总括 发黄暑湿蒸脾得,内外因分治最良;更有胎元生便见,切宜多服地黄汤。
脉法 脉沉,渴欲饮水,小便不利,皆发黄。凡发黄,寸口无脉,鼻气冷,并不可治。
《内经》曰∶中央黄色,入通于脾。又曰∶诸湿肿满皆属于脾土。夫黄胆为病,肌肉必虚肿而色黄,盖湿热郁积于
脾胃之中,久而不散,故土色行于面与肌肤也。脾主肌肉,肺主皮毛,母能令子虚,母病而子亦病矣。故有诸中者必形
诸外。其症虽分为五,终无寒热之异。
丹溪曰∶同是温热如 曲相似,正经所谓知其要者一言而终是也。外有伤寒热病,阳明内实,失于汗下,故使湿热
拂郁内甚,令人发黄病也。或有疳泻亦主皮黄发竖,肚青筋肌肉消瘦身必发黄。此因疳而有是症,仍以疳症治之自愈。
治疸之法用五苓散倍加菌陈服之,或茵陈汤及茯苓渗湿汤之类,无不应手获效。又曰湿在上宜汗、在下宜利小便,或二
法并用,使上下分消。
又有小儿生下,遍体俱黄,惟面目 浓如金色,身发壮热,名为胎黄,因未产之前母受极热,母子俱宜服生地黄汤。
疸有五∶有黄胆、有黄汗、有酒疸、有谷疸、女劳疸。
〔附方〕
五苓散 见疟疾症内。
茵陈汤 茵陈蒿(一两) 栀子(三大枚) 大黄(三钱)
茯苓渗湿汤 黄连 黄柏 栀子 防己 白松 苍术 青皮 陈皮 枳实 茵陈 泽泻 猪苓 赤茯苓
生地黄汤 生地 赤芍 川芎 当归 天花粉
白玉散(治酒疸) 黑丑 甘遂(各五钱) 水煎五更时服。
总括:发黄多因暑湿熏蒸脾胃所致,分清内外病因进行治疗最为适宜;更有胎儿在母体内时便出现的黄疸,务必多服用地黄汤。
脉法:脉象沉,口渴想喝水,小便不通畅,都会导致发黄。凡是出现发黄的病症,如果寸口脉搏摸不到,鼻气寒冷,都属于不可治愈的绝症。
《内经》说:“中央对应黄色,与脾相通。”又说:“各种湿气引起的肿胀和腹满都归属于脾土。”黄疸这种病,肌肉必定虚肿且颜色发黄,这是因为湿热郁积在脾胃之中,时间久了不能消散,所以土的黄色显现于面部和肌肤。脾主肌肉,肺主皮毛,母脏(脾)能使子脏(肺)虚弱,母脏生病则子脏也会受累。所以内部有病变必然反映在外表。虽然症状分为五种,但最终都没有寒热性质的差异。
朱丹溪说:“同样是温热之邪,就像酒曲发酵一样,经典所说的‘懂得关键要点的人一语道破’就是这个意思。”外感伤寒热病,阳明腑实,如果误治或失治(该发汗未发汗,该攻下未攻下),导致湿热拂郁在内严重化生,使人患上黄疸病。或者患有疳积腹泻的患儿也会出现皮肤发黄、毛发竖起、腹部青筋暴露、肌肉消瘦、身体必然发黄的症状。这是因为疳积而引发的这些症状,仍然按照疳积的方法来治疗,自然就会痊愈。
治疗黄疸的方法是用五苓散加倍茵陈服用,或者使用茵陈汤及茯苓渗湿汤之类的方剂,没有不立刻见效的。又说:湿邪在上部宜用发汗法,在下部宜用利小便法,或者两种方法并用,使上下分消湿邪。
又有小儿出生后,全身都发黄,只有面目颜色浓重如金色,身体发高烧,称为胎黄,这是因为分娩前母亲受到极热的影响,母子双方都应当服用生地黄汤。
〔附方〕
五苓散 见疟疾症内。
茵陈汤 茵陈蒿(一两) 栀子(三大枚) 大黄(三钱)
茯苓渗湿汤 黄连 黄柏 栀子 防己 白松(注:原文如此,疑为白术或茯苓皮之误,此处依原文翻译) 苍术 青皮 陈皮 枳实 茵陈 泽泻 猪苓 赤茯苓
生地黄汤 生地 赤芍 川芎 当归 天花粉
白玉散(治疗酒疸) 黑丑 甘遂(各五钱) 水煎,在五更时分服用。
General Overview: Jaundice (Huangdan) is mostly caused by damp-heat steaming the spleen and stomach due to summer-heat and dampness; distinguishing between internal and external causes for treatment is most effective. There are also cases of jaundice present since birth, in which Dihuang Tang (Rehmannia Decoction) should be taken frequently.
Pulse Diagnosis: A deep pulse, thirst with desire to drink water, and difficult urination all lead to jaundice. In any case of jaundice, if the cunkou (radial artery at the wrist) pulse is imperceptible and breath from the nose is cold, it is considered incurable.
The *Neijing* states: "The center corresponds to yellow, connecting through to the Spleen." It also states: "All dampness, swelling, and fullness belong to Spleen Earth." The disease of jaundice involves muscles that are necessarily flaccidly swollen and yellow in color, because damp-heat stagnates within the Spleen and Stomach, failing to dissipate over time; thus, the earth element's yellow color manifests on the face and skin. The Spleen governs muscles, and the Lung governs skin and hair; the mother organ can cause deficiency in the child organ, so when the mother is diseased, the child is also affected. Therefore, internal pathology must manifest externally. Although symptoms are divided into five types, there is ultimately no difference regarding cold or heat nature.
Zhu Danxi said: "Both are warm-heat pathogens, similar to fermenting qu (yeast); this is what the classics mean by 'those who understand the essence can conclude with one word.'" Externally, there are cold damage and febrile diseases where Yangming interior excess occurs; if sweating or purging methods are missed or misapplied, damp-heat becomes stifled and stagnant internally, causing people to suffer from jaundice. Alternatively, children with gan malnutrition diarrhea may exhibit yellow skin, erect hair, cyanotic abdominal veins, emaciated muscles, and inevitable body yellowing. These symptoms arise due to gan malnutrition; treating them according to gan malnutrition protocols will result in spontaneous recovery.
The method for treating dan uses Wuling San (Five-Ingredient Powder with Poria) with doubled Yinchen (Artemisiae Scopariae Herba), or such formulas as Yincheng Tang (Artemisiae Scopariae Decoction) and Fuling Shenshi Tang (Poria Damp-Draining Decoction), none of which fail to produce immediate effects. It is also stated: for dampness in the upper part, sweating is appropriate; for dampness in the lower part, promoting urination is appropriate; or both methods may be used together to drain dampness from above and below.
There are also infants born with jaundice covering the entire body, where the face and eyes are intensely golden-yellow, accompanied by high fever; this is named Taihuang (Fetal Jaundice). This is caused by extreme heat affecting the mother prior to delivery, and both mother and infant should take Shengdihuang Tang (Fresh Rehmannia Decoction).
Dan is categorized into five types: Huangdan (Jaundice), Huanghan (Yellow Sweat), Jiudan (Wine Jaundice), Gudan (Grain Jaundice), and Nulaodan (Sexual Exhaustion Jaundice).
[Attached Formulas]
Wuling San (Five-Ingredient Powder with Poria) See Malaria Syndrome section.
Yincheng Tang (Artemisiae Scopariae Decoction) Yinchen Hao (Artemisiae Scopariae Herba, 1 liang), Zhizi (Gardeniae Fructus, 3 large pieces), Dahuang (Rhei Radix et Rhizoma, 3 qian).
Fuling Shenshi Tang (Poria Damp-Draining Decoction) Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Zhizi (Gardeniae Fructus), Fangji (Stephaniae Tetrandrae Radix), Baishong (Bai Song - note: original text error likely for Baizhu or Fuling Pi), Cangzhu (Atractylodis Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Chenpi (Citri Reticulatae Pericarpium), Zhishi (Aurantii Fructus Immaturus), Yinchen (Artemisiae Scopariae Herba), Zexie (Alismatis Rhizoma), Zhuling (Polyporus), Chi Fuling (Red Poria).
Shengdihuang Tang (Fresh Rehmannia Decoction) Shengdi (Rehmanniae Radix Recens), Chishao (Paeoniae Radix Rubra), Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Tianhuafen (Trichosanthis Radix).
Baiyu San (White Jade Powder) (Treats Wine Jaundice) Heiqiu (Semen Cassiae), Gansui (Kansui Radix) (each 5 qian). Decoct in water and take at wugeng (between 3 AM and 5 AM).