按热病论云。太阴脉。布胃中。络于嗌。故腹满嗌干。此热伤太阴之标。自阳部注经之症。非太阴本病也。仲景立
本病为提纲。因太阴主内。故不及中风四肢烦疼之表。又为阴中至阴。故不及热病嗌干之症。太阴为开。又阴道虚。太
阴主脾。所生病。脾主湿。又主输。故提纲主腹满时痛。而吐利。皆是里虚不固。湿胜外溢之症也。脾虚则外亦虚。食
不下者。胃不主纳也。要知胃家不实。即转太阴耳。世举阳明传少阳之谬。反昧传太阴之义。热病腹满。是热郁太阴之
经。有嗌干可证。症在表也。寒温腹满。是寒生至阴之藏。有自利可证。病在本也。脾经有热。则阴精不上输于肺。故
嗌干。脏有寒。则脾不能为胃行其精液。故下利。夫阳明之当下因本病。而太阴之下症。反在标病。可见阴阳异位之故。
又以见阴从阳转之义也。
参中阴溜府之义。知热邪不遽入至阴。虽热在太阴之经。而实仍在阳明之胃。可知下症只在阳明。太阴本无下法。
腹满亦两经之症。不大便而腹满。或绕脐痛者。为实热。属阳明。下利而腹满时痛。为虚寒。属太阴。寒湿是太阴
本症。湿热又伤寒所致之变症也。其机关在小便不利。则湿热外见而身黄。小便自利。非暴烦下利而自愈。即大便硬而
不使。所以然者。脾肤相连。此脾家实。则腐秽自去。而成太阴之开。若胃家实。则地道不通。而转阳明之合矣。叔和
但知有阳明。不知有太阴阳明症。
序例谓太阴受病。脉当沉细。不知沉细。是太阴本病之脉。不是热症嗌干之脉。盖脉从病见。如太阴中风则脉浮。
不从脏之阴。而从风之阳也。然浮为麻黄汤脉。而用桂枝者。以太阴是里之表症。桂枝汤。是里之表药。因脾主肌肉。
是宜解肌耳。太阴伤寒脉浮而缓者。亦非太阴本病。盖浮为阳脉。缓为胃脉。太阴伤寒。脉不沉细。而反浮缓。是阴中
有阳脉。有胃气。所以手足自温。而显脾家之实。或发黄便硬。而转属阳明。此脉症在太阴阳明之间。故曰系在。若太
阴自受寒邪。不应如是矣。
太阴脉浮为在表。当见四肢烦疼等症。沉为在里。当兼腹痛吐利等症。表有风热可发汗。宜桂枝汤。里有寒邪当温
之。宜四逆辈。太阳而脉沉者。因于寒。寒为阴邪。沉为阴脉也。太阴而脉浮者。因于风。风为阳邪。浮为阳脉也。当
知脉从病变。不拘于经。故阳经有阴脉。阴经有阳脉。世为脉在三阴则俱沉。阴经不当发汗者。未审此耳。
太阴中风。阳微阴涩。不长者为欲愈。要知涩与长。不是并见。涩本病脉。涩而转长。病始愈耳。风脉本浮。今浮
已微。知风邪当去。涩则少气少血。故中风。今长则气结。故愈。
太阴中风。四肢烦疼。太阴伤寒。手足自温。此指表热言也。热在四肢。则身体不热可知。盖太阴主内。表当无热。
惟四肢为诸阳之本。脾为胃行津液以灌四旁。故得主四肢。则四肢之温热。仍是阳明之阳也。且曰自温。便见有时不温。
有时四肢厥逆矣。
内经云。人有四肢热。逢风而如炙如火者。是阴气虚而阳气盛。风者阳也。四肢亦阳也。两阳相搏。是人当肉烁。
此即太阴中风症。要知太阴中风。与三阳不同。太阴之病。名曰关 。故阳邪不得深入。惟病在四关。久而不愈。脾液
不足以充肌肉。故肉烁。世人最多此症。其有手足心热者。亦中风之轻者耳。然太阴中风。因阴虚而阳凑之。外风为内
热所致。但当滋阴以和阳。不得驱风而增热也。
手足自温句。暗对身不发热言。非言太阴伤寒。必当手足温也。夫病在三阳。尚有手足冷者。何况太阴。陶氏分太
阴手足温。少阴手足寒。厥阴手足冷。是大背太阴手足烦疼。少阴一身尽热之义矣。凡伤于寒则为病热。寒为阴。太阴
为至阴。两阴相合。无热可发。惟四末为阴阳之会。故尚温耳。惟手足自温。中宫不遽受邪。故或发身黄。或暴烦下利
自止。即手足自温处。因以见脾家之实也。
发黄。自阳明病。太阴身当发黄。非言太阴本有发黄症也。以手足温处。是阳明之阳盛。寒邪不得伤太阴之脏。脏
无寒而身有湿。故当发黄。若湿从溺泄。暴烦下利。仍是脾主转输。故不失为太阴病。若烦而不利。即胃家之热实。非
太阴之湿热矣。此太阴伤寒。全藉阳明之阳为之根。故有转属之症也。人知伤寒以阳为主。不知太阴伤寒以阳明为主。
东垣以有声无声分呕吐非也。呕吐皆有声有物。惟干呕是有声无物。呕以水胜。属上焦也。吐以物胜。属中焦也。
六经皆有呕属少阳。以喜呕。故吐属太阴。而不属阳明。亦主输主内之分。
太阳以阴为根。而太阴以阳为本。太阳不敢妄汗。尤恐亡少阴之津也。太阴不敢轻下。恐伤阳明之气也。太阴本无
下症。因太阳妄下。而阳邪下陷于太阴。因而有桂枝汤。加芍药等法。太阴脉弱。知胃气已动。盒饭少加矣。此因里急
后重者不可不用。又不可多用。故如此叮咛耳。
根据《热病论》记载：太阴经脉，分布于胃中，联络于咽喉。因此出现腹部胀满、咽喉干燥的症状。这是热邪损伤了太阴经的标部（外部表现），是由阳经传入本经的病证，并非太阴的本脏病。
张仲景确立太阴病的提纲，是因为太阴主司内脏功能（主内），所以不涉及中风引起的四肢烦痛等表证；又因为太阴是“阴中之至阴”，所以也不涉及热病中的咽喉干燥等症状。
太阴主“开”（开启、发散），且属于阴道（虚静之道）。太阴对应脾脏，其所主的病证中，脾主湿，又主运化输布。因此，太阴病的提纲主要体现为腹部胀满、时而疼痛，以及呕吐、下利，这些都是里气虚弱不固、湿气过盛向外溢出的病证。
脾气虚弱，则体表也虚弱。饮食不能下行，是因为胃不能正常受纳。要知道，只要胃中没有实邪结滞，病邪就会转入太阴。世人常错误地认为病邪从阳明传至少阳，反而忽略了传变至太阴的道理。
《热病论》所说的腹满，是热邪郁结在太阴经脉，伴有咽喉干燥作为佐证，病位在表。寒温病（此处指伤寒类疾病）的腹满，是寒邪生于至阴之脏，伴有自发性下利作为佐证，病位在本。
脾经有热，则阴精不能向上输注于肺，所以导致咽喉干燥；脏腑有寒，则脾不能为胃输送精微液体，所以导致下利。
阳明病需要攻下的原因，在于其本病（腑实）；而太阴病出现下利的症状，反而是在标病（脾虚湿盛）阶段。这可见阴阳病位不同的缘故，同时也体现了阴病可以从阳转化的道理。
参考“中阴溜府”（阴经病邪传入阳经腑）的意义，可知热邪不会立即进入至阴之脏。虽然热邪在太阴经脉，但实际上仍在阳明的胃中。可知攻下法只适用于阳明病，太阴本脏没有攻下法。
腹部胀满是这两经都有的症状。如果不大便且腹部胀满，或者绕脐疼痛，属于实热，归属于阳明；如果下利且腹部胀满、时而疼痛，属于虚寒，归属于太阴。寒湿是太阴的本症，湿热则是伤寒导致的变症。
其关键机制在于小便是否不利。如果小便不利，湿热外现则身体发黄；如果小便自利，如果不是突然烦躁并下利后自愈，就是大便干硬而不通。之所以这样，是因为脾与胃相表里相连。如果是脾家实证（脾运化功能恢复或积滞排出），腐秽之物自然去除，从而形成太阴的“开”机；如果是胃家实证（胃肠燥结），则地道不通，转而成为阳明的“合”机。王叔和只知道有阳明病，不知道还有太阴与阳明合病的情况。
《序例》说太阴受病，脉象应当沉细。不知道沉细脉是太阴本病的脉象，而不是热症咽喉干燥的脉象。一般来说，脉象随病症变化。如太阴中风，脉象则浮，这是因为不从脏之阴，而从风之阳。
然而，浮脉通常是麻黄汤证的脉象，这里却用桂枝汤，是因为太阴病属于“里之表症”（半表半里或里证兼表），桂枝汤是治疗“里之表症”的药物。因为脾主肌肉，所以适宜使用解肌的方法。
太阴伤寒，脉象浮而缓，也不是太阴的本病。因为浮是阳脉，缓是胃脉。太阴伤寒，脉不沉细反而浮缓，说明阴中有阳脉，有胃气，所以手足自然温暖，显现出脾家的实证。或者出现发黄、大便干硬，从而转属阳明。这种脉症介于太阴和阳明之间，所以说“系在”（关联于）。如果是太阴直接感受寒邪，不应如此。
太阴脉浮，表示病在表，应当见到四肢烦痛等症状；脉沉，表示病在里，应当兼见腹痛、吐利等症状。表有风热可以发汗，宜用桂枝汤；里有寒邪当温补，宜用四逆汤之类。
太阳病脉沉，是因为感寒，寒为阴邪，沉为阴脉。太阴病脉浮，是因为感风，风为阳邪，浮为阳脉。应当知道脉象随病变而变化，不拘泥于某一经。所以阳经可以有阴脉，阴经可以有阳脉。世人认为三阴经脉象都是沉的，阴经不当发汗，就是没有明白这个道理。
太阴中风，脉象阳微阴涩，脉象由涩转长是病情将要痊愈的迹象。要知道，涩脉和长脉不是同时出现的。涩脉是本病的脉象，涩脉转为长脉，病才开始痊愈。风脉本应浮，现在浮象已微弱，可知风邪将去。涩脉代表少气少血，所以发生中风；现在脉长，说明气机通畅，所以痊愈。
太阴中风，表现为四肢烦痛；太阴伤寒，表现为手足自温。这是指表热而言。热在四肢，则身体其他部位不发热可知。因为太阴主内，体表应当无热。只有四肢是诸阳之本，脾为胃输送津液以灌溉四周，所以主管四肢。那么四肢的温热，仍然是阳明之阳气的作用。而且说“自温”，就表明有时不温，有时会出现四肢厥逆。
《内经》说：人有四肢发热，遇到风就像被烧烤一样火热，这是阴气虚而阳气盛。风是阳邪，四肢也是阳，两阳相搏，人就会肌肉消瘦。这就是太阴中风的症状。要知道太阴中风与三阳病不同。太阴的病，名为“关阖”失调（此处原文似有缺字或特定语境，意指病在关隘），所以阳邪不能深入，只在四肢关隘处停留，久治不愈，脾液不足以充盈肌肉，所以肌肉消瘦。世上这种人最多。那些手心脚心发热的，也是中风较轻的情况。然而太阴中风，是因为阴虚而导致阳邪凑集，外风是由内热引起的，应当滋阴以调和阳气，不得驱散风邪而增加内热。
“手足自温”这一句，暗含了对比“身体不发热”。并不是说太阴伤寒必然手足温。病在三阳经，还有手足冷的情况，何况太阴？陶氏将太阴分为手足温，少阴分为手足寒，厥阴分为手足冷，这大大违背了太阴“手足烦疼”、少阴“一身尽热”的原义。
凡是伤于寒邪就会变成热病。寒是阴邪，太阴是至阴，两阴相合，没有热可发。只有四肢末端是阴阳交会之处，所以尚且温暖。只有手足自温，说明中焦脾胃没有立即受邪，所以或者发黄，或者突然烦躁下利后自愈。正是在手足自温这一点上，可以看出脾家的实证。
发黄，源于阳明病。太阴身当发黄，并不是说太阴本脏有发黄的病症。因为手足温的地方，是阳明阳气旺盛，寒邪不能伤害太阴之脏。脏无寒而有湿，所以应当发黄。如果湿邪从小便排泄，突然烦躁下利，仍然是脾主转输的功能，所以不失为太阴病。如果烦躁但不利，那就是胃家的热实，不是太阴的湿热了。这是太阴伤寒，完全依赖阳明之阳作为根本，所以才有转属阳明的症状。人们只知道伤寒以阳为主，不知道太阴伤寒以阳明为主。
李东垣用有声无声来区分呕吐是错误的。呕吐都是有声音且有物吐出，只有干呕是有声无物。呕是因为水饮胜，属于上焦；吐是因为食物胜，属于中焦。六经都有呕吐，但归属于少阳，是因为少阳喜呕，所以吐归属于太阴，而不归属于阳明。这也是主输（输出）与主内（受纳）的区别。
太阳以阴为根，而太阴以阳为本。太阳不敢妄用发汗法，尤其担心亡失少阴的津液。太阴不敢轻用攻下法，恐怕损伤阳明的气机。太阴本无攻下症，是因为太阳病误用攻下，导致阳邪陷入太阴，因而有桂枝汤加芍药等方法。太阴脉弱，说明胃气已经动，饭量应当稍微增加（此处原文“盒饭”疑为衍文或错字，结合上下文意为饮食状况）。这是因为如果有里急后重的症状，不可不用此法，但又不可多用，所以如此叮咛告诫。
According to the *Treatise on Heat Diseases* (Re Bing Lun): The Taiyin meridian distributes in the stomach and connects with the throat. Therefore, abdominal fullness and dryness of the throat occur. This is heat damaging the "biao" (branch/exterior manifestation) of the Taiyin, a syndrome transmitted from the yang meridians into this meridian, not the primary disease of the Taiyin organ itself.
Zhang Zhongjing established the outline for Taiyin disease because Taiyin governs internal functions ("zhu nei"). Thus, it does not involve exterior symptoms like vexing pain in the four limbs seen in wind-stroke. Furthermore, as the "extreme yin within yin," it does not involve symptoms like throat dryness seen in heat diseases.
Taiyin governs "opening" (kai) and belongs to the yin pathway (void/quiet). Taiyin corresponds to the Spleen. In diseases governed by the Spleen, the Spleen governs dampness and transportation/transformation. Therefore, the Taiyin outline primarily manifests as abdominal fullness, intermittent pain, vomiting, and diarrhea. These are all syndromes of deficiency and insecurity in the interior, with excessive dampness overflowing outward.
When Spleen qi is deficient, the exterior is also deficient. Inability to eat indicates that the Stomach fails to receive and decompose food. One must understand that if the Stomach lacks excess pathogenic factors, the disease will transition to Taiyin. The world erroneously claims transmission from Yangming to Shaoyang, ignoring the meaning of transmission to Taiyin.
In *Heat Diseases*, abdominal fullness results from heat stagnating in the Taiyin meridian, evidenced by throat dryness; the pathology is at the exterior level. In cold-warmth diseases (Shanghan), abdominal fullness results from cold generating in the Zhiyin (Extreme Yin) organs, evidenced by spontaneous diarrhea; the pathology is at the interior/root level.
If there is heat in the Spleen meridian, yin essence cannot transport upward to the Lungs, causing throat dryness. If there is cold in the zang organs, the Spleen cannot distribute fluids for the Stomach, causing diarrhea.
The indication for purgation in Yangming lies in its benbing (primary/fu-organ disease); conversely, the symptom of diarrhea in Taiyin appears during the biao (branch/spleen-deficiency dampness) stage. This illustrates the difference in yin-yang locations and the principle that yin diseases can transform via yang.
Considering the concept of "Zhong Yin Liu Fu" (pathogens from yin meridians entering yang fu-organs), one knows that heat pathogens do not immediately enter the Zhiyin organs. Although heat is in the Taiyin meridian, it essentially remains in the Yangming Stomach. Thus, purgation applies only to Yangming; Taiyin has no purgative method per se.
Abdominal fullness is a symptom of both meridians. Constipation with abdominal fullness or periumbilical pain indicates excess heat, belonging to Yangming. Diarrhea with abdominal fullness and intermittent pain indicates deficiency-cold, belonging to Taiyin. Cold-dampness is the primary syndrome of Taiyin; damp-heat is a variant caused by Shanghan.
The key mechanism lies in urination. If urination is difficult, damp-heat manifests externally as jaundice. If urination is free, either sudden irritability followed by self-limiting diarrhea leads to recovery, or constipation occurs. This is because the Spleen and Stomach are closely connected. If the Spleen homeostasis is restored ("Spleen Shi"), rotting filth is expelled naturally, activating Taiyin's "opening." If the Stomach homeostasis is obstructed ("Stomach Shi"), the earthy pathway is blocked, transitioning to Yangming's "closing." He Shuhe only knew of Yangming and did not recognize combined Taiyin-Yangming syndromes.
The *Xu Li* states that when Taiyin is affected, the pulse should be deep and fine. However, deep and fine pulses belong to the primary Taiyin disease, not the heat syndrome with throat dryness. Pulses follow the disease manifestation. For example, Taiyin wind-strike presents with a floating pulse, following the yang nature of wind rather than the yin nature of the organ.
Although a floating pulse is typically associated with Mahuang Tang, Guizhi Tang is used here because Taiyin disease represents an "exterior-of-the-interior" syndrome. Guizhi Tang treats exterior-of-the-interior conditions. Since the Spleen governs muscles, resolving the muscle layer is appropriate.
In Taiyin cold damage, a floating and moderate pulse is not the primary disease. Floating is a yang pulse; moderate is a stomach pulse. A floating-moderate pulse in Taiyin cold damage indicates yang within yin and the presence of stomach qi, resulting in warm hands and feet, revealing Spleen excess. It may progress to jaundice or hard stools, transferring to Yangming. These pulse-symptom complexes lie between Taiyin and Yangming, hence described as "related to" (Xi Zai). Direct cold invasion of Taiyin would not present thus.
A floating Taiyin pulse indicates exterior involvement, manifesting as vexing limb pain. A deep pulse indicates interior involvement, manifesting as abdominal pain, vomiting, and diarrhea. Exterior wind-heat requires sweating; Guizhi Tang is suitable. Interior cold requires warming; Si Ni Tang and similar formulas are suitable.
In Taiyang disease, a deep pulse indicates cold invasion (cold is yin evil, deep is yin pulse). In Taiyin disease, a floating pulse indicates wind invasion (wind is yang evil, floating is yang pulse). One must know that pulses change with the disease and are not fixed to specific meridians. Thus, yang meridians can have yin pulses, and yin meridians can have yang pulses. The belief that all three yin meridians have deep pulses and should not be treated with sweating methods stems from ignorance of this principle.
In Taiyin wind-strike, the pulse is superficially weak and internally choppy. Recovery is indicated when the pulse changes from choppy to long. Choppy and long pulses do not appear simultaneously. Choppy is the disease pulse; a shift to long indicates recovery. Wind pulses are normally floating; a weakening float indicates wind pathogen departure. Choppy indicates qi and blood deficiency. Long indicates unobstructed qi flow, signifying health.
Taiyin wind-strike presents with vexing limb pain; Taiyin cold damage presents with spontaneously warm hands and feet. This refers to exterior heat. Heat in the limbs implies no fever in the body, as Taiyin governs the interior. Only the limbs are the root of all yang. The Spleen transports fluids to nourish the four extremities. Thus, warmth in the limbs reflects Yangming yang. "Spontaneously warm" implies periods of non-warmth or even cold limbs.
The *Nei Jing* states: When limbs are hot and feel like roasting upon exposure to wind, it is due to deficient yin and abundant yang. Wind is yang; limbs are yang. Two yangs clashing causes muscle wasting. This is Taiyin wind-strike. Unlike three yang meridians, Taiyin disease involves "guan he" (closure/opening dysfunction), preventing deep penetration of yang pathogens. Pathogens remain at the limb joints. Prolonged illness depletes Spleen fluids, failing to nourish muscles, causing wasting. Those with hot palms and soles have milder cases. Taiyin wind-strike arises from yin deficiency attracting yang pathogens; external wind is driven by internal heat. Treatment should nourish yin to harmonize yang, avoiding dispersing wind which increases heat.
"Spontaneously warm hands and feet" contrasts with "no body fever." It does not mean Taiyin cold damage always features warm limbs. Even in three yang diseases, cold limbs occur. Tao's differentiation of Taiyin (warm limbs), Shaoyin (cold limbs), and Jueyin (chilled limbs) contradicts the original texts describing Taiyin limb vexation and Shaoyin whole-body heat.
Cold damage transforms into heat. Cold is yin; Taiyin is extreme yin. Two yins combine without generating heat. Only the extremities, where yin and yang meet, remain warm. Spontaneous warmth indicates the central jiao is not immediately invaded, leading to either jaundice or sudden irritability with self-limiting diarrhea. This warmth reveals Spleen excess.
Jaundice originates from Yangming. Taiyin patients may develop jaundice, but this is not a primary Taiyin symptom. Warm limbs indicate abundant Yangming yang, preventing cold from damaging Taiyin zang organs. With no cold in the zang but dampness present, jaundice occurs. If dampness drains via urine, sudden irritability and diarrhea reflect Spleen transportation, maintaining the Taiyin diagnosis. Irritation without diarrhea indicates Stomach excess heat, not Taiyin damp-heat. Taiyin cold damage relies on Yangming yang as its root, allowing for transfer syndromes. People know Shanghan prioritizes yang, but fail to see Taiyin Shanghan prioritizes Yangming.
Li Dongyuan's distinction of vomiting by sound is incorrect. Vomiting involves sound and matter; dry heaving involves sound only. "Ou" (vomiting water) relates to the upper jiao; "Tu" (spitting food) relates to the middle jiao. While vomiting occurs in all six meridians, it associates with Shaoyang due to frequent occurrence. Spitting associates with Taiyin, not Yangming, reflecting the difference between transportation (Shu) and reception (Nei).
Taiyang roots in yin; Taiyin grounds in yang. Taiyang avoids reckless sweating to preserve Shaoyin fluids. Taiyin avoids laxatives to protect Yangming qi. Taiyin has no purgative indications originally; however, mistaken purgation in Taiyang allows yang pathogens to sink into Taiyin, necessitating Guizhi Tang with Shaoyao. A weak Taiyin pulse indicates moving stomach qi; dietary intake should increase slightly. This advice warns against overuse for tenesmus-like symptoms.