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Two-Yang Concurrent Disease. When the Taiyang disease (disease syndrome caused by pathogenic invasion of the Taiyang meridian) is first contracted, diaphoresis (sweating therapy) is applied, but the sweat does not come out thoroughly. Consequently, the condition transfers to the Yangming (disease syndrome caused by pathogenic invasion of the Yangming meridian). Subsequently, there is continuous slight sweating and aversion to cold ceases. If the Taiyang disease symptoms have not yet resolved, purgation (downward-draining therapy) must not be used; using it constitutes a contraindicated treatment (adverse method). In such cases, mild diaphoresis may be employed. If the patient's face exhibits a persistent, bright red color, this indicates that Yang Qi is constrained and stagnant at the exterior. It should be treated with methods to resolve the exterior, such as fumigation to induce sweating. If diaphoresis was insufficient, leading to constrained Yang Qi unable to vent, and sweating should have occurred but did not, the patient will experience restlessness and irritability (Zaofan), unaware of the specific location of pain, which shifts between the abdomen and the four limbs, and cannot be pinpointed by palpation. The patient also suffers from shortness of breath, solely due to incomplete sweating. Re-administering diaphoresis will lead to recovery. How do we know the sweating was incomplete? We know this because the pulse is choppy (Se).

"Two-Yang" refers to Taiyang and Yangming. "Concurrent disease" means that although Taiyang has been invaded by pathogens and has transferred to Yangming, the Taiyang symptoms have not yet ceased; both meridians are diseased. Although this clause mentions Two-Yang concurrent disease, its legislative intent is to show people that when pathogens in both meridians are predominantly in Taiyang, the treatment should focus on Taiyang, and one should not lightly treat Yangming. From "when Taiyang disease is first contracted" to "sweating without aversion to cold," this explains the cause of Taiyang transferring to Yangming, i.e., the meaning of transmission through meridians, which is the general principle of this clause. From "If Taiyang disease symptoms have not yet ceased" to "may mildly induce sweating," this describes the milder case where sweating was incomplete and Taiyang has not resolved; this section is secondary. From "face exhibits persistent bright red color" to the end is the main content. It means that Taiyang pathogens are abundant and unresolved, while the newly transferred Yangming pathogens are light and negligible; thus, treatment should focus on Taiyang exterior symptoms. The idea is: when Taiyang disease is first contracted, if sweating is incomplete, pathogens cannot be fully expelled, leading to transformation into Yangming. Once pathogens transfer to Yangming, symptoms such as spontaneous slight sweating and lack of aversion to cold appear, unlike Taiyang symptoms of fever, aversion to cold, and anhidrosis. This aligns with the meaning in the Yangming chapter: fever, spontaneous sweating, no aversion to cold, but aversion to heat. If pathogens have transferred to Yangming but Taiyang symptoms remain unresolved, it means the exterior syndrome is not fully cleared, pathogens have not entered the interior of Yangming, and the Stomach is not full of pathogens; therefore, purgation is contraindicated, and using it is adverse. Such residual exterior pathogens are merely due to incomplete sweating. Since most pathogens have left and few remain, mild diaphoresis can resolve them spontaneously. If the patient's face shows a persistent, bright red flush, it is because Yang Qi is blocked by cold pathogens and constrained at the exterior. It should be resolved via diaphoresis or fumigation. Although this is also a case of incomplete sweating, the retained pathogens are numerous, similar to completely unresolved Taiyang exterior pathogens. Thus, the previous statement about "mildly inducing sweating for incomplete sweating" is insufficient. This is because Yang Qi is constrained by cold pathogens, stagnating between the skin and interstices, unable to vent. Sweating should have occurred but did not, causing depression and irritability. The reason for not knowing the pain location is that if cold pathogens were only in the Taiyang exterior, as stated in the first clause of Shanghan, there would be body ache, lower back pain, and joint pain with fixed locations. Here, although cold pathogens are in Taiyang, they have transferred to Yangming. The Yangming meridian is in the muscle layer, and the abdomen and four limbs belong to the Yangming Stomach meridian. As stated in *Suwen: Taiyin Yangming Lun*, "the four limbs all receive Qi from the Stomach." In the Yangming chapter, there are symptoms of floating and large pulse, shortness of breath, and abdominal fullness. Generally, when Taiyang pathogens initially transfer to Yangming, whether in the meridian or fu-organ, their location is indefinite, hence the sensation of pain shifting between the abdomen and limbs, unfindable by palpation. The patient simply has shortness of breath, as described in *Suwen: Lihe Zhenye Lun*: "This pathogen has recently invaded and has no fixed location." Given these manifestations, although Taiyang has just transferred to Yangming, the Taiyang exterior syndrome is vigorous, and Yangming is negligible. It is solely due to incomplete sweating; re-inducing sweating will cure it. However, how do we know sweating was incomplete? The pulse is the dynamic movement of Qi and Blood circulation. Cold pathogens injure Ying-Blood, preventing excretion via sweat. Yang Qi becomes stagnant, and blood vessels flow sluggishly, resulting in a choppy pulse. Thus, we know this from the choppy pulse.

Two-Yang Concurrent Disease. If Taiyang symptoms have ceased, but there is tidal fever (Chaore), sweating of the hands and feet, difficulty in defecation, and delirious speech (Shanyu), purgation will cure it. Da Chengqi Tang (Great Order the Qi Decoction) is appropriate.

Taiyang-Yangming concurrent disease shares the same meaning as the previous clause. However, in the previous clause, Taiyang symptoms were predominant and unresolved; although Yangming symptoms existed, purgation was still contraindicated, and treatment should focus exclusively on Taiyang via diaphoresis. In this clause, Taiyang symptoms have ceased, leaving only Yangming Stomach excess syndromes such as tidal fever, hand and foot sweating, difficulty in defecation, and delirious speech. Treatment should focus on Yangming via purgation. Both illustrate the method of syndrome differentiation and treatment.

Taiyang-Shaoyang Concurrent Disease. Symptoms include stiffness and pain in the head and neck, dizziness and vertigo (Xuanmao), occasional feeling resembling Jie Xiong (Chest Binding), and epigastric hardness. Acupoints Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) should be needled. Diaphoresis must be strictly avoided. Inducing sweating will cause delirious speech and a wiry pulse (Xianmai). If delirious speech persists for five to six days, Qimen (LR14) should be needled.

Stiffness and pain in the head and neck are Taiyang symptoms. Dizziness and vertigo are Shaoyang Liver-Gallbladder diseases. The Foot-Shaoyang Gallbladder Meridian originates at the outer canthus. The Foot-Jueyin Liver Meridian ascends to the nasopharynx and connects to the eye system. Pathogenic heat in Shaoyang affects the connected Liver and Gallbladder organs; heat pathogens in the collaterals invade the eye system upward, causing dizziness. "Or dizziness" means occasional dizziness. "Occasionally resembling Chest Binding" means occasionally feeling like Chest Binding, but actually not being Chest Binding. The Shaoyang meridian descends past Jiache, converges at Quepen, and enters the chest. Pathogens in Shaoyang cause occasional Chest Binding-like sensations and epigastric hardness. Moreover, the chest also belongs to Taiyang. Pathogens in Taiyang require diaphoresis; pathogens in Shaoyang prohibit diaphoresis. In Taiyang-Shaoyang concurrent disease, diaphoresis is also contraindicated. Since diaphoresis is impossible, there is no other way to resolve the constrained pathogens in both meridians. Therefore, Dazhui (first interspace), Feishu, and Ganshu should be needled. It is repeatedly emphasized: strictly avoid diaphoresis. Inducing sweating causes delirious speech, consistent with the prohibitions in the Shaoyang chapter. Dazhui is located above the first vertebra of the twenty-one vertebral segments of the spine, also known as Bailao. Feishu consists of two points, each 1.5 cun lateral to the third thoracic vertebra. Ganshu consists of two points, each 1.5 cun lateral to the ninth thoracic vertebra. Needling Dazhui expels pathogens causing head and neck stiffness. Insertion depth: 0.5 cun; retain needles for three exhalations; apply reducing method for five inhalations. Needling Feishu expels Lung Qi to open the skin and hair. Cold pathogens lodge in the skin and hair, which are the exterior correspondence of the Lung. Although expelling Lung Qi and opening the skin/hair normally requires Ma Huang Tang (Ephedra Decoction) for diaphoresis, since diaphoresis is contraindicated in Taiyang-Shaoyang concurrent disease, needling is used to expel pathogens from the skin/hair, substituting for the sweating effect of Ma Huang Tang. Insertion depth: 0.3 cun; retain needles for seven exhalations. Needling Ganshu drains Shaoyang pathogens. Insertion depth: 0.3 cun; retain needles for six inhalations. These three needleings all vent Qi from both meridians and resolve Taiyang-Shaoyang pathogens. Thus, when pathogens are in Shaoyang, diaphoresis must be strictly avoided. Inducing sweating leads to interior deficiency and pathogen sinking, causing delirious speech. Delirious speech indicates pathogens have invaded Yangming; the pulse should be flooding (Hongmai) rather than wiry. A wiry pulse indicates Shaoyang Liver-Gallbladder pathogens. A wiry pulse with persistent delirious speech after five to six days indicates Wood (Liver-Gallbladder) pathogens are abundant and unresolved. Therefore, Qimen, the Front-Mu point of the Liver meridian, should be needled to drain pathogens, following the principle of "draining according to excess."

Correction of Errors: Some commentators do not know that the chest belongs to Taiyang and that the Shaoyang meridian also descends into the chest, erroneously considering the chest part of Yangming, which is definitely wrong. Others suspect that since Liver and Gallbladder are paired, needling Ganshu drains Shaoyang; but Lung and Bladder are not paired. Since Lung governs Qi, perhaps needling it promotes Bladder Qi transformation? They fail to realize that Taiyang exterior pathogens are external, while Bladder Qi transformation is internal. Promoting internal Qi transformation cannot immediately resolve external exterior pathogens; this argument is even more absurd. Shanglun (Zhang Yin'an) did not scrutinize this and adopted this theory, stating that although Bladder and Lung are not paired, since Lung governs Qi, needling Feishu promotes Qi flow, allowing Bladder Qi transformation to proceed so pathogens cannot remain. Alas! Even wise people tread the tracks of predecessors; this is indeed "the blind leading the blind." Sigh.

Taiyang-Shaoyang Concurrent Disease. Epigastric hardness, neck stiffness, and dizziness require needling Dazhui, Feishu, and Ganshu. Purgation must be strictly avoided.

This repeats the syndrome and treatment from above. The previous clause only mentioned avoiding diaphoresis, not purgation. This clause reiterates the prohibition against purgation.

Taiyang-Shaoyang Concurrent Disease treated with purgation instead results in Chest Binding with epigastric hardness, incessant diarrhea, inability to take in fluids, and mental restlessness.

The previously mentioned "occasionally resembling Chest Binding" was the original syndrome, not a complication of erroneous purgation. Thus, it was merely a sensation resembling Chest Binding with epigastric hardness, similar to but not actual Chest Binding. Because both Taiyang and Shaoyang concurrent diseases prohibit purgation, using purgation on such cases leads to Chest Binding and epigastric hardness. Furthermore, due to deficiency caused by erroneous purgation, Middle Qi fails to secure, causing incessant diarrhea. Pathogens sink into the chest, preventing intake of fluids. Mental restlessness occurs because, after erroneous purgation, Yang pathogens sink into the Diaphragm, causing deficiency-related restlessness. However, the condition is severe, and Zhang Zhongjing did not establish a treatment method, leading Fang Youzhi to suspect missing bamboo slips. Shanglun stated: In concurrent disease, even without erroneous purgation, symptoms resemble Chest Binding and epigastric hardness; how much worse with erroneous purgation? This is likely more severe than Chest Binding caused by erroneous purgation in Taiyang. Moreover, "mental restlessness" seems like an unfinished sentence. In Taiyang Chest Binding, when all symptoms are present, restlessness and agitation indicate death. Perhaps this implies that mental restlessness alone indicates death? I fear not all such cases are fatal. Restlessness syndromes in the Three Yang meridians vary and are not necessarily fatal. Only simultaneous restlessness and agitation are critical, as restlessness belongs to Yang and agitation to Yin. Thus, patients with cold extremities and agitation in the Three Yin meridians often die. In the Three Yang chapters, sweating absence with restlessness indicates exterior excess where pathogens cannot vent externally, treated with Da Qinglong Tang (Major Green Dragon Decoction). Post-sweating or post-purgation persistence of restlessness indicates interior deficiency with Yang deficiency and Yin excess, treated with Fuling Sini Tang (Poria and Aconite Decoction). Only Chest Binding with all symptoms present plus restlessness indicates death, because erroneous purgation in Taiyang allows pathogens to sink into Chest Binding, and with all symptoms present, restlessness signifies extreme Yin and loss of Yang, leading to death. Although this case also involves Chest Binding due to erroneous purgation, if the patient has mental restlessness but no agitation, there might be a treatment method, though unknown. One should roughly search for curative methods among Zhang Zhongjing's various restlessness syndromes.