典藏书目

Cinnamon Twig (Guizhi, 3 liang) Rhubarb (Dahuang, 2 liang) White Peony Root (Shaoyao, 6 liang) Licorice Root (Gancao, roasted, 2 liang) Fresh Ginger (Shengjiang, sliced, 3 liang) Jujube (Dazao, broken open, 12 pieces)
The above six ingredients are boiled in seven sheng of water until three sheng remain. The dregs are removed, and one sheng is taken warm, three times a day.

[Collected Commentary] Ke Qin said: Abdominal fullness is a symptom present in both Taiyin disease and Yangming disease, yet although the location is the same, their functions differ. Taiyin governs excretion; when Taiyin is diseased, putrid and turbid qi stagnates and fails to flow smoothly, resulting in fullness and intermittent pain. Yangming governs reception and decomposition; when Yangming is diseased, putrid and turbid matter becomes dry and bound, failing to move, resulting in severe excess and pain. Thus, it is known that "severe excess and pain" belongs to Yangming disease, not Taiyin disease. Zhang Zhongjing, because the exterior syndrome had not resolved and yang pathogenic factors had already sunk into Taiyin, doubled the dosage of Shaoyao to benefit the spleen and harmonize the middle jiao, thereby eliminating abdominal fullness and intermittent pain. This is the method of using yin to harmonize yang. If the exterior pathogen remains unresolved and the yang pathogen sinks into Yangming, Dahuang is added to moisten the stomach and unblock constipation, thereby eliminating the pain of severe excess. This is the method of simultaneously releasing the exterior and interior. Any reckless use of purgatives will inevitably damage the qi and fluids of the stomach. When stomach qi is deficient, yang pathogens invade the yin aspect, causing the disease to transfer to Taiyin; when stomach fluids are exhausted, two yangs contend with each other, causing the disease to transfer to Yangming. When belonging to Taiyin, there is abdominal fullness and intermittent pain without hardness, due to the deficiency of the yin pathway; when belonging to Yangming, there is abdominal fullness, severe excess, and pain, due to the excess of the yang pathway. Fullness with intermittent pain is an omen of diarrhea; severe excess with pain is a sign of dry feces. Therefore, doubling Shaoyao represents a slight modification of the Xiao Jianzhong Decoction formula; slightly adding Dahuang indicates the prescription of the Tiaowei Chengqi Tang formula.

In Taiyin disease, if the pulse is weak and the patient continues to have spontaneous bowel movements, if Da Huang or Shao Yao were indicated, their dosages should be reduced, because the patient's stomach qi is weak and easily disturbed by such agents.

[Annotation] In Taiyin disease, there must be abdominal fullness and pain. The treatment method requires careful consideration based on the pulse. If the patient's pulse is weak, it indicates insufficiency in the center. Although the qi does not rush downward to the lower abdomen, there will necessarily be continuous spontaneous bowel movements. If Da Huang or Shao Yao were indicated, their dosages should be reduced, because the weak stomach qi cannot withstand harsh purgation, and the bowels are easily moved. From this, it can be inferred that for patients with hard stools, regardless of whether they belong to yin or yang channels, those with a weak pulse should not be lightly purged.

[Collected Notes] Cheng Zhi said: This discusses weak Taiyin pulses, fearing continued diarrhea. Even with abdominal pain, attack methods should not be used, which elucidates the principle alongside the Jianzhong Decoction.
Yu Chang said: This section of caution elucidates the content mutually with the Yangming chapter. In the Yangming chapter, phrases like "no passage of gas," "hard first then loose," and "not yet determined to be hard" all express fear of damaging the spleen qi of Taiyin. Here, in Taiyin syndrome with a weak pulse, fearing continued diarrhea, reducing the use of Da Huang and Shao Yao despite abdominal pain expresses fear of damaging the stomach qi of Yangming.
Wang Hu said: One might ask: Da Huang damages stomach qi, so it should be reduced; Shao Yao regulates spleen yin, why should it also be reduced? The answer is: A weak pulse indicates deficient qi. Zhang Zhongjing holds that warm and sweet herbs generate qi. Shao Yao has a sour and cold flavor. Although not as harsh as Da Huang, it is not suitable for excessive use by those with weak qi, hence it is also reduced.

In Shanghan (Cold Damage), if the pulse is floating and slow, and the hands and feet are naturally warm, the disease is associated with Taiyin. Taiyin should manifest as jaundice; however, if urination is spontaneous and free, jaundice cannot develop. After seven or eight days, even if there is sudden irritability and diarrhea occurring more than ten times a day, it will certainly stop spontaneously. This is because the spleen's healthy qi is substantial (Pi Jia Shi), and the putrid and turbid matter is destined to be expelled.

[Annotation] In Shanghan, a floating and slow pulse with hot hands and feet indicates association with Taiyang. Now, with warm hands and feet, we know it is associated with Taiyin. Taiyin is associated with dampness; when dampness and heat bind together, jaundice should develop. If urination is spontaneous, dampness does not accumulate, and heat does not bind, so jaundice cannot develop. If after seven or eight days the stool becomes hard, it would indicate transfer to Yangming. Since it is not hard now, even with sudden irritability and diarrhea more than ten times a day, it will certainly stop spontaneously. Why? Because the floating and slow pulse with warm hands and feet indicates that the Taiyin spleen was originally substantial. The pathogen cannot remain, and the putrid and turbid matter is destined to be expelled.

[Collected Notes] Cheng Zhi said: Regarding spontaneous diarrhea, if the pulse is floating and slow and the hands and feet are warm, it indicates spleen excess. The Taiyin pulse is inherently slow. Thus, although floating and slow resembles Taiyang wind-strike, the spontaneous warmth of the hands and feet distinguishes it from the fever of Taiyang and the cold extremities of Shaoyin and Jueyin, confirming association with Taiyin. Taiyin damp-heat steaming will inevitably cause jaundice. However, if urination is free, dampness drains downward, and jaundice does not occur. Although this sudden irritability and frequent diarrhea resemble Shaoyin syndrome, the diarrhea will stop spontaneously. This is because the floating and slow pulse and warm hands and feet indicate strong spleen qi, not comparable to deficiency-cold. The putrid and turbid matter accumulated by damp-heat will naturally be driven out downward. If one fails to distinguish this and treats with Sini Tang, it would be an error.
Cheng Yingmao said: When Taiyin presents with floating-slow pulse and warm hands and feet, stomach yang is active, ruling out pain from cold organs, though yin depression may exist. Lack of urination leads to jaundice; even if jaundice occurs, it is not yin-jaundice. If urination is spontaneous, jaundice cannot develop. As yin seeks to depress, yang drives it out. By the seventh or eighth day, despite sudden irritability and diarrhea over ten times a day, it will stop. This is because the pulse is floating and slow rather than deep and weak, and hands/feet are warm rather than cold. Yin receives protection from yang, thus remaining warm; being warm means not deficient, constituting "spleen substantiality." The Classic states: "The yang pathway is excess, the yin pathway is deficient." Yin moving along the yang pathway would not tolerate pathogens lingering long; thus, the putrid and turbid matter is expelled.
Wang Hu said: Diarrhea with irritability indicates death when diarrhea precedes irritability, signifying collapse of healthy qi and disturbance by pathogenic qi. Here, irritability precedes diarrhea, indicating substantial healthy qi in the spleen resisting the pathogen, resulting in sudden onset of irritability and heat.

In Taiyang wind-strike, if there is irritability and pain in the four limbs, and the pulse is slightly choppy and long, recovery is imminent.

[Annotation] "Taiyin wind-strike" refers to a Taiyin disease transmitted from Taiyang wind-strike, hence presenting with irritability and pain in the four limbs. Yin and yang are discussed in terms of floating and sunken. With a Taiyin pulse that is floating-micro and sunken-choppy, combined with the long pulse characteristic of Yangming, this constitutes a yin disease presenting with yang pulse. Pathogenic factors transferring from zang to fu indicate impending recovery.

[Collected Notes] Cheng Zhi said: Shanghan involves yin pathogens, causing spontaneous diarrhea, treated with Sini Tang. Wind-strike involves yang pathogens, causing irritability and pain in the four limbs. In Taiyin disease, a floating pulse usually indicates Taiyin wind-strike.
Yu Chang said: Observing the pulse as long rather than short amidst the micro and choppy qualities indicates that primordial qi is intact, and the disease will heal spontaneously.

Taiyin disease resolves during the hours from Hai to Chou.

[Annotation] Pathogens resolve during their time of dominance. Hai, Zi, and Chou are the hours when Taiyin is dominant. During this period of dominance, the pathogen cannot prevail and resolves spontaneously.