Sudden Yellow Skin and Eyes (Jaundice)? Song Dynasty Formula Master Doctor Xu Shuwei Uses Yin Chen Hao Tang (Capillaris Decoction) to Clear Damp-Heat — Yellowing Cleared Within Days
Patient search words: body turning yellow / skin turning yellow / eyes turning yellow / urine yellow as gold / jaundice / hepatitis / cholecystitis / gallstones
Corresponding medical terms: yang jaundice (yang huang) · damp-heat accumulation (shi re yun jie) · liver-gallbladder damp-heat (gan dan shi re) · Yin Chen Hao Tang pattern (yin chen hao tang zheng)
The opening: in the fifth month, a wealthy man turned yellow all over
Today we continue the stories of Doctor Xu Shuwei, the great formula master of the Song dynasty, using the formulas of the Treatise on Cold Damage.
Doctor Xu Shuwei, courtesy name Zhike, was a celebrated physician of the transition between the Northern and Southern Song dynasties, known as "Scholar Xu" (Xu Xueshi). He was one of the founders of the classical formula school (jing fang pai) and has had a great influence on Chinese medicine. Why do we study him? To learn his way of thinking — everyone knows the Treatise on Cold Damage is the clinical foundation of Chinese medicine. No matter how you write a prescription today, the roots go back to Zhang Zhongjing. Almost every path later physicians took in treating disease grew out of Zhang Zhongjing. So to understand Doctor Xu Shuwei is to understand the classical formulas, and to understand the roots of Chinese medicine.
💬 Note from Doctor Luo: This story takes place in the fifth month — the lunar fifth month, when the south of the Yangtze was already hot, the season of damp and heat. That year, to escape the chaos of war, Doctor Xu Shuwei had left his hometown of Yizheng (very close to Yangzhou) and taken refuge in Yangzhou. In those times of turmoil even a great physician had to flee; but a great physician is a great physician wherever he goes — wherever he stayed, everyone who was ill asked him to treat them.
In the place where he had taken refuge lived a "yì háo zǐ" — what does that mean? It means a commercial magnate, a very wealthy man. This wealthy man fell ill.
💬 Note from Doctor Luo: Why did Doctor Xu Shuwei take care to mention the fifth month and a rich man? There is deep meaning here — some diseases, what kind of people catch them easily? The rich, who eat too much rich, sweet, greasy food; and the fifth month’s weather is damp and hot. When Doctor Xu Shuwei wrote his case records, everything was deliberate.
Who was the patient, and how sick was he? — yellow as gold
This wealthy merchant had been ill with cold damage for eight or nine days. What state was his body in? His body turned yellow — yellow so bright, so glossy it looked almost translucent; his skin turned yellow. Note that with skin yellowing, the sclera of the eyes and other places with mucous membranes usually turn the most yellow. And his nose and eyes both hurt — the nose and the inside of the eyes ached; both arms, and the neck, head and lower back were all stiff (qiáng jí) — stiff and rigid; his stool was dry; and his urine was like gold — extremely yellow, yellow as gold.
💬 Note from Doctor Luo: This disease is rarely seen nowadays but was common in the past — this is jaundice! When the skin turns yellow, everyone understands at once. Doctor Xu Shuwei was called in. Though he was a refugee, his reputation stood, and every household asked him to come.
What did Doctor Xu Shuwei think? The most crucial stroke of the whole case
When Doctor Xu Shuwei took the pulse: tight and rapid (jǐn ér shù) — the pulse tight, and beating fast. How had the illness come about? He said: "The disease begins with the spleen receiving dampness" — first the spleen is deficient, dampness overflows; it is because the spleen is deficient that it can no longer control the dampness.
And why would the spleen and stomach become deficient? Doctor Xu Shuwei said there are generally two situations: one is the poor who genuinely go hungry — starvation damages the spleen and stomach; the other is those who eat exceptionally well — rich, sweet, greasy food injures the spleen and stomach. Two extremes, but both wound the spleen and stomach.
💬 Note from Doctor Luo: When the spleen and stomach are injured, dampness becomes very heavy; and then it happens to be summer, so there is accumulated heat in the body — the rich, sweet, greasy food slowly builds up and turns to fire. Dampness plus heat is called damp-heat; summer heat is the extreme of heat. Damp-heat and summer heat mingle together and accumulate in the foot taiyin spleen channel (the spleen-stomach channel), and that is the root of the illness.
With damp-heat inside, the qi factions struggle (shù qì xiāng bó) — heat consumes the body fluids, so the stool becomes dry and bound; the intestines are blocked, damp-heat and dry stool bind together inside, "wanting to fight their way out but unable to discharge" (yù zhēng ér bù dé xiè) — the body wants to eliminate them but cannot, and the normal functions of drainage grow weaker and weaker.
There are two more symptoms to watch carefully: this patient sweated on the head and face, but below the neck there was no sweat at all. Why? Because the head is the meeting point of all the yang channels — the yang channels all gather at the head. When damp-heat in the interior cannot be discharged, the head sweats profusely and burns with heat.
💬 Note from Doctor Luo: Doctor Xu Shuwei also mentioned a critical danger sign — if the breath from the nose is cold (bí zhōng qì lěng) and there is no pulse at the cun kou position, the illness is grave and very hard to treat. In this patient, the pulse and symptoms happened to match exactly the pattern Zhang Zhongjing described — so there was a way.
The prescription: Yin Chen Hao Tang mixed with Wu Ling San — better within days
What formula was used? Yin Chen Hao Tang mixed with Wu Ling San (yǐ yīn chén hāo tāng diào wǔ líng sǎn) — and within a few days, he recovered.
Two formulas are involved here: Yin Chen Hao Tang and Wu Ling San. What does "mixed" mean? Boil Yin Chen Hao Tang, then take Wu Ling San (ground into a coarse powder) and stir it into the hot decoction, then drink it down — that is "Yin Chen Hao Tang mixed with Wu Ling San." Drink it for a few days and the jaundice recedes.
💬 Note from Doctor Luo: Everyone knows Wu Ling San — zhu ling (polyporus), ze xie (alisma), bai zhu (atractylodes), fu ling (poria), and gui zhi (cinnamon twig) — the classic Chinese medicine formula for draining water and removing dampness. We won’t dwell on Wu Ling San today; today’s star is Yin Chen Hao Tang — a very important formula for treating "yellowing."
Knowledge card: why does the body turn yellow? What does Western medicine say?
First, everyone should understand: why does a person turn yellow and develop jaundice?
💬 Note from Doctor Luo: Our bile contains bilirubin. If bilirubin metabolism is impaired, it accumulates in places where it easily builds up — for example the skin and the sclera of the eyes. Those parts with mucous membranes easily turn very yellow. That is why a person looks yellow — and some yellows really are golden yellow. Yellow also divides into bright yellow and dark yellow — in Chinese medicine, when you look at the yellow, a different color means a different problem.
Jaundice appearing means something is wrong where? Liver and gallbladder disease — either the liver itself has a problem, causing bilirubin metabolism disorder; or the bile duct is blocked, bile cannot be discharged, and jaundice appears. That is the Western explanation. So when jaundice appears, you should generally go to the hospital quickly for a diagnosis — the body must have some real problem for this to happen.
How does Chinese medicine look at it? Chinese medicine does not care what Western medicine labels the disease; from its own angle it divides jaundice into yang jaundice (yang huang) and yin jaundice (yin huang).
The science of yellow: yang jaundice, yin jaundice, wei huang, and orange-stained yellow
Yang jaundice — exactly the case Doctor Xu Shuwei encountered: caused by damp-heat. The body has heavy dampness and exuberant heat; sometimes heat outweighs dampness, sometimes dampness outweighs heat, and the prescription differs accordingly — either way, damp-heat is the cause. This is often an acute condition, sometimes brought on by external contraction — an external pathogen disrupts the movement and transformation of qi, damp-heat accumulates, and all at once it triggers liver-gallbladder problems. The approach for yang jaundice: remove dampness, clear heat, and open the bowels — open the qi mechanism and let it flow freely.
Yin jaundice — caused by cold-damp. Cold-damp wreaks havoc inside the body, and the yellow is not the bright kind — it is usually gray and dark; the person is not running a high fever but is instead low, listless and afraid of cold. Yin jaundice requires warming the yang, removing dampness, and strengthening the spleen.
Wei huang (萎黄, withered yellow) — a chronic kind of yellow: the person is extremely weak, and prolonged weakness has led to spleen deficiency with lurking dampness, slowly producing a withered yellow. The color is very dark, a faint dull yellow, looking withered; it is a sign of qi and blood deficiency, often with severe malnutrition. Wei huang must be tonified — the first two types call for removing dampness and clearing heat, or warming the yang; wei huang must be built up.
💬 Note from Doctor Luo: Why must wei huang be treated by tonifying the spleen? Because the color of spleen-earth is yellow — when spleen-earth is severely deficient, yellow washes up onto the surface of the body. So the three are distinct: the first two are true jaundice; the last one just shows a tinge of yellow, with nothing wrong in the liver or gallbladder — tonify spleen-earth and it is done.
There is one more kind of yellow to distinguish: the yellow from eating oranges and carrots — some people see their skin turn yellow and are terrified: "I must have a terrible disease!" You may have eaten carrots or oranges for several days in a row, and the color has accumulated inside. In this kind, the sclera of the eyes basically does not change color — only the skin changes. It is not a pathological yellow; everyone can make the distinction.
Breaking down Yin Chen Hao Tang: three herbs — one drains through urine, one through stool
Today’s subject is yang jaundice, and the main formula is Zhang Zhongjing’s Yin Chen Hao Tang.
Why is it called Yin Chen Hao Tang? Yin chen and yin chen hao are the same plant — people in different regions call it differently, some say yin chen, some say yin chen hao. There is an old folk saying: "March yin chen, April wormwood, May and June burn it as firewood" (sān yuè yīn chén sì yuè hāo, wǔ yuè liù yuè dāng chái shāo) — yin chen sprouts in March, and this is when its medicinal power is at its best; by April it has grown tall, looking like sweet wormwood or mugwort (they are in fact close relatives of the same plant), and it is basically no longer used as medicine; by May and June it is burned as firewood.
💬 Note from Doctor Luo: Yin chen is the chief herb (jun yao) of this formula, used in a large dose. It clears damp-heat and soothes the liver and gallbladder — it grows in many places across the country, and farmers pick it and put it in soup or cook it as a vegetable; everyone knows it clears damp-heat. When damp-heat is heavy, urine is yellow and stool is dry, use it to drain the fire out.
What is zhi zi (gardenia fruit) for? Zhi zi clears the fire of the three burners and guides it out through the urine — why is the urine yellow now? The fire is too exuberant, and in fact the urine is scanty; zhi zi increases the urine output and flushes the fire out through the urine.
Then da huang (rhubarb) — da huang is a cold purgative. The stool is dry, heat is trapped inside, and the more it is blocked the less it can come out; da huang opens the bowels and drains the heat out through the stool.
💬 Note from Doctor Luo: So you see — zhi zi drains through urine, da huang drains through stool; yin chen hao soothes the liver and gallbladder, opening their qi mechanism. Heat is carried out through both the stool and the urine, and the jaundice naturally recedes. The formula is very simple, just three herbs. The decoction method has a special point: Zhang Zhongjing said to boil the yin chen first, cook the water down by half, then add the zhi zi and da huang, cook it down to half again, and take it in three doses.
Zhang Zhongjing’s original text: what does "stagnant heat in the interior" mean?
Why did Zhang Zhongjing build the formula this way? He explained it very clearly —
"In yang ming disease, fever with sweating: this is heat escaping outward (rè yuè), and jaundice cannot develop." In yang ming disease with exuberant heat, when the patient has fever and sweats, the sweat carries the heat out, so jaundice will not occur.
"But when only the head sweats, the body has no sweat, the sweat stops at the neck (jì jǐng ér huán), urination is difficult, and the patient is thirsty and drinks fluids — this is stagnant heat in the interior (yū rè zài lǐ), and the body will surely turn yellow; Yin Chen Hao Tang governs." — Only the head sweats; the sweat stops at the neck; the urine does not flow freely; the sweat cannot come out and the urine cannot come out either; heat is bound inside. This is called stagnant heat in the interior — heat depressed within the body, heat stored up in the liver and gallbladder, and the body begins to turn yellow. What to do? Yin Chen Hao Tang — soothe the liver and gallbladder, clear damp-heat, promote urination, and guide the heat out through the urine; add da huang to purge the stool and let heat leave through the bowels as well. Once the heat is unloaded, the body gradually recovers.
And another passage: "In cold damage of seven or eight days, the body is yellow like the color of an orange, urination is difficult, and the abdomen is slightly full — Yin Chen Hao Tang governs." — Yellow like the color of an orange, yellow very bright: that is heat, that is damp-heat; urination difficult, the belly slightly distended — use Yin Chen Hao Tang.
💬 Note from Doctor Luo: To sum up the typical presentation of damp-heat jaundice: yellow body, difficult urination, fever, no sweat, abdominal distension and fullness, constipation, yellow greasy tongue coating, red (or red-purple) tongue body, and a rapid pulse. See this group and use Yin Chen Hao Tang. Chinese medicine treats the root — I don’t care exactly where your liver or gallbladder has a problem; once the damp-heat is unloaded, it is cured.
How is it used today? Hepatitis, cholecystitis, gallstones — use it when the pattern matches
Today, when we meet similar conditions — jaundice-type hepatitis, cholecystitis, gallstones and so on — as long as the symptoms match, use Yin Chen Hao Tang with modifications: if the heat is too exuberant, add a little long dan cao (Chinese gentian); if the dampness is too heavy, combine it with Wu Ling San as Doctor Xu Shuwei did, adding more dampness-removing herbs — the results are excellent.
💬 Note from Doctor Luo: Doctor Xu Shuwei’s case was liver-gallbladder damp-heat brought on by external contraction. In fact, the formulas of the Treatise on Cold Damage — apart from externally contracted diseases — as long as the pattern matches, can be used for any illness; a formula is a principle, and it governs everything inside that principle. Below are three case records from senior physicians of the modern era. None of the patients had jaundice, but all had damp-heat accumulation — and all were cured with Yin Chen Hao Tang and its modifications.
Bonus case one: Doctor Liu Duzhou treats a "strange illness from eating oranges" — five years of burning heat in the chest and abdomen
The first is a case from Doctor Liu Duzhou, the late great master.
A male patient, surnamed Sun, 55 years old, came for treatment in April 1992. Three years earlier, after a bath in which he sweated heavily, he ate two oranges, and suddenly felt an unbearable burning heat in his chest and abdomen. It was extremely intense. From then on he could not eat wheat-based foods or rich dishes such as chicken, duck, fish or meat, nor could he drink hot water — the moment he did, the heat blazed up inside his belly, terribly uncomfortable; he had to drink cold water to feel better. Hospital tests all came back normal. After many treatments failed, he made a special trip from the northeast to Beijing to see Doctor Liu.
💬 Note from Doctor Luo: This is a strange illness! Think about it: eating oranges after sweating — how did that produce burning heat in the chest and abdomen? Doctor Liu looked: the man usually had dry mouth and throat, a distended belly, scanty yellow urine, and dry stool — scanty yellow urine and dry stool basically point to heat in the body; then the tongue: red-crimson tongue body with a white greasy coating, and a wiry, slippery pulse.
Doctor Liu’s judgment: a gallbladder-heat disease — damp-heat accumulated in the middle, impairing the liver and gallbladder’s functions of draining and metabolism. How to treat? Soothe the liver and gallbladder, clear heat — use chai hu (bupleurum) and huang qin (baical skullcap root) (the thinking of Xiao Chai Hu Tang, soothing the liver, clearing the gallbladder, draining fire), plus yin chen, zhi zi, and da huang (Yin Chen Hao Tang). After taking it, large amounts of turbid filth came out in the stool, the abdominal distension dropped by half, and he still wanted cold water — the tongue was still red with a white greasy coating — the damp-heat steaming in the interior had not yet been removed.
Second visit: aromatics to transform turbidity, bitter cold to clear heat — use pei lan (eupatorium) (aromatic, transforming turbidity, opening the stomach qi — using the fragrant qi to dissolve the damp-heat), plus huang qin, huang lian, huang bai, and zhi zi. After several consecutive doses, the thirst and craving for cold drinks were resolved, the tongue and pulse returned to normal, and he could eat normally again — the illness was cured from then on.
💬 Note from Doctor Luo: Notice that at first, yin chen, zhi zi and da huang were used to unlock the "lock," and then a bit of heat-clearing was added for even better effect. The formula Doctor Liu used later has the shadow of Zhi Zi Bai Pi Tang in it — that is also a Treatise on Cold Damage formula for jaundice (zhi zi and huang bai), used when heat outweighs dampness; in clinical practice today, Zhi Zi Bai Pi Tang and Yin Chen Hao Tang are often combined, and the heat clears right away.
Bonus case two: Doctor Lin Jiakun treats thirst that prefers hot drinks — damp-heat hiding inside yang deficiency
The second is a case from Doctor Lin Jiakun.
A female patient, surnamed Han, 45 years old, came on September 7, 1987. She reported thirst for two years, relieved by hot drinks — thirsty, but she liked hot water; hot drinks felt comfortable; her mouth was sticky and uncomfortable, she had no appetite, and her body was obese. The tongue: pale and puffy in body, but with a yellow greasy coating; the pulse deep and wiry.
💬 Note from Doctor Luo: The pattern discrimination in this case is interesting. A pale puffy tongue could mean spleen deficiency and insufficiency of yang qi; but a yellow greasy coating says there is also damp-heat inside — illnesses are often a tangle of several conditions, not a case of "heat means the tongue must be red." You have to analyze each concrete situation.
The earlier physicians’ prescriptions were essentially resolving dampness or nourishing yin (for thirst, nourish yin) — none worked. Why? Doctor Lin’s analysis: the damp-heat is in the body, but the spleen yang is also insufficient; the damp-heat traps and binds the spleen, the spleen yang cannot transport normally, and body fluids cannot rise, so the patient is thirsty. Following the Treatise on Cold Damage passage "If the patient is thirsty and drinks fluids, this is stagnant heat in the interior; Yin Chen Hao Tang governs," he used Yin Chen Hao Tang with modifications — yin chen, jiao zhi zi (charred gardenia fruit), and sheng da huang (raw rhubarb), 6 grams each, plus fu zi (aconite) to warm the spleen yang and fu ling (poria) to drain dampness — one more layer added.
💬 Note from Doctor Luo: Using Yin Chen Hao Tang alone clears damp-heat; but this patient had yang deficiency and damp-heat coexisting — yang deficiency makes dampness heavy, and dampness turns to heat, so you must both warm the yang and clear the damp-heat. The formula looks a little contradictory, but it follows from the actual condition.
The result: after two doses the thirst was reduced; then five more doses, and the thirst was gone. The tongue coating was still a bit yellow and greasy, so it was changed to pei lan, bo he (mint), and sheng gan cao (raw licorice) brewed in water as a tea substitute (pei lan is aromatic and transforms dampness, bo he clears the throat). A six-month follow-up found no recurrence.
Bonus case three: Doctor Yu Huiqing treats oral ulcers — a purple, swollen, damp-heat tongue
The third is a case from Doctor Yu Huiqing.
A female patient, surnamed Sun, 51 years old, came in June 1989. She had extensive ulceration of the oral cavity — the whole inside of the mouth was eroded — with burning pain, worst on the tongue body itself; treatments everywhere had failed. The tongue body was purple-dark and swollen — what does a purple-dark tongue mean? Stasis; when red deepens into purple, it means very intense heat; swelling also indicates heat. In addition there was head distension and pain, vexation and restlessness (this relates to the liver and gallbladder), dry mouth (body fluids insufficient, heat in the body), and constipation; the tongue coating was yellow and greasy (especially thick at the rear), and the pulse was slippery.
💬 Note from Doctor Luo: Dry stool and difficult urination often go together — the body has stagnant heat inside. This patient’s pattern was damp-heat bound with stasis.
How was it treated? Yin Chen Hao Tang modified — the original yin chen, da huang, zhi zi, plus dan pi (moutan bark), sheng di (raw rehmannia), and yi ren (coix seed) (cooling the blood, nourishing yin, removing dampness), decocted and taken three times a day after rinsing the mouth. After three doses the swelling of the tongue body was markedly better and the ulcers shrank; continuing the original formula, twelve doses cured it completely.
💬 Note from Doctor Luo: None of these three patients had jaundice, yet whenever there is stagnant heat in the interior and damp-heat accumulation — especially damp-heat with blood stasis — Yin Chen Hao Tang can resolve it. That is why, when writing prescriptions for damp-heat conditions today, many physicians like to add a little yin chen: for dry bound stool, add a little da huang; for difficult urination, add a little zhi zi; adjust as needed inside the formula. When jaundice actually appears, Yin Chen Hao Tang works even better — it is the specific formula for the specific condition, and the yellow recedes with immediate effect.
Closing: classical formulas never need more than three doses — why is Zhang Zhongjing the medical sage?
Why is Zhang Zhongjing so remarkable? What he left behind has been passed down for a thousand years, and it still saves people. Why is he called the medical sage? Even today, everyone suffering from illness can receive his grace.
💬 Note from Doctor Luo: What characterizes the classical formulas? They act extremely fast — as long as the pattern matches, generally within three doses you clearly feel a change; that is the saying "classical formulas never need more than three doses" (jīng fāng bù guò sān). I once heard an old physician teaching a young man: when you go out to practice, use Zhang Zhongjing’s formulas — if after three doses there is no change, if the patient shows no improvement, don’t hold the patient up — change the formula at once — because if the pattern truly matches, three doses will surely show effect. That is the charm of the classical formulas.
The way of thinking we use today is Zhang Zhongjing’s way of thinking — in Chinese medicine there is a school called the classical formula school (jing fang pai), the school that excels at using Zhang Zhongjing’s formulas. When the pattern and the formula line up, when you aim your forces correctly, people recover remarkably fast.
This shows that the wisdom of our ancestors is extraordinary — their analysis of the human body was extremely sophisticated. The more you understand these ways of regulating the body, the stronger your ability to protect yourself, and the more secure your life.
(Compiled from Doctor Luo Dalun’s lecture on Doctor Xu Shuwei’s case records; the case comes from Discussion of Ninety Cases of Cold Damage · The Yin Chen Hao Tang Pattern.)