典藏书目

In the prescription of Guizhi Tang (Cinnamon Twig Decoction), add three liang of Shaoyao (White Peony Root), totaling six liang together with the previous amount. The remaining decoction and administration methods follow the protocol of Guizhi Tang.

Guizhi (Cinnamon Twig) 3 liang, Dahuang (Rhubarb Root) 2 liang, Shaoyao (White Peony Root) 6 liang, Gancao (Licorice Root, honey-fried) 2 liang, Shengjiang (Fresh Ginger, sliced) 3 liang, Dazao (Jujube, split) 12 pieces.
These six ingredients are boiled in seven sheng of water to obtain three sheng of liquid. Remove the dregs, and take one sheng warm per dose, three times a day.
[Collected Explanations]
Ke Qin stated: Abdominal fullness is a symptom present in both Taiyin (Greater Yin) and Yangming (Bright Yang) diseases, yet although the location is the same, their functions differ. Taiyin governs output; when Taiyin is diseased, putrid filth qi stagnates and fails to flow smoothly, resulting in fullness and intermittent pain. Yangming governs intake; when Yangming is diseased, putrid filth becomes dry and knotted, failing to move, resulting in severe excess and pain. Thus, we know that "severe excess pain" is a manifestation of Yangming disease, not Taiyin disease. Zhang Zhongjing, because the exterior syndrome was unresolved and the yang pathogen had already sunk into Taiyin, doubled the dosage of Shaoyao to benefit the spleen and harmonize the middle jiao, thereby eliminating abdominal fullness and intermittent pain. This is the method of using yin to harmonize yang. If the exterior pathogen remains unresolved and the yang pathogen sinks into Yangming, then Dahuang is added to moisten the stomach and unblock constipation, thereby eliminating the severe excess pain. This is the method of simultaneously resolving the exterior and interior. Any reckless use of purgatives will inevitably damage the qi and fluids of the stomach. When stomach qi is deficient, yang pathogens attack the yin, so the disease transfers to Taiyin; when stomach fluids are exhausted, two yangs contend, so the disease transfers to Yangming. When belonging to Taiyin, there is abdominal fullness and intermittent pain without solidity, due to the deficiency of the yin pathway; when belonging to Yangming, there is abdominal fullness, severe excess, and pain, due to the excess of the yang pathway. Fullness with intermittent pain is an omen of diarrhea; severe excess with pain is a sign of dry feces. Therefore, doubling Shaoyao is a slight modification of the Xiaojianzhong Tang (Minor Construct the Middle Decoction), and adding a small amount of Dahuang slightly indicates the formula of Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction).
@@@
In Taiyin disease, if the pulse is weak and the person continues to have spontaneous bowel movements, if one were to administer Dahuang or Shaoyao, the dosages should be reduced, because the person's stomach qi is weak and prone to being easily disturbed [leading to diarrhea].
[Annotation]
Taiyin disease necessarily presents with abdominal fullness and pain. The treatment method should be determined by considering the pulse. If the pulse is weak, it indicates insufficiency in the center. Although there may be no sensation of qi rushing down to the lower abdomen, there will certainly be continuous spontaneous bowel movements. If Dahuang or Shaoyao were indicated, their dosages should be reduced because the weak stomach qi cannot withstand harsh purgation, and the bowels are easily moved. From this, we can infer that for those with □ [normal/soft] stools, regardless of whether the disease is in the yin or yang meridians, any case with a weak pulse should not be lightly purged.
[Collected Annotations]
Cheng Zhi said: This discusses Taiyin with a weak pulse, fearing continuous diarrhea. Even if there is abdominal pain, purgatives should not be used, which elucidates the principle alongside Xiaojianzhong Tang.
Yu Chang said: This section of admonition elucidates the content mutually with the Yangming chapter. In Yangming, phrases like "no passage of gas," "hard stool first followed by loose stool," and "dry stool not yet formed" all express fear of damaging Taiyin spleen qi. Here, in Taiyin syndrome with a weak pulse, fearing continuous diarrhea, reducing Dahuang and Shaoyao even if abdominal pain exists expresses fear of damaging Yangming stomach qi.
Wang Hu said: One might ask: Dahuang damages stomach qi, so it should be reduced; Shaoyao regulates spleen yin, why should it also be reduced? The answer is: A weak pulse indicates deficient qi. Zhang Zhongjing believed that warm and sweet herbs generate qi. Shaoyao has a sour and cold flavor; although not as harsh as Dahuang, it is not suitable for excessive use in those with deficient qi, hence it is also reduced.
@@@
In Shanghan (Cold Damage), if the pulse is floating and moderate, and the hands and feet are naturally warm, the disease is associated with Taiyin. Taiyin disease typically manifests as jaundice; however, if urination is spontaneous and free, jaundice will not develop. By the seventh or eighth day, even if there is sudden irritability and diarrhea occurring more than ten times a day, it will certainly stop spontaneously. This is because the spleen qi is sufficient (Shi), and the putrid filth is destined to be expelled.
[Annotation]
Shanghan with a floating and moderate pulse, accompanied by hot hands and feet, indicates association with Taiyang. Now, since the hands and feet are merely warm, we know the disease is associated with Taiyin. Taiyin is associated with dampness; when dampness and heat stasis interact, jaundice should develop. If urination is spontaneous, dampness does not accumulate and heat does not stagnate, so jaundice cannot develop. If by the seventh or eighth day, the stool becomes □ [dry/hard], it would indicate transfer to Yangming. Since it is not □ here, even with sudden irritability and diarrhea more than ten times a day, it must stop spontaneously. Why? Because the floating and moderate pulse and warm hands and feet indicate that the Taiyin spleen is inherently solid/excess (Shi). The pathogen cannot remain, and the putrid filth must be expelled.
[Collected Annotations]
Cheng Zhi said: Regarding spontaneous diarrhea, if the pulse is floating and moderate and the hands and feet are warm, it indicates spleen excess (Shi). The Taiyin pulse is naturally moderate. Although floating and moderate resembles Taiyang wind-strike, the spontaneous warmth of the hands and feet distinguishes it from the fever of Taiyang, and even more so from the cold limbs of Shaoyin and Jueyin. Thus, it is associated with Taiyin. Taiyin damp-heat steaming inevitably leads to jaundice, but if urination is free, dampness drains downward and jaundice does not occur. Although this sudden irritability and frequent diarrhea resemble Shaoyin syndrome, the diarrhea will stop spontaneously. The reason is that the floating and moderate pulse and warm hands and feet indicate strong spleen qi, unlike deficiency-cold. The putrid filth accumulated by damp-heat will naturally be driven out downward. If one fails to distinguish this and treats it with Sini Tang (Frigid Extremities Decoction), it would be a mistake.
Cheng Yingmao said: When Taiyin presents with floating-moderate pulse and warm hands and feet, stomach yang is active, so there is naturally no pain from cold in the zang organs, though yin depression may exist. If urination is obstructed, jaundice develops; even if it occurs, it is not yin-jaundice. If urination is spontaneous, jaundice does not develop. As yin attempts to depress, yang drives it out. By the seventh or eighth day, despite sudden irritability and diarrhea more than ten times a day, it will stop. The reason is that the pulse is floating and moderate rather than deep and weak, and the hands and feet are warm rather than cold. Yin is protected by yang, so it is not cold; not cold means not deficient. This is called "spleen excess." The Classic states: The yang pathway is excess, the yin pathway is deficient. Yin traveling the yang pathway would not tolerate the pathogen staying long. This is why the putrid filth is expelled.
Wang Hu said: Diarrhea with irritability and restlessness indicates death when it occurs after diarrhea, as this signifies depletion of righteous qi and disturbance by pathogenic qi. Here, irritability precedes diarrhea, indicating that the spleen's righteous qi is strong, resisting the pathogen, thus causing sudden onset of irritability and heat.
@@@
In Taiyin wind-strike, with irritability and pain in the four limbs, if the pulse is superficially faint and deeply choppy but long, recovery is imminent.
[Annotation]
Taiyin wind-strike refers to a Taiyin disease transmitted from Taiyang wind-strike, hence presenting with irritability and pain in the four limbs. "Yin and Yang" here refer to superficial and deep positions. With a Taiyin pulse that is superficially faint and deeply choppy, combined with the long pulse characteristic of Yangming, this represents a yin disease manifesting a yang pulse. Pathogen transferring from zang to fu indicates impending recovery.
[Collected Annotations]
Cheng Zhi said: Shanghan is yin pathogen, causing spontaneous diarrhea, treated with Sini Tang. Wind-strike is yang pathogen, causing irritability and pain in the four limbs. In Taiyin disease, a floating pulse usually indicates Taiyin wind-strike.
Yu Chang said: Amidst the faint and choppy qualities, observing that the pulse is long and not short indicates that the primordial qi is intact, and the disease will heal itself.
@@@
Taiyin disease tends to resolve between the hours of Hai (9 PM - 11 PM) and Chou (1 AM - 3 AM).
[Annotation]
The resolution of pathogenic factors occurs during their time of prosperity. Hai, Zi, and Chou are the prosperous times for Taiyin. During these prosperous times, the pathogen cannot prevail and resolves spontaneously.
Phonetic Notes
Qu: pronounced as 'qi ju' jie.
Jie: pronounced as 'jie'.
Fu: pronounced as 'fu'.
Hui: pronounced as 'yu fei' jie.