16. 伤寒三日二阳尽, 热微烦躁入阴传, 其人能食而不呕, 脉小尿清
为不传.
【注】伤寒三日, 三阳受邪为尽, 三阴当受邪, 其人身热虽微, 而烦
躁者, 谓邪去阳入阴不解也. 若其人反能食而不呕, 脉静小, 小便清,
谓邪未入于阴为不传, 欲自愈也.
太阴阴邪脉证
17. 太阴阴邪沉迟脉, 吐食腹满有时疼, 手足自温痢不渴, 理中汤主
悸加苓, 腹满去术加附子, 吐多去术加姜生, 虽吐下多还用术, 渴欲
得水倍术宁, 欲作奔豚术易桂, 干姜寒倍参腹疼.
【注】太阴阴邪, 谓邪从阴化之寒证也. 脉沉迟, 太阴阴邪脉也. 吐
食,腹满时痛, 太阴里寒证也. 手足自温, 邪入阴也. 自痢不渴, 脏
无热也, 宜理中汤主之. 若心下悸, 加茯苓. 腹满, 去术加附子. 吐
多,去术加生姜. 唯吐若下痢多, 还用白术. 若渴欲得饮水, 仍倍加
术.若脐下欲作奔豚, 去术易桂. 中寒倍加干姜. 腹痛倍加人参. 详
太阴篇.
18. 阳邪嗌干腹满痛, 误下时痛大实疼, 大承桂枝加芍大, 脉弱芍大
当审行.
【注】阳邪, 谓太阴邪从阳化之热证也. 嗌干, 谓咽干太阴热也. 腹
满痛, 太阴有余证也. 误下, 谓误下邪陷太阴当分轻重也. 时痛, 谓
腹有时痛, 有时不痛, 宜桂枝加芍药汤和之. 大实痛, 谓腹大满痛,
无时不痛, 宜桂枝加大黄汤下之. 兼阳明胃实, 以大承气汤下之. 若
脉弱即当行大黄芍药, 宜斟酌减之, 以其人胃气弱易动也. 详太阴篇.
16. 伤寒病经过三天，三阳经的邪气已经传尽，热势轻微并出现烦躁，这是邪气传入阴经的表现。如果患者能够进食且不呕吐，脉象细小、小便清长，说明邪气没有传入阴经，病情不会进一步传变。
【注】伤寒病经过三天，三阳经受邪的情况已经结束，按理说三阴经应当受邪。此时患者虽然身热轻微，但出现烦躁症状，这说明邪气离开阳经进入阴经后并未解除。如果患者反而能够进食且不呕吐，脉象平静而细小，小便清长，这说明邪气未进入阴经，属于不传变，病情有望自愈。
太阴经受阴邪的脉证
17. 太阴经受阴邪表现为沉迟脉，伴有呕吐食物、腹部胀满、有时疼痛，手足自然温暖、下痢但不口渴，治疗主方为理中汤。若伴有心悸，加用茯苓；若腹部胀满明显，去掉白术加用附子；若呕吐严重，去掉白术加用生姜。虽然呕吐和下痢严重，但仍需使用白术；若口渴想喝水，加倍使用白术以宁心定志；若感觉脐下有奔豚气发作的趋势，去掉白术改用桂枝；若中焦寒盛，干姜用量加倍，人参用量也加倍，针对腹痛。
【注】太阴经受阴邪，是指邪气从阴化而为寒证的病证。脉象沉迟，是太阴经受阴邪的典型脉象。呕吐食物、腹部胀满且时有疼痛，是太阴经里寒证的表现。手足自然温暖，说明邪气已入阴经。自发性下痢且不口渴，说明脏腑内无热邪，适宜用理中汤主治。若出现心下悸动，加用茯苓。若腹部胀满，去掉白术加用附子。若呕吐剧烈，去掉白术加用生姜。唯独在呕吐或下痢严重时，仍要使用白术。若口渴想要饮水，仍然加倍加入白术。若脐下感觉有奔豚气欲发，去掉白术改用桂枝。中焦寒盛则加倍干姜。腹痛则加倍人参。详见太阴篇。
18. 太阴经受阳邪表现为咽干、腹部胀满疼痛，若误用攻下法导致邪气内陷，会出现时痛或剧烈的大实痛。治疗大实痛可用桂枝加大黄汤，若脉象虚弱，当审慎使用大黄和芍药的剂量。
【注】阳邪，是指太阴经受邪后从阳化火的热证。咽干，指太阴经有热导致的咽喉干燥。腹部胀满疼痛，是太阴经有余（实证）的表现。误下，指错误地使用攻下法导致邪气陷入太阴经，此时应当区分病情的轻重。时痛，指腹部有时疼痛、有时不痛，适宜用桂枝加芍药汤调和。大实痛，指腹部胀满疼痛且持续不断，适宜用桂枝加大黄汤攻下。若兼有阳明胃腑实证，用大承气汤攻下。若脉象虚弱，则应当谨慎使用大黄和芍药，宜斟酌减量，因为此类患者胃气虚弱，容易因药力过猛而动伤正气。详见太阴篇。
16. After three days of Shanghan (Cold Damage), the pathogenic factors in the Three Yang meridians have been exhausted. The heat is slight, accompanied by irritability and restlessness, indicating the transmission of pathogens into the Yin meridians. If the patient can eat without vomiting, and presents with a fine pulse and clear urine, it indicates that the pathogens have not transmitted into the Yin meridians, and the disease will not progress further.
[Annotation] After three days of Shanghan, the involvement of the Three Yang meridians is complete, and theoretically, the Three Yin meridians should become involved. Although the body heat is slight, the presence of irritability and restlessness indicates that the pathogens have left the Yang meridians and entered the Yin meridians but have not yet resolved. However, if the patient can instead eat without vomiting, and presents with a calm and fine pulse along with clear urine, it signifies that the pathogens have not entered the Yin meridians. This is considered non-transmission, suggesting the condition is likely to heal spontaneously.
Pulse and Symptoms of Taiyin Meridian Affected by Yin Pathogens
17. When the Taiyin meridian is affected by Yin pathogens, the pulse is deep and slow. Symptoms include vomiting food, abdominal fullness, intermittent pain, naturally warm hands and feet, spontaneous diarrhea without thirst. The primary formula for treatment is Lizhong Tang (Regulate the Middle Decoction). If palpitations are present, add Fuling (Poria); if abdominal fullness is prominent, remove Baizhu (Atractylodis Macrocephalae Rhizoma) and add Fuzi (Aconiti Lateralis Radix Praeparata); if vomiting is severe, remove Baizhu and add Shengjiang (Zingiberis Rhizoma Recens). Even with severe vomiting or diarrhea, Baizhu should still be used; if there is thirst and desire for water, double the dosage of Baizhu to calm the spirit; if there is a sensation of Ben Tun (Rushing Pig) rising from below the umbilicus, remove Baizhu and substitute Guizhi (Cinnamomi Ramulus); if middle jiao cold is prevalent, double the dosage of Ganjiang (Zingiberis Rhizoma); for abdominal pain, double the dosage of Renshen (Ginseng Radix et Rhizoma). See the Taiyin chapter for details.
[Annotation] Taiyin affected by Yin pathogens refers to a cold syndrome where the pathogen transforms according to Yin characteristics. A deep and slow pulse is the typical pulse for Taiyin Yin pathogens. Vomiting food, abdominal fullness, and intermittent pain are signs of interior cold in the Taiyin meridian. Naturally warm hands and feet indicate that the pathogen has entered the Yin meridians. Spontaneous diarrhea without thirst indicates the absence of heat within the zang organs, making Lizhong Tang appropriate. If epigastric palpitations occur, add Fuling. For abdominal fullness, remove Baizhu and add Fuzi. For severe vomiting, remove Baizhu and add Shengjiang. Only in cases of severe vomiting or profuse diarrhea should Baizhu still be retained. If thirst and desire for water persist, increase the dosage of Baizhu. If there is a sensation of Ben Tun arising from below the umbilicus, remove Baizhu and use Guizhi instead. For prevalent middle jiao cold, double the dosage of Ganjiang. For abdominal pain, double the dosage of Renshen. Refer to the Taiyin chapter for details.
18. When the Taiyin meridian is affected by Yang pathogens, symptoms include dry throat and abdominal fullness with pain. If mistakenly treated with purgatives, leading to the sinking of pathogens into the Taiyin meridian, this may result in intermittent pain or severe, solid pain. Severe solid pain is treated with Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb). If the pulse is weak, the dosages of Dahuang (Rhei Radix et Rhizoma) and Shaoyao (Paeoniae Radix Alba) must be carefully assessed and adjusted.
[Annotation] Yang pathogens refer to heat syndromes in the Taiyin meridian where the pathogen transforms according to Yang characteristics. Dry throat indicates heat in the Taiyin meridian causing dryness of the pharynx. Abdominal fullness and pain are signs of excess (solid) conditions in the Taiyin meridian. Mistaken purgation refers to the erroneous use of purgative methods, causing pathogens to sink into the Taiyin meridian; in such cases, the severity of the condition must be distinguished. Intermittent pain refers to abdominal pain that comes and goes, which should be harmonized with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony Root). Severe solid pain refers to continuous abdominal fullness and pain, which should be purged with Guizhi Jia Dahuang Tang. If accompanied by Yangming stomach excess, Da Chengqi Tang (Major Order the Qi Decoction) is used for purgation. If the pulse is weak, one should exercise caution with the use of Dahuang and Shaoyao, adjusting the dosage downwards as these patients have weak stomach qi and are easily injured by strong medicinal forces. Refer to the Taiyin chapter for details.