论二首 脉证十四条 方七首（按当作六首。）
寸口脉浮而缓。
〔尤〕脾脏瘀热而色黄。脾者。四运之轴也。脾以其所瘀之热。转输流布。而肢体面目尽黄矣。故曰瘀热以行。
按平人气象论曰。缓而滑。曰热中。邪气脏腑病形篇曰。缓者多热。平脉法曰。缓者胃气实。实则谷消而水化也。
又伤寒论曰。伤寒脉浮而缓。手足自温者。是为系在太阴。太阴者身当发黄。合此诸义观之。则知是缓为胃热。而浮缓
为发黄之诊。又知浮则为风之风。即热气外熏之谓。（伤寒论。有此例。）非邪气中表之义。又知缓则为痹之痹字。盖是
瘅字之讹。始与文义相叶。（缓瘅烦三字韵。黄行二字韵。）顾以其讹作痹。后人不辨。遂补痹非中风一句也。再按痹非
中风一句。推他文例。当是风瘅相搏四字。（此愚弱冠时说。极知臆妄。然痹字遂难解。注家循文解释。不免牵强。仍
姑存录。以俟识者。仓公传曰。风瘅客脬。难于大小溲溺赤。）
趺阳脉紧而数。
〔赵〕女劳疸。惟言额上黑。不言身黄。省文也。后人虽曰交接水中所致。特其一端耳。
按先兄曰。尺脉浮为伤肾。趺阳脉紧为伤脾。二句插入。以对示女劳疸谷疸二证之脉。此不承食即为满句。
亦不接风寒相搏句。注家与上下相连为解。殆觉 谬。又阴被其寒。诸注以阴为肾脏。似失当。特尤氏曰。谷不消
而气以瘀。则胃中苦浊。浊气当出下窍。若小便通。则浊随溺去。今不通。则浊虽下流。而不外出。于是阴受其湿。阳
受其热。转相流被。而身体尽黄矣。朱氏曰。是太阴虽被寒郁。而郁久化成之湿热。流祸膀胱。并是。又按女劳疸。注
家以为肾热。其说诚是。盖人斫丧太过。精液亏乏。则肾中之阳必亢极。营血为之郁黩。遂为发黄也。又此证小便自利。
魏氏曰。阳虚气降。无所收摄节制也。金鉴曰。膀胱急。小便利。下焦虚也。腹满如水状。脾肾两败。故谓不治也。亦
是一说。盖此证本是下虚。故其初小便不禁。久而真元闭绝。小便不利。遂至腹如水状也。
又按舒氏伤寒论集注曰。酒中有热有湿。均足为患。因其本气而患之。本气虚寒者。本不患热。惟患其湿。真阳素
旺者。不患其湿。而患其热。（此本于张介宾酒泄说。然其意少异。）盖酒疸之证。舒氏所谓。不患其湿。而患其热者也。
酒疸心中热。
按此上条脉浮者之谓。似不必与懊 有微甚之别。
酒疸下之。久久为黑疸。
按据巢源千金。诸疸皆久为黑疸。虽黑微黄。盖通言之。不特自酒疸变者。（变作桃皮色。亦本于巢源。）尤氏以女
劳疸对言。然女劳疸。亦尺脉浮。身尽黄。不必脉沉身纯黑。
师曰。病黄胆。
按此条。言黄胆有因火劫得者。然此病多自湿得之。而其证有二端。尤氏谓非内兼湿邪。则热与热相攻。而反相散
者。恐失其当。如伤寒火逆条。两阳相熏灼。其身发黄。风温被火。微发黄色。阳明病被火。必发黄俱不内兼湿邪者。
腹满舌痿黄。
按赵氏曰。黄胆之黄深。实热之黄。痿黄之黄浅。虚热之黄。当考。
疸而渴者。其疸难治。
按赵氏曰。疸。即瘅也。单阳无阴。此说本于圣济。未确。盖发黄用瘅字。见玉机真藏论。胃热用疸字。见平人气
象论。此瘅疸相同之明征也。又刺疟篇。胃疟者。令人旦病也。太素旦。作疸。注。疸。音旦。内热病也。
谷疸之为病。寒热不食。
〔沈〕浊气内壅。所以心胸不安。不安者。即懊 热痛之类也。
茵陈蒿汤方
赵氏曰。盖茵陈汤。治热结发黄。佐栀子。去胃热。通小便。更以大黄为使。荡涤之。虽然治疸。不可不分轻重。
如栀子柏皮汤。解身热发黄。内热之未实者。麻黄连翘赤小豆汤。治表寒湿。内有瘀热而黄者。大黄硝石汤。下内热之
实者。栀子大黄汤次之。茵陈汤又次之。○按栀子大黄汤治上热。此方治胃热。其病位本不同。且此方。大黄二两。彼
则一两。此方其剂大。彼则剂小。可知此方力重于彼。喻氏亦以此为轻。误矣。（栀子柏皮汤。麻黄连轺赤小豆汤二方。
伤寒论述。义有详说。兹不赘。）
又按尿如皂角汁状。此湿去之征。故曰黄从小便去也。
幼幼新书。吉氏家传。治小儿身体黄。及小便黄。眼白睛黄。即是疸也。宜此方。于本方。加朴硝。
黄家。日晡所发热。而反恶寒。（外台。疸。作瘅。本草。图经引。亦疸。作瘅。其腹胀。作腹胪胀满。）
按发热而反恶寒。金鉴说为是。尤注难从。
又按此证本是虚因。而更有水蓄腹满。故云难治。盖仲景书。其称难治者。在伤寒论则七见。在本经则五见。
大抵谓病寒热相错。虚实互呈。其治不得纯一。有所顾虑者。宜深味焉。（余尝着虚实论。既有详说。录在药治通
义中。宜参。）
硝石矾石散方（图经引。作硝石。熬黄。矾石。烧令汁尽。二物等之合。秘绢筛。大麦粥汁和。服方寸匕。日
三。重衣覆取微汗。病随大小便去。小便正黄。大便正黑也。大麦用无皮者。）
按此方用大麦粥。其理与石膏配粳米相同。药性论云。硝石。君。恶曾青。畏粥。
本草纲目曰。绿矾。燥湿化涎。利小便消食积。故胀满黄肿。疟痢疳疾方。往往用之。其源则自张仲景用矾石硝石。
治女劳黄胆方中。变化而来。
圣济。治赤白痢。矾石丸。白矾（四两） 硝石（一两半） 捣为末。（云云）用米醋浸炊饼心丸。如梧桐子大。
每服十丸。空心米饮下。
魏氏家藏方。硝矾圆。治暗风痫病年深者。
于本方。（硝石半两白矾一两枯） 加赤石脂。（二两火 ）为细末。糯米粥为丸。如绿豆大。每服十五丸。食后温
水下。日进三服。
一日一次发者。服之半月。永除根本。
酒黄胆。心中懊 。（首句。外台。作酒瘅者。）
按此上条脉沉弦者之治也。
栀子大黄汤（宋本外台。栀子。七枚。擘。枳实。破。水渍。炙。香豉。一升。绵裹。分温三服。作去滓温服七合。
日三服。）
诸病黄家。但利其小便。
按桂枝加黄 汤证。即湿邪表郁者。盖与湿家身色如熏黄。有阴阳之别。
诸黄。猪膏发煎主之。
按赵氏既引伤寒类要。以证此条之为血燥。然其说冗杂不核。仍不采入。
猪膏发煎方
圣惠。治黄胆。耳目悉黄。食饮不消。胃中胀热。此肠间有燥粪。宜服此方。
上煎炼猪脂。五两。每服抄大半匙。以葱白汤频服之。以通利为度。
沈氏尊生书曰。有服对证药不能效。耳目皆黄。食不消者。是胃中有干粪也。宜饮熬猪油。量人气禀。或一杯。或
半杯。日三次。以燥粪下为度。即愈。
黄胆病。茵陈五苓散主之。
按此条不言何疸。殆是谷疸之轻证。否则湿邪内郁所致乎。
黄胆腹满。小便不利而赤。
按此条不言何疸。盖是谷疸之最重者也。自汗出。为里热蒸迫之候。诸注以为表和者。非是。盖此证一属里实。故
举表和二字。以征自汗之非表邪也。
大黄硝石汤方（千金。硝石。作芒硝。难从。宋本外台。煎取二升半。去滓。内硝石。更煎取一升。先食顿服。）
按硝石矾石散。及此方。不用芒硝。而用硝石者。盖以芒硝润品。不宜湿热。故取于火硝之燥且利焉。繇是观之。
则今之医。治阳明病。于承气汤中。换用硝石者。坐于不深研经旨矣。
黄胆病。小便色不变。欲自利。
〔朱〕此黄胆中之中气虚寒者。小便色不变。非时下无壅热。并见虚寒之象。乃自利腹满而喘。是浊邪横逆。清气
不运。使医者误认腹满而喘为实热。反以寒药除之。益致胃败而为哕。且以小半夏汤。温通上焦。以止逆除哕。而后渐
次调理脾胃可也。
按阳明篇曰。阳明病。不能食。攻其热必哕。所以然者。胃中虚冷故也。以其人本虚。攻其热必哕。正与此条同机。
圣惠方。治阴黄小便色不变。欲自利而不利。腹满而喘者必哕。哕者。宜服小半夏汤方。
于本方。加人参。葛根。
男子黄。小便自利。
〔赵〕男子黄者。必由入内虚热而致也。反见小便自利。为中下无热。惟虚阳浮沉为黄耳（按沉。疑泛字。）故与
治虚劳之剂补正气。正气旺。则营卫阴阳和。而黄自愈矣。
按赵说是。盖女劳疸初起之证治也。先兄曰。上条。有手足中热。膀胱急。少腹满诸证。而此特举小便自利者。使
人推知其他也。今与虚劳篇相参。其膀胱急。少腹满者。尤氏所谓阳病不与阴和。则阴以其寒独行。为里急。为腹中痛。
而其实非阴之盛者。若身体尽黄。手足中热。亦尤氏所谓阴病不能与阳和。则阳以其热独行。
为手足烦热。而实非阳之炽者。阴阳不相和谐。外生虚热。而所谓黄病。非土色外呈之候。其用小建中汤者。意在
使阴阳相就。而寒以温热以和也。
附方
瓜蒂汤
外台。延年秘录。疗急黄心上坚硬。渴欲得水吃。气息喘粗眼黄。但有一候相当。即须服此瓜蒂散吐则瘥方。
于仲景原方中。去香豉。○又许仁则方。有用瓜蒂。丁香。赤小豆。捣筛末。以新汲水。和一方寸匕与服者。
千金。麻黄醇酒汤。（外台。疸。作瘅。本草。伤寒类要。引张仲景伤寒论。文稍与外台同。二升半。作半升。下
有去滓二字。）
〔余述〕按黄胆之病。有阴阳二证。更有湿胜燥胜之异。今考经文。酒疸。阳而属燥者也。故治主清凉。女劳疸。
阴而属燥者也。故初治从和中。而末治须润导。谷疸。有阳有阴。其阳属湿热。治在疏荡。其阴属寒湿。治要温利。后
世以茵陈附子并用者。即寒湿之治已。如茵陈五苓散证。岂湿热发黄之轻者乎。此诸黄者。皆病之属里者也。如桂枝加
黄汤证。湿热郁表。亦阳黄之类已。此他。伤寒论中发黄诸条。不一而足。皆与本篇互发。学人宜参互详审焉。
论二首，脉证十四条，方七首（按：应当是六首）。
寸口脉浮而缓。
〔尤在泾〕脾脏瘀滞蕴热而面色发黄。脾，是全身气机运转的枢纽。脾将其所瘀滞之热，转输流布于全身，致使肢体和面目全部发黄。所以说“瘀热以行”。
按：《平人气象论》说：“脉缓而滑，主热中。”《邪气脏腑病形篇》说：“脉缓者多属热。”《平脉法》说：“脉缓表示胃气充实，充实则能消化谷物并化生水液。”
又据《伤寒论》说：“伤寒脉浮而缓，手足自温者，这是病系于太阴。太阴病应当身体发黄。”综合这些义理来看，可知“缓”代表胃热，而“浮缓”则是发黄的脉象诊断。又知“浮”指的是风，此处的风即指热气向外熏蒸的意思。（《伤寒论》中有此类先例。）并非邪气侵袭肌表的意义。又知“缓”字在此处通“痹”，其实是“瘅”字的讹误，这样才与文义押韵相协。（“缓、瘅、烦”三字押韵，“黄、行”二字押韵。）可惜后人因它讹作“痹”字，无法辨别，于是补上了“痹非中风”这一句。再根据“痹非中风”这一句，推测其他文例，此处应当是“风瘅相搏”四个字。（这是我年轻时所说的，深知是主观臆断，然而“痹”字实在难以解释，注家顺着文字解释，不免牵强附会，仍暂且收录，以等待高明之士指正。《仓公传》说：“风瘅客于膀胱，导致大小便困难，尿色赤。”）
趺阳脉紧而数。
〔赵以德〕女劳疸，只提到额头黑，没有提到身体黄，这是省略了文字。后人虽然说是因为房事在水中所致，这只是其中一方面罢了。
按：我的亡兄说：“尺脉浮为伤肾，趺阳脉紧为伤脾。”这两句插入文中，用来对应展示女劳疸和谷疸两种证候的脉象。这里既不承接“食即为满”一句，也不连接“风寒相搏”一句。注家将其与上下文相连来解释，大概觉得谬误。另外，“阴被其寒”，各注家将“阴”解释为肾脏，似乎不恰当。唯有尤氏说：“谷物不能消化而气机瘀滞，则胃中苦于浊气，浊气应当从下窍排出。如果小便通畅，则浊气随尿液排出；现在不通畅，则浊气虽然下行，但不能外出。于是阴部受湿邪困扰，阳部受热邪困扰，相互流转浸渍，致使身体全部发黄。”朱氏说：“这是太阴虽受寒邪郁闭，但郁久化生湿热，流祸及膀胱。”这两种说法都有道理。又按：女劳疸，注家认为是肾热，这种说法确实正确。大概是因为人体过度耗损，精液亏乏，则肾中的阳气必然亢盛至极，营血因此郁滞污浊，遂致发黄。又此证小便自利，魏氏说：“阳气虚衰，气机下降，无所收摄节制。”《医宗金鉴》说：“膀胱急迫，小便利，说明下焦虚。腹部胀满像有水状，是脾肾两败，所以称为不治之症。”这也是一种说法。大概此证本是下元虚损，所以起初小便不禁，时间久了真元闭绝，小便不利，遂至腹部胀满如水状。
又按：舒驰远《伤寒论集注》说：“酒中含有热和湿，都足以致病。根据其本气的虚实寒热而患病。本气虚寒的人，本来不患热，只患湿；真阳素来旺盛的人，不患湿，而患热。”（这基于张介宾关于酒泄的说法，但意思略有不同。）大概酒疸之证，就是舒氏所说的“不患湿而患热”的情况。
酒疸心中懊憹。
按：这是对上一条脉浮者的描述，似乎不必与“懊憹”有轻重之别。
酒疸若用下法治疗，久而久之会变成黑疸。
按：据巢元方《诸病源候论》和孙思邈《千金方》，各种黄疸久了都会变成黑疸，虽然是黑中带微黄，这是通称而言，并不只是从酒疸变来的。（颜色变为桃皮色，也源于《诸病源候论》。）尤氏以此与女劳疸对举，然而女劳疸也是尺脉浮，身尽黄，不一定脉沉身纯黑。
老师说：患黄疸病。
按：这一条，是说黄疸有因火劫疗法导致的。然而此病多由湿邪引起，而其证候有两类。尤氏认为如果不内兼湿邪，则热与热相攻，反而互相消散，恐怕失当。如《伤寒论》火逆条所说：“两阳相熏灼，其身发黄；风温被火，微发黄色；阳明病被火，必发黄”，这些都不内兼湿邪。
腹部胀满，舌体萎软，面色萎黄。
按：赵氏说：“黄疸的黄深，是实热之黄；萎黄之黄浅，是虚热之黄。”应当考证。
黄疸而口渴的，其黄疸难治。
按：赵氏说：“疸，即瘅也。单阳无阴。”这种说法本于《圣济总录》，并不确切。大概发黄用“瘅”字，见于《玉机真藏论》；胃热用“疸”字，见于《平人气象论》。这是瘅疸相同的明证。又《刺疟篇》说：“胃疟者，令人旦病也。”《太素》中“旦”作“疸”。注解说：“疸，音旦，内热病也。”
谷疸之为病，恶寒发热，不欲饮食。
〔沈目南〕浊气内壅，所以心胸不安。不安，即懊憹、热痛之类症状。
茵陈蒿汤方
赵氏说：大概茵陈汤，治疗热结发黄，佐以栀子，去除胃热，通利小便，更以大黄为使药，荡涤积滞。虽然治疗黄疸，不可不分轻重。如栀子柏皮汤，解身热发黄，针对内热未实的患者；麻黄连翘赤小豆汤，治疗表寒湿，内有瘀热而发黄者；大黄硝石汤，攻下内热实证；栀子大黄汤次之；茵陈汤又次之。○按：栀子大黄汤治疗上焦热，此方治疗胃热，病位原本不同。而且此方大黄用二两，彼方只用一两，此方剂量大，彼方剂量小，可知此方力量重于彼方。喻嘉言也认为此方较轻，是错误的。（栀子柏皮汤、麻黄连轺赤小豆汤二方，在《伤寒论》中有详细论述，义理详尽，此处不再赘述。）
又按：尿如皂角汁状，这是湿邪去掉的征象，所以说“黄从小便去也”。
《幼幼新书》引吉氏家传：治疗小儿身体黄，以及小便黄，眼白睛黄，这就是疸病。宜用此方，在本方基础上加朴硝。
黄疸患者，日晡时发热，反而恶寒。（《外台秘要》中，疸作瘅。《本草图经》引用，也将疸作瘅。其腹胀，作腹胪胀满。）
按：发热而反恶寒，《医宗金鉴》的说法是正确的，尤在泾的注释难以遵从。
又按：此证本是虚因，而又伴有水蓄积导致腹满，所以说难治。大概张仲景书中，称“难治”的，在《伤寒论》中出现七次，在《金匮要略》中出现五次。大抵是指病寒热错杂，虚实互见，治疗不能单一，有所顾虑的情况。应当深入体味。（我曾撰写《虚实论》，已有详细说明，收录在《药治通义》中，宜参考。）
硝石矾石散方（《本草图经》引用：硝石，熬至黄色；矾石，烧令汁液流尽。两物等分混合，用细绢筛过，用大麦粥汁调和，服用一方寸匕，每日三次。服药后穿厚衣覆盖取微汗。病随大小便而去，小便正黄，大便正黑。大麦需用无皮的。）
按：此方用大麦粥，其道理与石膏配粳米相同。《药性论》说：硝石为君药，恶曾青，畏粥。
《本草纲目》说：绿矾，燥湿化痰，利小便消食积。所以胀满黄肿、疟痢疳疾等方，往往使用它。其源头则来自张仲景用矾石、硝石治疗女劳黄疸方中的变化而来。
《圣济总录》：治疗赤白痢，矾石丸。白矾（四两）、硝石（一两半），捣为末。（云云）用米醋浸泡炊饼心，丸如梧桐子大。每服十丸，空心米饮送下。
魏氏《家藏方》：硝矾圆，治疗暗风痫病年深者。
在本方（硝石半两，白矾一两枯）中，加赤石脂（二两火煅），为细末，糯米粥为丸，如绿豆大。每服十五丸，食后温水送下，每日进三服。
一日发作一次的，服用半月，永除根本。
酒黄疸，心中懊憹。（首句，《外台秘要》作“酒瘅者”。）
按：这是对上一条脉沉弦者的治疗。
栀子大黄汤（宋本、《外台秘要》：栀子七枚，擘开；枳实，破开，用水浸泡，炙；香豉一升，绵裹。分温三服，去滓，温服七合，每日三次。）
凡是患黄疸的人，只要通利其小便即可。
按：桂枝加黄芪汤证，即湿邪郁于肌表者。大概与湿家身色如熏黄，有阴阳的区别。
各种黄疸，猪膏发煎主治。
按：赵氏既然引用《伤寒类要》，证明此条为血燥，但其说法冗杂不确，仍不采纳。
猪膏发煎方
《太平圣惠方》：治疗黄疸，耳目皆黄，饮食不消，胃中胀热。这是肠间有燥粪，宜服此方。
上将猪脂煎炼，五两。每次取大半匙，用葱白汤频频服用，以通利为度。
沈氏《尊生书》说：有服用对症药物无效的，耳目皆黄，饮食不消的，是胃中有干粪。宜饮用熬熟的猪油，根据人气禀赋，或一杯，或半杯，每日三次，以燥粪排出为度，即愈。
黄疸病，茵陈五苓散主治。
按：这一条没说是什么黄疸，大概是谷疸的轻证，否则是湿邪内郁所致吧？
黄疸腹部胀满，小便不利而色赤。
按：这一条没说是什么黄疸，大概是谷疸中最重的。自汗出，是里热蒸迫的征候。各注家认为是表和，是不对的。大概此证属于里实，所以举出“表和”二字，以证明自汗不是表邪所致。
大黄硝石汤方（《千金方》：硝石，作芒硝，难以遵从。宋本、《外台秘要》：煎取二升半，去滓，内硝石，更煎取一升，饭前顿服。）
按：硝石矾石散及此方，不用芒硝而用硝石，大概因为芒硝是润品，不宜用于湿热证，所以取用火硝的燥烈且通利特性。由此看来，现今的医生在治疗阳明病时，在承气汤中换用硝石，是由于没有深入研究经旨的缘故。
黄疸病，小便颜色不变，想要自利（腹泻）。
〔朱肱〕这是黄疸中的中气虚寒者。小便颜色不变，不是时下无壅热，并见虚寒之象。若是自利、腹满而喘，是浊邪横逆，清气不运。使医者误认腹满而喘为实热，反而用寒药清除，更加导致胃败而出现呃逆。且用小半夏汤，温通上焦，以止逆除哕，而后渐次调理脾胃即可。
按：《阳明篇》说：“阳明病，不能食，攻其热必哕。所以然者，胃中虚冷故也。以其人本虚，攻其热必哕。”正与此条机理相同。
《太平圣惠方》：治疗阴黄，小便颜色不变，想要自利而不利，腹满而喘者必哕。哕者，宜服小半夏汤方。
在本方中，加人参、葛根。
男子发黄，小便自利。
〔赵以德〕男子发黄，必定是由入内虚热所致。反而出现小便自利，说明中下焦无热，只有虚阳浮沉导致发黄耳（按：“沉”疑为“泛”字之误）。所以给予治疗虚劳的药剂补益正气，正气旺盛，则营卫阴阳调和，而黄自愈。
按：赵氏说得对。这大概是女劳疸初起的证治。我的亡兄说：上一条，有手足中热、膀胱急、少腹满诸证，而此条特别提出小便自利，是为了让人推知其他症状。如今与《虚劳篇》参看，其膀胱急、少腹满者，是尤氏所谓“阳病不与阴和，则阴以其寒独行”，表现为里急、腹中痛，而其实并非阴盛。若身体尽黄、手足中热，也是尤氏所谓“阴病不能与阳和，则阳以其热独行”，表现为手足烦热，而实并非阳炽。阴阳不相和谐，外生虚热，而所谓的黄病，并非土色外呈的征候。使用小建中汤，意在使阴阳相就，寒者温热之，热者和之。
附方
瓜蒂汤
《外台秘要》引《延年秘录》：治疗急黄，心上坚硬，渴欲得水喝，气息喘粗，眼黄。只要有一候相当，即须服此瓜蒂散，吐则病愈方。
在仲景原方中，去掉香豉。○又许仁则方，有用瓜蒂、丁香、赤小豆，捣筛末，以新汲水和一方寸匕服用者。
《千金方》：麻黄醇酒汤。（《外台秘要》：疸，作瘅。《本草》、《伤寒类要》引张仲景《伤寒论》，文字稍与《外台》同。二升半，作半升，下有“去滓”二字。）
〔余无言述〕按：黄疸病，有阴阳二证，更有湿胜、燥胜的差异。今考经文，酒疸，是阳而属燥的，所以治疗主清凉；女劳疸，是阴而属燥的，所以初治从和中，而末治须润导；谷疸，有阳有阴，其阳属湿热，治疗在疏荡；其阴属寒湿，治疗要温利。后世用茵陈、附子并用的，就是寒湿的治疗了。如茵陈五苓散证，难道是湿热发黄的轻者吗？这些诸黄，都是病属于里的。如桂枝加黄芪汤证，湿热郁于表，也是阳黄的一类。此外，《伤寒论》中发黄诸条，不一而足，皆与本篇互相发明，学人宜参互详审焉。
Two Treatises, Fourteen Pulse and Symptom Items, Seven Prescriptions (Note: Should be six prescriptions).
The pulse at the Cun Kou (Radial Artery) is floating and moderate.
[You Zaijing] Stasis-heat in the Spleen organ causes yellow complexion. The Spleen is the axis of movement for the four directions. The Spleen transmits and distributes its stagnant heat throughout the body, causing the limbs and face to become entirely yellow. Thus it is said that "stasis-heat moves along."
Note: *Ping Ren Qi Xiang Lun* (Treatise on the Manifestations of a Healthy Person) states: "Moderate and slippery pulse indicates Heat in the Middle." *Xie Qi Zang Fu Bing Xing Pian* (Treatise on Pathogenic Factors and Organ Manifestations) states: "A moderate pulse often indicates Heat." *Ping Mai Fa* (Method of Examining Normal Pulses) states: "A moderate pulse signifies fullness of Stomach Qi; when full, grains are digested and fluids are transformed."
Furthermore, according to *Shang Han Lun* (Treatise on Cold Damage): "In cold damage, if the pulse is floating and moderate, and the hands and feet are warm by themselves, this indicates the disease is related to the Tai Yin. Tai Yin disease should result in jaundice." Observing these various principles together, we know that "moderate" represents Stomach Heat, and "floating-moderate" is the diagnostic pulse for jaundice. We also know that "floating" refers to Wind, where "Wind" here means the external薰 steaming of Heat. (*Shang Han Lun* has such examples.) It does not mean pathogenic factors attacking the exterior. We also know that "moderate" here corresponds to "Bi" (Obstruction), which is actually a textual error for "Dan" (Crimson Jaundice/Heat Jaundice), making it rhyme with the text. ("Moderate," "Dan," and "Fan" rhyme; "Huang" and "Xing" rhyme.) Regrettably, later generations, unable to distinguish the error, added the phrase "Bi is not Wind Strike." Furthermore, inferring from other textual examples based on "Bi is not Wind Strike," this passage should originally read "Wind and Dan contend." (This was my speculation when I was young; I know it is presumptuous, but the character "Bi" is difficult to explain. Commentators forcing an interpretation inevitably resort to strained explanations. I retain it here for scholars to judge. *Cang Gong Zhuan* states: "Wind-Dan invades the Bladder, causing difficulty in urination and defecation with red urine.")
The pulse at the Fu Yang (Dorsalis Pedis Artery) is tight and rapid.
[Zhao Yi De] In Nu Lao Dan (Jaundice due to Sexual Exhaustion), only the black forehead is mentioned, not the yellow body; this is an elliptical expression. Later generations claimed it was caused by intercourse in water, but this is only one aspect.
Note: My late brother said: "Floating pulse at the Chi position indicates Kidney injury; tight pulse at the Fu Yang position indicates Spleen injury." These two sentences are inserted to correspondingly display the pulses for Nu Lao Dan and Gu Dan (Grain Jaundice). This section neither follows the sentence "eating leads to fullness" nor connects to "contending with wind-cold." Commentators linking it to the surrounding context likely find it erroneous. Additionally, regarding "Yin is affected by Cold," most commentators interpret "Yin" as the Kidney, which seems inappropriate. Only You Shi says: "When food fails to digest and Qi stagnates, the Stomach suffers from turbid Qi. Turbid Qi should exit through the lower orifices. If urination is unobstructed, turbidity leaves with urine. Now, since it is obstructed, although turbidity flows downward, it does not exit externally. Thus, Yin receives dampness, and Yang receives heat, circulating and permeating each other, causing the entire body to turn yellow." Zhu Shi says: "Although Tai Yin is constrained by Cold, long-term constraint transforms into Damp-Heat, which wreaks havoc in the Bladder." Both views have merit. Also, regarding Nu Lao Dan, commentators attribute it to Kidney Heat, which is indeed correct. Generally, excessive depletion of essence and fluids causes Kidney Yang to hyperactive, leading to stagnation and pollution of Ying Blood, resulting in yellowing. Furthermore, in this condition, urination is spontaneous. Wei Shi says: "Yang deficiency allows Qi to descend without retention or control." *Yi Zong Jin Jian* (Golden Mirror of Medicine) states: "Urgency of the Bladder and free urination indicate Lower Jiao deficiency. Abdominal fullness resembling water accumulation indicates failure of both Spleen and Kidney, hence termed untreatable." This is another perspective. Essentially, this condition originates from Lower Deficiency. Initially, there is urinary incontinence; over time, true Yuan Qi closes off, urination becomes obstructed, leading to abdominal distension like water.
Furthermore, Shu Chi Yuan's *Shang Han Lun Ji Zhu* states: "Wine contains both Heat and Dampness, both sufficient to cause disease. Depending on the person's fundamental Qi: those with deficient-cold fundamental Qi do not suffer from Heat, only Dampness; those with robust Yang do not suffer from Dampness, only Heat." (Based on Zhang Jiebin's theory on wine-induced diarrhea, though the meaning differs slightly.) The syndrome of Jiu Dan (Wine Jaundice) corresponds to Shu Shi's description of "not suffering from Dampness but suffering from Heat."
Jiu Dan presents with internal restlessness (Ao Nao).
Note: This refers to the previous item regarding the floating pulse. There seems to be no need to distinguish degrees between "floating" and "restlessness."
If Jiu Dan is treated with purgatives, it will eventually transform into Hei Dan (Black Jaundice).
Note: According to Chao Yuanfang's *Zhu Bing Yuan Hou Lun* and Sun Simiao's *Qian Jin Fang*, all types of jaundice can eventually become Black Jaundice, appearing black with a slight yellow tint. This is a general term, not specific to transformation from Jiu Dan. (The color changing to peach-bark hue also originates from *Zhu Bing Yuan Hou Lun*.) You Shi contrasts this with Nu Lao Dan, however, Nu Lao Dan also presents with a floating Chi pulse and whole-body yellowing, not necessarily a deep pulse and pure black skin.
The Master said: Patients with Jaundice Disease.
Note: This item discusses jaundice caused by fire therapy. However, this disease mostly arises from Dampness, presenting in two forms. You Shi argues that without internal Dampness, Heat would attack Heat and dissipate, which is likely incorrect. For example, in the Fire Reversal section of *Shang Han Lun*: "Two Yangs scorch each other, causing yellowing; Wind-Warmth subjected to fire causes slight yellowing; Yangming disease subjected to fire must cause yellowing." None of these involve internal Dampness.
Abdominal fullness, flaccid tongue, and sallow complexion.
Note: Zhao Shi says: "The yellow of Jaundice is deep, indicating Excess Heat; the yellow of Sallow Complexion is pale, indicating Deficient Heat." This requires verification.
Jaundice accompanied by thirst is difficult to treat.
Note: Zhao Shi says: "Dan is synonymous with Can. It is Single Yang without Yin." This view stems from *Sheng Ji Zong Lu* and is not accurate. Generally, "Can" is used for yellowing in *Yu Ji Zhen Cang Lun*, while "Dan" is used for Stomach Heat in *Ping Ren Qi Xiang Lun*. This is clear evidence of their equivalence. Also, *Ci Mie Pian* states: "Stomach Malaria makes people sick in the morning." *Tai Su* writes "Dan" instead of "Dan" (morning). The commentary notes: "Dan sounds like 'Dan', an internal heat disease."
Gu Dan (Grain Jaundice) manifests as aversion to cold, fever, and loss of appetite.
[Shen Mu Nan] Internal obstruction of turbid Qi causes mental discomfort. Discomfort refers to symptoms like Ao Nao (restlessness) and hot pain.
Yin Chen Hao Tang Prescription
Zhao Shi says: Yin Chen Tang treats heat-binding causing yellowing. Gardenia clears Stomach Heat and promotes urination, while Rhubarb acts as the guiding drug to purge accumulation. Although treating jaundice, severity must be distinguished. Zhi Zi Bai Pi Tang resolves surface heat and yellowing for internal heat not yet solidified; Ma Huang Lian Qiao Chi Xiao Dou Tang treats exterior cold-damp with internal stasis-heat; Da Huang Xiao Shi Tang purges internal excess heat; Zhi Zi Da Huang Tang is secondary; Yin Chen Tang is tertiary.○ Note: Zhi Zi Da Huang Tang treats Upper Jiao Heat, whereas this formula treats Stomach Heat; their locations differ. Moreover, this formula uses 2 liang of Rhubarb, while the other uses 1 liang; this formula has a larger dose and greater potency. Yu Jia Yan considered this formula mild, which was an error. (Zhi Zi Bai Pi Tang and Ma Huang Lian Qiao Chi Xiao Dou Tang are detailed in *Shang Han Lun*; omitted here.)
Note: Urine resembling soapberry juice indicates the departure of Dampness; thus it is said that "Yellow exits via the urine."
*You You Xin Shu* cites Ji Family Tradition: To treat children with yellow body, yellow urine, and yellow sclera (Jaundice), use this prescription with added Glauber Salt (Mirabilite).
Jaundice patients experience fever at dusk and paradoxical aversion to cold. (*Wai Tai Mi Yao* writes Dan for Jaundice; *Ben Cao Tu Jing* also writes Dan. Abdominal distension is written as abdominal bloating.)
Note: Fever with paradoxical aversion to cold: *Yi Zong Jin Jian* is correct; You Zaijing's annotation is questionable.
Note: This condition originates from deficiency but involves water retention causing abdominal fullness, hence termed difficult to treat. In Zhang Zhongjing's works, "difficult to treat" appears seven times in *Shang Han Lun* and five times in *Jin Gui Yao Lue*. It generally implies mixed cold-heat and deficiency-excess patterns requiring cautious, non-uniform treatment. One should ponder this deeply. (I wrote *Shi Xu Lun* with detailed explanations, recorded in *Yao Zhi Tong Yi*; please refer to it.)
Xiao Shi Fan Shi San Prescription (*Ben Cao Tu Jing* citation: Calcined Nitre until yellow; Burn Alum until juices dry. Mix equal parts, sift through fine silk, mix with barley gruel, take one cun cube daily three times. Cover with heavy clothing to induce slight sweating. Disease exits via stool and urine; urine turns normal yellow, stool turns normal black. Use hulled barley.)
Note: Using barley gruel in this formula parallels using rice kernels with Gypsum. *Yao Xing Lun* states: Nitre is the sovereign drug, incompatible with Azurite, and fears gruel.
*Ben Cao Gang Mu* states: Green Vitriol dries dampness, transforms phlegm, promotes urination, and reduces food stagnation. Hence, formulas for bloating, yellow swelling, malaria, dysentery, and infantile malnutrition often use it. Its origin traces back to Zhang Zhongjing's use of Alum and Nitre for Nu Lao Jaundice.
*Sheng Ji Zong Lu*: For red-white dysentery, Fan Shi Wan. White Alum (4 liang), Nitre (1.5 liang), pounded to powder. Soak steamed bread heart in rice vinegar, pill like wutong seeds. Take 10 pills on an empty stomach with rice drink.
Wei Shi's *Jia Zang Fang*: Xiao Fan Yuan, for chronic dark wind epilepsy.
To this base formula (Nitre 0.5 liang, Calcined Alum 1 liang), add Red Halloysite (2 liang calcined), pound to fine powder, make pills with glutinous rice gruel, size of mung beans. Take 15 pills after meals with warm water, three times daily.
For attacks occurring once a day, take for half a month to eradicate the root.
Wine Jaundice, with internal restlessness (Ao Nao). (First sentence in *Wai Tai Mi Yao* reads "Wine Dan".)
Note: This is the treatment for the previous item regarding the deep-stringy pulse.
Zhi Zi Da Huang Tang Prescription (Song Edition, *Wai Tai Mi Yao*: Gardenia 7 pieces, split; Immature Bitter Orange broken, soaked in water, roasted; Fermented Soybean 1 sheng, wrapped in silk. Divide into three warm doses. Remove dregs, warm 7 he per dose, three times daily.)
For all patients with jaundice, promoting urination is the primary approach.
Note: Gui Zhi Jia Huang Qi Tang syndrome involves Dampness constrained at the exterior. It differs from the "smoked-yellow" complexion of Dampness patients in terms of Yin-Yang distinction.
For all types of jaundice, Zhu Gao Fa Jian (Pig Fat and Hair Decoction) is indicated.
Note: Zhao Shi cited *Shang Han Lei Yao* to prove this item relates to Blood Dryness, but his explanation was verbose and inaccurate, so it is not adopted.
Zhu Gao Fa Jian Prescription
*Tai Ping Sheng Hui Fang*: Treats jaundice with yellow eyes/ears, indigestion, and gastric bloating-heat. This indicates dry feces in the intestines; this formula is suitable.
Refine Pig Fat, 5 liang. Take half a large spoonful each time, frequently administer with Scallion White Decoction, stopping when bowel movements normalize.
Shen Shi's *Zun Sheng Shu* states: Cases where appropriate medicines fail, presenting with yellow eyes/ears and indigestion, indicate dry feces in the Stomach. Drink boiled pig lard, dosage depending on constitution (one cup or half cup), three times daily, until dry feces pass, then cure.
Jaundice Disease, treated with Yin Chen Wu Ling San.
Note: This item does not specify the type of jaundice, likely a mild case of Grain Jaundice, or perhaps caused by internal Dampness constraint?
Jaundice with abdominal fullness, obstructed urination, and reddish urine.
Note: This item does not specify the type of jaundice, likely the most severe case of Grain Jaundice. Spontaneous sweating indicates interior Heat steaming outward. Commentators interpreting this as "Exterior Harmony" is incorrect. This condition belongs to Interior Excess; thus, "Exterior Harmony" is cited to prove that spontaneous sweating is not due to Exterior Pathogens.
Da Huang Xiao Shi Tang Prescription (*Qian Jin Fang*: Nitre written as Mang Xiao/Mirabilite, hard to follow. Song Edition, *Wai Tai Mi Yao*: Decoct to 2.5 sheng, remove dregs, add Nitre, decoct again to 1 sheng. Take on an empty stomach in one dose.)
Note: Neither Xiao Shi Fan Shi San nor this formula uses Mang Xiao (Mirabilite/Glauber Salt) but uses Xiao Shi (Nitre). Mang Xiao is moistening and unsuitable for Damp-Heat; thus, the drying and purging nature of Fire Nitre is chosen. From this, we see that modern physicians replacing Mang Xiao with Nitre in Cheng Qi Tang for Yangming disease fail to deeply study classical principles.
Jaundice Disease, urine color unchanged, desire for spontaneous diarrhea.
[Zhu Gong] This is Jaundice with Middle Qi Deficiency-Cold. Unchanged urine color indicates no current Heat obstruction, showing Deficient-Cold signs. If accompanied by spontaneous diarrhea, abdominal fullness, and wheezing, it indicates Turbid Evil reversing upward and Clear Qi failing to ascend. Physicians might mistake abdominal fullness and wheezing for Excess-Heat and mistakenly use cold herbs, worsening Stomach failure and causing hiccup. Use Xiao Ban Xia Tang to warm and unblock the Upper Jiao to stop reversal and hiccups, followed by gradual Spleen-Stomach regulation.
Note: *Yang Ming Pian* states: "Yangming disease, inability to eat, attacking heat causes hiccups. Why? Stomach deficiency-cold. Because the person is fundamentally deficient, attacking heat causes hiccups." This shares the same mechanism as this item.
*Sheng Hui Fang*: Treats Yin Jaundice with unchanged urine color, desire for diarrhea but inability, abdominal fullness, wheezing, and hiccups. For hiccups, use Xiao Ban Xia Tang.
Add Ginseng and Pueraria to this base formula.
Male Yellowing, with spontaneous urination.
[Zhao Yi De] Male yellowing must result from internal deficient-heat. Paradoxically presenting with spontaneous urination indicates no Heat in Middle/Lower Jiao; only Floating Deficient Yang causes yellowing. (Note: "Sunken" is suspected to be a typo for "Floating"). Therefore, tonify Zheng Qi with formulas for Deficiency Consumption. When Zheng Qi is robust, Ying-Wei and Yin-Yang harmonize, and yellowing heals.
Note: Zhao Shi is correct. This describes the initial treatment of Nu Lao Dan. My late brother said: The previous item mentions heat in hands/feet, bladder urgency, and lower abdominal fullness. This item highlights spontaneous urination to allow inference of other symptoms. Comparing with *Xu Lao Pian*, bladder urgency and lower abdominal fullness correspond to You Shi's "Yang disease not harmonizing with Yin, allowing Yin Cold to act alone," causing interior urgency and abdominal pain, though not truly Yin Excess. Whole-body yellowing and hand/foot heat correspond to "Yin disease not harmonizing with Yang, allowing Yang Heat to act alone," causing irritability in extremities, though not truly Yang Flare-up. Yin-Yang disharmony generates external deficient heat. The so-called yellowing is not merely Earth color manifesting externally. Xiao Jian Zhong Tang is used to harmonize Yin and Yang, warming cold and harmonizing heat.
Attached Formulas
Gua Di Tang
*Wai Tai Mi Yao* cites *Yan Nian Mi Lu*: Treats Acute Jaundice with hardness above the heart, thirst for water, coarse breathing, and yellow eyes. If any symptom matches, administer Gua Di San immediately; vomiting leads to recovery.
Remove Fermented Soybean from Zhang Zhongjing's original formula.○ Also, Xu Ren Ze's formula uses Gua Di, Clove, and Adzuki Bean, pounded to powder, taken with fresh well water, one cun cube.
*Qian Jin Fang*: Ma Huang Chun Jiu Tang. (*Wai Tai Mi Yao*: Dan for Jaundice. *Ben Cao*, *Shang Han Lei Yao* citing Zhang Zhongjing's *Shang Han Lun*, text slightly differs from *Wai Tai*. 2.5 sheng written as 0.5 sheng, includes "remove dregs".)
[Yu Wu Yan Narrates]: Jaundice has Yin and Yang syndromes, and differences between Dampness dominance and Dryness dominance. Examining the classic text: Jiu Dan is Yang and Dryness-type, so treatment focuses on cooling; Nu Lao Dan is Yin and Dryness-type, so initial treatment harmonizes internally, later treatment moistens and guides; Gu Dan has both Yang and Yin. Yang is Damp-Heat, treated by draining; Yin is Cold-Damp, treated by warming and promoting urination. Later generations using Yin Chen with Fu Zi treat Cold-Damp. Is Yin Chen Wu Ling San a mild case of Damp-Heat yellowing? All these jaundices belong to Interior diseases. Gui Zhi Jia Huang Qi Tang syndrome involves Damp-Heat constrained at the Exterior, also a type of Yang Jaundice. Other jaundice items in *Shang Han Lun* complement this chapter. Students should study them comprehensively.