(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 distension, 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 attached according to the majority.)
Jaundice: The typical manifestation of Taiyin disease includes abdominal distension accompanied by vomiting, inability to eat, 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; however, if the pulse is floating, Guizhi Tang should be used to induce slight sweating. If aversion to cold is severe and persistent, neither Lizhong Tang nor Sini Tang (Fried Aconite Root Decoction) will suffice. All three Yin channels present with aversion to cold, but true aversion to cold is characterized by a desire for thick clothing. If the aforementioned condition is mistakenly treated with purgation, it will inevitably lead to hardness and binding below the chest, at which point Xixin Tang (Heart-Draining Decoction) becomes appropriate. Although Xixin Tang is used due to mistaken purgation rather than transmitted heat pathogen, all three Yin channels can have transmitted heat pathogens and thus heat syndromes, which differ from the Yin syndromes described above and require careful investigation. Treatment methods for Taiyin channel include sweating, purging, warming, harmonizing, and resolving:
Sweating method: Guizhi Tang (Cinnamon Twig Decoction), Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony).
Purging method: Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb).
Warming method: Sini Tang (Fried Aconite Root Decoction), Lizhong Tang (Cinnamon Twig and Dried Ginger Decoction).
Harmonizing/Resolving method: Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction), Yinyin Wuling San (Artemisia Capillaris and Five-Ingredient Powder with Poria).
The Classic of Internal Medicine states: "When both cun and chi pulses are deep and fine, Taiyin is affected." Because the Taiyin channel spreads through the stomach and connects to the throat, abdominal distension and dryness of the throat occur. However, upon reviewing the Taiyin chapter, the symptom of dry throat is missing.
The typical manifestation of Taiyin disease includes abdominal distension, vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain; if mistakenly purged, it leads to hardness and binding below the chest. (Cheng Wuji's commentary: Taiyin disease involves Yang pathogens transmitting inward. The Taiyin channel spreads through the stomach; when pathogens stagnate, abdominal distension occurs. Upward failure to descend causes vomiting and inability to eat; downward failure to ascend causes worsening spontaneous diarrhea. Occasional spontaneous abdominal pain differs from constant pain caused by internal Yin-cold; this is Yang pathogens disturbing the interior, causing intermittent pain. Mistaken purgation leaves Yin pathogens in the lower chest, forming hardness and binding. The text says: When a disease originating in Yin is mistakenly purged, pi syndrome results.) Spontaneous diarrhea without thirst belongs to Taiyin; a floating and moderate pulse with naturally warm hands and feet indicates the disease is in Taiyin; post-purgation abdominal distension and occasional pain belong to Taiyin; if the Taiyin disease pulse is floating, sweating may be induced using Guizhi Tang (Cinnamon Twig Decoction). (In Taiyang disease, a floating pulse without sweat warrants Mahuang Tang (Ephedra Decoction); here, although the pulse is floating and likely without sweat, it is not stated because Yin diseases do not typically present with sweat, so it need not be mentioned. Guizhi Tang is used instead of Mahuang Tang because Yin diseases should not further disperse Yang Qi. Note that Guizhi Tang can also be used when there is no sweat.) Originally suffering from Taiyang disease, if a physician mistakenly uses purgation, leading to abdominal distension and occasional pain, it belongs to Taiyin and is primarily treated with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony). For severe pain with excess signs, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb) is used. (Pathogens entering the interior cause abdominal pain. Pain from Qi transmission to the interior is intermittent and requires harmonization with acrid-warm agents; pain from internal Yin-cold is continuous and requires warming with hot agents; pain from dry stool or retained food involves constipation, abdominal distension, and pain, requiring purgation. The text states: Various pains are often excess syndromes where pain decreases with defecation; these are all interior syndromes treated differently.)
Guizhi Jia Shaoyao Tang Formula:
Guizhi (Cinnamon Twig) and Shengjiang (Fresh Ginger) (each 3.5 liang), Gancao (Licorice Root, honey-fried) (2 liang), Shaoyao (Peony Root) (6 liang), Dazao (Jujube) (12 pieces, split). These five ingredients are boiled in 7 sheng of water to yield 3 sheng, strained, and taken in three warm doses.
Guizhi Jia Dahuang Tang Formula:
Guizhi (Cinnamon Twig) (1 liang), Shaoyao (Peony Root) (1.5 liang), Gancao (Licorice Root, honey-fried) (0.5 liang), Dahuang (Rhubarb Root and Rhizome) (0.5 liang; add 1 liang if stool is hard and painful; use original formula for deficiency). The herbs are crushed, combined with 3 jujubes and 4 slices of ginger, decocted in water, and taken warm.
Zhang Yuansu said: Some ask why Sizhi Tang (Fried Aconite Root Decoction) is appropriate for Taiyin disease, yet Guizhi Tang (Cinnamon Twig Decoction) and Dahuang (Rhubarb Root and Rhizome) are also used. Dahuang is extremely cold; why use it in Yin channels? Moreover, combining cold Guizhi and Dahuang seems contradictory. The answer is: Spontaneous diarrhea with thirst belongs to Shaoyin, indicating cold in the Lower Jiao; spontaneous diarrhea without thirst belongs to Taiyin, indicating cold in the Middle Jiao. Using Sizhi Tang (Fried Aconite Root Decoction) to warm the organs is the standard treatment for this channel. Regarding Taiyang disease mistakenly purged, where exterior pathogens remain and transmit to Taiyin causing abdominal distension and occasional pain, Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony) is used; for severe excess pain, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb) removes exterior and interior pathogens. Although these cases follow purgation, the diarrhea has stopped, and distension/pain persist, making Shaoyao and Dahuang suitable. If the pulse is floating and weak, and the patient continues to have loose stools, even if Dahuang and Shaoyao are indicated, their dosage should be reduced because the Stomach Qi is weak and prone to movement.
Zhao Yi de said: The *Huo Ren Shu* (Book of Saving Lives) Question 4 states that abdominal distension and occasional pain belong to Taiyin, and abdominal pain is treated with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony), while severe pain uses Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb). I carefully examine that Taiyin abdominal distension has three types: transmitted pathogens, direct invasion of the channel, and pathogens sinking after purgation. Abdominal distension with dry throat indicates transmitted Yang pathogens, treated by purging. Abdominal distension with vomiting, inability to eat, worsening spontaneous diarrhea, and occasional pain, where mistaken purgation causes lower chest hardness, indicates direct Yin pathogens invading the channel, treated by warming. Abdominal distension and occasional pain following mistaken Taiyang purgation indicate sinking pathogens, treated with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony); severe excess pain uses Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb). The current question fails to specify these two formulas for post-purgation treatment and omits "severe excess pain," merely saying "severe pain." If one encounters direct Yin pathogen invasion with abdominal distension, occasional pain, and deep/fine pulses, using Guizhi Jia Shaoyao/Dahuang Tangs would cause regret over lower chest hardness. "Severe excess pain" refers to solidified dry pathogens in the Stomach causing intense pain, distinct from major excess syndromes. Thus, Taiyin Yin pathogen distension suits Lizhong Tang (Cinnamon Twig and Dried Ginger Decoction) with Qingpi (Aged Tangerine Peel) and Chenpi (Tangerine Peel); transmitted pathogen distension with dry throat suits Da Chaihu Tang (Major Bupleurum Decoction); post-purgation distension and pain see the previous formula.
Taiyin disease with a weak pulse and continued loose stools: if Dahuang (Rhubarb Root and Rhizome) and Shaoyao (Peony Root) are indicated, reduce dosage due to weak Stomach Qi. Taiyin wind-stroke presents with uncomfortable pain in the four limbs; a pulse that is faint at cun, choppy at chi, yet long indicates impending recovery. (*Inner Classic*: Limbs receive Qi from the Stomach but rely on the Spleen to transport fluids. Spleen disease prevents fluid transport, causing limb decline, poor pulse flow, and lack of Qi in sinews/muscles. The Spleen corresponds to the four seasons and extremities, so Taiyin disease affects the limbs.) Taiyang disease resolves from Hai to Chou hours (Spleen is Yin Earth, prosperous during Hai/Zi/Chou hours, facing Yang, hence the resolution time).
Hua Shou said: Ancients believed that on the fourth day, Taiyin syndrome affecting the chest/diaphragm could be cured by emesis. Response: Incorrect. Taiyin syndrome with large pulse, chest fullness, and phlegm may be vomited; large pulse without emesis signs requires sweating only.
Generally, exterior conditions are treated by sweating, interior by purging, upper by emesis, lower by draining. Gualou Zhichi Sui (Trichosanthes Fruit, Gardenia, and Soybean Paste) are applied according to syndrome, not fixed days.
Zhao Yi de said: *Huo Ren Shu* Question 56 asks: "Do Yin syndromes have fever?" Taiyin and Jueyin do not feature fever; only Shaoyin does. However, examining Zhang Zhongjing's treatise, all three Yin channels have fever. Beyond two Shaoyin syndromes, there are cases of vomiting/diarrhea with non-cold hands/feet and reverse fever (not fatal); Shaoyin disease with whole-body/hand-foot heat due to bladder heat causing hematuria; Si Ni San (Four Counterflow Powder) in Shaoyin uses Chaihu (Bupleurum Root) for fever; Jueyin disease with initial cold then fever and diarrhea stops spontaneously; diarrhea with rapid pulse, slight fever, and sweat indicates recovery; red face/slight fever indicates depression/emotion; vomiting with fever uses Xiao Chaihu Tang (Minor Bupleurum Decoction); Taiyin wind-stroke with limb pain shows all three Yin channels have fever, contradicting rigid claims. Also, Taiyin chapter lacks emesis methods; empty irritability or diaphragmatic excess allowing emesis belong to other channels. Only Hua Tuo mentions fourth-day chest emesis without specifying Taiyin. Why does *Huo Ren Shu* claim Taiyin chest/diaphragm emesis? The chest is not Taiyin territory; Zhang Zhongjing notes mistaken purgation causes chest binding as a complication, but the lower chest near the heart/abdomen is not suitable for emetics. Regarding pulses, Zhang Zhongjing only states Taiyin cun/chipulses are deep and fine, never mentioning large pulses.