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[General Principle] Zhang Zhongjing stated: The primary manifestations of Taiyin disease include abdominal fullness accompanied by vomiting, difficulty in accepting food, progressively worsening diarrhea, and spontaneous abdominal pain occurring at times. If purgative methods are mistakenly applied, it will inevitably lead to stagnation and hardness below the chest and diaphragm.

[Commentary] Ke Qin stated: Abdominal pain, vomiting, and diarrhea arise from the transformation into dampness. The Taiyin meridian distributes within the stomach, and pathology often originates there. Due to cold-dampness in the stomach, food cannot be properly received, leading to alternating episodes of vomiting and diarrhea.

[General Principle] Zhang Zhongjing stated: Spontaneous diarrhea without thirst indicates involvement of the Taiyin, due to cold in the internal organs. Treatment should employ warming methods, preferably using formulas similar to Sini Tang (Four Reversal Decoction).
In the course of Shanghan (Cold Damage) lasting four or five days, if abdominal pain occurs with a sensation of gas moving downward toward the lower abdomen, this is a sign that diarrhea is impending.

[Commentary] Liu Wansu stated: Zhang Zhongjing’s main point is that "spontaneous diarrhea without thirst" serves as the criterion for Taiyin disease. This is because the Taiyin spleen belongs to wet earth; if heat pathogens enter the spleen, they will steam and mobilize the dampness. Mobilized dampness results in non-thirsty yellowing of the body accompanied by diarrhea. Conversely, "diarrhea with thirst" serves as the criterion for Shaoyin disease. This is because the Shaoyin kidney belongs to cold water; if heat pathogens enter the kidney, they will consume and melt the fluids. Consumed fluids result in thirst and restlessness. Differentiating meridians and syndromes is of great significance.

Wei Litong stated: This passage discusses cold syndromes within Taiyin disease, distinguishing them from heat pathogens transmitted via meridians, thereby establishing distinct treatment principles. The Taiyin zang organ is Yin, while the Taiyin meridian is the exterior of Yin. Pathogens transmitted through meridians typically transform from wind-cold into heat and transmit sequentially, constituting heat pathogens. However, some cases involve inherent cold in the Taiyin zang organ causing disease, which requires careful symptom assessment and treatment, avoiding confusion with heat pathogens to prevent mismanagement. Generally, diarrhea is accompanied by thirst; if diarrhea occurs without thirst, it is not a disease of the Taiyin meridian but of the Taiyin zang organ. The meridian is the superficial layer of the interior, while the zang organ is the deep interior. If a person has deficient spleen yang and stagnant cold-dampness, obstructing the dynamic movement of Qi, water and grain fail to separate in the intestines and stomach, leading to severe downward discharge. Applying ascending and dispersing methods for meridian pathogens would be inappropriate. Therefore, warming is required. Warming refers to warming the zang organ. Using Sini Tang (Four Reversal Decoction) does not imply a single fixed formula but adheres to the principle of warming. For pathogens in the six meridians of Shanghan, one must analyze the root and branch to distinguish between meridian diseases and zang-fu diseases; otherwise, the specific meridian involvement becomes confused. This is especially true when considering combined diseases, concurrent diseases, and distinctions in sequential transmission. Furthermore, this diarrhea refers to cases where no erroneous sweating, vomiting, or purging has occurred, indicating inherent cold in the zang rather than drug-induced injury. Since it is spontaneous diarrhea and involves cold zang, neither caused by mis-treatment nor by transmission, it can be described as direct invasion of cold pathogen into Taiyin. Both Shaoyin and Jueyin have direct invasions: Shaoyin direct invasion is cold, Jueyin direct invasion is wind, and Taiyin direct invasion is dampness. Although wind, cold, and damp are three distinct pathogens, cold is predominant.

[General Principle] Zhang Zhongjing stated: In Shanghan, if the pulse is floating and slow, and the hands and feet are naturally warm, the disease is associated with Taiyin. Taiyin disease typically presents with jaundice; however, if urination is free and abundant, jaundice will not develop. By the seventh or eighth day, although sudden irritability may occur with frequent diarrhea (more than ten times a day), this is due to the restoration of Spleen Qi (Splei Jia Shi), expelling putrid and foul matter.

[Commentary] Shen Jin'ao noted: The initial mention of potential jaundice indicates Taiyin cold-dampness affecting the exterior; the subsequent sudden irritability and diarrhea indicate Taiyin damp-heat accumulating internally. Cold-dampness affecting the exterior is expelled via urine; thus, free urination prevents jaundice. Damp-heat affecting the interior is expelled via stool; thus, frequent diarrhea eventually stops spontaneously. Typically, diseases originating in Yin meridians resolve in six days; by the seventh or eighth day, Yang Qi recovers, causing sudden irritability and diarrhea. When diarrhea reaches more than ten times a day, it indicates that putrid matter is being expelled, so it must stop spontaneously. The hands and feet remain warm because exterior Yang persists; sudden irritability occurs because interior Yang suddenly activates. This represents Yang within Yin, distinctly different from the pure Yin-without-Yang condition of previous cold-zang syndromes.

[General Principle] Zhang Zhongjing stated: In Taiyin disease, if the pulse is weak and the patient continues to have loose stools, if Da Huang (Rhubarb Rhizome) or Bai Shao (White Peony Root) were indicated, their dosages should be reduced. This is because the Stomach Qi is weak and easily disturbed by strong medications.

[Commentary] Ke Qin stated: Diarrhea is a primary symptom of Taiyin. If diarrhea is due to Spleen excess (accumulation), it resolves once putrid matter is expelled. If due to cold zang, it resolves with warming formulas like Sini Tang (Four Reversal Decoction). If caused by erroneous purgation in Taiyang disease, resulting in abdominal fullness and intermittent pain, Bai Shao (White Peony Root) should be added; for severe pain, Da Huang (Rhubarb Rhizome) should be added. In the current case, post-purgation weak pulse indicates weak Stomach Qi, hence reducing the dosage. Da Huang (Rhubarb Rhizome) drains the Stomach and acts on the Blood level of Yangming; Bai Shao (White Peony Root) drains the Spleen and acts on the Qi level of Taiyin. For diarrhea and abdominal pain caused by heat pathogens, Bai Shao (White Peony Root) is suitable for purging; for those caused by yin-cold, it is unsuitable. Zhang Zhongjing mentions both here; do not overlook this.

[General Principle] Zhang Zhongjing stated: Aversion to cold, a faint pulse, and continued diarrhea indicate loss of blood. The principal formula is Sini Jia Renshen Tang (Four Reversal Decoction plus Ginseng).

[Commentary] Zhang Jianshan stated: Diarrhea should cease, but since aversion to cold persists, Sini Tang (Four Reversal Decoction) is still appropriate. Because the faint pulse indicates blood deficiency, Ren Shen (Ginseng Root) is added.

[General Principle] Zhang Zhongjing stated: If the pathogen is above the diaphragm, vomiting will necessarily occur; if below the diaphragm, diarrhea will necessarily occur.

[Commentary] Ke Qin stated: The original symptoms were vomiting and diarrhea. Due to stagnation and hardness below the chest, Qi flow was blocked. Guiding the pathogen according to its tendency eliminates the stagnation and hardness.

[General Principle] Zhang Zhongjing stated: In Shanghan with diarrhea, if the pulse is excessively forceful (excess pulse) despite frequent stools (more than ten times a day), the prognosis is fatal.

[Commentary] Ke Qin stated: Spleen Qi is deficient while pathogenic factors are excessive, resulting in an apparent excess pulse.