六气之邪，感人虽同，人受之而生病各异者，何也？盖以人之形有厚薄，气有盛衰，
藏有寒热，所受之邪，每从其人之藏气而化，故生病各异也。是以或从虚化，或从实
化，或从寒化，或从热化。譬诸水火，水盛则火灭，火盛则水耗，物盛从化，理固然
也。诚知乎此，又何疑乎？阳邪传阴，变寒化热，而遂以为奇耶？自后汉迄今，千载
以来，皆谓三阴寒邪不传，且以伤寒传经阴邪，谓为直中，抑知直中乃中寒之证，非
传经之邪耶！是皆未曾熟读仲景之书，故有此误耳！如论中下利腹胀满，身体疼痛者
，先温其里，乃攻其表，温里宜四逆汤，攻表宜桂枝汤，此三阳阳邪，传入太阴，邪
从阴化之寒证也。如少阴病下利，白通汤主之，此太阴寒邪，传少阴之寒证也。如下
利清谷，里寒外热，汗出而厥者，通脉四逆汤主之，此少阴寒邪传厥阴之寒证也。皆
历历可据，岂得谓伤寒阴不相传，无阳从阴之化理乎？夫太阴湿土，纯阴之藏也，故
病一入太阴，则邪从阴化者多，从阳化者少；从阴化者，如论中腹满，吐食，自利，
不渴，手足自温，时腹自痛，宜服理中四逆辈者是也；从阳化者，如论中发汗后不解
，腹满痛者，急下之，宜大承气汤；腹满大实痛者，宜桂枝加大黄汤主之者是也。盖
脾与胃同处腹中，故腹满、腹痛两皆有之。然腹满为太阴主病，心下满为阳明主病，
其阳明亦有腹满者，以阳明腹满与热同化，故必有潮热、自汗、不大便之证，而不似
太阴与湿同化，有发黄、暴烦、下利秽腐之证也。诚能更于腹之时痛，大实痛，腹满
痛处，详审虚实，斟酌温下，则了无余义矣。故以此括之，自知太阴之要法也。
@@@
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□。
【按】
吴人驹曰：「自利益甚」四字，当在「必胸下结□」句之下，其说甚是。若在「吐食
不下」句之下，则是已吐食不下，而自利益甚矣。仲景复曰：若下之无所谓也。
【注】
太阴，脾经也，其脉布胃中，络于嗌。寒邪传于太阴，故腹满时腹自痛。寒邪循脉犯
胃，故吐食不下，此太阴里虚，邪从寒化之证也，当以理中四逆辈温之。若腹满嗌干
，不大便，大实痛，始为太阴里实，邪从热化之证，当以桂枝加大黄汤下之矣。若以
太阴虚寒之满痛，而误认为太阴实热之满痛而下之，则寒虚相抟，必变为藏结痞□，
及自利益甚矣。此太阴病全篇之提纲，后凡称太阴病者，皆指此证而言也。
【集注】
程应旄曰：阳邪亦有腹满，得吐则满去而食可下者，今腹满而吐，食不下，则满为寒
胀，吐为寒格也。阳邪亦有下利腹痛，得利则痛随利减者，今下利而时腹自痛，则利
为寒利，痛为寒痛也。曰胸下阴邪结于胸下之阴分，异于阳邪结胸之在胸，且按之而
痛也。曰结□，无阳以化气则为坚阴，异于痞之濡而耎也。彼皆阳从上陷而阻留，此
则阴从下逆而不归，寒热大别也。
吴人驹曰：自利有时，而腹自痛，非若积蓄而常痛者，若以诸痛为实，从而下之，其
满益甚，必令胸下皆为结□，而自利益甚矣。
@@@
伤寒四、五日，腹中痛，若转气下趋少腹者，此欲自利也。
【注】
伤寒四、五日，邪入太阴之时也。腹中痛，若不转气下趋者，属阳明也。今腹中痛，
转气下趋少腹者，乃太阴欲作自利之候也。此仲景示人不可以诸痛为实，而妄议下之
意也。
【集注】
方有执曰：腹中痛转气下趋者，里虚不能守，而寒邪下迫也。
张璐曰：腹痛亦有属火者，其痛必自下而上攻。若痛自上而下趋者，定属寒痛无疑矣
。
魏荔彤曰：此重在预防下利，而非辨寒热也。玩「若」字、「欲」字，可见其辨寒邪
者，自有别法。
自利不渴者，属太阴，以其藏有寒故也，当温之，宜服四逆辈。
【注】
凡自利而渴者，里有热，属阳也。若自利不渴，则为里有寒，属阴也。今自利不渴，
知为太阴本藏有寒也，故当温之。四逆辈者，指四逆、理中、附子等汤而言也。
【集注】
程知曰：言太阴自利为寒，宜温者也。少阴属肾水，热入而耗其水，故自利而渴。太
阴属脾土，寒入而从其湿，则不渴而利，故太阴自利当温也。
程应旄曰：三阴同属藏寒，少阴厥阴有渴证，太阴独无渴证者，以其寒在中焦，总与
龙雷之火无涉。少阴中有龙火，底寒甚则龙升，故自利而渴；厥阴中有雷火，故有消
渴。太阳一照雷雨收声，故发热则利止，见厥而复利也。
魏荔彤曰：「自利」二字，乃未经误下、误汗、误吐而成者，故知其藏本有寒也。
六气（风、寒、暑、湿、燥、火）的邪气，虽然感染人的途径相同，但人感受后所患的疾病却各不相同，为什么呢？这是因为人的形体有厚薄之分，正气有盛衰之别，脏腑有寒热之异，所感受的邪气，往往随着患者脏腑的气化特点而发生转化，所以产生的疾病各不相同。因此，有的转化为虚证，有的转化为实证，有的转化为寒证，有的转化为热证。这就好比水和火的关系，水势旺盛则火势熄灭，火势旺盛则水分耗竭，事物发展到极盛就会向对立面转化，这是自然的道理。真正明白了这一点，还有什么可怀疑的呢？难道阳邪传入阴经，由寒转热，就认为是奇怪的现象吗？自东汉以来，至今一千年，人们都认为三阴经（太阴、少阴、厥阴）的寒邪不会传变，并且将伤寒传经过程中出现的阴经邪气，称为“直中”（病邪直接侵犯脏腑），哪里知道“直中”乃是中寒的证候，而不是传经的邪气呢！这都是因为未曾熟读张仲景的著作，所以才会产生这种误解！例如《伤寒论》中提到：下利（腹泻）、腹胀满、身体疼痛的患者，应当先温补里虚，然后再解表邪；温里适宜用四逆汤，解表适宜用桂枝汤。这是三阳经的阳邪传入太阴，邪气从阴化而为寒证的情况。又如少阴病出现下利，用白通汤主治，这是太阴寒邪传入少阴的寒证。如下利排出未消化的食物，里有寒而外有热，出汗且四肢厥冷，用通脉四逆汤主治，这是少阴寒邪传入厥阴的寒证。这些都有据可查，怎么能说伤寒阴经之间不相传变，没有阳气随阴经转化的道理呢？太阴属湿土，是纯阴的脏腑，所以病邪一旦进入太阴，从阴化寒的多，从阳化热的少；从阴化寒的，如《伤寒论》中所说的腹满、呕吐饮食、自发性腹泻、口不渴、手足自然温暖、时常腹部自发疼痛，适宜服用理中汤、四逆汤等方剂；从阳化热的，如《伤寒论》中所说的发汗后病不解，出现腹满痛，应当急下，适宜用大承气汤；如果腹满且大实痛，适宜用桂枝加大黄汤主治。这是因为脾与胃同处腹腔之中，所以腹满和腹痛两种症状在两者中都可能出现。然而，腹满是太阴经的主要病症，心下（胃脘部）胀满是阳明经的主要病症。阳明经也有腹满的情况，是因为阳明腹满与热邪共同作用，所以必然伴有潮热、自汗、大便不通的症状，而不像太阴经与湿邪共同作用，会出现发黄、突然烦躁、排泄秽浊腐败之物等症状。如果能进一步在腹痛、大实痛、腹满痛处，详细审察虚实，斟酌使用温法或下法，就没有什么遗漏的了。所以用这些来概括，就能掌握太阴病的要领了。
@@@
太阴病的主要表现是：腹部胀满并呕吐，饮食难以下咽，自发性腹泻日益加重，时常腹部自发疼痛，如果误用攻下法，一定会导致胸下痞结硬块。
【按语】
吴人驹说：“自利益甚”这四个字，应当放在“必胸下结□”这句话的下面，他的说法非常正确。如果放在“吐食不下”这句话的下面，那就是已经出现呕吐、饮食难下，然后才出现腹泻日益加重的情况。张仲景又说，如果误用攻下法，那就无所谓了（意指后果更严重）。
【注释】
太阴，指的是脾经，其经脉分布到胃中，联络于咽喉。寒邪传入太阴，所以腹部胀满，时常腹部自发疼痛。寒邪顺着经脉侵犯胃腑，所以呕吐饮食，饮食难下，这是太阴里虚，邪气从寒化的证候，应当用理中汤、四逆汤等方剂温补。如果表现为腹满、咽喉干燥、大便不通、剧烈疼痛，这才属于太阴里实，邪气从热化的证候，应当用桂枝加大黄汤攻下。如果用治疗太阴虚寒引起的胀满疼痛的方法，却错误地认为是太阴实热引起的胀满疼痛而使用攻下法，那么寒邪与虚损相互搏结，必然会转变为脏结痞块，以及腹泻日益加重的情况。这是太阴病全篇的提纲，后面凡是提到太阴病的，都是指这种证候而言。
【集注】
程应旄说：阳邪也会有腹满，如果通过呕吐，胀满就会消除，饮食就可以进食；现在腹满且呕吐，饮食难下，说明胀满是寒胀，呕吐是寒格拒所致。阳邪也会有下利腹痛，如果腹泻后疼痛随之减轻；现在下利且时常腹部自发疼痛，说明腹泻是寒利，疼痛是寒痛。所谓“胸下”，是指阴邪结聚在胸下的阴分，不同于阳邪结胸位于胸部，而且按压时会疼痛。所谓“结□”，是指没有阳气来气化，就会形成坚硬的阴结，不同于痞证的柔软无力。那些（阳邪结胸、痞证）都是阳气从上陷落而阻留，这里则是阴气从下逆乱而不能归位，寒热性质截然不同。
吴人驹说：自发性腹泻有时发生，且腹部自发疼痛，不像积蓄已久的疼痛那样持续不断。如果把各种疼痛都当作实证，从而使用攻下法，胀满会更加严重，必定会导致胸下全部变成痞结硬块，并且腹泻日益加重。
@@@
伤寒发病四、五天，腹部疼痛，如果有气向下运行趋向小腹，这是即将发生自发性腹泻的征兆。
【注释】
伤寒发病四、五天，是邪气传入太阴的时候。腹部疼痛，如果没有气向下运行，属于阳明病。现在腹部疼痛，且有气向下运行趋向小腹，这是太阴病即将发生自发性腹泻的征候。这是张仲景告诉人们，不能把所有疼痛都当作实证，从而妄加使用攻下法的意思。
【集注】
方有执说：腹部疼痛且有气向下运行，是因为里虚不能固守，寒邪向下逼迫所致。
张璐说：腹痛也有属于火邪的，其疼痛一定是从下向上攻冲。如果疼痛是从上向下趋向，一定属于寒痛无疑。
魏荔彤说：这重在预防腹泻，而不是辨别寒热。玩味“若”字、“欲”字，可以看出辨别寒邪自有其他方法。
自发性腹泻且不口渴的，属于太阴病，因为该脏腑有寒的缘故，应当温补，适宜服用四逆汤类方剂。
【注释】
凡是自发性腹泻且口渴的，说明里有热，属于阳证。如果自发性腹泻且不口渴，则为里有寒，属于阴证。现在自发性腹泻且不口渴，知道是太阴本脏有寒，所以应当温补。四逆辈，指的是四逆汤、理中汤、附子汤等方剂。
【集注】
程知说：意思是太阴自发性腹泻属于寒证，适宜温补。少阴属肾水，热邪侵入会耗伤肾水，所以自发性腹泻且口渴。太阴属脾土，寒邪侵入会伴随湿气，所以不口渴而腹泻，因此太阴自发性腹泻应当温补。
程应旄说：三阴经都涉及脏腑有寒，少阴和厥阴有口渴的证候，唯独太阴没有口渴证候，是因为寒在中焦，总与龙雷之火无关。少阴中有龙火，底寒严重时龙火上炎，所以自发性腹泻且口渴；厥阴中有雷火，所以有消渴症。太阳经如同日照雷雨收声，所以发热时腹泻停止，见到厥逆时又腹泻。
The pathogenic factors of the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire) may infect people in the same way, yet the diseases they contract vary. Why is this? It is because people differ in the thickness of their physique, the strength of their Zheng Qi (Vital Energy), and the cold-heat constitution of their Zang-Fu organs. The pathogenic factors received tend to transform according to the Qi transformation characteristics of the patient's internal organs; thus, the resulting diseases are different. Therefore, some transform into deficiency patterns, some into excess patterns, some into cold patterns, and some into heat patterns. This is analogous to the relationship between water and fire: when water is abundant, fire is extinguished; when fire is abundant, water is depleted. When things reach an extreme, they transform into their opposites, which is the natural principle. Once one truly understands this, what remains to be doubted? Is it strange that Yang pathogenic factors transmit to Yin meridians, changing from cold to heat? Since the Eastern Han Dynasty until now, for a thousand years, people have believed that the cold pathogenic factors of the Three Yin meridians (Taiyin, Shaoyin, Jueyin) do not transmit. Furthermore, they referred to Yin meridian pathogens appearing during the transmission of Shanghan (Cold Damage) as "Zhi Zhong" (Direct Invasion, where pathogens directly attack the Zang-Fu). Little did they know that "Zhi Zhong" refers to the syndrome of direct Cold invasion, not transmitted pathogens! These errors arise from a failure to thoroughly study the works of Zhang Zhongjing. For instance, in the *Shanghan Lun* (Treatise on Cold Pathogenic Diseases), it is stated: In cases of diarrhea, abdominal fullness, and body pain, one should first warm the interior and then attack the exterior. To warm the interior, Si Ni Tang (Frigid Extremities Decoction) is appropriate; to attack the exterior, Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate. This represents Yang pathogens from the Three Yang meridians transmitting to Taiyin, transforming into a cold pattern due to Yin transformation. Similarly, in Shaoyin disease with diarrhea, Bai Tong Tang (White Congee Decoction) is used; this is a cold pattern where Taiyin cold pathogens transmit to Shaoyin. In cases of diarrhea with undigested food, interior cold with exterior heat, sweating, and cold extremities, Tong Mai Si Ni Tang (Pulse-Unblocking Si Ni Decoction) is used; this is a cold pattern where Shaoyin cold pathogens transmit to Jueyin. All these are well-documented. How can one claim that Yin meridians do not transmit in Shanghan, denying the principle of Yang transforming along with Yin? Taiyin belongs to Wet Earth and is a pure Yin organ. Thus, once pathogens enter Taiyin, they mostly transform via Yin (into cold) and rarely via Yang (into heat). Transformations via Yin include symptoms such as abdominal fullness, vomiting, spontaneous diarrhea, absence of thirst, naturally warm hands and feet, and occasional spontaneous abdominal pain, for which Li Zhong Tang (Middle-Warming Decoction) or Si Ni Tang are indicated. Transformations via Yang include symptoms after sweating where the disease persists with abdominal fullness and pain, requiring urgent purgation with Da Cheng Qi Tang (Major Order the Qi Decoction); or severe abdominal fullness and intense pain, treated with Gui Zhi Jia Huang Qi Tang (Cinnamon Twig Decoction plus Rhubarb). Since the Spleen and Stomach reside together in the abdomen, both fullness and pain occur in both. However, abdominal fullness is the primary manifestation of Taiyin, while sub-xiphoid fullness is the primary manifestation of Yangming. Although Yangming also presents with abdominal fullness, it transforms with Heat; thus, it must present with tidal fever, spontaneous sweating, and constipation. This differs from Taiyin, which transforms with Dampness, presenting with jaundice, sudden irritability, and foul-smelling diarrhea. By carefully examining the timing of pain, severe pain, and areas of fullness and pain to distinguish deficiency/excess and decide between warming and purging methods, one leaves nothing unexplained. Thus, summarizing these points allows one to grasp the essential methods of Taiyin disease.
@@@
The defining manifestations of Taiyin disease are abdominal fullness and vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purgatives are incorrectly applied, it will inevitably lead to epigastric binding/clumping.
[Commentary]
Wu Renju states that the phrase "worsening spontaneous diarrhea" should follow the sentence "inevitably leads to epigastric binding/clumping," which is correct. If placed after "vomiting and inability to eat," it implies that vomiting and eating difficulties precede the worsening diarrhea. Zhang Zhongjing further notes that if purgatives are used, the consequences are dire.
[Annotation]
Taiyin refers to the Spleen Meridian, which spreads through the stomach and connects to the throat. When Cold pathogens transmit to Taiyin, abdominal fullness and occasional spontaneous abdominal pain occur. When Cold pathogens follow the meridians to invade the Stomach, vomiting and inability to eat result. This is a Taiyin interior deficiency pattern where pathogens transform into cold; it should be treated with warming agents like Li Zhong Tang or Si Ni Tang. If, however, there is abdominal fullness, dry throat, constipation, and severe pain, it constitutes a Taiyin interior excess pattern where pathogens transform into heat, treated with purgatives like Gui Zhi Jia Huang Qi Tang. If one mistakenly treats Taiyin deficiency-cold fullness and pain as Taiyin excess-heat and applies purgatives, Cold and Deficiency will contend, leading to Zang Binding (Zang Jie) and痞 (Pi - Glomus), with worsening spontaneous diarrhea. This paragraph serves as the outline for the entire Taiyin chapter; subsequent references to Taiyin disease refer to this syndrome.
[Collected Notes]
Cheng Yingmao says: Yang pathogens can cause abdominal fullness, but if vomiting relieves the fullness and allows eating, it is different. Here, fullness with vomiting and inability to eat indicates Cold distension and Cold rejection. Yang pathogens can cause diarrhea and abdominal pain, where pain decreases after defecation. Here, diarrhea with occasional spontaneous pain indicates Cold diarrhea and Cold pain. "Epigastric region" refers to Yin pathogens binding in the Yin aspect below the chest, distinct from Yang pathogens binding in the chest, and painful upon pressure. "Binding/Clumping" (Jie Kou) refers to hard Yin accumulation due to lack of Yang Qi to transform Qi, distinct from the soft nature of Pi. Those (Yang binding/Pi) involve Yang sinking from above and stagnating; this involves Yin counterflow from below failing to return, marking a clear distinction between Cold and Heat.
Wu Renju says: Spontaneous diarrhea occurs intermittently with spontaneous abdominal pain, unlike persistent pain from accumulated pathogens. If all pains are treated as excess and purged, fullness will worsen, inevitably causing widespread epigastric binding/clumping and worsening diarrhea.
@@@
In Shanghan, on the fourth or fifth day, if there is abdominal pain and gas moving downward toward the lower abdomen, this indicates impending spontaneous diarrhea.
[Annotation]
On the fourth or fifth day of Shanghan, pathogens enter Taiyin. Abdominal pain without gas moving downward belongs to Yangming. Here, abdominal pain with gas moving downward toward the lower abdomen is a sign that Taiyin is about to produce spontaneous diarrhea. This illustrates Zhang Zhongjing’s teaching that not all pain should be considered excess, preventing reckless use of purgatives.
[Collected Notes]
Fang Youzhi says: Abdominal pain with gas moving downward indicates interior deficiency failing to hold, with Cold pathogens pressing downward.
Zhang Lu says: Abdominal pain caused by Fire rises from below to above. Pain moving downward is undoubtedly Cold pain.
Wei Litong says: The emphasis here is on preventing diarrhea, not distinguishing Cold from Heat. The words "if" (Ruo) and "about to" (Yu) reveal specific methods for identifying Cold pathogens.
Spontaneous diarrhea without thirst belongs to Taiyin, because the internal organs possess Cold. It should be warmed, preferably with Si Ni Tang category formulas.
[Annotation]
Spontaneous diarrhea with thirst indicates interior Heat and belongs to Yang. Spontaneous diarrhea without thirst indicates interior Cold and belongs to Yin. Current spontaneous diarrhea without thirst confirms Taiyin intrinsic Cold, requiring warming treatment. "Si Ni category" refers to formulas like Si Ni Tang, Li Zhong Tang, and Fu Zi Tang.
[Collected Notes]
Cheng Zhi says: This explains that Taiyin spontaneous diarrhea is Cold and requires warming. Shaoyin belongs to Kidney Water; Heat invading consumes Water, causing diarrhea with thirst. Taiyin belongs to Spleen Earth; Cold invading combines with Dampness, causing diarrhea without thirst. Hence, Taiyin spontaneous diarrhea requires warming.
Cheng Yingmao says: The Three Yin meridians all involve organ Cold. Shaoyin and Jueyin present with thirst, but Taiyin does not, because the Cold is in the Middle Jiao, unrelated to Dragon/Lion Fire. Shaoyin contains Dragon Fire; severe bottom Cold causes Dragon Fire to rise, causing diarrhea with thirst. Jueyin contains Lion Fire, causing Xiao Ke (Wasting-Thirst). Taiyin is like sunlight stopping thunderstorms; fever stops diarrhea, while Jue (cold extremities) brings back diarrhea.
Wei Litong says: The term "spontaneous diarrhea" refers to cases arising without prior misapplication of purgatives, sweating-inducers, or emetics, confirming pre-existing organ Cold.