凡发黄黄胆等证，多由湿热。如小水不利，或黄或赤，或小腹胀满不痛，或大便实而渴甚，脉
来沉实有力，皆湿热之证。轻则茵陈五苓散，重则茵陈汤，分利小便，清血泻火，则黄自退矣。然
黄有阴证及诸治法，俱详黄胆门，宜参用之。
仲景曰∶太阳病，脉浮而动数，头痛发热，微盗汗出，而反恶寒者，表未解也，医反下之，则
为结胸；若不结胸，但头汗出，小便不利，身必发黄也。曰∶阳明病，无汗，小便不利，心中懊
者，身必发黄。阳明病，发热汗出者，此为热越，不能发黄也。但头汗出，身无汗，际颈而还，小
便不利，渴饮水浆者，此为瘀热在里，身必发黄，茵陈蒿汤主之。曰∶伤寒，脉浮而缓，手足自温
者，系在太阴，身当发黄。若小便自利者，不能发黄，至七八日大便硬者，为阳明病也。曰∶伤寒
，发汗已，身目为黄，所以然者，以寒湿在里，不解故也。以为不可下也，于寒湿中求之。伤寒身
黄发热者，栀子柏皮汤主之。
孙真人曰∶黄胆脉浮者，当以汗解之，宜桂枝加黄 汤。
伤寒发狂，本阳明实热之病，然复有如狂证者，虽似狂而实非狂，此中虚实相反，最宜详辨，
不可忽也。凡实热之狂，本属阳明，盖阳明为多气多血之经，阳邪传入胃腑，热结不解，因而发狂
。《内经·阳明脉解篇》
曰∶胃者土也，故闻木音而惊者，土恶木也。其恶火者，热甚则恶火也。其恶人者，以阳明厥则喘
而惋，惋则恶人也。其病甚则弃衣而走，登高而歌，或数日不食，或逾垣上屋者，以四肢为诸阳之
本，阳盛则四肢实，实则能登高也。其弃衣而走者，以热盛于身也。其妄言骂詈，不避亲疏而歌者
，以阳盛为邪也。又曰∶阴不胜其阳，则脉流薄疾，并乃狂。又曰∶邪入于阳则狂。是皆以阳明热
邪上乘心肺，故令神志昏乱若此，此阳狂也。然伤寒病至发狂，是为邪热已极，使非峻逐火邪，则
不能已。故但察其大便硬结，或腹满而坚，有可攻之证，则宜以大小承气，或凉膈散、六一顺气汤
之类，下之可也。如无胀满实坚等证，而惟胃火致然者，则但以白虎汤、抽薪饮之类，泄去火邪，
其病自愈。
一、如狂证本非实热发狂，其证亦有轻重。如仲景曰∶太阳病不解，热结膀胱，其人如狂。其外
证不解者，尚未可攻，当先解外。外已解，但少腹急结者，乃可攻之，宜桃仁承气汤。又曰∶太阳
病，六七日，表证仍在，脉微而沉，反不结胸，其人如狂者，以热在下焦，少腹当硬满。小便自利
者，下其血乃愈，抵当汤主之。按此二条，以太阳热邪不解，随经入腑，但未至发狂，故曰如狂。
此以热搏血分，蓄聚下焦，故宜下也。
一、近见伤寒家则别有如狂之证，古人所未及言者，盖或由失志而病，其病在心也；或由悲忧
而病，其病在肺也；或由失精而病，其病在肾也；或由劳倦思虑而病，其病在肝脾也。此其本病已
伤于内，而寒邪复感于外，则病必随邪而起矣。其证如狂，亦所谓虚狂也。而虚狂之证，必外无黄
赤之色，刚暴之气，内无胸腹之结，滑实之脉，虽或不时躁扰，而禁之则止，口多妄诞，而声息不
壮，或眼见虚空，或惊惶不定，察其上则口无焦渴，察其下则便无硬结，是皆精气受伤，神魂不守
之证。此与阳极为狂者，反如冰炭，而时医不能察，但见错乱，便谓阳狂，妄行攻泻，必致杀人。
凡治此者，须辨阴阳。其有虚而挟邪者，邪在阳分，则宜补中益气汤之类；邪在阴分，则宜补阴益
气煎之类。虚而无邪者，在阳分，则宜四君、八珍、十全大补汤、大补元煎之类；
在阴分，则宜四物、六味、左归饮、一阴煎之类。阴虚挟火者，宜加减一阴煎、二阴煎之类。阳虚
挟寒者，宜理中汤、回阳饮、八味汤、右归饮之类。此方治之宜，大略如此，而变证之异，则有言
不能传者，能知意在言表，则知所未言矣。
一、凡身有微热，或面赤戴阳，或烦躁不宁，欲坐卧于泥水中，然脉则微弱无力，此阴证似阳
也，名为阴躁。盖以阳虚于下，则气不归原，故浮散于上，而发躁如狂。速当温补其下，命门暖则
火有所归，而病当自愈。若医不识此，而误用寒凉者必死。
一、发狂，下痢谵语者不治。狂言，反目直视者，为肾绝，死。汗出后辄复热，狂言不食者死。
凡是出现发黄、黄疸等证候，大多由湿热引起。如果小便不通利，颜色黄或赤，小腹胀满但不疼痛，或者大便干结且极度口渴，脉象沉实有力，这些都是湿热的证候。病情轻的，用茵陈五苓散；病情重的，用茵陈汤，通过分利小便，清血泻火，黄色自然消退。然而黄疸也有阴证及其他各种治法，都在黄疸门中详细记载，应当参考使用。
张仲景说：太阳病，脉象浮而动数，头痛发热，微微盗汗，反而恶寒的，说明表证未解，医生反而用攻下法，就会形成结胸；如果不形成结胸，只是头部出汗，小便不利，身体一定会发黄。又说：阳明病，无汗，小便不利，心中烦闷懊恼的，身体一定会发黄。阳明病，发热汗出的，这是热邪向外发散，不会发黄。只有头部出汗，身上无汗，汗止于颈部，小便不利，想喝水浆的，这是瘀热在体内，身体一定会发黄，用茵陈蒿汤主治。又说：伤寒，脉象浮而缓，手脚自温的，病系在太阴，身体应当发黄。如果小便自利的，就不会发黄，到了七八天大便变硬的，就是阳明病了。又说：伤寒，发汗后，身体眼睛发黄，之所以这样，是因为寒湿在体内，不能解除的缘故。认为不可用攻下法，应当在寒湿中证求治法。伤寒身黄发热的，用栀子柏皮汤主治。
孙思邈说：黄疸脉浮的，应当用发汗法解表，适宜用桂枝加黄芪汤。
伤寒发狂，本是阳明实热的病，然而又有像狂的证候，虽然看似发狂但实际上不是真狂，这里虚实相反，最应当仔细辨别，不可忽视。凡是实热导致的发狂，本属于阳明，因为阳明是多气多血的经络，阳邪传入胃腑，热结不解，因而发狂。《内经·阳明脉解篇》说：胃属土，所以听到木音就惊恐的，是土厌恶木。厌恶火的，是热盛所以厌恶火。厌恶人的，是因为阳明经气厥逆则喘息且心中郁闷，郁闷所以厌恶人。病情严重时脱衣奔跑，登高唱歌，或者几天不吃饭，或者翻墙爬屋的，是因为四肢为诸阳之本，阳气盛则四肢充实，充实就能登高。脱衣奔跑的，是因为热盛于身体。胡言乱语骂人，不分亲疏而唱歌的，是因为阳盛成为邪气。又说：阴不胜其阳，则血脉流动急迫，并合起来就发狂。又说：邪气侵入阳分就发狂。这些都是因为阳明热邪上乘心肺，所以导致神志昏乱如此，这就是阳狂。然而伤寒病发展到发狂，说明邪热已经极盛，如果不是峻猛地驱逐火邪，就不能停止。所以只要观察到大便硬结，或者腹部胀满坚硬，有可攻下的证候，就适宜用大承气汤、小承气汤，或者凉膈散、六一顺气汤之类，攻下即可。如果没有胀满实坚等证候，仅仅是胃火导致的，那么就只用白虎汤、抽薪饮之类，泄去火邪，病自然会好。
其一，像狂的证候本来不是实热发狂，其证候也有轻重。如张仲景说：太阳病不解，热结膀胱，其人像狂。外证未解的，还不可以攻下，应当先解外证。外证已解，只有少腹急结的，才可以攻下，适宜用桃仁承气汤。又说：太阳病，六七天，表证仍在，脉微而沉，反而不结胸，其人像狂的，是因为热在下焦，少腹应当硬满。小便自利的，攻下瘀血就好了，用抵当汤主治。按这两条，是因为太阳热邪不解，随经络入腑，但未到真正发狂的程度，所以说像狂。这是因为热与血搏结，蓄积在下焦，所以适宜攻下。
其一，近来见到伤寒患者有别于上述的像狂证候，这是古人没有提及的，大概是由于失意而生病，病在心；或者是由于悲伤忧愁而生病，病在肺；或者是由于失精而生病，病在肾；或者是由于劳倦思虑而生病，病在肝脾。这些本病已经内伤，而寒邪又外感，那么病必定随着邪气而起。其证候像狂，也就是所谓的虚狂。而虚狂的证候，一定外部没有面红目赤之色，刚暴之气，内部没有胸腹结聚，滑实之脉，虽然有时躁动不安，但制止后就停止，口中多妄诞之言，但声音气息不壮，或者眼见虚空，或者惊惶不定，检查其上则口无焦渴，检查其下则大便无硬结，这都是精气受伤，神魂不守的证候。这与阳极为狂的情况，相反如同冰炭，而当时的医生不能察觉，只见错乱，就认为是阳狂，妄行攻泻，必然致人死亡。凡是治疗这类情况，必须辨别阴阳。其中有虚而挟带邪气的，邪在阳分，就适宜用补中益气汤之类；邪在阴分，就适宜用补阴益气煎之类。虚而无邪的，在阳分，就适宜用四君子汤、八珍汤、十全大补汤、大补元煎之类；在阴分，就适宜用四物汤、六味地黄丸、左归饮、一阴煎之类。阴虚挟火的，适宜用加减一阴煎、二阴煎之类。阳虚挟寒的，适宜用理中汤、回阳饮、八味汤、右归饮之类。这些方剂的治疗大致如此，而变证的差异，则有言语无法传达的，能知道意在言表，就知道那些未说出来的了。
其一，凡是身体有微热，或者面赤戴阳，或者烦躁不宁，想要坐卧在泥水中，但是脉象微弱无力，这是阴证似阳，名为阴躁。因为阳气虚于下，则气不归原，所以浮散于上，而发躁像狂。应当迅速温补下部，命门温暖则火有所归，病应当自愈。如果医生不认识这个，而误用寒凉药，必死无疑。
For conditions such as jaundice and yellowing of the skin, they are mostly caused by damp-heat. If urination is difficult, with urine being yellow or red, or if there is fullness and distension in the lower abdomen without pain, or if the stool is dry and there is extreme thirst, and the pulse is deep, solid, and forceful, these are all signs of damp-heat. For mild cases, Yinchen Wuling San (Yinchen Five-Ling Powder) is used; for severe cases, Yinchen Tang (Inula Decoction) is used. By promoting diuresis to separate dampness from heat, clearing blood and draining fire, the yellow color will naturally recede. However, jaundice also includes yin-patterns and various other treatment methods, which are detailed in the chapter on Jaundice and should be consulted.
Zhang Zhongjing stated: In Taiyang disease, if the pulse is floating, active, and rapid, accompanied by headache, fever, slight night sweating, and aversion to cold, the exterior syndrome has not yet resolved. If a physician erroneously applies purgation, it leads to Jie Xiong (Chest Binding); if it does not lead to Chest Binding, but only head sweating occurs, along with difficulty in urination, the body will inevitably become yellow. He also stated: In Yangming disease, if there is no sweating, difficulty in urination, and mental restlessness (Ao Nao), the body will inevitably become yellow. In Yangming disease, if there is fever and sweating, this indicates that heat is venting outward, and jaundice will not occur. If there is only head sweating, no body sweating, sweating stopping at the neck, difficulty in urination, and a desire to drink fluids, this indicates stagnant heat inside the body, leading to inevitable jaundice, treated primarily with Yinchen Hao Tang (Artemisia Capillaris Decoction). He further stated: In Shang Han (Cold Damage), if the pulse is floating and slow, and the hands and feet are warm, the disease is related to Taiyin, and the body should become yellow. If urination is normal, jaundice will not occur; after seven or eight days, if the stool becomes hard, it becomes Yangming disease. He also stated: After treating Shang Han with sweating, if the body and eyes turn yellow, it is because cold-dampness is trapped inside and cannot resolve. Purging should not be used; instead, treatment should seek to address the cold-dampness. For Shang Han presenting with body yellowing and fever, Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction) is used.
Sun Simiao stated: For jaundice with a floating pulse, sweating should be induced to resolve the exterior, using Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus).
Shang Han (Cold Damage) causing mania is originally a disease of Yangming excess-heat. However, there is also a condition resembling mania (Ru Kuang), which looks like mania but is not true mania. The difference between deficiency and excess here is opposite, requiring careful differentiation, and must not be ignored. True mania caused by excess-heat belongs to Yangming, as Yangming is a meridian abundant in Qi and Blood. When pathogenic Yang heat transmits to the Stomach Fu organ, heat binds and does not resolve, leading to mania. The *Neijing · Yangming Meridian Resolution Chapter* states: The Stomach belongs to Earth, so hearing Wood sounds causes fright because Earth fears Wood. Fearing fire is due to excessive heat. Hating people is because when Yangming Qi rebels, there is panting and depression, leading to aversion to others. When the disease is severe, patients may discard clothes and run, climb high and sing, go several days without eating, or jump over walls and roofs. This is because the four limbs are the root of all Yang meridians; when Yang is excessive, the limbs become solid and strong, enabling climbing. Discarding clothes and running is due to heat prevailing in the body. Speaking nonsense, cursing, ignoring kinship, and singing are due to Yang excess becoming pathogenic. It also states: When Yin cannot overcome Yang, the pulses flow rapidly and violently, resulting in mania. It also states: When pathogenic factors enter the Yang aspect, mania occurs. These all indicate that Yangming heat pathogens ascend to overwhelm the Heart and Lungs, causing such mental confusion, which is Yang Mania. However, when Shang Han progresses to mania, it means the pathogenic heat is extremely intense. Unless fierce expulsion of fire pathogens is employed, it cannot cease. Therefore, if one observes hard and bound stools, or abdominal fullness and hardness, indicating signs suitable for purging, Da Cheng Qi Tang (Major Order the Qi Decoction), Xiao Cheng Qi Tang (Minor Order the Qi Decoction), Liang Ge San (Cool the Diaphragm Powder), or Liu Yi Shun Qi Tang (Six-One Smooth Qi Decoction) can be used to purge. If there are no signs of fullness, hardness, or excess, but the cause is solely Stomach Fire, then Bai Hu Tang (White Tiger Decoction) or Chou Xin Yin (Fire-Draining Drink) can be used to drain the fire pathogens, and the disease will heal itself.
First, the condition resembling mania is not originally caused by excess-heat mania, and its severity varies. As Zhang Zhongjing stated: If Taiyang disease does not resolve, and heat binds in the Bladder, the person resembles mania. If the exterior symptoms have not resolved, purging should not yet be applied; the exterior should be resolved first. Once the exterior is resolved, if only urgency and binding in the lower abdomen remain, purging can be applied, using Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction). He also stated: In Taiyang disease, after six or seven days, if the exterior syndrome persists, the pulse is faint and deep, and contrary to expectation, there is no Chest Binding, but the person resembles mania, it is because heat is in the Lower Jiao, and the lower abdomen should be hard and full. If urination is normal, purging the blood will cure it, using Di Dang Tang (Di Dang Decoction). According to these two passages, because Taiyang heat pathogens do not resolve and follow the meridians into the Fu organs, but have not reached true mania, it is called "resembling mania." This is because heat combats blood, accumulating in the Lower Jiao, hence purging is appropriate.
Second, recently I have observed cases of Shang Han with a different type of resembling mania, which ancient texts did not mention. This may arise from illness due to frustration, affecting the Heart; or from grief and sorrow, affecting the Lungs; or from loss of essence, affecting the Kidneys; or from fatigue and overthinking, affecting the Liver and Spleen. In these cases, the root disease has already injured the interior, and cold pathogens are externally contracted, so the illness arises following the pathogens. The symptoms resemble mania, known as Deficiency Mania. Symptoms of deficiency mania definitely lack external signs of red face and eyes or violent temperament, and internally lack chest/abdominal binding or slippery/solid pulses. Although there may be occasional restlessness, it stops when restrained; speech may be absurd, but the voice and breath are weak; the patient may see empty spaces or be constantly frightened. Examination shows no scorched thirst above, and no hard stools below. These are all signs of damaged Jing-Qi and unsettled Shen-Hun. This is contrary to Yang Excess Mania, like ice and charcoal. Contemporary physicians often fail to distinguish this; seeing confusion, they assume Yang Mania and blindly apply purging, which inevitably leads to death. Treatment for such cases requires distinguishing Yin and Yang. For deficiency with accompanying pathogens, if the pathogen is in the Yang aspect, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is suitable; if in the Yin aspect, Bu Yin Yi Qi Jian (Nourish Yin and Augment Qi Decoction) is suitable. For deficiency without pathogens, if in the Yang aspect, Si Jun Zi Tang (Four Gentlemen Decoction), Ba Zhen Tang (Eight Treasures Decoction), Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction), or Da Bu Yuan Jian (Great Tonify Origin Decoction) are suitable; if in the Yin aspect, Si Wu Tang (Four Substances Decoction), Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), Zuo Gui Yin (Left Restoring Drink), or Yi Yin Jian (One Yin Decoction) are suitable. For Yin deficiency with fire, Jia Jian Yi Yin Jian (Modified One Yin Decoction) or Er Yin Jian (Two Yins Decoction) are suitable. For Yang deficiency with cold, Li Zhong Tang (Regulate the Middle Decoction), Hui Yang Yin (Restore Yang Drink), Ba Wei Tang (Eight Flavor Decoction), or You Gui Yin (Right Restoring Drink) are suitable. The general principles of treatment are as described above; variations in complex syndromes may exceed verbal description, but understanding the intent behind the words reveals what is unsaid.
Third, if there is slight body heat, or a red face with floating Yang (Dai Yang), or irritability and restlessness, desiring to sit or lie in mud or water, but the pulse is faint and weak, this is a Yin syndrome resembling Yang, named Yin Zao (Yrestlessness). Because Yang is deficient in the lower part, Qi fails to return to its origin and floats upward, causing restlessness resembling mania. Immediate warming and tonification of the lower part is required; once the Mingmen (Gate of Life) is warmed, Fire returns to its source, and the disease heals. If physicians do not recognize this and mistakenly use cold-cooling herbs, death is certain.
Fourth, mania accompanied by dysentery and delirious speech is incurable. Manic speech with reversed gaze and fixed staring indicates Kidney Exhaustion, leading to death. Sweating followed by recurrent fever, manic speech, and refusal to eat indicates death.