体肿。发热汗出而渴。状如风水。汗沾衣。色正黄。如柏汁。脉自沉。（前此详其病状。
而其病源。）何从得之。（请再申言。而出其方治。）师曰。以汗出入水中浴。水从汗
孔入得之。（盖汗出则腠疏。客水之气。从毛孔而伤其心。故水火相蒸而色黄。水气搏
结而脉迟。然此证亦有从酒后汗出当风所致者。虽无外水。而所出之汗。因风内返。亦
是水也。凡脾胃受湿。湿久生热。湿热交蒸而成黄者。皆可以汗出入水之气推之也。）
宜芍桂酒汤主之。
此为黄汗证出其方治也。
尤在泾云、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。得苦
酒则气益和而行愈周。盖欲使营卫通行。而邪气
毕达耳。云苦酒阻者。欲行而未得遽行。久积药力。乃自行矣。故曰、服至六七日乃解。
又云、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。
黄 芍药桂枝苦酒汤方
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。（阳被郁而不下通。则）两胫自冷。（身热而胫冷。为黄汗之的证。）
假令（一身中尽）发热。此属历节。（不为黄汗也。然黄汗郁证也。汗出则有外达之
机。若）食已汗出。（乃荣中之热。因气之动而外浮）又身常（于入）暮盗汗出者。（
乃荣中之热。乘阳之间而潜出。）此（皆责之）荣气（之热）也。若汗出已。反发热者。
（是热与汗。俱出于外也。）久久其身必甲错。发热不止者。必生恶疮。（所谓自内
之外。而盛于外是也。）若身重汗出已。辄轻者。（是湿与汗俱出也。然湿虽出。而阳亦
伤。）久久必身 。 即胸中痛。又（若）从腰以上汗出。（腰以）下无汗。（是阳上
通。而下不通也。故）腰 弛痛。如有物在皮中（之）状（不能便捷。更有病）剧（而未
经得汗）者。（则窒于胸而）不能食。（壅于肉理而）身疼重。（郁于心而）烦躁。（
闭于下而）小便不利。（此其进退微甚之机。不同如此。而要皆水气伤心之所致。可以
切指之曰。）此为黄汗。（以）桂枝加黄 汤主之。
此言黄汗变证不一。总缘发黄本为郁病。得汗不能透彻。则郁热不得外达。所以又
出一桂枝加黄
之方法也。
桂枝加黄 汤方
桂枝 芍药（各三两） 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。（心营肺卫。脉应寸口。今）寸口脉迟而涩。迟（者其病在营。无以速卫气
之行。）则为寒。涩（者其病在卫。无以致营血之濡。）为血不足。（再诊之胃脉之趺
阳。今）趺阳脉微而迟。微则（知其病）为（不足于）气。迟则（知其不足于气。即）
为寒。（合寸口趺阳而诊之。则知其）寒（而）气（血）不足。即手足逆冷。（盖以阳
气起于四肢。以贯一身。而调营卫故也。）手足逆冷。则营卫不利。营卫不利。则腹满
胁鸣。（腔中纯是客寒。）相逐气转。膀胱营卫俱（困乏而疲）劳。（盖以营卫受气于
阳明。而太阳又为营卫之统司也。经云。巨阳主气。为诸阳所属。要知膀胱内主津液之
灌注。则为阳中之阴。外主阳热之布护。则为阳中之阳。）阳（热之）气不通。即身冷。
阴（液之）气不通。即骨疼。（此阴阳之各自为病也。）阳前（而阴不与俱）通。则
（阴失阳而）恶寒。阴前（而阳不与俱）通。则（阳独治而）痹不仁。（此阴阳之互相
为病也。总由阴阳相失。遂闭塞而成痞。治之者。当使）阴阳相得。其气乃行。大气一
转。其气乃散。（若证之）实（者。得药）则矢气。（邪从大便喧吹而出。证之）虚
（者。得药）则遗溺。（邪从小便涌溢而行。病之所以成。病之所以散。皆一气主之。
故）名曰气分。
此非黄病。因黄病之脉沉上下。营卫不通等证。触类引伸。而及于气分之专证。其
实水与气。虽分有形无形。而其源则非二也。肿与胀虽分在外在内。而其病则相因也。
然每见病胀者。以治水之法施之。往往不效。至腹胀而四肢不肿。名曰单鼓胀。或因水
病而攻破太过者有之。或因宿有 瘕积块痞块。重加外感内伤而发者有之。有日积月累。
初时不觉。及觉而始治之。则已晚矣。若至腹大如箕。腹大如瓮。
虽卢扁亦莫之何。内经明胀病之旨。而无其治。仲景微示其端。而未立其法。后人用大
攻大下大补大温等剂。愈速其危。而不知仲景于此节虽未明言胀病单鼓。而所以致此之
由。所以治此之法。无不包括其中。下节两出其方。一主一宾。略露出鼓胀之机倪。令
人寻绎其旨于言外。 按沈自南以火气二字。指膻中之宗气而言。颇为得解。喻嘉言寓
意草。谓人身胸中空旷如太空。地气上则为云。必天气降而为雨。地气始收藏不动。诚
会上焦如雾。中焦如沤。下焦如渎之意。则云行雨施。而后沟渎皆盈。水道通决。乾坤
有一番新景象矣。此义首重在膀胱一经。经云、膀胱者。州都之官。津液藏焉。气化则
能出矣。如人之饮酒无算而不醉者。皆从膀胱之气化而出也。膻中位于膈内。膀胱位于
腹内。膀胱之气化。则空洞善容。而膻中之气得以下运。若膀胱不化。则腹先胀。而膻
中之气安能下达耶。然欲膀胱之气化。其权尤在于葆肾。肾以膀胱为腑者也。肾气动。
必先注于膀胱。屡动不已。膀胱满胀。势必奔逆于胸膈。其窒塞之状。不可明言。肾气
不动。则收藏愈固。膀胱得以清净无为。而膻中之气注之不盈矣。膻中之气下注。则胸
中旷若太空矣。
徐忠可云、仲景于论正水后。结出一血分。于论黄汗后。结出一气分。何也。盖正水由
肾受邪。发于下焦。下焦血为主用。故论正水而因及于经血不通。黄汗由心受邪。发于
上焦。上焦气为主用。故因黄汗而推及于大气不转。惟上下之气血阳阴不同。此仲景治
黄汗以桂枝为君。主取其化气。而治正水以麻黄为君。主取其入营也。石水以附子为君。
主取其破阴也。审其立言之次第。则立方之意。不晓然耶。
（病在）气分。（大气下转。其）心下坚大如盘。边如旋盘。（其势亦已甚矣。然不直
攻其气。而止用辛甘温药行阳而化气。以）桂甘姜枣麻辛附子汤主之。
此承上节气分之结病而出其方治也。
桂甘姜枣麻辛附子汤方
桂枝 生姜（各三两） 细辛 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。（即结之阳。复散行于周身。乃有是象。）
（若夫病源不同。而病形相类者。不可不辨而药之。）心下坚大如盘。边如旋盘。（
当于所言之病。因病证细辨。而知其系）水饮所作。（乃气分之大分别也。水有形。药
宜苦泄。以）枳术汤主之。
此言水饮以别乎气分。亦借宾以定主也。
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。病者当下
重。从腰以上为和。腰以下
当肿及阴。难以屈伸。（方见风湿）
Body edema. Fever, sweating, and thirst. The presentation resembles Fengshui disease (a syndrome characterized by edema of the head and face, aversion to wind, and a floating pulse). Sweat stains the clothing with a bright yellow color, resembling cypress juice. The pulse is deep. (The preceding text detailed the pathological manifestations and their etiology.) How is this contracted? (Please elaborate further and provide treatment.) The Master said: This occurs because one bathes in water while sweating; water qi enters through the sweat pores. (When sweating, the couli [pores] are open, allowing external water qi to enter through the skin and injure Heart Yang. Thus, water and fire steam each other, resulting in yellow coloration; water qi stagnates and knots, causing a slow pulse. However, this syndrome can also result from sweating after drinking alcohol and being exposed to wind. Although there is no direct contact with external water, the sweat expelled returns inward due to wind pathogenic factors, which essentially constitutes a water pathogen. Any case where Spleen and Stomach are affected by dampness, which lingers and transforms into heat, leading to jaundice/yellowing through the steaming interaction of damp-heat, can be understood by extrapolating from the mechanism of "entering water while sweating.") Shaoyao Guizhi Kujiu Tang (Peony, Cinnamon Twig, and Vinegar Decoction) is indicated as the primary treatment.
This provides the formula and treatment for Huanghan syndrome (Yellow Sweat Syndrome).
You Zaijing stated: Huanghan disease is similar to Fengshui disease, but in Fengshui the pulse is floating, whereas in Huanghan it is deep; Fengshui involves aversion to wind, while Huanghan does not, which are the differences. The fact that sweat stains clothes bright yellow like cypress juice is unique to Huanghan. Fengshui involves wind pathogenic factors combining externally with water qi; Huanghan involves water qi restraining heat internally. Heat is constrained by water; water and heat interact, steaming and stagnating mutually, causing sweat to turn yellow. The formula uses Huangqi (Astragalus Root), Guizhi (Cinnamon Twig), and Shaoyao (White Peony Root) to move Yang and benefit Yin. With Kujiu (Vinegar), the Qi becomes more harmonious and circulation more comprehensive. The intention is likely to allow Ying and Wei Qi to circulate freely so that pathogenic factors may be fully expelled. The mention of Kujiu having a "blocking" effect implies that the medicinal power desires to move but cannot immediately do so completely; after accumulating force over time, it moves on its own. Hence it is said that relief comes after six or seven days of administration. It is also mentioned that in Article 2 previously: if urination is free and clear, there is cold in the Upper Jiao, and there is excessive saliva in the mouth; this is Huanghan. In Article 4: the body is swollen and cold, resembling Zhoubi (a type of bi-syndrome involving whole-body pain). Here it says Huanghan disease presents with body swelling, fever, sweating, and thirst. Later it states that in severe cases, the patient cannot eat, experiences body ache and heaviness, and has difficulty urinating. Why are the descriptions inconsistent? Is it a distinction between new vs. old onset or mild vs. severe conditions? When the pathogenic factor is newly acquired and has not yet stagnated into heat, the body is cold, urination is free, and there is excess saliva. If stagnation persists and heat becomes severe, the body is hot, there is thirst, and urination is difficult. This follows natural principles.
Huangqi Shaoyao Guizhi Kujiu Tang Formula
Huangqi (Astragalus Root) (5 liang)
Shaoyao (White Peony Root)
Guizhi (Cinnamon Twig) (3 liang each)
These three ingredients are combined with one sheng of Kujiu (Vinegar) and seven sheng of water. Boil to obtain three sheng. Take one sheng warm. One should experience mental restlessness (xin fan); relief will occur after six or seven days. If mental restlessness persists, it is due to the blocking nature of Kujiu.
Huanghan disease. (If Yang Qi is constrained and cannot descend smoothly,) the calves will naturally feel cold. (Fever in the upper body with cold calves is a definitive sign of Huanghan.) If, hypothetically, (the entire body) feels feverish, this belongs to Lijie disease (Jie syndrome characterized by severe joint pain), not Huanghan. However, Huanghan is a constraint syndrome; sweating offers an outlet for release. If sweating occurs after eating, (this is heat within the Ying level floating outward due to Qi movement,) and if there is often night sweating (during twilight/evening hours,) (this is also Ying-level heat emerging secretly when Yang is weak.) These are all attributed to (heat in the) Ying Qi. If fever persists after sweating, (it indicates that both heat and sweat originate from the exterior.) Over time, the body will inevitably develop Ji cuo (skin roughness resembling fish scales). Persistent fever will lead to malignant sores. (This is what is meant by pathogens moving from interior to exterior and flourishing on the surface.) If the body feels heavy and lightens after sweating, (it indicates dampness is exiting with sweat. However, although dampness exits, Yang Qi is also damaged.) Over time, the body will become numb and insensible, potentially leading to chest pain. Furthermore, if there is sweating above the waist but no sweating below the waist, (this indicates Yang Qi flows upward but not downward, thus) the lower back feels flaccid and painful, with a sensation as if something is trapped in the skin (causing discomfort). In more severe cases where sweating has not occurred, there is chest stuffiness preventing eating, heaviness and body ache due to obstruction in muscle tissue, irritability due to stagnation in the Heart, and difficulty urinating due to closure below. (These represent the nuances of disease progression and severity. Ultimately, all stem from water qi injuring the Heart, which can be explicitly identified as) Huanghan. Treat with Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus Root).
This section discusses the various transformations of Huanghan. The root cause lies in the fact that yellowing originates from constraint; if sweating is not thorough, constrained heat cannot exit. Therefore, another method using Guizhi Jia Huangqi Tang is presented.
Guizhi Jia Huangqi Tang Formula
Guizhi (Cinnamon Twig)
Shaoyao (White Peony Root) (3 liang each)
Gancao (Licorice Root)
Huangqi (Astragalus Root) (2 liang each)
Shengjiang (Fresh Ginger) (3 liang)
Dazao (Jujube) (12 pieces)
These six ingredients are boiled in eight sheng of water to yield three sheng. Take one sheng warm. Shortly after, drink more than one sheng of hot thin porridge to assist the medicinal action. Cover with blankets to induce slight sweating. If no sweat occurs, administer again.
The Master said: (The pulses of Heart Ying and Lung Wei reflect at the Cun Kou [radial artery]. Now,) the Cun Kou pulse is slow and choppy. A slow pulse (indicates pathology in Ying, unable to rapidly propel Wei Qi,) signifies Cold. A choppy pulse (indicates pathology in Wei, unable to nourish Ying Blood,) signifies Blood deficiency. (Re-examining the Stomach pulse at Fu Yang,) the Fu Yang pulse is faint and slow. Faintness indicates (deficiency in) Qi. Slowness indicates insufficiency of Qi, which signifies Cold. (Combining the diagnoses of Cun Kou and Fu Yang,) we know there is Cold and deficiency of Qi and Blood, manifesting as cold extremities reaching up to the hands and feet. (Since Yang Qi originates in the four limbs and permeates the whole body to regulate Ying and Wei,) cold extremities indicate poor Ying and Wei circulation. Poor Ying and Wei circulation leads to abdominal fullness and borborygmus in the hypochondrium. (The cavity is filled with exogenous Cold.) Cold chases Qi, causing rotation. The Ying and Wei of the Bladder are both (exhausted and fatigued.) (Because Ying and Wei derive Qi from the Yangming channel, and the Taiyang channel governs Ying and Wei. The Classics state: Ju Yang [Great Yang] governs Qi and is the master of all Yang. Note that the Bladder internally governs the infusion of fluids, making it Yin within Yang; externally it governs the distribution of Yang heat, making it Yang within Yang.) If Yang (heat) Qi does not flow, the body feels cold. If Yin (fluid) Qi does not flow, bones ache. (This represents Yin and Yang suffering independently.) If Yang flows first without Yin accompanying it, then (Yin loses Yang's warmth and feels) aversion to cold. If Yin flows first without Yang accompanying it, then (Yang acts alone and causes) numbness and insensibility. (This represents Yin and Yang affecting each other. The root cause is the separation of Yin and Yang, leading to obstruction and痞 [pi - glomus/fullness]. Treatment should aim to make) Yin and Yang harmonious, so Qi can circulate. Once the Great Qi turns, pathogenic Qi disperses. (In excess patterns, medication induces) flatulence, (as evil exits via the large intestine with noise; in deficiency patterns, medication induces) enuresis, (as evil exits via the urinary bladder. The formation and resolution of disease are both governed by Qi. Hence it is named Qifen [Qi Division/Pattern].)
This is not Huanghan disease. It is derived by analogy from the symptoms of Huanghan such as deep pulse and lack of Ying-Wei communication between upper and lower parts, extending to the specific pattern of Qifen. Although Water Disease and Qi Disease differ in form versus formlessness, their source is not two. Edema and Distension differ in location (exterior vs. interior), but their pathology is interrelated. However, it is often seen that patients with distension are treated with methods for water disease, often without effect. Abdominal distension without limb edema is called Dan Guzhang (Single Drum Distension). This may result from excessive purgation in water diseases, or from pre-existing masses (zheng jia) and痞块 (pi kuai) exacerbated by external contraction and internal injury. Accumulating over months and years, it goes unnoticed initially; by the time treatment begins, it is too late. If the abdomen becomes as large as a basket or a jar, even Lu Yi and Bian Que could not save them. The Neijing elucidates the principles of distension but lacks treatment methods. Zhang Zhongjing hints at the beginning but does not establish laws. Later practitioners used strong purging, draining, tonifying, and warming formulas, accelerating danger, unaware that although Zhang Zhongjing did not explicitly name single drum distension in this section, the causes and treatments are implicitly included. The following section presents two formulas, one principal and one auxiliary, revealing the mechanism of distension subtly, inviting readers to infer the meaning beyond the words. Shen Zinan interpreted "fire qi" as referring to the Zong Qi (Gathering Qi) in the Danzhong. This interpretation is quite apt. Yu Jiayan, in Yuyi Cao, stated that the chest is empty like the sky; earth qi rises to form clouds, but must descend as rain for earth qi to store and remain still. This truly understands the concepts of Upper Jiao like mist, Middle Jiao like fermentation, and Lower Jiao like ditches. Only when clouds move and rain falls do ditches fill, waterways clear, and heaven and earth renew. This principle emphasizes the Bladder channel. The Classics say: The Bladder is the official of the capital, storing fluids; transformation allows them to exit. Just as one can drink unlimited alcohol without getting drunk, it is due to the transformation function of the Bladder. Danzhong is located inside the diaphragm; the Bladder is inside the abdomen. Normal Bladder transformation allows emptiness and receptivity, enabling Qi from Danzhong to descend. If the Bladder fails to transform, the abdomen distends first, and how can Qi from Danzhong reach below? To promote Bladder transformation, the key lies in preserving Kidney Qi. The Kidney pairs with the Bladder as its fu organ. Kidney Qi moves, first pouring into the Bladder. Repeated movement fills the Bladder, forcing rebellion toward the chest and diaphragm, causing unbearable stuffiness. If Kidney Qi does not move, storage remains solid, the Bladder stays pure and quiet, and Qi from Danzhong does not overflow. When Qi from Danzhong descends, the chest becomes spacious like the sky.
Xu Zhongke said: Zhang Zhongjing concludes with Xuefen (Blood Division) after discussing Zhengshui (True Water); he concludes with Qifen (Qi Division) after discussing Huanghan. Why? Zhengshui originates from Kidney invasion in the Lower Jiao, where Blood is primary; thus, discussing Zhengshui leads to discussing obstructed menstrual blood. Huanghan originates from Heart invasion in the Upper Jiao, where Qi is primary; thus, discussing Huanghan leads to discussing stagnant Great Qi. Because the Qi, Blood, Yin, and Yang differ between upper and lower, this explains why Zhang Zhongjing uses Guizhi as the sovereign herb for Huanghan to transform Qi, uses Mahuang as the sovereign herb for Zhengshui to enter Ying, and uses Fuzi as the sovereign herb for Shuishui (Stone Water) to break Yin. Examining the sequence of his discourse makes the intent behind the formulas obvious.
(When pathology is in) Qifen. (As Great Qi descends,) the area below the heart becomes hard and large like a plate, with edges like a rotating plate. (The condition is severe. However, instead of directly attacking Qi, use pungent, sweet, and warm herbs to move Yang and transform Qi, treating with) Guizhi Gancao Jiangzao Maxing Fuzi Tang (Cinnamon Twig, Licorice, Ginger, Jujube, Ephedra, and Prepared Aconite Decoction).
This continues the discussion of Qifen pathology and provides treatment.
Guizhi Gancao Jiangzao Maxing Fuzi Tang Formula
Guizhi (Cinnamon Twig)
Shengjiang (Fresh Ginger) (3 liang each)
Xixin (Asarum)
Gancao (Licorice Root)
Mahuang (Ephedra Herb) (2 liang each)
Fuzi (Prepared Aconite Root) (one piece, processed)
Dazao (Jujube) (12 pieces)
These seven ingredients are boiled in seven sheng of water. First boil Mahuang, remove the foam, then add other herbs. Boil to obtain two sheng. Divide into three warm doses. Sweating should occur, with a sensation like insects crawling under the skin; this indicates cure. (This shows the constrained Yang dispersing and circulating throughout the body, producing this phenomenon.)
(If the etiology differs but the manifestation is similar, differentiation is essential before medicating.) The area below the heart is hard and large like a plate, with edges like a rotating plate. (One must carefully differentiate based on the discussed diseases to know it is caused by) Water-Fluid retention. (This is a major distinction within Qifen. Water has form, so herbs should be bitter and draining. Use) Zhizhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction).
This distinguishes Water-Fluid pathology from Qifen, using the auxiliary to define the principal.
Zhizhu Tang Formula
Zhishi (Immature Bitter Orange Fruit) (7 pieces)
Baizhu (Atractylodes Macrocephala Rhizome) (2 liang)
These two ingredients are boiled in five sheng of water to yield three sheng. Divide into three warm doses. When the abdomen softens, the pathogen will dissipate.
Attached Formulas
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 sweating only on the head, with no other exterior symptoms. The patient should feel heaviness in the lower body. From the waist up is normal; from the waist down
there is edema extending to the genitals, with difficulty in flexion and extension. (Formula found in the Rheumatism chapter.)