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Taiyang (Greater Yang) and Yangming (Yang Brightness) simultaneous disease. When there is panting and chest fullness, purgation is contraindicated; Mahuang Tang (Ephedra Decoction) should be administered as the primary treatment.

Simultaneous disease of Taiyang and Yangming refers to the presence of manifestations from both meridians simultaneously. Among the manifestations of these two meridians, the presence of panting and chest fullness indicates that the exterior pathogenic factor of Taiyang is biased towards affecting Yangming. How could it be like Fang Youzhi's assertion that the severity is equal and the quantity is the same, or Yu Jiayan's theory that each meridian presents half of the symptoms? Panting is caused by the excess and fullness of pathogenic factors in the Lung. Cold pathogenic factors invade the couli (interstices), and the Lung governs the skin and hair; the skin and hair are the external correspondence of the Lung. When the Lung organ is affected by pathogens, qi becomes stagnant and panting occurs. Therefore, the first clause of Shanghan Lun states: "Headache, fever, body pain, lower back pain, aversion to wind, anhidrosis, and panting should be treated with Mahuang Tang." This is because Mahuang (Ephedrae Herba) is a specific herb for acridly dispersing Lung qi, Xingren (Armeniacae Semen Amarum) is a key herb for lubricating Lung qi, and among the herbs in the decoction, only Guizhi (Cinnamomi Ramulus) is a Taiyang meridian herb for dissipating Wei (Defensive) pathogenic factors. Zhang Zhongjing uses Hand-Taiyin Lung meridian herbs to treat Foot-Taiyang Bladder meridian diseases because the Lung governs the skin and hair. Moreover, the chest belongs to the region of the Taiyang meridian. The Treatise on Essential Requirements for Pulse Diagnosis states: "The back is the mansion of the chest." There are four courses of the Foot-Taiyang meridian, all running along the back on both sides of the Du meridian. The Treatise on Bi Syndrome states: "Wei Qi circulates within the skin and between muscle textures, steaming into the Huang membrane and scattering into the chest and abdomen." Ying (Nutritive) and Wei Qi are both governed by the Taiyang meridian; thus, the chest belongs to Taiyang. Chest fullness indicates that the Taiyang exterior pathogenic factor has not yet resolved and is about to enter the interior but has not fully done so. In Yangming disease, if there is hardness and fullness below the heart, attacking with purgatives is still contraindicated; if attacked, leading to unceasing diarrhea, death ensues. How much more so in simultaneous disease of Taiyang and Yangming? Because the Taiyang exterior syndrome has not ceased, attacking with purgatives might cause the pathogen to sink inward and lead to adverse changes; therefore, it is stated that purgation is contraindicated, and Mahuang Tang should be used to specifically disperse the cold pathogen of the Taiyang meridian. This clause should have been omitted from the examples of Taiyang Cold Damage.

Simultaneous disease of Taiyang and Yangming inevitably leads to spontaneous diarrhea; Gegen Tang (Puerariae Decoction) should be administered as the primary treatment.

Although simultaneous disease of Taiyang and Yangming shares the same principle as the previous clause, in the previous clause, the pathogen was in the chest and diaphragm and had not yet invaded the Stomach. Here, stating that it inevitably leads to diarrhea indicates that the pathogen has invaded internally and affected the Stomach. Since the stagnant pathogen of Taiyang is already in the Ying and Wei levels, and the heat pathogen of Yangming is flourishing between the muscles, the heat pathogens of both meridians are excessively strong. Without waiting for them to fully sink inward, the heat pathogen forces inward, causing the true Qi of the Stomach to fail to hold fast, inevitably resulting in diarrhea. However, although there is diarrhea, the pathogen remains at the exterior level and should not be blamed on the interior level. Since it is not after mistaken purgation and the Stomach Qi is not yet deficient, one must absolutely not treat it using methods for協熱下利 (diarrhea with accompanying heat). One should still prioritize the exterior syndromes of both meridians; therefore, Gegen Tang is administered. Mahuang and Guizhi dissipate the pathogen in the Ying and Wei of Taiyang, and adding Gegen (Puerariae Radix) dissipates the meridian pathogen in the muscles of Yangming. Resolving the exterior early is precisely the way to block the path to entering the interior.

Correction of Misunderstandings: The Shanglun school asserts that Gegen Tang is simply Guizhi Tang (Cinnamon Twig Decoction) with added Gegen, without Mahuang, which is correct. However, this view is likely incorrect. It should be stated: For Wind Strike with spontaneous sweating, use Guizhi Jia Gegen Tang (Cinnamon Twig Decoction with Added Pueraria); for Cold Damage without sweating, use Gegen Tang containing Mahuang. This is the flexible method. At the beginning of the Yangming chapter, those with sweating and aversion to wind have Taiyang-Yangming Wind Strike, so they use Guizhi Jia Gegen Tang. Those without sweating and with aversion to wind have Taiyang-Yangming Cold Damage, so they use Gegen Tang. Gegen Tang is a combination of Guizhi Tang and Mahuang Huang Tang (Ephedra, Cinnamon Twig, and Licorice Decoction) plus Gegen; Guizhi Jia Gegen Tang is the complete Guizhi Tang plus Gegen. Here, it is called only Gegen Tang, not Guizhi Jia Gegen Tang; does this not imply the use of Mahuang? However, the subsequent Gegen Jia Banxia Tang (Pueraria and Pinellia Decoction) already contains Mahuang, so the Gegen Tang in this clause naturally implies the presence of Mahuang as well. Furthermore, previously, those with Mahuang were called only Gegen Tang, while those without Mahuang were named Guizhi Jia Gegen Tang. What is there left to debate?

Simultaneous disease of Taiyang and Yangming, without diarrhea but with vomiting only, should be treated with Gegen Jia Banxia Tang (Pueraria and Pinellia Decoction).

As mentioned before, in simultaneous disease of Taiyang and Yangming, if there is no diarrhea but only vomiting, it means the stagnant heat exterior pathogen attacks inward, not flowing downward but reversing upward. Vomiting indicates the pathogen is in the chest and invades the stomach opening. Therefore, in the Gegen Tang which resolves the exterior of both meridians, Banxia (Pinelliae Rhizoma) is added for its acrid-warm property to dispel fluid retention, thereby lubricating the pathogen in the chest and diaphragm.

Gegen Jia Banxia Tang Formula
Gegen (4 liang), Mahuang (3 liang, remove nodes), Guizhi (2 liang), Shaoyao (2 liang), Gancao (2 liang), Shengjiang (3 liang), Dazao (12 pieces), Banxia (0.5 jin).
These eight ingredients are boiled in 1 dou of water. First boil Gegen and Mahuang until reduced by 2 sheng, remove the white foam, then add the remaining herbs. Boil to obtain 3 sheng of liquid, strain, and take 1 sheng warm. Cover the patient to induce a slight sweat.

Simultaneous disease of Taiyang and Shaoyang with spontaneous diarrhea should be treated with Huangqin Tang (Scutellaria Decoction). If there is vomiting, Huangqin Jia Banxia Shengjiang Tang (Scutellaria, Pinellia, and Ginger Decoction) should be given.

The syndromes of the Taiyang and Shaoyang (Lesser Yang) meridians appearing together constitute simultaneous disease. Although Taiyang is at the exterior, Shaoyang is situated semi-interiorly, constituting the semi-exterior semi-interior level. Due to the heat pathogens of both meridians attacking inward, the water and grain in the Stomach rush downward, causing spontaneous diarrhea. Huangqin (Scutellariae Radix) should be used to withdraw the heat, and Shaoyao (Paeoniae Radix Alba) to astringe the Yin. Gancao (Glycyrrhizae Radix) and Dazao (Ziziphi Jujubae Fructus) harmonize the middle and slow the downward rushing of fluids.
If there is vomiting, it indicates the pathogen does not flow downward but reverses upward; the pathogen is at the stomach opening, and Qi in the chest reverses causing vomiting. Therefore, Banxia is added for its acrid-lubricating property, and Shengjiang (Zingiberis Rhizoma Recens) for its acrid-dispersing property, forming a specific agent for dispelling fluid retention and treating vomiting.

Huangqin Tang Formula
Huangqin (3 liang), Shaoyao (2 liang), Gancao (2 liang), Dazao (12 pieces).
These four ingredients are boiled in 1 dou of water to obtain 3 sheng of liquid. Strain and take 1 sheng warm, twice daily and once at night. If vomiting occurs, add Banxia (0.5 sheng) and Shengjiang (3 liang).

Huangqin Jia Banxia Shengjiang Tang (See administration instructions attached above).

Simultaneous disease of Yangming and Shaoyang inevitably leads to diarrhea. If the pulse is "not negative" (Fu), it is a favorable condition; if "negative," it is unfavorable. Mutual overacting is called "negative." A slippery and rapid pulse indicates retained food. Purging should be applied, and Da Chengqi Tang (Major Order the Qi Decoction) is suitable.

Yangming corresponds to Stomach Earth, and Shaoyang corresponds to Liver-Gallbladder Wood. Both meridians are affected, and their syndromes appear together. Heat pathogens link up, approaching the interior. The interior is pressured from outside, and Earth is punished by Wood. The Stomach Earth fails to hold, and water and grain rush downward, inevitably causing diarrhea. If the pulse is "not negative," it is favorable and harmless. If "negative," it is a failing syndrome of lost vitality. The term "negative" refers to defeat. In cases of Wood overacting on Earth, if the true Qi of the Stomach is undamaged, although the pulse may be rapid or large, the harmonious and thick Qi remains. This means Wood overacts on Earth but Earth is not injured, so it is favorable and harmless. This is called "having Stomach Qi leads to life." If Earth is overacted upon by Wood, and the Qi of Stomach Earth is damaged and failing, the pulse may be wiry, fine, forceful, urgent, and suspended, or like a newly strung bowstring, or like touching a blade, or like plucking a zither string, or the right Cun and Guan positions may be wiry, fine, short, and abrupt, unpressable, or micropulse, fine, knotted, and intermittent. This indicates the Middle Earth is ruined, accompanied by hiccups, cold extremities, and a dusty yellow-green complexion, representing a fatal syndrome of lost true Qi. Thus, it is called mutual overacting, named "negative." The Treatise on the Differences of Yin and Yang in Suwen states: "Pulses have Yin and Yang. Of Yang, there are five; five times five make twenty-five Yang. What is called Yin is the Zang-organ revealing itself. To reveal is failure; failure leads to death. What is called Yang is the Yang of the Epigastrium. Three Yang pulses are at the head, Three Yin pulses are at the hand; this refers to the same principle." I interpret the scriptural meaning as regarding the Yang of the Epigastrium as the master of the twenty-five Yangs. All post-natal growth and nourishing Qi emanate from here. "Three Yang at the head" refers to the Stomach pulses of the Three Yang meridians, located at the arterial pulse 1.5 cun lateral to the Adam's apple, named Renying (Human Welcome). The Stomach pulses of the Three Yin meridians are at the Cun Kou (Inlet) pulse, 1 cun posterior to the Thenar eminence on the right hand, named Qikou, which is also the Hand-Taiyin Lung pulse. Hence, it is said that the Lung directs all pulses. The classics state: "Qikou alone serves as the master of the Five Zang organs" because the Stomach is the Sea of Water and Grain, the great source of the Five Zang and Six Fu organs. The five flavors enter the mouth, store in the intestines and stomach, and nourish the Qi of the Five Zang organs. Qikou is the grand meeting of pulses; the Qi of the Five Zang and Six Fu organs manifests at Qikou. These two pulses are essentially the same pulse for assessing Stomach Qi; hence, it is said "what is called one." If harmonious and thick Qi exists, it is "not negative" and favorable; if the harmonious Qi of Stomach is absent, it becomes a Zang-revealing pulse and is lost. If the pulse is slippery and rapid, slippery indicates strength and smoothness, a sign of Stomach excess and vigorous Qi, a favorable and "not negative" pulse. Slippery and rapid indicate heat pathogens flourishing in the interior and food stagnation in the Stomach, thus indicating retained food. Observing a thick yellow-black tongue coating and hardness/pain upon palpation of the epigastrium and around the umbilicus indicates that the meridian pathogens of Shaoyang and Yangming have all converged into the Yangming Fu organs. Therefore, purging should be applied, and Da Chengqi Tang is suitable.

Simultaneous disease of the Three Yangs, with a floating and large pulse extending to the Guan position, drowsiness, and sweating when closing the eyes.

Cheng Wuji considers floating to belong to Taiyang and large to belong to Yangming. While this reasoning has merit, he fails to realize that the floating and large pulse appears only at the Guan position. This likely refers to the Yangming pulse being floating and large. Looking at the subsequent manifestations, they all belong to Yangming, which confirms this. Furthermore, relying on the Guan pulse to exclusively monitor Shaoyang Qi and claiming gallbladder heat causes sleepiness—does the right Guan also monitor Liver-Gallbladder pathogens? This view is particularly incomplete. The Treatise on Essential Requirements for Pulse Diagnosis in Suwen states: "Above the middle, the left exterior monitors the Liver, interior monitors the Diaphragm; the right exterior monitors the Stomach, interior monitors the Spleen. 'Guan Shang' refers to the Guan pulse." In Zhang Zhongjing's Chapter on Differentiating Pulses, Chi pulse is called Chi Zhong, Guan pulse is called Guan Shang, and Cun pulse is called Cun Kou. The Neijing mentions only Chi Zhong and Cun Kou, not Guan. Generally, Chi Ze is called Chi Zhong, Yu Ji is called Cun Kou. The middle of Cun and Chi is the halfway point up and down, hence called Guan. Therefore, the entire Neijing mentions only Chi and Cun pulses, excluding Guan. In the Treatise on the Phenomena of Healthy People, discussions on Cun and Chi exist, but Guan is not mentioned. Now, saying "pulse floating and large extending to Guan Shang" means the floating and large quality of the Guan pulse extends beyond the Guan position. Although the left side monitors the Liver, the Shaoyang Gallbladder meridian is the external correspondence of the Liver. Thus, when Shaoyang is affected, floating and large qualities appear on the left. The right Guan monitors Spleen and Stomach; thus, when pathogens enter Yangming, floating and large qualities appear on the right Guan. Not specifying left or right but stating "pulse floating and large extending to Guan Shang" encompasses both sides collectively, showing that pathogens coming from Taiyang, combined with Shaoyang heat pathogens and Yangming heat pathogens, cause the Qi of stagnant heat in the three meridians to steam together, leading to mental confusion and drowsiness, hence the desire to sleep. Sweating when closing the eyes is the meaning of "if the pulse is merely floating, there will surely be nocturnal sweating" found under the Yangming Wind Strike clause. This is originally Yangming Wind Strike, hence the pulse is floating and large. Wind Strike inherently involves floating Yang and weak Yin, often presenting with spontaneous sweating. When eyes are closed, Wei Qi enters inward and cannot control opening and closing, pores do not close, hence sweating. In this case of simultaneous disease of the Three Yangs, Taiyang requires diaphoresis, Yangming requires purgation, but Shaoyang pathology contraindicates both; diaphoresis leads to delirium, purgation leads to palpitations and fright. So both diaphoresis and purgation are forbidden. However, since all Three Yangs are affected, why is emphasis placed solely on Shaoyang to forbid diaphoresis and purgation? Zhang Zhongjing states: "In Cold Damage and Wind Strike, if Chaihu syndrome is present, seeing even one symptom suffices; it is not necessary for all to be present." This implies that if even one Shaoyang symptom is seen, treatment should focus on Shaoyang. Given this, Zhang Zhongjing does not specify a treatment method; how is therapy ultimately applied? The answer is: The floating and large pulse appears exclusively at the Guan position, and drowsiness and sweating upon closing the eyes are Yangming manifestations. This indicates heat pathogens are exclusively flourishing in Yangming. Abandoning diaphoresis, purgation, and harmonizing methods, the treatment likely refers to the joint treatment mentioned in the following text.

Simultaneous disease of the Three Yangs, with abdominal fullness, heaviness of the body, difficulty turning over, insensitivity of the mouth, facial dirtiness, delirium, and urinary incontinence. Diaphoresis leads to delirium; purgation leads to sweating on the forehead and cold extremities. If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) should be administered.

Abdominal fullness and body heaviness refer to what is described in the Yangming chapter as "the body must feel heavy," "abdominal fullness with panting," and "abdominal fullness and pain." Difficulty turning over, insensitivity of the mouth, and facial dirtiness: The Treatise on the Meridians in Ling Shu states: "When the Foot-Shaoyang meridian moves, it causes bitter taste, frequent sighing, pain in the heart and hypochondrium, inability to turn over, and in severe cases, a face resembling dust and lack of luster in the body." The Treatise on the True and Required Great Principles regarding Yangming ruling the interior and Yangming governing the year states that people suffer from liking to vomit, bitter vomiting, frequent sighing, pain in the heart and hypochondrium, inability to turn over, and in severe cases, a face resembling dust and lack of luster. Regarding Yangming ruling the interior and Yangming governing the year, people suffer from liking to vomit, bitter vomiting, frequent sighing, pain in the heart and hypochondrium, inability to reverse sides, dry throat, dusty face, and lack of luster in the body. These are all responses to Yangming Dry Metal ruling the Qi and Shaoyang Liver-Gallbladder being affected by pathogens. However, the Stomach opens into the mouth. The Ling Shu states: "When the Stomach is harmonious, the mouth can perceive the five flavors." The insensitivity of the mouth mentioned here is also a disease of the Yangming Stomach. Delirium indicates heat pathogens in the Stomach. Only urinary incontinence indicates the pathogen is in the interior of the Foot-Taiyang meridian, with heat in the Lower Jiao, causing the Bladder to fail to retain urine. Given such severe manifestations in simultaneous disease of the Three Yangs, with Shaoyang pathogens also involved, both diaphoresis and purgation are contraindicated.

Diaphoresis violates the prohibition for Shaoyang, leading to delirium. By the time delirium and urinary incontinence occur, the righteous Qi is already failing to hold. If purgation is applied, Stomach Yang is lost, leading to sweating on the forehead. Why? The head is the gathering place of all Yang meridians, and Yangming runs along the front of the body; the forehead is the region of Yangming. The Treatise on Solving the Meaning of the Yangming Pulse in Suwen states: "The four limbs are the root of all Yang." The Treatise on Taiyin and Yangming states: "The four limbs receive Qi from the Stomach." Mistaken purgation leads to the loss of Stomach Yang, causing pathogens to enter Yin and resulting in cold extremities. Thus, both diaphoresis and purgation are contraindicated. If, despite seeing the aforementioned Three Yang symptoms, there is spontaneous sweating, it indicates that the pathogens of Taiyang and Shaoyang have diminished and merged exclusively into the interior of Yangming. This corresponds to "body heat with spontaneous sweating" and "Yangming disease typically involves much sweating" mentioned at the beginning of the Yangming chapter. With heat pathogens in the interior, neither diaphoresis nor purgation is needed or tolerated; therefore, Baihu Tang is administered.