太阴经病,自古混同立言,故方药多错乱,今细按之,有三法焉。夫太阴有传经之邪,
有直中之邪,有误下内陷之邪,不可不辨也。如经所谓腹满嗌干者,此传经之阳邪也,法当
用小柴胡去人参,加芍药以和之。不已,则下之。经又谓腹满而吐,食不下,自利益甚,时
腹自痛者,此直中之寒邪也,法当理中汤以温之。又谓太阳证,医反下之,因尔腹满时痛者
此误下内陷之邪也,法当用桂枝加芍药,大实痛者,桂枝加大黄汤。以是知传经之邪,宜
用大、小柴胡辈,直中之邪,宜理中,误下内陷之邪,宜用桂枝汤加减法。今先举传入太阴
者言之,其见症也。腹满痛,嗌干,脉沉实,大柴胡汤主之。若自利,去大黄,加黄连以清
之。
柴胡(一钱五分) 半夏(洗,七分) 黄芩 芍药(各二钱) 枳实(一钱) 大黄(二钱)
水煎服。
若兼寒热往来,加生姜五分,大枣三个。
问曰∶腹满痛,何以是太阴证?答曰∶脾为坤土,坤为腹,阴中之至阴也。邪气传之,
则腹满而痛。又问曰∶腹痛既为里证,当投大黄,而先用柴胡、芍药者,何也?答曰∶此少
阳传入太阴者也。少阳之邪,传入太阴,肝木乘脾,致成腹痛,故用柴胡加芍药以和之。痛
甚者,加大黄以下之。又如太阳证,为医误下,以致邪气内陷而成腹痛,用桂枝汤加芍药,
大实痛者,桂枝汤加大黄,意正相等。然腹痛虽属太阴,又有传经、直中之分,大抵传经之
邪,由三阳传入;直中之邪,猝然骤至也。传经之邪,则脉沉实;直中之邪,则脉沉细也。
传经之邪,则嗌干口燥;直中之邪,则口鼻气冷也。以此为别。
Taiyin Channel diseases have historically been discussed in a confused manner, leading to frequent errors in the application of prescriptions and herbs. Upon careful examination, there are three distinct therapeutic approaches. Pathogenic factors affecting the Taiyin may be transmitted from other channels (Chuanjing), strike directly (Zhizhong), or sink inward due to improper purgation (Wuxia Neixian); these must not be confused.
For instance, as stated in the classics, "abdominal fullness and dry throat" indicates Yang pathogenic factors transmitted via channels. The appropriate treatment is Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Ginseng removed and Shaoyao added to harmonize. If this fails, a purgative method should be employed. The classics also state: "abdominal fullness with vomiting, inability to eat, worsening diarrhea, and spontaneous abdominal pain at times," which indicates Cold pathogenic factors striking directly. The appropriate treatment is Lizhong Tang (Regulate the Middle Decoction) to warm the interior. Furthermore, regarding Taiyang channel disease where the physician erroneously applied purgation, resulting in abdominal fullness and intermittent pain, this indicates pathogenic factors sinking inward due to improper purgation. The treatment should be Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Paeonia). In cases of severe excess pain (Dashitong), Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rheum) is used. Thus, we know that transmitted pathogenic factors are best treated with formulas such as Da Chai Hu Tang (Major Bupleurum Decoction) and Xiao Chai Hu Tang; directly striking pathogenic factors are treated with Lizhong Tang; and pathogenic factors sinking inward due to improper purgation are treated with modified Guizhi Tang.
Now, let us discuss cases transmitted to the Taiyin channel and their manifestations: abdominal fullness and pain, dry throat, and a deep, forceful pulse. The primary prescription is Da Chai Hu Tang. If accompanied by diarrhea, remove Dahuang and add Huanglian to clear heat.
Prescription Composition: Chaihu (1.5 qian), Banxia (washed, 0.7 qian), Huangqin, Shaoyao (each 2 qian), Zhishi (1 qian), Dahuang (2 qian). Decoct in water and take orally.
If accompanied by alternating chills and fever, add Shengjiang (0.5 qian) and Dazao (3 pieces).
Question: Why is abdominal fullness and pain considered a Taiyin syndrome?
Answer: The Spleen corresponds to Kun Earth, and Kun represents the abdomen; it is the extreme Yin within Yin. When pathogenic factors transmit here, abdominal fullness and pain occur.
Another question: Since abdominal pain is a Interior syndrome, why use Dahuang for purgation but first employ Chaihu and Shaoyao?
Answer: This is caused by Shaoyang pathogenic factors transmitting into the Taiyin. When Shaoyang pathogens enter the Taiyin, Liver Wood overacts on Spleen Earth, resulting in abdominal pain. Therefore, Chaihu and Shaoyao are used to harmonize. For severe pain, Dahuang is added to purge. Similarly, in Taiyang disease, if improper purgation causes pathogens to sink inward resulting in abdominal pain, Guizhi Jia Shaoyao Tang is used; for severe excess pain, Guizhi Jia Dahuang Tang is used. The intent is consistent. However, although abdominal pain belongs to the Taiyin category, there is a distinction between transmitted and direct strike pathogens. Generally, transmitted pathogens enter from the Three Yang channels, while direct strike pathogens arrive suddenly. Transmitted pathogens present with a deep, forceful pulse; direct strike pathogens present with a deep, fine pulse. Transmitted pathogens cause dry throat and mouth; direct strike pathogens cause cold breath from the mouth and nose. These serve as differentiating criteria.