如水状。大便必黑。时溏。此女劳之病。非水也。腹满者难治。硝矾散主之。
硝石矾石散方 硝石 矾石（烧各等分）
上二味。为散。以大麦粥汁。和服方寸匕。日三服。病从大小便去。小便正黄。大便正黑。是其候也。
此申言女劳疸之症候治例也。言发黄之家。但凡薄暮而日将晡时。便发热者。大似阳明胃实之症。然胃实
者。法当恶热。而此则反恶寒者。此为阴虚于阴分。至其时而相火以无附而充炽。真阴不支亢烈。故发热。卫
气不胜邪火。故恶寒。谓非得之女劳。不至此也。膀胱急十二句。所言诸症。见三条注。硝石咸寒降润。矾石酸
凉敛抑。以之主火气飞扬之候。允为至当。但酸咸之性。易于趋下。故以填心益气之大麦。作粥汁而和服之。
欲其少为留恋。俾矾石刮垢磨光之性。徐徐澄彻而下。则热随黄黑。从大小便而俱去矣。但三条曰腹如水
状不治。此条曰腹满者难治。是女劳疸病。诸症具而腹不满者。生。满甚而如水肿状者。死。腹若已满。虽不甚。
而生死即相半矣。此仲景论女劳疸之深意也。
十七条 酒黄胆。心中懊 。或热痛。栀子大黄汤主之。
栀子大黄汤方 栀子（十四枚） 大黄（一两） 枳实（五枚） 豉（一升）
上四味。以水六升。煮取二升。分温三服。
此申言酒疸之症候治例也。心中懊 而热。见四条注。痛则热气 炙。而腔内悬强拘急之应。然即六条注
中。所谓热从浮见。浮则上炎之应。故以苦寒之栀子。降膻中之热。苦寒之枳实。散胸中之滞。重用香豉者。所
以滋胃液也。佐以大黄者。所以下胃热也。但亦凭高润下之剂。热黄从大小便去者居多。旧注。谓为吐剂。则
失之远矣。按前人误谓栀豉汤能吐者。因瓜蒂散中重用香豉。遂认吐为香豉之性。殊不知吐由瓜蒂。赤小
豆特引瓜蒂。少为下行之使。香豉。用以滋阴安胃。恐吐后致烦。故预为伏案耳。详瓜蒂散本注。愿天下同志。
留神试用。同为剥正。不令仲景叫冤。栀豉抱屈。则幸甚矣。
十八条 诸病黄家。但利其小便。假令脉浮。当以汗解之。宜桂枝加黄 汤主之。（方见水门。）
自此。至篇终。凡七条。因疸、而广论诸黄之治例也。诸病黄家。皆系湿热。小便利。则湿去而热亦随之。故以利
小便为法也。假令脉浮。则湿热在上在表。又当以汗解之。为便道矣。盖桂枝本汤。泄汗以解热。加黄 、以助
卫气。而送湿出表。故宜主之。利小便。不特十五条之茵陈蒿汤。十九条之膏发煎。二十条之茵陈五苓散。凡
水饮门之渗泄诸方。俱在其中。门人问曰。黄症俱由热湿。故疸病诸方。多用苦寒咸寒。及克削之品。既闻
其义矣。本条曰诸病黄家。则疸症似亦在内。而独主辛温而热之桂枝汤。并加补气之黄 。以主脉浮者。不
虞其热以济热者。敢问何说耶。答曰。仲景之书。每条各有主症主见。苟不求其立言之旨。与方治针锋逼对
处。则问津无路矣。盖本条以卫气外虚。而先招湿水之候。湿水生热。湿热郁于皮肤经络而发黄者。是卫虚、
为第一层病。湿、为第二层病。热、为第三层病。请问卫气虚者。有不宜桂枝之辛温。及黄 之补益者乎。且热
在湿中。湿为本而热为虚假之标病。则遵汗例以去湿者为本治。而热自无所容矣。下文十九条。为津血虚
而生热之黄。二十条、为胸先热而招内水。及久蓄化热之黄。二十一条、为中焦热实。上冲下结之黄。二十三
条、为中焦热实。不冲中路胃脘。而冲两旁胁下之黄。二十二、二十四、两条。上焦之宗气虚劳。不能传送。因而
便难。渐致下结上浮之黄。病因不同。故其主治亦别也。
十九条 诸黄。猪膏乱发煎主之。
猪膏乱发煎方 猪膏（半斤） 乱发（如鸡子大三枚）
上二味。和膏中煎之。发消药成。分再服。病从小便去。
诸黄中又有一种津血短少。而阳气偏胜者。夫津血短少。则勾留水气而生湿。阳气偏胜。则郁蒸火气而生
热。是湿热又以津血虚竭为本病矣。则滋津血以替湿。而湿自下行。养阴血以润气。而气自流转。湿热去。而
黄将自散也。猪膏、生津。乱发、补血。其主之也宜矣。
二十条 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。先饮食。服方寸匕、日三服。
诸黄中。又有一种先因热而致水。后又积水。而更化热者。先因热起。故从黄胆之病例而曰黄胆。亦从黄胆
之治例而主茵陈。此热黄、水黄相兼之症。故从两治也。茵陈及五苓散义。各别见。
二十一条 黄胆。腹满。小便不利而赤。自汗出。此为表和里病。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。
但凡黄家。俱是毛窍闭塞。小便不利。湿热交盛于上下内外之所致。然惟湿黄、水黄如此。以汗出。则水湿之
势。泄于上与外。小便利。则水湿之势。泄于下与内故也。若夫疸病。起于热因。内热既盛。则虽有汗。而在内之
热不减。故仍作黄候也。盖谓疸病。又有一种不横传于表。其热但在中焦。因而上侵胸膈。下彻肝肾。而作直
竖之症者。如腹满、为里湿之应。小便不利而赤。为里热之应。是里病矣。里病湿热。法当外传于表。今自汗出。
则其经络皮毛。无郁热而表和。夫表和里病者。当以下之、为正治矣。主本汤者。因实热在中焦。故以苦寒之
大黄。咸寒之硝石。从承气攻下之例。且中热者。必上熏阳位。故加善走膻中之栀子以降之。又中热者。必下
贯至阴。故加阴沁肝肾之黄柏以坚之。至咸以胜热。苦以燥湿。又其余蕴也。
二十二条 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。（方见痰饮。）
此
言黄胆。又有一种下焦无热。故小便不变色而淡白。中焦无热。故大便欲自利而不实。但以脾气湿重而腹
满。膈气劳热而肺喘者。以劳热与湿气相蒙。久亦成疸故也。但此为因劳而神火浮动。故生虚假之热。与彼
热实者不同。故不可用攻下以除其热也。热除。则膈虚胃寒。以寒犯虚。故知其必哕矣。哕者主小半夏汤。以
其能填胸温胃。降逆除寒。而哕可平。故主之。汤意详饮门注。
二十三条 诸黄。腹满而呕者。宜柴胡汤。（大小柴胡汤方。俱别见。）
诸黄、是兼黄胆、黄家而言。宜柴胡汤。是兼大小柴胡而言。此总言先热后湿之疸。先湿后热之黄。流贯少阳
之症治也。腹满已见。少阳得热。则从胁下而上逆。故其症善呕。但热疸湿黄。二者俱有此症。盖因热召湿之
疸症。脾胃率多热实。脾胃热实之气。偏从腹之两旁而上熏于胁。便是少阳之部。因湿生热之黄家。胸膈率
多湿热。胸膈湿热之气。偏从胸之两旁而横溢于胁。亦是少阳之部。故皆能致呕。但曰宜柴胡汤、而不指明
大小柴胡者。因疸、以热为本。而湿为标。治热。宜攻下。则主大柴。黄、以湿为本。而热为标。治湿。宜发汗。则主
小
柴。欲俟人之神而明之耳。大小柴胡汤意。俱别见。
二十四条 男子黄。小便自利。当与虚劳小建中汤。（方见虚劳。）
此因前二十二条。但立救误之方。而无正方。故补言之也。小便自利。即前条色不变之义。盖膀胱得热。则癃
闭。而其色黄赤。利、则不变者。即在其中矣。但小便自利。则热泄湿减。安得发黄。故知此黄。为宗气因虚致劳。
幻生假热者所致。是宜以辛温之小建中汤。填其在天之气。则太阳朗照。而龙雷之阴火。岚气之阴湿。自当
伏藏消散矣。女子黄。小便自利。大概产后及崩漏者多。故不得以虚劳为诊。此症之黄。淡而不焦。俗名
乏力黄者、即是。妇人无用力之任。故无此病也。
像水胀的样子。大便必定发黑，时而稀溏。这是女劳疸的病证，不是水气病。如果腹部胀满的，难以治愈。用硝矾散主治。
硝石矾石散方：硝石、矾石（烧制后各取等分）。
以上两味药，研成散剂。用大麦粥汁调和，每次服用一方寸匕，每日三次服药。病邪从大小便排出，小便颜色正黄，大便颜色正黑，就是病愈的征候。
这里进一步阐述女劳疸的症状表现和治疗法则。说那些发黄的患者，凡是傍晚时分（日将晡时），就出现发热的，很像阳明胃实证的病症。然而，如果是胃实证，按照法度应当恶热，而此症反而恶寒，这是因为阴分阴虚，到了那个时辰，相火因为没有依附而亢盛炽烈，真阴无法支撑这种亢烈的火势，所以发热；卫气不能抵御邪火，所以恶寒。说是因为得了女劳疸，才导致这样的状况。膀胱急迫等十二句中所说的各种症状，参见第三条的注释。硝石性咸寒，具有降润的作用；矾石性酸凉，具有收敛抑制的作用，用来主治火气飞扬的症状，确实是非常恰当的。但是酸咸之性容易趋向下行，所以用能补益心气的麦作粥汁来调和服用，想要让它稍微停留片刻，使得矾石刮垢磨光的药性，慢慢地澄清透彻地向下运行，那么热邪随着黄色和黑色，从大小便一起排出去。但是第三条说腹如水状的不治，这一条说腹满的难治，这说明女劳疸病，诸症具备而腹部不胀满的，可生；胀满严重且像水肿状的，死；腹部如果已经胀满，虽然不严重，但生死也就各占一半了。这是张仲景论述女劳疸的深意啊。
栀子大黄汤方：栀子（十四枚）、大黄（一两）、枳实（五枚）、豆豉（一升）。
以上四味药，用水六升，煮取二升，分三次温服。
这里进一步阐述酒疸的症状表现和治疗法则。心中烦闷懊恼而热，参见第四条注释。疼痛则是热气熏灼，导致胸中悬强拘急的反应。然而正如第六条注释中所述，所谓热象从浮脉显现，浮脉则是热邪上炎的反应。所以用苦寒的栀子，来降膻中之热；用苦寒的枳实，来散胸中之滞。重用香豉的原因，是用来滋养胃液。佐以大黄的原因，是用来下泄胃热。但这终究是凭借高源之水润泽下流的药剂，热黄大多从大小便排出。旧注解说这是吐剂，那就差得太远了。按前人误认为栀豉汤能催吐，是因为瓜蒂散中重用了香豉，于是把催吐认为是香豉的药性。却不知道催吐是由瓜蒂引起的，赤小豆只是引导瓜蒂，稍微作为下行的使者，香豉是用来滋阴安胃的，恐怕吐后导致烦躁，所以预先为伏案（治疗）做准备罢了。详细查看瓜蒂散的原本注释，希望天下志同道合的人，留心尝试使用，共同剥去谬误，纠正正道，不让张仲景叫冤，让栀豉抱屈，那就是万幸了。
第十八条 所有患黄疸病的患者，只要通利小便即可。假如脉象浮，应当用发汗的方法解除，适宜用桂枝加黄芪汤主治。（方剂见水气病篇。）
从这里到本篇结束，共有七条，因为黄疸病而广泛论述各种黄疸的治疗法则。所有患黄疸病的患者，都系湿热所致，小便通利，则湿气去除而热邪也随之而去，所以以通利小便为法则。假如脉象浮，则湿热在上在表，又应当用发汗的方法解除，作为便利的途径。因为桂枝汤本身能泄汗以解热，加入黄芪，以助卫气，从而送湿气出表，所以适宜用它。通利小便，不仅仅是第十五条的茵陈蒿汤，第十九条的膏发煎，第二十条的茵陈五苓散，凡是水饮门中的渗泄各类方剂，都包含在其中。门人问：黄疸症状都是由热湿引起，所以疸病各方多用苦寒、咸寒及攻削的药物，我已经听到其中的道理了。本条说“所有患黄疸病的患者”，那么疸症似乎也包括在内，却唯独主张辛温而热的桂枝汤，并加上补气之黄芪，来主治脉浮者，不怕它用热来帮助热吗？请问这是什么说法呢？回答说：张仲景的书，每条都有主症和主见，如果不探求其立言的宗旨，以及方治与病情针锋相对之处，就没有入门的路径了。因为本条是由于卫气外虚，先招致湿水的症状，湿水生热，湿热郁结于皮肤经络而发黄，这是卫气虚是第一层病，湿是第二层病，热是第三层病。请问卫气虚者，难道不适宜用桂枝的辛温，以及黄芪的补益吗？况且热在湿中，湿是本，热是虚假的标病，那么遵循发汗法以去湿是本治，而热自然无处容身了。下文第十九条，是为津血虚而生热的黄疸；第二十条，是为胸先热而招致内水，以及久蓄化热的黄疸；第二十一条，是中焦热实，上冲下结的黄疸；第二十三条，是中焦热实，不冲中路胃脘，而冲两旁胁下的黄疸；第二十二条、二十四条，是上焦宗气虚劳，不能传送，因而大便困难，逐渐导致下结上浮的黄疸。病因不同，所以主治也不同。
猪膏乱发煎方：猪膏（半斤）、乱发（如鸡蛋大三枚）。
以上两味药，在膏中合煎，头发消溶药即成，分两次服用。病邪从小便排出。
各种黄疸中又有一种津血短少，而阳气偏胜的。津血短少，则留积水气而生湿；阳气偏胜，则郁蒸火气而生热。这样湿热又以津血虚竭为本病了。那么滋润津血以替代湿气，而湿气自然下行；养阴血以润气，而气自然流转。湿热去除，而黄疸将自行消散。猪膏生津，乱发补血，用它主治是适宜的。
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，先在饮食前，服用一方寸匕，每日三次。
各种黄疸中，又有一种先因热而导致水停，后又积水而更化热的。先因热起，所以从黄疸病的病例角度称为黄疸，也从黄疸的治疗法则角度主张用茵陈。这是热黄与水黄兼夹的症状，所以采用两方面的治疗方法。茵陈及五苓散的意义，各自另见注释。
第二十一条 黄疸，腹部胀满，小便不利且色赤，自汗出，这是表证和解里证，应当用攻下法，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，纳入硝石再煮，取一升，一次顿服。
凡是患黄疸病的，都是毛窍闭塞，小便不利，湿热交盛于上下内外所导致的。然而只有湿黄、水黄是这样，因为出汗，则水湿之势泄于上与外；小便通利，则水湿之势泄于下与内。至于疸病，起于热因，内热既然旺盛，那么虽然有汗，而在内的热并不减少，所以仍然呈现黄疸症状。可以说疸病又有一种不横传于表的，其热只在中焦，因此上侵胸膈，下彻肝肾，而作直竖的症状。如腹满，是里湿的反应；小便不利且色赤，是里热的反应，这是里病了。里病湿热，法度当外传于表，现在自汗出，则其经络皮毛没有郁热而表证已解。表解里病者，应当用攻下法为正治。主治本汤的原因，是因为实热在中焦，所以用苦寒的大黄、咸寒的硝石，遵循承气汤攻下的法度。而且中焦热者，必上熏阳位，所以加善于走膻中的栀子以降之；中焦热者，必下贯至阴，所以加浸润肝肾的黄柏以坚之。至于咸以胜热，苦以燥湿，又是其余蕴的意思。
第二十二条 黄疸病，小便颜色不变，想自行腹泻，腹部胀满且喘，不可除热，热除必呃逆，呃逆者，用小半夏汤主治。（方剂见痰饮篇。）
这里说黄疸病，又有一种下焦无热的，所以小便不变色而淡白；中焦无热的，所以大便想自行腹泻而不实。只是因为脾气湿重而腹部胀满，膈气劳热而肺喘，因为劳热与湿气相蒙蔽，久了也形成黄疸。但这因为是因劳而导致神火浮动，所以产生虚假的热，与那种热实证不同。所以不可用攻下法来除其热。热被除去，则膈虚胃寒，以寒犯虚，所以知道必然会出现呃逆。呃逆者主治小半夏汤，因为它能填胸温胃，降逆除寒，而呃逆可以平息，所以主治它。汤剂的用意详见痰饮门注释。
第二十三条 各种黄疸，腹部胀满且呕吐的，适宜用柴胡汤。（大、小柴胡汤方，俱另见。）
各种黄疸，是兼指黄疸病和黄家而言。适宜用柴胡汤，是兼指大、小柴胡汤而言。这里总述先热后湿的疸，先湿后热的黄，流贯少阳的症状治疗。腹满已见过，少阳得热，则从胁下而上逆，所以其症状善于呕吐。但热疸和湿黄，二者都有这个症状。大概因为热召湿的疸症，脾胃多属热实，脾胃热实之气，偏从腹部两旁而上熏于胁，便是少阳的部位；因湿生热的黄家，胸膈多属湿热，胸膈湿热之气，偏从胸部两旁而横溢于胁，也是少阳的部位。所以都能导致呕吐。但只说适宜用柴胡汤，而不指明是大柴胡还是小柴胡，是因为疸以热为本，而湿为标，治热适宜攻下，则主大柴胡；黄以湿为本，而热为标，治湿适宜发汗，则主小柴胡。想要等待人们的神妙明悟罢了。大、小柴胡汤的用意，俱另见注释。
第二十四条 男子黄，小便自利，应当给予虚劳小建中汤。（方剂见虚劳篇。）
这是因为前二十二条，只立下救误的方子，而没有正方，所以补充说明。小便自利，就是前条小便颜色不变的义理。大概膀胱得热，则癃闭，而其色黄赤；通利，则不变色的情况就在其中了。但小便自利，则热泄湿减，怎么能发黄呢？所以知道这个黄，是宗气因虚致劳，幻生假热所导致的。这适宜用辛温的小建中汤，填补其在天之气，则太阳朗照，而龙雷之阴火，岚气之阴湿，自然应当伏藏消散了。女子黄，小便自利，大多是产后及崩漏者多见，所以不能诊断为虚劳。此症的黄，淡而不焦，俗名乏力黄的，就是这种。妇人没有用力的职责，所以没有这个病。
Like water distension. The stool must be black, sometimes loose. This is the disease of female labor jaundice (Nü Lao Dan), not water qi disease. If there is abdominal fullness, it is difficult to treat. Xiao Fan San (Magnesia and Alum Powder) is the main treatment.
Xiao Shi Fan Shi San Formula: Xiao Shi (Sodium Nitrate), Fan Shi (Alum) (calcined, equal parts).
The above two ingredients are ground into a powder. Mix with barley porridge juice, take one Fang Cun Bi (a measure approx. 2.7 cm square) per dose, three times a day. The pathogen exits via urination and defecation; when urine becomes normally yellow and stool becomes normally black, this is the sign of recovery.
This further elaborates on the symptoms and treatment principles of female labor jaundice. It states that among those who have yellowing, if they experience fever whenever evening approaches (around dusk), it resembles the syndrome of Yangming Stomach Excess. However, in cases of Stomach Excess, according to the method, one should fear heat, whereas here one fears cold instead. This is because Yin deficiency in the Yin aspect leads to Ministerial Fire (Xiang Huo) becoming hyperactive and blazing due to lack of attachment at that time, causing True Yin to fail to withstand the fierce heat, thus resulting in fever; Wei Qi (Defensive Qi) cannot overcome the pathogenic fire, thus resulting in aversion to cold. It is said that without contracting female labor jaundice, one would not reach this state. The twelve sentences mentioning "bladder urgency" etc., describe various symptoms; see the annotation for Article 3. Xiao Shi is salty and cold, descending and moistening; Fan Shi is sour and cool, astringent and suppressing. Using them to govern the condition of flying fire qi is indeed very appropriate. However, the nature of sour and salty tends to move downward, so using barley, which fills the heart and benefits Qi, as porridge juice to mix and take it, intends to make it linger slightly, allowing the scum-scraping and polishing nature of Fan Shi to slowly clarify and descend thoroughly. Then, heat follows the yellow and black colors, exiting together from urination and defecation. But Article 3 says abdominal distension like water is incurable, while this article says abdominal fullness is difficult to treat. This indicates that for female labor jaundice, if all symptoms are present but the abdomen is not full, life is preserved; if fullness is severe and resembles edema, death ensues; if the abdomen is already full, even if not severe, life and death are equally probable. This is Zhang Zhongjing's profound meaning in discussing female labor jaundice.
Article 17: Wine Jaundice (Jiu Huang Dan), with mental restlessness and vexation (Ao Nu) or hot pain, is mainly treated with Zhi Zi Da Huang Tang (Gardenia and Rhubarb Decoction).
Zhi Zi Da Huang Tang Formula: Zhi Zi (Gardeniae Fructus, 14 pieces), Da Huang (Rhei Radix et Rhizoma, 1 liang), Zhi Shi (Aurantii Fructus Immaturus, 5 pieces), Chi Shao Dou Chi (Fermented Soybean, 1 sheng).
The above four ingredients are boiled in 6 sheng of water to obtain 2 sheng, divided into three warm doses.
This further elaborates on the symptoms and treatment principles of wine jaundice. Mental restlessness and vexation with heat are seen in the annotation for Article 4. Pain indicates heat burning, leading to a sensation of suspension, rigidity, and tension in the chest cavity. As mentioned in the annotation for Article 6, heat appearing via a floating pulse indicates an upward flare-up of heat. Therefore, bitter-cold Zhi Zi is used to descend heat in the Epigastrium (Tan Zhong); bitter-cold Zhi Shi is used to dissipate stagnation in the Chest. Heavy use of Fermented Soybean (Chi Dou Chi) is to nourish Stomach fluids. Adding Da Huang is to purge Stomach heat. Ultimately, these are agents relying on high-source water nourishing the lower flow; most hot yellows exit via urination and defecation. Old annotations claiming this is an emetic formula are far off. Predecessors mistakenly believed Zhi Zi Dou Chi Tang could induce vomiting because Fermented Soybean was heavily used in Gua Di San (Melon Peduncle Powder), leading them to attribute emesis to the nature of Fermented Soybean. They did not realize that emesis comes from Melon Peduncle (Gua Di); Coix Seed (Chi Xiao Dou) merely guides Melon Peduncle, acting slightly as a descending messenger. Fermented Soybean is used to nourish Yin and calm the Stomach, fearing post-emesis irritability, thus preparing in advance. Refer to the original annotation of Gua Di San. I hope all colleagues pay attention and try it, jointly stripping away errors and correcting the truth, so that Zhang Zhongjing does not cry injustice and Zhi Zi Dou Chi does not suffer grievance. That would be fortunate.
Article 18: All patients with jaundice should benefit from promoting urination. If the pulse is floating, it should be resolved by sweating; Gui Zhi Jia Huang Qi Tang (Cinnamon Twig Decoction plus Astragalus) is suitable. (Formula see Water Disease section.)
From here to the end of the chapter, there are seven articles in total, broadly discussing treatment principles for various yellows based on jaundice. All patients with jaundice involve damp-heat. When urination is free, dampness leaves and heat follows, so promoting urination is the method. If the pulse is floating, damp-heat is in the upper and exterior layers, requiring resolution by sweating as a convenient pathway. Gui Zhi Tang itself induces sweating to resolve heat; adding Huang Qi (Astragali Radix) assists Wei Qi to send dampness out to the exterior, hence it is suitable. Promoting urination includes not only Article 15's Yin Chen Hao Tang (Artemisiae Scopariae Decoction), Article 19's Gao Fa Jian (Pig Fat and Hair Decoction), and Article 20's Yin Chen Wu Ling San (Artemisiae Scopariae and Five-Ingredient Poria Pill), but also all seeping and draining formulas in the Fluid Retention section. A student asked: Jaundice symptoms arise from heat and dampness, so formulas for jaundice mostly use bitter-cold, salty-cold, and purgative items. Having heard the rationale, this article says "all patients with jaundice," implying jaundice is included, yet it uniquely advocates the acrid-warm and hot Gui Zhi Tang, plus Qi-tonifying Huang Qi, for floating pulses. Is there no concern about heat aiding heat? Please explain. The answer is: In Zhang Zhongjing's book, each article has its main symptom and perspective. If one does not seek the intent of the statement and the precise correspondence between formula and pathology, there is no way to enter. This article addresses a condition where exterior Wei Qi deficiency first attracts damp-water. Damp-water generates heat; damp-heat stagnates in skin and collaterals causing yellowing. Thus, Wei Qi deficiency is the first layer of disease, dampness is the second, and heat is the third. Would Wei Qi deficiency not suit Gui Zhi's acrid-warmth and Huang Qi's tonification? Moreover, heat exists within dampness; dampness is the root, and heat is a false branch. Following the sweating example to remove dampness treats the root, leaving no room for heat. Subsequent Article 19 deals with yellow caused by heat generated from fluid-blood deficiency; Article 20 deals with yellow where chest heat first attracts internal water, or long-standing retention transforms into heat; Article 21 deals with middle-jiao heat-excess, ascending and descending blockage; Article 23 deals with middle-jiao heat-excess attacking the flanks rather than the stomach; Articles 22 and 24 deal with upper-jiao Zong Qi deficiency and consumption, inability to transport, leading to difficulty in defecation and gradual upward-floating yellow. Etiologies differ, so main treatments differ.
Article 19: Various yellows are mainly treated with Zhu Gao Luan Fa Jian (Pig Fat and Loose Hair Decoction).
Zhu Gao Luan Fa Jian Formula: Zhu Gao (Pig Fat, half jin), Luan Fa (Loose Hair, three pieces the size of a chicken egg).
The above two ingredients are boiled together in the fat until the hair dissolves and the medicine is ready. Divide into two doses. The disease exits via urination.
Among various yellows, there is a type where fluid-blood is short and Yang Qi is excessive. Short fluid-blood retains water qi generating dampness; excessive Yang Qi stagnates and steams fire qi generating heat. Here, damp-heat takes fluid-blood exhaustion as the root disease. Nourishing fluid-blood replaces dampness, allowing dampness to descend naturally; nourishing Yin blood moistens Qi, allowing Qi to circulate freely. Once damp-heat is removed, yellow will dissipate naturally. Zhu Goo generates fluids; Luan Fa supplements blood. Using them is appropriate.
Article 20: Jaundice disease is mainly treated with Yin Chen Wu Ling San (Artemisiae Scopariae and Five-Ingredient Poria Pill).
Yin Chen Wu Ling San Formula: Yin Chen Hao Mo (Artemisiae Scopariae Herba Powder, ten parts), Wu Ling San (Five-Ingredient Poria Pill, five parts).
Mix the above two ingredients. Take one Fang Cun Bi before eating, three times a day.
Among various yellows, there is a type where heat initially causes water retention, followed by water accumulation transforming into more heat. Since it starts from heat, it is called jaundice following jaundice cases, and treated with Yin Chen following jaundice methods. This is a combined syndrome of heat-yellow and water-yellow, hence treated by both aspects. The meanings of Yin Chen and Wu Ling San are seen elsewhere.
Article 21: Jaundice with abdominal fullness, dysuria with red urine, and spontaneous sweating indicates exterior harmony and interior disease. Purge internally; Da Huang Xiao Shi Tang (Rhubarb and Sodium Nitrate Decoction) is suitable.
Da Huang Xiao Shi Tang Formula: Da Huang (Rhei Radix et Rhizoma), Xiao Shi (Sodium Nitrate), Huang Bo (Phellodendri Cortex, four liang each), Zhi Zi (Gardeniae Fructus, fifteen pieces).
Boil the above four ingredients in 6 sheng of water to obtain 2 sheng. Remove dregs, add Xiao Shi, boil again to obtain 1 sheng. Take once in one dose.
All jaundice cases involve closed pores and dysuria, caused by intense damp-heat interacting inside and outside, above and below. Only damp-yellow and water-yellow present this way: sweating releases damp-water upwards and externally; free urination releases damp-water downwards and internally. For jaundice arising from heat, internal heat is vigorous; even with sweating, internal heat does not decrease, so yellow persists. There is a type of jaundice that does not spread horizontally to the exterior, but whose heat stays in the Middle Jiao, invading the chest/diaphragm upwards and penetrating liver/kidneys downwards, presenting vertically. Abdominal fullness is a response of interior dampness; dysuria with red urine is a response of interior heat—this is interior disease. Interior damp-heat should theoretically transmit to the exterior. Now, with spontaneous sweating, meridians and skin/hair have no stagnant heat, indicating exterior harmony. For exterior harmony and interior disease, purging internally is the correct treatment. The reason for this formula is excess-heat in the Middle Jiao; thus, bitter-cold Da Huang and salty-cold Xiao Shi follow the Cheng Qi method of purging downward. Heat in the middle must熏 (smoke/ascend) to Yang positions, so Zhi Zi, which travels well to the Epigastrium, is added to descend it. Heat in the middle must penetrate to Yin, so Huang Bo, which moistens liver/kidneys, is added to firm it. Salty overcomes heat, bitter dries dampness—these are residual implications.
Article 22: Jaundice disease with unchanged urine color, desire for spontaneous diarrhea, abdominal fullness, and wheezing should not have heat removed. Removing heat will cause hiccups. Hiccups are mainly treated with Xiao Ban Xia Tang (Minor Ginger and Pinellia Decoction). (Formula see Phlegm-Fluid section.)
This describes a type of jaundice where there is no heat in the Lower Jiao, so urine remains unchanged and pale white; no heat in the Middle Jiao, so stool desires spontaneous diarrhea and is unformed. It is solely due to heavy Spleen Qi dampness causing abdominal fullness, and Diaphragm Qi labor-heat causing Lung wheezing. Labor-heat mingling with dampness eventually forms jaundice. However, this arises from labor causing Divine Fire to float, generating false heat, different from true heat-excess. Thus, purging to remove heat is contraindicated. Removing heat makes the Diaphragm deficient and Stomach cold; attacking deficiency with cold guarantees hiccups. Hiccups are treated with Xiao Ban Xia Tang because it fills the chest, warms the Stomach, descends rebellion, removes cold, and calms hiccups. See Phlegm-Fluid section for decoction details.
Article 23: Various yellows with abdominal fullness and vomiting should use Chai Hu Tang (Bupleurum Decoction). (Major and Minor Chai Hu Tang formulas are seen elsewhere.)
"Various yellows" refers to both jaundice disease and yellow-family conditions. "Suitable for Chai Hu Tang" refers to both Major and Minor Chai Hu Tangs. This generally discusses syndromes and treatments flowing through Shaoyang for jaundice where heat precedes dampness, and yellow where dampness precedes heat. Abdominal fullness is seen previously. Shaoyang receiving heat reverses upward from the hypochondrium, causing frequent vomiting. Both heat-jaundice and damp-yellow have this symptom. Heat-attracting-damp jaundice often has Spleen/Stomach heat-excess; Spleen/Stomach heat-excess qi biases towards the sides of the abdomen, ascending to the hypochondrium, which is the Shaoyang region. Damp-generating-heat yellow often has chest/diaphragm damp-heat; chest/diaphragm damp-heat qi biases towards the sides of the chest, overflowing horizontally to the hypochondrium, also the Shaoyang region. Hence both can cause vomiting. Saying "suitable for Chai Hu Tang" without specifying Major or Minor is because jaundice takes heat as root and damp as branch; treating heat suits purging, hence Major Chai Hu; yellow takes damp as root and heat as branch; treating damp suits sweating, hence Minor Chai Hu. Waiting for people's divine understanding. Meanings of Major and Minor Chai Hu Tangs are seen elsewhere.
Article 24: Male yellow with free urination should be given Xu Lao Xiao Jian Zhong Tang (Deficiency Consumption Minor Constructive Middle Decoction). (Formula see Deficiency Consumption section.)
This supplements because the previous Article 22 only established rescue-for-error formulas without standard formulas. Free urination implies the meaning of unchanged color from the previous article. Generally, Bladder receiving heat causes strangury with yellow-red color; free urination implies the unchanged state. But if urination is free, heat drains and dampness reduces; how can yellow appear? Thus, this yellow is caused by Zong Qi deficiency leading to consumption,幻 (illuding) false heat. It suits Xiao Jian Zhong Tang's acrid-warmth to fill Heaven's Qi. Then Sun shines brightly, and Dragon-Lei Yin Fire, Lanqi Yin Dampness, naturally hide and dissipate. Female yellow with free urination is mostly postpartum or metrorrhagia/metrostaxis cases, so it cannot be diagnosed as deficiency consumption. The yellow in this condition is pale, not scorched. Commonly known as "Fatigue Yellow." Women do not bear the burden of strenuous effort, so they do not have this disease.