理中汤。桂枝汤。五苓散。四逆汤。四逆加人参汤。三物白散。桂枝加芍药汤。桂枝加大黄汤。
腹满。腹痛。发黄。吐利。
太阴湿土所主。仲景以腹满而吐。食不下。时腹自痛。自利不渴等症。为太阴病。乃湿土自病。非阳经注
入之症也。其脉必沉而细。无论外受寒邪。内伤生冷。总以温中散寒为主。理中汤主之。
邵评∶太阴受邪有二端。一因外受风寒。一因内伤冷食。与他经不同也。自受寒邪。治宜温中。
若太阴中风。其脉尺寸俱浮。其症四肢烦疼者。可发汗。宜桂枝汤。其脉阳微阴涩而长者。为欲愈也。
太阴腹满而痛。自利不渴者。因于寒。咽干而渴者。因于热。因于寒。湿土自病。宜理中温之。因于热。
病必关于阳明。或暴烦下利。或发黄便硬。此脾家热。即属胃家之热。为转属阳明之症。宜从阳明治。
邵评∶同是满痛自利。着眼渴与不渴。不渴自受寒邪。故宜温。渴是阳经热邪传入太阴。脾胃相连。
故病关阳明。太阴热邪转属胃腑。故可从阳明治。此太阴满痛自利。以渴不渴辨寒热。最为要诀。
伤寒脉浮而缓。身不发热。手足自温者。太阴也。太阴身当发黄。若小便自利者。不
能发黄。盖寒湿伤于肌肉。不能外越皮肤。故发黄。若小便利。则湿气下输膀胱。便不发黄。设小水不利。
当用五苓散利之。若寒湿伤于太阴之表。可从小便而出。若湿热伤于太阴之里。又当从大便而出。故至
七八日。暴烦下利。虽日十余行。不必治之。以脾家实。所积腐秽。行尽自止矣。盖不须温。亦不须下也。
邵评∶太阴热邪暴烦。是里阳陡发。下利虽多。正是脾家秽积之去路。去尽则自止。此条是太阴湿热。
故脉浮缓。治当利小便。若七八日暴烦下利。有阳气来复。脾家所有积秽。下尽自止。不须用温与下也。
伤寒四五日。腹中痛。若转气下趋少腹者。此欲自利也。自利不渴者属太阴。以其脏有寒故也。当温之。四逆辈。
邵评∶太阴自受寒邪。气机下注。故有下利之兆。自利因于寒湿。故不渴。治当温脏祛寒。
恶寒脉微而复利。四逆加人参汤主之。
邵评∶恶寒而脉微下利。阳虚而阴胜也。此为阴寒下利。用四逆汤温里。人参补虚。最为精当。
下利十余行。脉反实者死。此脾气虚。而邪气盛故也。
太阴腹满时痛。误下之。胸下结硬。而成寒实结胸。无热症者。与三白小陷胸汤。病在膈上
者必吐。膈下者必利。如不利。进热粥一杯。利过不止。进冷粥一杯。（三白小陷胸汤即三物白散）
邵评∶腹满时痛。太阴寒邪。误与寒药下之。寒邪与寒药相结。成寒实结胸。与热实结胸不同。
故用温通一法。无热症者。不四肢烦疼也。
若太阳误下。续得自利。脉弱腹满而痛。此太阳之热邪。陷于太阴之里也。腹满时痛为虚。宜桂枝加
芍药汤。腹满大痛为实。宜桂枝加大黄汤。然脉弱。则胃气亦弱。故云。设当用大黄、芍药者。宜减之。
邵评∶下利为太阴本症。自利因脾实。秽尽则愈。自利因脏寒者。四逆辈温之。此自利因太阳误下。
而邪入太阴。则腹满时痛。当加芍药。大实痛者。当加大黄矣。然下后脉弱。则胃气亦弱。当小其制而减用
之。虽然。下利腹痛。热邪为患。故用芍药。若阴寒腹痛。非芍药所宜。仲景与大黄并提。勿得轻视。
若误下太阳。热邪陷入太阴。是阳经注入之症。分虚实治之。
Li Zhong Tang (Replenish the Middle Decoction). Guizhi Tang (Cinnamon Twig Decoction). Wuling San (Five-Ingredient Powder with Poria). Sini Tang (Frigid Extremities Decoction). Sini Jia Renshen Tang (Frigid Extremities Decoction with Ginseng). Sanwu Baisan (Three-Ingredient White Powder). Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction with Added Peony Root). Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction with Added Rhubarb).
Abdominal fullness. Abdominal pain. Jaundice. Vomiting and diarrhea.
The Taiyin meridian is governed by damp-earth. Zhang Zhongjing considers abdominal fullness accompanied by vomiting, inability to eat, spontaneous occasional abdominal pain, spontaneous diarrhea without thirst as symptoms of Taiyin disease. This is a self-disease of damp-earth, not a syndrome transmitted from the Yang meridians. The pulse must be deep and fine. Regardless of whether it is caused by external contraction of cold pathogenic factors or internal injury from raw and cold food, the treatment generally focuses on warming the middle and dispersing cold, primarily using Li Zhong Tang.
Shao's Commentary: There are two ways for the Taiyin meridian to contract pathogens. One is due to external contraction of wind-cold, and the other is due to internal injury from cold food. This differs from other meridians. If the Taiyin meridian contracts cold pathogens itself, the treatment should focus on warming the middle.
If there is Taiyin wind-stroke, with pulses floating at both the cun and chi positions, and symptoms of vexatious pain in the four limbs, sweating can be induced, preferably using Guizhi Tang. If the pulse is faint at the yang position (cun) and choppy yet long at the yin position (chi), it indicates that the condition is about to heal.
In Taiyin disease, if there is abdominal fullness and pain with spontaneous diarrhea and no thirst, it is due to cold; if there is dry throat and thirst, it is due to heat. Due to cold, it is a self-disease of damp-earth, suitable for warming with Li Zhong Tang. Due to heat, the pathology necessarily involves the Yangming meridian. It may present as sudden vexation with diarrhea, or jaundice with hard stool. This is heat in the spleen home, which is essentially heat in the stomach home, representing a syndrome transferred to Yangming. Treatment should follow Yangming principles.
Shao's Commentary: For the same symptoms of fullness, pain, and spontaneous diarrhea, the key lies in distinguishing between thirst and no thirst. No thirst indicates self-contracted cold pathogens, thus suitable for warming. Thirst indicates heat pathogens from Yang meridians transmitting into Taiyin. Since the spleen and stomach are connected, the pathology relates to Yangming. When Taiyin heat pathogens transfer to the stomach fu, treatment can follow Yangming principles. Distinguishing cold and heat in Taiyin fullness, pain, and diarrhea based on thirst is the most crucial key.
In Shanghan (Cold Damage), with a floating and slow pulse, no fever, but warm hands and feet naturally, this belongs to Taiyin. Taiyin conditions typically involve jaundice. However, if urination is free, jaundice will not occur. This is because cold-dampness injures the muscles and cannot vent outward through the skin, leading to jaundice. If urination is unobstructed, dampness drains downward to the bladder, preventing jaundice. If urination is difficult, Wuling San should be used to promote diuresis. If cold-dampness injures the exterior of Taiyin, it can exit via urination. If damp-heat injures the interior of Taiyin, it should exit via defecation. Therefore, after seven or eight days, sudden vexation with diarrhea, even occurring more than ten times a day, requires no specific treatment, as the spleen home becomes solid (righteous qi recovers), and the accumulated foul matter will stop spontaneously once expelled. Thus, neither warming nor purging methods are needed.
Shao's Commentary: Sudden vexation due to Taiyin heat pathogens indicates a sudden surge of interior yang. Although diarrhea is frequent, it is precisely the pathway for the expulsion of turbid accumulations in the spleen home. Once expelled, it stops naturally. This clause discusses Taiyin damp-heat, hence the floating-slow pulse, and treatment should promote urination. If after seven or eight days there is sudden vexation and diarrhea, it indicates the return of yang qi, and all accumulated foul matter in the spleen home will be expelled and stop naturally, requiring neither warming nor purging methods.
Four or five days into Shanghan, with abdominal pain, and if bowel sounds move downward toward the lower abdomen, this is a sign of impending spontaneous diarrhea. Spontaneous diarrhea without thirst belongs to Taiyin, because the zang organs have cold. It should be warmed, using Sini Tang category formulas.
Shao's Commentary: Taiyin self-contracted cold pathogens cause qi mechanism to sink downward, resulting in signs of diarrhea. Spontaneous diarrhea due to cold-dampness results in no thirst. Treatment should warm the zang organs and dispel cold.
Aversion to cold, faint pulse, and recurrent diarrhea are primarily treated with Sini Jia Renshen Tang (Frigid Extremities Decoction with Ginseng).
Shao's Commentary: Aversion to cold, faint pulse, and diarrhea indicate yang deficiency and yin excess. This is cold-type diarrhea; Sini Tang warms the interior, and Ginseng tonifies deficiency, making it highly appropriate.
Diarrhea occurring more than ten times with a pulse that is unexpectedly excessive/strong indicates a fatal prognosis. This is due to spleen qi deficiency and pathogenic excess.
Taiyin abdominal fullness and occasional pain, if mistakenly treated with purgatives, leads to hardness and binding below the chest, forming Cold Excess Jie Xiong (Binding Chest). In cases without heat symptoms, Sanwu Baisan (Three-Ingredient White Powder) is given. If the pathology is above the diaphragm, vomiting will occur; if below the diaphragm, diarrhea will occur. If diarrhea does not occur, administer one cup of hot porridge to assist the medicine; if diarrhea persists excessively, administer one cup of cold porridge to moderate its intensity. (Sanwu Baisan is also referred to as Sanbai Xiao Xianxiong Tang in some texts).
Shao's Commentary: Abdominal fullness and occasional pain indicate Taiyin cold pathogens. Mistakenly administering cold purgatives causes the cold pathogens to bind with the cold medicine, forming Cold Excess Jie Xiong, which differs from Heat Excess Jie Xiong.
Therefore, a warming and unblocking method is used. Without heat symptoms, there is no vexatious pain in the four limbs.
If Taiyang disease is mistakenly purged, followed by spontaneous diarrhea, weak pulse, abdominal fullness, and pain, this is heat pathogens from Taiyang sinking into the interior of Taiyin. Abdominal fullness with occasional pain is considered deficient, suitable for Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction with Added Peony Root). Abdominal fullness with severe pain is considered excess, suitable for Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction with Added Rhubarb). However, since the pulse is weak, stomach qi is also weak, so it is stated that if Dahuang (Rhubarb) or Shaoyao (Peony Root) should be used, their dosages should be reduced.
Shao's Commentary: Diarrhea is a primary symptom of Taiyin. Spontaneous diarrhea due to spleen excess (righteous qi resisting pathogens) resolves when foul matter is expelled. Spontaneous diarrhea due to cold zang organs is treated with warming Sini Tang categories. This spontaneous diarrhea results from mistaken purging of Taiyang, allowing pathogens to enter Taiyin, causing abdominal fullness and occasional pain, requiring the addition of Shaoyao. For severe excess pain, Dahuang is added. However, post-purging weak pulse indicates weak stomach qi, so dosages should be reduced. Although, for diarrhea and abdominal pain caused by heat pathogens, Shaoyao is used. For cold-type abdominal pain, Shaoyao is not suitable. Zhang Zhongjing mentions Dahuang together, so it should not be overlooked.
If Taiyang is mistakenly purged and heat pathogens sink into Taiyin, this is a syndrome transmitted from Yang meridians. It should be treated by differentiating between deficiency and excess.