此与上条证候颇同。而治特异。麻黄之发阳气。十倍防己。乃反减黄 之实表。增石膏之辛寒。
何耶。脉浮不渴句。或作脉浮而渴。渴者热之内炽。汗为热逼。与表虚出汗不同。故得以石膏清热。
麻黄散肿。而无事兼固其表也。
越婢汤方
麻黄（六两） 石膏（半斤） 生姜（三两） 甘草（二两） 大枣（十二枚）
上五味。以水六升。先煮麻黄。去上沫。内诸药。煮取三升。分温三服。恶风加附子一枚。风水
加术四两。
皮水为病。四肢肿。水气在皮肤中。四肢聂聂动者。防己茯苓汤主之。
皮中水气。浸淫四末。而壅遏卫气。气水相逐。则四肢聂聂动也。防己、茯苓善驱水气。桂枝得茯
苓。则不发表而反行水。且合黄 、甘草。助表中之气。以行防己、茯苓之力也。
防己茯苓汤方
防己 黄 桂枝（各三两） 茯苓（六两） 甘草（二两）
上五味。以水六升。煮取二升。分温三服。
里水。越婢加术汤主之。甘草麻黄汤亦主之。
里水。即前一身面目黄肿。脉沉。小便不利之证。越婢汤义见前。甘草、麻黄。亦内助土气。外
行水气之法也。
越婢加术汤方（见上）
甘草麻黄汤方
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。
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。
水气脉沉小者属少阴。言肾水也。脉浮者为风。即风水也。其无水而虚胀者。则为气病而非水病
矣。气病不可发汗。水病发其汗则已。然而发汗之法。亦有不同。少阴则当温其经。风水即当通其肺。
故曰脉沉者。宜麻黄附子汤。脉浮者。宜杏子汤。沉谓少阴。浮谓风也。
麻黄附子汤方
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。温服八合。日三服。
杏子汤方（缺恐是麻黄杏仁甘草石膏汤）
厥而皮水者。蒲灰散主之。
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。
蒲灰散方（见消渴）
问曰。黄汗之为病。身体肿。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。
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。黄 、桂枝、芍药。行阳益阴。得酒则气益和而行愈周。盖欲使营卫大行。而
邪气毕达耳。云苦酒阻者。欲行而未得遽行。久积药力。乃自行耳。故曰服至六七日乃解。
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。
芍桂酒汤方
黄 （五两） 芍药 桂枝（各三两）
上三味。以苦酒一升。水七升相合。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。
黄汗之病。两胫自冷。假令发热。此属历节。食已汗出。又身尝暮盗汗出者。此营气也。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。又从腰以上汗出。下无汗。腰 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。
两胫自冷者。阳被郁而不下通也。黄汗本发热。此云假令发热。便为历节者。谓胫热。非谓身热
也。盖历节黄汗。病形相似。而历节一身尽热。黄汗则身热而胫冷也。食已汗出。又身尝暮卧盗汗出
者。营中之热。因气之动而外浮。或乘阳之间而潜出也。然黄汗、郁证也。汗出则有外达之机。若汗
出已反发热者。是热与汗俱出于外。久而肌肤甲错。或生恶疮。所谓自内之外而盛于外也。若汗出已
身重辄轻者。是湿与汗俱出也。然湿虽出而阳亦伤。久必身 而胸中痛。若从腰以上汗出。下无汗者。
是阳上通而不下通也。故腰 弛痛。如有物在皮中状。其病之剧而未经得汗者。则窒于胸中而不能食。
壅于肉理而身体重。郁于心而烦躁。闭于下而小便不通利也。此其进退微甚之机。不同如此。而要皆
水气伤心之
所致。故曰此为黄汗。桂枝、黄 。亦行阳散邪之法。而尤赖饮热稀粥取汗。以发交郁之邪也。
桂枝加黄 汤方
桂枝 芍药 甘草 黄 （各二两） 生姜（三两） 大枣（十二枚）
上六味。以水八升。煮取三升。温服一升。须臾。啜热稀粥一升余。以助药力。温覆取微汗。若
不汗。更服。
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。
即手足逆冷。手足逆冷。则营卫不利。营卫不利。则腹满胁鸣相逐。气转膀胱。营卫俱劳。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。
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。营卫无源而不利。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。营卫俱劳者。营卫俱乏竭也。阳气温于表。故不通则身冷。阴气营
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。
气分。心下坚大如盘。边如旋盘。桂甘姜枣麻辛附子汤主之。
气分即寒气乘阳之虚。而结于气者。心下坚大如盘。边如旋盘。其势亦已甚矣。然不直攻其气。而
以辛甘温药。行阳以化气。视后人之袭用枳、朴、香、砂者。工拙悬殊矣。云当汗出如虫行皮中者。
盖欲使既结之阳。复行周身而愈也。
桂甘姜枣麻辛附子汤方
桂枝 生姜（各三两） 细辛（二两） 甘草 麻黄（各二两） 附子（一枚炮） 大枣（十二
枚）
上七味。以水七升。先煮麻黄。去上沫。内诸药。煮取二升。分温三服。当汗出如虫行皮中。
即愈。
心下坚大如盘。边如旋盘。水饮所作。枳术汤主之。
证与上同。曰水饮所作者。所以别于气分也。气无形。以辛甘散之。水有形。以苦泄之也。
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。腹中软。即当散也。
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。腰以下当肿及阴。难以屈伸。（方见风湿）
这与上一条的证候颇为相似，但治疗方法却截然不同。麻黄发散阳气的力量是防己的十倍，这里反而减少麻黄以固护表气，增加石膏的辛寒之性。为什么呢？“脉浮不渴”这一句，有的版本作“脉浮而渴”。口渴是因为热邪在体内炽盛，汗液被热邪逼迫而出，这与表虚出汗不同，所以可以用石膏来清热。麻黄能消散肿胀，而无须兼顾固护表气。
越婢汤方
麻黄（六两） 石膏（半斤） 生姜（三两） 甘草（二两） 大枣（十二枚）
以上五味药，用水六升，先煮麻黄，去掉上面的浮沫，再加入其他药物，煮取三升药液，分三次温服。如果恶风，加附子一枚；如果是风水证，加白术四两。
皮水病表现为四肢浮肿，水气停留在皮肤之中，四肢微微颤动的，用防己茯苓汤主治。
皮肤中的水气浸淫四肢末端，并壅遏卫气，气与水相互追逐，就会导致四肢微微颤动。防己、茯苓善于驱除水气，桂枝配合茯苓，则不再发汗解表，反而能通利水道，并且配合黄芪、甘草，资助体表之气，以增强防己、茯苓行水的作用。
防己茯苓汤方
防己 黄芪 桂枝（各三两） 茯苓（六两） 甘草（二两）
以上五味药，用水六升，煮取二升药液，分三次温服。
里水病，用越婢加术汤主治；甘草麻黄汤也可以主治。
里水，就是前面提到的全身面目发黄肿胀、脉象沉、小便不利的证候。越婢汤的意义见前文。甘草、麻黄，也是内助脾土之气、外行水气的方法。
越婢加术汤方（见上文）
甘草麻黄汤方
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，煮取三升药液，温服一升。覆盖衣被使汗出，若不出汗再服用。注意避免风寒侵袭。
水气病，脉象沉小的，属于少阴病；脉象浮的，属于风邪致病；没有水湿而虚胀的，属于气病。水病通过发汗即可治愈。脉象沉的，适宜用麻黄附子汤；脉象浮的，适宜用杏子汤。
水气病脉象沉小，属于少阴，指的是肾水。脉象浮的属于风，即风水证。那些没有水湿而虚胀的，则是气病而不是水病。气病不可发汗，水病发汗则愈。然而发汗的方法也有不同。少阴病应当温通经脉，风水证则应当宣通肺气。所以说脉沉的，适宜用麻黄附子汤；脉浮的，适宜用杏子汤。沉指少阴，浮指风邪。
麻黄附子汤方
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，煮取二升半药液，温服八合，每日三次。
杏子汤方（缺，恐怕是麻黄杏仁甘草石膏汤）
出现厥逆且患有皮水的，用蒲灰散主治。
出现厥逆且患有皮水的，是水邪在外盛极，阻隔了身体内部的阳气，使其不能运行到四肢所致。这种因水导致的厥逆，去除水邪则厥逆自愈，不必使用附子、桂枝之类药物来助长内部潜伏的阳气。蒲灰散的意义见前文。
蒲灰散方（见消渴篇）
问：黄汗病的症状是身体肿胀，发热，出汗且口渴，状似风水证，汗水沾衣，颜色正黄，像柏树汁一样，脉象自沉。这是怎么得的呢？老师说：这是因为出汗时进入水中沐浴，水从汗孔侵入而得此病。适宜用芍药桂枝苦酒汤主治。
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，这是两者的区别。其汗水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，水与热相交蒸互郁，汗液因此变黄。黄芪、桂枝、芍药，能通行阳气、补益阴血，得到酒（苦酒）的帮助则气机更加调和且运行更加周遍。大概是想要使营卫之气大行，从而使邪气全部排出。说“苦酒阻”，是指药力欲行而未立即通行，需要积聚药力后才能自行运行。所以说服药至六七天才能痊愈。
按前第二条说：小便通利，上焦有寒，口中多涎，这是黄汗。第四条说：身体肿胀且冷，状如周痹。这里说黄汗病，身体肿胀，发热，出汗且口渴，后又说病情严重者不能进食，身体疼痛沉重，小便不利。为什么前后描述不一致呢？难道是新旧、轻重程度的区别吗？病邪初受，尚未郁结为热时，则身体冷，小便通利，口中多涎；郁结日久且热势严重时，则身体热且口渴，小便不利。这也是自然规律。
芍药桂枝苦酒汤方
黄芪（五两） 芍药 桂枝（各三两）
以上三味药，用苦酒一升、水七升混合，煮取三升药液，温服一升。服药后可能会心烦，服药至六七天才能痊愈。如果心烦不止，是因为苦酒阻滞的缘故。
黄汗病，两小腿自然发冷。假如发热，这属于历节病。饭后出汗，或者经常夜间盗汗的，这是营气的问题。如果出汗后反而发热，久而久之身体必然会出现肌肤甲错（皮肤干燥粗糙如鱼鳞），发热不止的人，一定会生恶疮。如果身体沉重，出汗后随即减轻，久而久之身体必定会麻木不仁（身䐜）。即胸中痛，又如果腰部以上出汗，腰部以下无汗，腰部弛缓疼痛，好像有东西在皮肤中一样。病情严重者不能进食，身体疼痛沉重，烦躁，小便不利，这是黄汗，用桂枝加黄芪汤主治。
两小腿自然发冷，是阳气被郁结而不能下行通达。黄汗本应发热，这里说“假如发热”，便认为是历节病，是指小腿热，而不是全身热。大概历节和黄汗的病形相似，而历节是全身都热，黄汗则是身热而小腿冷。饭后出汗，以及经常夜间卧床盗汗的，是营中的热邪，随着气的运动而外浮，或者乘阳气间隙而潜出。然而黄汗属于郁证，出汗则有向外透达的契机。如果出汗后反而发热，说明热与汗都出于体外，久而久之肌肤甲错，或生恶疮，这就是所谓“自内之外而盛于外”。如果出汗后身体沉重随即减轻，说明湿与汗一同排出。然而湿气虽出，阳气也受损，久而久之身体必会麻木不仁且胸中痛。如果腰部以上出汗，腰部以下无汗，这是阳气上行通达而不能下行通达。所以腰部弛缓疼痛，好像有东西在皮肤中一样。病情严重且尚未得汗的，则窒塞于胸中而不能进食，壅滞于肌肉纹理而身体沉重，郁结于心而烦躁，闭塞于下而小便不通利。这些进退轻重的机理，竟然如此不同。但归根结底都是水气伤心所致。所以说这是黄汗。桂枝、黄芪，也是通行阳气、疏散邪气的方法，尤其依赖饮用热稀粥取汗，以发散交结郁滞的邪气。
桂枝加黄芪汤方
桂枝 芍药 甘草 黄芪（各二两） 生姜（三两） 大枣（十二枚）
以上六味药，用水八升，煮取三升药液，温服一升。片刻后，喝热稀粥一升多，以助药力。覆盖衣被使微汗出。若不出汗，再服用。
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，导致手足逆冷。手足逆冷，则营卫运行不利。营卫不利，则腹部胀满，胁部鸣响相互追逐。气转注膀胱，营卫俱乏竭。阳气不通则身体冷，阴气不通则骨痛。阳气先行而阴气不随，则恶寒；阴气先行而阳气不随，则麻痹不仁。阴阳相得，气机才能运行。大气一转，邪气才能消散。实证表现为失气（放屁），虚证表现为遗尿，这叫气分病。
“微则为气”是说气不足。寒气与气血不足，涵盖寸口和趺阳脉而言，即寒邪盛而气血又不足。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，则腹部胀满，胁部鸣响相互追逐，气转注膀胱，即后面所说的失气、遗尿的开端。营卫俱劳，是说营卫俱乏竭。阳气温煦于体表，所以不通则身体冷；阴气营守于体内，所以不通则骨痛。不通，是指极度虚弱而不能运行，与有余而壅塞的情况不同。阳气先行而阴气不随，则恶寒；阴气先行而阳气不随，则麻痹不仁。大概阴与阳常需相互依存，不可缺失。缺失则气机不续而邪气附着；不缺失则上下交通而邪气不容纳。所以说阴阳相得，气机才能运行。大气一转，邪气才能消散。失气、遗尿，都是阴阳相失的征象。称为气分，是说寒气乘阳气之虚，而在气分发病。
气分病，心下坚硬大如盘子，边缘如旋转的盘子，用桂枝去芍药加麻辛附子汤主治。
气分病即寒气乘阳气之虚，而结聚于气分。心下坚硬大如盘子，边缘如旋转的盘子，其病势也已很严重了。然而不直接攻伐其气，而是用辛甘温药，通行阳气以化气，这与后人袭用枳实、厚朴、香附、砂仁等药物的做法相比，高下悬殊很大。说应当汗出如虫行皮中，大概是想要使已经结聚的阳气，重新运行周身而痊愈。
桂枝去芍药加麻辛附子汤方
桂枝 生姜（各三两） 细辛（二两） 甘草 麻黄（各二两） 附子（一枚，炮制） 大枣（十二枚）
以上七味药，用水七升，先煮麻黄，去掉上面的浮沫，加入其他药物，煮取二升药液，分三次温服。应当汗出如虫行皮中，即痊愈。
心下坚硬大如盘子，边缘如旋转的盘子，由水饮所作，用枳术汤主治。
证候与上面相同，说是水饮所作，是为了与气分病区别。气无形，用辛甘药发散；水有形，用苦泄药攻下。
枳术汤方
枳实（七枚） 白术（二两）
以上两味药，用水五升，煮取三升药液，分三次温服。腹中变软，即当消散。
附方
外台防己黄芪汤 治疗风水脉浮，病位在表。其人或者头汗出，表无其他病症，病人只觉得下身沉重，从腰部以上是正常的，腰部以下应当肿胀及阴部，难以屈伸。（方剂见风湿篇）
This condition is quite similar to the previous one, but the treatment method is specifically different. The power of Mahuang (Ephedrae Herba) to disperse Yang Qi is ten times that of Fangji (Stephaniae Tetrandrae Radix); here, however, the dosage of Mahuang is reduced to secure the exterior, and the pungent-cold Shigao (Gypsum Fibrosum) is increased. Why? The phrase "pulse floating without thirst" is rendered in some versions as "pulse floating with thirst." Thirst indicates that heat is blazing internally; sweat is forced out by the heat, which differs from sweating due to exterior deficiency. Therefore, Shigao can be used to clear heat. Mahuang disperses swelling, and there is no need to simultaneously secure the exterior.
Yebip Decoction (Cinnamon Twig and Gypsum Decoction)
Mahuang (Ephedrae Herba, 6 liang), Shigao (Gypsum Fibrosum, 0.5 jin), Shengjiang (Zingiberis Rhizoma Recens, 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang), Dazao (Jujubae Fructus, 12 pieces).
Take the above five ingredients, add six sheng of water, first decoct Mahuang, remove the foam on the surface, then add the remaining herbs. Decoct until three sheng remain. Divide into three warm doses. If aversion to wind is present, add one Paozhi Fuzi (Aconiti Lateralis Radix Praeparata). If it is Fengshui (Wind Edema), add four liang of Baizhu (Atractylodis Macrocephalae Rhizoma).
Pi Shui (Skin Water/Edema) presents with edema in the four limbs, where water qi stagnates in the skin. When the four limbs tremble slightly, Fangji Fuling Tang (Stephania and Poria Decoction) is the primary treatment.
Water qi in the skin permeates the extremities and obstructs Wei Qi (Defensive Qi). As Qi and water chase each other, slight trembling of the four limbs occurs. Fangji and Fuling are good at driving out water qi. Guizhi (Cinnamomi Ramulus) combined with Fuling does not induce sweating to release the exterior but instead promotes urination. Furthermore, combined with Huangqi (Astragali Radix) and Gancao, it assists the Qi in the exterior to enhance the water-draining power of Fangji and Fuling.
Fangji Fuling Tang (Stephania and Poria Decoction)
Fangji (Stephaniae Tetrandrae Radix), Huangqi (Astragali Radix), Guizhi (Cinnamomi Ramulus) (each 3 liang), Fuling (Poria, 6 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang).
Take the above five ingredients, add six sheng of water, decoct until two sheng remain. Divide into three warm doses.
Li Shui (Interior Water) is primarily treated with Yebip Jia Zhu Tang (Cinnamon Twig, Gypsum, and Atractylodes Decoction); Gancao Mahuang Tang (Licorice and Ephedra Decoction) may also be used.
Li Shui refers to the syndrome mentioned earlier: generalized yellowish swelling of the face and body, deep pulse, and difficulty in urination. The principle of Yebip Tang is explained previously. Gancao and Mahuang represent a method of internally assisting Earth Qi (Spleen/Stomach Qi) and externally promoting the movement of water qi.
Yebip Jia Zhu Tang (See above)
Gancao Mahuang Tang (Licorice and Ephedra Decoction)
Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang), Mahuang (Ephedrae Herba, 4 liang).
Take the above two ingredients, add five sheng of water, first decoct Mahuang, remove the foam, then add Gancao. Decoct until three sheng remain. Take one sheng warm. Cover with blankets to induce sweating; if no sweat occurs, take another dose. Avoid wind and cold.
In diseases of water qi, a deep and small pulse belongs to Shaoyin (Lesser Yin); a floating pulse indicates Wind pathogen; distension without water accumulation belongs to Qi disorders. For water disease, inducing sweating cures it. For a deep pulse, Mahuang Fuzi Tang (Ephedra and Prepared Aconite Decoction) is suitable; for a floating pulse, Xingzi Tang (Apricot Seed Decoction) is suitable.
A deep and small pulse in water qi disease belongs to Shaoyin, referring to Kidney Water. A floating pulse indicates Wind, i.e., Fengshui (Wind Edema). Those who are distended without water accumulation suffer from Qi disorders, not water disorders. Qi disorders should not be treated with sweating; water disorders are cured by sweating. However, methods of sweating differ. For Shaoyin, one should warm the meridians; for Fengshui, one should unblock the Lung. Thus, it is said: for a deep pulse, use Mahuang Fuzi Tang; for a floating pulse, use Xingzi Tang. Deep refers to Shaoyin, floating refers to Wind.
Mahuang Fuzi Tang (Ephedra and Prepared Aconite Decoction)
Mahuang (Ephedrae Herba, 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang), Fuzi (Aconiti Lateralis Radix Praeparata, one piece, prepared).
Take the above three ingredients, add seven sheng of water, first decoct Mahuang, remove the foam, then add the other herbs. Decoct until two and a half sheng remain. Take eight ge warm, three times a day.
Xingzi Tang (Apricot Seed Decoction) (Missing; likely Mahuang Xingren Gancao Shigao Tang / Ephedra, Apricot Seed, Licorice, and Gypsum Decoction).
For patients with Jue (Cold Extremities) and Pi Shui (Skin Water), Pushui San (Reed Mosaic Ash Powder) is the primary treatment.
Jue accompanied by Pi Shui occurs when external water pathogens are excessive, blocking the internal Yang Qi from reaching the four limbs. This type of Jue caused by water resolves once the water is removed; there is no need to use drugs like Fuzi or Guizhi to assist the internally latent Yang. The principle of Pushui San is explained previously.
Pushui San (Reed Mosaic Ash Powder) (See Xiao Ke / Wasting-Thirst chapter).
Question: In Huanghan (Yellow Sweat) disease, the body swells, fever occurs, sweating happens with thirst, resembling Fengshui. The sweat stains clothes yellow, like cypress juice, and the pulse is naturally deep. How is this contracted? The Master says: It is contracted by bathing in water while sweating, allowing water to enter through the sweat pores. Shaoyao Guizhi Kujiu Tang (Peony, Cinnamon Twig, and Vinegar Decoction) is suitable.
Huanghan resembles Fengshui, but Fengshui has a floating pulse while Huanghan has a deep pulse; Fengshui involves aversion to wind, while Huanghan does not. The sweat staining clothes bright yellow like cypress juice is unique to Huanghan. Fengshui is wind combining externally with water qi; Huanghan is water qi suppressing heat internally. Heat suppressed by water leads to steaming and郁 (stagnation), turning sweat yellow. Huangqi, Guizhi, and Shaoyao promote Yang and benefit Yin. With wine (Kujiu/Vinegar), Qi becomes harmonious and circulates thoroughly. The goal is to allow Ying (Nutritive) and Wei (Defensive) Qi to flow freely so that pathogens are expelled. "Kujiu obstruction" means the medicinal force desires to move but does not immediately do so; it requires accumulated force to act spontaneously. Hence, it is said that resolution occurs after six or seven days.
According to Article 2 earlier: Clear urination, cold in the Upper Jiao, and excessive salivation indicate Huanghan. Article 4 states: Body swelling with coldness, resembling Zhou Bi (Generalized Bi Syndrome). Here, Huanghan presents with body swelling, fever, sweating, and thirst. Later, severe cases cannot eat, have body pain and heaviness, and difficulty urinating. Why the discrepancy? Is it a distinction between new/old or mild/severe conditions? Initially, when pathogens are received and have not yet stagnated into heat, the body is cold, urination is clear, and there is excessive salivation. When stagnation lasts long and heat is severe, the body is hot and thirsty, and urination is difficult. This is natural law.
Shaoyao Guizhi Kujiu Tang (Peony, Cinnamon Twig, and Vinegar Decoction)
Huangqi (Astragali Radix, 5 liang), Shaoyao (Paeoniae Radix, 3 liang), Guizhi (Cinnamomi Ramulus, 3 liang).
Take the above three ingredients, combine one sheng of Kujiu (Vinegar) with seven sheng of water, decoct until three sheng remain. Take one sheng warm. Heart vexation may occur; resolution takes six to seven days. If heart vexation persists, it is due to Kujiu obstruction.
In Huanghan disease, the lower legs are naturally cold. If they become hot, it belongs to Li Jie (Joint Bi). Sweating after eating, or night sweats during sleep, relates to Ying Qi. If fever persists after sweating, the skin will eventually become rough like fish scales (Jiacuo), and persistent fever may lead to malignant sores. If the body feels heavy but lightens after sweating, chronic numbness (Shen Cheng) and chest pain may develop. If sweating occurs only above the waist but not below, with flaccid pain in the lower back and a sensation of something in the skin, severe cases cannot eat, have body pain/heaviness, irritability, and difficulty urinating. This is Huanghan, treated with Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus).
Coldness in the lower legs indicates Yang Qi is blocked and cannot descend. Huanghan typically involves fever; the mention of "if hot" refers to Li Jie, meaning leg heat, not whole-body heat. Li Jie and Huanghan look similar, but Li Jie involves whole-body heat, whereas Huanghan involves body heat with cold legs. Sweating after eating or night sweats indicate Ying heat floating outward due to Qi movement or escaping through Yang gaps. Huanghan is a stagnation syndrome; sweating provides an outlet. If fever persists after sweating, heat and sweat exit together, leading to Jiacuo or sores over time ("from inside to outside"). If heaviness lightens after sweating, dampness exits with sweat. However, dampness loss damages Yang, leading to chronic numbness and chest pain. Sweating only above the waist indicates Yang ascending but not descending, causing lower back pain and the sensation of an object in the skin. Severe cases without sweating experience chest obstruction (anorexia), muscle congestion (heaviness), heart stagnation (irritability), and lower closure (urinary difficulty). These variations in progression and severity all stem from water qi injuring the Heart. Hence, it is called Huanghan. Guizhi and Huangqi promote Yang and scatter pathogens, relying especially on drinking hot millet gruel to induce sweating and dispel stagnant pathogens.
Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus)
Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Huangqi (Astragali Radix) (each 2 liang), Shengjiang (Zingiberis Rhizoma Recens, 3 liang), Dazao (Jujubae Fructus, 12 pieces).
Take the above six ingredients, add eight sheng of water, decoct until three sheng remain. Take one sheng warm. Shortly after, drink more than one sheng of hot millet gruel to assist the medicinal power. Cover with blankets to induce slight sweating. If no sweat, take again.
The Master says: A slow and choppy pulse at the Cun Kou (Radial Artery) indicates Cold (slow) and Blood Deficiency (choppy). A faint and slow pulse at the Zu Yang (Dorsalis Pedis Artery) indicates Qi Deficiency (faint) and Cold (slow). Cold Qi combined with insufficiency leads to cold extremities. Cold extremities impair Ying and Wei circulation. Impaired Ying and Wei cause abdominal fullness and borborygmus. Qi shifts to the Bladder. When Ying and Wei are exhausted, Yang blockage causes body coldness, and Yin blockage causes bone pain. If Yang moves forward alone, aversion to cold occurs; if Yin moves forward alone, numbness occurs. When Yin and Yang harmonize, Qi flows. When the Great Qi rotates, pathogens dissipate. Excess manifests as flatulence; deficiency manifests as urinary incontinence. This is called Qi Fen (Qi Division/Disease).
"Faint indicates Qi" means Qi insufficiency. "Cold Qi and insufficiency" refers to both Cun Kou and Zu Yang pulses, indicating excess Cold and deficient Qi/Blood. Insufficiency leads to cold extremities and impaired Ying/Wei. Consequently, Zhen Qi (True Qi) in organs is insufficient, allowing pathogenic Cold to dominate, causing abdominal fullness, borborygmus, and Qi shifting to the Bladder (precursors to flatulence/incontinence). "Exhausted Ying and Wei" means depletion. Yang warms the exterior; blockage causes coldness. Yin nourishes the interior; blockage causes bone pain. Blockage here means extreme weakness preventing movement, differing from excess stagnation. Yang moving alone causes cold aversion; Yin moving alone causes numbness. Yin and Yang must support each other. Loss leads to stagnant Qi and pathogen attachment; harmony allows communication and repels pathogens. Thus, "Yin and Yang harmonize, Qi flows; Great Qi rotates, pathogens dissipate." Flatulence and incontinence are signs of disharmony. "Qi Fen" means disease in the Qi level due to Cold exploiting Yang deficiency.
Qi Fen disease presents with hardness and enlargement under the heart (epigastrium) like a plate, with edges like a rotating disk. Guizhi Qu Shaoyao Jia Ma Xin Fu Zi Tang (Cinnamon Twig, Removing Peony, Adding Ephedra, Asarum, and Prepared Aconite Decoction) is the primary treatment.
Qi Fen disease arises when Cold exploits Yang deficiency and knots in the Qi level. The epigastric hardness is severe. Instead of directly attacking Qi, pungent-sweet-warm herbs are used to promote Yang and transform Qi, superior to later practitioners' reliance on Zhi Shi (Immature Bitter Orange), Houpo (Magnolia Bark), Xiangfu (Cyperus Rhizome), and Sharen (Amomum Fruit). Sweating like insects crawling on the skin indicates the restored Yang circulating throughout the body for cure.
Guizhi Qu Shaoyao Jia Ma Xin Fu Zi Tang (Cinnamon Twig, Removing Peony, Adding Ephedra, Asarum, and Prepared Aconite Decoction)
Guizhi (Cinnamomi Ramulus), Shengjiang (Zingiberis Rhizoma Recens) (each 3 liang), Xixin (Asari Radix et Rhizoma, 2 liang), Gancao (Glycyrrhizae Radix et Rhizoma), Mahuang (Ephedrae Herba) (each 2 liang), Fuzi (Aconiti Lateralis Radix Praeparata, one piece, prepared), Dazao (Jujubae Fructus, 12 pieces).
Take the above seven ingredients, add seven sheng of water, first decoct Mahuang, remove foam, then add other herbs. Decoct until two sheng remain. Divide into three warm doses. Sweating like insects crawling on the skin indicates cure.
Hardness and enlargement under the heart like a plate, caused by Water-Fluid retention, is treated with Zhizhu Tang (Immature Bitter Orange and Atractylodes Decoction).
The syndrome is identical to the above, but specified as caused by Water-Fluid to distinguish it from Qi Fen. Qi is formless and dispersed by pungent-sweet herbs; Water is tangible and drained by bitter-purgative herbs.
Zhizhu Tang (Immature Bitter Orange and Atractylodes Decoction)
Zhishi (Immaturus Citri Grandis sive Citri Aurantii Fructus, 7 pieces), Baizhu (Atractylodis Macrocephalae Rhizoma, 2 liang).
Take the above two ingredients, add five sheng of water, decoct until three sheng remain. Divide into three warm doses. Softening of the abdomen indicates dissipation.
Attached Formula
Waitai Fangji Huangqi Tang (External Standard Fangji Astragalus Decoction) treats Fengshui with a floating pulse, indicating the pathogen is in the exterior. The patient may have head sweating, no other exterior symptoms, but feels heaviness in the lower body. From the waist up is normal; the waist down should swell including the yin region, with difficulty in flexion and extension. (Formula see Rheumatism chapter)