脉经曰脉沉渴欲饮水小便不利者皆发黄胆凡发黄寸口无脉鼻气冷并不可治
钱氏曰凡小儿身皮目皆黄者黄病也身痛膊背强大小便涩一身皆黄面目指爪皆黄小便如屋
尘色
着物皆黄渴者难治此黄胆也二证多得于大病后又有一证生下百日及半身不因病后身微黄者胃
热也
大人亦同又有面黄腹大食土渴者脾疳也又有目生而身黄者胎疸也经云诸疸皆属于热色深黄者
是也
若淡黄兼白者胃怯胃不和也丹溪云不必分五同是湿热如 曲相似此理甚明全婴方论云夫发黄
者皆由寒湿之气蕴结于脾胃蒸发而成也阳明病无汗小便不利心中热壅必发黄巢氏曰小儿百日
半岁非伤寒瘟病而身微黄者亦是脾胃热忌不可灸也灸之则热甚此是将息过度所为微薄其衣欲
与除热丸散投之自歇不得妄与汤剂及灸为害不浅浅也
论发黄治例
难知云色如熏黄乃湿病也一身尽痛色如橘子黄者黄病也一身不痛干黄燥也小便自利四肢
不
沉重渴而引饮者栀子柏皮汤湿黄脾也小便不利四肢沉重似渴不欲饮者大茵陈汤若大便自利而
黄者茵陈栀子黄连三物汤往来寒热一身尽黄者小柴胡加栀子汤罗谦甫云小儿季夏身体蒸热胸
膈烦满皮肤如渍橘之黄眼中白睛亦黄筋骨痿弱不能行立此由季夏之热加以湿气而蒸热搏于经
络入于骨髓使脏气不平故脾遂乘心湿热相合而成此疾也盖心火实则身体蒸热胸膈烦满脾湿
胜则皮肤如渍橘之黄有余之气必乘已所胜而侮不胜是肾肝受邪而筋骨痿弱不能行立内经言脾
热者色黄而肉蠕动又言湿热成痿信哉所言也所谓子能令母实实则泻其子也盖脾土退其本
位肾得复心火自平矣又内经曰治痿独取于阳明正谓此也加减泻黄散主之
加减泻黄散方 此药退脾土复肾水降心火
黄连 茵陈(各五分) 黄柏 黄芩
茯苓 山栀(各三分) 泽泻(二分)
上 咀都作一服水一盏煎至六分去渣稍热服食后一服减半待五日再服而良愈
内经云土位之主其泻以苦又云脾苦湿急食苦以燥之故用黄连茵陈之苦寒除湿热为君肾欲
坚急
食苦以坚之所以黄柏之苦辛寒强筋骨为臣湿热成烦以苦泻之故以黄芩山栀子之苦寒止烦满为
佐湿淫于内以淡泄之故以茯苓泽泻之甘淡利小便导湿为使也
茵陈汤 治小儿阳明病发热汗出者此为热越不能发黄也身无汗剂颈而还小便不利渴欲饮
水者此为瘀热在里必发黄伤寒七八日身黄如橘色小便不利腹痛者并主之
山茵陈 栀子仁 川大黄
上等分 咀水煎加减服日进三服小盒饭利尿如皂荚汁状色正赤一宿腹减痛黄随小便中去
栀子柏皮汤 治小儿身黄发热
栀子仁(十个) 甘草(一两炙) 黄柏(二两)
上 咀水一小盏煎六分加减服
犀角散 治小儿黄胆一身尽黄
犀角(一两) 茵陈 栝蒌根 升麻 龙胆草 生地黄(各半两寒水石)
上 咀水一盏煎六分温服一方治小儿忽发黄面目皮肉尽黄栝蒌汁和蜜服之良验
瓜蒂散 治小儿三岁忽发心满坚硬脚手心热则变为黄病不急治杀人
瓜蒂(七个) 赤小豆(七粒) 秫米(七粒)
上为末用一字吹两鼻内令黄水出未尽再用水调服之得吐黄水即瘥一方瓜蒂一两赤小豆四
两为末每服一钱湿水调服药下即卧当有吐以吐清黄汁为妙虚人不可用
茯苓渗湿汤 治小儿黄胆寒热呕吐而渴欲饮冷水身体面目俱黄小便不利不得安卧不思食
白茯苓(五分) 泽泻(三分) 茵陈(六分) 猪苓(二钱)
黄芩 黄连 栀子 防己 白术 苍术 陈皮 青皮 枳壳(各二钱)
上锉散水一小盏煎六分徐徐湿服
丹溪一方 治小儿吐泻黄胆
三棱 蓬术 青皮 陈皮 神曲 麦芽 黄连 甘草 白术 茯苓
上为末温水调服伤乳食吐泻加山楂时气吐泻加滑石发热加薄荷
《脉经》说:脉象沉,口渴想喝水,小便不通畅的,都会出现黄疸。凡是发黄的患者,如果寸口脉摸不到,鼻气寒冷,都是不可治疗的证候。
钱乙说:凡是小儿全身皮肤和眼睛都发黄的,是黄病(黄疸)。身体疼痛,胳膊和背部僵硬,大小便涩滞不畅,全身发黄,面目手指指甲都黄,小便颜色像屋尘一样浑浊,伴有口渴的,难以治疗,这是黄疸。这两种证候大多是在大病之后出现的。又有一种情况,婴儿出生一百天以内或半岁,并非因病后导致,而是身体微微发黄,这是胃热所致,成人也是如此。又有面色发黄、腹部胀大、想吃泥土、口渴的,是脾疳。又有出生时即身体发黄的,是胎疸。医经说:各种黄疸都属于热证,颜色深黄的即是如此。如果是淡黄色兼带白色的,是胃气虚弱、胃功能不和。朱丹溪说:不必区分五种黄疸,它们都是湿热,就像酒曲发酵相似,这个道理很明白。《全婴方》论述说:发黄,都是由寒湿之气蕴结在脾胃,蒸发而成。阳明病无汗、小便不利、心中烦热壅塞的,必然发黄。巢元方说:小儿百日到半岁,如果不是伤寒瘟疫病而身体微黄的,也是脾胃有热,切忌不可用灸法。灸了就会使热更盛。这是护理过度造成的,应当减少衣物,想要给予除热丸散服用,自然就会缓解,不要随意使用汤剂及灸法,否则危害不浅。
论述发黄的治法条例:
滑寿(号知难)说:颜色像熏黄的是湿病,全身疼痛;颜色像橘子黄的是黄病(黄疸),全身不痛;干燥发黄的是干黄燥,小便自利,四肢不沉重;口渴想喝水的是栀子柏皮汤证;湿黄属于脾,小便不利,四肢沉重,似渴但不欲饮水的是大茵陈汤证。如果大便自利而发黄的是茵陈、栀子、黄连三物汤证。寒热往来、全身尽黄的是小柴胡加栀子汤证。罗谦甫说:小儿在夏季末(季夏),身体蒸热,胸膈烦闷胀满,皮肤像浸渍过的橘子皮那样黄,眼中白睛也黄,筋骨痿弱不能行走站立。这是由于季夏的热加上湿气,蒸热搏结于经络,深入骨髓,使脏气不平,所以脾土乘克心火,湿热相合而成为此疾。大概心火实盛则身体蒸热、胸膈烦满;脾湿胜则皮肤像浸渍过的橘子皮那样黄。有余之气必定乘其所胜(金)而侮其所不胜(水),导致肾肝受邪,筋骨痿弱不能行走站立。《内经》说:脾热的表现是面色黄且肌肉蠕动跳动;又说湿热成痿,确实如此。所谓“子能令母实”,实则泻其子。脾土退去其本位,肾气得复,心火自然平息。又《内经》说:治疗痿证独取阳明,正是说的这个意思。主方用加减泻黄散。
加减泻黄散方:此药能退脾土之热,复肾水,降心火。
黄连、茵陈(各五分)、黄柏、黄芩、茯苓、山栀(各三分)、泽泻(二分)。
以上药物切碎,共作一服,用水一盏煎至六分,去渣,稍热服用。饭后服,一服减半,待五日后再服,即可痊愈。
《内经》说:土位之主,用苦味泻之;又说脾苦湿,急食苦以燥之。所以用黄连、茵陈的苦寒来除湿热,作为君药。肾欲坚,急食苦以坚之,所以用黄柏的苦辛寒来强筋骨,作为臣药。湿热导致烦闷,用苦味泻之,所以用黄芩、山栀子的苦寒来止烦满,作为佐药。湿淫于内,用淡味渗泄之,所以用茯苓、泽泻的甘淡利小便以导湿,作为使药。
茵陈汤:治疗小儿阳明病发热汗出的,这是热邪外越,不能发黄。如果身体无汗,仅颈部以下出汗,小便不利,口渴想喝水的,这是瘀热在里,必然发黄。伤寒七八日,身黄如橘色,小便不利,腹痛的,并以此方主治。
山茵陈、栀子仁、川大黄。
以上等分切碎,水煎,加减服用,每日进三服。小便应该像皂荚汁一样通畅,颜色正赤,过一夜腹部减轻,黄随小便而去。
栀子柏皮汤:治疗小儿身黄发热。
栀子仁(十个)、甘草(一两,炙)、黄柏(二两)。
以上切碎,用水一小盏煎至六分,加减服用。
犀角散:治疗小儿黄疸,全身尽黄。
犀角(一两)、茵陈、栝蒌根、升麻、龙胆草、生地黄(各半两)、寒水石。
以上切碎,用水一盏煎至六分,温服。另一方法治疗小儿突然发黄,面目皮肉尽黄,用栝蒌汁和蜜服用,效果良好。
瓜蒂散:治疗小儿三岁突然发作,心下痞满坚硬,手脚心热,则变为黄病,不及时治疗会致死。
瓜蒂(七个)、赤小豆(七粒)、秫米(七粒)。
以上研为细末,用一字量吹入两个鼻孔内,令黄水流出,未尽再用水调服。得吐黄水即愈。另一方:瓜蒂一两,赤小豆四两,研为细末,每服一钱,湿水调服。服药后即卧,应当有呕吐,以吐出清黄汁为妙。虚人不可用。
茯苓渗湿汤:治疗小儿黄疸,寒热呕吐,口渴想饮冷水,身体面目俱黄,小便不利,不得安卧,不思饮食。
白茯苓(五分)、泽泻(三分)、茵陈(六分)、猪苓(二钱)、黄芩、黄连、栀子、防己、白术、苍术、陈皮、青皮、枳壳(各二钱)。
以上锉散,用水一小盏煎至六分,徐徐湿服(少量频服)。
丹溪一方:治疗小儿吐泻引起的黄疸。
三棱、蓬术、青皮、陈皮、神曲、麦芽、黄连、甘草、白术、茯苓。
以上研为细末,温水调服。伤乳食导致的吐泻加山楂;时气(流行性传染病)吐泻加滑石;发热加薄荷。
The *Mai Jing* (Pulse Classic) states: When the pulse is deep, there is thirst with a desire to drink water, and urination is difficult, jaundice will occur. In all cases of jaundice, if the Cun position at the wrist has no palpable pulse and breath from the nose is cold, it is untreatable.
Qian Yi stated: Whenever a child's skin and eyes are yellow, it is Huang Bing (Jaundice). If accompanied by body pain, stiffness in the arms and back, difficulty in defecation and urination, general yellowing of the body, face, eyes, fingers, and nails, urine turbid like house dust, and thirst, it is difficult to treat; this is Huang Dan (Jaundice). These two conditions mostly occur after severe illness. There is another condition where infants under one hundred days or half a year old, not due to post-illness weakness, present with slight yellowing of the body; this is Stomach Heat, which also applies to adults. Another condition involves a yellowish complexion, abdominal distension, pica (eating earth), and thirst; this is Pi Gan (Spleen-related Infantile Malnutrition). Yet another is Tai Dan (Fetal Jaundice), where the body is yellow from birth. The classics state that all types of jaundice belong to Heat; those with deep yellow color exemplify this. If the color is pale yellow mixed with white, it indicates Stomach Qi Deficiency and disharmony. Zhu Danxi said: There is no need to distinguish between the five types of jaundice; they are all Damp-Heat, similar to fermentation by Qu (yeast/mold starter); this principle is very clear. The *Quan Ying Fang* discusses that jaundice arises from Cold-Dampness accumulating in the Spleen and Stomach, evaporating to cause yellowing. In Yangming disease, if there is no sweat, urination is difficult, and there is internal heat obstruction, jaundice must occur. Chao Yuanfang stated: For infants aged 100 days to six months, if they are not suffering from Shanghan (Cold Damage) or epidemic diseases but have slight yellowing, it is also Spleen-Stomach Heat. Moxibustion is strictly contraindicated; applying moxibustion will exacerbate the heat. This results from improper nursing care. One should reduce clothing and administer heat-clearing pills or powders to resolve it spontaneously. Do not casually use decoctions or moxibustion, as the harm would be significant.
Discussion on Treatment Principles for Jaundice:
Hua Shou (courtesy name Zhinan) stated: A color resembling smoked yellow indicates Wet Disease, accompanied by whole-body pain. A color resembling orange yellow indicates Huang Bing (Jaundice), without whole-body pain. Dry yellow indicates dryness, with spontaneous urination and heavy-free limbs. Thirst with a desire to drink indicates the Zhi Zi Bai Pi Tang (Gardenia, Phellodendron, and Licorice Decoction) pattern. Damp-yellow belongs to the Spleen; difficulty in urination, heavy limbs, apparent thirst but no desire to drink, indicates the Da Yin Chen Tang (Large Coptis and Mugwort Decoction) pattern. If stools are loose yet yellowing occurs, the Yin Chen, Zhi Zi, and Huang Lian Three-Ingredient Decoction is indicated. Alternating chills and fever with general yellowing indicates Xiao Chai Hu Jia Zhi Zi Tang (Minor Bupleurum Decoction plus Gardenia). Luo Qianfu stated: In late summer, children may experience steaming heat, chest and diaphragm fullness and irritability, skin yellow like soaked orange peel, scleral icterus, and flaccidity of sinews and bones rendering them unable to walk. This is caused by late summer heat combined with dampness, steaming and binding in the meridians, penetrating into the bone marrow, causing organ qi imbalance. Consequently, Spleen Earth overacts on Heart Fire, and Damp-Heat combine to form this disease. When Heart Fire is excess, there is steaming heat and chest/diaphragm fullness; when Spleen Dampness is excessive, the skin turns yellow like soaked orange peel. Excess qi attacks what it controls (Metal) and insults what it cannot control (Water), leading to Kidney and Liver pathogenic invasion, resulting in flaccid sinews and bones. The *Neijing* states: Spleen heat manifests as yellow complexion and muscle twitching; it also states that Damp-Heat causes Wei syndrome (flaccidity syndrome). Truly所言 (as stated). The principle "the Child can make the Mother Excess" applies; when Excess, drain the Child. Spleen Earth retreats from its position, Kidney Water recovers, and Heart Fire naturally calms. Furthermore, the *Neijing* states: Treat Wei syndrome by focusing solely on the Yangming channels. This refers to this situation. The primary formula is Jia Jian Xie Huang San (Modified Draining Yellow Powder).
Jia Jian Xie Huang San Formula: This herb group drains Spleen Earth heat, restores Kidney Water, and descends Heart Fire.
Huang Lian (Coptidis Rhizoma), Yin Chen (Artemisiae Scopariae Herba) (each 5 fen), Huang Bo (Phellodendri Cortex), Huang Qin (Scutellariae Radix), Fu Ling (Poria), Shan Zhi Zi (Gardeniae Fructus) (each 3 fen), Ze Xie (Alismatis Rhizoma) (2 fen).
Chop these ingredients, combine as one dose, boil in one cup of water until reduced to 60%, strain, and take slightly warm. Take half the dose after meals. After five days, resume full dosing for complete recovery.
The *Neijing* states: For the ruler of the Earth phase, drain with bitter flavors. It also states: Spleen dislikes Dampness; urgently eat bitter flavors to dry it. Therefore, use the bitter-cold properties of Huang Lian and Yin Chen to remove Damp-Heat as the Sovereign herbs. The Kidney desires firmness; urgently eat bitter flavors to firm it. Thus, use the bitter-pungent-cold property of Huang Bo to strengthen sinews and bones as the Minister herbs. Damp-Heat causes vexation; drain with bitter flavors. Thus, use the bitter-cold properties of Huang Qin and Shan Zhi Zi to stop vexation and fullness as the Assistant herbs. Dampness invading internally requires leaching with bland flavors. Thus, use the sweet-bland properties of Fu Ling and Ze Xie to promote urination and guide out Dampness as the Guide herbs.
Yin Chen Tang: Treats pediatric Yangming disease with fever and sweating; this indicates heat venting outward, so jaundice does not occur. If there is no sweat except on the neck, difficulty in urination, and thirst with desire to drink, this indicates stagnant heat in the interior, inevitably leading to jaundice. For Shanghan lasting seven to eight days with orange-yellow skin, difficulty in urination, and abdominal pain, this formula is primarily indicated.
Shan Yin Chen (Artemisiae Scopariae Herba), Zhi Zi Ren (Gardeniae Semen), Chuan Da Huang (Rhei Radix et Rhizoma).
Equal parts, chop, boil in water, adjust dosage, take three times daily. Urination should become smooth like soap pod juice, reddish in color. After one night, abdominal distension decreases, and yellow pigment exits via urine.
Zhi Zi Bai Pi Tang: Treats pediatric jaundice with fever.
Zhi Zi Ren (Gardeniae Semen) (10 seeds), Gan Cao (Glycyrrhizae Radix et Rhizoma) (1 liang, honey-fried), Huang Bo (Phellodendri Cortex) (2 liang).
Chop, boil in one small cup of water until reduced to 60%, adjust dosage.
Xi Jiao San: Treats pediatric jaundice with general yellowing.
Xi Jiao (Rhinocerotis Cornu), Yin Chen (Artemisiae Scopariae Herba), Gua Lou Gen (Trichosanthis Radix), Sheng Ma (Cimicifugae Rhizoma), Long Dan Cao (Gentianae Radix), Sheng Di Huang (Rehmanniae Radix) (each half liang), Han Shui Shi (Halloysit Rubrum).
Chop, boil in one cup of water until reduced to 60%, take warm. Another method for sudden pediatric jaundice with yellow face, eyes, skin, and flesh: use Gua Lou juice mixed with honey; effective.
Gua Di San: Treats sudden onset in three-year-olds with epigastric fullness and hardness, hot palms and soles, progressing to jaundice. Untreated, it can be fatal.
Gua Di (Momordicae Fructus) (7 pieces), Chi Xiao Dou (Vignaemen Adzuki Semen) (7 grains), Shu Mi (Sorghei Fructus Glutinosis) (7 grains).
Grind into powder. Use a quantity equivalent to "one character" (approx. 0.3-0.5g) insufflated into both nostrils to induce discharge of yellow fluid. If incomplete, administer orally with water. Vomiting yellow fluid indicates cure. Alternative formula: Gua Di (1 liang), Chi Xiao Dou (4 liang), grind into powder. Take 1 qian per dose, mixed with water. Lie down after ingestion. Vomiting is expected; clearing yellow juice is ideal. Contraindicated in deficient patients.
Fu Ling Shen Shi Tang: Treats pediatric jaundice with alternating chills and fever, vomiting, thirst for cold water, general yellowing of body and face, difficulty in urination, restlessness, and anorexia.
Bai Fu Ling (Poria) (5 fen), Ze Xie (Alismatis Rhizoma) (3 fen), Yin Chen (Artemisiae Scopariae Herba) (6 fen), Zhu Ling (Polyporus) (2 qian), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Zhi Zi (Gardeniae Fructus), Fang Ji (Stephaniae Tetrandrae Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Cang Zhu (Atractylodis Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Qing Pi (Citri Reticulatae Pericarpium Viride), Zhi Ke (Aurantii Fructus Immaturus) (each 2 qian).
Cut into pieces, boil in one small cup of water until reduced to 60%, take slowly in small frequent doses.
Danxi's Formula: Treats pediatric jaundice caused by vomiting and diarrhea.
San Leng (Sparganii Rhizoma), Peng Ze (Curcumae Rhizoma), Qing Pi (Citri Reticulatae Pericarpium Viride), Chen Pi (Citri Reticulatae Pericarpium), Shen Qu (Massae Fermentatae Medicinalis), Mai Ya (Hordei Fructus Germinatus), Huang Lian (Coptidis Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria).
Grind into powder, mix with warm water. For food stagnation-induced vomiting/diarrhea, add Shan Zha (Crataegi Fructus). For epidemic vomiting/diarrhea, add Hua Shi (Talcum). For fever, add Bo He (Menthae Haplocalycis Herba).