太阴者。土也。在脏为脾。在气为湿。伤寒传经之热。入而与之相抟。则为腹满吐利等证。直
中之寒。入而与湿相抟。亦为腹满吐利等证。但有肢冷肢温。脉迟脉数。口渴不渴之异耳。又三阴为
三阳之里。而三阴亦自有表里。是以风寒所中。不必尽入于脏。而亦留连于经。故有太阴中风之条。与桂
枝发汗之法。又下利腹胀满。身体疼痛者。此为经脏俱病之证。故与先里后表之法。乃今之论三
阴者。但云直中传经而已。是知有三阴之里。不知有三阴之表也。兹篇先列脏病。次列经病。又次
为经脏俱病。凡十条。为一卷。
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。
此足太阴病之的证也。太阴之脉。入腹属脾络胃。上膈挟咽。故其病有腹满而吐。食不下。
自利腹痛等证。然太阴为病。不特传经如是。即直中亦如是。且不特伤寒如是。即杂病亦如是。
但有属阴属阳。为盛
为虚之分耳。而太阴者。脏也。满而不实。法不可下。若下之。则胸下结硬。中气伤者。邪气必结也
。
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。
病在太阳。不与解表。而反攻里。因而邪气乘虚陷入太阴之位。为腹满而时痛。陶氏所谓误下
传者是也。夫病因邪陷而来者。必得邪解而后愈。而脏阴为药所伤者。亦必以药和之而后安。故须
桂枝加芍药汤主之。桂枝所以越外入之邪。芍药所以安伤下之阴也。按金匮云、伤寒阳脉涩。阴脉
弦。法当腹中急痛者。与小建中汤。不瘥者。与小柴胡汤。此亦邪陷阴中之故。而桂枝加芍药。亦小
建中之意。不用胶饴者。以其腹满。不欲更以甘味增满耳。
桂枝加芍药汤方
于桂枝汤方内更加芍药三两。随前共六两。余根据桂枝汤法。
大实痛者。桂枝加大黄汤主之。
此承上条而言。腹满而未实。痛而不甚者。可以桂枝加芍药。和而解之。若大实大痛者。邪气
成聚。必以桂枝加大黄。越陷邪而去实滞也。夫太阴、脾脏也。脏何以能实而可下。阳明者。太阴
之表。以膜相连。脏受邪而腑不行则实。故脾非自实也。因胃实而实也。大黄所以下胃。岂以下脾
哉。少阴厥阴亦有用承气法。详见各篇。所当互考。
桂枝加大黄汤方
桂枝（三两去皮） 甘草（三两炙） 大黄（一两） 生姜（三两切） 大枣（十二枚）
芍药（六两）
上六味。以水七升。煮取三升。去滓。温服一升。日三服。
太阴病。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。
此亦承上条而言。大黄、芍药之得以用者。为其胃实而便坚也。若其人脉弱。续自便利。则虽
有大实痛证。此法不可用矣。即欲用之。亦宜量减而与之。所以然者。胃气弱而不振。邪气不聚而
易动。故可以缓图。而难以峻攻也。
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。暴烦下利。日十余行。必自止。以脾家实。秽腐当去故也。
伤寒脉浮而缓者。脉紧去而成缓。为寒欲变热之证。如太阳第四十七条之例也。手足自温。非
太阴定证。见太阴有寒。手足必寒。有热。手足乃自温耳。又阳明受热。即一身及手足热。太阴则
身不热。而手足温。兹寒已变热。而手足自温。则伤寒之邪。不之阳明而之太阴。而其脉仍浮。则
其邪亦未尽入。故曰系在太阴。谓以太阳而内连太阴也。于法太阴受热而汗不出者。热与湿抟。当
发身黄。若小便自利者。其热得通。不能蒸郁为黄矣。至七八日。暴烦下利者。正气内作。邪气欲
去也。虽日十余行。继必自止。所以然者。脾家本有秽腐当去。故为自利。秽腐尽。则利亦必自止
矣。
自利不渴者。属太阴。以其脏有寒故也。当温之。宜四逆辈。
自利不渴者。太阴本自有寒。而阴邪又中之也。曰属太阴。其脏有寒。明非阳经下利。及传经
热病之比。法当温脏祛寒。如四逆汤之类。不可更以苦寒坚之清之。如黄芩汤之例也。
太阴经，五行属土。在脏腑中对应脾脏，在气机属性上对应湿邪。伤寒病传经而来的热邪，侵入体内与湿邪相互搏结，就会形成腹部胀满、呕吐、腹泻等症状；若是寒邪直中内脏，侵入后与湿邪相搏结，同样会出现腹部胀满、呕吐、腹泻等证候。这两者的区别仅在于四肢是冷还是温，脉象是迟还是数，以及口是否口渴。另外，三阴经（太阴、少阴、厥阴）是三阳经的里层，但三阴经自身也有表里之分。因此，风寒之邪侵袭人体，不一定全部传入脏腑，也可能滞留于经络。所以有“太阴中风”的条文，并采用桂枝汤发汗的治疗方法。又有下利且腹部胀满、身体疼痛的情况，这是经络和脏腑同时患病的证候，所以采用先治里、后治表的治法。然而现在讨论三阴病的人，只说直中和传经两种情况，只知道三阴经有里证，却不知道三阴经也有表证。本篇先列出脏腑本身的病变，其次列出经络的病变，再次列出经络和脏腑同时患病的情况，共十条，构成一卷。
太阴病的主要表现是：腹部胀满，呕吐，饮食难以下咽，自发性腹泻日益加重，时常出现腹部自发疼痛。如果误用泻下法，必然导致胸膈下方痞结坚硬。
这是足太阴脾经疾病的典型证候。太阴经脉，进入腹腔，归属于脾，联络胃，向上穿过膈肌，夹持咽喉两侧。所以它的病症表现为腹部胀满、呕吐、饮食不下、自发性腹泻和腹痛等。然而，太阴病不仅传经如此，即使是寒邪直中也如此；不仅是伤寒如此，杂病也是如此。只是有属于阴证或阳证、实证或虚证的分别罢了。而太阴属于脏，特点是“满而不实”，按照医理不可使用泻下法。如果误用泻下法，就会导致胸膈下方痞结坚硬，这是因为中气受损，邪气便会凝结在那里。
原本患有太阳病，医生反而误用泻下法，导致患者出现腹部胀满、时时疼痛的症状，这属于太阴病。应当用桂枝加芍药汤主治。
病邪本在太阳经，医生不给予解表治疗，反而攻伐里气，导致邪气乘虚陷入太阴经的部位，引起腹部胀满和时时疼痛。这就是陶氏所说的误用下法导致的传变。既然病因是邪气内陷所致，必须使邪气解除才能痊愈；而脏阴之气被药物所伤，也必须通过药物调和才能安宁。所以需要用桂枝加芍药汤来主治。桂枝的作用是发散外入的邪气，芍药的作用是安抚因误下而受伤的阴气。按《金匮要略》记载：“伤寒见阳脉涩、阴脉弦，法当腹中急痛者，与小建中汤；服药后未愈者，与小柴胡汤。”这也是邪气陷入阴分的缘故。桂枝加芍药汤也蕴含着小建中汤的意思，只是不用饴糖，是因为患者腹部胀满，不想再用甘味药物增加胀满感。
桂枝加芍药汤方剂组成：
在桂枝汤原方基础上，增加芍药三两，连同前面的药材共计六两。其余煎服方法均依照桂枝汤的法度。
如果是腹部胀满严重且疼痛剧烈的“大实痛”，应当用桂枝加大黄汤主治。
这是承接上一条而言的。如果腹部胀满但未至坚实，疼痛也不剧烈，可以用桂枝加芍药汤调和而解。如果是大实大痛，说明邪气聚集成实，必须用桂枝加大黄汤，以发散陷入的邪气并去除实滞。太阴是脾脏，脏怎么会有实证而可以使用下法呢？阳明胃腑是太阴脾脏的表层，两者以膜相连。脾脏受邪而胃腑传导失职，就会形成实证。所以脾并非自己产生实证，而是因为胃腑实证牵连导致的。大黄是用来通泄胃腑实热的，哪里是用来泻脾脏的呢？少阴和厥阴病也有使用承气汤法的，详见各篇，应当互相参考考证。
桂枝加大黄汤方剂组成：
桂枝（三两，去皮）、甘草（三两，炙）、大黄（一两）、生姜（三两，切片）、大枣（十二枚）、芍药（六两）。
以上六味药，用水七升，煮取三升，去渣滓。每次温服一升，每日服用三次。
太阴病患者，如果脉象虚弱，其人持续自行大便通畅，那么即使病情需要用到大黄、芍药，也应该减少用量。因为此人胃气虚弱，容易受到药物影响而动气。
这也是承接上一条而言的。大黄、芍药之所以能被使用，是因为患者胃气实盛且大便干结。如果患者脉象虚弱，持续自行大便通畅，那么即使有大实痛的证候，这种方法也不可使用了。即便想用，也应该酌情减量给予。之所以这样，是因为胃气虚弱不能振奋，邪气没有聚集成实且容易变动，所以可以采取缓和的策略，难以进行猛烈的攻伐。
伤寒病脉象浮而缓，手足自然温暖，这是病邪关联到太阴经。太阴经受邪，身体应当发黄。如果小便通畅自如，就不会发黄。到了七八天，突然烦躁并伴有腹泻，一天十几次，必定会自行停止。这是因为脾家正气恢复（脾家实），体内的秽浊腐败之物应当排出的缘故。
伤寒脉象浮而缓，脉紧消失变成缓脉，是寒邪欲转化为热证的迹象，如同太阳病第四十七条的例子。手足自然温暖，不是太阴病的固定证候，见到太阴病有寒证时，手足必定寒冷；有热证时，手足才自然温暖。另外，阳明经受热，会导致全身及手足发热；太阴经受热则身体不热，只有手足温暖。这里寒邪已经转化为热邪，且手足自然温暖，说明伤寒之邪没有传入阳明经而是传入太阴经，且脉象仍然浮，说明邪气并未完全入里。所以说“系在太阴”，意思是病邪从太阳经内连影响到太阴经。按医理，太阴经受热且无汗者，热与湿相互搏结，应当发生身黄。如果小便通畅，热邪得以通达，就不能蒸郁发黄了。到了七八天，突然烦躁并腹泻，这是正气在内作动，邪气欲去的征兆。虽然一天腹泻十几次，随后必定会自行停止。之所以这样，是因为脾家本来就有秽浊腐败之物需要排出，所以出现自发性腹泻。秽浊腐败之物排尽，腹泻也必定会停止。
自发性腹泻且不口渴的，属于太阴病。因为内脏有寒的缘故。应当采用温法治疗，适宜使用四逆汤类方剂。
自发性腹泻且不口渴，是太阴本自有寒，阴邪又侵袭所致。说它属于太阴，其内脏有寒，明确区别于阳经的下利以及传经的热病。治法应当温补脏腑、祛除寒邪，如四逆汤之类。不可再用苦寒的药物来坚阴清热，像黄芩汤那样的用法就不合适了。
Taiyin (Greater Yin) corresponds to the Earth element. In the zang-fu organs, it corresponds to the Spleen (Pi); in terms of qi and pathogenic factors, it corresponds to Dampness (Shi). When the heat from a cold damage disease transmitted through the meridians enters the interior and contends with Dampness, it results in symptoms such as abdominal fullness, vomiting, and diarrhea. When cold pathogen directly invades the interior and contends with Dampness, it similarly presents with abdominal fullness, vomiting, and diarrhea. The distinction lies only in whether the limbs are cold or warm, the pulse is slow or rapid, and whether there is thirst or not. Furthermore, the Three Yin meridians (Taiyin, Shaoyin, Jueyin) are the interior counterpart to the Three Yang meridians, yet the Three Yin themselves possess their own exterior-interior relationship. Therefore, wind-cold pathogens do not necessarily enter all the way to the zang organs; they may also linger in the meridians. Hence, there are clauses regarding "Taiyin Wind-Strike" and the method of inducing sweating using Guizhi Tang (Cinnamon Twig Decoction). Additionally, cases involving diarrhea with abdominal fullness and body pain represent simultaneous disease of both the meridians and the zang organs; thus, the treatment principle is to address the interior first and the exterior subsequently. However, contemporary discussions on Three Yin diseases often mention only direct invasion and meridian transmission, knowing only of the interior aspect of the Three Yin but ignoring their exterior aspect. This chapter first lists zang organ diseases, then meridian diseases, and finally simultaneous meridian-zang diseases, comprising ten clauses in one volume.
The defining syndrome of Taiyin disease includes abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purgatives are incorrectly applied, it will inevitably lead to hardness and binding below the chest.
This is the definitive syndrome of Foot-Taiyin Spleen disease. The Taiyin meridian enters the abdomen, connects with the Spleen, and links with the Stomach; it ascends through the diaphragm and flanks the throat. Consequently, its manifestations include abdominal fullness, vomiting, food retention, spontaneous diarrhea, and abdominal pain. However, Taiyin pathology is not limited to meridian transmission; it occurs similarly in direct invasion, and applies not only to Cold Damage but also to miscellaneous diseases. The differentiation lies merely in whether the condition belongs to Yin or Yang, excess or deficiency. Since Taiyin is a Zang organ, characterized by "fullness without solidity," purgation is contraindicated according to medical principles. Incorrect purgation damages the Middle Qi, allowing pathogenic factors to bind, resulting in hardness below the chest.
In a case originally presenting as Taiyang disease, if the physician erroneously applies purgation, leading to abdominal fullness and intermittent pain, this indicates involvement of the Taiyin system. It should be treated primarily with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root).
When the pathogen remains in the Taiyang stage, failure to resolve the exterior and instead attacking the interior allows the pathogen to sink into the Taiyin position due to deficiency, causing abdominal fullness and intermittent pain. This corresponds to what Tao described as transmission caused by erroneous purgation. Since the etiology involves pathogen sinking, recovery requires resolving the pathogen; since the Zang Yin has been injured by drugs, it requires medicinal harmonization for peace. Thus, Guizhi Jia Shaoyao Tang is indicated. Guizhi disperses the externally invading pathogen, while Shaoyao soothes the Yin injured by purgation. According to the *Jingui Yaolue*: "In cold damage, if the Yang pulse is choppy and the Yin pulse is string-taut, abdominal cramping pain is expected; administer Xiao Jianzhong Tang. If ineffective, administer Xiao Chaihu Tang." This is also due to pathogen sinking into the Yin. Guizhi Jia Shaoyao Tang shares the intent of Xiao Jianzhong Tang but omits Yitang (Maltose) because the patient has abdominal fullness and should not receive sweet substances that might exacerbate fullness.
Formula: Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root)
Add three liang of Shaoyao (Peony Root) to the original Guizhi Tang formula, totaling six liang of Shaoyao. Follow the preparation and administration methods of Guizhi Tang for the remainder.
In cases of severe excess and intense pain ("Da Shi Tong"), Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb) is indicated.
This follows the previous clause. If abdominal fullness is present but not solid, and pain is not severe, Guizhi Jia Shaoyao Tang can harmonize and resolve the condition. However, in cases of severe excess and intense pain, pathogenic factors have aggregated into excess; thus, Guizhi Jia Dahuang Tang must be used to disperse the sunken pathogen and eliminate stagnation. Taiyin is the Spleen Zang; how can a Zang organ present with excess requiring purgation? Yangming (Stomach) is the exterior counterpart to Taiyin, connected by membranes. When the Zang receives pathogen and the Fu organ fails to transport, excess results. Therefore, the Spleen does not generate excess independently but becomes affected by Stomach excess. Dahuang (Rhubarb) is used to purge the Stomach, not the Spleen. Shaoyin and Jueyin conditions also utilize Chengqi formulas; see respective chapters for cross-reference.
Formula: Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb)
Guizhi (Cinnamon Twig, 3 liang, bark removed), Gancao (Licorice Root, 3 liang, honey-fried), Dahuang (Rhubarb Root and Rhizome, 1 liang), Shengjiang (Fresh Ginger, 3 liang, sliced), Dazao (Jujube Fruit, 12 pieces), Shaoyao (Peony Root, 6 liang).
These six ingredients are boiled in seven sheng of water to yield three sheng. Strain the dregs. Take one sheng warm, three times daily.
In Taiyin disease, if the pulse is weak and the patient continues to have spontaneous loose stools, even if Dahuang or Shaoyao were indicated, their dosages should be reduced. This is because the person's Stomach Qi is weak and easily disturbed.
This also follows the previous clause. Dahuang and Shaoyao are applicable when there is Stomach excess and hard stool. If the pulse is weak and spontaneous loose stools continue, these methods are contraindicated even in cases of severe pain. If used, dosages must be carefully reduced. The reason is that weak Stomach Qi cannot rally, and pathogens do not aggregate firmly but move easily; thus, a gradual approach is suitable, whereas aggressive attack is difficult.
In cold damage, if the pulse is floating and moderate, and the hands and feet are naturally warm, the disease is associated with Taiyin. In Taiyin involvement, jaundice should develop. However, if urination is free and easy, jaundice will not occur. By the seventh or eighth day, sudden irritability followed by diarrhea occurring more than ten times a day will necessarily stop spontaneously. This is because the Spleen's righteous Qi is sufficient ("Spleen Home Excess"), and foul turbidity is being expelled.
A floating and moderate pulse in cold damage indicates the disappearance of the tight pulse becoming moderate, signaling a transformation of cold into heat, similar to Clause 47 of Taiyang. Naturally warm hands and feet are not a fixed sign of Taiyin; in Taiyin cold, hands and feet are cold; in Taiyin heat, they are naturally warm. Yangming heat causes fever in the whole body and extremities, whereas Taiyin heat causes no body fever but warm extremities. Here, cold has transformed into heat, and extremities are warm, indicating the pathogen has moved from Taiyang to Taiyin rather than Yangming. The persistent floating pulse suggests the pathogen has not fully entered the interior. Hence, it is said to be "associated with Taiyin," meaning connection from Taiyang to Taiyin. According to protocol, Taiyin heat with anhidrosis leads to heat-contending-with-dampness and jaundice. If urination is free, heat dissipates and cannot steam to cause jaundice. By days 7-8, sudden irritability and diarrhea indicate internal righteous Qi activity and pathogen expulsion. Although occurring ten-plus times daily, it will cease spontaneously. This occurs because the Spleen naturally contains foul turbidity to be expelled, causing spontaneous diarrhea. Once turbidity is cleared, diarrhea stops.
Spontaneous diarrhea without thirst indicates Taiyin involvement, due to cold in the Zang organs. Treatment should employ warming methods, preferably Si Ni Tang (Frigid Extremities Decoction) or similar formulas.
Spontaneous diarrhea without thirst indicates inherent Taiyin cold compounded by Yin pathogen invasion. Identifying it as Taiyin confirms internal cold, distinct from Yang meridian diarrhea or transmitted heat diseases. The method should warm the Zang and dispel cold, using formulas like Si Ni Tang. Bitter-cold herbs for clearing heat and consolidating Yin, such as those in Huangqin Tang (Scutellaria Decoction), are contraindicated.