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。
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。虽痛而亦不常痛。但时时腹自痛也。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。
王三阳云。此风寒中于太阴经。非阳邪传里也。若阳邪传里。正当下之。何结硬之
有。况痞字与硬字亦自分别。邪之初起。必先入经而后入腑脏。此邪中太阴经。其病犹
在上膈。非中脏腑之阴证也。当用辛甘之药温散之。则邪散去而自和矣。今误下之。则
邪气乘虚入胸膈间作硬耳。
黄仲理云。宜理中汤。阴经少有用桂枝者。如此证。若肺浮。即用桂枝汤微汗之。
若恶寒甚不已者。非理中四逆不可。
太阴中风四肢烦疼。阳微。阴涩而长者。为欲愈。
太阴、脾也。主营四末。太阴中风。四肢烦疼者。风淫末疾也。表邪少则微。里向
和则涩而长。长者、阳也。阴病见阳脉则生。以阴得阳则解。故云欲愈。
太阴病欲解时。从亥至丑上。
脾为阴土。王于丑亥子。向阳。故云解时。
太阴病脉浮者。可发汗。宜桂枝汤。
经曰。浮为在表。沉为在里。太阴病脉浮者。邪在经也。故当汗散之。
王宇泰云。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
桂枝证。
自利不渴者。属太阴。以其脏有寒故也。当温之。宜服四逆辈。
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。与四逆等
汤。以温其脏。
张兼善云。经言辈字。谓药性同类。惟轻重优劣不同耳。四逆汤。甘辛相合。乃大
热之剂。苟轻用之。恐有过度之失。所以仲景不为定拟也。莫若以理中循循而用之。至
为稳当。
伤寒脉浮而缓。手足自温者。系在太阴。太阴当发身黄。若小便自利者。不能发黄。
至七八日。虽暴烦。下利日十余行。必自止。以脾家实腐秽当去故也。
太阴病。至七八日。大便硬者。为太阴入腑。传于阳明也。今至七八日。暴烦。下利
十余行者。脾家实。腐秽去也。下利烦燥者死。此以脾气和。逐邪下泄。故虽暴烦下利
日十余行。而利必自止。
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。
表邪未罢。医下之。邪因乘虚传于太阴。里气不和。故腹满时痛。与桂枝汤以解表。
加芍药以和里。
Taiyin disease is characterized by abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purgatives are misapplied, it will inevitably result in hardness and obstruction below the chest.
Taiyin disease occurs when yang pathogens transmit inward. The Taiyin meridian spreads through the stomach; when pathogens stagnate, abdominal fullness results. When qi fails to descend, vomiting and inability to ingest food occur; when qi fails to ascend, spontaneous diarrhea worsens. Occasional spontaneous abdominal pain arises because abdominal pain caused by internal yin-cold is typically constant. Here, however, yang pathogens interfere with the interior; although painful, it is not constantly painful, but only occasionally spontaneously painful. If purgatives are misapplied, yin pathogens remain below the chest, causing hardness and obstruction. The Classics state: "When a disease originates from yin and is treated with purgation, pi (glomus) formation results."
Wang Sanyang stated: This is wind-cold invading the Taiyin meridian, not the transmission of yang pathogens into the interior. If yang pathogens transmitted into the interior, purgation would be indicated, and how could hardness result? Moreover, there is a distinction between "pi" (obstruction) and "hardness." Pathogens initially enter the meridians before reaching the zang-fu organs. This pathogen strikes the Taiyin meridian, and the pathology remains in the upper jiao (diaphragm area), not constituting a yin syndrome of the zang-fu organs. Acrid-sweet herbs should be used to warm and disperse the pathogens; once dispersed, harmony is restored. Now, due to erroneous purgation, pathogens enter the chest and diaphragm via deficiency, causing hardness.
Huang Zhongli stated: Lizhong Tang (Cinnamon Twig and Atractylodes Macrocephala Decoction) is appropriate. Yin-meridian diseases rarely utilize Guizhi Tang (Cinnamon Twig Decoction). In such cases, if the pulse is floating, Guizhi Tang (Cinnamon Twig Decoction) should be used to induce slight sweating. If chills are severe and persistent, neither Lizhong Tang (Cinnamon Twig and Atractylodes Macrocephala Decoction) nor Sini Tang (Frigid Extremities Decoction) is sufficient.
In Taiyin wind-stroke, with vexing pain in the four limbs, a pulse that is slightly superficial, choppy, and long indicates impending recovery.
Taiyin corresponds to the spleen, which governs the four extremities. Taiyin wind-stroke causing vexing pain in the limbs is a disorder of the extremities caused by wind. When exterior pathogens are mild, symptoms subside; when interior harmony approaches, the pulse becomes choppy and long. A long pulse belongs to yang. When a yin disease presents with a yang pulse, life is preserved, as yin disorders resolve with yang. Thus, it is said that recovery is imminent.
The time for resolution of Taiyin disease is from Hai hour to Chou hour.
The spleen is yin-earth, flourishing at Chou, Hai, and Zi hours, trending toward yang. Hence, this is stated as the time of resolution.
In Taiyin disease, if the pulse is floating, sweating therapy may be applied; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
The Classics state: Floating indicates the exterior; deep indicates the interior. In Taiyin disease, a floating pulse indicates pathogens in the meridians; therefore, they should be dispersed via sweating.
Wang Yutai stated: In Taiyang disease, a floating pulse without sweating indicates Ma Huang Tang (Ephedra Decoction). Here, with a floating pulse, one might expect no sweating, but it is not mentioned because yin diseases typically do not present with sweating, so it need not be stated. Guizhi Tang (Cinnamon Twig Decoction) is used instead of Ma Huang Tang (Ephedra Decoction) because yin diseases should not further disperse yang. It must be recognized that there are indications for using Guizhi Tang (Cinnamon Twig Decoction) even in the absence of sweating.
Spontaneous diarrhea without thirst belongs to Taiyin, due to cold in the viscera. Warming therapy should be employed; Sini Tang (Frigid Extremities Decoction) or similar formulas are appropriate.
Spontaneous diarrhea with thirst belongs to Shaoyin, due to cold in the lower jiao. Spontaneous diarrhea without thirst belongs to Taiyin, due to cold in the middle jiao. Formulas such as Sini Tang (Frigid Extremities Decoction) are given to warm the viscera.
Zhang Jianshan stated: The term "lei" (class/category) in the text refers to herbs of similar nature, differing only in potency and quality. Sini Tang (Frigid Extremities Decoction) is a highly hot formula combining sweet and acrid properties. If used lightly, there is a risk of excessive treatment. Therefore, Zhang Zhongjing did not prescribe it as a fixed formula. It is more prudent to use Lizhong Tang (Cinnamon Twig and Atractylodes Macrocephala Decoction) gradually, which is most stable and safe.
In Shanghan (Cold Damage), if the pulse is floating and slow, and the hands and feet are naturally warm, the disease is associated with Taiyin. Taiyin disease typically manifests with jaundice; however, if urination is free and spontaneous, jaundice will not develop. By the seventh or eighth day, even if sudden vexation occurs and diarrhea exceeds ten times daily, it will necessarily cease spontaneously, because the spleen's qi is restoring (Shi), and putrefied filth is being expelled.
In Taiyin disease, if by the seventh or eighth day the stool becomes hard, the disease has entered the fu organs and transmitted to Yangming. However, now at the seventh or eighth day, sudden vexation and diarrhea exceeding ten times indicate that the spleen's qi is restoring and filth is being expelled. If diarrhea is accompanied by restlessness, the prognosis is fatal. This is because spleen qi is harmonious, driving pathogens downward; thus, despite sudden vexation and frequent diarrhea, the diarrhea will cease spontaneously.
Originally suffering from Taiyang disease, if the physician erroneously applies purgation, resulting in abdominal fullness and occasional pain, the condition belongs to Taiyin. Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction with Added Paeonia Root) is the primary formula.
Exterior pathogens have not yet resolved; erroneous purgation allows pathogens to enter Taiyin via deficiency, disrupting interior harmony, leading to abdominal fullness and occasional pain. Guizhi Tang (Cinnamon Twig Decoction) is used to release the exterior, while adding Shaoyao (Paeonia Root) to harmonize the interior.