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The syndrome of interior cold and exterior heat in Shaoyin disease manifests as facial redness, a body that paradoxically does not feel aversion to cold, cold limbs (Jue), diarrhea with undigested food (Qinggu), and a faint or imperceptible pulse. It should be treated primarily with Tongmai Sini Tang (Pulse-Reviving Four Reversal Decoction). If diarrhea ceases but the pulse remains absent after administration, add Renshen (Ginseng Radix et Rhizoma); if the face is intensely red, add Congbai (Allii Fistulosi Bulbus); if there is abdominal pain, add Shaoyao (Paeoniae Radix Alba); if there is sore throat, add Jiegeng (Platycodonis Radix); if there is vomiting, add Shengjiang (Zingiberis Rhizoma Recens).

On the first day, simultaneous involvement of Taiyang and Shaoyin presents with headache, dry mouth, thirst, and irritability. On the second day, simultaneous involvement of Yangming and Taiyin presents with abdominal fullness, anorexia, fever, and delirious speech. On the third day, simultaneous involvement of Shaoyang and Jueyin presents with deafness, retraction of the testicles, cold limbs, inability to take fluids, and coma. By the sixth day, vital energy is exhausted, and life is difficult to preserve.

[Note] "Lianggan" (simultaneous contraction of two meridians) refers to the simultaneous pathogenic invasion of zang-fu organs and their corresponding exterior-interior pairs. On the first day, headache indicates Taiyang involvement; dry mouth, irritability, and thirst indicate Shaoyin involvement. On the second day, fever and delirium indicate Yangming involvement; abdominal fullness and anorexia indicate Taiyin involvement. On the third day, deafness indicates Shaoyang involvement; retraction of the testicles and cold limbs indicate Jueyin involvement. Pathogens transmitted via meridian transmission progress gradually, whereas pathogens causing Lianggan progress rapidly. This is because the yang pathogen is fierce, and the righteous qi cannot resist it. Consequently, after three days, the intake of fluids ceases, the qi of the six fu organs is about to perish, consciousness is lost, and the spirit of the five zang organs has failed. The reason for not dying immediately is that the stomach qi has not yet completely exhausted. Therefore, after another three days, the qi fully exhausts, leading to death. Zhang Jiegu formulated Da Qianghuo Tang (Great Notopterygium Decoction), using herbs such as Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Huangqin (Scutellariae Radix), and Lianhua (Lotus Plumule), employing acrid-sweet properties to disperse the exterior pathogen of Taiyang and bitter-cold properties to clear the interior heat of Shaoyin. This method is appropriate for cases where the exterior and interior conditions are not urgent. However, if on the first day there is headache, dry mouth, irritability, and thirst; on the second day, fever, delirium, abdominal fullness, and anorexia; and on the third day, deafness, retraction of the testicles, cold limbs, inability to take fluids, and coma, with such rapid progression, using the mild Da Qianghuo Tang may cause one to miss the optimal treatment window. One should follow Zhang Zhongjing’s principle of prioritizing treatment based on urgency, assessing whether the exterior or interior condition is more critical, and treating according to the syndrome, which might still offer a chance of survival. Thus, for this syndrome at its onset, if both exterior and interior present with heat on the first day, following the method for Shaoyin disease presenting with dry mouth and throat after two or three days, use a heavy dose of Dachengqi Tang (Major Order the Qi Decoction) to purge the fierce yang pathogen. If both exterior and interior present with cold, following the method for early-stage Shaoyin disease presenting with fever and a deep pulse, use Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) to relieve the urgent yin pathogen. On the second day, if both exterior and interior present with excess, following the method for Yangming disease with delirium, tidal fever, abdominal fullness that occasionally relieves but insufficiently, use Dachengqi Tang to attack. If both exterior and interior present with deficiency, following the method for combined disease of the three yang meridians with abdominal fullness, heaviness of the body, greasy complexion, and delirium, use a large dose of Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) to clear. On the third day, if both exterior and interior present with heat, following the principle that "the deeper the cold reversal, the deeper the heat," use Dachengqi Tang to purge. If both exterior and interior present with cold, following the method for faint pulse and cold limbs, use Danggui Sini Jia Wuzhuyu Shengjiang Tang (Angelica Sinensis Decoction Modified with Evodia and Fresh Ginger) to warm. Delayed treatment will be ineffective. Some patients do survive among these cases; future practitioners must pay close attention.