太阴之病,有时可由汗解者,然必须病机有外越之势,原非强发其汗也。
《伤寒论》原文∶太阴病脉浮者,可发汗,宜桂枝汤。
脉浮者,乃太阴之病机外越,原可因其势而导之,故可服桂枝汤以发其汗也。若其脉之浮而有力者,宜
将桂枝减半(用钱半),加连翘三钱,盖凡脉有浮热之象者,过用桂枝,恒有失血之虞,而连翘之性凉而
宣散,凡遇脉象之浮而有力者,恒得之即可出汗,故减桂枝之半而加之以发汗也。恐其汗不出者,服药后亦可
啜粥,若间有太阴腹满之本病者,可加生莱菔子三钱,盖莱菔子
生用,其辛辣之味不但可以消胀满,又可助连翘发汗也。
太阴自少阳传来原无寒证,乃有其脏本素有寒积,经外感传入而触发之,致太阴外感之证不显,而
惟显其内蓄之寒凉以为病者,是则不当治外感,惟宜治内伤矣。
《伤寒沦》原文∶自利不渴者,属太阴,以其脏有寒故也。当温之,宜四逆辈。
陈修园曰∶自利者,不因下而利也。凡利则津液下注,多见
口渴,惟太阴湿土之为病不渴,至于下利者当温之,而浑言四逆辈,所包括之方原甚广。
王和安谓∶温其中兼温其下宜四逆,但温其中宜理中、吴茱萸,寒结宜大建中汤。湿宜真武汤,渴者
宜五苓散,不渴而滑宜赤石脂禹余粮汤。而愚则谓甘草干姜汤、干姜附子汤、茯苓四逆汤诸方,皆可因证选用也。
太阴病,有时可以通过发汗而解除,但这必须建立在病机有向外透达趋势的前提下,原本就不是强行发汗。
《伤寒论》原文记载:太阴病,脉象浮的,可以发汗,适宜使用桂枝汤。
脉象浮,是太阴病的病机向外透达的表现,原本就可以顺应这种趋势加以引导,所以可以服用桂枝汤来发汗。如果脉象浮而有力,应当将桂枝用量减半(用一钱半),加入连翘三钱。因为凡是脉象呈现浮热之象的,过度使用桂枝,常常会有导致出血的危险;而连翘药性凉快且具有宣散作用,凡是遇到脉象浮而有力的情况,通常使用它就能出汗,所以减少一半桂枝的量并加入它来发汗。担心患者不出汗的,服药后也可以喝些热粥助汗。如果偶尔伴有太阴病腹满的根本症状,可以加入生莱菔子三钱,因为莱菔子生用时,其辛辣的味道不仅能消除胀满,又能帮助连翘发汗。
太阴病从少阳传来,原本没有寒证,而是因为该脏腑本身素有寒积,经过外感邪气传入而触发,导致太阴外感的症状不明显,而只显现出内部蓄积的寒凉作为病症,这种情况下就不应当治疗外感,只适宜治疗内伤。
《伤寒论》原文记载:自发性腹泻且不口渴的,属于太阴病,因为内脏有寒的缘故。应当温补,适宜使用四逆汤类方剂。
陈修园说:自利,是指不因误用泻下法而导致的腹泻。凡是腹泻,津液向下流失,多见口渴,只有太阴湿土受邪为病时才不口渴。至于出现下利的情况应当温补,笼统地说“四逆辈”,所包含的方剂原本就很广泛。
王和安认为:温中兼温下的适宜用四逆汤,但仅温中的适宜用理中汤、吴茱萸汤,寒结适宜的用大建中汤。湿气重的适宜用真武汤,口渴的适宜用五苓散,不渴且滑脱失禁的适宜用赤石脂禹余粮汤。而我则认为甘草干姜汤、干姜附子汤、茯苓四逆汤等方剂,都可以依据具体证候选用。
Taiyin disease may sometimes be resolved through sweating, but this requires that the pathogenesis has a tendency to move outward; it is originally not about forcibly inducing sweat.
The original text of *Shanghan Lun* states: In Taiyin disease, if the pulse is floating, sweating may be induced, and Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
A floating pulse indicates that the pathogenesis of Taiyin disease is moving outward; thus, one can originally follow this trend to guide it, so taking Guizhi Tang (Cinnamon Twig Decoction) to induce sweating is permissible. If the floating pulse is forceful, the dosage of Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*) should be halved (use 1.5 qian), and Lianqiao (Forsythia Fruit, *Forsythiae Fructus*) 3 qian should be added. This is because whenever the pulse presents with a floating-heat appearance, overusing Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*) often carries the risk of bleeding; whereas Lianqiao (Forsythia Fruit, *Forsythiae Fructus*) is cool in nature and dispersing. Whenever encountering a floating and forceful pulse, using it usually induces sweating. Therefore, half the amount of Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*) is reduced and replaced with it to induce sweating. To prevent failure to sweat, the patient may also drink hot porridge after taking the medicine. If there are occasionally underlying symptoms of abdominal fullness characteristic of Taiyin disease, raw Laifuzi (Radish Seed, *Raphani Semen*) 3 qian can be added. When used raw, the pungent-spicy flavor of Laifuzi (Radish Seed, *Raphani Semen*) not only eliminates bloating but also assists Lianqiao (Forsythia Fruit, *Forsythiae Fructus*) in inducing sweating.
Taiyin disease transmitted from Shaoyang originally does not involve cold syndromes; rather, it occurs when the organ itself harbors pre-existing cold accumulation, which is triggered by external contraction, causing the external Taiyin symptoms to be inconspicuous, while only the internal accumulated cold manifests as the disease. In such cases, treating the external contraction is inappropriate; instead, treating the internal injury is indicated.
The original text of *Shanghan Lun* states: Spontaneous diarrhea without thirst belongs to Taiyin, due to cold in the zang organs. It should be warmed, and formulas similar to Sini Tang (Frigid Extremities Decoction) are appropriate.
Chen Xiuyuan stated: "Spontaneous diarrhea" refers to diarrhea not caused by improper purgation. Generally, diarrhea leads to fluid loss downward and often presents with thirst; however, in diseases of Taiyin damp-earth, there is no thirst. As for lower diarrhea requiring warming, the term "Sini Tang category" broadly encompasses many formulas.
Wang He'an argued: For warming both middle and lower jiao, Sini Tang (Frigid Extremities Decoction) is suitable; for warming only the middle, Lizhong Tang (Regulate the Middle Decoction) or Wuzhuyu Tang (Evodia Fruit Decoction) are suitable; for cold accumulation, Dajianzhong Tang (Greatly Build the Middle Decoction) is suitable. For dampness, Zhenwu Tang (True Warrior Decoction) is suitable; for thirst, Wuling San (Five-Ling Powder) is suitable; for non-thirsty cases with slippery incontinence, Chishizhi Yuyuliang Tang (Red Halloysite and Hematite Decoction) is suitable. However, I believe that Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction), Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction), and Fuling Sini Tang (Poria and Frigid Extremities Decoction) can all be selected according to the specific syndrome.