【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。
[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.