太阴居三阳二阴之间本无外中之寒即有中风亦必缘饮食后腠理疏而入故太阴但有桂枝而无麻黄证也。尚论以为但举
桂枝而麻黄不待言者。亦未达。此义或言太阴既无中寒。何得有四逆汤证曰。此盖脾胃素虚之人。内伤饮食得之。故太
阴寒证。但曰脏寒不曰中寒。其他传经之证或缘先伤饮食。或缘攻下所致。故太阴传经之邪无大热证。非少阴厥阴之比。
惟桂枝大黄汤一证。乃缘误下。阳邪内陷而腹痛用以泄陷内之阳邪。非太阴有可下之例也。即先伤饮食致传者。亦必邪
传胃腑。乃可攻下。太率当下当温。以腹之或满或痛辨其虚实治之为当也。若循经从少阳传次太阴不过往来寒热等。少
阳证罢而见烦躁不宁腹满时痛手足自温。肌肉重按则热。肌表却不热。脉沉细或微畏寒足冷。当从传经例随证分解之。
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。
腹满自利。太阴之本证也。吐而食不下。则邪迫于上利甚而腹满。则邪迫于下。上下交乱。胃中空虚。此但可行温
散。设不知而误下之。其在下之邪可去。而在上之邪陷矣。故胸中结硬与结胸之变颇同。胃中津液上结胸中。阳气不布。
卒难开涤也。
自利不渴者。属太阴。以其脏有寒故也。当温之。宜服四逆 。
自利不渴者属太阴。太阴主水谷。故病自利内有真寒。故不渴。注谓自利不渴。湿胜也。故用四逆 。以燠土燥湿
非也。仲景大意以自利不渴者。属太阴以自利而渴者属少阴。分经辨证所关甚钜。盖太阴属湿土。邪热入而蒸动其湿。
则显有余故不渴而多发黄。少阴属肾水热。邪入而消耗其水。则显不足。故口渴而多烦躁也。今自利不渴。知太阴脏寒
故当温之。宜用四逆 。则理中等可不言而喻也。太阴湿土之脏有寒不用理中。而用四逆者。水土同出一源。冬月水暖
则土亦暖夏月水寒。则土亦寒。所以土寒即阴内阳外。故用四逆以温土也。
以上太阴脏寒证。
本太阳病医反下之因尔腹满时痛者。属太阴也。桂枝加芍药汤主之。
太阳之误下。其病皆在胸胁以上。阳邪伤阳分也。此因误下。而腹满时痛无胸胁等证。则其邪已入阴位。所以属太
阴也。腹满者太阴里气不足也。时痛者有时而痛。非大实大满之痛也。故仍用桂枝解肌之法。以升举阳邪但倍白芍药。
以收太阴之逆气本方不增一药斯为神耳。
大实痛者桂枝加大黄汤主之。
大实痛则非有时而痛者。可例矣故前方但倍芍药而此则加大黄。加大黄者取其苦寒能荡实热也。以其大实大满宜从
急下然阳分之邪。初陷太阴未可峻攻。但于桂枝汤中少加大黄。七表三里以分杀其邪可也。
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。
此段叮咛与阳明。篇中互发阳明曰不转失气曰先硬后溏曰未定成硬皆是恐伤。太阴脾气此太阴证而脉弱便利减用大
黄芍药又是恐伤阳明胃气也。
伤寒脉浮而缓。手足自温者。系在太阴。太阴当发身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利
以脾家实腐秽易去故也。
太阴脉本缓故浮缓虽烦太阳之中风手足自温。则不似太阳之发热。更不似少阴之四逆与厥。所以系在太阴允为恰当
也。太阴脉见浮缓其湿热交盛势必蒸身为黄。若小便自利者湿热从水道而泄不能发黄也。至七八日暴烦下利日数十行其
证又与少阴无别。而利尽腐秽当自止。则不似少阴之烦躁有加下利漫无止期也。况少阴之烦而下利手足反温脉紧反去者。
仍为欲愈之候。若不辨晰而误以四逆之法治之几何不反增危困耶。虽阳明与太阴腑脏相连。其便硬。与下利自有阳分阴
分之别而下利中又有温里实脾之别温里宜四逆汤实脾宜五苓散。利水即所以实脾。脾实则腐秽不攻而去也。
以上误下热传太阴证。
伤寒脉浮而缓手足自温者是为系在太阴。太阴者。身当发黄。若小便自利者。不能发黄。至七八日。大便硬者。为
阳明病也。
此太阴转属胃腑证也。脉浮而缓。本为表证。然无发热恶寒外候。而手足自温者。是邪已去表而入里其脉之浮缓。
又是邪在太阴。以脾脉主缓故也。邪入太阴势必蒸湿为黄若小便自利。则湿行而发黄之患可免。但脾湿。既行胃益干燥
胃燥则大便必硬。因复转为阳明内实。而成可下之证也。下之宜桂枝大黄汤。
伤寒其脉微涩者。本是霍乱。今是伤寒。却四五日至阴经上转入阴必利本呕下利者。不可治若欲似大便而反失气仍
不利者。属阳明也。便必硬。十三日愈其所以然者。经尽故也。
霍乱为胃中郁滞寒物。故其脉当微涩。今复寒是外邪。脉当浮盛而不当微涩也。四五日为转入阴经之时忽然自利呕
逆。而脉微涩者恐是阳气顿逆阴气暴逆其势叵测。故不可妄治。非不治也。若欲似大便。而反失气。仍不利也。此太阴
转属阳明必便硬可攻。至十三日过经而愈也。
下利后当便硬。硬则能食者愈。今反不能食。到后经中颇能食复过一经能食过之一日当愈不愈者。不属阳明也。
此言下利止后。必能食而便硬。阳明胃气有权也。若利虽止而不能食。邪热去而胃气空虚也。俟过一经。胃气渐复
自能食矣。设日久不能食。将成脾胃虚寒呕逆变证也。或能食而久不愈。此热气有余。必发痈脓也。
以上太阴转阳明证。
太阴病脉浮者。可发汗。宜桂枝汤。
太阴脉尺寸俱沉细。今脉浮。里邪还于表可知矣。故仍用桂枝击其邪而隋之归也。
太阴中风四肢烦疼。阳微阴涩而长者为欲愈。
四肢烦疼者脾主四肢。亦风淫末疾之验也。阳脉微阴脉涩则风邪已去而显不足之象。但脉见不足正恐元气已离。暗
伏危机。故必微涩之中。更加其脉之长而不短。知元气未衰。其病为自愈也。注家未审来意。谓涩为血凝气滞大谬。岂
有血凝气滞反为欲愈之理耶。
以上太阴转阳明经证。
太阴病欲解时从亥至丑上。
上条太阴经证自解候。
太阴经位于三阳经与二阴经之间，本无外感寒邪的情况；即使有中风，也必定是因为饮食之后腠理疏松而侵入的。因此，太阴病只有桂枝汤证，而没有麻黄汤证。尚论派认为这里只提及桂枝汤，意味着麻黄汤证不言自明，这种理解也是未通达此义。有人问：既然太阴没有中寒，为什么会有四逆汤证呢？回答说：这大概是脾胃素来虚弱的人，因内伤饮食而致病。所以太阴的寒证，只称为“脏寒”，而不称为“中寒”。其他传经的病证，有的因为先伤了饮食，有的因为误用攻下法所致。因此，太阴传经的邪气没有大热证，这与少阴、厥阴不同。只有桂枝加大黄汤这一证，是由于误用攻下法，导致阳邪内陷引起腹痛，用来宣泄陷入内部的阳邪，并不是说太阴有可以攻下的常规例证。即使是先伤饮食导致的传变，也必须是邪气传入胃腑，才可以攻下。大体上应当用下法还是温法，要根据腹部是胀满还是疼痛来辨别虚实，这样治疗才恰当。如果循经从少阳传至太阴，不过是往来寒热等症状，当少阳证消失后，出现烦躁不宁、腹部胀满、时时疼痛、手足自然温暖、肌肉重按时发热但肌表却不热、脉象沉细或微弱、畏寒、足冷等情况，应当按照传经的规律，随证分解治疗。
太阴病的症状是腹部胀满且呕吐，饮食难以下咽，腹泻逐渐加重，时常腹部自行疼痛。如果误用攻下法，必然会导致心下痞结坚硬。
腹部胀满和腹泻，是太阴的本证。呕吐且饮食不下，说明邪气逼迫于上；腹泻严重且腹部胀满，说明邪气逼迫于下。上下交乱，胃中空虚。这种情况只能采用温散的方法。如果不知道这一点而误用攻下法，在下部的邪气虽然可以去掉，但在上部的邪气就会陷入体内。所以会出现胸中痞结坚硬，这与结胸证的变证颇为相似。胃中的津液上结于胸中，阳气不能布散，很难迅速开泄涤荡。
腹泻但不口渴的，属于太阴病，因为内脏有寒的缘故。应当用温法，适宜服用四逆汤。
腹泻但不口渴的属于太阴病。太阴主管水谷，所以患病时腹泻，体内有真寒，因此不口渴。注解说腹泻不口渴是因为湿胜，所以用四逆汤来暖土燥湿，这是错误的。张仲景的大意是：腹泻不口渴的属于太阴，腹泻且口渴的属于少阴，区分经络辨证关系非常重大。大概太阴属湿土，邪热进入并蒸动湿气，则显得有余，所以不口渴且多发生黄疸；少阴属肾水，邪热进入并消耗水分，则显得不足，所以口渴且多烦躁。现在腹泻不口渴，知道是太阴脏寒，所以应当用温法，适宜用四逆汤。那么理中汤的使用道理就可以不言而喻了。太阴湿土之脏有寒，不用理中汤而用四逆汤的原因在于：水土同出一源，冬天水暖则土也暖，夏天水寒则土也寒。所以土寒就是阴在内而阳在外（指阳气被郁或相对不足），因此用四逆汤来温补脾土。
原本的太阳病，医生反而用了攻下法，因而出现腹部胀满、时时疼痛的，属于太阴病，用桂枝加芍药汤主治。
太阳病误用攻下，病变通常都在胸胁以上，这是因为阳邪损伤了阳分。这里因为误用攻下，出现腹部胀满、时时疼痛，却没有胸胁等症状，说明邪气已经进入阴位，所以属于太阴病。腹部胀满是太阴里气不足的表现；时时疼痛是指有时疼痛，不是大实大满那种剧烈的疼痛。所以仍然使用桂枝汤解肌的方法，以升举阳邪，只是加倍使用白芍药，以收敛太阴的逆气。原方不增加一味药，这才是神妙之处。
如果是大实痛，用桂枝加大黄汤主治。
大实痛就不是有时疼痛的情况了，不能一概而论。所以前面的方子只是加倍芍药，而这个方子则加入大黄。加入大黄是取其苦寒之性能荡涤实热。因为大实大满应当从急下，然而阳分之邪刚刚陷入太阴，不可峻猛攻伐，只需在桂枝汤中少量加入大黄，通过七表三里来分散削弱邪气即可。
太阴病脉象弱，其人持续自行大便通畅，即使应当使用大黄、芍药的，也应该减量，因为此人胃气虚弱，容易受药物影响而动摇。
这段叮嘱与阳明篇相互阐发。阳明篇说：如果不转失气，说先硬后溏，说尚未确定成硬结，都是担心损伤脾气。这里是太阴证而脉弱、大便通畅，减少使用大黄、芍药，又是担心损伤阳明胃气。
伤寒脉浮而缓，手足温暖的，病系在太阴。太阴病应当身体发黄，如果小便自利，就不能发黄。到了七八天，虽然突然烦躁，腹泻一天十几次，但必然自愈，因为脾家实，腐秽之物容易排出去。
太阴脉本来缓，所以浮缓虽烦，不像太阳中风那样发热；手足自温，也不像少阴那样四肢逆冷和厥逆。所以说是系在太阴，确实恰当。太阴脉见浮缓，湿热交盛，势必蒸腾身体发黄。如果小便自利，湿热从水道排泄，就不能发黄。到了七八天，突然烦躁腹泻，一天几十次，其证候又与少阴没有区别，但如果泻尽腐秽，应当自止，就不像少阴那样烦躁加剧、腹泻漫无止期。况且少阴病烦躁而下利，手足反而温暖，脉紧反而消失的，仍然是欲愈的征候。如果不辨晰清楚，误用四逆汤法治它，岂不是反而增加危困吗？虽然阳明与太阴脏腑相连，大便硬与下利自有阳分阴分之别，而在下利中又有温里和实脾的区别。温里宜用四逆汤，实脾宜用五苓散。利水也就是实脾，脾实则腐秽不攻自去。
伤寒脉浮而缓，手足温暖的，这是病系在太阴。太阴病，身体应当发黄。如果小便自利，就不能发黄。到了七八天，大便硬的，就是阳明病了。
这是太阴转属胃腑的证候。脉浮而缓，本是表证，然而没有发热恶寒的外在表现，而手足自温，说明邪气已经离开表而入里。脉之浮缓，又是邪在太阴，因为脾脉主缓的缘故。邪气入太阴，势必蒸湿为黄。如果小便自利，则湿行而发黄的祸患可免。但是脾湿既行，胃益干燥，胃燥则大便必硬，因而复转为阳明内实，而成可下的证候。下之宜用桂枝加大黄汤。
伤寒脉微涩的，本来是霍乱。现在是伤寒，却过了四五日传到阴经，转入阴经必然腹泻。本来呕吐又腹泻的，不可妄治。如果想大便却反而放屁，仍不腹泻的，属于阳明病。大便必然硬。十三天痊愈，之所以这样，是因为经气尽的缘故。
霍乱是因为胃中郁滞寒物，所以脉应当微涩。现在又是伤寒，是外邪，脉应当浮盛而不应当微涩。四五日是转入阴经的时候，忽然自利呕逆，而脉微涩，恐怕是阳气顿逆、阴气暴逆，其势难以预测，所以不可妄治。并非不治。如果想大便，却反而放屁，仍不腹泻。这是太阴转属阳明，必然大便硬，可以攻下。到了十三天，过经而愈。
下利之后应当大便硬，硬则能食的会痊愈。现在反而不能食，等到过了一经之后颇能食，再过一日应当痊愈。如果不愈的，不属于阳明病。
这是说下利停止后，必然能食而大便硬，这是阳明胃气有权衡的表现。如果利虽止而不能食，是邪热去而胃气空虚。等到过了一经，胃气渐复，自然能食了。设若日久不能食，将形成脾胃虚寒、呕吐逆变的证候。或者能食而久不愈，这是热气有余，必然发生痈脓。
太阴脉尺寸俱沉细，现在脉浮，说明里邪还归于表可知。所以仍用桂枝汤击退邪气，使之归顺。
四肢烦疼，脾主四肢，也是风淫末疾的验证。阳脉微、阴脉涩，说明风邪已去而显不足之象。但脉见不足，正恐元气已离，暗伏危机。所以必须在微涩之中，再加脉长而不短，才知道元气未衰，其病为自愈。注家未审察来意，说涩是血凝气滞，大错特错。哪有血凝气滞反而为欲愈的道理呢？
太阴病欲解的时间是从亥时至丑时。
上一条讲太阴经证自解的候机。
The Taiyin meridian is located between the three Yang meridians and the two Yin meridians. It does not originally suffer from external cold invasion; even if wind-stroke occurs, it must enter due to loose interstices (couli) after dietary intake. Therefore, Taiyin disease presents only with Guizhi Tang syndrome, without Mahuang Tang syndrome. The Shanglun school argues that mentioning only Guizhi Tang implies Mahuang Tang syndrome is self-evident; this understanding is also a failure to grasp the principle. Some ask: If Taiyin has no mid-cold (Zhonghan), how can there be Sini Tang syndrome? The answer is: This likely affects individuals with constitutionally weak Spleen and Stomach, caused by internal injury from diet. Thus, Taiyin cold syndromes are termed "Zang cold" (internal organ cold) rather than "mid-cold." Other transmitted syndromes may result from prior dietary injury or erroneous purgation. Hence, transmitted pathogens in Taiyin do not present with high heat, unlike Shaoyin and Jueyin. Only the Guizhi Dahuang Tang syndrome results from erroneous purgation causing Yang pathogen to sink inward, leading to abdominal pain; it is used to vent the sunk Yang pathogen, not because Taiyin has a standard indication for purgation. Even if transmission follows dietary injury, the pathogen must have entered the Stomach Fu organ before purgation is applicable. Generally, whether to use purgation or warming depends on distinguishing deficiency and excess via abdominal fullness or pain. If transmission proceeds from Shaoyang to Taiyin along the meridian, symptoms are limited to alternating chills and fever. When Shaoyang symptoms resolve, restlessness, abdominal fullness, intermittent pain, naturally warm hands and feet, heat upon deep palpation of muscles but not the surface, deep-thin or faint pulse, aversion to cold, and cold feet appear. These should be treated according to transmission patterns, resolving symptoms accordingly.
Taiyin disease manifests as abdominal fullness and vomiting, inability to eat, worsening spontaneous diarrhea, and intermittent spontaneous abdominal pain. If purged erroneously, epigastric knotting and hardness will definitely occur.
Abdominal fullness and spontaneous diarrhea are the root syndromes of Taiyin. Vomiting and inability to eat indicate pathogen forcing upward; severe diarrhea and abdominal fullness indicate pathogen forcing downward. Upper and lower chaos empties the Stomach. In such cases, only warming and dispersing methods are suitable. Ignorance leading to erroneous purgation removes pathogen below but sinks pathogen above, resulting in chest knotting similar to Jie Xiong (chest binding) variations. Stomach fluids knot in the chest, Yang Qi fails to distribute, making rapid resolution difficult.
Spontaneous diarrhea without thirst belongs to Taiyin due to internal Zang cold. Warming treatment is indicated, preferably Sini Tang.
Spontaneous diarrhea without thirst belongs to Taiyin. Taiyin governs water and grain; thus, internal true cold causes diarrhea without thirst. Commentaries claiming dampness excess justifies Sini Tang to warm Earth and dry dampness are incorrect. Zhang Zhongjing's main point is: diarrhea without thirst belongs to Taiyin, while diarrhea with thirst belongs to Shaoyin. Differentiating meridians is crucial. Taiyin belongs to wet Earth; when heat pathogen enters and steams dampness, excess appears, causing non-thirst and often jaundice. Shaoyin belongs to Kidney Water; when heat pathogen enters and consumes water, deficiency appears, causing thirst and irritability. Now, with diarrhea and no thirst, knowing it is Taiyin Zang cold, warming with Sini Tang is appropriate. The rationale for Lizhong Tang becomes self-evident. Using Sini Tang instead of Lizhong Tang for Taiyin wet Earth cold exists because Water and Earth share a source: winter warmth warms Earth, summer cold chills Earth. Earth cold implies Yin inside and Yang outside, hence Sini Tang warms Earth.
Above are Taiyin Zang cold syndromes.
Original Taiyang disease treated erroneously with purgation leads to abdominal fullness and intermittent pain, belonging to Taiyin, treated with Guizhi Ji Shaoyao Tang.
Erroneous purgation in Taiyang usually affects the chest and hypochondrium, injuring Yang division. Here, post-purgation abdominal fullness and intermittent pain without chest/hypochondrium symptoms indicate pathogen entering Yin positions, thus Taiyin. Abdominal fullness indicates insufficient interior Qi of Taiyin; intermittent pain is not severe constipation/pain. Thus, Guizhi Tang's muscle-releasing method lifts Yang pathogen, doubling Baishao to collect rebellious Taiyin Qi. Not adding any herb makes it divine.
For severe excessive pain, Guizhi Dahuang Tang is indicated.
Severe excessive pain differs from intermittent pain. The previous formula doubled Shaoyao; this adds Dahuang. Dahuang's bitter-cold nature sweeps excessive heat. Although excessive fullness requires urgent purgation, newly sunk Yang pathogen in Taiyin cannot be aggressively attacked. Adding small amounts of Dahuang to Guizhi Tang disperses pathogen through seven exterior and three interior layers.
In Taiyin disease with weak pulse and continuous normal bowel movements, even if Dahuang or Shaoyao were indicated, doses should be reduced because weak Stomach Qi is easily disturbed.
This section echoes the Yangming chapter. Yangming warns against damaging Spleen Qi (e.g., hard stool turning loose). Here, reducing Dahuang/Shaoyao in Taiyin with weak pulse and loose stools protects Yangming Stomach Qi.
In cold damage, floating and slow pulse with warm hands and feet indicates Taiyin involvement. Taiyin typically causes jaundice; if urination is free, jaundice does not develop. By day 7-8, sudden irritability and frequent diarrhea (10+ times/day) will self-resolve because Spleen Qi becomes sufficient to expel rotting filth.
Taiyin pulse is inherently slow. Floating-slow pulse with irritability differs from Taiyang wind-stroke fever. Warm hands/feet differ from Shaoyin cold limbs/jue. Thus, "Taiyin involvement" is accurate. Floating-slow pulse with intense damp-heat steams body yellow. Free urination drains damp-heat, preventing jaundice. Day 7-8 sudden irritability/diarrhea resembles Shaoyin, but once filth is expelled, it stops, unlike Shaoyin's endless diarrhea. If Shaoyin irritability/diarrhea presents with warm hands/feet and disappearing tight pulse, recovery is imminent. Misusing Sini Tang would worsen the condition. Although Yangming and Taiyin are connected, hard stool vs. diarrhea distinguishes Yang/Yin divisions. Diarrhea treatment distinguishes warming interior (Sini Tang) vs. strengthening Spleen (Wuling San). Draining water strengthens Spleen; strong Spleen expels filth without aggressive purgation.
Above are heat-transmitted Taiyin syndromes from erroneous purgation.
Cold damage with floating-slow pulse and warm hands/feet indicates Taiyin. Taiyin usually causes jaundice. Free urination prevents jaundice. By day 7-8, hard stool indicates Yangming disease.
This is Taiyin transferring to Stomach Fu. Floating-slow pulse is exterior, but lack of fever/chills and warm extremities show pathogen moved interior. Slow pulse confirms Taiyin (Spleen governs slowness). Pathogen steams dampness to yellow; free urination prevents this. However, drained dampness dries Stomach, hardening stool, transforming into Yangming interior excess requiring purgation. Guizhi Dahuang Tang is suitable.
Cold damage with faint-choppy pulse is originally Huoluan (cholera-like disorder). Now it is cold damage, progressing to Yin meridians by day 4-5, causing diarrhea. Original vomiting and diarrhea should not be blindly treated. If one feels urge to defecate but passes gas without diarrhea, it belongs to Yangming. Stool will be hard. Recovery by day 13 occurs because the meridian cycle completes.
Huoluan involves stagnant cold in Stomach, causing faint-choppy pulse. Cold damage (external pathogen) causes floating-abundant pulse, not faint-choppy. Day 4-5 transition to Yin brings sudden diarrhea/vomiting with faint-choppy pulse, suggesting abrupt Yang/Yin rebellion, unpredictable, hence caution. Feeling urge to defecate but passing gas indicates Taiyin transferring to Yangming, hard stool, amenable to purgation. Recovery by day 13 follows meridian completion.
After diarrhea cessation, stool should harden; ability to eat indicates recovery. Inability to eat suggests empty Stomach Qi despite cleared pathogen. After one meridian cycle, Qi recovers, eating resumes. Prolonged inability to eat leads to Spleen-Stomach deficiency-cold and vomiting. Ability to eat but prolonged illness indicates excess heat, likely leading to abscess/pus.
Above are Taiyin transferring to Yangming syndromes.
Taiyin disease with floating pulse allows sweating; Guizhi Tang is suitable.
Taiyin pulse is normally deep-thin at both cun and chi. Floating pulse indicates interior pathogen returning to exterior. Guizhi Tang drives out pathogen, guiding it back.
Taiyin wind-stroke with painful limbs shows desire for recovery if Yang pulse is faint, Yin pulse is choppy, yet long. Painful limbs reflect Spleen governing limbs and wind affecting extremities. Faint Yang and choppy Yin indicate wind pathogen gone, showing deficiency. Deficiency fears Yuan Qi loss. Long pulse within faint-choppy indicates intact Yuan Qi, predicting self-healing. Commentators wrongly calling choppy blood stasis/qi stagnation is erroneous; stasis never predicts recovery.
Above are Taiyin transferring to Yangming meridian syndromes.
Taiyin disease resolves from Hai hour to Chou hour.
The previous section discussed Taiyin meridian syndrome resolution timing.