按热病论云。太阴脉。布胃中。络于嗌。故腹满嗌干。此热伤太阴之标。自阳部注经之症。非太阴本病也。仲景立
本病为提纲。因太阴主内。故不及中风四肢烦疼之表。又为阴中至阴。故不及热病嗌干之症。太阴为开。又阴道虚。太
阴主脾。所生病。脾主湿。又主输。故提纲主腹满时痛。而吐利。皆是里虚不固。湿胜外溢之症也。脾虚则外亦虚。食
不下者。胃不主纳也。要知胃家不实。即转太阴耳。世举阳明传少阳之谬。反昧传太阴之义。热病腹满。是热郁太阴之
经。有嗌干可证。症在表也。寒温腹满。是寒生至阴之藏。有自利可证。病在本也。脾经有热。则阴精不上输于肺。故
嗌干。脏有寒。则脾不能为胃行其精液。故下利。夫阳明之当下因本病。而太阴之下症。反在标病。可见阴阳异位之故。
又以见阴从阳转之义也。
参中阴溜府之义。知热邪不遽入至阴。虽热在太阴之经。而实仍在阳明之胃。可知下症只在阳明。太阴本无下法。
腹满亦两经之症。不大便而腹满。或绕脐痛者。为实热。属阳明。下利而腹满时痛。为虚寒。属太阴。寒湿是太阴
本症。湿热又伤寒所致之变症也。其机关在小便不利。则湿热外见而身黄。小便自利。非暴烦下利而自愈。即大便硬而
不使。所以然者。脾肤相连。此脾家实。则腐秽自去。而成太阴之开。若胃家实。则地道不通。而转阳明之合矣。叔和
但知有阳明。不知有太阴阳明症。
序例谓太阴受病。脉当沉细。不知沉细。是太阴本病之脉。不是热症嗌干之脉。盖脉从病见。如太阴中风则脉浮。
不从脏之阴。而从风之阳也。然浮为麻黄汤脉。而用桂枝者。以太阴是里之表症。桂枝汤。是里之表药。因脾主肌肉。
是宜解肌耳。太阴伤寒脉浮而缓者。亦非太阴本病。盖浮为阳脉。缓为胃脉。太阴伤寒。脉不沉细。而反浮缓。是阴中
有阳脉。有胃气。所以手足自温。而显脾家之实。或发黄便硬。而转属阳明。此脉症在太阴阳明之间。故曰系在。若太
阴自受寒邪。不应如是矣。
太阴脉浮为在表。当见四肢烦疼等症。沉为在里。当兼腹痛吐利等症。表有风热可发汗。宜桂枝汤。里有寒邪当温
之。宜四逆辈。太阳而脉沉者。因于寒。寒为阴邪。沉为阴脉也。太阴而脉浮者。因于风。风为阳邪。浮为阳脉也。当
知脉从病变。不拘于经。故阳经有阴脉。阴经有阳脉。世为脉在三阴则俱沉。阴经不当发汗者。未审此耳。
太阴中风。阳微阴涩。不长者为欲愈。要知涩与长。不是并见。涩本病脉。涩而转长。病始愈耳。风脉本浮。今浮
已微。知风邪当去。涩则少气少血。故中风。今长则气结。故愈。
太阴中风。四肢烦疼。太阴伤寒。手足自温。此指表热言也。热在四肢。则身体不热可知。盖太阴主内。表当无热。
惟四肢为诸阳之本。脾为胃行津液以灌四旁。故得主四肢。则四肢之温热。仍是阳明之阳也。且曰自温。便见有时不温。
有时四肢厥逆矣。
内经云。人有四肢热。逢风而如炙如火者。是阴气虚而阳气盛。风者阳也。四肢亦阳也。两阳相搏。是人当肉烁。
此即太阴中风症。要知太阴中风。与三阳不同。太阴之病。名曰关 。故阳邪不得深入。惟病在四关。久而不愈。脾液
不足以充肌肉。故肉烁。世人最多此症。其有手足心热者。亦中风之轻者耳。然太阴中风。因阴虚而阳凑之。外风为内
热所致。但当滋阴以和阳。不得驱风而增热也。
手足自温句。暗对身不发热言。非言太阴伤寒。必当手足温也。夫病在三阳。尚有手足冷者。何况太阴。陶氏分太
阴手足温。少阴手足寒。厥阴手足冷。是大背太阴手足烦疼。少阴一身尽热之义矣。凡伤于寒则为病热。寒为阴。太阴
为至阴。两阴相合。无热可发。惟四末为阴阳之会。故尚温耳。惟手足自温。中宫不遽受邪。故或发身黄。或暴烦下利
自止。即手足自温处。因以见脾家之实也。
发黄。自阳明病。太阴身当发黄。非言太阴本有发黄症也。以手足温处。是阳明之阳盛。寒邪不得伤太阴之脏。脏
无寒而身有湿。故当发黄。若湿从溺泄。暴烦下利。仍是脾主转输。故不失为太阴病。若烦而不利。即胃家之热实。非
太阴之湿热矣。此太阴伤寒。全藉阳明之阳为之根。故有转属之症也。人知伤寒以阳为主。不知太阴伤寒以阳明为主。
东垣以有声无声分呕吐非也。呕吐皆有声有物。惟干呕是有声无物。呕以水胜。属上焦也。吐以物胜。属中焦也。
六经皆有呕属少阳。以喜呕。故吐属太阴。而不属阳明。亦主输主内之分。
太阳以阴为根。而太阴以阳为本。太阳不敢妄汗。尤恐亡少阴之津也。太阴不敢轻下。恐伤阳明之气也。太阴本无
下症。因太阳妄下。而阳邪下陷于太阴。因而有桂枝汤。加芍药等法。太阴脉弱。知胃气已动。盒饭少加矣。此因里急
后重者不可不用。又不可多用。故如此叮咛耳。
According to the *Treatise on Heat Diseases* (Re Bing Lun): The Taiyin meridian distributes in the stomach and connects with the throat. Therefore, abdominal fullness and dryness of the throat occur. This is heat damaging the "biao" (branch/exterior manifestation) of the Taiyin, a syndrome transmitted from the yang meridians into this meridian, not the primary disease of the Taiyin organ itself.
Zhang Zhongjing established the outline for Taiyin disease because Taiyin governs internal functions ("zhu nei"). Thus, it does not involve exterior symptoms like vexing pain in the four limbs seen in wind-stroke. Furthermore, as the "extreme yin within yin," it does not involve symptoms like throat dryness seen in heat diseases.
Taiyin governs "opening" (kai) and belongs to the yin pathway (void/quiet). Taiyin corresponds to the Spleen. In diseases governed by the Spleen, the Spleen governs dampness and transportation/transformation. Therefore, the Taiyin outline primarily manifests as abdominal fullness, intermittent pain, vomiting, and diarrhea. These are all syndromes of deficiency and insecurity in the interior, with excessive dampness overflowing outward.
When Spleen qi is deficient, the exterior is also deficient. Inability to eat indicates that the Stomach fails to receive and decompose food. One must understand that if the Stomach lacks excess pathogenic factors, the disease will transition to Taiyin. The world erroneously claims transmission from Yangming to Shaoyang, ignoring the meaning of transmission to Taiyin.
In *Heat Diseases*, abdominal fullness results from heat stagnating in the Taiyin meridian, evidenced by throat dryness; the pathology is at the exterior level. In cold-warmth diseases (Shanghan), abdominal fullness results from cold generating in the Zhiyin (Extreme Yin) organs, evidenced by spontaneous diarrhea; the pathology is at the interior/root level.
If there is heat in the Spleen meridian, yin essence cannot transport upward to the Lungs, causing throat dryness. If there is cold in the zang organs, the Spleen cannot distribute fluids for the Stomach, causing diarrhea.
The indication for purgation in Yangming lies in its benbing (primary/fu-organ disease); conversely, the symptom of diarrhea in Taiyin appears during the biao (branch/spleen-deficiency dampness) stage. This illustrates the difference in yin-yang locations and the principle that yin diseases can transform via yang.
Considering the concept of "Zhong Yin Liu Fu" (pathogens from yin meridians entering yang fu-organs), one knows that heat pathogens do not immediately enter the Zhiyin organs. Although heat is in the Taiyin meridian, it essentially remains in the Yangming Stomach. Thus, purgation applies only to Yangming; Taiyin has no purgative method per se.
Abdominal fullness is a symptom of both meridians. Constipation with abdominal fullness or periumbilical pain indicates excess heat, belonging to Yangming. Diarrhea with abdominal fullness and intermittent pain indicates deficiency-cold, belonging to Taiyin. Cold-dampness is the primary syndrome of Taiyin; damp-heat is a variant caused by Shanghan.
The key mechanism lies in urination. If urination is difficult, damp-heat manifests externally as jaundice. If urination is free, either sudden irritability followed by self-limiting diarrhea leads to recovery, or constipation occurs. This is because the Spleen and Stomach are closely connected. If the Spleen homeostasis is restored ("Spleen Shi"), rotting filth is expelled naturally, activating Taiyin's "opening." If the Stomach homeostasis is obstructed ("Stomach Shi"), the earthy pathway is blocked, transitioning to Yangming's "closing." He Shuhe only knew of Yangming and did not recognize combined Taiyin-Yangming syndromes.
The *Xu Li* states that when Taiyin is affected, the pulse should be deep and fine. However, deep and fine pulses belong to the primary Taiyin disease, not the heat syndrome with throat dryness. Pulses follow the disease manifestation. For example, Taiyin wind-strike presents with a floating pulse, following the yang nature of wind rather than the yin nature of the organ.
Although a floating pulse is typically associated with Mahuang Tang, Guizhi Tang is used here because Taiyin disease represents an "exterior-of-the-interior" syndrome. Guizhi Tang treats exterior-of-the-interior conditions. Since the Spleen governs muscles, resolving the muscle layer is appropriate.
In Taiyin cold damage, a floating and moderate pulse is not the primary disease. Floating is a yang pulse; moderate is a stomach pulse. A floating-moderate pulse in Taiyin cold damage indicates yang within yin and the presence of stomach qi, resulting in warm hands and feet, revealing Spleen excess. It may progress to jaundice or hard stools, transferring to Yangming. These pulse-symptom complexes lie between Taiyin and Yangming, hence described as "related to" (Xi Zai). Direct cold invasion of Taiyin would not present thus.
A floating Taiyin pulse indicates exterior involvement, manifesting as vexing limb pain. A deep pulse indicates interior involvement, manifesting as abdominal pain, vomiting, and diarrhea. Exterior wind-heat requires sweating; Guizhi Tang is suitable. Interior cold requires warming; Si Ni Tang and similar formulas are suitable.
In Taiyang disease, a deep pulse indicates cold invasion (cold is yin evil, deep is yin pulse). In Taiyin disease, a floating pulse indicates wind invasion (wind is yang evil, floating is yang pulse). One must know that pulses change with the disease and are not fixed to specific meridians. Thus, yang meridians can have yin pulses, and yin meridians can have yang pulses. The belief that all three yin meridians have deep pulses and should not be treated with sweating methods stems from ignorance of this principle.
In Taiyin wind-strike, the pulse is superficially weak and internally choppy. Recovery is indicated when the pulse changes from choppy to long. Choppy and long pulses do not appear simultaneously. Choppy is the disease pulse; a shift to long indicates recovery. Wind pulses are normally floating; a weakening float indicates wind pathogen departure. Choppy indicates qi and blood deficiency. Long indicates unobstructed qi flow, signifying health.
Taiyin wind-strike presents with vexing limb pain; Taiyin cold damage presents with spontaneously warm hands and feet. This refers to exterior heat. Heat in the limbs implies no fever in the body, as Taiyin governs the interior. Only the limbs are the root of all yang. The Spleen transports fluids to nourish the four extremities. Thus, warmth in the limbs reflects Yangming yang. "Spontaneously warm" implies periods of non-warmth or even cold limbs.
The *Nei Jing* states: When limbs are hot and feel like roasting upon exposure to wind, it is due to deficient yin and abundant yang. Wind is yang; limbs are yang. Two yangs clashing causes muscle wasting. This is Taiyin wind-strike. Unlike three yang meridians, Taiyin disease involves "guan he" (closure/opening dysfunction), preventing deep penetration of yang pathogens. Pathogens remain at the limb joints. Prolonged illness depletes Spleen fluids, failing to nourish muscles, causing wasting. Those with hot palms and soles have milder cases. Taiyin wind-strike arises from yin deficiency attracting yang pathogens; external wind is driven by internal heat. Treatment should nourish yin to harmonize yang, avoiding dispersing wind which increases heat.
"Spontaneously warm hands and feet" contrasts with "no body fever." It does not mean Taiyin cold damage always features warm limbs. Even in three yang diseases, cold limbs occur. Tao's differentiation of Taiyin (warm limbs), Shaoyin (cold limbs), and Jueyin (chilled limbs) contradicts the original texts describing Taiyin limb vexation and Shaoyin whole-body heat.
Cold damage transforms into heat. Cold is yin; Taiyin is extreme yin. Two yins combine without generating heat. Only the extremities, where yin and yang meet, remain warm. Spontaneous warmth indicates the central jiao is not immediately invaded, leading to either jaundice or sudden irritability with self-limiting diarrhea. This warmth reveals Spleen excess.
Jaundice originates from Yangming. Taiyin patients may develop jaundice, but this is not a primary Taiyin symptom. Warm limbs indicate abundant Yangming yang, preventing cold from damaging Taiyin zang organs. With no cold in the zang but dampness present, jaundice occurs. If dampness drains via urine, sudden irritability and diarrhea reflect Spleen transportation, maintaining the Taiyin diagnosis. Irritation without diarrhea indicates Stomach excess heat, not Taiyin damp-heat. Taiyin cold damage relies on Yangming yang as its root, allowing for transfer syndromes. People know Shanghan prioritizes yang, but fail to see Taiyin Shanghan prioritizes Yangming.
Li Dongyuan's distinction of vomiting by sound is incorrect. Vomiting involves sound and matter; dry heaving involves sound only. "Ou" (vomiting water) relates to the upper jiao; "Tu" (spitting food) relates to the middle jiao. While vomiting occurs in all six meridians, it associates with Shaoyang due to frequent occurrence. Spitting associates with Taiyin, not Yangming, reflecting the difference between transportation (Shu) and reception (Nei).
Taiyang roots in yin; Taiyin grounds in yang. Taiyang avoids reckless sweating to preserve Shaoyin fluids. Taiyin avoids laxatives to protect Yangming qi. Taiyin has no purgative indications originally; however, mistaken purgation in Taiyang allows yang pathogens to sink into Taiyin, necessitating Guizhi Tang with Shaoyao. A weak Taiyin pulse indicates moving stomach qi; dietary intake should increase slightly. This advice warns against overuse for tenesmus-like symptoms.