使郁汗及水寒之邪。并散矣。是此汤系责气元之下伏。而提之使出之意也。方后曰心烦者。肝木上生心
火。而液不胜也。心烦不止。因苦酒酸而阻滞之故。则六七日黄汗解后。或可服辛凉以散其所阻乎。
三十一条 黄汗之病。两胫逆冷。假令发热。此属历节。食已汗出。又身常暮盗汗出者。此劳气也。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
上必汗出。下无汗。腰髋弛痛。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。
桂枝加黄 汤方
于桂枝汤方中。加黄 二两。余如桂枝法。取微汗。
若卫气素虚。又因水入汗孔。而得黄汗之病。则卫阳伏而水气与肾脏相召。两胫。为肾之府。阳气缩而不贯。
又肾得水寒之气。而症见其府。故两胫逆冷。此症原不该见热。假令发热。此为历节。而非黄汗矣。盖历节黄
汗。虽同为汗出入水所得。水气内入骨缝。则为历节。但在经表而窥探脏腑。则为黄汗。黄汗。有热、有不热。历
节。以气郁骨缝。而无不热者故也。若两胫逆冷。但凡食已而汗出者。又或暮夜而盗汗者。此为宗气因劳而
馁。故不能出而固密之所致。亦非黄汗也。若两胫逆冷之症。起初不热。汗已而反发热者。是汗出伤阴。又水
气郁而化热。故虽卫微而见热也。然水邪化热。则气滞。气滞。则血凝。故知其身必斑驳而甲错。发热不止。则
凝滞久而溃烂。故知其必生恶疮也。此从血分上言。若逆冷而兼身重。是水邪沉着之应。水从汗减。故汗已
辄轻。但汗则伤气。久则气虚。而经脉 动。经气根于胸中。身 。则胸中之气。匀走经络。而内生虚痛矣。此从
气分上言。夫甲错恶疮。身 胸痛。特就腰以上有汗。而推其症耳。其腰以下无汗。则水邪自在。故从腰及腰
下之髋髀（腰下之大骨也）板骨。沉坠如弛脱而痛。腰下之皮中如有物状者。皆水搏身重之应也。此从
上部解。而下部不解者言也。剧、指水寒之邪深重而言。寒气从表。而内注胸中以及胃脘。则熟谷之化迟。而
不能饮食。气郁则疼。水滞则重。逆其汗气。故烦。欲汗出而不得。故躁。水寒之气犯胸。而胸阳不布。故小便不
利。此为黄汗。承上文历节劳气。而言如此种种。方为黄汗之确症耳。主桂枝加黄 汤者。本为水寒激伏其
卫气。故主行阳解表之桂枝汤以发之。本为卫虚而表气不摄。遂致汗出而气血两伤。故加补气之黄 。趁
便固之。一补一散之中。而具剿抚并行。攻守兼备之道矣。
三十二条 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。
则
手足逆
冷。手足逆冷。则营卫不利。营卫不利。则腹满肠鸣相逐。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。虚则遗尿。名曰
气分。
本条及下文三十三、三十四共三条。言气虚而病水者。当在十九条之后。二十条之前。次黄汗之后。无谓。疑
错简也。盖先气分而后血分。先男子而后妇人。既为合法。且其文义。与二十及二十一条实同故也。本条、历
言气虚召水之由。下条、言气分之正病正治。末条言变症变法也。但气分有方。而血分不出方者。以血分之
水。其治例与男子同。已散见各条。而治血诸方。详妇人杂病门并疟门。鳖甲煎丸中之小方。及虚劳门之大
黄虫丸等方。故不赘也。右手寸口。内应肺与胸中。外应营卫者也。其脉若迟而涩。迟则阳气虚寒。故其
鼓动之机。不能连贯。涩则阴血不足。故其形体之神。不能流利也。夫寸口者。所以为胃腑行精悍。而外出为
营卫者也。今气寒而血不足。则其内外已可知矣。及按趺阳。趺阳、为精悍之源。脉微而迟。微则其气虚微。故
有无力鼓努之象。迟则与寸口同断。而亦为胃气虚寒也。胃中阳虚而寒。因而其气不足。则不能从肺与胸
中而贯及手足之末。故手足逆冷。夫胃中阳气之所以贯及手足者。先从膈而外出经络之营卫。然后从营
卫而充行手足者也。手足逆冷。则营卫先已不利。可见矣。营卫又根于胸膈。营卫不利于经络。则膈间之宗
气衰微。不能化被中土。故腹满。腹满略减。则其气下行而为肠鸣。于是腹满肠鸣。循环不已。有如相逐之状
矣。又膀胱之气。本属下化。今不行而其水气有上蒸之象。营卫之气。本自充满。今劳馁而其经络有嘘吸之
机。故曰气转膀胱。营卫俱劳者。正言病水之根脚。而水气之所以上走皮肤也。阳主护外。阳不通于表。而阴
邪外出阳分。故身冷。阴主固内。阴不滋于里。而虚热余于骨间。故骨疼也。四句即营卫俱劳。而言水病之症。
阳前通则微阳复而不足以自温。故反知恶寒。阴前通则孤阴出而不足以外健。故痹而不仁也。四句又即
营卫俱劳。而言水病欲愈不愈之症。惟运气月日之官旺。与脏腑之气血生扶。使阴阳相得。则其气乃流行
而无偏弊。盖阴阳合德。为天地得一之大气。大气一转。亦何六淫之邪之不散乎。于是邪实者。则得后与气。
而快然如衰。正虚者。犹将膀胱不约而遗溺。曰实则失气。虚则遗溺者。是言病邪欲散之佳兆尚如此。非言
病机也。条中虽曰涩为血不足。又言卫而并言营。以气根于血。卫附于营。故并及之。然始终以气虚致水。气
转病散。气偏通。则似减而实未减。故名为气分也。
三十三条 气分。心下坚大如盘。边如旋杯。水饮所作。桂枝去芍药。加麻黄附子细辛汤主之。
桂枝去芍药加麻黄附子细辛汤方
桂枝（三两） 麻黄（一两） 附子（一枚炮） 细辛（一两） 甘草（二两） 生姜（三两） 大枣（十二枚）
上七味。以水七升。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。
此即上文寸口脉迟而涩。趺阳脉微而迟之症治也。盖寸口之膈气虚寒。趺阳之胃气亦虚寒。则水聚膈下
胃上。而正当心之下矣。承上文而言气分之症。心下坚大。其形如盘。旋杯旋盘。即车床刮刀。旋转所成之器。
言其边之圆转如旋杯也。此系上中二焦之气。不能分运。故水饮聚于中上两间之所作也。譬之太虚。阴云
湿雾。沉滞痞塞之象。不得风以鼓之。雨以泄之。太阳之真火照耀之。则此气猝不可散。故其主桂枝汤者。鼓
天地之大气而发之以为风也。加麻黄者。振龙雷之起蛰。而沛为雨泽也。佐辛热之附子、细辛者。风雨之后。
云开日朗。所以收水性之余湿也。但其病在气分。其部在心下。独于桂枝汤中。去酸收下行之芍药者。所谓
汗之而愈。仍从腰以上之例也。观本条紧承气分。而此及下条。俱曰水饮所作。是与黄汗何涉。而徐氏谓
上条为泛论病机。又与本门何涉。惟置之血分以前。允为恰当。有识君子。当不以为妄耶。
三十四条 心下坚大如盘。边如旋盘。水饮所作。枳实白术汤主之。
枳实白术汤方 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 。即水散也。
此非承接寸口迟涩。趺阳微迟之脉而言。乃就上条心下坚大。而言气实致水。似同实异之变症也。但除诊
脉外。其外症颇难辨认。惟是气中虚而致水者。其心下则中平而边高。气中实而致水者。其心下则中高而
边平。为少异耳。杯、深而高。盘、浅而低。故取以为辨也。然所谓气实者。非充实之谓。乃即胸痹门之留气。留气
实于心下。而水饮上升。于是气以提饮。饮以附气。留气留饮。两相搏结。而成坚大之形者。譬之干云在天。其
色常白。郁久不散。地气上升。地乃湿气。云湿相并。其色渐黑。沉浓郁滞。悬而未下之象。故以破气之枳实为
君。先散留气。以燥湿之白术为佐。并去留饮。则气泄而水自下注。故曰腹中 。即水散矣。若于寸口迟涩。趺
阳微迟之脉。上焦中焦。寒气不足之症。投以破损高真之枳实。用至七枚。其不心愦愦而忙乱欲死者。几希
矣。我故曰。此气实致水之变症变治也。留气、见胸痹注。留饮、见痰饮注。
使郁积的汗邪以及水寒之邪，一并消散。因此，此汤剂旨在责求下伏的气元，并将其提举出表的意思。方后注说：若出现心烦，是肝木生心火，而津液不足以制约所致。如果心烦不止，是因为苦酒（醋）酸涩导致阻滞的缘故，那么在六七日黄汗病解除后，或许可以服用辛凉药物来疏散其阻滞。
第三十一条 患黄汗病的人，两小腿逆冷。假如发热，这属于历节病。饭后出汗，且身体常在傍晚盗汗的，这是劳气病。如果出汗后反而发热，时间久了身体必然会出现肌肤甲错（皮肤干燥粗糙如鳞甲）。发热不止的人，必定会生恶疮。如果身体沉重，出汗后随即感觉轻快，时间久了必然身体麻木不仁，进而导致胸中疼痛。并且从腰部以上必然出汗，腰部以下无汗，腰髋部位弛缓疼痛，感觉像有东西在皮中一样。病情严重的不能进食，身体疼痛沉重，烦躁不安，小便不利。这就是黄汗病。用桂枝加黄芪汤主治。
桂枝加黄芪汤方
在桂枝汤方中，加入黄芪二两，其余按照桂枝汤的方法煎服，取微汗。
如果是卫气素来虚弱，又因水湿进入汗孔，从而得黄汗病，那么卫阳被伏遏，水气与肾脏相互感召。两胫（小腿），是肾的外府。阳气收缩而不能贯通，加上肾得到水寒之气，病症表现在其外府，所以两小腿逆冷。此症原本不该见发热，假如发热，这就属于历节病，而不是黄汗了。大概历节和黄汗，虽然都是由于汗出时入水所得，但水气内入骨缝，就形成历节；只在经络体表而窥探脏腑，就形成黄汗。黄汗病，有发热的，也有不发热的；历节病，因为气郁结在骨缝，所以没有不发热的。如果两小腿逆冷，凡是吃饭后就出汗的，或者在夜间盗汗的，这是宗气因为劳累而衰馁，所以不能外出固密腠理所致，也不是黄汗病。如果两小腿逆冷的症状，起初不发热，出汗后反而发热的，这是汗出伤阴，加上水气郁结而化热，所以虽然卫气微弱却见到发热。然而水邪化热，则气机阻滞；气机阻滞，则血液凝滞。所以知道身体必然斑驳且肌肤甲错。发热不止，则凝滞日久溃烂，所以知道必定生恶疮。这是从血分角度论述。如果逆冷兼身体沉重，是水邪沉着的反应。水湿随汗排出，所以出汗后随即轻快。但是出汗会伤气，久了则气虚，经脉气动，经气根于胸中，身体麻木不仁，则胸中之气均匀流向经络，内生虚痛。这是从气分角度论述。至于肌肤甲错、恶疮、身体麻木胸痛，只是针对腰部以上有汗这一情况推导出的症状罢了。其腰部以下无汗，说明水邪自在，所以从腰部到腰下的髋骨（腰下的大骨）板重坠胀如弛脱而疼痛，腰部以下的皮中如有异物感，都是水邪搏结身体沉重的反应。这是从上部和下部都不解的角度来说的。“剧”，指水寒之邪深重而言。寒气从体表向内注入胸中以及胃脘，则熟谷的消化变慢，而不能饮食。气郁则疼痛，水滞则沉重，逆乱其汗气，所以烦；想出汗而出不来，所以躁。水寒之气侵犯胸中，胸阳不能布散，所以小便不利。这就是黄汗病。承接上文历节和劳气，说如此种种症状，才是黄汗病的确切证候。主用桂枝加黄芪汤，本是因为水寒激惹伏遏了卫气，所以主用行阳解表的桂枝汤来发散它；本是因为卫虚而表气不摄，导致汗出而气血两伤，所以加入补气固表的黄芪。在一补一散之中，具备剿抚并行、攻守兼备的道理。
第三十二条 老师说：寸口脉迟而涩，迟则为寒，涩为血不足。趺阳脉微而迟，微则为气虚，迟则为寒。寒气与正气不足，则手足逆冷。手足逆冷，则营卫运行不利。营卫运行不利，则腹部胀满，肠鸣声互相追逐，气转至膀胱。营卫俱劳损，阳气不通，则身体寒冷；阴气不通，则骨骼疼痛。阳气先通，则怕冷；阴气先通，则麻痹不仁。阴阳相合，气机才能运行，大气一转，邪气才能消散。实证则失气（放屁），虚证则遗尿，名叫气分病。
本条及下文三十三、三十四条共三条，讲的是气虚而致病水的情况，应当排在第十九条之后，第二十条之前，次在黄汗之后。现在排列顺序不对，怀疑是竹简错乱。大概先论气分而后论血分，先论男子而后论妇人，既符合逻辑，且其文义与第二十、二十一条实际上相同。本条历述气虚召致水气的缘由，下条讲气分病的正病正治，末条讲变症变法。但气分病有方，而血分病不出方的原因，是因为血分的水气，其治疗原则与男子相同，已散见于各条，而治疗血分的诸方，详细记载在妇人杂病门并疟疾门，如鳖甲煎丸中的小方，以及虚劳门的大黄虫丸等方，所以不再赘述。右手寸口脉，内应肺与胸中，外应营卫。其脉若迟而涩，迟则阳气虚寒，所以其鼓动的机制，不能连贯；涩则阴血不足，所以其形体的神气，不能流利。夫寸口脉，是用来让胃腑输送精悍之气，并外出化为营卫的。如今气寒而血不足，那么内外情况已经可知。等到按诊趺阳脉，趺阳脉是精悍之气的源头，脉微而迟，微则是其气虚微，所以有无力鼓努的现象；迟则与寸口脉同断，也是胃气虚寒。胃中阳虚而寒，因而其气不足，则不能从肺与胸中贯达手足末端，所以手足逆冷。夫胃中阳气之所以能贯达手足，先从膈部外出至经络的营卫，然后从营卫充行于手足。手足逆冷，则营卫先前已经不利，由此可见。营卫又根源于胸膈，营卫不利于经络，则膈间的宗气衰微，不能化育中土，所以腹部胀满。腹部胀满略减，则其气下行而为肠鸣，于是腹满肠鸣，循环不已，有如互相追逐的状态。又膀胱之气，本属下化，如今不行而其水气有上蒸之象，营卫之气，本自充满，如今劳损衰馁而其经络有嘘吸之机，所以说“气转膀胱”。所谓“营卫俱劳”，正是言明病水的根本，以及水气之所以走上皮肤的原因。阳主护卫外表，阳不通于表，而阴邪外出侵扰阳分，所以身体寒冷；阴主固护内部，阴不滋于里，而虚热余留于骨间，所以骨骼疼痛。这四句即是在营卫俱劳的基础上，言明水病的症状。阳气先通则微阳复而不足以自温，所以反而知怕冷；阴气先通则孤阴出而不足以外健，所以麻痹而不仁。这四句又即在营卫俱劳的基础上，言明水病欲愈未愈的症状。只有运气月日的官旺，与脏腑的气血生扶，使阴阳相得，则其气才能流行而无偏弊。盖阴阳合德，是天地得一的大气，大气一转，又何惧六淫之邪不散乎？于是邪实者，则通过大便排气，而快感如衰减；正虚者，犹将膀胱不约而遗溺。说“实则失气，虚则遗溺”，是言病邪欲散的佳兆尚且如此，并非言病机。条文中虽曰“涩为血不足”，又言卫而并言营，因为气根于血，卫附于营，所以一并提及。然而始终以气虚致水，气转病散，气偏通，则似减轻而实际未减轻，所以名为气分病。
第三十三条 气分病，心下坚硬大如盘，边缘如旋转的杯子，由水饮所作。用桂枝去芍药加麻黄附子细辛汤主治。
桂枝去芍药加麻黄附子细辛汤方
桂枝（三两） 麻黄（一两） 附子（一枚炮制） 细辛（一两） 甘草（二两） 生姜（三两） 大枣（十二枚）
以上七味药，用水七升，先煮麻黄，去掉上面的沫，再加入其他药，煮取二升，分三次温服。应当出汗，感觉像虫子在皮中行爬，即痊愈。
这就是上文寸口脉迟而涩、趺阳脉微而迟的症状治疗。大概寸口脉反映膈气虚寒，趺阳脉反映胃气亦虚寒，则水聚积在膈下胃上，正当心之下。承接上文而言气分的症状，心下坚硬大如盘，形状如盘，旋杯旋盘，即车床刮刀旋转所成的器具，言其边缘圆转如旋杯。这是上中二焦之气，不能分运，所以水饮聚积在中上两间所致。譬如太虚，阴云湿雾，沉滞痞塞之象，不得风以鼓动，雨以宣泄，太阳真火照耀，则此气猝然不可散。所以主用桂枝汤，是鼓动天地的大气而发之以为风；加入麻黄，是振起龙雷之气的起蛰，而沛降为雨泽；佐以辛热的附子、细辛，是风雨之后，云开日朗，所以收水性之余湿。但其病在气分，部位在心下，唯独在桂枝汤中去掉酸收下行的芍药，所谓“汗之而愈”，仍遵循从腰以上的治例。看本条紧承气分，而此条及下条，都说是水饮所作，这与黄汗有什么关系，而徐氏谓上条为泛论病机，又与本门何干？只有将其置于血分以前，才恰当。有识之士，应当不会认为这是妄言吧。
第三十四条 心下坚硬大如盘，边缘如旋转的盘，由水饮所作。用枳实白术汤主治。
枳实白术汤方
枳实（七枚） 白术（二两）
以上两味药，用水五升，煮取三升，分三次温服。腹中雷鸣，就是水气消散。
这不是承接寸口迟涩、趺阳微迟的脉象而言，而是就上条心下坚大而言，是气实致水，看似相同实则不同的变症。但除诊脉外，其外在症状颇难辨认。只有气中虚而致水者，其心下则中间平而边缘高；气中实而致水者，其心下则中间高而边缘平，稍有差异而已。杯，深而高；盘，浅而低，所以取用来辨别。然而所谓气实，并非充实之意，乃是即胸痹门之留气。留气实于心下，而水饮上升，于是气以提饮，饮以附气，留气与留饮，两相搏结，而成坚大之形。譬如干云在天，其色常白，郁久不散，地气上升，地乃湿气，云湿相并，其色渐黑，沉浓郁滞，悬而未下之象。所以以破气的枳实为君药，先散留气；以燥湿的白术为佐药，并去留饮，则气泄而水自下注，所以说“腹中雷鸣，即水散矣”。如果在寸口迟涩、趺阳微迟的脉象，上焦中焦寒气不足的病症，投以破损高真之气的枳实，用到七枚，那能不心中愦愦而忙乱欲死吗？极少有这样的情况。所以我说是气实致水的变症变治。留气，见胸痹注；留饮，见痰饮注。
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.