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To disperse the accumulated sweat pathogens and the cold-dampness pathogens together. Thus, this decoction aims to address the qi yuan (vital energy) submerged below and lift it out. The post-prescription notes state: If mental restlessness occurs, it is due to Liver Wood generating Heart Fire, while body fluids are insufficient to control it. If mental restlessness persists, it is caused by the astringent nature of vinegar causing obstruction. Therefore, after the resolution of yellow sweating in six or seven days, perhaps sour-cool herbs could be administered to dissipate the obstruction.

Article 31 Patients with yellow sweating disease present with reverse coldness in both calves. If fever is present, this belongs to Li Jie (Migratory Joint Bi). Sweating after eating, along with frequent night sweats in the evening, indicates Lao Qi (consumptive qi disorder). If fever occurs after sweating, over time the skin will inevitably become rough and scaly like fish scales (Jia Cuo). Persistent fever will surely lead to malignant sores. If the body feels heavy and becomes lighter immediately after sweating, over time the body will inevitably become numb and insensible, leading to pain in the chest. Furthermore, there will be sweating above the waist but no sweating below the waist; the loins and hips will feel flaccid and painful, as if something were trapped in the skin. In severe cases, the patient cannot eat, suffers from body pain and heaviness, irritability, and difficult urination. This is Yellow Sweating Disease, treated primarily with Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus).

Guizhi Jia Huangqi Tang Formula
Add two liang of Huangqi (Astragali Radix) to the Guizhi Tang formula. Prepare and administer according to the method for Guizhi Tang, aiming for a slight perspiration.

If Wei Qi (Defensive Qi) is inherently deficient, and water dampness enters through the sweat pores, resulting in Yellow Sweating Disease, then Wei Yang (Defensive Yang) is suppressed, and Water Qi (Pathogenic Water) calls upon the Kidney. The calves are the external mansion of the Kidney. Yang Qi contracts and fails to penetrate; combined with the Kidney receiving Cold-Damp Qi, symptoms manifest in its mansion, hence the reverse coldness in the calves. This condition should not normally present with fever. If fever is present, it is Li Jie (Migratory Joint Bi), not Yellow Sweating Disease. Although both Li Jie and Yellow Sweating can result from sweating and entering water, when Water Qi enters the bone gaps, it forms Li Jie; when it remains at the exterior of the meridians and probes the Zang-Fu organs, it forms Yellow Sweating. Yellow Sweating may or may not involve heat; Li Jie, due to Qi stagnation in the bone gaps, always involves heat. If the calves are cold, and the patient sweats after eating or has night sweats, this is due to Zong Qi (Pectoral Qi) being depleted by labor, failing to exit and secure the interstices; this is also not Yellow Sweating. If the calf coldness initially lacks heat but develops fever after sweating, this indicates that sweating has injured Yin, and Water Qi has stagnated and transformed into Heat. Thus, despite weak Wei Qi, heat is observed. However, when Water Pathogen transforms into Heat, Qi stagnates; when Qi stagnates, Blood coagulates. Therefore, the skin will become mottled and scaly (Jia Cuo). Persistent fever leads to long-term stagnation and ulceration, resulting in malignant sores. This explanation focuses on the Blood aspect. If coldness accompanies body heaviness, it reflects the sinking of Water Pathogen. As water reduces through sweat, the patient feels lighter immediately after sweating. However, sweating injures Qi; over time, Qi deficiency causes meridian movement. Since Meridian Qi originates in the chest, body numbness implies that Qi from the chest distributes evenly to the meridians, generating internal dull pain. This explanation focuses on the Qi aspect. Regarding Jia Cuo, malignant sores, body numbness, and chest pain, these are deduced specifically from the symptom of sweating above the waist. Below the waist, where there is no sweating, Water Pathogen remains free. Thus, from the waist down to the hip bones (large bones below the waist), there is a sensation of heaviness, flaccidity, and pain. The sensation of an object in the skin below the waist is a response to Water clashing with body heaviness. This addresses the case where neither the upper nor lower parts resolve. "Severe" refers to deep and heavy Cold-Damp pathogens. Cold Qi enters from the exterior into the chest and stomach, slowing the digestion of cooked food and causing anorexia. Qi stagnation causes pain; Water stagnation causes heaviness. Reversing the Qi of sweating causes irritability (Fan); inability to sweat causes restlessness (Zao). Cold-Damp invading the chest prevents the distribution of Chest Yang, causing difficult urination. This is Yellow Sweating Disease. Following the discussion of Li Jie and Lao Qi, these various symptoms constitute the definitive signs of Yellow Sweating. The primary use of Guizhi Jia Huangqi Tang is because Cold-Damp suppresses Wei Qi; thus, Guizhi Tang is used to promote Yang and release the exterior. Because Wei deficiency leads to uncontrolled sweating and injury to both Qi and Blood, Huangqi is added to tonify Qi and secure the exterior. Within the balance of tonification and dispersion, it employs strategies of simultaneous suppression and pacification, attack and defense.

Article 32 The Master said: The Cun Kou pulse is slow and choppy. Slow indicates Cold; choppy indicates Blood insufficiency. The Zu Yang pulse is faint and slow. Faint indicates Qi deficiency; slow indicates Cold. Cold Qi and insufficiency lead to cold extremities. Cold extremities imply that Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) are obstructed. Obstruction of Ying and Wei leads to abdominal fullness and borborygmus chasing each other, with Qi shifting to the Bladder. When Ying and Wei are exhausted, Yang Qi is blocked, causing body coldness; Yin Qi is blocked, causing bone pain. If Yang opens first, there is aversion to cold; if Yin opens first, there is numbness and insensibility. When Yin and Yang harmonize, Qi flows; when the Great Qi rotates, pathogens dissipate. Excess manifests as passing gas; deficiency manifests as enuresis. This is named Qi Fen (Qi Division/Disorder).

These three articles (31-33) discuss water diseases caused by Qi deficiency. They should logically follow Article 19 and precede Article 20, after Yellow Sweating. Their current placement suggests bamboo slip error. Discussing Qi before Blood, and Men before Women, is logical, and the text aligns with Articles 20 and 21. Article 31 details how Qi deficiency summons Water; Article 32 covers the standard treatment for Qi Fen disorders; Article 33 discusses variant symptoms and treatments. Formulas are provided for Qi Fen but not explicitly for Blood Fen, as Blood Fen water treatment principles are similar to men's and scattered throughout previous texts. Treatments for Blood Fen are detailed in the Women's Miscellaneous Diseases and Malaria sections, such as the small formulas in Biejia Jian Wan and Dahuang Zhechong Wan in the Deficiency Consumption section, so they are not repeated here. The right-hand Cun Kou pulse corresponds internally to the Lungs and Chest, and externally to Ying and Wei. A slow and choppy pulse indicates Yang Qi deficiency and Cold (slow) preventing coherent pulsation, and Yin Blood insufficiency (choppy) preventing fluid circulation. Cun Kou conveys Jing Han (Essential Vigor) from the Stomach to form Ying and Wei. With Cold Qi and insufficient Blood, the internal and external states are clear. The Zu Yang pulse is the source of Jing Han. A faint and slow Zu Yang pulse indicates Qi deficiency (faint) and Stomach Qi deficiency/Cold (slow). Stomach Yang deficiency prevents Qi from reaching the extremities via the Lungs and Chest, causing cold extremities. This path requires Qi to move from the Diaphragm to the exterior meridians (Ying/Wei) and then to the hands and feet. Cold extremities indicate prior Ying/Wei obstruction. Since Ying/Wei root in the Chest/Diaphragm, their obstruction depletes Zong Qi, failing to transform the Middle Jiao, causing abdominal fullness. As fullness subsides slightly, Qi descends causing borborygmus, creating a cycle of fullness and sound. Bladder Qi should descend; now it steams upward. Ying/Wei, originally abundant, are now exhausted, causing respiratory-like movements in the meridians. "Qi shifts to Bladder" describes the root of water disease and why Water Qi rises to the skin. Yang protects the exterior; if Yang does not reach the surface, Yin pathogens invade Yang areas, causing body coldness. Yin secures the interior; if Yin does not nourish the interior, empty heat remains in the bones, causing bone pain. These four sentences describe water disease symptoms under Ying/Wei exhaustion. If Yang opens first, weak Yang returns but is insufficient for warmth, causing aversion to cold. If Yin opens first, isolated Yin exits but is insufficient for strength, causing numbness. These four sentences describe symptoms of recovery or non-recovery. Only when timing (auspicious months/days) and organ Qi support allow Yin and Yang to harmonize will Qi flow without deviation. The Great Qi (Unity of Yin and Yang) rotating disperses Six Evils. In excess cases, passing gas brings relief; in deficiency cases, bladder incontinence occurs. "Excess passes gas, deficiency enuresis" describes favorable signs of pathogen dissipation, not the disease mechanism itself. Although the text mentions "choppy means Blood insufficiency" and discusses Wei alongside Ying, it emphasizes that Qi roots in Blood and Wei attaches to Ying. Ultimately, Qi deficiency causes Water; Qi rotation resolves the disease. Partial opening of Qi seems to reduce symptoms but does not truly resolve them, hence the name Qi Fen.

Article 33 In Qi Fen disorders, hardness and distension in the epigastrium resembling a plate, with edges like a turned cup, caused by Fluid Retention. Treated primarily with Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Prepared Aconite, and Asarum).

Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang Formula
Guizhi (Three liang), Mahuang (One liang), Fuzi (One piece, prepared), Xixin (One liang), Gancao (Two liang), Shengjiang (Three liang), Dazao (Twelve pieces).
Boil these seven ingredients in seven sheng of water. First boil Mahuang, remove foam, then add remaining herbs. Boil until two sheng remain. Divide into three warm doses. Recovery occurs when sweating feels like insects crawling under the skin.

This treats the symptoms of slow/choppy Cun Kou and faint/slow Zu Yang pulses. Epigastric Qi deficiency/cold and Stomach Qi deficiency/cold cause Water accumulation between the Diaphragm and Stomach, directly below the heart. This describes Qi Fen symptoms: epigastric hardness like a plate, with rounded edges like a turned cup. This results from Upper and Middle Jiao Qi failing to distribute, causing Fluid Retention in the middle-upper regions. Like clouds and mist in the void, stagnant and obstructed, requiring Wind to blow, Rain to wash, and Solar Fire to shine to dissipate it. Guizhi Tang acts as Wind to stir the Great Qi; Mahuang acts as Rain to awaken hibernating energies; Fuzi and Xixin act as Sun to dry residual moisture after rain. Since the disease is in Qi Fen located in the epigastrium, Shaoyao (which is sour, descending, and astringent) is removed from Guizhi Tang. This follows the principle of treating conditions above the waist with sweating. These articles specify "Fluid Retention," distinguishing them from Yellow Sweating. Placing this section before Blood Fen disorders is appropriate.

Article 34 Hardness and distension in the epigastrium resembling a plate, with edges like a turned tray, caused by Fluid Retention. Treated primarily with Zhishi Baizhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction).

Zhishi Baizhu Tang Formula
Zhishi (Seven pieces), Baizhu (Two liang).
Boil these two ingredients in five sheng of water until three sheng remain. Divide into three warm doses. Borborygmus in the abdomen indicates the dispersion of Water.

This does not follow the slow/choppy/faint pulse pattern but addresses the epigastric hardness from the previous article as a variant where Excess Qi causes Water. Differentiation is difficult without pulse diagnosis. For Qi deficiency causing Water, the epigastrium is flat in the center and high at the edges. For Qi excess causing Water, the epigastrium is high in the center and flat at the edges. Cups are deep/high; trays are shallow/low, used for differentiation. "Qi Excess" here refers to "Retained Qi" from the Chest Bi section. Retained Qi stagnates in the epigastrium, causing Fluid Retention to rise. Qi lifts Fluid, Fluid adheres to Qi; their interaction creates hardness. Like white clouds turning black with rising earth moisture, becoming dense and suspended. Zhishi (dispersing Qi) is the sovereign herb to scatter Retained Qi; Baizhu (drying Dampness) is the assistant to eliminate Retained Fluid. Once Qi dissipates, Water drains downward, indicated by borborygmus. Using seven pieces of Zhishi (a harsh dispersant) for patients with Cold Qi deficiency (slow/choppy/faint pulses) would likely cause severe confusion and distress. Thus, this is a variant treatment for Qi Excess causing Water. See Chest Bi notes for Retained Qi; see Phlegm-Fluid notes for Retained Fluid.