(腹满 腹痛 黄 吐与利下三门并附入少阴病盖此三门之病本属太阴病因在少阴者反多故从其多者附也)
黄 太阴之为病腹满而吐食不下自利益甚时腹自痛者宜理中也阴经少有用桂枝汤者如此证若脉浮即用桂枝汤微汗
之若恶寒甚不已者非理中四逆不可也三阴俱有恶寒但喜浓衣即恶寒也前证若下之必胸下结硬又宜泻心汤也虽然用泻心
者由误下而致非传经热邪也三阴虽皆有传经热邪故自有热证与此阴证不同大宜详究太阴经治法有汗下温和解
汗 桂枝汤 桂枝加芍药汤
下 桂枝加大黄汤
温 四逆汤 理中汤
和 解 栀子柏皮汤 茵陈五苓散
经云尺寸俱沉细者太阴受病也以其脉布胃中络于嗌故腹满而嗌干今查太阴篇缺嗌干证 太阴之为病腹满而吐食不
下自利益甚时腹自痛若下之必胸下结硬(成 太阴为病阳邪传里也太阴之脉布胃中邪气壅而为腹满上不得降者呕吐而
食不下下不得升者自利益甚时腹自痛阴寒在内而为腹痛者则为常痛此阳邪干里虽痛而亦不常但有时腹自痛也若下之则
阴邪留于胸下为结硬经曰病发于阴而反下之因作痞)自利不渴者属太阴脉浮而缓手足自温者系在太阴下后腹满时痛者属
太阴太阴病脉浮者可发汗宜桂枝汤(在太阳则脉浮无汗宜麻黄汤此脉浮当亦无汗而不言者谓阴不得有汗不必言也不用麻
黄而用桂枝者以阴病不当更发其阳也须识无汗亦有用桂枝汤)本太阳病医反下之因而腹满时痛者属太阴也桂枝加芍药汤
主之大实痛者桂枝加大黄汤主之(邪气入里则为腹痛盖气传里而痛者其痛不常当以辛温之剂和之阴寒在内而痛者则痛无
休止时欲作利也当以热剂温之有燥屎宿食为痛者则不大便腹满而痛也则须下之经曰诸痛为实痛随利减此皆为里证而治
各不同)
桂枝加芍药汤方
桂枝 生姜(各三两半) 甘草(二两炙) 芍药(六两) 大枣(十二枚擘)上五味以水七升煮取三升去滓分
温三服
桂枝加大黄汤方
桂枝(一两) 芍药(一两半) 甘草(炙半两) 大黄(半两大便实痛者加一两虚者照本方) 上 咀大枣三枚
生姜四片水煎温服
张 或谓太阴病用四逆等固当然复用桂枝大黄夫大黄至寒何为用之于阴经又兼桂枝大黄寒热相杂而用何也曰夫自
利而渴者属少阴为寒在下焦自利不渴者属太阴为寒在中焦以四逆等汤温其脏此本经当用之药也其太阳病反下之表邪未
解乘虚传于太阴因而腹满时痛用桂枝芍药汤若大实痛者桂枝加大黄以除表里之邪以上二节虽下后而利已此兼有满痛形
证故用芍药大黄为宜若脉浮弱其人续自便利设当行大黄芍药者宜减之以其人胃气弱故易动也
赵 活人书第四问太阴经病证中云腹满时痛属太阴也又云腹痛桂枝加芍药汤痛甚桂枝加大黄汤愚详太阴病腹满证
有三有次第传经之邪有直入本经之邪有下后内陷之邪不可不辨也如腹满咽干者此非传经之阳邪者乎法当下之腹满而吐
食不下自利益甚时腹自痛若下之必胸下结硬此非直入本经之阴邪者乎法当温之如太阳病医反下之因尔腹满时痛此误下
内陷之邪也法当用桂枝加芍药汤大实痛者桂枝加大黄汤今此问中不言桂枝加芍药加大黄二汤为治误下后之剂又不曰大
实痛但曰痛甚设遇本经直入阴邪腹满时痛而脉沉细者根据此用桂枝加芍药大黄等下之岂不贻胸下结硬之悔又所谓大实痛
者乃胃中邪实结燥而痛则痛甚与大实证全别以是知本经阴邪腹满者宜理中青皮陈皮传经之邪腹满咽干者属大柴胡证下
后腹满痛方见上
太阴病脉弱其人续自便利设当行大黄芍药者宜减之以其人胃气弱易动故也太阴中风四肢烦疼脉阳微阴涩而长者为
欲愈(内经曰四肢皆禀气于胃而不得至经必因于脾脾病不能为胃行其津液四肢不禀水谷气日以就衰脉道不利筋脉血肉皆
无气以生故不用 脾在时则寄旺于四季在人则应于手足故太阴病则四肢应之)太阳病欲解时从亥至丑上(脾为阴土旺于
亥子丑向阳故云解时)
活 古人以四日太阴证病在胸膈可吐而愈何也答曰不然有太阴证脉大胸满多痰者可吐之脉大而无吐证者可汗而已
大抵在表者汗之在里者下之在上者涌之在下者泄之栝蒌栀豉随证施用不可拘以日数也
赵 活人五十六问云阴证有发热者乎太阴厥阴皆不发热只少阴有发热证愚详仲景论中三阴皆有发热如少阴二证外
又有吐利手足不逆冷反发热者不死少阴病一身手足尽热以热在膀胱必便血少阴病四逆散中用柴胡亦有发热又厥阴病先
厥后发热而利者必自止下利脉数有微热汗出今欲愈面赤身微热为郁冒呕而发热小柴胡与夫太阴病中风四肢烦疼是三阴
皆有发热何其言之拘耶又云太阴篇无吐法如虚烦膈实等证可吐者皆属他经独华佗云四日在胸可吐之亦不曰太阴今活人
伤寒问中云太阴病在胸膈可吐何耶况胸中本非太阴经部分仲景虽有下之则胸结硬是误下后坏病也而胸下乃近心腹处亦
非吐药可治也至于论脉仲景但云太阴尺寸皆沉细亦未尝言脉大
(Abdominal fullness, abdominal pain, and jaundice, along with the three categories of vomiting and diarrhea, are appended to the Shaoyin disease chapter. This is because these conditions originally belong to Taiyin disease, but since they appear more frequently in Shaoyin disease, they are appended following the majority.)
Jaundice: The typical symptoms of Taiyin disease include abdominal fullness and vomiting, inability to eat or drink, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain; Lizhong Tang (Cinnamon Twig and Dried Ginger Decoction) is appropriate. In Yin channel diseases, Guizhi Tang (Cinnamon Twig Decoction) is rarely used alone. For such conditions, if the pulse is floating, Guizhi Tang should be used to induce slight sweating. If chills are severe and persistent, only Lizhong Tang or Sini Tang (Fried Aconite Root Decoction) will suffice. All three Yin channels present with chills, but those who prefer thick clothing have chills. If the aforementioned conditions are mistakenly treated with purgatives, it will inevitably lead to hardness and binding below the chest; Xixin Tang (Heart-Draining Decoction) would then be appropriate. Although Xixin Tang is used due to mistaken purgation, it is not caused by heat pathogens transmitted via channels. While all three Yin channels can have transmitted heat pathogens and thus present with heat syndromes, this differs from the aforementioned Yin syndromes and requires careful investigation. Treatment methods for the Taiyin channel include: Sweating method (Guizhi Tang, Guizhi Jia Shaoyao Tang [Cinnamon Twig Decoction plus Peony Root]; Purging method (Guizhi Jia Dahuang Tang [Cinnamon Twig Decoction plus Rhubarb]); Warming method (Sini Tang, Lizhong Tang); Harmonizing method (Zhizi Bopi Tang [Gardenia and Phellodendron Bark Decoction], Yinchin Wuling San [Artemisia Capillaris and Five-Ingredient Powder with Poria]).
The Classics state: "When both Cun and Chi pulses are deep and fine, the Taiyin channel is affected." Because the Taiyin channel spreads through the stomach and connects to the throat, abdominal fullness and dry throat occur. Upon reviewing the Taiyin chapter, the symptom of dry throat is missing. The symptoms of Taiyin disease are abdominal fullness and vomiting, inability to eat or drink, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain; if mistakenly purged, it leads to hardness and binding below the chest. (Cheng Wuji notes: Taiyin disease involves Yang pathogens transmitting into the interior. The Taiyin channel spreads through the stomach; pathogenic qi stagnates causing abdominal fullness. Unable to descend upward, it causes vomiting and inability to eat; unable to ascend downward, it causes worsening spontaneous diarrhea. Occasional spontaneous abdominal pain: if caused by internal Yin-cold, the pain is constant; this is Yang pathogens interfering with the interior, so although there is pain, it is not constant, occurring only occasionally. Mistaken purgation leaves Yin pathogens lingering below the chest, forming hardness and binding. The Classic states: Diseases originating from Yin, when mistakenly purged, result in Pi [glomus] syndrome.) Spontaneous diarrhea without thirst belongs to Taiyin disease; a floating and moderate pulse with naturally warm hands and feet indicates Taiyin disease; post-purgation abdominal fullness with occasional pain belongs to Taiyin disease; Taiyin disease with a floating pulse can be treated with sweating, using Guizhi Tang. (In Taiyang disease, a floating pulse with no sweat indicates Ma Huang Tang [Ephedra Decoction]; here the floating pulse also implies no sweat, but it is not stated because Yin diseases should not have sweat, so it need not be mentioned. Guizhi Tang is used instead of Ma Huang Tang because Yin diseases should not further disperse Yang Qi. Note that Guizhi Tang is also used for cases without sweat.) Original Taiyang disease, mistakenly purged by the physician, leading to abdominal fullness and occasional pain, belongs to Taiyin disease; Guizhi Jia Shaoyao Tang is the main formula. For severe excessive pain, Guizhi Jia Dahuang Tang is the main formula. (Pathogens entering the interior cause abdominal pain. Pain from Qi transmitting to the interior is not constant and should be harmonized with acrid-warm mild agents. Pain from internal Yin-cold is ceaseless and indicates impending diarrhea, requiring hot agents to warm. Pain from dry stool or retained food involves constipation, abdominal fullness, and pain, requiring purgation. The Classic states: Various pains are mostly excess syndromes; pain decreases with bowel movement. These are all interior syndromes, but treatments differ.)
Guizhi Jia Shaoyao Tang Formula: Guizhi (Cinnamon Twig), Shengjiang (Fresh Ginger) (each 3 liang half), Zhigancao (Honey-fried Licorice Root) (2 liang), Shaoyao (Peony Root) (6 liang), Dazao (Jujube) (12 pieces, split). The above five ingredients are boiled in 7 sheng of water to obtain 3 sheng. Strain and take warm in three doses.
Guizhi Jia Dahuang Tang Formula: Guizhi (1 liang), Shaoyao (1 liang half), Zhigancao (Honey-fried Licorice Root) (half liang), Dahuang (Rhubarb Root and Rhizome) (half liang; add 1 liang if stool is solid and painful; use original dosage for deficiency). Chop the herbs, add 3 jujubes and 4 slices of fresh ginger, decoct in water, and take warm.
Zhang Yuansu said: Some ask why Sini Tang etc. are appropriately used for Taiyin disease, yet Guizhi and Dahuang are also reused? Dahuang is extremely cold; why is it used in Yin channels? Moreover, Guizhi and Dahuang mix cold and hot properties; what is the rationale? I reply: Spontaneous diarrhea with thirst belongs to Shaoyin disease, indicating cold in the Lower Jiao; spontaneous diarrhea without thirst belongs to Taiyin disease, indicating cold in the Middle Jiao. Using Sini Tang etc. to warm the Zang organs is the appropriate medication for this primary channel. If Taiyang disease is mistakenly purged, leaving exterior pathogens unresolved, which enter the Taiyin channel due to deficiency, causing abdominal fullness and occasional pain, Guizhi Jia Shaoyao Tang is used. For severe excessive pain, Guizhi Jia Dahuang Tang is used to eliminate exterior and interior pathogens. Although the latter two sections involve purgation followed by diarrhea, the presence of fullness and pain syndromes makes Shaoyao and Dahuang suitable. If the pulse is floating and weak, and the person continues to have loose stools, even if Dahuang and Shaoyao should theoretically be used, their dosage should be reduced because the person's Stomach Qi is weak and prone to diarrhea.
Zhao Sixian's *Huoren Shu* Question 4 states: "Abdominal fullness with occasional pain belongs to Taiyin," and also says "Abdominal pain uses Guizhi Jia Shaoyao Tang; severe pain uses Guizhi Jia Dahuang Tang." I carefully examine that Taiyin abdominal fullness has three types, distinguished by sequence: transmitted pathogens, direct entry into the primary channel, and pathogens sinking inward after purgation. Abdominal fullness with dry throat: is this not a transmitted Yang pathogen? The treatment should be purgation. Abdominal fullness with vomiting, inability to eat, worsening spontaneous diarrhea, occasional pain, and potential chest binding if purged: is this not a direct Yin pathogen entering the primary channel? The treatment should be warming. Taiyang disease mistakenly purged, leading to abdominal fullness and occasional pain: this is a pathogen sinking inward due to mistaken purgation; the treatment should be Guizhi Jia Shaoyao Tang. For severe excessive pain, Guizhi Jia Dahuang Tang. However, this question does not mention Guizhi Jia Shaoyao Tang and Guizhi Jia Dahuang Tang as treatments for post-purgation conditions, nor does it specify severe excessive pain, only "severe pain." If one encounters a direct Yin pathogen entering the primary channel, presenting with abdominal fullness, occasional pain, and deep-fine pulse, and applies Guizhi Jia Shaoyao/Dahuang purgation based on this, would it not lead to regret over chest binding? The so-called "severe excessive pain" refers to pathogenic excess and dryness binding in the Stomach causing severe pain, which is entirely different from Excess Syndromes. Thus, abdominal fullness caused by primary channel Yin pathogens should use Lizhong Tang, Qingpi (Aurantii Fructus Immaturus), and Chenpi (Aurantii Pericarpium); abdominal fullness with dry throat from transmitted pathogens belongs to Da Chaihu Tang (Major Bupleurum Decoction) syndrome; abdominal fullness and pain after purgation see the formula above.
Taiyin disease with a weak pulse, where the person continues to have loose stools, if Dahuang and Shaoyao should theoretically be used, their dosage should be reduced because the person's Stomach Qi is weak and prone to diarrhea. Taiyin Wind Strike presents with vexing pain in the four limbs; a pulse that is Yang-micro, Yin-choppy yet long indicates impending recovery. (*Neijing* states: The four limbs receive Qi from the Stomach but cannot reach the channels directly; they rely on the Spleen. If the Spleen is diseased and cannot transport fluids for the Stomach, the four limbs do not receive Grain Qi, becoming increasingly deficient, the pulse channels become obstructed, and tendons, vessels, muscles, and flesh lack Qi to generate, hence... The Spleen corresponds to the four seasons in terms of timing and to the hands and feet in the human body; thus, Taiyin disease manifests in the four limbs.) Taiyang disease resolves from Hai hour to Chou hour (The Spleen is Yin Earth, prosperous during Hai, Zi, and Chou hours; facing Yang, hence the resolution time).
Hua Shuo said: Ancients believed that on the fourth day, Taiyin syndrome located in the chest and diaphragm could be cured by emesis. Why? I reply: Incorrect. Taiyin syndrome with a large pulse, chest fullness, and much phlegm can be treated by emesis; a large pulse without emesis indications can be treated by sweating. Generally, exterior conditions are treated by sweating, interior by purging, upper by emesis, lower by draining. Gualou Zhichi Tang (Trichosanthes Fruit, Gardenia, and Soybean Seed Decoction) is applied according to the syndrome, not rigidly by day count.
Zhao Sixian's *Huoren Shu* Question 56: Are there feverish conditions in Yin syndromes? Taiyin and Jueyin do not have fever; only Shaoyin has fever. I carefully examine Zhang Zhongjing's discussions: all three Yin channels have fever. Besides two Shaoyin conditions, there are vomiting/diarrhea with non-cold hands/feet and counter-fever (not fatal); Shaoyin disease with whole-body and hand/foot heat, blood in urine due to heat in the Bladder; Shaoyin disease Si Ni San (Four Counterflow Powder) contains Chaihu (Bupleuri Radix) and also presents fever; Jueyin disease first cold limbs then fever with diarrhea stops spontaneously; diarrhea with rapid pulse, slight fever, and sweating indicates recovery; red face and slight heat indicate Yu Mao [depression and dizziness]; vomiting with fever uses Xiao Chaihu Tang (Minor Bupleurum Decoction); and Taiyin Wind Strike with vexing limb pain. All three Yin channels have fever; why is the statement so restrictive? It also states the Taiyin chapter lacks emesis methods; Xu Fan [deficiency vexation] and Ge Shi [diaphragmatic excess] suitable for emesis belong to other channels. Only Hua Tuo said fourth-day chest conditions can be emetic, not specifying Taiyin. Now *Huoren Shanghan Wen* says Taiyin disease in the chest/diaphragm can be emetic. Why? The chest is not part of the Taiyin channel. Zhang Zhongjing mentions chest binding after purgation as a complication of mistaken purgation, but the area below the chest is near the heart and abdomen, not treatable by emetics. Regarding pulses, Zhang Zhongjing only states Taiyin Cun and Chi are both deep and fine, never mentioning a large pulse.