黄汗之病。两胫自冷。假令发热。此属历节。食已汗出。又身常暮卧盗汗出者。此荣
气也。若汗出已。反发热者。久久其身必甲错。发热不止者。必生恶疮。若身重汗出
已。辄轻者。久久必身 。 即胸中痛。又从腰以上必汗出。下无汗。腰髋弛痛。如有
物在皮中状。剧者不能食。身疼重。烦躁。小便不利。此为黄汗。桂枝加黄 汤主之。
桂枝加黄 汤方
桂枝（二两） 芍药（二两） 甘草（二两） 生姜（三两） 大枣（十二枚） 黄 （二两）
上六味。以水八升。煮取三升。温服一升。须臾饮热稀粥一升余。以助药力。温覆取微汗。若不汗。更服。
〔衍义〕黄汗病。由阴阳水火不既济。阴阳者。荣卫之主。荣卫者。阴阳之用。阴阳不
既济。而荣卫亦不循行上下。阳火独壅于上。为黄汗。阴水独积于下。致两胫冷。
设阳火热甚。及肌肉则发热。阴水寒及筋骨。则历节痛。若起居饮食过节之劳。
必伤脾胃。将荣卫不充于腠理。而食入所长之阳。即与劳气相搏。散出为汗。又
或日暮气门不闭。其津液常泄为盗汗也。凡汗出必当热解。今汗已反发热者。
是邪气胜而津液亡也。斯肌肉无以润泽。久久必枯涩而甲错。发热不已。其热
逆于肉里。乃生恶疮。若邪正相搏于分肉间。则身重。汗出已。虽身重辄轻。然正
气又从汗散而虚。荣卫衰微。脉络皆空。久久邪气热生风火。动于分肉脉络间。
必作身 。 即胸中痛者。由胸中属肺金主气。行营卫之部。气海在焉。即虚之气。
不胜风火之击。是以痛也。又从腰以上必汗出者。腰以上阳也。阳与荣卫俱虚。
腠理不密。故津液被风火泄出也。腰以下阴也。为孤阴痹于下。故无汗。所以
腰髋弛痛。如有物在皮中状者。即内经所谓痛痹逢寒之类也。剧则不能食。身
疼烦躁。小便不利者。为荣卫甚虚。谷气不充。不能食。荣卫不充于分肉。故身
疼重。胃中虚。热上注心中作烦躁。小便不利者。因津液从汗出故也。
师曰。寸口脉迟而涩。迟则为寒。涩为血不足。趺阳脉微而迟。微则为气。迟则为寒。
寒气不足。则手足逆冷。手足逆冷。则荣卫不利。荣卫不利。则腹满胁鸣相逐。气转
膀胱。荣卫俱劳。阳气不通。即身冷。阴气不通。即骨疼。阳前通。则恶寒。阴前通。则痹
不仁。阴阳相得。其气乃行。大气一转。其气乃散。实则失气。虚则遗溺。名曰气分。
〔衍义〕人之血气荣卫。皆主于谷。谷入于胃。化为精微。脾与胃以膜相连。主四肢。
脾输谷气于三阴。胃输谷气于三阳。六经皆起于手足。故内外悉藉谷气温养
之也。寸口以候荣卫。趺阳以候脾胃。脾胃之脉虚寒。则手足不得禀水谷气。故
逆冷也。手足逆冷。则荣卫之营运于阴阳六经者皆不利。荣卫不利。则逆冷之
气。入积于中而不泻。不泻则内之温气去。寒独留。寒独留。则宗气不行而腹满。
脾之幕在季胁章门。寒气入于幕。止当少阳经脉所过。且少阳为枢。主十二官
行气之使。少阳之腑。三焦也。既不得行升发之气于三焦以化荣卫。必引留幕之寒。相逐于三焦之下输。下输属膀胱也。
当其时。卫微营衰。卫气不得行其阳
于表。即身冷。营气不得行其阴于里。即痛。阳虽暂得前通。身冷不能即温。斯恶
寒也。阴既前通。痛应少愈。然营气未与卫之阳合。孤阴独至。故痹而不仁。必从
膻中气海之宗气通转。然后阴阳和。荣卫布。邪气乃从下焦而散也。下焦者。中
渎之官。水道出焉。前后二窍皆属之。前窍属阳。后窍属阴。阳道实。则前窍固。邪
从后窍失气而出阳道虚。则从前窍遗尿而去矣。为大气一转而邪散。故曰气分。
气分。心下坚大如盘。边如旋杯。水饮所作。桂枝去芍药加麻黄细辛附子汤主之。
桂枝去芍加麻黄细辛附子汤方
桂枝（三两） 生姜（三两） 甘草（二两） 大枣（十二枚）
麻黄（二两） 细辛（二两） 附子（一枚炮）
上七味。以水七升。煮麻黄。去上沫。内诸药。煮取二升。分温三服。当汗出。如虫行皮中即愈。
是症与上条所叙不同。名气分即同。与下条亦同。
心下坚大如盘。边如旋杯。水饮所作。枳术汤主之。
枳术汤方
枳实（七枚） 白术（二两）
上二味。以水五升。煮取三升。分温三服。腹中 。即当散也。
〔衍义〕心下。胃土脘也。胃气弱。则所饮之水。入而不消。痞结而坚。必强其胃。乃可
消痞。白术健脾强胃。枳实善消心下痞。逐停水。散滞血。
附方
外台防己黄 汤。治风水。脉浮为在表。其人或头汗出。表无他病。病者但下重。
从腰以上为和。腰以下为肿及阴。难以屈伸。（方见风湿中）
头汗者风。腰以下肿者。水甚于风。故表无他病。当治腰下为要。然是汤前条治
风水在表。此可治风水在下之病。何也。考本草防己疗风水肿。手脚挛急。李东
垣亦以治腰下及足湿热肿甚。脉浮头汗。虽曰表无他病。然与表同。故可通治。
黄汗病，表现为双小腿自然发凉。假如双小腿发热，这属于历节病（关节疼痛游走不定）。如果在进食后出汗，并且身体经常在傍晚卧床时出现盗汗，这是营气病变。如果出汗之后，反而出现发热，时间久了皮肤必定会出现如鳞甲般的粗糙干裂；如果发热持续不止，一定会产生恶疮。如果身体沉重，出汗后身体反而觉得轻快，但时间久了必然出现身体拘急不舒、胸中疼痛的症状。并且腰部以上必然出汗，腰部以下无汗，腰髋部松弛疼痛，感觉像有东西在皮肤里一样。病情严重的不能进食，身体疼痛沉重，烦躁不安，小便不利，这就是黄汗病，用桂枝加黄芪汤主治。
桂枝加黄芪汤方
桂枝（二两） 芍药（二两） 甘草（二两） 生姜（三两） 大枣（十二枚） 黄芪（二两）
以上六味药，用水八升，煮取三升，温服一升。服药片刻后，喝热稀粥一升多，以助药力。覆盖衣被使身体微微出汗。如果不出汗，再服用。
〔衍义〕黄汗病，是由于阴阳水火不能既济所致。阴阳是营卫的主宰，营卫是阴阳的作用。阴阳不能既济，导致营卫也不能上下循行。阳火独自壅滞于上，形成黄汗；阴水独自积聚于下，导致双小腿发凉。
假设阳火热势很盛，波及肌肉则发热；阴水寒邪波及筋骨，则引起历节痛。如果起居饮食违背常度，过度劳累，必然损伤脾胃，使得营卫不能在腠理间充盈。于是食物所化生的阳气，与劳损之气相互搏结，散发出来成为汗。或者因为日暮时分毛孔不闭合，津液经常外泄成为盗汗。凡是出汗，应当热退身凉，现在出汗后反而发热，这是邪气胜而津液亡失的表现。这样肌肉失去润泽，时间久了必然枯涩而出现甲错。发热不已，热气逆乱于肌肉纹理之间，便产生恶疮。如果邪气与正气在分肉间相搏，则身体沉重。出汗后，虽然身体沉重感减轻，然而正气也从汗液中耗散而变得虚弱，营卫衰微，脉络空虚。时间久了，邪气化生风火，扰动分肉和脉络，必然导致身体拘急不舒。所谓胸中疼痛，是因为胸部属肺金，主司气机，是运行营卫的部位，也是气海所在。虚弱的正气，不胜受风火的冲击，所以产生疼痛。又因为腰部以上属阳，阳与营卫都虚弱，腠理不致密，所以津液被风火泄出而汗出。腰部以下属阴，为孤阴痹阻于下，所以无汗。因此腰髋部松弛疼痛，感觉像有东西在皮中，这就是《内经》所说的痛痹逢寒之类的病症。病情严重时不能进食，身体疼痛沉重，烦躁，小便不利，这是因为营卫极度虚弱，谷气不能充盈，所以不能进食；营卫不能充盈于分肉，所以身体疼痛沉重；胃中虚弱，热气上注心中导致烦躁；小便不利，是因为津液从汗液流失的缘故。
老师说：寸口脉迟而涩，迟脉主寒，涩脉主血不足。趺阳脉微而迟，微脉主气虚，迟脉主寒。寒气与气血不足，导致手足逆冷。手足逆冷，导致营卫运行不畅。营卫运行不畅，导致腹部胀满，胁肋部鸣响互相追逐，气转至膀胱。营卫俱劳损，阳气不通畅，则身体寒冷；阴气不通畅，则骨骼疼痛。阳气先通，则怕冷；阴气先通，则麻木不仁。阴阳相合，气机才能运行，大气一转，邪气才能消散。实证表现为放屁，虚证表现为遗尿，这叫气分病。
〔衍义〕人的血气营卫，都依赖于水谷精微。食物进入胃中，化为精微物质。脾与胃通过膜相连，主管四肢。脾将谷气输送到三阴经，胃将谷气输送到三阳经。六经都起于手足，所以内外都依赖谷气来温养。寸口脉用来候察营卫，趺阳脉用来候察脾胃。脾胃的脉象虚寒，则手足得不到水谷之气的禀赋，所以逆冷。手足逆冷，则营卫在阴阳六经中的营运都不利。营卫不利，则逆冷之气进入体内积聚而不能排泄。不排泄则体内的温气消失，只有寒气独留。寒气独留，则宗气不行而导致腹满。脾的膜位于季胁章门穴处，寒气侵入膜中，正好停留在少阳经脉经过的地方。而且少阳为枢，是主持十二官行气的使者，少阳的腑是三焦。既然不能在通过三焦升发气化以化生营卫，必然会牵引留在膜中的寒气，在三焦的下输处互相追逐。下输属于膀胱。在这个时候，卫气微弱，营气衰败。卫气不能在体表运行其阳气，则身体寒冷；营气不能在体内运行其阴气，则疼痛。阳气虽然暂时得以通行，但身体寒冷不能立即温暖，所以怕冷。阴气既然已经先行通达，疼痛应该稍减，然而营气未能与卫气之阳结合，孤阴独至，所以麻木不仁。必须从膻中气海的宗气通畅运转，然后阴阳调和，营卫布散，邪气才能从下焦消散。下焦是中渎之官，水道由此而出。前后二窍都属于下焦。前窍属阳，后窍属阴。阳道实，则前窍固摄有力，邪气从后窍以放屁的形式排出；阳道虚，则从前窍以遗尿的形式排出。因为大气一转而邪气消散，所以叫气分。
气分病，心下坚硬肿大如盘，边缘像倒扣的杯子，这是水饮所作，用桂枝去芍药加麻黄细辛附子汤主治。
桂枝去芍药加麻黄细辛附子汤方
桂枝（三两） 生姜（三两） 甘草（二两） 大枣（十二枚）
麻黄（二两） 细辛（二两） 附子（一枚，炮制）
以上七味药，用水七升，先煮麻黄，去掉上面的浮沫，再加入其他药物，煮取二升，分三次温服。应当出汗，感觉像虫子在皮肤中爬行一样，这就痊愈了。
这个症状与上一条所述不同，但名为气分，与下一条也相同。
心下坚硬肿大如盘，边缘像倒扣的杯子，这是水饮所作，用枳术汤主治。
枳术汤方
枳实（七枚） 白术（二两）
以上两味药，用水五升，煮取三升，分三次温服。服药后腹中咕咕作响，痞结就会消散。
〔衍义〕心下，指胃脘部。胃气虚弱，则饮入的水进入后不能消化，痞结而坚硬。必须增强胃的功能，才可以消除痞结。白术能健脾强胃，枳实善于消除心下的痞结，驱逐停聚的水饮，消散停滞的血瘀。
附方
外台防己黄芪汤。治疗风水病，脉浮表示病在表。患者或者头部出汗，体表没有其他病症，病人只觉得下半身沉重。腰部以上是正常的，腰部以下浮肿及阴部肿胀，难以屈伸。（方剂见风湿篇中）
头部出汗是因为风邪，腰部以下浮肿是因为水湿重于风邪，所以体表没有其他病症，治疗的重点应当在腰部以下。但是这个汤剂在前一条中治疗风水在表，这里可以治疗风水在下部的病症，为什么呢？考察本草，防己治疗风水肿、手脚挛急。李东垣也用此药治疗腰部以下及足部湿热严重、脉浮、头汗出的情况。虽然说体表没有其他病症，但病机与表证相同，所以可以通用治疗。
The disease of Yellow Sweat presents with spontaneous coldness in both shins. If, however, the shins are warm, this belongs to Li Jie (Lichuan Joint Disease, characterized by wandering joint pain). Sweating after eating, combined with frequent nocturnal sweating while lying down at dusk, indicates a disorder of Ying Qi (Nutritive Qi). If fever occurs after sweating, over time the body will inevitably develop xerosis cutis resembling fish scales; if the fever persists without ceasing, malignant sores will certainly arise. If the body feels heavy and becomes lighter after sweating, over time it will inevitably lead to muscle spasms and chest pain. Furthermore, there will be sweating above the waist but no sweating below the waist, accompanied by flaccid pain in the loins and hips, with a sensation as if an object were trapped in the skin. In severe cases, the patient cannot eat, experiences body pain and heaviness, irritability, and difficult urination; this is Yellow Sweat, which should be treated with Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus).
Guizhi Jia Huangqi Tang Formula
Guizhi (Ramulus Cinnamomi, two liang), Shaoyao (Radix Paeoniae Rubra or Radix Paeoniae Alba, two liang), Gancao (Radix Glycyrrhizae, two liang), Shengjiang (Rhizoma Zingiberis Recens, three liang), Dazao (Fructus Jujubae, twelve pieces), Huangqi (Radix Astragali, two liang).
Take these six herbs, add eight sheng of water, decoct to obtain three sheng. Take one sheng warm. Shortly after, drink more than one sheng of hot thin rice gruel to assist the medicinal power. Cover with blankets to induce slight sweating. If sweat does not occur, take another dose.
[Commentary] The disease of Yellow Sweat arises from the failure of Yin and Yang to interact properly (Water and Fire failing to achieve mutual interaction). Yin and Yang are the masters of Ying (Nutritive) and Wei (Defensive) Qi; Ying and Wei are the functions of Yin and Yang. When Yin and Yang fail to interact, Ying and Wei cannot circulate up and down normally. Yang fire stagnates exclusively in the upper part, causing Yellow Sweat; Yin water accumulates exclusively in the lower part, causing coldness in the shins.
If Yang heat is excessive and affects the muscles, fever ensues; if Yin cold affects the sinews and bones, Li Jie pain results. If daily life and diet violate regularity, leading to excessive labor, the Spleen and Stomach will inevitably be injured. Consequently, Ying and Wei will fail to fill the Cou Li (interstices). The Yang Qi generated from food intake will then contend with Qi from labor, dispersing out as sweat. Alternatively, if the pores remain open at dusk, body fluids may leak frequently, causing nocturnal sweating. Normally, sweating should resolve heat; now, however, fever persists after sweating. This indicates that pathogenic factors have prevailed while body fluids have been depleted. Thus, the muscles lose moisture, and over time become dry and rough, manifesting as xerosis cutis. Persistent fever causes heat to reverse into the muscle layers, generating malignant sores. If pathogens and healthy Qi contend between the muscle fibers, the body feels heavy. Although the heaviness may lessen after sweating, healthy Qi is also dispersed through sweat, becoming deficient. Ying and Wei decline, and the meridians become empty. Over time, pathogens generate wind and fire, disturbing the muscle fibers and meridians, inevitably causing muscle spasms. The chest pain mentioned occurs because the chest belongs to Lung Metal, governs Qi, is the region where Ying and Wei circulate, and houses the Qi Sea. The deficient healthy Qi cannot withstand the assault of wind and fire, hence the pain. Sweating above the waist occurs because the upper body is Yang; since Yang, Ying, and Wei are all deficient, the Cou Li are not secure, allowing body fluids to be discharged by wind and fire. The lower body is Yin; isolated Yin bi obstructs the lower part, hence no sweating. Therefore, there is flaccid pain in the loins and hips, with a sensation of an object in the skin, which corresponds to the Nei Jing's description of Painful Bi syndrome encountering cold. In severe cases, inability to eat, body pain and heaviness, irritability, and difficult uritation occur because Ying and Wei are extremely deficient, Grain Qi fails to fill them, leading to anorexia; Ying and Wei fail to fill the muscle fibers, causing body pain and heaviness; deficiency in the Stomach allows heat to ascend to the Heart, causing irritability; difficult urination results from fluid loss through sweat.
The Master said: A Chi (slow) and Se (choppy) pulse at the Cun Kou (radial artery) indicates Cold for Chi and insufficient Blood for Se. A Wei (faint) and Chi (slow) pulse at the Fu Yang (dorsalis pedis artery) indicates Qi deficiency for Wei and Cold for Chi. Cold Qi combined with insufficiency leads to cold extremities. Cold extremities impair the circulation of Ying and Wei. Impaired Ying and Wei circulation leads to abdominal fullness and borborygmus in the hypochondrium, with Qi shifting to the Bladder. When Ying and Wei are exhausted, Yang Qi fails to unblock, resulting in coldness of the body; Yin Qi fails to unblock, resulting in bone pain. If Yang opens first, aversion to cold occurs; if Yin opens first, numbness and insensitivity (Bi) occur. When Yin and Yang harmonize, Qi flows; when the Great Qi rotates, pathogenic Qi dissipates. Excess manifests as flatulence; deficiency manifests as enuresis. This is called the Qi Fen (Qi Division) pattern.
[Commentary] Human Blood, Qi, Ying, and Wei all depend on Grain Qi. Food enters the Stomach and transforms into essence. The Spleen and Stomach are connected by membranes and govern the four limbs. The Spleen transmits Grain Qi to the Three Yin meridians, and the Stomach transmits Grain Qi to the Three Yang meridians. Since all Six Meridians originate from the hands and feet, the interior and exterior rely on Grain Qi for warmth and nourishment. The Cun Kou pulse diagnoses Ying and Wei; the Fu Yang pulse diagnoses the Spleen and Stomach. If the Spleen and Stomach pulses are deficient and cold, the extremities do not receive the endowment of Water and Grain Qi, hence coldness. Cold extremities imply that the operation of Ying and Wei in the Yin-Yang and Six Meridians is impaired. Impaired Ying and Wei allow cold Qi to accumulate internally without discharge. Lack of discharge causes internal warmth to vanish, leaving only Cold. Isolated Cold prevents Zong Qi (Gathering Qi) from moving, causing abdominal fullness. The membrane of the Spleen is located at the lateral costal margin near Zhangmen (LR13). Cold Qi entering the membrane stops exactly where the Shaoyang (Lesser Yang) meridian passes. Shaoyang serves as the pivot, governing the movement of Qi among the Twelve Organs; its fu organ is the San Jiao (Triple Burner). If it cannot promote ascending and transforming Qi in the San Jiao to generate Ying and Wei, it will inevitably draw the retained cold from the membrane, chasing it to the lower transmission points of the San Jiao. The lower transmission belongs to the Bladder. At this time, Wei Qi is weak and Ying Qi is decadent. Wei Qi cannot circulate its Yang on the exterior, causing body coldness; Ying Qi cannot circulate its Yin on the interior, causing pain. Although Yang temporarily opens, the body remains cold and cannot immediately warm, hence aversion to cold. Although Yin has opened and pain should subside slightly, Ying Qi has not merged with Wei Yang; isolated Yin arrives alone, causing numbness and insensitivity. It is necessary for the Zong Qi at Danzhong (CV17) and the Qi Sea to rotate smoothly before Yin and Yang harmonize, Ying and Wei distribute, and pathogenic Qi dissipates from the Lower Burner. The Lower Burner is the official of mid-channel channels, from which water passages exit. Both anterior and posterior orifices belong to it. The anterior orifice is Yang, the posterior is Yin. If the Yang pathway is solid, the anterior orifice secures, and pathogens exit via the posterior orifice as flatulence; if the Yang pathway is deficient, the anterior orifice leaks urine. Because the Great Qi rotates and pathogens dissipate, it is called Qi Fen.
In the Qi Fen pattern, hardness and enlargement under the heart (epigastrium) like a plate, with edges like an inverted cup, caused by fluid retention, should be treated with Guizhi Qu Shaoyao Jia Mahuang Xixin Fuzi Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Asarum, and Prepared Aconite).
Guizhi Qu Shaoyao Jia Mahuang Xixin Fuzi Tang Formula
Guizhi (Ramulus Cinnamomi, three liang), Shengjiang (Rhizoma Zingiberis Recens, three liang), Gancao (Radix Glycyrrhizae, two liang), Dazao (Fructus Jujubae, twelve pieces), Mahuang (Herba Ephedrae, two liang), Xixin (Radix et Rhizoma Asari, two liang), Fuzii Praeparata (Radix et Rhizoma Aconiti Lateralis Preparata, one piece, processed).
Take these seven herbs, add seven sheng of water. First decoct Mahuang, remove the foam on top, then add the remaining herbs. Decoct to obtain two sheng. Divide into three warm doses. Sweating should occur; recovery follows when the patient feels a sensation like insects crawling under the skin.
This condition differs from the previous clause but shares the name Qi Fen, and is similar to the following clause.
Hardness and enlargement under the heart like a plate, with edges like an inverted cup, caused by fluid retention, should be treated with Zhizhu Tang (Immature Bitter Orange and Atractylodes Decoction).
Zhizhu Tang Formula
Zhishi (Fructus Aurantii Immaturus, seven pieces), Baizhu (Rhizoma Atractylodis Macrocephalae, two liang).
Take these two herbs, add five sheng of water, decoct to obtain three sheng. Divide into three warm doses. After ingestion, gurgling in the abdomen indicates that the palpable mass will dissipate.
[Commentary] "Under the heart" refers to the epigastrium (Stomach region). If Stomach Qi is weak, ingested water enters but fails to digest, forming a palpable, hard obstruction. One must strengthen the Stomach to eliminate the obstruction. Baizhu strengthens the Spleen and Stomach; Zhishi effectively eliminates epigastric palpitations, expels stagnant water, and disperses stagnant blood.
Attached Formulas
Waitai Fangji Huangqi Tang (Astragalus and Stephania Decoction from Waitai Mi Yao). Treats Feng Shui (Wind-Edema). A floating pulse indicates the pathogen is in the Exterior. The patient may have head sweating, with no other exterior symptoms, but feels heaviness in the lower body. The area above the waist is normal; the area below the waist is swollen, including the genitalia, making flexion and extension difficult. (Formula found in the Rheumatism section).
Head sweating indicates Wind; swelling below the waist indicates Water exceeds Wind. Thus, there are no other exterior symptoms, and treatment should focus on the lower body. However, this formula treats Feng Shui in the Exterior in the previous clause, yet here it treats Feng Shui in the Lower Body. Why? According to Materia Medica, Fangji treats Wind-Edema and limb spasms. Li Dongyuan also used it for damp-heat swelling in the lower body and feet, with floating pulse and head sweating. Although it states "no other exterior symptoms," the pathology aligns with the Exterior, thus it can be used generally.