〔沈〕此邪在皮肤而肿也。风入于卫。阳气虚滞。则四肢肿。皮毛气虚。受风而肿。所谓水气在皮肤
中。邪正相搏。风虚内鼓。故四肢聂聂 动。是因表虚也。盖肺与三焦之气。同入膀胱。而行决渎。今水不
行。则当使小便利。而病得除。故防己茯苓。除湿而利水。以黄 补卫而实表。表实而邪不能客。甘草安土
而制水邪。桂枝以和营卫。又行阳化气而实四末。俾风从外出。水从内泄矣。
巢源。水分候云。水分者。言肾气虚弱。不能制水。令水气分散。流布四肢。故云水分。但四肢皮肤
虚肿。聂聂而动者。名水分也。案此条证。据巢源。即水分也。
防己茯苓汤方（外台。引深师。名木防己汤云。本出仲景伤寒论。）
防己（三两） 黄 （三两） 桂枝（三两） 茯苓（六两） 甘草（二两○外台有炙字）
上五味。以水六升。煮取二升。分温三服。（圣惠。治皮水一方。有桑根白皮。）
外台。范汪。水防己汤。疗肿患下水气。四肢肿聂聂动。
于本方中。加生姜芍药各二两。白术三两。
里水。越婢加术汤主之。甘草麻黄汤亦主之。（外台。引范汪。
里水作皮水。又云。皮水。一身面目悉肿。甘草麻黄汤主之。二方各为一条。案外台为是。）
〔鉴〕里字。当是皮字。岂有里水而用麻黄之理。阅者自知是传写之讹。皮水。表虚有汗者。防己茯
苓汤。固所宜也。若表实无汗有热者。则当用越婢加术汤。无热者。则当用甘
草麻当汤。发其汗。使水外从皮去也。
越婢加术汤方（〔原注〕见上。于内加白术四两。又见中风中。）
甘草麻黄汤方（外台。引范汪云。本出仲景伤寒论。）
甘草（二两） 麻黄（四两）
上二味。以水五升。先煮麻黄。去上沫。内甘草。煮取三升。温服一升。重覆汗出。不汗再服。慎风寒。
千金云。有人患气急。积久不瘥。遂成水肿。如此者众。
诸皮中浮水。攻面目身体。从腰以上肿。皆以此汤发汗。悉愈方。（即本方。）
济生云。有人患气促。积久不瘥。遂成水肿。服之有效。但此药发表。老人虚人。不可轻用。更宜详审。
水之为病。其脉沉小。属少阴。浮者为风。无水虚胀者
为气水。发其汗即已。脉沉者。宜麻黄附子汤。浮者宜杏子汤。（气水下。魏添一病字。）
〔鉴〕为气水之气字。当是风字。若是气字。则无发汗之理。且通篇并无气水之病。水之为病。其脉
沉小。属少阴水也。今脉不沉小而浮。浮者为风。非少阴水也。若无水虚胀者。为风水也。风水发其汗即已。
风水脉沉者。宜麻黄附子汤汗之。脉浮者宜杏子汤汗之。
案魏气水之下。添一病字。气下为句云。无水虚胀者。所病不在水。乃气虚散漫。更不宜发汗。尤
亦为气作句。以水字接下句云。无水而虚胀者。则为气病。不可发汗。水病
发其汗则已。今考文义。殊不相协。又圣惠论。有气水肿。与本条所言自异。故姑仍金鉴。
麻黄附子汤方（少阴篇。作麻黄附子甘草汤。）
麻黄（三两） 甘草（二两） 附子（一枚炮）
上三味。以水七升。先煮麻黄。去上沫。内诸药。煮取二升半。温服八分。日三服。（八分。伤寒论。
作八合。）
〔沈〕水病始得之源。未有不从肾虚。而受风寒。郁住卫气。胃关不利。水邪泛溢。以致通身肿满。故
当补阳之中。兼用轻浮通阳。开郁利窍之剂。则真阳宣而邪自去。正谓不治水。而水自愈。今人不知通阳开
窍。惟用肾气丸。阴重阳轻之剂。壅补其内。阳气愈益不宣。转补转壅。邪无出路。
水肿日增。因药误事。不知凡几矣。
外台。古今录验。麻黄汤。疗风水身体面目尽浮肿。腰背牵引髀股。不能食。
于本方中。加桂心生姜。
杏子汤方（〔原注〕未见。恐是麻黄杏仁甘草石膏汤。）
〔沈〕脉浮者。邪居气分而属肺。详杏子汤。必以杏子为君。而杏乃专泻肺气。使肺气通调。邪去而肿
自退。方虽遗失。意想可知也。
〔魏〕余谓浮者为风。仲景自言其证矣。杏子汤之方。内水湿而外风寒。其
挟热者。可以用麻杏甘石也。如不挟热者。莫妙于前言甘草麻黄汤。加杏子。今谓之三拗汤矣。
案金鉴载杏子汤。即麻黄甘草杏仁三味。盖根据魏注也。
厥而皮水者。蒲灰散主之。（〔原注〕方见消渴中。）
〔尤〕厥而皮水者。水邪外盛。隔其身中之阳。不行于四
肢也。此厥之成于水者。去其水则厥自愈。不必以附子桂枝之属。助其内伏之阳也。蒲灰散义见前。
问曰。黄汗之为病。身体肿。（一作重。）发热汗出而渴。状如风水。汗沾衣。色正黄如柏汁。脉
自沉。何从得之。师曰。以汗出入水中浴。水从汗孔入得之。宜 芍桂酒汤主之。（身体
肿。脉经。千金。作身体洪肿而渴。脉经注云。一作不渴。沉下。外台有也字。脉经作黄
芍药桂枝苦酒汤。赵本柏作药。非。）
〔尤〕黄汗之病。与风水相似。但风水脉浮。而黄汗脉沉。风水恶风。而黄汗不恶风为异。其汗沾衣。
色正黄如柏汁。则黄汗之所独也。风水为风气外合水气。黄汗为水气内遏热气。热被水遏。水与热得。交蒸互
郁。汗液则黄。按前第二条云。小便通利。上焦有寒。其口多涎。此为黄汗。第四条
云。身肿而冷。状如周痹。此云。黄汗之病。身体肿。发热
汗出而渴。后又云。剧者不能食。身疼重。小便不利。何前后之不侔也。岂新久微甚之辨欤。夫病邪初受。
其未郁为热者。则身冷。小便利口多涎。其郁久而热甚者。则身热而渴。小便不利。亦自然之道也。
〔鉴〕黄
桂枝。解肌邪以固卫气。芍药苦酒。止汗液以摄营气。营卫调和。其病已矣。李升玺曰。按汗出浴水。亦
是偶举一端言之耳。大约黄汗。由脾胃湿久生热。积热成黄。湿热交蒸而汗出矣。
潘氏医灯续焰云。黄汗一证。仲景金匮要略。收入水气
病中。其主治与治疸。亦自悬绝。后人以其汗黄。遂列为五疸之一。实非疸也。
黄 芍药桂枝苦酒汤方（外台。引仲景伤寒论云。备急。张文仲。千金。
古今录验。深师。范汪。经心录同。）
黄 （五两） 芍药（三两） 桂枝（三两）
上三味。以苦酒一升。水七升。相和煮取三升。温服一升。当心烦。服至六七日乃解。若心烦不止者。
以苦酒阻故也。（〔原注〕一方。用美酒醯。代苦酒。○外台云。阻一作一方。用美清醯。代酒。）
〔尤〕苦酒阻者。欲行而未得遽行。久积药力。乃自行耳。故曰服至六七日乃解。
〔魏〕古人称醋为
苦酒。非另有所谓苦酒也。美酒醯。即人家所制社醋。即镇江红醋是也。又醋之
劣者。即白酒。醋各处皆是。总以社醋入药。
何氏医碥云。水寒遏郁汗液于肌内。为热所蒸。而成黄汗。然汗出浴水。亦举隅之论耳。当推展之。
愚按。黄 芍药桂枝苦酒汤。无清热去湿之品。徒取固敛。得无壅乎。此方恐是错简。终不可用。
倪氏本草汇言。四仙散。治汗出染衣。黄如柏汁。此名黄汗。其证发热汗出而渴。身体浮肿。此因出
汗时。受风冷水寒之气。入于汗孔得之。宜此方。用罗勒二钱。桂枝三钱。
黄白芍药各五钱。水酒各一碗煎服。（出罗勒条。）
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。此劳气也。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。（劳气。原本。作荣气。今根据诸本改之。外台。引仲景伤寒论。物作虫。）
〔程〕湿就下而流关节。故黄汗病。两胫冷。若两胫热。则属历节之病。其食已汗出。为胃气外泄。
暮而盗汗。为荣气内虚。又属虚劳之证。二者俱汗出。皆非黄汗也。欲作黄汗之证。汗出已。而热不为汗衰。
反发热。而热不止。薄于外。则销铄皮肤。故令身体枯槁。薄于里。则溃脉烂筋。故
令生恶疮也。夫湿胜则身重汗出。虽湿去身轻。而正气未必不损。如此久久。必耗散诸阳。故身 而胸痛。
是以上焦阳虚。则腰以上汗出。下焦湿胜。而为腰髋弛痛。如有物在皮中状也。剧则内伤于脾。而不能食。
外伤肌肉。而身体疼重。若烦躁小便不利。则水气无从出。蕴蓄肌中。必为黄汗。
案此条义难通。今姑仍程注。金鉴云。此承黄汗。详申
其证也。但文义未属。必是错简。不释。此说似是。
桂枝加黄 汤方
桂枝 芍药（各三两） 甘草（二两） 生姜（三两） 大枣（十二枚） 黄
（二两○千金黄胆门五两）
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。
〔尤〕桂枝黄 。亦行阳散邪之法。而尤赖饮热稀粥取汗。以发交郁之邪。
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。（实则。徐沈作寒则。注。寒恐是实字。胁鸣。程魏。作肠鸣。是。）
〔尤〕微则为气者。为气不足也。寒气不足。该寸口趺阳为言。寒而气血复不足也。寒气不足。则手足
无气而逆冷。荣卫无源而不利。由是脏腑之中。真气不充。而客寒独胜。则腹满胁鸣相逐。气转膀胱。即后
所谓失气遗溺之端也。荣卫俱劳者。荣卫俱乏竭也。阳气温于表。故不通则身冷。阴气荣于里。故不通即骨
疼。不通者。虚极而不能行。与有余而壅者不同。阳前通则恶寒。阴前通则痹不仁者。阳先行而
阴不与俱行。则阴失阳而恶寒。阴先行而阳不与俱行。则阳独滞而痹不仁也。盖阴与阳常相须也。不可失。失则
气机不续。而邪乃着。不失则上下交通。而邪不容。故曰阴阳相得。其气乃行。大气一转。其气乃散。失气
遗溺。皆相失之征。曰气分者。谓寒气乘阳之虚。而病于气也。
〔沈〕营卫相和。膻中宗气一转。大气乃行。
痹着之邪。相随而去。谓大气一转。其气乃散。而实者失气。邪从大便喧吹而泄。虚者遗溺。
邪从小便而去。此阳虚气滞化水。而精血为痹。故曰气分。（案此与尤注异。然义亦通。故两存之。）
〔程〕此章以明水在气分之大义。以气行则水寒之气亦行。非下章结于心下。为盘为杯也。
〔鉴〕名曰气分之下。当有下条桂枝去芍药加麻黄附子细辛汤主之十五字。
气分。心下坚。大如盘。边如旋杯。水饮所作。桂枝去
芍药加麻辛附子汤主之。（脉经。或枳术汤主之。）
〔鉴〕气分。心下坚大如盘。边如旋杯。水饮所作之十六字。当是衍文。观心下坚之本条。自知桂枝
去芍药加麻黄附子细辛汤主之十五字。当在上条气分之下。义始相属。正是气分之治法。必是错简在此。
桂枝去芍药加麻黄细辛附子汤方（三因。名桂附汤。）
桂枝（三两） 生姜（三两） 甘草（二两） 大枣（十二枚） 麻黄 细辛
各（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。
〔鉴〕用桂枝去芍药加麻黄附子细辛汤者。温养荣卫阴阳。
发散寒邪之气也。
〔尤〕当汗出。如虫行皮中者。盖欲使既结之阳。复行周身而愈也。
心下坚。大如盘。边如旋盘。水饮所作。枳术汤主之。（
肘后。卒心痛门。作心下坚痛。大如碗。边如旋 。名为气分。水饮所结。 。即盘字。
外台。心痛门。引文仲亦同。下盘字。徐沈作杯。案证类本草。作枳实术汤。近是。）
〔鉴〕心下坚。大如盘。边如旋盘。此里水所作也。赵良曰。心下胃上脘也。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。逐停水散滞气。
徐云。若盘字。乃即杯字。偶误。勿泥。盖坚大如盘。上之取义在大。边如旋杯。下之取义在圆。不
应又取大字义耳。合言之。总是坚大而圆也。案此注未允。潘氏续焰云。旋。圆也。上盘字。当据肘后作碗。
盖碗高于盘。盘大于碗。谓其坚大如碗。其边如圆盘。文意始通。若仍旧文。或从徐
下盘字为杯。则其义竟难解焉。
枳术汤方（外台。引张文仲云。此张仲景伤寒论方。备急。肘后同。）
枳实（七枚） 白术（二两）
上二味。以水五升。煮取三升。分温三服。腹中软。即当散也。（外台。五升。作一斗。）
〔鉴〕李 曰。枳实消胀。苦以泄之也。白术去湿。苦以燥之也。后张元素治痞。用枳术丸。亦从此
汤化出。但此乃水饮所作。则用汤以荡涤之。彼属食积所伤。则用丸以消磨之。一汤一丸。各有深意。非
漫无主张也。
【沈明宗注】这是邪气在皮肤导致的浮肿。风邪侵入卫分，阳气虚弱阻滞，就会导致四肢浮肿；皮毛之气虚弱，受风邪侵袭而浮肿。这就是所说的水气停留在皮肤中，邪气与正气相互搏结，风邪虚邪在内鼓动，所以四肢微微颤动。这是因为表虚的缘故。肺和三焦的气机，共同进入膀胱，行使决渎（疏通水道）的功能。如今水液不行，就应当通利小便，病才能去除。所以用防己、茯苓除湿利水，用黄芪补益卫气以充实肌表，表实了邪气就不能客留，甘草安定脾胃（土）以制约水邪，桂枝调和营卫，又通行阳气化生元气以充实四肢末端，使得风邪从外排出，水湿从内泄出。
《诸病源候论·水分候》说：所谓“水分”，是指肾气虚弱，不能制约水液，导致水气分散，流布于四肢，所以叫“水分”。只是四肢皮肤虚肿，微微颤动的，名叫“水分”。按此条证候，根据《诸病源候论》，就是“水分”病。
防己茯苓汤方（《外台秘要》引用《深师方》，名为木防己汤，说本出自张仲景《伤寒论》。）
防己（三两） 黄芪（三两） 桂枝（三两） 茯苓（六两） 甘草（二两○《外台秘要》有“炙”字）
以上五味药，用水六升，煮取二升，分三次温服。（《太平圣惠方》治皮水的方子，有桑根白皮。）
《外台秘要》引范汪方：水防己汤，治疗肿患下水气，四肢浮肿微微颤动。
在本方中加入生姜、芍药各二两，白术三两。
里水病，用越婢加术汤主治。甘草麻黄汤也主治。（《外台秘要》引范汪，将“里水”作“皮水”，又说：“皮水，一身面目全部浮肿，用甘草麻黄汤主治。”这两方各为一条。案：《外台秘要》的说法是正确的。）
【戴天章注】“里”字，应当是“皮”字。哪有里水病却用麻黄的道理？读者自然知道这是传写之误。皮水表虚有汗的，防己茯苓汤固然适宜。如果表实无汗且有热的，则应当用越婢加术汤；没有热的，则应当用甘草麻黄汤，发其汗，使水湿从皮肤排出。
越婢加术汤方（〔原注〕见上文，在此基础上加白术四两，又见于中风篇。）
甘草麻黄汤方（《外台秘要》引范汪说：本出自张仲景《伤寒论》。）
甘草（二两） 麻黄（四两）
以上两味药，用水五升，先煮麻黄，去掉上面的浮沫，加入甘草，煮取三升，温服一升。盖厚被子出汗，若不出汗再服。注意防风寒。
《千金方》说：有人患气急，积久不愈，遂成水肿。像这样的人很多。
各种皮水中浮水，攻冲面目身体，从腰部以上浮肿的，都用此汤发汗，都能痊愈。（即本方。）
《济生方》说：有人患气促，积久不愈，遂成水肿，服用此方有效。但此药发表，老人和体虚之人，不可轻用，更应详细审察。
水气病，脉象沉小，属于少阴经；脉象浮的属于风邪；没有水湿而虚胀的，属于气病。发其汗就好了。脉沉的，宜用麻黄附子汤；脉浮的，宜用杏子汤。（“气水”下，魏荔彤添了一个“病”字。）
【戴天章注】“为气水”的“气”字，应当是“风”字。如果是“气”字，就没有发汗的道理。且通篇并无“气水”这种病。水气病，脉象沉小，属于少阴水病。现在脉不沉小而浮，浮的是风邪，不是少阴水病。如果没有水湿而虚胀的，是风水病。风水病发其汗就好了。风水病脉沉的，宜用麻黄附子汤发汗；脉浮的，宜用杏子汤发汗。
案：魏荔彤在“气水”下添了一个“病”字，断句为“气，下为句云：无水虚胀者”。意思是所病的不在水，乃是气虚散漫，更不宜发汗。这也把“气”作为一句，以“水”字连接下句云：“无水而虚胀者，则为气病，不可发汗。水病发其汗则已。”现在考证文义，殊不相协调。又《太平圣惠方》论述中有“气水肿”，与本条所言自不相同。所以姑且保留《金鉴》的观点。
麻黄附子汤方（《少阴篇》作麻黄附子甘草汤。）
麻黄（三两） 甘草（二两） 附子（一枚，炮制）
以上三味药，用水七升，先煮麻黄，去掉上面的浮沫，加入其他药物，煮取二升半，温服八分，每日三次。（“八分”，《伤寒论》作“八合”。）
【沈明宗注】水病起始的原因，没有不从肾虚，感受风寒，郁滞卫气，胃关不利，水邪泛溢，以致全身肿满的。所以应当在补阳之中，兼用轻浮通阳、开郁利窍的药物，那么真阳宣通而邪气自去。正谓“不治水，而水自愈”。如今的人不知道通阳开窍，只用肾气丸这种阴重阳轻的药物，壅补体内，阳气更加不宣通，转补反而转壅塞，邪气没有出路，水肿日益增加，因用药失误误事的，不知有多少了。
《外台秘要》引《古今录验》：麻黄汤，治疗风水身体面目全部浮肿，腰背牵引大腿，不能进食。
在本方中加入桂心、生姜。
【沈明宗注】脉浮的，邪气在气分而属肺。详查杏子汤，必定以杏子为君药，而杏子专泻肺气，使肺气通调，邪气去而浮肿自退。方剂虽然遗失，意想可以知晓。
【魏荔彤注】我认为浮的是风邪，张仲景自己说了这个证候。杏子汤这个方子，内含水湿而外感风寒，其中挟热的，可以用麻黄杏仁甘草石膏汤。如果不挟热的，莫过于前面说的甘草麻黄汤加杏子，现在叫作三拗汤。
案：《金鉴》记载杏子汤，即麻黄、甘草、杏仁三味药。大概是依据魏注。
出现厥逆且患有皮水的，用蒲灰散主治。（〔原注〕方剂见消渴篇中。）
【尤在泾注】出现厥逆且患有皮水的，是水邪外盛，阻隔了身体中的阳气，不能运行到四肢。这种厥逆是由水引起的，去除了水，厥逆自然痊愈，不必用附子、桂枝之类的药物来助长内伏的阳气。蒲灰散的义理见前文。
问曰：黄汗病，身体浮肿（一作身体沉重），发热，汗出而口渴，症状像风水，汗沾衣服，颜色正黄如柏树汁，脉象自沉，这是什么原因得的？老师说：因为出汗时进入水中沐浴，水从汗孔进入而得的。宜用黄芪芍药桂枝苦酒汤主治。（“身体肿”，《脉经》、《千金方》作“身体洪肿而渴”，《脉经》注云：一作不渴。“沉”下，《外台秘要》有“也”字。《脉经》作“黄芍药桂枝苦酒汤”，赵开美本“柏”作“药”，非。）
【尤在泾注】黄汗病，与风水相似，但风水脉浮，而黄汗脉沉；风水恶风，而黄汗不恶风，这是不同之处。其汗沾衣，颜色正黄如柏树汁，则是黄汗所独有的。风水是风气外合水气，黄汗是水气内遏热气，热被水遏制，水与热结合，交蒸互郁，汗液变黄。按前第二条说：小便通利，上焦有寒，口中多涎，此为黄汗。第四条说：身肿而冷，状如周痹。这里说：黄汗病，身体肿，发热，汗出而渴。后又说：严重的不能进食，身体疼重，小便不利。为什么前后不一致呢？难道是新旧、轻重程度的区别吗？病邪初受，尚未郁结为热的，则身冷，小便通利，口中多涎；郁结久了且热甚的，则身热而渴，小便不利。这也是自然的道理。
【戴天章注】黄芪、桂枝，解肌邪以固护卫气；芍药、苦酒，止汗液以摄纳营气。营卫调和，病就好了。李升玺说：按出汗后洗冷水澡，也是偶然举一端来说罢了。大约黄汗，由脾胃湿气久蕴生热，积热成黄，湿热交蒸而汗出。
潘氏《医灯续焰》说：黄汗这一证，张仲景《金匮要略》收入水气病中，其主治与治黄疸，也截然不同。后人因为其汗黄，遂列为五疸之一，其实不是疸病。
黄芪芍药桂枝苦酒汤方（《外台秘要》引张仲景《伤寒论》说：备急千金方、张文仲方、千金方、古今录验、深师方、范汪方、经心录同。）
黄芪（五两） 芍药（三两） 桂枝（三两）
以上三味药，用苦酒一升，水七升，混合煮取三升，温服一升。应当心烦，服药至六七天才会缓解。如果心烦不止的，是因为苦酒阻碍的缘故。（〔原注〕一方，用美酒醋，代替苦酒。○《外台秘要》云：阻，一作“组”。一方，用美清醋，代酒。）
【尤在泾注】苦酒阻碍，是想行而未得遽行，久积药力，乃自行耳。所以说服药至六七天才会缓解。
【魏荔彤注】古人称醋为苦酒，并非另有所谓苦酒。美酒醋，即人家所制的社醋，即镇江红醋是也。又劣等的醋，即白酒醋。各处都有醋，总之以社醋入药。
何氏《医碥》说：水寒遏制郁滞汗液于肌肉内，被热所蒸，而成黄汗。然而出汗后洗冷水澡，也是举隅之论。应当推展理解。
愚按：黄芪芍药桂枝苦酒汤，没有清热去湿的药物，徒取固敛，难道不会壅塞吗？此方恐怕是错简，终究不可用。
倪氏《本草汇言》：四仙散，治疗汗出染衣，黄如柏汁，这名叫黄汗。其证发热汗出而渴，身体浮肿。这是因为出汗时，受风冷水寒之气，进入汗孔而得的。宜用此方，用罗勒二钱，桂枝三钱，黄芪、白芍药各五钱，水酒各一碗煎服。（出自罗勒条。）
黄汗病，两小腿自冷。假如发热，这属于历节病。饭后汗出，又经常傍晚卧时盗汗出的，这属于劳气病。如果汗出后反而发热的，久久身体必然甲错（皮肤干燥如鳞甲），发热不止的，必生恶疮。如果身体重，汗出后随即减轻的，久久必然身体消瘦（原文缺字，据意补），即胸中痛。又从腰部以上必汗出，下部无汗，腰髋弛缓疼痛，如有物在皮中状。严重的不能进食，身体疼重烦躁，小便不利，此为黄汗。用桂枝加黄芪汤主治。（“劳气”，原本作“荣气”，今根据诸本改之。《外台秘要》引张仲景《伤寒论》，“物”作“虫”。）
【程林注】湿性就下而流注关节，所以黄汗病，两小腿冷。如果两小腿热，则属于历节病。其饭后汗出，为胃气外泄；傍晚盗汗，为荣气内虚，又属于虚劳之证。这两种情况都汗出，都不是黄汗。欲作黄汗的证候，汗出后，热不为汗衰减，反而发热，而且热不止。热薄于外，则销铄皮肤，所以令身体枯槁；薄于里，则溃脉烂筋，所以令生恶疮也。湿胜则身重，汗出后虽湿去身轻，而正气未必不损。像这样久久，必耗散诸阳，所以身体消瘦而胸痛。因此上焦阳虚，则腰以上汗出；下焦湿胜，而为腰髋弛痛，如有物在皮中状。严重则内伤于脾，而不能进食；外伤肌肉，而身体疼重。若烦躁小便不利，则水气无从出，蕴蓄肌中，必为黄汗。
案：此条义理难通，今姑且保留程注。《金鉴》说：此承接黄汗，详细申述其证候。但文义未属，必是错简，不解释。此说似是。
桂枝加黄芪汤方
桂枝 芍药（各三两） 甘草（二两） 生姜（三两） 大枣（十二枚） 黄芪（二两○《千金方》黄疸门五两）
以上六味药，用水八升，煮取三升，温服一升。须臾间喝热稀粥一升余，以助药力。温覆取微汗。若不出汗再服。
【尤在泾注】桂枝、黄芪，也是行阳散邪的方法，而尤其依赖喝热稀粥取汗，以发散交郁之邪。
老师说：寸口脉迟而涩，迟则为寒，涩为血不足。趺阳脉微而迟，微则为气虚，迟则为寒。寒气与气血不足，则手足逆冷。手足逆冷，则营卫不利。营卫不利，则腹满胁鸣相互追逐，气转至膀胱。营卫俱劳（衰竭），阳气不通，即身冷；阴气不通，即骨疼。阳气先行而阴气不与俱行，则恶寒；阴气先行而阳气不与俱行，则痹不仁。阴阳相得，其气乃行，大气一转，其气乃散。实则失气（放屁），虚则遗溺（尿失禁），名叫气分。（“实则”，徐灵胎、沈明宗作“寒则”。注：寒恐是实字之误。“胁鸣”，程林、魏荔彤作“肠鸣”，是对的。）
【尤在泾注】“微则为气”，是气不足的意思。“寒气不足”，涵盖寸口、趺阳而言，指寒而气血复不足。寒气与气血不足，则手足无气而逆冷。营卫无源而不利。由此脏腑之中，真气不充，而客寒独胜，则腹满胁鸣相互追逐，气转至膀胱，即后所谓失气遗溺的端绪。荣卫俱劳，是荣卫俱乏竭。阳气温煦于表，故不通则身冷；阴气荣养于里，故不通即骨疼。不通者，是虚极而不能行，与有余而壅塞的不同。阳先行而阴不与俱行，则阴失阳而恶寒；阴先行而阳不与俱行，则阳独滞而痹不仁。盖阴与阳常相互依存，不可缺失。缺失则气机不续，而邪乃附着。不缺失则上下交通，而邪不容留。所以说“阴阳相得，其气乃行。大气一转，其气乃散。”失气遗溺，都是相失的征象。叫作“气分”，是说寒气乘阳之虚，而病于气。
【沈明宗注】营卫相和，膻中宗气一转，大气乃行。痹着之邪，相随而去。谓“大气一转，其气乃散”。实证者失气，邪从大便喧吹而泄；虚证者遗溺，邪从小便而去。此乃阳虚气滞化水，而精血为痹，故曰气分。（案：这与尤注不同，但义理也通，故两存之。）
【程林注】此章阐明水在气分的大义。以气行则水寒之气亦行，并非下章结于心下，为盘为杯那样。
【戴天章注】“名曰气分”之下，应当有下条“桂枝去芍药加麻黄附子细辛汤主之”十五个字。
气分，心下坚，大如盘，边如旋杯，水饮所作。桂枝去芍药加麻辛附子汤主之。（《脉经》或作枳术汤主之。）
【戴天章注】“气分，心下坚大如盘，边如旋杯，水饮所作”的十六字，应当是衍文。观心下坚之本条，自知“桂枝去芍药加麻黄附子细辛汤主之”十五字，应当在上条气分之下，义始相属。正是气分之治法，必是错简在此。
桂枝去芍药加麻黄细辛附子汤方（《三因方》名桂附汤。）
桂枝（三两） 生姜（三两） 甘草（二两） 大枣（十二枚） 麻黄 细辛各（二两） 附子（一枚，炮制）
以上七味药，用水七升，煮麻黄，去掉上面的浮沫，加入其他药物，煮取二升，分三次温服。应当汗出，如虫行皮中，即愈。
【戴天章注】用桂枝去芍药加麻黄附子细辛汤，是为了温养荣卫阴阳，发散寒邪之气。
【尤在泾注】当汗出，如虫行皮中者，大概是想要使既结之阳，复行周身而愈。
心下坚，大如盘，边如旋盘，水饮所作。枳术汤主之。（《肘后备急方》，卒心痛门，作“心下坚痛，大如碗，边如旋碗”，名为气分，水饮所结。碗，即盘字。《外台秘要》，心痛门，引文仲亦同。下“盘”字，徐灵胎、沈明宗作“杯”。案《证类本草》，作“枳实术汤”，近是。）
【戴天章注】心下坚，大如盘，边如旋盘，这是里水所作。赵良说：心下是胃之上脘。胃气弱，则所饮之水，入而不消，痞结而坚。必须强其胃，乃可消痞。白术健脾强胃，枳实善消心下痞，逐停水散滞气。
徐灵胎说：若“盘”字，即是“杯”字，偶误，勿拘泥。盖坚大如盘，上取义在大；边如旋杯，下取义在圆。不应又取大字义耳。合言之，总是坚大而圆也。案：此注未允。潘氏《续焰》说：旋，圆也。上“盘”字，当据《肘后方》作“碗”。盖碗高于盘，盘大于碗。谓其坚大如碗，其边如圆盘，文意始通。若仍旧文，或从徐下“盘”字为“杯”，则其义竟难解焉。
枳术汤方（《外台秘要》引张文仲说：此张仲景《伤寒论》方。备急方、肘后方同。）
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。腹中软，即当散也。（《外台秘要》，五升，作一斗。）
【戴天章注】李东垣说：枳实消胀，苦以泄之；白术去湿，苦以燥之。后来张元素治痞，用枳术丸，也是从此汤化出。但这乃是水饮所作，则用汤以荡涤之；彼属食积所伤，则用丸以消磨之。一汤一丸，各有深意，并非漫无主张也。
[Shen Mingzong's Commentary] This is edema caused by pathogenic factors in the skin. Wind pathogens invade the Wei (Defensive) level; when Yang Qi is deficient and stagnant, it leads to edema of the four limbs. When the Qi of the skin and hair is deficient and affected by wind, swelling occurs. This is what is meant by water qi remaining in the skin, where pathogenic factors and healthy Qi struggle against each other. The internal鼓动 (pulsating/disturbance) of wind and deficiency causes the four limbs to tremble slightly (nie nie dong). This is due to exterior deficiency. The Qi of the Lung and the Sanjiao (Triple Burner) jointly enters the Bladder to perform the function of regulating water passages (jue du). Now that water flow is obstructed, one should promote urination to eliminate the disease. Therefore, Fangji (Stephaniae Tetrandrae Radix) and Fuling (Poria) are used to remove dampness and promote diuresis; Huangqi (Astragali Radix) tonifies Wei Qi to strengthen the exterior. Once the exterior is solid, pathogens cannot lodge. Gancao (Glycyrrhizae Radix et Rhizoma) stabilizes the Spleen (Earth) to control water pathogens, and Guizhi (Cinnamomi Ramulus) harmonizes Ying (Nutritive) and Wei (Defensive) Qi, while also promoting Yang Qi transformation to nourish the extremities. Thus, wind exits from the outside, and water drains from the inside.
*Zhubing Yuanhou Lun* (Source Book of All Pathologies), "Water Division Syndrome" chapter states: "Water division" refers to Kidney Qi deficiency failing to control water, causing water qi to disperse and flow to the four limbs, hence the name "Water Division." However, when there is only flaccid swelling of the four limbs' skin with slight trembling, it is named "Water Division." According to this syndrome description, based on *Zhubing Yuanhou Lun*, it is indeed the "Water Division" syndrome.
Fangji Fuling Decoction Formula (cited in *Waitai Miyao* from *Shenshi Fang*, named Mufangji Tang, stating it originally comes from Zhang Zhongjing's *Shanghan Lun*.)
Fangji (3 liang) Huangqi (3 liang) Guizhi (3 liang) Fuling (6 liang) Gancao (2 liang ○ *Waitai Miyao* adds "roasted")
The above five herbs are boiled in 6 sheng of water to obtain 2 sheng. Divide into three warm doses. (*Taiping Shenghui Fang*'s formula for Pi Shui includes Sangbaipi [Morus Alba Root Bark].)
*Waitai Miyao* cites Fan Wang's formula: Shuifangji Tang treats swelling with water qi below, causing four limbs to swell and tremble slightly.
Add Shengjiang (Fresh Ginger) and Shaoyao (Paeoniae Radix) 2 liang each, and Baizhu (Atractylodis Macrocephalae Rhizoma) 3 liang to this base formula.
Li Shui (Interior Water) is primarily treated with Yuespi Jia Zhu Tang (Jade Bi Decoction plus Atractylodes). Gancao Mahuang Tang (Licorice and Ephedra Decoction) is also indicated. (*Waitai Miyao* cites Fan Wang, changing "Li Shui" to "Pi Shui," and stating: "Pi Shui presents with complete swelling of the body, face, and eyes, treated with Gancao Mahuang Tang." These two formulas are listed separately. Case: *Waitai Miyao*'s account is correct.)
[Dai Tianzhang's Commentary] The character "Li" (Interior) should be "Pi" (Skin/Exterior). How could Interior Water be treated with Mahuang? Readers will naturally realize this is a transcription error. For Pi Shui with exterior deficiency and sweating, Fangji Fuling Tang is appropriate. If there is exterior excess without sweating and with heat, Yuespi Jia Zhu Tang should be used; if there is no heat, Gancao Mahuang Tang should be used to induce sweating, allowing water to exit via the skin.
Yuespi Jia Zhu Tang Formula ([Original Note] See above, add Baizhu 4 liang. Also found in the Stroke chapter.)
Gancao Mahuang Tang Formula (*Waitai Miyao* cites Fan Wang: Originally from Zhang Zhongjing's *Shanghan Lun*.)
Gancao (2 liang) Mahuang (4 liang)
The above two herbs are boiled in 5 sheng of water. First boil Mahuang, remove the foam on top, then add Gancao. Boil to obtain 3 sheng. Take 1 sheng warm. Cover thickly to induce sweating; if no sweat, take again. Avoid wind and cold.
*Qianjin Fang* states: Someone suffers from shortness of breath, which persists for a long time and eventually becomes edema. Many people present like this.
For floating water in various skin types attacking the face, eyes, and body, with swelling above the waist, all can be cured by inducing sweat with this decoction. (This is the current formula.)
*Jisheng Fang* states: Someone suffers from panting, which persists for a long time and eventually becomes edema. Taking this formula is effective. However, this formula releases the exterior; it should not be used lightly on the elderly or the weak. Careful examination is required.
In water diseases, if the pulse is deep and small, it belongs to Shaoyin; if floating, it belongs to Wind. If there is no water but false distension, it is a Qi disorder. Inducing sweat resolves it. If the pulse is deep, Mahuang Fuzi Tang is suitable; if floating, Xingzi Tang is suitable. (Wei Litong added the character "bing" [disease] after "Qi Shui".)
[Dai Tianzhang's Commentary] The character "Qi" in "Wei Qi Shui" should be "Feng" (Wind). If it were "Qi," there would be no rationale for inducing sweat. Moreover, the entire text does not mention a disease called "Qi Shui." In water diseases, a deep and small pulse indicates Shaoyin Water. Now, since the pulse is not deep and small but floating, the floating indicates Wind, not Shaoyin Water. If there is no water but false distension, it is Feng Shui (Wind Water). Feng Shui is resolved by inducing sweat. For Feng Shui with a deep pulse, Mahuang Fuzi Tang is used to induce sweat; for a floating pulse, Xingzi Tang is used.
Case: Wei Litong added "bing" after "Qi Shui," punctuating as "Qi... Below is a sentence: Those without water but with false distension..." meaning the pathology is not water, but scattered Qi deficiency, which definitely should not be treated with sweat-inducing methods. He also treats "Qi" as a separate clause, connecting "Shui" to the next sentence: "Without water but with false distension, it is a Qi disease,不可发汗 (cannot induce sweat). Water diseases are resolved by inducing sweat." Examining the textual logic, this does not fit well. Furthermore, *Taiping Shenghui Fang* discusses "Qi Edema," which differs from the current passage. Therefore, I tentatively retain the view of *Jin Jian*.
Mahuang Fuzi Tang Formula (*Shaoyin Chapter* makes it Mahuang Fuzi Gancao Tang.)
Mahuang (3 liang) Gancao (2 liang) Fuziu (1 piece, processed)
The above three herbs are boiled in 7 sheng of water. First boil Mahuang, remove the foam, then add the other herbs. Boil to obtain 2.5 sheng. Take 0.8 sheng warm, three times a day. ("0.8 sheng" in *Shanghan Lun* is written as "0.8 he".)
[Shen Mingzong's Commentary] The origin of water disease invariably starts with Kidney deficiency, contracting wind-cold, which stagnates Wei Qi. The Stomach gate becomes obstructed, leading to overflowing water pathogens and general full-body edema. Therefore, one must combine Yang-tonifying herbs with light, floating herbs that unblock Yang, open depression, and benefit orifices. Thus, True Yang is disseminated, and pathogens depart spontaneously. This is precisely "treating water without directly targeting water, yet water heals itself." Nowadays, people do not understand unblocking Yang and opening orifices; they only use Shenqi Wan, a formula heavy in Yin and light in Yang, clogging the interior. This further obstructs Yang Qi. Instead of tonifying, they cause blockage; pathogens have no exit. Edema increases daily. Countless cases have been mishandled due to incorrect medication.
*Waitai Miyao* cites *Gujin Luyan*: Mahuang Tang treats Feng Shui with complete swelling of the body, face, and eyes, back pain radiating to the thighs, and anorexia.
Add Guixin (Cinnamon Heart) and Shengjiang to this formula.
Xingzi Tang Formula ([Original Note] Not seen. Likely Mahuang Xingren Gancao Shigao Tang [Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction].)
[Shen Mingzong's Commentary] A floating pulse indicates pathogens in the Qi level belonging to the Lung. Detailed analysis of Xingzi Tang suggests Xingren (Apricot Kernel) must be the sovereign herb. Xingren specifically purges Lung Qi, ensuring smooth Lung Qi circulation. Once pathogens leave, swelling recedes. Although the formula is lost, its intent can be imagined.
[Wei Litong's Commentary] I believe floating indicates Wind, as Zhang Zhongjing himself described the syndrome. Regarding the Xingzi Tang formula, containing internal water-dampness and external wind-cold: if accompanied by heat, Mahuang Xingren Gancao Shigao Tang can be used. If not accompanied by heat, nothing is better than adding Xingren to the previously mentioned Gancao Mahuang Tang, now known as San'ao Tang.
Case: *Jin Jian* records Xingzi Tang as consisting of Mahuang, Gancao, and Xingren. This is likely based on Wei's commentary.
When Jue (cold extremities) occurs with Pi Shui (Skin Water), Puhui San (Puhui Powder) is indicated. ([Original Note] Formula seen in the Xiao Ke [Wasting-Thirst] chapter.)
[You Zaijing's Commentary] When Jue occurs with Pi Shui, external water pathogens are excessive, blocking the body's Yang Qi from reaching the four limbs. This Jue is caused by water; removing the water cures the Jue. There is no need to use Fuzi or Guizhi to assist the internally latent Yang. The principle of Puhui San is explained earlier.
Question: In Huang Han (Yellow Sweat) disease, the body swells (or feels heavy), fever occurs, sweating happens with thirst, resembling Feng Shui. The sweat stains clothes yellow like catalpa juice, and the pulse is self-deep. How was this contracted? Master said: It is contracted by bathing in water while sweating, allowing water to enter through the sweat pores. Yi Huang Shao Yao Gui Zhi Ku Jiu Tang (Astragalus, Peony, Cinnamon Twig, and Vinegar Decoction) is indicated. ("Body swelling," *Mai Jing* and *Qianjin* read "body severely swollen and thirsty"; *Mai Jing* note says: alternatively "no thirst." After "deep," *Waitai* has "ye." *Mai Jing* reads "Huang Shaoyao Guizhi Kujiu Tang." Zhao Kaimei's edition changes "Bai" [catalpa] to "Yao" [peony], which is incorrect.)
[You Zaijing's Commentary] Huang Han disease resembles Feng Shui, but Feng Shui has a floating pulse while Huang Han has a deep pulse; Feng Shui involves aversion to wind, while Huang Han does not. The sweat staining clothes yellow like catalpa juice is unique to Huang Han. Feng Shui is wind combining externally with water qi; Huang Han is water qi suppressing heat internally. Heat suppressed by water, combined and steaming mutually, turns sweat yellow. Referring to Article 2 earlier: clear urination, cold in the Upper Jiao, excessive salivation—this is Huang Han. Article 4 states: body swelling with cold, resembling Zhou Bi. Here it states: Huang Han disease, body swelling, fever, sweating with thirst. Later it states: severe cases cannot eat, body ache and heaviness, difficult urination. Why the discrepancy? Is it a distinction between new/old or mild/severe? Initially, when pathogens are received but not yet郁结 (stagnated into heat), the body is cold, urination is clear, and there is excessive salivation. When stagnated for a long time with severe heat, the body is hot and thirsty, with difficult urination. This is natural.
[Dai Tianzhang's Commentary] Huangqi and Guizhi release muscle-layer pathogens to secure Wei Qi; Shaoyao and Ku Jiu (vinegar) stop sweating to conserve Ying Qi. When Ying and Wei are harmonized, the disease resolves. Li Shengxi says: Bathing in water after sweating is merely cited as one example. Generally, Huang Han arises from long-standing Spleen-Stomach dampness generating heat, accumulating into yellow, with damp-heat steaming causing sweat.
Pan Shi's *Yi Deng Xu Yan* states: The syndrome of Huang Han is included in Water Qi Disease in Zhang Zhongjing's *Jin Gui Yao Lue*. Its treatment is distinct from treating Jaundice. Later generations, because the sweat is yellow, classified it as one of the Five Jaundices, which is actually incorrect; it is not Jaundice.
Huangqi Shaoyao Guizhi Kujiu Tang Formula (*Waitai Miyao* cites Zhang Zhongjing's *Shanghan Lun*: Beiji, Zhang Wenzhong, Qianjin, Gujin Luyan, Shenshi, Fan Wang, Jingxin Lu all agree.)
Huangqi (5 liang) Shaoyao (3 liang) Guizhi (3 liang)
The above three herbs are boiled together with 1 sheng of Ku Jiu (vinegar) and 7 sheng of water to obtain 3 sheng. Take 1 sheng warm. One should feel mental restlessness (fan xin); relief comes after 6-7 days. If restlessness persists, it is due to the obstruction by Ku Jiu. ([Original Note] Another formula uses fine wine vinegar instead of Ku Jiu. ○ *Waitai Miyao* says: "Zu" [obstruct] is alternatively "Zu" [group]. Another formula uses fine clear vinegar to replace wine.)
[You Zaijing's Commentary] "Obstruction by Ku Jiu" means the medicine wants to act but cannot immediately; after accumulating power over time, it acts spontaneously. Hence, "relief comes after 6-7 days."
[Wei Litong's Commentary] Ancients called vinegar "Ku Jiu"; there is no other specific substance called Ku Jiu. Fine wine vinegar is the She Cu (Temple Vinegar) made at home, i.e., Zhenjiang Red Vinegar. Inferior vinegar is Baijiu vinegar. Vinegar is available everywhere; always use She Cu for medicinal purposes.
He Shi's *Yi Biao* states: Cold water suppresses sweat fluid in the muscles, steamed by heat, forming Huang Han. However, bathing in water after sweating is just an illustrative example. One should expand upon this.
I submit: Huangqi Shaoyao Guizhi Kujiu Tang lacks heat-clearing and damp-draining herbs, relying solely on astringency. Would this not cause blockage? This formula is likely a misplaced slip (cuo jian) and ultimately unusable.
Ni Shi's *Bencao Huiyan*: Six Immortals Powder treats sweat staining clothes yellow like catalpa juice, named Huang Han. Symptoms include fever, sweating with thirst, and body swelling. This is contracted by wind-cold entering sweat pores during sweating. Use this formula: Luo Le (Ocimum Basilicum) 2 qian, Guizhi 3 qian, Huangqi and Baishao 5 qian each. Decoct with water and wine, one bowl each. (From Luo Le entry.)
In Huang Han disease, the calves are naturally cold. If they feel hot, it belongs to Li Jie (Joint Bi). Sweating after eating, and frequent night sweats upon lying down, belong to Lao Qi (Consumptive Qi). If fever recurs after sweating, the body will eventually become rough and scaly (jia cuo). Persistent fever will generate malignant sores. If the body feels heavy and lightens after sweating, eventually the body will emaciate, accompanied by chest pain. Sweating will occur above the waist but not below. The loins and hips will feel loose and painful, as if something is trapped in the skin. Severe cases involve anorexia, body ache/heaviness, irritability, and difficult urination. This is Huang Han, treated with Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus). ("Lao Qi," original text reads "Rong Qi," corrected here according to various editions. *Waitai Miyao* cites *Shanghan Lun*, changing "wu" [thing] to "chong" [insect].)
[Cheng Lin's Commentary] Dampness flows downward to joints, so in Huang Han disease, the calves are cold. If the calves are hot, it belongs to Li Jie disease. Sweating after eating indicates Stomach Qi leaking outward; night sweating indicates Rong Qi deficiency inward, belonging to Xu Lao (Deficiency Consumption). Both involve sweating but are not Huang Han. For impending Huang Han, after sweating, heat does not decrease but rather increases and persists. Heat pressing outward consumes skin, causing emaciation; pressing inward damages vessels and tendons, causing malignant sores. Excess dampness causes heaviness; although dampness leaves and lightness returns, Zheng Qi may be damaged. Over time, Yang Qi is depleted, leading to emaciation and chest pain. Thus, Upper Jiao Yang deficiency causes sweating above the waist; Lower Jiao damp excess causes loose hip pain, feeling like something in the skin. Severe cases injure the Spleen internally (anorexia) and Muscles externally (ache/heaviness). If there is irritability and difficult urination, water Qi has no outlet, accumulates in muscles, and becomes Huang Han.
Case: The meaning of this passage is difficult to interpret. I tentatively retain Cheng's commentary. *Jin Jian* states: This follows up on Huang Han to detail its symptoms. But the textual logic is disjointed, likely a misplaced slip. No explanation given. This view seems plausible.
Guizhi Jia Huangqi Tang Formula
Guizhi Shaoyao (each 3 liang) Gancao (2 liang) Shengjiang (3 liang) Dazao (12 pieces) Huangqi (2 liang ○ *Qianjin* Jaundice section: 5 liang)
The above six herbs are boiled in 8 sheng of water to obtain 3 sheng. Take 1 sheng warm. Shortly after, drink more than 1 sheng of hot thin porridge to aid the medicinal power. Cover warmly to induce slight sweating. If no sweat, take again.
[You Zaijing's Commentary] Guizhi and Huangqi are methods to promote Yang and scatter pathogens, especially relying on drinking hot thin porridge to induce sweat, thereby dispersing intertwined pathogens.
Master said: The Cun Kou (Radial) pulse is slow and choppy. Slow indicates Cold; choppy indicates Blood deficiency. The Zu Yang (Dorsalis Pedis) pulse is faint and slow. Faint indicates Qi deficiency; slow indicates Cold. Cold Qi and deficiency lead to cold hands and feet. Cold hands and feet lead to unfavorable Ying and Wei circulation. Unfavorable Ying and Wei circulation leads to abdominal fullness and borborygmus in the hypochondrium, with Qi moving to the Bladder. When Ying and Wei are exhausted, Yang Qi is blocked, causing cold body; Yin Qi is blocked, causing bone pain. If Yang advances first without Yin accompanying, there is aversion to cold; if Yin advances first without Yang accompanying, there is numbness and insensitivity (Bi Bu Ren). When Yin and Yang harmonize, their Qi circulates. When the Great Qi rotates, pathological Qi dissipates. Excess manifests as passing gas (shi qi); deficiency manifests as urinary incontinence (yi ni). This is named Qi Fen (Qi Division/Level). ("Excess," Xu Lingtai and Shen Mingzong read "Cold." Note: "Cold" is likely a typo for "Excess." "Hypochondrial borborygmus," Cheng Lin and Wei Litong read "Intestinal borborygmus," which is correct.)
[You Zaijing's Commentary] "Faint indicates Qi" means Qi deficiency. "Cold Qi and deficiency" refers to both Cun Kou and Zu Yang pulses, indicating Cold with simultaneous Qi and Blood deficiency. Cold Qi and deficiency result in cold extremities due to lack of Qi. Ying and Wei lack source and fail to circulate. Consequently, within the Zang-Fu, True Qi is insufficient while Guest Cold prevails, leading to abdominal fullness and borborygmus, with Qi moving to the Bladder—the precursors to the later mentioned passing gas and incontinence. "Ying and Wei exhausted" means Ying and Wei are depleted. Yang warms the exterior, so blockage causes cold body; Yin nourishes the interior, so blockage causes bone pain. Blockage here means extreme deficiency preventing movement, different from excess and congestion. If Yang moves first without Yin, Yin loses Yang and experiences aversion to cold; if Yin moves first without Yang, Yang stagnates alone causing numbness. Yin and Yang must depend on each other. Loss leads to interrupted Qi mechanism and pathogen attachment; retention allows upper-lower communication and prevents pathogen lodging. Hence, "When Yin and Yang harmonize, Qi circulates. When Great Qi rotates, pathological Qi dissipates." Passing gas and incontinence are signs of loss. Named "Qi Fen" because Cold Qi takes advantage of Yang deficiency to affect Qi.
[Shen Mingzong's Commentary] When Ying and Wei harmonize, the Zong Qi in Danzhong rotates, and Great Qi circulates. Pathogens of Bi stagnation depart with it. "Great Qi rotates, pathological Qi dissipates." In excess, pathogens exit via stool (passing gas); in deficiency, pathogens exit via urine. This is Yang deficiency and Qi stagnation transforming into water, with essence and blood becoming Bi. Hence, it is called Qi Fen. (Case: This differs from You's commentary but is logically sound, so both are retained.)
[Cheng Lin's Commentary] This chapter clarifies the major principle of water in the Qi level. As Qi moves, Cold-Water Qi also moves; it is not like the next chapter where water knots in the epigastrium, forming a plate or cup.
[Dai Tianzhang's Commentary] Under "Named Qi Fen," the fifteen characters "Gui Zhi Qu Shao Yao Jia Ma Huang Fu Zi Xi Xin Tang Zhu Zhi" (Treated with Cinnamon Twig Decoction minus Peony plus Ephedra, Aconite, and Coptis Decoction) from the following paragraph should be inserted.
Qi Fen: Epigastric hardness, large as a plate, edge like a turned cup, caused by water-fluid retention. Treated with Gui Zhi Qu Shao Yao Jia Ma Huang Xi Xin Fu Zi Tang. (*Mai Jing* alternatively says Zhi Zhu Tang.)
[Dai Tianzhang's Commentary] The sixteen characters "Qi Fen, epigastric hardness large as a plate, edge like a turned cup, caused by water-fluid retention" are likely interpolations. Observing the original entry for epigastric hardness, one realizes the fifteen characters "Gui Zhi Qu Shao Yao Jia Ma Huang Fu Zi Xi Xin Tang Zhu Zhi" should precede the current Qi Fen entry for logical coherence. This is the treatment for Qi Fen and is likely a misplaced slip here.
Gui Zhi Qu Shao Yao Jia Ma Huang Xi Xin Fu Zi Tang Formula (*Sanyin Fang* names it Gui Fu Tang.)
Guizhi (3 liang) Shengjiang (3 liang) Gancao (2 liang) Dazao (12 pieces) Mahuang Xi Xin (each 2 liang) Fuzi (1 piece, processed)
The above seven herbs are boiled in 7 sheng of water. First boil Mahuang, remove foam, then add other herbs. Boil to obtain 2 sheng. Divide into three warm doses. One should sweat, feeling like insects crawling under the skin, indicating cure.
[Dai Tianzhang's Commentary] Using Gui Zhi Qu Shao Yao Jia Ma Huang Fu Zi Xi Xin Tang warms and nourishes Ying, Wei, Yin, and Yang, and disperses Cold pathogens.
[You Zaijing's Commentary] Sweating, feeling like insects crawling under the skin, aims to restore the previously congealed Yang Qi to circulate throughout the body for healing.
Epigastric hardness, large as a plate, edge like a turned plate, caused by water-fluid retention. Treated with Zhi Zhu Tang. (*Zhou Hou Bei Ji Fang*, Acute Heartache section, reads "epigastric hardness and pain, large as a bowl, edge like a turned bowl," named Qi Fen, knot of water-fluid. Bowl is equivalent to Plate. *Waitai Miyao*, Heartache section, cites Wen Zhong similarly. The character "plate" below, Xu Lingtai and Shen Mingzong read "cup." Case: *Zheng Lei Ben Cao* reads "Zhishi Zhutang," which is closer.)
[Dai Tianzhang's Commentary] Epigastric hardness, large as a plate, edge like a turned plate, is caused by Interior Water. Zhao Liang says: The epigastrium is the Upper Jiao of the Stomach. Weak Stomach Qi fails to digest ingested water, leading to痞结 (glomus/knotting) and hardness. One must strengthen the Stomach to resolve the glomus. Baizhu strengthens the Spleen and Stomach; Zhishi excels at resolving epigastric glomus, driving out retained water and dispersing stagnant Qi.
Xu Lingtai says: If "plate" is a typo for "cup," do not cling to it. "Large as a plate" emphasizes size; "edge like a turned cup" emphasizes roundness. It shouldn't emphasize size again. Combined, it means hard, large, and round. Case: This annotation is unsatisfactory. Pan Shi's *Xu Yan* states: "Xuan" means round. The upper "plate" should be read as "bowl" according to *Zhou Hou*. Bowls are higher than plates; plates are larger than bowls. Describing it as "hard and large as a bowl, edge like a round plate" makes sense. If retaining the original text or following Xu's "cup," the meaning is hard to decipher.
Zhi Zhu Tang Formula (*Waitai Miyao* cites Zhang Wenzhong: This is Zhang Zhongjing's *Shanghan Lun* formula. Beiji and Zhou Hou agree.)
Zhishi (7 pieces) Baizhu (2 liang)
The above two herbs are boiled in 5 sheng of water to obtain 3 sheng. Divide into three warm doses. When the abdomen softens, the condition will dissipate. (*Waitai Miyao*: 5 sheng is written as 1 dou.)
[Dai Tianzhang's Commentary] Li Dongyuan said: Zhishi reduces distension via bitter drainage; Baizhu removes dampness via bitter drying. Later, Zhang Yuansu treated glomus with Zhi Zhu Wan, derived from this decoction. However, this is caused by water-fluid retention, so a decoction is used to scour it; the other is caused by food stagnation, so a pill is used to dissolve it. One decoction, one pill, each has profound meaning, not arbitrary.