合病者。两阳经。或三阳经齐病。不传者也。并病者。一阳经先病未尽。又过一经。而
传者也。太阳阳明并病。若并未尽。所谓太阳症不罢。面赤佛郁。烦躁短气。是传未尽。尚有表
症。当麻黄桂枝各半汤汗之。若并已尽所谓太阳症罢。潮热。手足汗出。便硬。谵语。当承
气汤下之。三阳合病。皆自下利。太阳阳明合病。葛根汤。太阳少阳合病。黄芩汤。少阳阳
明合病。调胃承气汤。
阳厥者。初得病。身热头疼。以后传入三阴。大便闭。小便赤。谵渴躁乱。见诸热症而
发厥者。热极反兼胜已之化也。热微厥亦微。宜四逆散。热深厥亦深。宜承气汤。阴厥者。初得
病。无身热头疼。面寒肢冷。引衣蜷卧。见诸寒症而发厥者。轻则理中汤。重则四逆汤。二
厥之脉。皆沉。阴厥沉迟而弱。指头常冷。阳厥沉而滑。指头常温。
误投麻黄。汗多亡阳。误投承气。下多亡阴。老弱虚人。但当微利。或猪胆。或炼蜜导
之。尺脉弱者禁下。寸脉弱者禁吐。吐蛔一症。虽有热症。大忌寒凉。误服必死。初愈勿骤进参
。邪气得补即复。脉虚神倦者。不在禁例。宜随机活变。伤寒欲饮水为欲愈。不可禁绝。
不可多与。初愈勿过饱。勿劳动。勿忧怒。勿行房。勿食羊肉。勿多饮酒。勿轻见
风。
两感伤寒不须治。阴阳毒过七朝期。黑 下厥与上竭。阳症见阴脉者危。舌卷耳聋囊更
缩。阴阳交及摸寻衣。重 除中皆不治。唇吻青兮面黑黧。咳逆不已并脏结。溲屎遗失便难医。
汗出虽多不至足。口张目陷更何为。喘不休与阴阳易。离经脉见死当知。结胸症具烦躁甚。
直视摇头是死时。少阳症与阳明合。脉弦长大救时迟。汗后反加脉躁疾。须知脏厥死无疑。
He Bing (Combined Disease) refers to the simultaneous onset of pathogenic factors in two Yang meridians, or three Yang meridians, without transmission. Bing Bing (Consecutive Disease) refers to the transmission where the pathogenic factor in one Yang meridian has not yet completely resolved, and then spreads to another meridian.
In the case of Taiyang and Yangming Bing Bing, if the Taiyang pathogenic factor has not yet completely resolved—manifesting as facial flushing,郁热 (stifling heat), irritability, and shortness of breath—it indicates that the transmission is incomplete and exterior symptoms remain. In this scenario, Mahuang Guizhi Gemi Tang (Mahuang and Guizhi Half-Volume Decoction) should be used to induce sweating. If the Taiyang pathogenic factor has completely resolved—manifesting as tidal fever, sweating on the hands and feet, hard stool, and delirium—the Taiyang syndrome has ceased. In this case, Chengqi Tang (Gut-Purging Decoction) should be used to purge the bowels.
San Yang He Bing (Combined Disease of the Three Yang Meridians) typically presents with diarrhea. Specifically, Taiyang and Yangming He Bing is treated with Gegen Tang (Kudzu Decoction); Taiyang and Shaoyang He Bing is treated with Huangqin Tang (Scutellaria Decoction); and Shaoyang and Yangming He Bing is treated with Tiaowei Chengqi Tang (Regulating the Stomach Gut-Purging Decoction).
Yang Jue (Yang Reversal/Cold Limbs due to Heat) occurs when a patient initially presents with fever and headache, after which the disease transmits to the Three Yin meridians. This leads to constipation, dark urine, delirium, thirst, and restlessness. The occurrence of cold limbs amidst these heat symptoms is described as "extreme heat manifesting as the transformation of the overcoming element" (True Heat, False Cold). Mild heat results in mild cold limbs, treated with Sini San (Frigid Extremities Powder); deep heat results in deep cold limbs, treated with Chengqi Tang.
Yin Jue (Yin Reversal/Cold Limbs due to Cold) occurs when a patient initially lacks fever and headache, presenting instead with a cold face, cold limbs, a preference for curling up and covering oneself, and cold limbs amidst cold symptoms. Mild cases are treated with Lizhong Tang (Regulate the Middle Decoction); severe cases are treated with Sini Tang (Frigid Extremities Decoction).
The pulse in both types of Jue is Chen (Deep). In Yin Jue, the pulse is Deep, Slow, and Weak, with cold fingertips; in Yang Jue, the pulse is Deep and Slippery, with warm fingertips.
Misuse of Mahuang Tang can lead to excessive sweating and loss of Yang Qi. Misuse of Chengqi Tang can lead to excessive purging and loss of Yin fluids. For elderly, weak, or deficient individuals, only mild laxation should be induced, using either pig bile or refined honey as an enema/suppository. A weak Chi (Cun-Che-Guan: Chi position) pulse contraindicates purging; a weak Cun (Cun-Che-Guan: Cun position) pulse contraindicates emesis. Vomiting roundworms, despite accompanying heat symptoms, strictly forbids the use of cold-natured herbs; misuse will result in death. After initial recovery, do not abruptly administer Ginseng (Renshen), as tonification may cause the residual pathogen to rebound. However, patients with a Deficient pulse and mental fatigue are exempt from this prohibition and require flexible treatment. Thirst in a Shanghan (Cold Damage) patient indicates impending recovery; water intake should not be strictly forbidden but also not given in excess. After recovery, avoid overeating, physical exertion, emotional agitation (worry/anger), sexual intercourse, eating mutton, excessive alcohol consumption, and exposure to wind.
Liang Gan Shanghan (Simultaneous Contraction of Exterior and Interior in Cold Damage) is considered untreatable (due to poor prognosis). Yang-Yin Du (Yin-Yin Toxicity) persisting beyond seven days is difficult to manage. Black spots (ecchymosis) with lower limb reversal and upper body bleeding exhaustion, Yang syndromes presenting with Yin pulses, tongue retraction, deafness, testicular retraction, Yin-Yang Jiao (Intertwining of Yin and Yang), involuntary grasping at bedclothes, severe Chu Zhong (Stomach Qi Exhaustion), cyanotic lips and corners of the mouth, sallow black complexion, persistent cough and counterflow qi, Zang Jie (Zang Knotting), incontinence of urine and feces with difficult defecation, sweating that does not reach the feet, open mouth and sunken eyes, unceasing panting, Yin-Yang Yi (Transmission between Yin and Yang via sexual contact), Li Jing Mai (Departing Pulse), full presentation of Jie Xiong (Chest Binding) with severe irritability, fixed staring, and head shaking—all indicate imminent death. When Shaoyang and Yangming combine, a String-taut, Large, and Long pulse indicates it is too late to save. Sweating followed by a rapid and restless pulse indicates Zang Jue (Visceral Reversal), which is undoubtedly fatal.