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The younger brother of my clan fell ill initially with headache, dry mouth, irritability, and excessive thirst. On the third day, I went to visit him and found that he had already suffered from deafness, retraction of the scrotum, coma with loss of consciousness, cold extremities (Jue Ni), and an inability to swallow even water or gruel. I said, "Hurry and make arrangements for funeral affairs; this is called Liang Gan Syndrome (Two-Yin Simultaneous Infection), which is incurable." Three days later, he died.

In commentary: Zhang Zhongjing discussed Liang Gan in Shanghan Lun, stating, "Generally, injury by cold, even if accompanied by severe heat, does not lead to death. However, if one contracts cold on both exterior and interior simultaneously (Liang Gan), death is inevitable." He also stated, "When Liang Gan occurs, symptoms manifest simultaneously; treatment has a sequence, distinguishing between releasing the exterior and purging the interior, which are originally different methods." If it is said that death is inevitable, yet there is a sequence of treatment, why is this? Broadly speaking, this disease involves simultaneous transmission to both exterior and interior, affecting all zang-fu organs. Ten out of ten patients die, hence it is said to be inevitably fatal. Yet, did Zhang Zhongjing merely use his own opinion to mislead future generations? Therefore, he mentioned releasing the exterior and purging the interior to encourage successors, hoping that after ten thousand years, a sage might arise to cure it, unwilling to cause despair among later practitioners. Zhang Zhongjing's heart was truly benevolent.

A merchant named Li Jiu's wife suffered from abdominal pain, heaviness of the body, inability to turn over, and urinary incontinence. Some treated it as dampness striking the middle (Zhong Shi). I said, "This is incorrect. It is San Yang He Bing Syndrome (Combined Disease of the Three Yangs). Zhang Zhongjing states, see Chapter 10 of the Yangming section. In Combined Disease of the Three Yangs, there is abdominal fullness, heaviness of the body making turning difficult, dysfunction of taste in the mouth (Kou Bu Ren), facial greasiness/dirtiness, delirium, and urinary incontinence. Sweating is contraindicated; if sweating is induced, delirium will occur. Purging is contraindicated; if purging is performed, sweat will appear only on the forehead, and the hands and feet will become cold." She was treated with three doses of Baihu Tang (White Tiger Decoction) and recovered.

Wang Wu Jing, a military officer, initially vomited. Soon after, a physician administered purgatives. Eight or nine days passed, and internal and external heat manifested. Upon pulse diagnosis, I said, "Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) should be used." Someone objected, "Since vomiting and purging have already occurred, the interior is deficient. Can Baihu Tang be used?" I replied, "Zhang Zhongjing states, see Chapter 28 of the Taiyang section. If after purging, the condition remains unresolved after seven or eight days, with heat consolidated in the interior and both exterior and interior presenting heat, Baihu Jia Renshen Tang is indicated. The symptoms match. Vomiting indicates heat in the stomach region, causing the pulse to appear deficient and large. After three doses, she recovered."

In commentary: Zhang Zhongjing stated that if, after emesis or purging in Shanghan, the condition remains unresolved after seven or eight days, with heat consolidated in the interior and both exterior and interior presenting heat, Renshen Baihu Tang should govern. He also stated, "In Shanghan, if the pulse is floating, there is no sweat, and fever persists, Baihu Tang must not be given." Furthermore, he stated, "If the pulse is slippery, indicating heat in the exterior and cold in the interior, Baihu Tang governs." During the Song Dynasty, Lin Yi, in his correction of the text, claimed that Zhang Zhongjing's mention of "exterior and interior" contained errors. This is entirely incorrect. Broadly, Baihu Tang can eliminate heat in both exterior and interior in Shanghan. Thus, prior texts may say "heat in both exterior and interior" or "heat in exterior and cold in interior"; both are indications for its use. The specific clause stating "if the exterior is not resolved, do not take it" refers to cases where sweating is appropriate for fever; those are purely Shaoyin or Taiyang patterns suitable for Mahuang Tang or Gegen Tang. How could Baihu Tang be used there? Lin Yi merely saw the discrepancy in the description of exterior/interior and concluded it was a textual error, which is an oversight due to lack of deep thought and precision.