脉 脉多沉数。渴欲饮水。小便不利。皆发黄也。脉浮紧。乃因暴热入冷水。热伏胸中。
身面目悉如金色。名曰黄胆。脉紧数。乃饥发热。大食伤胃。食则腹满。名曰 疸。阳明病
脉迟者。食难用饱。饱则发烦。头眩者。小便难。欲作谷疸。脉沉弦。或紧细。因酒百脉热
。当风入水。懊 。心烦。足热。名曰酒疸。脉浮者。先吐之。脉沉弦者。先下之。寸脉微
而弱。微则恶寒。弱则发热。当发不发。骨节疼痛。当烦不烦。而极汗出。趺阳脉缓而迟。
胃气反强。饱则烦满。满则发热。客热消谷。食已则饥。谷强肌瘦。名曰谷疸。尺脉紧为伤
肾。跌阳脉紧为伤脾。风寒相抟。食已则眩。谷气不消。胃中浊气下流小便不通。阴被其寒
。热流膀胱。身体尽黄。名曰谷疸脉浮紧。乃大热交接入水肾。气虚流湿于脾。额黑。日晡
热。小腹急。足下热。大便黑。时溏。名曰女劳疸。腹如水状不治。
症 内经曰∶中央黄色。入通于脾。夫黄胆为病。肌必虚肿而色黄。盖湿热郁积于脾胃之中。
久而不散。故其土色形于外。盖脾主肌肉。肺主皮毛。母能令子虚。母病子亦病矣。丹溪云∶
不必分五疸。同是湿热。如盒曲相似。外有伤寒热。病阳内实。当下而不得下。当汗而不得
汗。当分利而不得分利。故使湿热拂郁内甚。皆能令人发黄也。
治 病虽有五。同是湿热。治宜渗湿清热。五苓散。加茵陈黄连之类。食积者。量其虚实下
之。其余但利小便。小便利。则黄自退。在上者。尤宜发汗为佳。
方茵陈五苓散治湿热发黄
白术（二钱） 茯苓（一钱五分） 猪苓（一钱） 泽泻（一钱） 桂枝（八分） 茵陈（三钱）
上作一服。用姜三片。枣一枚。灯心一弹丸。煎服。
湿甚。加苍术（二钱）、浓朴（一钱）。
热甚。加黄连（一钱五分）、山栀（一钱）。
痰甚，加半夏（一钱五分）、枳实（一钱）、或用吐法。
食积。加山楂、神曲、三棱、莪术（各一钱五分）、针砂枳实（各一钱共为丸妙）。
酒疸。加葛根、黄连（各一钱五分）、郁金、石膏（各一钱）。
谷疸。加浓朴、枳实、栀子（各一钱）、大黄（二钱五分）。
脾胃不和。黄肿。小便赤涩。加滑石（一钱五分）、浓朴、苍术、陈皮（各一钱）。
肾疸。目黄、小便赤涩。加黄柏、苍术（各一钱五分）、桂（五分）。
黄胆。脉沉细而迟。肢体逆冷。腰以上冷汗。本方。去猪苓。泽泻。加干姜、附子（各一
钱五分）、甘草（五分）。
发黄而喘。加桑白皮、黄芩（各一钱五分）、葶苈子（炒一钱）。
瘀血发黄。加当归、
诸黄。小便自利。不渴。加黄 、桂枝、白芍药、甘草（减半余各等分），去猪苓、泽泻。
诸黄。小便不利而渴。加麦门冬、山栀、木通（各一钱五分）、滑石（一钱）。
妇人小儿诸疸同。大人加减用。
【脉象】
脉象多表现为沉而数。伴有口渴想喝水、小便不通畅的症状，这都会导致身体发黄。如果脉象浮紧，是因为突然受热后进入冷水，热气潜伏在胸中。全身、面部和眼睛都呈现如金色般的黄色，这种病称为黄疸。如果脉象紧而数，是因为饥饿时发热，或因饮食过量损伤了胃气，进食后腹部胀满，这种病称为谷疸（因谷物饮食引起的黄疸）。如果是阳明病，脉象迟缓，说明食物难以消化至饱腹，吃饱后会感到心烦、头晕目眩，且小便困难，这是将要发生谷疸的征兆。如果脉象沉弦，或者紧细，是因为饮酒导致全身血脉热盛，又受风邪侵袭并接触冷水，心中懊恼烦乱，心情烦躁，脚心发热，这种病称为酒疸。对于脉象浮的酒疸患者，应当先用催吐法治疗；对于脉象沉弦的患者，应当先用泻下法治疗。
如果寸脉微而弱，脉微则怕冷，脉弱则发热。本该发汗解表却没有发汗，导致骨节疼痛；本该出现烦躁症状却没有烦躁，反而极度出汗。趺阳脉（足背动脉）缓而迟，说明胃气反而强盛，吃饱后感到烦闷胀满，胀满则发热，客居的热邪消耗谷物精气，吃完饭后容易饥饿，虽然谷物精气强盛但肌肉消瘦，这种病称为谷疸。尺脉（手腕内侧近腕横纹处）紧，表示伤肾；趺阳脉紧，表示伤脾。风寒邪气相互搏结，进食后感到头晕，谷气不能消化，胃中的浊气向下流注导致小便不通。阴分受到寒邪侵袭，热邪流入膀胱，全身皮肤尽皆发黄，这种病称为谷疸。如果脉象浮紧，是因为大热之后立即接触冷水，肾气虚弱，湿气流注于脾脏，额头发黑，下午申时（15:00-17:00）发热，小腹部拘急不适，脚底发热，大便颜色黑，时而稀溏，这种病称为女劳疸（因房劳过度引起的黄疸）。如果腹部像有水状鼓胀，属于难治之症。
【症状】
《内经》说：“中央方位对应黄色，通应于脾脏。”黄疸这种疾病，肌肉必然虚肿且肤色发黄。这是因为湿热郁积在脾胃之中，长久不散，所以脾土的颜色显现于体表。因为脾主肌肉，肺主皮毛，母脏（脾）能使子脏（肺）虚弱，母脏生病，子脏也会受累。朱丹溪说：“不必区分五种黄疸，它们都是湿热所致，就像制曲发酵一样相似。”如果有外感伤寒的热邪，病势在阳分且内部实热，应当用泻下法却未能泻下，应当用发汗法却未能发汗，应当用分利小便法却未能分利，因此使湿热郁结在内更加严重，这些情况都能导致人发黄。
【治法】
疾病虽然有五种分类，但本质上都是湿热。治疗应当采用渗湿清热的方法。可以使用五苓散，加入茵陈、黄连之类的药物。如果有食积，根据其虚实情况使用泻下法。其余情况只要利小便即可，小便通畅，黄疸自然消退。病邪在上焦的，尤其适宜用发汗法为佳。
【方剂】
茵陈五苓散：治疗湿热引起的发黄。
组成：白术（二钱）、茯苓（一钱五分）、猪苓（一钱）、泽泻（一钱）、桂枝（八分）、茵陈（三钱）。
用法：以上药材作为一服剂量，用生姜三片、大枣一枚、灯心草一小团（弹丸大小），煎煮后服用。
加减法：
湿气重的，加苍术（二钱）、厚朴（一钱）。
热邪重的，加黄连（一钱五分）、山栀（一钱）。
痰湿重的，加半夏（一钱五分）、枳实（一钱），或者使用催吐法。
有食积的，加山楂、神曲、三棱、莪术（各一钱五分），以及针砂、枳实（各一钱，共同制成丸药，效果更佳）。
酒疸，加葛根、黄连（各一钱五分）、郁金、石膏（各一钱）。
谷疸，加厚朴、枳实、栀子（各一钱）、大黄（二钱五分）。
脾胃不和，出现黄肿，小便赤涩，加滑石（一钱五分）、厚朴、苍术、陈皮（各一钱）。
肾疸，出现目黄、小便赤涩，加黄柏、苍术（各一钱五分）、桂枝（五分）。
黄疸，脉象沉细而迟，四肢逆冷，腰部以上出冷汗，使用本方，去掉猪苓、泽泻，加干姜、附子（各一钱五分）、甘草（五分）。
发黄且伴有气喘，加桑白皮、黄芩（各一钱五分）、葶苈子（炒制一钱）。
瘀血导致的发黄，加当归。
各种黄疸，如果小便自利（通畅），口不渴，加黄芪、桂枝、白芍药、甘草（减半，其余各药等分），去掉猪苓、泽泻。
各种黄疸，如果小便不利且口渴，加麦门冬、山栀、木通（各一钱五分）、滑石（一钱）。
妇女和小儿的各类黄疸治疗方法相同，成人可根据具体情况加减使用。
[Pulse]
The pulse is mostly deep and rapid. Accompanied by thirst with desire to drink water and difficult urination, these conditions all lead to jaundice. If the pulse is floating and tight, it is due to sudden heat exposure followed by immersion in cold water, causing heat to stagnate in the chest. The whole body, face, and eyes appear golden yellow; this condition is named Jaundice (Huang Dan). If the pulse is tight and rapid, it is due to fever while hungry or stomach injury from overeating, leading to abdominal fullness after eating; this is named Grain Jaundice (Gu Dan). In Yangming disease, if the pulse is slow, it indicates difficulty in tolerating a full meal; feeling vexed and dizzy after eating, along with difficult urination, suggests impending Grain Jaundice. If the pulse is deep and wiry, or tight and fine, it is due to heat in the blood vessels from alcohol consumption, combined with wind invasion and contact with cold water, resulting in inner restlessness, mental irritability, and hot soles of the feet; this is named Wine Jaundice (Jiu Dan). For Wine Jaundice with a floating pulse, emesis should be induced first; for those with a deep and wiry pulse, purgation should be used first.
If the cun pulse (distal radial pulse) is faint and weak, a faint pulse indicates aversion to cold, while a weak pulse indicates fever. Failure to induce sweating when indicated leads to joint pain; failure to experience vexation when expected results in profuse sweating. The Yuyang pulse (dorsalis pedis artery) is slow and delayed, indicating excessive stomach qi. Fullness and vexation occur after eating; fullness generates heat. Exogenous heat consumes grain essence, causing hunger shortly after eating. Despite strong grain essence, muscles become emaciated; this is named Grain Jaundice. A tight chi pulse (proximal radial pulse) indicates kidney injury; a tight Yuyang pulse indicates spleen injury. Wind-cold pathogens combine, causing dizziness after eating. Grain qi fails to digest, turbid qi in the stomach flows downward obstructing urination. Yin is affected by cold, while heat flows into the bladder, causing the entire body to turn yellow; this is named Grain Jaundice. If the pulse is floating and tight, it is due to extreme heat immediately followed by water contact. Kidney qi is deficient, allowing dampness to flow to the spleen. The forehead turns black, there is afternoon fever (during Shen hour), lower abdominal urgency, hot soles, black stool that is occasionally loose; this is named Female Labor Jaundice (Nv Lao Dan). Abdominal distension resembling fluid accumulation is difficult to treat.
[Symptoms]
The *Neijing* states: "The central direction corresponds to yellow and connects to the Spleen." In Jaundice, the muscles are necessarily swollen and flaccid with yellowish discoloration. This is because damp-heat accumulates and stagnates within the Spleen and Stomach, persisting for a long time, thus manifesting the earth element's color externally. Since the Spleen governs muscles and the Lung governs skin and hair, the mother organ (Spleen) can cause deficiency in the child organ (Lung); when the mother is diseased, the child is also affected. Zhu Danxi stated: "There is no need to distinguish among the five types of jaundice; they are all caused by damp-heat, similar to fermentation in a starter culture." If there is exogenous Shaoyang/Taiyang heat, with excess pathology in the yang aspect internally, purgation is indicated but not performed, sweating is indicated but not performed, and diuresis is indicated but not performed. Consequently, damp-heat becomes severely constrained internally, all of which can cause yellowing of the body.
[Therapeutic Methods]
Although the disease has five classifications, they are essentially all damp-heat. Treatment should focus on promoting diuresis to drain dampness and clearing heat. Wuling San (Five-Ling Decoction) can be used, adding herbs such as Yinchen (Artemisiae Scopariae Herba) and Huanglian (Coptidis Rhizoma). For food stagnation, purge according to the patient's deficiency or excess. For other cases, simply promote urination; once urination is smooth, jaundice will naturally recede. For pathogenic factors located in the upper jiao, inducing sweating is particularly appropriate.
[Formulas]
Yinchen Wuling San (Artemisia Five-Ling Decoction): Treats jaundice caused by damp-heat.
Ingredients: Baizhu (Atractylodis Macrocephalae Rhizoma, 2 qian), Fuling (Poria, 1.5 qian), Zhuling (Polyporus, 1 qian), Zexie (Alismatis Rhizoma, 1 qian), Guizhi (Cinnamomi Ramulus, 0.8 qian), Yinchen (Artemisiae Scopariae Herba, 3 qian).
Preparation: Combine as one dose. Add three slices of Shengjiang (Zingiberis Rhizoma Recens), one Zao (Jujubae Fructus), and a small ball-sized amount of Dengxincao (Junci Medulla). Decoct and take orally.
Modifications:
For severe dampness: Add Cangzhu (Atractylodis Rhizoma, 2 qian), Houpo (Magnoliae Officinalis Cortex, 1 qian).
For severe heat: Add Huanglian (Coptidis Rhizoma, 1.5 qian), Shanzhi (Gardeniae Fructus, 1 qian).
For severe phlegm: Add Banxia (Pinelliae Rhizoma, 1.5 qian), Zhishi (Aurantii Fructus Immaturus, 1 qian), or use emetic therapy.
For food stagnation: Add Shanzha (Crataegi Fructus), Shenqu (Massa Medicata Fermentata), Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma) (each 1.5 qian), plus Zhen Sha (Ferrum Oxydatum Rubrum) and Zhishi (each 1 qian, processed into pills for better effect).
For Wine Jaundice: Add Gegen (Puerariae Lobatae Radix), Huanglian (each 1.5 qian), Yujin (Curcumae Longae Rhizoma), Shigao (Gypsum Fibrosum, each 1 qian).
For Grain Jaundice: Add Houpo (Magnoliae Officinalis Cortex), Zhishi (Aurantii Fructus Immaturus), Zhizi (Gardeniae Fructus) (each 1 qian), Dahuang (Rhei Radix et Rhizoma, 2.5 qian).
For Spleen-Stomach disharmony with yellow edema and red, scanty urine: Add Huashi (Talcum, 1.5 qian), Houpo (Magnoliae Officinalis Cortex), Cangzhu (Atractylodis Rhizoma), Chenpi (Citri Reticulatae Pericarpium) (each 1 qian).
For Kidney Jaundice with yellow eyes and red, scanty urine: Add Huangbai (Phellodendri Cortex), Cangzhu (Atractylodis Rhizoma) (each 1.5 qian), Guizhi (Cinnamomi Ramulus, 0.5 qian).
For Jaundice with deep, fine, and slow pulse, cold extremities, and cold sweat above the waist: Use this base formula, remove Zhuling (Polyporus) and Zexie (Alismatis Rhizoma), add Ganjiang (Zingiberis Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata) (each 1.5 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 0.5 qian).
For jaundice with wheezing: Add Sangbaipi (Mori Cortex), Huangqin (Scutellariae Radix) (each 1.5 qian), Tinglizi (Descurainiae Semen Lepidii et Lepidii Semen, fried, 1 qian).
For jaundice due to blood stasis: Add Danggui (Angelicae Sinensis Radix).
For various jaundices where urination is free and there is no thirst: Add Huangqi (Astragali Radix), Guizhi (Cinnamomi Ramulus), Baishaoyao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma) (reduce dosage of others to half, keep remaining ingredients in equal proportions), remove Zhuling (Polyporus) and Zexie (Alismatis Rhizoma).
For various jaundices with difficult urination and thirst: Add Maimendong (Ophiopogonis Radix), Shanzhi (Gardeniae Fructus), Mutong (Akebiae Caulis) (each 1.5 qian), Huashi (Talcum, 1 qian).
The treatment for women and children with various jaundices is the same; adults should modify dosages accordingly.