Library

Gancao (2 liang) Mahuang (4 liang)
Take the above two herbs, add five sheng of water, first decoct Mahuang, remove the foam on the surface, then add Gancao, and decoct to obtain three sheng. Take one sheng warm after each dose. Cover with blankets to induce sweating; if no sweat occurs, take another dose. Avoid wind and cold.

For patients presenting with cold extremities and Pi Shui (Water Qi disease where water accumulates in the skin), Puhui San is the primary prescription.
[Note] The characters "Jue er" (cold extremities and) are likely interpolations.
[Commentary] When Water Qi remains in the skin for a long time, it inevitably causes rotting, ulceration, and weeping of fluid. It should be treated by applying Puhui San externally to dry the dampness.
Puhui San formula (see under Xiao Ke chapter).

In Water Qi diseases, if the pulse is deep and small, it belongs to Shaoyin. If the pulse is floating, it indicates Wind pathogen; if there is no water but distension due to deficiency, it is Qi Shui, which can be cured by inducing sweating. If the pulse is deep, Mahuang Fuzi Tang is suitable; if the pulse is floating, Xingzi Tang is suitable.
[Note] The character "Qi" in "Qi Shui" should be "Feng" (Wind). If it were "Qi", there would be no rationale for inducing sweating, and moreover, the entire text does not mention a disease called "Qi Shui".
[Commentary] In Water Qi diseases, a deep and small pulse indicates Shaoyin Water Qi. However, if the pulse is not deep and small but floating, it indicates Wind, not Shaoyin Water Qi. If there is no water but distension due to deficiency, it is Feng Shui (Wind Water), which can be cured by inducing sweating. For Feng Shui with a deep pulse, Mahuang Fuzi Tang should be used to induce sweating; for a floating pulse, Xingzi Tang should be used.

Mahuang Fuzi Tang Formula
Mahuang (3 liang) Gancao (2 liang) Fuzi (processed, one piece)
Take the above three herbs, add seven sheng of water, first decoct Mahuang, remove the foam, then add the other herbs, and decoct to obtain two and a half sheng. Take eight ge warm, three times a day.
[Collected Commentary] Shen Mingzong said: Mahuang Fuzi Tang is currently neglected by practitioners, so I specifically bring it up to clarify it. Mahuang and Fuzi unblock Yang and open orifices; it is an excellent remedy for treating water. Nowadays, people only use Shenqi Tang or pills to tonify internally, causing Yang Qi to become stagnant. The more they tonify, the more stagnation occurs, leaving no exit for the pathogen. Edema increases daily, leading to hemoptysis and death, yet countless such cases go unnoticed.

Xingzi Tang Formula
Mahuang (4 liang) Xingren (50 pieces) Gancao (honey-fried, 2 liang)
Add seven sheng of water, first decoct Mahuang until reduced by two sheng, remove the foam, then add the other herbs, and decoct to obtain three sheng. Strain the dregs, take one sheng warm. Stop administration once sweating occurs.

Question: Regarding Huang Han (Yellow Sweat disease), the patient presents with body swelling, fever, sweating, thirst, and symptoms resembling Feng Shui. The sweat stains clothes yellow like cypress juice, and the pulse is naturally deep. How is this contracted? The Master said: This is contracted when one enters water for bathing while sweating, allowing water to enter through the sweat pores. Huangqi Shaoyao Guizhi Kujiu Tang is indicated.
[Commentary] This follows up on the detailed discussion of Huang Han symptoms to clarify its treatment. Huang Han is attributed to Dampness, hence body swelling; it is attributed to Wind, hence fever, sweating, and thirst. "Resembling Feng Shui" refers to facial and ocular edema. "Sweat staining clothes, color bright yellow like cypress juice" refers to sticky, yellow sweat. "Pulse naturally deep" indicates the etiology involves water/dampness. Investigating the cause, bathing in cold water while sweating allows cold pathogens to enter internally, suppressing and stagnating sweat fluids in the muscle interstices. As they are steamed out by Earth Qi transformation, the color becomes yellow. Huangqi and Guizhi should be used to resolve exterior pathogens and secure Wei Qi (Defensive Qi); Baishao and Kujiu (vinegar) should be used to stop sweating and conserve Ying Qi (Nutritive Qi). When Ying and Wei harmonize, the disease resolves.
[Collected Notes] Cheng Lin said: Sweating opens the Yuan Fu (sweat pores); bathing in water introduces cold, which lodges in the couli (interstices) and skin, causing body swelling and fever. Sweat staining clothes like cypress juice depletes internal Jin Ye (Body Fluids), causing thirst and sweating. Although body swelling resembles Feng Shui, Feng Shui pulses are not deep, sweat is not yellow, and there is no thirst, which distinguishes them.
Li Shengxi said: Bathing in water while sweating is merely cited as one example. Generally, Huang Han arises from long-standing Spleen and Stomach Dampness generating Heat. Accumulated Heat turns yellow, and Damp-Heat steaming together causes sweating.
Wei Litong said: Huang Han refers to sweat that is yellow while the body itself is not yellow, differing from Fa Huang (Jaundice/Yellowing).
You Yi said: Huang Han disease is similar to Feng Shui. However, Feng Shui has a floating pulse, whereas Huang Han has a deep pulse; Feng Shui involves aversion to wind, whereas Huang Han does not. The sweat staining clothes bright yellow like cypress juice is unique to Huang Han. Feng Shui is Wind combining with Water Qi externally; Huang Han is Water Qi combining with Heat externally. Heat is suppressed by Water, leading to mutual stagnation and steaming, turning the sweat yellow. Using Huangqi, Guizhi, and Shaoyao promotes Yang to benefit Yin, harmonizing Ying Qi and circulating Wei Qi. The goal is to vigorously move Ying and Wei to expel all pathogens.

Huangqi Shaoyao Guizhi Kujiu Tang Formula
Huangqi (5 liang) Shaoyao (3 liang) Guizhi (3 liang)
Take the above three herbs, mix with one sheng of Kujiu (vinegar) and seven sheng of water, decoct to obtain three sheng. Take one sheng warm. One may experience mental restlessness (xin fan); relief typically comes after six or seven days. If mental restlessness persists, it is due to the obstructive nature of Kujiu.
[Formula Analysis] Mental restlessness after taking the medicine is because Kujiu stops sweating too abruptly. Since sweat originates from the Heart, stopping it abruptly prevents its release, causing mental restlessness. Relief after six or seven days indicates the restoration of Zheng Qi (Upright Qi) and the natural retreat of pathogens.
[Collected Commentary] Wei Litong said: Ancients referred to vinegar as Kujiu; there is no separate substance called Kujiu. Fine wine vinegar, also known as She Cu made by households, is essentially Zhenjiang Red Vinegar. Inferior vinegar, such as Baijiu vinegar, is available everywhere, but She Cu is generally used in prescriptions.
You Yi said: "Kujiu obstruction" means the action is desired but cannot happen immediately; it requires accumulated medicinal force over time to act spontaneously, hence "relief comes after six or seven days."

In Huang Han disease, the calves are naturally cold; if they are hot, it belongs to Li Jie (Joint Bi syndrome characterized by severe joint pain). Sweating after eating, along with night sweats occurring regularly in the evening while lying down, belongs to Lao Qi (Consumptive Qi disorder). If sweating is followed by fever, the skin will eventually become rough and scaly (Jia Cuo); if fever persists, malignant sores will develop. If the body feels heavy and lightens after sweating, prolonged illness will lead to numbness, potentially chest pain. Sweating will occur above the waist but not below; the lower back and hips will feel loose and painful, with a sensation of something trapped in the skin. In severe cases, appetite loss, body ache and heaviness, irritability, and dysuria occur. This is Huang Han, treated with Guizhi Jia Huangqi Tang.
[Note] This continues the detailed description of Huang Han symptoms. However, the textual coherence is lacking, suggesting bamboo slips were misplaced; thus, it is not explained.

Guizhi Jia Huangqi Tang Formula
Guizhi Shaoyao (2 liang each) Gancao (2 liang) Shengjiang (3 liang) Dazao (12 pieces) Huangqi (2 liang)
Take the above 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 porridge to assist the medicinal power. Cover with blankets to induce mild sweating. If no sweat occurs, administer again.

The Cun Kou (inch position) pulse is floating and slow. Floating indicates Heat; slow indicates潜藏 (submergence/retention). The interaction of Heat and Submergence is named Chen (Deep). The Fu Yang pulse is floating and rapid. Floating indicates Heat; rapid indicates restriction/stopping. The interaction of Heat and Restriction is named Fu (Hidden). The interaction of Deep and Hidden is named Water Disease. Deep implies deficiency in collateral vessels; Hidden implies difficulty in urination. The interaction of Deficiency and Difficulty causes Water Qi to flow into the skin, resulting in Water Disease.
[Note] The meaning of this passage is unclear; it is not explained.

The Cun Kou pulse is wiry and tight. Wiry implies obstruction of Wei Qi movement, leading to aversion to cold. Water fails to circulate normally and flows into the intestines.
[Note] There must be missing text in this passage; it is not explained.

Question: A patient suffers from Water Disease, with swelling of the face, eyes, body, and limbs, and dysuria. Upon pulse diagnosis, instead of mentioning Water Disease, the physician mentions chest pain, Qi rushing up to the throat with a sensation of a lump of roasted meat, accompanied by slight cough and wheezing. If this is true as the Master said, what kind of pulse would it be? The Master said: The Cun Kou pulse is deep and tight. Deep indicates Water; tight indicates Cold. The interaction of Deep and Tight knots at the Guan Yuan point. Initially, it is subtle and unnoticed in youth. After Yang Qi declines, Ying and Wei interfere with each other. Yang damage leads to Yin excess. The knotted Cold moves slightly, causing Kidney Qi to rush upward, blocking the throat, and causing acute pain in the hypochondrium. Physicians mistook this for Liu Yin (flowing fluid/phlegm-fluid) and used harsh purgatives. The Qi attack remained unresolved, and the disease persisted. Later, emetics were used again, causing Stomach deficiency, vexation, dry throat, desire to drink water, dysuria, indigestion, and swelling of the face, eyes, hands, and feet. Then Tingli Wan was given to drain water. The condition seemed slightly better initially, but overeating caused the swelling to return. Chest and hypochondriac distress ensued, resembling Ben Tun (Running Piglet Qi). Water overflowed, causing floating cough and wheezing. One should first attack the Rushing Qi to stop it, then treat the cough. Once the cough stops, the wheezing will heal naturally. Treat new conditions first; old conditions follow later.
[Note] The meaning of this passage is unclear; it is not explained.