Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. This chapter mentions yellow sweat twice and gives a formula each time: 黄芪芍药桂枝苦酒汤 for the short case, and this one for the long one. The two are best read together, because the interesting part is the difference between them.
The long entry is the longest in the chapter, and it does not stay with the colour of the sweat. The shins are cold on their own. Sweating after eating, and night sweating that comes regularly at dusk, are noted and given a name, 劳气. If fever returns after the sweating, the text says the skin will in time become dry and scaly; if the fever does not stop, sores will form. Heaviness of the body that lifts once sweating starts will in time become twitching, and the twitching is followed by pain in the chest; sweating above the waist and none below, laxity and pain around the hips and loins, a sensation as though something lay beneath the skin, in severe cases inability to eat, heaviness and pain of the body, restlessness and difficult urination — this is yellow sweat, and this formula governs it.
Two of those clauses deserve to be carried into a modern reading, because they are the ones that get examined rather than interpreted. The first is the night sweating that recurs. It has a differential that has to be worked through: tuberculosis, lymphoma, HIV, an overactive thyroid, the menopause, obstructive sleep apnoea, low blood sugar during the night, and a long list of medicines including antidepressants and antipyretics. It is one of the few symptoms whose investigation is genuinely short — a chest radiograph, a blood count, and in the right circumstances a test for tuberculosis. The second is 肌肤甲错, the dry scaly skin the text predicts from prolonged fever: acquired ichthyosis has been described in association with lymphoproliferative disease, which is a reason to take the clause seriously rather than to read it as a figure of speech.
Then the cold shins. Cold lower legs on their own belong on a vascular and endocrine list: peripheral arterial disease, an underactive thyroid, anaemia, and the cold extremities that accompany heart failure. And difficult urination in someone who is oedematous is the clause with a clock: urine output and kidney function are measured, and obstruction is looked for.
The ingredients are 桂枝汤 with astragalus added: cinnamon twig, peony, fresh ginger, jujube and licorice, plus astragalus. Three of them carry notes. 桂枝 is the young twig of Cinnamomum cassia and contains cinnamaldehyde and coumarin. 甘草 carries the glycyrrhizin effect — apparent mineralocorticoid excess, with salt and water retention, potassium loss and raised blood pressure, reported at ordinary amounts over weeks and more serious in someone taking a diuretic or digoxin. 大枣 is jujube, which is a real sugar load rather than a flavouring. 黄芪 is Astragalus root. 生姜 is fresh ginger, and an antiplatelet effect has been discussed in the literature; this library records that the discussion exists and does not settle it.
Pregnancy is an absolute exclusion. This library lists no quantities, no preparation and makes no claim of effect.
本篇两次提到黄汗，两次各给一首方：简短的那一条用黄芪芍药桂枝苦酒汤，长的这一条用本方。两首应当**一起**读，有意思的是这一对之间的差别。
长这一条是本篇最长的一条，而它并没有停在汗的颜色上：两胫自冷；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，久久必身瞤，瞤即胸中痛，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，本方主之。
其中有两句值得带进今天的阅读，因为它们是拿来**查**而不是拿来解释的。**第一句是「暮盗汗出」** —— 反复出现的盗汗有一张必须走完的表：结核、淋巴瘤、HIV、甲状腺功能亢进、绝经、阻塞性睡眠呼吸暂停、夜间低血糖，以及一长串药物（含抗抑郁药与退热药）。它是少数「查起来其实很快」的症状之一：一张胸片、一次血常规，情形合适时再加一项结核检测。**第二句是「身必甲错」** —— 条文从久热推演出皮肤干枯如鳞：获得性鱼鳞病与淋巴增殖性疾病之间的关联有文献记载，这是把这句当真而不是当修辞来读的理由。
然后是**两胫自冷**。小腿自冷属于一张血管与内分泌的表：外周动脉疾病、甲状腺功能减退、贫血，以及心力衰竭时的肢体发凉。而**一个小便不利的水肿病人**，就是那句带时钟的：尿量与肾功能拿来量，梗阻拿来找。
药味是桂枝汤加黄芪：桂枝、芍药、生姜、大枣、甘草，加黄芪。其中三味各有注脚：**桂枝**是肉桂（Cinnamomum cassia）的嫩枝，含桂皮醛与香豆素；**甘草**带着甘草酸那一层效应 —— 假性醛固酮增多症，钠水潴留、失钾、血压升高，在普通量连服数周的情形下也有报告，与利尿剂或强心苷同用时更须留意；**大枣**是枣，它是真实的糖负荷而不是调味。黄芪是豆科黄芪属的根。生姜是鲜姜，抗血小板作用在文献中有讨论，本库记「有此讨论」而不裁决。
**孕期是本方的绝对排除项。** 本库不列用量、不列制法、不作任何效果主张。