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Chapter 17 of 27
金匮要略
Overall Paraphrase
This chapter focuses exclusively on jaundice (a category of conditions with yellowing of the body, eyes, and urine as primary symptoms). The original text includes two discourses, fourteen pulse-pattern items, and seven formulas. Below is a paraphrase following the order of the original text.
Cunkou pulse (radial artery pulse at the wrist) floating and slow: floating indicates wind, slow indicates bi- syndrome (impediment). Here, "bi" does not refer to wind-strike (apoplexy), but rather to irritability and discomfort in the four limbs; the spleen belongs to Earth and its color is yellow. When damp-heat accumulates and moves with spleen qi, yellowing develops.
Fuyang pulse (pulse at the dorsum of the foot, used in antiquity to assess the spleen and stomach) is tight and rapid: rapid indicates heat, and heat can digest grain; tight indicates cold, and cold causes abdominal distension after eating. Chi pulse (proximal pulse position) floating suggests injury to the kidneys, while Fuyang pulse tight suggests injury to the spleen. When wind and cold pathogenic qi mutually contend, there is dizziness after eating, water and grain are not transformed, turbid qi stagnates in the stomach, and turbid qi flowing downward causes urinary obstruction; when there is cold in the lower burner and heat flowing into the bladder, the entire body turns yellow — this is called grain jaundice (jaundice caused by food stagnation and spleen-stomach disharmony).
The forehead turning black, slight sweating, heat in the palms and soles, worsening in the evening, bladder cramping, and spontaneous urination — this is called sexual taxation jaundice (jaundice believed in antiquity to be related to kidney injury from excessive sexual activity). If the abdomen becomes enlarged like edema, the prognosis is poor.
Irritability and burning sensation in the chest, inability to eat, and frequent nausea — this is called alcohol jaundice (jaundice caused by excessive alcohol consumption).
In Yangming disease with a slow pulse, the patient cannot eat to fullness; after eating to fullness, there is irritability, dizziness, and difficult urination — this is a sign that grain jaundice is about to form. Even if purging is applied, the abdominal fullness does not resolve, because a slow pulse indicates cold deficiency.
In alcohol jaundice, there must be urinary difficulty, with manifestations of heat in the chest and heat in the soles of the feet. Some cases of alcohol jaundice do not present with fever, only lower abdominal fullness, nausea, and nasal dryness. If the pulse is floating, emetic therapy may be used first; if the pulse is deep and wiry, purging may be used first.
For alcohol jaundice with heat in the chest and a desire to vomit, emetic therapy will bring recovery. If alcohol jaundice is mistakenly treated with purging, over time it transforms into black jaundice (jaundice of long duration with bluish-black complexion): eyes appear blue, face appears black, the chest feels辛辣 like eating pickled garlic, stool is pitch black, the skin is numb with loss of sensation, and the pulse is floating and weak; although dark, there is still a hint of yellow, thus it is known that this results from erroneous purging of alcohol jaundice.
The teacher said: In jaundice disease with fever, irritability, wheezing, chest fullness, and dry mouth, this is because at the onset of the disease, fire methods were used to forcefully induce sweating, and the fire pathogen combined with the disease heat. However, jaundice is most often acquired from dampness pathogen. If there is generalized fever with yellowing and abdominal heat, this indicates heat in the interior, and the purging method should be used.
Deep pulse, thirst with desire to drink water, and difficult urination — any of these may lead to yellowing.
Abdominal fullness, withered yellow body, dryness with inability to sleep — this belongs to jaundice disease.
The course of jaundice disease cycles in eighteen-day periods. If there is improvement after ten or more days of treatment, that is favorable; if it worsens instead, it is more difficult to treat.
Jaundice with thirst is difficult to treat; without thirst, it is treatable. When the disease originates from the yin aspect, the patient tends to vomit; when it originates from the yang aspect, there is chills and fever.
Grain jaundice manifests as alternating chills and fever, inability to eat, dizziness after eating, restlessness in the chest and heart, and yellowing developing after a prolonged period — treat with Yinchenhao Decoction (Artemisia Yinchenhao Decoction) as the primary formula. The formula consists of Yinchenhao (Oriental wormwood), Zhizi (Gardenia fruit), and Dahuang (Rhubarb). After decoction, take warm in three divided doses. The classical text describes that after taking the medicine, urination becomes free and smooth, the urine takes on a deep red color like soapbean juice, abdominal fullness decreases after one night, and the yellow color is eliminated through urination.
Jaundice with fever in the evening and chills instead — this is due to sexual taxation. Bladder cramping, lower abdominal fullness, yellowing of the entire body, blackening of the forehead, and heat in the soles of the feet — this then forms black jaundice. Abdominal distension like edema, black stool, and frequent loose stools — this is sexual taxation disease, not water-qi disease. Abdominal fullness indicates difficulty in treatment — use Xiaoshi Fanshi Powder (Niter and Alum Powder) as the primary formula. The formula consists of equal parts of niter (Xiaoshi) and calcined alum (Fanshi), ground into powder and taken with congee juice from barley; the classical text states that the pathogen is eliminated through urine and stool — yellow urine and black stool indicate effectiveness.
Alcohol jaundice with irritability in the chest or heat pain — treat with Zhizi Dahuang Decoction (Gardenia and Rhubarb Decoction) as the primary formula. The formula consists of Zhizi (Gardenia fruit), Dahuang (Rhubarb), Zhishi (Immature bitter orange), and Dandouchi (Fermented soybean). After decoction, take warm in three divided doses.
For all types of jaundice, the general principle should be to promote urination; however, if the pulse is floating, the sweating method should be used, and Guizhi plus Huangqi Decoction (Cinnamon Twig plus Astragalus Decoction) is appropriate as the primary treatment.
For various yellow diseases, Zhugao Fajian (Lard and Human Hair Decoction) can be used as the primary treatment. The formula uses lard and tangled human hair boiled together; after the hair dissolves, take in divided doses, allowing the pathogen to be eliminated through urination.
For jaundice disease, Yinchen Wuling Powder (Artemisia Yinchen and Five-Ingredient Powder) is the primary treatment. The formula combines Yinchenhao powder with Wuling Powder.
For jaundice with abdominal fullness, difficult urination with reddish urine, and spontaneous sweating — this indicates that the exterior qi is already harmonized and heat is bound in the interior; the purging method should be used, and Dahuang Xiaoshi Decoction (Rhubarb and Niter Decoction) is appropriate. The formula consists of Dahuang (Rhubarb), Huangbai (Phellodendron bark), Xiaoshi (Niter), and Zhizi (Gardenia fruit).
For jaundice with urine color unchanged, a tendency toward diarrhea, abdominal fullness with wheezing — the heat-clearing method must not be used; if heat-clearing is erroneously applied, hiccough will inevitably result. For hiccough, Xiao Banxia Decoction (Minor Pinellia Decoction) can be used as the primary treatment.
For various yellow diseases with abdominal pain and vomiting, Xiao Chaihu Decoction (Minor Bupleurum Decoction) is appropriate.
For a man with yellowing and spontaneous urination, this belongs to deficiency taxation and should be treated with Xiao Jianzhong Decoction (Minor Construct the Middle Decoction).
Attached formulas: Guadi Decoction (Muskmelon Pedicel Decoction) treats various yellow diseases; Qianjin Fang Mahuang Chunjiu Decoction (Ephedra and Pure Wine Decoction) treats jaundice, using ephedra boiled with clear wine — use wine in winter, water in spring.
(The above formula compositions, dosages, and administration methods are all transcribed from the classical text and are provided for study purposes only, not as medication guidance.)
This chapter establishes the general outline that jaundice "is acquired from dampness." Zhang Zhongjing held that the core pathogenesis of jaundice involves dampness pathogen, which may be complicated by cold, heat, blood stasis, or deficiency. The disease location is primarily in the spleen and stomach, with secondary involvement of the bladder, kidneys, liver, and gallbladder. The Cunkou, Fuyang, and Chi pulses are integrated to assess the deficiency or excess and cold or heat nature of the visceral organs.
Therapeutically, the emphasis is on "giving the pathogen a route of exit": when dampness is in the lower burner, promote urination; when heat is in the interior, purge; when the pathogen is above, use emesis; when the exterior is unresolved, induce sweating; when jaundice is chronic with deficiency, supplement. This approach of guiding according to the situation reflects the characteristic feature of the Synopsis of the Golden Chamber of combining pulse and pattern assessment with staged treatment strategies.
In modern medicine, jaundice is primarily related to abnormal bilirubin metabolism, commonly seen in hepatocyte injury, biliary obstruction, hemolysis, and other conditions. Some manifestations described in this chapter — "yellow body, urine yellow like soapbean juice, pitch-black stool, black forehead, abdominal distension like edema" — partially approximate clinical phenomena of cholestasis, liver cirrhosis, or gastrointestinal bleeding, demonstrating the careful observation of ancient physicians.
However, ancient disease names cannot be directly equated with modern disease names. For example, "sexual taxation jaundice" is not necessarily entirely caused by sexual overindulgence, nor is "black jaundice" necessarily only the result of erroneous purging. Formulas such as Yinchenhao, Zhizi, and Dahuang have indeed been shown in modern research to have choleretic, hepatoprotective, and anti-inflammatory effects, but they still need to be evaluated within the framework of the modern diagnostic and therapeutic system — they cannot be self-administered according to the original text. References to prognostic periods such as "eighteen-day cycles" should also be understood as empirical observations from antiquity rather than absolute prognostic criteria.
Bu-Gua Reminder: This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.