (Zhao Yangkui)
Xu Huang (Deficiency Jaundice)
For a man with sallow complexion and spontaneous free urination, one should administer Xiao Jianzhong Tang (Minor Construct the Middle Decoction) for deficiency consumption. (*Jin Gui Yao Lue*)
Regarding Xu Huang (Deficiency Jaundice), the symptoms include bland taste in the mouth, palpitations, tinnitus, weak legs, lethargy and lack of strength, slight alternating chills and fever, and turbid, difficult urination. Although the skin is yellow, the fingernails remain normal. This is caused by excessive labor leading to deficiency of both Qi and Blood. One must not recklessly use cold medicines; instead, one should regulate the Middle Jiao and cultivate the Earth (Spleen/Stomach). If the complexion is greenish-yellow with spontaneous free urination, it is called Wood overacting on Earth (Liver overacting on Spleen), and treatment should focus on fortifying the Spleen and suppressing the Liver. (*Zheng Hui Hui Bu*)
If jaundice persists despite prolonged use of exterior-resolving and pathogen-expelling drugs, it should be treated as a deficiency syndrome. Sizijunzi Tang (Four Gentlemen Decoction) should be taken, swallowed with Bawei Wan (Eight-Ingredient Pill). One must not indulge in clearing heat and promoting diuresis, which would ruin Spleen Qi and dry up Kidney Water, inevitably leading to a critical state. (Xu Donggao)
Jaundice caused by external pathogens disappears naturally once the heat resolves. Jaundice caused by internal injury recedes only when deficiency is restored. For exogenous onset in robust constitutions, cooling medications can cure it. For endogenous onset in depleted constitutions, tonification is essential for recovery. (*Hui Xin Lu*)
Post-Illness Jaundice
After various hemorrhages, the face often turns yellow. The human body relies on Blood for nourishment; a ruddy complexion indicates abundant Blood. When Blood is lost, the face reveals yellow, similar to bamboo or wood: green leaves in spring and summer, yellow leaves in autumn, representing the difference between moist and dry states. ○ Jaundice after malaria is common; this is the color of Spleen pathology manifesting on the face. Treatment should regulate the Spleen using Yigong San (Extraordinary Power Powder) added with Huangqi (Astragalus Root) and Bian Dou (Lablab Bean). This applies to jaundice following other illnesses as well, except that the body and face are yellow while the eyes remain unaffected. (Dai Fu'an)
Chronic epigastric pain transforming into jaundice indicates severe depletion of the Spleen and Stomach. Unless there is retained blood stasis internally, there is phlegm-fluid retention mixed within. In cases of deficient heat, saving Spleen Yin is urgent; in cases of deficient cold, saving Stomach Yang is paramount. (*Hui Xin Lu*)
Huang Pang (Yellow Puffy Syndrome / Anemia)
Huang Dan (Jaundice) and Huang Pang (Yellow Puffy Syndrome) are different. In Huang Dan, both eyes and sclera are yellow, with no swelling; Huang Pang involves swelling, the color is yellow mixed with white, the eyes remain normal, and the patient may appear listless. Although the root of both diseases lies in the Spleen, Huang Dan results from damp-heat steaming and stagnating in the Spleen channel; Huang Pang involves less severe damp-heat and is mostly caused by parasite infestation (Gan disease) and food accumulation. Symptoms necessarily include vomiting yellow water, erect hair, or craving raw rice, tea leaves, soil, or charcoal. ○ Laborers who suffer excessive physical strain may develop Huang Pang, commonly known as "Depleted Strength Jaundice," characterized by increased appetite with easy hunger, lethargy, and weakness. Treatment should use Zaofan Wan (Alum and Date Pill). (*Jian Wen Lu*)
Gan Huang (Parasitic Jaundice), commonly known as Huang Pang. Huang Dan is an acute disease; Gan Huang is a chronic disease. Even in persistent cases, although Zaofan Wan is available, it is only suitable for robust laborers. It should not be lightly tried on those accustomed to rich foods and delicate constitutions. (*Zhang Shi Yi Tong*)
Pulse Diagnosis
A deep pulse, thirst with desire to drink, and difficult urination all indicate impending jaundice. A surging pulse with free stool and thirst indicates death. A minute pulse with free urination and no thirst indicates survival. In all jaundice patients, examine the Cun Kou (radial artery); if the pulse is absent near the palm, and breath from mouth and nose is cold, the condition is incurable. Young individuals with strong Qi and robust constitutions, presenting with slippery pulses and firm stools, will recover easily. Elderly individuals with weak Qi, presenting with deficient and choppy pulses and free urination/stool, will be difficult to cure. (*Zhang Shi Yi Tong*)
Selected Cases
A patient suffered from Spleen deficiency abdominal distension and tidal fever at night after labor. Suddenly, his whole body and face turned yellow. After using clearing and draining herbs, the night fever worsened. The pulse was hard, strong, surging, and striking the finger, identified as a Ge Pulse (Leather Pulse). This indicates excess on the exterior but insufficiency on the interior; it cannot be treated as ordinary jaundice. Yellow is the true color of the Spleen. Since he had chronic Spleen deficiency, one should fortify the Spleen and support healthy Qi. Moreover, frequent urination distinguishes this from damp-heat syndromes. The prescription used Renshen (Ginseng Root), Bian Dou (Lablab Bean), Shanyao (Chinese Yam), Chenpi (Tangerine Peel), Fuling (Poria), Gancao (Licorice Root), and Wei Jiang (Baked Ginger). Due to night fever, Danggui (Angelica Sinensis Root) and Danpi (Moutan Bark) were added. Baizhu (Atractylodes Rhizome) was omitted because he previously felt uncomfortable taking it. After the first dose, fever lightened, spirit calmed, and symptoms decreased. Later, high fever returned. Renshen was added, and Banxia (Pinellia Tuber) removed. Fever subsided, but abdominal distension persisted, indicating Spleen deficiency. Baizhu was necessary, but feared to increase distension. Therefore, the mother element (Fire generates Earth) was tonified to promote circulation in the Three Jiao, digest grains, and enhance the action of Renshen and Baizhu. Rougui (Cinnamon Bark) and Fuzi (Prepared Aconite Root) were added. Saliva production resumed, appetite improved, abdomen softened significantly, and he recovered after conditioning. (Wu Tianshi)
Nv Lao Dan (Female Labor Jaundice) originates from Kidney Water deficiency. Water deficiency leads to Earth dryness, resulting in a withered black color. Treatment should strengthen Water (nourish Kidney Yin); when Water is sufficient, Earth is not dry. Yu Tianmin stated: Nv Lao Dan should be treated as Xu Lao (Deficiency Consumption). A patient with this condition was cured after 100 doses of Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) added with Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), Qinjiao (Gentiana Macrophylla Root), Yiren (Coix Seed), and Maidong (Ophiopogon Tuber).
Sun Qushi suffered from jaundice. The physician used Wuling San (Five-Ingredient Powder with Poria) and Yinchen Hao Tang (Artemisia Capillaris Decoction) without effect; switching to warming the Middle led to a critical condition. I reasoned: Yellowing of the eyes first indicates Liver Wood stagnation; black forehead indicates Kidney Water exhaustion; heavy pain in waist and abdomen are signs of extreme Liver-Kidney deficiency. Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) added with Chaihu (Bupleurum Root) and Danggui (Angelica Sinensis Root) showed improvement in four doses and resolution in ten doses. (Cheng Huazhong)
A patient suffered from jaundice with a black forehead and white feces. The physician used Bawei Wan (Eight-Ingredient Pill) to tonify Fire to generate Earth, but failed, and the patient died. I reflected: The forehead belongs to South Li Fire. Seeing black here is a sign of Kidney Water overcoming Heart Fire. Ultimately, it stems from weak Earth failing to control Water, causing Water pathogen to overflow upward into the Heart channel region. White feces belong to Metal, corresponding to Autumn, which governs killing/harvesting; hence death. Analyzing this case, it is衰弱 of Ji Earth (Spleen Earth). If Heart Yang were tonified, rescue might have been possible. (Fang Xingyan)
Prepared Formula
For Huang Pang (Yellow Puffy Syndrome): Hongzao (Red Dates) 4 liang, Zaofan (Alum) 2 liang, Guojiao (Scorched Rice Crust) 3 liang, Heye (Lotus Leaf) 2 liang, Huaimian (Ash Flour) 12 liang. Stir-fry the ash flour until yellow. Boil red dates until cooked, remove skin and pits, take the flesh. Boil scorched rice crust until soft. Decoct alum and lotus leaf in juice. Mash everything together to form pills. Take 3 qian per dose.