《素问·腹中论》帝曰∶夫子数言热中、消中,不可服膏粱、芳草、石药,石药发癫,芳草发狂。夫热
中、消中者,皆富贵人也,今禁膏粱,是不合其心,禁芳草、石药,是病不愈,愿闻其说。岐伯曰∶芳草之气
美,石药之气悍,二者其气急疾坚劲,故非缓心和人,不可以服此二者。帝曰∶何以然?岐伯曰∶大热气 悍,
药气亦然,二者相遇,恐内伤脾。脾者土也,而恶木,服此药者,至甲乙日更论。
热中、消中,本由膏粱浓味蕴酿而成,乃有上中下消之分,虚实之异,故当禁膏粱浓味也。芳草虽可祛秽
消腐,而香散以耗津液,石药如石膏、芒硝之类,虽可清热,而质重伤脾,脾已困于浓味,不任再伤,故治消
病,非缓心和平之人,不可以服此二药,以其病气 悍,而药气又急疾坚劲,则格斗于中而伤脾土。土恶木者,
故服此药者,必至甲乙木旺之日时,病不加重,方可更论治法也。
《灵枢·论疾诊尺篇》曰∶身痛而色微黄,齿垢黄,爪甲上黄,黄胆也,安卧,小便黄赤,脉小而涩者,不嗜食。
湿热蕴积而成黄胆,有阴阳之分。其色晦滞者为阴,属脾病;色鲜明者为阳,属胃病。此条脉小而涩,
阳气不振而脾困,故安卧不嗜食,身痛而色微黄,则不鲜明,乃是脾病之阴黄也。本经又云∶溺黄赤安卧者,
黄胆;已食如饥者,胃疸。可见黄胆是不嗜食之阴黄,已食如饥者名胃疸,即阳黄也。仲景所云身黄如橘子色,
则鲜明为阳黄,故用茵陈蒿汤,以大黄下之;若阴黄,当用苍术二妙散,或正气散等方,口渴喜冷者,兼阳明证,
宜苍术白虎汤加茵陈。仲景《金匮要略》又分谷疸、酒疸、女劳疸诸证,更当详究之。
黄帝问道:先生多次提到热中病和消中病,认为这两种病不可服用膏粱厚味、芳草类药物以及石药。因为石药容易引发癫证,芳草类药物容易引发狂证。然而,患热中病和消中病的人,大多是生活优渥的富贵之人,现在禁止他们食用膏粱厚味,这违背了他们的心意;禁止使用芳草和石药,又担心疾病无法痊愈。我希望听听其中的道理。
岐伯回答说:芳草的气味芳香美好,石药的药性猛烈悍急,这两类药物的气机都急疾且性质坚劲。因此,对于心性急躁、不能平和心境的人来说,不可以服用这两类药物。
黄帝问:为什么这样说呢?
岐伯说:大热之邪的性质是猛烈悍急的,药物的气性也是如此,两者相遇,恐怕会内伤脾脏。脾在五行中属土,而土恶木(即脾虚易受肝木克制),服用这类药物的人,到了甲乙日(五行属木的日子),病情可能会有变化,届时再另行讨论治疗方案。
热中病和消中病,原本是由长期食用膏粱厚味蕴酿而成,其中有上消、中消、下消的区别,也有虚证和实证的不同,所以应当禁止食用膏粱厚味。芳草虽然可以祛除秽浊、消除腐败,但其香气发散会耗伤津液;石药如石膏、芒硝之类,虽然可以清热,但质地沉重会损伤脾胃。脾脏已经被浓味所困顿,不再能承受进一步的伤害。因此,治疗消渴病时,如果不是心性平缓、性格平和的人,不可以服用这两类药物。因为疾病的邪气悍急,而药气又急疾坚劲,两者在中焦相互格斗,从而损伤脾土。因为土恶木,所以服用这类药物的人,必定会在甲乙日(木旺之时)病情加重,只有等到那时观察病情未加重,才可以进一步讨论治法。
《灵枢·论疾诊尺篇》说:身体疼痛且面色微黄,牙齿垢腻发黄,指甲上也发黄,这是黄胆病。如果患者嗜睡安卧,小便黄赤,脉象小而涩,食欲不振,也是黄胆的表现。
湿热蕴结积聚而形成黄胆,有阴黄和阳黄之分。面色晦暗滞浊的是阴黄,属于脾病;面色鲜明光亮的是阳黄,属于胃病。此条文中脉象小而涩,说明阳气不振而脾脏困顿,所以出现嗜睡安卧、食欲不振、身体疼痛且面色微黄但不鲜明的症状,这是脾病引起的阴黄。
本经又说:“小便黄赤且嗜睡安卧的,是黄胆;吃完饭却感觉像没吃饱一样饥饿的,是胃疸。”由此可见,黄胆表现为食欲不振的属于阴黄;吃完饭后却感到饥饿的称为胃疸,也就是阳黄。
张仲景所说的“身体发黄颜色如橘子色”,色泽鲜明,属于阳黄,所以使用茵陈蒿汤,用大黄来通下泄热;如果是阴黄,应当使用苍术二妙散,或者正气散等方剂。如果口渴喜欢冷饮,兼有阳明证,适宜使用苍术白虎汤加茵陈。
The Yellow Emperor asked: The Master has often mentioned *Rezhong* (Heat in the Middle) and *Xiaozhong* (Wasting-Thirst in the Middle), stating that these conditions should not be treated with rich, greasy foods (*Gaoliang*), fragrant herbs (*Fangcao*), or mineral drugs (*Shiyao*). Mineral drugs may induce *Dian* (epilepsy-like madness), while fragrant herbs may induce *Kuang* (manic psychosis). However, those suffering from *Rezhong* and *Xiaozhong* are mostly wealthy individuals. Prohibiting them from consuming rich foods goes against their desires, and prohibiting the use of fragrant herbs and mineral drugs raises concerns that the disease will not be cured. I wish to hear your explanation.
Qibo replied: The qi of fragrant herbs is aromatic and beautiful; the qi of mineral drugs is fierce and vigorous. Both types of drugs have qi that is rapid, forceful, and solid. Therefore, for individuals who are not calm-hearted and peaceful in disposition, it is inadvisable to consume these two types of drugs.
The Yellow Emperor asked: Why is this so?
Qibo said: Pathogenic heat is fierce and vigorous, and the nature of drug qi is similar. When these two meet, there is a fear of internal injury to the Spleen. The Spleen belongs to Earth in the Five Phases, and Earth fears Wood. For those taking such drugs, by the Jia-Yi days (days associated with Wood in the Heavenly Stems), the condition may change, and treatment strategies should be discussed anew at that time.
*Rezhong* and *Xiaozhong* originally arise from the accumulation caused by long-term consumption of rich, greasy foods. There are distinctions among Upper, Middle, and Lower Wasting-Thirst, as well as between Deficiency and Excess patterns; thus, the consumption of rich foods must be prohibited. Although fragrant herbs can dispel turbidity and eliminate putrefaction, their aromatic dispersing nature consumes Body Fluids (*Jinye*). Mineral drugs, such as Gypsum Fibrosum (*Shigao*) and Mirabilite (*Mangxiao*), although capable of clearing Heat, are heavy in texture and damage the Spleen-Stomach. The Spleen is already burdened by rich flavors and cannot withstand further injury. Therefore, when treating Wasting-Thirst diseases, if the patient is not of a calm and peaceful disposition, they should not take these two types of drugs. Because the pathogenic qi is fierce, and the drug qi is rapid and forceful, they contend within the Middle Jiao, thereby damaging Spleen Earth. Since Earth fears Wood, patients taking such drugs will likely experience worsening of symptoms on Jia-Yi days (when Wood energy is prosperous). Only if the condition does not worsen at that time can further discussion of treatment methods proceed.
The *Lingshu · Lun Ji Zhen Chi Pian* states: "Body pain accompanied by a slightly yellow complexion, yellowish dental calculus, and yellow nails indicates *Huangdan* (Jaundice). Lethargy, yellow-red urine, a small and choppy pulse, and loss of appetite are also signs of jaundice."
*Huangdan* formed by the accumulation of Damp-Heat is divided into Yin Jaundice and Yang Jaundice. A dull and turbid complexion indicates Yin Jaundice, which belongs to Spleen pathology; a bright and lustrous complexion indicates Yang Jaundice, which belongs to Stomach pathology. In this passage, the small and choppy pulse indicates failing Yang Qi and Spleen distress, leading to lethargy, loss of appetite, body pain, and a slightly yellow but not bright complexion. This is Yin Jaundice resulting from Spleen pathology.
The classic further states: "Yellow-red urine with lethargy indicates *Huangdan*; feeling hungry shortly after eating indicates *Wei Dan* (Stomach Jaundice)." Thus, *Huangdan* presenting with loss of appetite is Yin Jaundice, while *Wei Dan*, characterized by hunger after eating, is Yang Jaundice.
Zhang Zhongjing described "body yellow like the color of an orange," which is bright and clear, indicating Yang Jaundice. Therefore, *Yinchen Hao Tang* (Artemisia Capillaris Decoction) is used, employing Rhizoma Rhei Preparatum (*Dahuang*) to purge downward. If it is Yin Jaundice, one should use *Cangzhu Ermiao San* (Atractylodes Two Marvels Powder) or *Zhengqi San* (Righteous Qi Powder), etc. If there is thirst and a preference for cold drinks, indicating a concurrent Yangming pattern, *Cangzhu Baitou Tang* (Atractylodes White Tiger Decoction) with added Yinchen (Herba Artemisiae Scopariae) is appropriate.
In the *Jingui Yaolue*, Zhang Zhongjing further distinguished various syndromes such as *Gu Dan* (Grain Jaundice), *Jiu Dan* (Alcohol Jaundice), and *Nü Lao Dan* (Female Exhaustion Jaundice), which warrant detailed investigation.