膀胱急，小腹满，身尽黄，额上黑，足下热，因作黑瘅。其腹胀如水状，大便必黑，时溏，此女劳之病，非水也。腹满
者难治。硝石矾石散主之。从来不解用硝石之义，方书俱改为滑石矾石散，方下谬云以小便出黄水为度，且并改大黄硝
石汤为大黄滑石汤，医学之陋，一至此乎！夫男子血化为精，精动则一身之血俱动，以女劳而倾其精，血必继之，故因
女劳而尿血者，其血尚行，犹易治也。因女劳而成瘅者，血瘀不行，为难治矣。甚者血瘀之久，大腹尽满，而成血蛊，
尤为极重而难治矣。昧仲景之文，反制方之意，女劳瘅，非亟去其膀胱少腹之瘀血，万无生路。在伤寒热瘀膀胱之证，
其人下血乃愈。血不下者，用抵当汤下之，亦因其血之暂结，可峻攻也。此女劳瘅蓄积之血，必匪朝夕，峻攻无益，但
取石药之悍，得以疾趋而下达病所，硝石咸寒走血，可消逐其热瘀之血，故以为君；矾石本草谓其能除锢热在骨髓，用
以清肾及膀胱脏腑之热，并建消瘀除浊之功，此方之极妙可法者也。以陈无择之贤，模棱两可其说，谓无发热恶寒脉滑
者，用此汤。若发热恶寒者，其脉浮紧，则以滑石石膏治之。青天白日，梦语喃喃，况其他乎！世岂有血蓄下焦，反见
浮滑且紧之脉者乎？妄矣！妄矣！
夏月天气之热，与地气之湿交蒸，人受二气，内郁不散，发为黄瘅，与龛酱无异。必从外感汗下吐之法，去其湿热。
然夏月阳外阴内，非如冬月伤寒，邪气伏藏难动之比，仲景慎用三法之意，昌明之矣。其谷瘅、酒瘅、女劳瘅，则病自
内伤，与外感无涉，仲景补《内经》之阙，曲尽其微，昌并明之矣。至于阴瘅一证，仲景之方论已亡，千古之下，惟罗
谦甫茵陈附子干姜甘草汤一方，治用寒凉药过当，阳瘅变阴之证，有合往辙，此外无有也。今人但云阳瘅色明，阴
瘅色晦，此不过气血之分，辨之不清，转足误人。如酒瘅变黑，女劳瘅额上黑，岂以其黑遂谓阴瘅，可用附子、干姜乎？
夫女劳瘅者，真阳为血所壅闭，尚未大损，瘀血一行，阳气即通矣。阴瘅则真阳衰微不振，一任湿热与浊气败血，团结
不散，必复其阳，锢结始开。傥非离照当空，幽隐胡繇毕达耶？学人试于前卷方论中究心焉，思过半矣。
【律三条】
黄瘅病，得之外感者，误用补法，是谓实实，医之罪也。
黄瘅病，得之内伤者，误用攻法，是谓虚虚，医之罪也。
阴瘅病，误从阳治，袭用苦寒，倒行逆施，以致极重不返者，医杀之也。阴瘅无热恶寒，小便自利，脉迟而微，误
开鬼门，则肌肤冷 ，自汗不止；误洁净府，则膀胱不约，小便如奔，死期且在旦暮，况于吐下之大谬乎？即以平善之
药迁延，亦为待毙之术耳。在半阴半阳之证，其始必先退阴复阳，阴退乃从阳治，若以附子、黄连合用，必且有害，奈
何纯阴无阳，辄用苦寒耶？
膀胱拘急，小腹胀满，全身发黄，额头发黑，脚心发热，因此形成黑疸。其腹部胀大如水状，大便必定发黑，时而稀溏，这是女劳疸的病证，不是水气病。如果腹部胀满严重的，难以治愈。用硝石矾石散主治。从来没有人解释清楚使用硝石的深意，方书都将其改为滑石矾石散，方剂下错误地记载“以小便排出黄水为限度”，并且还将大黄硝石汤改为大黄滑石汤，医学界的陋习，竟然到了这种地步！男子将血转化为精，精气发动则全身的血液随之流动，因为房劳过度而耗竭精气，血液必然随后受损，所以因女劳而导致尿血的，其血液尚能运行，还容易治疗。因女劳而成黄疸的，血液瘀滞不行，就难治了。严重的，血液瘀滞日久，整个腹部胀满，形成血蛊，更是极重且难治的病证。如果不理解张仲景原文的含义，反而违背制方的本意，女劳疸，不急于去除膀胱和小腹部位的瘀血，万无生路。在伤寒热邪瘀结膀胱的证候中，患者通过下血才能痊愈。如果血不下行，就用抵当汤攻下，这也是因为血是暂时凝结，可以峻猛攻伐。而这女劳疸蓄积的瘀血，必定不是朝夕之间形成的，峻猛攻伐没有益处，只能取石药悍烈之性，使其迅速趋向并下达病所，硝石味咸性寒，走血分，可以消除驱逐热瘀之血，所以作为君药；矾石本草记载它能除去骨髓中的锢热，用来清除肾及膀胱脏腑的热邪，并建立消瘀除浊的功效，这是此方极其精妙值得效法的地方。像陈无择这样贤能的人，对说法模棱两可，认为如果没有发热恶寒脉滑的，才用这个汤。如果有发热恶寒的，其脉浮紧，就用滑石石膏治疗。这简直是青天白日下的梦话喃喃自语，何况其他谬误呢！世上哪有血蓄积在下焦，反而出现浮滑且紧的脉象的呢？荒谬啊！荒谬啊！
夏季天气炎热，与地气湿气交蒸，人受这两种邪气，内郁不散，发为黄瘅，与龛酱（发酵酱料）没有什么不同。必须从外感病的汗、下、吐法，去除湿热。然而夏季阳气在外阴气在内，不像冬季伤寒，邪气伏藏难以触动那样，张仲景慎用这三种方法的意思，我已经阐明。至于谷疸、酒疸、女劳疸，则是病自内伤引起，与外感无关，张仲景补全《内经》的缺失，详尽地揭示了其中的微妙之处，我也一并阐明。至于阴疸这一证候，张仲景的方论已经亡佚，千古之下，只有罗谦甫的茵陈附子干姜甘草汤一方，治疗因过用寒凉药物，导致阳疸转为阴疸的证候，符合以往的法则，此外就没有别的了。现在的人只说阳疸颜色鲜明，阴疸颜色晦暗，这不过是气血的区别，辨析不清，反而足以误导人。比如酒疸变黑，女劳疸额头发黑，难道因为它们发黑就说是阴疸，可以用附子、干姜吗？女劳疸者，真阳被血液壅闭，尚未严重亏损，瘀血一旦运行，阳气即刻通畅。阴疸则是真阳衰微不振，任凭湿热与浊气败血，团结不散，必须恢复阳气，锢结才能打开。如果不是太阳高悬空中，幽暗隐蔽之处怎能全部通达呢？学医之人试着在前一卷的方论中用心探究，思虑便超过一半了。
【法律三条】
黄瘅病，得自外感的，误用补法，这叫实实（使实证更实），是医生的罪过。
黄瘅病，得自内伤的，误用攻法，这叫虚虚（使虚证更虚），是医生的罪过。
阴疸病，误从阳证治疗，袭用苦寒药物，倒行逆施，导致病情极重无法挽回的，是医生杀死了病人。阴疸无热恶寒，小便自利，脉迟而微，误用开鬼门（发汗）法，则肌肤寒冷，自汗不止；误用洁净府（利小便）法，则膀胱不能约束，小便失禁如奔涌，死期就在早晚，何况是大错特错的吐下法呢？即使是用平和的药物拖延时间，也是等待死亡的方法罢了。在半阴半阳的证候中，起初必须先退阴复阳，阴退之后才从阳证治疗，如果用附子、黄连合用，必定有害，奈何纯阴无阳时，却辄然使用苦寒药呢？
The bladder feels tense, the lower abdomen is full, the whole body turns yellow, the forehead is black, and the soles of the feet are hot; thus, Black Jaundice (Hei Dan) develops. The abdominal distension resembles water accumulation, the stool must be black, and occasionally loose. This is a disease of Female Labor Jaundice (Nü Lao Dan), not Water Disease (Shui Bing). If the abdomen is full, it is difficult to treat. Xiao Shi Fan Shi San (Mineral Stone and Alum Powder) is the primary prescription. No one has ever explained the meaning of using Xiao Shi (Niter); medical texts have all changed it to Hua Shi Fan Shi San (Talcum Stone and Alum Powder), and erroneously stated under the formula that "the degree is reached when yellow water is discharged via urine." Furthermore, they changed Da Huang Xiao Shi Tang (Rhubarb and Niter Decoction) to Da Huang Hua Shi Tang (Rhubarb and Talcum Stone Decoction). How low has the state of medicine fallen! In men, blood transforms into essence (Jing). When essence moves, the blood of the entire body moves. Due to excessive sexual activity depleting the essence, the blood follows suit. Therefore, those who experience hematuria due to female labor still have flowing blood, which is relatively easy to treat. However, jaundice resulting from female labor involves stagnant blood that does not flow, making it difficult to treat. In severe cases, long-standing blood stasis causes the entire abdomen to become full, forming Blood Gu (Xue Gu), which is extremely severe and difficult to treat. Those who fail to understand Zhang Zhongjing’s original text and instead contradict the intent of the prescription will find no path to survival for Female Labor Jaundice unless they urgently remove the blood stasis in the bladder and lower abdomen. In cases of Heat Stasis in the Bladder from Cold Damage (Shang Han), the patient recovers after bleeding. If blood does not descend, Di Dang Tang (Ephedra, Persimmon Seed, Silkworm, and Earthworm Decoction) is used to purge it, because the blood is temporarily congealed and can be aggressively attacked. However, the accumulated blood in Female Labor Jaundice has gathered over days or months, not overnight; aggressive purging is useless. One must rely on the fierce nature of mineral drugs to rapidly reach the disease site. Xiao Shi (Niter) is salty and cold, enters the blood level, and can eliminate and expel heat-stagnant blood, thus serving as the sovereign drug. Fan Shi (Alum) is recorded in herbal classics as capable of removing entrenched heat in the bone marrow; it is used to clear heat in the Kidney and Bladder organs and establish the function of eliminating stasis and turbidity. This is the most exquisite aspect of this formula worth emulating. Chen Wuyue, though virtuous, was ambiguous in his theory, stating that this decoction should be used only if there is no fever, aversion to cold, or slippery pulse. If there is fever and aversion to cold with a floating-tight pulse, Hua Shi (Talcum Stone) and Shi Gao (Gypsum) should be used. This is merely mumbling dream talk in broad daylight, let alone other errors! Is there any case in the world where blood accumulates in the Lower Jiao but presents with a floating, slippery, and tight pulse? Absurd! Absurd!
In summer, the heat of the weather and the dampness of the earth steam together. Humans receive these two qi, which remain internally stagnant and unresolved, leading to Yellow Jaundice (Huang Dan), indistinguishable from fermented sauce. Treatment must follow the methods of sweating, purging, or vomiting for exterior patterns to eliminate damp-heat. However, in summer, yang qi is external and yin qi is internal, unlike winter Cold Damage where pathogenic qi lies dormant and hard to move. I have clarified Zhang Zhongjing’s intention to use these three methods cautiously. As for Grain Jaundice (Gu Dan), Wine Jaundice (Jiu Dan), and Female Labor Jaundice (Nü Lao Dan), these diseases arise from internal injury and are unrelated to exterior contraction. Zhang Zhongjing supplemented the gaps in *Nei Jing* (The Inner Canon) and exhaustively revealed its subtleties, which I have also elucidated. Regarding Yin Jaundice (Yin Dan), Zhang Zhongjing’s formulas and discussions have been lost. Since ancient times, only Luo Qianfu’s Yin Chen Fu Zi Gan Jiang Gan Cao Tang (Artemisia Capillaris, Aconite, Ginger, and Licorice Decoction) exists. It treats conditions where excessive use of cold-cooling medicines caused Yang Jaundice to transform into Yin Jaundice, aligning with past precedents; there are no others. Modern practitioners merely say that Yang Jaundice has a bright color and Yin Jaundice has a dull color. This distinction based on qi and blood is unclear and leads to misleading patients. For instance, Wine Jaundice turning black or Female Labor Jaundice presenting with a black forehead—does their black color imply Yin Jaundice, warranting the use of Fu Zi (Aconite Root) and Gan Jiang (Dried Ginger)? In Female Labor Jaundice, True Yang is obstructed by blood stasis but not yet severely damaged; once the stasis moves, Yang Qi flows freely. In Yin Jaundice, however, True Yang is weak and failing, allowing damp-heat, turbid qi, and ruined blood to knot together without dispersing. One must restore Yang Qi for the entrenched knots to open. Without the sun shining brightly in the sky, how could hidden darkness be illuminated? Students should study the formulas and theories in the previous volume carefully, and their understanding will be more than half complete.
[Three Laws]
1. For Yellow Jaundice acquired from exterior contraction, mistakenly using tonification methods constitutes "reinforcing excess" (Shi Shi), which is the physician's fault.
2. For Yellow Jaundice acquired from internal injury, mistakenly using purgative methods constitutes "depleting deficiency" (Xu Xu), which is the physician's fault.
3. For Yin Jaundice, mistakenly treating it according to Yang patterns and blindly applying bitter-cold herbs, acting against nature, leading to an irreversible critical state, results in the physician killing the patient. Yin Jaundice presents with no fever but aversion to cold, free urination, and a slow, faint pulse. Mistakenly using Kai Gui Men (opening the ghost gate/sweating) causes cold skin and incessant spontaneous sweating; mistakenly using Jing Ji Fu (cleaning the water reservoir/diuresis) causes bladder incontinence and urinary urgency like rushing water, with death imminent within day or night. How much worse are the gross errors of vomiting and purging! Even delaying with mild medicines is merely a method of waiting for death. In semi-yin semi-yang patterns, one must first retreat yin and restore yang; only after yin retreats should treatment follow yang patterns. Combining Fu Zi (Aconite Root) and Huang Lian (Coptis Rhizome) will surely cause harm. Why, then, resort to bitter-cold medicines when the pattern is purely yin without yang?