Library

The pathogenic factors of the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire) may infect people in the same way, yet the diseases they contract vary. Why is this? It is because people differ in the thickness of their physique, the strength of their Zheng Qi (Vital Energy), and the cold-heat constitution of their Zang-Fu organs. The pathogenic factors received tend to transform according to the Qi transformation characteristics of the patient's internal organs; thus, the resulting diseases are different. Therefore, some transform into deficiency patterns, some into excess patterns, some into cold patterns, and some into heat patterns. This is analogous to the relationship between water and fire: when water is abundant, fire is extinguished; when fire is abundant, water is depleted. When things reach an extreme, they transform into their opposites, which is the natural principle. Once one truly understands this, what remains to be doubted? Is it strange that Yang pathogenic factors transmit to Yin meridians, changing from cold to heat? Since the Eastern Han Dynasty until now, for a thousand years, people have believed that the cold pathogenic factors of the Three Yin meridians (Taiyin, Shaoyin, Jueyin) do not transmit. Furthermore, they referred to Yin meridian pathogens appearing during the transmission of Shanghan (Cold Damage) as "Zhi Zhong" (Direct Invasion, where pathogens directly attack the Zang-Fu). Little did they know that "Zhi Zhong" refers to the syndrome of direct Cold invasion, not transmitted pathogens! These errors arise from a failure to thoroughly study the works of Zhang Zhongjing. For instance, in the *Shanghan Lun* (Treatise on Cold Pathogenic Diseases), it is stated: In cases of diarrhea, abdominal fullness, and body pain, one should first warm the interior and then attack the exterior. To warm the interior, Si Ni Tang (Frigid Extremities Decoction) is appropriate; to attack the exterior, Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate. This represents Yang pathogens from the Three Yang meridians transmitting to Taiyin, transforming into a cold pattern due to Yin transformation. Similarly, in Shaoyin disease with diarrhea, Bai Tong Tang (White Congee Decoction) is used; this is a cold pattern where Taiyin cold pathogens transmit to Shaoyin. In cases of diarrhea with undigested food, interior cold with exterior heat, sweating, and cold extremities, Tong Mai Si Ni Tang (Pulse-Unblocking Si Ni Decoction) is used; this is a cold pattern where Shaoyin cold pathogens transmit to Jueyin. All these are well-documented. How can one claim that Yin meridians do not transmit in Shanghan, denying the principle of Yang transforming along with Yin? Taiyin belongs to Wet Earth and is a pure Yin organ. Thus, once pathogens enter Taiyin, they mostly transform via Yin (into cold) and rarely via Yang (into heat). Transformations via Yin include symptoms such as abdominal fullness, vomiting, spontaneous diarrhea, absence of thirst, naturally warm hands and feet, and occasional spontaneous abdominal pain, for which Li Zhong Tang (Middle-Warming Decoction) or Si Ni Tang are indicated. Transformations via Yang include symptoms after sweating where the disease persists with abdominal fullness and pain, requiring urgent purgation with Da Cheng Qi Tang (Major Order the Qi Decoction); or severe abdominal fullness and intense pain, treated with Gui Zhi Jia Huang Qi Tang (Cinnamon Twig Decoction plus Rhubarb). Since the Spleen and Stomach reside together in the abdomen, both fullness and pain occur in both. However, abdominal fullness is the primary manifestation of Taiyin, while sub-xiphoid fullness is the primary manifestation of Yangming. Although Yangming also presents with abdominal fullness, it transforms with Heat; thus, it must present with tidal fever, spontaneous sweating, and constipation. This differs from Taiyin, which transforms with Dampness, presenting with jaundice, sudden irritability, and foul-smelling diarrhea. By carefully examining the timing of pain, severe pain, and areas of fullness and pain to distinguish deficiency/excess and decide between warming and purging methods, one leaves nothing unexplained. Thus, summarizing these points allows one to grasp the essential methods of Taiyin disease.

@@@

The defining manifestations of Taiyin disease are abdominal fullness and vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purgatives are incorrectly applied, it will inevitably lead to epigastric binding/clumping.

[Commentary]
Wu Renju states that the phrase "worsening spontaneous diarrhea" should follow the sentence "inevitably leads to epigastric binding/clumping," which is correct. If placed after "vomiting and inability to eat," it implies that vomiting and eating difficulties precede the worsening diarrhea. Zhang Zhongjing further notes that if purgatives are used, the consequences are dire.

[Annotation]
Taiyin refers to the Spleen Meridian, which spreads through the stomach and connects to the throat. When Cold pathogens transmit to Taiyin, abdominal fullness and occasional spontaneous abdominal pain occur. When Cold pathogens follow the meridians to invade the Stomach, vomiting and inability to eat result. This is a Taiyin interior deficiency pattern where pathogens transform into cold; it should be treated with warming agents like Li Zhong Tang or Si Ni Tang. If, however, there is abdominal fullness, dry throat, constipation, and severe pain, it constitutes a Taiyin interior excess pattern where pathogens transform into heat, treated with purgatives like Gui Zhi Jia Huang Qi Tang. If one mistakenly treats Taiyin deficiency-cold fullness and pain as Taiyin excess-heat and applies purgatives, Cold and Deficiency will contend, leading to Zang Binding (Zang Jie) and痞 (Pi - Glomus), with worsening spontaneous diarrhea. This paragraph serves as the outline for the entire Taiyin chapter; subsequent references to Taiyin disease refer to this syndrome.

[Collected Notes]
Cheng Yingmao says: Yang pathogens can cause abdominal fullness, but if vomiting relieves the fullness and allows eating, it is different. Here, fullness with vomiting and inability to eat indicates Cold distension and Cold rejection. Yang pathogens can cause diarrhea and abdominal pain, where pain decreases after defecation. Here, diarrhea with occasional spontaneous pain indicates Cold diarrhea and Cold pain. "Epigastric region" refers to Yin pathogens binding in the Yin aspect below the chest, distinct from Yang pathogens binding in the chest, and painful upon pressure. "Binding/Clumping" (Jie Kou) refers to hard Yin accumulation due to lack of Yang Qi to transform Qi, distinct from the soft nature of Pi. Those (Yang binding/Pi) involve Yang sinking from above and stagnating; this involves Yin counterflow from below failing to return, marking a clear distinction between Cold and Heat.

Wu Renju says: Spontaneous diarrhea occurs intermittently with spontaneous abdominal pain, unlike persistent pain from accumulated pathogens. If all pains are treated as excess and purged, fullness will worsen, inevitably causing widespread epigastric binding/clumping and worsening diarrhea.

@@@

In Shanghan, on the fourth or fifth day, if there is abdominal pain and gas moving downward toward the lower abdomen, this indicates impending spontaneous diarrhea.

[Annotation]
On the fourth or fifth day of Shanghan, pathogens enter Taiyin. Abdominal pain without gas moving downward belongs to Yangming. Here, abdominal pain with gas moving downward toward the lower abdomen is a sign that Taiyin is about to produce spontaneous diarrhea. This illustrates Zhang Zhongjing’s teaching that not all pain should be considered excess, preventing reckless use of purgatives.

[Collected Notes]
Fang Youzhi says: Abdominal pain with gas moving downward indicates interior deficiency failing to hold, with Cold pathogens pressing downward.

Zhang Lu says: Abdominal pain caused by Fire rises from below to above. Pain moving downward is undoubtedly Cold pain.

Wei Litong says: The emphasis here is on preventing diarrhea, not distinguishing Cold from Heat. The words "if" (Ruo) and "about to" (Yu) reveal specific methods for identifying Cold pathogens.

Spontaneous diarrhea without thirst belongs to Taiyin, because the internal organs possess Cold. It should be warmed, preferably with Si Ni Tang category formulas.

[Annotation]
Spontaneous diarrhea with thirst indicates interior Heat and belongs to Yang. Spontaneous diarrhea without thirst indicates interior Cold and belongs to Yin. Current spontaneous diarrhea without thirst confirms Taiyin intrinsic Cold, requiring warming treatment. "Si Ni category" refers to formulas like Si Ni Tang, Li Zhong Tang, and Fu Zi Tang.

[Collected Notes]
Cheng Zhi says: This explains that Taiyin spontaneous diarrhea is Cold and requires warming. Shaoyin belongs to Kidney Water; Heat invading consumes Water, causing diarrhea with thirst. Taiyin belongs to Spleen Earth; Cold invading combines with Dampness, causing diarrhea without thirst. Hence, Taiyin spontaneous diarrhea requires warming.

Cheng Yingmao says: The Three Yin meridians all involve organ Cold. Shaoyin and Jueyin present with thirst, but Taiyin does not, because the Cold is in the Middle Jiao, unrelated to Dragon/Lion Fire. Shaoyin contains Dragon Fire; severe bottom Cold causes Dragon Fire to rise, causing diarrhea with thirst. Jueyin contains Lion Fire, causing Xiao Ke (Wasting-Thirst). Taiyin is like sunlight stopping thunderstorms; fever stops diarrhea, while Jue (cold extremities) brings back diarrhea.

Wei Litong says: The term "spontaneous diarrhea" refers to cases arising without prior misapplication of purgatives, sweating-inducers, or emetics, confirming pre-existing organ Cold.