脏病连经 太阴病脉浮者可发汗宜桂枝汤(太阴经病桂枝症)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(四逆桂枝症)本太阳病医反下之因而腹满时痛者属太阴也(桂枝芍药症)大实痛者桂枝加大黄主之(桂
枝大黄症)
脏病 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发热头痛脉反沉不瘥身体疼痛当温其里宜四
逆汤(四逆症)下利清谷不可攻表汗出必胀满(下利清谷症)自利不渴者属太阴其脏有寒故也当温之(四逆症)伤寒胸
中有热胃中有邪气腹中痛欲呕吐者(黄连汤症)太阴为病脉弱续自便利设当行大黄芍药者宜减之以胃气弱易动故也(芍
药大黄症)伤寒脉浮而缓手足自温者系在太阴太阴身当发黄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
以脾家实腐秽当去也(暴烦下利症)伤寒七八日身黄如橘子色小便不利腹微满(茵陈蒿症)伤寒瘀热在里身必发黄(麻
黄连翘赤小豆症)伤寒身黄发热者(栀子柏皮症)伤寒发汗已身目为黄以寒湿在里不解故也不可下当于寒湿中求之(寒
湿发黄症)太阴中风四肢烦疼阳微阴涩而长者为欲愈(中风欲愈)太阴病欲解时从亥至丑上
方药
四逆汤
甘草 干姜 附子
黄连汤
黄连 半夏 人参 甘草 大枣 干姜 桂枝
桂枝芍药汤
桂枝 甘草 大枣 生姜 芍药 于桂枝汤内加芍药三两
桂枝加大黄汤
桂枝 甘草 大枣 生姜 芍药 大黄
茵陈蒿汤
茵陈蒿 栀子 大黄
麻黄连翘赤小豆汤
麻黄 杏仁 生姜 生梓白皮 连翘 甘草 大枣 赤小豆
栀子柏皮汤
栀子 甘草 黄柏皮
脏病牵连经络:太阴病脉象浮的,可以发汗,适宜用桂枝汤(这是太阴经病兼有桂枝汤证的情况)。出现下利、腹部胀满、身体疼痛的症状,应当先温补里虚,然后再解表;温里适宜用四逆汤,解表适宜用桂枝汤(这是四逆汤与桂枝汤证并存的情况)。原本患太阳病,医生反而使用攻下法,导致腹部胀满、时时作痛的,属于太阴病(适用桂枝加芍药汤证);如果疼痛剧烈且伴有实邪阻滞的,用桂枝加大黄汤主治(这是桂枝汤加大黄的证候)。
脏病本身:太阴病的典型症状是腹部胀满、呕吐、饮食难以下咽,腹泻逐渐加重,时常腹痛。如果误用攻下法,必然导致胸膈下部痞结硬满。若有发热、头痛,但脉象反而沉细,病情不愈,身体疼痛,应当温补里虚,适宜用四逆汤(这是四逆汤证)。下利排出未消化的食物残渣,不可攻表,若强行发汗导致出汗,必然引起腹部胀满(这是下利清谷证)。自发性腹泻且不口渴的,属于太阴病,这是因为内脏有寒的缘故,应当采用温法治疗(这是四逆汤证)。伤寒病,胸中有热,胃中有邪气,腹中疼痛,想要呕吐的,适用黄连汤证。太阴病脉象弱,持续自行大便通畅,假如必须使用大黄、芍药的,应当减少用量,因为胃气虚弱,容易受药物影响而损伤(这是芍药与大黄需减量使用的证候)。伤寒脉象浮而缓,手足自然温暖,病系在太阴;太阴病身体应当发黄,但如果小便自利,则不会发黄。到了七八天,虽然突然烦躁并腹泻,一天十几次,但必定会自行停止,这是因为脾家正气恢复,腐秽之物应当排出的缘故(这是暴烦下利的自愈征兆)。伤寒七八天,身体发黄如橘子色,小便不利,腹部轻微胀满,适用茵陈蒿汤证。伤寒瘀热郁结在体内,身体必定发黄,适用麻黄连翘赤小豆汤证。伤寒身体发黄且发热的,适用栀子柏皮汤证。伤寒发汗后,身体和眼睛发黄,是因为寒湿在体内未能解除,所以不可攻下,应当在治疗寒湿的方法中寻找对策(这是寒湿发黄证)。太阴中风,四肢烦扰疼痛,脉象微涩而长,是即将痊愈的表现(中风欲愈证)。太阴病欲解的时间是从亥时到丑时。
方药:
四逆汤:甘草、干姜、附子。
黄连汤:黄连、半夏、人参、甘草、大枣、干姜、桂枝。
桂枝加芍药汤:桂枝、甘草、大枣、生姜、芍药,即在桂枝汤基础上增加芍药三两。
桂枝加大黄汤:桂枝、甘草、大枣、生姜、芍药、大黄。
茵陈蒿汤:茵陈蒿、栀子、大黄。
麻黄连翘赤小豆汤:麻黄、杏仁、生姜、生梓白皮、连翘、甘草、大枣、赤小豆。
栀子柏皮汤:栀子、甘草、黄柏皮。
When a zang-organ disease extends to the meridians: In Taiyin disease, if the pulse is floating, sweating may be induced; Guizhi Tang (Cinnamon Twig Decoction) is appropriate (this refers to Taiyin meridian disease with Guizhi Tang syndrome). If there are diarrhea, abdominal fullness, and body pain, one should first warm the interior and then attack the exterior. To warm the interior, Sini Tang (Frigid Extremities Decoction) is appropriate; to attack the exterior, Guizhi Tang is appropriate (this refers to the coexistence of Sini Tang and Guizhi Tang syndromes). Originally suffering from Taiyang disease, if the physician erroneously used purgation, resulting in abdominal fullness and frequent pain, this belongs to Taiyin disease (Guizhi Jia Shaoyao Tang syndrome); if there is severe pain due to excess and stagnation, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb) is indicated (this refers to the syndrome of Guizhi Tang plus Dahuang).
Disease within the Zang organs: The defining symptoms of Taiyin disease include abdominal fullness, vomiting, inability to eat, worsening diarrhea, and spontaneous abdominal pain. If purgation is mistakenly applied, it will inevitably lead to hardness and obstruction below the chest. If accompanied by fever and headache, but the pulse is unexpectedly deep and the condition does not improve, along with body pain, one should warm the interior; Sini Tang is appropriate (Sini Tang syndrome). In cases of diarrhea with undigested food, the exterior should not be attacked; forcing sweat will inevitably cause abdominal fullness (diarrhea with clear grains syndrome). Spontaneous diarrhea without thirst indicates Taiyin disease, caused by cold in the zang organs; warming treatment is required (Sini Tang syndrome). In Shanghan (cold damage), if there is heat in the chest, pathogenic qi in the stomach, abdominal pain, and a desire to vomit, Huanglian Tang (Coptis Decoction) is indicated. In Taiyin disease, if the pulse is weak and there is continuous spontaneous bowel movement, even if Dahuang (Rhubarb) and Shaoyao (Peony Root) were to be used, their dosages should be reduced because the stomach qi is weak and easily disturbed (syndrome requiring reduced dosage of Shaoyao and Dahuang). In Shanghan, if the pulse is floating and slow, and the hands and feet are naturally warm, the disease is associated with Taiyin; the body should become jaundiced, but if urination is normal, jaundice will not occur. After seven or eight days, although sudden irritability and diarrhea occurring more than ten times a day may happen, it will stop spontaneously because the spleen's righteous qi is restored and putrefied filth is being expelled (signs of self-hearing in sudden irritability and diarrhea). In Shanghan after seven or eight days, if the body is yellow like an orange peel, urination is difficult, and the abdomen is slightly full, Yinchen Hao Tang (Artemisiae Scopariae Decoction) is indicated. If stagnant heat is trapped inside in Shanghan, jaundice will surely occur; Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia, and Red Bean Decoction) is indicated. If Shanghan presents with jaundice and fever, Zhizi Bopi Tang (Gardeniae and Phellodendron Bark Decoction) is indicated. After inducing sweat in Shanghan, if the body and eyes turn yellow because cold-dampness remains unresolved in the interior, purgation is contraindicated; one should seek treatment among methods for cold-dampness (cold-damp jaundice syndrome). In Taiyin wind-stroke, if the four limbs are painful and irritable, and the pulse is faint, choppy, yet long, recovery is imminent (wind-stroke approaching resolution). The time when Taiyin disease tends to resolve is from Hai hour to Chou hour.
Formulas:
Sini Tang (Frigid Extremities Decoction): Gancao (Licorice Root), Ganjiang (Dried Ginger), Fuzi (Aconite Root).
Huanglian Tang (Coptis Decoction): Huanglian (Coptis Rhizome), Banxia (Pinellia Tuber), Renshen (Ginseng Root), Gancao (Licorice Root), Dazao (Jujube Fruit), Ganjiang (Dried Ginger), Guizhi (Cinnamon Twig).
Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root): Guizhi (Cinnamon Twig), Gancao (Licorice Root), Dazao (Jujube Fruit), Shengjiang (Fresh Ginger), Shaoyao (Peony Root); add three liang of Shaoyao to Guizhi Tang.
Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb): Guizhi (Cinnamon Twig), Gancao (Licorice Root), Dazao (Jujube Fruit), Shengjiang (Fresh Ginger), Shaoyao (Peony Root), Dahuang (Rhubarb Root).
Yinchen Hao Tang (Artemisiae Scopariae Decoction): Yinchenhao (Artemisiae Scopariae Herba), Zhizi (Gardeniae Fructus), Dahuang (Rhubarb Root).
Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia, and Red Bean Decoction): Mahuang (Ephedrae Herba), Xingren (Prunus Armeniacae Semen), Shengjiang (Fresh Ginger), Shengzibapi (Broussonetiae Cortex), Lianqiao (Forsythiae Fructus), Gancao (Licorice Root), Dazao (Jujube Fruit), Chixiaodou (Vigna Angularis Seed).
Zhizi Bopi Tang (Gardeniae and Phellodendron Bark Decoction): Zhizi (Gardeniae Fructus), Gancao (Licorice Root), Huangbipi (Phellodendri Cortex).