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Taiyang-Shaoyin simultaneous infection (Lianggan Shanghan) refers to the simultaneous transmission of pathogenic factors into both Yin and Yang meridians. Although this is considered a critical condition with a poor prognosis, there remains a possibility of rescue. This is because the sequence of medication administration and the distinction between releasing the exterior and purging the interior are fundamentally different.

The *Qianjin Yifang* (Book of Vitality) advocates first rescuing the interior with Sini Tang (Four Reversal Decoction), and subsequently attacking the exterior with Guizhi Tang (Cinnamon Twig Decoction). However, it fails to realize that Zhang Zhongjing stated: In Taiyang-Shaoyin simultaneous disease, headache and aversion to cold indicate the pathogen is in the exterior; dry mouth and thirst indicate the pathogen is in the interior. In Yangming-Taiyin simultaneous disease, fever, eye pain, and discomfort indicate the pathogen is in the exterior; anorexia and abdominal fullness indicate the pathogen is in the interior. In Shaoyang-Jueyin simultaneous disease, deafness, hypochondriac pain, alternating chills and fever, and vomiting indicate the pathogen is in the exterior; irritability, fullness, and retraction of the genitals indicate the pathogen is in the interior. For the headaches, fever, deafness, hypochondriac pain, aversion to cold, and vomiting associated with the Three Yang meridians, since the pathogen is in the exterior, purgative methods should inherently not be used. Conversely, for the abdominal fullness, thirst, genital retraction, and delirium associated with the Three Yin meridians, since the pathogen is in the interior, can one refrain from using purgatives? The *Qianjin Yifang* cites the precedent of "diarrhea with body ache," a deficiency-cold pattern requiring urgent interior rescue, and attempts to apply this treatment to "irritability, fullness, and genital retraction," which are excess-heat patterns. Is this appropriate?

Zhang Zhongjing's concept of "releasing the exterior" refers to herbs such as Gegen (Kudzu Root) and Mahuang (Ephedra). His concept of "purging the interior" refers to Tiaowei Chengqi Tang (Stomach-Regulating Major Purge Decoction). Yet, the *Qianjin Yifang* claims that rescuing the interior requires Sini Tang and attacking the exterior requires Guizhi Tang. To treat "rescuing the interior" as "attacking the exterior" is contradictory. If Sini Tang is used in this context, it is akin to adding fuel to fire. How will symptoms like abdominal fullness and genital retraction be resolved? How will the Zang-Fu organs become unobstructed? How will Ying and Wei Qi circulate? Consequently, death may occur immediately. How can practitioners rigidly adhere to a single fixed method in their minds?

Simultaneous disease (Hebing) and overlapping disease (Bingbing) are difficult for the world to comprehend. Without profound expertise, how can one recognize these patterns? Simultaneous disease occurs when two or three meridians are affected simultaneously without sequential transmission. Overlapping disease occurs when the pathogen of one meridian has not fully resolved before transmitting to another. If the overlap is incomplete, transmission is not yet finished, and exterior signs remain, the treatment principle is diaphoresis (sweating). If the overlap is complete, transmission has finished, the treatment principle is purgation. Thus, transmission implies entry into the Fu organs, while no transmission implies no entry into the Fu organs, describing the nature of transmission.

When the Three Yang meridians mutually combine, diarrhea often ensues. For Taiyang-Yangming simultaneous disease, Gegen Tang (Kudzu Decoction) is the primary formula. For Taiyang-Shaoyang simultaneous disease, Huangqin Tang (Scutellaria Decoction) is the primary formula. For Shaoyang-Yangming simultaneous disease, Chengqi Tang (Purge Decoction) is the primary formula. When Three Yang simultaneous disease presents without exterior signs, purgation is applicable. However, in Zhang Zhongjing's discussions on Three Yang simultaneous disease, there is no mention of "aversion to cold in the back." Cases involving dry mouth, thirst, irritability, and slight aversion to cold in the back belong to Taiyang syndrome, not Three Yang simultaneous disease. If the Three Yang meridians combine with the Three Yin meridians, it becomes Lianggan (simultaneous Yin-Yang infection); therefore, there are no examples of combination solely within the Three Yin meridians.