《千金》及《外台》引《金匮》黄胆篇文，皆以硝矾散症为女劳疸。而《近效》云女劳
疸疗
与黑疸同。《病源》则曰女劳疸之状，身目皆黄，发热恶寒，小腹满急，小便难，因大劳大
热
而交接竟即入水所致也。黑疸之状，小腹满，身体尽黄，额上反黑，足下热，大便黑是也。
夫黄胆、酒疸、女劳疸，久久变成黑疸。据疸说，则《金匮》硝矾散症，经文当断，自膀胱
急以下十六字，属黑疸，独日晡发热恶寒，为女劳疸的候，余则女劳疸久久变为黑疸之候也
。如此疏解，则于经文“得之”二字及“因作”二字语气极合。巢氏真善会仲景意者。其硝
矾
散本是治黑疸之方，以黑疸与女劳疸同治，故《金匮》不别言之，《近效》之说，信而有征
。详余所撰《金匮方论注》中。
亡血之大症四∶吐、衄、便、溺是也。亡津之大症四∶呕、利、消、汗是也。吐血出于
贲门
，与呕吐同；衄血名为红汗，与汗出同；便血出于魄门，与下利同；溺血出于胞，与消利同
。八症以四属之，殊途而同归，为亡津、亡血最大者也。《灵枢经》云∶“夺血者无汗，
夺汗者无血。”是津血同类。又手阳明主津，足阳明主血，是津血又同经。津血之为物既同
，故八症之为诊从同。八症之由热得之者，并以见阴脉及阴症为欲已。见阳脉及阳症为未解
；其由寒得之者，并以见阳脉及阳症为向愈，见阴脉及阴症为将脱。俱详《灵》、《素》、
《脉经》等书，不赘引。凡辨症有当分而观之者，如痰饮篇是也；有当合而观之者，如此篇
是也。
《千金方》和《外台秘要》引用《金匮要略》黄疸篇的内容，都将硝矾散证（以消石、明矾组成的散剂所治疗的病证）认定为女劳疸（因房劳过度导致的黄疸）。而《近效方》记载女劳疸的治疗方法与黑疸相同。《诸病源候论》则描述女劳疸的症状为：全身和眼睛都发黄，发热怕冷，小腹胀满急迫，小便困难，这是由于在大劳累和大发热之后进行房事，随即入水所致。黑疸的症状则是：小腹胀满，全身发黄，额头反而发黑，脚心发热，大便颜色发黑。
一般来说，黄疸、酒疸（因饮酒过多导致的黄疸）、女劳疸，时间久了都会转化为黑疸。根据对黄疸的理论分析，《金匮要略》中关于硝矾散证的经文应当这样断句理解：从“膀胱急”以下的十六个字，属于黑疸；只有“日晡时发热恶寒”（下午3-5点发热怕冷），才是女劳疸的确切征象；其余症状则是女劳疸日久转化为黑疸的征象。如此解释，就与经文中“得之”二字以及“因作”二字的语气非常吻合。巢元方确实善于领会张仲景的本意。硝矾散原本是治疗黑疸的方剂，因为黑疸与女劳疸可以同治，所以《金匮要略》没有单独分开论述，《近效方》的说法，确实有依据。详细情况见我撰写的《金匮方论注》中。
导致亡血的大症有四类：吐血、鼻衄（鼻出血）、便血、尿血。导致亡津液的大症也有四类：呕吐、下利（腹泻）、消渴（多饮多尿）、汗出。吐血出自贲门（胃的上口），与呕吐同类；鼻衄被称为“红汗”，与汗出同类；便血出自魄门（肛门），与下利同类；尿血出自胞（膀胱），与消渴同类。这八种症状分为两类归属，虽然途径不同但归宿一致，都是导致津液和血液严重亏损的最大病症。《灵枢经》说：“夺血者无汗，夺汗者无血。”这说明津液和血液性质同类。又因为手阳明大肠经主司津液，足阳明胃经主司血液，所以津液和血液又同属一条经脉系统。既然津液和血液本质相同，所以这八种症状在诊断上可以参照同一原则。这八种症状如果是由于热邪引起的，见到阴脉和阴症表示病情将要痊愈；见到阳脉和阳症表示病邪未解；如果是由于寒邪引起的，见到阳脉和阳症表示病情趋向好转，见到阴脉和阴症表示正气即将脱失。这些详细内容可参考《灵枢》、《素问》、《脉经》等书籍，此处不再赘引。凡是辨证时应当分开观察的，如痰饮篇那样；也有应当合并观察的，就像本篇这样。
The *Qianjin Fang* (Thousand Golden Prescriptions) and the *Waitai Miyao* (Essential Prescriptions from the Imperial Library), citing the Jaundice chapter of the *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet), both identify the syndrome treated by Xiaofan San (Magnesia and Alum Powder) as Nü Lao Dan (Female Labor Jaundice). However, the *Jin Xiao Fang* (Near-Efficacy Prescriptions) states that the treatment for Nü Lao Dan is the same as that for Hei Dan (Black Jaundice). The *Bing Yuan* (Source of Diseases) describes the manifestation of Nü Lao Dan as follows: the body and eyes are both yellow, accompanied by fever and aversion to cold, fullness and urgency in the lower abdomen, and difficult urination. This is caused by engaging in sexual intercourse immediately after entering water while suffering from severe fatigue and high heat. The manifestation of Hei Dan includes: fullness in the lower abdomen, yellowing of the entire body, blackening of the forehead specifically, heat in the soles of the feet, and black stools.
Generally speaking, Huang Dan (Jaundice), Jiu Dan (Alcohol-induced Jaundice), and Nü Lao Dan can all transform into Hei Dan over a long period. Based on the theory of jaundice, the text in the *Jingui Yaolue* regarding the Xiaofan San syndrome should be punctuated as follows: the sixteen characters starting from "Bladder Urgency" belong to Hei Dan; only "fever and aversion to cold at dusk" (Shen hour, 3-5 PM) constitutes the specific sign of Nü Lao Dan; the remaining symptoms are signs of Nü Lao Dan transforming into Hei Dan over time. Such an interpretation aligns perfectly with the tone of the phrases "obtained from" (De Zhi) and "because it arises" (Yin Zuo) in the original text. Chao Yuanfang indeed possessed a profound understanding of Zhang Zhongjing's intent. Xiaofan San was originally a formula for treating Hei Dan. Since Hei Dan and Nü Lao Dan share similar treatments, the *Jingui Yaolue* did not discuss them separately. The statement in the *Jin Xiao Fang* is credible and well-founded. For details, please refer to my commentary, *Jingui Fang Lun Zhu*.
There are four major syndromes leading to Blood Loss (Wang Xue): hematemesis (vomiting blood), epistaxis (nosebleed), hematochezia (blood in stool), and hematuria (blood in urine). There are also four major syndromes leading to Fluid Loss (Wang Jin): vomiting, diarrhea, Xiao Ke (Wasting-Thirst/Polydipsia), and sweating. Hematemesis originates from the Ben Men (cardia/upper stomach opening) and is similar to vomiting; epistaxis is named "Red Sweat" and is similar to sweating; hematochezia originates from the Po Men (anus) and is similar to diarrhea; hematuria originates from the Bao (bladder) and is similar to Wasting-Thirst. These eight symptoms are categorized into two groups, taking different paths but converging on the same outcome, representing the most significant causes of fluid and blood depletion. The *Ling Shu Jing* (Spiritual Pivot) states: "Those who lose blood should not sweat; those who lose sweat should not bleed." This indicates that fluids and blood are of the same nature. Furthermore, the Hand-Yangming Large Intestine Meridian governs fluids, while the Foot-Yangming Stomach Meridian governs blood, indicating that fluids and blood are also associated with the same meridian system. Since fluids and blood share the same essence, the diagnosis of these eight symptoms follows the same principles. For symptoms caused by Heat, the appearance of Yin pulses and Yin syndromes indicates the disease is about to resolve; the appearance of Yang pulses and Yang syndromes indicates the pathogen remains unresolved. For symptoms caused by Cold, the appearance of Yang pulses and Yang syndromes indicates recovery is approaching, while the appearance of Yin pulses and Yin syndromes indicates impending collapse of vital energy. These details are elaborated in texts such as the *Ling Shu*, *Su Wen* (Basic Questions), and *Mai Jing* (Pulse Classic), and will not be repeated here. When differentiating syndromes, some require separate observation, as seen in the Phlegm-Fluids chapter; others require combined observation, as in this chapter.