Taiyin stage, its condition, pulse and treatment

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医宗金鉴卷六

<<Yi Zong Jin Jian>>  Chapter 6

辨太阴病脉证并治全篇

Taiyin stage, its condition, pulse and treatment

六气之邪,感人虽同,人受之而生病各异者,何也?盖以人之形有厚薄,气有盛衰,藏有寒热,所受之邪,每从其人之藏气而化,故生病各异也。是以或从虚化,或从实化,或从寒化,或从热化。譬诸水火,水盛则火灭,火盛则水耗,物盛从化,理固然也。诚知乎此,又何疑乎?阳邪传阴,变寒化热,而遂以为奇耶?自後汉迄今,千载以来,皆谓三阴寒邪不传,且以伤寒传经阴邪,谓为直中,抑知直中乃中寒之证,非传经之邪耶!是皆未曾熟读仲景之书,故有此误耳!如论中下利腹胀满,身体疼痛者,先温其里,乃攻其表,温里宜四逆汤,攻表宜桂枝汤,此三阳阳邪,传入太阴,邪从阴化之寒证也。如少阴病下利,白通汤主之,此太阴寒邪,传少阴之寒证也。如下利清谷, 里寒外热,汗出而厥者,通脉四逆汤主之,此少阴寒邪传厥阴之寒证也。皆历历可据,岂得谓伤寒阴不相传,无阳从阴之化理乎?

Although the six major Xieqi can attack everybody, the clinic syndromes for each people are quite different. Why? This is because the persons’ body constitution is different. Some people are strong originally from birth, some are strong later due to exercise or something else. Some people are weak from the birth, and some due to later diseases. Some may take some kinds of chemical medications, and some are drinking alcohol, smoke, abuse in sex, etc. Therefore the body can be Hot, or can be Cold in constitution, or can be Fire or Wet in body nature, so that once attacked by the same kind of Xieqi from out of the body, the sufferings of each people is different. The same kind of Xieqi after invasion, can cause Fire, or Cold; making people weak, or creating mass in the body. If the body starts to have more Water, his Fire in the body will be reduced or suppressed down. If the Fire is overwhelming, his Water (Jingye) will be exhausted. If we know this, there should be no question. A Xieqi of Yang nature can transfer into a Xieqi of Yin in nature; or a Fire Xieqi can cause a Cold reaction in the body. No surprise. From Han dynasty, for thousands of years, it is commonly believed that the Cold Xieqi does not transfer among the Yin stages. If there is Cold syndrome in the Yin stages, it is due to the straight penetration of the Cold Xieqi into the Yin stages. People do not know that the straight penetration is just the Cold-invasion quickly into the Yin stages! All is because they do not read the Shanghan Lun in a very careful manner, so to have such mistakes! For example, in the book it is said if the person has diarrhea and fullness in stomach, and pain in the body, we should warm and support the body inside first, by using Sini Tang, then deplete the Xieqi from body, by using Guizhi Tang. This is a condition in which the Xieqi of Yang in nature developed into the Yin condition and cause Cold syndrome inside of the body. If in the Shaoyin stage, the person has Cold diarrhea, the Cold comes from the Taiyin stage. Baitong Tang is the main herbs. If the person has water- or food-like diarrhea, Cold in side but feels hot, sweat but cold in hands and feet, herb Tongmai Sini Tang is needed. This is a Cold Xieqi from Shaoyin to Jueyin stage. These are the good examples. How can we say that a Yin Xie does not pass from a Yin stage to another Yin stage, or a Yang Xie does not pass into a Yin stage?

夫太阴湿土,纯阴之藏也,故病一入太阴,则邪从阴化者多,从阳化者少;从阴化者,如论中腹满,吐食,自利,不渴,手足自温,时腹自痛,宜服理中四逆辈者是也;从阳化者,如论中发汗後不解,腹满痛者,急下之,宜大承气汤;腹满大实痛者,宜桂枝加大黄汤主之者是也。盖脾与胃同处腹中,故腹满、腹痛两皆有之。然腹满为太阴主病,心下满为阳明主病,其阳明亦有腹满者,以阳明腹满与热同化,故必有潮热、自汗、不大便之证,而不似太阴与湿同化,有发黄、暴烦、下利秽腐之证也。诚能更於腹之时痛,大实痛,腹满痛处,详审虚实,斟酌温下,则了无馀义矣。故以此括之,自知太阴之要法也。

Taiyin stage/meridian is associated with the Wet and Soil. It is a pure Yin stage. Therefore once the disease develops into the Taiyin stage, the Xieqi transferred into a Yin condition mostly; and into a Yang condition very rarely. The example for the Yin conditions are fullness in stomach, vomiting food, self-diarrhea, no thirsty, warm hands and feet, stomach pain from time to time. Lizhong Tang and other Sini group are needed. Example for the Yang condition is, as the book introduced, fullness and pain in Stomach after sweat therapy. Da Chengqi Tang is used; if the person has severe fullness and pain, Guizhi jia Dahuang Tang is needed. This is because the spleen and stomach are both located in the Stomach area, so the fullness and pain are shared by both spleen (Taiyin) and the stomach (Yangming). However, fullness in whole stomach (the Stomach) is the main symptom for Taiyin stage, whereas fullness in the upper stomach is the main symptom for Yangming. Yangming stage has also whole stomach fullness, but in this condition, the person has wave-hot, self-sweat, no bowel movement. For Yaiyin with fullness in whole Stomach, the person feels jaundice, terrible annoyed/impatience, diarrhea of terrible odor stools. If the doctor can pay attention to the time-to-time pain, or whole Stomach hard and pain, to distinguish the two stages, it should not be difficult. By this way, readers should know the key points of the Taiyin stage.

 

01 太阴之为病,腹满而吐,食不下,时腹自痛。若下之,必胸下结硬, 自利益甚。

Whenever having following conditions, a Taiyin stage should be considered: fullness in Stomach with vomiting, want to eat but cannot finish the eating, stomach pain from time to time with diarrhea If a bowel-cleansing therapy is used, the person will have hard and stock feeling in the upper stomach and the diarrhea becomes severe.[1]

02 伤寒四、五日,腹中痛,若转气下趋少腹者,此欲自利也。

With Cold-invasion Shanghan disease for four to five days, if the person feels pain in stomach, and the pain moves down to the lower stomach, it suggests a diarrhea. [2]

03 自利不渴者,属太阴,以其藏有寒故也,当温之,宜服四逆辈。

If the person has self-diarrhea[3] but no thirsty, this condition belongs to Taiyin[4], since there is Cold inside. It should be warmed, by using Sini Groups.[5]

理中方

Lizhong Tang

人参 白术 甘草(炙) 乾姜各三两

Renshen 45 gram, Baishu 45 gram, Gancao (processed) 45 gram, Ganjiang 45 gram.

右四味,捣筛,蜜和为丸,如鸡子黄许大,以沸汤数合,和一丸,研碎温服之,日三、四,夜二服。腹中未热,益至三、四丸,然不及汤。汤法以四物,依两数切,用水八升,煮取三升,去滓,温服一升,日三服。

Prepare the herbs into pills to use. Or, add the herbs and 2000 ml water into a herbal pot. Bring to boil then keep in mild boiling until the liquid volume in it is about 750 ml. Collect the herbal tea. Drink one third each time, three times a day. 

加减法:若脐上筑者,肾气动也,去术加桂四两。吐多者,去术加生姜三两。下多者,还用术;悸者,加茯苓二两。渴欲得水者,加术,足前成四两半。腹中痛者,加人参,足前成四两半。寒者,加乾姜,足前成四两半。腹满者,去术加附子一枚。服汤後,如食顷,饮热粥一升许,微自温,勿发揭衣被。

Modifications: if the person has jumping feeling in the upper stomach (or above the naval), it is the movement of Kidney Qi, remove Baishu, but add Guizhi 60 gram. If with vomiting, remove Baishu, add Fresh ginger 45 gram; if with frequent diarrhea, add little bit more Baishu; if with palpitation, add Fuling 30 gram; if with thirsty and willing to drink water, add additional Baishu 23 gram; if with stomach pain, add additional Renshen 23 gram; if with Cold inside, add Ganjiang 23 gram; if with fullness in the Stomach, remover Baishu, add Fuzi 45 gram. After drinking the tea, eat rise soup about 250 ml. Cover the body and lie down for one hour to let the body feel warm.

04 伤寒,本自寒格[6],医复吐下之,寒格,更逆吐下,若食入口即吐,乾姜黄连黄芩人参汤主之。

If in Cold-invasion Taiyin stage, the person has Cold-block syndrome inside, but he is given a vomiting therapy or a bowel-cleansing therapy again. This results in the worse of the Cold-block syndrome, in which people has vomiting right after eating, has more vomiting and diarrhea. Ganjiang Huanglian Huangqin Renshen Tang is to be used.

乾姜黄连黄芩人参汤方

Ganjiang Huanglian Huangqin Renshen Tang is to be used.

乾姜, 黄连, 黄芩, 人参各三两

Ganjiang 45 gram, Huanglian 45 gram, Huangqin 45 gram, Renshen 45 gram.

右四味,以水六升,煮取二升,去滓,分温再服。

Add the herbs and 1500 ml water into a herbal pot. Bring to boil then keep in mild boiling until there is about 500 ml liquid left. Collect the herbal tea, separate it into several parts to drink during the day.

05 伤寒,医下之,续得下利清谷不止,身疼痛者,急当救里;後身疼痛,清便自调者,急当救表。救里宜四逆汤,救表宜桂枝汤。

With Cold-invasion Shanghan disease, a bowel-cleansing therapy is given that caused continuous diarrhea of non-digested food in the stool and body pain. This is urgent to support the inside of the body, using Sini Tang; after the diarrhea stops but body pain remains, using Guizhi Tang to deplete the Cold in the body surface layer. [7]

06下利清谷,不可攻表,汗出必胀满。

In Taiyin stage, if the person has diarrhea with non-digested food in the stool, sweating therapy should not be used, other wise the person will have fullness in Stomach. [8]

07下利,腹胀满,身体疼痛者,先温其里,乃攻其表,温里宜四逆汤,攻表宜桂枝汤。

If a person has diarrhea, fullness in Stomach area, and body pain, warm and support the body inside first, and improve the body surface condition later. Use Sini Tang to support the inside and use Guizhi Tang to improve the body surface condition.

08 发汗後,腹胀满者,厚朴生姜半夏甘草人参汤主之。

After a sweat therapy, if the person has fullness in the Stomach, use Houpo Shengjiang Banxia Gancao Renshen Tang. [9]

厚朴生姜半夏甘草人参汤方

Houpo Shengjiang Banxia Gancao Renshen Tang

厚朴(炙,去皮)半斤, 生姜(洗)半斤, 半夏(洗)半升, 甘草(炙)二两, 人参 一两

Houpo (remove skin, processed) 60 gram, Fresh ginger 60 gram, Banxia (washed) 62 gram, Gancao (processed) 30 gram, Renshen 15 gram.

右五味,以水一斗,煮取三升,去滓,温服一升,日三服。

Add the herbs and 2500 ml water in a herbal pot. Bring to boil and keep in mild boiling until the liquid in the pot is about 750 ml. Collect the herbal tea. Drink one third of the tea each time, three times a day.

09 发汗不解,腹满痛者,急下之,宜大承气汤。腹满不减,减不足言,当下之,宜大承气汤。

If a sweat therapy does not work to release surface conditions, and the person further more has fullness and pain in the whole stomach, Da Chengqi Tang should be used as soon as possible. If it only reduces[10] the fullness very little, it should be repeated again. 

10 太阴病,脉浮者,可发汗,宜桂枝汤。

In the Taiyin stage, if the person has floating pulse, sweat therapy can be used, but use the Guizhi Tang. [11]

11 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。大实痛者,桂枝加大黄汤主之。

If a person with Taiyang condition, was given bowel-cleansing therapy, he starts to have fullness in the stomach with pain from time to time, his condition has turned into Taiyin stage. Use Guizhi jia Shaoyao Tang[12]. If the pain is severe and the whole stomach is hard on press, use Guizhi jia Dahuang Tang. [13]  

桂枝加芍药汤方

Guizhi jia Shaoyao Tang

於桂枝汤方内,更加芍药三两,随前共六两,馀依桂枝汤法。

Add more Shaoyao in the standar Guizhi Tang, making the final amount of the Shaoyao in the formula as 90 gram. Cook and drink the tea as for Guizhi Tang.

桂枝加大黄汤方

Guizhi jia Dahuang Tang

桂枝  三两, 大黄  二两, 芍药  六两, 甘草(炙)二两, 生姜(切)三两, 大枣(擘)十二枚

Guizhi 45 gram, Dahuang 30 gram, Shaoyao 90 gram, Gancao (processed) 30 gram, Fresh ginger 45 gram, Chinese date 62 gram.

右六味,以水七升,煮取三升,去滓,温服一升,日三服。

Add the herbs and 1750 ml water into a herbal pot. Bring to boil then keep in mild boiling until the liquid in the pot is about 750 ml. Drink one third of the tea each time, three times a day.

12 太阴为病,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。

In Taiyin stage, if the person’s pulse is weak, has loss bowel movement and if other conditions suggesting the use of Shaoyao or Dahuang, the herbs should be used in low dose. The reason is that the spleen condition of the person is weak, strong herb may disturb his Weiqi (to cause more trouble).

13  伤寒脉浮而缓,手足自温者,系在太阴。太阴当发身黄,若小便自利者,不能发黄,至七、八日,虽暴烦,下利日十馀行,必自止,以脾家实,腐秽当去故也。

If a person with Cold-invasion Shanghan disease has floating and slow pulse, and his hand and feet is warm when touch, his condition is in Taiyin stage.[14] Disease in Taiyin stage tends to develop into jaundice. If the person has easy urine, he will not have jaundice. For such person, after seven to eight days, he may feel very annoyed/impatience and has diarrhea more than ten times a day[15]. Even so, the diarrhea will stop by it self, since it is to remove dirty rotten stools out of the body now – his Spleen system is not so weak yet.[16]

14 太阴中风,四肢烦痛,阳微阴涩而长者,为欲愈。

With Wind-invasion in the Taiyin stage, if the person feels continuous pain in the arms or legs, but his pulse is weak when slightly touch the pulse and harsh and long when deeper touch, it indicates the trends to cure of the disease. [17]

15 太阴病,欲解时,从亥至丑上。

For a disease in the Taiyin stage, it may be improved from any time between 9 pm and 2 am, or it may be worse from any time of this time period.[18]

With a proper treatment, or if the disease is in cure by itself, or if the disease belongs to a weak condition, the disease is improved from any time during this time period[19]. With an improper treatment, or if the disease is progressing, or if the nature of the disease belongs to a Shi condition, it will be worse from any time during this time period.[20]




[1] The stomach meridian connects to the spleen meridian. If the Cold invades into the Taiyin stage, the cold affects the function of the stomach, so the person cannot eat and has vomit. This is an inside weakness condition in the Taiyin stage. Herb Lizhong Tang and Sini group are needed. If the one feels fullness in the whole stomach, has dry nausea, pain and hard in the Stomach, no bowel movement, it is inside Shi condition of the Taiyini stage, which needs Guizhi jia Dahuang Tang to treat. If the herbs are used opposite, the person will have hard and stock feeling in the upper stomach and the diarrhea becomes severe. A Yang condition in the stomach can also have fullness and pain, but vomiting out of the stock food can release the Xieqi to cure. In the Taiyin inside weakness condition, the vomiting does not improve the fullness. Yang condition can also have a diarrhea, with the diarrhea, the accumulated Xieqi is depleted out of the body, so the person feels less pain with the diarrhea. Now in the Taiyin inside Shi condition, the diarrhea makes the pain and fullness worse.

[2] If the pain is due to a Fire, the pain will move from lower stomach upper. If it is due to a Cold, it moves from upper stomach down to the lower stomach. The Mater remind do not to use bowel-cleansing therapy for such Cold condition.

[3] The diarrhea here means the diarrhea that is not caused by a wrong sweat, vomiting or bowel-cleansing therapy. It comes by itself, suggesting that the body has Cold inside.

[4] If a diarrhea with thirsty, it indicates a Fire in the inside. Now, the diarrhea is without thirsty. So it is a mark of Cold inside of the Taiyin stage.

[5] Sini Goups: several herbal formula work similarly to warm the Yin conditions, such Sini Tang, Lizhong Tang, Jianzhong Tang, Baitong Tang, Tongmai Sini Tang, etc. It is easy to distinguish the Taiyin diarrhea with the Yangming diarrhea for the diarrhea with hot and thirsty in the Yangming. There is diarrhea also in Shaoyin and Jueyin stage, both has thirsty. Thirsty in Shaoyin is mild in intensity, it is very extensive in Jueyin stage. The thirsty in Jueyin is released when the person has hot feeling but worse when the hands and feet feels cold (reverse cold).

[6] In original version, it is bowel-cleansing therapy, not the “Cold-block syndrome” .

[7] Whenever there is inside Taiyin, Shaoyin and Jueyin conditions and surface condition, solve the inside Yin conditions first.

[8] This is true for all the three Yin stages.

[9] Stomach fullness after a sweat therapy suggests that the condition has turned into the Taiyin Stage.  It suggests that the person may be weak in the Spleen system usually, before the treatment.

[10] Note here: the person feels not only fullness, but also pain. This is a Shi condition, whereas the Houpo Shengjiang Banxia Gancao Renshen Tang is suitable for a weak condition. Here it is indicated that no matter it is a Shi condition or a weak condition in the Taiyin stage, if the person has also a Taiyang conditions, solve the Taiyin condition first. This is under the condition that the person has symptoms for Taiyang, but the pulse is not floating, it is still deep and weak – the Taiyin pulse. If it is floating pulse, then Guizhi Tang should be used to solve the Taiyang first.

[11] No matter the person has his own sweat or not. Here, it implies that the Guizhi Tang can be used to person without sweat – if he is in Yin condition and he is weak inside of the body.

[12] There is herb Shaoyao in the standard Guizhi Tang. Now simply increasing the amount of one ingredient in the formula, the function of the whole formula has been changed. This is a common phenomenon in the TCM. Therefore, if readers tend to guess the function of a herb formula by checking its ingredients but not the exact amount in it, they will be confused. So many times, the secret of the TCM herbal therapy is the dose of the herb ingredients.

[13] Here the Guizhi Tang per se is not a proper one, since the pulse is not floating.

[14] If the pulse is floating and slow, but the hands and feet is hot, the hot is his own feeling, not on touch, his condition belongs to Taiyang stage.

[15] Note, the person has annoyed/impatience feeling before the diarrhea, indicating the release of Xieqi from the body. If the annoyed/impatience feeling comes after the diarrhea, it will indicates a worse development of the disease. Annoyed in this case suggests the accumulation of body defense system to remove dirty rotten stools later. TCM doctor needs to know the exact meaning of an annoyed/impatience feeling of patients in the course of a disease.

[16] Floating and slow pulse and warm hands and feet, all suggests that the Spleen system is not so weak.

[17] If the Taiyin stage is due to Cold-invasion, the person tends to have diarrhea. If it is due to Wind-invasion, the person tends to have pain in arm and legs.

[18] This is a time period which corresponding to the production of a Yangqi in the nature and in the body. The trends of the Yangqi in the Nature helps, vibrates with the Yangqi in the body, so to cause corresponding trends of the Yangqi in the body: to increase the Yangqi in the inside of the body, or to warm the inside of the body.

 

This is a time period of evening. Therefore in winter, it starts close to the 9 am and in summer, it starts close to 2 am. It therefore also varies from the location of city on the earth.

[19] Proper treatment plus the Yangqi movement in the Nature (moves deeper) helps the cure of the disease.

[20] It is a very important to distinguish the Taiyin stage from other stages by checking its improvement time period or a worse period.