凡九条方二
阴经皆属脏。脏病不易治。虽然。治之得其道。则反易愈。由其不似阳经之数于变也。三阴
惟太阴之条目少者。孤脏也。然以大概言之。首尾只病三阳而病者极多。盖太阳主表。先太阳而
病者。常也。天人之自然也。各经之自中凿说也。无此事理也。且三阳当病之时。得治则愈。又
况一入阳明。则不复转。所以病阴证而病者绝少。临病切要仔细端详。不可苟且忽略。谣俗专以
交口阴阳。偶尔中伤。执为阴证。下医又快售。乃习迷而同醉。遂致普通大谬。（数。音速。夫
以病在三阳。而谓之阳证。病在三阴而谓之阴证。非甚高远难知也。而徇俗者。乃胶固执迷而不
醒。道之不明有以夫。）
（一）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。脾经也。其脉起于大趾之端。上循膝股内廉。入腹。属脾。络胃。上膈。挟咽。连舌
本。灵枢曰。是动。则舌本强。食则呕。胃脘痛。腹胀。身体皆重。是主脾所生病者。舌本痛。
体不能动摇。食不下。盖脾为胃之合。自利益甚者。脾苦湿。病而不能为胃以行其津液。水谷不
分也。时腹自痛者。灵枢曰。足太阴之别。名曰公孙。去本节之后一寸。别走阳明。其别入络肠胃。
实则肠中切痛是也。胸下结硬者。足太阴之脉。其支者复从胃别上膈。注心中。故误下。则邪反
聚其别也。
（二）太阴中风。四肢烦疼。阳微。阴涩而长者。为欲愈。
四肢。四末也。脾主四末。素问曰。风淫末疾。是也。阳微。阳经无邪也。阴涩。太阴统血。
血凝气滞也。长。阳气胜也。阳主发生。
故邪自退。而病欲愈也。
（三）太阴病。脉浮者。可发汗。宜桂枝汤。
浮为在表。太阴之脉。尺寸俱沉细。今见浮。则邪见还表可知。然浮为风。宜桂枝汤者。以
太阴之中风言也。方见太阳上编。
（四）自利不渴者属太阴。以其脏有寒故也。当温之。宜服四逆辈。
自利不渴。湿胜也。太阴湿土。故曰有寒。四逆之辈。皆能燠土以燥湿。故曰温之也。
（五）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。秽腐当去故也。
此条二节。自不能发黄以上。与阳明第四十一条上节同。下节相反。盖同感异变。而各成一
家之证也。然彼以至七八日。反大便硬。为转阳明。此以至七八日。暴下利。秽腐当去。为脾家
实。何也。盖脾主为胃以行其津液。暴下利则脾得以为胃行其津液矣。所以脾为实。而证为犹系
太阴也。彼大便硬者。由脾不能为胃行其津液而反为约。所以为转阳明也。然则一脾胃也。而反
覆之变不同有如此者。医之为道。岂可以易易言哉。
（六）本太阳病。医反下之。因尔腹满。时痛者。属太阴也。桂枝加芍药汤主之。
桂枝加芍药汤方
于桂枝汤方内。更加芍药三两。随前共六两。余根据桂枝汤法。
腹满时痛者。脾受误伤而失其职司。故曰属太阴也。以本太阳病而反下也。故仍用桂枝以
解之。以太阴之被伤而致痛也。故倍芍药以和之。
（七）大实痛者。桂枝加大黄汤主之。
桂枝加大黄汤方
桂枝（三两去皮） 大黄（一两） 芍药（六两） 甘草（二两炙） 生姜（二两切）
大枣（十二枚擘）
上六味。以水七升。煮取三升。去滓。温服一升。日三服。
此承上条。而又以胃家本来实者言。本来实者。旧有宿食也。所以实易作而痛速。故不曰阳
明而曰大实。例之变也。桂枝加大黄者。因变以制宜也。然曰桂枝加。则补方者。当一例如上文
云云。不当载成方。且以本方加也。而用芍药六两。水七升。不合数。皆后人之苟用者。当斟酌焉。
（八）太阴为病。脉弱。其人续自利便。设当行大黄芍药者。宜减之。以其人胃气弱。易动
故也。
此承上条。申致戒谨之意。
（九）太阴病。欲解时。从亥至丑上。
亥子丑。太阴所王之三时也。欲解者。正王则邪不胜也。
共九条，涉及两个方剂。
阴经都归属于脏。脏病不容易治疗。虽然如此，如果治疗得当，反而容易痊愈。这是因为它们不像阳经那样变化迅速。三阴经中，唯独太阴经的条目较少，因为它是孤立的脏（脾）。然而从大体上讲，从头到尾只涉及三阳经而发病的情况极多。大概太阳主表，先于太阳经发病，是常理，也是天地人自然的规律。其他各经自行穿凿附会的说法，并不符合事理。况且在三阳经应当发病的时候，得到正确治疗就能痊愈。更何况一旦进入阳明经，病情就不再回转。所以患阴证的人极少。临证时必须仔细端详，不可草率疏忽。世俗谣言专门以口头谈论阴阳为能事，偶尔有人中伤，就固执地认为是阴证。低水平的医生又急于推销药方，于是习以为常，如同同醉一般迷惑，最终导致普遍的大错。（“数”读音为“速”。以病在三阳称为阳证，病在三阴称为阴证，这并不是很高深难懂的道理。但顺从世俗的人，却胶着固执、沉迷不醒，道之所以不明，是有原因的。）
（一）太阴病的症状是：腹部胀满，呕吐，饮食不下，自发性腹泻日益严重，时常腹部自发疼痛。如果误用攻下法，必然导致胸下痞结硬满。
太阴经是脾经。它的脉气起于大脚趾末端，向上沿膝盖和大腿内侧上行，进入腹部，属脾，络胃，向上穿过膈肌，夹咽部，连舌根。《灵枢》说：这条经脉发生变动，就会出现舌根强直，进食则呕吐，胃脘痛，腹胀，身体沉重。这是脾所主的病变，表现为舌根痛，身体不能动摇，饮食不下。因为脾是胃的合脏，自发性腹泻日益严重，是因为脾苦于湿邪，生病后不能为胃运行津液，导致水谷不分。时常腹部自发疼痛，《灵枢》说：足太阴经的别络，名叫公孙，距离本节之后一寸，别走阳明经，其别络进入联络肠胃。实证时会出现肠中剧烈疼痛。胸下痞结硬满，是因为足太阴经的支脉，又从胃部分出，上穿膈肌，注入心中。所以误用下法，邪气反而聚集在它的别络处。
（二）太阴中风，四肢烦扰疼痛。脉象阳部微、阴部涩且长，这是将要痊愈的征兆。
四肢就是四末。脾主管四末，《素问》说：风邪淫溢会导致末梢疾病，说的就是这个。阳微，表示阳经没有邪气。阴涩，太阴统血，血凝滞气机不畅。长，表示阳气胜。阳气主生发，所以邪气自然退去，病将要痊愈。
（三）太阴病，脉浮的，可以用发汗法，适宜用桂枝汤。
浮脉表示病在表。太阴经的脉象，寸关尺三部俱沉细。现在见到浮脉，说明邪气有回归表的趋势。然而浮脉主风，适宜用桂枝汤，是因为这里说的是太阴的中风。方剂见太阳篇上编。
（四）自发性腹泻且不口渴的，属于太阴病，因为内脏有寒的缘故。应当用温法，适宜服用四逆汤类方剂。
自利不渴，是湿邪偏胜的表现。太阴属湿土，所以说有寒。四逆汤之类方剂，都能温暖脾土以燥湿，所以说是用温法。
（五）伤寒脉浮而缓，手足自温的，病系在太阴。太阴病应当出现身黄，如果小便自利的，就不会发黄。到了七八天，虽然突然烦躁，每天腹泻十几次，必定会自行停止，因为脾家实，污秽腐浊之物应当排出的缘故。
这一条分两节，从“自不能发黄”以上，与阳明篇第四十一条上节相同，下节相反。大概是感受相同但变化不同，各自形成一种证候。然而阳明篇到七八天，反见大便硬，是转属阳明；这里到七八天，暴下利，污秽腐浊当去，是脾家实。为什么呢？因为脾主为胃运行津液，暴下利则脾得以发挥为胃运行津液的作用，所以脾为实，证候仍然系在太阴。阳明篇大便硬，是由于脾不能为胃运行津液反而被约束，所以转属阳明。既然如此，同样是脾胃，反复变化的不同竟有如此之大。医道的精妙，岂能用轻易来概括呢。
（六）原本是太阳病，医生反而用了下法，因此出现腹部胀满，时常疼痛的，属于太阴病。用桂枝加芍药汤主治。
桂枝加芍药汤方
在桂枝汤方内，再加芍药三两，连同前面的总共六两。其余按照桂枝汤的方法煎服。
腹满时痛，是因为脾受到误治损伤而失去职司，所以说属于太阴。因为是原本太阳病而误用下法，所以仍用桂枝来解表。因为太阴受伤导致疼痛，所以加倍使用芍药来调和止痛。
（七）大实痛的，用桂枝加大黄汤主治。
桂枝加大黄汤方
桂枝（三两去皮） 大黄（一两） 芍药（六两） 甘草（二两炙） 生姜（二两切） 大枣（十二枚擘）
以上六味药，用水七升，煮取三升，去渣滓。温服一升，每日三次。
这是承接上一条，又针对胃家本来实的状况而言。所谓本来实，是指旧有宿食。所以实证容易发作且疼痛迅速，因此不叫阳明而叫大实，这是变通的例子。桂枝加大黄汤，是因变制宜。然而说“桂枝加”，那么补方的写法，应当像上文一样举例说明，不应当直接列出成方。而且在本方基础上加药，却使用芍药六两，水七升，不合常规数量，都是后人随意使用的结果，应当斟酌。
（八）太阴病，脉弱，其人持续自发性腹泻。假设应当使用大黄、芍药的，应当减量。因为此人胃气弱，容易动泄泻的缘故。
这是承接上一条，进一步表达谨慎告诫的意思。
（九）太阴病，欲解的时间，是从亥时到丑时。
亥、子、丑三个时辰，是太阴经王气的时段。所谓欲解，是因为正气旺盛则邪气不胜。
Nine articles, involving two formulas.
The Yin meridians all belong to the Zang organs. Diseases of the Zang organs are not easy to treat. Nevertheless, if treated correctly, they can heal more easily. This is because they do not change as rapidly as the Yang meridians. Among the Three Yin meridians, only the Taiyin meridian has fewer entries because it is a solitary Zang organ (Spleen). However, generally speaking, cases involving only the Three Yang meridians from beginning to end are extremely common. Roughly speaking, the Taiyang governs the exterior; contracting disease in the Taiyang first is the norm and follows the natural law of Heaven, Earth, and Humanity. Speculative theories for other meridians do not conform to logical principles. Moreover, when diseases occur in the Three Yang meridians, proper treatment leads to recovery. Furthermore, once the disease enters the Yangming meridian, it does not revert. Therefore, patients with Yin syndromes are very rare. In clinical practice, one must examine carefully and cannot be negligent or casual. Folk rumors specialize in verbally discussing Yin and Yang; occasionally someone is harmed, yet they stubbornly insist it is a Yin syndrome. Incompetent doctors are eager to sell prescriptions, becoming accustomed to this confusion and drunk together, ultimately leading to widespread major errors. ("Shuo" is pronounced "Su". Calling a disease in the Three Yang meridians a Yang syndrome, and a disease in the Three Yin meridians a Yin syndrome, is not high or difficult to understand. Yet those who follow custom cling stubbornly to their delusions without waking up. The reason the Dao remains obscure is understandable.)
(1) The manifestations of Taiyin disease are: abdominal fullness and vomiting, inability to eat, spontaneous diarrhea that worsens over time, and occasional spontaneous abdominal pain. If purgatives are misused, chest hypochondriac binding and hardness will inevitably result.
The Taiyin meridian is the Spleen meridian. Its pulse originates at the tip of the big toe, ascends along the medial aspect of the knee and thigh, enters the abdomen, connects with the Spleen, and links with the Stomach. It ascends through the diaphragm, flanks the throat, and connects to the root of the tongue. The *Ling Shu* states: When this meridian undergoes pathological changes, the root of the tongue becomes stiff, vomiting occurs after eating, epigastric pain, abdominal distension, and heaviness of the body ensue. These are diseases governed by the Spleen, manifesting as pain at the root of the tongue, inability to move the body, and difficulty eating. Since the Spleen is the interior-exterior paired organ of the Stomach, worsening spontaneous diarrhea occurs because the Spleen suffers from dampness and, being diseased, cannot transport fluids for the Stomach, leading to the failure to separate clear from turbid. Occasional spontaneous abdominal pain: The *Ling Shu* states that the Luo-connecting vessel of the Foot-Taiyin meridian is named Gongsun (SP4), located one cun posterior to the base of the first metatarsal bone, diverging to connect with the Yangming meridian, and its branch enters and links with the intestines and stomach. In excess conditions, there is severe cutting pain in the intestines. Chest hypochondriac binding and hardness: The collateral branch of the Foot-Taiyin meridian diverges from the Stomach, ascends through the diaphragm, and pours into the Heart. Thus, erroneous purgation causes the pathogen to gather in its collateral branch.
(2) Taiyin wind-stroke presents with vexing pain in the four limbs. If the pulse is superficially faint (Yang micro), deeply choppy (Yin涩), and long, recovery is imminent.
The four limbs are the four extremities. The Spleen governs the four extremities. The *Su Wen* states: Wind pathogen invading excessively leads to diseases of the extremities. "Yang micro" indicates no pathogen in the Yang meridians. "Yin choppy" reflects that Taiyin governs blood; blood stagnation causes Qi stasis. "Long" indicates an abundance of Yang Qi. Yang Qi governs generation and growth, so the pathogen naturally retreats, and the disease is about to heal.
(3) In Taiyin disease, if the pulse is floating, sweating therapy may be used; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
A floating pulse indicates the pathogen is in the exterior. The Taiyin pulse is typically deep and fine at all three positions (Cun, Guan, Chi). Seeing a floating pulse now indicates the pathogen is returning to the exterior. Floating pulses also indicate Wind. Guizhi Tang is appropriate here because this refers to Taiyin wind-stroke. The formula is found in the upper section of the Taiyang chapter.
(4) Spontaneous diarrhea without thirst belongs to Taiyin, due to cold in the internal organs. Warming therapy should be applied; Sibei Tang (Four Reversals Decoction) or similar formulas are suitable.
Spontaneous diarrhea without thirst indicates excessive dampness. Taiyin corresponds to Wet Earth, hence it is described as having cold. Formulas like Sibei Tang warm the Earth (Spleen) to dry dampness, thus constituting warming therapy.
(5) In Shanghan (Cold Damage), if the pulse is floating and slow, and the hands and feet are spontaneously warm, the disease is associated with Taiyin. Taiyin disease should present with jaundice; however, if urination is free and normal, jaundice will not develop. By the seventh or eighth day, although sudden irritability occurs and diarrhea happens more than ten times a day, it will certainly stop spontaneously because the Spleen Qi becomes substantial (Shi), and foul waste is expelled.
This article has two sections. From "cannot develop jaundice" upwards, it is identical to the first section of Article 41 in the Yangming chapter, while the second section is opposite. They share the same initial contraction but differ in transformation, forming distinct syndromes. In the Yangming case, by the seventh or eighth day, constipation indicates transformation into Yangming. Here, by the seventh or eighth day, violent diarrhea indicates the expulsion of foul waste, signifying Spleen Shi (Excess/Substantiality). Why? Because the Spleen governs transporting fluids for the Stomach. Violent diarrhea allows the Spleen to function in transporting fluids for the Stomach, making the Spleen "substantial," and the syndrome remains associated with Taiyin. In the Yangming case, constipation occurs because the Spleen fails to transport fluids and instead becomes constrained, leading to transformation into Yangming. Thus, although both involve the Spleen and Stomach, the variations in transformation are so different. How can the medical art be dismissed as simple?
(6) Originally a Taiyang disease, but the physician erroneously used purgation, resulting in abdominal fullness and occasional pain, belongs to Taiyin. Treat with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root).
Formula: Guizhi Jia Shaoyao Tang
Add Shaoyao (Peony Root) 3 liang to the Guizhi Tang formula, totaling 6 liang. Prepare according to the method of Guizhi Tang.
Abdominal fullness and occasional pain indicate the Spleen was injured by erroneous treatment and lost its function, hence belonging to Taiyin. Since it originated as a Taiyang disease treated wrongly with purgation, Guizhi is still used to resolve the exterior. Because the Taiyin injury caused pain, Shaoyao is doubled to harmonize and relieve pain.
(7) For severe excess pain, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb) is indicated.
Formula: Guizhi Jia Dahuang Tang
Guizhi (Cinnamon Twig) 3 liang, peeled; Dahuang (Rhubarb Root and Rhizome) 1 liang; Shaoyao (Peony Root) 6 liang; Gancao (Licorice Root) 2 liang, honey-fried; Shengjiang (Fresh Ginger) 2 liang, sliced; Dazao (Jujube Fruit) 12 pieces, split.
These six ingredients are boiled in 7 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm, three times daily.
This follows the previous article, addressing cases where the Stomach house originally had excess (old retained food). Such excess manifests quickly with rapid pain, hence termed "Da Shi" (Great Excess) rather than Yangming, representing a variation. Guizhi Jia Dahuang Tang adapts the formula to the changed condition. However, stating "Guizhi Jia" implies the modification method should be explained as before, not just listing the final formula. Also, using 6 liang of Shaoyao with 7 sheng of water deviates from standard proportions, likely due to later editors' arbitrary additions; these should be considered with discretion.
(8) In Taiyin disease, if the pulse is weak and the patient continues to have spontaneous diarrhea, if Da Huang (Rhubarb) or Shaoyao (Peony) were indicated, their dosages should be reduced. This is because the person's Stomach Qi is weak and prone to loose stools.
This follows the previous article, emphasizing caution.
(9) Taiyin disease tends to resolve during the hours of Hai to Chou.
Hai, Zi, and Chou are the three double-hours when Taiyin Qi is dominant. "Tending to resolve" means that when righteous Qi is dominant, pathogenic factors cannot prevail.