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）
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)