初诊：病经一月，治疗无效。面目肌肤发黄，鲜明如桔色，浮肿且痒，但无疹点。烧热口苦，食少神倦，头目眩 晕。溺短而赤，大便干结。夜间烦躁，手足灼热，身困体重。脉象眩数有力，舌红苔黄燥。证属阳黄，系由肝胆湿热蕴郁不化，阳明燥结，气分不宣所致。治宜清热化湿，兼佐通利。拟方；
绵茵陈18克 焦栀子9克 焦黄柏6克 生大黄6克 广连
翘6克 红饭豆15克(冲) 芦苇根30克 白通草3克 净竹
茹6克
二诊：上方服三剂，大便已通，小便增多，手足心发热轻减。面目及肢体黄染浮肿均渐消退。夜能静卧，可进少量饮食。脉象弦数，舌红、苔薄黄。证属阳明气分宣通，肝胆湿热较化。前方已有效，仍守原意增减：
绵茵陈18克 滑石9克 猪苓9克 木通9克 焦栀子3克
焦黄柏3克芦根30克广连翘6克 自通草3克
三诊：上方连进十剂，小便清长，大便通畅。面目及全身黄染即将退尽，浮肿消失。惟头昏神倦，肢软乏力，自汗，肤痒。脉舌如前。此湿热甫净，脾虚气弱，续拟清化调理之品。处方：
茵陈12克茯苓15克猪苓9克泽泻6克 饭豆15克 苡
仁15克 木通3克 芦根15克 通草3克 竹茹6克
上方服五剂后，脉象调和，舌润苔淡。于前方去茵陈、泽泻、通草，加条参15克、扁豆12克、白术12克，服十五剂，黄染、浮肿诸症全消。睡眠、饮食恢复正常。再以六君善后。翌年受孕怀胎，足月顺产，母子均安。
[按]湿热熏蒸，迫胆汁外溢，发黄鲜明如桔， 虽经多日，其候不变。细参脉症，病属阳黄。针对病机，以茵陈栀子大黄汤加味，阳明宣通，邪无所据。随以茵陈四苓，肝胆清舒，再重调理。
黄 痘(肝硬化)
刘××，男，四十三岁，部队干部。1970年6月。
初诊。患者病经半年以上，初起觉身困头眩，食欲不佳，右胁下隐隐作痛，心烦欲呕。小便黄，大便秘。继则周身及面目出现黄疸，口苦烦躁，食减眠差。入某医院，经多次化验检查，确诊为黄疸性肝炎，已发展为肝硬化。住院治疗数月，黄疸未见消退，反而出现腹水，面足浮肿，胸痞，胁痫，腹胀，饮食日减，小便短涩，大便干燥。夜难入睡。服姜桂术附及理中、四逆汤等药，病情未减，反趋急剧，约余会诊。
脉弦滑而数，重按有力，舌苔黄腻且干。症属湿热发黄[阳黄]，肝胆气滞。病势绵缠，治以舒肝利胆，清热化湿。拟茵陈温胆汤加减。处方：
绵茵陈18克败酱草15克鸡骨草30克焦栀子9克炒枳实
9克(冲)净竹茹9克醋法夏9克广陈皮6克广木香4．5克
炒柴胡9克 醋郁金9克(冲) 大腹皮15克 连皮茯苓30克
烧鸡金6克
二诊；前方服五剂后，大便通顺，小便稍多，色尚深黄如浓茶，口苦燥。黄疸未退，胸腹胀满稍减，自觉腹中作鸣，可略进饮食。肢体仍浮肿，入夜烦躁不宁，精神倦怠。
此肝胆气分渐舒，内伏湿热尚重，脾为湿困，运化失调。脉弦滑而数，重按渐软，舌苔薄黄而润，续用原方加减。处方：
绵茵陈15克 茯苓30克猪苓15克炒泽泻9克炒柴胡9克
炒枳实9克(冲) 鸡骨草30克 大腹皮15克 广木香4．5克
净竹茹9克 醋郁金6克 车前子9克(包煨) 烧鸡金6克
三诊：上方连服十五剂后，小便增多，腹水陆续消退，全身已不浮肿，胸痞、胁痛均较前减轻，渐思饮食，夜能静卧，面目尚有轻度发黄，可单独行走来医院门诊。脉象细弦，舌苔淡黄薄腻，是黄疸湿热将化，脾弱肝胆气分渐舒，拟从调达肝脾，清化未尽湿热兼治。方用茵陈四苓散加味：
绵茵陈9克 白术12克 茯苓18克 猪苓9克 炒泽泻9克
广木香3克 西砂仁9克(冲) 法半夏0克 广陈皮6克
苡仁15克 竹茹6克 烧鸡金2枚
上方又连服十数剂，黄疸消失，饮食增加，二便正常，睡眠安定，只觉精神体力尚未恢复。续以归芍香砂六君汤：
苏条参16克 白术9克 茯苓18克生甘草3克法半夏9克
广陈皮6克 全当归15克 炒杭芍9克 广木香2．4克 西
砂仁6克(冲)
服上方调理月余，全愈出院。
[姚按]“黄疸性肝炎”中医没有这个名词，但是祖国医
学文献里有“阳黄”“阴黄”的记载，和现代的“黄痘性肝
炎”都有相同之处。这一病例，从它的临床症状、体征i脉
象、舌诊等各方面的情况看，确系“阳黄”症，所以，我们
根据治阳黄的方法长期给惠者服药，终于治愈。
黄疸臌胀(肝硬化)
常××，男，三十二岁，解放军指挥员。1959年4月。
初诊：患者起病于1956年，因庆功筵豪饮大醉，昏睡一昼夜之久。此后，食欲锐减，形体渐瘦，而自恃体力，不以为患。半年后，又出现右胁疼痛、恶心、呕吐等症状。在部队医院治疗，因胁痛剧烈，曾注射吗啡数支。后出现黄疸，乃入昆明军区总医院以“急性黄疸型肝炎”治疗，好转后出院。出院后，未克休息，且劳累过度，病复发，于1959年4月二次入院，诊断为“肝硬化”，采取中西合治。据云所服中药，有大剂量桂、附。服后，胸腹烧灼难忍，反而腹胀增大，黄疸加深，病情渐趋恶化。4月30日晚，邀余会诊。
诊见患者全身色如金桔，汗出皆黄，衣被尽染。发高热，(每日持续在40℃左右)腹部胀大如鼓，膨隆高起，不能自视其足。小便短赤不利，大便不畅，烦渴而饮少。脉弦滑数，舌质红黯、苔黄厚腻。此肝脾屡伤，血郁气滞，土困木横，湿热熏蒸，运化疏泄及传导失司，遂发为黄疸臌胀，病势凶险，法当清湿热以疏肝络，消黄疸兼除臌胀。处方：
菌陈15克 炒栀子6克 带皮茯苓24克 猪苓15克 泽泻
9克 枳实6克(炒冲) 醋郁金9克(冲) 焦柏6克 炒厚
朴9克 大腹皮1 5克 通草6克 滑石18克 竹茹6克 芦
根30克
二诊：上方服四剂，体温降至37—38℃之间，黄疸明显消退，烦渴已少，精神好转。但臌胀未消，日夜痛楚。脉弦滑，舌苔黄，厚腻未退。症属黄疸湿热较化，肝脾气机壅滞未舒，运化无权，水邪停留。本当攻逐，但久病脾胃屡伤，用峻猛之品，恐难胜任；若随攻随胀，预后尤为不良！提笔踌躇，忽忆同道鲁绍曾老先生曾谓：“用大蒜煮鲜肉，可消腹水，且不伤正。”因嘱试服用生大蒜120克(去皮)鲜猪肉半斤，同熬粑烂为度，顿服。并处方：
茵陈15克带皮茯苓30克猪苓15克泽泻9克炒枳壳9克
炒厚朴9克 广陈皮6克 大腹皮9克 冲郁金9克 广木
香4．5克 焦柏4．5克 烧鸡金6克 甘草3克
三诊：患者自诉：服上述单方及汤药后，约二时许，脘腹胀闷欲死，心泛欲吐，而强忍之。又二时许，腹中鸣动，随即二便如注。半日共下稀水粪便十三次，后臌胀顿消，如释重负。发热也退净，精神爽适，且知饥索食。诊脉转现弱缓，舌苔退薄。此病退，肝脾未复，续宜调肝扶脾，和胃清化。处方：
茵陈9克 苍术9克 茯苓2．4克 猪苓9克 泽泻6克 苡
仁12克 波寇6克 炒枳壳6克 甘草3克 竹茹6克
烧鸡金6克
四诊：上方服一周，病势稳定，精神好转，食欲旺盛。
脉缓微弦，舌红、苔薄微腻。症候续宜调理，再拟下方：
茯苓15克 猪苓9克 泽泻9克 苍术9克 炒厚朴9克
广木香3克 西砂仁9克 陈皮6克 苡仁12克 甘草3克
竹茹6克 烧鸡金6克 鸡骨草12克
上方化裁出入，治疗约一月，诸症俱消。出院后，改服逍遥、六君类加减，前后二、三年，巩固疗效。因庆再生，与余结成革命友谊，至今往来不绝。
[按]辛劳骤饮，肝脾损伤，血郁气滞，湿热熏蒸，运化、疏泄、及开阖失常，发为黄疸臌胀奇险重症。首用清泻分消之剂，继投辛温通导、扶正驱邪验方，效应如响f此即内经：“中满者，泻之于内。”及“劳者温之”之意焉。
肿 胀
管××，男，十六岁，学生。1954年7月。
初诊：患者月前因剧烈运动后，外感发热，腰痛，肢软乏力，未加诊治。继则面目及肢体浮肿，小便不利，腰痛加重，精神尤感疲乏，饮食减少，胸腹胀闷，大便稀溏，经某医院诊断为肾炎。
诊见面色苍白，脸足浮肿。脉沉细，左尺兼弦，右关濡弱，舌淡苔薄腻。此系肾虚脾弱，水湿不化，治以温肾固脾，除湿通络，拟方：
茯苓18克 白术12克 桂枝木9克 泽泻9克 猪苓9克
大腹皮9克 广陈皮6克 怀牛夕6克 桑寄生12克 红饭
豆12克 炒苡仁12克生甘草3克车前子0克炒川断9克
二诊：连服上方五剂后，小便增加，面足浮肿渐消，腰痛减轻，精神好转。复感表邪，痰凝作咳。脉两寸微浮，苔腻退薄，此脾胃运化渐复，气虚卫弱，续拟下方：
生口芪12克 防风片6克 白术9克 川独活6克 桑寄片
12克 法半夏9克 广陈皮6克 茯苓15克 苡仁12克 桂
枝木6克 生甘草3克 生姜1片 小红枣11枚
三诊：上方连服五剂，表解，卫阳已固，小便清长，便溏转干。面足微浮，偶有腰痛。诊脉沉细而缓，舌粉苔薄，脾阳较振，肾气尚虚，续拟下方调理：
桂枝木4．5克 白术9克 杜仲12克 干地黄12克枣皮4．5克
粉丹皮4．5克 泽泻6克 茯苓15克 炒淮药12克 桑寄
生12克怀牛夕6克生甘草3克
上方服十余剂后，诸症全消，面色转润，嘱常服金匮肾气丸巩固疗效。
[按]本例由于脾肾两虚所致，运泄无权，水湿留滞，阳气不运，浸瑶肌肤，发为肤胀。方用苓桂术甘加减及五苓等，俾气化而湿无所留。若妄以淡渗利水之品，则气化益衰，致蹈舍本逐末之弊。
初诊：患病已一个月，治疗无效。面目肌肤发黄，颜色鲜明如橘子色，伴有浮肿且瘙痒，但没有皮疹点。身体发热，口苦，食欲减退，精神疲倦，头晕目眩。小便短少且颜色红赤，大便干结。夜间烦躁不安，手足心灼热，身体困重。脉象弦数有力，舌质红，苔黄燥。证属阳黄，是由肝胆湿热蕴结郁滞不能化解，阳明腑实燥结，气机宣发受阻所致。治疗宜清热化湿，兼用通利之法。拟方如下：
绵茵陈18克 焦栀子9克 焦黄柏6克 生大黄6克 广连翘6克 红饭豆15克(冲服) 芦苇根30克 白通草3克 净竹茹6克
二诊：服用上方三剂后，大便已通畅，小便增多，手足心发热减轻。面目及肢体黄染和浮肿均逐渐消退。夜间能够安静卧床，可以进食少量食物。脉象弦数，舌质红，苔薄黄。证属阳明气分宣通，肝胆湿热较前化解。前方已经有效，仍遵循原意进行增减：
绵茵陈18克 滑石9克 猪苓9克 木通9克 焦栀子3克 焦黄柏3克 芦根30克 广连翘6克 白通草3克
三诊：上方连续服用十剂后，小便清长，大便通畅。面目及全身黄染即将退尽，浮肿消失。仅有头昏、精神疲倦、肢体软弱乏力、自汗、皮肤瘙痒。脉象舌象与之前相同。这是湿热刚刚清除，脾虚气弱的表现，继续拟定清化调理的方药。处方：
茵陈12克 茯苓15克 猪苓9克 泽泻6克 饭豆15克 苡仁15克 木通3克 芦根15克 通草3克 竹茹6克
上方服用五剂后，脉象调和，舌润苔淡。在前方中去掉茵陈、泽泻、通草，加入条参15克、扁豆12克、白术12克，再服用十五剂，黄染、浮肿等症状全部消除。睡眠、饮食恢复正常。随后以六君子汤善后调理。次年受孕怀孕，足月顺产，母子平安。
[按语]湿热熏蒸，迫使胆汁外溢，发黄鲜明如桔子色，虽然经过多日，症状没有改变。仔细参详脉症，病属阳黄。针对病机，使用茵陈蒿汤加味，使阳明气机宣通，邪气无所依附。随后使用茵陈四苓散，使肝胆清利舒畅，再着重调理。
黄疸（肝硬化）
刘××，男，四十三岁，部队干部。1970年6月。
初诊：患者患病半年以上，起初感觉身体困重、头晕，食欲不佳，右胁下隐隐作痛，心烦想呕吐。小便黄，大便秘结。随后周身及面目出现黄疸，口苦烦躁，食量减少，睡眠差。进入某医院，经多次化验检查，确诊为黄疸性肝炎，已发展为肝硬化。住院治疗数月，黄疸未见消退，反而出现腹水，面部和足部浮肿，胸闷痞塞，胁肋疼痛，腹胀，饮食日益减少，小便短涩，大便干燥。夜间难以入睡。服用姜桂术附汤及理中汤、四逆汤等药物，病情未减，反而急剧恶化，约请余会诊。
脉象弦滑而数，重按有力，舌苔黄腻且干。症属湿热发黄[阳黄]，肝胆气滞。病势缠绵，治疗以疏肝利胆，清热化湿为主。拟茵陈温胆汤加减。处方：
绵茵陈18克 败酱草15克 鸡骨草30克 焦栀子9克 炒枳实9克(冲服) 净竹茹9克 醋法半夏9克 广陈皮6克 广木香4.5克 炒柴胡9克 醋郁金9克(冲服) 大腹皮15克 连皮茯苓30克 烧鸡内金6克
二诊：前方服用五剂后，大便通顺，小便稍多，颜色尚深黄如浓茶，口苦口干。黄疸未退，胸腹胀满稍减，自觉腹中鸣响，可略进饮食。肢体仍浮肿，入夜烦躁不宁，精神倦怠。
此乃肝胆气分渐舒，但内伏湿热尚重，脾脏被湿邪困阻，运化功能失调。脉象弦滑而数，重按渐软，舌苔薄黄而润，继续使用原方加减。处方：
绵茵陈15克 茯苓30克 猪苓15克 炒泽泻9克 炒柴胡9克 炒枳实9克(冲服) 鸡骨草30克 大腹皮15克 广木香4.5克 净竹茹9克 醋郁金6克 车前子9克(包煎) 烧鸡内金6克
三诊：上方连续服用十五剂后，小便增多，腹水陆续消退，全身已不浮肿，胸闷痞塞、胁痛均较前减轻，渐渐想吃东西，夜间能安静卧床，面目尚有轻度发黄，可单独行走来医院门诊。脉象细弦，舌苔淡黄薄腻，是黄疸湿热将化，脾弱肝胆气分渐舒的表现，拟从调达肝脾，清化未尽湿热兼治。方用茵陈四苓散加味：
绵茵陈9克 白术12克 茯苓18克 猪苓9克 炒泽泻9克 广木香3克 西砂仁9克(冲服) 法半夏0克 广陈皮6克 苡仁15克 竹茹6克 烧鸡内金2枚
上方又连续服用十数剂，黄疸消失，饮食增加，二便正常，睡眠安定，只觉精神体力尚未恢复。续以归芍香砂六君子汤调理：
苏条参16克 白术9克 茯苓18克 生甘草3克 法半夏9克 广陈皮6克 全当归15克 炒杭芍9克 广木香2.4克 西砂仁6克(冲服)
服用上方调理月余，痊愈出院。
[姚按语]“黄疸性肝炎”中医没有这个名词，但是祖国医学文献里有“阳黄”“阴黄”的记载，和现代的“黄疸性肝炎”都有相同之处。这一病例，从它的临床症状、体征、脉象、舌诊等各方面的情况看，确系“阳黄”症，所以，我们根据治阳黄的方法长期给患者服药，终于治愈。
黄疸臌胀（肝硬化）
常××，男，三十二岁，解放军指挥员。1959年4月。
初诊：患者起病于1956年，因庆功宴豪饮大醉，昏睡一昼夜之久。此后，食欲锐减，形体渐瘦，而自恃体力，不以为患。半年后，又出现右胁疼痛、恶心、呕吐等症状。在部队医院治疗，因胁痛剧烈，曾注射吗啡数支。后出现黄疸，乃入昆明军区总医院以“急性黄疸型肝炎”治疗，好转后出院。出院后，未能休息，且劳累过度，病复发，于1959年4月二次入院，诊断为“肝硬化”，采取中西合治。据云所服中药，有大剂量桂枝、附子。服后，胸腹烧灼难忍，反而腹胀增大，黄疸加深，病情渐趋恶化。4月30日晚，邀余会诊。
诊见患者全身色如金桔，汗出皆黄，衣被尽染。发高热（每日持续在40℃左右），腹部胀大如鼓，膨隆高起，不能自视其足。小便短赤不利，大便不畅，烦渴而饮少。脉弦滑数，舌质红黯、苔黄厚腻。此肝脾屡伤，血郁气滞，土困木横，湿热熏蒸，运化疏泄及传导失司，遂发为黄疸臌胀，病势凶险，法当清湿热以疏肝络，消黄疸兼除臌胀。处方：
茵陈15克 炒栀子6克 带皮茯苓24克 猪苓15克 泽泻9克 枳实6克(炒冲) 醋郁金9克(冲) 焦柏6克 炒厚朴9克 大腹皮15克 通草6克 滑石18克 竹茹6克 芦根30克
二诊：上方服用四剂，体温降至37—38℃之间，黄疸明显消退，烦渴已少，精神好转。但臌胀未消，日夜痛楚。脉弦滑，舌苔黄，厚腻未退。症属黄疸湿热较化，肝脾气机壅滞未舒，运化无权，水邪停留。本当攻逐，但久病脾胃屡伤，用峻猛之品，恐难胜任；若随攻随胀，预后尤为不良！提笔踌躇，忽忆同道鲁绍曾老先生曾谓：“用大蒜煮鲜肉，可消腹水，且不伤正。”因嘱试服用生大蒜120克(去皮)鲜猪肉半斤，同熬烂为度，顿服。并处方：
茵陈15克 带皮茯苓30克 猪苓15克 泽泻9克 炒枳壳9克 炒厚朴9克 广陈皮6克 大腹皮9克 冲郁金9克 广木香4.5克 焦柏4.5克 烧鸡内金6克 甘草3克
三诊：患者自诉：服上述单方及汤药后，约二时许，脘腹胀闷欲死，心泛欲吐，而强忍之。又二时许，腹中鸣动，随即二便如注。半日共下稀水粪便十三次，后臌胀顿消，如释重负。发热也退净，精神爽适，且知饥索食。诊脉转现弱缓，舌苔退薄。此病退，肝脾未复，续宜调肝扶脾，和胃清化。处方：
茵陈9克 苍术9克 茯苓2.4克 猪苓9克 泽泻6克 苡仁12克 波蔻6克 炒枳壳6克 甘草3克 竹茹6克 烧鸡内金6克
四诊：上方服用一周，病势稳定，精神好转，食欲旺盛。脉缓微弦，舌红、苔薄微腻。症候续宜调理，再拟下方：
茯苓15克 猪苓9克 泽泻9克 苍术9克 炒厚朴9克 广木香3克 西砂仁9克 陈皮6克 苡仁12克 甘草3克 竹茹6克 烧鸡内金6克 鸡骨草12克
上方化裁出入，治疗约一月，诸症俱消。出院后，改服逍遥散、六君子汤类加减，前后二、三年，巩固疗效。因庆再生，与余结成革命友谊，至今往来不绝。
[按语]辛劳骤饮，肝脾损伤，血郁气滞，湿热熏蒸，运化、疏泄、及开阖失常，发为黄疸臌胀奇险重症。首用清泻分消之剂，继投辛温通导、扶正驱邪验方，效应如响；此即内经：“中满者，泻之于内。”及“劳者温之”之意焉。
肿胀
管××，男，十六岁，学生。1954年7月。
初诊：患者月前因剧烈运动后，外感发热，腰痛，肢软乏力，未加诊治。继则面目及肢体浮肿，小便不利，腰痛加重，精神尤感疲乏，饮食减少，胸腹胀闷，大便稀溏，经某医院诊断为肾炎。
诊见面色苍白，脸足浮肿。脉沉细，左尺兼弦，右关濡弱，舌淡苔薄腻。此系肾虚脾弱，水湿不化，治以温肾固脾，除湿通络，拟方：
茯苓18克 白术12克 桂枝木9克 泽泻9克 猪苓9克 大腹皮9克 广陈皮6克 怀牛膝6克 桑寄生12克 红饭豆12克 炒苡仁12克 生甘草3克 车前子0克 炒川断9克
二诊：连服上方五剂后，小便增加，面足浮肿渐消，腰痛减轻，精神好转。复感表邪，痰凝作咳。脉两寸微浮，苔腻退薄，此脾胃运化渐复，气虚卫弱，续拟下方：
生黄芪12克 防风片6克 白术9克 川独活6克 桑寄生12克 法半夏9克 广陈皮6克 茯苓15克 苡仁12克 桂枝木6克 生甘草3克 生姜1片 小红枣11枚
三诊：上方连服五剂，表解，卫阳已固，小便清长，便溏转干。面足微浮，偶有腰痛。诊脉沉细而缓，舌粉苔薄，脾阳较振，肾气尚虚，续拟下方调理：
桂枝木4.5克 白术9克 杜仲12克 干地黄12克 枣皮4.5克 粉丹皮4.5克 泽泻6克 茯苓15克 炒淮山药12克 桑寄生12克 怀牛膝6克 生甘草3克
上方服用十余剂后，诸症全消，面色转润，嘱常服金匮肾气丸巩固疗效。
[按语]本例由于脾肾两虚所致，运泄无权，水湿留滞，阳气不运，浸淫肌肤，发为肤胀。方用苓桂术甘汤加减及五苓散等，俾气化而湿无所留。若妄以淡渗利水之品，则气化益衰，致蹈舍本逐末之弊。
First Visit: The illness has persisted for one month with ineffective treatment. The face, eyes, and skin are yellow, bright like orange peel, accompanied by edema and itching, but without rash spots. There is fever, bitter taste in the mouth, poor appetite, mental fatigue, dizziness, and vertigo. Urine is short and red; stool is dry and constipated. Restlessness at night, burning sensation in hands and feet, heavy body sensation. Pulse is wiry, rapid, and forceful; tongue is red with dry yellow coating. The syndrome belongs to Yang Jaundice (Yang Huang), caused by damp-heat accumulating and stagnating in the Liver and Gallbladder, failing to transform, combined with Yangming dryness and accumulation, leading to impaired Qi circulation. Treatment should focus on clearing heat and resolving dampness, assisted by promoting urination and unblocking bowels. Prescribed formula:
* Yinchen (Artemisiae Scopariae Herba) 18g
* Jiaozhizi (Gardeniae Fructus, carbonized) 9g
* Jiaohuangbai (Phellodendri Cortex, carbonized) 6g
* Shengdahuang (Rhei Radix et Rhizoma, raw) 6g
* Guanglianqiao (Forsythiae Fructum) 6g
* Hongfandou (Phaseoli Semen Rubrum) 15g (decocted separately)
* Lugen (Phragmitis Rhizoma) 30g
* Bitongcao (Tetrapanacis Medulla) 3g
* Jingzhuru (Bambusae Caulis in Taeniam) 6g
Second Visit: After taking three doses of the above prescription, bowel movements have become smooth, urine volume has increased, and the burning sensation in the palms and soles has diminished. The jaundice and edema on the face and limbs have gradually subsided. The patient can lie quietly at night and consume a small amount of food. The pulse is wiry and rapid; the tongue is red with a thin yellow coating. The syndrome indicates that Yangming Qi circulation has been restored, and the damp-heat in the Liver and Gallbladder has largely resolved. The previous formula was effective; continue with modifications based on the original intent:
* Yinchen (Artemisiae Scopariae Herba) 18g
* Huashi (Talcum) 9g
* Zhuling (Polyporus) 9g
* Mutong (Akebiae Caulis) 9g
* Jiaozhizi (Gardeniae Fructus, carbonized) 3g
* Jiaohuangbai (Phellodendri Cortex, carbonized) 3g
* Lugeng (Phragmitis Rhizoma) 30g
* Guanglianqiao (Forsythiae Fructum) 6g
* Bitongcao (Tetrapanacis Medulla) 3g
Third Visit: After continuously taking ten doses of the above prescription, urine became clear and abundant, and bowel movements were smooth. The jaundice on the face and whole body is almost completely gone, and edema has disappeared. Only dizziness, mental fatigue, limb weakness, spontaneous sweating, and skin itching remain. The pulse and tongue presentation are unchanged from before. This indicates that damp-heat has just cleared, revealing Spleen deficiency and Qi weakness. Continue with formulas for clearing transformation and regulation. Prescribed:
* Yinchen (Artemisiae Scopariae Herba) 12g
* Fuling (Poria) 15g
* Zhuling (Polyporus) 9g
* Zexie (Alismatis Rhizoma) 6g
* Fandou (Phaseoli Semen Rubrum) 15g
* Yiren (Coicis Semen) 15g
* Mutong (Akebiae Caulis) 3g
* Lugeng (Phragmitis Rhizoma) 15g
* Tongcao (Tetrapanacis Medulla) 3g
* Zhuru (Bambusae Caulis in Taeniam) 6g
After five doses of the above prescription, the pulse harmonized, and the tongue became moist with a pale coating. Yinchen, Zexie, and Tongcao were removed from the previous formula; Tiaoshen (Codonopsis Radix), Biandou (Dolichoris Semen), and Baizhu (Atractylodis Macrocephalae Rhizoma) were added. After fifteen doses, all symptoms of jaundice and edema disappeared. Sleep and diet returned to normal. Subsequently, Liujunzi Tang (Six Gentlemen Decoction) was used for convalescence. The following year, she conceived and delivered a healthy baby at full term, mother and child both safe.
[Commentary] Damp-heat steaming and forcing bile to overflow externally causes bright yellow jaundice like an orange. Despite many days passing, the condition remains unchanged. Carefully analyzing the pulse and symptoms, the disease belongs to Yang Jaundice. Targeting the pathogenesis, Yinchen Hao Tang (Artemisia, Gardenia, and Rhubarb Decoction) with modifications was used to unblock Yangming Qi, leaving no foothold for pathogens. Subsequently, Yinchen Siling San (Artemisia and Four Mushrooms Powder) was used to clear and soothe the Liver and Gallbladder, followed by emphasis on regulation.
Jaundice (Liver Cirrhosis)
Liu XX, Male, 43 years old, Military Cadre. June 1970.
First Visit: The patient had been ill for over half a year. Initially, he felt heavy body sensations, dizziness, poor appetite, dull pain in the right hypochondrium, irritability, and nausea. Urine was yellow, stool was constipated. Later, generalized jaundice appeared on the body and face, accompanied by bitter taste, irritability, reduced food intake, and poor sleep. He entered a hospital where multiple laboratory tests confirmed Jaundice Hepatitis, which had progressed to Liver Cirrhosis. After several months of hospitalization, the jaundice did not subside; instead, ascites developed, along with facial and pedal edema, chest oppression, hypochondriac pain, abdominal distension, decreasing appetite, scanty and difficult urination, and dry stool. Difficulty sleeping at night. Medications such as Jianggui Shufu Tang (Ginger, Cinnamon, Atractylodes, and Aconite Decoction), Lizhong Tang (Regulate the Middle Decoction), and Sini Tang (Reverse the Extremities Decoction) failed to alleviate the condition, which instead worsened rapidly. I was invited to consult.
The pulse is wiry, slippery, and rapid, forceful upon deep pressure. The tongue coating is yellow, greasy, and dry. The syndrome is Damp-Heat Jaundice [Yang Jaundice] with Liver-Gallbladder Qi stagnation. The disease course is lingering; treatment aims to soothe the Liver, benefit the Gallbladder, clear heat, and resolve dampness. Yinchen Wendan Tang (Artemisia and Gallbladder-Calming Decoction) with modifications is prescribed. Formula:
* Mianyinchen (Artemisiae Scopariae Herba) 18g
* Baijiangcao (Patriniae Herba) 15g
* Jigucao (Puerariae Lobatae Radix) 30g
* Jiaozhizi (Gardeniae Fructus, carbonized) 9g
* Chao Zhishi (Aurantii Fructus Immaturus, stir-fried) 9g (decocted separately)
* Jingzhuru (Bambusae Caulis in Taeniam) 9g
* Cu Banxia (Pinelliae Rhizoma, vinegar-processed) 9g
* Guang Chenpi (Citri Reticulatae Pericarpium) 6g
* Guang Muxiang (Aucklandiae Radix) 4.5g
* Chao Chaihu (Bupleuri Radix, stir-fried) 9g
* Cu Yujin (Curcumae Longae Rhizoma, vinegar-processed) 9g (decocted separately)
* Dafupi (Arecae Pericarpium) 15g
* Lianpi Fuling (Poria with bark) 30g
* Shao Jijinn (Galli Gigerii Endothelium Corneum, roasted) 6g
Second Visit: After five doses of the previous prescription, bowel movements were smooth, urine volume slightly increased but remained dark yellow like strong tea, and there was a bitter, dry mouth. Jaundice had not receded, but chest and abdominal distension had slightly decreased. The patient felt borborygmus in the abdomen and could eat slightly. Limbs remained edematous; restlessness at night and mental fatigue persisted.
This indicates gradual soothing of Liver-Gallbladder Qi, but internal damp-heat remains heavy, trapping the Spleen and disrupting transportation and transformation. The pulse is wiry, slippery, and rapid, becoming softer upon deep pressure; the tongue coating is thin, yellow, and moist. Continue with the original prescription with modifications. Formula:
* Mianyinchen (Artemisiae Scopariae Herba) 15g
* Fuling (Poria) 30g
* Zhuling (Polyporus) 15g
* Chao Zexie (Alismatis Rhizoma, stir-fried) 9g
* Chao Chaihu (Bupleuri Radix, stir-fried) 9g
* Chao Zhishi (Aurantii Fructus Immaturus, stir-fried) 9g (decocted separately)
* Jigucao (Puerariae Lobatae Radix) 30g
* Dafupi (Arecae Pericarpium) 15g
* Guang Muxiang (Aucklandiae Radix) 4.5g
* Jingzhuru (Bambusae Caulis in Taeniam) 9g
* Cu Yujin (Curcumae Longae Rhizoma, vinegar-processed) 6g
* Cheqianzi (Plantaginis Semen, wrapped) 9g
* Shao Jijinn (Galli Gigerii Endothelium Corneum, roasted) 6g
Third Visit: After continuously taking fifteen doses of the above prescription, urine volume increased, and ascites gradually subsided. Generalized edema disappeared. Chest oppression and hypochondriac pain were significantly reduced. Appetite improved, allowing quiet sleep at night. Mild jaundice remained on the face and eyes. The patient could walk independently to the outpatient clinic. The pulse was fine and wiry; the tongue coating was pale yellow and thinly greasy. This indicates that damp-heat jaundice is transforming, Spleen weakness is present, and Liver-Gallbladder Qi circulation is gradually soothing. The approach is to regulate and soothe the Liver and Spleen, while clearing residual damp-heat. Yinchen Siling San (Artemisia and Four Mushrooms Powder) with modifications is used:
* Mianyinchen (Artemisiae Scopariae Herba) 9g
* Baizhu (Atractylodis Macrocephalae Rhizoma) 12g
* Fuling (Poria) 18g
* Zhuling (Polyporus) 9g
* Chao Zexie (Alismatis Rhizoma, stir-fried) 9g
* Guang Muxiang (Aucklandiae Radix) 3g
* Xi Sharen (Amomi Fructus, Western variety) 9g (decocted separately)
* Banxia (Pinelliae Rhizoma) 0g
* Guang Chenpi (Citri Reticulatae Pericarpium) 6g
* Yiren (Coicis Semen) 15g
* Zhuru (Bambusae Caulis in Taeniam) 6g
* Shao Jijinn (Galli Gigerii Endothelium Corneum, roasted) 2 pieces
After another dozen or so doses, jaundice disappeared, appetite increased, urination and defecation normalized, and sleep stabilized. Only mental and physical fatigue remained. Guishao Xiangsha Liujunzi Tang (Angelica, Peony, Aucklandia, and Amomi Six Gentlemen Decoction) was continued for regulation:
* Tiaoshen (Codonopsis Radix) 16g
* Baizhu (Atractylodis Macrocephalae Rhizoma) 9g
* Fuling (Poria) 18g
* Sheng Gancao (Glycyrrhizae Radix et Rhizoma, raw) 3g
* Banxia (Pinelliae Rhizoma) 9g
* Guang Chenpi (Citri Reticulatae Pericarpium) 6g
* Quan Danggui (Angelicae Sinensis Radix) 15g
* Chao Hangshao (Paeoniae Radix Alba, stir-fried) 9g
* Guang Muxiang (Aucklandiae Radix) 2.4g
* Xi Sharen (Amomi Fructus, Western variety) 6g (decocted separately)
After more than a month of regulation with this prescription, the patient recovered and was discharged.
[Dr. Yao's Commentary] "Jaundice Hepatitis" is not a term in Traditional Chinese Medicine (TCM). However, ancient medical texts record "Yang Jaundice" and "Yin Jaundice," which share similarities with modern "Jaundice Hepatitis." Based on clinical symptoms, signs, pulse, and tongue diagnosis, this case is indeed "Yang Jaundice." Therefore, we treated the patient long-term according to the methods for Yang Jaundice, ultimately achieving a cure.
Jaundice and Distension (Liver Cirrhosis)
Chang XX, Male, 32 years old, PLA Commander. April 1959.
First Visit: The illness began in 1956 after excessive drinking at a celebration banquet, leading to unconsciousness for a day and night. Since then, appetite sharply decreased, and the body emaciated. Relying on his strength, he ignored the condition. Half a year later, right hypochondriac pain, nausea, and vomiting appeared. In a military hospital, due to severe pain, morphine injections were administered. Later, jaundice developed, and he was admitted to Kunming Military Region General Hospital for "Acute Jaundice Hepatitis." He improved and was discharged. Upon discharge, he failed to rest and overworked himself, causing relapse. He was readmitted in April 1959 and diagnosed with "Liver Cirrhosis," receiving integrated Chinese and Western medicine treatment. It is reported that he took large doses of Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata). Afterward, unbearable burning in the chest and abdomen occurred, abdominal distension increased, jaundice deepened, and the condition deteriorated. On the evening of April 30, I was invited to consult.
Examination revealed the whole body color like a golden orange, sweat turning clothes and bedding yellow. High fever (persisting around 40°C daily). Abdominal distension like a drum, bulging high, unable to see his own feet. Urine was short, red, and difficult; stool was unsmooth. Irritability, thirst with little desire to drink. Pulse was wiry, slippery, and rapid. Tongue body was red and dark; coating was thick, yellow, and greasy. This indicates repeated injury to the Liver and Spleen, Blood stasis and Qi stagnation, Earth failing to control Wood, damp-heat steaming, and dysfunction in transportation, transformation, excretion, and conduction, resulting in Jaundice and Distension. The disease is critical. The method must be to clear damp-heat to soothe Liver collaterals, eliminate jaundice, and reduce distension. Prescribed:
* Yinchen (Artemisiae Scopariae Herba) 15g
* Chao Zhizi (Gardeniae Fructus, stir-fried) 6g
* Daipi Fuling (Poria with bark) 24g
* Zhuling (Polyporus) 15g
* Zexie (Alismatis Rhizoma) 9g
* Zhishi (Aurantii Fructus Immaturus) 6g (stir-fried, decocted separately)
* Cu Yujin (Curcumae Longae Rhizoma, vinegar-processed) 9g (decocted separately)
* Jiao Bai (Phellodendri Cortex, carbonized) 6g
* Chao Houpo (Magnoliae Officinalis Cortex, stir-fried) 9g
* Dafupi (Arecae Pericarpium) 15g
* Tongcao (Tetrapanacis Medulla) 6g
* Huashi (Talcum) 18g
* Zhuru (Bambusae Caulis in Taeniam) 6g
* Lugeng (Phragmitis Rhizoma) 30g
Second Visit: After four doses of the above prescription, temperature dropped to between 37–38°C, jaundice significantly receded, irritability and thirst decreased, and spirit improved. However, distension remained, with day and night pain. Pulse was wiry and slippery; tongue coating was yellow, thick, and greasy, unchanged. The syndrome indicates that damp-heat jaundice has largely transformed, but Liver-Spleen Qi mechanism remains obstructed, transportation is powerless, and water evil stays. Purging should theoretically be used, but given the chronic nature and repeated Spleen-Stomach injury, harsh purgatives may not be tolerated; if distension recurs immediately after purging, the prognosis would be particularly poor. Hesitating, I suddenly recalled Mr. Lu Shaozeng stating: "Boiling fresh garlic with fresh meat can eliminate ascites without damaging healthy Qi." Thus, I instructed trying 120g of raw peeled garlic boiled with half a jin (250g) of fresh pork until soft, taken in one dose. Additionally prescribed:
* Yinchen (Artemisiae Scopariae Herba) 15g
* Daipi Fuling (Poria with bark) 30g
* Zhuling (Polyporus) 15g
* Zexie (Alismatis Rhizoma) 9g
* Chao Zhike (Aurantii Fructus, stir-fried) 9g
* Chao Houpo (Magnoliae Officinalis Cortex, stir-fried) 9g
* Guang Chenpi (Citri Reticulatae Pericarpium) 6g
* Dafupi (Arecae Pericarpium) 9g
* Chong Yujin (Curcumae Longae Rhizoma, decocted separately) 9g
* Guang Muxiang (Aucklandiae Radix) 4.5g
* Jiao Bai (Phellodendri Cortex, carbonized) 4.5g
* Shao Jijinn (Galli Gigerii Endothelium Corneum, roasted) 6g
* Gancao (Glycyrrhizae Radix et Rhizoma) 3g
Third Visit: The patient reported: About two hours after taking the single-ingredient remedy and decoction, severe epigastric and abdominal fullness and impending death-like distress occurred, with nausea, which he endured. Another two hours later, borborygmus occurred, followed by profuse urination and defecation. In half a day, thirteen times of watery stool were passed. Subsequently, distension instantly vanished, feeling relieved. Fever completely subsided, spirit refreshed, and hunger arose. Pulse turned weak and slow; tongue coating thinned. This indicates the pathogen has retreated, but Liver and Spleen have not recovered. Continue to regulate the Liver, support the Spleen, harmonize the Stomach, and clear transformation. Prescribed:
* Yinchen (Artemisiae Scopariae Herba) 9g
* Cangzhu (Atractylodis Rhizoma) 9g
* Fuling (Poria) 2.4g
* Zhuling (Polyporus) 9g
* Zexie (Alismatis Rhizoma) 6g
* Yiren (Coicis Semen) 12g
* Boko (Amomi Fructus, likely referring to Sha Ren or similar aromatic damp-resolving herb, text says Bo Ke) 6g
* Chao Zhike (Aurantii Fructus, stir-fried) 6g
* Gancao (Glycyrrhizae Radix et Rhizoma) 3g
* Zhuru (Bambusae Caulis in Taeniam) 6g
* Shao Jijinn (Galli Gigerii Endothelium Corneum, roasted) 6g
Fourth Visit: After one week of the above prescription, the disease stabilized, spirit improved, and appetite was vigorous. Pulse was slow and slightly wiry; tongue was red with thin, slightly greasy coating. Further regulation is needed. Prescribed:
* Fuling (Poria) 15g
* Zhuling (Polyporus) 9g
* Zexie (Alismatis Rhizoma) 9g
* Cangzhu (Atractylodis Rhizoma) 9g
* Chao Houpo (Magnoliae Officinalis Cortex, stir-fried) 9g
* Guang Muxiang (Aucklandiae Radix) 3g
* Xi Sharen (Amomi Fructus, Western variety) 9g
* Chenpi (Citri Reticulatae Pericarpium) 6g
* Yiren (Coicis Semen) 12g
* Gancao (Glycyrrhizae Radix et Rhizoma) 3g
* Zhuru (Bambusae Caulis in Taeniam) 6g
* Shao Jijinn (Galli Gigerii Endothelium Corneum, roasted) 6g
* Jigucao (Puerariae Lobatae Radix) 12g
With modifications over approximately one month, all symptoms disappeared. After discharge, Xiaoyao San (Free and Easy Wanderer Powder) and Liujunzi Tang (Six Gentlemen Decoction) variations were taken for two to three years to consolidate efficacy. Grateful for renewed life, he formed a revolutionary friendship with me, and we maintain contact to this day.
[Commentary] Excessive labor and sudden drinking injure the Liver and Spleen, causing Blood stasis and Qi stagnation, damp-heat steaming, and dysfunction in transportation, excretion, and opening/closing, resulting in the critical and dangerous syndrome of Jaundice and Distension. Initially, clearing, purging, and separating agents were used. Subsequently, a verified formula for warming, unblocking, supporting healthy Qi, and expelling pathogens was administered, yielding immediate effects. This aligns with the *Neijing*: "For fullness in the middle, purge from within," and "For exhaustion, warm it."
Edema
Guan XX, Male, 16 years old, Student. July 1954.
First Visit: A month prior, after intense exercise, the patient contracted an external pathogen with fever, lower back pain, and limb weakness, without treatment. Later, facial and limb edema developed, urination was difficult, lower back pain worsened, mental fatigue increased, appetite decreased, chest and abdominal distension occurred, and stool was loose. Diagnosed with Nephritis at a certain hospital.
Examination showed pale complexion, facial and pedal edema. Pulse was deep and fine; left Chi position was wiry, right Guan position was soggy and weak. Tongue was pale with thin, greasy coating. This is Kidney deficiency and Spleen weakness, failing to transform water-dampness. Treatment aims to warm the Kidney, secure the Spleen, remove dampness, and unblock collaterals. Prescribed:
* Fuling (Poria) 18g
* Baizhu (Atractylodis Macrocephalae Rhizoma) 12g
* Guizhimu (Cinnamomi Ramulus, wood part) 9g
* Zexie (Alismatis Rhizoma) 9g
* Zhuling (Polyporus) 9g
* Dafupi (Arecae Pericarpium) 9g
* Guang Chenpi (Citri Reticulatae Pericarpium) 6g
* Huainiuqi (Achyranthis Bidentatae Radix) 6g
* Sangjisheng (Taxilli Herba) 12g
* Hongfandou (Phaseoli Semen Rubrum) 12g
* Chao Yiren (Coicis Semen, stir-fried) 12g
* Sheng Gancao (Glycyrrhizae Radix et Rhizoma, raw) 3g
* Cheqianzi (Plantaginis Semen) 0g
* Chao Chuanduan (Dipsaci Radix, stir-fried) 9g
Second Visit: After five doses of the above prescription, urine volume increased, facial and pedal edema gradually subsided, lower back pain lessened, and spirit improved. A new external pathogen was contracted, leading to phlegm condensation and cough. Pulse at both Cun positions was slightly floating; greasy coating thinned. This indicates Spleen-Stomach transportation is gradually recovering, but Qi deficiency and Wei (Defensive) weakness persist. Prescribed:
* Sheng Huangqi (Astragali Radix, raw) 12g
* Fangfeng (Saposhnikoviae Radix) 6g
* Baizhu (Atractylodis Macrocephalae Rhizoma) 9g
* Chuan Du Huo (Angelicae Pubescentis Radix) 6g
* Sangjisheng (Taxilli Herba) 12g
* Banxia (Pinelliae Rhizoma) 9g
* Guang Chenpi (Citri Reticulatae Pericarpium) 6g
* Fuling (Poria) 15g
* Yiren (Coicis Semen) 12g
* Guizhimu (Cinnamomi Ramulus, wood part) 6g
* Sheng Gancao (Glycyrrhizae Radix et Rhizoma, raw) 3g
* Shengjiang (Zingiberis Rhizoma Recens, fresh ginger) 1 slice
* Xiao Hongzao (Jujubae Fructus, small red dates) 11 pieces
Third Visit: After five doses of the above prescription, the exterior was resolved, Wei Yang was secured, urine became clear and abundant, and loose stool turned solid. Mild facial and pedal edema remained, with occasional lower back pain. Pulse was deep, fine, and slow. Tongue was pink with thin coating. Spleen Yang was relatively strengthened, but Kidney Qi was still deficient. Prescribed for regulation:
* Guizhimu (Cinnamomi Ramulus, wood part) 4.5g
* Baizhu (Atractylodis Macrocephalae Rhizoma) 9g
* Duzhong (Eucommiae Cortex) 12g
* Gan Dihuang (Rehmanniae Radix Preparata, dried Rehmannia) 12g
* Zaopi (Corni Fructus) 4.5g
* Fen Danpi (Moutan Cortex) 4.5g
* Zexie (Alismatis Rhizoma) 6g
* Fuling (Poria) 15g
* Chuaishanyao (Dioscoreae Rhizoma, stir-fried) 12g
* Sangjisheng (Taxilli Herba) 12g
* Huainiuqi (Achyranthis Bidentatae Radix) 6g
* Sheng Gancao (Glycyrrhizae Radix et Rhizoma, raw) 3g
After more than ten doses of the above prescription, all symptoms disappeared, and the complexion became lustrous. The patient was advised to regularly take Jin Gui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet) to consolidate efficacy.
[Commentary] This case resulted from dual deficiency of the Spleen and Kidney. Transportation and excretion were powerless, water-dampness stagnated, Yang Qi failed to circulate, and moisture soaked into the muscles and skin, causing cutaneous edema. Formulas like Linggui Zhugan Tang (Poria, Cinnamon, Atractylodes, and Licorice Decoction) with modifications and Wuling San (Five-Ingredient Powder with Poria) were used to facilitate Qi transformation so that dampness would have nowhere to stay. If one recklessly uses bland-draining diuretics, Qi transformation will further decline, falling into the error of neglecting the root for the branch.