可治血燥乎。又太阳证。身尽黄。脉沉结。小便自利。其人如狂者。血证谛也。抵当
汤主之。乃重剂也。此则治血燥之轻剂也。
黄胆病。茵陈五苓散主之。
茵陈五苓散方
茵陈蒿末（十分） 五苓散（五分）
上二味和。先食饮方寸匕。日三服。
〔衍义〕此亦治黄胆。不言他证。与猪肤发煎并出者。彼以燥在血。此以燥在气也。
夫病得之汗出入水。何以成燥。曰湿热相纽而不解。则肺金治节之政不行。津
液不布而成燥也。燥郁之久。湿热蒸为黄胆矣。本草茵陈治热结黄胆。小便不
利。故主之也。燥因热胜。栀子柏皮汤。因湿郁。茵陈五苓散。然非徒治湿而已。亦
润剂也。桂枝开腠理。致津液通气。白术茯苓生津。皆可润燥也。古人论黄胆。有
湿黄。有热黄。湿黄者。色如熏黄。热黄者。色如橘子色。更有阳黄。有阴黄。阳黄者。
大黄佐茵陈。阴黄者。附子佐茵陈。此用五苓散佐者。因湿热郁成燥也明矣。
黄胆腹满。小便不利而赤。自汗出。此为表和里实。当下之。宜大黄硝石汤。
大黄硝石汤方
大黄 硝石 黄柏（各四两） 栀子（十五枚）
上四味。以水六升。煮取二升。去滓。内硝。更煮。取一升。顿服。
〔衍义〕邪热内结。成腹满。自汗。大黄、硝石。荡而去之。膀胱内热。致小便不利而赤。
黄柏、栀子。凉以行之。此下黄胆重剂也。
黄胆病。小便色不变。欲自利。腹满而喘。不可除热。热除必哕。哕者。小半夏汤主之。
〔衍义〕小便不变。欲自利者。内有湿。饮积而热未盛也。脾太阴湿甚。土气不化则
满。脾湿动肺则喘。有似支饮之状者。故不可除其热。热除则胃中反寒。寒气上
逆为哕矣。半夏、生姜。能散逆去湿。消痰止哕。此汤用在除热之后。非治未除热之前者也。
诸黄。腹满而呕者。宜柴胡汤。
柴胡汤方
柴胡（半斤） 半夏（半升） 人参 甘草 黄芩（各三两） 大枣（十二枚） 生姜（三两切）
上六味。以水六升。煮取三升。分温服。日三服。
〔衍义〕邪正相击。在里则腹满气逆。在上则呕。上犹表也。故属半表半里。小柴胡
汤主之。柴胡、黄芩除里热。半夏散里逆。人参、甘草补正缓邪。生姜大枣和荣卫。
合表里。调阴阳也。又必随证加减。法在伤寒论小柴胡汤后。
男子黄。小便自利。当与虚劳小建中汤。
〔衍义〕杂病中虚。致脾胃不化。湿热蓄积而为黄。虽小便不利。亦当补泻兼施。男
子黄者。必由入内虚热而致也。反见小便自利。为中下无实热。惟虚阳浮沉为
黄耳。故与治虚劳之剂补正气。正气旺。则荣卫阴阳和而黄自愈矣。
〔补注〕伤寒论中云。小便利者。不能发黄。以热从小便去故也。今便利而黄自若。
则其黄亦必色淡气虚。非诚有大热也。故从补。不然。便即利矣。黄胡为乎来哉。
与瘀血在脾者不侔也。与热积膀胱者不侔也。此明系虚黄上泛。从中下二焦
虚得之。然仲景微示房劳之意。而仍补中焦者。正以黄终归土色也。
瓜蒂散
古方多用此治黄。或作散。或吹鼻。皆取黄水为效。此治水饮郁热在膈上者。何
也。盖瓜蒂吐剂也。内经曰。在上者。因而越之。仲景云。湿家身上疼而黄。内药鼻中。是亦邪浅之故也。
附方
千金麻黄醇酒汤方
麻黄（一把去节绵裹） 美酒（五升）
上二味。煮取半升。顿服。取小汗。春月用水煮。
可以治疗血燥吗？又有太阳病证，全身发黄，脉象沉而结滞，小便自利，其人如发狂状，这是蓄血证的明证。用抵当汤主治。这是重剂。这里所说的是治疗血燥的轻剂。
茵陈五苓散方
茵陈蒿末（十分） 五苓散（五分）
以上两味药混合均匀。饭前服用一方寸匕的药量，每日三次服用。
〔衍义〕这也是治疗黄疸，没有提及其它证候。与猪肤发煎并列出现的情况是：猪肤发煎是针对血分燥热，这里是针对气分燥热。
这种病是由于出汗后入水所致，怎么会形成燥呢？回答说：湿热纠缠不解，导致肺金治理调节的功能不能行使，津液不布散而形成燥。燥郁积久了，湿热蒸腾成为黄疸了。本草记载茵陈治疗热结黄疸、小便不利，所以用它为主药。燥是因为热盛，栀子柏皮汤是因湿郁，茵陈五苓散也是如此。然而这不仅仅是治湿，也是润剂。桂枝开泄腠理，使津液通达、气机通畅；白术、茯苓生津，都可以润燥。古人论述黄疸，有湿黄，有热黄。湿黄者，颜色像熏过的黄色；热黄者，颜色像橘子色。更有阳黄和阴黄之分。阳黄者，大黄佐助茵陈；阴黄者，附子佐助茵陈。这里使用五苓散佐助，是因为湿热郁结而成燥，这是很明显的。
黄疸病，腹部胀满，小便不利且色赤，自汗出，这是表气和里实，应当攻下。宜用大黄硝石汤。
大黄硝石汤方
大黄 硝石 黄柏（各四两） 栀子（十五枚）
以上四味药，用水六升，煮取二升，去渣滓，加入硝石，再煮，取一升，一次性服下。
〔衍义〕邪热内结，形成腹满、自汗。大黄、硝石荡涤邪热而去之。膀胱内有热，导致小便不利且色赤。黄柏、栀子性凉以行热。这是治疗黄疸的重剂。
黄疸病，小便颜色不变，想自行腹泻，腹部胀满且气喘，不可清除热邪。如果清除热邪，必然发生呃逆。呃逆者，用小半夏汤主治。
〔衍义〕小便颜色不变，想自行腹泻，说明体内有湿，饮邪积聚而热势未盛。脾太阴湿气过重，土气不运化则腹胀。脾湿动及肺脏则气喘，有类似支饮的症状，所以不可清除其热。如果清除热邪，胃中反而变寒，寒气上逆导致呃逆。半夏、生姜能散逆气、去湿邪、消痰止呃。此汤用在除热之后，而不是在尚未除热之前使用。
柴胡汤方
柴胡（半斤） 半夏（半升） 人参 甘草 黄芩（各三两） 大枣（十二枚） 生姜（三两切）
以上六味药，用水六升，煮取三升，分次温服，每日三次服用。
〔衍义〕邪正相争，在里则腹满气逆，在上则呕吐。上部仍属表证范畴，所以属于半表半里证。用小柴胡汤主治。柴胡、黄芩清除里热，半夏散降里逆之气，人参、甘草补正气以缓邪气，生姜、大枣调和营卫，合和表里，调理阴阳。又必须随证加减，方法见《伤寒论》小柴胡汤条后。
〔衍义〕杂病中的虚损，导致脾胃不运化，湿热蓄积而发黄。即使小便不利，也应当补泻兼施。男子发黄，必定是由内部虚热所致。反而见到小便自利，说明中下焦没有实热，只是虚阳浮沉导致发黄罢了。所以给予治疗虚劳的药剂来补益正气。正气旺盛，则营卫阴阳调和，黄疸自然痊愈。
〔补注〕《伤寒论》中说，小便利的人，不会发黄，因为热从小便排除了。现在小便通利而黄色依旧，那么他的黄色必然是色淡气虚，并不是真正有大热。所以从补法治疗。不然的话，小便既然通利，黄色为什么还会来呢？这与瘀血在脾的情况不同，与热积在膀胱的情况也不同。这明确是虚黄上泛，从中下二焦虚损得到。然而张仲景微妙地暗示了房劳的意思，而仍然补益中焦，正是因为黄色最终归属于土色。
瓜蒂散
古方多用此方治疗黄疸，或做成散剂，或吹入鼻中，都是取排出黄水为疗效。这是治疗水饮郁热在膈上的方子。为什么呢？因为瓜蒂是吐剂。《内经》说：“病位在上者，因势利导使其涌越而出。”张仲景说：“患湿病的人身上疼痛且发黄，将药吹入鼻中。”这也是因为邪气浅表的缘故。
Can it treat blood dryness? Furthermore, in Taiyang syndrome (Taiyang disease), with full-body jaundice, a deep and knotted pulse, free urination, and the patient appearing manic, this is undoubtedly a blood stasis syndrome. It is primarily treated with Dishuang Tang (Dichong Decoction). This is a heavy-duty formula. What is described here is a mild formula for treating blood dryness.
For jaundice disease, Yinchen Wuling San (Artemisiae Scopariae and Poria Pill Powder) is primarily used.
Yinchen Wuling San Formula
End of Artemisiae Scopariae Spica powder (10 parts) Wuling San (5 parts)
Mix the above two ingredients. Take one cun bi (a measure roughly equivalent to a tablespoon) before meals, three times daily.
[Commentary by Yan Yi] This also treats jaundice, without mentioning other syndromes. It appears alongside Zhufu Fa Jian (Pig Skin and Hair Decoction): the latter addresses dryness in the blood level, whereas this addresses dryness in the qi level.
How does this disease, contracted from sweating and entering water, result in dryness? The answer is: when damp-heat entangles and fails to resolve, the regulatory function of Lung Metal (Lung organ's governing and diffusing functions) cannot operate, leading to a lack of distribution of body fluids and resulting in dryness. After dryness stagnates for a long time, damp-heat steams and transforms into jaundice. Materia Medica records that Yinchen (Artemisiae Scopariae Spica) treats heat-binding jaundice and difficult urination; hence it is used as the principal herb. Dryness arises because heat prevails; Zhizi Bopi Tang (Gardeniae and Phellodendri Decoction) addresses damp-stagnation; Yinchen Wuling San does likewise. However, it is not merely for treating dampness but also acts as a moistening agent. Guizhi (Cinnamomi Ramulus) opens the interstices (pores), facilitating the flow of fluids and qi; Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria) generate fluids, all capable of moistening dryness. Ancients discussed jaundice, distinguishing between damp jaundice and heat jaundice. In damp jaundice, the complexion resembles smoked yellow; in heat jaundice, it resembles orange color. There are further distinctions between Yang jaundice and Yin jaundice. For Yang jaundice, Dahuang (Rhei Radix et Rhizoma) assists Yinchen; for Yin jaundice, Fuzi (Aconiti Lateralis Radix Preparata) assists Yinchen. Here, using Wuling San as an assistant indicates that damp-heat stagnation has transformed into dryness, which is evident.
In jaundice disease, with abdominal fullness, difficult and dark red urination, and spontaneous sweating, this indicates exterior harmony and interior excess. Purging is indicated. Da Huang Xiaoshi Tang (Rhei Radix et Natrii Sulfas Decoction) is suitable.
Da Huang Xiaoshi Tang Formula
Dahuang (4 liang) Xiaoshi (4 liang) Huangbai (4 liang) Zhizi (15 pods)
Take the above four herbs, add six sheng of water, decoct to obtain two sheng, remove the dregs, add Xiaoshi (Natrii Sulfas), boil again to obtain one sheng, and take in one dose.
[Commentary by Yan Yi] Pathogenic heat binds internally, causing abdominal fullness and spontaneous sweating. Dahuang and Xiaoshi purge and eliminate them. Heat in the Bladder causes difficult and dark red urination. Huangbai (Phellodendri Cortex) and Zhizi (Gardeniae Fructus) are cool in nature to clear heat. This is a heavy-duty formula for treating jaundice.
In jaundice disease, if the urine color remains unchanged, there is a desire for spontaneous diarrhea, abdominal fullness, and wheezing, heat-clearing methods must not be used. If heat is cleared, hiccups will inevitably occur. For hiccups, Xiao Banxia Tang (Minor Pinellia Decoction) is primarily used.
[Commentary by Yan Yi] Unchanged urine color and desire for spontaneous diarrhea indicate internal dampness, with fluid accumulation and unprospered heat. Excessive dampness in the Spleen-Taiyin leads to failure of Earth qi transformation, causing fullness. Spleen dampness affecting the Lung causes wheezing, resembling symptoms of Zhi Yin (Fluid Retention in the Chest). Therefore, clearing heat is contraindicated. Clearing heat would cause cold in the Stomach, leading to rebellious cold qi rising and causing hiccups. Banxia (Pinelliae Rhizoma) and Shengjiang (Zingiberis Rhizoma Recens) can disperse rebellion, eliminate dampness, resolve phlegm, and stop hiccups. This decoction is used after heat has been cleared, not before.
For various types of jaundice with abdominal fullness and vomiting, Chai Hu Tang (Bupleurum Decoction) is appropriate.
Chai Hu Tang Formula
Chaihu (8 liang) Banxia (0.5 sheng) Renshen (3 liang) Gancao (3 liang) Huangqin (3 liang) Dazao (12 pieces) Shengjiang (3 liang, sliced)
Take the above six herbs, add six sheng of water, decoct to obtain three sheng, divide into warm doses, taken three times daily.
[Commentary by Yan Yi] When pathogenic factors and righteous qi clash, binding internally causes abdominal fullness and rebellious qi; occurring superiorly causes vomiting. The superior aspect still relates to the exterior, thus belonging to the Shaoyang (half-exterior, half-interior) stage. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is primarily used. Chaihu and Huangqin clear interior heat; Banxia disperses rebellious qi within; Renshen and Gancao tonify righteousness and moderate pathogens; Shengjiang and Dazao harmonize Ying and Wei (nutritive and defensive qi), integrate exterior and interior, and regulate Yin and Yang. Modifications must follow the syndrome, as detailed in the post-script of Xiao Chai Hu Tang in Shanghan Lun.
For men presenting with yellow complexion and free urination, Xu Lao Xiao Jian Zhong Tang (Deficiency Consumption Minor Construct the Middle Decoction) should be given.
[Commentary by Yan Yi] Deficiency in miscellaneous diseases leads to failure of Spleen and Stomach transformation, causing damp-heat accumulation and jaundice. Even if urination is difficult, tonification and purging should be combined. Jaundice in men is necessarily caused by internal deficiency heat. The presence of free urination indicates no excess heat in the Middle and Lower Jiao; rather, floating and sinking deficient yang causes yellowing. Thus, formulas for treating deficiency consumption are used to tonify righteous qi. When righteous qi is robust, Ying and Wei, Yin and Yang harmonize, and jaundice resolves spontaneously.
[Supplementary Note] Shanghan Lun states that those with free urination do not develop jaundice because heat exits via the urine. Now, with free urination yet persistent jaundice, the yellowing must be pale and due to qi deficiency, not genuine excessive heat. Therefore, tonification is indicated. Otherwise, since urination is already free, why would jaundice appear? This differs from blood stasis in the Spleen or heat accumulation in the Bladder. This is clearly deficient jaundice floating upward, originating from deficiency in the Middle and Lower Jiao. Although Zhang Zhongjing subtly hints at sexual exhaustion, he still tonifies the Middle Jiao because yellow ultimately corresponds to the Earth element.
Gua Di San (Melon Sprout Powder)
Ancient formulas often used this to treat jaundice, either as a powder or insufflated into the nose, aiming to expel yellow fluid. This treats water-fluid retention and stagnant heat in the upper Jiao (diaphragm area). Why? Because Gua Di (Cucumeritis Fructus) is an emetic. The Neijing states: "For pathogens located superiorly, induce vomiting to expel them." Zhang Zhongjing said: "For patients with dampness suffering body pain and jaundice, insufflate medicine into the nose." This is also because the pathogen is superficial.
Appendix Formulas
Qianjin Mahuang Chunjiu Tang (Thousand Golden Ephedra Mellow Wine Decoction)
Mahuang (one bundle, nodes removed, wrapped in silk) Meijiu (5 sheng of fine wine)
Decoct the above two ingredients to obtain half a sheng, take in one dose to induce slight sweating. In spring months, use water for decoction instead of wine.