仲景曰。脉尺寸俱沉细者。太阴受病也。当四五日发。以其脉布
胃中。络于嗌。故腹满而嗌干。庞氏云。宜大承气汤下之。雍谓更当
详证而后可下。此即仲景辨太阴之说也。未可遽下。
又曰。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。雍曰。若太阴本证。脏寒自利不渴。当根据仲景温
之以四逆辈。若本太阳病。因误下腹痛。转属太阴者。根据仲景用桂枝
加芍药汤。以太阳误下。表证未解也。
又曰。太阴中风。四肢烦疼。阳微阴涩而长者。为欲愈。
又曰。太阴病欲解时。从亥至丑上。
又曰。太阴病。脉浮者。可发汗。宜桂枝汤。
又曰。自利不渴者。属太阴。以其脏有寒故也。当温之。宜服四
逆辈。
又曰。伤寒三日。太阳脉弱。至四日。太阴脉大。庞氏云。脉大而
胸满多痰者。可吐之。无此证者。宜汗之。雍曰。吐用瓜蒂散。汗用桂
枝汤。仍须脉浮。则可汗也。
又曰。伤寒脉浮而缓。(庞氏云亦大之类)手足自温者。系在太
阴。太阴当发身黄。(庞氏云。小便不利者。必发黄。以五苓散加茵
陈主之。)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。腐秽当去故也。庞氏云。可类要四味桔皮
汤。
又曰。本太阳病。医反下之。因而腹满时痛者。属太阴也。桂枝
加芍药汤主之。大实痛者。桂枝加大黄汤主之。
又曰。太阴为病。脉弱。其人续自便利。设当行大黄芍药者。宜
减之。以其人胃气弱。易动故也。校正云。下利者。先煎芍药二沸。雍
曰。以脉弱。故知胃气弱也。
张仲景说:寸脉和尺脉都呈现沉细象的,是太阴经受邪所致。这种病通常在发病后的第四或第五天显现症状。因为太阴经脉分布进入胃中,并联络咽喉,所以会出现腹部胀满和咽喉干燥的症状。庞安时认为,应当使用大承气汤来攻下。郭雍认为,更应当详细审查证候之后才能考虑使用下法。这就是张仲景关于辨别太阴病的论述,此时不可贸然使用下法。
又说:太阴病的主要表现是腹部胀满、呕吐、饮食难以下咽、腹泻逐渐加重,时常出现腹部自发性疼痛。如果误用下法,必然导致胸膈下方痞结硬满。郭雍说:如果是太阴的本证,表现为脏寒导致的自发性腹泻且不口渴,应当遵循张仲景的教导,用四逆汤类方剂进行温补。如果是原本患有太阳病,因误用下法导致腹痛,进而转属为太阴病的,应当遵循张仲景的教导,使用桂枝加芍药汤,这是因为太阳病误下后,表证仍未解除。
又说:太阴病感受风邪,四肢烦扰疼痛,脉象微弱而涩且长的,是病情将要痊愈的迹象。
又说:太阴病欲解的时间,是从亥时到丑时这段时间。
又说:自发性腹泻且不口渴的,属于太阴病,这是因为脏腑有寒的缘故。应当采用温法,适宜服用四逆汤类方剂。
又说:伤寒发病三天,太阳脉象微弱;到了第四天,太阴脉象变大。庞安时说:脉象大且伴有胸部胀满、多痰的,可以使用吐法。没有这些证候的,应当使用汗法。郭雍说:吐法使用瓜蒂散,汗法使用桂枝汤,但仍需脉象浮,才可以发汗。
又说:伤寒脉象浮而缓,手足自然温暖的,病系在太阴。太阴病应当出现身体发黄(庞安时说:小便不利的,必定发黄,以五苓散加茵陈主治)。如果小便通畅自利,就不会发黄。到了第七八天,虽然突然烦躁并伴有腹泻,一天十几次,但必定会自行停止,这是因为脾家实(正气恢复),腐败秽浊之物应当排出的缘故。庞安时说:可以用《类要》中的四味桔皮汤。
又说:原本是太阳病,医生反而使用了下法,因而导致腹部胀满、时时作痛的,属于太阴病,由桂枝加芍药汤主治。如果实证疼痛严重的,由桂枝加大黄汤主治。
又说:太阴病,脉象弱,病人持续大便通畅。假设需要使用大黄和芍药的,应当减少用量,因为病人的胃气虚弱,容易受到药物影响而动泄。校正者注云:对于下利的情况,先煎煮芍药两沸。郭雍说:因为脉象弱,所以知道胃气虚弱。
Zhang Zhongjing stated: When both the cun (inch) and chi (foot) pulses are deep and fine, it indicates that the Taiyin meridian is affected. This condition typically manifests on the fourth or fifth day of onset. Since the Taiyin meridian distributes into the stomach and connects with the throat, symptoms include abdominal fullness and dryness of the throat. Pang Anshi suggested using Dachengqi Tang (Major Order the Qi Decoction) to purge. Guo Yong argued that one must carefully examine the syndrome before considering purgation. This refers to Zhang Zhongjing's differentiation of Taiyin disease; purgation should not be applied hastily.
He further stated: The primary manifestations of Taiyin disease include abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purgation is mistakenly applied, it will inevitably lead to hardness and knotting below the chest. Guo Yong said: For primary Taiyin syndromes characterized by cold in the zang organs leading to spontaneous diarrhea without thirst, one should follow Zhang Zhongjing’s guidance and use warming formulas such as Sini Tang (Frigid Extremities Decoction). However, if a patient originally had Taiyang disease (Taiyang Meridian Disease), and due to mistaken purgation developed abdominal pain and the condition transferred to Taiyin, one should follow Zhang Zhongjing’s guidance and use Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony Root), because the exterior syndrome of Taiyang has not yet resolved after mistaken purgation.
He also stated: In Taiyin disease complicated by wind-pathogen, with painful and uncomfortable limbs, if the pulse is weak, choppy, and long, it indicates that recovery is imminent.
He further stated: The time when Taiyin disease tends to resolve is from Hai hour (21:00–23:00) to Chou hour (01:00–03:00).
He also stated: In Taiyin disease, if the pulse is floating, sweating therapy may be used, and Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
He further stated: Spontaneous diarrhea without thirst belongs to Taiyin, caused by cold in the internal organs. Warming therapy should be employed, and Sini Tang (Frigid Extremities Decoction) or similar formulas are suitable.
He also stated: In Shanghan (Cold Damage) disease, on the third day, the Taiyang pulse becomes weak; by the fourth day, the Taiyin pulse becomes large. Pang Anshi noted: If the pulse is large accompanied by chest fullness and excessive phlegm, emesis therapy may be used. If these symptoms are absent, sweating therapy is appropriate. Guo Yong clarified: Emesis uses Gengti San (Melon Stalk Powder); sweating uses Guizhi Tang (Cinnamon Twig Decoction). However, the pulse must still be floating to justify sweating therapy.
He further stated: In Shanghan disease, if the pulse is floating and slow, and the hands and feet remain naturally warm, the disease is associated with Taiyin. Taiyin disease typically presents with jaundice (Pang Anshi added: If urination is difficult, jaundice will definitely occur; treat with Wuling San (Five-Ingredient Poria Powder) augmented with Yinchen (Artemisiae Scopariae Herba)). If urination is normal and free, jaundice will not develop. By the seventh or eighth day, even if there is sudden irritability and severe diarrhea occurring more than ten times a day, it will inevitably stop spontaneously. This is because the spleen’s qi has become sufficient (Pi Jia Shi), allowing the rotting and foul matter to be expelled. Pang Anshi suggested using Siwei Jupi Tang (Four-Ingredient Tangerine Peel Decoction) from the *Lei Yao*.
He also stated: If a patient originally had Taiyang disease, but the physician mistakenly applied purgation, resulting in abdominal fullness and intermittent pain, this belongs to Taiyin and is treated with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony Root). If the pain is severe and excess-type, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb) is indicated.
He further stated: In Taiyin disease, if the pulse is weak and the patient continues to have loose stools, any prescription containing Dahuang (Rhei Radix et Rhizoma) or Shaoyao (Paeoniae Radix) should have its dosage reduced. This is because the patient’s stomach qi is weak and easily disturbed. The corrected text notes: For patients with diarrhea, boil Shaoyao (Paeoniae Radix) for two boils first. Guo Yong commented: The weak pulse indicates weak stomach qi.