黄胆多属太阴脾经，脾不能胜湿，复挟火热，则郁而生黄，譬如 曲相似，以湿物而当暑月，又加
覆盖，湿热相搏，其黄乃成。经所谓湿热交攻，民当病疸是也。故疸病必先溺赤目黄。经曰∶溺黄赤
安卧者黄胆。溺赤为热之症，安卧为湿之症。又曰∶目黄者黄胆，目为宗脉之所聚，诸经有湿热，则上
蒸于目而为先黄矣。然湿与热，又自有别。湿胜之黄，色暗不明，热胜之黄，色光而润。治之大法，挟
表者脉浮。汗之而愈，葛根、薄荷、秦艽、淡豉之属。《金匮》云∶发于阳部，其人振寒而发热。又
云∶假令脉浮当以汗解之是也。挟里者腹胀，下之而安，茵陈蒿汤之属。《金匮》云∶黄家腹满，小便
不利而赤，自汗出，此为表和里实，当下之是也。因食伤者，则为谷疸。《金匮》云∶谷疸之病，寒热
不食，食即头眩。心胸不安，久久发黄，为谷疸是也。宜消食化滞，而佐以清热利湿之药。因酒伤
者，则名酒疸。《金匮》云∶心中懊 而热不能食，时欲吐，名曰酒疸是也。宜解酒毒，消食滞，而佐
以清热利湿之剂。有脉沉有力，少腹急结，小便自利，粪硬易解，其色黑者，此为瘀血发黄。宜犀角地
黄桃仁承气汤之属。亦有脉
沉细迟，身冷自汗，泻利溺白，此属脾肾虚寒，名曰阴黄。宜遵茵陈四逆汤之属。然疸病多属湿热。惟
罗谦甫则谓有因寒凉大过，阳疸变阴之症，此千百难逢一、二也。若夫因房劳伤肾而疸者，其症《金
匮》云∶额上黑，微汗出，手足热，薄暮即发热恶寒。〔肾阴虚也。〕膀胱急，少腹满，小便自利，大
便必黑时溏，名曰女劳疸。腹如水状不治。嘉言谓夫男子血化为精，精动则一身之血俱动，以女劳而倾其
精，血必继之。故因女劳而尿血者，其血尚行，犹易治也；因女劳而成疸者，血瘀不行，为难治矣。故
膀胱急，少腹满，小便自利，大便必黑时溏，种种皆膀胱蓄血之验。甚者血瘀之久，大腹尽满，而成血
盅，是先后天之根本俱败矣。故曰腹如水状，而实非水也。观仲景硝、矾二石，以消瘀除浊为主，用大
麦饮调服。引入肠胃，俾瘀血分从二便而出，盖非急去其膀胱少腹之瘀血，则万无生理，然不用虻、蛭
者，恐其过峻，不可以治女劳也。虞天民云∶若此症肾精久虚，元气惫极者，必当壮水之主，佐人参以
培气之原，随症以加行湿热之剂，则标本同治，或可收功。统言疸症，清热除湿利水为主，兼养胃气。因
食伤者，消其食积；因酒伤者，解其酒毒，因瘀血者，行其瘀血。虽有汗下之法，而汗法固难轻用，即
下法亦在所慎施。所以古人云∶治疸忌大汗大下，及温补燥热，并破气闭气等剂，不可不知。
茵陈治疸汤〔自制。〕《金匮》云∶黄家从湿得之。〔湿挟
火热，则郁而生黄。〕又云∶诸病黄家，但利其小便。此方加减。
茵陈 黄芩〔清热除湿。〕 黑山栀 滑石 茯苓 车前〔水利则湿自去。但用一味，
连根捣汁饮，神效。〕 橘红〔气化则湿自行。〕引用茅根，热甚加黄连，渴加麦冬、花粉，因
食伤加山楂、麦芽，因酒伤加煨葛根、甘蔗浆。
此方清热除湿，化气利水，宗仲淳治疸之法也。
经验治疸汤
生地〔三钱。〕 当归〔润其血燥。〕红花〔行其血瘀。〕 橘红 枳壳〔各一
钱。〕 浓朴〔消其积滞，八分。〕 黄芩〔二钱。〕 黄连〔清其湿热，五分，热甚量
加。〕 车前〔利其小水，二钱。〕 鹅毛菌陈、摇铃茵陈〔各五钱。〕煎汤〔一碗。〕 白
酒〔一碗。〕入药同煎。加炒砂仁。〔四分。〕冲服。
此方滋阴、活血、清热、利湿之剂。数剂之后，黄自渐退。
《金匮》猪膏发煎 通治诸黄。〔疸病皆由湿热郁蒸，日久阴血必耗，不论气分血分，皆宜兼滋其
阴。〕并治女劳疸，及黄汗病。〔汗出如柏汁，此由汗出入水，水从汗孔入所致。〕
猪膏〔通二便，除五疸。〕 乱发〔消瘀血，利小便，洗净各四两。〕 〔发和膏煎，发
消药成，分再服，病从小便出。〕女劳疸加生地 牛膝 鳖甲〔补阴消瘀。〕 花
粉〔除热疗疸。〕 女人经衣灰〔取类相从，气相感，能导邪热。〕皆应用之品。
此润燥、消瘀、利水之剂，而治湿热也。猪膏借血余之力，引入血分而润其血之燥，并借其力，
开膀胱瘀血，利其小水以除湿热。
黄胆湿热，洪数偏宜，不妨浮大，微涩难医。
疸而不渴者，其疸可治，疸而渴者，其疸难治。寸口近掌无脉，口鼻冷者死。疸毒入腹喘满者死。
黄疸多归属于太阴脾经，脾脏不能运化水湿，又夹杂火热之邪，导致湿热郁结而发黄，这就像制曲一样，用湿物在暑热月份，再加上覆盖，湿热相互搏结，黄色便形成了。《内经》所说的“湿热交攻，民众当患疸病”就是这个道理。所以疸病必然先出现小便赤黄、眼睛发黄的症状。《内经》说：“小便黄赤且嗜睡的是黄疸。”小便赤黄是热的症状，嗜睡是湿的症状。又说：“眼睛发黄的是黄疸”，眼睛是众多经脉汇聚的地方，各条经络若有湿热，就会上蒸于眼部而首先表现为眼黄。然而湿与热，又有区别。湿邪偏盛的黄疸，颜色晦暗不明；热邪偏盛的黄疸，色泽光亮润泽。治疗的大法中，兼有表证的脉象浮，用发汗法即可痊愈，可用葛根、薄荷、秦艽、淡豆豉这类药物。《金匮要略》说：“发于阳部的病，病人怕冷并发热。”又说：“假如脉浮，应当用发汗法解除”，就是这个意思。兼有里证的腹部胀满，用泻下法即可安宁，可用茵陈蒿汤这类方剂。《金匮要略》说：“黄疸病患者腹部胀满，小便不利且色赤，自汗出，这是表证已解而里实证，应当用泻下法”，就是这个意思。因饮食损伤脾胃导致的，称为谷疸。《金匮要略》说：“谷疸的病，恶寒发热，不想吃东西，一吃食物就头晕目眩，心胸不安稳，时间久了发黄，这就是谷疸。”适宜消食导滞，并辅助以清热利湿的药物。因饮酒过度损伤导致的，称为酒疸。《金匮要略》说：“心中烦闷懊恼且发热，不能进食，时常想呕吐，称为酒疸”，就是这个意思。适宜解酒毒，消食滞，并辅助以清热利湿的药剂。如果脉象沉而有力，少腹拘急硬结，小便自利，大便干硬但容易排出，颜色发黑，这是瘀血发黄。适宜用犀角地黄桃仁承气汤这类方剂。也有脉象沉细迟，身体寒冷自汗，腹泻且小便清白，这属于脾肾虚寒，称为阴黄。适宜遵循茵陈四逆汤这类方剂治疗。然而疸病多属湿热。只有罗谦甫认为有因寒凉药使用过度，导致阳疸转变为阴症的情况，这在千百例中难得遇到一二例。至于因房劳伤肾而患疸病的，其症状《金匮要略》说：“额头发黑，微微出汗，手足发热，傍晚时即出现发热恶寒。（这是肾阴虚。）膀胱拘急，少腹胀满，小便自利，大便必定发黑且时而稀溏，称为女劳疸。腹部像有水状者难治。嘉言（张景岳）说：男子血液化为精液，精液妄动则全身血液随之而动，因女劳而耗竭精液，血液必然继之受损。所以因女劳而尿血的，血液尚能运行，还比较容易治疗；因女劳而成黄疸的，血液瘀滞不行，就难以治疗了。所以膀胱拘急，少腹胀满，小便自利，大便必黑且时而稀溏，种种表现都是膀胱蓄血的验证。严重的甚至瘀血日久，大腹全部胀满，形成血蛊，这是先后天根本都败坏了。所以说腹部像有水状，但实际上并不是水。观察仲景用硝石、矾石两味矿物药，以消除瘀血、清除浊邪为主，用大麦汁调服。引入肠胃，使瘀血分从大小二便排出，如果不紧急去除膀胱和少腹的瘀血，就完全没有生机，然而不用虻虫、水蛭等药，是担心药性过于峻猛，不可以用来治疗女劳疸。虞天民说：如果是这种病症，肾精久虚，元气极度疲惫的，必须壮水之主（滋补肾阴），佐以人参来培补气的本源，随症加入行湿热之剂，则标本同治，或许可以收到功效。统而言之，疸症的治疗以清热除湿利水为主，兼养胃气。因饮食损伤的，消除其食积；因饮酒损伤的，解除其酒毒；因瘀血的，行散其瘀血。虽然有发汗和泻下的方法，但发汗法固然难以轻易使用，即使泻下法也应当谨慎施用。所以古人说：治疗黄疸忌讳大汗、大下，以及温补燥热，还有破气、闭气等药剂，不可不知道。
茵陈治疸汤〔自制〕。《金匮要略》说：“黄疸患者从湿邪得病。”〔湿邪夹杂火热，则郁结而生黄。〕又说：“各种黄疸病患者，只要通利小便。”此方在此基础加减。
茵陈 黄芩〔清热除湿。〕 黑山栀 滑石 茯苓 车前〔水利则湿自去。若只用一味，连根捣汁饮用，神效。〕 橘红〔气化则湿自行。〕引用茅根，热甚加黄连，口渴加麦冬、花粉，因饮食损伤加山楂、麦芽，因饮酒损伤加煨葛根、甘蔗浆。
此方清热除湿，化气利水，遵循仲淳治疗黄疸的方法。
经验治疸汤
生地〔三钱。〕 当归〔润其血燥。〕红花〔行其血瘀。〕 橘红 枳壳〔各一钱。〕 浓朴〔消其积滞，八分。〕 黄芩〔二钱。〕 黄连〔清其湿热，五分，热甚量加。〕 车前〔利其小水，二钱。〕 鹅毛菌陈、摇铃茵陈〔各五钱。〕煎汤〔一碗。〕 白酒〔一碗。〕入药同煎。加炒砂仁。〔四分。〕冲服。
此方是滋阴、活血、清热、利湿的药剂。服用数剂之后，黄色自然渐渐消退。
《金匮要略》猪膏发煎 通治诸黄。〔疸病皆由湿热郁蒸，日久阴血必然耗损，不论气分血分，都适宜兼滋其阴。〕并治疗女劳疸，及黄汗病。〔汗出如柏树汁，这是由于汗出时入水，水从汗孔进入所致。〕
猪膏〔通二便，除五疸。〕 乱发〔消瘀血，利小便，洗净各四两。〕 〔发与膏同煎，发消药成，分两次服用，病邪从小便排出。〕女劳疸加生地 牛膝 鳖甲〔补阴消瘀。〕 花粉〔除热疗疸。〕 女人经衣灰〔取类相从，气相感，能导邪热。〕都是应用的药材。
此方是润燥、消瘀、利水的药剂，而用于治疗湿热。猪膏借助血余的力量，引入血分而滋润血的干燥，并借助其力量，开通膀胱瘀血，利其小便以除湿热。
黄疸湿热，脉象洪数偏宜，不妨见浮大脉，若见微涩脉则难医。
患疸而不口渴的，其疸可治；患疸而口渴的，其疸难治。寸口脉搏摸不到，口鼻冰冷的死。疸毒入腹气喘胀满的死。
Jaundice mostly belongs to the Taiyin Spleen Meridian. When the Spleen fails to overcome dampness and additionally harbors heat-fire, damp-heat stagnates and generates yellowing, similar to the process of making koji: wet materials exposed to summer heat and covered up, where damp-heat contend with each other, resulting in yellow color. This corresponds to the Classic saying, "When damp-heat attack mutually, the people shall suffer from jaundice." Therefore, jaundice must first present with red urine and yellow eyes. The Classic states: "Red urine accompanied by a desire to lie down indicates jaundice." Red urine is a symptom of heat; lying down (lethargy) is a symptom of dampness. It also states: "Yellow eyes indicate jaundice." The eyes are the gathering point of numerous meridians; if damp-heat exists in various meridians, it steams upward to the eyes, causing yellowing there first. However, dampness and heat have their distinctions. Jaundice dominated by dampness has a dark and dull color; jaundice dominated by heat has a bright and lustrous color. In general treatment principles, if accompanied by exterior syndrome, the pulse is floating. Recovery can be achieved through sweating methods, using herbs such as Puerariae Radix (Gegen), Menthae Haplocalycis Herba (Bohe), Gentianae Macrophyllae Radix et Rhizoma (Qinjiao), and Fermented Soybean (Danchi). The *Jin Gui Yao Lue* states: "Diseases originating in the Yang aspect manifest with chills and fever." It further states: "If the pulse is floating, it should be resolved through sweating," which refers to this principle. If accompanied by interior syndrome with abdominal distension, relief can be achieved through purgation, using formulas such as Yinchen Hao Tang. The *Jin Gui Yao Lue* states: "In cases of jaundice with abdominal fullness, difficult urination with red urine, and spontaneous sweating, this indicates the exterior is resolved but the interior is excess; it should be treated with purgation," referring to this principle. Caused by food injury, it is called Grain Jaundice (Gu Dan). The *Jin Gui Yao Lue* states: "The disease of Grain Jaundice presents with alternating chills and fever, anorexia, dizziness after eating, mental restlessness, and eventual yellowing over time, which is Grain Jaundice." Treatment should focus on resolving food stagnation, assisted by herbs that clear heat and promote diuresis to remove dampness. Caused by alcohol injury, it is called Wine Jaundice (Jiu Dan). The *Jin Gui Yao Lue* states: "Vexation and heat in the heart, inability to eat, and frequent urge to vomit constitute Wine Jaundice." Treatment should resolve alcohol toxicity and food stagnation, assisted by agents that clear heat and promote diuresis to remove dampness. If the pulse is deep and forceful, with acute binding in the lower abdomen, free urination, hard stools that are easy to pass, and black color, this is jaundice due to blood stasis. Treatment should use formulas such as Xijiao Dihuang Tao Ren Chengqi Tang. There are also cases with a deep, fine, and slow pulse, cold body with spontaneous sweating, diarrhea, and white urine, belonging to Spleen and Kidney Deficiency-Cold, named Yin Jaundice. Treatment should follow formulas such as Yinchen Sini Tang. However, jaundice mostly belongs to damp-heat. Only Luo Qianfu stated that there are cases where excessive use of cold-cooling herbs causes Yang Jaundice to transform into Yin syndrome, which is rare, occurring once or twice in thousands of cases. As for jaundice caused by sexual exhaustion injuring the Kidney, the symptoms described in the *Jin Gui Yao Lue* are: "Black forehead, slight sweating, hot hands and feet, fever and chills starting at dusk. [This is Kidney Yin Deficiency.] Urgency of the Bladder, fullness of the lower abdomen, free urination, and stools that are necessarily black yet occasionally loose, named Woman-Labor Jaundice (Nv Lao Dan). Abdominal distension resembling water accumulation is untreatable. Jiayan [Zhang Jingyue] said: Men's blood transforms into essence; when essence moves, the blood of the whole body moves. Depleting essence through woman-labor causes subsequent damage to blood. Therefore, hematuria caused by woman-labor, where blood still flows, is relatively easy to treat; jaundice formed from woman-labor, where blood is stagnant and does not flow, is difficult to treat. Thus, urgency of the Bladder, fullness of the lower abdomen, free urination, and black, occasionally loose stools are all signs of Blood Accumulation in the Bladder. Severe cases involve long-term blood stasis leading to total abdominal distension, forming Blood Gu, indicating the failure of both Pre-heaven and Post-heaven roots. Hence, it is said that the abdomen resembles water, but it is actually not water. Observing Zhang Zhongjing's use of Nitrum (Xiaoshi) and Alum (Fan) to eliminate stasis and turbidity, taken with Barley Decoction, introduces the remedy into the intestines and stomach, allowing stasis to exit via both bowels. Without urgently removing the stasis from the Bladder and lower abdomen, there is no hope. However, Maggot (Meng) and Leech (Zhi) are not used, fearing their action is too harsh for treating woman-labor jaundice. Yu Tianmin said: For such cases with long-term Kidney Essence deficiency and extreme Qi exhaustion, one must strengthen the master of Water [nourish Kidney Yin], assist with Ginseng Radix et Rhizoma (Renshen) to cultivate the source of Qi, and add damp-heat resolving agents according to symptoms, achieving simultaneous treatment of root and branch, possibly yielding results. Generally speaking, jaundice treatment focuses on clearing heat, removing dampness, and promoting diuresis, while supporting Stomach Qi. For food injury, resolve food accumulation; for alcohol injury, resolve alcohol toxin; for blood stasis, move blood stasis. Although sweating and purging methods exist, sweating is rarely used lightly, and purging must also be applied cautiously. Thus, ancients said: Treating jaundice contraindicates heavy sweating, heavy purging, warming-tonifying dry-hot herbs, and qi-breaking or qi-stagnating agents; this must be known.
Yinchen Zhidan Decoction [Self-made]. The *Jin Gui Yao Lue* states: "Jaundice arises from dampness. [Dampness mixed with heat-fire leads to stagnation and yellowing.]" It also states: "For all jaundice patients, simply promote urination." This formula is modified based on this.
Yin Chen Hao (Artemisiae Scopariae Herba), Huang Qin (Scutellariae Radix) [Clear heat and remove dampness], Hei Shan Zhi (Gardeniae Fructus), Hua Shi (Talcum), Fu Ling (Poria), Che Qian Cao (Plantaginis Herba) [Promoting urination removes dampness naturally. Using only one herb, crushed with roots and drunk, yields miraculous effects], Ju Hong (Citri Reticulatae Pericarpium Rubrum) [Qi transformation allows dampness to move naturally]. Reference Mugen Gen (Imperatae Rhizoma); add Huang Lian (Coptidis Rhizoma) for severe heat; add Maidong (Ophiopogonis Radix) and Huafen (Trichosanthis Radix) for thirst; add Shanzha (Crataegi Fructus) and Maiya (Hordei Fructus Germinatus) for food injury; add Wei Gegen (Puerariae Radix Preparata) and Ganshe Jiang (Sacchari Sinarum Liquamen) for alcohol injury.
This formula clears heat, removes dampness, transforms Qi, and promotes diuresis, following Zhongchun's method for treating jaundice.
Experience Zhidan Decoction
Sheng Di Huang (Rehmanniae Radix) [3 qian. Nourishes Yin and moistens blood dryness], Dang Gui (Angelicae Sinensis Radix) [Moistens blood dryness], Hong Hua (Carthami Flos) [Moves blood stasis], Ju Hong (Citri Reticulatae Pericarpium Rubrum), Zhi Ke (Aurantii Fructus) [1 qian each], Hou Po (Magnoliae Officinalis Cortex) [Resolves stagnation, 8 fen], Huang Qin (Scutellariae Radix) [2 qian], Huang Lian (Coptidis Rhizoma) [Clears damp-heat, 5 fen, increase dosage if heat is severe], Che Qian Zi (Plantaginis Semen) [Promotes urination, 2 qian], E Mao Jun Chen (Artemisiae Scopariae Herba variant), Yao Ling Yin Chen (Artemisiae Scopariae Herba variant) [5 qian each]. Decoct in water [1 bowl] and Baijiu [1 bowl]. Add Chao Sha Ren (Amomi Fructus Rotundus Preparatus) [4 fen], take with decoction.
This formula nourishes Yin, invigorates blood, clears heat, and removes dampness. After several doses, the yellowing will gradually recede.
*Jin Gui Yao Lue* Pig Fat and Hair Decoction treats all types of jaundice generally. [Jaundice arises from damp-heat stagnation; over time, Yin and Blood are consumed. Regardless of Qi or Blood level, nourishing Yin is appropriate.] It also treats Woman-Labor Jaundice and Yellow Sweat Disease. [Sweat like paulownia sap juice, caused by entering water while sweating, allowing water to enter through pores.]
Zhu Gao (Pinguinis Porci) [Opens both bowels, eliminates five types of jaundice], Luan Fa (Capillis Humanis) [Eliminates blood stasis, promotes urination, washed clean, 4 liang each]. [Simmer hair with fat until hair dissolves and medicine forms; divide into two doses; pathogen exits via urination.] For Woman-Labor Jaundice, add Sheng Di Huang (Rehmanniae Radix), Niu Xi (Achyranthis Bidentatae Radix), Bie Jia (Testudinis et Testae Carapacis et Plastrum) [Tonify Yin and eliminate stasis], Fen Liang (Trichosanthis Radix) [Clears heat and treats jaundice], Nu Ren Jing Yi Hui (Ash of Menstrual Cloth) [Similarity attracts similarity, Qi resonates, guides out pathogenic heat]. These are applicable ingredients.
This is a formula for moistening dryness, eliminating stasis, and promoting diuresis, used here to treat damp-heat. Pig Fat borrows the power of Hair to enter the Blood level and moisten blood dryness, and uses its power to open Bladder stasis and promote urination to remove damp-heat.
For jaundice with damp-heat, a surging and rapid pulse is favorable; a floating and large pulse is acceptable, but a minute and choppy pulse is difficult to treat.
Jaundice without thirst is treatable; jaundice with thirst is difficult to treat. Absence of pulse at the Cun position near the palm, with cold mouth and nose, indicates death. Jaundice toxin entering the abdomen with wheezing and fullness indicates death.