病由少阳而愈者,借少阳之枢转而外出也。乃有治不如法,其病不能借少阳之枢转外出,而转由腔上
之膜息息透入腹中,是由少阳而传太阴也。夫病既传于太阴,其病情必然变易,自当另
议治法,是则太阴经发现之病状与其治法,又当进而研究矣。
《伤寒论》原文∶太阴之为病,腹满而吐,食不下,自利益甚,时腹自痛,若下之,必胸中结硬。
脾为太阴之府,其处重重油脂包裹,即太阴之经也。盖论其部位,似在中焦之内,惟其处油脂独浓于
他处,是太阴之经虽与三焦相连,而实不与三焦相混也。且《难经》谓脾有散膏半斤,即西人所谓甜肉汁,原
系胰子团结而成,方书谓系脾之副脏,其分泌善助小肠化食,实亦太阴经之区域也。为其经居于腹之中
间,是以腹满为太阴经之的病。其吐食、自利者,此经病而累及于府,脾病不能运化饮食,是以吐利交作也。
其腹痛者,因病在太阴,中焦郁满而气化不通也。下之必胸中结硬者,因下后脾气下陷,不能散精以
达于肺(《内经》谓脾气散精,以达于肺),遂致郁于胸中而为结硬也。
此节提纲甚详,而未言治法,及下节汇通观之,可自得其治法矣。
《伤寒论》原文∶太阴中风,四肢烦疼,阳微阴涩而长者,为欲愈。
唐容川曰∶此节言太阴中风,脉若阳大而阴滑,则邪盛内陷矣。今阳不大而微,阴涩而又见长者,乃
知微涩是邪不盛,不是正气虚。长是正气足,不嫌其微涩,故为欲愈也。
一人,年甫弱冠,当仲春之时,因伏气化热窜入太阴,腹中胀满,心中烦躁,两手肿疼,其脉大而濡,两
尺重按颇实。因思腹中者太阴之部位也,腹中胀满乃太阴受病也,太阴之府为脾,脾主四肢,因伏气化热
窜入太阴,是以两手肿疼也,其两足无恙者,因窜入太阴者,原系热邪,热之性喜上行,是以手病而足不
病也。为其所受者热邪,是以觉烦躁也。因忆《伤寒论》太阴篇有谓“太阴中风,四肢烦疼,阳微阴涩而长
者,为欲愈”今此证所现之脉,正与欲愈之脉相反,是不得不细商治法也。为疏方,用生莱菔子、生鸡内
金各三钱以开其胀满,滑石、生杭芍各六钱以清其烦躁,青连翘、生蒲黄各四钱以愈其两手肿疼,按方煎服
两剂,诸病皆愈。诚以太阴之病原属湿热,其湿热之郁蒸于上者,服此汤后得微汗而解,其湿热之陷溺于
下者,服此汤后亦可由小便分利而解矣。若执此案之方以治前节所言之病,于方中加法半夏三钱,则在
上之吐可止,再加生山药八钱,下焦之利亦可愈,至方中之连翘、蒲黄,不但能治手肿疼,即腹中作痛服之亦能
奏效,将方中药味,略为增加以治前节之病,亦可随手治愈也。
病邪由少阳经痊愈,是借助少阳枢机的转输作用而向外排出。然而,若治疗不当,病邪不能借少阳枢机外出,反而通过腹腔内的膜原间隙透入腹中,这就是由少阳传入太阴。既然病邪已经传入太阴,病情必然发生变化,自然应当另行商议治疗方法,因此对于太阴经出现的病症及其治法,又需要进一步研究。
《伤寒论》原文:太阴病的提纲证是,腹部胀满且呕吐,饮食难以下咽,腹泻逐渐加重,时常腹部自行疼痛,如果误用攻下法,必然导致胸中痞结坚硬。
脾是太阴的腑,其部位被层层油脂包裹,这就是太阴经所在之处。从部位来看,似乎位于中焦之内,但此处的油脂比其他地方更为浓厚,所以太阴经虽然与三焦相连,但实际上并不与三焦混淆。而且《难经》说脾有半斤重的散膏,即西医所说的胰液,原本是由胰腺聚集而成,医方书籍称其为脾的副脏,其分泌功能善于帮助小肠消化食物,实际上也属于太阴经的区域。因为该经脉居于腹部中间,所以腹部胀满是太阴经的典型病症。呕吐食物、自发性腹泻,是因为此经发病累及了腑,脾病导致不能运化饮食,所以吐利同时发作。腹痛,是因为病在太阴,中焦郁滞胀满且气化不通所致。误用攻下法必然导致胸中痞结坚硬,是因为攻下后脾气下陷,不能将精微物质散布输送到肺(《内经》说脾气散精,以达于肺),从而导致郁结在胸中形成痞硬。
这一节提纲非常详细,但没有说明治法,结合下一节综合观察,可以自然得出其治法。
《伤寒论》原文:太阴中风,四肢烦扰疼痛,脉象寸部微弱、尺部涩而长,这是将要痊愈的表现。
唐容川说:这一节讲太阴中风,如果脉象寸部大而尺部滑,那么邪气就会强盛并内陷。现在寸部不大而微弱,尺部涩而又见长脉,就知道微涩代表邪气不盛,而不是正气虚弱。长脉代表正气充足,所以不嫌弃脉象微涩,因此判断为将要痊愈。
有一人,刚成年,正值仲春时节,因伏气温邪化热窜入太阴,腹部胀满,心中烦躁,双手肿胀疼痛,脉象大而濡软,两尺部重按颇实。我想到腹部是太阴经的部位,腹部胀满是太阴受病,太阴的腑是脾,脾主四肢,因为伏气温邪化热窜入太阴,所以双手肿胀疼痛。两脚没有异常,是因为窜入太阴的是热邪,热性喜向上走,所以手生病而脚不生病。因为感受的是热邪,所以感到烦躁。想起《伤寒论》太阴篇中说“太阴中风,四肢烦疼,阳微阴涩而长者,为欲愈”,现在这个病例所呈现的脉象,正好与欲愈的脉象相反,所以不得不仔细商讨治疗方法。于是开方,用生莱菔子、生鸡内金各三钱来消除胀满,滑石、生杭芍各六钱来清除烦躁,青连翘、生蒲黄各四钱来治愈双手肿疼,按照方子煎服两剂,所有疾病都痊愈了。确实因为太阴病因属于湿热,其中的湿热郁蒸于上部,服用此汤后通过微微出汗而解除;湿热陷溺于下部,服用此汤后也可以通过小便分利而解除。如果拿着这个病例的方子去治疗上一节所说的病,在方中加入法半夏三钱,那么上部的呕吐可以停止,再加生山药八钱,下部的腹泻也可以痊愈,至于方中的连翘、蒲黄,不仅能治疗手部肿疼,即使腹部疼痛服用也能奏效,将方中的药味略作增加以治疗上一节的病,也可以随手治愈。
When a disease recovers from the Shaoyang (Lesser Yang) stage, it is expelled outward by leveraging the pivot function of the Shaoyang. However, if treatment is improper, the pathogen cannot be expelled via the Shaoyang pivot and instead penetrates into the abdominal cavity through the membranous spaces (membrane origin), representing a transmission from Shaoyang to Taiyin (Greater Yin). Since the pathogen has transmitted to Taiyin, the clinical presentation must inevitably change, necessitating a different therapeutic approach. Therefore, the symptoms manifesting in the Taiyin meridian and their corresponding treatments require further study.
Original text from *Shanghan Lun* (Treatise on Cold Pathogenic Diseases): The general outline of Taiyin disease includes abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purgatives are incorrectly applied, it will certainly result in chest congestion and hardness.
The spleen is the fu-organ of Taiyin. Its location is wrapped in layers of adipose tissue, which constitutes the pathway of the Taiyin meridian. Anatomically, it appears to be within the middle jiao (middle burner), but the adipose tissue here is denser than elsewhere. Thus, although the Taiyin meridian connects with the Sanjiao (Triple Burner), it does not mix with it. Furthermore, *Nanjing* (Classic of Difficult Issues) states that the spleen contains half a jin (approx. 250g) of "San Gao" (loose fat/pancreas), which corresponds to what Western medicine calls pancreatic juice. This substance is formed by the aggregation of the pancreas. Medical texts describe it as an accessory organ of the spleen; its secretions aid digestion in the small intestine and essentially fall within the territory of the Taiyin meridian. Because this meridian resides in the center of the abdomen, abdominal fullness is a characteristic symptom of Taiyin meridian disease. Vomiting food and spontaneous diarrhea occur because the meridian disease affects the fu-organ; spleen dysfunction leads to an inability to transport and transform food and drink, resulting in simultaneous vomiting and diarrhea. Abdominal pain arises because the disease is in Taiyin, causing stagnation and fullness in the middle jiao with impaired qi transformation. Incorrect use of purgatives leads to chest congestion and hardness because purging causes spleen qi to sink, preventing it from dispersing essence to reach the lungs (as stated in *Neijing*: "Spleen qi disperses essence to reach the lungs"), thereby causing stagnation in the chest leading to congestion and hardness.
This section provides a detailed outline but omits treatment methods. By synthesizing it with the following section, one can naturally derive the appropriate treatment.
Original text from *Shanghan Lun*: In Taiyin wind-stroke, there is painful discomfort in the four limbs. If the pulse is superficially slight (yang micro) and deepbound (yin choppy) yet long, recovery is imminent.
Tang Rongchuan stated: This section discusses Taiyin wind-stroke. If the pulse were superficially large and deeply slippery, the pathogen would be strong and sinking inward. Now, since the superficial pulse is not large but slight, and the deep pulse is choppy yet long, we know that "slight and choppy" indicates the pathogen is not strong, rather than deficiency of healthy qi. A "long" pulse indicates sufficient healthy qi; thus, the slight and choppy quality is not a concern, indicating impending recovery.
A patient, just reaching adulthood, during mid-spring, suffered from latent heat transforming into fire and invading Taiyin. He experienced abdominal distension, mental restlessness, and swelling and pain in both hands. His pulse was large and soggy (ru), with the two chi positions feeling solid upon heavy pressure. I reasoned that the abdomen is the region of Taiyin; abdominal distension indicates Taiyin pathology. The fu-organ of Taiyin is the spleen, which governs the four limbs. Since latent heat invaded Taiyin, both hands swelled and hurt. The feet remained unaffected because the invading pathogen was heat, and heat tends to ascend; hence, the hands were diseased while the feet were not. Because the pathogen was heat, he felt restless. Recalling the statement in the Taiyin chapter of *Shanghan Lun*: "In Taiyin wind-stroke, painful discomfort in the four limbs, with a superficially slight, deeply choppy, and long pulse, indicates impending recovery," I noted that the pulse presented in this case was exactly opposite to the pulse indicating recovery. Therefore, careful consideration of treatment was necessary. I prescribed a formula using raw Radish Seed (Laifuzi) and raw Chicken Gizzard Lining (Jineijin), each 3 qian, to relieve distension; Talcum (Huashi) and raw Hang Shao Yao (Paeonia lactiflora), each 6 qian, to clear restlessness; Green Forsythia Fruit (Lianqiao) and raw Polygonum multiflorum seed powder (Puhuang), each 4 qian, to cure hand swelling and pain. After two doses decocted and taken according to the prescription, all ailments resolved. Indeed, Taiyin disease originates from damp-heat. The damp-heat stagnating upward was resolved via slight sweating after taking this decoction, while the damp-heat sinking downward was resolved via diuresis. If one were to apply this case's formula to treat the disease described in the previous section, adding 3 qian of processed Pinellia Rhizome (Banxia) would stop the upper vomiting, and adding 8 qian of raw Dioscorea Rhizome (Shanyao) would cure the lower diarrhea. Moreover, the Lianqiao and Puhuang in the formula, besides treating hand swelling and pain, would also alleviate abdominal pain. By slightly increasing the ingredients in this formula to treat the disease in the previous section, it could be cured readily.