问曰。少阳病不解。即传三阴乎。答曰。有传有不传。仲景云。伤寒三日。三阳为尽。
三
阴当受邪。其人反能食不呕。此谓三阴不受邪也。若此者。其病机本不传。又少阳证一见。
即从少阳治法而病速已。则亦不传。凡阳经之病。在太阳则头痛发热。阳明则潮热汗自出。
少阳则往来寒热。若久之无大热。其人躁烦者。此为阳去入阴之候。其中具有先见之机。然
则治伤寒家。何如乘其机之未动。亟从少阳解去其邪。以预弭阳去入阴之变。何便如之。
问曰。何以识为太阴病。答曰。太阴之脉。起于大指之端。上循膝股内廉入腹。属脾络
胃。
上膈挟咽。连舌本。仲景以腹满而吐。食不下。自利益甚。时腹自痛。属太阴之为病。盖太
阴为阴中之至阴。太阴之前。名曰阳明。太阴之后。名曰少阴。太阴受病。不能为阳明行其
津液。而少阴肾水。因泛浸而无所制。故见吐利满痛等证。仲景以是为太阴病之提纲。太阴
属里。吐利满痛。皆里证也。凡伤寒之邪。在阳经误治。转陷入阴者。必种种表证全罢。但
见吐利满痛等证。却是邪入太阴之候。然又必以脉为辨。故仲景云。太阴病。脉浮者可发汗
。宜桂枝汤。太阴病脉本当沉。今反浮。则是虽见太阴病。而邪尚逗遛于表。仍可逆挽其邪
。
使从表解。由是推之。则太阴之脉必主沉。又不必言矣。太阴证具。而脉又沉。即宜专就太
阴论治。若邪直犯太阴。不因传经而本经自病者。亦当专就太阴论治。内经言三阴之离合。
太阴为开。厥阴为阖。少阴为枢。饮食入胃。全恃太阴司转输之职。太阴受病则转输之道窒。
故食不下。腹满时痛。因之上涌则吐。下注则利。其主治之法。大约宜扶植中州阳气。使复
其转输之常职。则病自已。仲景辨列六经。而太阴独略。然就此义而引伸触类。大旨初不越
乎此。奚俟繁言哉。
Q: If Shaoyang disease (Shaoyang Syndrome) does not resolve, does it necessarily transmit to the Three Yin meridians? A: It may or may not transmit. Zhang Zhongjing stated: "In San-yang diseases, after three days, the San-yang period is exhausted, and the San-yin should be affected by pathogenic factors." However, if the patient can eat and does not vomit, this indicates that the San-yin meridians are not affected by pathogens. In such cases, the pathological mechanism inherently does not involve transmission. Furthermore, once Shaoyang syndrome appears, if treatment follows the methods for Shaoyang disease and the condition resolves rapidly, transmission will also not occur. Generally, diseases of the Yang meridians manifest as headache and fever in Taiyang; tidal fever and spontaneous sweating in Yangming; and alternating chills and fever in Shaoyang. If, after a long duration, there is no high fever but the patient becomes restless and irritable, this is a sign that Yang pathogens are departing and entering the Yin. There are precursory signs indicating this shift. Therefore, physicians treating Shanghan (Cold Damage) should seize the opportunity before the pathological mechanism shifts, urgently resolving the pathogen via the Shaoyang method to preemptively prevent the change of Yang pathogens entering Yin. What could be more convenient than this?
Q: How can one identify Taiyin disease? A: The Taiyin meridian originates at the tip of the great toe, ascends along the medial aspect of the knee and thigh, enters the abdomen, connects with the Spleen, and links with the Stomach. It passes through the diaphragm, flanks the throat, and connects with the root of the tongue. Zhang Zhongjing identified abdominal fullness, vomiting, inability to eat, worsening diarrhea, and spontaneous abdominal pain as belonging to Taiyin disease. This is because Taiyin is the "Extreme Yin" within the Yin category. Anterior to Taiyin lies Yangming, and posterior to Taiyin lies Shaoyin. When Taiyin is diseased, it fails to distribute fluids for Yangming, causing Kidney Water of Shaoyin to flood and overflow without restraint, resulting in symptoms such as vomiting, diarrhea, fullness, and pain. Zhang Zhongjing used these as the outline for Taiyin disease. Taiyin belongs to the Interior; vomiting, diarrhea, fullness, and pain are all Interior syndromes. Generally, when Shanghan pathogens are mistreated in the Yang meridians and sink into the Yin, all exterior symptoms must cease, leaving only symptoms like vomiting, diarrhea, fullness, and pain, which indicates the pathogen has entered Taiyin. However, differentiation must also rely on the pulse. Thus, Zhang Zhongjing stated: "In Taiyin disease, if the pulse is floating, sweating therapy may be used, preferably Guizhi Tang (Cinnamon Twig Decoction)." The pulse in Taiyin disease should typically be deep; if it is unexpectedly floating, it indicates that although Taiyin symptoms are present, the pathogen remains lingering on the Exterior. The pathogen can still be reversed and resolved from the Exterior. From this, it can be deduced that the Taiyin pulse must be deep, which needs no further elaboration. When Taiyin symptoms are complete and the pulse is deep, treatment should focus exclusively on Taiyin. If pathogens directly attack Taiyin, arising from the meridian itself rather than through transmission, treatment should also focus exclusively on Taiyin. The *Neijing* discusses the separation and union of the Three Yin meridians: Taiyin acts as the Opening, Jueyin as the Closing, and Shaoyin as the Pivot. Food entering the Stomach relies entirely on Taiyin's function of transportation and transformation. When Taiyin is diseased, this pathway is obstructed, leading to inability to eat, abdominal fullness, and intermittent pain. Consequently, upward rebellion causes vomiting, and downward flow causes diarrhea. The primary treatment method generally involves supporting and consolidating the Yang Qi of the Middle Jiao (Central Region), restoring its normal transportation functions, after which the disease will resolve spontaneously. Zhang Zhongjing analyzed and listed the Six Meridians, yet treated Taiyin briefly. However, extending this principle through analogy, the main idea does not exceed this scope, making verbose explanations unnecessary.