【黄汗身肿之症】身热胸满，四肢黄肿而渴，状如风水，汗出沾衣，色如柏汁，久不愈
痈脓。又有不恶风，小便利，若上焦寒，口多涎，身冷肿痛，状如周痹，脑中窒，不能食。
又有两胫不冷，反发热，名历节。食已汗出，常见盗汗，汗出不凉，反发热，久久必甲错，
生恶疮，身 胸中痛，剧者不能食，身疼重烦躁，小便不利，皆黄汗肿症也。
【黄汗身肿之因】以汗出入水，水邪内侵，或汗出当风；汗与水皆寒湿之气，内结郁久
，则成热成黄，而黄汗肿之症作矣。
【黄汗身肿之脉】其脉自沉，或多沉迟，阳症阴脉，故用桂枝。
【黄汗身肿之治】《金匮》以身肿发热，汗出而渴，状如风水者，用黄 芍药桂酒汤。
两胫不冷，反发热，名历节。食已汗出，暮盗汗，汗出反发热者，用桂枝加黄 汤。
黄 芍药桂酒汤
黄 桂枝 白芍药
上三味，以苦酒煮。如怕烦心，以美酒易苦酒。
桂枝加黄 汤
桂枝 芍药 生姜 黄 大枣 生甘草
桢按∶《金匮》治黄汗症，一曰身体痛，发热汗出而渴，汗出色如柏汁，脉自沉者，黄
芍
已，胃火劳动而汗出，暮夜则营分有虚热而盗汗，然既汗出，则宜身凉，今因水邪内结不散
，故反发热，热久汗多，则皮肤之阴血，为热所灼，为汗所耗，久久必甲错，若再热，营气
热，必生恶疮。若身重，汗出辄轻，旋又复重，则汗虽出，发热不减，身重不除，久久
内气必虚，肌肉 而动。内虚中气不得运，则胸中痛。元气上下不贯，则腰上有汗，下
，腰 弛痛，如有物在皮肤中而不和顺；剧者不能食，疼痛烦躁，小便不利，桂枝加黄
。按前一症，以汗出不固，水邪入营，郁而发热，热甚则发黄而渴，故以桂枝和营，以苦酒
引入血分，散其水寒，则热自退，脉不沉矣。但卫虚不宜多汗，故用黄 之力实卫耳。后一
症，即桂枝原方，加生姜、大枣、甘草，又饮热粥以助胃得汗，其加黄 实表固卫者何故？
盖治脉浮发热，汗多热不退之症，不得不用桂枝，以其多汗盗汗，又不得不用黄 ，此症因
水寒之邪，盘结不散，汗虽出而热不减，正所云汗出而邪不出者，故仲景于桂枝散表方中，
重加黄 ，佐以大枣、甘草、生姜，和其胃气，同功卫外，使其邪出而汗不出也。仲景以黄
汗列之水气门，不入黄胆症中；宇泰又以黄汗为黄胆之首，而水肿门略注一条，此亦互相发
明之意。然又有分别，汗出染衣，遍身无肿，乃黄胆中之黄汗，即《准绳》所云黄汗也。黄
汗染衣，发热胫冷，即仲景黄 芍药桂酒汤所治之黄汗也；黄汗染衣，若胫不冷，反发热，
即仲景桂枝加黄 汤所治之历节也。二症有肿不肿之分，故有水肿、黄胆之别。水寒之邪，
内结脉沉，当同伤寒例。太阳发热多汗之桂枝症，用辛温解肌，使其邪散身凉；不可同热病
门，热邪伏内，汗出热不退之症，用清里退热者比。
【黄汗身肿的症状】身体发热，胸部胀满，四肢发黄肿胀且口渴，症状类似风水病（一种以头面浮肿为主的风水证），出汗沾湿衣服，汗色像柏树汁液一样，久治不愈会形成痈脓。又有不恶风、小便通利的情况；如果上焦有寒，口中多涎，身体寒冷肿痛，症状类似周痹（一种全身性疼痛的痹证），头部感觉窒塞，不能进食。又有两小腿不冷，反而发热，称为历节病（一种关节疼痛剧烈的痹证）。饭后出汗，常见盗汗（夜间睡眠中出汗），出汗后身体不凉，反而发热，时间久了皮肤必然粗糙如鳞甲交错（肌肤甲错），生成恶疮，身体和胸中疼痛，严重的不能进食，身体疼痛沉重且烦躁，小便不利，这些都是黄汗身肿症。
【黄汗身肿的病因】因为出汗时进入水中，水邪侵入体内，或者出汗时吹受风邪；汗与水都属于寒湿之气，在体内结聚郁滞日久，则化热变黄，于是黄汗身肿的症状就产生了。
【黄汗身肿的脉象】其脉象自沉，或者多见沉迟脉，这是阳证见阴脉，所以使用桂枝汤类方剂。
【黄汗身肿的治疗】《金匮要略》中对于身体肿胀发热，出汗而口渴，症状类似风水病的，使用黄芪芍药桂酒汤。对于两小腿不冷，反而发热，称为历节病；饭后出汗，傍晚盗汗，出汗后反而发热的，使用桂枝加黄芪汤。
黄芪芍药桂酒汤
黄芪 桂枝 白芍药
以上三味药，用苦酒（醋）煎煮。如果担心引起心烦，可以用美酒代替苦酒。
桢按：《金匮要略》治疗黄汗症，一种是身体痛，发热出汗而口渴，汗出色如柏汁，脉自沉的，用黄芪芍药桂酒汤；另一种是胃火因劳动而亢盛导致出汗，夜晚营分有虚热导致盗汗，既然已经出汗，身体应该凉爽，现在因为水邪在体内结聚不散，所以反而发热，热久汗多，则皮肤的阴血被热邪灼烧，被汗水耗损，时间久了必然出现肌肤甲错，如果再受热，营气受热，必然生成恶疮。如果身体沉重，出汗后暂时减轻，随即又加重，那么虽然出汗，发热不减，身体沉重不除，时间久了内气必然虚弱，肌肉跳动。内虚导致中气不能运化，则胸中疼痛。元气上下不通贯，则腰部以上有汗，腰部以下无汗或冷，腰部弛缓疼痛，好像有东西在皮肤中而不和顺；严重的不能进食，疼痛烦躁，小便不利，用桂枝加黄芪汤。按前面的病症，是因为出汗不固密，水邪进入营分，郁结而发热，热甚则发黄而口渴，所以用桂枝调和营卫，用苦酒引入血分，散其水寒之邪，则热自然退去，脉不再沉。但是卫气虚弱不宜过多出汗，所以用黄芪的力量来充实卫气。后面的病症，即桂枝原方，加上生姜、大枣、甘草，又喝热粥以助胃气发汗，其中加入黄芪来实表固卫的原因是什么？大概是治疗脉浮发热，汗多热不退的病症，不得不使用桂枝，因为其有多汗、盗汗的情况，又不得不使用黄芪，此症因为水寒之邪盘结不散，虽然出汗但热不减，正是所谓“汗出而邪不出”，所以仲景在桂枝解表方中，重用黄芪，佐以大枣、甘草、生姜，调和胃气，共同功效护卫体表，使邪气外出而汗不外泄。仲景将黄汗列在水气门中，不列入黄疸症中；宇泰又将黄汗作为黄疸之首，而在水肿门中略注一条，这也是互相阐发的意思。然而又有区别，出汗染衣，遍身无肿，乃是黄疸中的黄汗，即《准绳》所说的黄汗。黄汗染衣，发热而小腿冷，即仲景黄芪芍药桂酒汤所治疗的黄汗；黄汗染衣，若小腿不冷，反而发热，即仲景桂枝加黄芪汤所治疗的历节。这两种病症有肿与不肿的区别，所以有水肿、黄疸的不同。水寒之邪，在体内结聚脉象沉，应当同伤寒例处理。太阳病发热多汗的桂枝症，用辛温解肌的方法，使邪气散去身体凉爽；不可同热病门中，热邪伏于体内，出汗热不退的病症，用清里退热的方法相比。
[Symptoms of Yellow Sweat and Body Swelling] The body is hot, the chest feels full, the four limbs are yellow and swollen with thirst. The condition resembles Fengshui (Wind-water edema), sweat stains the clothes, the color of the sweat is like cypress sap. If it persists for a long time without healing, it may develop into carbuncles and pus. There are also cases where there is no aversion to wind and urination is free. If there is cold in the Upper Jiao (Upper Burner), there is excessive saliva, the body is cold, painful, and swollen, resembling Zhoubi (a type of bi-syndrome with widespread pain), the head feels obstructed, and one cannot eat. In other cases, the calves are not cold but feel hot instead, known as Lijie (Journey Joint disease, a severe form of bi-syndrome). Sweating occurs after eating, night sweats are common, and the body does not cool down after sweating but becomes feverish. Over time, the skin will inevitably become rough and scaly (skin resembling fish scales or cracked earth), malignant sores may arise, and there is pain in the body and chest. In severe cases, one cannot eat, the body feels heavy and painful with irritability, and urination is difficult. All these are symptoms of Yellow Sweat and Body Swelling.
[Etiology of Yellow Sweat and Body Swelling] This occurs when one enters water while sweating, allowing Water Pathogens to invade internally, or when one is exposed to wind while sweating. Both sweat and water belong to Cold-Dampness Qi. When they knot together and stagnate internally for a long time, they transform into Heat and Yellow, causing the symptoms of Yellow Sweat and Body Swelling to appear.
[Pulse of Yellow Sweat and Body Swelling] The pulse is naturally Chen (Deep), or often Chen Chi (Deep and Slow). This is a Yang Syndrome presenting with a Yin Pulse, therefore Guizhi Tang (Cinnamon Twig Decoction) or similar formulas are used.
[Treatment of Yellow Sweat and Body Swelling] According to *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), for cases with body swelling, fever, sweating, thirst, and symptoms resembling Fengshui, Huangqi Shaoyao Guijiu Tang (Astragalus, Peony, and Vinegar Decoction) is used. For cases where the calves are not cold but feel hot, known as Lijie; sweating after eating, night sweats in the evening, and fever persisting after sweating, Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus) is used.
Huangqi Shaoyao Guijiu Tang (Astragalus, Peony, and Vinegar Decoction)
Huangqi (Astragali Radix)
Guizhi (Cinnamomi Ramulus)
Baishaoyao (Paeoniae Radix Alba)
Boil the above three ingredients with Kujiu (Bitter Wine/Vinegar). If it causes heart vexation, replace Kujiu with fine wine.
Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus)
Guizhi (Cinnamomi Ramulus)
Shaoyao (Paeoniae Radix)
Shengjiang (Zingiberis Rhizoma Recens)
Huangqi (Astragali Radix)
Dazao (Ziziphi Jujubae Fructus)
Sheng Gancao (Glycyrrhizae Radix et Rhizoma Recens)
Commentary by Zhen: *Jin Gui Yao Lue* treats Yellow Sweat syndrome in two ways. One type involves body pain, fever, sweating, thirst, sweat color like cypress sap, and a Deep pulse, treated with Huangqi Shaoyao Guijiu Tang. The other type involves stomach fire becoming active due to labor causing sweating, and deficiency heat in the Ying (Nutritive) level at night causing night sweats. Since sweating has occurred, the body should be cool; however, because Water Pathogens are knotted internally and do not dissipate, fever persists. Prolonged heat and excessive sweating scorch the Yin blood of the skin and consume fluids, leading to skin becoming rough and scaly over time. If heat continues, the Ying Qi becomes heated, likely generating malignant sores. If the body feels heavy, it may temporarily lighten after sweating but quickly returns to heaviness. Although sweat is excreted, fever does not decrease, and body heaviness remains. Over time, internal Qi becomes deficient, and muscles may twitch. Internal deficiency prevents the Middle Qi from transforming and transporting, leading to chest pain. If Yuan Qi (Original Qi) fails to connect upper and lower, there is sweat above the waist but not below, with flaccid pain in the waist, feeling as if something is stuck in the skin and uncomfortable. In severe cases, one cannot eat, experiencing pain, irritability, and difficult urination, treated with Guizhi Jia Huangqi Tang. Regarding the former syndrome, it is caused by insecure sweating allowing Water Pathogens to enter the Ying level, stagnating and generating heat. Severe heat leads to yellowing and thirst. Thus, Guizhi is used to harmonize the Ying, and Kujiu is used to guide the medicine into the Blood level to disperse Water-Cold, thereby reducing heat and normalizing the pulse. However, since Wei (Defensive) Qi is deficient, excessive sweating should be avoided; thus, Huangqi is used to strengthen the Wei. Regarding the latter syndrome, it uses the original Guizhi Tang formula plus Shengjiang, Dazao, and Gancao, along with drinking hot congee to assist the Stomach Qi in producing sweat. Why add Huangqi to solidify the exterior and secure the Wei? It is because for conditions with a Floating pulse, fever, and excessive sweating that does not reduce heat, Guizhi is indispensable. Given the presence of excessive sweating and night sweats, Huangqi is also necessary. This condition is due to Water-Cold pathogens knotting and not dispersing; although sweat is produced, heat does not subside, fitting the description of "sweating out but pathogens remaining." Therefore, Zhongjing heavily adds Huangqi to the Guizhi exterior-releasing formula, assisted by Dazao, Gancao, and Shengjiang to harmonize Stomach Qi and jointly protect the exterior, ensuring pathogens exit while sweat is retained. Zhongjing classified Yellow Sweat under the Water Gate chapter, not the Jaundice chapter. Yutai considered Yellow Sweat as the beginning of Jaundice and noted it briefly in the Edema chapter, which serves to mutually illuminate the concepts. However, distinctions exist: sweat staining clothes with no body swelling belongs to Jaundice-type Yellow Sweat, as described in *Zhun Sheng*. Yellow sweat staining clothes with fever and cold calves corresponds to the Yellow Sweat treated by Zhongjing's Huangqi Shaoyao Guijiu Tang. Yellow sweat staining clothes with non-cold calves and instead fever corresponds to the Lijie treated by Zhongjing's Guizhi Jia Huangqi Tang. These two syndromes differ in the presence or absence of swelling, hence the distinction between Water Edema and Jaundice. Water-Cold pathogens knotting internally result in a Deep pulse, which should be handled similarly to Shanghan (Cold Damage) patterns. For the Guizhi pattern of Taiyang syndrome with fever and excessive sweating, use Acrid-Warm methods to release the muscle layer, allowing pathogens to scatter and the body to cool. This should not be compared to patterns in the Heat Disease chapter where Heat pathogens are latent internally, causing fever that persists despite sweating, which requires clearing interior heat.