太阳与阳明合病。喘而胸满者。不可下。宜麻黄汤主之。
胸中为阳之位。喘而胸满者。病发于阳而盛于阳也。邪在阳则可汗。在阴则可下。此以阳邪
盛于阳位。故不可下之以虚其里。里虚则邪且陷矣。而宜麻黄汤汗之以疏其表。表疏则邪自解矣。
合病者。两经同病。邪气盛者。其伤必多。甚则遍及三阳也。
太阳与阳明合病者。必自下利。葛根汤主之。太阳与阳明合病。不下利。但呕者。葛根加半夏汤主之。
伤寒之邪。在上则为喘满。入里则为下利。两阳合病。邪气盛大。不特充斥于上。抑且浸
淫于里。故曰必
自下利。其不下利者。则必上逆而呕。晰而言之。合病下利者。里气得热而下行也。不下利但呕
者。里气得热而上行也。夫邪盛于外而之内者。仍当先治其邪。葛根汤合用桂枝麻黄而加葛根。
所以解经中两阳相合之邪。其不下利而但呕者。则加半夏以下逆气。而葛根解外。法所不易矣。
葛根汤方
葛根（四两） 生姜（三两切） 甘草（二两炙） 芍药（二两） 桂枝（二两去皮）
麻黄（三两去节汤炮去黄汁焙干称） 大枣（十二枚擘）
上七味。以水一斗。先煮葛根、麻黄减二升。去上沫。纳诸药。煮取三升。去滓。温服一升。覆取微
似汗。不须啜粥。余如桂枝法将息及禁忌。
葛根加半夏汤方
于葛根汤内加半夏半升。洗。
太阳与少阳合病。自下利者。与黄芩汤。若呕者。黄芩加半夏生姜汤主之。
少阳居表里之间。视阳明为较深。其热气尤易内侵。是以太阳与少阳合病。亦自下利。而治法
则不同矣。太阳阳明合病者。其邪近外。驱之使从外出为易。太阳少阳合病者。其邪近里。
治之使从里和为易。故彼用葛根。而此与黄芩也。夫热气内淫。黄芩之苦。可以清之。肠胃得热而不固。芍药之
酸。甘草之甘。可以固之。若呕者。热上逆也。故加半夏、生姜。以散逆气。而黄芩之清里。
亦法所不易矣。
黄芩汤方
黄芩（三两） 甘草（二两炙） 芍药（二两） 大枣（十二枚擘）
上四味。以水一斗。煮取三升。去滓。温服一升。日再。夜一服。
黄芩加半夏生姜汤方
于黄芩汤内加半夏半升。生姜三两。余根据前法。
三阳合病。腹满身重。难以转侧。口不仁而面垢。谵语遗尿。发汗则谵语。下之则额上生汗。
手足逆冷。若自汗出者。白虎汤主之。此条叔和隶阳明篇中。
三阳合病。脉浮大。上关上。但欲眠睡。目合则汗。此条隶少阳篇中。
三阳合病。视诸合病邪气为较大矣。而太阳之腑膀胱。阳明之腑胃。少阳之腑胆。热邪盛满
自经入腑。故腹满身重。口不仁而面垢。谵语遗尿。及但欲眠睡。目合则汗。皆为里为热之征也
。夫里而不表。故不可汗。汗之则津亡。胃燥而谵语。热而不实。复不可下。下之则中伤气竭。而额上生汗。手足
逆冷。若自汗出句。顶腹满身重四句来。谓有腹满身重等证而自汗出者。则虽三阳合病。而邪聚于
阳明者较太阳为多。故宜白虎汤清而解之。若不自汗出者。则太阳为多。白虎不可与矣。脉浮大。上
关上者。病盛于阳经。故脉亦盛于阳位也。但欲眠睡者。热胜而神昏也。目合则汗者。胆热则液泄
也。此条盖补上条之所未备。而热之聚于少阳者。视太阳阳明较多矣。设求治法。岂白虎汤所能尽哉
。
白虎汤方
石膏（一斤） 知母（六两） 甘草（二两） 粳米（六合）
上先煮石膏数十沸。再投药米。米熟汤成。温服。
Taiyang (Sun) and Yangming (Yang Brightness) meridians suffer from simultaneous disease. When panting and chest fullness occur, purgation is contraindicated; Mahuang Tang (Ephedra Decoction) is indicated.
The chest is the residence of Yang Qi. Panting with chest fullness indicates that the pathogen originates in the Yang aspect and flourishes there. When the pathogen is in the Yang aspect, diaphoresis (sweating method) is applicable; when in the Yin aspect, purgation is applicable. Here, because Yang pathogens are excessive in the Yang position, purgation must not be used to avoid emptying the interior. If the interior becomes deficient, the pathogen will sink inward. Therefore, it is appropriate to use Mahuang Tang to induce sweating and disperse the exterior. Once the exterior is dispersed, the pathogen resolves naturally.
"Simultaneous disease" (He Bing) refers to two meridians being diseased at the same time. When pathogens are excessive, the damage is necessarily greater, and in severe cases, it may extend to all three Yang meridians.
When Taiyang and Yangming meridians suffer from simultaneous disease, spontaneous diarrhea inevitably occurs; Gegen Tang (Kudzu Root Decoction) is indicated. When Taiyang and Yangming meridians suffer from simultaneous disease, if there is no diarrhea but only vomiting, Gegen Jia Banxia Tang (Gegen Tang with Added Pinellia) is indicated.
Pathogens of Cold Damage (Shang Han), if remaining in the upper part, cause panting and fullness; if entering the interior, they cause diarrhea. In simultaneous disease of two Yang meridians, pathogens are abundant, filling not only the upper part but also gradually infiltrating the interior; hence, spontaneous diarrhea is inevitable. Those who do not have diarrhea will inevitably experience upward rebellion leading to vomiting. Specifically, diarrhea in simultaneous disease results from interior Qi moving downward due to heat; vomiting without diarrhea results from interior Qi moving upward due to heat. Since pathogens are excessive externally and affect the interior, treatment should first address the external pathogens. Gegen Tang combines the effects of Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang, adding Kudzu Root to resolve pathogens combining in the two Yang meridians. For cases without diarrhea but with vomiting, Pinellia is added to direct rebellious Qi downward, while Kudzu Root resolves the exterior; this principle remains unchangeable.
**Gegen Tang Formula:**
Kudzu Root (Puerariae Radix, 4 liang), Fresh Ginger (Zingiberis Rhizoma Recens, 3 liang, sliced), Licorice Root (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried), White Peony Root (Paeoniae Radix Alba, 2 liang), Cinnamon Twig (Cinnamomi Ramulus, 2 liang, bark removed), Ephedra Stem (Ephedrae Herba, 3 liang, nodes removed, boiled in water to remove yellow foam, dried before weighing), Jujube (Zizyphi Fructus, 12 pieces, split).
Take these seven ingredients, add ten dou of water, first boil Kudzu Root and Ephedra until the volume reduces by two dou, skim off the foam on top, then add the remaining herbs. Boil until three sheng of liquid remain, strain, and take one sheng warm. Cover with blankets to achieve a slight sweat. No porridge needs to be consumed afterward. Rest and dietary restrictions follow the guidelines for Guizhi Tang.
**Gegen Jia Banxia Tang Formula:**
Add Pinellia Tuber (Pinelliae Rhizoma, half sheng), washed, to Gegen Tang.
When Taiyang and Shaoyang (Lesser Yang) meridians suffer from simultaneous disease, resulting in spontaneous diarrhea, Huangqin Tang (Scutellaria Decoction) is administered. If vomiting occurs, Huangqin Jia Banxia Shengjiang Tang (Huangqin Tang with Added Pinellia and Fresh Ginger) is indicated.
Shaoyang resides between the exterior and interior, deeper than Yangming, making its heat more prone to invading inward. Thus, simultaneous disease of Taiyang and Shaoyang also causes spontaneous diarrhea, but the treatment differs. In simultaneous disease of Taiyang and Yangming, pathogens are closer to the exterior, making it easier to drive them out outwardly. In simultaneous disease of Taiyang and Shaoyang, pathogens are closer to the interior, making it easier to harmonize them from within. Hence, the former uses Gegen Tang, while the latter uses Huangqin Tang. Heat invading inward can be cleared by the bitter property of Scutellaria Root (Huangqin); the sour property of White Peony Root and the sweet property of Licorice Root can secure the intestines and stomach heated by pathogens. If vomiting occurs, it indicates heat rebelling upward, so Pinellia and Fresh Ginger are added to scatter rebellious Qi, while Scutellaria clears the interior; this method is indispensable.
**Huangqin Tang Formula:**
Scutellaria Root (Scutellariae Radix, 3 liang), Licorice Root (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried), White Peony Root (Paeoniae Radix Alba, 2 liang), Jujube (Zizyphi Fructus, 12 pieces, split).
Take these four ingredients, add ten dou of water, boil until three sheng remain, strain, and take one sheng warm. Take twice daily and once at night.
**Huangqin Jia Banxia Shengjiang Tang Formula:**
Add Pinellia Tuber (Pinelliae Rhizoma, half sheng) and Fresh Ginger (Zingiberis Rhizoma Recens, 3 liang) to Huangqin Tang. Follow the previous method for the rest.
In simultaneous disease of the three Yang meridians, symptoms include abdominal fullness, body heaviness, difficulty turning over, numbness of the mouth and face (loss of taste/sensation), facial grease, delirium, and urinary incontinence. Diaphoresis would worsen delirium; purgation would cause sweating on the forehead and cold extremities. If spontaneous sweating occurs, Baihu Tang (White Tiger Decoction) is indicated. This clause was categorized by Wang Shuhe into the Yangming chapter.
In simultaneous disease of the three Yang meridians, the pulse is floating and large, prominent above the Guan position; the patient desires sleep, and sweating occurs upon closing the eyes. This clause was categorized by Wang Shuhe into the Shaoyang chapter.
Simultaneous disease of the three Yang meridians involves larger pathogenic factors than other simultaneous diseases. The Fu organs of Taiyang (Bladder), Yangming (Stomach), and Shaoyang (Gallbladder) are filled with excess heat transferring from the channels to the Fu organs. Thus, abdominal fullness, body heaviness, oral numbness, facial grease, delirium, urinary incontinence, desire for sleep, and sweating upon eye closure are all signs of interior heat. Since the pathology is interior rather than exterior, diaphoresis is contraindicated; inducing sweat depletes fluids, causing stomach dryness and worsening delirium. Although heat exists, it is not solidified, so purgation is also contraindicated; purging damages middle Qi and exhausts Yuan Qi, leading to forehead sweating and cold extremities. The phrase "if spontaneous sweating occurs" follows the description of abdominal fullness and body heaviness. It means that if these symptoms accompany spontaneous sweating, although it is a three-Yang simultaneous disease, the pathogen concentrates more in Yangming than in Taiyang. Therefore, Baihu Tang is suitable to clear and resolve the heat. If there is no spontaneous sweating, Taiyang involvement is predominant, and Baihu Tang is contraindicated. A floating and large pulse, prominent above the Guan position, indicates disease flourishing in the Yang meridians, hence the pulse is also vigorous at the Yang position. Desire for sleep indicates mental confusion due to excessive heat. Sweating upon closing the eyes indicates fluid leakage due to Gallbladder heat. This clause supplements the previous one, showing that heat concentrates more in Shaoyang than in Taiyang or Yangming. If seeking treatment, could Baihu Tang alone suffice?
**Baihu Tang Formula:**
Gypsum Fibrosum (Shigao, 1 jin), Anemarrhenae Rhizoma (Zhimu, 6 liang), Licorice Root (Glycyrrhizae Radix et Rhizoma, 2 liang), Rice (Oryzae Semen, 6 he).
First boil Gypsum for dozens of boils, then add the other herbs and rice. Cook until the rice is tender and the decoction is ready. Take warm.