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The *Suwen* (Basic Questions) states: When humans are injured by cold pathogens, they develop febrile diseases. Even if the heat is severe, it will not result in death. However, for those who contract "Lianggan" (simultaneous contraction of exterior and interior meridians) from cold, death is inevitable.

It further states: In cases of Lianggan contracted from cold, on the first day, the Taiyang (Greater Yang) and Shaoyin (Lesser Yin) meridians are affected simultaneously, resulting in headache, dry mouth, vexation, fullness, and thirst. On the second day, the Yangming (Bright Yang) and Taiyin (Greater Yin) meridians are affected simultaneously, resulting in abdominal fullness, generalized fever, anorexia, and delirious speech. On the third day, the Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) meridians are affected simultaneously, resulting in deafness, retraction of the scrotum, and cold extremities; the patient cannot take fluids or food and loses consciousness. Death occurs on the sixth day.

The *Bingyuan* (Source of Diseases) states: If the patient cannot take fluids or food and has lost consciousness, death will occur on the sixth day. The rationale is very clear.

A question arises: The *Suwen* states that loss of consciousness leads to death on the sixth day, yet it also says that "the qi exhausts after three days." What is the reason? Guo Yong replies: In Lianggan disease, the exterior and interior meridians transmit the pathogen simultaneously. After three days, the transmission through the six meridians is completed. Although the transmission process is complete, the vital qi has not yet completely exhausted. Therefore, three days after the completion of the meridian transmission, the qi finally exhausts. When it says "three days," it refers to the exhaustion of the Qi of the Yangming meridian at that time. When it says "six days," it refers to the total duration of the meridian transmission. The transmission takes three days, and the qi exhausts, hence the mention of the sixth day. How is this clarified? At the time when the six meridians' transmission completes on the third day, the five zang organs are already damaged, the six fu organs are obstructed, and the Ying (Nutritive) and Wei (Defensive) qi cease to circulate. After such a state persists for another three days, the qi exhausts and death ensues. The Yellow Emperor asked out of doubt, and Qibo answered that because the Qi and Blood of the Yangming meridian are abundant, the patient experiences loss of consciousness, and death occurs three days later. Since the text says "after such a state," it implies after the transmission through the six meridians is complete. It also says "loss of consciousness for three days," which indicates the period before the Yangming qi is completely exhausted. The process of meridian transmission is clear. However, some believe that death occurs after the transmission through the six meridians. If there were a second transmission, death would not occur. Originally, the pathogen transmits to the Shaoyang meridian and intends to transmit to the Taiyin meridian, but the Taiyin meridian has already received the pathogen simultaneously with the Yangming meridian and cannot accept subsequent transmitted pathogens. Although the Taiyin meridian might attempt to transmit the pathogen back to the Three Yang meridians, the pathogens in the Three Yang meridians are already full and cannot accommodate more. The two pathogens resist each other, filling all six meridians, preventing flow and discharge. Thus, the six fu organs are obstructed, the Ying and Wei qi do not circulate, fluids and food cannot be taken, and consciousness is lost, waiting only for the Qi of the Yangming meridian to exhaust before death. The Yangming meridian is the Stomach meridian. The Stomach is the sea of Qi and Blood; the Qi and Blood that nourish the Ying, Wei, six fu organs, and twelve meridians morning and evening are all derived from the Stomach. Although the Qi and Blood of all other meridians may be exhausted, the Qi and Blood of the Yangming meridian remain unexhausted, hence death occurs three days later. Whether stated as death on the sixth day or the third day, it refers to the single syndrome of Lianggan. Some argue that a second transmission causes death on the sixth day, while direct entry into Yangming causes death on the third day, thus dividing it into two syndromes. This view is erroneous, fails to understand the classic's intent, incorrectly changes "abundant Qi and Blood" to "abundant pathogen," and posits that "Qi and Blood exhaust along with the pathogen," all of which are mistakes. Repeatedly reading the classic will lead to natural understanding.

Pang Shi states: The *Suwen* does not record pulse diagnoses for Lianggan. Analyzing it now, any sinking pulse belongs to the Yin category. On the first day, the pulse should be sinking and large. Sinking represents Shaoyin; large represents Taiyang. On the second day, the pulse should be sinking and long. On the third day, the pulse should be sinking and wiry. These correspond to the exterior-interior pulse relationships. Sinking, long, and wiry pulses are all implicit within the sinking-large pulse. Generally, there are no combined diseases among the Three Yin meridians, only among the Three Yang meridians. Now, since the Three Yang and Three Yin meridians are involved in a combined disease, the pulse resembles sinking-tight and large, or sinking-solid and long, similar to the Ge (Leather) pulse or the Zhi (Arrival) pulse, which are signs of death.

Wang Zhonggong, Supervisor, states: The original treatise discusses Lianggan occurring simultaneously, with treatment having a sequence. Releasing the exterior and purging the interior are fundamentally different. Recently, Zhang Yi cited a case where a patient with Cold Damage was treated with purgatives, resulting in persistent diarrhea and body pain. In such cases, one should urgently rescue the interior. Later, when body pain ceases and bowel movements normalize, one should urgently rescue the exterior. One can follow this model for treatment. Since treatment has a sequence, rescuing the interior should come first. Only when the interior is warm can treatment proceed. However, rescuing the exterior should not be delayed. Zhu Shi states: Rescuing the interior is particularly urgent. Guo Yong states: For rescuing the interior, use Sini Tang (Four Reversal Decoction); for rescuing the exterior, use Guizhi Tang (Cinnamon Twig Decoction). This method is a last resort, but better than waiting passively for death. Zhang Zhongjing states: Use Sini Tang for rescuing the interior and Guizhi Tang for rescuing the exterior. Adjust based on the degree of cold and heat at the time. If both exterior and interior symptoms are mild, urgently treat the more severe one. However, treatment must be swift. After three days, the patient cannot take fluids; even if medicine is available, it cannot be retained. Zhang Yi did not grasp this point.

The *Treatise on Lianggan* states: There are syndromes considered incurable, so ancients did not discuss formulas for them. While theoretical discussion may proceed this way, physicians might adopt this attitude. However, when one's close relatives suffer from such diseases, how can one sit idly without seeking methods to save them from near-death situations? Sun Simiao stated that for patients with depleted spirit and prolonged illness nearing death, administering medicine might cure three or four out of ten. Thus, even for incurable diseases, while vital qi remains, there is no reason not to administer medicine until the end. Observing the Lianggan syndrome, the pathogens fill both Yin and Yang meridians, preventing mutual transmission, making it a fatal prognosis. If treated early, while within three days the pathogens have not fully filled the meridians and Ying-Wei circulation is still possible, survival might be achieved. However, if after three days the pathogens in all six meridians are full, the patient cannot take fluids, and how could decoctions enter? Urgent treatment is necessary at the initial stage. Yet, at the onset, who can definitively diagnose Lianggan without hesitation? By the time of deliberation, it is too late, leading inevitably to death. Guo Yong believes that at this stage, acupuncture and moxibustion are superior to herbal decoctions. Decoctions may not reach the target effectively, and even if they do, the outcome depends on the struggle between medicine and pathogen. Acupuncture and moxa can expel pathogens externally according to severity. In the case of the Crown Prince of Guo, Bian Que used external expulsion techniques. His condition involved upward-rushing Jue Qi (Rebellious Qi), severing Yang and breaking Yin, worse than the unconsciousness in Lianggan. Bian Que diagnosed descending Yang pulses and ascending Yin pulses, causing Qi blockage. Jue Qi is also a pathogen. Yang and Yin pulses refer to Yang and Yin meridians. Descending Yang pulses imply pathogen transmission to Yang meridians; ascending Yin pulses indicate conflict and inability to bear it. Qi blockage results from excess pathogens in both Yin and Yang meridians, leading to inability to take fluids. Bian Que did not use decoctions but immediately applied needles. He selected the San Yang Wu Hui (Three Yang Five Meetings) acupoint externally. After a while, the prince revived. This shows that decoctions cannot reach externally, whereas needles can expel externally. After revival, he used hot compresses (five fen thickness) to drive out residual pathogens. Once pathogens were cleared, decoctions were administered, and health returned in twenty days. Had decoctions been used first, they could not have entered, and revival would have been impossible. The sudden lethality of Lianggan pathogens is similar to that of Shijue (Corpse-like Coma) pathogens. If one could emulate Bian Que’s technique of needle first, then decoction, selecting points from the Three Yang meridians to缓 (slow/relax) their Qi, then burning intersection points of the Three Yin meridians to expel pathogens, and using decoctions only after pathogens are exhausted to nourish the body, although survival is not guaranteed, the treatment would be grounded and correct. My suggestion is to first select Kunlun (BL60) and Weizhong (BL40), bleed to expel Taiyang pathogens. Next, select Zusanli (ST36) to expel Yangming pathogens. Then, select Qiuxu (GB40) and Yanglingquan (GB34) to expel Shaoyang pathogens. Once the Three Yang Qi is relaxed, urgently moxa Sanyinjiao (SP6) to expel Three Yin pathogens. This point is difficult to locate accurately; slight deviation misses the point. All Three Yin meridians must be correctly targeted. Careful measurement is required. Subsequently, moxa Yinlingquan (SP9) above to expel Taiyin pathogens, Taixi (KI3) to expel Shaoyin pathogens, and Dazhuan (LR1) to expel Jueyin pathogens. Use wheat-grain-sized moxa cones, moxa slowly to gradually expel Qi; quantity is not as important as quality. Regardless, Sanyinjiao (SP6) must be moxa first to jointly expel, then balance Yin and Yang. Only when Yin-Yang Qi is relaxed can decoctions be taken. Expelling pathogens does not fear excess; treatment does not fear speed, as there is only a three-day window. I dare not use hot compresses due to the risk of Fire Pathogens, so I rely solely on decoctions. Both conditions involve blocked Yin Qi, sharing similarities but differing in cold/heat presentation. Considering this, in combined diseases of the Three Yin meridians with deficient pulses, moxa and acupuncture are also suitable. For example, in Yangming-Shaoyang combined disease with a deficient pulse, Shaoyang Wood Qi is excessive. Reducing Qiuxu and Yanglingquan calms Shaoyang Wood; tonifying Zusanli strengthens Yangming Earth. For those unfamiliar with tonification/reduction, using needle for reduction and moxa for tonification is an ancient method. Thus, even in fatal cases, there is hope for recovery, aligning with Sun Simiao’s statistic of 30-40% survival. Although matters vary in size and nature, the principle is one. Just as Yu the Great drained the floods to allow habitation, I realized that diseases can be treated via external expulsion. Had I mastered this earlier, Bian Que’s art would have been accessible. Yan Yuan said, "What kind of person was Shun? What kind of person am I? Those who act will be like him." How much more so for masters like Lu and Bian? I regret learning this in my twilight years, limiting its application, but I dare not withhold it from future generations. Hence, I state it fully.