典藏书目

(Abdominal distension, abdominal pain, and jaundice, along with the three categories of vomiting and diarrhea, are appended to the Shaoyin disease chapter. This is because these conditions originally belong to Taiyin disease, but since they appear more frequently in Shaoyin disease, they are attached according to the majority.)

Jaundice: The typical manifestation of Taiyin disease includes abdominal distension accompanied by vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain; Lizhong Tang (Cinnamon Twig and Dried Ginger Decoction) is appropriate. In Yin channel diseases, Guizhi Tang (Cinnamon Twig Decoction) is rarely used; however, if the pulse is floating, Guizhi Tang should be used to induce slight sweating. If aversion to cold is severe and persistent, neither Lizhong Tang nor Sini Tang (Fried Aconite Root Decoction) will suffice. All three Yin channels present with aversion to cold, but true aversion to cold is characterized by a desire for thick clothing. If the aforementioned condition is mistakenly treated with purgation, it will inevitably lead to hardness and binding below the chest, at which point Xixin Tang (Heart-Draining Decoction) becomes appropriate. Although Xixin Tang is used due to mistaken purgation rather than transmitted heat pathogen, all three Yin channels can have transmitted heat pathogens and thus heat syndromes, which differ from the Yin syndromes described above and require careful investigation. Treatment methods for Taiyin channel include sweating, purging, warming, harmonizing, and resolving:
Sweating method: Guizhi Tang (Cinnamon Twig Decoction), Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony).
Purging method: Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb).
Warming method: Sini Tang (Fried Aconite Root Decoction), Lizhong Tang (Cinnamon Twig and Dried Ginger Decoction).
Harmonizing/Resolving method: Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction), Yinyin Wuling San (Artemisia Capillaris and Five-Ingredient Powder with Poria).

The Classic of Internal Medicine states: "When both cun and chi pulses are deep and fine, Taiyin is affected." Because the Taiyin channel spreads through the stomach and connects to the throat, abdominal distension and dryness of the throat occur. However, upon reviewing the Taiyin chapter, the symptom of dry throat is missing.

The typical manifestation of Taiyin disease includes abdominal distension, vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain; if mistakenly purged, it leads to hardness and binding below the chest. (Cheng Wuji's commentary: Taiyin disease involves Yang pathogens transmitting inward. The Taiyin channel spreads through the stomach; when pathogens stagnate, abdominal distension occurs. Upward failure to descend causes vomiting and inability to eat; downward failure to ascend causes worsening spontaneous diarrhea. Occasional spontaneous abdominal pain differs from constant pain caused by internal Yin-cold; this is Yang pathogens disturbing the interior, causing intermittent pain. Mistaken purgation leaves Yin pathogens in the lower chest, forming hardness and binding. The text says: When a disease originating in Yin is mistakenly purged, pi syndrome results.) Spontaneous diarrhea without thirst belongs to Taiyin; a floating and moderate pulse with naturally warm hands and feet indicates the disease is in Taiyin; post-purgation abdominal distension and occasional pain belong to Taiyin; if the Taiyin disease pulse is floating, sweating may be induced using Guizhi Tang (Cinnamon Twig Decoction). (In Taiyang disease, a floating pulse without sweat warrants Mahuang Tang (Ephedra Decoction); here, although the pulse is floating and likely without sweat, it is not stated because Yin diseases do not typically present with sweat, so it need not be mentioned. Guizhi Tang is used instead of Mahuang Tang because Yin diseases should not further disperse Yang Qi. Note that Guizhi Tang can also be used when there is no sweat.) Originally suffering from Taiyang disease, if a physician mistakenly uses purgation, leading to abdominal distension and occasional pain, it belongs to Taiyin and is primarily treated with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony). For severe pain with excess signs, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb) is used. (Pathogens entering the interior cause abdominal pain. Pain from Qi transmission to the interior is intermittent and requires harmonization with acrid-warm agents; pain from internal Yin-cold is continuous and requires warming with hot agents; pain from dry stool or retained food involves constipation, abdominal distension, and pain, requiring purgation. The text states: Various pains are often excess syndromes where pain decreases with defecation; these are all interior syndromes treated differently.)

Guizhi Jia Shaoyao Tang Formula:
Guizhi (Cinnamon Twig) and Shengjiang (Fresh Ginger) (each 3.5 liang), Gancao (Licorice Root, honey-fried) (2 liang), Shaoyao (Peony Root) (6 liang), Dazao (Jujube) (12 pieces, split). These five ingredients are boiled in 7 sheng of water to yield 3 sheng, strained, and taken in three warm doses.

Guizhi Jia Dahuang Tang Formula:
Guizhi (Cinnamon Twig) (1 liang), Shaoyao (Peony Root) (1.5 liang), Gancao (Licorice Root, honey-fried) (0.5 liang), Dahuang (Rhubarb Root and Rhizome) (0.5 liang; add 1 liang if stool is hard and painful; use original formula for deficiency). The herbs are crushed, combined with 3 jujubes and 4 slices of ginger, decocted in water, and taken warm.

Zhang Yuansu said: Some ask why Sizhi Tang (Fried Aconite Root Decoction) is appropriate for Taiyin disease, yet Guizhi Tang (Cinnamon Twig Decoction) and Dahuang (Rhubarb Root and Rhizome) are also used. Dahuang is extremely cold; why use it in Yin channels? Moreover, combining cold Guizhi and Dahuang seems contradictory. The answer is: Spontaneous diarrhea with thirst belongs to Shaoyin, indicating cold in the Lower Jiao; spontaneous diarrhea without thirst belongs to Taiyin, indicating cold in the Middle Jiao. Using Sizhi Tang (Fried Aconite Root Decoction) to warm the organs is the standard treatment for this channel. Regarding Taiyang disease mistakenly purged, where exterior pathogens remain and transmit to Taiyin causing abdominal distension and occasional pain, Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony) is used; for severe excess pain, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb) removes exterior and interior pathogens. Although these cases follow purgation, the diarrhea has stopped, and distension/pain persist, making Shaoyao and Dahuang suitable. If the pulse is floating and weak, and the patient continues to have loose stools, even if Dahuang and Shaoyao are indicated, their dosage should be reduced because the Stomach Qi is weak and prone to movement.

Zhao Yi de said: The *Huo Ren Shu* (Book of Saving Lives) Question 4 states that abdominal distension and occasional pain belong to Taiyin, and abdominal pain is treated with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony), while severe pain uses Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb). I carefully examine that Taiyin abdominal distension has three types: transmitted pathogens, direct invasion of the channel, and pathogens sinking after purgation. Abdominal distension with dry throat indicates transmitted Yang pathogens, treated by purging. Abdominal distension with vomiting, inability to eat, worsening spontaneous diarrhea, and occasional pain, where mistaken purgation causes lower chest hardness, indicates direct Yin pathogens invading the channel, treated by warming. Abdominal distension and occasional pain following mistaken Taiyang purgation indicate sinking pathogens, treated with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony); severe excess pain uses Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb). The current question fails to specify these two formulas for post-purgation treatment and omits "severe excess pain," merely saying "severe pain." If one encounters direct Yin pathogen invasion with abdominal distension, occasional pain, and deep/fine pulses, using Guizhi Jia Shaoyao/Dahuang Tangs would cause regret over lower chest hardness. "Severe excess pain" refers to solidified dry pathogens in the Stomach causing intense pain, distinct from major excess syndromes. Thus, Taiyin Yin pathogen distension suits Lizhong Tang (Cinnamon Twig and Dried Ginger Decoction) with Qingpi (Aged Tangerine Peel) and Chenpi (Tangerine Peel); transmitted pathogen distension with dry throat suits Da Chaihu Tang (Major Bupleurum Decoction); post-purgation distension and pain see the previous formula.

Taiyin disease with a weak pulse and continued loose stools: if Dahuang (Rhubarb Root and Rhizome) and Shaoyao (Peony Root) are indicated, reduce dosage due to weak Stomach Qi. Taiyin wind-stroke presents with uncomfortable pain in the four limbs; a pulse that is faint at cun, choppy at chi, yet long indicates impending recovery. (*Inner Classic*: Limbs receive Qi from the Stomach but rely on the Spleen to transport fluids. Spleen disease prevents fluid transport, causing limb decline, poor pulse flow, and lack of Qi in sinews/muscles. The Spleen corresponds to the four seasons and extremities, so Taiyin disease affects the limbs.) Taiyang disease resolves from Hai to Chou hours (Spleen is Yin Earth, prosperous during Hai/Zi/Chou hours, facing Yang, hence the resolution time).

Hua Shou said: Ancients believed that on the fourth day, Taiyin syndrome affecting the chest/diaphragm could be cured by emesis. Response: Incorrect. Taiyin syndrome with large pulse, chest fullness, and phlegm may be vomited; large pulse without emesis signs requires sweating only.

Generally, exterior conditions are treated by sweating, interior by purging, upper by emesis, lower by draining. Gualou Zhichi Sui (Trichosanthes Fruit, Gardenia, and Soybean Paste) are applied according to syndrome, not fixed days.

Zhao Yi de said: *Huo Ren Shu* Question 56 asks: "Do Yin syndromes have fever?" Taiyin and Jueyin do not feature fever; only Shaoyin does. However, examining Zhang Zhongjing's treatise, all three Yin channels have fever. Beyond two Shaoyin syndromes, there are cases of vomiting/diarrhea with non-cold hands/feet and reverse fever (not fatal); Shaoyin disease with whole-body/hand-foot heat due to bladder heat causing hematuria; Si Ni San (Four Counterflow Powder) in Shaoyin uses Chaihu (Bupleurum Root) for fever; Jueyin disease with initial cold then fever and diarrhea stops spontaneously; diarrhea with rapid pulse, slight fever, and sweat indicates recovery; red face/slight fever indicates depression/emotion; vomiting with fever uses Xiao Chaihu Tang (Minor Bupleurum Decoction); Taiyin wind-stroke with limb pain shows all three Yin channels have fever, contradicting rigid claims. Also, Taiyin chapter lacks emesis methods; empty irritability or diaphragmatic excess allowing emesis belong to other channels. Only Hua Tuo mentions fourth-day chest emesis without specifying Taiyin. Why does *Huo Ren Shu* claim Taiyin chest/diaphragm emesis? The chest is not Taiyin territory; Zhang Zhongjing notes mistaken purgation causes chest binding as a complication, but the lower chest near the heart/abdomen is not suitable for emetics. Regarding pulses, Zhang Zhongjing only states Taiyin cun/chipulses are deep and fine, never mentioning large pulses.