太阴主内，为阴中至阴，最畏虚寒，用温补以理中，此正法也。然太阴为开，故太阴亦能中风，则亦有可
汗症。若见四肢烦疼之表，而脉浮者，始可与桂枝汤发汗。若表热里寒，下利清谷，是为中寒，当用四逆以急
救其里，不可攻表，以汗出必胀满也。又恐妄汗而腹胀满，故更制浓朴生姜甘草半夏人参汤以解之。太阴本无
下症，因太阳妄下而腹满时痛者，是阳邪内陷，故有桂枝加芍药汤之下法。若病不从太阳来，而腹满时痛，是太
阴本病。倘妄下之，必胸下结硬而成寒实结胸，故更制三物白散以散之。此仲景为太阴误汗误下者立救逆法也。
叔和不能分明六经之方治，而专以汗吐下之三法教人，重集诸可与、不可与等浮泛之辞，以混仲景切近的当之
方法，是点金成铁矣。
理中丸∶
人参 白术 干姜 甘草
太阴病，以吐利腹满痛为提纲，是遍及三焦矣。然吐虽属上，而
由于腹满，利虽属下，而由于腹满，皆因中焦不治以致之也。其来由有三∶有因表虚而风寒自外入者，有因下
虚而寒湿自下上者，有因饮食生冷而寒邪由中发者。总不出于虚寒，法当温补以扶胃脘之阳，一理中而满痛
吐利诸症悉平矣。故用白术培脾土之虚，人参益中宫之气，干姜散胃中之寒，甘草缓三焦之急也。且干姜得白
术，能除满而止吐，人参得甘草，能疗痛而止利。或汤或丸，随机应变，此理中确为之主剂欤！夫理中者理中
焦，此仲景之明训，且加减法中又详其吐多下多腹痛满等法。而叔和录之于大病瘥后治真吐一症，是坐井观天
者乎！
按∶太阴伤寒，手足自温者，非病由太阳，必病关阳明。此阴中有阳，必无吐利交作之患，或暴烦下利，
或发黄便硬，则腹满腹痛，是脾家实，而非虚热，而非寒矣，又当于茵陈、调胃辈求之。
四逆汤∶
干姜 附子 甘草
脉浮而迟，表热里寒二句，是立方之大旨。脉浮为在表，迟为在脏，浮中见迟，是浮为表虚，迟为脏寒矣。
腹满吐利，四肢厥逆，为太阴症。姜、附、甘草，本太阴药，诸条不冠以太阴者，以此方为太阳并病立法也。
按四逆诸条，皆是太阳坏病转属太阴之症。太阳之虚阳留于表而不罢，太阴之阴寒，与外来之寒邪相得而益深。
故外症则恶寒发热，或大汗出，身体痛，四肢疼，手足冷，或脉浮而迟，或脉微欲绝；内症则腹满腹胀，下利
清谷，小便自利，或吐利交作。此阴邪猖獗，真阳不归，故云逆也。本方是用四物以救逆之谓，非专治四肢厥
冷而为名。盖仲景凡治虚症，以补中为主，观协热下利，脉微弱者用人参，汗后身疼，脉沉迟者加人参。此脉
微欲绝，下利清谷，且不烦不咳，中气大虚，元气已虚，若但温不补，何以救逆乎？观茯苓四逆之治烦躁，且用
人参，其冠以茯苓而不及参，则本方有参可知。夫人参通血脉者也，通脉四逆，岂得无参？是必因本方之脱落
而仍之耳。薛新甫用三生饮，加人参两许，而驾驭其邪，则仲景用生附，安得不用人参以固其元气耶？叔和以
太阴之吐利四逆，混入厥阴，不知厥阴之厥利，是木邪克土为实热，太阴之厥利，是脾土自病属虚寒，径庭自异。
若以姜、附治相火，岂不逆哉？按理中、四逆二方，在白术、附子之别。白术为中宫培土益气之品，附子为坎宫
扶阳生气之剂。故理中只理中
州脾胃之虚寒，四逆能佐理三焦阴阳之厥逆也。后人加附子于理中，名曰附子理中汤，不知理中不须附子，而
附子之功不专在理中矣。盖脾为后天，肾为先天，少阴之火所以生太阴之土。脾为五脏之母，少阴更太阴之母，
与四逆之为剂，重于理中也。不知其义者，谓生附配干姜，补中有发。附子得生姜而能发散，附子非干姜则不热，
得甘草则性缓。是只知以药性上论寒热攻补，而不知于病机上分上下浅深也，所以不入仲景之门也哉！
浓朴生姜半夏甘草人参汤∶
此太阴调胃承气之方也。凡治病必分表里，而表里偏有互呈之证，如麻黄之喘，桂枝之自汗，大青龙之烦
躁，小青龙之咳，皆病在表而夹里症也。用杏仁以治喘，芍药以止汗，石膏以治烦躁，五味、干姜以治咳，是
于表剂中兼治里也。若下利腹胀满者，太阴里症而兼身体疼痛之表症，又有先温其里，后解其表之法。若下利
清谷，而兼脉浮表实者，又有只宜治里，不可攻表之禁。是知仲景重内轻外之中，更有浅深之别也。夫汗为阳
气，而腰以上为阳，发汗只可散上焦营卫之寒，不能治下焦脏腑之湿。若病在太阴，寒湿在肠胃而不在营卫，
故阴不得有汗，妄发其汗，则胃脘之微阳随而达于表，肠胃之寒湿入经络，而留于腹中，下利或止，而清谷不
消，所以汗出必胀满也，凡太阳汗后胀满，是阳实于里，将转属阳明；太阴汗后而腹满，是寒实于里，而阳虚
于内也。邪气盛则实，故用浓朴、姜、夏，散邪而除胀满；正气夺则虚，故用人参、甘草，补中而益元气。此
亦理中之剂欤！若用之于太阳汗后，是抱薪救火，如此症而妄作太阳治之，如水益深矣。
三物白散∶
桔梗 贝母 巴豆
太阳表热未除，而反下之，热邪与水气相结，成实热结胸；太阴腹满时痛，而反下之，寒热相结，成寒实
结胸。夫大小陷胸用苦寒之品者，为有热也。此无热症者，则不得概以阳症之法治之矣。三物小陷胸汤者，即白
散也。以其结硬而不甚痛，故亦以小名之；以三物皆白，欲以别于小陷胸之黄连，故以白名之。在太阳则或汤
或丸，在太阴则或汤或散，随病机之宜也。贝母善开心胸郁结之气，桔梗能提胸中陷下之气。然微寒之品，不足
以胜结硬之阴邪，非巴豆之辛热斩关而入，何以使胸中之阴气流行也？故用二分之贝、桔，必得一分之巴豆以佐
之，则清阳升而浊阴降，结硬斯可得而除矣。和以白饮之甘，取其留恋于胃，不使速下，散以散之，比汤以荡
之者，尤为的当也。服之而病在膈上必吐，在膈下者必利，以本症原自吐利，因胸下结硬而暂止耳。今因其势
而利导之，使还其出路，则结硬自散也。然此剂非欲其吐，本欲其利，亦不欲其过利。故不利进热粥一杯，利
过不止进冷粥一杯，此又复方之妙理欤！仲景每用粥为反佐者，以草木之性各有偏长，惟稼穑作甘为中和之味，
人之精神血气，皆赖之以生。故桂枝汤以热粥发汗，理中汤以热粥温中，此以热粥导利，复以冷粥止利，神哉！
东垣云∶“淡粥为阴中之阳，所以利小便。”则利水之剂，未始不可用也。今人服大黄后用冷粥止利，尚是仲
景遗意乎？此证叔和编在太阳篇中水 病后，云“寒实结胸无热症者，与三物小陷胸汤，白散亦可服。”按
本论小陷胸汤是黄连、栝蒌、半夏三物，而贝母、桔梗、巴豆亦是三物。夫黄连、巴豆，寒热天渊，岂有可服
黄连之症，亦可服巴豆之理？且此外更无别方，则当云三物小陷胸汤为散亦可服。如云白散亦可服，是二方矣。
而方后又以身热皮粟一段杂之，使人昏昏不辨。今移之太阴胸下结硬之后，其症其方，若合符然。
麻仁丸∶
杏仁 芍药 枳壳 浓朴 大黄 麻仁
土为万物之母者，以其得和平之气也。湿土不能生草木，然稻、藕、菱、芡等物，亦有宜于水者。若燥土
坚硬无水以和之，即不毛之地矣。凡胃家之实，多因于阳明之热结，而亦有因太阴之不开者，是脾不能为胃行
其津液，故名为脾约也。承气诸剂，只能清胃，不能扶脾。如病在仓卒，胃阳实而脾阴不虚，用之则胃气通
而大便之开阖如故。若无恶热、自汗、烦躁、胀满、谵语、潮热等症，饮食小便如常，而大便常自坚硬，或数
日不行，或出之不利，是谓之孤阳独行。此太阴之病不开，而秽污之不去，乃平素之蓄积使然也。慢而不治，
则饮食不能为肌肉，必至消瘦而死。然腑病为客，脏病为主，治客须急，治主须缓。病在太阴，不可荡涤以取
效，必久服而始和。盖阴无骤补之法，亦无骤攻之法。故取麻仁之甘平入脾，润而多脂者为君，杏仁之降气利
窍，大黄之走而不守者为臣，芍药之滋阴敛液，与枳、朴之消导除积者为佐，炼蜜为丸，少服而渐加焉，以和
为度。此调脾承气，推陈致新之和剂也。使脾胃更虚更实，而受盛传道之官，各得其职，津液相
成，精血相生，神气以清，内外安和，形体不敝矣。
上太阴五方。按诸经皆有温散温补法，惟少阳不用温；诸经皆有益阴清火法，惟太阴忌寒凉。若热病传经
有嗌干等症，仍当清火；素有脾约大便不顺，亦当滋阴。要知制方，全在活法，不可执也。
太阴经主管体内运化，属于阴气中最盛的一类，最畏惧虚寒之邪，因此使用温补的方法来调理中焦，这是正治之法。然而，太阴经主“开”的功能，所以太阴病也能感受风邪，从而出现可以用发汗法治疗的证候。如果见到四肢烦疼等表证，且脉象浮的，才可以给予桂枝汤来发汗解表。如果出现体表发热而体内有寒，腹泻排出未消化的食物，这属于中寒证，应当使用四逆汤来紧急救治里寒，不可攻伐表邪，因为如果强行发汗导致出汗，必然会引起腹部胀满。又担心误用发汗法导致腹胀满，所以另外制定了浓朴生姜甘草半夏人参汤来解除这种症状。太阴病本身没有需要攻下的证候，如果是因太阳病误用下法而导致腹部胀满、时时作痛的，这是阳热邪气内陷所致，因此有桂枝加芍药汤作为攻下的方法。如果病症不是从太阳病传变而来，而是直接出现腹部胀满、时时作痛，这是太阴的本病。倘若误用下法，必然会导致胸下结硬，形成寒实结胸证，所以另外制定三物白散来消散它。这是张仲景为太阴病误汗、误下者设立的救逆之法。
王叔和不能明确区分六经的方剂治疗方法，而专门教导人们使用汗、吐、下这三种方法，大量收集诸如“可与”、“不可与”等空泛的言辞，混淆了张仲景确切恰当的治疗方法，这简直是点金成铁（把好的东西弄坏）。
太阴病的提纲是呕吐、腹泻、腹部胀满疼痛，这表明病邪波及上、中、下三焦。然而，呕吐虽然属于上焦症状，但根源在于腹部胀满；腹泻虽然属于下焦症状，根源也在于腹部胀满，这都是因为中焦脾胃失于调理所导致的。其病因主要有三种：有因体表虚弱，风寒从外侵入的；有因下焦虚弱，寒湿从下向上侵犯的；有因饮食生冷，寒邪从中焦引发的。总归不出于虚寒，治法应当温补以扶持胃脘的阳气，只要运用理中法，那么腹满、疼痛、呕吐、腹泻等症状都会平息。因此，使用白术来培补脾土的虚弱，人参来增益中宫（脾胃）的气，干姜来驱散胃中的寒气，甘草来缓解三焦的急迫。而且，干姜配合白术，能消除胀满并停止呕吐；人参配合甘草，能治疗疼痛并止住腹泻。无论是做成汤剂还是丸剂，都应根据情况灵活变化，这确实是理中汤的主方啊！所谓“理中”，就是调理中焦，这是张仲景明确的教诲，而且在加减法中还详细说明了呕吐多、腹泻多、腹痛胀满等具体治法。而王叔和却将其记录在大病愈后治疗真吐这一症候中，这真是坐井观天啊！
按语：太阴伤寒，如果手足自然温暖，说明病不是由太阳传入，必定与阳明有关。这是阴中有阳，必然不会出现呕吐和腹泻同时发作的祸患，或者出现突然烦躁腹泻，或者发黄、大便坚硬，进而出现腹部胀满疼痛，这是脾家实证，而不是虚热，也不是寒证，这时应当在茵陈蒿汤、调胃承气汤这类方剂中寻找治法。
“脉浮而迟，表热里寒”这两句话，是确立此方的主要宗旨。脉浮表示病在表，脉迟表示病在脏，浮脉中见到迟象，说明浮代表表虚，迟代表脏寒。腹部胀满、呕吐腹泻、四肢厥冷，是太阴病的症状。干姜、附子、甘草，本是太阴病的用药，各条文不冠以太阴之名，是因为此方是为太阳病合并太阴病而立法的。
考察四逆汤相关的条文，都是太阳病坏证转属太阴的症状。太阳的虚阳留滞于体表而不能罢休，太阴的阴寒之气，与外来的寒邪相结合而更加深重。所以外在症状表现为恶寒发热，或大汗出，身体疼痛，四肢疼痛，手足冰冷，或脉浮而迟，或脉微细欲绝；内在症状表现为腹部胀满腹胀，腹泻排出未消化的食物，小便清长自利，或呕吐腹泻同时发作。这是阴邪猖獗，真阳不能回归本位，所以称为“逆”。本方是用这四味药来救治逆证的意思，并不是专门治疗四肢厥冷而得名。大概张仲景凡是治疗虚证，都以补益中气为主，看协热下利、脉微弱的使用人参，发汗后身体疼痛、脉沉迟的增加人参。这里脉微细欲绝，腹泻排出未消化的食物，且不烦躁不咳嗽，中气大虚，元气已衰，如果只是温阳而不补气，怎么能救治逆证呢？看茯苓四逆汤治疗烦躁，也使用了人参，既然冠名茯苓而没有提到人参，那么本方含有参是显而易见的。夫人参是能通血脉的，通脉四逆汤，难道能没有参吗？这一定是因为本方原文脱落而后人补充的罢了。薛新甫使用三生饮，加入人参一两左右，来驾驭邪气，那么张仲景使用生附子，怎么不用人参来固护元气呢？王叔和将太阴病的呕吐腹泻四逆混入厥阴病，不知道厥阴病的厥冷腹泻，是木邪克土导致的实热证，太阴病的厥冷腹泻，是脾土自身病变属于虚寒证，两者截然不同。如果用干姜、附子去治疗相火妄动，岂不是背道而驰吗？按理中汤和四逆汤两个方子，区别在于白术和附子。白术是培补中宫脾胃之气土的药材，附子是扶起坎宫（肾）阳气生发的药剂。所以理中汤只调理中州脾胃的虚寒，四逆汤能辅助调理三焦阴阳的厥逆。后人将附子加入理中汤，命名为附子理中汤，却不知道理中汤不需要附子，而附子的功效不仅仅局限于理中汤。大概脾为后天之本，肾为先天之本，少阴之火所以能生太阴之土。脾是五脏之母，少阴更是太阴之母，四逆汤作为方剂，比理中汤更为重要。不了解其中含义的人，认为生附子配干姜，是在补益中兼有发散。附子得到生姜就能发散，附子没有干姜就不热，得到甘草则药性缓和。这只是知道从药性上来讨论寒热攻补，而不知道从病机上区分上下浅深，所以不能进入张仲景学术的门径啊！
浓朴生姜甘草半夏人参汤：
这是太阴病类似调胃承气汤的方剂。凡是治病必须分清表里，而表里之间常有互相呈现的证候，比如麻黄汤证的喘，桂枝汤证的自汗，大青龙汤证的烦躁，小青龙汤证的咳嗽，都是病在表而夹杂里证。使用杏仁来治疗喘，芍药来止汗，石膏来治疗烦躁，五味子、干姜来治疗咳嗽，这是在表剂中兼治里证。如果是腹泻伴腹部胀满，这是太阴里证而兼有身体疼痛的表证，又有先温里、后解表的方法。如果是腹泻排出未消化的食物，兼有脉浮表实的，又有只宜治里、不可攻表的禁忌。由此可知，张仲景重视内部轻外部之中，更有深浅的区别。汗液属于阳气，腰以上属于阳，发汗只能疏散上焦营卫的寒气，不能治疗下焦脏腑的湿气。如果病在太阴，寒湿在肠胃而不在营卫，所以阴证不应该有汗，如果误发其汗，那么胃脘的微阳随之达于体表，肠胃的寒湿进入经络，而留滞在腹中，腹泻或许停止，但完谷不化的症状不会消除，所以发汗后必然会出现腹部胀满。凡是太阳病发汗后出现的胀满，是阳实于里，将要转属阳明；太阴病发汗后出现的腹满，是寒实于里，而阳气虚于内。邪气盛则表现为实，所以使用浓朴、干姜、半夏，来疏散邪气并消除胀满；正气夺则表现为虚，所以使用人参、甘草，来补益中气并增益元气。这也是理中汤类的方剂啊！如果把它用于太阳病发汗后的情况，那就是抱薪救火，像这样的病症如果误当作太阳病治疗，就像水越加越深了。
太阳表热未除，反而误用下法，热邪与水气相结合，形成实热结胸；太阴病腹部胀满、时时作痛，反而误用下法，寒热相互结合，形成寒实结胸。大小陷胸汤使用苦寒的药物，是因为有热邪。这里没有热证，就不能一概用阳证的方法来治疗。三物小陷胸汤，就是白散。因为它结硬但不甚疼痛，所以也用“小”来命名；因为三味药都是白色的，想要区别于小陷胸汤中的黄连，所以用“白”来命名。在太阳病中，或做汤剂或做丸剂，在太阴病中，或做汤剂或做散剂，随病机的适宜而定。贝母善于开通心胸郁结之气，桔梗能提起胸中陷下之气。然而，这些微寒的药物，不足以战胜结硬的阴邪，如果不是巴豆的辛热斩关而入，怎么能使胸中的阴气流行呢？所以使用二分量的贝母、桔梗，必须得一分量巴豆来佐助，这样清阳上升而浊阴下降，结硬才能得以消除。用白饮（米汤）调和它的甘味，取其留恋于胃，不让药力迅速下行，用散剂来消散它，比起用汤剂来荡涤它，更为恰当。服用后，如果病在膈上必然呕吐，在膈下必然腹泻，因为原本就有呕吐腹泻的症状，是因为胸下结硬而暂时停止罢了。现在顺应病势而引导它，使其恢复出路，那么结硬自然消散。然而，这个方剂并不是想让它呕吐，本想让它腹泻，也不希望腹泻过度。所以如果不腹泻，就喝一杯热粥；如果腹泻不止，就喝一杯冷粥，这又是复方运用的妙理啊！张仲景经常用粥作为反佐，因为草木的药性各有偏长，只有五谷的甘味是中正平和的味道，人的精神和血气，都依赖它而生。所以桂枝汤用热粥来发汗，理中汤用热粥来温中，这里用热粥来引导腹泻，再用冷粥来止住腹泻，真是神妙啊！李东垣说：“淡粥属于阴中之阳，所以能利小便。”那么利水的方剂，未尝不可以使用粥。现在人服用大黄后用冷粥止泻，这还是张仲景遗留的意旨吗？这个证候王叔和编排在太阳篇的水病之后，说“寒实结胸无热证者，与三物小陷胸汤，白散亦可服。”按照本论，小陷胸汤是黄连、栝蒌、半夏三味药，而贝母、桔梗、巴豆也是三味药。黄连和巴豆，寒热相差如天地深渊，哪里有可以服用黄连的病症，也可以服用巴豆的道理？况且此处更没有别的方子，应该说三物小陷胸汤做成散剂也可以服用。如果说白散也可服用，那就是两个方子了。而在方后又混杂了一段关于身热皮粟的描述，使人昏昏沉沉无法辨别。现在将其移置到太阴病胸下结硬之后，其症状与其方剂，若符契相合。
土是万物的母亲，因为它得和平之气。湿土不能生长草木，然而稻、藕、菱、芡等物，也有适宜于水的。如果燥土坚硬无水来调和，就是不毛之地了。凡是胃家的实证，多因于阳明热的结聚，但也有因太阴不开泄导致的，这是脾不能为胃输送津液，所以称为脾约。承气汤类方剂，只能清胃，不能扶脾。如果病情仓促，胃阳实而脾阴不虚，使用它们则胃气通畅而大便的开阖恢复正常。如果没有恶热、自汗、烦躁、胀满、谵语、潮热等症状，饮食和小便如常，而大便常常自坚硬，或数日不行，或排出困难，这叫做孤阳独行。这是太阴的病机不开泄，而秽浊之物不去，乃平素蓄积造成的。缓慢而不治疗，那么饮食不能转化为肌肉，必至消瘦而死。然而腑病为客邪，脏病为主病，治客邪须急，治主病须缓。病在太阴，不能用荡涤的方法来求取疗效，必须久服才能调和。大概阴证没有骤补的方法，也没有骤攻的方法。所以选取麻仁的甘平入脾，润而多脂作为君药，杏仁降气利窍，大黄走而不守作为臣药，芍药滋阴敛液，与枳实、厚朴消导除积作为佐药，炼蜜为丸，少量服用并逐渐增加，以调和为度。这是调脾承气，推陈致新的和缓剂型。使得脾胃更虚更实，而受纳和传导的官职，各自得其职责，津液相生，精血互化，神气清明，内外安和，形体不毁败了。
以上是太阴病的五个方剂。考察各经都有温散、温补的方法，只有少阳经不用温法；各经都有益阴、清火的方法，只有太阴经忌讳寒凉。如果热病传经出现咽干等症状，仍当清火；素有脾约大便不顺的，也当滋阴。要知道制定方剂，全在于灵活运用，不可固执拘泥。
Taiyin governs internal transformation and is the most yin among yin, being most fearful of deficiency-cold. Therefore, using warming and tonifying methods to regulate the Middle Jiao is the orthodox treatment. However, since Taiyin governs "opening," Taiyin disease can also contract wind-pathogens, presenting symptoms that may be treated with sweating methods. If exterior symptoms such as vexing pain in the four limbs are observed along with a floating pulse, Guizhi Tang (Cinnamon Twig Decoction) may be administered to induce sweating and release the exterior. If there is heat on the exterior and cold on the interior, accompanied by diarrhea with undigested food, this constitutes Cold-Invading-the-Middle; Sini Tang (Frigid Extremities Decoction) should be used to urgently rescue the interior cold. The exterior should not be attacked, for inducing sweat will inevitably lead to abdominal fullness. Fearing that mistaken sweating will cause abdominal distension, Nongpou Shengjiang Gancao Banxia Renshen Tang (Poria, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction) was formulated to resolve this. Taiyin disease inherently lacks indications for purgation; however, if abdominal fullness and intermittent pain occur due to mistaken purgation of a Taiyang disease, it indicates yang pathogens sinking inward, thus requiring Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root) as a purgative method. If the disease did not originate from Taiyang but presents with abdominal fullness and intermittent pain, it is a primary Taiyin condition. Mistaken purgation would likely result in hardness below the chest, forming Cold-Excess Jie Xiong (Chest Binding), so Sanwu Baisan (Three-Ingredient White Powder) was created to dissipate it. These are the emergency rescue methods established by Zhang Zhongjing for Taiyin diseases complicated by mistaken sweating or purgation.
Wu Shuhe failed to clearly distinguish the formulas and treatments for the Six Channels, instead teaching people exclusively through the three methods of sweating, vomiting, and purging. He collected vague terms like "may use" or "may not use," confusing Zhang Zhongjing's precise and appropriate methods, which is akin to turning gold into iron.
Lizhong Wan (Regulate the Middle Pill):
Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Ganjiang (Dried Ginger Rhizome), Gancao (Licorice Root).
The outline for Taiyin disease is vomiting, diarrhea, abdominal fullness, and pain, indicating involvement of the Upper, Middle, and Lower Jiao. Although vomiting belongs to the Upper Jiao, its root lies in abdominal fullness; although diarrhea belongs to the Lower Jiao, its root also lies in abdominal fullness. All stem from the failure of the Middle Jiao to function properly. There are three origins: one where wind-cold enters from outside due to exterior deficiency; one where cold-dampness rises from below due to lower deficiency; and one where cold pathogens arise from within due to consumption of raw or cold foods. Ultimately, all fall under deficiency-cold. The treatment method should be warming and tonifying to support the stomach's yang qi. Once Lizhong is applied, symptoms such as abdominal fullness, pain, vomiting, and diarrhea will subside. Therefore, Baizhu is used to strengthen the deficiency of Spleen Earth, Renshen to benefit Qi in the Central Palace (Spleen/Stomach), Ganjiang to disperse cold in the Stomach, and Gancao to relieve urgency in the Three Jiao. Furthermore, Ganjiang combined with Baizhu eliminates fullness and stops vomiting; Renshen combined with Gancao treats pain and stops diarrhea. Whether prepared as a decoction or pill depends on flexibility. This is indeed the principal formula for regulating the Middle. "Lizhong" means regulating the Middle Jiao, a clear instruction from Zhang Zhongjing, who detailed modifications for excessive vomiting, excessive diarrhea, abdominal pain, and fullness. Yet Wu Shuhe recorded it under post-febrile disease treating true vomiting, which is like viewing the sky from a well!
Note: In Taiyin Shanghan (Cold Damage), if the hands and feet are naturally warm, the disease did not come from Taiyang but relates to Yangming. This represents yin containing yang, so there will be no simultaneous vomiting and diarrhea. Alternatively, sudden vexation and diarrhea, or jaundice with hard stool leading to abdominal fullness and pain, indicate Spleen Excess rather than deficiency-heat or cold. In such cases, one should look to Yinchen Hao Tang (Artemisia Capillaris Decoction) or Tiaowei Chengqi Tang (Harmonize the Stomach and Direct Downward Decoction).
Sini Tang (Frigid Extremities Decoction):
Ganjiang (Dried Ginger Rhizome), Fuzi (Prepared Aconite Lateral Root), Gancao (Licorice Root).
"Pulse floating and slow, heat on the exterior, cold on the interior" summarizes the principle of this formula. Floating indicates the exterior; slow indicates the Zang organs. A floating pulse revealing slowness suggests exterior deficiency and interior organ cold. Abdominal fullness, vomiting, diarrhea, and cold extremities are Taiyin symptoms. Ganjiang, Fuzi, and Gancao are herbs for Taiyin. These clauses do not prefix "Taiyin" because this formula is established for concurrent Taiyang-Taiyin conditions.
Examining clauses regarding Sini Tang, they describe Taiyang pathological changes transferring to Taiyin. Deficient Yang of Taiyang remains at the exterior without resolving, while Yin-cold of Taiyin combines with external cold pathogens, deepening the condition. Exterior symptoms include aversion to cold and fever, or profuse sweating, body pain, limb pain, cold hands and feet, floating and slow pulse, or faint pulse nearly imperceptible. Interior symptoms include abdominal fullness, diarrhea with undigested food, free urination, or simultaneous vomiting and diarrhea. This rampant Yin pathogen prevents True Yang from returning, hence termed "Ni" (Reversal/Counterflow). The formula uses these four ingredients to rescue reversal, not merely to treat cold extremities. Generally, when treating deficiency, Zhang Zhongjing prioritizes tonifying the Middle. For example, in協熱下利 (diarrhea with fever) with a weak pulse, Renshen is used; after sweating with body pain and a deep-slow pulse, Renshen is added. Here, with a faint pulse, diarrhea with undigested food, no vexation or cough, the Middle Qi is greatly deficient and Yuan Qi is depleted. If only warming without tonifying, how can reversal be rescued? In Fuling Sini Tang (Poria and Sini Tang) treating vexation, Renshen is also used. Since Fuling Sini Tang mentions Fuling but omits Renshen in the name, implying Renshen is present in the base formula, it confirms Sini Tang contains Renshen. Renshen unifies blood vessels; Tongmai Sini Tang (Unify Pulse Sini Tang) certainly requires Renshen. It is likely that Renshen was omitted in the original text and later restored. Xue Xinpu used Sansheng Yin (Three-Life Decoction) adding a large amount of Renshen to control pathogens; thus, when Zhang Zhongjing used raw Fuzi, why not use Renshen to secure Yuan Qi? Wu Shuhe confused Taiyin vomiting/diarrhea/Sini with Jueyin, not realizing Jueyin cold extremities/diarrhea involve Wood overacting on Earth causing excess-heat, whereas Taiyin involves Spleen Earth self-disease causing deficiency-cold. They are distinct. Using Ganjiang and Fuzi to treat Minister Fire would be counterproductive. The difference between Lizhong Tang and Sini Tang lies in Baizhu versus Fuzi. Baizhu strengthens Earth and benefits Qi in the Center; Fuzi supports Yang and generates Qi in Kan (Kidney). Thus, Lizhong regulates Middle Jiao Spleen-Stomach deficiency-cold, while Sini Tang assists in regulating Three Jiao Yin-Yang reversal. Later generations added Fuzi to Lizhong, naming it Fuzi Lizhong Tang, not realizing Lizhong does not require Fuzi, and Fuzi's function extends beyond Lizhong. The Spleen is the Post-Heaven root; the Kidney is the Pre-Heaven root. The Fire of Shaoyin generates Earth of Taiyin. The Spleen is the mother of the Five Zang; Shaoyin is the mother of Taiyin. Sini Tang is heavier/more critical than Lizhong. Those who do not understand this believe raw Fuzi paired with Ganjiang provides warming with dispersal. Fuzi disperses with Shengjiang (Fresh Ginger); without Ganjiang, Fuzi is not hot enough; with Gancao, its nature becomes mild. Such people only discuss cold/hot and attack/tonify based on herb properties, failing to differentiate upper/lower and shallow/deep based on pathology, thus failing to enter Zhang Zhongjing's school.
Nongpou Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction):
This is a Taiyin formula analogous to Tiaowei Chengqi Tang. Treating disease requires distinguishing interior/exterior, yet they often present together. For instance, asthma in Mahuang Tang, spontaneous sweating in Guizhi Tang, vexation in Da Qinglong Tang, and cough in Xiao Qinglong Tang are all exterior diseases with interior complications. Xingren treats asthma; Shaoyao stops sweating; Shigypsum treats vexation; Wuweizi and Ganjiang treat cough—treating the interior within exterior formulas. If diarrhea accompanies abdominal fullness, it is a Taiyin interior syndrome with exterior body pain, requiring first warming the interior then releasing the exterior. If diarrhea with undigested food accompanies a floating, solid exterior pulse, one must treat the interior only and avoid attacking the exterior. This shows Zhang Zhongjing's emphasis on the interior over the exterior, with distinctions of depth. Sweat is Yang Qi; the upper body is Yang. Sweating only disperses cold in the Ying and Wei of the Upper Jiao, not dampness in the Lower Jiao organs. In Taiyin, cold-dampness is in the intestines/stomach, not in Ying/Wei. Yin syndromes should not sweat. Mistaken sweating causes slight Yang of the stomach to reach the exterior, while cold-dampness from intestines enters collaterals and stays in the abdomen. Diarrhea may stop, but undigested food remains, leading to abdominal fullness upon sweating. After Taiyang sweating, fullness indicates Yang Excess in the interior, transferring to Yangming. After Taiyin sweating, fullness indicates Cold Excess in the interior and Yang Deficiency inside. Pathogen excess creates Excess; thus, Nongpou, Ganjiang, and Banxia disperse pathogens and remove fullness. Healthy Qi depletion creates Deficiency; thus, Renshen and Gancao tonify the Middle and boost Yuan Qi. This is also a Lizhong-type formula. Using it for post-Taiyang sweating is like throwing wood on fire; treating this as Taiyang is like adding water to a deepening well.
Sanwu Baisan (Three-Ingredient White Powder):
Jiegeng (Platycodon Root), Beimu (Fritillaria Bulb), Badou (Croton Seed).
If Taiyang exterior heat is not resolved and purgation is mistakenly used, heat pathogens bind with water-qis, forming Heat-Excess Jie Xiong. If Taiyin abdominal fullness/pain is mistakenly purged, cold and heat bind, forming Cold-Excess Jie Xiong. Xiaoxianxiong Tang and Daxianxiong Tang use bitter-cold herbs because of heat. Here, lacking heat, one cannot use Yang-syndrome methods. Sanwu Xiaoxianxiong Tang is Baisan. It is called "Small" because binding is hard but not very painful. It is called "White" because all three ingredients are white, distinguishing it from Xiaoxianxiong Tang's Huanglian. In Taiyang, it can be decoction or pill; in Taiyin, decoction or powder, depending on pathology. Beimu opens stagnation in the chest; Jiegeng lifts sunken Qi in the chest. However, their slight cold nature cannot overcome hard-binding Yin pathogens. Only Badou's acrid-hot nature can break through, allowing Yin Qi in the chest to circulate. Two parts Beimu/Jiegeng require one part Badou to assist, raising Clear Yang and lowering Turbid Yin, removing hardness. Mixed with Baiyin (rice gruel) for its sweetness, it lingers in the stomach, preventing rapid downward action. Powder form dissipates better than decoction's scouring. If the pathogen is above the diaphragm, vomiting occurs; if below, diarrhea occurs. Originally, vomiting/diarrhea stopped temporarily due to chest binding. Now, following the trend guides them out, dissolving the binding. The goal is not vomiting but mild diarrhea, avoiding excessive diarrhea. If no diarrhea, drink a cup of hot porridge; if diarrhea persists, drink a cup of cold porridge. This is the subtle logic of compound formulas. Zhang Zhongjing often uses porridge as an antagonistic agent. Plant herbs have biases; only grains offer neutral sweetness, sustaining spirit and blood. Guizhi Tang uses hot porridge to induce sweat; Lizhong Tang uses hot porridge to warm the middle. Here, hot porridge guides diarrhea, cold porridge stops it. Li Dongyuan said: "Light porridge is Yang within Yin, promoting urination." Thus, diuretics can use porridge. Modern use of cold porridge after Dahuang to stop diarrhea follows Zhang's legacy. Wu Shuhe placed this clause in Taiyang Water Disease, stating "For Cold-Excess Jie Xiong without heat, give Sanwu Xiaoxianxiong Tang; Baisan may also be taken." According to the text, Xiaoxianxiong Tang consists of Huanglian, Gualou, and Banxia. Beimu, Jiegeng, and Badou are also three ingredients. Huanglian and Badou are opposites in cold/hot. How can a patient taking Huanglian take Badou? With no other formula mentioned, it should say "Xiaoxianxiong Tang made as powder may be taken." Saying "Baisan may also be taken" implies two different formulas. The subsequent text about skin gooseflesh confuses matters. Moving it after Taiyin chest binding aligns symptoms and formula perfectly.
Maren Wan (Hemp Seed Pill):
Xingren (Apricot Seed), Shaoyao (Peony Root), Zhike (Bitter Orange Fruit), Nongpou (Magnolia Bark), Dahuang (Rhubarb Root), Maren (Hemp Seed).
Earth is the mother of all things due to its balanced nature. Wet earth cannot grow grass/trees, yet rice, lotus, water caltrop, etc., thrive in water. Dry, hard earth without water is barren. Stomach Excess usually stems from Yangming heat binding, but sometimes from Taiyin failure to open. This is Spleen inability to transport fluids to the Stomach, named Pi Yue (Spleen Restriction). Chengqi formulas clear the Stomach but do not support the Spleen. In acute cases with Stomach Yang Excess and non-deficient Spleen Yin, they restore bowel function. Without signs of heat intolerance, sweating, vexation, fullness, delirium, or tidal fever, with normal diet/urine, but hard stool or infrequent/difficult passage, this is "Lonely Yang traveling alone." Taiyin fails to open, retaining filth due to chronic accumulation. Untreated, food fails to nourish muscles, leading to emaciation and death. Fu (Bowels) disease is guest/pathogenic; Zang (Organs) disease is host/primary. Guest needs urgent treatment; host needs slow treatment. Taiyin disease cannot be cleared rapidly; long-term administration is needed for harmony. Yin syndromes lack sudden tonification or sudden purgation methods. Maren, sweet and neutral entering Spleen, moist and oily, serves as Monarch. Xingren descends Qi and opens orifices; Dahuang moves freely without staying, serving as Ministers. Shaoyao nourishes Yin and retains fluids; Zhishi and Nongpou eliminate stagnation and accumulate, serving as Assistants. Honey pills are taken in small doses, gradually increased, aiming for harmony. This is a harmonizing formula for regulating Spleen and directing downward, pushing out the old and generating the new. It restores balance to Spleen/Stomach, ensuring proper reception and transmission, mutual generation of fluids and blood, clarity of spirit, and peace of interior/exterior, preserving the body.
Above are the five formulas for Taiyin. All channels have warming/dispersing and warming/tonifying methods, except Shaoyang which avoids warming. All channels have nourishing Yin and clearing fire methods, except Taiyin which forbids cold/cooling. If heat disease transmits channels with throat dryness, clearing fire is still required. If one has chronic Pi Yue with constipation, nourishing Yin is appropriate. Formulation relies on flexible application, not rigidity.