经云。身痛而色微黄。齿垢黄。爪甲上黄。黄瘅也。安卧小便黄赤。脉小而涩者。不嗜食。
溺黄赤安卧者。曰黄瘅。食已如饥者。曰胃瘅。目黄曰黄瘅。
金匮云。诸病黄家。但利其小便。假令脉浮。当以汗解之。宜桂枝加黄 汤主之。
黄家一证。大率从水湿得之。治湿之法。当利小便为第一义。然脉浮者。知湿不在里而在表。
又当以汗解之。设表湿乘虚入里而作癃闭。又当利其小便也。故下条云。黄瘅病。茵陈五苓散主
之。活法在心。可拘执乎。黄瘅病。茵陈五苓散主之。
夫病酒黄瘅。必小便不利。其候心中热。足下热。是其证也。
酒黄瘅者。或无热。靖言了了。腹满欲吐。鼻燥。其脉浮者。先吐之。沉弦者。先下之。酒
瘅心中热。欲吐者吐之愈。
酒黄瘅。心中懊 。或热痛。栀子大黄汤主之。
此即枳实栀子豉汤之变名也。大病后劳复发热。服枳实、栀子、豉三味。覆令微汗。使余热
从外而解。若有宿食。则加大黄从内而解。此治酒瘅之脉沉弦者。用此方以下之。其脉浮当先吐
者。则用栀子豉汤。可不言而喻矣。盖酒瘅伤胃发黄。无形之湿热。故宜栀子豉涌之。与谷瘅之
当用茵陈蒿者。泾渭自殊。即此汤亦自治酒食并伤之湿郁。故可用下。观枳实栀子豉汤之加大黄。
亦是因宿食而用也。更有栀子柏皮汤治身黄发热一证。又以苦燥利其渗道也。合此比例而推。治
黄之法。无余蕴矣。
酒瘅下之。久久为黑瘅。目黄面黑。心中如啖蒜齑状。大便正黑。皮肤爪之不仁。其脉浮弱。
虽黑微黄。故知之。金匮治酒瘅。用或吐或下之法。言虽错出。义实一贯。盖酒之积热。入膀胱
则气体不行。必小便不利。积于上焦。则心中热。积于下焦。则足下热。其无心中足下热者。则
靖言了了而不神昏。但见腹满欲吐鼻燥三证。可知其膈上与腹中。阴阳交病。须分先后治之。当
辨脉之浮沉。以定吐下之先后。若但心中热欲呕吐。则病全在上焦。吐之即愈。何取下为哉。其
酒热内结。心神昏乱。而作懊 及痛楚者则。不可不下。故以栀子、香豉。皆治其心中懊 。大
黄荡涤实热。枳实破结。逐去宿垢也。但以此劫病之法。不可久用。久久下之。必脾肺之阳气尽
伤。不能统领其阴血。其血有日趋于败而变黑耳。然酒瘅之黑。非女劳瘅之黑也。女劳瘅之黑。
为肾气所发。酒瘅之黑。为败血之色。因酒之湿热伤脾胃。脾胃不和。阳气不化。阴血不运。若
更下之。久久则运化之用愈耗矣。气耗血积。败腐瘀浊。色越肌面为黑。味变于心。咽作嘈杂。
心辣如啖蒜齑状。营血衰而不行。痹于皮肤。爪之不仁。输于大肠。便如漆黑。其目
黄与脉浮弱。皆病血也。仲景于一酒瘅。胪列先后次第。以尽其治。其精而且详如此。
谷瘅之为病。寒热不食。食即头眩。心胸不安。久久发黄为谷瘅。茵陈蒿汤主之。
额上黑。微汗出。手足中热。薄暮即发。膀胱急。小便自利。名曰女劳瘅。腹如水状。不治。
女劳之瘅。惟言额上黑。不言身黄。简文也。然黑为北方阴晦之色。乃加于南方离明之位。
以女劳无度。而脾中之浊阴。下趋入肾。水土互显之色。乃至微汗亦随火而出于额。心之液且外
亡矣。手足心热。内伤皆然。日暮阳明用事。阳明主阖。收敛一身之湿热。疾趋而下膀胱。其小
便自利。大便黑时溏。又是膀胱蓄血之验。腹如水状。实非水也。正指蓄血而言。故为不治。
黄家日晡所发热。而反恶寒。此为女劳得之。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。
此治女劳瘅之急方也。夫男子精动。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。非急去膀胱少腹之瘀血。万无
生路。乃取皂矾以涤除瘀垢。硝石以破积散坚。二味相胥。锐而不猛。此方之妙用也。
黄瘅腹满。小便不利而赤。自汗出。此为表和里实。当下之。大黄硝石汤。
黄瘴最难得汗。自汗则表从汗解。故曰。此为表和里实。方用大黄、硝石解散在里血结。黄
柏专祛下焦湿热。栀子轻浮。能使里热从渗道而泄也。
诸黄。猪膏发煎主之。
详此治瘀血发黄之缓剂。以诸黄虽多湿热。然经脉久病。不无瘀血阻滞也。肘后方以此治女
劳瘅。身目尽黄。发热恶寒。少腹满。小便难。以大热大寒女劳。交接入水所致。用发灰专散瘀
血。和猪膏煎之。以润经络肠胃之燥。较硝石矾石散。虽缓急轻重悬殊。散瘀之旨则一也。
瘅而渴者。其瘅难治。瘅而不渴者。其瘅可治。发于阴部。其人必呕。阳部。其人振寒而发热也。
瘅为湿热固结。阻其津液往来之道。故以渴与不渴。证津液之通与不通也。呕为肠胃受病。
振寒发热。为经络受伤。于此可证其表里阴阳而治也。
黄瘅者。色如熏黄。一身尽痛。乃湿病也。色如橘子黄。身不痛。乃瘅病也。瘅分为五。黄
汗。黄瘅。谷瘅。酒瘅。女劳瘅。黄汗者。其证两胫自冷。从腰以上必汗出。下无汗。腰髋弛痛。
如有物在皮中状。剧者不能食。身疼重。烦躁小便不利。此为黄汗。宜 芍桂酒汤。昼热。加防风
。夜热。加当归。食少。加白术、茯苓。黄瘅有干有湿。干黄者。肺燥也。小便自利。四肢不沉
重。渴而引饮。栀子柏皮汤。湿黄者。脾湿也。小便不利。四肢沉重。似渴不欲饮者。麻黄连轺
赤小豆汤。身黄如橘子色。小便不利。腹微满者。茵陈蒿汤。渴者。茵陈五苓散。谷瘅者。食毕
即头眩。心中怫郁不安。遍身发黄是也。小柴胡去参加白术、炮姜、胆草、枳实。二便秘者。茵
陈蒿汤。胃瘅食已如饥。胃热消谷。面黄瘦。胸满胁胀。小便秘赤。补中益气加猪胆汁炒川连、
酒黄柏、泽泻。酒瘅者。身目发黄。腹如水状。心下懊 而热。不能食。时时欲吐。足胫肿。小
便黄。面发赤斑。此因饥中饮酒。大醉当风入水所致。栀子大黄汤。酒瘅下之。久久为黑瘅者。
前方去大黄合犀角、地
黄。不应。去地黄加桂心、桃仁、穿山甲。色瘅者。身黄额上微黑。小便利。大便黑。此因房事
过伤。血蓄小腹而发黄。故小腹连腰下痛。大黄附子汤去细辛加肉桂。若神思困倦。头目昏重。
脾气不运。大便不实者。四君子汤下硝石矾石丸。阴黄者。厥冷脉沉。或服寒凉过多。变为阴黄。
或因过食寒物而成。四肢皮肤皆冷。心下痞硬。眼涩不欲开。自利蜷卧。茵陈附子干姜汤。或茵
陈四逆汤加白术。冷食不化。腹中结痛。去甘草加枳实、白术、草豆蔻。小便不利。加桂、苓、
泽泻。有瘀血发黄。大便必黑。腹胁有块或胀。脉沉或弦。大便不利。脉稍实而不甚弱者。桃核
承气汤。下尽黑物则退。失血后崩后。一切病后。脾胃肺元气大伤。面色痿黄。或淡白色。悉属
虚。从内伤治。不可误认作瘅。食劳疳黄。俗名黄胖。夫黄瘅者。暴病也。疳黄者。宿病也。至
有久不愈者。温中丸、枣矾丸。然此仅可治实人。及田家力作之辈。若膏粱柔脆之人。未可轻试
也。戴氏云。食积发黄。量其虚实而下之。其余但利小便。小便清利。则黄自退。喻嘉言曰。
夏月天气之热。与地气之湿交蒸。人受二气。内结不散。发为黄瘅。与 酱无异。必从外感汗吐
下之法去其湿热。然夏月阳外阴内。非若冬月伤寒人气伏藏难动之比。其谷瘅酒瘅女劳瘅则纯是
内伤。与外感无涉。仲景补内经之阙。曲尽其微。至于阴瘅一证。仲景之方论已亡。千古之下。
惟罗谦甫茵陈四逆汤一方。治过用寒凉阳瘅变阴之证。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聚不散。必复其阳。固结始开。倘非离照当空。
幽隐何由毕达耶。黄瘅得之外感者。误用补法。是谓实实。得之内伤者。误用攻法。是谓虚虚。
阴瘅误从阳治。袭用苦寒者。皆医杀之也。
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。况且有害。奈何纯
阴无阳。辄用苦寒耶。
石顽曰。黄瘅证中。惟黑瘅最剧。良由酒后不禁。酒湿流入髓藏所致。土败水崩之兆。始病
形神未槁者。尚有湿热可攻。为祛瘅之向导。若病久肌肉消烁。此真元告匮。不能回荣于竭泽也。
中翰汪先于病瘅。服茵陈五苓不应。八月间。邀石顽诊之。弦大而芤。肾伤挟瘀。结积不散所致。
急乘元气尚可攻击时。用金匮硝石矾石散兼桂苓丸之制。以洗涤之。迟则难为力矣。汪氏有业医
者。以为药力太峻。不便轻用。旋值公郎乡荐。继以公车。未免萦心。不及调治。迨至新正二日。
复邀石顽相商。脉转弦劲而革。真元竭尽无余。半月以来。日服人参数钱。如水投石。延至正月
下浣。遣内使窃问。予谓之曰。挨至今日小主场事。可无碍矣。其后安公联捷。不及殿试而返。
信予言之不谬也。同时有伶人黑瘅。投以硝石矾石散作丸。晨夕各进五丸服。至四日。少腹攻绞。
小便先下瘀水。大便继下溏黑。至十一日瘀尽。次与桂、苓、归、芍之类。调理半月而安。或问
近世治瘅。多用草头单方。在穷乡绝域。犹之可也。城郭愚民。亦多效尤。仁人鉴此。岂不痛欤。
尝见有服商陆根、苦匏酒、过山龙、雪里青、鹿葱等汁。吐利脱元而死者。指不胜屈。曾有孕妇
病黄。误用瓜蒂搐鼻。呕逆喘满。致胎息上冲。惨痛叫号而毙。设当此际。得何法以救之耶。答
言。是皆与飞蛾触火无异。欲救之者。惟广行刊布。垂诫将来。勿蹈前辙。庶不失仁人之用心。
若欲手挽既覆之车。吾末如之何也。
目黄 目黄曰黄瘅。亦有目黄而身不黄者。经云。风气与阳明入胃。循脉而上至目内 。其
人肥。则风气不得外泄。则为热中而目黄。烦渴引饮。宣明用青龙散。殊失经旨。合用越婢加术
汤、桂枝二越婢一汤选用。病久属虚者。理
苓汤倍用桂、苓。凡黄瘅目黄不除。或头重。以瓜蒂散搐鼻。后用茵陈五苓散清利之。
〔诊〕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。瘅毒入腹。喘满者危。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。
《黄帝内经》说：身体疼痛且面色微黄，齿垢发黄，指甲上发黄，这是黄瘅病。嗜睡、小便黄赤、脉象小而涩、食欲不振的，是黄瘅病。嗜睡且小便黄赤的，称为黄瘅；进食后仍感觉饥饿的，称为胃瘅；眼睛发黄的，称为黄瘅。
《金匮要略》说：凡是患黄疸病的患者，只要通利小便即可。假如脉象浮，应当用发汗法解表，适宜用桂枝加黄芪汤主治。
黄疸这一证候，大率都是从水湿之邪引起的。治疗湿邪的方法，以通利小便是首要原则。然而如果脉象浮，说明湿邪不在里而在表，又应当用发汗法解表。假设表部的湿邪乘虚侵入体内导致小便不通（癃闭），又应当通利小便。所以下一条条文说：黄瘅病，用茵陈五苓散主治。治病灵活变通在于心中，岂可拘泥固执呢？黄瘅病，用茵陈五苓散主治。
患有酒疸病的，必然小便不利。其症状表现为心中烦热，脚心发热，这就是它的证候。
酒疸病，有的没有发热，神志清醒安静，言语正常，但腹部胀满想呕吐，鼻干燥。脉象浮的，先用吐法；脉象沉弦的，先用下法。酒疸病心中烦闷懊恼，或者伴有热痛，用栀子大黄汤主治。
这方剂就是枳实栀子豉汤的变名。大病之后因劳累复发而发热，服用枳实、栀子、豆豉三味药，盖被令其微微出汗，使余热从体表解除。如果有宿食停滞，则加大黄从体内排出。这是治疗酒疸病脉象沉弦者，用此方以下泻。如果脉象浮应当先吐的，则用栀子豉汤，这不言而喻了。因为酒疸损伤胃部导致发黄，属于无形的湿热，所以适宜用栀子豉汤涌吐。这与谷疸应当用茵陈蒿汤的情况，界限分明。即使用这个汤剂也是治疗酒食共同损伤导致的湿气郁结，所以可以用下法。观察枳实栀子豉汤加入大黄，也是因为宿食才使用的。更有栀子柏皮汤治疗身黄发热的一个证候，又是用苦燥药物通利水道。综合这些比例类推，治疗黄疸的方法，就没有遗漏了。
酒疸如果用下法治疗，久而久之会变成黑疸。症状为眼睛黄、面色黑，心中像吃了蒜泥一样的辛辣感，大便正黑，皮肤麻木不仁。脉象浮弱，虽然面色黑中透黄，所以可以知道是黑疸。《金匮要略》治疗酒疸，采用或吐或下的方法，说法虽然交错出现，义理其实是一贯的。大概酒的积热，进入膀胱则气机运行不畅，必然小便不利；积聚在上焦，则心中发热；积聚在下焦，则脚心发热。那些没有心中和脚心发热的，就神志清醒安静而不昏迷。只要见到腹满、想呕吐、鼻干燥这三个症状，就可以知道膈上和腹中阴阳交杂生病，必须分先后治疗。应当辨别脉象的浮沉，以确定吐法和下法的先后顺序。如果只是心中发热想呕吐，那么病全在上焦，用吐法就能痊愈，何必用下法呢？如果是酒热内结，心神昏乱，而出现懊恼及疼痛痛苦的，则不可不下。所以用栀子、香豉，都治疗心中的懊恼；大黄荡涤实热，枳实破结，驱除宿垢。但是这种攻劫病邪的方法，不可以长期使用。长期用下法，必然损伤脾肺的阳气，不能统领阴血，阴血一天天趋向败坏而变成黑色。然而酒疸的黑，不是女劳疸的黑。女劳疸的黑，是由肾气病变引发的；酒疸的黑，是败血的颜色。因为酒的湿热损伤脾胃，脾胃不和，阳气不化，阴血不运，如果再使用下法，久而久之运化的功能更加耗损。气耗血积，败腐瘀浊，颜色外现于肌肤面部变为黑色，味道变化于心，咽喉感到嘈杂，心里辣得像吃了蒜泥一样。营血衰败而不运行，痹阻在皮肤，皮肤麻木不仁，传导到大肠，大便像漆黑一样。眼睛黄和脉象浮弱，都是病在血分。张仲景对一个酒疸病，罗列了治疗的先后次第，以穷尽其治疗方法，如此精详。
谷疸这种病，恶寒发热，不想吃东西，吃东西就头晕，心胸不安，时间久了发黄成为谷疸，用茵陈蒿汤主治。
额头黑，微微出汗，手足心发热，傍晚时分发作，膀胱急迫，小便自利，名叫女劳疸。腹部像有水状，无法治愈。
女劳疸，只说额头黑，不说身体黄，是简略的文辞。然而黑色是北方阴晦的颜色，却加在南方离明（心脏/面部）的位置，是因为房事无度，导致脾中的浊阴下趋进入肾脏，水土互显的颜色，以至于微汗也随着火气而出现在额头，心的津液且向外亡失。手足心发热，内伤疾病都是这样。傍晚阳明经当令，阳明主阖，收敛一身之湿热，疾速向下流入膀胱，其小便自利，大便黑有时稀溏，又是膀胱蓄血的验证。腹部像有水状，实际上并不是水，正是指蓄血而言，所以说是无法治愈。
黄疸病患者在日晡时（下午3-5点）发热，反而恶寒，这是由女劳引起的。膀胱急迫，小腹满，全身尽黄，额头黑，脚心发热，因此形成黑疸。其腹胀像有水状，大便必黑有时稀溏，这是女劳的病，不是水饮病。腹部胀满的难治，用硝石矾石散主治。
这是治疗女劳疸的急救方剂。男子精气发动，则一身之血随之而动，因为女劳而倾泄其精，血必继之。所以因女劳而尿血的，其血尚能运行，还容易治疗。因女劳而成疸的，血瘀不行，如果不紧急去除膀胱少腹的瘀血，万无生路。于是取皂矾以涤除瘀垢，硝石以破积散坚，两味药相辅相成，锐利而不猛烈，这是此方的妙用。
黄疸病腹部胀满，小便不利且色赤，自汗出，这是表证和解，里实证，应当用下法，用大黄硝石汤。
黄疸病最难得出汗，自汗则表证从汗而解，所以说：这是表和里实。方中使用大黄、硝石解散在里的血结，黄柏专门祛除下焦湿热，栀子轻浮，能使里热从水道排泄。
各种黄疸，用猪膏发煎主治。
详细分析此方是治疗瘀血发黄的缓剂。因为各种黄疸虽然多由湿热引起，但经脉久病，无不有瘀血阻滞。《肘后备急方》用此方治疗女劳疸，身目尽黄，发热恶寒，少腹满，小便难，这是因为大热大寒的女劳，交接入水所致。用发灰专门消散瘀血，和猪膏煎服，以润经络肠胃之燥。与硝石矾石散相比，虽然缓急轻重悬殊，但消散瘀血的主旨是一致的。
疸病而口渴的，其疸难治；疸病而不口渴的，其疸可治。病发于阴部的，其人必然呕吐；病发于阳部的，其人振寒而发热。
疸病是湿热固结，阻断了津液往来的道路，所以通过渴与不渴，来证明津液的通与不通。呕吐是肠胃受病，振寒发热是经络受伤，在此可以证明表里阴阳而进行治疗。
黄疸病，颜色像熏黄，全身疼痛，这是湿病。颜色像橘子黄，身体不痛，这是疸病。疸分为五种：黄汗、黄疸、谷疸、酒疸、女劳疸。黄汗病，其症状是小腿自冷，腰部以上必然出汗，腰部以下无汗，腰髋弛痛，好像有东西在皮中，严重的不能吃饭，身体疼重，烦躁，小便不利，这是黄汗，宜用芍药桂枝苦酒汤。白天热，加防风；晚上热，加当归；吃得少，加白术、茯苓。黄疸有干有湿，干黄的，是肺燥，小便自利，四肢不沉重，口渴想喝水，用栀子柏皮汤；湿黄的，是脾湿，小便不利，四肢沉重，似渴不欲饮水，用麻黄连轺赤小豆汤。身黄如橘子色，小便不利，腹部微满的，用茵陈蒿汤。口渴的，用茵陈五苓散。谷疸病，吃完饭后立即头晕，心中烦闷不安，遍身发黄，用小柴胡汤加白术、炮姜、胆草、枳实。二便秘结的，用茵陈蒿汤。胃疸病，吃完食物像饥饿，胃热消谷，面黄瘦，胸满胁胀，小便短赤，用补中益气汤加猪胆汁炒川连、酒黄柏、泽泻。酒疸病，身目发黄，腹部像有水状，心中懊恼而热，不能吃饭，时时想吐，足胫肿，小便黄，面发赤斑，这是因为饥中饮酒，大醉当风入水所致，用栀子大黄汤。酒疸病用下法，久而久之变成黑疸的，前方去大黄合犀角、地黄。无效，去地黄加桂心、桃仁、穿山甲。色疸病，身黄额头微黑，小便利，大便黑，这是因为房事过度损伤，血蓄在小腹而发黄，所以小腹连腰下痛，用大黄附子汤去细辛加肉桂。如果神思困倦，头目昏重，脾气不运，大便不成形的，用四君子汤送服硝石矾石丸。阴黄病，四肢厥冷脉沉，或者是服用寒凉药过多，变为阴黄，或者是因过食寒物而成，四肢皮肤皆冷，心下痞硬，眼涩不想睁开，自利蜷卧，用茵陈附子干姜汤，或者茵陈四逆汤加白术。冷食不化，腹中结痛，去甘草加枳实、白术、草豆蔻。小便不利，加桂枝、茯苓、泽泻。有瘀血发黄，大便必黑，腹胁有块或胀，脉沉或弦，大便不利，脉稍实而不甚弱的，用桃核承气汤。下尽黑物则退。失血后、崩漏后，一切病后，脾胃肺元气大伤，面色萎黄，或者淡白色，都属于虚证，从内伤治疗，不可误认作疸病。食劳疳黄，俗名黄胖。夫黄疸病，是暴病；疳黄病，是宿病。甚至有久不愈的，用温中丸、枣矾丸。然而这仅可治疗体质强壮的人，以及田间劳作之辈。如果是富贵柔脆之人，不可轻易尝试。戴氏说：食积发黄，衡量其虚实而下之，其余只利小便，小便清利，则黄自退。喻嘉言说：夏月天气之热，与地气之湿交蒸，人受二气，内结不散，发为黄疸，与发酵酱无异，必须从外感汗吐下之法去除其湿热。然而夏月阳外阴内，不像冬月伤寒人气伏藏难动那样。至于谷疸、酒疸、女劳疸则是纯内伤，与外感无关。张仲景补充《内经》的缺漏，曲尽其微妙。至于阴疸一证，张仲景的方论已亡，千古之下，只有罗谦甫的茵陈四逆汤一方，治疗过用寒凉阳疸变阴的证候，符合既往法则，此外没有了。今人只说阳疸色明，阴疸色晦，这不过是气血之分，辨析不清，反而足以误人。比如酒疸变黑，女劳疸额头黑，难道因为其黑就说是阴疸，可用附子、干姜吗？夫女劳疸者，真阳被血壅闭，尚未大损，瘀血一行，阳气即通了。阴疸则真阳衰微不振，一任湿热与浊气败血团聚不散，必须恢复其阳气，固结才能打开。如果不是太阳当空，幽隐之处怎能完全到达呢？黄疸得之外感的，误用补法，这叫实实（使实证更实）；得之内伤的，误用攻法，这叫虚虚（使虚证更虚）。阴疸误从阳治，袭用苦寒的，都是医生杀死的。
在半阴半阳的证候，开始必须先退阴复阳，阴退乃从阳治。如果用附子、黄连合用，况且有害，何况纯阴无阳，辄用苦寒呢？
石顽说：黄疸证中，只有黑疸最剧烈，良由酒后不禁，酒湿流入髓脏所致，是土败水崩的征兆。初病形神未枯槁的，尚有湿热可攻，作为祛疸的向导。如果病久肌肉消烁，这是真元告罄，不能回荣于枯竭之泽。
中翰汪先生患疸病，服用茵陈五苓散无效。八月间，邀请石顽诊脉，脉弦大而芤，是肾伤挟瘀，结积不散所致。急需趁元气尚可攻击时，用《金匮要略》硝石矾石散兼桂苓丸的制法，以洗涤之。迟则难以为力了。汪氏家有行医者，认为药力太峻，不便轻用。恰逢其子乡试中举，接着参加会试，未免萦怀在心，不及调治。等到新年初二，再次邀请石顽商量，脉转弦劲而革，真元竭尽无余。半月以来，每天服人参数钱，如水投石。延至正月下旬，派遣家仆暗中询问，我对他说：“挨到今天小主场事（科举考试），应该无碍了。”后来汪公接连考中，来不及殿试就返回，相信我的话不谬。同时有一个伶人患黑疸，投以硝石矾石散做成丸药，早晚各进五丸服用。到第四天，少腹攻绞，小便先下瘀水，大便继下溏黑。到第十一天瘀尽，其次用桂、苓、归、芍之类，调理半月而安。有人问：近世治疸，多用草头单方，在穷乡绝域，还可以。城郭愚民，也多效仿，仁人看到此景，岂不痛心吗？我曾见有服用商陆根、苦匏酒、过山龙、雪里青、鹿葱等汁，吐利脱元而死的，指不胜屈。曾有孕妇病黄，误用瓜蒂搐鼻，呕逆喘满，致胎息上冲，惨痛叫号而死。设若此时，有什么办法可以救她呢？回答说：这都是与飞蛾触火无异，想要救人的，只有广泛刊布，垂诫将来，不要重蹈覆辙，庶几不失仁人的用心。如果想要手挽既覆之车，我也无可奈何了。
目黄 眼睛发黄叫做黄疸。也有眼睛黄而身体不黄的。《内经》说：风气与阳明经入胃，循脉而上至目内眦，其人肥胖，则风气不得外泄，则为热中而目黄，烦渴引饮，宣明用青龙散，殊失经旨，合用越婢加术汤、桂枝二越婢一汤选用。病久属虚的，理苓汤倍用桂、苓。凡黄疸目黄不除，或者头重，用瓜蒂散搐鼻，后用茵陈五苓散清利之。
〔诊〕脉沉渴欲饮水，小便不利的，都发黄。脉洪大，大便利而渴的，死。脉微小，小便利不渴的，生。凡黄家，候其寸口近掌无脉，口鼻气冷，并不可治。疸毒入腹，喘满的危。凡年壮气实，脉滑便坚的易愈。年衰气弱，脉虚涩而便利的难痊。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the body aches and the complexion is slightly yellow, the dental plaque is yellow, and the nails are yellow, this is Huangdan (Jaundice). Lethargy, dark yellow urine, a pulse that is small and choppy, and loss of appetite indicate Huangdan. Lethargy with dark yellow urine is called Huangdan; feeling hungry immediately after eating is called Weidan (Stomach Jaundice); yellowing of the eyes is called Huangdan.
The *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) states: For all patients suffering from jaundice, promoting urination is sufficient. If the pulse is floating, sweating should be used to resolve the exterior; Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus) is appropriate.
This syndrome of jaundice generally arises from water-dampness. The primary method for treating dampness is to promote urination. However, if the pulse is floating, it indicates that the dampness is not in the interior but on the exterior, and sweating should be used to resolve it. If exterior dampness enters the interior due to deficiency and causes urinary retention (Longbi), then promoting urination is required. Thus, the next clause states: For Huangdan disease, Yinchen Wuling San (Artemisiae Scopariae Decoction with Five Ingredients) is indicated. Treatment requires flexibility of mind; one cannot be rigid. For Huangdan disease, Yinchen Wuling San is indicated.
In cases of Jiudan (Alcoholic Jaundice), there must be difficulty in urination. The symptoms include heat in the heart and heat under the feet; this is its presentation.
In Jiudan, some cases have no fever, with the patient quiet and lucid, yet experiencing abdominal fullness, desire to vomit, and dry nose. If the pulse is floating, induce vomiting first; if the pulse is deep and wiry, purge first. For Jiudan with heat pain or mental restlessness (Aonao) in the heart, Zhizi Dahuang Tang (Gardenia and Rhubarb Decoction) is indicated.
This formula is a variation of Zhishi Zhizi Chitang (Mature Buckwheat Fruit, Gardenia, and Fermented Soybean Decoction). After a major illness, recurrence due to overexertion causing fever is treated with Zhishi, Zhizi, and Chiren (Fermented Soybeans); covering the patient to induce slight sweating allows residual heat to resolve from the exterior. If there is retained food, Dahuang (Rhubarb) is added to resolve from the interior. This treats Jiudan with a deep-wiry pulse using purgation. If the pulse is floating and vomiting is indicated, Zhizi Chitang is used, which goes without saying. Since Jiudan damages the stomach leading to yellowing, involving formless damp-heat, inducing vomiting with Zhizi Chitang is suitable. This differs distinctly from Gudan (Grain Jaundice), which requires Yinchen Hao Tang (Artemisiae Scopariae and Yellow Gentian Root Decoction). Even this decoction treats dampness stagnation caused by combined injury from alcohol and food, hence purgation can be used. Observing the addition of Dahuang to Zhishi Zhizi Chitang also depends on retained food. Furthermore, Zhizi Bapi Tang (Gardenia and Phellodendri Bark Decoction) treats yellowing with fever by using bitter-drying herbs to unblock the fluid passages. By analogy, the methods for treating jaundice are comprehensive.
If Jiudan is treated with purgation for too long, it may transform into Heidan (Black Jaundice). Symptoms include yellow eyes, black complexion, a sensation in the heart like eating minced garlic, black stools, and skin numbness (Buren). The pulse is floating and weak; although the complexion is black with a hint of yellow, this confirms Heidan. The *Jingui Yaolue* treats Jiudan with either emesis or purgation; though the methods appear mixed, the principle is consistent. Generally, accumulated heat from alcohol entering the Bladder impedes Qi mechanism, causing urinary difficulty; accumulating in the Upper Jiao causes heart heat; accumulating in the Lower Jiao causes foot heat. Those without heart or foot heat remain lucid and unconscious-free. Seeing only abdominal fullness, desire to vomit, and dry nose indicates simultaneous pathology in the diaphragm and abdomen, requiring sequential treatment. One must distinguish between floating and deep pulses to determine the order of emesis or purgation. If only heart heat and desire to vomit exist, the disease is entirely in the Upper Jiao, and emesis suffices; why use purgation? If internal binding of alcohol-heat causes mental confusion, Aonao, and pain, purgation is necessary. Thus, Zhizi and Xiangchi (Fermented Soybeans) treat heart Aonao; Dahuang purges excess heat; Zhishi breaks stagnation and expels retained waste. However, such aggressive methods should not be used long-term. Long-term purgation injures Spleen and Lung Yang, failing to control Yin blood, leading to blood degeneration and blackening. However, the blackness of Jiudan differs from Nulao Dan (Female Labor Jaundice). Nulao Dan’s blackness stems from Kidney Qi pathology; Jiudan’s blackness is the color of degenerated blood. Alcohol-damp-heat damages the Spleen and Stomach; disharmony prevents Yang transformation and Yin blood circulation. Further purgation exhausts transformation functions. Qi depletion and blood stasis lead to corruption and turbidity, manifesting as blackness on the skin and face, and a spicy sensation in the heart like eating garlic. Ying blood fails to circulate, causing skin numbness; transmission to the Large Intestine results in pitch-black stools. Yellow eyes and floating-weak pulses indicate blood-level pathology. Zhang Zhongjing details the sequential treatment for Jiudan with such precision.
Gudan (Grain Jaundice) presents with aversion to cold, fever, anorexia, dizziness upon eating, chest discomfort, and eventual yellowing. Yinchen Hao Tang is indicated.
Black forehead, slight sweating, heat in hands and feet, evening onset, bladder urgency, and normal urination constitute Nulao Dan. Abdominal distension resembling water accumulation is incurable.
Nulao Dan mentions only a black forehead, omitting body yellowing, implying brevity. Black is the color of Northern Yin obscurity, appearing on the Southern Li Brightness position (face/heart) due to excessive sexual activity causing Spleen turbidity to descend into the Kidney, mixing Earth and Water colors. Slight sweat follows fire to the forehead, losing Heart fluids. Heat in palms and soles is common in internal injury. At dusk, Yangming governs, closing and gathering damp-heat downward to the Bladder. Normal urination and occasional black loose stools verify Bladder blood stasis. Abdominal water-like distension actually refers to blood stasis, hence incurable.
Jaundice patients fevers at sunset (Shiwu) with paradoxical aversion to cold indicate Nulao origin. Bladder urgency, abdominal fullness, generalized yellowing, black forehead, and foot heat constitute Heidan. Abdominal water-like distension and black loose stools confirm Nulao disease, not water retention. Abdominal fullness is difficult to treat; Xiaoshi Fanshi San (Niter and Alumen Powder) is indicated.
This is an emergency formula for Nulao Dan. Male essence movement mobilizes blood; excessive female labor depletes essence and blood. Hematuria from female labor is easier to treat as blood still flows. Jaundice from female labor involves stagnant blood; urgent removal of Bladder/Lower Abdomen stasis is vital. Xiaoshi (Niter) clears stasis; Fanshi (Alumen) breaks accumulation. These two work synergistically, sharp but not fierce, representing the formula’s efficacy.
For Jaundice with abdominal fullness, dark/scanty urination, and spontaneous sweating, the exterior is harmonious while the interior is excess; purgation is required using Dahuang Xiaoshi Tang (Rhubarb and Niter Decoction).
Jaundice rarely induces sweating; spontaneous sweating resolves the exterior, confirming "Exterior Harmonious, Interior Excess." Dahuang and Xiaoshi resolve interior blood binding; Huangbai (Phellodendri Cortex) clears Lower Jiao damp-heat; Zhizi (Gardeniae Fructus) is light and floating, allowing interior heat to drain via fluid passages.
For various jaundices, Zhaogao Faxian Jian (Pig Fat and Human Hair Decoction) is indicated.
This is a mild formula for jaundice due to blood stasis. Although most jaundices involve damp-heat, chronic meridian disease inevitably involves stasis. *Zhouhou Fang* uses this for Nulao Dan with generalized yellowing, fever, chills, lower abdominal fullness, and difficult urination, caused by extreme heat/cold from sexual activity followed by water exposure. Renmao (Human Hair Ash) disperses stasis; pig fat moistens meridians and bowels. Compared to Xiaoshi Fanshi San, it is milder but shares the goal of dispersing stasis.
Jaundice with thirst is difficult to treat; without thirst, it is curable. Disease originating in Yin parts causes vomiting; in Yang parts, chills and fever. Jaundice involves solidified damp-heat blocking fluid pathways; thirst indicates blockage, lack thereof indicates flow. Vomiting indicates Stomach/Intestine pathology; chills/fever indicate Meridian injury. This distinguishes Exterior/Interior and Yin/Yang for treatment.
Huangdan with smoky-yellow color and body pain is Wet Disease. Orange-yellow color without pain is Dan Disease. Dan divides into five: Huanghan (Yellow Sweat), Huangdan, Gudan, Jiudan, Nulao Dan. Huanghan presents with cold calves, sweating above waist, no sweat below, loins/hips pain, sensation of foreign body in skin, severe cases anorexia, heavy body pain, irritability, and scanty urination. Shaoyao Guizhi Kujiu Tang (Peony, Cinnamon Twig, and Vinegar Decoction) is indicated. Add Fangfeng (Saposhnikoviae Radix) for daytime heat; Danggui (Angelicae Sinensis Radix) for night heat; Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria) for poor appetite. Huangdan has Dry and Wet types. Dry Huang (Lung dryness): normal urination, non-heavy limbs, thirst for drinks; Zhizi Bapi Tang is indicated. Wet Huang (Spleen dampness): scanty urination, heavy limbs, false thirst without desire to drink; Mazi Lianqiao Chixiaodou Tang (Ephedra, Loranthus, and Red Adzuki Bean Decoction) is indicated. Orange-yellow skin, scanty urination, mild abdominal fullness: Yinchen Hao Tang. With thirst: Yinchen Wuling San. Gudan: dizziness after eating, chest oppression, generalized yellowing; Xiao Chaihu Tang modified with Baizhu, Paoshengjiang (Prepared Ginger), Danshen (Gentiana Scabra), Zhishi. Constipation: Yinchen Hao Tang. Weidan: hunger after eating, stomach heat consuming grain, sallow thin face, chest/hypochondriac fullness, scanty red urine; Buzhong Yiqi Tang modified with Pig Bile-fried Huanglian (Coptidis Rhizoma), Jiuhuangbai (Wine-processed Phellodendri Cortex), Zexie (Alismatis Rhizoma). Jiudan: yellow eyes/skin, water-like abdomen, heart Aonao/heat, anorexia, frequent vomiting, swollen calves, yellow urine, red spots on face; caused by drinking while hungry, getting drunk in wind/water; Zhizi Dahuang Tang is indicated. If Jiudan purged leads to Heidan, remove Dahuang from previous formula, add Xijiao (Rhinocerotis Cornu - substitute with Niujiao/Bovis Cornu clinically), Dihuang (Rehmanniae Radix). If ineffective, remove Dihuang, add Guixin (Cinnamomi Ramulus), Taoren (Pruni Semen), Shanjiajia (Manis Squama). Se Dan: yellow body, slightly black forehead, normal urination, black stool; caused by excessive intercourse, blood stasis in lower abdomen causing yellowing and lower back/abdominal pain; Dahuang Fuzi Tang modified (remove Xixin, add Rougui) is indicated. If mental fatigue, heavy head, poor Spleen transport, loose stools: Sijunzi Tang with Xiaoshi Fanshi Wan. Yin Huang: cold limbs, deep pulse, or caused by excessive cold herbs/diet; cold skin, epigastric hardness, dry eyes, spontaneous diarrhea, curled posture; Yinchen Fuzi Ganjiang Tang or Yinchen Sini Tang plus Baizhu. For cold food indigestion, abdominal cramping: remove Gancao, add Zhishi, Baizhu, Caodoukou (Black Cardamom). For scanty urination: add Guizhi, Fuling, Zexie. Jaundice with blood stasis: black stool, abdominal/flank mass/bloating, deep/wiry pulse, constipation, pulse slightly firm not weak: Taohhe Chengqi Tang. Discharge black material to resolve. Post-hemorrhage or post-miscarriage, general post-illness with great Spleen/Stomach/Lung Qi deficiency, sallow or pale complexion: all deficiency, treat as internal injury, do not mistake for Jaundice. Shi Lao Gan Huang (Food/Labor Malnutrition Jaundice), vulgarly "Yellow Puffiness": Huangdan is acute; Gan Huang is chronic. For persistent cases: Wenzhong Wan, Zaofan Wan. Only for robust individuals or laborers; delicate persons should not use. Dai Shi says: Food-stagnation jaundice requires purging based on deficiency/excess; otherwise, promote urination. Clear urine resolves jaundice. Yu Jiayan says: Summer heat and earth dampness combine; humans absorb these, forming internal knots causing jaundice, like fermenting sauce. Must use exterior-releasing, emetic, or purgative methods to clear damp-heat. However, summer has exterior Yang and interior Yin, unlike winter Cold where Qi hides. Gudan, Jiudan, Nulao Dan are purely internal injuries, unrelated to exterior pathogens. Zhang Zhongjing supplemented the *Neijing*, detailing subtleties. Regarding Yin Dan, Zhang’s formulas are lost; only Luo Qianfu’s Yinchen Sini Tang remains, treating Yang Dan transformed to Yin by excessive cold herbs, following ancient precedent. Moderns say Yang Dan is bright, Yin Dan is dull; this confuses Qi/Blood differentiation and misleads. E.g., Jiudan turning black or Nulao Dan black forehead—does black imply Yin Dan treatable with Fuzi/Ganjiang? Nulao Dan: True Yang blocked by blood, not severely damaged; once blood moves, Yang restores. Yin Dan: True Yang deficient; damp-heat/turbid blood accumulate; Yang must be restored to break stagnation. Without sun illuminating darkness, how can hidden things be reached? Exterior-derived Jaundice treated with tonics is "Solidifying Solid" (Shi Shi); Internal-derived Jaundice treated with purgatives is "Emptying Empty" (Xu Xu). Treating Yin Dan as Yang with bitter-cold herbs kills patients.
In half-Yin half-Yang syndromes, initially restore Yang to retreat Yin; only then treat Yang. Combining Fuzi and Huanglian is harmful; using bitter-cold for pure Yin without Yang is worse.
Shiwan stated: Among jaundices, Heidan is most severe, caused by alcohol indulgence allowing dampness to enter marrow stores, signaling Spleen failure and Kidney collapse. Early stage with intact spirit/form has damp-heat to attack, guiding jaundice removal. Late stage with muscle wasting indicates Yuan Qi exhaustion, unable to nourish dried-up sources.
Official Wang suffered jaundice; Yinchen Wuling San failed. August diagnosis: pulse string-large-empty, indicating Kidney injury with stasis and accumulation. Urgently use Jingui Xiaoshi Fanshi San combined with Guiling Wan formulation to cleanse while Yuan Qi permits; delay makes it difficult. Wang’s physician deemed drugs too harsh. Soon after, Wang’s son passed provincial exams, causing mental distraction, delaying treatment. New Year’s Day 2nd: pulse string-tough-leather, Yuan Qi exhausted. Daily Ginseng doses failed like water on stone. Late January inquiry: I predicted safety after imperial exams. Wang succeeded, returned early, proving my words correct. Simultaneously, an actor with Heidan took Xiaoshi Fanshi San pills (5 morning/evening). Day 4: lower abdominal colic, bloody urine first, then black loose stools. Day 11: stasis cleared. Followed by Guiling/Danggui/Shaoyao for 15 days to recover. Question: Moderns use herbal folk remedies for jaundice; acceptable in remote areas, but urban fools imitate them. Is this not painful for benevolent men? I have seen deaths from Shanglu (Veratrum), Kugua (Bitter Melon), Guoshanlong, Xueliqing, Luchong juices causing vomiting/diarrhea and Qi collapse. Pregnant woman with jaundice used Genti (Momordica seed) nasal insufflation, causing vomiting, asthma, fetal distress, and death. How to save her? Answer: Like moths to flame. To save lives, publish warnings to prevent future errors, preserving benevolence. Saving overturned carts is impossible.
Eye Jaundice: Eye yellowing is Huangdan. Some have yellow eyes but non-yellow body. *Neijing*: Wind-Qi and Yangming enter Stomach, ascend via meridians to inner canthus. In obese people, wind cannot escape, causing Heat-Middle and eye yellowing, thirst. Xuanming used Qinglong San, missing the canon’s intent. Use Yebipi Jia Zhu Tang or Guizhi Er Yebipi Yi Tang appropriately. Chronic deficiency: Liling Tang doubled Guizhi/Fuling. For persistent eye jaundice or heavy head: Genti San nasal insufflation, followed by Yinchen Wuling San to clear/drain.
[Diagnosis] Deep pulse, thirst for water, scanty urination: all indicate jaundice. Surging pulse, free stool, thirst: death. Tiny pulse, free urination, no thirst: survival. For all jaundice patients, if radial pulse near palm is absent, and mouth/nose breath is cold: incurable. Jaundice toxin entering abdomen with wheezing/fullness: critical. Young/robust with slippery/firm stool: easy recovery. Elderly/weak with empty/choppy pulse and free stool: difficult cure.