伤寒热甚虽不死。两感伤寒漫料理。（仲景云。凡伤于寒则发为热。虽甚不死。若两感于寒而病者。必死。又曰两感
病俱作。治有先后。发表攻里。本自不同。故漫料理可也。）一日太阳少阴病。腹痛口干烦饮水。（太阳膀胱也。少阴肾
也。为表里。故仲景云。太阳与少阴俱病。则腹痛口干。烦满而渴。）二日阳明合太阴。腹满身热如火炽。不欲饮食鼻内
干。妄言谵语终难睡。（仲景云。二日阳明与太阴俱病。则腹满身热。不欲食。谵语。）三日少阳合厥阴。耳聋囊缩不知
人。厥逆水浆不入口。六日为期是死辰。（仲景云。三日少阳与厥阴俱病。则耳聋囊缩而厥。水浆不入口。不知人者。六
日死矣。）
太阳阳明与少阳。三阳传入是其常。（一二日太阳。二三日阳明。三四日少阳。各以其经传入也。）太阳脉浮恶寒气。
阳明恶热脉来长。（太阳脉浮。阳明脉长。太阳恶寒恶风。阳明不恶寒反恶热。）少阳口苦胁下满。往来寒热脉弦张。（仲
景云。少阳之为病。口苦。咽干。目眩。又曰。太阳病不解。转入少阳者。胁下坚满。往来寒热。其脉弦细。）阳若独盛
阴暴绝。变为阳毒必发狂。（三阳病不治。必变为阳毒。）内外热结舌又卷。鼻中煤烟不可当。脉应洪实或滑促。宜用升
麻栀子汤。
Although severe heat in Shanghan (Cold Damage) is not necessarily fatal, two-gan Shanghan (simultaneous infection of exterior and interior meridians by cold pathogen) is difficult to manage. (Zhang Zhongjing stated: "Whenever one is injured by cold, it manifests as heat; even if severe, it is not fatal. However, if one suffers from two-gan due to cold, death is inevitable." He further said: "When two-gan occurs, both exterior and interior are affected simultaneously. Treatment must follow a sequence of priority; releasing the exterior and purging the interior are fundamentally different approaches. Thus, it is described as difficult to manage.")
On the first day, Taiyang (Greater Yang) and Shaoyin (Lesser Yin) diseases occur together, presenting with abdominal pain, dry mouth, irritability, and thirst for water. (Taiyang corresponds to the Bladder, and Shaoyin corresponds to the Kidney; they are exterior-interior pairs. Hence, Zhang Zhongjing stated: "When Taiyang and Shaoyin are diseased together, there is abdominal pain, dry mouth, irritability, fullness, and thirst.")
On the second day, Yangming (Yang Brightness) and Taiyin (Greater Yin) diseases combine, characterized by abdominal distension, body heat blazing like fire, anorexia, dryness inside the nose, delirious speech, and ultimate insomnia. (Zhang Zhongjing stated: "On the second day, when Yangming and Taiyin are diseased together, there is abdominal distension, body heat, aversion to eating, and delirium.")
On the third day, Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) diseases combine, manifesting as deafness, retraction of the testicles, loss of consciousness, cold extremities, and inability to swallow fluids. The sixth day marks the time of death. (Zhang Zhongjing stated: "On the third day, when Shaoyang and Jueyin are diseased together, there is deafness, retraction of the testicles, and cold extremities; inability to take in fluids and loss of consciousness indicate death will occur on the sixth day.")
The transmission among Taiyang, Yangming, and Shaoyang constitutes the normal progression of these three Yang meridians. (Day 1-2 involves Taiyang; Day 2-3 involves Yangming; Day 3-4 involves Shaoyang; each transmits according to its meridian.) Taiyang presents with a floating pulse, aversion to cold, and aversion to wind. Yangming presents with aversion to heat and a long pulse. (Taiyang pulse is floating; Yangming pulse is long. Taiyang has aversion to cold and wind; Yangming lacks aversion to cold but has aversion to heat.) Shaoyang presents with bitter taste, hypochondriac fullness, alternating chills and fever, and a wiry pulse. (Zhang Zhongjing stated: "The disease of Shaoyang includes bitter taste, dry throat, and vertigo." He also said: "If Taiyang disease does not resolve and transfers to Shaoyang, there is hardness and fullness below the costal region, alternating chills and fever, and a thin-wiry pulse.") If Yang qi becomes excessively dominant while Yin qi suddenly perishes, it transforms into Yang Du (Yang Toxin), inevitably leading to mania. (Untreated diseases of the three Yangs will inevitably transform into Yang Du.) With internal and external heat binding, the tongue curls, and soot-like blackness appears in the nostrils, which is unbearable. The pulse should be surging and solid or slippery and rapid. Shengma Zizi Tang (Cimicifugae Rhizoma and Gardeniae Decoction) is indicated.