保命集云凡发黄有六有蓄血发黄邪热传于太阳之本小便先淋而黄其人暴狂内有血也为太
阳发
黄本病也湿热发黄太阴并阳明之本为小便不利风湿热发黄并少阳也寒湿发黄太阴并少阳也结
胸发黄下之早附太阳也痞气发黄附太阴也凡六者各随脉证标本而治之大抵发黄从太阴阳明而
论脾胃皆土也故见黄色当从其脾病色黄土气化湿非湿毒何能发黄也
韩 和云病患三五日服下药太过虚其脾胃亡其津液渴饮水浆脾土为阴湿加之与邪热相会
发黄
此阴黄也当以温药治之如两手脉沉细迟肢体逆冷皮肤有粟起或呕吐舌上有胎遍身发黄烦躁欲
于泥水中卧小便赤少皆阴候也故阴黄多以热汤温之或汤渍布搭其胸腹或以汤盛瓢中坐于脐下
熨之其病愈者曾治赵显宗病伤寒至六七日因服下药太过致发黄其脉沉细迟无力皮肤凉发躁欲
于泥中卧喘呕小便赤涩先投茵陈橘皮汤喘呕止次服小茵陈汤半剂脉微出不欲于泥中卧次日又
服茵陈附子汤半剂四肢发热小便二三升当日中大汗而愈似此治愈者不一一录凡伤寒病黄每遇
太阳或太阴司天岁若下之太过往往变成阴黄盖辰戌太阳寒水司天水来犯土丑未太阴湿土司天
土气不足即脾胃虚弱亦水来侵犯多变此证也
按以上论伤寒阴阳二证发黄殆无余蕴大抵本形气虚实受证不同用药有汗下温之禁非若杂
病
之比也我丹溪先生谓发黄如 曲相似湿热有微甚及兼热兼寒瘀血所因不同故治例不可不分
《保命集》说：凡是出现发黄症状，共有六种情况。一是蓄血发黄，邪热传入太阳经的本部，小便先出现淋涩且颜色黄，病人突然发狂，体内有瘀血，这是太阳发黄，属于本病。二是湿热发黄，涉及太阴和阳明经的本部，表现为小便不利。三是风湿热发黄，涉及少阳经。四是寒湿发黄，涉及太阴和少阳经。五是结胸发黄，因攻下过早而关联到太阳经。六是痞气发黄，关联到太阴经。以上六种情况，都要根据脉象和证候，辨别标本进行治疗。大抵发黄主要从太阴和阳明经来论述，因为脾胃都属土，所以见到黄色，应当从脾病考虑，脾的色为黄，土气化生湿气，如果不是湿毒，怎么能导致发黄呢？
韩和说：病患在发病三五天后，如果服用泻下药太过分，导致脾胃虚弱，津液耗损，口渴想喝水浆。此时脾土受到阴湿侵袭，与邪热相搏结，就会发黄，这属于阴黄，应当用温性药物治疗。例如两手脉象沉细迟，四肢逆冷，皮肤起鸡皮疙瘩，或者呕吐，舌苔厚腻，遍身发黄，烦躁想要躺在泥水中，小便短赤，这些都是阴证的候象。所以阴黄多用热汤温熨治疗，或者用热汤浸湿布搭在胸腹部，或者将热汤盛在瓢中，坐在脐下熏熨。病情痊愈的案例很多，曾治疗赵显宗患伤寒至六七天，因为服用泻下药太过分导致发黄。其脉象沉细迟无力，皮肤凉，发躁想要躺在泥水中，气喘呕吐，小便赤涩。先投予茵陈橘皮汤，气喘呕吐停止；接着服用小茵陈汤半剂，脉象微出，不再想要躺在泥水中；第二天又服用茵陈附子汤半剂，四肢发热，小便二三升，当天中午大汗出而痊愈。像这样治愈的病例不一一记录。大凡伤寒病发黄，每逢太阳或太阴司天之年，如果攻下太过，往往变成阴黄。盖因辰戌年太阳寒水司天，水来犯土；丑未年太阴湿土司天，土气不足即脾胃虚弱，也是水来侵犯，多变为此证。
按语：以上论述伤寒阴阳二证发黄，几乎穷尽了其中的奥妙。大抵由于人体形气虚实不同，受证不同，用药有发汗、攻下、温补的禁忌，不像杂病那样简单。我丹溪先生曾说，发黄就像酒曲发酵相似，湿热有轻重之分，以及兼热、兼寒、瘀血等原因不同，所以治疗法则不可不加以区分。
The *Baoming Ji* states: In cases of jaundice (yellowing of the skin and eyes), there are six types. The first is Jaundice due to Blood Stasis (蓄血发黄): pathogenic heat transmits to the root of the Taiyang channel, urination becomes scanty and yellow initially, the patient suddenly becomes manic, and blood stasis exists internally; this is Taiyang Jaundice, which is the primary disease. The second is Damp-Heat Jaundice (湿热发黄), involving the roots of the Taiyin and Yangming channels, characterized by difficult urination. The third is Wind-Damp-Heat Jaundice (风湿热发黄), involving the Shaoyang channel. The fourth is Cold-Damp Jaundice (寒湿发黄), involving the Taiyin and Shaoyang channels. The fifth is Juxiong (Chest Binding) Jaundice (结胸发黄), caused by premature purgation and associated with the Taiyang channel. The sixth is Piqi (Stagnant Qi) Jaundice (痞气发黄), associated with the Taiyin channel. For these six types, treatment should be based on the pulse and symptoms, distinguishing between the root and branch. Generally, jaundice is discussed in terms of the Taiyin and Yangming channels because the Spleen and Stomach both belong to Earth. Therefore, when yellow color appears, it should be attributed to Spleen pathology; the color of the Spleen is yellow, and Earth qi generates dampness. Without damp-toxin, how could jaundice occur?
Han He stated: If a patient takes excessive purgatives three or five days after onset, it weakens the Spleen and Stomach and depletes body fluids. Thirst leads to drinking water or liquids. The Spleen Earth is then invaded by Yin-dampness, which combines with pathogenic heat to cause jaundice; this is Yin-Jaundice (阴黄) and should be treated with warm medicines. Signs include deep, fine, and slow pulses in both hands, cold extremities, gooseflesh on the skin, vomiting, coating on the tongue, generalized yellowing of the body, irritability, and a desire to lie in mud or water. Urine is scanty and red. These are all signs of Yin patterns. Therefore, Yin-Jaundice is often treated by warming with hot decoctions, such as applying hot wet cloths to the chest and abdomen, or sitting over a ladle filled with hot water to fumigate the area below the umbilicus. Many such cases have been cured. For example, I treated Zhao Xianzong who suffered from Shanghan (Cold Damage) for six or seven days. Due to excessive purgation, he developed jaundice. His pulse was deep, fine, slow, and forceless; his skin was cool; he was irritable and desired to lie in mud; he had panting and vomiting; and his urine was red and difficult to pass. Initially, Yinchin Jupi Tang (Artemisiae Scopariae and Tangerine Peel Decoction) was administered, stopping the panting and vomiting. Then, Xiao Yinchin Tang (Minor Artemisiae Scopariae Decoction), half a dose, was given. The pulse became slightly palpable, and the desire to lie in mud ceased. The next day, Yinchin Fuzi Tang (Artemisiae Scopariae and Aconite Decoction), half a dose, was given. His limbs became warm, he passed two or three sheng of urine, and at noon that day, he sweated profusely and recovered. Such cures are numerous and not recorded one by one. Generally, in Shanghan jaundice, if excessive purgation is used during years governed by the Taiyang or Taiyin celestial stems, it often transforms into Yin-Jaundice. This is because in Chen-Xu years, Taiyang Cold-Water governs, and Water invades Earth; in Chou-Wei years, Taiyin Damp-Earth governs, Earth qi is insufficient meaning the Spleen and Stomach are weak, and Water still invades, frequently leading to this condition.
Commentary: The above discussion on Yin and Yang patterns of jaundice in Shanghan covers the subject exhaustively. Generally, due to differences in constitution, Qi deficiency or excess, and the nature of the contracted pathogen, there are contraindications for diaphoresis, purgation, and warming treatments, unlike miscellaneous diseases. My teacher, Mr. Danxi, said that jaundice resembles the fermentation of Qu (yeast). Damp-heat varies in severity, and causes differ regarding accompanying heat, accompanying cold, or blood stasis. Therefore, treatment principles must be clearly distinguished.