王 两目身体皆黄，小便自利色清。此属脾虚，非湿热也，名曰虚黄。
黄 （一两） 白芍（三两） 伏苓（二两） 地肤子（二两）
酒浸服。
周 伏暑湿热为黄胆，腹微痛，小便利，身无汗。用麻黄连翘赤小豆汤表而汗之。
麻黄 连翘 杏仁 淡豆豉 茵 草 赤苓 川朴 枳壳 通草 六神曲（炒）
赤小豆一两，煎汤代水。
朱 湿热内走太阴，遍体发黄，肌肤粟起，小便黄赤。与茵 栀子柏皮汤。
茵 连翘 赤苓 大黄 泽泻 黑山栀 黄柏 淡芩 通草
曾 脉形乍大乍小，面色暗晦不泽，似有一团阴气阻遏于
中。苔黄而湿，腹满足肿，小便黄赤，又有湿遏热伏之形。色症
合参，是属女劳黑疸。变为腹满，在法难医。姑拟泄肾热以去脾湿，仿《金匮》法。
冬瓜皮 桑白皮 地骨皮 生姜皮 黄柏 川朴 茵
陈大麦柴煎汤代水。
施 三疟止而复作，腹满平而又发。今目黄脉细，面黑溺
少，防延黑疸。然疸而腹满者难治，姑与分消。
制附子 大腹皮 陈皮 麦芽 绵茵 赤苓 滑石 焦山栀 通草 栝蒌皮
渊按∶疸而腹满，前人未言其故。余谓肝脾脏气两伤，木土相克也，故难治。
又 面色黎黑，腹满足肿，脉沉而细。此脾肾之阳不化，水湿阻止于中，证势甚重。且与通阳燥湿。
四苓散加肉桂、川朴、陈皮、大腹皮、焦六曲、细辛、香橼皮、麦芽。
黄 面黄无力，能食气急，脱力伤脾之证也。用张鸡峰伐木丸。
皂矾（一两，泥土包固，置糠火中，煨一日夜，取出，候冷，矾色已红，去泥土净）
川朴（五钱） 茅术（一两，米泔浸，切，炒） 制半夏（一两） 陈皮（二两，盐水炒） 茯苓（一两） 炙甘草（五
钱）
共研细末，用大枣肉煮烂为丸。每服二钱，开水送。饮酒者酒下。此方颇效。
仁渊曰∶黄胆亦湿热郁遏之病，与伏暑、疟疾同一来路。古
人谓如 酱，湿热壅遏不泄所致。但有阴黄、阳黄、女劳、谷、
酒之分。同是湿热，阳黄则黄色鲜明，脉大口渴，其证多实，治
如茵 五苓、平胃、栀子柏皮等，甚则茵 大黄之类，开化中
宫，分泄湿热，从小便而出，其黄自退。阴黄则脾肾阳气素虚，
不能升化其邪，黄色暗晦，脉细皮寒，口不渴，分化湿热，宜佐
通阳理脾，如茵 五苓佐理中、真武之类。谷疸则食伤脾胃，酒
疸则酒伤肺脾，皆湿热阻而不化，各有所主。女劳黑疸，最为难
治，乃内伏湿邪，更伤女劳而得，肾精大伤，根本已坏，湿热之
邪深伏厥、少，正气不能胜任故也。又有虚黄一证，并非黄胆，
乃中虚木胜，土色发见于外，其黄色淡白，小便不变，脉弱口
淡，能食而无力，俗名懒黄，乃劳倦内伤之症，宜崇土疏木，调
补中气，如补中益气之类。诸黄证虽以分泄湿热为主，尤须察其阴阳虚实，有无兼证而调之，始为尽善。
王姓患者：双眼及全身皮肤发黄，小便通畅且颜色清亮。这属于脾虚所致，并非湿热引起，病名为“虚黄”。
处方：茵陈（一两） 白芍（三两） 茯苓（二两） 地肤子（二两）
用酒浸泡后服用。
周姓患者：因伏暑湿热导致黄疸，腹部轻微疼痛，小便通利，身体无汗。使用麻黄连翘赤小豆汤通过发汗解表来治疗。
处方：麻黄 连翘 杏仁 淡豆豉 茵陈 甘草 赤茯苓 厚朴 枳壳 通草 六神曲（炒制）
另取赤小豆一两，煎煮汤液代替水来煎药。
朱姓患者：湿热内侵太阴经，全身发黄，肌肤出现粟粒状突起，小便黄赤。给予茵陈栀子柏皮汤。
处方：茵陈 连翘 赤茯苓 大黄 泽泻 黑山栀 黄柏 黄芩 通草
曾姓患者：脉象忽大忽小，面色晦暗无光泽，似乎有一团阴气阻滞在中焦。舌苔黄而湿润，腹部胀满且浮肿，小便黄赤，呈现出湿邪遏制、热邪潜伏的征象。结合色诊与脉诊，诊断为女劳黑疸。若发展为腹满，按医法难以医治。暂拟泄肾中热邪以去除脾中湿气，仿照《金匮要略》的方法。
处方：冬瓜皮 桑白皮 地骨皮 生姜皮 黄柏 厚朴 茵陈 大麦柴（注：此处原文可能为笔误或特定草药，依原文保留）煎汤代水。
施姓患者：三日疟症状停止后又复发，腹部胀满消退后又再次发作。如今眼睛发黄，脉象细弱，面色发黑，尿量减少，担心演变为黑疸。然而黄疸伴有腹满者难治，暂予分消湿热之法。
处方：制附子 大腹皮 陈皮 麦芽 绵茵陈 赤茯苓 滑石 焦山栀 通草 瓜蒌皮
渊按：黄疸伴有腹满，前人未曾阐明其原因。我认为这是肝脾脏气两伤，木克土所致，所以难治。
又案：面色黧黑，腹部胀满且浮肿，脉象沉细。这是脾肾阳气不能运化，水湿阻滞于中，病情严重。先予以通阳燥湿之法。
处方：四苓散加肉桂、厚朴、陈皮、大腹皮、焦六曲、细辛、香橼皮、麦芽。
黄姓患者：面色萎黄无力，能进食但气短急促，这是脱力损伤脾气的证候。使用张鸡峰的伐木丸。
处方：皂矾（一两，用泥土包裹固定，置于糠火中煨烧一日一夜，取出待冷，矾色变红，去掉泥土洗净）
厚朴（五钱） 苍术（一两，米泔水浸泡，切片，炒制） 制半夏（一两） 陈皮（二两，盐水炒） 茯苓（一两） 炙甘草（五钱）
共研为细末，用大枣肉煮烂制成丸药。每次服用二钱，开水送服。饮酒者可酒后送服。此方颇为有效。
仁渊曰：黄疸也是湿热郁遏的疾病，与伏暑、疟疾同源。古人形容其色泽如酱，是湿热壅盛不得宣泄所致。但有阴黄、阳黄、女劳疸、谷疸、酒疸之分。同为湿热，阳黄则黄色鲜明，脉大口渴，证候多属实证，治疗可用茵陈五苓散、平胃散、栀子柏皮汤等，严重时用茵陈大黄之类，开通中焦，分泄湿热，从小便排出，黄色自然消退。阴黄则脾肾阳气素来虚弱，不能升发化解邪气，黄色晦暗，脉细怕冷，口不渴，分化湿热时，宜佐以通阳理脾之品，如茵陈五苓散佐以理中汤、真武汤等。谷疸则是饮食损伤脾胃，酒疸则是饮酒损伤肺脾，都是湿热阻滞不能化除，各有主治方药。女劳黑疸最为难治，乃体内潜伏湿邪，加之房劳过度损伤所致，肾精大伤，根本已坏，湿热邪气深伏于厥阴、少阴经，正气不能胜任的缘故。又有虚黄一证，并非真正的黄疸，乃是中气虚弱、肝木乘脾，脾土之色外现，黄色淡白，小便颜色不变，脉弱口淡，能食但无力，俗名“懒黄”，属于劳倦内伤的病症，宜崇土疏木，调补中气，如补中益气汤之类。各种黄证虽然以分泄湿热为主，尤其必须辨别阴阳虚实，有无兼夹证候而进行调理，才算尽善尽美。
Patient Wang: Both eyes and the whole body are yellow, urination is free and the urine is clear. This belongs to Spleen deficiency (Spleen Qi deficiency), not damp-heat, named "Deficiency Jaundice" (Xu Huang).
Prescription: Yinchen Hao (Artemisiae Scopariae Herba) (1 liang), Baishao (Paeoniae Radix Alba) (3 liang), Fuling (Poria) (2 liang), Difuzi (Kochiae Fructus) (2 liang).
Take after soaking in wine.
Patient Zhou: Jaundice caused by latent summerheat-dampness, slight abdominal pain, free urination, no sweating on the body. Use Mahlianqiao Chixiaodou Tang (Mahuang, Forsythia, and Red Bean Decoction) to release the exterior through sweating.
Prescription: Mahuang (Ephedrae Herba), Lianqiao (Forsythiae Fructus), Xingren (Armeniacae Semen Amarum), Danshichu (Fermented Soybean), Yinchenshao (Artemisiae Scopariae Herba), Gancao (Glycyrrhizae Radix et Rhizoma), Chiling (Poria cum Rhus), Chuanpu (Magnoliae Officinalis Cortex), Zhike (Aurantii Fructus Immaturus), Tongcao (Tetrapanacis Medulla), Liushenqu (Massa Medicata Fermentata, stir-fried).
Use 1 liang of Chixiaodou (Phaseoli Semen Rubrum), decocted as water substitute for boiling other herbs.
Patient Zhu: Damp-heat moves inward to the Taiyin channel, whole body turns yellow, skin presents with millet-like papules, urine is yellow and red. Administer Yinzhi Zige Bopi Tang (Yinchen, Gardenia, and Phellodendron Bark Decoction).
Prescription: Yinchenshao (Artemisiae Scopariae Herba), Lianqiao (Forsythiae Fructus), Chiling (Poria cum Rhus), Dahuang (Rhei Radix et Rhizoma), Zexie (Alismatis Rhizoma), Heishanzhi (Gardeniae Fructus), Huangbai (Phellodendri Cortex), Huangqin (Scutellariae Radix), Tongcao (Tetrapanacis Medulla).
Patient Zeng: Pulse fluctuates between large and small, complexion is dark and dull, resembling a mass of Yin qi obstructing the middle jiao. Coating is yellow and moist, abdomen is full and swollen, urine is yellow and red, presenting signs of dampness suppressing heat. Combining inspection of color and pulse diagnosis, it is classified as Nulao Hei Dan (Black Jaundice due to sexual exhaustion). If it develops into abdominal fullness, it is difficult to treat according to standard methods. Tentatively prescribe to drain Kidney heat to remove Spleen dampness, imitating the method from *Jingui Yaolue*.
Prescription: Dongguapi (Benincasae Exocarpium), Sangbaipi (Mori Cortex), Digupi (Lycii Cortex), Shengjiangpi (Zingiberis Recens Cortex), Huangbai (Phellodendri Cortex), Chuanpu (Magnoliae Officinalis Cortex), Yinchenshao (Artemisiae Scopariae Herba), Damai Mai (Hordei Fructus Germinatus) decocted as water substitute.
Patient Shi: San Nu (Triennial Malaria) stops and recurs, abdominal fullness subsides and reappears. Now eyes are yellow, pulse is fine, face is black, urine volume is low, fear of progressing to Black Jaundice. However, jaundice with abdominal fullness is difficult to treat; tentatively use methods to separate and eliminate [pathogens].
Prescription: Zhi Fuzi (Aconiti Lateralis Radix Praeparata), Dafupi (Arecae Pericarpium), Chenpi (Citri Reticulatae Pericarpium), Maiya (Hordei Fructus Germinatus), Mian Yinchenshao (Artemisiae Scopariae Herba), Chiling (Poria cum Rhus), Huashi (Talcum), Jiaoshanzhi (Gardeniae Fructus, scorched), Tongcao (Tetrapanacis Medulla), Gualoupi (Trichosanthis Pericarpium).
Yu's Note: Jaundice with abdominal fullness, previous authors did not explain the cause. I believe it is due to injury of Liver and Spleen organ qi, where Wood overacts on Earth, hence difficult to treat.
Another Case: Complexion is dark black, abdomen is full and swollen, pulse is deep and fine. This is due to Spleen and Kidney Yang failing to transform, water-dampness obstructing the middle, the condition is severe. First apply methods to unblock Yang and dry dampness.
Prescription: Siling San (Four Poria Powder) plus Rougui (Cinnamomi Cortex), Chuanpu (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), Dafupi (Arecae Pericarpium), Jia Liuqu (Massa Medicata Fermentata, scorched), Xixin (Asari Radix et Rhizoma), Xiangyuanpi (Citri Reticulatae Pericarpium Citranthae), Maiya (Hordei Fructus Germinatus).
Patient Huang: Face is sallow and weak, able to eat but short of breath, this is a syndrome of exhaustion injuring the Spleen. Use Zhang Jifeng's Famou Wan (Wood-Chopping Pill).
Prescription: Zaofan (Vitriolum Ferricum) (1 liang, wrapped in soil, roasted in chaff fire for one day and night, taken out when cool, when the color turns red, remove soil and clean), Chuanpu (Magnoliae Officinalis Cortex) (5 qian), Maoyu (Atractylodis Rhizoma) (1 liang, soaked in rice wash water, sliced, stir-fried), Zhi Banxia (Pinelliae Rhizoma Praeparatum) (1 liang), Chenpi (Citri Reticulatae Pericarpium) (2 liang, stir-fried with salt water), Fuling (Poria) (1 liang), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparata) (5 qian).
Grind into fine powder, make pills using boiled and mashed Jujube flesh. Take 2 qian each time, washed down with warm water. Those who drink alcohol may take it after drinking. This prescription is quite effective.
Ren Yuan said: Jaundice is also a disease of damp-heat stagnation, sharing the same origin as latent summerheat and malaria. Ancients described its color like soy sauce paste, caused by damp-heat congestion and failure to vent. However, there are distinctions among Yin Jaundice, Yang Jaundice, Nulao Jaundice, Gu Dan (Grain Jaundice), and Jiu Dan (Wine Jaundice). Although all involve damp-heat, Yang Jaundice presents with bright yellow color, large pulse, and thirst, the syndrome is mostly excess; treatment uses formulas like Yinchen Wuling San, Pingwei San, or Zige Bipi Tang, and in severe cases, Yinchen Dahuang, to open the Middle Jiao, separate and drain damp-heat, which exits via urination, and the yellow color recedes. Yin Jaundice involves inherent deficiency of Spleen and Kidney Yang, unable to ascend and transform pathogens, presenting with dark yellow color, fine pulse, cold skin, and no thirst; when separating damp-heat, it is appropriate to assist with warming Yang and regulating Spleen, such as Yinchen Wuling San combined with Lizhong Tang or Zhenwu Tang. Gu Dan results from food damaging Spleen and Stomach, Jiu Dan results from alcohol damaging Lung and Spleen, both involve damp-heat obstruction without transformation, each having specific treatments. Nulao Hei Dan is the most difficult to treat, caused by latent internal dampness further injured by sexual exhaustion, great damage to Kidney essence, destruction of the root, with damp-heat pathogens deeply lodged in Jueyin and Shaoyin channels, and righteous Qi unable to cope. There is also Deficiency Jaundice, which is not true jaundice, but rather Middle deficiency with Liver Wood overacting, causing Spleen Earth color to manifest externally; the yellow color is pale white, urine color does not change, pulse is weak, mouth tastes bland, able to eat but lacks strength, commonly known as "Lazy Jaundice," belonging to fatigue-induced internal injury syndromes; treatment should strengthen Earth and soothe Wood, regulate and tonify Middle Qi, such as Buzhong Yiqi Tang. Although various jaundice syndromes focus mainly on separating and draining damp-heat, one must especially observe Yin-Yang and deficiency-excess, and any concurrent syndromes to adjust treatment, only then can it be perfect.